Timing of elective termination of Pregnancy in Preterm Premature Rupture of membranes, A prospective randomized controlled trial

Abstract

Background: Rupture of fetal membranes before the 37th week of gestation is defined as preterm premature rupture of membranes (PPROM) and is related with a high-risk perinatal period. PPROM occurs in approximately 3% of all pregnancies. Aim of the work: to determine the effectiveness of elective delivery at 34 weeks of gestation compared to delivery at 36 weeks of gestation on reducing maternal and neonatal morbidities at maternal hospital Ain Shams University. Patients and Methods: A randomized study was conducted on 140 Eligible and consenting gravid women divided into either conservative group (70) that delivered at 36 weeks of gestation or termination group (70) that delivered at 34 weeks of gestation from March 2019 to august 2019, at maternity hospital of Ain Shams University. Informed consent was obtained from all participants. Results: Compared with conservative management until 36 weeks, termination at 34 weeks increased the risk of several adverse newborn outcomes:, Respiratory distress syndrome (RR 0.25, 95% Cl 0.06–1.14), IVH (RR 0.20, 95% Cl 0.02–1.67)), Admission to the neonatal intensive care unit (RR 0.50, 95% Cl 0.32–0.78), Neonatal sepsis (RR 2.00, 95% Cl 0.38–10.57) , For the mother, termination at 34 weeks resulted in:, Lower rate of chorioamnionitis (RR 2.00, 95% Cl 0.52–7.68), Higher cesarean delivery rate (RR 0.63, 95% Cl 0.40–0.98), Lower rate of endometritis (RR 2.00, 95% Cl 0.19–21.56). Conclusion: Our findings show that delivery at 34 weeks of gestation does not reduce rate of intraamniotic infection, but does increase the likelihood of respiratory distress and mechanical ventilator support and rate of NICU admission for the baby and caesarean section for the mother. This results support the practice of conservative management in pregnant women with ruptured membranes if there is no contraindication to extend the pregnancy.