Perinatal Outcomes of Twin Pregnancies With Preterm Premature Rupture of the Membranes at 24–34 Weeks’ Gestation

Abstract Objective: To describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity.Methods: This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks’ gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis.Results: Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score < 7 increased severe neonatal morbidity.Conclusion: As GA at PPROM increased, the risk of adverse perinatal outcomes decreased. GA at PPROM and latency period were significantly associated with discharge without severe or moderate-severe neonatal morbidity.

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Perinatal outcomes of twin pregnancies with preterm premature rupture of the membranes at 24–34 weeks’ gestation

Scientific Reports ◽

10.1038/s41598-021-02884-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shuwei Zhou ◽

Yajun Yang ◽

XiaoYan Zhang ◽

Xiaoling Mu ◽

Quan Quan ◽

...

Keyword(s):

Latency Period ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Premature Rupture ◽

Factors Associated ◽

Preterm Premature Rupture ◽

Significant Difference ◽

Adverse Perinatal Outcomes ◽

Twin Pregnancies

AbstractTo describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity. This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks’ gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM and compared between PPROM and non PPROM twins. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis. Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. There was no significant difference in general neonatal outcomes between PPROM and non PPROM twins. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score < 7 increased severe neonatal morbidity. As GA at PPROM increased, the risk of adverse perinatal outcomes decreased. GA at PPROM and latency period were significantly associated with discharge without severe or moderate-severe neonatal morbidity.

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The effects of oligohydramnios on perinatal outcomes after preterm premature rupture of membranes

Perinatal Journal ◽

10.2399/prn.21.0291005 ◽

2021 ◽

Vol 29 (1) ◽

pp. 27-32

Author(s):

Subhashini Ladella ◽

David Lee ◽

Fatemeh Abbasi ◽

Brian Morgan

Keyword(s):

Amniotic Fluid ◽

Medical Center ◽

Predictor Variable ◽

Latency Period ◽

Perinatal Outcomes ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Apgar Scores ◽

Preterm Premature Rupture ◽

Adverse Perinatal Outcomes

Objective Amniotic fluid plays a vital protective role in fetal growth and development. Low amniotic fluid index (AFI) during pregnancy increases risk of adverse perinatal outcomes. Prior studies reported association of oligohydramnios (AFI<5 cm) with shorter latency period and inconsistent correlation with chorioamnionitis after preterm premature rupture of membranes (PPROM). We studied effects of oligohydramnios on perinatal outcomes after PPROM. Methods A retrospective cross-sectional study was performed at our medical center on women with PPROM between 23 to 34 weeks during 2014 to 2016. The primary predictor variable was AFI of <5 cm or ≥5 cm in relationship to perinatal outcomes. Results From a total of 117 PPROM cases reviewed, 46 women had AFI<5 cm and 71 had AFI≥5 cm. Length of stay (LOS) in neonatal intensive care unit (NICU) was 42 days for AFI<5 cm versus 26.5 days for AFI>5 cm (p<0.007). The mean neonatal Apgar scores at 1 and 5 minutes (5.2 and 7.4 respectively) were lower in the AFI<5 cm group compared to AFI≥5 cm (6.9 at 1 minute and 8.4 at 5 minutes, p<0.001). Conclusion Oligohydramnios after PPROM is associated with adverse perinatal outcomes such as lower Apgar scores and longer LOS in the NICU. No association was observed with latency period and chorioamnionitis.

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Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0341 ◽

2018 ◽

Vol 46 (5) ◽

pp. 555-565 ◽

Cited By ~ 13

Author(s):

Verena Kiver ◽

Vinzenz Boos ◽

Anke Thomas ◽

Wolfgang Henrich ◽

Alexander Weichert

Keyword(s):

Survival Rate ◽

Pregnancy Termination ◽

Treatment Options ◽

Latency Period ◽

Perinatal Outcomes ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Mortality And Morbidity ◽

Membrane Rupture ◽

Preterm Premature Rupture

Abstract Objective: A current descriptive assessment of perinatal outcomes in pregnancies complicated by previable preterm premature rupture of membranes (pPPROM) at <24 weeks of gestation, after expectant treatment. Study design: Maternal and short-term neonatal data were collected for patients with pPPROM. Results: Seventy-three patients with 93 fetuses were hospitalized with pPPROM at 15–24 weeks’ gestation. Among these patients, 27.4% (n=20) chose pregnancy termination, 27.4% (n=20) miscarried and 45.2% (n=33) proceeded to live births. After a median latency period of 38 days, ranging from 1 to 126 days, 24 singletons and 20 multiples were live-born, of whom 79.5% (n=35) survived the perinatal period. The main neonatal sequelae were pulmonary hypoplasia (29.5%; n=13), connatal infection (56.8%; n=25), intraventricular hemorrhage (25%; n=11; resulting in five neonatal deaths) and Potter’s syndrome (15.9%; n=7). Nine newborns died, within an average of 2.8 days (range, 1–10 days). The overall neonatal survival rate was 51.5% – including miscarriages but not elective terminations. The intact survival rate was 45.5% of all live-born neonates. Conclusions: Even with limited treatment options, overall neonatal survival is increasing. However, neonatal mortality and morbidity rates remain high. The gestational age at membrane rupture does not predict neonatal outcome.

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Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34–36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1718954 ◽

2020 ◽

Vol 42 (11) ◽

pp. 717-725

Author(s):

Malú Flôres Ferraz ◽

Thaísa De Souza Lima ◽

Sarah Moura Cintra ◽

Edward Araujo Júnior ◽

Caetano Galvão Petrini ◽

...

Keyword(s):

Gestational Age ◽

Perinatal Outcomes ◽

Expectant Management ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Management Group ◽

Group I ◽

Adverse Perinatal Outcomes ◽

Group Ii

Abstract Objective To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. Methods In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Results Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). Conclusion There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

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Effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184130 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4068

Author(s):

Ashima Arora ◽

Ratna Biswas ◽

Bhawna Dubey ◽

Binita Goswami ◽

Sonal Saxena

Keyword(s):

Neonatal Sepsis ◽

Neonatal Intensive Care ◽

Inflammatory Marker ◽

Perinatal Outcomes ◽

Admission Rate ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Adverse Perinatal Outcomes ◽

High Level

Background: The aim is to study the effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes (PPROM).Methods: 60 women with PPROM at 28–34 weeks of gestation were enrolled in the study. All the women were given antibiotics as per hospital protocol and were subjected to blood sampling for Interleukin -6(IL-6) at admission, delivery and umbilical cord blood. IL-6 levels were assessed for associations with adverse perinatal outcomes and the effect of antibiotic treatment on IL-6 and perinatal outcomes were studied. The data were analyzed using t test and χ2 test.Results: Increased level of IL-6 was associated with chorioamnionitis and neonatal sepsis (p<0.001). High level of IL-6 led to early delivery and complete course of antibiotics suppressed IL-6 (p<0.001) and clinical chorioamnionitis in women with PROM. Full course of antibiotics also decreased the admission rate of babies to neonatal intensive care unit and suppressed respiratory distress syndrome, neonatal sepsis.Conclusions: Increased level of IL-6 is seen in women with chorioamnionitis and neonatal sepsis. Antibiotics suppress the IL-6 levels, chorioamnionitis and neonatal sepsis.

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Maternal and perinatal outcome in preterm premature rupture of membranes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172339 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2498

Author(s):

Jameela Diraviyam M. V. ◽

Lalithambica Karunakaran

Keyword(s):

Perinatal Mortality ◽

Conservative Management ◽

Perinatal Outcome ◽

Latency Period ◽

Perinatal Outcomes ◽

Preterm Births ◽

Perinatal Complications ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture

Background: Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for approximately one third of all preterm births. Objective of present study was to analyse the maternal and perinatal outcome of PPROM patients between 28 to 36 weeks +6daysMethods: A descriptive study was conducted on 141 antenatal patients between 28 to 36weeks+6days with PPROM admitted to Department of Obstetrics and Gynecology, Government TD Medical College, Alappuzha, Kerala, India from September 2014 to September 2015. After establishing the diagnosis of PPROM patients were monitored and Maternal and perinatal outcomes were studied.Results: 77% patients had late PPROM. 60% of early PPROM latency period >24 hrs and were managed conservatively till 34 weeks. 18% had chorioamnionitis and immediate termination of pregnancy. 73% of newborns in this group needed admission due to complications of prematurity like RDS (54.54%). Perinatal mortality (2.12%) was due to sepsis. 80% of late PPROM had latency period <24 hrs and only 4% had chorioamnionitis.18.5% babies in this group had hyperbilirubinemia. There was statistically significant association between latency period and perinatal complications (p=0.001). RDS was 33% in latency period <24hrs, 18% in >24hrs and sepsis was 36% in >24hrs and 10% in <24hrs.Conclusions: The most common cause of perinatal mortality in early PPROM is prematurity and its complications. Hence conservative management to prolong pregnancy is recommended under strict monitoring for evidence of chorioamnionitis. At the earliest evidence of chorioamnionitis termination irrespective of gestational age is warranted. In late PPROM, perinatal outcome is good. So, termination is advised as conservative management shall add to the fetal and maternal morbidity due to sepsis.

