Factors Associated with Previable Delivery following Second Trimester Rupture of Membranes

Abstract

Objective To identify factors associated with previable delivery in second trimester preterm rupture of membranes (PROM).

Study Design We conducted a single-center retrospective cohort study of women with pregnancies complicated by second trimester PROM (14.0–21.9 weeks' gestation) from 2000 to 2015 who elected expectant pregnancy management and achieved at least 24 hours latency. Maternal characteristics and clinical factors were compared among pregnancies that reached viability (≥ 23.0 weeks) and pregnancies delivered before viability (< 23.0 weeks) using appropriate statistical methods.

Results Of 73 pregnancies complicated by second trimester PROM, 49 (67%) delivered before viability. Maternal race, history of preterm birth, and tobacco use were similar between women who delivered < 23 weeks versus ≥ 23 weeks. Gestational age at PROM, cervical dilation > 1cm, Group B streptococcus carrier status, bacterial vaginosis, and chlamydial infection during pregnancy were similar between groups. Median time to delivery was significantly shorter in women who delivered < 23 weeks compared with those who reached ≥ 23 weeks (6 vs. 46 days, p < 0.01).

Conclusion Previable delivery occurred in the majority of women with second trimester PROM. No maternal or clinical factors were associated with delivery prior to viability. Counseling women with second trimester PROM should include the inability to determine which pregnancies will reach viability.

Keywords

midtrimester - rupture of membranes - viability

Note

These data were presented in part as a poster at the 2016 Meeting of the Infectious Diseases Society of Obstetrics and Gynecology in Annapolis, Maryland.

• References

• 1 Mercer BM, Miodovnik M, Thurnau GR. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. JAMA 1997; 278 (12) 989-995
• 2 Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201 (03) 230-240
• 3 Schucker JL, Mercer BM. Midtrimester premature rupture of the membranes. Semin Perinatol 1996; 20 (05) 389-400
• 4 Waters TP, Mercer B. Preterm PROM: prediction, prevention, principles. Clin Obstet Gynecol 2011; 54 (02) 307-312
• 5 Falk SJ, Campbell LJ, Lee-Parritz A. , et al. Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation. J Perinatol 2004; 24 (10) 611-616
• 6 Dewan H, Morris JM. A systematic review of pregnancy outcome following preterm premature rupture of membranes at a previable gestational age. Aust N Z J Obstet Gynaecol 2001; 41 (04) 389-394
• 7 Hunter TJ, Byrnes MJ, Nathan E, Gill A, Pennell CE. Factors influencing survival in pre-viable preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2012; 25 (09) 1755-1761
• 8 Melamed N, Hadar E, Ben-Haroush A, Kaplan B, Yogev Y. Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2009; 22 (11) 1051-1056
• 9 Aziz N, Cheng YW, Caughey AB. Factors and outcomes associated with longer latency in preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2008; 21 (11) 821-825
• 10 Dagklis T, Petousis S, Margioula-Siarkou C. , et al. Parameters affecting latency period in PPROM cases: a 10-year experience of a single institution. J Matern Fetal Neonatal Med 2013; 26 (14) 1455-1458
• 11 Kibel M, Asztalos E, Barrett J. , et al. Outcomes of pregnancies complicated by preterm premature rupture of membranes between 20 and 24 weeks of gestation. Obstet Gynecol 2016; 128 (02) 313-320
• 12 Dinsmoor MJ, Bachman R, Haney EI, Goldstein M, Mackendrick W. Outcomes after expectant management of extremely preterm premature rupture of the membranes. Am J Obstet Gynecol 2004; 190 (01) 183-187
• 13 van der Heyden JL, van der Ham DP, van Kuijk S. , et al. Outcome of pregnancies with preterm prelabor rupture of membranes before 27 weeks' gestation: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2013; 170 (01) 125-130
• 14 Kilpatrick SJ, Patil R, Connell J, Nichols J, Studee L. Risk factors for previable premature rupture of membranes or advanced cervical dilation: a case control study. Am J Obstet Gynecol 2006; 194 (04) 1168-1174
• 15 Test G, Levy A, Wiznitzer A. , et al. Factors affecting the latency period in patients with preterm premature rupture of membranes. Arch Gynecol Obstet 2011; 283 (04) 707-710
• 16 Linehan LA, Walsh J, Morris A. , et al. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16: 25
• 17 Gopalani S, Krohn M, Meyn L, Hitti J, Crombleholme WR. Contemporary management of preterm premature rupture of membranes: determinants of latency and neonatal outcome. Am J Perinatol 2004; 21 (04) 183-190