Risk factors for previable premature rupture of membranes or advanced cervical dilation: A case control study

doi:10.1016/j.ajog.2005.12.017

American Journal of Obstetrics and Gynecology

Volume 194, Issue 4, April 2006, Pages 1168-1174

https://doi.org/10.1016/j.ajog.2005.12.017 Get rights and content

Objective

The purpose of this study was to identify risk factors for second trimester premature preterm rupture of membranes or advanced cervical dilation in a high-risk population.

Study design

A retrospective case control study was performed that compared women with premature preterm rupture of membranes or advanced cervical dilation to term control subjects. The cases included all singleton pregnancies between 14 and 24 weeks of gestation with premature preterm rupture of membranes or advanced cervical dilation between 1996 and 2000. The next 2 term deliveries were chosen as control subjects. The variables compared between cases and control subjects included pregnancy history, infectious and medical histories, cervical/uterine procedures, and habits. This study had institutional review board approval.

Results

There were 102 women with premature preterm rupture of membranes, 56 women with advanced cervical dilation, and 316 control subjects. The mean gestational ages for premature preterm rupture of membranes or advanced cervical dilation were 20 ± 2.6 and 19.9 ± 2.6 weeks. Tobacco use, history of or current cervical incompetence, previous second trimester delivery, previous termination at <20 weeks of gestation, and previous premature preterm rupture of membranes were associated significantly with premature preterm rupture of membranes or advanced cervical dilation compared with term control subjects. When controlled for parity, age, marital status, and race, these variables remained significant. Bacterial vaginosis in current pregnancy was associated significantly with only advanced cervical dilation but not premature preterm rupture of membranes compared with control subjects. A history of Chlamydia was most common in the term control subjects (19.6%).

Conclusion

In a high-risk population of inner city women, only pregnancy history and tobacco use distinguished women with second trimester premature preterm rupture of membranes or advanced cervical dilation from term control subjects. No infectious risk factors distinguished control women from women with premature preterm rupture of membranes. The only modifiable risk identified was tobacco use.

Section snippets

Methods

A retrospective case control study was performed that compared women with PPROM or ACD to term control subjects. Cases and control subjects were identified from the delivery log book, and charts were reviewed to confirm diagnosis and to collect data. The cases were all singleton pregnancies between 14 weeks 0/7 days and 24 weeks 0/7 days of gestation with PPROM or ACD between January 1, 1996, and December 31, 2000. ACD was defined as membranes bulging to or through the external cervical os

Results

One hundred two women had second trimester PPROM, and 56 women had ACD during the study period. Control subjects were collected in a 2:1 control to total case (PPROM and ACD) ratio and were not matched on any characteristics. Therefore, there were 316 control subjects. The total number of deliveries at the University of Illinois at Chicago, during the study period was 12,674; the prevalences of previable PPROM and ACD were 0.8% and 0.4%, respectively. Interestingly, 23 of the 56 women (41%)

Comment

The rate of mid-trimester PPROM or ACD in our population was 1%, which is relatively high and suggests that this is a very high-risk group of women for early PPROM.1, 2, 12 In a case control study in a high-risk population of inner city women of color, we found that the significant associations with mid-trimester PPROM were similar to those reported associations for later PPROM and included tobacco use and history of previous poor pregnancy outcome.14, 15, 16 The largest associations were with

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Cited by (26)

