Perinatal outcome in preterm premature rupture of membranes before 37 weeks of gestation

Objectives: The aim of this study was to assess the maternal and neonatal outcome in patients with preterm premature rupture of membranes between 22 to 37 weeks of gestation in comparison to preterm birth patients.  Material and methods: Group of PPROM patients consisted of 127 women, the control group counted 141 women who delivered prematurely. The control group was formed by matching patient with the same gestational age at delivery and neonatal birth weight to every woman from study group. In both groups speculum and ultrasound examinations were performed, microbiological swabs were taken. In unclear cases of PPROM tests detecting amniotic proteins, such as PAMG-1 or IGFBP-1, were performed. According to gestational age at delivery, neonates were divided into subgroups: extremely premature infants (< 27 weeks 6 days), moderate premature infants (from 28 weeks 0 days to 33 weeks 6 days), late premature infants (from 34 weeks 0 days to 37 weeks 0 days).  Results: In the study group, median gestational age of delivery was 34 weeks 1 day and the same in control group — 34 weeks and 5 days (p > 0.05). Parameters of inflammatory status were more often reported in the PPROM group than in the preterm birth group, even if they weren’t statistically significant (positive culture of cervical swab, increased leukocytosis, CRP above 5). The rate of neonate survival was similar in both groups (93.7% and 94.1%). Congenital infection was more often diagnosed in group of neonates from PPROM pregnancies than in neonates from control group; (36% and 21.2% respectively; p = 0.009).  Conclusions: Our research appears to be consistent with theory of inflammatory etiology of PPROM. Optimal management of infection in PPROM patients seems to be the most important in efforts to prolong pregnancy.