Wellbeing of Women and Little Heartbeats have funded one of the largest studies into the outcomes of premature breaking of waters (PPROM) before 23 weeks’ gestation, finding that 26% of babies survive to discharge from hospital.

Researchers at the University of Liverpool assessed data from obstetric units across the UK between September 2019 and February 2021 to understand pregnancy outcomes in more than 300 women affected by PPROM before 23 weeks' gestation.

Babies develop inside a bag of fluid called the amniotic sac. PPROM is a pregnancy complication where the amniotic sac membranes break too early. Most women who have PPROM after 24 weeks of pregnancy have a good outlook, with care underpinned by national guidelines.

However, for the one in 1000 women who experience early PPROM between 16- and 23-weeks’ of pregnancy, the outlook is often judged to be so poor that termination is recommended. Very little evidence exists about the optimal management of early PPROM from which to formulate guidelines.

The research team found that a substantial minority of women can expect to take home a surviving baby (26%), but there was moderate risk of maternal sepsis (14%) and a small risk of maternal death (0.5%). Immediate termination of pregnancy did not always mitigate the risk of maternal sepsis.

BBC News reported on the findings and you can find the broadcast below.

Dr Laura Goodfellow, one of the lead investigators of the study said: “Sadly, these women often fall through the cracks between emergency departments and midwifery, gynaecology, obstetrics, and neonatology services, and are left unsupported because healthcare staff lack guidance about how or where to manage their care. Conflicting information adds to psychological distress for women and families facing early PPROM. We cannot understate the gravitas of the decision to end a wanted pregnancy for women and their families. In this vulnerable position, they rely heavily on doctors’ advice and require evidence to help support their decision making. We were passionate about conducting this research to ensure women have access to the most accurate information as possible.”

Dr Goodfellow continued: “PPROM under 23 weeks’ gestation is too uncommon for one clinician to gain adequate experience from clinical practice alone, or to facilitate interventional research at a small number of centres. But it is common enough that at the UK population level, it affects many women. Our research provides data to allow more unified counselling about the outlook for women and babies after early PPROM and informed decisions about whether to continue a pregnancy.

“Now that we understand the level of risk attributed to this pathology, we need expert consensus, evidence-based research, clinical guidelines, and a reorganisation of services to find the best care for these women and babies.”

The paper, Preterm prelabour rupture of membranes before 23 weeks’ gestation: prospective observational study, was published in BMJ Medicine.