Controversies in treatment practices of the mother-infant dyad at the limit of viability
2022, Seminars in Perinatology
Citation Excerpt :
Rupture of membranes at the limit of viability is a rare event (<1%).73 The vast majority of periviable PPROM occurs spontaneously, but risk factors include a history of preterm delivery (OR: 15.2; 95% CI 16.1–37.8), cervical incompetence in the current pregnancy (OR, 12.7; 95% CI 3.5–46.4), cerclage (OR, 10.3; 95% CI 2.8–38.8), prior history of PROM (OR, 7.3; 95% CI 2.5–22.3), and tobacco use (OR, 2.0; 95% CI, 1.1–3.9).74 Following multi-disciplinary counseling, the majority of women confronted with PPROM at the limit of viability terminate pregnancy (∼82%).75
In the setting of threatened extreme preterm birth, balancing maternal and fetal risks and benefits in order to choose the best available treatment options is of utmost importance. Inconsistency in treatment practices for infants born between 22 and 24 weeks of gestatotional age may account for inter-hospital variation in survival rates with and without impairment. Most importantly, non-biased and accurate information must be presented to the family as soon as extremely preterm birth is suspected, including counseling on morbidities and mortality associated with delivery at the limits of viability. This review will focus on different therapeutic medical and surgical practices available for threatened extremely preterm birth to improve fetal and maternal outcomes while highlighting the importance of patient-centered approaches.
Periviable Premature Rupture of Membranes
2020, Obstetrics and Gynecology Clinics of North America
Citation Excerpt :
These factors include a history of cervical insufficiency or cerclage, antepartum bleeding, multiple gestations, prior PPROM or preterm labor, tobacco smoking, and amniocentesis.11 Although inflammation from bacterial infection can lead to extracellular matrix weakening, in a review by Kilpatrick and colleagues,12 infection with gonorrhea, chlamydia, or bacterial vaginosis was not associated with PPROM. This suggests that other bacteria play a role in inflammation as evidenced by a higher level of histologic chorioamnionitis13 and fetal inflammatory response syndrome.14
Antenatal management in case of preterm premature rupture of membranes before fetal viability: CNGOF Preterm Premature Rupture of Membranes Guidelines
2018, Gynecologie Obstetrique Fertilite et Senologie
Préciser le pronostic maternel, périnatal et infantile à long terme en cas de rupture prématurée des membranes préviable et préciser les interventions susceptibles de réduire les risques et d’améliorer le pronostic.
Recherche bibliographique en langue française et anglaise à partir des bases de données Medline et Cochrane entre 1994 et septembre 2018 et à partir des recommandations de sociétés savantes internationales.
La RPM préviable est un évènement rare dont la fréquence varie suivant les estimations entre 0,3 et 1 % (NP4). Lorsqu’elles surviennent au décours d’une amniocentèse le pronostic est meilleur qu’en cas de RPM spontanée (NP3). Entre 23 et 39 % des femmes accoucheront dans la semaine qui suit la RPM et près de 40 % des femmes n’auront pas accouché 2 semaines après (NP3). La fréquence des interruptions médicales de grossesse est très variable suivant les études (NP4), tout comme celle des morts fœtales (NP4). Les taux de survie hospitalière et de survie sans morbidité majeure rapportés au nombre de patientes ayant un traitement conservateur varient respectivement de 17 à 55 % et 26 à 63 % (NP4). Le pronostic néonatal est largement dominé par la prématurité et ses complications (NP3). La fréquence du sepsis maternel varie entre 0,8 et 4,8 % dans les études les plus récentes (NP4). Un seul cas de mort maternelle est rapporté, 3 cas ont cependant été identifiés en France entre 2007 et 2012 (NP3). L’information est une composante à part entière du soin à apporter aux femmes et à leur conjoint (Accord professionnel). Une période d’hospitalisation initiale peut être proposée (Accord professionnel). Au décours, il n’y a pas d’argument pour recommander une prise en charge hospitalière plutôt qu’une prise en charge extra-hospitalière dès lors qu’il n’existe pas d’argument en faveur d’une infection intra-utérine (Accord Professionnel). Une évaluation de la quantité de liquide amniotique par échographie pourra être proposée lors de la consultation initiale et après un délai de 7 à 14 jours si la grossesse se poursuit (Accord Professionnel). Il est recommandé d’administrer un traitement antibiotique prophylactique dès le diagnostic de RPM (Accord professionnel). L’âge gestationnel à partir duquel débuter un traitement par corticoïdes sera fonction des seuils choisis pour entreprendre des soins de réanimation néonatale. Il prendra notamment en compte le positionnement parental (accord professionnel). À partir du moment où est décidé de réaliser une réanimation néonatale et jusqu’à l’âge gestationnel de 32 SA, il est recommandé d’administrer du MgSO₄ à la patiente dont l’accouchement est imminent (grade A). Il n’est pas recommandé d’administrer une tocolyse dans ce contexte (Accord professionnel). Dans certaines situations répondant strictement aux conditions mentionnées par le Code de santé publique article L. 2213-1, une demande maternelle d’interruption médicale de grossesse pourra être discutée.
