JOURNAL OF TROPICAL PEDIATRICS, VOL. 56, NO.

1, 2010

The Incidence Rate of Premature Rupture of Membranes and

its Influence on Fetal–neonatal Health: A Report From
Mainland China
by Jing Liu, Zhi-Chun Feng, and Jing Wu
Department of Neonatology & NICU, Bayi Children’s Hospital Affiliated with Beijing Military Region General Hospital, Beijing, China

Summary

Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021

Premature rupture of membranes (PROM) is a common pregnancy complication and is associated with
significant risks of fetal and neonatal morbidity and mortality. However, there is a lack of data
concerning PROM in China. We investigated the incidence rate and analysed the influence of PROM
on fetal and neonatal health. This used data from five specialist hospitals and one general hospital in
mainland China. The total number of deliveries and the number of those complicated by PROM were
recorded between January 2003 and December 2007. The time from initiation of PROM until delivery
(latent period), the volume of amniotic fluid at delivery, fetal conditions and neonatal clinical conditions
were recorded. The results suggest that the incidence of PROM was 19.53% and it could influence
various aspects of the health of fetuses and neonates, including platelet parameters, erythrocyte
parameters, neonatal jaundice and myocardial injury.

Introduction respectively. Yang et al. [3] reported incidence rates

Premature rupture of membranes (PROM) is a
common pregnancy complication and is associated
with significant risks of morbidity and mortality [1–4].
This complication is therefore of importance to
perinatologists [5–8]. Getahun et al. [9] reported
that the incidences of PROM and acute and chronic
respiratory conditions were 5%, 2.1% and 9.5%,
Acknowledgements
We thank the following doctors for providing some
data: Dr Ya-Bin Yu from Beijing Obstetrics and
Gynecology Hospital, Dr Xue-Feng Zhang from
Beijing Haidian District Maternity and Infants’
hospital, Dr Hong-Yan Lu from Zhanjiang
Maternity and Infants’ hospital of Jiangsu Province,
Dr Shi-Wen Xia from Hubei Maternity and Infants’
hospital, Dr Gui-Lian Qin from Qinhuangdao
Maternity and Infants’ hospital of Hebei Province.
Funding
Chinese Post-Doctoral Research Fund (20080431
405&200801041).
Correspondence: Pro. Zhi-Chun Feng, M.D., Department
of Neonatology & NICU, Bayi Children’s Hospital
Affiliated with Beijing Military Region General Hospital,
5 Nanmen Cang, Dongcheng District, Beijing100700,
China. Tel: 86-10-66721786. E-mail: <Liujingbj@live.cn>.
of 30.1% and 17.8% for stillbirths and neonatal
deaths in presence of PROM, while 15.7% of
liveborn infants had pulmonary hypoplasia and
62.5% of which resulted in neonatal death. Gerards
et al. [10] found that the incidence of pulmonary
hypoplasia was 33.3% in pregnancies complicated by
preterm PROM (PPROM), diagnosed on the basis of
clinical, radiological and/or pathological criteria.
Reports from the United States also linked health
risks to infants associated with PROM, with overall
rates of infant death of 11.6%, respiratory distress
syndrome (RDS) 15.1%, assisted ventilation 25.9%
and neonatal seizures 0.2% in infants delivered
following PROM [11]. Data from Nigeria (a devel-
oping country) suggested that the incidence of
PPROM was 29.7% and that the perinatal mortality
in these infants was high (52%) at gestational ages of
28–30 weeks [12]. However, despite being the largest
developing country, China still lacks general data on
PROM. We therefore investigated the incidence and
analysed the influences of PROM on fetal and
neonatal health, in order to develop a working
protocol for improving fetal and neonatal health
after the occurrence of PROM.
Materials and Methods
Survey of the incidence of PROM in mainland China
Data were acquired from five specialist hospitals and
one general hospital, including Beijing Obstetrics and

