{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:56:16Z","timestamp":1787165776248,"version":"build-2736575974"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Standard practice prior to Texas Senate Bill 8 (SB 8) for those with periviable prelabor rupture of membranes (PROM) without contraindications to expectant management was to offer termination of pregnancy or expectant management. After SB 8 went into effect, pregnancy termination was only offered for these patients after the development of chorioamnionitis or clinically significant maternal hemorrhage. The aim of this study was to compare maternal outcomes of periviable PROM before and after SB 8 in Houston, TX.<\/jats:p>\n                  <jats:p>This retrospective cohort study compared outcomes of periviable PROM less than 22 weeks of gestational age before and after SB 8 at three tertiary care hospitals from January 1, 2018, to March 31, 2023. Our primary outcome was a composite of adverse maternal outcomes: Sepsis, transfusion, and intensive care unit (ICU) admission. Secondary outcomes included intraamniotic infection, postpartum hemorrhage, abruption, septic shock, hospital length of stay, time from rupture of membranes to delivery, and neonatal survival.<\/jats:p>\n                  <jats:p>Over the 5-year study period, 161 women met the inclusion criteria (96 pre-SB 8 vs. 65 post-SB8). Approximately half (54%) of those with periviable PROM opted for termination prior to SB8. Post-SB8, women were more likely to develop an adverse outcome (22.9 vs. 35.4%; aRR\u2009=\u20091.69, 95% confidence interval [CI]: 1.03\u20132.78), and were more likely to develop sepsis (9.4 vs. 29.2%; adjusted relative risk [aRR]\u2009=\u20092.97, 95% CI: 1.43\u20136.17). Five neonates survived to hospital discharge post-SB8, and one survived prior to SB8. Additionally, those expectantly managed post-SB8, compared with those expectantly managed pre-SB8, experienced a longer time from rupture of membranes to delivery (6.5 days post [2\u201314] vs. 3 days pre [1\u20137.5]), and a higher rate of sepsis (18 post [30.0%] vs. 6 pre [15.0%]).<\/jats:p>\n                  <jats:p>These results provide evidence that periviable PROM alone is a life-threatening condition with a serious risk of maternal harm. Waiting for maternal infection or hemorrhage to develop before offering pregnancy termination increases the risks of serious maternal morbidity.<\/jats:p>","DOI":"10.1055\/a-2712-5549","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T23:06:35Z","timestamp":1759187195000},"page":"949-954","source":"Crossref","is-referenced-by-count":3,"title":["Maternal Morbidity following Periviable Prelabor Rupture of Membranes after Texas Senate Bill 8"],"prefix":"10.1055","volume":"43","author":[{"given":"Danna","family":"Ghafir","sequence":"additional","affiliation":[{"name":"McGovern Medical School at UTHealth, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Fahl","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Ukoh","sequence":"additional","affiliation":[{"name":"McGovern Medical School at UTHealth, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean C.","family":"Blackwell","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene A.","family":"Stafford","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref3","volume-title":"Care Post-Roe: Documenting Cases of Poor-Quality Care since the Dobbs Decision","author":"D Grossman","year":"2024"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.ajog.2009.06.049","article-title":"The management of preterm premature rupture of the membranes near the limit of fetal viability","volume":"201","author":"T P Waters","year":"2009","journal-title":"Am J Obstet Gynecol"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1055\/a-2302-8657","article-title":"Periviable premature rupture of membranes-maternal and neonatal risks: A systematic review and meta-analysis","volume":"41","author":"A M Saucedo","year":"2024","journal-title":"Am J Perinatol"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1111\/aogs.14452","article-title":"Maternal mortality in women with pre-viable premature rupture of membranes: An analysis from the French confidential enquiry into maternal deaths","volume":"101","author":"Y Abrahami","year":"2022","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"627","DOI":"10.2147\/IJWH.S303120","article-title":"Perinatal outcomes and influence of amniotic fluid volume following previable, preterm prelabor rupture of membranes (pPPROM): A historical cohort study","volume":"13","author":"C Pylypjuk","year":"2021","journal-title":"Int J Womens Health"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"558.e1","DOI":"10.1016\/j.ajog.2021.10.036","article-title":"Maternal morbidity after preterm premature rupture of membranes at <24 weeks' gestation","volume":"226","author":"A Sklar","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1097\/OGX.0000000000001198","article-title":"Management and interventions in previable and periviable preterm premature rupture of membranes: A review","volume":"78","author":"A Phillips","year":"2023","journal-title":"Obstet Gynecol Surv"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1097\/AOG.0000000000002352","article-title":"Obstetric Care consensus No. 6: Periviable birth","volume":"130","author":"American College of Obstetricians and Gynecologists","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1097\/AOG.0000000000003700","article-title":"Prelabor rupture of membranes: ACOG Practice Bulletin, Number 217","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2024.07.016","article-title":"Society for Maternal-Fetal Medicine Consult Series #71: Management of previable and periviable preterm prelabor rupture of membranes","volume":"231","author":"A N Battarbee","year":"2024","journal-title":"Am J Obstet Gynecol"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jama.2020.24096","article-title":"Changes in abortion in Texas following an executive order ban during the coronavirus pandemic","volume":"325","author":"K White","year":"2021","journal-title":"JAMA"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2023.05.019","article-title":"Society for Maternal-Fetal Medicine Consult Series #67: Maternal sepsis","volume":"229","author":"A D Shields","year":"2023","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1097\/AOG.0000000000002236","article-title":"Committee Opinion No. 712: Intrapartum management of intraamniotic infection","volume":"130","author":"American College of Obstetricians and Gynecologists","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.ajog.2022.06.060","article-title":"Maternal morbidity and fetal outcomes among pregnant women at 22 weeks' gestation or less with complications in 2 Texas hospitals after legislation on abortion","volume":"227","author":"A Nambiar","year":"2022","journal-title":"Am J Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2712-5549.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T02:34:34Z","timestamp":1784342074000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2712-5549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":14,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2026,4,24]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2712-5549","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9,29]]},"published":{"date-parts":[[2025,9,29]]}}}