Poster Session 4
Timothy Wen, MD, MPH (he/him/his)
Assistant Professor
University of California, San Diego
Irvine, California, United States
Brittany Arditi, MD, MSCR
Clinical Fellow
Columbia University Irving Medical Center
New York, NY, United States
.jpg "Nasim C. Sobhani, MD, MS photo")
Nasim C. Sobhani, MD, MS
Assistant Professor
UCSF
San Francisco, California, United States
Cynthia Gyamfi-Bannerman, MD, MS (she/her/hers)
Professor and Chair
University of California, San Diego
San Diego, California, United States
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor
Cleveland Clinic Lerner College of Medicine
Cleveland, Ohio, United States
Teresa C. Logue, MD, MPH (she/her/hers)
OB/GYN Resident
Christiana Care Health System
Newark, DE, United States
Maria Andrikopoulou, MD
Assistant Professor
Columbia University Irving Medical Center
New York, New York, United States
Lanbo Yang, MD (he/him/his)
Resident Physician
Tulane University School of Medicine
Tulane University School of Medicine, Louisiana, United States
.jpg "Milli Desai, MD, MS photo")
Milli Desai, MD, MS
University of California, San Francisco
University of California, San Diego, California, United States
Alexander M. Friedman, MD, MPH
Professor of Obstetrics and Gynecology
Columbia University Irving Medical Center
New York, New York, United States
Kartik K. Venkatesh, MD, PhD (he/him/his)
Associate Professor
The Ohio State University
Columbus, Ohio, United States
International data suggest that expectant management of preterm premature rupture of membranes (PPROM) up to 37 weeks is safe compared with 34-week delivery. U.S. data on this evolving practice is lacking. We examined maternal outcomes and healthcare utilization between delivery at 35-37 versus 34 weeks after a PPROM diagnosis < 34 weeks.
Study Design:
This study included livebirth delivery hospitalizations in the Nationwide Inpatient Sample from 2016-2021 that had a diagnosis of PPROM < 34 weeks with consequent delivery between 34-37 weeks. The exposure was timing of delivery defined as 34+0 to 34+6 versus 35+0 to 37+6 weeks per best obstetrical estimate of gestational age in completed weeks at delivery per National Center for Health Statistics recommendations. Outcomes at delivery included a composite of maternal infection (chorioamnionitis, endometritis, sepsis, shock), severe maternal morbidity (SMM) with and without transfusion, and cesarean delivery. Secondary outcomes included postpartum length of stay (ppLOS) and total hospitalization costs. Logistic regression models adjusted for payer type, self-reported race as a social construct, obstetric comorbidity index, hospital characteristics, and birth year.
Results:
Among 73,365 deliveries between 34-37 weeks with a PPROM diagnosis < 34 weeks, 920 (1.3%) delivered between 35-37 weeks. Delivery between 35-37 weeks was associated with a higher risk of maternal infection (3.3% vs. 12.5%, aOR: 3.74, 95% CI: 2.37, 5.91) and cesarean delivery (28.4% vs. 44.7%, aOR 1.69, 95% CI: 1.22, 2.34) versus delivery at 34 weeks. There were no differences in SMM by timing of delivery (Figure 1). Hospitalization costs were three-fold higher with delivery between 35-37 weeks ($22,487 vs. $6,669), but median ppLOS were similar between the two groups (Figure 2).
Conclusion:
Later delivery between 35+0 to 37+6 weeks following PPROM < 34 weeks was associated with higher likelihood of infectious morbidity and cesarean delivery compared with delivery between 34+0 to 34+6 weeks. These national U.S. observational data contrast with recent international trials.
