Clinical significance and outcome of preterm prelabor rupture of membranes: population-based study

Objective: To evaluate maternal characteristics and neonatal and maternal b irth outcome in cases of prelabor rupture of membranes (PPROM) in a non-sel ected parturient population. Study design: The study population consisted o f 5660 singleton preterm births (24-36 weeks gestation) occurring between 1 988 and 1997 at the Soroka University Medical Center in Israel. Parturients with no prenatal care were excluded from the study. A cross-sectional stud y was designed between two groups. The study group consisted of patients wi th PPROM (n = 968) and the comparison group consisted of patients without P PROM (n = 4692). The data were analyzed by SPSS package. Information was ob tained using a computerized database based on detailed obstetrical records. Logistic regression was used to assess the contribution of different risk factors to PPROM. Results: PPROM was associated with a significantly lower gestational age (24-32 weeks) and birth weight (< 2500 g) than those with i ntact membranes. The rates of chorioamnionitis and urinary infection were f ound significantly higher in the PPROM group compared with women without PP ROM (16.5 vs. 2.7%; 5.1 vs. 3.3%, respectively) (P < 0.001). The rate of en dometritis and bacteremia in the postpartum period were significantly highe r in women with PPROM compared with controls 2.8 vs. 1.4%, (P = 0.003) and 9.4 vs. 5%, (P = 0.001), respectively. Total perinatal mortality rates were significantly higher in the group without PPROM 10.5 vs. 7.2% (P = 0.01), however, rates of postpartum death were higher in the PPROM group 5.5 vs. 4 % (P<0.01). When adjusted for recognized risk factors using logistic regres sion analysis, infection of amniotic fluid (OR = 6.6) and genito-urinary tr act infection (OR = 1.64) remained the independent risk factors associated with PPROM. Conclusions. Infectious morbidity in patients with preterm prel abor rupture of membranes and preterm delivery remained an important risk f actor for obstetrical and neonatal complications. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.