Rate of Spontaneous Version Following Preterm Premature Rupture of Membranes [28N

Abstract

INTRODUCTION: Malpresentation is a common problem early in pregnancy. The rate of spontaneous version (SV) by gestational age has been studied, but is poorly understood after preterm premature rupture of membranes (PPROM), which complicates 3% of pregnancies in the United States. The objective of our study was to report the rate of SV following PPROM. METHODS: We conducted a retrospective cohort study on women age 18 or above with singleton intrauterine pregnancies who experienced PPROM between 22-34 weeks gestation and were delivered at the Mayo Clinic from 01/2010-12/2015. Demographic characteristics, obstetric history, and prenatal care details were abstracted through chart review. Aneuploidy, major fetal anomalies, maternal Müllerian anomalies, and delivery less than 24 hours after PPROM were excluded. RESULTS: Among 120 patients included in the study, 29 were nulliparous. Mean maternal age at PPROM diagnosis was 29.3 years. The median gestational age at PPROM diagnosis and at delivery was 31 1/7 weeks and 32 5/7 weeks, respectively. Intrauterine growth restriction was diagnosed in 10 women following PPROM. Sixty-nine (57.5%) patients delivered vaginally and 51 (42.5%) underwent cesarean section. Twenty-three (19.2%) women experienced SV following PPROM. Of the 21 breech presentations at PPROM diagnosis, 4 (19%) converted to cephalic presentation at delivery. CONCLUSION: We determined that approximately 1 out of 5 women experience SV in the setting of PPROM. Data about SV following PPROM is important in order to counsel patients about expectations for the remainder of their pregnancy. This new evidence can better prepare patients and providers for safe delivery.