Preterm prelabour rupture of membranes: a retrospective cohort study of association with adverse outcome in subsequent pregnancy

I M Aris, S Logan, C Lim, M Choolani, A Biswas, S Bhattacharya

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVE: To assess the association of first pregnancy preterm prelabour rupture of membranes (PPROM) with adverse maternal and perinatal outcomes in the next pregnancy.

DESIGN: Retrospective cohort study.

SETTING: Grampian, Scotland, UK.

POPULATION: Women with first deliveries recorded in the Aberdeen Maternity Neonatal Databank, 1986-2005.

METHODS: Women identified from the AMND database (n = 37 776) were classified into exposed (PPROM in first pregnancy; n = 1979) and unexposed (no PPROM in first pregnancy; n = 35 797) cohorts. Each cohort (exposed n = 1174; unexposed n = 20 860) was followed up until December 2012 for next singleton pregnancy.

MAIN OUTCOME MEASURES: Second pregnancy, miscarriage, pregnancy-induced hypertension (PIH), pre-eclampsia (PE), antepartum haemorrhage (APH) and postpartum haemorrhage, repeat PPROM, type of labour, mode of delivery, preterm delivery, low birth weight (LBW), admission to neonatal unit, neonatal infections and death.

RESULTS: PPROM in the first singleton pregnancy was associated with an equal likelihood of second pregnancy but with a significantly increased risk of adverse outcomes in the next singleton pregnancy: PPROM [odds ratio (OR) (95% confidence interval (CI)): 6.6 (5.4-7.9)], PE [2.4 (1.7-3.5)], instrumental [2.2 (1.7-2.8)] and caesarean delivery [1.8 (1.5-2.3)], PIH [1.5 (1.2-1.9)] and APH [1.3 (1.1-1.6)] in the mother, and neonatal infection [5.4 (1.4-20.3)], death [2.6 (1.0-6.7)], admission to neonatal unit [2.4 (2.0-2.9)], preterm delivery [2.3 (1.8-2.9)] and LBW [1.44 (1.1-1.9)]. Even in women without a recurrent PPROM, there was still a significant increase in PIH [1.4 (1.1-1.8)], PE [2.3 (1.6-3.5)], instrumental [2.2 (1.7-2.9)] and caesarean delivery [1.9 (1.5-2.4)], and neonatal unit admission [1.6 (1.3-2.0)].

CONCLUSIONS: PPROM in the first pregnancy is associated with significant adverse maternal and perinatal outcomes in the next pregnancy, but not reduced likelihood of second pregnancy.

TWEETABLE ABSTRACT: PPROM in the first singleton pregnancy increases risk of adverse maternal and perinatal outcomes in the next singleton pregnancy.

Original languageEnglish
Pages (from-to)1698-1707
Number of pages10
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume124
Issue number11
Early online date28 Dec 2016
DOIs
Publication statusPublished - Oct 2017

Fingerprint

Rupture
Cohort Studies
Retrospective Studies
Pregnancy
Membranes
Pregnancy Induced Hypertension
Pre-Eclampsia
Mothers
Low Birth Weight Infant
Databases
Hemorrhage
Postpartum Hemorrhage
Scotland
Spontaneous Abortion
Infection
Odds Ratio
Confidence Intervals

Keywords

  • Cohort
  • neonatal outcome
  • obstetric outcome
  • preterm delivery
  • preterm prelabour rupture of membranes
  • recurrence
  • subsequent pregnancy

