Intentional delivery versus expectant management in preterm prelabour rupture of membranes at 28-34 weeks of gestation - A prospective observational study.

Abstract

BackgroundPreterm prelabour rupture of membrane (PPROM) often precedes a significant number of preterm deliveries. However, the optimal timing of delivery in women with PPROM remains unclear.ObjectiveTo compare duration of neonatal intensive care between two management strategies - intentional delivery and expectant delivery, in women with PPROM between 28 and 34 weeks of gestation. Additionally, we also compared other crucial neonatal and maternal outcomes between the two groups.Materials/methodThis prospective observational study enrolled women aged over 18 years; singleton pregnancy complicated by PPROM occurring between 28 and 34 weeks of gestation. These women were managed either by intentional delivery (ID) or expectant management (ED), as per clinician discretion.ResultA total of 115 women were included in the study; 68 women underwent intentional delivery and 47 women by expectant management. Neonates born to mothers in the ID group had a significantly shorter hospital stay compared to those in the ED group (12.71 ± 13.89 vs. 20.02 ± 20.94, Mean difference 7.3 days, 95% CI: -0.9 to -13.7 days, p 0.026). The early onset neonatal sepsis was similar [11 (16.2%) in the ID group and 9 (19.1%) in the ED group, p 0.688 and other neonatal and maternal outcomes were also comparable between the two groups.ConclusionIn intentional management, the duration of neonatal hospital stay was shorter in comparison to the expectant management group, while there was no difference in other maternal and major neonatal outcomes. There was a clinician preference for expectant delivery with lower foetal weight.