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Preterm Premature Rupture of Membranes – Inpatient Versus Outpatient Management: an Evidence-Based Review

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1515-2801 ◽

2021 ◽

Author(s):

Werner Rath ◽

Holger Maul ◽

Ioannis Kyvernitakis ◽

Patrick Stelzl

Keyword(s):

Pregnant Women ◽

Latency Period ◽

Neonatal Morbidity ◽

Future Research ◽

Evidence Based ◽

Outpatient Management ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Maternal Complications ◽

Preterm Premature Rupture

AbstractAccording to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the increasing burden on obstetric departments and the growing importance of satisfaction and right to self-determination in pregnant women, outpatient management in PPROM is a possible alternative to inpatient monitoring. The most important criterion for this approach is to ensure the safety of both the mother and the child. Due to the small number of cases (n = 116), two randomised controlled trials (RCTs) comparing inpatient and outpatient management were unable to draw any conclusions. By 2020, eight retrospective comparative studies (cohort/observational studies) yielded the following outcomes: no significant differences in the rate of maternal complications (e.g., chorioamnionitis, premature placental abruption, umbilical cord prolapse) and in neonatal morbidity, significantly prolonged latency period with higher gestational age at birth, higher birth weight of neonates, and significantly shorter length of stay of preterm infants in neonatal intensive care, shorter hospital stay of pregnant women, and lower treatment costs with outpatient management. Concerns regarding this approach are mainly related to unpredictable complications with the need for rapid obstetric interventions, which cannot be performed in time in an outpatient setting. Prerequisites for outpatient management are the compliance of the expectant mother, the adherence to strict selection criteria and the assurance of adequate monitoring at home. Future research should aim at more accurate risk assessment of obstetric complications through studies with higher case numbers and standardisation of outpatient management under evidence-based criteria.

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The Effect of Transabdominal Amnioinfusion on Perinatal Outcomes in Preterm Premature Rupture of Membranes

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1263 ◽

2014 ◽

Vol 6 (1) ◽

pp. 28-32

Author(s):

Nasira Tasnim ◽

Ghazala Mahmud ◽

Saba Fatima

Keyword(s):

Controlled Trial ◽

Latency Period ◽

Perinatal Outcomes ◽

Expectant Management ◽

Management Control ◽

Control Group ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Significant Prolongation

ABSTRACT Objective To evaluate the role of transabdominal amnioinfusion in improving the latency period and perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM). Materials and methods A randomized controlled trial was carried out at MCH Centre, Unit I, PIMS, Islamabad, from Jan 2008 to Dec 2008. Sixty women with singleton pregnancies between 28 and 32 completed weeks of gestation, complicated with PPROM was randomly allocated into two groups viz transabdominal amnioinfusion (amnioinfusion group) and expectant management (control group), within 24 hours of admission. Results The demographic characteristics were comparable in both the groups. Amnioinfusion group showed significant improvement in PPROM to delivery interval (18.47 ± 6.699 vs 8.93 ± 4.741 days; p = 0.001), neonatal birth weight (p = 0.019) and Apgar scores at 1 and 5 minutes (p = 0.007 for 1 minute and p = 0.012 for 5 minutes). There was less frequency of respiratory distress syndrome (p = 0.032), neonatal sepsis (p = 0.020) and neonatal jaundice (p = 0.002) in the amnioinfusion group. Fewer neonates were admitted to NICU (p = 0.010) and higher survival rate was found in amnioinfusion group (p = 0.023). Conclusion The treatment with transabdominal amnioinfusion in pregnancies complicated with PPROM resulted in significant prolongation of pregnancy and better neonatal outcomes as compared to women who were managed with traditional expectant management. How to cite this article Fatima S, Tasnim N, Mahmud G. The Effect of Transabdominal Amnioinfusion on Perinatal Outcomes in Preterm Premature Rupture of Membranes. J South Asian Feder Obst Gynae 2014;6(1):28-32.

