Neonatal outcomes after elective delivery management of preterm premature rupture of the membranes before 34 weeks’ gestation (DOMINOS study)

Abstract

Objective The objective was to compare the impact of the reason for delivery (elective delivery versus spontaneous onset of labor) on neonatal outcome after preterm premature rupture of the membranes (PPROMs). Study design A regional prospective cohort study of all women with PPROM at between 24 and 34 weeks’ gestation was conducted. We compared the effects of elective delivery ( n = 133), spontaneous labor ( n = 170), and admission for medical complications ( n = 169) like fetal distress, maternal hyperthermia, or placental abruption, on neonatal outcomes. Primary outcome measures were a composite of neonatal mortality and morbidity, which included periventricular leukomalacia, grade III/IV intraventricular hemorrhage, neonatal sepsis, and oxygen requirement at 36 weeks’ gestation. Results Among 472 cases, mean gestational age at PPROM was 31.2 ± 2.6 weeks. Neonatal outcomes improved as gestational age advanced, but a latency period of over 14 days did not improve outcomes. A logistic regression analysis showed that only elective delivery (OR 0.41, 95%CI: 0.19–0.87, P = 0.02), maternal age >35 years (OR 2.13, 95%CI: 1.19–3.85, P = 0.01), and gestational age at rupture remained associated with primary outcome. Conclusion Elective delivery in women with PPROM can be associated with decreased neonatal morbidity compared to spontaneous labor.