(598) Patient Outcomes: Preterm Prelabor Rupture of Membranes Before 34 weeks with Late Preterm Delivery

Preterm prelabor rupture of membranes (PPROM) affects 3% of births in the United States and is a significant cause neonatal morbidity and mortality. Guidelines recommend offering expectant management of delivery when appropriate. The objective of this study was to evaluate neonatal and maternal outcomes by gestational week of delivery for patients with PPROM before 34 weeks and delivery at 34 weeks or greater.

Study Design:

This was a historical cohort study of patients delivered for PPROM at a single institution between January 2015 and October 2023. The study group included patients who had PPROM with a singleton gestation and non-anomalous fetus. Maternal and neonatal outcomes were compared by gestational week of delivery.

Results:

In the cohort, 72 patients had PPROM before 34 weeks with delivery at 34 weeks or greater. Maternal and neonatal outcomes are outlined in the table. Those who delivered at 34 weeks were more likely to have a vaginal delivery after spontaneous preterm labor, compared to those that delivered at 35 weeks, who were more likely to have a vaginal delivery after induction of labor (p=0.039). Neonates delivered at 35 weeks were less likely to have hyperbilirubinemia (p=0.019) and less likely to be admitted to the neonatal intensive care unit (p < 0.001) than those delivered at 34 weeks. Outcomes of cesarean delivery, chorioamnionitis, postpartum endometritis, postpartum hemorrhage, 5-minute APGAR < 7, neonatal hypoglycemia, neonatal sepsis, respiratory distress or tachypnea, and neonatal resuscitation were not significantly different between groups. There were no differences in maternal death, neonatal death, necrotizing enterocolitis, intraventricular hemorrhage, and fetal demise.

Conclusion:

For those with PPROM before 34 weeks and delivery at 34 weeks or greater, those that delivered at 34 weeks were more likely to have spontaneous preterm labor, neonatal intensive care unit admission, and neonatal hyperbilirubinemia than those delivered at 35 weeks. This data supports counseling patients for expectant management to 35 weeks or more when appropriate.