PP026 Obstetrical And Neonatal Outcome Of Premature Rupture Of Amniotic Membranes Before 28 Weeks Of Gestation.

Objective

Premature rupture of the membranes (PRM) is defined as a proven rupture of the amnion and chorion, including fissures.The frequency of PRM before 28 weeks' gestation (WG) varies between 0.1% and 0.7% of all deliveries, depending on the author. It affects between 7% and 51% of premature deliveries (30% on average). It can result in serious maternal and neonatal morbidity and mortality.
The objectives of this study were to describe the outcome of pregnancies after isolated preterm delivery before 28 weeks' gestation and to assess neonatal mortality and morbidity.

Methods

It was a prospective observational study including all pregnancies complicated by a PRM before 28 WG completed, of at least 24 hours, between January 2022 and March 2024 and admitted to the maternity unit of Farhat Hached Hospital Sousse, Tunisia.

Results

We enrolled 28 pregnancies, with an average maternal age of 31 years [21-44 years]. Therapeutic interruption of pregnancy was indicated in 9 cases, due to severe anamnios (5), chorioamniotitis (2) and early PRM at 17 WG (2). Armed expectative management was indicated in 19 cases, with weekly clinical, biological (infectious work-up) and ultrasound monitoring. The onset of PRM was at an average of 25 days [18-28 days]. Chorioamniotitis was noted in 3 cases, a urinary tract infection in 4 cases and a positive vaginal swab in 2 cases. Pulmonary maturation and antibiotic therapy were instituted in all patients. The average duration of PRM was 30 days [1-80 days]. Delivery was vaginal in 8 cases. All neonates were hospitalized in the NICU for neonatal respiratory distress, of variable severity, and suspected early onset neonatal sepsis, which was confirmed in 4 cases. The subsequent outcome was fatal in 4cases secondary to refractory septic shock. Survivors had an average hospital stay of 35 days, with only one patient being followed for bronchopulmonary dysplasia.

Conclusion

Early PRM is a serious complication of pregnancy, which can lead to serious complications for the mother and, above all, for the fetus, which is exposed to the risks of prematurity and infection, and therefore to a high risk of mortality or morbidity, correlated with the duration of PRM.

Keywords

Preterm premature rupture of membranes, mortality, morbidity, neonatal outcome.