853 Length of stay and perinatal outcomes after preterm premature rupture of membranes between 28-33 weeks

Abstract

Pregnancies complicated by preterm premature rupture of membranes (PPROM) are associated with adverse neonatal outcomes. Length of antepartum admission before delivery can serve as a proxy for duration of PPROM diagnosis. It is standard practice for women with PPROM to be managed on an inpatient antepartum unit. We sought to investigate the association between neonatal outcomes and length of antepartum admission in pregnancies complicated by PPROM. This is a retrospective cohort study of singleton, non-anomalous gestations complicated by PPROM in California between 2007-2011 using birth registry and ICD-9 data. We categorized antepartum admission stay as <7 days or ≥7 days. Gestational age at time of delivery ranged from 28-33 weeks gestation. We investigated the association between length of antepartum admission and adverse perinatal outcomes. Outcomes include newborn septicemia, chorioamnionitis, NICU admission >24 hours, neonatal death, respiratory distress syndrome (RDS), necrotizing enterocolitis, and intraventricular hemorrhage (IVH). Analyses utilized chi-square tests and multivariable logistic regression models. A p-value of less than 0.05 was considered statistically significant. In this cohort of 6,708 deliveries complicated by PPROM between 28-33 weeks gestational age, rates of chorioamnionitis were statistically lower in the cohort with <7 day length of stay compared to a length of stay ≥7 days (9.3% vs. 22.1%, p-value < 0.001) (Table 1). Rates of RDS were statistically lower in the cohort with <7 day length of stay compared to a length of stay ≥7 days (66.4% vs. 71.9%, p-value < 0.001). Rates of NICU admission were higher in the cohort with <7 day length of stay compared to a length of stay ≥7 days (92.5% and 90.3%, p-value = 0.009). Longer antepartum length of stay ≥7 days was associated with higher rates of chorioamnionitis and some adverse neonatal outcomes in the setting of PPROM during 28-33 weeks gestation.