Prolongation of pregnancy with complications at <32+0 weeks of gestation – Benefits and risks

Objective: To evaluate the benefit (increasing fetal maturity) and risks (risk of neonatal infection and complications) of prolonging pregnancy before 32+0 weeks of gestation. Methods: Following data of all women hospitalized at gestational age <32 weeks from July 2003 to September 2006 for pregnancy complications (preterm labor, preterm premature rupture of membranes (PPROM), short cervix, bleeding, placenta previa, preeclampsia, fetal growth restriction) were extracted from the charts: neonatal morbidity such as neonatal infection, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH). Results: 233 pregnancies resulted in 288 live infants. Prolongation of pregnancy >1 week with PPROM was associated with increased risk of neonatal infection. The risk of chorioamnionitis (CA) increased with an increasing duration of time between rupture of membranes and delivery and with it the risk of neonatal infection (CA 34% vs. no CA 9%; p=0,001). In infants with neonatal infection the rate of IVH was sig. higher (28 vs. 8%; p<0,0001). After 28+0 weeks of gestation, pregancy prolongation lead to a significant decrease in major morbidities associated with prematurity (IVH, RDS, NEC..). Conclusions: In PPROM prolongation of pregnancy seems to increase neonatal infection rate. Consequently the goal in PPROM should be to delay delivery only for the time needed to permit administration of antepartum glucocorticoids and to allow in utero transfer to a neonatal intensive care unit. Prolongation of high risk pregnancies after 28+0 weeks of gestation appeared to be of no benefit, but may increase the risk of neonatal infections and subsequent IVH.

IVH - complications - pregnancy prolongation - premature delivery - preterm rupture of membranes