Cite this

Preterm prelabour rupture of membranes : a retrospective cohort study of association with adverse outcome in subsequent pregnancy. / Aris, I M; Logan, S; Lim, C; Choolani, M; Biswas, A; Bhattacharya, S.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 124, No. 11, 10.2017, p. 1698-1707.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To assess the association of first pregnancy preterm prelabour rupture of membranes (PPROM) with adverse maternal and perinatal outcomes in the next pregnancy.DESIGN: Retrospective cohort study.SETTING: Grampian, Scotland, UK.POPULATION: Women with first deliveries recorded in the Aberdeen Maternity Neonatal Databank, 1986-2005.METHODS: Women identified from the AMND database (n = 37 776) were classified into exposed (PPROM in first pregnancy; n = 1979) and unexposed (no PPROM in first pregnancy; n = 35 797) cohorts. Each cohort (exposed n = 1174; unexposed n = 20 860) was followed up until December 2012 for next singleton pregnancy.MAIN OUTCOME MEASURES: Second pregnancy, miscarriage, pregnancy-induced hypertension (PIH), pre-eclampsia (PE), antepartum haemorrhage (APH) and postpartum haemorrhage, repeat PPROM, type of labour, mode of delivery, preterm delivery, low birth weight (LBW), admission to neonatal unit, neonatal infections and death.RESULTS: PPROM in the first singleton pregnancy was associated with an equal likelihood of second pregnancy but with a significantly increased risk of adverse outcomes in the next singleton pregnancy: PPROM [odds ratio (OR) (95{\%} confidence interval (CI)): 6.6 (5.4-7.9)], PE [2.4 (1.7-3.5)], instrumental [2.2 (1.7-2.8)] and caesarean delivery [1.8 (1.5-2.3)], PIH [1.5 (1.2-1.9)] and APH [1.3 (1.1-1.6)] in the mother, and neonatal infection [5.4 (1.4-20.3)], death [2.6 (1.0-6.7)], admission to neonatal unit [2.4 (2.0-2.9)], preterm delivery [2.3 (1.8-2.9)] and LBW [1.44 (1.1-1.9)]. Even in women without a recurrent PPROM, there was still a significant increase in PIH [1.4 (1.1-1.8)], PE [2.3 (1.6-3.5)], instrumental [2.2 (1.7-2.9)] and caesarean delivery [1.9 (1.5-2.4)], and neonatal unit admission [1.6 (1.3-2.0)].CONCLUSIONS: PPROM in the first pregnancy is associated with significant adverse maternal and perinatal outcomes in the next pregnancy, but not reduced likelihood of second pregnancy.TWEETABLE ABSTRACT: PPROM in the first singleton pregnancy increases risk of adverse maternal and perinatal outcomes in the next singleton pregnancy.",
keywords = "Cohort, neonatal outcome, obstetric outcome, preterm delivery, preterm prelabour rupture of membranes, recurrence, subsequent pregnancy",
author = "Aris, {I M} and S Logan and C Lim and M Choolani and A Biswas and S Bhattacharya",
note = "Funding This work was supported by a grant from the National University Hospital, Singapore OGPFF 2013 fund. The funding committee had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.",
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TY - JOUR

T1 - Preterm prelabour rupture of membranes

T2 - a retrospective cohort study of association with adverse outcome in subsequent pregnancy

AU - Aris, I M

AU - Logan, S

AU - Lim, C

AU - Choolani, M

AU - Biswas, A

AU - Bhattacharya, S

N1 - Funding This work was supported by a grant from the National University Hospital, Singapore OGPFF 2013 fund. The funding committee had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

PY - 2017/10

Y1 - 2017/10

N2 - OBJECTIVE: To assess the association of first pregnancy preterm prelabour rupture of membranes (PPROM) with adverse maternal and perinatal outcomes in the next pregnancy.DESIGN: Retrospective cohort study.SETTING: Grampian, Scotland, UK.POPULATION: Women with first deliveries recorded in the Aberdeen Maternity Neonatal Databank, 1986-2005.METHODS: Women identified from the AMND database (n = 37 776) were classified into exposed (PPROM in first pregnancy; n = 1979) and unexposed (no PPROM in first pregnancy; n = 35 797) cohorts. Each cohort (exposed n = 1174; unexposed n = 20 860) was followed up until December 2012 for next singleton pregnancy.MAIN OUTCOME MEASURES: Second pregnancy, miscarriage, pregnancy-induced hypertension (PIH), pre-eclampsia (PE), antepartum haemorrhage (APH) and postpartum haemorrhage, repeat PPROM, type of labour, mode of delivery, preterm delivery, low birth weight (LBW), admission to neonatal unit, neonatal infections and death.RESULTS: PPROM in the first singleton pregnancy was associated with an equal likelihood of second pregnancy but with a significantly increased risk of adverse outcomes in the next singleton pregnancy: PPROM [odds ratio (OR) (95% confidence interval (CI)): 6.6 (5.4-7.9)], PE [2.4 (1.7-3.5)], instrumental [2.2 (1.7-2.8)] and caesarean delivery [1.8 (1.5-2.3)], PIH [1.5 (1.2-1.9)] and APH [1.3 (1.1-1.6)] in the mother, and neonatal infection [5.4 (1.4-20.3)], death [2.6 (1.0-6.7)], admission to neonatal unit [2.4 (2.0-2.9)], preterm delivery [2.3 (1.8-2.9)] and LBW [1.44 (1.1-1.9)]. Even in women without a recurrent PPROM, there was still a significant increase in PIH [1.4 (1.1-1.8)], PE [2.3 (1.6-3.5)], instrumental [2.2 (1.7-2.9)] and caesarean delivery [1.9 (1.5-2.4)], and neonatal unit admission [1.6 (1.3-2.0)].CONCLUSIONS: PPROM in the first pregnancy is associated with significant adverse maternal and perinatal outcomes in the next pregnancy, but not reduced likelihood of second pregnancy.TWEETABLE ABSTRACT: PPROM in the first singleton pregnancy increases risk of adverse maternal and perinatal outcomes in the next singleton pregnancy.

