Relationships Between Preterm Premature Rupture of Membrane at Gestational Age 20 - 36<sup>+6</sup> Weeks and Perinatal Outcomes; A Cross-sectional Study from Tehran, Iran

Background: Preterm premature rupture of membranes (PPROM) significantly contributes to fetal and maternal complications. Objectives: This study aimed to evaluate the risk factors, comorbidities, and outcomes associated with PPROM based on a well-characterized retrospective study. Methods: A cross-sectional study was conducted in Tehran, Iran, from 2020 to 2023. Patient files were assessed, and relevant data were extracted, including patients' age, underlying diseases, gestational age at admission, events preceding or following PROM, cause of death, cervical length, and duration of hospital admission. All data were statistically analyzed to identify correlations between PPROM and various variables. Results: A total of 396 patients with PPROM were included, and 153 separate neonatal files were reviewed. The mean gestational age at admission was 31.1 weeks. The main comorbidities associated with PPROM were vaginal bleeding (39.2%), labor pain (20.2%), and chorioamnionitis (10.7%). The mean duration of maternal hospitalization was 4 days. Low gestational age was a significant risk factor for neonatal mortality (P = 0.002), respiratory distress syndrome (RDS) (P < 0.001), and surfactant requirement (P = 0.008). Neonates with lower birth weights were at higher risk for surfactant requirement (P = 0.025). Normal vaginal delivery (NVD) was a significant factor influencing neonatal mortality among PPROM patients (P = 0.0001). The need for surfactant administration was more frequently observed in neonates born by cesarean delivery (P = 0.047). Conclusions: The findings of this study indicate that vaginal bleeding is a major complication following PPROM. Preterm premature rupture of membranes also leads to increased perinatal mortality and morbidity. These findings underscore the importance of early diagnosis and interventions to prevent adverse outcomes.