Infectious morbidity and microbiological findings in early and late preterm prelabor rupture of membranes managed expectantly.

OBJECTIVE

The objective of this study was to describe and compare maternal infectious morbidity, microbiological findings, and neonatal outcomes among pregnancies with early (<34 weeks) and late (34 + 0-36 + 6 weeks) prelabor rupture of membranes (PPROM) managed expectantly at a single tertiary referral center.

METHODS

This single-center retrospective cohort study included consecutive singleton pregnancies complicated by PPROM at ≥24 weeks of gestation and managed expectantly at Galilee Medical Center, a university-affiliated tertiary referral center in Nahariya, Israel, between August 2017 and May 2024. Patients were categorized according to gestational age at membrane rupture into early (n = 136) and late (n = 548) PPROM. Expectant management was applied using a 7-day antibiotic regimen (ampicillin-based until March 2023, followed by cefuroxime-based prophylaxis). Patients with active labor or clinical infection at admission were excluded. Primary outcomes were clinical chorioamnionitis and early-onset neonatal sepsis.

RESULTS

Late PPROM was associated with lower rates of postpartum maternal infectious morbidity than early PPROM, including lower rates of intrapartum fever (2.6% vs. 6.6%), postpartum fever (0.2% vs. 2.9%), and surgical site infection (0.8% vs. 12.3%). In exploratory adjusted analysis, cefuroxime-based prophylaxis was associated with lower observed odds of clinical chorioamnionitis compared with ampicillin-based prophylaxis, whereas late versus early PPROM was not independently associated with clinical chorioamnionitis.

CONCLUSION

Among pregnancies with PPROM managed expectantly, late PPROM was associated with lower observed rates of maternal infectious morbidity compared with early PPROM.