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Published on: November 20, 2015
Optimal time for delivery with preterm premature rupture of membranes from 32 to 36 6/7 weeks
Christopher Nold1, Naveed Hussain, Kathleen Smith
1Department of Obstetrics and Gynecology, University of Conn. Health Center, Farmington, Connecticut, USA. noldc2000@yahoo.com
Objective:
To evaluate the optimal time for delivery in singleton pregnancies with preterm premature rupture of membranes (PPROM) when delivered between 32 and 36 6/7 weeks gestational age (GA).
Study Design:
We performed a retrospective cohort study of all singleton pregnancies with PPROM who delivered between 32 and 36 6/7 weeks gestation at our institution. We matched the delivery and NICU datasets to determine composite morbidity (COMP MORB) and NICU length of stay (LOS) stratified by weeks of gestation. COMP MORB was defined as one or more of: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing entercolitis, intraventricular hemorrhage, dissiminated intravascular coagulation, and culture proven sepsis. We used χ² and student 't' test as appropriate and a receiver operating characteristc curve (ROC).
Results:
There were 195 newborns with PPROM with a range of 30 babies at 36 weeks to a high of 53 at 34 weeks. The mean (± SD) NICU LOS was 22.5 (± 9.9) days at 32 weeks, 17.8 (± 10.0) days at 33 weeks, 14.8 (± 11.0) days at 34 weeks, 4.5 (± 4.7) days at 35 weeks, and 1.5 (± 4.4) days at 36 weeks (p < 0.0001). There was no difference in duration of ROM by GA with a range of 6.8 to 1.9 by week (p = NS). The ROC curve had a cut point for COMP MORB at 34.1 weeks GA (sens = 95%, FPR 48.6%, area under curve 0.782, p = 0.0002).
Conclusion:
Our study suggests that delivery of PPROM pregnancies at 34.1 weeks GA avoids 95% of composite morbidity, and delivery after 35 weeks GA will decrease the NICU LOS.
