Comparison of obstetric, maternal, and neonatal outcomes between preterm prelabor rupture of membranes at 34 + 0-36 + 6 weeks and term prelabor rupture of membranes at ≥ 37 weeks.

backgroundTo compare preterm prelabor rupture of membranes (PPROM) at 34 + 0-36 + 6 weeks with term prelabor rupture of membranes at ≥ 37 weeks in terms of obstetric outcomes, maternal morbidity, and short-term neonatal outcomes.

methodsThis retrospective cohort study included 646 singleton pregnancies diagnosed with PROM at 34 + 0 weeks or later in a tertiary care center between January 1, 2018 and July 30, 2025. Cases were grouped as PPROM at 34 + 0-36 + 6 weeks (n = 334) and term PROM at ≥ 37 weeks (n = 312). Maternal, obstetric, and neonatal outcomes were compared. Logistic regression was used to identify factors associated with NICU admission and the respiratory neonatal morbidity composite.

resultsCompared with term PROM, the 34 + 0-36 + 6 weeks PPROM group had longer antibiotic use, higher rates of tocolysis and antenatal corticosteroid administration and longer latency. Infectious maternal morbidity did not differ significantly between groups. However, PPROM at 34 + 0-36 + 6 weeks was associated with lower birth weight, a higher rate of NICU admission (25.7% vs. 6.7%, p < 0.001), and a higher rate of the respiratory neonatal morbidity composite (14.5% vs. 3.5%, p < 0.001). In multivariable analysis, PPROM at 34 + 0-36 + 6 weeks remained independently associated with NICU admission (aOR 5.05, 95% CI 2.90-8.76) and respiratory neonatal morbidity composite (aOR 5.91, 95% CI 2.82-12.37).

conclusionsPPROM at 34 + 0-36 + 6 weeks appears to be a distinct clinical entity rather than simply an earlier form of term PROM. Despite similar maternal infectious morbidity, its substantially higher neonatal morbidity burden supports individualized management and consideration of expectant management in carefully selected cases.