Exposure to prolonged rupture of membranes at term increases the risk for ventilatory support in uninfected neonates

Background: The effects of prolonged rupture of membranes (ROM) on perinatal outcomes are still unclear and the management of those women remains controversial. This study aims to evaluate how the exposure of pregnant women to a prolonged ROM affects maternal and neonatal outcomes. Methods: This retrospective cohort study included singleton pregnant women at term delivering between January 2019, and March 2020 in a tertiary hospital. All relevant sociodemographic, pregnancy, and perinatal variables (maternal age, pre-pregnancy BMI, labor, and delivery outcomes) were collected anonymously. Data were compared between the "ROM < 24 hours" and "ROM ≥24 hours" study groups. Results: A total of 2689 dyads were included in the study and divided according to their ROM-delivery time: ROM <24 hours, (2369 women, 88.1%), and ROM ≥ 24 hours (320 women, 11.9%). Maternal baseline characteristics were comparable except for the rate of nulliparous women, which was significantly higher among patients with ROM ≥ 24 hours. No significant differences were found regarding infectious neonatal outcomes. However, mechanical ventilation and CPAP were more common among neonates born after ROM ≥ 24 h. The greater likelihood of neonatal respiratory distress was also confirmed among infants born to GBS-negative women with ROM ≥ 24 hours (15 out of 267 neonates, 5.6% vs 52 out of 1529 with ROM < 24 hours, 3.4%, p=0.04). Conclusions: According to the actual expectant policy, prolonged ROM is associated with an increased risk of respiratory support, in non-infected neonates. Further investigations are required to explain such an association.