Abstract
Background:
Premature rupture of membranes (PROM) is a complication affecting 7-12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (i.e., <37 weeks’ gestation) precedes one-third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis.
Aim:
To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009-2017.
Methods:
This retrospective population-based cohort study included all singleton pregnancies from 2009-2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: a) expectant management, b) induction of labour (IOL) and c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management.
Results:
Of 636,590 singleton pregnancies, 52,669 (8.3%) births with PROM at term (42,439; 6.7%) or PPROM (10,230; 1.6%) were identified. Of these, the majority were managed expectantly (n= 22,726;43.1%), or with IOL (25931; 49.2%). While elCS represented only 7.6% of these cases (n=4012), its’ use rose consistently from 2009-2017 for PROM at term and PPROM alike. For women with PPROM at 34-36 weeks the odds of elCS increased by 5% annually [AOR: 1.05 (1.02, 1.08)] and 2% for IOL [AOR: 1.02 (1.00, 1.05)] versus expectant management.
Conclusions: The use of elective caesarean section and induction of labour in PPROM is rising in Victoria, particularly between 34-36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase.
Premature rupture of membranes (PROM) is a complication affecting 7-12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (i.e., <37 weeks’ gestation) precedes one-third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis.
Aim:
To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009-2017.
Methods:
This retrospective population-based cohort study included all singleton pregnancies from 2009-2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: a) expectant management, b) induction of labour (IOL) and c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management.
Results:
Of 636,590 singleton pregnancies, 52,669 (8.3%) births with PROM at term (42,439; 6.7%) or PPROM (10,230; 1.6%) were identified. Of these, the majority were managed expectantly (n= 22,726;43.1%), or with IOL (25931; 49.2%). While elCS represented only 7.6% of these cases (n=4012), its’ use rose consistently from 2009-2017 for PROM at term and PPROM alike. For women with PPROM at 34-36 weeks the odds of elCS increased by 5% annually [AOR: 1.05 (1.02, 1.08)] and 2% for IOL [AOR: 1.02 (1.00, 1.05)] versus expectant management.
Conclusions: The use of elective caesarean section and induction of labour in PPROM is rising in Victoria, particularly between 34-36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase.
| Original language | English |
|---|---|
| Number of pages | 9 |
| Journal | Australian and New Zealand Journal of Obstetrics and Gynaecology |
| Early online date | 20 Nov 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 20 Nov 2023 |
Bibliographical note
Funding Information:N.J.C. received the Enid Linder Foundation Award. This work was also supported by a Women's Visiting Gynaecological Club Prize (awarded to N.J.C. by the Royal College of Obstetricians and Gynaecologists), and a BMDST‐RSM Student Elective Award (awarded to N.J.C. by the Royal Society of Medicine). The funders had no role in: the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.
Data Availability Statement
Additional supporting information may be found online in the Supporting Information section at the end of the article.Keywords
- caesarean section
- induction of labour
- premature rupture of membranes
- preterm birth
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Data From Incidence and management of premature rupture of membranes in Victoria, Australia: A retrospective cohort study of 636 590 births between 2009 and 2017
Cameron, N. (Creator), Wertaschnigg, D. (Creator), Davey, M. (Creator), Janne Burger, R. (Creator), Mol, B. (Creator) & Woolner, A. M. (Creator), University of Aberdeen, 20 Nov 2023
DOI: 10.1111/ajo.13773, https://obgyn.onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1111%2Fajo.13773&file=ajo13773-sup-0001-AppendixS1.docx
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