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

This study evaluates neonatal outcomes following previable preterm premature rupture of membranes (previable PPROM) before 24 weeks' gestation, and identifies factors associated with death or severe comorbidities. A retrospective analysis of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 24 weeks gestation was conducted at the University Hospital of Lille from 2014 to 2019. Maternal and neonatal data until hospital discharge were collected. 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 due to 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.

Parental counseling should consider both current, evolving outcomes, and the unpredictable course of pregnancies complicated by previable PPROM. Prolonging pregnancy through close monitoring and implementation of current guidelines on neonatal management are essential to reduce adverse outcomes.

• Preterm Premature Rupture of Membranes (PPROM) before 24 weeks' gestation is associated with high rates of neonatal mortality and severe morbidity. • Existing evidence is largely derived from small, heterogeneous cohorts, with substantial variability in obstetric and neonatal management strategies.

• This large single-center study demonstrates improved neonatal outcomes following previable PPROM, likely reflecting in perinatal practices, compared to the historical cohort. • Short latency between previable PPROM and delivery, as well as lower gestational age at birth, were identified as independent risk factors for death or severe morbidity. • The study provides updated, real-world data to guide parental counseling and clinical decision-making regarding previable PPROM.