title: Premature rupture of membranes before 34 weeks managed expectantly: maternal and perinatal outcomes in singletons.
abstract: OBJECTIVE
  To ascertain the risk factors for imminent delivery and infection in pregnant women with premature rupture of membranes (PPROM) before 34 weeks of gestation, evaluate maternal and fetal outcomes and identify obstetric factors for determining which patients meet the criteria for home follow-up.
  
  
  METHODS
  Medical charts of all women with PPROM admitted to the Vall d'Hebron Hospital (HVH) between January 2006 and December 2010 were retrospectively reviewed.
  
  
  RESULTS
  During the study period, 216 women were admitted with a diagnosis of PPROM <34 weeks of gestation with a singleton, live, structurally-normal fetus. Mean gestational age at delivery was 31 weeks. Sixty-two patients (28.7%) delivered before 28 weeks and 76 of the infants (35.2%) had birth weight <1,500 g. Overall, 202 infants (93.5%) survived to be discharged home. On stratifying by gestational age at PPROM diagnosis, prognosis was better when PPROM occurred near to term. Gestational age at delivery was increased in pregnant women with no oligohydramnios, no shortened cervix and with negative endocervical and vaginal cultures at PPROM diagnosis (33 weeks of gestation) vs. pregnant women with positive cultures at admission (27 weeks), oligohydramnios at admission (28 weeks) and shortened cervix (26 weeks). This difference was statistically significant (p = 0.005).
  
  
  CONCLUSIONS
  Protective factors for PPROM could be normal AFI, cervical length >25 mm and negative cultures at PPROM diagnosis. These factors could permit home follow-up of this group of patients.
authors.affiliation: Maternal-Fetal Medicine Unit, Obstetrics Department, Hospital Vall d'Hebron, Universidad Autònoma de Barcelona, Barcelona, Spain. mgoya@vhebron.net
authors.forename: Maria
authors.initials: M
authors.lastname: Goya
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernabeu
authors.forename: Natalia
authors.initials: N
authors.lastname: García
authors.forename: John
authors.initials: J
authors.lastname: Plata
authors.forename: Franceline
authors.initials: F
authors.lastname: Gonzalez
authors.forename: Carme
authors.initials: C
authors.lastname: Merced
authors.forename: Elisa
authors.initials: E
authors.lastname: Llurba
authors.forename: Anna
authors.initials: A
authors.lastname: Suy
authors.forename: Manuel
authors.initials: M
authors.lastname: Casellas
authors.forename: Elena
authors.initials: E
authors.lastname: Carreras
authors.forename: Luis
authors.initials: L
authors.lastname: Cabero
mesh_terms: D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005865:Gestational Age; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000401:mortality; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors