Preterm premature rupture of membranes: correlates and pregnancy outcome in a tertiary care setting

Abstract

INTRODUCTIONPrelabour membrane rupture before 37 weeks of gestation is referred to as preterm premature rupture of membranes (PPROM). Incidence of PPROM is about 2% of all pregnancies. 1 The consequences of PPROM for the neonate fall into three major overlapping categories. The first is the significant neonatal morbidity and mortality associated with prematurity. Secondly the complications during labor and delivery increase the risk for neonatal resuscitation and thirdly infection. The relative contributions of prematurity and perinatal infections to perinatal mortality are responsible for most of the controversy surrounding the optimal management of PPROM. Complications such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) contribute to most of the cases of neonatal mortality.Since the goal of management in PPROM is prolongation of pregnancy, the most commonly accepted management scheme less than 36 weeks is expectant, with patient ABSTRACT Background: Prelabour membrane rupture before 37 weeks of gestation is referred to as preterm premature rupture of membranes (PPROM). Incidence of PPROM is about 2% of all pregnancies. This prospective study aims to determine fetal and early neonatal outcome of pregnancies with PPROM. Methods: The study was conducted in 190 antenatal women with PPROM between 24 weeks to 36weeks of gestation over a period of 18 months. Their babies were followed up till discharge from Pediatric new born unit. Results: Prevalence of PPROM was 0.8%, accounting for 19% of preterm deliveries. 61% of women with PPROM showed evidence of lower genito-urinary tract infection, 28% had anemia, 48% gave history of coitus during pregnancy. Mean gestational age of membrane rupture was 32 weeks, the mean latency between membrane rupture and delivery was 4.4 days. Chorioamnionitis developed in 13% of women with PPROM, cord prolapse in 4% and abruption in 3%. The gestational age wise survival was 40% in babies weighing less than 1.5kg, 88% in babies weighing 1.5 to 2.5kg and 93% in those more than 2.5kg. The predominant causes of neonatal mortality were hyaline membrane disease (HMD) in babies born before 28 weeks, HMD and sepsis between 29 to 33 weeks and sepsis in babies born after 34 weeks. Conclusions: Screening and treatment of risk factors may contribute to prevention of PPROM. Neonatal survival depends on gestational age and availability of advanced NICU facilities. Patients and family members should be counseled regarding the outcome of pregnancies with PPROM. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure a healthy and fruitful life for mother and baby.

Prevalence, Risk Factors and Outcome of Preterm Premature Rupture of Membranes at the Bamenda Regional Hospital

“…The prevalence of PPROM among women admitted at the Bamenda Regional Hospital was 4.91% and it accounted for one-third of all preterm births. Our prevalence is close to 4.1% reported by Abouseif et al [11] in Egypt and to 4% reported by Rajan et al [7] in India. Our prevalence is higher than the 3.3% reported by Okeke et al [10] in Nigeria, the 2.8% reported by Bouvier et al [8] in Canada and that reported by Hackenhaar et al [9] in Brazil of 3.1%.…”

“…Preterm PROM occurs in approximately 3% of all pregnancies and causes about one third of preterm births [2]. The prevalence of PPROM ranges from 2.2% -4% in India [6] [7], 2.8% in Canada [8], 3.1% in Brazil [9], 3.3% in Nigeria [10], to 4.1% in Egypt [11].…”

Clinical Profile and Short Term Outcome of Hypoxic Ischemic Encephalopathy Among Birth Asphxiated Babies in a Tertiary Care Hospital

“…This was found to be same as seen by another national study by Majeed et al 6 where he showed that 24% babies whose mother had PROM, developed birth asphyxia. PROM is not only associated with increased incidence of emergency caesarian section but it is also associated with birth asphyxia but the frequency of birth asphyxia in PROM was found to be higher as compared to international studies (24.9% vs. 10%) 15 .…”

Maternal and Fetal Outcome of Preterm Prelabor Rupture of the Membranes in a Tertiary Care Hospital

“…Complications such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) contribute to most of the cases of neonatal mortality. 11,12 PROM and PPROM are commonly seen in the obstetric ward in our country. There are very limited studies about PPROM.…”