Preterm prelabor rupture of membranes in singletons: maternal and neonatal outcomes

Ichchha Madan; Frank I. Jackson; Reinaldo Figueroa; Ray Bahado-Singh

doi:10.1515/jpm-2022-0373

Article

Preterm prelabor rupture of membranes in singletons: maternal and neonatal outcomes

Ichchha Madan , Frank I. Jackson , Reinaldo Figueroa and Ray Bahado-Singh

Published/Copyright: February 6, 2023

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Perinatal Medicine Volume 51 Issue 6

Abstract

Objectives

To determine the effect of gestational age at delivery on maternal and neonatal outcomes in preterm prelabor rupture of membranes (PPROM) and assess various predictors of neonatal and infant mortality in these pregnancies.

Methods

United States birth data from CDC-National Center for Health Statistics natality database for years 2004–2008 was used to identify singleton pregnancies with PPROM and delivery from 32 0/7 to 36 6/7 weeks. Controls were singletons at 37–40 weeks, without PPROM. Maternal and neonatal complications reported by all states were analyzed along with neonatal outcomes such as chorioamnionitis and hyaline membrane disease, reported by a subgroup of states. OR (95% CI) were calculated after adjusting for preeclampsia, diabetes, chronic hypertension, maternal race, and infant sex.

Results

There were 134,502 PPROM cases and similar number of controls. There was a significant decrease in need for prolonged ventilation, hyaline membrane disease, 5 min Apgar score <7, and NICU admission with advancing gestational age. Placental abruption decreased and chorioamnionitis and cord prolapse were not different between 34 and 37 weeks. We found reductions in early death, neonatal death, and infant mortality with advancing gestational age (p<0.001 for each). Gestational age at delivery was the strongest predictor for early death, neonatal death, and infant mortality in PPROM. These differences persisted after adjusting for antenatal steroid use.

Conclusions

We provide population-based evidence showing a decrease in neonatal complications and death with advancing gestational age in PPROM. Gestational age at delivery in pregnancies with PPROM is the strongest predictor of mortality risk.

Keywords: infant mortality; neonatal death; perinatal complications; preterm prelabor rupture of membranes

Corresponding author: Ichchha Madan, MD, Assistant Professor, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; and Center for Maternal Fetal Medicine, Howard County General Hospital, 5755 Cedar Ln, Columbia, MD, 21044, USA, Phone: 973-668-7296, E-mail: ichchha.madan@yahoo.com

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 obtained from all individuals included in this study.
Ethical approval: The Wayne State University Institutional Review Board deemed the study exempt from review.

References

1. Arias, F, Tomich, P. Etiology and outcome of low birth weight and preterm infants. Obstet Gynecol 1982;60:277–81.Search in Google Scholar

2. Lee, RM, Major, CA. Controversial and special situations in the management of preterm premature rupture of membranes. Clin Perinatol 2001;28:877–84. https://doi.org/10.1016/s0095-5108(03)00084-8.Search in Google Scholar PubMed

3. Lee, T, Silver, H. Etiology and epidemiology of preterm premature rupture of the membranes. Clin Perinatol 2001;28:721–34. https://doi.org/10.1016/s0095-5108(03)00073-3.Search in Google Scholar PubMed

4. Mercer, BM, Goldenberg, RL, Meis, PJ, Moawad, AH, Shellhaas, C, Das, A, et al.. The preterm prediction study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. Am J Obstet Gynecol 2000;183:738–45. https://doi.org/10.1067/mob.2000.106766.Search in Google Scholar PubMed

5. Mercer, BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin N Am 2005;32:411–28. https://doi.org/10.1016/j.ogc.2005.03.003.Search in Google Scholar PubMed

6. 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:CD004735.10.1002/14651858.CD004735.pub4Search in Google Scholar PubMed PubMed Central

7. American College of Obstetricians and Gynecologists. Prelabor rupture of membranes. ACOG Practice Bulletin, Number 217. Obstet Gynecol 2020;135:e80–97. https://doi.org/10.1097/AOG.0000000000003701.Search in Google Scholar PubMed

8. Thomson, AJ, Royal College of Obstetricians and Gynaecologists. Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation. Green-top Guideline No. 73. BJOG 2019;126:e152–66. https://doi.org/10.1111/1471-0528.15803.Search in Google Scholar PubMed

9. Schmitz, T, Sentilhes, L, Lorthe, E, Gallot, D, Madar, H, Doret-Dion, M, et al.. Preterm premature rupture of the membranes: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2019;236:1–6. https://doi.org/10.1016/j.ejogrb.2019.02.021.Search in Google Scholar PubMed

10. Ham, DPVD, Heyden, JLVD, Opmeer, BC, Mulder, ALM, Moonen, RMJ, Beek, JJV, et al.. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012;207:276.e1–10.10.1016/j.ajog.2012.07.024Search in Google Scholar PubMed

11. Morris, JM, Roberts, CL, Bowen, JR, Patterson, JA, Bond, DM, Algert, CS, et al.. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet 2016;387:444–52. https://doi.org/10.1016/s0140-6736(15)00724-2.Search in Google Scholar

12. Naef, RW, 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 PubMed

13. Neerhof, MG, Cravello, C, Haney, EI, Silver, RK. Timing of labor induction after premature rupture of membranes between 32 and 36 weeks’ gestation. Am J Obstet Gynecol 1999;180:349–52. https://doi.org/10.1016/s0002-9378(99)70212-7.Search in Google Scholar PubMed

14. Healy, AJ, Veille, JC, Sciscione, A, McNutt, LA, Dexter, SC, Society of Maternal-Fetal Medicine. The timing of elective delivery in preterm premature rupture of the membranes: a survey of members of the Society of Maternal-Fetal Medicine. Am J Obstet Gynecol 2004;190:1479–81. https://doi.org/10.1016/j.ajog.2004.02.036.Search in Google Scholar PubMed

15. Buchanan, S, Crowther, C, Morris, J. Preterm prelabour rupture of the membranes: a survey of current practice. Aust N Z J Obstet Gynaecol 2004;44:400–3. https://doi.org/10.1111/j.1479-828x.2004.00256.x.Search in Google Scholar PubMed

16. Kim, SY, Kwon, HS, Lee, J, Sul, AR, Ko, HS, Yang, JI. Questionnaire survey on the management of pregnant women with preterm premature rupture of membranes. Obstet Gynecol Sci 2020;63:286–92. https://doi.org/10.5468/ogs.2020.63.3.286.Search in Google Scholar PubMed PubMed Central

Received: 2022-07-31

Accepted: 2022-12-26

Published Online: 2023-02-06

Published in Print: 2023-07-26

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jpm-2022-0373

Keywords for this article

infant mortality; neonatal death; perinatal complications; preterm prelabor rupture of membranes