Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation

To examine maternal and neonatal outcomes in expectant management of spontaneous preterm premature rupture of membranes (PPROM) before 24 weeks.

Patients presenting with spontaneous PPROM from 14 to 23 completed weeks' gestation between January 1, 1995 and December 31, 1999 were reviewed. A total of 108 pregnancies were evaluated; 57 patients elected expectant management.

Median latency from rupture of membranes (ROM) to delivery was 6 days; the overall survival rate was 26.3%. In ROM <20 weeks, a twin and a triplet pregnancy with loss of the presenting fetuses yielded the only survivors. In patients with ROM from 20 to 21 and 22 to 23 weeks, survival rates were 2/16 (12.5%) and 11/20 (55.0%), respectively. In all, 18/57 (31.6%) of patients developed chorioamnionitis. There was no maternal sepsis or death. There were three cases of pulmonary hypoplasia, all in patients with ROM <20 weeks.

Neonatal survival in spontaneous PPROM before 20 weeks is rare, irrespective of latency from ROM to delivery. When PPROM occurs from 20 to 24 weeks, survival improves with increasing gestational age at ROM and at delivery.