27 - Childhood outcomes after induction of labour or expectant management for PPROM: PPROMEXIL 10 year follow-up

Friday, February 10, 2023

8:30 AM – 8:45 AM

Location: Room 3022, Moscone West, Level 3

Objective: In women with late preterm prelabour rupture of membranes (PPROM) between 34⁺⁰ and 36⁺⁶ weeks of gestation treatment with induction of labour (IoL) showed no reduction in the risk of neonatal sepsis compared to expectant management (EM). This follow-up study compares long-term outcomes of these interventions in women’s offspring.

Study Design: Follow-up study of the randomized controlled PPROMEXIL trials, assessing children born after pregnancies complicated by late PPROM and randomised to IoL or EM at 10-12 years of age (Netherlands Trial Register 6953). Main outcomes were cognition, motor function and behaviour, assessed with respectively the Wechsler Intelligence Scale for Children-V-NL (WISC-V-NL), Movement Assessment Battery for Children-2 (M-ABC) and Child Behaviour Checklist (CBCL). Secondary outcomes were sensory processing, respiratory problems, educational attainment and general health. Mild delay was defined as -1 standard deviation (SD) or corresponding percentile.

Results: Of the 714 randomised women with a singleton pregnancy, 711 surviving children were invited for follow-up. In total 248 children (35%) participated (IoL=127, EM=121). A mild cognitive delay was seen in 7/122 (5·7%) children after IoL versus 12/120 (10·0%) after EM (Relative Risk (RR) 0·57, 95% CI 0·23 to 1·41). A mild delay in motor function was seen in 42/122 (34·4%) children after IoL versus 55/120 (45·8%) after EM (RR 0·75, 95% CI 0·55 to 1·03). Mild abnormal behaviour was seen in 37/125 (29·6%) children after IoL vs 33/118 (28·0%) after EM (RR 1·05, 95% CI 0·71 to 1·57). Most secondary outcomes were comparable between groups. After IoL there were significantly more children without any hospital admissions (RR 1·35, 95% CI 1·05 to 1·74) or surgeries (RR 1·35, 95% CI 1·12 to 1·64).

Conclusion: In women with late PPROM, induction of labour did not affect long-term outcomes in children 10 to 12 years of age as compared to expectant management.

Primary & Presenting Author(s)

Noor E. Simons, MD (she/her/hers)

Resident
Department of Obstetrics and Gynaecology, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands

Slides

Coauthor(s)

Ad

Annemijn de Ruigh, MD

Department of Obstetrics and Gynaecology, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Jv

Janneke van 't Hooft, MD, PhD

Department of Obstetrics and Gynaecology, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
CA

Cornelieke Aarnoudse-Moens, PhD

Department of Neonatology and Paediatrics, Emma Children’s Hospital, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Mv

Madelon van Wely, PhD

Centre for Reproductive Medicine, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
dv

david van der ham, MD, PhD

Department of Obstetrics and Gynaecology, Martini Hospital
Groningen, Groningen, Netherlands
Sv

Stijn van Teeffelen, MD, PhD

Department of Obstetrics and Gynaecology, Maastricht UMC+
Maastricht, Limburg, Netherlands
TR

Tessa J. Roseboom, PhD

Professor of Early Development and Health
Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Ben Willem W. Mol, MD, PhD (he/him/his)

Professor of Obstetrics/Gynecology
Paediatrics and Reproductive Health, Monash University Melbourne
Clayton, Victoria, Australia
AL

Aleid G. Leemhuis, MD, PhD

Pediatrician
Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Eva Pajkrt, MD, PhD (she/her/hers)

Head of Obstetrics
Department of Obstetrics and Gynecology, Amsterdam UMC, location University of Amsterdam
Amsterdam, Noord-Holland, Netherlands