Expectant management versus termination of pregnancy in preterm premature rupture of membranes at 34 to 36+6 weeks gestation: a randomised control trial

Amanjot Kaur; Vanita Jain; Rashmi Bagga; S.  Radhika; S. Venkataseshan

doi:10.18203/2320-1770.ijrcog20242473

Authors

Amanjot Kaur Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
Vanita Jain Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
Rashmi Bagga Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
S. Radhika Department of Cytology and Gynaecologic Pathology, PGIMER, Chandigarh, India
S. Venkataseshan Department of Neonatology, PGIMER, Chandigarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242473

Keywords:

Preterm birth, Prematurity, Premature complications, pPROM, Corticosteroid, Expectant management, Latency, Neonatal outcome

Abstract

Background: This research work aimed to study the effect of expectant management till 37 weeks on various maternal and neonatal outcomes in comparison delivery at 34 weeks in pregnant women with pPROM.

Methods: All pregnant women presenting to our tertiary care institution with pPROM at a viable gestational age fulfilling the inclusion and exclusion criteria were managed conservatively till 37 weeks. The maternal and neonatal outcomes were noted and compared with women with pPROM who delivered at 34 weeks of gestation.

Results: There is no significant increase in the neonatal or maternal sepsis in the patients with preterm premature rupture of membranes managed conservatively beyond 34 weeks period of gestation. Two third of the patients managed conservatively had spontaneous onset of labor thereby reducing the complications of induction of labor. In addition, 44% of patients managed expectantly gained >5 days of maturity beyond 34 weeks.

Conclusions: Expectant management of pPROM beyond 34 weeks period of gestation may be an alternative to immediate delivery.

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References

Maxwell GL. Preterm premature rupture of membranes. Obstet Gynecol Surv. 1993;48(8):576-83.

Merenstein GB, Weisman LE. Premature rupture of the membranes: neonatal consequences. Semin Perinatol. 1996;20(5):375-80.

Douvas SG, Brewer MJ, McKay ML, Rhodes PG, Kahlstorf JH, Morrison JC. Treatment of premature rupture of the membranes. J Reprod Med. 1984;29(10):741-4.

Lieman JM, Brumfield CG, Carlo W, Ramsey PS. Preterm premature rupture of membranes: is there an optimal gestational age for delivery?. Obstet Gynecol. 2005;105(1):12-17.

Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol. 2013;122(4):918-30.

Thomson AJ. Care of women presenting with suspected preterm prelabour rupture of membranes from 24+ 0 weeks of gestation: green-top guideline No. 73. BJOG: Int J Obstetr Gynaecol. 2019;126(9).

Van Der Ham DP, Vijgen SM, Nijhuis JG, Van Beek JJ, Opmeer BC, Mulder AL, et al. Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: a randomized controlled trial. PLoS Med. 2012;9(4):e1001208.

Van Der Ham DP, Van Der Heyden JL, Opmeer BC, Mulder AL, Moonen RM, van Beek JH, et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol. 2012;207(4):276-e1.

Lieman JM, Brumfield CG, Carlo W, Ramsey PS. Preterm premature rupture of membranes: is there an optimal gestational age for delivery?. Obstet Gynecol. 2005;105(1):12-7.

Neerhof MG, Cravello C, Haney EI, Silver RK. Timing of labor induction after premature rupture of membranes between 32 and 36 weeks' gestation. Am J Obstet Gynecol. 1999;180(2 Pt 1):349-52.

Kayem G, Bernier-Dupreelle A, Goffinet F, Cabrol D, Haddad B. Active versus expectant management for preterm prelabor rupture of membranes at 34-36 weeks of completed gestation: comparison of maternal and neonatal outcomes. Acta Obstet Gynecol Scand. 2010;89(6):776-81.

Naef RW, Allbert JR, Ross EL, Weber BM, Martin RW, Morrison JC. Premature rupture of membranes at 34 to 37 weeks' gestation: aggressive versus conservative management. Am J Obstet Gynecol. 1998;178(1 Pt 1):126-30.

Bennet P. Preterm labor. In: Dewhurst’s Textbook of Obstetrics and Gynaecology. 7th ed. Massachusetts; Blackwell; 2007.

Bond DM, Middleton P, Levett KM, van der Ham DP, Crowther CA, Buchanan SL, et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2017;3(3):CD004735.

Seo K, McGregor JA, French JI. Preterm birth is associated with increased risk of maternal and neonatal infection. Obstet and Gynecol. 1992;79:75-80.

Wu YW, Colford JM Jr. Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis. JAMA. 2000;284(11):1417-24.

Soraisham AS, Singhal N, McMillan DD, Sauve RS, Lee SK; Canadian Neonatal Network. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol. 2009;200(4):372.e1-372.e3726.

Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB. Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA. 2003;290(20):2677-84.