Preterm premature rupture of membranes before 32 weeks of gestation: Management and pregnancy outcomes

Abstract

ABSTRACT Preterm premature rupture of membranes (PPROM) is a major obstetric complication, particularly at early gestational ages. This retrospective, bicentric study (2019–2023) analyzed the short-term outcomes of pregnancies complicated by PPROM between 22 and 32 weeks of gestation under expectant management. Patients were divided into two groups: G1 (22–26 weeks) and G2 (26–32 weeks). The mean maternal age was 32 years, with a history of PPROM and preterm birth in 26% and 29% of cases, respectively. Antenatal corticosteroids were administered to all patients in G2 and to 28% of those in G1 (p<0.001). Chorioamnionitis was observed in 48% of patients in G1 and 37% in G2 (p=0.183). The mean gestational age at delivery was 28.03 weeks, with an overall neonatal survival rate of 26% in G1 and 88% in G2 (p<0.001), with survival starting from 25 weeks. Hyaline membrane disease was more frequent in G1 (83% vs. 43%, p<0.001), as was intraventricular hemorrhage without ventricular dilation (70% vs. 27%, p=0.003). Free hyperbilirubinemia was more common in G2 (70% vs. 47%, p=0.002). The analysis of factors influencing neonatal prognosis highlighted the gestational age at rupture, gestational age at delivery, birth weight, Apgar score, and the amount of amniotic fluid as key determinants. In conclusion, these factors play a critical role in neonatal prognosis in cases of PPROM.