PPROM is estimated to complicate 3% of all births and is associated with up to 40% all preterm births. Recently ACOG has extended the appropriateness of the administration of latency antibiotics starting at 20 wks of gestation for patients who opt for expectant management in the periviable period. Our objective was to evaluate perinatal outcomes among PPROM patients in the periviable period (20-23+6 wks of gestation).METHODS:
This is a case series of all cases of PPROM after 20 weeks of gestation delivered at our institution from January 2014-May 2017.RESULTS:
We reviewed 14 cases of PPROM in the periviable period (20 wks and 2 days to 23 wks and 5 days) that were managed expectantly. 13 patients (93%) received latency antibiotics on admission, 9 patients (64%) received betamethasone at 23 wks or later in gestation, 6 patients (43%) received tocolytics and 6 patients (43%) received magnesium for neuroprotection. Seven7 patients (50%) delivered prior to reaching 24 wks of gestation and 11 patients (79%) delivered prior to reaching 25 wks of gestation. The furthest gestational age reached was 31wks and 2 days. The following maternal and fetal/neonatal morbidities were noted: 5 (36%) chorioamnionitis, 1 (7%) abruption, 1 (7%) cord prolapse, 6 (43%) IUFDs and 2 (14%) neonatal demises. 6 neonates (43%) survived to discharge from the hospital.CONCLUSION:
Given the significant morbidity and mortality associated with expectant management of PPROM cases at less than 24 wks of gestation, appropriate and accurate counseling of maternal and neonatal outcomes is required.