title: Fetal, Infant and Maternal Outcomes among Women with Prolapsed Membranes Admitted before 29 Weeks Gestation.
abstract: BACKGROUND
  Few studies have examined fetal, infant and maternal mortality and morbidity among pregnant women at very early gestation with an open cervix and prolapsed membranes. We carried out a study describing the outcomes of women hospitalized with prolapsed membranes at 22-28 weeks' gestation.
  
  
  METHODS
  We prospectively recruited women with singleton pregnancies admitted at 22-28 weeks' gestation to tertiary hospitals of the Canadian Perinatal Network between 2005 and 2009. Time-to-delivery, perinatal death, neonatal intensive care unit (NICU) admission, severe neonatal morbidity and severe maternal morbidity were compared between women admitted at 22-25 vs. 26-28 weeks gestation. Logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals.
  
  
  RESULTS
  129 women at 22-25 weeks gestation and 65 women at 26-28 weeks gestation were admitted to hospital and the median time-to-delivery was 4 days in both groups. Stillbirth rates were 12.4% vs 4.6% among women admitted at earlier vs later gestation (AOR 2.8, 95% CI 0.5-14.8), while perinatal death rates were 38.0% vs 6.1% (AOR 14.1, 95% CI 3.5-59.0), respectively. There were no significant differences in NICU admission and severe morbidity among live-born infants; 89.4% and 82.3% died or were admitted to NICU, (P value 0.18), and 53.9% vs 44.0% of NICU infants had severe neonatal morbidity (P value 0.28). Antibiotics, tocolysis and cerclage did not have a significant effect on perinatal death. Maternal death or severe maternal morbidity occurred in 8.5% and 6.2% of women admitted at 22-25 vs 26-28 weeks (AOR 1.2, 95% CI 0.4-4.2).
  
  
  CONCLUSIONS
  Perinatal mortality among women with prolapsed membranes at very early gestation is high, although significantly lower among those admitted at a relatively later gestational age. Rates of adverse maternal outcomes are also high. This information can be used to counsel women with prolapsed membranes at 22 to 28 weeks gestation.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Robertson
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Sarka
authors.initials: S
authors.lastname: Lisonkova
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Tang
authors.initials: T
authors.lastname: Lee
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Dane A
authors.initials: DA
authors.lastname: De Silva
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Pediatrics, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Synnes
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Liston
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia and the British Columbia's Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
mesh_terms: D000328:Adult; D000650:Amnion; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008428:Maternal Mortality; D016017:Odds Ratio; D066087:Perinatal Death; D011247:Pregnancy; D050497:Stillbirth; D055815:Young Adult