Neonatology
Poster Session 2
Marta Perez, MD (she/her/hers)
MFM Fellow
UT Dell Medical School
Austin, TX, United States
Emily Hall, PhD
University of Texas at Austin, Dell Medical School
Austin, TX, United States
Miriam Alvarez, PhD
University of Texas at Austin, Dell Medical School
Austin, TX, United States
George A. Macones, MD, MSCE
The University of Texas at Austin
Austin, TX, United States
Lorie M. Harper, MD, MSCI (she/her/hers)
Associate Professor
University of Texas at Austin, Dell Medical School
Austin, TX, United States
.jpg "Alison G. Cahill, MD photo")
Alison G. Cahill, MD
Professor
University of Texas at Austin, Dell Medical School
Austin, TX, United States
Early artificial rupture of membranes (eAROM) during induction of labor (IOL) is associated with shorter time to delivery with no difference in cesarean delivery (CD) or infectious morbidity. However, definitions of eAROM vary and were developed prior to contemporary labor management. We analyzed associations of varying definitions of eAROM at specific, incremental cutoffs by either time since completion of cervical ripening or by cervical dilation with neonatal outcomes.
Study Design:
This was a retrospective cohort study of patients who had IOL and cervical ripening with intact membranes, term, singleton pregnancy at a tertiary care hospital 2015-2022. For the time-based analysis, we grouped patients by timing of ROM after completion of first dose of cervical ripening. For the dilation-based analysis, we grouped patients by the cervical dilation at the time of or preceding ROM. The outcomes were neonatal intensive care unit (NICU) admission and 5-minute APGAR < 7. Descriptive statistics were performed using chi-squared tests. Log-binomial regression was performed to estimate risk ratios adjusted for mode of delivery, gestational age, and maternal fever.
Results:
Of the 4,562 patients who met inclusion criteria, 353 (7.7%) infants were admitted to the NICU and 75 (1.6%) had a 5-minute APGAR < 7. Time of ROM since completion of cervical ripening was associated with higher risk of NICU admission and 5-minute APGAR < 7 in the unadjusted analysis. However, in the adjusted analysis, only ROM >12 hours after completion of cervical ripening had significantly higher risk of 5 min APGAR < 7 (aRR [95% CI]: 2.61 [1.14-5.98]), but not NICU admission. For the dilation-based analysis, there was no association with increased risk of either outcome in unadjusted or adjusted analysis.
Conclusion:
In examining neonatal outcomes by varied definitions of eAROM, ROM >12 hours after completion of cervical ripening is associated with increased risk of 5-minute APGAR < 7. There is no association of cervical dilation at ROM with adverse neonatal outcomes. Later, rather than eAROM, by time may increase neonatal risk.