title: [Premature rupture of membranes before 32 weeks of gestation: prenatal prognosis factors].
abstract: OBJECTIVE
  Premature preterm rupture of membranes (PPROM) accounts for a significant part of overall perinatal mortality and morbidity. This study aims to define potential prognostic factors for neonatal outcome.
  
  
  METHODS
  One hundred and thirty-one pregnancies complicated with PPROM at between 26 and 32 weeks were retrospectively reviewed over a three-year period. The influence of chorioamnionitis on perinatal morbidity and mortality was assessed using a composite outcome.
  
  
  RESULTS
  On admission, gestational age (GA) at diagnosis, fetal heart rate anomalies and increasing severity of clinical features of chorioamnionitis were significantly related with an adverse outcome. Significant factors associated with a favourable outcome were an administration of steroids for lung maturation, prophylactic antibiotics and tocolytic therapies. Stratifying according to GA at PPROM, the survival rates were 43 and 52% at before 22 weeks and between 22 and 26 weeks respectively. The prognosis dramatically improved after 26 weeks with an 84.6% rate of survival without impairment. Although this rate reached 97.5% after 30 weeks, there was no statistical evidence supporting any benefit to prolong pregnancies beyond this point. The complete expression of chorioamnionitis independently increased the mortality rate by 41% (OR=1.41; 95% CI [0.99-2.01]. Overall, the most relevant factor was GA at delivery, levelling the prognostic value of GA at diagnosis.
  
  
  CONCLUSIONS
  If no consensus rules PPROM at the moment, the most efficient prognosis factor before 34 weeks is mostly determined by GA at delivery.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38 boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Paumier
authors.forename: C
authors.initials: C
authors.lastname: Gras-Leguen
authors.forename: B
authors.initials: B
authors.lastname: Branger
authors.forename: G
authors.initials: G
authors.lastname: Boog
authors.forename: J-C
authors.initials: JC
authors.lastname: Roze
authors.forename: H-J
authors.initials: HJ
authors.lastname: Philippe
authors.forename: N
authors.initials: N
authors.lastname: Winer
mesh_terms: D000293:Adolescent; D000328:Adult; D002869:Chromosome Aberrations / Q000706:statistics & numerical data*; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome