Poster Session 3
Category: Prematurity
Poster Session 3
Marissa A. Hand, MD
Resident
Cleveland Clinic Foundation
Cleveland Clinic Foundation, Cleveland, Ohio, United States
Hannah Sinks, MD
Hofstra Northwell School of Medicine
Hofstra Northwell School of Medicine, New York, United States
Amrit Dhanushkoti, BS
University of Newcastle
University of Newcastle, New South Wales, Australia
Christine Chien, MD
Resident
Carle Foundation Hospital
Urbana, Illinois, United States
Caroline Pennacchio, MD
Resident
University of Pittsburgh Medical Center
University of Pittsburgh Medical Center, Pennsylvania, United States
Catherine Klammer, MD
Fellow
University of Pennsylvania
University of Pennsylvania, Pennsylvania, United States
Adriana Huelmo, BS
University of Newcastle
University of Newcastle, New South Wales, Australia
Meng Yao, MS
Cleveland Clinic Foundation
Cleveland Clinic Foundation, Ohio, United States
Carol Wang, BSc
University of Newcastle
University of Newcastle, New South Wales, Australia
Lisa Gray, BS, MD
Associate Medical Director of Maternal-Fetal Medicine
Carle Foundation Hospital
Carle Foundation Hospital, Illinois, United States
Dzhamala Gilmandyar, MD
Associate Director, Division of Maternal-Fetal Medicine
Hofstra Northwell School of Medicine
Hofstra Northwell School of Medicine, New York, United States
Ahmed Ahmed, MD, MSc, RDMS
Cleveland Clinic Foundation
Cleveland Clinic Foundation, Ohio, United States
Amol Malshe, MD
MFM
Cleveland Clinic Foundation
Cleveland Clinic Foundation, Ohio, United States
Craig Pennell, MBBS, PhD (he/him/his)
Chair in Obstetrics and Gynaecology, Professor of Maternal Fetal Medicine
University of Newcastle
University of Newcastle, New South Wales, Australia
Previable rupture of membranes is associated with high rates of fetal loss, neonatal morbidity, and maternal complications. The timing of rupture may influence both immediate and future outcomes. Early mid-trimester loss (14–20 weeks) may represent a distinct clinical phenotype compared to later losses (20–24 weeks), potentially altering recurrence risk. However, data on how gestational age at rupture impacts subsequent pregnancy outcomes remain limited.
Study Design:
This multinational retrospective cohort study included women with previable PPROM (14w0d–23w6d) from U.S. and Australian sites (2010–2023) who had a subsequent pregnancy reaching ≥14 weeks. Exclusions included intrauterine fetal demise prior to rupture or iatrogenic rupture. Subsequent pregnancies were categorized as term (≥37w), preterm birth (24w0d–36w6d), or mid-trimester loss (14w0d–23w6d). Group comparisons were performed using Chi-square and ANOVA tests; p < 0.05 was considered significant.
Results:
Among 140 patients with prior previable PPROM, 48 (34.3%) had MTL or PTB in a subsequent pregnancy, while 92 (65.7%) delivered at term. Early mid-trimester loss in the index pregnancy was strongly associated with mid-trimester loss in the subsequent pregnancy (71.4% vs. 28.6%, p < 0.001). Progesterone use in the index pregnancy was more common among those with adverse outcomes (52.2% vs. 20.7%, p < 0.001), whereas aspirin or progesterone use in the subsequent pregnancy did not differ. Cerclage was more frequent in those with recurrent MTL or PTB (64.6% vs. 43.5%, p = 0.028). Rates of hypertensive disorders and recurrence did not differ by country.
Conclusion:
One-third of patients with previable PPROM had recurrent MTL or PTB, highlighting substantial risk in future pregnancies. Early mid-trimester loss appears to mark a high-risk phenotype for recurrent adverse outcomes, warranting tailored counseling and intensified surveillance in future pregnancies.