title: A prospective population-based study of 598 cases of PPROM between 24 and 34 weeks' gestation: description, management, and mortality (DOMINOS cohort).
abstract: OBJECTIVE
  Description of mothers' characteristics, obstetricians' practices, and PPROM-linked mortality in all 81 maternity hospitals in the Rhône-Alpes Region, over a period of 2 years.
  
  
  METHODS
  Prospective cohort study of 598 women with PPROM between 24 and 34 weeks' gestation, leading to 680 births. At time of PPROM, collection of mothers' socio-economic characteristics, medical and obstetric histories and PPROM circumstances. Collection of perinatal management, neonates' medical status and postnatal referral.
  
  
  RESULTS
  The birth rate after PPROM between 24 and 34 weeks' gestation was 0.47% (95% CI: 0.42-0.48). Sixty percent of PPROM occurred before 32 weeks' gestation and 98% of births before 37 weeks. The incidence of previous PPROM was 14.3%. Antibiotics, corticosteroids, and tocolytics were given to 82, 78, and 52% of women, respectively. The rate of antibiotics and antenatal corticosteroids varied with gestational age (lower rates for antibiotics just after the limit of viability (23-24 weeks) and after 32 weeks, higher rates of corticosteroids between 26 and 30 weeks). The PPROM-birth interval became shorter as gestation advanced. The incidence of C-section was 58.7% (n = 270), C-section before labour being the most frequent mode of delivery. Sixty-seven percent of neonates were born in Level-3 hospitals. The overall neonatal mortality rate at 28 days decreased with gestational age at PPROM, and was 17.2% (16/93), 3% (6/200), and 0.41% (1/241) at 24-27, 28-31 and 32-33 weeks of PPROM, respectively.
  
  
  CONCLUSIONS
  After PPROM, antibiotics and antenatal corticosteroids were widely used in our cohort, and C-section rates were elevated. With that up-to-date management, the perinatal mortality rate was less than 3% following PPROM after 28 weeks' gestation.
authors.affiliation: Department of Obstetrics, Edouard Herriot Hospital and Claude Bernard University, 5 place d'Arsonval, 69437 Lyon Cedex 03, France. jean-charles.pasquier@chu-lyon.fr
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Pasquier
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Picaud
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.forename: Olivier
authors.initials: O
authors.lastname: Claris
authors.forename: Pascal
authors.initials: P
authors.lastname: Gaucherand
authors.forename: Frédéric
authors.initials: F
authors.lastname: Collet
authors.forename: Pierre
authors.initials: P
authors.lastname: Chabert
authors.forename: Georges
authors.initials: G
authors.lastname: Mellier
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies