Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks

Objective To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. Study Design This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant. Results A total of 280 mother–infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis. Conclusion There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

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Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention

American Journal of Perinatology Reports ◽

10.1055/s-0040-1721421 ◽

2020 ◽

Vol 10 (04) ◽

pp. e395-e402

Author(s):

Felicia LeMoine ◽

Robert C. Moore ◽

Andrew Chapple ◽

Ferney A. Moore ◽

Elizabeth Sutton

Keyword(s):

Gestational Age ◽

Neonatal Intensive Care ◽

Intensive Care Unit Discharge ◽

Expectant Management ◽

Antibiotic Administration ◽

Tertiary Referral Center ◽

Membrane Rupture ◽

South Central ◽

Prelabor Rupture Of Membranes ◽

Latency Duration

Abstract Objective To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM). Study Design Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival. Results Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 180/7 to 226/7 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74). Conclusion Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.

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Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction

PLoS ONE ◽

10.1371/journal.pone.0261906 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261906

Author(s):

Francesco D’Ambrosi ◽

Nicola Cesano ◽

Enrico Iurlaro ◽

Alice Ronchi ◽

Ilaria Giuditta Ramezzana ◽

...

Keyword(s):

High Risk ◽

Cesarean Section ◽

Neonatal Intensive Care ◽

Perinatal Outcomes ◽

Expectant Management ◽

Low Risk ◽

Clinical Protocol ◽

Hemolytic Streptococcus ◽

Beta Hemolytic Streptococcus ◽

Prelabor Rupture Of Membranes

Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group. Results Of the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH < 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered. Conclusions A clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.

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Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

American Journal of Perinatology ◽

10.1055/s-0038-1648228 ◽

2018 ◽

Vol 36 (01) ◽

pp. 045-052 ◽

Cited By ~ 2

Author(s):

Katherine Bowers ◽

Jane Khoury ◽

Tetsuya Kawakita

Keyword(s):

Intensive Care Unit ◽

Cesarean Delivery ◽

Retrospective Cohort ◽

Neonatal Intensive Care ◽

Expectant Management ◽

Induction Of Labor ◽

Neonatal Outcomes ◽

Nulliparous Women ◽

Maternal And Neonatal Outcomes ◽

Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

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Drug Therapy in Neonatal Sepsis

Journal of Pharmacy Practice ◽

10.1177/089719008900200105 ◽

1989 ◽

Vol 2 (1) ◽

pp. 28-35

Author(s):

Susan Phillips ◽

Glenn Kaplan

Keyword(s):

Neonatal Sepsis ◽

Bacterial Infections ◽

Neonatal Intensive Care ◽

Clinical Status ◽

Clinical Manifestations ◽

Neonatal Morbidity ◽

Treatment Modalities ◽

Isolation And Identification ◽

Technological Advances ◽

High Risk Infants

Despite the remarkable technological advances in neonatal intensive care, bacterial infections continue to be a significant cause of neonatal morbidity and mortality. The clinical manifestations of sepsis are frequently subtle and nonspecific. Progression of the disease is rapid and mortality continues to be high. Antimicrobial therapy must be instituted as soon as possible after symptomatic and high risk infants are identified. Empiric broad spectrum antibiotic therapy is initiated to cover the most likely pathogens that are etiologic in neonatal sepsis. Pathogen specific therapy is guided by the isolation and identification of the infecting organism and its susceptibility patterns. The clinical status of the infant must be closely monitored, and basic supportive care provided to optimize the infants chance of survival. The emergence of drug resistance and adverse drug reaction profiles may further dictale which antimicrobial regimen is the safest and most effective. Unconventional therapies should be reserved for the most critically ill infants after conventional treatment has failed. Controlled trials of pharmacologic and nonpharmacologic treatment modalities for neonatal sepsis are needed to optimize the management of these infants.

