# Neonatal Outcome After Expectant Management of Preterm Premature Rupture of Membranes (PPROM) Between 34+0 and 36+6 Weeks of Gestation: A Single-Center Cohort Study

## TL;DR

This study found that waiting to deliver babies after early water breaking between 34 and 36 weeks is generally safe for the baby, as long as there are no signs of infection.

## Contribution

The study evaluates the safety of expectant management for PPROM between 34+0 and 36+6 weeks using the TRIPLE-I criteria.

## Key findings

- Mean gestational age at birth was 35.9 weeks with a mean birth weight of 2,660 g.
- No significant increase in risks for low umbilical artery pH, low Apgar score, or NICU admission due to infection was found.
- Only two maternal fever cases were observed, and no case met all TRIPLE-I diagnostic criteria.

## Abstract

Objectives: The aim of the study was to assess adverse neonatal outcome after preterm premature rupture of membranes (PPROM) between 34+0 and 36+6 weeks of gestation in patients undergoing expectant management after PPROM according to the intrauterine inflammation, infection, or both (TRIPLE-I) criteria.

Study design: This retrospective analysis included 323 singleton pregnancies with PPROM between 34+0 and 36+6 weeks of gestation. Groups of cases that met at least some of the TRIPLE-I diagnostic criteria and were suspected of having TRIPLE-I were created and compared with groups of cases that did not meet these criteria.

Results: Mean gestational age at time of birth was 35.9 weeks [IQR; 35.0-36.4], mean gestational age at time of PPROM was 34.7 [IQR; 34.0 -35.4], and mean birth weight was 2,660 g [IQR; 2,140-2,985]. Two hundred four (63.2%) infants were delivered vaginally, 107 (33.1%) via caesarean section and 12 (3.7%) women had vaginal operative delivery (vacuum extraction). There were only two cases of maternal fever, and no case met all TRIPLE-I diagnostic criteria. No significant increase in risks were found for low umbilical artery pH (OR: 1.88 (95% CI: 0.50-5.88), p = 0.29), low Apgar score (OR: 1.14 (95% CI: 0.17-4.73), p = 0.86), or need for neonatal admission to neonatal intensive care unit (NICU) due to infection (OR: 1.14 (95% CI: 0.17-4.73), p = 0.62) in women with elevated white blood cell count in performed logistic regressions. Same applied for cases with tachycardic cardiotocography (CTG).

Conclusion: Expectant management appears to be a viable and potentially safe approach for managing cases of PPROM between 34+0 and 36+6 weeks of gestation, without significantly increasing the risk of adverse neonatal outcome. However, close monitoring, personalized care and readiness to intervene are important for optimally managing these clinical cases.