Les niveaux de preuve des travaux scientifiques sur la prise en charge des RPM préviables sont faibles ; aussi, un certain nombre des recommandations proposées ici sont-établis à partir d’accord professionnel par extension « raisonnable » des recommandations valables pour des âges gestationnels plus avancés.
To evaluate the maternal, perinatal and long-term prognosis in the event of previable premature rupture of the membranes (PROM) and to specify the interventions likely to reduce the risks and improve the prognosis.
The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
Previable PROM is a rare event whose frequency varies from 0.3 to 1% according to estimates (NP4). When occurring as a complication of amniocentesis, the prognosis is generally better than when spontaneous (NP3). Between 23 and 39% of women will deliver in the week following PROM and nearly 40% of women will not have given birth 2 weeks after (NP3). The frequency of medical termination of pregnancy varies greatly according to the studies (NP4), as does that of fetal death (NP4). Hospital survival and survival rates without major morbidity as a proportion of conservatively treated patients range from 17–55% and 26–63%, respectively (NP4). Neonatal prognosis is largely dominated by prematurity and its complications (NP3). The frequency of maternal sepsis varies from 0.8 to 4.8% in the most recent studies (NP4). Only one case of maternal death is reported, although 3 cases were identified in France between 2007 and 2012 (NP3). Information is a major component of the care to be provided to women and their partners (Professional consensus). An initial period of hospitalization may be proposed after previable PROM (Professional consensus). Thereafter, there is no argument to recommend hospital management rather than extra-hospital management when there is no argument in favour of intrauterine infection (Professional consensus). An evaluation of the amount of amniotic fluid by ultrasound may be proposed at the initial consultation and after a period of 7 to 14 days if pregnancy continues (Professional consensus). Prophylactic antibiotic treatment is recommended as soon as PROM is diagnosed (Professional consensus). The gestational age at which corticosteroid therapy may be proposed will depend on the thresholds selected for neonatal resuscitation care. In particular, it will take into account parental positioning (Professional consensus). From the time of the decision to perform neonatal resuscitation until the gestational age of 32 weeks, it is recommended to administer MgSO₄ to the woman whose delivery is imminent (Grade A). Tocolysis is not recommended in this context (Professional consensus). In certain situations, meeting strictly the conditions mentioned by the CSP article L. 2213-1, a maternal request for medical interruption of pregnancy may be discussed.
The levels of evidence of scientific work on the management of previable PROM are low, therefore, most of the recommendations proposed here are based on professional agreement by “reasonable” extension of recommendations valid for later gestational ages.
Genetics and genomics of preterm birth
2018, Human Reproductive and Prenatal Genetics
Preterm birth (PTB) is one of the major pregnancy disorders that results in significant fetal mortality and morbidity. For those fetuses that survive, the resulting complications negatively impact lifelong health and well-being. To date, the accurate and early identification of women who will subsequently deliver preterm has been largely unsuccessful, compounded by the lack of an effective therapy or preventive solutions. New approaches are urgently needed to reduce the medical, social, and economic costs of PTB. The major focus of recent investigations pointed to potential molecular markers of this dysfunction. Existing evidence clearly support a notion that PTB has its roots in maternal genetics. This chapter also includes a critical analysis of the current literature on the epidemiology and genomics of PTB. We also discuss implications for future research: new large-scale genomic analysis might help to identify women predisposed to develop this pregnancy complication as well as help in their management and care.
Management and outcomes of pregnancies complicated by preterm premature rupture of membranes before 26 weeks of gestation
2014, Gynecologie Obstetrique et Fertilite
Évaluer le devenir à court terme des grossesses compliquées d’une rupture prématurée des membranes (RPDM) avant 26 semaines d’aménorrhée (SA).
Étude rétrospective incluant 40 patientes prises en charge entre 1998 et 2008.
