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Previable Preterm Premature Rupture of the Membranes Reaching Viability: Canadian Outcomes.
Anja Gojic1, Yanchen Wang1, Prakesh S Shah2
1Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|June 29, 2026
Summary
Preterm premature rupture of membranes (PPROM) before 22 weeks gestation is linked to earlier birth and higher severe morbidity in extremely preterm infants. Despite significant risks, over 75% of these infants survived to discharge.
Area of Science:
- Neonatalogy
- Perinatology
- Obstetrics
Background:
- Preterm premature rupture of membranes (PPROM) before 22 weeks gestation presents unique challenges for perinatal counseling.
- Understanding neonatal outcomes is crucial for guiding clinical decisions and parental support.
Purpose of the Study:
- To compare birth timing and neonatal outcomes in infants with previable PPROM (<22 weeks) versus those without prolonged PPROM.
- To provide data to aid perinatal counseling at the threshold of viability.
Main Methods:
- Retrospective cohort study of 8071 liveborn singletons born <32 weeks in Canada (2018-2022).
- Compared outcomes between 225 infants with PPROM <22 weeks and 7846 infants with rupture of membranes <24 hours at 22-31 weeks.
- Primary outcome: composite of mortality or severe neonatal morbidity; multivariable generalized estimating equations used.
Main Results:
- Infants with PPROM <22 weeks were more likely to be born extremely preterm (65%) compared to the control group (36%).
- Increasing gestational age at PPROM was inversely related to gestational age at birth.
- Previable PPROM was associated with increased odds of mortality/severe neonatal morbidity (90% vs. 66%), but 77% survived to discharge.
Conclusions:
- In infants reaching viability, previable PPROM is associated with earlier delivery and a high incidence of severe neonatal morbidity.
- Despite the high morbidity, a significant proportion of these extremely preterm infants survive.
- Findings support the need for careful counseling regarding risks and benefits of active care for previable PPROM.
