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157: Near-term premature rupture of membranes: Expectant management compared to delivery in a community hospital

      Objective

      To characterize neonatal and maternal morbidity rates of expectant mangement compared with a hospital policy of delivery of pregnancies complicated by near-term premature rupture of membranes (PROM).

      Study Design

      Historical Case-Control study. Control patients (N=29) experienced PROM from 34 1/7 to 35 6/7 weeks between April 2002 and December 2004. Pregnancies with PROM were managed expectantly until at least 36 weeks gestation. Study patients (N=26) were from May 2005 to February 2008. The policy was established that delivery will be recommended without delay for PROM after 34 0/7 weeks in May 2005. The outcomes evaluated included neonatal mortality, composite major and minor neonatal morbidity, individual major and minor neonatal morbidity rates, maternal infection morbidity, and maternal and neonatal length of stay.

      Results

      Neonates of the control group had lower rate of RDS (20.7% vs 52%), minor (27.6% vs 88%), major morbidities (0% vs 20%) and shorter length of neonatal stay (4 vs 9 days)(all p<0.05). The control group had a trend towards a lower rate of chorioamnionitis 3.4% vs 8.0% (p=0.51), endometritis 0% vs 4% (p=1.00) and significantly lower cesarean section 20.7% vs 44% (p=0.02).

      Conclusion

      Our findings suggest that expectant management of near term pregnancies with PROM reduced the risk of RDS, neonatal major and minor morbidities and neonatal length of hospital stay at 34-35 weeks gestation without a significant difference in risk of chorioamnionitis and endometritis in a community hospital.