Association between latency period and perinatal outcomes after preterm premature rupture of membranes at 32–37 weeks of gestation: a perinatal registry-based cohort study

Marie Bitenc; Lea Ovsenik; Miha Lučovnik; Ivan Verdenik; Lilijana Kornhauser Cerar

doi:10.1515/jpm-2021-0082

Article

Association between latency period and perinatal outcomes after preterm premature rupture of membranes at 32–37 weeks of gestation: a perinatal registry-based cohort study

Marie Bitenc , Lea Ovsenik , Miha Lučovnik , Ivan Verdenik and Lilijana Kornhauser Cerar

Published/Copyright: July 20, 2021

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From the journal Journal of Perinatal Medicine Volume 50 Issue 1

Abstract

Objectives

To investigate association between latency after preterm premature rupture of membranes (PPROM) and perinatal outcomes at moderately and late preterm gestation.

Methods

National perinatal registry-based cohort study using data for the period 2013–2018. Singleton pregnancies with non-malformed fetuses in cephalic presentation complicated by PPROM at 32⁺⁰–36⁺⁶ weeks were included. Associations between latency period and perinatal mortality, neonatal respiratory distress syndrome (RDS), early onset neonatal infection (EONI), and cesarean section were assessed using multiple logistic regression, adjusting for potential confounders (labor induction, maternal body-mass-index, maternal age, antenatal corticosteroids, and small-for-gestational-age). p<0.05 was considered statistically significant.

Results

Of 3,017 pregnancies included, 365 (12.1%) had PPROM at 32⁺⁰–33⁺⁶ weeks and 2,652 (87.9%) at 34⁺⁰–36⁺⁶ weeks. Among all cases, 2,540 (84%) had latency <24 h (group A), 305 (10%) 24–47 h (group B), and 172 (6%) ≥48 h (group C). Longer latency was associated with higher incidence of EONI (adjusted odds ratio [aOR] 1.350; 95% confidence interval [CI] 0.900–2.026 for group B and aOR 2.500; 95% CI 1.599–3.911 for group C) and higher rate of caesarean section (aOR 2.465; 95% CI 1.763–3.447 for group B and aOR 1.854; 95% CI 1.172–2.932 for group C). Longer latency was not associated with rates of RDS (aOR 1.160; 95% CI 0.670–2.007 for group B and aOR 0.917; 95% CI 0.428–1.966 for group C).

Conclusions

In moderately to late PPROM, increased latency is associated with higher risk of EONI and cesarean section with no reduction in RDS.

Keywords: cesarean section; early onset neonatal infection; expectant management; induction of labor; perinatal mortality; preterm premature rupture of membranes; respiratory distress syndrome

Corresponding author: Lilijana Kornhauser Cerar, MD, PhD, Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Zaloška 11, 1525 Ljubljana, Slovenia, Phone: +386 31741414, E-mail: lilijana.kornhauser-cerar@guest.arnes.si

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was not needed due to anonymous data entry.
Ethical approval: The state Institutional Review Board deemed the studies of anonymised data from perinatal registry exempt from review.

References

1. Maxwell, GL. Preterm premature rupture of membranes. Obstet Gynecol Surv 1993;48:576–83. https://doi.org/10.1097/00006254-199308000-00026.Search in Google Scholar

2. Noor, S, Nazar, AF, Bashir, R, Sultana, R. Prevalance of PPROM and its outcome. J Ayub Med Coll Abbottabad 2007;19:14–7.Search in Google Scholar

3. Bond, DM, Middleton, P, Levett, KM, van der Ham, DP, Crowther, CA, Buchanan, SL, et al.. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks’ gestation for improving pregnancy outcome. Cochrane Database Syst Rev 2017;3:CD004735. https://doi.org/10.1002/14651858.CD004735.pub4.Search in Google Scholar

4. van der Ham, DP, Vijgen, SM, Nijhuis, JG, Mol, BW, van Beek, JJ, Opmeer, BC, et al.. Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: a randomized controlled trial. PLoS Med 2012;9:e1001208. https://doi.org/10.1371/journal.pmed.1001208.Search in Google Scholar

