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Risk factors for clinically significant intra-ventricular hemorrhage in pregnancies complicated by preterm premature rupture of membranes

Giamberardino W, Winn VD, Armstrong J*

Objectives: Preterm birth is a major cause of adverse perinatal outcomes, including intraventricular hemorrhage (IVH). IVH has been shown to contribute to lasting neurological disability, however the role of maternal characteristics and potentially modifiable risk factors that contribute to these outcomes have not been well defined. We sought to determine predictors of IVH in pregnancies complicated by early preterm premature rupture of membranes (PPROM).

Study design: We performed a retrospective cohort study of all singleton pregnancies with early PPROM <32 weeks GA and delivery >22 weeks GA at University of Colorado Hospital (UCH) from 1/1/2007-12/31/2011. Clinically significant IVH (Grade III or IV) was the primary outcome of this study. To determine independent predictors of IVH we created a multivariate model including all univariate covariates with p-value of ≤ 0.10.

Results: In our cohort (n=229), when adjusted for non-white race, younger maternal age and increased BMI were independent predictors of clinically significant IVH (OR=1.4 CI 1.04- 1.79, p=0.03; OR 1.2 CI 1.04-1.33, p=0.01, respectively). Female gender was also found to be an independent predictor of poor 5 minute APGAR (OR=2.3 CI 1.06-5.28, p=0.04).

Conclusions: In our cohort, infants born to younger mothers or mothers with higher BMI appear to be at increased risk for clinically significant IVH. Interestingly, on further analysis, we found that female newborns had a 2-fold greater risk of poor 5 minute APGAR of less than 7. Given these data, larger studies are warranted to examine modifiable and non-modifiable risk pregnancy that may be associated with IVH and subsequent adverse neurological outcomes in pregnancies complicated by early PPROM