ß The Author [2009]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org 36
doi:10.1093/tropej/fmp051 Advance Access Published on 19 June 2009
J. LIU ET AL.
Gynecology Hospital, Beijing Haidian District
Maternity and Infants’ Hospital, Hubei Maternity
and Infants’ Hospital, Qinhuangdao Maternity and
Infants’ Hospital of Hebei Province, Zhanjiang
Maternity and Infants’ Hospital of Jiangsu
Province and Beijing Military Region General
Hospital. The total number of deliveries and the
number of those complicated by PROM were
recorded between January 2003 and December
2007. The time from initiation of PROM until
delivery (latent period) and the volume of amniotic
fluid at delivery were also recorded simultaneously.
The influence of PROM on fetal health
Fetal conditions including birth weight, Apgar score
after the first and fifth minutes and signs of fetal
distress were recorded.
The influence of PROM on neonatal health
Patients admitted to the Department of Neonatology
and NICU, Bayi Children’s Hospital Affiliated with
Beijing Military Region General Hospital between
May 2007 and April 2008 were considered for
inclusion in this section of investigation. The
presence or absence of PROM was recorded and
any diseases suffered by the infants, laboratory
parameters and results of blood bacteria cultures
were recorded in patients with PROM.
Statistical analysis
Data analysis was conducted using SPSS for
Windows (Release 12.0, SPSS, Chicago, IL).
Analysis was performed using the 2 test, and
P < 0.05 was considered statistically significant.
Results
Survey of the incidence of PROM
A total of 29 143 pregnancies complicated by PROM
were identified among the 149 200 deliveries at the six
hospitals over the past 5 years (between January 2003
and December 2007). The incidence of PROM in this
population was therefore 19.53%.
The proportion of in-patients accounted for by
PROM infants
From May 2007 to April 2008, there were 6640
patients in our Department of Neonatology, of
whom 1422 were patients with PROM (21.4%).
Among the 1422 patients with PROM, there were 405
full-term infants (218 males and 187 females)
accounting for 10.1% (405 of 4044) of full-term in-
patients. The average birthweight of these infants was
3204.2  586.9 g (range, 1335–5100 g), and the aver-
age gestational age was 38.8  1.24 weeks (range,
37–42 weeks). There were 1017 premature infants
(622 males and 395 females) accounting for 39.2%
Journal of Tropical Pediatrics Vol. 56, No. 1
(1017 of 2596) of premature in-patients. The average
birthweight of these infants was 1997.2  532.3 g
(range, 700–3900 g), and the average gestational age
was 32.4  2.01 weeks (range, 26–36 weeks).
Correlation between PROM and premature birth
The incidence of premature birth was 11.2% (3265 of
29 143) in the PROM group and 5.96% (7150 of 120
057) in the non-PROM group (2 ¼ 1004.86,
P < 0.001).
The latent period
Among the 1422 infants with PROM, the latent
Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021
period was <12 h in 142 cases (10.0%), 12 h in 469
cases (33.0%), 24 h in 178 cases (12.5%), 48 h in
251 cases (17.7%), 72 h in 142 cases (10.0%), 96 h
in 89 cases (6.3%), 1 week in 72 cases (5.0%), 2
weeks in 58 cases (4.1%), 4 weeks in 20 cases
(1.41%) and the longest latent period was 12 weeks in
one infant (0.07%).
Correlation between PROM and oligohydramnios
The overall incidence of oligohydramnios in patients
with PROM was 12.8% (182 of 1422). The incidences
of oligohydramnios were 25.9% (88/340) in the
group with a latent period 96 h and 11.3% (122 of
1082) in the group with a latent period <96 h
(2 ¼ 43.85; P < 0.001).
Correlation between PROM and fetal distress
The incidence rate of fetal distress was 15.1% (215 of
1422) in PROM infants, which was significantly
higher than that in non-PROM patients (8102/120
057, 6.7%) (2 ¼ 154.41, P < 0.001).
Correlation between PROM and neonatal asphyxia
Birth asphyxia occurred in 214 infants in the PROM
group (214 of 1422, 15.0%) and in 355 patients in the
non-PROM group (355 of 5218, 6.8%) (2 ¼ 96.98,
P < 0.001).
Correlation between PROM and neonatal RDS
There were 139 cases of RDS among the 1422 PROM
patients (9.8%). Among the 139 RDS patients, there
were 21 full-term infants and 118 premature infants.
The incidence of RDS was 5.2% (21 of 405) in full-
term infants and 11.6% (118 of 1017) in premature
infants (2 ¼ 13.53, P < 0.001).
Correlation between PROM and neonatal
infectious diseases
Infectious diseases occurred in 445 of the 1422
PROM infants (31.3%). Infections included infec-
tious pneumonia (184 cases), septicemia (181 cases),
meningitis (33 cases), urinary tract infections (31
cases) and others (16 cases). Blood cultures were
performed in all the 1422 PROM infants, and
bacteria were detected in 179 patients, giving an
overall positivity rate of 12.6%. The positivity rate
37
 J. LIU ET AL.

