Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention

Abstract

Objective To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM). Study Design Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival. Results Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 180/7 to 226/7 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74). Conclusion Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.

Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes

“…All patients received ampicillin with or without azithromycin for 7 days. Tocolytic agents were never prescribed to any patient 8 . In the case of maternal and fetal well‐being after 7 days, patients were managed as outpatients with weekly fetal US examination and CBC counts.…”

“…Outpatients expectant management continued until 24 0/7 weeks of gestation. This threshold of gestational age was determined as the viability limit of our hospital 8 . Patients who have reached 24 0/7 weeks of gestation were readmitted for inpatient management until delivery.…”

“…Patients who have reached 24 0/7 weeks of gestation were readmitted for inpatient management until delivery. This management included the daily measuring of maternal temperature, uterine tenderness, twice‐daily nonstress testing, twice‐weekly evaluation of fetal growth and biophysical profile, and measuring of CBC counts and CRP values every second day 4,8,13 . Only a single course of Betamethasone was given to promote fetal lung maturation at or beyond 24 weeks of gestation.…”

“…Previous studies demonstrated approximately 50% of expectantly managed pregnancies complicated by previable PPROM give birth within 1 week of membrane rupture, while different reports show 22%–34% of previable PPROM patients have latency periods above 1 month 6,7 . Although a prolonged latency period may provide a higher number of deliveries beyond the viability limit, membrane rupture before fetal viability may still predict adverse short‐ and long‐term neonatal consequences secondary to extreme prematurity complications 8 …”

“…However, it is hard to predict the ultimate maternal and neonatal outcomes as various factors affect them such as the amniotic fluid volume, gestational age at delivery, and the presence of chorioamnionitis and sepsis 11 . Maternal risks include placental abruption, retained placenta, endometritis, chorioamnionitis, sepsis, and postpartum hemorrhage, which is commonly associated with the prolonged latency period 8 …”