(691) Neonatal outcomes in late preterm premature rupture of the membranes – subpopulation analysis

Following the PPROMT trial, our departmental protocol was revised in 2016, so that pregnant women with late preterm premature rupture of the membranes (PPROM), are managed conservatively up to 37 weeks. This study assessed neonatal outcomes according to clinical subpopulations, as various clinical scenarios in the face of late PPROM can affect outcomes and accordingly- clinical decisions.  

Study Design:

The study included all women with late PPROM (defined as PPROM 34–37 weeks of gestation), during 2016-2022. The conservative management (CM) group (n=397) and the active management (AM) group (n=82) were compared according to neonatal outcomes (5-minute Apgar score ≤7, phototherapy, NICU admission, neonatal respiratory support, and antibiotic treatment). Subpopulations were further analyzed: patients after cesarean delivery (CD) (n=66), twin pregnancy (n=24), diabetes mellitus (n=78), small for gestational age (SGA) (n=46), group B Strep carriers (n=15), and obesity (n=138).

Results:

When comparing active to conservative management, we found higher rates of CD (45.6% vs. 13.9%, p< 0.001), neonatal phototherapy (25.6% vs. 16.9%, p=0.05) and neonatal antibiotic treatment (6.6% vs. 1.4%, p=0.05), respectively.

Further analysis of patients after CD, twin pregnancy, diabetes or obesity, found vaginal delivery was more common in the CM compared to the AM group (P< 0.001). We also found higher rates of neonatal respiratory support in obese patients in the AM group (11.4% vs. 8.0%; P=0.002).

Conclusion:

Patients with PPROM managed conservatively had a lower CD rate, which is particularly important when emphasizing the importance of preventing primary CD. Results were similar among the different subpopulations. Importantly, we found no differences in neonatal outcomes among diabetic patients and among twin pregnancies with late PPROM, where antenatal corticosteroid treatment was not used.