OBJECTIVES: Preterm premature rupture of membranes (PPROM) is defined as a 
rupture of the amniotic membranes occurring before 37 weeks of gestation and 
before the onset of labor. Extreme PPROM occurs prior to 26 weeks gestation and 
contributes to an increased risk of prematurity, leading to maternal and fetal 
complications. This study aims to estimate the risk factors associated with 
various maternal complications and to determine the worst outcomes in Omani 
females with extreme PPROM.
METHODS: A retrospective cohort study was conducted on 44 women with extreme 
PPROM, who delivered at Sultan Qaboos University Hospital (SQUH) from January 
2006 to December 2011. Women with incomplete information, multiple gestations, 
or a preterm delivery resulting from medical intervention, as well as women who 
delivered elsewhere were excluded from the study.
RESULTS: Forty-four women with extreme PPROM were included in our study. The 
results revealed the most important risk factor to be history of infection, 
which was noted in 24 study participants. The mean maternal age was 30 years. 
The mean gestational age at PPROM and at delivery were 20.7±3.2 (range: 16-26 
weeks) and 29.7±7.6 weeks (range: 17-40 weeks), respectively. The maternal 
complications observed in this study included; infection which was seen in 20 
(45%) patients, antepartum hemorrhage in 11 (25%) patients, and cesarean section 
which was required in 12 (27%) patients. There was no significant association 
between risk factors such as gestational age at delivery, parity, maternal age 
at PPROM, or maternal Body Mass Index (BMI) and cesarean section rate. Infection 
played a major role, both as a risk factor and in causing extreme PPROM, which 
in turn increased in 12 patients (27%). In the multivariable model for 
predicting the need for cesarean section (gestational age at delivery, parity, 
maternal age at PPROM in years and maternal BMI), none of the factors were 
statistically significant.
CONCLUSION: Overall, concurrent infection rate was high among patients 
presenting with extreme PPROM. None of the baseline maternal factors predicted 
the need for cesarean section. This is likely due to the small sample size; 
hence, larger prospective studies are needed to confirm these findings.