Am J Perinatol 2024; 41(S 01): e958-e967
DOI: 10.1055/a-1973-7482
Original Article

Maternal and Perinatal Outcomes in Singleton Nulliparous Spontaneous Preterm Birth with and without Preterm Premature Rupture of Membranes—A National Population-Based Cohort Study

1   Department of Women's and Children's Health, Section of Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
,
Susanne Hesselman
1   Department of Women's and Children's Health, Section of Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
2   Department of Clinical Research, Falun; Uppsala University, Uppsala, Sweden
,
Linda Lindström
1   Department of Women's and Children's Health, Section of Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
,
Ove Axelsson
1   Department of Women's and Children's Health, Section of Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
3   Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden and Centre for Clinical Research, Sörmland, Uppsala University, Eskilstuna, Sweden
,
Inger Sundström Poromaa
1   Department of Women's and Children's Health, Section of Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
› Author Affiliations
Funding The study was supported by grants from the Research Council of Uppsala-Örebro County Council and ALF funding from Uppsala University Hospital.

Abstract

Objective Preterm birth (PTB, birth before 37 gestational weeks) is the leading cause of neonatal death and a major challenge for obstetric and neonatal care. About two-thirds of PTBs are spontaneous PTB (sPTB), of which approximately 30% start with preterm premature rupture of membranes (PPROM). The aim of the study was to investigate risk factors and maternal and perinatal outcomes in sPTB with and without PPROM.

Study Design This is a national population-based cohort study including all singleton pregnancies in nulliparous women with spontaneous onset of labor and vaginal births (n = 266,968) registered in the Swedish Medical Birth Register 2005 to 2014. sPTB with PPROM (sPTB-PPROM) and sPTB without PPROM were compared regarding risk factors and maternal and perinatal outcomes. Logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adjustments were made for maternal age, body mass index, country of birth, smoking, chronic hypertension, pregestational and gestational diabetes, and gestational length.

Results sPTB-PPROM (n = 5,037), compared with sPTB without PPROM (n = 8,426), was more common in women with previous spontaneous abortions, prepregnancy urinary tract infections, chronic hypertension, and gestational diabetes and had a higher risk of postpartum endometritis (aOR: 2.78, 95% CI: 1.55–5.00). Infants born to women with sPTB-PPROM had a lower risk of birth asphyxia (aOR: 0.60, 95% CI: 0.43–0.83), respiratory distress syndrome (aOR: 0.86, 95% CI: 0.70–1.00), retinopathy of prematurity (aOR: 0.93, 95% CI: 0.92–0.94), necrotizing enterocolitis (aOR: 0.95, 95% CI: 0.94–0.96), and higher risk of hypoglycemia (aOR: 1.14, 95% CI: 1.01–1.28), and hyperbilirubinemia (aOR: 1.28, 95% CI: 1.19–1.38) compared with infants born to sPTB without PPROM.

Conclusion Our findings of risk factors and distinct differences in adverse outcomes after sPTB-PPROM compared with sPTB without PPROM are of vital importance and might serve as a basis when elaborating programs for the prevention and management of PPROM.

Key Points

  • This is a large cohort study of spontaneous preterm birth (sPTB).

  • Singleton nulliparous sPTB with/without preterm premature rupture of membrane (PPROM) were studied.

  • Distinct differences in adverse perinatal outcomes in sPTB with and without PPROM were observed.

