Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

Souza, Alex Sandro Rolland; Patriota, Adriane Farias; Guerra, Gláucia Virgínia de Queiroz Lins; Melo, Brena Carvalho Pinto de

doi:10.1590/1806-9282.62.03.269

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Original Articles • Rev. Assoc. Med. Bras. 62 (3) • May 2016 • https://doi.org/10.1590/1806-9282.62.03.269 copy

Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

Avaliação dos resultados perinatais em gestantes com rotura prematura das membranas pré-termo

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

Objective:

To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM).

Method:

A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test.

Results:

When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age.

Conclusion:

The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.

Keywords
amniotic fluid; premature rupture of fetal membranes; neonatal intensive care units

Characterization of the sample	Average ± SD	Median, IIQ	Variation
Mother’s age (years)	25.4±6.1	-	14 - 40
Gestational age at	31.9±2.8	-	25 - 35
admission (weeks)
AFI at admission (cm)	3.7±2.1	-	0 - 8
Previous gestations	-	2, 1-3	1 - 13
Previous parity	-	1, 0-2	0 - 12
BMI (kg/m²)	27.0±5.1	-	18.2 - 40.8

Characteristics of the women	AFI < 3 cm		AFI > 3 cm		p^* * Chi-square test	AFI < 5 cm		AFI > 5 cm		p^* * Chi-square test
Characteristics of the women	n=30	%	n=56	%	p^* * Chi-square test	n=48	%	n=38	%	p^* * Chi-square test
Age > 30 years	6	20.0	12	21.4	0.88	11	22.9	7	18.4	0.69
Gestational age at diagnosis < 30 weeks	19	63.3	17	30.4	0.003	25	52.1	11	28.9	0.04
Body mass index (BMI) > 30 kg/m²	12	48.0	13	52.0	0.10	19	39.6	6	15.8	0.02
Formal education < 7 years	13	43.3	23	41.1	0.84	24	50.0	12	31.6	0.12
Previous gestations < 1	8	26.7	22	39.3	0.24	18	37.5	12	31.6	0.68
Recife and greater area	15	50.0	27	48.2	0.87	21	43.7	21	55.2	0.20

Neonatal outcomes	AFI < 5 cm		AFI > 5 cm		RR	95CI	p
	n	%	n	%
Neonatal hospitalization: > 10 days	13	36.1	13	38.2	0.94	0.51-1.73	0.85^* * Chi-square test;
Birth weight: < 2.000 g	33	68.8	22	59.5	1.15	0.83-1.60	0.37^* * Chi-square test;
Apgar score at 1 minute: <7	20	41.7	10	27.0	1.54	0.82-2.88	0.16^* * Chi-square test;
Apgar score at 5 minutes: <7	9	18.8	3	8.1	2.31	0.67 - 7.9	0.16^* * Chi-square test;
NICU hospitalization	29	61.7	18	48.6	1.27	0.85-1.89	0.23^* * Chi-square test;
Perinatal complication	32	65.3	19	51.4	1.27	0.87 - 1.84	0.19^* * Chi-square test;
Neonatal sepsis	6	12.8	3	8.1	1.57	0.42-5.88	0.37^ Fisher's exact test.
Ventilatory assistance	29	61.7	18	48.6	1.27	0.85-1.89	0.23^* * Chi-square test;
Early mortality	9	19.1	3	8.1	2.36	0.69-8.10	0.15^* * Chi-square test;
Late mortality	3	7.9	1	2.9	2.68	0.29 - 24.6	0.35^ Fisher's exact test.
Intrauterine death	4	8.2	0	0.0	-	-	0.10^ Fisher's exact test.
General mortality	16	32.7	4	10.8	3.02	1.10 - 8.3	0.02^* * Chi-square test;

Neonatal outcomes	AFI < 3 cm		AFI > 3 cm		RR	95CI	p
	n	%	n	%
Neonatal hospitalization: > 10 days	8	40.0	18	36.0	1.11	0.58-2.13	0.75^* * Chi-square test;
Birth weight: < 2.000 g	22	73.3	33	60.0	1.22	0.90-1.66	0.22^* * Chi-square test;
Apgar score at 1 minute: <7	16	53.3	14	25.5	2.09	1.19-3.68	0.01^* * Chi-square test;
Apgar score at 5 minutes: <7	7	23.3	5	9.1	2.57	0.89-7.39	0.07^ Fisher’s exact test.
NICU hospitalization	20	66.7	27	50.0	1.33	0.92-1.93	0.14^* * Chi-square test;
Perinatal complication	20	66.7	31	55.4	1.20	0.85-1.70	0.31^* * Chi-square test;
Neonatal sepsis	6	20.0	3	5.6	3.60	1.01-13.3	0.04^ Fisher’s exact test.
Ventilatory assistance	20	66.7	27	50.0	1.33	0.92-1.93	0.14^* * Chi-square test;
Early mortality	8	26.7	4	7.4	3.60	1.18-10.9	0.02^ Fisher’s exact test.
Late mortality	3	13.6	1	2.0	6.81	0.75-61.9	0.08^ Fisher’s exact test.
Intrauterine death	1	3.3	3	5.4	0.62	0.07-5.72	0.56^ Fisher’s exact test.
General mortality	12	40.0	8	14.3	2.80	1.29-6.09	0.007^* * Chi-square test;

	Coefficient	95CI	Standard error	P
Gestational age at delivery (weeks)	0.78	0.47 - 1.09	0.15	< 0,0001
Birth weight (grams)	122.6	70.9 - 174.3	26.1	< 0,0001
Apgar score at 1 min	0.55	0.33 - 0.78	0.11	< 0,0001
Apgar score at 5 min	0.45	0.24 - 0.67	0.11	< 0,0001

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