TABLE 1
The changing in platelet parameter in full-term infants with and without PROM (x  s)

Groups n PLT (109/l) MPV (fl) PDW (%) PCT (%)

Without PROM 50 301.6  78.6 8.56  1.32 17.53  0.81 0.243  0.055
With PROM 100 264.7  87.0 9.69  1.09 11.54  2.28 0.255  0.088
t 2.44 4.81 22.92 0.71
P 0.017 0.000 0.000 0.48

TABLE 2
The changing in platelet parameter in premature infants with and without PROM (x  s)

Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021

Groups n PLT (109/l) MPV (fl) PDW (%) PCT (%)

Without PROM 50 274.3  77.6 8.51  1.76 17.55  1.03 0.208  0.09
With PROM 100 233.2  70.0 9.84  1.03 11.35  1.71 0.241  0.06
t 3.16 5.06 27.41 2.25
P 0.002 0.000 0.000 0.028

TABLE 3
The changing in erythrocyte parameter in full-term infants with and without PROM (x  s)

Groups n RBC Hb Hct MCV MCH MCHC RDW

Without PROM 50 3.98  0.57 140.3  21.4 0.41  0.06 101.6  6.21 35.5  1.97 336.8  18.6 17.3  2.01
With PROM 100 4.25  0.85 154.6  33.1 0.46  0.09 107.8  6.36 37.4  2.04 347.6  11.6 17.2  1.91
t 2.29 3.19 4.20 5.78 5.55 3.76 0.30
P 0.023 0.002 0.000 0.000 0.000 0.0004 0.76

was 8.4% (34 of 405) in full-term infants and 14.3%
(145 of 1017) in premature infants (2 ¼ 9.05,
P ¼ 0.003). The bacteria isolated included Gram-
positive cocci in 82 cases (45.8%) and Gram-negative
bacilli in 97 cases (54.2%) (no significant difference,
2 ¼ 0.820, P ¼ 0.365). Two epiphytes were also
found in this group of patients.
Changes in blood bilirubin levels in infants
with PROM
The average bilirubin blood levels in premature and
full-term infants with PROM were 214.5  90.8 mmol/l
(range, 45.4–697.0 mmol/l, 95% CI 205.9–223.1) and
209.7  120.6 mmol/l (range, 29.0–591.0 mmol/l, 95%
CI 190.3–229.1), respectively. Average blood bilir-
ubin levels were 220 mmol/l in 37.1% (377 of 1017)
of premature infants and in 29.1% (118 of 405) of
full-term infants. Hyperbilirubinemia was therefore
more common in premature infants with PROM.
(PCT,%) were recorded in 100 premature infants
and 100 full-term infants with PROM, and these
parameters were compared with those in 50 healthy
premature infants and 50 healthy full-term infants.
The results are shown in Tables 1 and 2, respectively.
Changes in erythrocyte parameters in infants
with PROM
Erythrocyte parameters including red blood cell
count (RBC, 1012/l), hemoglobin (Hb, g/l), hema-
tocrit (HCT, %), mean corpuscular volume (MCV,
fl), mean corpuscular Hb (MCH, pg), mean corpus-
cular Hb concentration (MCHC, g/l) and red blood
cell volume distribution width (RDW, %) were
recorded in 100 premature infants and 100 full-term
infants with PROM, and these parameters were
compared with those in 50 healthy premature infants
and 50 healthy full-term infants. The results are
shown in Tables 3 and 4, respectively.

