Background and aims

Babies grow and develop in a protective sac of fluid inside the mother’s womb. Usually these “waters” break during labour, after 37 weeks of pregnancy, when they are no longer necessary. In a rare, but serious situation, these waters can break too early in pregnancy and before labour occurs. This condition is called Preterm Prelabour Rupture of the Membranes (PPROM).

The PPROM study focuses specifically on occurrences of the condition exceptionally early in pregnancy (before 23 weeks). The baby is then at risk of infection, injury or dying. Additionally, there is a high chance of labour starting when the baby is too immature to survive, or at a stage of pregnancy where there is risk of long-term disability for survivors. Some mothers can also develop life-threatening complications, such as sepsis. For all these reasons, termination of the pregnancy for medical reasons (TFMR) is offered. However, some babies and mums can have healthy outcomes.

In the UK there are currently no national guidelines to inform clinicans on how best to care for women in experiencing PPROM. Additionally, there is no accurate data to help guide the decision to continue with the pregnancy. This lack of information on the condition is due to the rarity of very early PPROM, with some hospitals treating a patient with the condition as infrequently as once or twice a year.

The patient advocacy and support group, Little Heartbeats, contacted researchers at the University of Liverpool suggesting a collaborative project to improve information for doctors, women and families at the time of PPROM. They identified that some women were counselled with a focus on maternal and fetal risk, without providing data on babies with healthy outcomes. When several women and families reported their babies were born alive without any serious disability, despite being told there was no chance of a healthy outcome, it sparked distrust in the medical profession, and highlighted the urgent need for good quality and balanced data to inform care. Research teams from University of Liverpool and UKOSS (UK Obstetric Surveillance System) have since worked together to perform a national study of all women with PPROM from 16 weeks and 0 days to 22 weeks and 6 days of pregnancy over 18 months in 2019-2021.

Aims of our research

We wanted to be able to tell women, their families and doctors, at the time of PPROM, what the chances were of:

• The woman giving birth in the week after PPROM
• The baby being born alive
• The baby leaving hospital alive
• The baby leaving hospital alive without severe illness
• The mother developing sepsis
• The mother being admitted to intensive care
• The mother dying.

In addition, we wanted to know survival rates of babies from twin pregnancies and how long surviving babies stayed in the hospital. We also wanted to know whether there were differences in mother or baby outcomes in the periods September 2019-February 2020 (pre-pandemic) and March 2020-February 2021 (during the pandemic).