International Multicenter Term PROM Study: Evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term,☆☆,,★★

Presented at the Seventeenth Annual Meeting of the Society of Perinatal Obstetricians, Anaheim, California, January 20-25, 1997.
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Abstract

OBJECTIVE: Our objective was to determine significant predictors for the development of neonatal infection in infants born to patients with premature rupture of membranes at term.

STUDY DESIGN: Multivariate analysis was used to determine the significant predictors of neonatal infection in infants born to women with premature rupture of the membranes who were enrolled in the Term PROM Study. In a randomized, controlled trial, the Term PROM Study recently compared induction of labor with expectant management for premature rupture of membranes at term.

RESULTS: The following variables were identified as independent predictors of neonatal infection: clinical chorioamnionitis (odds ratio 5.89, P < .0001), positive maternal group B streptococcal status (vs negative or unknown, odds ratio 3.08, P < .0001), 7 to 8 vaginal digital examinations (vs 0 to 2, odds ratio 2.37, P = .04), 24 to <48 hours from membrane rupture to active labor (vs <12 hours, odds ratio 1.97, P = .02), ≥ 48 hours from membrane rupture to active labor (vs <12 hours, odds ratio 2.25, P = .01), and maternal antibiotics before delivery (odds ratio 1.63, P = .05).

CONCLUSIONS: Among infants born to patients with premature rupture of membranes at term, clinical chorioamnionitis and maternal colonization with group B streptococci are the most important predictors of subsequent neonatal infection. (Am J Obstet Gynecol 1998;179:635-9.)

Section snippets

Patients and methods

This study is a secondary analysis of data from patients enrolled in the International Multicenter Term PROM Study. This randomized, controlled study, which involved 72 hospitals in Canada, the United Kingdom, Australia, Israel, Sweden, and Denmark, compared 4 strategies of management: induction with oxytocin, induction with prostaglandin, and expectant management with induction with oxytocin or prostaglandin if necessary. The study found no statistically significant differences among the 4

Results

Between January 1992 and May 1995, 5041 patients were recruited for the Term PROM Study. After exclusion of 13 patients who did not have spontaneous or induced labor, 5028 patients remained for this secondary analysis of the clinically important predictors of neonatal infection. Demographic data and perinatal outcomes are reported in Table I. Spontaneous labor occurred in 2225 patients (44%). Thirty-one percent of patients (1541) had internal fetal heart rate monitoring during labor.

Comment

The incidence of neonatal infection for infants born to women with premature rupture of the membranes at term in this study was 2.6%. This is higher than the often-quoted risk of 1% with premature rupture of the membranes at term2 but is consistent with that reported in a retrospective study by Haque.5 These differences may be explained in part by differences in the definition of neonatal infection.

By means of stepwise logistic regression analysis this study identified important maternal

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From the Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecologya and Paediatricsb, the Maternal, Infant and Reproductive Health Research Unit, Centre for Research in Women’s Health,c and the Faculty of Nursing,d University of Toronto, the Department of Pediatrics, St Helier,e and the Department of Obstetrics and Gynecology, Bnai Zion Medical Centre.

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Supported by grant No MA-11392 from the Medical Research Council of Canada.

Reprint requests: P.G.R. Seaward, MB, BCh, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mt Sinai Hospital, Suite 775B, 600 University Ave, Toronto, Ontario, Canada M5G 1X5.

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