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A study on the obstetric outcome in preterm pre-labour rupture of membranes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205411 ◽

2020 ◽

Vol 10 (1) ◽

pp. 78

Author(s):

Anusree Saraswathy ◽

Ajitha Ravindran ◽

Jayshree V. Vaman ◽

C. Nirmala

Keyword(s):

Neonatal Sepsis ◽

Early Onset ◽

Tertiary Care ◽

Expectant Management ◽

Neonatal Morbidity ◽

Fetal Distress ◽

Postnatal Period ◽

Neonatal Deaths ◽

Management Scheme ◽

Gestational Age At Delivery

Background: The major risks to the baby following preterm pre-labour rupture of membranes (PPROM) are related to the complications of prematurity. Since the goal of management in PPROM is prolongation of pregnancy, the most commonly accepted management scheme for the patient less than 34 weeks is expectant management in the hospital which consists of careful observation for signs of infection, labour or fetal distress in an effort to gain time for fetal growth and maturation.Methods: Patients admitted in Obstetrics and Gynaecology Department SAT Hospital, Medical College Trivandrum, Kerala with PPROM meeting the inclusion and exclusion criteria were recruited for the study. They were followed in the antenatal, intrapartum and postnatal period and the babies were also followed in the postnatal ward. The maternal and neonatal outcome were analysed and studied.Results: Maternal chorioamnionitis developed in 12.1% of cases, abruption 1.7%, puerperal pyrexia 8.8%, early onset neonatal sepsis in 22.9% of cases, congenital pneumonia in 17% cases and neonatal deaths in 6.3% of cases. The mean gestational age at delivery in this study was 33.42 weeks with majority of cases delivering between 32-34 weeks.Conclusions: The study suggests that maternal chorioamnionitis, puerperal pyrexia, congenital pneumonia, early onset neonatal sepsis, neonatal death, and requirement for ICU care occur with increased frequency in cohorts with PPROM. The present study concluded that most common maternal morbidity associated with PPROM was chorioamnionitis, that of neonatal morbidity was prematurity and its complications. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure healthy and fruitful life for the mother and her baby.

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Impact of Maternal Obesity on Perinatal Outcomes in Preterm Prelabor Rupture of Membranes ≥34 Weeks

American Journal of Perinatology ◽

10.1055/s-0039-1698833 ◽

2019 ◽

Vol 37 (05) ◽

pp. 467-474 ◽

Cited By ~ 2

Author(s):

Tara A. Lynch ◽

Amol Malshe ◽

Sarah Colihan ◽

Jeffrey Meyers ◽

Dongmei Li ◽

...

Keyword(s):

Maternal Obesity ◽

Neonatal Outcome ◽

Univariate Analysis ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Expectant Management ◽

Respiratory Support ◽

Antibiotic Administration ◽

Significant Difference ◽

Prelabor Rupture Of Membranes

Abstract Objective This study aimed to compare pregnancy outcomes in obese and nonobese women with preterm prelabor rupture of membranes (PPROM) ≥34 weeks. Study Design The present study is a secondary analysis of a multicenter retrospective cohort of singletons with PPROM from 2011 to 2017. Women with a delivery body mass index (BMI) ≥30 kg/m2 (obese) were compared with women with a BMI < 30 kg/m2 (nonobese). Pregnancies were stratified based on delivery policies of expectant management until 35 weeks versus immediate delivery ≥34 weeks. The primary outcome was a composite neonatal outcome (neonatal sepsis, antibiotic administration for duration >72 hours after delivery or respiratory support). Univariate analysis and general estimating equations models including maternal age, delivery timing, mode of delivery, hospital, and gestational age were used with p < 0.05 level of significance. Results Among 259 pregnancies, 47% were obese. Pregnant women with obesity had increased composite neonatal outcome versus nonobese pregnancies (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (CI): 1.01–2.17]). Obesity was also associated with increased neonatal antibiotic administration for a duration >72 hours after delivery, respiratory support, ventilation, oxygen supplementation, and surfactant administration. When stratified by delivery policies there was no significant difference in perinatal outcomes based on obesity. Conclusion Obese women with PPROM ≥34 weeks have an increased odds of adverse neonatal respiratory and infectious outcomes compared with nonobese women.

