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Am J Obstet Gynecol. 2018 Sep;219(3):298.e1-298.e14. doi: 10.1016/j.ajog.2018.05.029. Epub 2018 May 29.

Preterm premature rupture of membranes at 22-25 weeks' gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2).

Author information

1
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie Paris 06, Institut de Formation Doctorale, Paris, France; EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal, France. Electronic address: elsa.lorthe@gmail.com.
2
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Neonatal Medicine and Resuscitation Service in Port-Royal, Cochin Hospital, Paris, France.
3
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, Paris, France.
4
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Unité de Recherche Clinique-Centre d'Investigations Cliniques P1419, Département Hospitalo-Universitaire Risks in Pregnancy, Cochin Hotel-Dieu Hospital, Paris, France.
5
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France.
6
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie Paris 06, Institut de Formation Doctorale, Paris, France; Department of Neonatology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
7
Department of Neonatology, North Hospital, Marseille, France.
8
Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
9
Department of Obstetrics and Gynecology, Centre d'Investigation Clinique Mère Enfant, University Hospital, Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1280 Physiologie des Adaptations Nutritionnelles, Nantes, France.
10
Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
11
Department of Obstetrics and Gynecology, Jeanne de Flandre Hospital, Lille, France, Equipe d'Accueil 2694, Pôle de Recherche et d'Enseignement Supérieur University of Lille Nord de France, Lille, France.
12
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie Paris 06, Institut de Formation Doctorale, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

Abstract

BACKGROUND:

Most clinical guidelines state that with early preterm premature rupture of membranes, obstetric and pediatric teams must share a realistic and individualized appraisal of neonatal outcomes with parents and consider their wishes for all decisions. However, we currently lack reliable and relevant data, according to gestational age at rupture of membranes, to adequately counsel parents during pregnancy and to reflect on our policies of care at these extreme gestational ages.

OBJECTIVE:

We sought to describe both perinatal and 2-year outcomes of preterm infants born after preterm premature rupture of membranes at 22-25 weeks' gestation.

STUDY DESIGN:

EPIPAGE-2 is a French national prospective population-based cohort of preterm infants born in 546 maternity units in 2011. Inclusion criteria in this analysis were women diagnosed with preterm premature rupture of membranes at 22-25 weeks' gestation and singleton or twin gestations with fetus(es) alive at rupture of membranes. Latency duration, antenatal management, and outcomes (survival at discharge, survival at discharge without severe morbidity, and survival at 2 years' corrected age without cerebral palsy) were described and compared by gestational age at preterm premature rupture of membranes.

RESULTS:

Among the 1435 women with a diagnosis of preterm premature rupture of membranes, 379 were at 22-25 weeks' gestation, with 427 fetuses (331 singletons and 96 twins). Median gestational age at preterm premature rupture of membranes and at birth were 24 (interquartile range 23-25) and 25 (24-27) weeks, respectively. For each gestational age at preterm premature rupture of membranes, nearly half of the fetuses were born within the week after the rupture of membranes. Among the 427 fetuses, 51.7% were survivors at discharge (14.1%, 39.5%, 66.8%, and 75.8% with preterm premature rupture of membranes at 22, 23, 24, and 25 weeks, respectively), 38.8% were survivors at discharge without severe morbidity, and 46.4% were survivors at 2 years without cerebral palsy, with wide variations by gestational age at preterm premature rupture of membranes. Survival at 2 years without cerebral palsy was low with preterm premature rupture of membranes at 22 and 23 weeks but reached approximately 60% and 70% with preterm premature rupture of membranes at 24 and 25 weeks.

CONCLUSION:

Preterm premature rupture of membranes at 22-25 weeks is associated with high incidence of mortality and morbidity, with wide variations by gestational age at preterm premature rupture of membranes. However, a nonnegligible proportion of children survive without severe morbidity both at discharge and at 2 years' corrected age.

KEYWORDS:

EPIPAGE-2; cerebral palsy; perinatal outcome; periviable rupture of membranes; prematurity; preterm premature rupture of membranes

PMID:
29852153
DOI:
10.1016/j.ajog.2018.05.029

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