Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34-36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes

Ferraz, Malú Flôres; Lima, Thaísa De Souza; Cintra, Sarah Moura; Araujo Júnior, Edward; Petrini, Caetano Galvão; Caetano, Mario Sergio Silva Gomes; Paschoini, Marina Carvalho; Peixoto, Alberto Borges

doi:10.1055/s-0040-1718954

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. Bras. Ginecol. Obstet. 42 (11) • Nov 2020 • https://doi.org/10.1055/s-0040-1718954 copy

Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34-36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes

Manejo ativo versus expectante para ruptura prematura de membranas entre 34 e 36 semanas de gestação e os resultados perinatais adversos associados

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil.

Methods:

In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used.

Results:

Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x² [1] = 3.1, p = 0.0001, R² Nagelkerke = 0.138).

Conclusion:

There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

Keywords:
preterm premature rupture of membranes; antibiotic prophylaxis; maternal morbidity; neonatal morbidity

	Group I (n = 78)	Group II (n = 40)	p-value
Maternal age (years old)	23.7 (5.5)	22.7 (6.0)	0.379^† † Student t-test: mean (standard deviation).
Ethnicity			0.366^§ § Chi-squared percentage (absolute number), p < 0.05.
White	42.59% (33/77)	43.6% (17/39)
Mixed	49.4% (38/77)	51.3% (20/39)
Black	7.8% (6/77)	2.6% (1/39)
Asian	0% (0/77)	2.6% (1/39)
Tobacco use			0.565^§ § Chi-squared percentage (absolute number), p < 0.05.
Yes	11.1% (8/72)	7.7% (3/39)
No	88.9% (64/72)	92.3% (36/39)
Alcohol use			0.202^§ § Chi-squared percentage (absolute number), p < 0.05.
Yes	4.2% (3/72)	0% (0/38)
No	95.8% (69/72)	100% (38/38)
Number of pregnancies	1.9 (1.2)	1.9 (1.0)	0.876^† † Student t-test: mean (standard deviation).
Parity	0.70 (1.2)	0.60 (0.9)	0.456^† † Student t-test: mean (standard deviation).
GA at admission (weeks)	35.6 (0.7)	35.8 (0.7)	0.097^† † Student t-test: mean (standard deviation).
AFI (cm)	5.50 (3.4)	11.30 (3.5)	0.002^† † Student t-test: mean (standard deviation).
PCR at admission (mg/dl)	1.50 (2.4)	5.2 (3.1)	0.002^† † Student t-test: mean (standard deviation).
Time of prophylactic antibiotics (hours)	5.40 (6.5)	18.4 (16.0)	<0.001^† † Student t-test: mean (standard deviation).
Latency time (hours)	20.9 (17.6)	33.60 (24.0)	0.001^† † Student t-test: mean (standard deviation).
Type of delivery			0.303^§ § Chi-squared percentage (absolute number), p < 0.05.
Vaginal	71.8% (56/78)	62.5% (25/40)
Cesarean section	28.2% (22/78)	37.5% (15/40)
Birthweight (grams)	2577.4 (392.6)	2650 (416.3)	0.354^† † Student t-test: mean (standard deviation).
GA at delivery (weeks)	36.50 (0.9)	37.20 (1.1)	<0.001^† † Student t-test: mean (standard deviation).
Apgar score at 1^st minute	8.30(1.3)	8.30 (1.3)	0.941^† † Student t-test: mean (standard deviation).
Apgar score at 5^th minute	8.9 (0.5)	9.0 (0.8)	0.941^† † Student t-test: mean (standard deviation).
Time of NICU (hr)	306 (231.3)	191.4 (239.9)	0.459^† † Student t-test: mean (standard deviation).

	Group I (n = 78)			Group II (n = 40)			X²	p-value
	n	N	%	n	N	%
Apgar score at 5th min < 7							1.75	0.185
Yes	7	78	9.0	1	40	2.5
No	71	78	91.0	39	40	97.5
NICU							2.04	0.153
Yes	4	78	5.1	5	40	12.5
No	74	78	94.9	35	40	87.5
Needed oxygen within 24h							0.587	0.444
Yes	17	78	21.8	12	40	30.0
No	61	78	78.2	28	40	70.0
Surfactant								^† † It was not possible to perform statistical tests on variables with less than three patients in each category.
Yes	0	78	0.0	0	40	0.0
No	78	78	100.0	40	40	100.0
Fetal death								^† † It was not possible to perform statistical tests on variables with less than three patients in each category.
Yes	0	78	0.0	1	40	2.5
No	78	78	100.0	39	40	97.5
Neonatal death								^† † It was not possible to perform statistical tests on variables with less than three patients in each category.
Yes	0	78	0.0	0	40	0.0
No	78	78	100.0	40	40	100.0
Maternal death								^† † It was not possible to perform statistical tests on variables with less than three patients in each category.
Yes	0	78	0.0	0	40	0.0
No	78	78	100.0	40	40	100.0
Neonatal sepsis							0.479	0.489
Yes	2	78	2.6	2	40	5.0
No	76	78	97.4	38	40	95.0
Maternal sepsis								^† † It was not possible to perform statistical tests on variables with less than three patients in each category.
Yes	0	78	0.0	0	40	0.0
No	78	78	100.0	40	40	100.0
Chorioamnionitis							0.235	0.628
Yes	1	78	1.3	1	40	2.5
No	77	78	98.7	39	40	97.5
Composite neonatal outcome							0.668	0.414
Yes	18	78	23.1	12	40	30.0
No	60	78	76.9	28	40	70.0

	OR	95%CI	X²	R² (Nagelkerke)	p-value
Tobacco use	1.6	0.33–8.19	0.43	0.006	0.513
GA at admission (weeks)	3.1	1.56–6.31	0.14	0.138	0.001
AFI (cm)	0.97	0.76–1.23	0.058	0.005	0.810
PCR at admission (mg/dl)	0.9	0.87–1.08	3.67	0.149	0.055
Time of prophylactic antibiotics (hours)	1.0	0.97–1.06	0.84	0.011	0.36
Latency time (hours)	1.0	0.98–1.02	0.02	0	0.885

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[1] Address for correspondence Edward Araujo Júnior, PhD Rua Napole:o de Barros, 875 Vila Clementino, São Paulo, SP, 04024-002 Brazil araujojred@terra.com.br