Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(11): 717-725
DOI: 10.1055/s-0040-1718954
Original Article
Obstetrics/High Risk Prenancy

Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34–36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes

Manejo ativo versus expectante para ruptura prematura de membranas entre 34 e 36 semanas de gestação e os resultados perinatais adversos associados
Malú Flôres Ferraz 
1   Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
,
Thaísa De Souza Lima 
1   Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
,
Sarah Moura Cintra 
2   Service of Gynecology and Obstetrics, Hospital Universitário Mário Palmério, Universidade de Uberaba, Uberaba, MG, Brazil
,
Edward Araujo Júnior 
3   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
4   Medical course, Universidade Municipal de São Caetano do Sul, São Paulo, SP, Brazil
,
Caetano Galvão Petrini 
1   Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
2   Service of Gynecology and Obstetrics, Hospital Universitário Mário Palmério, Universidade de Uberaba, Uberaba, MG, Brazil
,
Mario Sergio Silva Gomes Caetano 
1   Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
,
Marina Carvalho Paschoini 
1   Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
,
Alberto Borges Peixoto 
2   Service of Gynecology and Obstetrics, Hospital Universitário Mário Palmério, Universidade de Uberaba, Uberaba, MG, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil.

Methods In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used.

Results Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138).

Conclusion There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

Resumo

Objetivo Comparar o tipo de manejo (ativo versus expectante) para ruptura prematura de membranas (PPROM, na sigla em inglês) entre 34 e 36 semanas e 6 dias de gestação e os resultados perinatais adversos relacionados, em 2 hospitais terciários do sudeste brasileiro.

Métodos No presente estudo de coorte retrospectivo, os dados foram obtidos através da revisão dos prontuários de gestantes internadas em dois centros terciários com protocolos diferentes para o seguimento da PPROM. As gestantes foram divididas em dois grupos com base no manejo da PPROM: grupo I (ativo) e grupo II (expectante). Para análise estatística, foram utilizados o teste t de Student, qui-quadrado e regressão logística binária.

Resultados Das 118 gestantes incluídas, 78 foram submetidas a tratamento ativo (grupo I) e 40 a seguimento expectante (grupo II). Comparado ao grupo II, o grupo I apresentou índice de líquido amniótico médio significativamente menor (5,5 versus 11,3 cm, p = 0,002), reação em cadeia da polimerase na admissão (1,5 versus 5,2 mg/dl, p = 0,002), tempo de antibióticos profiláticos (5,4 versus 18,4 horas, p < 0,001), tempo de latência (20,9 versus 33,6 horas, p = 0,001) e idade gestacional no parto (36,5 versus 37,2 semanas, p = 0,025). Não houve associações significativas entre os grupos e a presença de resultados perinatais adversos. A idade gestacional no diagnóstico foi o único preditor significativo de desfecho composto adverso (x2 [1] = 3,1, p = 0,0001, R2 Nagelkerke = 0,138).

Conclusão Não houve associação entre manejo ativo e expectante em gestantes com PPROM entre 34 e 36 semanas e 6 dias de gestação e resultados perinatais adversos.

Keywords

preterm premature rupture of membranes - antibiotic prophylaxis - maternal morbidity - neonatal morbidity

Palavras-chave

ruptura prematura de membranas - profilaxia antibiótica - morbidade materna - morbidade neonatal

Contributors

All authors participated in the concept and design of the study; analysis and interpretation of data; draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.




