title: Outcome of pregnancies with preterm prelabor rupture of membranes before 27 weeks' gestation: a retrospective cohort study.
abstract: OBJECTIVE
  Preterm prelabor rupture of membranes (PPROM) before 27 weeks' gestation is associated with severe perinatal complications, but quantitative estimates are lacking. The aim of this study was to report and predict outcomes of pregnancies complicated by early PPROM and to study antepartum risk factors that might predict perinatal death in future patients.
  
  
  METHODS
  We performed a retrospective cohort study of women with PPROM between 13(+0) weeks and 27(+0) weeks' gestation between 1994 and 2009 in three perinatal centers.
  
  
  METHODS
  Perinatal mortality, composite neonatal morbidity and premature delivery. A model to predict these outcomes was developed from antepartum variables.
  
  
  RESULTS
  We identified 314 women with PPROM before 27 weeks, including 28 multiple pregnancies. Six pregnancies (2%) were terminated before 24 weeks' gestation, and three were lost to follow up, leaving 305 pregnancies for analysis. Overall, there were 166 perinatal deaths (49%). The perinatal mortality rate decreased with increasing gestational age at PPROM (from 70% in the group PPROM 13-20 weeks to 27% in the group PPROM 24-27 weeks). Of the 170 surviving neonates, 70 suffered from serious morbidity (41%). Early gestational age at PPROM, long interval between PPROM and birth and positive vaginal culture (any bacteria) were associated with perinatal mortality.
  
  
  CONCLUSIONS
  Perinatal mortality in PPROM before 27 weeks occurred in half of the cases and among those who survive approximately 40% suffered serious morbidity. Antenatal parameters can be helpful to predict perinatal mortality.
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, The Netherlands. Electronic address: JvHeijden84@hotmail.com.
authors.forename: Jantien L
authors.initials: JL
authors.lastname: van der Heyden
authors.forename: David P
authors.initials: DP
authors.lastname: van der Ham
authors.forename: Sander
authors.initials: S
authors.lastname: van Kuijk
authors.forename: Kim J B
authors.initials: KJ
authors.lastname: Notten
authors.forename: Timothy
authors.initials: T
authors.lastname: Janssen
authors.forename: Jan G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: Christine
authors.initials: C
authors.lastname: Willekes
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.forename: Joris A
authors.initials: JA
authors.lastname: van der Post
authors.forename: Feico
authors.initials: F
authors.lastname: Halbertsma
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Eva
authors.initials: E
authors.lastname: Pajkrt
mesh_terms: D000328:Adult; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: Midtrimester PPROM; Neonatal morbidity; Perinatal mortality; Preterm birth; Preterm rupture of membranes