Maternal and perinatal outcomes in midtrimester rupture of membranes

Juliana Silva Esteves; Paulo Roberto Nassar de Carvalho; Renato Sa; Saint Clair Gomes Junior

doi:10.1080/14767058.2020.1821641

Maternal and perinatal outcomes in midtrimester rupture of membranes

J Matern Fetal Neonatal Med. 2022 Sep;35(18):3460-3466. doi: 10.1080/14767058.2020.1821641. Epub 2020 Oct 9.

Authors

Juliana Silva Esteves¹, Paulo Roberto Nassar de Carvalho^{2

3}, Renato Sa⁴, Saint Clair Gomes Junior⁵

Affiliations

¹ Department of Obstetrics, Rua Sacadura Cabral, Hospital Federal Servidores do Estado, Rio de Janeiro, Brazil.
² Clínica Perinatal Barra, Diagnostic Center, Rio de Janeiro, Brazil.
³ Department of Obstetrics, Instituto Fernandes Figueira/Fiocruz, Rio de Janeiro, Brazil.
⁴ Materno Infantil Department, Universidade Federal Fuminense, Niteroi, Brazil.
⁵ Clinical Research Department, Instituto Fernandes Figueira, Rio de Janeiro, Brazil.

PMID: 33032477
DOI: 10.1080/14767058.2020.1821641

Abstract

Objective: The aim of this study was to assess neonatal and maternal adverse outcomes following expectant management of preterm prelabor rupture of membranes (PPROM) between 18 and 26 weeks and to identify maternal morbidity and prognostic factors for neonatal outcomes.

Methods: Data were collected from all pregnant women who presented PPROM between 18⁺⁰ and 26⁺⁰ weeks admitted into two tertiary centers in Brazil from 2005 to 2016. The neonatal adverse outcomes (mortality or the development of a severe morbidity) and maternal adverse outcomes were analyzed and compared among four groups (18^0/7 to 20^0/7 weeks, 20⁺¹ to 22^0/7 weeks, 22⁺¹ to 24^0/7 weeks and 24⁺¹ to 26^0/7 weeks). A multiple logistic regression was performed for each predictor of neonatal adverse outcomes, and the area under the receiver operating characteristics curves for birth weight and gestational age at birth were calculated.

Results: Of the 101 women with PPROM during the study period, 97 fulfilled the eligible criteria. Among these patients, 30 (30.9%) had a miscarriage or stillbirth. Overall there were 67/97 (69.1%) livebirths, 45/97 newborns survived to discharge (46.3%), and 53/97 (54.6%) experienced severe neonatal adverse outcome. The median latency period was seven days, with 36 (37.1%) patients ending the pregnancy in 2-14 days. Among 29 patients with PPROM at 24⁺¹ to 26^0/7 weeks, only 13 (44.8%) delivered between 2 and 14 days. Multivariate analysis has demonstrated that the independent predictor for adverse neonatal outcome was birthweight. The maternal morbidity was high; however, the expectant management did not increase the rate of severe maternal morbidity.

Conclusions: PPROM between 18⁺⁰ and 26⁺⁰ weeks has high morbidity and mortality, and the only significant independent predictor of severe adverse neonatal outcomes is birthweight. Maternal morbidity is high, however, the expectant management is not increased by expectant management.

Keywords: Preterm birth; maternal outcomes; midtrimester PPROM; neonatal morbidity; neonatal survival; preterm prelabor rupture of membranes.

MeSH terms

Birth Weight
Female
Fetal Membranes, Premature Rupture* / epidemiology
Gestational Age
Humans
Infant, Newborn
Pregnancy
Pregnancy Outcome* / epidemiology
Pregnancy Trimester, Second
Retrospective Studies

Supplementary concepts

Preterm Premature Rupture of the Membranes