Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis

Abstract

Objective To determine whether prolonged latency after preterm prelabour rupture of membranes (PPROM) is associated with an increased risk for adverse neurodevelopmental outcomes.Design This is a secondary analysis of the randomised controlled trial of magnesium sulphate for the prevention of cerebral palsy. Setting Multicentre trial.Population A total of 1305 women with PPROM were analysed, 1056 of whom had an interval of <3 weeks between diagnosis and delivery and 249 of whom had an interval of ≥3 weeks between diagnosis and delivery.Methods We evaluated whether the time interval between diagnosis of PPROM and delivery was associated with an increased risk for adverse neurodevelopmental outcomes. Latency was analysed as a continuous variable and categorised by weeks of latency.Main outcome measures The primary outcome was motor and mental Bayley scores of <70 at 2 years of age. Secondary outcomes included motor and mental Bayley scores <85 and mean Bayley scores. Logistic regression was used to control for confounding factors.Results In the univariate analysis, motor and mental Bayley scores of <70 were similar in the <3 weeks (16.8 and 14.4%) and ≥3 weeks (15.3 and 14.1%) groups. In the regression analysis adjusting for confounding factors, PPROM for ≥3 weeks was an independent risk factor for motor (adjusted odds ratio (aOR) 2.12; 95% confidence interval, 95% CI 1.29-3.49) and mental (aOR 1.83, 95% CI 1.13-3.00) Bayley scores of <70. Neonatal sepsis, gestational age at delivery, maternal education, and race were significantly associated with neurodevelopmental outcomes.Conclusions Whereas delivery at later gestational age is associated with improved prognosis for many outcomes, prolonged exposure to an intrauterine environment of PPROM is an independent risk factor for adverse neurodevelopmental outcomes.

Safety of prolonged latency in preterm prelabor rupture of membranes

“…Ramsey 38 reported that the expectant management in PPLROM allowed prolongation of pregnancy benefited neonatal outcome, though increased the risk of chorioamnionitis and associated maternal and neonatal morbidity. Drassinower 39 has also reported that delivery at later gestational age was associated with improved prognosis for the baby. When the per week effect of latency was combined with the protective effect of each additional week of gestational age, the adjusted results pointed towards a slight (but not significant) net benefit from each additional week in utero.…”

Re: Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis

“…We thank Roberts et al for their interest in our study 1,2 and for the opportunity to clarify that our study does not show 'that there is a net disadvantage to additional time in utero'. We presented the unadjusted results, which show that motor and mental Bayley scores <70, <85, and mean motor and mental Bayley scores were similar in the <3 weeks and ≥3 weeks groups.…”

“…They raise concerns about the wide variation between the guidelines and highlight the higher thromboprophylaxis rates in the UK, whilst acknowledging the reduced maternal mortality associated with venous thromboembolism (VTE) in the UK in recent years. 2 The RCOG VTE prevention guidance was updated in 2015, 3 and the impact on thromboprophylaxis rates is as yet unknown. The key changes include alterations to thrombotic risk factors and modifications to prophylaxis recommendations per aggregate risk factors.…”

“…This was the approach taken by these authors in a previous paper that examined the effect of prolonged latency on the risk of cerebral palsy. 2 For this study they chose to adjust for gestational age at delivery instead, and this has led to a misleading result that gives the impression that there is a net disadvantage to additional time in utero for the fetus. &…”

Authors' reply re: Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis

“…We thank Roberts et al. for their interest in our study and for the opportunity to clarify that our study does not show ‘that there is a net disadvantage to additional time in utero’. We presented the unadjusted results, which show that motor and mental Bayley scores <70, <85, and mean motor and mental Bayley scores were similar in the <3 weeks and ≥3 weeks groups.…”