AB - OBJECTIVE: To assess the association of first pregnancy preterm prelabour rupture of membranes (PPROM) with adverse maternal and perinatal outcomes in the next pregnancy.DESIGN: Retrospective cohort study.SETTING: Grampian, Scotland, UK.POPULATION: Women with first deliveries recorded in the Aberdeen Maternity Neonatal Databank, 1986-2005.METHODS: Women identified from the AMND database (n = 37 776) were classified into exposed (PPROM in first pregnancy; n = 1979) and unexposed (no PPROM in first pregnancy; n = 35 797) cohorts. Each cohort (exposed n = 1174; unexposed n = 20 860) was followed up until December 2012 for next singleton pregnancy.MAIN OUTCOME MEASURES: Second pregnancy, miscarriage, pregnancy-induced hypertension (PIH), pre-eclampsia (PE), antepartum haemorrhage (APH) and postpartum haemorrhage, repeat PPROM, type of labour, mode of delivery, preterm delivery, low birth weight (LBW), admission to neonatal unit, neonatal infections and death.RESULTS: PPROM in the first singleton pregnancy was associated with an equal likelihood of second pregnancy but with a significantly increased risk of adverse outcomes in the next singleton pregnancy: PPROM [odds ratio (OR) (95% confidence interval (CI)): 6.6 (5.4-7.9)], PE [2.4 (1.7-3.5)], instrumental [2.2 (1.7-2.8)] and caesarean delivery [1.8 (1.5-2.3)], PIH [1.5 (1.2-1.9)] and APH [1.3 (1.1-1.6)] in the mother, and neonatal infection [5.4 (1.4-20.3)], death [2.6 (1.0-6.7)], admission to neonatal unit [2.4 (2.0-2.9)], preterm delivery [2.3 (1.8-2.9)] and LBW [1.44 (1.1-1.9)]. Even in women without a recurrent PPROM, there was still a significant increase in PIH [1.4 (1.1-1.8)], PE [2.3 (1.6-3.5)], instrumental [2.2 (1.7-2.9)] and caesarean delivery [1.9 (1.5-2.4)], and neonatal unit admission [1.6 (1.3-2.0)].CONCLUSIONS: PPROM in the first pregnancy is associated with significant adverse maternal and perinatal outcomes in the next pregnancy, but not reduced likelihood of second pregnancy.TWEETABLE ABSTRACT: PPROM in the first singleton pregnancy increases risk of adverse maternal and perinatal outcomes in the next singleton pregnancy.

KW - Cohort

KW - neonatal outcome

KW - obstetric outcome

KW - preterm delivery

KW - preterm prelabour rupture of membranes

KW - recurrence

KW - subsequent pregnancy

U2 - 10.1111/1471-0528.14462

DO - 10.1111/1471-0528.14462

M3 - Article

C2 - 28029224

VL - 124

SP - 1698

EP - 1707

JO - BJOG-An International Journal of Obstetrics and Gynaecology

JF - BJOG-An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 11

ER -