We hypothesized that PPROM with VB compared to those without will have increased neonatal morbidity due to shorter latency period. STUDY DESIGN: Secondary analysis of PPROM in the BEAM trial, an RCT investigating use of magnesium sulfate for fetal neuroprotection. Singletons at 24-31 weeks gestational age (GA) who remained undelivered after 24 hours were included. Participants received steroids and latency antibiotics, and use of tocolytics was prohibited. Study outcome was the composite neonatal morbidity (CMN), defined as seizure, sepsis, BPD, PVL, NEC 2/3, IVH 3/4 or death, and cerebral palsy (CP) at 2 years. Data analysis was initially performed for all subjects and then separately in those with VB with and without placental abruption using logistic regression to adjust for confounding variables. RESULTS: Of 1702 pregnancies, 14% (236) had VB (Fig). Women with PPROM and VB were more likely to be smokers (p¼0.01) whereas those with no VB were more likely to be nulliparous (p¼0.01) and to have no prenatal care (p¼0.02). Chorioamnionitis (p¼0.3), magnesium use (p¼0.09), and GA at delivery (p¼0.71) were similar among groups. Latency period was longer in the VB group (10.2 days versus 7.7 days in the no VB group, p¼0.01). Neonates from the VB group were more likely to have the CNM and death before discharge, even after adjusting for GA (OR 2.04, CI 1.36-3.06; table). CP was similar between groups. After excluding those with abruption (n¼39), rates of adverse neonatal outcomes remained higher in PPROM with VB (Fig: OR1.9, CI 1.2-2.9). CONCLUSION: Contrary to our hypothesis, patients with PPROM and VB have increased neonatal morbidity despite longer latency periods. These findings may be used to counsel patients and to design an RCT to determine optimal management of these pregnancies.
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