Supplementary Material



Publication History

Received: 31 January 2022

Accepted: 01 November 2022

Accepted Manuscript online:
08 November 2022

Article published online:
29 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Tielsch JM. Global incidence of preterm birth. Nestle Nutr Inst Workshop Ser 2015; 81: 9-15
  • 2 Blencowe H, Cousens S, Oestergaard MZ. et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832): 2162-2172
  • 3 Lu J, Wei D, Shen S. et al. Increasing trends in incidence of preterm birth among 2.5 million newborns in Guangzhou, China, 2001 to 2016: an age-period-cohort analysis. BMC Public Health 2020; 20 (01) 1653
  • 4 Ma R, Luo Y, Wang J. et al. Ten-year time trends in preterm birth during a sociodemographic transition period: a retrospective cohort study in Shenzhen, China. BMJ Open 2020; 10 (10) e037266
  • 5 Liu L, Johnson HL, Cousens S. et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379 (9832): 2151-2161
  • 6 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
  • 7 Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120 (06) 1337-1351
  • 8 Romero R, Espinoza J, Kusanovic JP. et al. The preterm parturition syndrome. BJOG 2006; 113 (Suppl. 03) 17-42
  • 9 Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science 2014; 345 (6198): 760-765
  • 10 Bouvier D, Forest JC, Blanchon L. et al. Risk factors and outcomes of preterm premature rupture of membranes in a cohort of 6968 pregnant women prospectively recruited. J Clin Med 2019; 8 (11) E1987
  • 11 Dekker GA, Lee SY, North RA, McCowan LM, Simpson NA, Roberts CT. Risk factors for preterm birth in an international prospective cohort of nulliparous women. PLoS One 2012; 7 (07) e39154
  • 12 Berkowitz GS, Blackmore-Prince C, Lapinski RH, Savitz DA. Risk factors for preterm birth subtypes. Epidemiology 1998; 9 (03) 279-285
  • 13 Statistik om graviditeter, förlossningar och nyfödda. Accessed November 11, 2022 at: https://www.socialstyrelsen.se/statistik-och-data/statistik/statistikamnen/graviditeter-forlossningar-och-nyfodda/
  • 14 Gimenez LG, Krupitzki HB, Momany AM. et al. Maternal and neonatal epidemiological features in clinical subtypes of preterm birth. J Matern Fetal Neonatal Med 2016; 29 (19) 3153-3161
  • 15 Kamath-Rayne BD, DeFranco EA, Chung E, Chen A. Subtypes of preterm birth and the risk of postneonatal death. J Pediatr 2013; 162 (01) 28-34.e2
  • 16 Tita AT, Doherty L, Roberts JM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Adverse maternal and neonatal outcomes in indicated compared with spontaneous preterm birth in healthy nulliparas: a secondary analysis of a randomized trial. Am J Perinatol 2018; 35 (07) 624-631
  • 17 Platt MJ. Outcomes in preterm infants. Public Health 2014; 128 (05) 399-403
  • 18 Cnattingius S, Ericson A, Gunnarskog J, Källén B. A quality study of a medical birth registry. Scand J Soc Med 1990; 18 (02) 143-148
  • 19 Axelsson O. The Swedish Medical Birth Register. Acta Obstet Gynecol Scand 2003; 82 (06) 491-492
  • 20 World Health Organization. . International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Accessed November 27, 2022 at: https://apps.who.int/iris/handle/10665/246208
  • 21 Norman M, Källén K, Wahlström E, Håkansson S. SNQ Collaboration. The Swedish Neonatal Quality Register—contents, completeness and validity. Acta Paediatr 2019; 108 (08) 1411-1418
  • 22 Marsál K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr 1996; 85 (07) 843-848
  • 23 Swiatkowska-Freund M, Traczyk-Łos A, Partyka A, Obara K, Damdinsuren A, Preis K. Perinatal outcome in preterm premature rupture of membranes before 37 weeks of gestation. Ginekol Pol 2019; 90 (11) 645-650
  • 24 Phillips C, Velji Z, Hanly C, Metcalfe A. Risk of recurrent spontaneous preterm birth: a systematic review and meta-analysis. BMJ Open 2017; 7 (06) e015402
  • 25 Tucker J, McGuire W. Epidemiology of preterm birth. BMJ 2004; 329 (7467): 675-678
  • 26 Menon R, Richardson LS. Preterm prelabor rupture of the membranes: a disease of the fetal membranes. Semin Perinatol 2017; 41 (07) 409-419
  • 27 Bryant-Greenwood GD. The extracellular matrix of the human fetal membranes: structure and function. Placenta 1998; 19 (01) 1-11
  • 28 Romero R, Miranda J, Chaemsaithong P. et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2015; 28 (12) 1394-1409
  • 29 Menon R. Spontaneous preterm birth, a clinical dilemma: etiologic, pathophysiologic and genetic heterogeneities and racial disparity. Acta Obstet Gynecol Scand 2008; 87 (06) 590-600
  • 30 Bond DM, Middleton P, Levett KM. et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev 2017; 3: CD004735
  • 31 DiGiulio DB, Romero R, Kusanovic JP. et al. Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes. Am J Reprod Immunol 2010; 64 (01) 38-57
  • 32 Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342 (20) 1500-1507
  • 33 Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2003; (02) CD001058
  • 34 Kenyon SL, Taylor DJ, Tarnow-Mordi W. ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet 2001; 357 (9261): 979-988
  • 35 Baser E, Kirmizi DA, Isik DU. et al. The effects of latency period in PPROM cases managed expectantly. J Matern Fetal Neonatal Med 2020; 33 (13) 2274-2283
  • 36 Edlow AG, Srinivas SK, Elovitz MA. Second-trimester loss and subsequent pregnancy outcomes: what is the real risk?. Am J Obstet Gynecol 2007; 197 (06) 581.e1-581.e6