Amniotic Fluid Volume as a Contextual Marker of Latency and Perinatal Outcomes in Premature Prelabor Rupture of Membranes

Abstract

Objectives: The aim of this study was to evaluate the association between amniotic fluid volume at preterm prelabor rupture of membranes (PPROM) diagnosis and latency, short-term delivery risk, and perinatal outcomes across different gestational ages. Methods: This retrospective cohort study included singleton pregnancies with PPROM before 34 weeks' gestation managed at a tertiary referral center. Amniotic fluid (AF) volume was categorized according to the deepest vertical pocket (?20 mm vs. >20 mm). Fetal and neonatal outcomes were analyzed as predefined composite outcomes. Latency to delivery was assessed using Kaplan-Meier estimates. Multivariable Cox regression models were used to evaluate associations after adjustment for clinically relevant confounders. Results: A total of 263 pregnancies were included, of which 66.5% had an AF pocket ? 20 mm at presentation. Lower AF volume was associated with a higher incidence of the fetal composite outcome (74.3% vs. 52.3%, p < 0.001) and a higher short-term risk of delivery across gestational-age strata. In multivariable analysis, AF pocket > 20 mm remained independently associated with lower risk of fetal composite outcome. AF volume was not associated with overall latency to delivery (Spearman ? = 0.03, p = 0.598). Although lower AF volume was associated with higher crude neonatal morbidity, this association was attenuated after adjustment for gestational age. Conclusions: Reduced AF volume at PPROM presentation was associated with adverse fetal outcomes and higher short-term delivery risk, whereas neonatal morbidity was mainly driven by gestational age at delivery. AF volume should therefore be interpreted as a contextual prognostic marker rather than an isolated determinant of outcome.