175: Does malpresentation affect latency and other perinatal outcomes among PPROM cases?

Abstract

PPROM is estimated to complicate 3% of all births and is associated with up to 40% all preterm births. PPROM is an important cause for perinatal mortality and morbidity and there are improved outcomes with longer latency. There is limited literature on whether fetal presentation affects latency among PPROM cases. Our objective was to determine whether fetal presentation at the diagnosis of PPROM has an effect on the latency period and other perinatal outcomes. All cases of PPROM after 20 weeks of gestation delivered at our institution from January 2014 though May 2017. Inclusion criteria: singleton gestations. Exclusion criteria: PPROM at less than 20 wks gestational age (GA), multiple gestations and fetal anomalies. The analysis was stratified based on GA at time of rupture: 20 - 26 wks, 26 wks+1d - 28 wks, 28 wks+1d - 30 wks, 30 wks+1d - 32 wks and 32 wks+1d - 36 wks+6d. We calculated that 20 women with noncephalic and 80 with cephalic presentations would give the study 80% power to detect HR of 1.3 for latency measured in days. 120 cases of PPROM were reviewed: 100 were cephalic and 20 noncephalic at presentation. There were no differences in maternal age, race, smoking status, infection on admission, bleeding in pregnancy, history of preterm delivery or the use of latency antibiotics between fetal presentation. There was no difference noted in latency period based on fetal presentation (HR = 1.17, CI: 0.66, 2.07). Noncephalic presentation at PPROM was associated with delivery for nonreassuring fetal status, lower Apgar scores at 1 and 5 minutes and fetal anemia. A fetal/neonatal composite morbidity composite variable consisting of sepsis, IUFD, RDS and neonatal demise showed a trend toward worse outcomes for fetuses in noncephalic presentation however it did not reach statistical significance (OR = 4.62, CI 0.94, 22.71, P=0.06). Fetal presentation at the time of PPROM does not appear to affect the length of the latency period. However, there may be increased maternal and fetal/neonatal morbidity associated with fetal malpresentation and closer fetal monitoring may be warranted for non-vertex presenting fetuses in cases of PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)