693: Tocolysis the setting of preterm premature rupture of membranes

Abstract

Tocolysis after PPROM is controversial, and evidence to guide management is limited. We sought to determine if tocolysis after PPROM is associated with adverse neonatal outcomes. This is a secondary analysis of a randomized trial of magnesium for neuroprotection. Women at 24-32 weeks with singleton gestations and PPROM were eligible. We excluded women tocolyzed prior to randomization, fetuses with chromosomal or single gene abnormalities, and those with incomplete outcome data. The primary exposure was post randomization tocolysis. The primary neonatal outcome was culture proven sepsis, and the primary childhood outcome was a composite of death or Bayley scores 2 standard deviations below the mean at age 2 (score <70). Death is included as a competing outcome. Patient characteristics were compared by exposure. We fit logistic regression models to adjust for factors that influence odds of the outcomes including exposure to magnesium, race, education level, gestational age at birth, maternal BMI and smoking status. Of 1667 patients, 38 (2.3%) received tocolysis while 1629 (97.7%) did not. The most common tocolytic agent was magnesium (42.1%). Maternal age, race and BMI were similar among groups. Women in the tocolysis group were more educated, more likely to have multiple courses of steroids, and less likely to smoke. Neonates of tocolyzed women were larger (1687g v 1439g, p=0.01) and delivered at a later gestational age (31+1 v 29+6 weeks, p=0.01). Rates of neonatal sepsis were similar in tocolyzed versus non-tocolyzed groups (6 (15%) v 260 (16%), p=0.9). In the adjusted model the odds for sepsis and abnormal psychomotor developmental index (PDI) or death were elevated with tocolysis, although this finding did not reach statistical significance. There was no difference in abnormal mental developmental index (MDI) or death. Although the neonates of mothers given tocolysis prolonged gestation and achieved higher birth weights, tocolysis after PPROM may be harmful given possible increase risks for sepsis and low Bayley PDI/death. Further data are needed to verify findings and guide practice.