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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

Tansim Akhter 
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.
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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.

Keywords

preterm birth - preterm premature rupture of membranes - maternal and perinatal outcomes - chorioamnionitis - postpartum endometritis - birth asphyxia

Supplementary Material



Publication History

Received: 31 January 2022

Accepted: 01 November 2022

Accepted Manuscript online:
08 November 2022

Article published online:
29 December 2022

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