5. Mercer, BM, Crocker, LG, Boe, NM, Sibai, BM. Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32 to 36 weeks: a randomized trial. Am J Obstet Gynecol 1993;169:775–82. https://doi.org/10.1016/0002-9378(93)90004-3.Search in Google Scholar

6. Robertson, PA, Sniderman, SH, Laros, RKJr, Cowan, R, Heilbron, D, Goldenberg, RL, et al.. Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States, 1983 through 1986. Am J Obstet Gynecol 1992;166:1629–41. https://doi.org/10.1016/0002-9378(92)91551-k.Search in Google Scholar

7. Fox, MD, Allbert, JR, McCaul, JF, Martin, RW, McLaughlin, BN, Morrison, JC. Neonatal morbidity between 34 and 37 weeks’ gestation. J Perinatol 1993;13:349–53.10.1097/00006254-199404000-00010Search in Google Scholar

8. Naef, RW3rd, Allbert, JR, Ross, EL, Weber, BM, Martin, RW, Morrison, JC. Premature rupture of membranes at 34 to 37 weeks’ gestation: aggressive versus conservative management. Am J Obstet Gynecol 1998;178:126–30. https://doi.org/10.1016/s0002-9378(98)70638-6.Search in Google Scholar

9. van der Ham, DP, van der Heyden, JL, Opmeer, BC, Mulder, AL, Moonen, RM, van Beek, JH, et al.. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012;207:276.el-10. https://doi.org/10.1016/j.ajog.2012.07.024.Search in Google Scholar

10. Cox, SM, Leveno, KJ. Intentional delivery versus expectant management with preterm ruptured membranes at 30–34 weeks’ gestation. Obstet Gynecol 1995;86:875–9. https://doi.org/10.1016/0029-7844(95)00303-9.Search in Google Scholar

11. Institute of Public Health. National Perinatal Information System: definitions and methodological guidelines. Available from: https://www.nijz.si/sites/www.nijz.si/files/uploaded/podatki/podatkovne_zbirke_raziskave/pis/peris-metodoloska-navodila-2020-v2-2.pdf.Search in Google Scholar

12. Lucovnik, M, Blickstein, I, Mirkovic, T, Verdenik, I, Bricelj, K, Vidmar Simic, M, et al.. Effect of pre-gravid body mass index on outcomes of pregnancies following in vitro fertilization. J Assist Reprod Genet 2018;35:1309–15. https://doi.org/10.1007/s10815-018-1193-6.Search in Google Scholar PubMed PubMed Central

13. Sweet, LR, Keech, C, Klein, NP, Marshall, HS, Tagbo, BN, Quine, D, et al.. Respiratory distress in the neonate: case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2017;35:6506–17. https://doi.org/10.1016/j.vaccine.2017.01.046.Search in Google Scholar PubMed PubMed Central

14. Simonsen, KA, Anderson-Berry, AL, Delair, SF, Davies, HD. Early-onset neonatal sepsis. Clin Microbiol Rev 2014;27:21–47. https://doi.org/10.1128/CMR.00031-13.Search in Google Scholar

15. Spinnato, JA, Shaver, DC, Bray, EM, Lipshitz, J. Preterm premature rupture of the membranes with fetal pulmonary maturity present: a prospective study. Obstet Gynecol 1987;69:196–201.10.1016/0020-7292(87)90096-8Search in Google Scholar

16. Statistical Office of the Republic of Slovenia. Census of population, households and housing; 2002. Available from: https://www.stat.si/popis2002/en/.Search in Google Scholar

Received: 2021-02-23

Accepted: 2021-06-25

Published Online: 2021-07-20

Published in Print: 2022-01-27

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Articles in the same Issue

https://doi.org/10.1515/jpm-2021-0082

Keywords for this article

cesarean section; early onset neonatal infection; expectant management; induction of labor; perinatal mortality; preterm premature rupture of membranes; respiratory distress syndrome