Amniotic Fluid Volume as a Contextual Marker of Latency and Perinatal Outcomes in Premature Prelabor Rupture of Membranes

Objectives: The aim of this study was to evaluate the association between amniotic fluid volume at preterm prelabor rupture of membranes (PPROM) diagnosis and latency, short-term delivery risk, and perinatal outcomes across different gestational ages. Methods: This retrospective cohort study included singleton pregnancies with PPROM before 34 weeks’ gestation managed at a tertiary referral center. Amniotic fluid (AF) volume was categorized according to the deepest vertical pocket (≤20 mm vs. >20 mm). Fetal and neonatal outcomes were analyzed as predefined composite outcomes. Latency to delivery was assessed using Kaplan–Meier estimates. Multivariable Cox regression models were used to evaluate associations after adjustment for clinically relevant confounders. Results: A total of 263 pregnancies were included, of which 66.5% had an AF pocket ≤ 20 mm at presentation. Lower AF volume was associated with a higher incidence of the fetal composite outcome (74.3% vs. 52.3%, p < 0.001) and a higher short-term risk of delivery across gestational-age strata. In multivariable analysis, AF pocket > 20 mm remained independently associated with lower risk of fetal composite outcome. AF volume was not associated with overall latency to delivery (Spearman ρ = 0.03, p = 0.598). Although lower AF volume was associated with higher crude neonatal morbidity, this association was attenuated after adjustment for gestational age. Conclusions: Reduced AF volume at PPROM presentation was associated with adverse fetal outcomes and higher short-term delivery risk, whereas neonatal morbidity was mainly driven by gestational age at delivery. AF volume should therefore be interpreted as a contextual prognostic marker rather than an isolated determinant of outcome.