Objective
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.
Results
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).
Conclusion
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
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References
- Preterm premature rupture of the membranes.Obstet Gynecol. 2003; 101: 178-193
- ACOG practice bulletin: Premature rupture of membranes: clinical management guidelines for obstetrician-gynecologists (no. 1).Int J Gynaecol Obstet. 1998; 63: 75-84
- The natural history of preterm ruptured membranes: what to expect of expectant management.Obstet Gynecol. 1988; 71: 558-562
- Expectant management of preterm premature rupture of the membranes.Am J Obstet Gynecol. 1994; 171: 350-358
- Premature rupture of membranes before 28 weeks: conservative management.Am J Obstet Gynecol. 1986; 155: 471-479
- Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae?.Obstet Gynecol. 1989; 74: 347-350
- Preterm premature rupture of membranes and abruptio placentae: Is there an association between these pregnancy complications?.Am J Obstet Gynecol. 1995; 172: 672-676
- Management of premature rupture of membranes before 26 weeks' gestation.Obstet Gynecol Clin North Am. 1992; 19: 339-351
- Association of prolonged, preterm premature rupture of membranes and abruptio placentae.J Reprod Med. 1986; 31: 249-253
- Preterm premature rupture of membranes: a risk factor for the development of abruptio placentae.Am J Obstet Gynecol. 1987; 156: 1235-1238
- 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
- Vaginal bleeding and adverse reproductive outcomes: a meta-analysis.Paediatr Perinat Epidemiol. 1994; 8: 62-78
- Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis.Obstet Gynecol. 1996; 8: 309-318
- Uterine activity among a diverse group of patients at high risk for preterm delivery.Obstet Gynecol. 1990; 76: 47S-51S
- Perinatal outcome of pregnancies complicated by vaginal bleeding.BJOG. 1992; 99: 959-963
- Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: a randomized controlled trial.JAMA. 1997; 278: 989-995
Article info
Publication history
Accepted:
October 28,
2004
Received in revised form:
September 28,
2004
Received:
May 7,
2004
Footnotes
Supported in part by cooperative agreements from the National Institute of Child Health and Human Development and supported by grants U10-HD-21434, U10-HD-27917, U10-HD27915, U10-HD-27869, U10-HD-27905, U10-HD-27861, U10-HD-27860, U10-HD-27889, U10-HD-27883, U10-HD-21414, U01-HD19897, and U01-HD36801 from the National Institute of Child Health and Human Development, Bethesda, Md.
Presented at the Twenty-second annual meeting of the Society for Maternal-Fetal Medicine, New Orleans, Louisiana, January 14-19, 2002.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
