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Poster Session 4

(1168) Clinical Factors Associated with Survival of Periviable Rupture of Membranes

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Rebecca Crowe, MD

    Fellow
    Medical University of South Carolina
    Charleston, SC, United States

    • Coauthor(s)

  • Eliza R. McElwee, MD

    Maternal Fetal Medicine Attending
    Medical University of South Carolina
    Columbia, South Carolina, United States

  • JP

    Jessica Pittman, BS

    Medical University of South Carolina
    Charleston, South Carolina, United States

  • DH

    Devin Hatchell, BS

    Medical University of South Carolina
    Columbia, South Carolina, United States

Objective: The aim of this study is to assess neonatal survival to discharge and factors that may influence survival in pregnancies affected by rupture of membranes (ROM) less than 25 weeks gestation (w). 

Study Design: This is a retrospective cohort study of non-anomalous, singleton pregnancies with ROM prior to 25w delivered at a tertiary care center from 2005-2024. Patients included in the study elected for expectant management at the diagnosis of ROM and delivered a liveborn neonate that was a candidate for resuscitation.  Patients who elected comfort care were excluded. Patients were stratified by neonatal survival to discharge.  Maternal, obstetric, and neonatal variables were compared between survival groups. Chi-square and student’s t-test were used to compare categorical and continuous variables.

Results: Of 90 patients with ROM less than 25 w, 54 (60%) neonates survived to discharge, and 36 (40%) had a neonatal demise. Gestational age (GA) at ROM (23.2w IQR 22.6-24 v 23.1w IQR 22.5 - 24, p=0.318), GA at delivery (24.4w IQR 23.7-24.9 v 24.2w IQR 23.6-24.9, p = 0.197), and latency from ROM to delivery (4.6d (IQR 2-16) v 4 (IQR 2-16), p=0.623) were not statistically different between survivors and non-survivors.  Six percent of patients delivered prior to 23w0d. Residual amniotic fluid values were not statistically different between survivors and non-survivors (p=0.42). Antenatal interventions, including antenatal corticosteroid (100% v 94.4%, p = 0.157) and antibiotic administration (90.7% v 83.3%, p=0.337) were not different between groups. Mode and indication for delivery did not impact neonatal survival to discharge.

Conclusion: In our cohort, overall survival of expectantly managed pregnancies affected by ROM less than 25 weeks gestation is 60%.  Survival to discharge is multi-factorial, and is challenging to predict in the periviable period.