Rupture of membranes before 26 weeks of gestation: Outcome of 148 consecutive cases

Aims: To assess the outcome of preterm prelabor rupture of the membranes (P PROM) before 26 weeks of gestation and to develop a prediction model for su rvival. Methods: 148 consecutive cases of PPROM before 26 weeks of gestation, colle cted between 1988 and 1996, were retrospectively analyzed. A multivariate a nalysis (generalized estimating equations) of 21 process and 5 short and lo ng term outcome variables was performed. Results: 40 out of 148 children (27%) died before or during birth, 57 (38.5 %) of the children survived more than 28 days, from which still 5 died afte r one month. Amongst the 52 survivors (35.1%), the Bayley Mental Developmen t Index and Psychomotor Development In-dex at a corrected age of 7 months w as normal in respectively 85.7% and 75.5% of the cases. At 6-7 years of age , 24 out of 33 children (73%) performed adequately at school. Sex, gestatio nal age at PPROM, birth weight, the administration of steroids and interact ions of steroid administration with sex and with gestational age at the tim e of PPROM largely determined the chances of survival. Conclusions: Overall fetal survival after PPROM before 26 weeks of gestatio n was 35.1%. Survival can be predicted with an accuracy of 75%, a sensitivi ty of 85% and a specificity of 60%. More than 70% of the survivors behaved and performed adequately at school age, but 27% require special long-term a ttention and care.