Expectant Management of PPROM Improves Neonatal Outcome—A Retrospective Study of 562 Patients

Abstract

Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period.

Preterm Prelabour Rupture of Membrane (PPROM) in a Young Female in South-South Nigeria: A Clinical Case Report

“…In a retrospective Romanian study between October 2015 to November 2020, 3% of pregnancies between 24 + 0/7 and 36 + 6/7 gestation were complicated by PPROM, with a worse prognosis in premature infants compared to term infants [7]. This study showed a strong correlation between expectant management of PPROM and neonatal outcomes, thus, demonstrating the advantage of expectant management of PPROM over immediate birth within 48 hours of diagnosis.…”

“…This study showed a strong correlation between expectant management of PPROM and neonatal outcomes, thus, demonstrating the advantage of expectant management of PPROM over immediate birth within 48 hours of diagnosis. The limitation of the study was that the exact time between the ROM and presentation at the emergency could not be ascertained, as well as the lack of standard protocol and antibiotic resistance [7]. The index case was placed on bed rest for three days, following which operative cesarean delivery was done.…”

“…There is currently no gold standard to diagnose PPROM. When rupture and leakage of the amniotic fluid from the cervix is obvious, diagnosing PPROM is easier, however, if not observed, anamnesis and some tests can aid in diagnosis [7].…”

“…Rupture is suggested to begin in this zone, leading to the pre-weakening of the membranes, however, in PPROM, it is usually mediated by inflammatory factors. Conditions such as polyhydramnios and twin gestation are associated with increased stretching of fetal membranes [5] while oligohydramnios, BMI < 18.5 kg/m 2 , vitamin deficiency, and cigarette smoking are also identified risk factors for PPROM [1,7].…”

Association between Gestational Age and Perinatal Outcomes in Women with Late Preterm Premature Rupture of Membranes

“…Preterm premature rupture of membranes (PPROM) is a condition in which the amniotic sac surrounding the fetus ruptures before the 37th week of pregnancy. [1][2][3] A diagnosis of PPROM carries the risk of various adverse maternal and neonatal outcomes, including premature birth, which can lead to complications for the newborn, such as respiratory distress syndrome, sepsis, and neurodevelopmental problems. 4,5 The risk of neonatal complications increases with earlier gestational age at delivery.…”