Duration of Preterm Premature Rupture of Membranes as Predictor of Histologic Chorioamnionitis and Early Onset Neonatal Sepsis: A Cohort Study

Abstract

Background: Preterm premature rupture of membranes (PPROM) has been associated with chorioamnionitis but studies are inconsistent on the relationship between PPROM latency and the risk of chorioamnionitis and early onset sepsis. Objective: To define the association of PPROM latency and the risk of histologic chorioamnionitis (HCA) and early onset neonatal sepsis (EONS). Methodology: A prospective cohort study was done at a public tertiary hospital on 569 mothers with spontaneous rupture of membranes and with fetuses EONS was defined using test of association and Receiver Operating Characteristics (ROC) curve analysis. The association of HCA with maternal and neonatal characteristics as well as adverse neonatal outcomes were also determined. Results: A total of 569 mothers with PPROM were included. Incidence of HCA and EONS were 13% and 24% respectively. PPROM latency was significantly associated with HCA and is a fair predictor of HCA (AUC = 0.7013; 76% accuracy at 31.5-hour cut-off) but failed as a predictor of EONS (AUC = 0.4799). PPROM, platelet count, CRP, and neutrophil count were ndependent predictors of HCA. HCA was associated with EONS and mortality. Mortality was higher in the presence of both HCA and EONS. Conclusion: Longer PPROM is associated with HCA and is a fair predictor of HCA at a cut-off of 31.5 hours. PPROM fails as a predictor of EONS.