Microbial Culture Profiles Following Fetal Surgery Versus Spontaneous Preterm Prelabor Rupture of Membranes in Multifetal Gestations

OBJECTIVE: To assess microbial culture profiles and antibiotic resistance patterns in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) following fetal surgery compared with spontaneous PPROM without fetal surgery. METHOD: This retrospective cross-sectional study included women with multiple pregnancies and PPROMs < 34 weeks who underwent fetal surgery between September 2018 and January 2024. The study group comprised those who had undergone fetoscopic laser surgery (FLS) or selective fetal reduction (SFR). Endocervical swab and urine cultures were obtained upon PPROM, and placental, uterine and neonatal blood cultures were collected at delivery. A control group included women with multiple pregnancies and PPROMs < 34 weeks without fetal surgery. Cases with other fetal surgeries, terminations of the pregnancy, or delivery prior to 23 weeks were excluded. RESULTS: Among 126 fetal surgeries, 39 (30.9%) developed PPROM; 32 met inclusion criteria. Compared to controls (n = 31), the fetal surgery group had higher rates of positive cultures (42.7% vs. 13.9% of site-level cultures, p < 0.01), and of ampicillin/macrolide resistance (18.8% vs. 4.3%, p < 0.01). There tended to be more positive placental cultures (43.8% vs. 25.8%, p = 0.47) in the fetal surgery group. No early-onset neonatal sepsis occurred in the fetal surgery group but one in the control group. CONCLUSION: PPROM following fetal surgery was characterized by a distinct bacterial profile and greater ampicillin/macrolide resistance than spontaneous PPROM. These exploratory findings warrant prospective confirmation before informing changes to clinical practice.