Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks

Tara A. Lynch; Courtney Olson-Chen; Sarah Colihan; Jeffrey Meyers; Conisha Holloman; Dongmei Li; Heather Link; Paola Torres; Annie Kim; Devon J. King; Cari Eckman; Anna Varlamov; Scott Dexter; Eva K. Pressman; Eleazar Soto-Torres; Amol Malshe

doi:10.1055/s-0038-1675647

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(07): 659-668
DOI: 10.1055/s-0038-1675647

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks

Authors

Tara A. Lynch

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
Courtney Olson-Chen

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
Sarah Colihan

²Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
Jeffrey Meyers

³Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
Conisha Holloman

⁴Department of Obstetrics and Gynecology, Winnie Palmer Hospital for Women and Babies, Orlando Health, Orlando, Florida
Dongmei Li

⁵Department of Clinical and Translational Research, University of Rochester, Rochester, New York

⁶Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester, Rochester, New York

⁷Department of Public Health Sciences, University of Rochester, Rochester, New York
Heather Link

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
Paola Torres

⁸Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas, Houston, Texas
Annie Kim

⁸Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas, Houston, Texas
Devon J. King

²Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
Cari Eckman

⁹Albany Medical College, Albany, New York
Anna Varlamov

⁴Department of Obstetrics and Gynecology, Winnie Palmer Hospital for Women and Babies, Orlando Health, Orlando, Florida
Scott Dexter

¹⁰Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
Eva K. Pressman

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
Eleazar Soto-Torres

⁵Department of Clinical and Translational Research, University of Rochester, Rochester, New York

⁶Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester, Rochester, New York

⁷Department of Public Health Sciences, University of Rochester, Rochester, New York
Amol Malshe

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York

Abstract

Objective To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks.

Study Design This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant.

Results A total of 280 mother–infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis.

Conclusion There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

Keywords

expectant management - late preterm birth - preterm prelabor rupture of membranes

Full Text

References

References
1 Practice Bulletin No. Practice Bulletin No. 160 Summary: Premature Rupture of Membranes. Obstet Gynecol 2016; 127 (01) 192-194
2 Horton AL, Lai Y, Rouse DJ. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes. Am J Perinatol 2015; 32 (04) 387-392
3 Bond DM, Middleton P, Levett KM. , et al. 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 2017; 3: CD004735
4 Quist-Nelson J, de Ruigh AA, Seidler AL. , et al; Preterm Premature Rupture of Membranes Meta-analysis (PPROMM) Collaboration. Immediate delivery compared with expectant management in late preterm prelabor rupture of membranes: an individual participant data meta-analysis. Obstet Gynecol 2018; 131 (02) 269-279
5 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
6 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
7 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
8 Naef III RW, Allbert JR, Ross EL, Weber BM, Martin RW, Morrison JC. Premature rupture of membranes at 34 to 37 weeks' gestation: aggressive versus conservative management. Am J Obstet Gynecol 1998; 178 (1 Pt 1): 126-130
9 Committee Opinion No. Committee Opinion No. 677 Summary: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol 2016; 128 (04) 940-941
10 Gyamfi-Bannerman C, Thom EA, Blackwell SC. , et al; NICHD Maternal–Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374 (14) 1311-1320
11 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111 (01) 35-41
12 van der Ham DP, van der Heyden JL, Opmeer BC. , et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012; 207 (04) 276.e1-276.e10
13 van der Ham DP, Vijgen SM, Nijhuis JG. , et al; PPROMEXIL trial group. Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: a randomized controlled trial. PLoS Med 2012; 9 (04) e1001208
14 Morris JM, Roberts CL, Bowen JR. , 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
15 Liem TB, Krediet TG, Fleer A, Egberts TC, Rademaker CM. Variation in antibiotic use in neonatal intensive care units in the Netherlands. J Antimicrob Chemother 2010; 65 (06) 1270-1275
16 Pierson RC, Gordon SS, Haas DM. A retrospective comparison of antibiotic regimens for preterm premature rupture of membranes. Obstet Gynecol 2014; 124 (03) 515-519
17 Nallamothu BK, Hayward RA, Bates ER. Beyond the randomized clinical trial: the role of effectiveness studies in evaluating cardiovascular therapies. Circulation 2008; 118 (12) 1294-1303