Rupture of membranes before 26 weeks of gestation: outcome of 148 consecutive cases

To assess the outcome of preterm prelabor rupture of the membranes (PPROM) before 26 weeks of gestation and to develop a prediction model for survival.

148 consecutive cases of PPROM before 26 weeks of gestation, collected between 1988 and 1996, were retrospectively analyzed. A multivariate analysis (generalized estimating equations) of 21 process and 5 short and long term outcome variables was performed.

40 out of 148 children (27%) died before or during birth, 57 (38.5%) of the children survived more than 28 days, from which still 5 died after one month. Amongst the 52 survivors (35.1%), the Bayley Mental Development Index and Psychomotor Development Index at a corrected age of 7 months was normal in respectively 85.7% and 75.5% of the cases. At 6-7 years of age, 24 out of 33 children (73%) performed adequately at school. Sex, gestational age at PPROM, birth weight, the administration of steroids and interactions of steroid administration with sex and with gestational age at the time of PPROM largely determined the chances of survival.

Overall fetal survival after PPROM before 26 weeks of gestation was 35.1%. Survival can be predicted with an accuracy of 75%, a sensitivity of 85% and a specificity of 60%. More than 70% of the survivors behaved and performed adequately at school age, but 27% require special long-term attention and care.