Analysis of risk factors, maternal and fetal outcome of spontaneous preterm premature rupture of membranes: a cross sectional study

Abstract

INTRODUCTIONPremature rupture of membranes (PROM) is defined as spontaneous membrane rupture that occurs before the onset of labour. When spontaneous membrane rupture occurs before 37 weeks gestation, it is referred to as preterm premature rupture of membranes (PPROM). 1PPROM complicates approximately 2%-3% of all pregnancies below 37 weeks gestation.2 P PROM complicates one-third of preterm births and is responsible for significant perinatal morbidity and mortality, largely related to prematurity. 3There are numerous risk factors for PPROM, such as physiologic changes, intrauterine infection at early gestational age, lower socioeconomic status of pregnant women, inadequate prenatal care and inadequate nutrition during pregnancy, sexually transmitted infections, ABSTRACTBackground: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. Objective of present study was to determine incidence, risk factors, maternal, fetal outcome of PPROM occurring in patients attending a tertiary hospital in North Eastern India.Methods: This descriptive cross-sectional study was carried out in the department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, India. Out of 15,969 deliveries between July 2010 to December 2011, 358 pregnant patients with spontaneous preterm premature rupture of membranes from 28-0 to 36-6weeks gestation were reviewed. After excluding patients with uterine anomalies, intrauterine deaths and congenital anomalies 293 patients were included and evaluated in this study. Results:The incidence of PPROM was 2.2%. Out of 293 patients 86% were singleton pregnancies, 12.9% were twins and 1.02% were triplets. 48.4% had previous history of termination of pregnancy, 28.6% history of previous PPROM and 16.3% had urinary tract infection. The mean gestational age at the onset of membrane rupture was 34.1+2.4 weeks and the latency from the membrane rupture to delivery interval ranged from 0-72 days with a mean of 48.4 hours. There were 7stillbirths (2.38%) and 4 neonatal deaths (1.02%) resulting in perinatal deaths of 3.29% and perinatal mortality rate of 0.329 per 1000 births due to PPROM. Maternal morbidity was minimal with postpartum haemorrhage in 11 patients (4.1%), abruptio placentae in 7 patients (2.3%) and sepsis in 43patients (14.6%). 66 patients (22.5%) underwent caesarean section for which malpresentations were the major cause. Conclusions: Despite remarkable advances in perinatal care, preterm premature rupture of membranes continues to cause perinatal morbidity and mortality. Strategies should be developed for its prevention. Management protocol should be improved in regard to vaginal swab culture and use of specific antibiotics.

Risk Factors of Premature Rupture of Membrane in A Tertiary Care Hospital, Bangladesh

“…Most of the women in our country are housewife so the incidence is higher in comparison to their study. Highest group of patient's (37.7%) education level was secondary level which is close to the study by Mohan S et al which was 40.2% 10 . In our study 66.4% patients came from urban, as it is a tertiary care private hospital.…”

“…Anaemia, hypertension and diabetes are associated risk factors of PPROM by affecting nutrition and immunity of the patient produce PROM 14,15 . In our study incidence of PIH, DM & GDM are 13.5% and10.5% respectively, which is higher than the study of Choudhary M et al, Mohan S et al and Akhter S et al where incidence was PIH (13%) and DM (1.03%) (4%) respectively 5,10,1 .…”

“…(Table II). which was higher than the study done by Mohan S et al where it was 55.2% 10 . In the study done by Begum N, low socioeconomic status was 50% 7 .…”

“…Low socio economic status is an important risk factor. In our study 60.6% patients came from low socio economic status 5,10,12,17 . History of spontaneous abortion 15% which was almost similar to the study by Mohan S et al where it was 17.7% 10 .…”

Outcome of neonates born to mothers with premature rupture of membranes

“…In this study total mortality was 2.4%, and the most common causes leading to death were sepsis and birth asphyxia. A study by Lokhande et al 19 had a mortality of 1.7% and a study by Mohan S, et al 21 had a mortality of 2.9% which are similar to the mortality in our study. However, the mortality was 5% in studies by Sharma et al 13 and Ramesh TV et al 16 which could be attributed to the inclusion criteria as they have included neonates whose mother had a history of PROM for more than 18 hours.…”