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Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review
Amy Phillips1, Megan Pagan1, Alex Smith1
1Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR.
Insights
Periviable and previable premature rupture of membranes (pPPROM) is rare but serious. Current interventions for pPPROM before 24 weeks gestation do not improve outcomes, with gestational age and latency period being key prognostic indicators.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Perinatal Medicine
Background:
- Periviable and previable premature rupture of membranes (pPPROM) affects less than 1% of pregnancies, carrying significant risks for maternal and fetal health.
- Improved understanding of risk factors, interventions, and outcomes is crucial for patient counseling and care.
Approach:
- A comprehensive literature search was conducted using PubMed, Web of Science, and CINAHL.
- Search terms included "previable" OR "periviable" AND "fetal membranes" OR "premature rupture" OR "PROM" OR "PPROM," limited to English language articles.
Key Points:
- Multiple risk factors for pPPROM exist, but their predictive value is low.
- Interventions used after 23-24 weeks gestation have not demonstrated improved outcomes in the previable/periviable stages.
- Neonatal survival without severe morbidity remains low, though outcomes have improved over time.
Conclusions:
- pPPROM is an uncommon event with persistently poor neonatal outcomes.
- Routine interventions for pPPROM beyond 24 weeks gestation lack proven benefit.
- Gestational age at pPPROM and latency period length are the most reliable indicators of prognosis.
Importance:
Periviable and previable premature rupture of membranes (pPPROM) occurs in <1% of pregnancies but can have devastating consequences for the mother and the fetus. Understanding risk factors, possible interventions, and both maternal and neonatal outcomes will improve the counseling and care provided for these patients.
Objective:
The aim of this review is to describe the etiology, risk factors, management strategies, neonatal and maternal outcomes, and recurrence risk for patients experiencing pPPROM.
Evidence Acquisition:
A PubMed, Web of Science, and CINAHL search was undertaken with unlimited years searched. The search terms used included "previable" OR "periviable" AND "fetal membranes" OR "premature rupture" OR "PROM" OR "PPROM." The search was limited to English language.
Results:
There were 181 articles identified, with 41 being the basis of review. Multiple risk factors for pPPROM have been identified, but their predictive value remains low. Interventions that are typically used once the fetus reaches 23 to 24 weeks of gestation have not been shown to improve outcomes when used in the previable and periviable stage. Neonatal outcomes have improved over time, but survival without severe morbidity remains low. Later gestational age at the time of pPPROM and longer latency period have been shown to be associated with improved outcomes.
Conclusions And Relevance:
Periviable and previable premature rupture of membranes are uncommon pregnancy events, but neonatal outcomes remain poor, and routine interventions for PPROM >24 weeks of gestation have not proven beneficial. The 2 most reliable prognostic indicators are gestational age at time of pPPROM and length of the latency period.
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