Preterm premature rupture of membranes (PPROM): outcomes of delivery at 32(°/7)-33(6/7) weeks after confirmed fetal lung maturity (FLM) versus expectant management until 34(°/7) weeks.
OBJECTIVE
Our objective was to compare maternal and neonatal outcomes in patients with preterm premature rupture of membranes (PPROM) delivered prior to 34(°/7) weeks upon confirmation of fetal lung maturity (FLM) to those managed expectantly until 34(°/7) weeks.


METHODS
We performed a retrospective cohort study of non-anomalous singleton gestations with PPROM occurring after 24 weeks delivered between 32(°/7) and 34(°/7) weeks from 2004 to 2012. Patients delivered upon documented FLM (+FLM)--defined as the presence of phosphatidylglycerol (PG) at 32(°/7)-33(6/7) weeks if amniotic fluid was obtainable vaginally--were compared with patients delivered without documented FLM between 32(°/7) and 34(°/7) weeks (expectant). Primary outcomes included maternal infection (clinically diagnosed endometritis or chorioamnionitis), placental abruption and a composite of neonatal morbidities (including but not limited to mechanical ventilation, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and respiratory distress syndrome). Statistical analysis was performed using Student's t-test for continuous variables and Chi-square or Fisher's exact test for categorical data. Covariates were analyzed via multivariate logistic regression and adjusted odds ratios were calculated.


RESULTS
Of 237 PPROMs delivered at 32(°/7)-34(°/7) weeks, 74 were intentionally delivered for +FLM and 163 were expectantly managed. No cord prolapse or stillbirth was observed. Maternal infection (chorioamnionitis or endometritis) was lower in the +FLM group (aOR 0.33 95% CI 0.12-0.88). Overall, there was no difference in composite neonatal morbidity did not differ between the two groups (aOR 1.36 95% CI 0.53-3.54).


CONCLUSIONS
In patients with PPROM, delivery after confirmation of FLM at 32(°/7)-33(6/7) weeks compared with expectant management until 34(°/7) weeks may prevent maternal infection without increasing neonatal morbidity.
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham , AL , USA and.
Akila
A
Subramaniam
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham , AL , USA and.
Sue S
SS
Cliver
b School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA.
Stephanie
S
Smeltzer
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham , AL , USA and.
Alan T
AT
Tita
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham , AL , USA and.
Luisa L
LL
Wetta
D000328:Adult; D000407:Alabama / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D008297:Male; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D057832:Watchful Waiting; D055815:Young Adult
Expectant management; PPROM; fetal lung maturity