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The impact of labor induction at 39 weeks gestation compared with expectant management on maternal and neonatal morbidity in low-risk women: A United States of America Cohort Study

10.22541/au.160915266.65778062/v1 ◽

2020 ◽

Author(s):

Sabrina Burn ◽

Ruofan Yao ◽

Maria Diaz ◽

Jordan Rossi ◽

Stephen Contag

Keyword(s):

Cohort Study ◽

Expectant Management ◽

Neonatal Morbidity ◽

Induction Of Labor ◽

P Value ◽

Cesarean Hysterectomy ◽

Management Group ◽

Induction Group ◽

Prolonged Ventilation ◽

Nicu Admission

Objective: To determine maternal and neonatal morbidity associated with induction of labor at 39 weeks compared with expectant management through 42 weeks. Design: Cohort study Setting & Population: Low risk American women who delivered between 39 and 42 weeks in 2015 to 2017. Methods: Data was abstracted from the national vital statistics database. Multivariable log-binomial regression analysis was conducted to estimate the relative risk of morbidity. Main Outcome Measures: Maternal morbidity included Triple I, blood transfusion, ICU admission, uterine rupture, cesarean hysterectomy, and cesarean delivery. Neonatal morbidity included 5 minute Apgar ≤3, prolonged ventilation, seizures, NICU admission, and neonatal death. Results: A total of 1,885,694 women were included for analysis. Women undergoing induction of labor at 39 weeks were less likely to develop Triple I (p-value < 0.001; aRR 0.66; 95% CI [0.64-0.68]) and require a cesarean section (p-value <0.01; aRR 0.69l 95% CI [0.68-0.69]) than the expectant management group. There was a small, but significant increase in cesarean hysterectomy in the induction group (p-value <0.01; aRR 1.32; 95% CI [1.05-1.65]). Neonates of the induction group were less likely to have 5 minute Apgar ≤3 (p-value < 0.01; aRR 0.69; 95% CI [0.64-0.74]), prolonged ventilation (p-value < 0.01; aRR 0.77; 95% CI [0.72-0.82]), NICU admission (p-value < 0.01; aRR 0.80; 95% CI [0.79-0.82]), and/or neonatal seizures (p-value <0.01; aRR 0.80; 95% CI [0.66-0.98]) compared to the expectant management group. Conclusions: Induction of labor at 39 weeks gestation compared with expectant management is not harmful and has maternal and neonatal benefits.

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Profile Of Neonatal Admission At Chitwan Medical College

Journal of Chitwan Medical College ◽

10.3126/jcmc.v3i4.9547 ◽

2014 ◽

Vol 3 (4) ◽

pp. 13-16

Author(s):

SP Shrestha ◽

AK Shah ◽

R Prajapati ◽

YR Sharma

Keyword(s):

