Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes.

OBJECTIVE

To evaluate fetal outcome and long-term impact of very early preterm premature rupture of membranes (PROM).

METHODS

In a retrospective cohort study, 78 women with singleton pregnancies who delivered at the Oulu University Central Hospital between 1990 and 1996 and who had early PROM, between the 17th and 30th gestational weeks, were matched with 78 women with spontaneous preterm delivery during the same time (control group). The main outcome measures were maternal morbidity, interval from early PROM to delivery, perinatal and neonatal mortality rates and neonatal morbidity, need for primary and recurrent hospitalization and later pulmonary complications of the infants, and growth and neurologic findings at 1 year of corrected age.

RESULTS

The perinatal mortality was 282 per 1000 births in the early PROM group and 256 per 1000 births in the control group. Histopathologically defined chorioamnionitis and puerperal infections were significantly more common in the early PROM group than in controls (51 versus 29%, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.3, 4.9 and 38 versus 22%, OR 2.3, 95% CI 1.1, 5.1, respectively). There were no differences in neonatal infections between groups. Pulmonary hypoplasia was detected more often in the early PROM group (in nine infants) compared with the control group (no infants). The duration of rehospitalization up to 1 year of age due to respiratory problems was a mean of 5 days in the early PROM group and a mean of 1 day in the control group (P = .01; 95% CI 0.9, 6.9). Symptomatic chronic lung disease at 1 year of age was detected more often in the early PROM group than in controls (22 versus 9%; OR 2.4, 95% CI 0.9, 6.5).

CONCLUSION

Early PROM seems to be a major obstetric and neonatal problem with pulmonary ramifications extending beyond the neonatal period. However, most of these infants can be saved.