La moitié des RPDM a eu lieu avant 23 SA. Un pourcentage de 21,4 des enfants ont survécu lorsque la RDPM a eu lieu avant 22 SA versus 54,5 % lorsqu’elle a eu lieu entre 22 et 23 SA + six jours et 80 % après 24 SA (p = 0,006). Les patientes primigestes ont été plus fréquemment confrontées à un décès périnatal (OR = 5,16 ; IC95 %[0,99–36,59]). La réalisation d’un geste invasif avant la RPDM n’a pas modifié le taux de survie. Le tabagisme a induit un raccourcissement de la latence (19,1 ± 13,8 jours vs 40,5 ± 32,3 jours ; p = 0,01). Une chorioamniotite a compliqué toutes les grossesses interrompues avant 26 SA versus 50 % des grossesses après 26 SA (p = 0,02). Soixante-dix pour cent des germes à l’origine d’une chorioamniotite étaient identifiés en anténatal. Les patientes dont la CRP était supérieure à 6 mg/L lors de la RPDM ont eu un taux de mortalité fœtale supérieur (63,6 % vs 27,8 % ; p = 0,02 ; OR = 4,3 ; IC95 %[0,99–22,1]). Il n’a pas été retrouvé de différence significative pour la fréquence de survenue d’une chorioamniotite en fonction de l’âge gestationnel à la rupture, du résultat du prélèvement vaginal à l’admission ou de la quantité de liquide amniotique (LA).
L’âge gestationnel de la RPDM et celui de la naissance restent les facteurs pronostiques majeurs. Les patientes primigestes sont plus exposées au décès périnatal. La CRP apparaît comme un facteur prédictif de décès périnatal.
To evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg).
Forty patients were included in a retrospective study from 1998 to 2008.
Fifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23 + 6 wg and reached 80% after 24 wg (P = 0.006). Perinatal mortality affected more frequently primigravida women (OR = 5.16; IC95%[0.99–36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1 ± 13.8 vs. 40.3 ± 2.3j; P = 0.01). Chorioamnionitis complicated all pregnancies terminated before 26wg versus 50% of pregnancies terminated after 26 wg (P = 0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P = 0.02; OR = 4.3; IC95%[0,99–22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid.
The gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.
Influence of atmospheric pressure and its variations on premature rupture of membranes
2013, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
Dans les croyances populaires, l’augmentation du taux de rupture prématurée des membranes (RPM) est fréquemment associée à des variations de pression atmosphérique (PA). Les résultats des études menées dans ce domaine sont divergents. Nous avons tenté de déterminer si les valeurs de PA influencent le taux de RPM.
Nous avons réalisé une étude rétrospective longitudinale des patientes hospitalisées pour RPM du 1^er janvier au 31 décembre 2009 avec en parallèle, un relevé des valeurs des pressions atmosphériques de l’année 2009.
Les valeurs de PA (moyenne, minimum et maximum) et ses variations n’influençaient pas le taux de RPM chez les 341 patientes incluses ainsi que chez le groupe des 187 patientes ayant eu un résultat de prélèvement vaginal ou de prélèvement de liquide amniotique négatif. Chez les 279 patientes ayant eu une RPM à terme, la moyenne de variation de la PA les jours précédant la RPM était plus importante que la veille des jours sans rupture (6,3 hPa IC95 % [5,65–7,00] vs. 5,2 IC95 % [4,70–5,79], p = 0,029). Aucune augmentation du taux de survenue des RPM n’a été mise en évidence lors des journées de basse pression (PA inférieure à PA moyenne de l’année égale à 1009 hPa ou PA inférieure à PA normale égale à 1013,2 hPa) ou lors des journées à variabilité élevée (PA maximale−PA minimale supérieure à 5 hPa).
Nos données ne permettent pas de soutenir l’hypothèse d’une influence de la PA sur le taux de survenue des RPM.
In popular belief, a higher rate of premature rupture of membranes (PROM) might be associated with atmospheric pressure (AP) variations. Results of past studies are contradictory. We aimed to assess whether or not AP values influence the rate of PROM.
We performed a retrospective longitudinal study of women admitted for PROM from January 1st, 2009 to December 3rd, 2009. AP values for 2009 were obtained at the local meteorological station.
AP values (average, minimum and maximum) and its variations did not influence the rate of PROM for 341 patients included in the study, as well as in the group of 187 patients with a negative result of vaginal swab or amniotic fluid sample. After exclusion of premature PROM, mean AP variation the days before PROM was higher than AP variations of the days without PROM (6.3 hPa IC95% [5.65–7.00] vs. 5.2 IC95% [4.70–5.79], P = 0.029). No higher rate of occurrence of PROM was noticed during the days with low AP (AP less than average AP of the year equal to 1009 hPa or AP less than normal AP equal to 1013.2 hPa) or during the days with a high variability (maximal AP−minimal AP greater than 5 hPa).
Our data did not support the hypothesis that AP influence the rate PROM.

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Presented at the Twenty-Fourth Annual Meeting of the American Gynecological and Obstetrical Society, September 29-October 1, 2005, Victoria, British Columbia, Canada.

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Transactions from the 24th Annual Meeting of the American Gynecological and Obstetrical SocietyRisk factors for previable premature rupture of membranes or advanced cervical dilation: A case control study

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Comment

Semin Perinatol

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Transactions from the 24th Annual Meeting of the American Gynecological and Obstetrical Society
Risk factors for previable premature rupture of membranes or advanced cervical dilation: A case control study