Extremely preterm prelabour rupture of membranes (EPPROM)

Key points

• Extremely preterm prelabour rupture of membranes (EPPROM) is a rare complication of pregnancy; it is frequently quoted to have an incidence of less than 1% ^1,2 but the exact incidence is unclear.
• It is currently unknown how women who experience EPPROM are counselled and managed across the UK.
• National guidance for EPPROM is not therefore underpinned by good quality scientific evidence.

Surveillance period

1^st September 2019 – 28^th February 2021

Background

EPPROM is a rare complication of pregnancy that carries significant maternal morbidity, neonatal morbidity and neonatal mortality. The true incidence of women undergoing ongoing conservative management for 'prolonged EPPROM' is difficult to establish from current literature due to different inclusion criteria and gestational age windows. The patient group 'Little Heartbeats' highlighted that it is unclear how this group of women is counselled and managed as there is currently a paucity of good quality data available and guidance for clinicians. Expectant mothers in the UK are presented with huge variation in information on prognosis and advice on termination. When conservative management is chosen, variation exists in location of management, use of monitoring, antibiotics and steroids. There is urgent need to develop an understanding of the characteristics of babies that survive EPPROM and accurate complication rates.

Objectives

To use the UK Obstetric Surveillance System (UKOSS) to estimate the prevalence of EPPROM in the UK and examine the management of the condition as well maternal and neonatal outcomes.

Research Questions

• What is the current incidence of EPPROM in pregnancy in the UK?
• How is EPPROM managed in pregnancy in the UK?
• What are the outcomes for mother and infant based on gestational age of membrane rupture?

Case definition

Any pregnant woman who has experienced rupture of membranes in pregnancy between 16+0 to 22+6 weeks gestation.

Excludes:

Cases in which membranes ruptured before 16+0 but were only diagnosed in the 16+0 – 22+6 period.

Funding

This study is being supported by Wellbeing of Women in partnership with Little Heartbeats.

Ethics committee approval

This study has been approved by the North London REC1 (Ref. Number: 10/H0717/20).

Lead investigators

Angharad Care, Zarko Alfirevic and Laura Goodfellow, Liverpool Women's Hospital.

Sampe Data Collection Form

UKOSS EPPROM Data Collection Form

References

1. Bentsen MH, Satrell E, Reigstad H, Johnsen SL, et al. Outcomes after pre-viable preterm premature rupture of the membranes. J Perinatology. 2017;37:1053-9.
2. Yeast LA. Preterm premature rupture of the membranes before viability. Clin Perinatol. 2001;28:849-6.