Objective To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil.
Methods In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used.
Results Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138).
Conclusion There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.
OBJECTIVE:The aim of this study was to evaluate the association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes. METHODS: This retrospective cohort included pregnant women with premature rupture of membranes (between 24 and 33+6 weeks) who used or did not use prophylactic antibiotics. Pearson's chi-square (χ²) test, Student's t-test, and binary logistic regression were used for statistical analysis. RESULTS: A significant effect was observed in patients with premature rupture of membranes using prophylactic antibiotics regarding amniotic fluid index (p=0.007), deepest vertical pocket (p=0.049), duration of antibiotic therapy (p≤0.001), C-reactive protein level upon admission (p≤0.001), leukocyte count upon admission (p=0.007), and length of stay in neonatal intensive care (p=0.047). A significant association was observed between the abovementioned patients and surfactant use during the neonatal period (p=0.04). A higher prevalence of surfactant use was noted in these patients (20.0 vs. 8.7%; p=0.04). CONCLUSION: No association was found between antibiotic prophylaxis and the presence of adverse perinatal outcomes in pregnant women with premature rupture of membranes between 24 and 33+6 weeks of gestation.
Objetivo: Avaliar a associação entre uso profilático de antibióticos e rotura prematura de membranas (RPM) e resultados perinatais adversos. Métodos: Trata-se de uma coorte retrospectiva de mulheres grávidas com rotura prematura de membranas, que fizeram ou não uso profilático de antibióticos entre 24 e 33 semanas e 6 dias. Para a análise estatística, foram utilizados teste χ2, teste t de Student e regressão logística binária. Resultados: Houve efeito significativo do grupo com RPM em uso profilático de antibióticos sobre a medida do índice de líquido amniótico (ILA) (p=0,007), a medida do maior bolsão vertical (MBV) (p=0,049), o tempo de uso de antibiótico (p≤0,001), a proteína C reativa na internação (p≤0,001), o número de leucócitos na internação (p=0,007) e o tempo de internação em unidade terapia intensiva (UTI) neonatal (p=0,047). Observou-se associação significativa entre o grupo com RPM em uso profilático de antibióticos e o uso de surfactante durante o período neonatal (p=0,04). As pacientes que utilizaram antibióticos profiláticos apresentaram maior prevalência de uso de surfactante (20,0 vs. 8,7%, p=0,04). Conclusão: Não se observou associação entre uso profilático de antibióticos com presença de resultados perinatais adversos em gestantes com RPM entre 24 e 33 semanas e 6 dias.
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