Neonatal Outcome After Expectant Management of Preterm Premature Rupture of Membranes (PPROM) Between 34+0 and 36+6...

The aim of the study was to assess adverse neonatal outcome after preterm premature rupture of membranes (PPROM) between 34+0 and 36+6 weeks of gestation in patients undergoing expectant management after PPROM according to the intrauterine inflammation, infection, or both (TRIPLE-I) criteria.

This retrospective analysis included 323 singleton pregnancies with PPROM between 34+0 and 36+6 weeks of gestation. Groups of cases that met at least some of the TRIPLE-I diagnostic criteria and were suspected of having TRIPLE-I were created and compared with groups of cases that did not meet these criteria.

Mean gestational age at time of birth was 35.9 weeks [IQR; 35.0-36.4], mean gestational age at time of PPROM was 34.7 [IQR; 34.0 -35.4], and mean birth weight was 2,660 g [IQR; 2,140-2,985]. Two hundred four (63.2%) infants were delivered vaginally, 107 (33.1%) via caesarean section and 12 (3.7%) women had vaginal operative delivery (vacuum extraction). There were only two cases of maternal fever, and no case met all TRIPLE-I diagnostic criteria. No significant increase in risks were found for low umbilical artery pH (OR: 1.88 (95% CI: 0.50-5.88), p = 0.29), low Apgar score (OR: 1.14 (95% CI: 0.17-4.73), p = 0.86), or need for neonatal admission to neonatal intensive care unit (NICU) due to infection (OR: 1.14 (95% CI: 0.17-4.73), p = 0.62) in women with elevated white blood cell count in performed logistic regressions. Same applied for cases with tachycardic cardiotocography (CTG).

Expectant management appears to be a viable and potentially safe approach for managing cases of PPROM between 34+0 and 36+6 weeks of gestation, without significantly increasing the risk of adverse neonatal outcome. However, close monitoring, personalized care and readiness to intervene are important for optimally managing these clinical cases.