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High ratio between the duration of membrane rupture to the total duration of labor is associated with increased morbidity in term neonates
Abstract Number: S-45
Abstract Type: Original Research
Objective: The duration of ruptured membranes (ROM) is an important risk factor for neonatal sepsis. However ROM duration is influenced by the duration of labor, yet studies investigating the influence of this relationship on neonatal outcomes are lacking. Our study hypothesis was that the ratio between duration of ROM-to-duration of labor may better identify patients at risk of neonatal morbidity compared to ROM duration alone.
Methods: We performed a secondary analysis using MFMU data from the Factor V Leiden Mutation Study. We identified women with singleton pregnancies who underwent vaginal delivery ≥37 weeks’ gestation. Women whose babies had congenital malformations or SGA <10th percentile were excluded. Our primary outcome – neonatal morbidity- was defined by the presence of at least one of the following conditions: stillbirth, respiratory distress syndrome, transient tachypnea of the newborn, sepsis, seizures, NICU admission or a 5 min APGAR ≤3. The ratio of ROM duration-to-labor duration was categorized into quartiles: (<0.24; 0.24 – 0.513; 0.514 – 0.99; ≥1.0). We performed bivariate analyses to assess the relationship between the ratio and other demographic, obstetric and intrapartum factors with neonatal morbidity. Variables associated with neonatal morbidity (P<0.1) were included in a multivariate logistic regression model. The AUROC was compared with a model containing ROM duration.
Results: Our cohort comprised 2826 women, of which 181 (6.4%) women had neonatal morbidity. Compared to women in the lowest quartile, women in the higher quartiles were at increased risk of neonatal morbidity (Table 1). Other factors independently associated with neonatal morbidity were: African-American race, Hispanic ethnicity, obesity and pre-eclampsia, HELLP or eclampsia. The AUROC for the model including the ratio (AUROC=0.66) was similar to the AUROC for a model with ROM duration (AUROC=0.65; P=0.43).
Conclusion: In this exploratory study, high ratios of ROM duration-to-labor duration were associated with an increased risk of neonatal morbidity. However the ratio and ROM duration may have similar predictive values for neonatal morbidity among term women undergoing vaginal delivery. Among term women with vaginal deliveries, ROM duration appears to be as predictive as ROM to labor duration ratio for identifying adverse neonatal outcomes.