Perinatal management of preterm premature ruptured membranes affects neonatal prognosis
-
Arisa Fujiwara
,
Hirosuke Inoue
Abstract
Aim: To determine the factors affecting neonatal prognosis in preterm premature rupture of membranes (PPROM).
Method: We conducted a case-control study involving 92 women between the years 2000 and 2010 diagnosed with PPROM between 25 and 31 weeks’ gestation, who received antenatal steroids, and delivered between 26 and 31 weeks’ gestation; a retrospective cohort study was conducted based on the results. We used data from four tertiary centers and compared the frequencies of neonatal neurologic deficits and neonatal deaths.
Results: There was a difference between the two groups; specifically, the ND group (n=18) consisted of patients whose infants had neurologic deficits and/or neonatal deaths and the neurologically normal (NN) group (n=74) included NN neonates amongst the patients who had expectant management (94% vs. 73%, respectively). Multivariable analysis revealed that expectant management was independently associated with an increased risk for neonatal neurologic deficits and neonatal deaths (odds ratio, 16.14). All neonates with poor prognosis in the expectant-management group delivered within 14 days after PPROM.
Conclusions: Expectant management within 14 days after PPROM is associated with poor neonatal outcomes. Decisions regarding an expectant strategy should be made carefully. An immediate, planned delivery after steroid administration should be considered to improve neonatal prognosis in patients who have PPROM after 26 weeks’ gestation.
Acknowledgments
This work was supported in part by a grant-in-aid from the Japan Ministry of Health and Labour (H22-Jisedai Ippan-007) and the Japan Ministry of Education (23591596).
References
[1] ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007;109:1007–19.10.1097/01.AOG.0000263888.69178.1fSuche in Google Scholar
[2] Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol. 2007;109:253–61.10.1097/01.AOG.0000253215.79121.75Suche in Google Scholar
[3] Cox SM, Leveno KJ. Intentional delivery versus expectant management with preterm ruptured membranes at 30–34 weeks’ gestation. Obstet Gynecol. 1995;86:875–9.10.1016/0029-7844(95)00303-9Suche in Google Scholar
[4] Fujimori T. Timing and mode of delivery. Jpn Soc Obstet Gynecol. 2007;59:423–7 [in Japanese].Suche in Google Scholar
[5] Fukushima K, Morokuma S, Fujita Y, Tsukimori K, Satoh S, Ochiai H, et al. Short-term and long-term outcomes of 214 cases of non-immune hydrops fetalis. Early Hum Dev. 2011;87:571–5.10.1016/j.earlhumdev.2011.04.015Suche in Google Scholar
[6] Garite TJ. Management of premature rupture of membranes. Clin Perinatol. 2001;28:837–47.10.1016/S0095-5108(03)00081-2Suche in Google Scholar
[7] Lieman JM, Brumfield CG, Carlo W, Ramsey PS. Preterm premature rupture of membranes: is there an optimal gestational age for delivery? Obstet Gynecol. 2005;105:12–7.10.1097/01.AOG.0000147841.79428.4bSuche in Google Scholar
[8] Locatelli A, Ghidini A, Paterlini G, Patane L, Doria V, Zorloni C, et al. Gestational age at preterm premature rupture of membranes: a risk factor for neonatal white matter damage. Am J Obstet Gynecol. 2005;193:947–51.10.1016/j.ajog.2005.06.039Suche in Google Scholar
[9] Melamed N, Ben-Haroush A, Pardo J, Chen R, Hadar E, Hod M, et al. Expectant management of preterm premature rupture of membranes: is it all about gestational age? Am J Obstet Gynecol. 2011;204:48.e1-8. doi: 10.1016/j.ajog.2010.08.02.Suche in Google Scholar
[10] Mercer BM, Crocker LG, Boe NM, Sibai BM. Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32–36 weeks: a randomized trial. Am J Obstet Gynecol. 1993;169:775–82.10.1016/0002-9378(93)90004-3Suche in Google Scholar
[11] Miyashita S, Nakamura T, Kikuchi A. Fertility status and problem of single preterm birth and small for gestational age at perinatal critical facilities. Year Book Jpn Soc Perinatal Neonatal Med. 2009;27:57–71 [in Japanese].Suche in Google Scholar
[12] Nakazawa Y, Ibara S, Maruyama Y, Maruyama H, Tokuhisa T, Hayashida R, et al. Limit growth of FGR in our center. Year Book Jpn Soc Perinatal Neonatal Med. 2009;27:73–82 [in Japanese].Suche in Google Scholar
[13] Parry S, Strauss JF 3rd. Premature rupture of the fetal membranes. N Engl J Med. 1998;338:663–70.10.1056/NEJM199803053381006Suche in Google Scholar PubMed
[14] Pasquier JC, Bujold E, Rabilloud M, Picaud JC, Ecochard R, Claris O, et al. Effect of latency period after premature rupture of membranes on 2 years infant mortality (DOMINOS study). Eur J Obstet Gynecol Reprod Biol. 2007;135:21–7.10.1016/j.ejogrb.2006.10.020Suche in Google Scholar PubMed
