Preterm premature rupture of membranes (PPROM): outcomes of delivery at 32°/7 –336/7 weeks after confirmed fetal lung maturity (FLM) versus expectant management until 34°/7 weeks

Abstract

Objective: Our objective was to compare maternal and neonatal outcomes in patients with preterm premature rupture of membranes (PPROM) delivered prior to 34°/7 weeks upon confirmation of fetal lung maturity (FLM) to those managed expectantly until 34°/7 weeks.Methods: We performed a retrospective cohort study of non-anomalous singleton gestations with PPROM occurring after 24 weeks delivered between 32°/7 and 34°/7 weeks from 2004 to 2012. Patients delivered upon documented FLM (+FLM) – defined as the presence of phosphatidylglycerol (PG) at 32°/7–336/7 weeks if amniotic fluid was obtainable vaginally – were compared with patients delivered without documented FLM between 32°/7 and 34°/7 weeks (expectant). Primary outcomes included maternal infection (clinically diagnosed endometritis or chorioamnionitis), placental abruption and a composite of neonatal morbidities (including but not limited to mechanical ventilation, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and respiratory distress syndrome). Statistical analysis was performed using Student’s t-test for continuous variables and Chi-square or Fisher’s exact test for categorical data. Covariates were analyzed via multivariate logistic regression and adjusted odds ratios were calculated.Results: Of 237 PPROMs delivered at 32°/7–34°/7 weeks, 74 were intentionally delivered for +FLM and 163 were expectantly managed. No cord prolapse or stillbirth was observed. Maternal infection (chorioamnionitis or endometritis) was lower in the +FLM group (aOR 0.33 95% CI 0.12–0.88). Overall, there was no difference in composite neonatal morbidity did not differ between the two groups (aOR 1.36 95% CI 0.53–3.54).Conclusions: In patients with PPROM, delivery after confirmation of FLM at 32°/7–336/7 weeks compared with expectant management until 34°/7 weeks may prevent maternal infection without increasing neonatal morbidity.