Maternal Morbidity following Periviable Prelabor Rupture of Membranes after Texas Senate Bill 8

Standard practice prior to Texas Senate Bill 8 (SB8) for those with periviable prelabor rupture of membranes (PROM) without contraindications to expectant management was to offer termination of pregnancy or expectant management. After SB8 went into effect, pregnancy termination was only offered for these patients after the development of chorioamnionitis or clinically significant maternal hemorrhage. The aim of this study was to compare maternal outcomes of periviable PROM before and after SB8 in Houston, Texas. This retrospective cohort study compared outcomes of periviable PROM less than 22 weeks gestational age before and after SB8 at three tertiary care hospitals from January 1, 2018 to March 31, 2023. Our primary outcome was a composite of adverse maternal outcomes: sepsis, transfusion, and intensive care unit (ICU) admission. Secondary outcomes included intraamniotic infection, postpartum hemorrhage, abruption, septic shock, hospital length of stay, time from rupture of membranes to delivery, and neonatal survival. Over the 5-year study period, 161 women met inclusion criteria (96 pre-SB8 vs 65 post-SB8). Approximately half (54%) of those with periviable PROM opted for termination prior to SB8. Post-SB8, women were more likely to develop an adverse outcome (22.9% vs 35.4%; aRR 1.69, CI 1.03-2.78), and more likely to develop sepsis (9.4% vs. 29.2%; aRR 2.97, CI 1.43-6.17). Five neonates survived to hospital discharge post-SB8, and one survived prior to SB8. Additionally, those expectantly managed post-SB8, compared to those expectantly managed pre-SB8, experienced longer time from rupture of membranes to delivery (6.5 days post [2-14] vs 3 days pre [1-7.5]), and a higher rate of sepsis (18 post [30.0%] vs. 6 pre [15.0%]). These results provide evidence that periviable PROM alone is a life-threatening condition with serious risk of maternal harm. Waiting for maternal infection or hemorrhage to develop before offering pregnancy termination increases risks of serious maternal morbidity.