The effects of tocolysis on neonatal septic death in women with PPROM: a retrospective cohort study.

Abstract

In women with preterm premature rupture of membranes (PPROM), particularly those with suspected chorioamnionitis, the benefit of tocolysis on neonatal outcome remains unclear. Our purpose was to evaluate the effect of tocolysis on neonatal septic death in women with PPROM with and without chorioamnionitis. A retrospective cohort study was used to address our study objective. We created a cohort consisting of all live births between 24 and 32weeks' gestation that were registered in the Linked Birth and Infant Death data files (2009-2013) from the United States. Multivariate logistic regression was used to evaluate the effect of tocolysis on neonatal septic death at 7 and 28days in births with and without chorioamnionitis. Of the 46,968 births that met our inclusion criteria, tocolysis was administered to 6264 (13.3%). Tocolysis was more commonly prescribed to Caucasians, smokers, in multiple birth pregnancies, and to women with a history of preterm births. Tocolysis was not significantly associated with neonatal septic death at 7days (OR 0.66, 95% CI 0.39-1.13) or at 28days (OR 0.85, 95% CI 0.60-1.19). This was consistent in pregnancies with and without chorioamnionitis. Furthermore, tocolysis was associated with a reduced risk of neonatal septic death at 7days when administered between 24 and 27weeks' gestation (OR 0.44, 95% CI 0.22-0.88). In the setting of PPROM, tocolysis does not appear to increase the risk of neonatal septic death at 7 and 28days. Therefore, consideration should be given to its administration if clinically indicated.