title: [Management and outcomes of pregnancies complicated by preterm premature rupture of membranes before 26 weeks of gestation].
abstract: OBJECTIVE
  To evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg).
  
  
  METHODS
  Forty patients were included in a retrospective study from 1998 to 2008.
  
  
  RESULTS
  Fifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23+6 wg and reached 80% after 24 wg (P=0.006). Perinatal mortality affected more frequently primigravida women (OR=5.16; IC9 5% [0.99-36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1±13.8 vs. 40.3±2.3j; P=0.01). Chorioamnionitis complicated all pregnancies terminated before 26 wg versus 50% of pregnancies terminated after 26 wg (P=0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P=0.02; OR=4.3; IC95% [0,99-22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid.
  
  
  CONCLUSIONS
  The gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Brest, 29609 Brest, France; Université européenne de Bretagne, 29609 Bretagne, France. Electronic address: lionelhomer@yahoo.fr.
authors.forename: L
authors.initials: L
authors.lastname: Homer
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Brest, 29609 Brest, France.
authors.forename: C
authors.initials: C
authors.lastname: Bernard
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Brest, 29609 Brest, France; Université européenne de Bretagne, 29609 Bretagne, France.
authors.forename: M
authors.initials: M
authors.lastname: Collet
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002821:Chorioamnionitis / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality / Q000628:therapy*; D046689:Fetal Mortality; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D002097:C-Reactive Protein