Periviable premature rupture of membranes (before 24 weeks gestation): Pregnancy and neonatal outcomes

Introduction : This study evaluates neonatal outcomes following periviable premature rupture of membranes (PPROM) before 24 weeks gestation, and identify factors associated with death or severe comorbidities. Methods : A retrospective analysis of pregnancies complicated by PPROM was conducted at the University Hospital of Lille from 2014 to 2019. Maternal and neonatal data until hospital discharge were collected. Results : Among 130 fetuses, 67% were live-born. The rate of medical termination of pregnancy was 8%. Seventy-five percent of those live-born were preterm. About one-third of neonates were admitted to the maternity ward without respiratory failure; 61% of neonates required neonatal intensive care unit admission for prematurity and/or immediate respiratory failure. Of the live-born infants, 90% were discharged from hospital, 74% with no severe comorbidities. Multivariate analysis identified preterm delivery (relative risk [RR] 3.51, 95% confidence interval [CI]: 1.82–6.76) and short latency from PPROM to delivery (RR 8.47, 95% CI: 1.07–66.67) as risk factors for death or severe comorbidities. Conclusion : Parent counseling should consider both current, evolving outcomes, and the unpredictable course of pregnancies complicated by PPROM. Prolonging pregnancy through close monitoring and implementation of current guidelines on neonatal management are essential to reduce adverse outcomes.