Individualized management reduces preterm birth

Individualized management may help prolong pregnancy and reduce preterm birth in cases of preterm premature rupture of membranes (PPROM), according to a recent study.

About 3% of pregnancies lead to PPROM. The condition is most often treated through expectant management, such as antenatal steroids for lung maturation and prophylactic antibiotic treatment. Investigators sought to analyze the results of management strategies for PPROM.

The multicenter retrospective study consisted of 513 women with singleton pregnancies, having experienced PPROM within 23 to 33 weeks of gestation. A standard management group of 324 individuals was given similar management to other patients, while an individualized management group of 189 individuals was given personalized management based on amniocentesis upon hospital admission. Of the 189 patients receiving individualized management, 112 were given amniocentesis.

Exclusion criteria for the individualized management included major fetal anomalies, contraindications to expectant management, active labor, and cervical dilatation greater than 2 centimeters. Latency of over 7 days was the primary outcome, while secondary outcomes included chorioamnionitis, latency to birth, and short-term adverse maternal and neonatal outcomes.

The patients with individualized management had a latency of over 7 days, and higher latency to birth. Investigators suspected that these patients also had a higher rate of clinical chorioamnionitis, but no higher rate of histologic chorioamnionitis was found, nor were there differences in funisitis, or composite infectious maternal outcomes. 

A reduction of preterm birth at under 32 weeks of gestation was seen in cases of prolonged latency in the individualized management group, as well as a reduction in neonatal intensive care unit admission and neonatal respiratory support at 28 days of life. Prolonged latency also led to fewer cases of neonatal severe morbidity at discharge.

Reference

Ronzoni S, Cobo T, D’Souza R, Barret J, Aldecoa V, Palacia M, et al. Individualized treatment of preterm premature rupture of membranes to prolong the latency period, reduce the rate of preterm birth, and improve neonatal outcomes. American Journal of Obstetrics Gynecology. 2022;227(2):296.E1-296.E18. doi:10.1016/j.ajog.2022.02.037