[15] Pasquier JC, Picaud JC, Rabilloud M, Claris O, Ecochard R, Moret S, et al. Neonatal outcomes after elective delivery management of preterm premature rupture of the membranes before 34 weeks’ gestation (DOMINOS study). Eur J Obstet Gynecol Reprod Biol. 2009;143:18–23.10.1016/j.ejogrb.2008.10.017Suche in Google Scholar PubMed
[16] Saito S. Realities of preterm birth in Japan. Clin Gynecol Obstet. 2011;65:1408–13 [in Japanese].Suche in Google Scholar
[17] Satoh S, Tsukimori K, Ishida K, Takashima T, Higashihara T, Shiraishi S, et al. Preterm PROM. Union Group Kyushu Region Jpn Soc Obstet Gynecol. 1992;12:29–34 [in Japanese].Suche in Google Scholar
[18] Yoon BH, Romero R, Park JS, Kim CJ, Kim SH, Choi JH, et al. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol. 2000;182:675–81.10.1067/mob.2000.104207Suche in Google Scholar PubMed
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2014 by Walter de Gruyter Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review articles
- The relationship between gestational weight gain and fetal growth: time to take stock?
- Risk factors for pregnancy-associated venous thromboembolism: a review
- Academy’s Corner
- Africa is only 14 km away from my country
- Primary prevention of preterm birth
- Original articles – Obstetrics
- Mother knows best? Comparing primiparous parturients’ expectations and predictions with actual birth outcomes
- Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period
- Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies
- Relation of placental diagnosis in stillbirth to fetal maceration and gestational age at delivery
- Evaluation of a novel placental alpha microglobulin-1 (PAMG-1) test to predict spontaneous preterm delivery
- The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial
- Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births
- Differences between external and internal fetal heart rate monitoring during the second stage of labor: a prospective observational study
- Perinatal management of preterm premature ruptured membranes affects neonatal prognosis
- Impact of the nitric oxide-donor pentaerythrityl-tetranitrate on perinatal outcome in risk pregnancies: a prospective, randomized, double-blinded trial
- Umbilical vein volume flow in monochorionic twin pairs at 11–14 weeks
- Gestational weight gain according to number of fetuses in Japanese women
- Original article – Fetus
- Prenatal diagnosis of sex chromosome aneuploidies and disorders of sex development – a retrospective analysis of 11-year data
- Short communication
- Reference range for amniotic fluid index measurements in a Brazilian population
- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Review articles
- The relationship between gestational weight gain and fetal growth: time to take stock?
- Risk factors for pregnancy-associated venous thromboembolism: a review
- Academy’s Corner
- Africa is only 14 km away from my country
- Primary prevention of preterm birth
- Original articles – Obstetrics
- Mother knows best? Comparing primiparous parturients’ expectations and predictions with actual birth outcomes
- Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period
- Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies
- Relation of placental diagnosis in stillbirth to fetal maceration and gestational age at delivery
- Evaluation of a novel placental alpha microglobulin-1 (PAMG-1) test to predict spontaneous preterm delivery
- The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial
- Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births
- Differences between external and internal fetal heart rate monitoring during the second stage of labor: a prospective observational study
- Perinatal management of preterm premature ruptured membranes affects neonatal prognosis
- Impact of the nitric oxide-donor pentaerythrityl-tetranitrate on perinatal outcome in risk pregnancies: a prospective, randomized, double-blinded trial
- Umbilical vein volume flow in monochorionic twin pairs at 11–14 weeks
- Gestational weight gain according to number of fetuses in Japanese women
- Original article – Fetus
- Prenatal diagnosis of sex chromosome aneuploidies and disorders of sex development – a retrospective analysis of 11-year data
- Short communication
- Reference range for amniotic fluid index measurements in a Brazilian population
- Congress Calendar
- Congress Calendar
