The effects of tocolysis on neonatal septic death in women with PPROM: a retrospective cohort study
- 50 Downloads
In women with preterm premature rupture of membranes (PPROM), particularly those with suspected chorioamnionitis, the benefit of tocolysis on neonatal outcome remains unclear. Our purpose was to evaluate the effect of tocolysis on neonatal septic death in women with PPROM with and without chorioamnionitis.
A retrospective cohort study was used to address our study objective. We created a cohort consisting of all live births between 24 and 32 weeks’ gestation that were registered in the Linked Birth and Infant Death data files (2009–2013) from the United States. Multivariate logistic regression was used to evaluate the effect of tocolysis on neonatal septic death at 7 and 28 days in births with and without chorioamnionitis.
Of the 46,968 births that met our inclusion criteria, tocolysis was administered to 6264 (13.3%). Tocolysis was more commonly prescribed to Caucasians, smokers, in multiple birth pregnancies, and to women with a history of preterm births. Tocolysis was not significantly associated with neonatal septic death at 7 days (OR 0.66, 95% CI 0.39–1.13) or at 28 days (OR 0.85, 95% CI 0.60–1.19). This was consistent in pregnancies with and without chorioamnionitis. Furthermore, tocolysis was associated with a reduced risk of neonatal septic death at 7 days when administered between 24 and 27 weeks’ gestation (OR 0.44, 95% CI 0.22–0.88).
In the setting of PPROM, tocolysis does not appear to increase the risk of neonatal septic death at 7 and 28 days. Therefore, consideration should be given to its administration if clinically indicated.
KeywordsChorioamnionitis Neonatal septic death PPROM Tocolysis
AC: Contributed to study design; interpretation of data; drafting of manuscript. NC-S: Data management; data analysis; revision of manuscript. HAA: Conception and design; acquisition of data; supervision; interpretation of data; critical revision of manuscript for important intellectual content.
No funding was received for this study. AC was a recipient of a McGill University Robert Courey Research Bursary. This was personal funding.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest. We had full control of all primary data and we agree to allow the Journal to review these data, if requested.
This study used exclusively publicly available data; hence, according to the Tri-Council Policy statement (2010), institutional review board approval was not required.
This study used exclusively publicly available data; hence, we did not personally obtain informed consent from study subjects. This would be the responsibility of the Agency for Healthcare Research and Quality (AHRQ), who sponsors the National Inpatient Sample.
- 1.Gynaecologists RCoO (2010) Preterm prelabor rupture of membranes. Royal College of Obstetricians & Gynaecologists, LondonGoogle Scholar
- 4.Mackeen AD, Seibel-Seamon J, Grimes-Dennis J, Baxter JK, Berghella V (2011) Tocolytics for preterm premature rupture of membranes. Cochrane Database Syst Rev 2011:CD007062Google Scholar
- 6.Kacerovsky M, Musilova I, Khatibi A, Skogstrand K, Hougaard DM, Tambor V et al (2012) Intraamniotic inflammatory response to bacteria: analysis of multiple amniotic fluid proteins in women with preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 25:2014–2019CrossRefPubMedCentralGoogle Scholar
- 8.Tan TC, Devendra K, Tan LK, Tan HK (2006) Tocolytic treatment for the management of preterm labour: a systematic review. Singap Med J 47:361–366Google Scholar
- 9.NCHS (2009) User guide to the 2009 period linked birth/infant death public use file. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/periodlinked/LinkPE09Guide.pdf. Accessed 9 Feb 2018
- 10.NCHS (2010) User guide to the 2010 period linked birth/infant death public use file. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/periodlinked/LinkPE10Guide.pdf. Accessed 9 Feb 2018
- 11.NCHS (2011) User guide to the 2011 period linked birth/infant death public use file. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/periodlinked/LinkPE11Guide.pdf. Accessed 9 Feb 2018
- 12.NCHS (2012) User guide to the 2012 period linked birth/infant death public use file. ftp://ftp.cdc.gov/pub/health_statistics/nchs/dataset_documentation/DVS/periodlinked/LinkPE12Guide.pdf. Accessed 9 Feb 2018
- 13.NCHS (2013) User guide to the 2013 period linked birth/infant death public use file. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/periodlinked/LinkPE13Guide.pdf. Accessed 9 Feb 2018
- 16.Kenyon S, Boulvain M, Neilson JP (2010) Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2010:CD001058Google Scholar
- 23.Archabald KL, Buhimschi IA, Bahtiyar MO, Dulay AT, Abdel-Razeq SS, Pettker CM et al (2016) Limiting the Exposure of Select Fetuses to Intrauterine Infection/Inflammation Improves Short-Term Neonatal Outcomes in Preterm Premature Rupture of Membranes. Fetal Diagn Therapy 42(2):99–110CrossRefGoogle Scholar
- 32.Driul L, Londero AP, Adorati-Menegato A, Vogrig E, Bertozzi S, Fachechi G et al (2014) Therapy side-effects and predictive factors for preterm delivery in patients undergoing tocolysis with atosiban or ritodrine for threatened preterm labour. J Obstet Gynaecol 34:684–689CrossRefPubMedCentralGoogle Scholar