Changes in platelet parameters in infants with PROM Changes in cardiac muscle enzymes in infants
Platelet parameters including platelet count (PLT, with PROM
109/l), mean platelet volume (MPV, fl), platelet Cardiac muscle enzymes including lactate dehydro-
distribution width (PDW, %) and plateletcrit genase (LDH, U/l), aspartate aminotransferase

38 Journal of Tropical Pediatrics Vol. 56, No. 1

J. LIU ET AL.

TABLE 4
The changing in erythrocyte parameter in premature infants with and without PROM (x  s)

Groups n RBC Hb Hct MCV MCH MCHC RDW

Without PROM 50 3.95  0.42 149.8  17.3 0.49  0.09 110.3  6.07 37.3  1.69 336.8  18.6 16.9  1.91
With PROM 100 4.52  0.84 170.9  29.2 0.45  0.04 113.3  5.99 38.3  1.84 346.9  10.6 17.4  1.61
t 5.53 5.53 3.91 2.91 3.38 3.55 1.55
P 0.000 0.000 0.0001 0.0045 0.001 0.0007 0.12

TABLE 5
The changing in cardiac muscle enzyme in full-term infants with and without PROM (x  s)

Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021

Groups n LDH AST CK CK-MB

Without PROM 50 536  217 52.6  35.1 428  238 59.9  45.8
With PROM 100 676  304 80.3  68.1 900  319 99.0  50.1
t 3.23 3.29 3.73 3.26
P 0.0016 0.0012 0.0003 0.0014

TABLE 6
The changing in cardiac muscle enzyme in premature infants with and without PROM (x  s)

Groups n LDH AST CK CK-MB

Without PROM 50 571  151 54.3  25.3 355  224 51.0  23.8
With PROM 100 660  303 68.3  41.7 605  316 89.8  47.7
t 2.40 2.55 4.12 4.58
P 0.018 0.012 0.0001 0.000

TABLE 7
The changing in blood levels of electrolyte in full-term infants with PROM (x  s)

Groups n Kþ Naþ Cl Ca2þ

Without PROM 50 4.54  0.57 138.3  3.90 101.9  4.59 1.96  0.33
With PROM 100 4.35  0.95 137.9  4.80 100.6  5.71 1.99  0.34
t 1.56 0.59 1.48 0.53
P 0.12 0.56 0.14 0.60

(AST, U/l), creatine kinase (CK, U/l), creatine
phosphatase kinase-MB (CK-MB, U/l) were
recorded in 100 premature infants and 100 full-term
infants with PROM, and these parameters were
compared with those in 50 healthy premature infants
and 50 healthy full-term infants. The results are
shown in Tables 5 and 6, respectively.
Changes in blood electrolyte levels in infants
with PROM
Blood levels of electrolytes, including potassium (Kþ,
mmol/l), sodium (Naþ, mmol/l), chloride (CL,
mmol/l) and calcium (Ca2þ, mmol/l) were recorded
in 100 premature infants and 100 full-term infants
with PROM, and these parameters were compared
with those in 50 healthy premature infants and 50
healthy full-term infants. The results are shown in
Tables 7 and 8, respectively.
Correlation between PROM and the incidence
of periventricular leukomalacia (PVL) in
premature infants
The incidence of PVL was 34.9% (355 of 1,017) in
premature infants with PROM and 24.9% (393 of
1579) in non-PROM premature infants (2 ¼ 30.26,
P < 0.001).

