A retrospective cohort study of fetal assessment following preterm premature rupture of membranes

Objective To evaluate maternal and neonatal outcomes following management of preterm premature rupture of membranes ( PPROM ) by two fetal assessment strategies. Methods In a retrospective cohort study performed at two hospitals in Philadelphia, Pennsylvania between July 2010 and June 2015, data were reviewed from 180 singleton pregnancies with PPROM at 23 0 –33 6  weeks of gestation that underwent expectant management. Outcomes were compared between continuous electronic fetal heart monitoring ( EFM ) with daily biophysical profile ( BPP ) (“continuous monitoring”) and non‐stress test ( NST ) three times per day (“periodic monitoring”) using Mann‐Whitney U and Fisher exact tests. Results Overall, 119 (66.1%) pregnancies were assessed by continuous monitoring and 61 (33.9%) by periodic monitoring. There was no difference in frequency of intrauterine death between the continuous monitoring (1, 0.8%) and periodic monitoring (3, 4.9%) groups ( OR , 0.16; 95% CI , 0.02–1.61). The continuous monitoring group was more likely to have an interventional ( OR , 2.17; 95% CI , 1.06–4.44) or cesarean ( OR 3.30, 95% CI 1.70–6.38) delivery. Conclusion Continuous EFM with daily BPP was associated with higher rates of intervention and cesarean delivery compared with periodic NST , but there was no difference in intrauterine or perinatal mortality.