Safety of prolonged latency in preterm prelabor rupture of membranes

Abstract

Preterm prelabor rupture of the membranes (PPLROM) reported to be occurring in 1-5% pregnancies, 1-6 is known to cause 30-40% preterm births. 7-10 And preterm births after PPLROM have been reported to be responsible for around 85% of neonatal morbidity and mortality 11,12 because of consequences like, respiratory distress syndrome (RDS), hypothermia, hypoglycemia, jaundice, necrotizing enterocolitis, intraventricular hemorrhage, neurologic impairment, retrolental fibroplasia, bronchopulmonary dysplasia, patent ductus arteriosus, fetal limb contracture, pulmonary hypoplasia and neonatal sepsis. The list is long. Final outcome is affected by gestational age, latency and many other factors. So research needs to continue for knowing causes of PPLROM, prevention and best management practices. Objectives Present study was carried out to know the outcome in cases of PPLROM with prolonged conservative management. Material methods Study was done at a rural referral institute. Women of 18 to 34years of age who presented between 28weeks to less than 37weeks with watery discharge were the study subjects. Exclusion criteria were diagnosed genitourinary renal anomalies in baby, known placenta praevia, term pregnancy, vaginal bleeding, active labor and fetal distress at admission. Institute's ethic's committee's approval and informed consent were taken. Demography of the study subjects and pregnancy outcome were recorded with the pre-designed tool. After taking history, general, systemic and spaculam examination were done in each case with all aseptic precautions to observe pooling of liquor. Additionally Nitrazine test and fern test were done for confirmation of PPLROM. Cervical and high vaginal swabs were cultured for microbes. Women were put on conservative management. Corticosteroids, tocolytics and antibiotics were given at admission with plans to observe mother and baby till term and then induce labour. Antibiotics were changed as per the sensitivity of microbes in the swabs which were similar in cervical/vaginal swabs. Any adverse situations, possibility of preterm spontaneous labour or need