Expectant versus immediate delivery in women with PPROM between 34 and 35(+6) weeks: A Retrospective cohort

CONTEXT: Studies comparing the efficacy of expectant management (EM) and immediate delivery (ID) in the management of women with preterm prelabor rupture of membranes (PPROM) between 34 and 35(+6) weeks have not been done in a developing country. Although large multicentric studies show better outcomes with EM, the economic implications have not been studied. AIMS: This study compared women with PPROM between 34 and 35 (+6) weeks, managed expectantly with women who were delivered immediately. SETTINGS AND DESIGN: Large tertiary center and retrospective cohort. METHODS AND MATERIALS: Data of 206 women with PPROM between 34 and 35(+6) weeks managed with immediate delivery in the years 2014 and 2015 were compared with seventy-five women with PPROM managed expectantly in the years 2016 and 2017. STATISTICAL ANALYSIS USED: Data was summarized using mean standard deviation (SD) or median interquartile range for continuous variables and frequency and percentage for categorical variables. Continuous variables were compared using independent t-test and categorical variables were compared using Chi-square statistics. RESULTS: Neonatal sepsis was seen in 1/75 (1.3%) in the group managed expectantly and 12/206 (5.8%) in the ID group (P = 0.109). Respiratory distress was seen in 3/75 (4%) in the group managed expectantly and 22/206 (10.7%) with ID (P = 0.08). Chorioamnionitis was similar in both groups. Cesarean rate was 17.3% with expectant management and 28% with ID (P = 0.065). The mean hospital bill was ₹.33,494/- in the ED group and ₹.27,079/- in the ID group (P < 0.001). CONCLUSIONS: Expectant management was more expensive.