Fetal, Infant and Maternal Outcomes among Women with Prolapsed Membranes Admitted before 29 Weeks Gestation.

Abstract

BACKGROUND:

Few studies have examined fetal, infant and maternal mortality and morbidity among pregnant women at very early gestation with an open cervix and prolapsed membranes. We carried out a study describing the outcomes of women hospitalized with prolapsed membranes at 22-28 weeks' gestation.

METHODS:

We prospectively recruited women with singleton pregnancies admitted at 22-28 weeks' gestation to tertiary hospitals of the Canadian Perinatal Network between 2005 and 2009. Time-to-delivery, perinatal death, neonatal intensive care unit (NICU) admission, severe neonatal morbidity and severe maternal morbidity were compared between women admitted at 22-25 vs. 26-28 weeks gestation. Logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals.

RESULTS:

129 women at 22-25 weeks gestation and 65 women at 26-28 weeks gestation were admitted to hospital and the median time-to-delivery was 4 days in both groups. Stillbirth rates were 12.4% vs 4.6% among women admitted at earlier vs later gestation (AOR 2.8, 95% CI 0.5-14.8), while perinatal death rates were 38.0% vs 6.1% (AOR 14.1, 95% CI 3.5-59.0), respectively. There were no significant differences in NICU admission and severe morbidity among live-born infants; 89.4% and 82.3% died or were admitted to NICU, (P value 0.18), and 53.9% vs 44.0% of NICU infants had severe neonatal morbidity (P value 0.28). Antibiotics, tocolysis and cerclage did not have a significant effect on perinatal death. Maternal death or severe maternal morbidity occurred in 8.5% and 6.2% of women admitted at 22-25 vs 26-28 weeks (AOR 1.2, 95% CI 0.4-4.2).

CONCLUSION:

Perinatal mortality among women with prolapsed membranes at very early gestation is high, although significantly lower among those admitted at a relatively later gestational age. Rates of adverse maternal outcomes are also high. This information can be used to counsel women with prolapsed membranes at 22 to 28 weeks gestation.

• Authors: Julie E Robertson, Sarka Lisonkova, Tang Lee, Dane A De Silva, Peter von Dadelszen, Anne R Synnes, K S Joseph, Robert M Liston, Laura A Magee, Canadian Perinatal Network and Canadian Neonatal Network Collaborative Groups
• Journal: PloS one (PLoS One) Vol. 11 Issue 12 Pg. e0168285 ( 2016) ISSN: 1932-6203 [Electronic] United States
• PMID: 28002467 (Publication Type: Journal Article)

Topics

• Adult
• Amnion
• Female
• Fetal Membranes, Premature Rupture (diagnosis)
• Gestational Age
• Humans
• Infant, Newborn
• Intensive Care Units, Neonatal
• Logistic Models
• Maternal Mortality
• Odds Ratio
• Perinatal Death
• Pregnancy
• Stillbirth
• Young Adult