Premature rupture of membranes in preterm pregnancy: prediction of perinatal outcomes

AIM: This study was aimed to determine predictors of severe lesions of the central nervous system in newborns from mothers with preterm labor complicated by premature rupture of membranes, and to develop a model for predicting adverse outcomes based on clinical data and biochemical markers.

MATERIALS AND METHODS: At the first, retrospective, stage of the study, in order to determine clinical predictors of severe cerebral injury, we studied anamnesis data and features of pregnancy and delivery in 101 patients with premature rupture of membranes, expectant management tactics and subsequent delivery at 26–33.6 weeks of gestation. At the second stage, in the prospective study, which included 33 patients, we evaluated the level of neuron-specific enolase in the amniotic fluid and determined its diagnostic significance as a predictor of severe lesions of the nervous system.

RESULTS: The following factors were determined as clinical predictors of severe cerebral ischemia in premature infants: delivery time, duration of the latency period, the proportion of stab leukocytes in the leukocyte formula, and the presence of funiculitis in the histological examination of the placenta. A prognostic model with sensitivity of 98% and specificity of 80%, including clinical predictors and neuron-specific enolase, was developed.

CONCLUSIONS: Prediction of severe cerebral ischemia and correction of the latency period allows for improving perinatal outcomes in premature infants and starting rehabilitation measures after birth in a timely manner.