(2) The Frequency and Severity of Complications after Previable PROM in Texas following SB8

Thursday, January 30, 2025

8:15 AM – 8:30 AM

Location: Aurora Ballroom, Lobby Level

Submitting Author(s)

Danna Ghafir, MBA (she/her/hers)

Medical Student
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Presenting Author(s)

Emily Fahl, MD

Resident Physician
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Coauthor(s)

NU

Nancy Ukoh, BA, MS

Medical Student
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
HC

Han-Yang M. Chen, PhD

Associate Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sean C. Blackwell, MD

Professor and Chair
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
JG

Julie Gutierrez, MD

Assistant Professor
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Irene A. Stafford, MD, MS

Associate Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Objective: Robust contemporary data concerning previable PROM are limited. The impact of changes in state abortion laws on maternal outcomes also remains unknown. We sought to compare outcomes of pregnant individuals who develop previable PROM at our center before and after the implementation of Texas Senate Bill 8 (SB8).

Study Design: This is a retrospective cohort study across three tertiary care hospitals from January 1, 2018-March 31, 2023. ICD-10 codes were used to identify individuals with previable PROM. Chart review was done by trained research staff. Individuals with singleton or twin gestions and clinical diagnosis of PROM < 22 weeks were studied, excluding those with IUFD and/or active PTL. We compared clinical characteristics and outcomes of individuals before and after the implementation of SB8 on September 1, 2021. Our primary outcome was composite adverse outcome, which included ICU admission, transfusion, and/or sepsis. Multivariable Poisson regression with robust error variance was used to adjust for confounding factors for the primary outcome. Adjusted relative risk (aRR) with 95% CIs was calculated.

Results: Over the 5-year study period, 166 individuals met inclusion criteria (97 pre-SB8 vs 69 post-SB8). There were no differences in baseline characteristics pre- vs post-SB8 (Table 1). Prior to SB8, 49% of individuals opted for immediate delivery. No individuals in the post-SB8 cohort were induced with previable ROM as the sole indication for delivery. There was a higher rate of the composite adverse outcome (20.6% vs 37.7%; aRR 2.02, 95% CI 1.2-3.3), after adjusting for age, race and ethnicity, and gestational age at delivery. Time from rupture to delivery was longer in the post-SB8 cohort (median [IQR]: 1 [1-3] days vs 6 [2-12] days, p< 0.001) and demonstrated a higher incidence of sepsis (6.2% vs 31.9%; aRR 5.15, 95% CI 2.27-11.7).

Conclusion: Prior to SB8, nearly one-half of individuals opted for pregnancy termination due to previable PROM. After SB8, risks of serious adverse outcomes increased nearly 2X, and the risk of sepsis increased over 4X.