title: Perinatal management of preterm premature ruptured membranes affects neonatal prognosis.
abstract: OBJECTIVE
  To determine the factors affecting neonatal prognosis in preterm premature rupture of membranes (PPROM).
  
  
  METHODS
  We conducted a case-control study involving 92 women between the years 2000 and 2010 diagnosed with PPROM between 25 and 31 weeks' gestation, who received antenatal steroids, and delivered between 26 and 31 weeks' gestation; a retrospective cohort study was conducted based on the results. We used data from four tertiary centers and compared the frequencies of neonatal neurologic deficits and neonatal deaths.
  
  
  RESULTS
  There was a difference between the two groups; specifically, the ND group (n=18) consisted of patients whose infants had neurologic deficits and/or neonatal deaths and the neurologically normal (NN) group (n=74) included NN neonates amongst the patients who had expectant management (94% vs. 73%, respectively). Multivariable analysis revealed that expectant management was independently associated with an increased risk for neonatal neurologic deficits and neonatal deaths (odds ratio, 16.14). All neonates with poor prognosis in the expectant-management group delivered within 14 days after PPROM.
  
  
  CONCLUSIONS
  Expectant management within 14 days after PPROM is associated with poor neonatal outcomes. Decisions regarding an expectant strategy should be made carefully. An immediate, planned delivery after steroid administration should be considered to improve neonatal prognosis in patients who have PPROM after 26 weeks' gestation.
authors.forename: Arisa
authors.initials: A
authors.lastname: Fujiwara
authors.forename: Kotaro
authors.initials: K
authors.lastname: Fukushima
authors.forename: Hirosuke
authors.initials: H
authors.lastname: Inoue
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takashima
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Nakahara
authors.forename: Shoji
authors.initials: S
authors.lastname: Satoh
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ochiai
authors.forename: Toshiro
authors.initials: T
authors.lastname: Hara
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Shimokawa
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Kato
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage; D016022:Case-Control Studies; D015331:Cohort Studies; D036861:Delivery, Obstetric; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D001623:Betamethasone