Targeted delivery at 34 versus 35 weeks in women with preterm prelabor rupture of membranes

Abstract Objective: To compare planned delivery at 34 versus 35 weeks for women with preterm prelabor rupture of membranes (PPROM). Materials and methods: We performed a retrospective cohort study of singleton pregnancies with PPROM after 24 weeks delivered from 2006 to 2014. In 2009, an institutional practice change established 35 weeks as the target gestational age before induction of labor was initiated after PPROM. Demographic and outcome measures were compared for two cohorts: women delivered 2006–2008 – target 34 weeks (T34) and women delivered 2009–2014 – target 35 weeks (T35). The primary outcome was neonatal intensive care unit (NICU) admission. Results: Of the 382 women with PPROM, 153 (40%) comprized the T34 cohort and 229 (60%) comprized the T35 cohort. Demographic characteristics were similar between groups. There were no differences between groups in gestational age at PPROM (31.0 ± 3.3 weeks versus 31.2 ± 3.1 weeks; p = .50) or maternal complications. The mean gestational age at delivery was earlier in the T34 group (31.8 ± 3.2 weeks versus 32.4 ± 2.7 weeks; p = .04). The median predelivery maternal length of stay (LOS) was 1 day longer in the T35 group (p = .03); the total and postpartum LOS were similar between groups (p > .05). There were no differences in the rate of NICU admission (T34 89.5% versus T35 92.1%; p = .38) or median neonatal LOS (T34 14 days versus T35 17 days; p = .15). In those patients who reached their target gestational age, both maternal predelivery LOS and total LOS were longer in the T35 group (p > .05). The frequency of NICU admission in those reaching their target gestational age was similar between groups (T34 83.37% versus T35 76.19%; p = .46). Conclusions: A 35-week target for delivery timing for women with PPROM does not decrease NICU admissions or neonatal LOS. This institutional change increased maternal predelivery LOS, but did not increase maternal or neonatal complications.

[1]  Jacqueline Pich.  Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy , 2018, International journal of nursing practice.

[2]  W. H. Pearse,et al.  American College of Obstetricians and Gynecologists , 2018, Definitions.

[3]  P. Middleton,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. , 2017, The Cochrane database of systematic reviews.

[4]  R. Ehsanipoor,et al.  Practice Bulletin No. 172: Premature Rupture of Membranes , 2016, Obstetrics and gynecology.

[5]  J. Thornton,et al.  Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial , 2016, The Lancet.

[6]  T. Dowswell,et al.  Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation. , 2014, The Cochrane database of systematic reviews.

[7]  T. Dagklis,et al.  Parameters affecting latency period in PPROM cases: a 10-year experience of a single institution , 2013, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[8]  B. Mol,et al.  Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. , 2012, American journal of obstetrics and gynecology.

[9]  B. Mol,et al.  Induction of Labor versus Expectant Management in Women with Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Randomized Controlled Trial , 2012, PLoS Medicine.

[10]  B. Mercer.  Is There a Role for Tocolytic Therapy During Conservative Management of Preterm Premature Rupture of the Membranes? , 2007, Clinical obstetrics and gynecology.

[11]  S. Ramin,et al.  Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers. , 2003, American journal of obstetrics and gynecology.

[12]  G. Thurnau,et al.  What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes. , 2003, Seminars in perinatology.

[13]  G. Thurnau,et al.  Antibiotic Therapy for Reduction of Infant Morbidity After Preterm Premature Rupture of the Membranes: A Randomized Controlled Trial , 1997 .

[14]  G. Thurnau,et al.  Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. , 1997, JAMA.

[15]  S. Kenyon,et al.  Preterm premature rupture of membranes. , 2012, Archivos argentinos de pediatria.

[16]  B. Sibai,et al.  Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32 to 36 weeks: a randomized trial. , 1993, American journal of obstetrics and gynecology.