Publication History

Received: 23 April 2020

Accepted: 14 September 2020

Article published online:
30 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32 (03) 411-428
    CrossrefPubMedSearch in Google Scholar
  • 2 Smith G, Rafuse C, Anand N, Brennan B, Connors G, Crane J. et al. Prevalence, management, and outcomes of preterm prelabour rupture of the membranes of women in Canada. J Obstet Gynaecol Can 2005; 27 (06) 547-553
    CrossrefPubMedSearch in Google Scholar
  • 3 Dars S, Malik S, Samreen I, Kazi RA. Maternal morbidity and perinatal outcome in preterm premature rupture of membranes before 37 weeks gestation. Pak J Med Sci 2014; 30 (03) 626-629
    CrossrefPubMedSearch in Google Scholar
  • 4 Cammu H, Verlaenen H, Perde MP. Premature rupture of membranes at term in nulliparous women: a hazard?. Obstet Gynecol 1990; 76 (04) 671-674
    PubMedSearch in Google Scholar
  • 5 Conway DI, Prendiville WJ, Morris A, Speller DC, Stirrat GM. Management of spontaneous rupture of the membranes in the absence of labor in primigravid women at term. Am J Obstet Gynecol 1984; 150 (08) 947-951
    CrossrefPubMedSearch in Google Scholar
  • 6 Zlatnik FJ. Management of premature rupture of membranes at term. Obstet Gynecol Clin North Am 1992; 19 (02) 353-364
    CrossrefPubMedSearch in Google Scholar
  • 7 Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL. et al; TERMPROM Study Group. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl J Med 1996; 334 (16) 1005-1010
    CrossrefPubMedSearch in Google Scholar
  • 8 Buchanan SL, Crowther CA, Levett KM, Middleton P, Morris J. 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 2010; (03) CD004735
    CrossrefPubMedSearch in Google Scholar
  • 9 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 172: premature rupture of membranes. Obstet Gynecol 2016; 128 (04) e165-e177
    CrossrefPubMedSearch in Google Scholar
  • 10 Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol 2013; 122 (04) 918-930
    CrossrefPubMedSearch in Google Scholar
  • 11 Royal College of Obstetricians & Gynaecologists. Preterm prelabour rupture of membranes [Internet]. 2010 [cited 2019 Feb 10]. (Green-top guideline; no. 44). Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg44/
    PubMedSearch in Google Scholar
  • 12 Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS. et al; PPROMT Collaboration. 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 (10017): 444-452
    CrossrefPubMedSearch in Google Scholar
  • 13 Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2013; (12) CD001058
    CrossrefPubMedSearch in Google Scholar
  • 14 Kenyon SL, Taylor DJ, Tarnow-Mordi W. ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet 2001; 357 (9261): 979-988
    CrossrefPubMedSearch in Google Scholar
  • 15 Mercer BM, Miodovnik M, Thurnau GR, Goldenberg RL, Das AF, Ramsey RD. 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
    CrossrefPubMedSearch in Google Scholar
  • 16 Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol 2006; 30 (01) 28-33
    CrossrefPubMedSearch in Google Scholar
  • 17 Phupong V, Kulmala L. Factors associated with latency period in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2016; 29 (16) 2650-2653
    CrossrefPubMedSearch in Google Scholar
  • 18 Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003; 101 (01) 178-193
    CrossrefPubMedSearch in Google Scholar
  • 19 Dagklis T, Petousis S, Margioula-Siarkou C, Mavromatidis G, Kalogiannidis I, Prapas N. 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
    CrossrefPubMedSearch in Google Scholar
  • 20 Nayot D, Penava D, Da Silva O, Richardson BS, de Vrijer B. Neonatal outcomes are associated with latency after preterm premature rupture of membranes. J Perinatol 2012; 32 (12) 970-977
    CrossrefPubMedSearch in Google Scholar
  • 21 Geethanath RM, Ahmed I, Abu-Harb M, Onwuneme C, McGarry K, Hinshaw K. Intrapartum antibiotics for prolonged rupture of membranes at term to prevent Group B Streptococcal sepsis. J Obstet Gynaecol 2019; 39 (05) 619-622
    CrossrefPubMedSearch in Google Scholar
  • 22 Saccone G, Berghella V. Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials. Am J Obstet Gynecol 2015; 212 (05) 627.e1-627.e9
    CrossrefPubMedSearch in Google Scholar
  • 23 Wojcieszek AM, Stock OM, Flenady V. Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database Syst Rev 2014; (10) CD001807
    CrossrefPubMedSearch in Google Scholar
  • 24 Ananth CV, Oyelese Y, Srinivas N, Yeo L, Vintzileos AM. Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstet Gynecol 2004; 104 (01) 71-77
    CrossrefPubMedSearch in Google Scholar
  • 25 Kurkinen-Räty M, Koivisto M, Jouppila P. Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes. Obstet Gynecol 1998; 92 (03) 408-415
    CrossrefPubMedSearch in Google Scholar
  • 26 Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215 (01) 103.e1-103.e14
    CrossrefPubMedSearch in Google Scholar
  • 27 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 (04) 775-782
    CrossrefPubMedSearch in Google Scholar
  • 28 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 (02) 196-201
    PubMedSearch in Google Scholar