(859) Neonatal and Maternal Outcomes Following Implementation of Expectant Management of Late Preterm PROM

Recent evidence suggests that both immediate delivery and expectant management until 37 weeks are reasonable options for stable preterm premature rupture of membranes (PPROM) in the late preterm period.  We compared maternal and neonatal outcomes pre- and post-implementation of a January 2021 institutional guideline which introduced the option of expectant management after 34 weeks’ gestation.

Study Design:

This was a retrospective cohort study of patients admitted with PPROM between 28 – 36 6/7 weeks’ gestation from May 2019 to December 2020 (pre-implementation) and from April 2021 to December 2022 (post-implementation). Pregnancies with fetal anomalies and multiple fetuses were excluded. The primary outcome was neonatal intensive care unit (NICU) length of stay (LOS). Secondary outcomes included neonatal sepsis, maternal LOS, and chorioamnionitis.  

Results:

Data were collected from 170 patients pre-implementation and 180 post-implementation. The median gestational age at the time of PPROM was the same between groups (34 weeks, IQR 32 – 35.3 vs. 34 weeks, IQR 32.1 – 35.1). NICU LOS was similar in both pre- and post-groups (14.7 days, IQR 4.4 - 29.7 vs. 12.7 days, IQR 4.0 - 23.4, p=0.35). When patients in active labor at the time of admission were excluded, results remained similar (13.5 days, IQR 4.0 - 27.7 vs. 11.0 days, IQR 4.0 - 22.9, p=0.35). The incidence of neonatal sepsis was similar between groups (1.8% vs. 3.9%, p=0.22), as was the incidence of chorioamnionitis (6.5% vs. 8.3%, p=0.51). There was a statistically significant increase in maternal LOS (3 days (IQR 3-5) vs. 4 days (IQR 3-7), p=0.02) in the post-implementation period. There were no significant differences in need for neonatal respiratory support, stillbirth or neonatal demise, maternal postpartum antibiotics, postpartum hemorrhage, or blood transfusion (Table 1). 

Conclusion:

Offering expectant management of late PPROM at a tertiary care academic center led to similar maternal and perinatal outcomes with no change in neonatal NICU LOS and a modest increase in maternal LOS.