(1001) Maternal and Neonatal Outcomes Following Previable PROM or Cervical Insufficiency < 22 weeks in Texas

Current Texas law prohibits immediate delivery in previable pregnancy complications, unless there is a medical emergency and threat to maternal health, which has in turn caused changes to the standard of care. We report maternal and neonatal outcomes of patients who presented < 22 wks with previable premature rupture of membranes (PPROM) or cervical insufficiency.


Study Design:

We conducted a retrospective cohort study of all individuals < 22 wks admitted with PPROM or cervical insufficiency between 9/1/21 - 6/30/22 at a single Level 4 medical center in Texas. Individuals who delivered within 24 hours of presentation and those with medical indication for delivery, including intrauterine fetal demise, at time of presentation were excluded. Composite maternal morbidity included cesarean delivery, postpartum hemorrhage, transfusion, dilation and evacuation (D&E) for retained placenta, and postpartum readmission. Other maternal and neonatal outcomes were studied. Data are reported in median (interquartile range) and number (percent) with mean ± standard deviation. 
 



Results:

Over the 10-month study period, there were 27 patients who met criteria, with 28 delivery episodes, including four (7.7%) with multiple gestation. The majority had PPROM (81.5%). The median maternal age was 31 years, with over without prior deliveries (55.6%) and with body mass index ≥30 (59.3%, Table 1). The median gestational age (GA) at presentation was 19.6 wks (18.0 – 21.4) with median latency period for delivery of 2.5 days (1 – 10 IQR). Except for spontaneous labor (36%), the most common medical indication for delivery was intraamniotic infection (36%). Composite maternal morbidity occurred in 15 (56%) of patients. 7 (26%) patients achieved 22 wks (25%) with liveborn delivery and 5 neonatal survivors (17.9%).


Conclusion:

In our patients with previable complications who undergo expectant management, approximately 56% develop significant maternal morbidity and 26% reach GA ≥ 22 wks. This is critical as more states transition to expectant management as the standard of care for these pregnancy complications.