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 -