(595) Outcomes of immediate subsequent pregnancy following previable preterm premature rupture of membranes

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: The risk of recurrent preterm birth (PTB) or premature rupture of membranes (PPROM) in subsequent pregnancy after spontaneous PTB or PPROM is well-described. Less is known about outcomes in subsequent pregnancy after previable PPROM (pPPROM). This study describes outcomes in a single health system over 10 years.

Study Design: Retrospective cohort study of the immediate subsequent pregnancy of patients with history of pPPROM ( < 23 weeks gestation) in a single health system from 2013-2022. Patients without immediate subsequent pregnancy lasting >14 weeks (wks) or those without delivery data were excluded. Primary outcome was gestational age (GA) at delivery in the immediate subsequent pregnancy. Secondary outcomes included recurrent PTB (delivery < 37wks GA), PPROM and pPPROM. A secondary analysis of factors associated with recurrent PTB was performed. Bivariate statistics were used for analysis.

Results: Of 93 patients with a history of pPPROM, 34 had an immediate subsequent pregnancy beyond 14 weeks GA of whom 2 were lost to follow-up. Median GA at delivery was 37.4wks (34.7, 38.5). 10 (29.4%) patients had recurrence of PTB, of whom 4 (11.8%) had recurrence of PPROM. 3 (8.9%) of these were pPPROM, all of whom had history of pPPROM before 20 weeks in the immediate prior pregnancy (Figure). Median GA of patients delivering preterm was 30.4wks (IQR 21,34). Demographics, use of intramuscular hydroxyprogesterone (17-P) or cerclage did not differ between those who did and did not deliver preterm in the immediate subsequent pregnancy (Table).

Conclusion:

In patients with prior pPPROM, most did not have recurrence of PPROM or PTB in the immediate subsequent pregnancy >14wks GA. Of those with recurrence of PPROM, most experienced pPPROM and all resulted in PTB. This data contributes to the limited literature on outcomes in the immediate subsequent pregnancy after pPPROM and may be useful in counseling such patients regarding recurrence risk of pPPROM, PPROM and PTB.

Primary & Presenting Author(s)

Ronan P. Sugrue, MBBCH, MPH (he/him/his)
MFM Fellow
Duke University Medical Center
Durham, North Carolina, United States

Coauthor(s)

KL
Katherine Lambert, BA, BS
Duke University
Durham, North Carolina, United States
Jennifer J. Cate, MD (she/her/hers)
MFM Fellow
Duke University
Durham, North Carolina, United States
Anne E. West Honart, MD, M.Phil
MFM Fellow
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Sarahn M. Wheeler, MD
Vice Chair for Equity, Diversity and Inclusion, Director Duke Prematurity Prevention Program
Duke University Medical Center
Durham, North Carolina, United States
MG
Matthew R. Grace, MD
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Sarah K. Dotters-Katz, MD
Assistant Professor
Duke University Medical Center
Durham, North Carolina, United States