397: Predicators for short latency period to delivery in p-PROM at less than 34 weeks of gestation

  • Wertheimer A
  • Ashwal E
  • Fraiman-Hakerem N
  • et al.
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Abstract

OBJECTIVE: To identify factors affecting the duration of the latency period to delivery in women presenting with preterm premature rupture of membranes (PPROM) at <34 weeks. STUDY DESIGN: A retrospective cohort study of all women with PPROM at 23+0-33+6 weeks in a single tertiary center (2007-2014). Latency period was defined as the time interval between onset of PPROM to either spontaneous delivery, labor induction at 34+0 weeks, or indicated delivery due to suspected cho-rioamnionitis. Women presenting with PPROM and cervical dilatation >2cm at presentation or with immediate indicated delivery for indications other than suspected chorioamnionitis were excluded. RESULTS: 1) Overall, among 59,935 deliveries during the study period 459 (1.5%) presented as PPROM <34 week of gestation, of them 299 met inclusion criteria. 2) Latency period exceeded 48 hours in 41.5% of cases and 7 days in only 22.4% of cases. 3) Latency period was not affected by classical risk factors for preterm delivery (PTD) such as previous PPROM or preterm delivery, previous late abortion or uterine anomalies (Table). 4) While mean latency period was 3.3 (2.6-4.0) days in women presenting at 30-33 weeks, in those presenting at 23-26 weeks it was 14.6 (8.2-20.9) days (P<0.001), confirming an inverse relation between gestational age at PPROM and latency period (Figure). 5) Using Cox pro-portional hazards model, gestational age at admission (HR¼1.15, 95%CI 1.09-1.22, <0.0001), contraction at admission (HR¼1.45, 95%CI 1.13-1.88, p¼0.004) and multifetal gestation (HR¼2.00, 95%CI 1.47-2.71, p<0.0001) were associated with short latency period. CONCLUSION: Several predictive factors for short latency period in cases of PPROM <34 weeks of gestation were identified. This in-formation may assist in risk stratification and consultation for women presenting with PPROM <34 weeks of gestation. 398 Should preterm prom between 24 and 34 weeks of gestation be managed with home care? a before-and-after study in a tertiary center OBJECTIVE: Patients with preterm PROM (PPROM) before 34 weeks of gestation (WG) are usually managed expectantly in the absence of maternal or fetal contraindications. In our tertiary academic center, a protocol to manage PPROM with home care was established in April 2013. Our purpose was to study perinatal issues before and after implementation of this protocol. STUDY DESIGN: All women admitted for PPROM before 34+0 WG between January 2011 and August 2015 were included (period A « before protocol »: 01/2011 to 04/2013 and period B « after protocol »: 04/2013 to 08/2015). Women eligible to home care management during period B were compliant women with a singleton cephalic fetus, without clinical or biological signs of infection, cervical length!20mm and amniotic fluid index!2cm. After a 3-5 days hospitalization, they were managed at home with a daily clinical surveillance and a weekly biological surveillance. We compared perinatal issues between periods A and B. RESULTS: One hundred and forty-five women with PPROM were included in period A and 157 in period B. During period B, 16% of women (n¼25) were eligible to home care management. The gestational age at PPROM and the term at delivery were similar between periods A and B (respectively, 28.9AE3.1 WG vs 29.4AE3.1; p¼0.199 and 30.7AE 3.3 vs 30.9AE3.3; p¼0.611). The duration of latency was not significantly different between periods A and B (12.9AE15.9 days vs 11.5AE14.4, p¼0.421), but was longer for women managed with home care (median 29.2 days, IQ[6-71]). The mean antenatal hospitalization duration was shorter during period B (12.7AE15.2 days vs 8.5AE10.9; p¼0.003). Mode of delivery was similar between the two periods. Lower rates of neonatal infection were observed (possible infection: 27 % vs 18 % / proven infection: 12 % vs 5 %; p¼ 0,007) and intraventricular hemorrhage (23 % vs 12 %; p¼ 0,013) during period B. Among the 25 women managed with home care during period B, we observed only one case of neonatal proven infection (4%) and only one case of intraventricular hemorrhage (4%). CONCLUSION: After implementation of the protocol, 16% of women with PPROM were eligible to home care management. We observed

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Wertheimer, A., Ashwal, E., Fraiman-Hakerem, N., Hadar, E., Aviram, A., Wiznitzer, A., … Hiersch, L. (2017). 397: Predicators for short latency period to delivery in p-PROM at less than 34 weeks of gestation. American Journal of Obstetrics and Gynecology, 216(1), S238. https://doi.org/10.1016/j.ajog.2016.11.655

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