Introduction: Midtrimester Premature Rupture of the Membranes (PPROM) can have devastating effects on fetal and maternal wellbeing. Management decisions can be difficult and present ethical challenges, particularly regarding termination of the pregnancy. This report aims to review these ethical issues and considerations to assist clinicians and patients with future management decisions.
Methods: Current literature related to the outcomes, management, prognosis and ethics of early PPROM was reviewed. Ethical considerations were examined in the context of a case of a 29-year-old woman who suffered from PPROM at 20+5 weeks, who then progressed to an emergency caesarean at 36 weeks gestation at a NSW district hospital with a level 2 special care nursery.
Results: Existing literature suggests that early PPROM is rare, however when it occurs, it is associated with increased neonatal and maternal morbidity. Complications for surviving neonates can include respiratory distress syndrome, pulmonary hypoplasia, intraventricular haemorrhage and limb contractures. If there is any evidence of maternal sepsis, termination of pregnancy is often recommended due to the significant risk of mortality or morbidity. Conversely, if the mother remains systemically well, she is presented with the difficult decision to continue or terminate the pregnancy, considering the poor prognosis for the foetus.
Discussion: It is not possible to accurately predict the foetal outcome, as this depends on numerous factors including the degree of oligohydramnios, the progression to chorioamnionitis and sepsis, and the gestational age at delivery. Therefore, counselling and management can be extremely difficult and requires sensitivity, reflection and careful consideration.