Predictors for cesarean delivery in preterm premature rupture of membranes

Lina Salman, Amir Aviram, Roie Holzman, Hadar Hay-Azogui, Eran Ashwal, Eran Hadar, Rinat Gabbay-Benziv*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To determine predictors for cesarean delivery (CD) in pregnancies complicated by preterm premature rupture of membranes (PPROM) with an intention for vaginal delivery. Materials and methods: A retrospective cohort analysis of all singleton, preterm deliveries (24 + 0 to 36 + 6 weeks) following PPROM (2007–2014). Exclusion criteria included: cases intended for CD prior to delivery; short interval from PPROM to delivery (<24 hours); cervical dilatation upon admission ≥4 cm; and major fetal anatomical/chromosomal abnormalities. Potential CD predictors were evaluated by univariate followed by multivariate regression analysis. Results: Overall, 465 deliveries met inclusion criteria. Of them, 53 (11.4%) ended with CD. Women in the CD group delivered at an earlier gestational age (34 versus 35 weeks) with lower birth weights (2115 versus 2386 grams), p <.05 for both. On univariate analysis, smaller cervical dilatation upon admission and prior to delivery, longer PPROM to delivery interval and delivery indication were the only significant determinants associated CD (p <.001 for all). On multivariable regression analysis, only la rger cervical dilatation prior to delivery remained an independent factor for lower rates of CD (aOR 0.15, 95% CI 0.08–0.28, p <.001). Conclusion: Small cervical dilatation prior to delivery is an independent risk factor for CD in pregnancies complicated by PPROM.

Original languageEnglish
Pages (from-to)3761-3766
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number22
StatePublished - 16 Nov 2020


  • Cervical dilatation
  • cesarean delivery
  • preterm delivery
  • preterm premature rupture of membranes


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