Journal of Tropical Pediatrics Vol. 56, No. 1 39


TABLE 8
The changing in blood levels of electrolyte in premature infants with PROM (x  s)
Groups n Kþ
Without PROM 50 4.66  0.84
With PROM 100 4.93  0.84
t 1.81
P 0.073
Correlation between PROM and the incidence of
periventricular-intraventricular hemorrhage (PIVH)
in premature infants
The incidence of PIVH in premature infants was
59.9% (610 of 1017) and 43.4% (693 of 1579) in
infants with and without PROM, respectively
(2 ¼ 64.07, P < 0.001).
Influence of PROM on the duration of
hospitalization in neonates
The average durations of hospitalization in full-term
infants with and without PROM were 16.82  6.81
days and 14.02  4.73 days, respectively (t ¼ 3.85,
P ¼ 0.0002), while the durations in premature infants
with and without PROM were 24.4  14.8 days and
19.5  7.50 days, respectively (t ¼ 4.41, P < 0.001).
The durations were prolonged by 20.0% in full-term
infants with PROM and by 25.1% in premature
infants with PROM, compared with infants without
PROM.
Influence of PROM on in-hospital costs
The average in-hospital costs for full-term infants
with and without PROM were 8913  5608 Yuan
RMB and 6832  3281 Yuan RMB, respectively
(t ¼ 3.67, P ¼ 0.0003), while the costs for premature
infants with and without PROM were 12 369  9339
Yuan RMB and 7749  3467 Yuan RMB, respec-
tively (t ¼ 8.18, P < 0.001). This represented an
increase of 30.5% for full-term infants with
PROM and of 60.0% for premature infants
with PROM, compared with infants without
PROM.
Influence of PROM on fetal death and stillbirth
The incidences of fetal death and stillbirth were 2.7%
(786 of 29 143) in pregnancies with PROM and
0.21% (252 of 120 057) in non-PROM pregnancies,
respectively (2 ¼ 2099.71, P < 0.001).
Influence of PROM on infant mortality
Neonatal mortality was significantly higher in
PROM infants (220 of 1422, 15.47%) than in non-
PROM infants (38 of 5218, 7.28%) (2 ¼ 650.37,
P < 0.001).
40
J. LIU ET AL.
Naþ Cl Ca2þ
137.9  5.9 102.1  4.5 1.96  0.30
136.7  4.7 103.5  6.1 1.94  0.33
1.88 1.67 0.42
0.062 0.098 0.68
Discussion
Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021
The incidence of PROM in mainland China
The results of the present investigation showed that
the incidence of PROM in mainland China was
nearly 20%, which was similar to that found in
Nigeria [12], but was much higher than that reported
in developed countries [4, 9]. There are almost
2 000 0000 pregnancies per year in China, thus
PROM complicates 4 000 000 annually. It has
been suggested that PROM is more common in
mainland China and in other developing nations than
in more developed countries. It is therefore important
to improve antenatal health care in order to reduce
the incidence of PROM, which can lead to fetal
death, stillbirth and other fetal and neonatal diseases.
Influence of PROM on fetal and neonatal health
PROM is associated with significant maternal, fetal
and neonatal risks. A number of studies have
demonstrated that PROM may be strongly asso-
ciated with the subsequent development of adverse
neonatal outcomes such as neonatal death, PVL,
PIVH, cerebral palsy and bronchopulmonary dys-
plasia [1–15], especially among children of women
who develop chorioamnionitis after PROM [16].
Reports from Saudi Arabia showed that the inci-
dence of neonatal mortality was 5.5%, respiratory
distress was 15.9%, neonatal sepsis was 7.7% and
necrotizing enterocolitis was 3.1% in patients with
PROM [17], while results from France showed the
incidences of neonatal mortality to be 11.7%,
neonatal sepsis 15%, bronchopulmonary dysplasia
8.4% and cerebral injury 11.7% in cases with
PPROM between 24 and 34 weeks gestation [18].
Everest et al. [19] found that most liveborn infants
required neonatal intensive care, including mechan-
ical ventilation (78%), if membrane rupture occurred
before 24 weeks’ gestation and had a latent period of
14 days’ duration. Airleak, occurred in 25% of
survivors and in 67% of those who died. Among the
survivors, 43% required supplemental oxygen at 36
weeks’ postmenstrual age and 10 infants suffered
from pulmonary hypoplasia. The results of this
investigation show that PROM can result in several
fetal and neonatal complications: (1) The incidences
of fetal death, stillbirth and neonatal mortality were
increased and were more common in twin
Journal of Tropical Pediatrics Vol. 56, No. 1
J. LIU ET AL.
pregnancies. This work found that the incidence of
fetal death and stillbirth was 2.7% and neonatal
mortality was 15.47%, which was lower than
previously reported. Kristensen et al. [20] reported
that 6% of stillbirths, 15% of neonatal deaths and
14% of infant deaths among twins in the United
States were attributable to PROM. (2) The incidence
of premature birth was increased. The incidence of
premature birth was 11.2% in our study. (3) There is
an increased risk of oligohydramnios, which can
influence fetal development [21, 22]. The incidence of
oligohydramnios was 12.8% in this group. (4)
PROM can lead to fetal distress. The incidence rate
