Optimum mode of delivery in gestations complicated by preterm premature rupture of the membranes

Abstract

Objectives: To provide evidence about the preferable mode of delivery, vaginal (VD) or caesarean section (CS), in PPROM. Methods: A retrospective study of 190 cases. Survival analysis was used to identify statistically significant differences in mortality rates. Results: A total of 126 pregnancies were included in our study. Mean gestational age of rupture was 28⁺⁰ weeks (min = 15, max = 36⁺⁴, sd = 5.796). Mean birth age was 30⁺⁰ weeks (min = 15, max = 37⁺², sd = 5.353). CS was performed in 55 cases (43.7%), VD in 71 cases (56.3%). Data analysis showed that, regardless of presentation, there was a statistically significant benefit on survival in favor of the CS in births below 30 gestational weeks (n = 39, nCS = 18, nND = 21, χ² = 7.946, p = 0.005). Hazard ratio estimation set the critical gestational age at 28 weeks. For vaginal deliveries, breech presentation was associated with inferior survival outcome compared to vertex (nTotal = 71; nVertex = 63, nBreech = 8, χ² = 13.012, p < 0.001.Also in breech presentation, VD survival outcome was inferior to CS (nTotal = 9; nVD = 6, nCS = 3, χ² = 5.145, p < 0.05). Conclusions: According to our results, in cases of PPROM, CS was beneficial below 28 weeks and in breech presentation below 30 weeks.

Keywords::

• PPROM
• cesarean section
• survival
• preterm birth
• rupture of membranes

Declaration of Interest: The authors report no declarations of interest.