Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study
Abstract Background Guidelines regarding management of prelabor rupture of membranes (PROM) at term vary between immediate induction and expectant management. A long interval between PROM and delivery increases the risk for perinatal infections. Severe perinatal infections are associated with excess...
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| Format: | Article |
| Language: | English |
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BMC
2020-01-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-020-2751-3 |
| _version_ | 1818854893783351296 |
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| author | Maren Mynarek Solveig Bjellmo Stian Lydersen Kristin Melheim Strand Jan Egil Afset Guro L. Andersen Torstein Vik |
| author_facet | Maren Mynarek Solveig Bjellmo Stian Lydersen Kristin Melheim Strand Jan Egil Afset Guro L. Andersen Torstein Vik |
| author_sort | Maren Mynarek |
| collection | DOAJ |
| description | Abstract Background Guidelines regarding management of prelabor rupture of membranes (PROM) at term vary between immediate induction and expectant management. A long interval between PROM and delivery increases the risk for perinatal infections. Severe perinatal infections are associated with excess risk for cerebral palsy (CP) and perinatal death. We investigated if increasing intervals between PROM and delivery were associated with perinatal death or CP. Methods Eligible to participate in this population-based cohort-study were term born singletons without congenital malformations born in Norway during 1999–2009. Data was retrieved from the Medical Birth Registry of Norway (MBRN) and the Cerebral Palsy Register of Norway. In line with the registration in the MBRN, intervals between PROM and delivery of more than 24 h was defined as ‘prolonged’ and intervals between 12 and 24 h as ‘intermediate’. Outcomes were stillbirth, death during delivery, neonatal mortality and CP. Logistic regression was used to calculate odds ratio (OR) with 95% confidence intervals (CI) for adverse outcomes in children born after prolonged and intermediate intervals, compared with a reference group comprising all children born less than 12 h after PROM or without PROM. Results Among 559,972 births, 34,759 children were born after intermediate and 30,332 were born after prolonged intervals. There was no association between increasing intervals and death during delivery or in the neonatal period, while the prevalence of stillbirths decreased with increasing intervals. Among children born after intermediate intervals 38 (0.11%) had CP, while among those born after prolonged intervals 46 (0.15%) had CP. Compared with the reference group, the OR for CP was 1.16 (CI; 0.83 to 1.61) after intermediate and 1.61 (CI; 1.19 to 2.18) after prolonged intervals. Adjusting for antenatal factors did not affect these associations. Among children with CP the proportion with diffuse cortical injury and basal ganglia pathology on cerebral MRI, consistent with hypoxic-ischemic injuries, increased with increasing intervals. Conclusion Intervals between PROM and delivery of more than 24 h were associated with CP, but not with neonatal mortality or death during delivery. The inverse association with stillbirth is probably due to reverse causality. |
| first_indexed | 2024-12-19T07:59:57Z |
| format | Article |
| id | doaj.art-7b1bc9c07a454429a3e6c21d6ba0a805 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-19T07:59:57Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-7b1bc9c07a454429a3e6c21d6ba0a8052022-12-21T20:29:54ZengBMCBMC Pregnancy and Childbirth1471-23932020-01-0120111110.1186/s12884-020-2751-3Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort studyMaren Mynarek0Solveig Bjellmo1Stian Lydersen2Kristin Melheim Strand3Jan Egil Afset4Guro L. Andersen5Torstein Vik6Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health SciencesDepartment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health SciencesDepartment of Mental Health, Regional Centre for Child and Youth Health and Child WelfareDepartment of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University HospitalDepartment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health SciencesDepartment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health SciencesDepartment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health SciencesAbstract Background Guidelines regarding management of prelabor rupture of membranes (PROM) at term vary between immediate induction and expectant management. A long interval between PROM and delivery increases the risk for perinatal infections. Severe perinatal infections are associated with excess risk for cerebral palsy (CP) and perinatal death. We investigated if increasing intervals between PROM and delivery were associated with perinatal death or CP. Methods Eligible to participate in this population-based cohort-study were term born singletons without congenital malformations born in Norway during 1999–2009. Data was retrieved from the Medical Birth Registry of Norway (MBRN) and the Cerebral Palsy Register of Norway. In line with the registration in the MBRN, intervals between PROM and delivery of more than 24 h was defined as ‘prolonged’ and intervals between 12 and 24 h as ‘intermediate’. Outcomes were stillbirth, death during delivery, neonatal mortality and CP. Logistic regression was used to calculate odds ratio (OR) with 95% confidence intervals (CI) for adverse outcomes in children born after prolonged and intermediate intervals, compared with a reference group comprising all children born less than 12 h after PROM or without PROM. Results Among 559,972 births, 34,759 children were born after intermediate and 30,332 were born after prolonged intervals. There was no association between increasing intervals and death during delivery or in the neonatal period, while the prevalence of stillbirths decreased with increasing intervals. Among children born after intermediate intervals 38 (0.11%) had CP, while among those born after prolonged intervals 46 (0.15%) had CP. Compared with the reference group, the OR for CP was 1.16 (CI; 0.83 to 1.61) after intermediate and 1.61 (CI; 1.19 to 2.18) after prolonged intervals. Adjusting for antenatal factors did not affect these associations. Among children with CP the proportion with diffuse cortical injury and basal ganglia pathology on cerebral MRI, consistent with hypoxic-ischemic injuries, increased with increasing intervals. Conclusion Intervals between PROM and delivery of more than 24 h were associated with CP, but not with neonatal mortality or death during delivery. The inverse association with stillbirth is probably due to reverse causality.https://doi.org/10.1186/s12884-020-2751-3Cerebral palsyProlonged intervalPrelabor rupture of membranesPerinatal infectionNeonatal mortalityStillbirth |
| spellingShingle | Maren Mynarek Solveig Bjellmo Stian Lydersen Kristin Melheim Strand Jan Egil Afset Guro L. Andersen Torstein Vik Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study BMC Pregnancy and Childbirth Cerebral palsy Prolonged interval Prelabor rupture of membranes Perinatal infection Neonatal mortality Stillbirth |
| title | Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study |
| title_full | Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study |
| title_fullStr | Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study |
| title_full_unstemmed | Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study |
| title_short | Prelabor rupture of membranes and the association with cerebral palsy in term born children: a national registry-based cohort study |
| title_sort | prelabor rupture of membranes and the association with cerebral palsy in term born children a national registry based cohort study |
| topic | Cerebral palsy Prolonged interval Prelabor rupture of membranes Perinatal infection Neonatal mortality Stillbirth |
| url | https://doi.org/10.1186/s12884-020-2751-3 |
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