Clara Murillo

Objective: To evaluate whether fetuses exposed to threatened preterm labor (PTL) without intra‐amniotic infection or inflammation (IAI), who were born ≥ 34 weeks' gestation, show signs of cardiac remodeling and dysfunction at admission and 4 weeks after the episode of threatened PTL. Methods: This was a prospective cohort study conducted at two tertiary referral centers including pregnant patients admitted between September 2018 and April 2021. The study group comprised women with singleton pregnancies and intact membranes who were admitted with a diagnosis of PTL between 23 and 34 weeks' gestation. Pregnancies were eligible for inclusion if amniocentesis was performed at admission and ruled out the occurrence of IAI. Exclusion criteria included latency to delivery shorter than 4 weeks and delivery < 34 weeks. Fetal echocardiography was performed within 72 h after admission and was repeated at follow‐up 4 weeks later. A control group of singleton pregnancies without PTL or preterm prelabor rupture of membranes (PPROM), matched with the study group at a ratio of 1:1 by gestational age at ultrasound, was also evaluated. Fetal cardiac morphology and function were assessed using a standardized echocardiographic protocol, and compared between the two groups. Amniotic fluid troponin I and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) concentrations were measured in the study group at the time at which amniocentesis was performed, and were compared with 20 amniotic fluid samples from the Clinic‐IDIBAPS Biobank that had been collected for indications other than PTL/PPROM or cardiac pathology. Results: A total of 32 fetuses exposed to threatened PTL (of which 84.4% were born at term) and 43 controls were compared. At admission, fetuses exposed to threatened PTL already showed signs of cardiac remodeling compared with controls, including a more globular cardiac shape (median global sphericity index, 1.17 vs 1.23; P = 0.012), an increased right atrial area‐to‐heart area ratio (median, 0.18 vs 0.16; P = 0.006) and early signs of diastolic dysfunction (median lower tricuspid E/A ratio, 0.65 vs 0.72; P = 0.027) and increased systolic function (median tricuspid annular plane systolic excursion, 6.5 vs 6.0 mm; P = 0.036). At admission, the threatened‐PTL group also showed significantly higher amniotic fluid troponin‐I levels (median, 1222.8 pg/mL vs 841.3 pg/mL; P = 0.026). Amniotic fluid NT‐proBNP was detectable in 25% of these cases, compared with none in the control group. At 4 weeks after the first ultrasound evaluation, in fetuses from mothers with threatened PTL, we observed that systolic function had normalized but cardiac remodeling persisted. These fetuses still exhibited a more globular cardiac shape (median global sphericity index, 1.16 vs 1.25; P = 0.036), and they now had a larger right ventricle (RV) (median RV area‐to‐heart area ratio, 0.26 vs 0.24; P = 0.037) without cardiomegaly. Diastolic function remained altered, with prolonged tricuspid inflow duration (median inflow time fraction, 0.39 vs 0.35; P = 0.001) and longer atrial contraction (median atrial time fraction, 0.23 vs 0.20; P = 0.039). Conclusions: Fetuses exposed to threatened PTL without IAI, who were born ≥ 34 weeks' gestation, exhibited signs of cardiac remodeling and subclinical diastolic dysfunction of the RV at admission that persisted for at least 4 weeks. Early identification of threatened PTL may provide opportunities to apply preventive strategies aimed at improving long‐term cardiovascular health. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Preterm prelabour rupture of membranes (PPROMs) before viability carries significant perinatal mortality and morbidity. Clinical management and prenatal counselling are a challenge, especially in twin pregnancies, due to scarce evidence on how previable PPROM affects this population. The aim of this study was to describe pregnancy outcomes of twin pregnancies complicated with previable PPROM and evaluate potential prognostic factors that may predict perinatal mortality. A retrospective cohort including dichorionic and monochorionic diamniotic twin pregnancies complicated with PPROM before 24 + 0 weeks of pregnancy was evaluated. Perinatal outcomes of pregnancies managed expectantly were described. Factors predicting perinatal mortality or reaching periviability (defined from 23 + 0 weeks onwards) were evaluated. Of the 45 patients included, 7 (15.6%) spontaneously delivered within the first 24 h after diagnosis. Two patients (5.3%) requested selective termination of the affected twin. In the 36 ongoing pregnancies that opted for expectant management, the overall survival rate was 35/72 (48.6%). There were 25/36 (69.4%) patients who delivered after 23 + 0 weeks of pregnancy. When periviability was achieved, neonatal survival increased up to 35/44 (79.5%). Gestational age at delivery was the only independent risk factor of perinatal mortality. The overall survival rate of twin pregnancies complicated with previable PPROM is poor but similar to singletons. No prognostic factors, apart from achieving periviability, were identified as individual predictors of perinatal mortality.

Objective: To evaluate the maternal, fetal, and neonatal outcomes of pregnant women complicated with preterm prelabor rupture of membranes (PPROM) eligible for outpatient care.Methods: This study included a retrospective cohort of patients with singleton pregnancies with PPROM between 23⁺⁰ to 34⁺⁰ weeks who remained pregnant after the first 72 h. Outpatient management was considered in women with clinical, ultrasound and analytical stability, and easy access to hospital. Maternal, fetal, and neonatal results were compared between women managed as inpatients versus those managed as outpatients.Results: Women eligible for the outpatient management had a better prognostic profile (no anhydramnios, longer cervical length, less intraamniotic infection, and clinical, ultrasound, and analytical stability) and presented a lower gestational age at admission and longer latency to delivery, resulting in a similar gestational age at delivery as the inpatient group. Postpartum curettage, uterine atony, respiratory distress syndrome, and bronchopulmonary dysplasia were less frequent in the outpatient group. Composite maternal‐fetal morbidity and mortality outcomes were similar in both groups, while composite neonatal morbidity and mortality outcomes were significantly lower in the outpatient group.Conclusion: Outpatient management may be an option for women presenting stable PPROM before 34 weeks when adequate selection criteria are fulfilled. Differences in perinatal outcomes in the outpatient group compared with the inpatient group are probably attributable to baseline characteristics. Further prospective randomized studies are needed to confirm the benefits of outpatient management in PPROM.