BACKGROUND AND PURPOSE:

• Guidelines differ on when best to deliver late preterm PROM
• ACOG
  • Expectant management, if no infection, between 23 and 34 weeks of gestation
  • Suggested delivery at 34 weeks
• The Royal College of Obstetricians and Gynecologists guidelines and the Dutch Society of Obstetrics and Gynecology suggest that at 34 or 35 weeks of gestation
  • Plan for delivery OR
  • Await labor using a shared care decision model
• Quist-Nelson et al. (Obstetrics & Gynecology, 2018) compared the effects of immediate delivery vs expectant management for late preterm period PROM

METHODS:

• Individual participant data meta-analysis
• All randomized controlled trials with individual participant data reporting on late preterm PROM with randomization to immediate delivery or expectant management were included
• Late preterm period: between 34 0/7 and 36 6/7 weeks
• Primary outcome was a composite of adverse neonatal outcomes
  • Probable or definitive neonatal sepsis
  • Necrotizing enterocolitis
  • Respiratory distress syndrome
  • Stillbirth or neonatal death

RESULTS:

• 3 eligible trials were included, totaling 2563 mothers and 2572 neonates
• Composite adverse neonatal outcome not significant
  • 9.6% of the immediate delivery group
  • 8.3% of the expectant management group
    • relative risk [RR] 1.20, 95% CI 0.94-1.55
• Neonatal sepsis rates did not differ
  • 2.6% of the immediate delivery group
  • 3.5% of the expectant management group
    • RR 0.74, 95% CI 0.47-1.15
• Neonates in the immediate delivery group were more likely to be
  • Diagnosed with respiratory distress syndrome (RR 1.47, 95% CI 1.10-1.97)
  • Admitted to the neonatal intensive care unit or special care nursery (RR 1.17, 95% CI 1.11-1.23) with longer admission stays
• Mothers randomized to immediate delivery were
  • Less likely to have an antepartum hemorrhage (RR 0.57, 95% CI 0.34-0.95)
  • Less likely to have chorioamnionitis (RR 0.21, 95% CI 0.13-0.35)
  • More likely to undergo cesarean delivery (RR 1.26, 95% CI 1.08-1.47)

CONCLUSION:

• Authors note this study does not assess long-term consequences
  • Potential benefit of immediate delivery: Avoid potential risk for poor long-term neurologic outcomes after preterm PROM, even in the absence of infection
  • Potential benefit of expectant management: Late preterm birth associated with higher risks of morbidity and academic difficulties
• A limitation of this study was the inconsistent definition of neonatal sepsis between studies
• For women with late preterm PROM, immediate delivery and expectant management had comparable rates of adverse composite neonatal outcome
• Individual secondary outcomes compared to primary composite outcome showed mixed results

Learn More – Primary Sources:

Immediate Delivery Compared With Expectant Management in Late Preterm Prelabor Rupture of Membranes: An Individual Participant Data Meta-analysis.  

Related ObG Topics:

ACOG Guidance Update: Diagnosis and Management of PROM (Prelabor Rupture of Membranes)

Should Tocolytics Be Used Following PPROM?

PROM 37 Weeks and Beyond: Induction or Watchful Waiting?