of fetal distress was 15.1% in the present investiga-
tion. (5) The incidence of birth asphyxia was
increased. The incidence was 15.0% in this study.
(6) The incidence of fetal and neonatal infectious
diseases was increased. The incidence was 31.3% in
the current study. PROM has also been shown to
increase the incidence of intrauterine infection, and
Tiufekchieva [23] found that there was a strong
relationship between inflammatory changes in the
fetal membranes, cord and placenta and the occur-
rence of neonatal infections. Herbst et al. [24]
reported that the risk of neonatal sepsis increased
linearly with the duration of membrane rupture
during the first 36 h; the rate of neonatal sepsis was
0.3% at a membrane rupture-to-delivery interval of
<6 h, 0.5% at 6–18 h, 0.8% at 18–24 h and 1.1% after
24 h. The pathogens isolated were similar in our
study and included Gram-positive cocci (45.8%) and
Gram-negative bacilli (54.2%), while group B strep-
tococci appeared to be the primary causative agent
associated with PPROM [25]. (7) PROM also
increased the probability of brain damage in pre-
mature infants, including PVL and PIVH. The
incidences were 34.9 and 59.9%, respectively. (8)
PROM increased the incidence of RDS and other
respiratory diseases in full-term and premature
infants. (9) It could also lead to neonatal jaundice
and an increased incidence of hyperbilirubinemia,
which was found in 37.1% of premature infants and
29.1% of full-term PROM infants, respectively. (10)
PROM was associated with abnormal platelet para-
meters, including thrombocytopenia, decreased PLT
and PDW and increased MPV and PCT (though this
only occurred in premature infants). (11) Abnormal
erythrocyte parameters, including anemia, were also
seen in PROM infants. (12) PROM was also
associated with neonatal myocardial injury. (13)
There was an increased probability of PROM
neonates needing to be treated in hospital, so
prolonging the period of hospitalization and increas-
ing the in-hospital costs. The duration of hospitaliza-
tion of neonates was prolonged by 20.0% in full-term
infants and by 25.1% in premature infants with
PROM, and the total in-hospital costs were increased
by 30.5% in full-term infants with PROM and by
60.0% in premature infants with PROM. (14)
Journal of Tropical Pediatrics Vol. 56, No. 1
However, we found no effects of PROM on neonatal
blood electrolytes.
Conclusion
Our study indicates that the incidence of PROM is
higher in China than in developed countries. PROM
could affect numerous different aspects of the health
of fetuses and neonates, including platelet para-
meters, erythrocyte parameters, neonatal jaundice
and myocardial injury. It therefore remains impor-
tant for Chinese doctors to improve the levels of
antenatal, perinatal and postnatal health care in the
Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021
future.
References
1. Oboro VO, Adekanle BA, Apantaku BD, et al. Preterm
prelabour repture of membranes: effect of chorioam-
nionitis on overall neonatal outcome. J Obstetr Gynecol
2006;26:740–3.
2. Ellestad SC, Swamy GK, Sinclair T, et al. Preterm
premature rupture of membrane management-inpatient
versus outpatient: a retrospective review. Am J
Perinatol 2008;25:69–73.
3. Yang LC, Taylor DR, Kaufman HH, et al. Maternal
and fetal outcomes of spontaneous preterm premature
rupture of membranes. JAOA 2004;104:537–42.
4. Smith G, Rafuse C, Anand N, et al. Prevalence,
management, and outcomes of preterm prelabour
rupture of the membranes of women in Canada.
J Obstet Gynaecol Can 2005;27:547–53.
5. Medina TM, Hili DA. Preterm premature rupture of
membranes: diagnosis and management. Am Fam
Physician 2006;73:659–64.
6. Kristensen S, Salihu HM, Ding H, et al. Early mortality
in twin pregnancies complicated by premature rupture
of membranes in the United States. J Obstet Gynaecol
2004;24:233–8.
7. Martinez MGV, Bano JB, Ibarra ML, et al. Active
management of the premature membrane rupture in
pregnancies of 34 to 37 weeks. Ginecol Obstet Mex
2006;74:252–9.
8. Hartling L, Chari R, Friesen C, et al. A systematic
review of intentional delivery in women with preterm
prelabor rupture of membranes. J Matern Fetal
Neonatal Med 2006;19:177–87.
9. Getahun D, Ananth CV, Oyelese Y, et al. Acute and
chronic respiratory diseases in pregnancy: associations
with spontaneous premature rupture of membranes.
J Matern Fetal Neonatal Med 2007;20:669–75.
10. Gerards FA, Twisk JW, Fetter WP, et al. Two- or
three-dimensional ultrasonography to predict pulmon-
ary hypoplasia in pregnancies complicated by preterm
premature rupture of the membranes. Prenat Diagn
2007;27:216–21.
11. Meirowitz NB, Ananth CV, Smulian JC, et al. Effect of
labor on infant morbidity and mortality with preterm
premature rupture of membranes: United States popu-
lation-based study. Obstet Gynecol 2001;97:494–8.
12. Obi SN, Ozumba BC. Pre-term premature rupture of
fetal membranes: the dilemma of management in a
developing nation. J Obstet Gynaecol 2007;27:37–40.
41

