Nold C, Hussain N, Smith K, Campbell W, Borgida A, Egan J. Optimal time for delivery with preterm premature rupture of membranes from 32 to 36 6/7 weeks.
J Matern Fetal Neonatal Med 2010;
24:933-5. [PMID:
21142773 DOI:
10.3109/14767058.2010.535876]
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Abstract
OBJECTIVE
To evaluate the optimal time for delivery in singleton pregnancies with preterm premature rupture of membranes (PPROM) when delivered between 32 and 36 6/7 weeks gestational age (GA).
STUDY DESIGN
We performed a retrospective cohort study of all singleton pregnancies with PPROM who delivered between 32 and 36 6/7 weeks gestation at our institution. We matched the delivery and NICU datasets to determine composite morbidity (COMP MORB) and NICU length of stay (LOS) stratified by weeks of gestation. COMP MORB was defined as one or more of: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing entercolitis, intraventricular hemorrhage, dissiminated intravascular coagulation, and culture proven sepsis. We used χ² and student 't' test as appropriate and a receiver operating characteristc curve (ROC).
RESULTS
There were 195 newborns with PPROM with a range of 30 babies at 36 weeks to a high of 53 at 34 weeks. The mean (± SD) NICU LOS was 22.5 (± 9.9) days at 32 weeks, 17.8 (± 10.0) days at 33 weeks, 14.8 (± 11.0) days at 34 weeks, 4.5 (± 4.7) days at 35 weeks, and 1.5 (± 4.4) days at 36 weeks (p < 0.0001). There was no difference in duration of ROM by GA with a range of 6.8 to 1.9 by week (p = NS). The ROC curve had a cut point for COMP MORB at 34.1 weeks GA (sens = 95%, FPR 48.6%, area under curve 0.782, p = 0.0002).
CONCLUSION
Our study suggests that delivery of PPROM pregnancies at 34.1 weeks GA avoids 95% of composite morbidity, and delivery after 35 weeks GA will decrease the NICU LOS.
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