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Am J Perinatol
DOI: 10.1055/a-2712-5549
Original Article

Maternal Morbidity following Periviable Prelabor Rupture of Membranes after Texas Senate Bill 8

Authors

  • Danna Ghafir

    1   McGovern Medical School at UTHealth, Houston, Texas, United States

  • Emily Fahl

    2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States

  • Nancy Ukoh

    1   McGovern Medical School at UTHealth, Houston, Texas, United States

  • Han-Yang Chen

    2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States

  • Sean C. Blackwell

    2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States

  • Julie Gutierrez

    2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States

  • Irene A. Stafford

    2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States
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Abstract

Objective

Standard practice prior to Texas Senate Bill 8 (SB 8) for those with periviable prelabor rupture of membranes (PROM) without contraindications to expectant management was to offer termination of pregnancy or expectant management. After SB 8 went into effect, pregnancy termination was only offered for these patients after the development of chorioamnionitis or clinically significant maternal hemorrhage. The aim of this study was to compare maternal outcomes of periviable PROM before and after SB 8 in Houston, TX.

Study Design

This retrospective cohort study compared outcomes of periviable PROM less than 22 weeks of gestational age before and after SB 8 at three tertiary care hospitals from January 1, 2018, to March 31, 2023. Our primary outcome was a composite of adverse maternal outcomes: Sepsis, transfusion, and intensive care unit (ICU) admission. Secondary outcomes included intraamniotic infection, postpartum hemorrhage, abruption, septic shock, hospital length of stay, time from rupture of membranes to delivery, and neonatal survival.

Results

Over the 5-year study period, 161 women met the inclusion criteria (96 pre-SB 8 vs. 65 post-SB8). Approximately half (54%) of those with periviable PROM opted for termination prior to SB8. Post-SB8, women were more likely to develop an adverse outcome (22.9 vs. 35.4%; aRR = 1.69, 95% confidence interval [CI]: 1.03–2.78), and were more likely to develop sepsis (9.4 vs. 29.2%; adjusted relative risk [aRR] = 2.97, 95% CI: 1.43–6.17). Five neonates survived to hospital discharge post-SB8, and one survived prior to SB8. Additionally, those expectantly managed post-SB8, compared with those expectantly managed pre-SB8, experienced a longer time from rupture of membranes to delivery (6.5 days post [2–14] vs. 3 days pre [1–7.5]), and a higher rate of sepsis (18 post [30.0%] vs. 6 pre [15.0%]).

Conclusion

These results provide evidence that periviable PROM alone is a life-threatening condition with a serious risk of maternal harm. Waiting for maternal infection or hemorrhage to develop before offering pregnancy termination increases the risks of serious maternal morbidity.

Key Points

  • Pre-SB8, 54% of women with periviable PROM chose termination.

  • Increased rates of sepsis were observed post-SB8.

  • Longer rupture of membranes to delivery times were observed post-SB8.

Keywords

abortion - periviable - prelabor rupture of membranes - sepsis - Texas law - Senate Bill 8

Ethical Approval

This study was approved by the IRB for the University of Texas Health Science Center at Houston – UTHealth (IRB approval no.: HSC-MS-21-1001).


Note

This study was presented as an oral plenary at the Society for Maternal Fetal Medicine Annual Pregnancy Meeting, January 30, 2025, Aurora, CO.


Supplementary Material



Publication History

Received: 05 August 2025

Accepted: 26 September 2025

Accepted Manuscript online:
29 September 2025

Article published online:
13 October 2025

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