Incidence and management of premature rupture of membranes in Victoria, Australia: A retrospective cohort study of 636 590 births between 2009 and 2017
Natalie Jardine Cameron, Dagmar Wertaschnigg, Mary-Ann Davey, Renée Janne Burger, Ben Willem Mol, Andrea Mary Woolner
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Abstract
Background
Premature rupture of membranes (PROM) is a complication affecting 7–12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (ie <37 weeks gestation) precedes one-third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis.
Aim
To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009 and 2017.
Materials and methods
This retrospective population-based cohort study included all singleton pregnancies from 2009 to 2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: (a) expectant management; (b) induction of labour (IOL); and (c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management.
Results
Of 636 590 singleton pregnancies, 52 669 (8.3%) births with PROM at term (42 439; 6.7%) or PPROM (10 230; 1.6%) were identified. Of these, the majority were managed expectantly (n = 22 726; 43.1%), or with IOL (25 931; 49.2%). While elCS represented only 7.6% of these cases (n = 4012), its use rose consistently from 2009 to 2017 for PROM at term and PPROM alike. For women with PPROM at 34–36 weeks the odds of elCS increased by 5% annually (adjusted odds ratio (aOR) 1.05; 95% CI 1.02–1.08) and 2% for IOL (aOR 1.02; 95% CI 1.00–1.05) vs expectant management.
Conclusions
The use of elCS and IOL in PPROM is rising in Victoria, particularly between 34 and 36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase.
期刊介绍:
The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.