Outcomes and latency to delivery in preterm prelabour rupture of membranes at 22–28 weeks: a retrospective cohort study

Background Preterm prelabour rupture of membranes (PPROM) is a major obstetric complication associated with adverse obstetric and neonatal outcomes. To reduce uncertainty in gestational-age–specific management and to support evidence-based counselling, large-cohort analyses are essential. In this study, we aimed to evaluate the latency to delivery and maternal and neonatal outcomes through 12 months of corrected age among pregnancies with very early PPROM (22+0–28+0 weeks gestation). Methods We conducted a single-center retrospective cohort study at SBÜ Zeynep Kamil Women’s and Children’s Diseases Training and Research Hospital between January 2018 and February 2023; the cohort included 167 pregnancies that were diagnosed with PPROM at 22+0 to 28+0 weeks. The neonatal survival analyses included 91 infants managed at our center. Pregnancies were grouped by gestational age at PPROM as 22+0 to 23+6, 24+0 to 25+6 and 26+0 to 28+0 weeks. Latency to delivery, as well as maternal and neonatal outcomes, were compared across gestational age groups. The neonatal endpoints were survival to discharge and survival without major morbidity at 12 months of corrected age. Results The mean gestational age at diagnosis was 25.0 weeks. The median latency to delivery was 6 days (IQR, 2–23) and did not differ significantly between the groups (median range 5-9 days; P = 0.896). The mean gestational age at delivery was 27.1 weeks. Maternal outcomes were similar across groups, except for placental abruption and cesarean delivery. Placental abruption and cesarean delivery were more common when PPROM occurred at 24+0–25+6 weeks (P = 0.004 and P = 0.009, respectively). Neonatal survival to discharge was 67.0% (61/91). Survival without major morbidity at 12 months of corrected age was 42.9% (39/91). Both outcomes were highest when PPROM was diagnosed at 26+0 to 28+0 weeks (P = 0.001, P = 0.001). Conclusions In PPROM at 22+0 to 28+0 weeks the median latency to delivery ranged between 5 and 9 days. An increasing gestational age at PPROM is associated with increased survival and increased survival without severe morbidity. In addition, longer latency was associated with more favourable neonatal outcomes. These data may be important for providing evidence-based counselling and management in very early PPROM. Trial registration: Not applicable.