A prospective population-based study of 598 cases of PPROM between 24 and 34 weeks' gestation: description, management, and mortality (DOMINOS cohort).
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.
Pasquier
Jean-Charles
JC
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
Rabilloud
Muriel
M
Picaud
Jean-Charles
JC
Ecochard
René
R
Claris
Olivier
O
Gaucherand
Pascal
P
Collet
Frédéric
F
Chabert
Pierre
P
Mellier
Georges
G
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