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Objective The American College of Obstetricians and Gynecologists (ACOG) suggests expectant management until 34 weeks for patients with preterm premature rupture of membranes (PPROM). New data suggest extending to 37 weeks might enhance neonatal outcomes, reducing prematurity-linked issues. This study aims to assess adverse neonatal outcomes across gestational ages in women with PPROM.

Study Design A retrospective cohort study was performed using linked vital statistics and the International Classification of Diseases, Ninth Revision data. Gestational age at delivery ranged from 32 to 36 weeks. Outcomes include neonatal intensive care unit (NICU) admission >24 hours, neonatal sepsis, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons.

Results In this cohort of 28,891 deliveries, there was a statistically significant decline in all studied adverse neonatal outcomes with increasing gestational age, without an increase in neonatal sepsis. At 32 weeks, 93% of newborns were in the NICU >24 hours compared with 81% at 34 weeks and 22% at 36 weeks (p < 0.001). At 32 weeks, 20% had neonatal sepsis compared with 11% at 34 weeks and 3% at 36 weeks (p < 0.001). At 32 weeks, 67% had respiratory distress syndrome compared with 44% at 34 weeks and 12% at 36 weeks (p < 0.001).

Conclusion In the setting of PPROM, later gestational age at delivery is associated with decreased rates of adverse neonatal outcomes without an increase in neonatal sepsis.

Key Points

The ACOG recommends expectant management until 34 weeks for patients with PPROM.

However, expectant management to 37 weeks might improve neonatal outcomes.

Later gestational age at delivery was associated with decreased rates of adverse neonatal outcomes.

Later gestational age at delivery was not associated with an increase in neonatal sepsis.

The management of PPROM is complex and should be individualized.

Keywords late preterm premature rupture of membranes - neonatal outcomes - expectant management Note

This study was conducted at Oregon Health and Science University in Portland, Oregon.

Findings from this study were presented as a poster presentation at the Pacific Coast Obstetrical and Gynecological Society Annual Meeting on September 1, 2022, in Wailea, HI.

Publication History

Received: 16 October 2023

Accepted: 15 May 2024

Accepted Manuscript online:
16 May 2024

Article published online:
18 June 2024

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