566 - Management of Preterm Prelabor Rupture of Membranes (PPROM) Before 22 Weeks: Impact on Neonatal Mortality and Severe Morbidity

Publication Number: 566.6010

Klara Jonas, Charles University Prague, Prague, Hlavni mesto Praha, Czech Republic

Background: Previable preterm prelabor rupture of membranes (PPROM) poses a significant risk for perinatal mortality and morbidity, leading many women to discontinue their pregnancies. Since the early 2000s, advances in neonatal intensive care, including high-frequency ventilation, surfactant administration, and nitric oxide inhalation, have improved neonatal outcomes.

Objective: To assess outcomes and provide insights on conservatively managed cases of PPROM occurring before 22 weeks, as data in this area remain limited.

Design/Methods: We conducted a retrospective comparison of newborn outcomes with PPROM before 22 weeks and matched non-PPROM controls born at the same gestational age from January 2010 to December 2020 at the Perinatal Centre of the General University Hospital in Prague, Czechia. We compared neonatal mortality and morbidity, including factors such as the need for mechanical/high-frequency oscillatory ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity between both groups.

Results: Our study included 44 preterm live-born infants per group, with a mean gestational age of 27.2 weeks (±3.7) and a mean birth weight of 1002 g (±535). The median (IQR) week of PPROM was 20 weeks (18-21), and the median (IQR) length of expectancy was 41 days (28-78). No significant difference in mortality was observed between the two groups (four deaths in the non-PPROM group versus six deaths in the PPROM before 22 weeks group). The PPROM group experienced a higher incidence of respiratory morbidity, but no other significant differences in neonatal morbidity were found between the groups.

Conclusion(s): Newborn outcomes with PPROM in the early second trimester at our centre demonstrated better results than previously reported, supporting the need for further prospective studies in pregnancies with previable PPROM.