Safety and efficacy of extended expectant management in preterm premature rupture of membrane between 32 and 34 weeks of pregnancy-A randomization control trial

Background

Cases of preterm premature rupture of membranes (PPROM) occur in approximately 3 % of pregnancies and are a significant contributor to preterm birth and its associated complications. Traditionally expectant management followed by delivery at 34 weeks is the recommended standard for treatment of PPROM but recent evidence suggests that extended expectant management in selected cases improves the pregnancy outcome. Thus the study aims to compare the feto-maternal outcome in PPROM cases between traditional management (delivery at 34 weeks) and extended expectant management (delivery at 36 weeks)

Methodology

Women presenting to labor emergency with leakage due to membrane rupture at 32 to 34 weeks of gestation were randomly assigned as per CONSORT guidelines into two groups, group A (n = 72) with traditional treatment and group B (n = 72) with extended expectant management. The pregnancy outcomes and feto-maternal outcomes of both groups were analyzed by appropriate statistical tools.

Results

Out of a total of 144 cases with comparable baseline characteristics, 72 patients in group A had the mean gestational age at delivery was 34.02 weeks and in group B it was 35.02 weeks. There is no significant increase in chorioamnionitis and other maternal morbidity in group B. The mean birth weight was significantly higher in group B patients. The median duration of NICU stay, need for mechanical ventilation and complications like neonatal jaundice and necrotizing enterocolitis were significantly lower (p-value < 0.05) in Group B as compared to Group A reflecting a better perinatal outcome.

Conclusion

Extended expectant management can safely be considered in PPROM cases till 36 weeks based on the timing of onset of PPROM without the fear of increased risk of maternal chorioamnionitis and adverse neonatal outcomes.