Short-Term and Long-Term Postnatal Outcomes of Expectant Management After Previable Preterm Premature Rupture of Membranes With and Without Persistent Oligohydramnios

摘要

OBJECTIVE:To compare postnatal outcomes in pregnancies managed expectantly after previable preterm premature rupture of membranes (PROM) in relation to amniotic fluid volume.METHODS:A retrospective cohort study was performed in 92 women with amniotic fluid leakage for more than a week after previable preterm PROM (gestational age 14 1/7-24 0/7 weeks) who delivered a liveborn neonate at or after 24 1/7 weeks of gestation from 2002 to 2014. Short-term (sepsis, intracerebral hemorrhage, retinopathy of prematurity, respiratory distress syndrome, bronchopulmonary dysplasia) and long-term (cerebral palsy and developmental delay) outcomes were compared between women with (n=58) and without persistent oligohydramnios (n=34), defined as maximal vertical pocket less than 2 cm or amniotic fluid index less than 5 cm. We analyzed discrete data using the (2) or Fisher's exact test and continuous variables using Student's t test or Mann-Whitney U test. We also performed multivariable analyses.RESULTS:There was a significant difference in survival rate at discharge (44/58 [75.9%] compared with 34/34 [100%], P=.001) and developmental delay at a median age of 4 years after performing multiple regression analysis (adjusted odds ratio [OR] 70.3, 95% confidence interval [CI] 2.9-1,719.9, P=.009) between participants with persistent oligohydramnios and participants with normal amniotic fluid volume. A multiple regression analysis, performed to control for confounders, revealed that gestational age at delivery (adjusted OR 0.3, 95% CI 0.1-0.7, P=.008) and breech presentation (adjusted OR 90.8, 95% CI 2.2-3,778.1, P=.018) were significant factors affecting survival of children with persistent oligohydramnios.CONCLUSION:The postnatal survival rate after previable preterm PROM was lower and developmental delay more frequent in participants with persistent oligohydramnios than in participants with normal amniotic fluid volume. Even so, most neonates born alive after previable preterm PROM and persistent oligohydramnios survived to discharge and were developmentally normal. The overall survival rate was higher than in previous studies.LEVEL OF EVIDENCE:II