Maternal and neonatal outcomes following expectant management of previable preterm premature rupture of membranes: a retrospective cohort study

OBJECTIVES: Previable Preterm Premature Rupture of Membranes (PPPROM), defined as rupture of membrane (ROM) before fetal viability. Currently, it is recommended to counsel the family regarding expectant management (EM) vs. termination of pregnancy (TOP) given the increased maternal morbidity associated with EM. Additionally, there is limited knowledge of outcomes following ROM ≤20 weeks. Given Mississippi's high-risk obstetric population and all mothers undergoing EM, we aimed to evaluate outcomes following PPPROM at our center. METHODS: A single-center retrospective cohort study conducted of patients with PPPROM [<24w gestational age (GA)] from 1/1/2014-2/28/2025. Demographic data and primary outcome of composite maternal morbidities and neonatal survival without severe morbidity were reviewed and compared between early (≤20 weeks) vs. late (>20 weeks) ROM. RESULTS: Total of 99 mothers (40 early vs. 59 late ROM) were included. 38 % had spontaneous abortion. Composite maternal morbidity was 34 %, with no difference between the groups. Each year increase in maternal age and gravidarum increased maternal morbidity by 10 % and 23 % respectively. Among live births, survival to discharge was 66 %, and survival without severe morbidity was 47.5 %, with no difference between groups. Increase in GA [OR 1.355 (1.095-1.678)], birth weight [OR 1.046 (1.011-1.183)], and 1-min Apgar [OR 1.35 (1.105-1.650)] showed higher survival without morbidity. Survival without morbidity increased with increase in latency period, only for ROM at early GA. CONCLUSIONS: PPPROM carries a substantial risk of maternal morbidity, which increases with maternal age and gravida. Among live births, neonatal survival without severe morbidity remained unchanged based on timing of ROM.