13. Liu J, Li J, Qin GL, et al. Periventricular leukomalacia
in premature infants in Mainland China. Am J
Perinatol 2008;25:535–540.
14. Liu J, He JW, Wang Q, et al. The incidence of
periventricular-intraventricular hemorrhage in preterm
infants and its high-risk factors. Zhonghua Er Ke Za
Zhi 2005;43:216–17.
15. Baud O, Fontaine RH, Olivier P, et al. Premature
rupture of membranes: pathophysiology of neurological
impact. Arch Pediatr 2007;14(Suppl 1): S49–53.
16. Ramsey PS, Lieman JM, Brumfield CG, et al.
Chorioamnionitis increases neonatal morbidity in
pregnancies complicated by preterm premature
rupture of membranes. Am J Obstet Gynecol
2005;192:1162–6.
17. Khashoggi TY. Outcome of pregnancies with preterm
premature rupture of membranes. Saudi Med J
2004;25:1957–61.
18. Nicaise C, Gire C, Fagianelli P, et al. Neonatal
consequences of preterm premature rupture of mem-
brane at 24-34 WG: 118 singleton pregnancies.
J Gynecol Obstet Biol Reprod 2002;31:747–54.
19. Everest NJ, Jacobs SE, Davis PG, et al. Outcomes
following prolonged preterm premature rupture of the
42
J. LIU ET AL.
membranes. Arch Dis Child- Fetal Neonatal Ed
2008;93:F207–11.
20. Kristensen S, Salihu HM, Ding H, et al. Early mortality
in twin pregnancies complicated by premature rupture
of membranes in the United States. J Obstet Gynaecol
2004;24:233–8.
21. Ananth CV, Oyelese Y, Srinivas N, et al. Preterm
premature rupture of membranes, intrauterine infec-
tion, and oligohydramnios. Obstet Gynecol 2004;
104:71–7.
22. Spinillo A, Montanari L, Sanpaolo P, et al. Fetal
growth and infant neurodevelopmental outcome after
preterm premature rupture of membranes. Obstet
Gynecol 2004;103:1286–93.
23. Tiufekchieva E. Intrauterine infection in cases with
Downloaded from https://academic.oup.com/tropej/article/56/1/36/1660114 by guest on 21 May 2021
premature rupture of fetal membranes- incidence,
structure. Akush Ginekol 2006;45:9–15.
24. Herbst A, Källén K. Time between membrane rupture
and delivery and septicemia in term neonates.
Obstetrics Gynecol 2007;110:612–18.
25. Loeb LJ, Gaither K, Woo KS, et al. Outcomes in
gestations between 20 and 25 weeks with preterm
premature rupture of membranes. South Med J
2006;99:709–12.
Journal of Tropical Pediatrics Vol. 56, No. 1