Expectant management of PPROM and major complications before planned delivery: A retrospective cohort study

Abstract

Women with pre-term pre-labour rupture of membranes (PPROM) 22–33 weeks’ gestation were included in a retrospective cohort study with a structured audit to identify risk factors of major complications following PPROM and to assess whether these complications are predictable. Of the 234 women analysed, 106 (45%) delivered within three days. Eighty-four women (36%) had at least one major complication and 45% of these complications occurred within three days. The complication rate was 64% in early PPROM before 28 weeks’ gestation and 11% in late PPROM at 28 weeks’ gestation or later. Nulliparous women had an increased risk of major complications (adjusted hazards ratio: 3.07 (95% confidence interval: 1.28–7.37)). The complication rates were highest in early PPROM and during the first three days after PPROM.

Multiparous women with late PPROM, who do not deliver within the first three days, have the lowest risk of major complications and are suitable for home care.

Keywords::

• Chorioamnionitis
• cord prolapse
• general obstetrics
• PPROM
• placental abruption
• place of care

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

The study was supported by grants from the Nordsjaellands Hospital, Hillerod, University of Copenhagen, Denmark; TrygFonden; Lundbeckfonden and the Danish Association of Midwives.