La rupture des membranes avant 22 SA est-elle un facteur pronostique néonatal indépendant du terme de naissance ?

Abstract

Objective

Compare, at the same gestational age at birth, survival without severe neonatal morbidity among live-born infants after previable premature rupture of membranes (PROM) occurring before 22 weeks of gestation (WG) versus at or after 22 weeks.

Methods

Retrospective study conducted in a tertiary care referral center between 2016 and 2021, including live births between 23 and 36 weeks + 6 days after PROM. Only live-born infants with neonatal resuscitation care were included. Each infant from the group PROM < 22 weeks was matched for gestational age at birth with the next two infants born after PROM ≥ 22 weeks. Maternal characteristics, obstetric outcomes, and neonatal outcomes were compared between the two groups. The primary outcome was survival without severe neonatal morbidity at discharge.

Results

In total, 35 infants were included in the PROM < 22 weeks group and 70 in the PROM ≥ 22 weeks group. The median gestational age at birth was 28,4 weeks (IQR [25,3–31,2]). The rate of survival without severe neonatal morbidity was significantly lower in the PROM < 22 weeks group compared to the PROM ≥ 22 weeks group (15/35 [42,9%] vs. 58/70 [82,9%], P < 0.01). The number of deaths in the neonatal intensive care unit before 36 weeks corrected age was higher in the PROM < 22 weeks group (6 [17,1%] versus 3 [4,3%], P = 0,03).

Conclusion

Previable PROM is associated with a survival rate without severe neonatal morbidity that is twice lower than infants born at the same gestational age after PROM ≥ 22 weeks.