Active versus expectant management for preterm prelabor rupture of membranes at 34-36 weeks of completed gestation: comparison of maternal and neonatal outcomes.

OBJECTIVE

To compare maternal and neonatal outcomes in deliveries managed by a policy of expectant management and active management of women with preterm prelabor rupture of membranes (pPROM), at 34-36 completed weeks of gestation.

DESIGN

Retrospective multicenter cohort study.

SETTING

Three tertiary care teaching hospitals in France.

POPULATION

Women with pPROM were identified from the databases of three perinatal centers.

METHODS

Maternal and neonatal complications were compared according to the hospital policy in effect at pPROM--expectant or active management.

MAIN OUTCOME MEASURES

Clinical chorioamnionitis, neonatal morbidity including neonatal infection, respiratory problems, and metabolic disorders.

RESULTS

During the seven-year study period, 634 women were admitted for pPROM at 34-36 completed weeks of gestation, 241 of whom were included in the study: 126 in the group with a policy of expectant management and 115 in the active management group. The incidence of clinical chorioamnionitis was 4.8% in the former and 0.9% in the latter (p = 0.07). Neonatal oxygen was still needed at 24 hours significantly more often in the active than in the expectant management group (7.0 vs. 1.6%, p = 0.05). However, after adjustment for gestational age at birth, only delivery at 34 weeks of gestation remained associated with the need for neonatal oxygen at 24 hours. The rate of hypoglycemia or hypocalcemia was 5.6% in the expectant management group versus 12.3% in the active management group (p = 0.07). There were no neonatal deaths.

CONCLUSION

A policy of active management, especially at 34 weeks of gestation, was associated with greater neonatal morbidity, whereas an expectant management policy tended to be associated with an increased rate of clinical chorioamnionitis.