Subscribe to RSS
DOI: 10.1055/s-0040-1721421
Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention
Funding Information No funding was received for this study. Organizational support was provided by Woman's Hospital, Baton Rouge, LA and Department of Obstetrics and Gynecology, Louisiana State University Health and Sciences Center, Baton Rouge, LA.
Abstract
Objective To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM).
Study Design Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival.
Results Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 180/7 to 226/7 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74).
Conclusion Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.
Authors' Contribution
F.A.M., R.C.M., and F.L. conceptualized and designed the study. F.L. collected the data. A.C. analyzed the data. F.L. and E.S. interpreted data and drafted the manuscript. All authors were involved in the review, revision, and editing of the final manuscript.
Publication History
Received: 30 January 2020
Accepted: 29 April 2020
Article published online:
03 December 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003; 101 (01) 178-193
- 2 Muris C, Girard B, Creveuil C, Durin L, Herlicoviez M, Dreyfus M. Management of premature rupture of membranes before 25 weeks. Eur J Obstet Gynecol Reprod Biol 2007; 131 (02) 163-168
- 3 Kilbride HW, Thibeault DW. Neonatal complications of preterm premature rupture of membranes. Pathophysiology and management. Clin Perinatol 2001; 28 (04) 761-785
- 4 Yeast JD. Preterm premature rupture of the membranes before viability. Clin Perinatol 2001; 28 (04) 849-860
- 5 Birth P. Obstetric Care Consensus No. 6 Summary: periviable birth. Obstet Gynecol 2017; 130 (04) 926-928
- 6 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
- 7 Manuck TA, Eller AG, Esplin MS, Stoddard GJ, Varner MW, Silver RM. Outcomes of expectantly managed preterm premature rupture of membranes occurring before 24 weeks of gestation. Obstet Gynecol 2009; 114 (01) 29-37
- 8 Wong LF, Holmgren CM, Silver RM, Varner MW, Manuck TA. Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks. Am J Obstet Gynecol 2015; 212 (02) 215.e1-215.e9
- 9 Manuck TA, Varner MW. Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes. Am J Obstet Gynecol 2014; 211 (03) 308.e1-308.e6
- 10 Kuba K, Bernstein PS. ACOG practice bulletin no. 188: prelabor rupture of membranes. Obstet Gynecol 2018; 131 (06) 1163-1164
- 11 Agresti A. Categorical Data Analysis, 2nd ed. New York: Wiley; 2002
- 12 Sim WH, Araujo Júnior E, Da Silva Costa F, Sheehan PM. Maternal and neonatal outcomes following expectant management of preterm prelabour rupture of membranes before viability. J Perinat Med 2017; 45 (01) 29-44
- 13 Hibbard JU, Hibbard MC, Ismail M, Arendt E. Pregnancy outcome after expectant management of premature rupture of the membranes in the second trimester. J Reprod Med 1993; 38 (12) 945-951
- 14 Manuck TA, Maclean CC, Silver RM, Varner MW. Preterm premature rupture of membranes: does the duration of latency influence perinatal outcomes?. Am J Obstet Gynecol 2009; 201 (04) 414.e1-414.e6
- 15 Khan Z, Morris N, Unterrainer H, Haiden N, Holasek SJ, Urlesberger B. Effect of standardized feeding protocol on nutrient supply and postnatal growth of preterm infants: a prospective study. J Neonatal Perinatal Med 2018; 11 (01) 11-19
- 16 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
- 17 Lee JY, Ahn TG, Jun JK. Short-term and Long-term postnatal outcomes of expectant management after previable preterm premature rupture of membranes with and without persistent oligohydramnios. Obstet Gynecol 2015; 126 (05) 947-953
- 18 Park JS, Yoon BH, Romero R. et al. The relationship between oligohydramnios and the onset of preterm labor in preterm premature rupture of membranes. Am J Obstet Gynecol 2001; 184 (03) 459-462
- 19 van Teeffelen AS, Van Der Heijden J, Oei SG. et al. Accuracy of imaging parameters in the prediction of lethal pulmonary hypoplasia secondary to mid-trimester prelabor rupture of fetal membranes: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2012; 39 (05) 495-499