Early planned labor induction vs expectant management in late preterm pre-labor rupture of membranes: maternal and neonatal outcomes
, 2, 2, 12, 12, 12
Abstract
Objectives: To compare expectant management with early planned labor induction in pregnancies complicated by late preterm pre-labor rupture of membranes (PPROM).
Material and methods: A retrospective file review was conducted in a single tertiary center from January 2015 to Sep-tember 2019. Singleton pregnancies complicated by late PPROM at 34–36 completed weeks of gestation were enrolled. We compared maternal and neonatal complications between expectant management and early planned labor induction.
Results: We retrospectively assigned 41 women to the expectant management group and 39 to the early planned labor induction group. No difference was found in the mode of delivery between the groups. Women in the expectant manage-ment group had a longer antepartum hospital stay compared with the induction group (median of three versus one day, p < 0.01). Neonates were delivered at a more advanced gestational age in the expectant management group compared with that in the induction group (35 5/7 versus 35 2/7 weeks, p < 0.01). In the induction group, 74.4% of the neonates were admitted to the intensive care unit (ICU), and 66.7% received antibiotics compared with 51.2% of neonates admitted to ICU and 29.3% receiving antibiotics in the expectant management group (p = 0.04 and p < 0.01, respectively).
Conclusions: In pregnancies complicated by late PPROM, early labor induction was associated with a shorter antepartum maternal hospital stay but a higher neonatal ICU admission rate and more frequent antibiotic administration than expect-ant management. We consider expectant management to be an acceptable alternative to early labor induction in PPROM.
Keywords: cesarean sectionchorioamnionitislabor inductionneonatal respiratory distress syndromepremature rupture of membrane (pregnancy)
References
- Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am. 2005; 32(3): 411–428.
- Prelabor Rupture of Membranes: ACOG Practice Bulletin Summary, Number 217. Obstet Gynecol. 2020; 135(3): 739–743.
- Thomson AJ. Royal College of Obstetricians and Gynaecologists. Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24 Weeks of Gestation: Green-top Guideline No. 73. BJOG. 2019; 126(9): e152–e166.
- Quist-Nelson J, de Ruigh AA, Seidler AL, et al. Preterm Premature Rupture of Membranes Meta-analysis (PPROMM) Collaboration. Immediate Delivery Compared With Expectant Management in Late Preterm Prelabor Rupture of Membranes: An Individual Participant Data Meta-analysis. Obstet Gynecol. 2018; 131(2): 269–279.
- Gyamfi-Bannerman C, Thom EA, Gyamfi-Bannerman C, et al. NICHD Maternal–Fetal Medicine Units Network. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med. 2016; 374(14): 1311–1320.
- Committee on Obstetric Practice. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2017; 130(2): e102–e109.
- Kamath-Rayne BD, Rozance PJ, Goldenberg RL, et al. Antenatal corticosteroids beyond 34 weeks gestation: What do we do now? Am J Obstet Gynecol. 2016; 215(4): 423–430.
- Morris JM, Roberts CL, Bowen JR, et al. PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet. 2016; 387(10017): 444–452.
- Ham Dv, Vijgen S, Nijhuis J, et al. Induction of Labor versus Expectant Management in Women with Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Randomized Controlled Trial. PLoS Medicine. 2012; 9(4): e1001208.
- van der Ham DP, van der Heyden JL, Opmeer BC, et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol. 2012; 207(4): 276.e1–276.10.
- Bond DM, Middleton P, Levett KM, et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2017; 3: CD004735.
- Johnson J, Quach C. Outbreaks in the neonatal ICU: a review of the literature. Curr Opin Infect Dis. 2017; 30(4): 395–403.
- Chertok IR, McCrone S, Parker D, et al. Review of interventions to reduce stress among mothers of infants in the NICU. Adv Neonatal Care. 2014; 14(1): 30–37.
- Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ. 2016; 355: i5044.
- Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery. Am J Obstet Gynecol. 2016; 215(2): B13–B15.
- National Institute for Health and Care Excellence. Preterm labour and birth. Nice guideline [NG25]. Published 20 November 2015. https://www.nice.org.uk/guidance/ng25/chapter/Recommendations#maternal-corticosteroids (23.01.20218).
- Stutchfield PR, Whitaker R, Gliddon AE, et al. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed. 2013; 98(3): F195–F200.
