Impact of the 2018 French National College of Gynecologists and Obstetricians recommendations for clinical practice on maternal and neonatal morbidity and mortality in cases of premature rupture of membranes before 32 weeks of amenorrhea at the University Hospital of Strasbourg.

INTRODUCTION

Spontaneous rupture of membranes before 37 weeks of amenorrhea (preterm premature rupture of membranes [pPROM]) is associated with two main complications: prematurity and fetal infection. Biological parameters, particularly C-reactive protein (CRP) levels, were monitored during a continued pregnancy. Group A represented our previous practice, that is, regular CRP monitoring with induced birth or cesarean section after two consecutive levels above 20 mg/L. Group B represented our practice after the publication of the national recommendations and the absence of induced delivery based on an isolated CRP level with no sign of intrauterine infection. This study aimed to assess the effect of these recommendations on neonatal morbidity and mortality rates.

MATERIAL AND

METHODS

This retrospective bicentric cohort study included 169 singleton pregnancies with pPROM <32 weeks, managed in 2017-2018 (Group A, n = 96) and 2020-2021 (Group B, n = 73). Maternal characteristics, inflammatory markers, delivery modalities, and neonatal outcomes were compared. Multivariate logistic regression using Firth's penalized likelihood method was employed to identify independent predictors of fetal mortality and severe neonatal morbidity.

RESULTS

Group B showed higher rates of early-onset neonatal infection (19.2 % vs. 7.3 %, p = 0.03), elevated CRP levels at birth, and more frequent positive neonatal blood cultures (5.5 % vs. 0 %, p = 0.04). Histological chorioamnionitis was also more prevalent (71.2 % vs. 50 %, p < 0.005). In multivariate analysis, fetal mortality was independently associated with shorter latency between rupture and delivery and male fetal sex. Belonging to Group B was associated with lower odds of fetal death (OR 0.15, 95 % CI [0.02-1.01], p = 0.05). Severe neonatal morbidity was significantly associated with lower birth weight (OR 3.76, 95 % CI [1.56-9.02], p = 0.003), while CRP evolution, latency, sex, and gestational age at birth were not independent predictors.

CONCLUSION

Severe neonatal morbidity remained frequent and was primarily influenced by fetal maturity factors, notably birth weight. These results suggest that while a less interventionist approach may be safe for maternal outcomes, careful monitoring is essential to prevent infectious complications. CRP remains a useful biomarker, but its interpretation must consider context and timing of intervention.