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- W4200529218 abstract "As the ideal timing of delivery for PPROM remains unclear, we capitalized on a unique hospital guideline to investigate outcomes of immediate delivery (ID) of PPROM at 35 wks compared to expectant management (EM) of PPROM until 36 wks. Retrospective cohort study of patients with singleton non-anomalous pregnancies admitted with PPROM > 20 wks from 1/1/2011-5/1/2021. Hospital guidelines for PPROM recommended delivery at 35 wks from 2011-2016 and 36 wks from 2017-2021. Subjects with ID at 35 wks were compared to those with EM until 36 wks. The primary outcome was composite neonatal morbidity: need for respiratory support, culture positive sepsis, or antibiotic administration for > 72 hrs. Secondary outcomes included NICU admission, length of NICU stay, and maternal infection. A total of 232 mother-infant dyads were included: 137 (59%) ID at 35 wks and 95 (41%) EM until 36 wks. The relative risk of the composite neonatal outcome was significantly higher in those managed with ID compared to EM (44.5% vs 24.2%; RR 1.4, 95% CI 1.2, 1.7). This finding remained significant after adjusting for differences in betamethasone administration (aOR 2.1, 95% CI 1.1, 4.1). Those with ID had a 2.8 times increased risk of NICU admission compared to EM (95% CI 1.7, 4.8). ID was also associated with a longer NICU stay than EM (median 7 days vs 1 day, p< 0.001). There was no difference in neonatal sepsis (p=0.59), maternal chorioamnionitis (p=0.38) or endometritis (p=0.25) between the two groups. There were no cases of stillbirth. This study found a higher risk of composite neonatal morbidity and NICU admission when PPROM was managed with ID at 35 wks compared to EM until 36 wks. EM until 36 wks did not increase maternal or neonatal infection. We encourage further dissemination of perinatal outcomes following expectant management of PPROM in the late preterm period." @default.
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- W4200529218 date "2022-01-01" @default.
- W4200529218 modified "2023-09-30" @default.
- W4200529218 title "Expectant management of PPROM until 36 weeks reduced neonatal morbidity without increasing chorioamnionitis" @default.
- W4200529218 doi "https://doi.org/10.1016/j.ajog.2021.11.296" @default.
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