Abstract
Objective
Preterm pre-labour rupture of membranes (PPROM), one of the leading causes of preterm
delivery, represents a serious economic and psychosocial health care burden. The unpredictability
of the interval between PPROM and labour, also known as the latency period, can be
unsettling for patients and clinicians alike. In singleton pregnancies, the literature
supports the use of ultrasound-determined cervical length to estimate the latency
period.
Methods
With this retrospective cohort study, we sought to determine whether a shorter cervical
length (≤25 vs. >25 mm) is associated with a shorter latency period in twin pregnancies
complicated by PPROM. At McMaster University Medical Centre, a tertiary care centre,
we used the Better Outcomes Registry Network (BoRN) database to identify patient records
that met our criteria for inclusion over a 5-year period.
Results
Forty-three records were included in our analysis. On average, shorter cervical length
was statistically significantly associated with a 6-day shorter latency period (P = 0.035). Confounders were controlled for using ANCOVA statistical analysis. A moderate,
positive correlation between cervical length and latency period was also identified
(r = 0.4).
Conclusion
Understanding that a shorter cervical length is associated with a shorter latency
period can assist clinicians in optimizing maternal counselling and patient care,
including triaging transfers to tertiary care centres.
Résumé
Objectif
La rupture prématurée des membranes avant terme (RPMAT), une des principales causes
d'accouchement prématuré, représente un fardeau économique et psychosocial considérable
en matière de soins de santé. L'imprévisibilité de l'intervalle entre la RPMAT et
le travail, aussi appelé période de latence, peut s'avérer déstabilisante tant pour les patientes que pour les cliniciens. Pour
les grossesses monofœtales, la littérature soutient le recours à la mesure échographique
de la longueur du col pour estimer la période de latence.
Méthodologie
Dans le cadre de cette étude de cohorte rétrospective, nous avons cherché à déterminer
si un col court (≤ 25 mm par rapport à > 25 mm) est lié à une période de latence plus
courte qu'en cas de col long pour les grossesses gémellaires compliquées par une RPMAT.
Au McMaster University Medical Centre, un centre de soins tertiaires, nous avons utilisé
la base de données du Registre et réseau des bons résultats dès la naissance (BORN)
pour repérer les dossiers de patientes répondant à nos critères d'inclusion sur une
période de 5 ans.
Résultats
Nous avons retenu 43 dossiers pour notre analyse. Nous avons observé qu'en moyenne,
un col court était lié de façon statistiquement significative à une période de latence
6 jours plus courte qu'en présence d'un col de plus de 25 mm (P = 0,035). Les facteurs de confusion ont été pris en compte pour l'utilisation de
l'analyse statistique de la covariance. Une corrélation moyenne et positive entre
la longueur du col et la période de latence a également été observée (r = 0,4).
Conclusion
Il peut être utile pour les cliniciens de savoir qu'un col court est lié à un raccourcissement
de la période de latence afin d'optimiser l'accompagnement maternel et les soins prodigués
aux patientes, y compris les transferts au triage vers des centres de soins tertiaires.
Keywords
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REFERENCES
- Ultrasonographic evaluation of cervical length in pregnancies complicated by preterm premature rupture of membranes.Ultrasound Obstet Gynecol. 2002; 19: 565-569
- The association between maternal biomarkers and pathways to preterm birth in twin pregnancies.J Matern Fetal Neonatal Med. 2014; 28: 504-508
- The natural history of preterm premature rupture of membranes in twin pregnancies.J Matern Fetal Neonatal Med. 2017; 30: 1829-1835
- Prematurity and twinning.J Matern Fetal Neonatal Med. 2012; 25: 6-10
- Premature rupture of membranes before 34 weeks managed expectantly: maternal and perinatal outcomes in singletons.J Matern Fetal Neonatal Med. 2013; 26: 290-293
- Randomized trial of endovaginal ultrasound in preterm premature rupture of membranes.Obstet Gynecol. 1997; 89: 458-461
- Parameters affecting latency period in PPROM cases: a 10-year experience of a single institution.J Matern Fetal Neonatal Med. 2013; 26: 1455-1458
- Twin versus singleton pregnancies complicated by preterm premature rupture of membranes.J Matern Fetal Neonatal Med. 2012; 25: 658-661
- Prediction of preterm premature rupture of membranes by transvaginal ultrasound features and risk factors in a high-risk population.Ultrasound Obstet Gynecol. 2002; 20: 245-251
- Epidemiology and causes of preterm birth.Lancet. 2008; 371: 75-84
- Preterm premature rupture of membranes in singleton vs twin pregnancies: the latency periods and the clinical outcomes revisited.J Obstet Gynaecol. 2014; 34: 593-597
- International comparison of common risk factors of preterm birth between the U.S. and Canada, using PRAMS and MES (2005-2006).Matern Child Health J. 2015; 19: 811-818
- The economic burden of prematurity in Canada.BMC Pediatr. 2014; 14: 1-10
- Transvaginal cervical length and amniotic fluid index: can it predict delivery latency.Am J Obstet Gynecol. 2015; 212: 401-409
- Does transvaginal ultrasound of the cervix predict preterm premature rupture of membranes in a high-risk population?.Ultrasound Obstet Gynecol. 2001; 18: 223-227
- The value of transvaginal ultrasonographic examination of the uterine cervix in predicting preterm delivery in patients with preterm premature rupture of membranes.Ultrasound Obstet Gynecol. 1998; 11: 23-29
- Cervical length measurement by translabial sonography in women with preterm premature rupture of membranes: can it be used to predict the latency period or peripartum maternal infection?.J Matern Fetal Neonatal Med. 2008; 21: 105-109
- The influence of prolonged preterm premature rupture of membranes on neonatal outcome of the presenting and non-presenting twin.Eur J Obstet Gynecol Reprod Biol. 2014; 181: 28-31
- Sonographic measurement of cervical length in preterm prelabor amniorrhexis.Ultrasound Obstet Gynecol. 2004; 24: 550-553
- Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994.Am J Obstet Gynecol. 1995; 173: 322-335
- Decline in effectiveness of antenatal corticosteroids with time to birth: real or artefact?.Br Med J. 2007; 335: 77-79
- Association between antenatal corticosteroid administration-to-birth interval and outcomes of preterm neonates.Obstet Gynecol. 2015; 125: 1377-1384
- Antenatal corticosteroid therapy for improving neonatal outcomes.J Obstet Gynecol Can. 2018; 40: 1219-1239
- Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies.J Obstet Gynecol Can. 2018; 40: 151-164
- Correlation of uterine cervical length measurment from transabdominal, transperineal and transvaginal ultrasonography.J Med Assoc Thai. 2004; 87: 326-332
- Preterm prelabour rupture of membranes: effect of latency on neonatal and maternal outcomes.J Obstet Gynecol Can. 2013; 35: 710-717
Article info
Publication history
Published online: April 13, 2020
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
