Preterm prelabour rupture of membranes may influence outcomes in the next pregnancy

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Takeaway 

  • Pregnancy preterm prelabour rupture of membranes (PPROM) in the first pregnancy is associated with significant adverse maternal and perinatal outcomes in the next pregnancy, but not reduced likelihood of second pregnancy.

Why this matters 

  • PPROM is associated with up to 40% of preterm births, and is a leading cause of maternal, foetal and neonatal morbidity and mortality that follow.

Study design

  • Women with a history of PPROM (n=37,776); divided into exposed (PPROM in first pregnancy; n=1979) and unexposed (no PPROM; n=35,797) cohorts.
  • Pregnancy outcomes in the second singleton pregnancy assessed in each cohort (exposed, n=1174; unexposed, n=20,860)
  • Funding: National University Hospital, Singapore.

Key results

  • PPROM women in the first singleton pregnancy were at an increased risk for adverse outcomes in the next singleton pregnancy:

          —   PPROM (OR, 6.6; P<.001),

          —   pre-eclampsia (OR, 2.4; P<.001),

          —   instrumental and caesarean delivery (OR, 1.8; P<.001),

          —   pregnancy-induced hypertension (OR, 1.5; P=.001),

          —   antepartum haemorrhage (OR, 1.3; P=.009),

          —   neonatal infection (OR, 5.4; P=.013),

          —   neonatal death (OR, 2.6; P=.044),

          —   admission to neonatal unit (OR, 2.4; P<.001),

          —   preterm delivery (OR, 2.3; P<.001) and

          —   low birth weight (OR, 1.4; P=.009).

Limitations

  • The results cannot be generalised to all women.