General Obstetrics and Gynecology: Obstetrics| Volume 193, ISSUE 1, P164-168, July 2005

Download started.


Perinatal outcomes in women with preterm rupture of membranes between 24 and 32 weeks of gestation and a history of vaginal bleeding


      The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding.

      Study design

      This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome.


      Outcome data were available for 581 patients (n = 50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5%; P = .01), perinatal death (16% vs 4.9%; P = .006), intraventricular hemorrhage (14.3% vs 5.9%; P = .03), and respiratory distress syndrome (69.4% vs 40.4%; P < .0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60%; P = .002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P = .02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P = .04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P = .004).


      Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mercer B.M.
        Preterm premature rupture of the membranes.
        Obstet Gynecol. 2003; 101: 178-193
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin: Premature rupture of membranes: clinical management guidelines for obstetrician-gynecologists (no. 1).
        Int J Gynaecol Obstet. 1998; 63: 75-84
        • Cox S.M.
        • Williams M.L.
        • Leveno K.J.
        The natural history of preterm ruptured membranes: what to expect of expectant management.
        Obstet Gynecol. 1988; 71: 558-562
        • Nelson L.H.
        • Anderson R.L.
        • O'Shea T.M.
        • Swain M.
        Expectant management of preterm premature rupture of the membranes.
        Am J Obstet Gynecol. 1994; 171: 350-358
        • Beydoun S.N.
        • Yasin S.Y.
        Premature rupture of membranes before 28 weeks: conservative management.
        Am J Obstet Gynecol. 1986; 155: 471-479
        • Gonen R.
        • Hannah M.E.W.
        • Milligan J.E.
        Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae?.
        Obstet Gynecol. 1989; 74: 347-350
        • Major C.A.
        • de Veciana M.
        • Lewis D.F.
        • Morgan M.A.
        Preterm premature rupture of membranes and abruptio placentae: Is there an association between these pregnancy complications?.
        Am J Obstet Gynecol. 1995; 172: 672-676
        • Mercer B.M.
        Management of premature rupture of membranes before 26 weeks' gestation.
        Obstet Gynecol Clin North Am. 1992; 19: 339-351
        • Nelson D.M.
        • Stempel L.E.
        • Zuspan F.P.
        Association of prolonged, preterm premature rupture of membranes and abruptio placentae.
        J Reprod Med. 1986; 31: 249-253
        • Vintzileos A.M.
        • Campbell W.A.
        • Nochimson D.J.
        • Weinbaum P.J.
        Preterm premature rupture of membranes: a risk factor for the development of abruptio placentae.
        Am J Obstet Gynecol. 1987; 156: 1235-1238
        • Holmgren P.A.
        • Olofsson J.I.
        Preterm premature rupture of membranes and the associated risk for placental abruption. Inverse correlation to gestational length.
        Acta Obstet Gynecol Scand. 1997; 76: 743-747
        • Ananth C.V.
        • Savitz D.A.
        Vaginal bleeding and adverse reproductive outcomes: a meta-analysis.
        Paediatr Perinat Epidemiol. 1994; 8: 62-78
        • Ananth C.V.
        • Savitz D.A.
        • Williams M.A.
        Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis.
        Obstet Gynecol. 1996; 8: 309-318
        • Martin Jr., J.N.
        • McColgin S.W.
        • Martin R.W.
        • Roach H.
        • Morrison J.C.
        Uterine activity among a diverse group of patients at high risk for preterm delivery.
        Obstet Gynecol. 1990; 76: 47S-51S
        • Sipila P.
        • Hartikainen-Sorri A.L.
        • Oja H.
        • Von Wendt L.
        Perinatal outcome of pregnancies complicated by vaginal bleeding.
        BJOG. 1992; 99: 959-963
        • Mercer B.M.
        • Miodovnik M.
        • Thurnau G.R.
        • Goldenberg R.L.
        • Das A.F.
        • Ramsey R.D.
        • et al.
        Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: a randomized controlled trial.
        JAMA. 1997; 278: 989-995