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Prematurity

Poster Session 2

(401) Digital exams in patients with PPROM: Outcomes based on number of exams

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: ACOG recommends minimizing digital exams in patients with preterm prelabor rupture of membranes (PPROM). However, many patients with PPROM ultimately receive digital exams when speculum exams are limiting or not feasible.  We examined the association between number of digital exams and outcomes in patients with PPROM in a modern population.

Study Design: This was a retrospective cohort study of patients with PPROM at a single center between January 2019 and March 2021. Inclusion criteria were singleton gestations between 24w0d and 33w6d gestation with confirmed rupture of membranes who delivered > 24 hours after PPROM diagnosis. The primary outcome was chorioamnionitis. Secondary outcomes were composite maternal and neonatal infectious morbidity. These outcomes were compared between patients who had <1 and >1 digital exams prior to the diagnosis of labor or start of induction.  A Cox proportional hazards regression model was performed to account for latency (duration between admission and delivery).

Results: 125 patients with PPROM were included in this analysis. The median number of digital exams performed were 2 (interquartile range 1, 3).  Patient with >1 digital exams were more likely to go into spontaneous labor (24% vs. 51%, p=0.003). However, there was no significant difference in pregnancy latency between patients with <1 and >1 digital exams (9 vs. 6 days, p=0.19). There was no difference in the rate of chorioamnionitis between patients with <1 and >1 digital exams (23.9% vs. 20.3%, hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.47, 2.18).  Composite maternal infectious morbidity (30.4% vs 24.1%, HR 0.92, 95% CI 0.46, 1.85) and neonatal infectious morbidity (2.2% vs 3.8%, HR 2.01, 95% CI 0.21, 19.59) were similar between groups.  

Conclusion: Although >1 digital exam was associated with an increase in spontaneous labor, this is likely confounded by indication (symptomatic patients are more likely to get digital exams than speculum exams). Importantly, there is no association between number of digital exams and latency or infectious morbidity in patients with PPROM.