Premature rupture of membranes at < 25 weeks: a management dilemma.

OBJECTIVE: A retrospective study was conducted to establish the perinatal and long-term neonatal outcome at 1 year of life (corrected) of pregnancies complicated by premature rupture of membranes before fetal viability.

STUDY DESIGN: The outcome of 94 singleton pregnancies admitted from June 1982 to June 1991 with premature rupture of membranes at < 25 weeks' gestation that were managed expectantly were studied. To establish the effect of rupture of membranes, the neonatal outcomes of babies born with birth weights > 500 gm and gestational ages > 24 weeks were compared with those of a similar group of neonates from patients without preterm rupture of membranes and matched by gestational age, birth weight, race, sex, and mode of delivery. The outcome of the surviving neonates at 1 year of life (corrected) was established on the basis of their Bailey mental and psychomotor scores and on the results of neurologic, ophthalmologic, and hearing examinations.

RESULTS: The overall incidence of amnionitis was 24%. The median latency period was 10.5 days; in 26% of patients delivery was delayed > 2 weeks. Pulmonary hypoplasia was detected in 5% of patients, and there was no evidence of orthopedic deformities. Survival was achieved in 39 (40%) of neonates; 63% of these survivors were considered to have had normal development at 1 year of life (corrected).

CONCLUSION: Premature rupture of membranes at < 25 weeks is associated with a relatively high risk of perinatal mortality and neonatal and long-term morbidity, but a successful outcome can be achieved in about 60% of survivors.