Grant: Op. Grant: Data Analysis Using Existing Databases and Cohorts-Infection/Immunity

TPROM refers to the rupture of fetal membranes prior to the onset of labor after 37 weeks' gestation, affecting approximately 10% of pregnancies. Prolonged TPROM increases the risk of maternal and fetal infection; for instance, the rates of chorioamnionitis increase from 4.0% to 8.9% when labor induction is delayed beyond 24 hours. Current evidence-based best practice is to offer labour induction at the time of presentation to hospital with TPROM. Approximately 700 cases of TPROM occur annually at BC Women's Hospital (BCWH). Preliminary data indicate that the majority of women deliver spontaneously within 24 hours of TPROM, however, approximately 25% will experience delays. Our study aims to assess the impact of this practice on birth outcomes among mothers and their newborns. We will examine the association between various risk factors, duration from TPROM to delivery and adverse birth outcomes, including operative delivery, fever during labor, chorioamnionitis, sepsis, endometritis, surgical site infection and neonatal sepsis. Data will be obtained from BC Perinatal Database Registry (BCPDR)and Population Data BC. The study population will comprise all term births in British Columbia from 2004/5 to 2023/24. BCPDR provides comprehensive information on maternal and delivery characteristics and birth outcomes. Piecewise additive mixed models will be used to estimate changes in adjusted hazard ratios for adverse outcomes, while accommodating nonlinear effects and non-proportional hazards. The study will add to the existing literature related to birth outcomes following TPROM and establish best practices for care of pregnant women in British Columbia.