(469) Change in Late Preterm PROM Guidelines Result in Increased Expectant Management

To investigate the rates of expectant management of preterm prelabor rupture of membranes (PPROM) past 34w0d before and after practice guideline changes in March 2020 at a tertiary level medical center and the corresponding maternal and neonatal outcomes.

Study Design:

This is a retrospective cohort study of 299 gravid, singleton patients who underwent PPROM prior to 36w6d and delivered at 34w0d to 36w6d between June 2015 and June 2022. The primary outcome is NICU admission rate, and secondary outcomes include PPROM latency, corticosteroid administration, composite neonatal morbidity (5-minute Apgar < 7, umbilical artery pH < 7.10, assisted ventilation, respiratory distress syndrome, hypoxic ischemic encephalopathy, antibiotic administration >72 hours, intraventricular hemorrhage, seizures, death) and composite maternal morbidity (chorioamnionitis, placental abruption, maternal sepsis, maternal transfusion).

Results:

176 patients (58.9%) before and 123 patients (41.1%) after March 2020 were included. No patients before 2020 and 6 patients (4.8%) after 2020 experienced PPROM before 34w0d and delivered in the late preterm period. There was no difference in PPROM and delivery gestational ages (Table 1). PPROM latency was longer after 2020 (1.01±0.32 vs. 0.52±0.11 days, p=0.001). More patients underwent expectant management (26.8% vs. 11.9%, p< 0.001) and received corticosteroids (78.0% vs. 60.2%, p=0.001) after 2020. There was no difference in NICU admission rates and composite neonatal and maternal morbidities (Table 1). In the patients who underwent expectant management, PPROM occurred at a higher gestational age prior to March 2020 (Table 2, p=0.04). There was no difference in delivery gestational age, latency, NICU admission rates, and composite neonatal and maternal morbidities in patients who underwent expectant management (Table 2).

Conclusion:

Significantly more patients underwent expectant management of PPROM past 34w0d after March 2020, but there was no difference in NICU admission rates and composite maternal and neonatal morbidities, even in those who underwent expectant management.