57 - Maternal and neonatal outcomes following Previable Preterm Premature Rupture of Membranes: A Mississippi experience

Publication Number: 2054.57

Dipen P. Vyas, University of Mississippi School of Medicine, Brandon, MS, United States; Collin Crawson, University of Mississippi School of Medicine, Flowood, MS, United States; Jasmine Butler, University of Mississippi School of Medicine, Clinton, MS, United States; Lachlan Shiver, University of Mississippi School of Medicine, Jackson, MS, United States; Aditya Patel, University of Mississippi School of Medicine, Jackson, MS, United States; Maher Ajour, University of Mississippi School of Medicine, Ridgeland, MS, United States

Background: Previable Preterm Premature Rupture of Membranes (PPPROM), defined as membrane rupture before the limit of fetal viability, is strongly associated with extremely preterm birth, maternal and neonatal morbidities. The American College of Obstetricians and Gynecologists recommends counseling the family regarding expectant management (EM) versus termination of pregnancy (TOP) for management of PPPROM owing to higher rates of maternal complications associated with EM. In Mississippi, the overall rate of perinatal morbidity is high; in addition, almost all PPPROM are managed expectantly.

Objective: Review of maternal and neonatal outcomes following PPPROM at University of Mississippi Medical Center (UMMC). Comparison of outcomes for pPPROM < 20 weeks(w) gestational age (GA) (early) versus 20-24w GA (Late).

Design/Methods: A retrospective chart review of mothers with PPPROM ( < 24w GA) during 1/1/2014-2/28/2025 was performed. Demographic data and the primary outcome of composite maternal morbidities and neonatal survival without severe morbidity were compared between the two groups.

Results: A total of 99 mothers were included for analysis. Baseline characteristics are shown in Table 1. 38.3% underwent spontaneous abortion following EM (Early 80%, late 10%). The median latency period overall was 12 days (d) (IQR, 6-45d). A high proportion of mothers had complications with post-partum hemorrhage (Overall 11.5%, early 21%, late 5%) and chorioamnionitis on histology (overall 70.4%, early 79%, late 64%). Composite maternal morbidity was high overall (34%), but no difference was found between the two groups (Table 2). A total of 61% of pregnancies resulted in live births (early 20%, late 89.8%). Neonatal survival without severe morbidity was 47.5%, but with no difference between groups (early 37%, late 49%). For all live births, a one-week increase in GA and a 25 g increase in birth weight (BW) were associated with 35% and 4.6% higher odds of survival without severe morbidity, respectively [GA OR 1.355(CI 1.095-1.678), BW 1.046(1,011-1,083)]. The outcome showed no association with the duration of the latency period or the timing of ROM (Table 2).

Conclusion(s): This retrospective review demonstrates that PPPROM carries a substantial risk of maternal morbidity. Despite expectant management, most early PPPROM pregnancies resulted in spontaneous abortion. Among pregnancies reaching viability, neonatal mortality and morbidity did not vary by timing of membrane rupture or latency period, with outcomes predominantly determined by gestational age and birth weight.

Maternal and neonatal Baseline characteristics
UTI urinary tract infection, w weeks, g gram

Maternal and neonatal primary outcomes
ICU intensive care unit, DVT deep vein thrombosis, PPH postpartum hemorrhage; a. Combine maternal morbidity: Either Clinical chorioanionitis, endometritis, ICU admission, pRBC transfusion, PPH, sepsis, DVT, Pulmonary embolism, uterine rupture, or death; Neonatal neuro morbidity: Either Grade III/IV Intarventricular hemorrhage, Periventricular leucomalacia, need for Shunt placement, Retinopathy of prematurity requiring intervention
Neonatal Respiratory Morbidity: Grade 2-3 Bronchopulmonary dysplasia(BPD), need for home respiratory medications, home oxygen, or tracheostomy; All severe morbidity: includes neuro morbidity or Grade 3 BPD, or surgical NEC; b. one unit increase is an increase of 25g weight; *adjusted for GA, BW, and latency period.

Subgroup analysis of all neonatal morbidities
ROP retinopathy of prematurity, d days.