Perinatal outcomes in pregnant women presenting with preterm premature rupture of membranes at a regional hospital in KwaZulu- Natal Province, South Africa

Abstract

Background. Worldwide, the incidence of preterm premature rupture of membranes (PPROM) is between 1% and 4% of all pregnancies. Objectives. The primary objectives of this study were to describe and compare the perinatal outcomes of HIV-positive and HIV-negative women presenting with PPROM to a regional hospital in KwaZulu-Natal. Methods. This was a retrospective analytical cross-sectional study which reviewed files of pregnant women presenting with premature rupture of membranes at gestation between 28 and 36 completed weeks. These were identified from the labour ward birth register and from the neonatal ward admission book. Categorical and numerical variables pertaining to the method of confirmation of diagnoses, clinical profiles, modes of delivery, maternal outcomes and neonatal outcomes were considered. Results. A total of 87 files were analysed. Forty-six women (53%) were HIV-negative and 41 (47%) were HIV-positive. Fifty-two percent were in the gestational age <34 weeks. Fifty-nine percent (n=51) of women delivered vaginally and 31% (n=27) delivered by caesarean delivery (CD). There was also no statistical significance between the Apgar scores of the HIV-exposed and HIV-unexposed neonates, birth weights and modes of delivery. There was no statistical significance in sepsis rates, the need for ventilation and the duration of hospital stay between the two groups. The odds of developing neonatal jaundice (NNJ) in the HIV-positive group was 0.14 (95% confidence interval (CI) 0-0.93), which was statistically significant. There was no reported maternal or neonatal mortality and no maternal morbidity associated with PPROM in either groups. Conclusion. This study suggests that there are no immediate significant differences in neonatal and maternal outcomes in pregnancies complicated by PPROM between HIV-negative and HIV-positive women on ART except that of NNJ.

Predictors of Premature Rupture of Membranes among Pregnant Women in Rural Uganda: A Cross-Sectional Study at a Tertiary Teaching Hospital

“…Although studies by Gahwagi et al [13] in Libya and Boskabadi and Zakerihamidi [25] in Iran showed no significant association between gestational age with PROM, our study found that pregnant women of 37 weeks and more were less likely to experience PROM compared to early gestation women of less than 34 weeks (aOR = 0:3, 95% CI: 0.14-0.71, p = 0:01). Similar observations were made by Shadma and Aymen [4] in India, Abouseif et al [19] in Egypt, and Msomi et al [26] in South Africa where majority of the women with PROM were below 34 weeks of gestation. This is probably due to gestational age-related differences regarding fetal presentation, fetal position, and fetal lie, as well as maternal physiology.…”

Preterm prelabour rupture of membranes (PPROM) and pregnancy outcomes in association with HIV-1 infection in KwaZulu-Natal, South Africa

“…Furthermore, the proportion of women on cART or with lower CD4 count or higher viral load was equally distributed among women with PPROM or without PPROM. The overall high HIV seroprevalence in our cohort is consistent with that reported in another PPROM study in the KZN region and the most recent national antenatal HIV survey [22,27]. Unfortunately, the other KZN study lacked a control group of preterm deliveries without PPROM.…”

“…Inconsistent with our high cesarean rate, the other KZN PPROM study reported a higher vaginal delivery rate among women with PPROM but did not compare this with other preterm deliveries [22]. Nonetheless, similar to our findings, there was no evidence of worse pregnancy and newborn outcomes among HIV-infected women with PPROM when compared to their HIV-uninfected counterparts [22]. As in our study, most HIV-infected women in the study by Msomi et al were also on cART prior to delivery [22].…”

“…Our incidence of PPROM (2.67%) in 2018 in a high HIV endemic region in South Africa is similar to findings reported for the US (2.4%) or France (2-3%) where the antenatal HIV prevalence is markedly lower [18,21]. In the only other study conducted in KwaZulu Natal in 2013, prior to the cART rollout for pregnant women, 130 (1.69%; 95%CI 1.4-1.98) of 7694 deliveries were complicated by PPROM [22]. Although intra-amniotic, urinary tract and sexually transmitted infections have long been identified as a cause of PPROM [23], our retrospective analysis did not allow for further exploration of the role of other infections in PPROM.…”

“…There was a lower cesarean delivery rate among women with PPROM when compared to the non-PPROM group, and comparable between HIV-infected and uninfected women. Inconsistent with our high cesarean rate, the other KZN PPROM study reported a higher vaginal delivery rate among women with PPROM but did not compare this with other preterm deliveries [22]. Nonetheless, similar to our findings, there was no evidence of worse pregnancy and newborn outcomes among HIV-infected women with PPROM when compared to their HIV-uninfected counterparts [22].…”