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  • Doctors for Choice

Study used to claim Andrea Prudente's fetus had a chance actually showed the exact opposite

Updated: Jan 12

A study referenced in court to claim that Andrea Prudente's fetus had a chance of survival after a preterm premature rupture of membranes (PPROM) at 15 weeks of pregnancy, actually showed that no fetuses from pregnancies with PPROM before 19 weeks survived.

The Times of Malta reported that it was said in court that "developments in the field over the past two decades or so meant that today there was a 79.2% survival rate of the unborn baby when the mother’s waters ruptured before 20 weeks pregnancy." It is easy to find out which study the figure of 79.2% was obtained from, because it is the first result that comes up when one searches "PPROM survival" on Google. The study is "Neonatal outcomes in women with preterm premature rupture of membranes at previable gestational age" by Herzlich, J., et al.

This study made the claim that the survival rate to discharge within neonates born after prolonged rupture of membrane at gestational week less than 24 weeks is 79.2%. However, a closer look at the data contained in the article shows that in the study population all cases of PPROM prior to 19 weeks of pregnancy resulted in a dead fetus or dead neonate. Andrea Prudente was 15 weeks pregnant when she suffered a PPROM.

Let's take a look at the data in the study. A group of patients who suffered a PPROM between 17 and 23 weeks of pregnancy were followed up (Group 1 in the table above). From these cases, the ones that led to a baby that survived to discharge had suffered PPROM between the gestational weeks (GW) of 19 and 23 (see first red underline). The ones whose fetus or neonate died before discharge from hospital had suffered PPROM between the gestational weeks (GW) of 17 and 22 (see second red underline). This means that all fetuses or neonates from pregnancies that suffered PPROM earlier than 19 weeks died before discharge. This is why it is inappropriate to use this study as evidence that Andrea Prudente could have ended up with a live child after she suffered a PPROM at 15 weeks.

"Conservative" Management

Another issue that came up in court is that the treating gynaecologist stated that he could only act within the boundaries of the current law, and this means treatment is limited to "conservative" management only. In practice, this means doctors cannot actively terminate a non-viable or barely viable pregnancy unless the woman is at the point of dying, and can only watch and wait until nature takes its course. The woman is observed for signs of deterioration and is given antibiotics if needed, but the woman and her doctor cannot elect to terminate such dangerous pregnancies until the last minute under the current law, by which time it may be too late.

Women with PPROM are at risk of a fatal infection that does not always respond to treatment with antibiotics once established. This is why Bill 28 needs to pass - to allow women with serious complications to prioritise their health and lives and allow their doctors to terminate their pregnancy.

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