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Prematurity

Poster Session 4

(996) Maternal and Neonatal Outcomes of Pregnancies with PPROM following Expectant Management or Elective Termination

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Preterm premature rupture of membranes (PPROM) accounts for one third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare patient outcomes following PPROM at 25-29 weeks to previable and periviable PPROM.

Study Design:

A retrospective cohort of 233 pregnancies with 256 neonates were identified by maternal ICD-9/10 codes for PPROM who delivered at UPMC between 2015 and 2019. Patients were excluded with congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM. Chi square test was used for dichotomous variables and t-test for continuous variables.

Results:

Neonatal demographics did not vary by cohort with the exception of GA at PPROM. In the previable and periviable cohorts, 77 pregnancies in our cohort (58%) ended in termination, fetal or neonatal demise. Significantly fewer maternal complications including chorioamnionitis, sepsis, endometritis, and death were observed in patients who underwent elective termination for previable PPROM (p= 0.0053). In our previable cohort, 100% of neonates from pregnancies that were expectantly managed had severe outcomes including late onset sepsis, intraventricular hemorrhage, and chronic lung disease. Neonatal outcomes were statistically significantly different across all cohorts, with increased morbidity associated with earlier GA at PPROM. Maternal morbidity rates were similar across cohorts. All cohorts achieved similar mean latencies.

Conclusion:

Despite achieving similar GA at birth and latency, earlier GA at PPROM is associated with higher neonatal death rates and severe morbidity in survivors. Moreover, neonatal morbidity is greater than has been reported by gestational age. Maternal morbidity was similar across all cohorts. However, significantly fewer maternal complications were seen in pregnancies with previable PPROM that were electively terminated.