The Effect of Non-Stress Test Results on Perinatal Outcomes in Expectantly Managed Pregnancies Complicated by Premature Rupture of Membranes
Öz
Aim: This study aimed to evaluate the impact of nonstress test (NST) findings on perinatal outcomes in pregnancies complicated by premature rupture of membranes (PROM) managed expectantly.
Materials and Methods: This retrospective study included pregnant women with preterm premature rupture of membranes (PPROM) between 26 and 34 weeks of gestation who were admitted to Konya City Hospital from January 2018 to January 2024.Patient data, including gestational age, maternal age, gravidity, parity, and comorbidities, were analyzed. NST results were classified into three categories based on the NICHD 2008 guidelines. A total of 96 patients were included in the study. Among them, 68 were classified as NST Category 1, 4 as NST Category 2, and 24 as NST Category 3. Since only four cases were identified in Category 2, this group was excluded from the analyses due to the inability to achieve statistical significance. Therefore, comparisons were conducted solely between Category 1 (n=68) and Category 3 (n=24) groups. Cases with abnormal Doppler findings, fetal anomalies, or intrauterine growth restriction were excluded. Perinatal outcomes were evaluated by recording birth weights, blood gas parameters, Apgar scores, NICU admission rates, NICU stay duration, and neonatal mortality rates.
Results: In our study, the parameters that demonstrated statistically significant differences in blood gas analysis were pH and base excess. The pH was 7.36 in Category 1 and 7.30 in Category 3 (p =0.003), while base excess was found to be significantly lower in Category 3 compared to Category 1 (-3.90 vs. -2.27; p = 0.028). The mean 1-minute Apgar scores were 7.64 for Category 1 and 7.33 for Category 3 (p = 0.253), while the mean 5-minute scores were 8.72 and 8.45, respectively (p = 0.306). There were 3 neonatal deaths (4.4%) in Category 1 and 1 death (4.2%) in Category 3; no significant difference was observed. NICU admission rates were 58.8% for Category 1 and 66.7% for Category 3.
Conclusion: Although NST is a useful method for assessing fetal well-being, its ability to predict perinatal outcomes in PPROM cases is limited. Since basing delivery decisions solely on NST findings may lead to unnecessary preterm births, clinical evaluation should be comprehensive and multidisciplinary. In pregnancies complicated by PPROM, an individualized management strategy should be adopted, and further studies are warranted to validate these findings.
Anahtar Kelimeler
Non-Stress Test (NST), Apgar Score, preterm premature rupture of membranes(PPROM)
Kaynakça
- 1. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 172: Premature Rupture of Membranes. Obstet Gynecol 2016; 128(4):e165-77
- 2. Menon R, Richardson LS. Preterm prelabor rupture of the membranes: A disease of the fetal membranes. Semin Perinatol. 2017 Nov;41(7):409-419
- 3. Royal College of Obstetricians and Gynaecologists. Preterm Prelabour Rupture of Membranes. Green-Top Guideline 2006;44.
- 4. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003; 101(1):178-93
- 5. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84.
- 6. J.H. Lin, Y.H. Hsu, P.H. Wang, Risks for preterm premature labor: many of them are preventable, J Chin Med Assoc, 83 (2020), pp. 421-422
- 7. Y.T. Chu, A. Hsu, C.C. Wu, H.D. Tsai, C. Tsung-Che Hsieh, Y.H. Hsiao Acute chorioamnionitis complicated with symmetrical peripheral gangrene .Taiwan J Obstet Gynecol. 2020 Nov;59(6):972-974.
- 8. J.E. Park, Y. Park, J.S. Yuk, Incidence of and risk factors for thromboembolism during pregnancy and postpartum: a 10-year nationwide population-based study, Taiwan J Obstet Gynecol, 60 (2021), pp. 103-110
- 9. Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229. Obstet Gynecol. 2021 Jun 01;137(6):e116-e127. 10. Indications for Outpatient Antenatal Fetal Surveillance: ACOG Committee Opinion, Number 828. Obstet Gynecol. 2021 Jun 01;137(6):e177-e197
- 11. Stout MJ, Cahill AG. Electronic fetal monitoring: past, present, and future. Clin Perinatol. 2011 Mar;38(1):127-42, vii.