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Long-Term Amnioinfusion through an Intrauterine Catheter in Preterm Premature Rupture of Membranes before 26 Weeks of Gestation: A Retrospective Multicenter Study

Fetal Diagnosis and Therapy ◽

10.1159/000517754 ◽

2021 ◽

pp. 1-6

Author(s):

Tomasz Goździewicz ◽

Magdalena Rycel-Dziatosz ◽

Klaudyna Madziar ◽

Tomasz Szczapa ◽

Witold Kędzia ◽

...

Keyword(s):

Latency Period ◽

Perinatal Outcomes ◽

Control Group ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Newborn Outcomes ◽

Management Group ◽

Retrospective Multicenter Study

Introduction: The objective of this study was to elucidate the efficacy of long-term amnioinfusion on perinatal outcomes in patients with preterm premature rupture of membranes (PPROM) before 26 weeks’ gestation. Material: A total of 31 patients with PPROM at a periviable gestational age (21 + 0–25 + 0 weeks) were enrolled. Long-term amnioinfusion was performed in 22 patients, and 9 patients did not receive amnioinfusion. Data were collected retrospectively from 2 clinical sites between January 2017 and March 2019. Results: In the medical management group, there was a significantly higher rate of chorioamnionitis compared to the long-term amnioinfusion group (89 vs. 15%, p = 0.001). The latency period between PPROM and delivery was higher in the amnioinfusion group (median, 5.5 vs. 3 weeks, p = 0.04). The frequency of bronchopulmonary dysplasia was higher in the control group compared to the amnioinfusion group (89 vs. 40%, p = 0.03). The rates of other neonatal complications were similar in both groups. Conclusions: Long-term amnioinfusion through an intrauterine catheter in PPROM before 26 weeks’ gestation may improve pregnancy and newborn outcomes.

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Association between latency period and perinatal outcomes after preterm premature rupture of membranes at 32–37 weeks of gestation: a perinatal registry-based cohort study

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0082 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Marie Bitenc ◽

Lea Ovsenik ◽

Miha Lučovnik ◽

Ivan Verdenik ◽

Lilijana Kornhauser Cerar

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Latency Period ◽

Perinatal Outcomes ◽

Maternal Body Mass Index ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Antenatal Corticosteroids ◽

Preterm Premature Rupture ◽

Group B

Abstract Objectives To investigate association between latency after preterm premature rupture of membranes (PPROM) and perinatal outcomes at moderately and late preterm gestation. Methods National perinatal registry-based cohort study using data for the period 2013–2018. Singleton pregnancies with non-malformed fetuses in cephalic presentation complicated by PPROM at 32+0–36+6 weeks were included. Associations between latency period and perinatal mortality, neonatal respiratory distress syndrome (RDS), early onset neonatal infection (EONI), and cesarean section were assessed using multiple logistic regression, adjusting for potential confounders (labor induction, maternal body-mass-index, maternal age, antenatal corticosteroids, and small-for-gestational-age). p<0.05 was considered statistically significant. Results Of 3,017 pregnancies included, 365 (12.1%) had PPROM at 32+0–33+6 weeks and 2,652 (87.9%) at 34+0–36+6 weeks. Among all cases, 2,540 (84%) had latency <24 h (group A), 305 (10%) 24–47 h (group B), and 172 (6%) ≥48 h (group C). Longer latency was associated with higher incidence of EONI (adjusted odds ratio [aOR] 1.350; 95% confidence interval [CI] 0.900–2.026 for group B and aOR 2.500; 95% CI 1.599–3.911 for group C) and higher rate of caesarean section (aOR 2.465; 95% CI 1.763–3.447 for group B and aOR 1.854; 95% CI 1.172–2.932 for group C). Longer latency was not associated with rates of RDS (aOR 1.160; 95% CI 0.670–2.007 for group B and aOR 0.917; 95% CI 0.428–1.966 for group C). Conclusions In moderately to late PPROM, increased latency is associated with higher risk of EONI and cesarean section with no reduction in RDS.

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