Obstetric and Neonatal Outcomes Following Immediate Delivery Versus Expectant Management in Pregnant Women With Preterm Premature Rupture of Membranes During the Late Preterm Period in Korea

Abstract

Background: This study aimed to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34+0-36+6 weeks of gestation. Methods: We conducted a retrospective study of singleton pregnancies with PPROM during the late preterm period using medical records from 12 tertiary medical centers in the republic of Korea between January 2007 and December 2016. Demographic characteristics and outcome measures were also recorded. The primary outcomes were maternal sepsis, neonatal sepsis, and neonatal death for neonatal outcomes. Results: Among 1,072 women with late PPROM, 782 (72.9%) underwent immediate delivery and 290 (27.1%) received expectant management. The incidence of clinical neonatal sepsis was significantly lower in the immediate delivery group than in the expectant management group (3.8% vs. 15.8%, P < 0.001). There were no significant differences in culture-proven neonatal sepsis (P = 0.211), neonatal death (P = 0.390), or maternal sepsis (P = 0.542) between groups. Although antenatal corticosteroids were more frequently administered in the expectant management group, the need for mechanical ventilation was not significantly higher (P = 0.414). However, the need for surfactant administration was lower (P = 0.010). Expectant management was associated with a lower rate of primary cesarean section (P = 0.002) but a higher incidence of antepartum fever and elevated C-reactive protein levels (P = 0.048 and P < 0.001, respectively). Conclusion: In women with late PPROM, expectant management does not increase the risk of severe maternal or neonatal morbidity or mortality compared to immediate delivery. Therefore, with close surveillance for complications, such as chorioamnionitis and fetal compromise, particularly clinical neonatal sepsis, expectant management can be a judicious treatment option in clinical practice.