Neonatal Sepsis ◽

Neonatal Intensive Care ◽

Birth Asphyxia ◽

Normal Vaginal Delivery ◽

Neonatal Hypoglycemia ◽

Lower Section ◽

Clinical Sepsis ◽

Medical College ◽

Common Causes ◽

Nicu Admission

In Nepal, three most common causes of newborn (NB) admission in the neonatal intensive care unit (NICU) are birth asphyxia, neonatal sepsis and prematurity and they are the leading causes of death too. A study previously done in Nepal shows asphyxia as a leading cause of hospital admission accounting 22% followed by prematurity 20% and neonatal sepsis 17% with mortality due to these three causes being 7%, 3% and 5% respectively. Reasons of NICU admission in Chitwan Medical College (CMC) are clinical sepsis in 50% of cases followed by birth asphyxia 17.6%, and prematurity in 6.7% cases. Respiratory distress syndromes (RDS), neonatal jaundice, congenital hydrocephalus, meningitis are other reasons of NICU admission. Most of the babies were delivered by normal vaginal delivery at health facility 53%, and 47% of NB was delivered through lower section Caesarean section (LSCS). Only 6% of NB was having birth weight of less than 1.5 kg and majority of them were above that. There were 65% NB who was born at term and remaining 35% were preterm. Majority of NB were admitted within 72 hours of birth with 79% of the total admission. Hypoglycemia was observed in 83 out of 202 newborns accounting 41% neonatal hypoglycemia at birth. Journal of Chitwan Medical College 2013; 3(4); 13-16 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9547

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Neonatal complications in women with premature rupture of membranes (PROM) at term and near term and its correlation with time lapsed since PROM to delivery

Tropical Doctor ◽

10.1177/0049475519886447 ◽

2019 ◽

Vol 50 (1) ◽

pp. 8-11

Author(s):

Shruti Gupta ◽

Sunita Malik ◽

Shailesh Gupta

Keyword(s):

Latent Period ◽

Neonatal Mortality ◽

Neonatal Sepsis ◽

Neonatal Intensive Care ◽

Birth Asphyxia ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Neonatal Complications ◽

Near Term ◽

Nicu Admission

Premature rupture of membranes (PROM) is a common problem with controversies in its management. The aim of our study was to find out the prevalence of neonatal complications and their correlation with the latent period in babies born to mothers with PROM at 34–40 weeks of gestation. This prospective cohort study was performed on 200 pregnant women with PROM at or near term. After birth, neonates were screened for sepsis. Other outcome measures included birth asphyxia, stay in the Neonatal Intensive Care Unit (NICU) and neonatal mortality. These were correlated against time spent from PROM. Duration after which risk of neonatal sepsis increased immensely was calculated by ROC. The prevalence of specific neonatal complications was as follows: birth asphyxia (8%); neonatal sepsis (4%); NICU admission (26%); and neonatal mortality (2%). Complications increased with an increasing latent period. Beyond 37 h of latency, the rate of neonatal sepsis increases dramatically. In conclusion, pregnancies with PROM at and near term should not be managed expectantly. All neonates born after 37 h of latent PROM should be stringently evaluated for sepsis.

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Perinatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes during the late preterm period

10.21203/rs.3.rs-156591/v1 ◽

2021 ◽

Author(s):

Hayan Kwon ◽

Suk Ho Kang ◽

Hyun Sun Ko ◽

Ja Young Kwon ◽

Han-sung Kwon ◽

...

Keyword(s):

Neonatal Sepsis ◽

Neonatal Death ◽

Expectant Management ◽

Neonatal Outcomes ◽

Late Preterm ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Significant Difference ◽

Maternal Sepsis

Abstract The aim of this study is to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34+ 0–36+ 6 weeks of pregnancy. We conducted a retrospective study on singleton pregnancies with PPROM during the late preterm period using medical records at twelve tertiary medical centres in Korea from January 2007 to December 2016. Data on demographic characteristics and outcome measures were collected. The primary outcomes were maternal sepsis for maternal outcome and neonatal sepsis and neonatal death for neonatal outcomes. Of the 1,072 women, 782 cases (72.9%) were assigned to the immediate delivery group, and 290 cases (27.1%) were categorized into the expectant management group. There was a significant difference in the rate of clinical neonatal sepsis (immediate delivery, 3.8% vs expectant management, 15.8%; p < 0.0001), however, no differences in maternal sepsis (p = 0.5424), culture-proven neonatal sepsis (p = 0.2108), or neonatal death (p = 0.3899) were observed. In conclusion, expectant management in women with PPROM during the late preterm period does not increase the risk of severe maternal and neonatal morbidities and mortality; however, careful monitoring for chorioamnionitis or fetal compromise should be considered during expectant management.

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