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Neonatal outcomes in preterm prelabour rupture of membrane

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Neonatal Outcomes in Preterm Prelabour Rupture of Membranes (PPROM) ≤24 weeks at Aberdeen Maternity Hospital

Navta Masand, Leena Thomas, Lena Crichton.  Aberdeen Maternity Hospital (AMH), Aberdeen, Scotland, UK


• PPROM ≤ 24 weeks complicates <1% of pregnancies but is associated with high rates of morbidity and mortality
• However outcomes have improved with the use of antibiotics, antenatal steroids, artificial surfactant, and advances in obstetric and neonatal management
• Management includes expectant management or termination of pregnancy
• Currently, lack of guidelines on the management of this specific group of patients
• No current data on survival/ neonatal outcomes within our own unit

Aims & Objectives

• To assess risk factors for PPROM
• Review perinatal outcomes in cases of PPROM ≤ 24 weeks in AMH:
ØRates of TOP, SB and LB
ØAudit use of Antibiotics
ØAudit use of Steroids
ØAssess outcomes of LB
• To develop a local clinical guideline for the management of women with previable PPROM

 TOP- Termination of pregnancy; SB- Still Birth; LB- Live Birth 

Design and Population

• Records reviewed between Jan 2008-Nov 2012 (59 months)
• Singleton pregnancies complicated by PPROM between 15+2 and 24+0 weeks of gestation at AMH
• Cases identified using data collected from ward records & Neonatal badger

Current management of PPROM <24 weeks

• Erythromycin for 10 days
• Antenatal steroids (24-34 weeks)
• Follow up scans, bloods and swabs/urine samples
• Conservative management vs. TOP
• Aim to deliver at 36 weeks
• Counsel by paediatricians

Maternal Results

•Median gestation at PPROM 21 weeks (15+2-24+0 weeks)
•Median gestation at delivery: 24+0 weeks (16+0-32+3 weeks)
•All confirmed SROM
•30/32 (94%) received antibiotics
•17 received full course of steroids (15/18 LBs, 2 SBs), 3 LBs received 1 dose

SROM- Spontaneous rupture of membranes

Outcomes and Conclusions

• Despite advances in antenatal care, PPROM is associated with high perinatal morbidity and mortality:
Ø6/18 (33%) LBs died
Ø2/18 11%) no comorbidities on discharge
Ø4/18 (22%) Home on Oxygen
Ø1 with global developmental delay at age 3 years, 7 discharged from routine follow up at 2 years (3 still under follow-up, age <2 years)

Action Plan

• Create standard local guideline for management of PPROM- further data needed (continue audit prospectively)
• Ensure patients are receiving steroids and antibiotics- When should these patients receive steriods?

Corresponding Author email: [email protected]

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