Perinatal outcomes in women with preterm rupture of membranes between 24 and 32 weeks of gestation and a history of vaginal bleeding.
OBJECTIVE
The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding.


METHODS
This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome.


RESULTS
Outcome data were available for 581 patients (n=50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5%; P=.01), perinatal death (16% vs 4.9%; P=.006), intraventricular hemorrhage (14.3% vs 5.9%; P=.03), and respiratory distress syndrome (69.4% vs 40.4%; P<.0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60%; P=.002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P=.02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P=.04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P=.004).


CONCLUSIONS
Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.
Hnat
Michael D
MD
Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX 75390-9032, USA. Michael.Hnat@UTSouthwestern.edu
Mercer
Brian M
BM
Thurnau
Gary
G
Goldenberg
Robert
R
Thom
Elizabeth A
EA
Meis
Paul J
PJ
Moawad
Atef H
AH
Iams
Jay D
JD
Van Dorsten
J Peter
JP
D000037:Abruptio Placentae / Q000453:epidemiology / Q000209:etiology; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008499:Medical Records; D015337:Multicenter Studies as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000150:complications / Q000503:physiopathology*