Preterm premature rupture of membranes (PPROM): Outcomes of delivery at 32°/7 -336/7 weeks after confirmed fetal lung maturity (FLM) versus expectant management until 34°/7 weeks

Academic Article

Abstract

  • © 2015 Taylor & Francis. Objective: Our objective was to compare maternal and neonatal outcomes in patients with preterm premature rupture of membranes (PPROM) delivered prior to 34°/7 weeks upon confirmation of fetal lung maturity (FLM) to those managed expectantly until 34°/7 weeks. Methods: We performed a retrospective cohort study of non-anomalous singleton gestations with PPROM occurring after 24 weeks delivered between 32°/7 and 34°/7 weeks from 2004 to 2012. Patients delivered upon documented FLM (+FLM) - defined as the presence of phosphatidylglycerol (PG) at 32°/7-336/7 weeks if amniotic fluid was obtainable vaginally - were compared with patients delivered without documented FLM between 32°/7 and 34°/7 weeks (expectant). Primary outcomes included maternal infection (clinically diagnosed endometritis or chorioamnionitis), placental abruption and a composite of neonatal morbidities (including but not limited to mechanical ventilation, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and respiratory distress syndrome). Statistical analysis was performed using Students t-test for continuous variables and Chi-square or Fishers exact test for categorical data. Covariates were analyzed via multivariate logistic regression and adjusted odds ratios were calculated. Results: Of 237 PPROMs delivered at 32°/7-34°/7 weeks, 74 were intentionally delivered for +FLM and 163 were expectantly managed. No cord prolapse or stillbirth was observed. Maternal infection (chorioamnionitis or endometritis) was lower in the +FLM group (aOR 0.33 95% CI 0.12-0.88). Overall, there was no difference in composite neonatal morbidity did not differ between the two groups (aOR 1.36 95% CI 0.53-3.54). Conclusions: In patients with PPROM, delivery after confirmation of FLM at 32°/7-336/7 weeks compared with expectant management until 34°/7 weeks may prevent maternal infection without increasing neonatal morbidity.
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    Author List

  • Subramaniam A; Cliver SS; Smeltzer S; Tita AT; Wetta LL
  • Start Page

  • 1895
  • End Page

  • 1899
  • Volume

  • 29
  • Issue

  • 12