Accessible Unlicensed Requires Authentication Published by De Gruyter January 11, 2014

Perinatal management of preterm premature ruptured membranes affects neonatal prognosis

Arisa Fujiwara, Kotaro Fukushima, Hirosuke Inoue, Takeshi Takashima, Hiromasa Nakahara, Shoji Satoh, Masayuki Ochiai, Toshiro Hara, Mototsugu Shimokawa and Kiyoko Kato


Aim: To determine the factors affecting neonatal prognosis in preterm premature rupture of membranes (PPROM).

Method: We conducted a case-control study involving 92 women between the years 2000 and 2010 diagnosed with PPROM between 25 and 31 weeks’ gestation, who received antenatal steroids, and delivered between 26 and 31 weeks’ gestation; a retrospective cohort study was conducted based on the results. We used data from four tertiary centers and compared the frequencies of neonatal neurologic deficits and neonatal deaths.

Results: There was a difference between the two groups; specifically, the ND group (n=18) consisted of patients whose infants had neurologic deficits and/or neonatal deaths and the neurologically normal (NN) group (n=74) included NN neonates amongst the patients who had expectant management (94% vs. 73%, respectively). Multivariable analysis revealed that expectant management was independently associated with an increased risk for neonatal neurologic deficits and neonatal deaths (odds ratio, 16.14). All neonates with poor prognosis in the expectant-management group delivered within 14 days after PPROM.

Conclusions: Expectant management within 14 days after PPROM is associated with poor neonatal outcomes. Decisions regarding an expectant strategy should be made carefully. An immediate, planned delivery after steroid administration should be considered to improve neonatal prognosis in patients who have PPROM after 26 weeks’ gestation.

Corresponding author: Kotaro Fukushima, MD, PhD, Department of Obstetrics and Gynecology, Kyushu University Hospital, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan, Tel.: +81-92-642-5395, Fax: +81-92-642-5414, E-mail:


This work was supported in part by a grant-in-aid from the Japan Ministry of Health and Labour (H22-Jisedai Ippan-007) and the Japan Ministry of Education (23591596).


[1] ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007;109:1007–19. Search in Google Scholar

[2] Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol. 2007;109:253–61. Search in Google Scholar

[3] Cox SM, Leveno KJ. Intentional delivery versus expectant management with preterm ruptured membranes at 30–34 weeks’ gestation. Obstet Gynecol. 1995;86:875–9. Search in Google Scholar

[4] Fujimori T. Timing and mode of delivery. Jpn Soc Obstet Gynecol. 2007;59:423–7 [in Japanese]. Search in Google Scholar

[5] Fukushima K, Morokuma S, Fujita Y, Tsukimori K, Satoh S, Ochiai H, et al. Short-term and long-term outcomes of 214 cases of non-immune hydrops fetalis. Early Hum Dev. 2011;87:571–5. Search in Google Scholar

[6] Garite TJ. Management of premature rupture of membranes. Clin Perinatol. 2001;28:837–47. Search in Google Scholar

[7] Lieman JM, Brumfield CG, Carlo W, Ramsey PS. Preterm premature rupture of membranes: is there an optimal gestational age for delivery? Obstet Gynecol. 2005;105:12–7. Search in Google Scholar

[8] Locatelli A, Ghidini A, Paterlini G, Patane L, Doria V, Zorloni C, et al. Gestational age at preterm premature rupture of membranes: a risk factor for neonatal white matter damage. Am J Obstet Gynecol. 2005;193:947–51. Search in Google Scholar

[9] Melamed N, Ben-Haroush A, Pardo J, Chen R, Hadar E, Hod M, et al. Expectant management of preterm premature rupture of membranes: is it all about gestational age? Am J Obstet Gynecol. 2011;204:48.e1-8. doi: 10.1016/j.ajog.2010.08.02. Search in Google Scholar

[10] Mercer BM, Crocker LG, Boe NM, Sibai BM. Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32–36 weeks: a randomized trial. Am J Obstet Gynecol. 1993;169:775–82. Search in Google Scholar

[11] Miyashita S, Nakamura T, Kikuchi A. Fertility status and problem of single preterm birth and small for gestational age at perinatal critical facilities. Year Book Jpn Soc Perinatal Neonatal Med. 2009;27:57–71 [in Japanese]. Search in Google Scholar

[12] Nakazawa Y, Ibara S, Maruyama Y, Maruyama H, Tokuhisa T, Hayashida R, et al. Limit growth of FGR in our center. Year Book Jpn Soc Perinatal Neonatal Med. 2009;27:73–82 [in Japanese]. Search in Google Scholar

[13] Parry S, Strauss JF 3rd. Premature rupture of the fetal membranes. N Engl J Med. 1998;338:663–70. Search in Google Scholar

[14] Pasquier JC, Bujold E, Rabilloud M, Picaud JC, Ecochard R, Claris O, et al. Effect of latency period after premature rupture of membranes on 2 years infant mortality (DOMINOS study). Eur J Obstet Gynecol Reprod Biol. 2007;135:21–7. Search in Google Scholar

[15] Pasquier JC, Picaud JC, Rabilloud M, Claris O, Ecochard R, Moret S, et al. Neonatal outcomes after elective delivery management of preterm premature rupture of the membranes before 34 weeks’ gestation (DOMINOS study). Eur J Obstet Gynecol Reprod Biol. 2009;143:18–23. Search in Google Scholar

[16] Saito S. Realities of preterm birth in Japan. Clin Gynecol Obstet. 2011;65:1408–13 [in Japanese]. Search in Google Scholar

[17] Satoh S, Tsukimori K, Ishida K, Takashima T, Higashihara T, Shiraishi S, et al. Preterm PROM. Union Group Kyushu Region Jpn Soc Obstet Gynecol. 1992;12:29–34 [in Japanese]. Search in Google Scholar

[18] Yoon BH, Romero R, Park JS, Kim CJ, Kim SH, Choi JH, et al. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol. 2000;182:675–81. Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-7-30
Accepted: 2013-12-13
Published Online: 2014-1-11
Published in Print: 2014-7-1

©2014 by Walter de Gruyter Berlin/Boston