Neonatal outcomes following preterm prelabor rupture of membranes during the periviable period

Abstract

Objective: Preterm prelabor rupture of membranes (PPROM) before 26 weeks of gestation presents a significant clinical challenge due to its association with high rates of neonatal morbidity and mortality. We aimed to assess neonatal outcomes and risk factors associated with perinatal mortality in pregnancies complicated by periviable preterm prelabor rupture of membranes (PPROM). Material and Methods: This retrospective cohort study analyzed medical records of 119 pregnancies complicated by PPROM between 20+0 and 25+6 weeks’ gestation, managed expectantly at a tertiary care center from 2015 to 2019. Data on maternal demographics, sonographic and laboratory parameters, and neonatal outcomes were collected. Statistical analyses included t-tests, Mann–Whitney U, chi-square, and ROC curve analysis to determine predictive cut-offs for perinatal mortality. Results: Of 142 women with mid-trimester PPROM, 119 (83.8%) were managed expectantly. Of the 119 cases, 53 neonates survived to discharge (44.5%). Gestational age at delivery, birth weight, and latency period were significantly higher in the survival group (p<0.001). ROC analysis revealed GA ≤23 weeks, latency ≤9 days, and birth weight ≤640 g as significant predictors of mortality. The combination model (AUC 0.78) yielded high sensitivity (90.38%) but limited specificity (50%). Conclusion: This study confirms that key prognostic indicators for neonatal survival in periviable PPROM include gestational age at delivery, latency period, and birth weight. The survival benefit was most evident in pregnancies with latency beyond 9 days and deliveries occurring after 23 weeks. While ROC-derived models can guide clinical decision-making, their specificity limitations must be considered. Further prospective, multicenter research is needed to validate these findings.