Because of the recent Supreme Court ruling, Dobbs vs. Jackson Women’s Health Organization, that overturned Roe v. Wade, misinformation has been spreading online and in public forums about the risk of maternal morbidity and mortality to mothers after premature rupture of membranes at less than 24 weeks or in the second trimester, which occurs in 0.3% to 0.4% of all pregnancies. The misinformation infllates the risk and usually tells of doctors’ hesitancy to treat due to fears of legal consequences.
In April, 2022, the American Journal of Obstetrics and Gynecology (AJOG) published an article, “Maternal morbidity after preterm premature rupture of membranes at <24 weeks’ gestation,” by Sklar A, Sheeder J, Davis AR, et al.
On average, there’s a greater risk in watch & wait. A day or 2 of careful conservative observation is much different than 14 days.
If you’re interested, here’s my review of the article Free! It costs $39 to read this whole thing, if not a subscriber.
We knew the risk difference for later gestations from past research. There have been a few studies describing the risks of maternal morbidity from premature spontaneous rupture of membranes (PROM) before 24 weeks, but the numbers were small & excluded women who chose termination of pregnancy.
In this retrospective cohort study – a chart review – from 2011 to 2018 at 3 hospitals, the review of 350 charts were randomly selected from an original 6747 potential cases to include. Of that 350, 208 were eligible, with women who spontaneously delivered within 24 hours excluded from the study, along with women with chorioamnionitis on initial presentation, fetal abnormalities, or PPROM after an invasive uterine procedure like amniocentesis.
Women who chose exprctant management (EM) but later decided to terminate the pregnancy were counted with the EM group.
Both induction of labor and d&e were included in the termination of pregnancy (TOP) cohort. Although the article describes the difference in the possibility of fetal survival, the outcomes were combined. This was noted as a weaknes in the article.
[My note: The prep for the induction is either a 1-2 day outpatient process for the d&e (with symptoms much like early labor), or an emergency manual dilation in the OR (with shorter preps having more risk to the integrity of the cervix).]
51.9%, 108 women, chose EM & those tended to be farther along in their pregnancies (mean gestational age 21 6/7 weeks vs 18 6/7).
2/3 of the TOP were labor induction & 1/3 d&e.
42 babies, 38%, of the 108 EM, survived to discharge. 15% of these mothers had no maternal morbidity, 37% of the group had both fetal demise & maternal morbidity. Composite morbidity was 60%.
All of the 100 TOP fetuses died. Maternal morbidity was 33%.
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