Prediction of the maternal and perinatal outcomes in premature rupture of membranes at and after 37 weeks of gestation using maternal serum C reactive protein levels
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20254285Keywords:
C-reactive protein, Chorioamnionitis, Neonatal sepsis, Premature rupture of membranesAbstract
Background: Premature rupture of membranes (PROM) complicates 5-10% of pregnancies, mostly at term, and increases the risk of maternal and neonatal morbidity due to intrauterine infection. Early prediction is crucial, and C-reactive protein (CRP), an acute-phase reactant, is frequently studied, though its diagnostic accuracy in PROM remains uncertain. This study was conducted to evaluate the role of maternal serum CRP in predicting chorioamnionitis and associated complications in term PROM.
Methods: This prospective observational study included 90 women with term PROM admitted to Swami Dayanand Hospital, New Delhi, between August 2022 and February 2024. Maternal serum CRP was measured at admission, and patients were followed for development of chorioamnionitis, mode of delivery, and maternal and neonatal outcomes. Diagnostic accuracy was calculated.
Results: Of 90 women, 72% were aged 21-30 years and 65.6% were primigravida; mean gestational age was 38.4 weeks. Adverse outcomes were significantly higher with leaking >24 hours (p=0.008). CRP ≥5 mg/L was associated with caesarean delivery (35.1% vs. 11.3%, p=0.02), postpartum febrile morbidity (32.4% vs. 7.5%, p=0.004), and neonatal antibiotic requirement (35.1% vs. 11.3%, p=0.006). No significant association was observed with chorioamnionitis, postpartum haemorrhage, low Apgar scores, neonatal intensive care unit (NICU) admission, or perinatal death. CRP predicted adverse outcomes with 64.7% sensitivity, 73.2% specificity, and 70% diagnostic accuracy.
Conclusions: Maternal CRP ≥5 mg/L is a useful predictor of adverse outcomes in term PROM, particularly postpartum infection and neonatal sepsis risk. Its high negative predictive value supports its role as a simple, cost-effective screening tool.
References
ACOG Practice Bulletin No. 217: Prelabor Rupture of Membranes. Available at: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/03/prelabor-rupture-of-membranes. Accessed on 1 June 2025.
Menon R, Richardson LS. Preterm prelabor rupture of the membranes: a disease of the fetal membranes. Semin Perinatol. 2017;41(7):409-19.
Brown RG, Marchesi JR, Lee YS, Smith A, Lehne B, Kindinger LM, et al. Vaginal dysbiosis increases risk of preterm birth irrespective of treatment for bacterial vaginosis: a prospective observational cohort study. BMC Med. 2018;16(1):9.
Yudin MH, van Schalkwyk J, Van Eyk N. No. 233: Management of preterm prelabour rupture of membranes. J Obstet Gynaecol Can. 2017;39(9):e194-207.
Ghosh S, Bhatla N, Kriplani A, Agarwal N, Sharma M. Predictive value of maternal serum C-reactive protein in pregnancies complicated by preterm premature rupture of membranes. J Obstet Gynaecol Res. 2020;46(2):241-8.
Blossia S, Tirkey RS, Kingsbury B, Yenuberi H, Mahasampath G, Jude J, et al. C-reactive protein levels in women with prelabour rupture of membranes and women with normal labour. J Family Med Prim Care. 2023;12(5):953-7.
Yasmina A, Barakat A. Prelabour rupture of membranes (PROM) at term: prognostic factors and neonatal consequences. Pan Afr Med J. 2017;26:68.
Chandra SN, Pradeep MR, Shashikumara. Maternal and neonatal outcomes and the associated risk factors for premature rupture of membranes. J South Asian Feder Obst Gynae. 2020;12(6):402-7.
Gupta S, Malik S, Gupta S. Neonatal complications in women with premature rupture of membranes (PROM) at term and near term and its correlation with time lapsed since PROM to delivery. Trop Doct. 2020;50(1):8-11.
Popowski T, Goffinet F, Maillard F, Schmitz T, Leroy S, Kayem G. Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study. BMC Pregnancy Childbirth. 2011;11:26.
Marchocki Z, Vinturache A, Collins K, O'Reilly P, O'Donoghue K. Amniotic fluid C-reactive protein as a predictor of infection in cesarean section: a feasibility study. Sci Rep. 2018;8:6372.
Starrach T, Schrey-Petersen S, Pecks U, Maass N, Rath W. PROM at term: when might be the best time to induce labour. Arch Gynecol Obstet. 2025;311(2):671-8.
Suryavanshi A, Kalra R. Study of association of C-reactive protein with maternal chorioamnionitis and early-onset neonatal sepsis in premature rupture of membranes deliveries: a diagnostic dilemma. Int J Appl Basic Med Res. 2019;9(4):236-40.
Ibrahim ZMM, Elgadal AH, Nasr A. Outcome of neonates born to mothers with prolonged premature rupture of membranes admitted to neonatal intensive care unit at Omdurman Maternity Hospital. Acad J Ped Neonatol. 2023;13(3):555916.
Naskar A, Ghosh S. Predictive value of maternal C-reactive protein for detection of histological chorioamnionitis in women with prelabour rupture of membranes. J Obstet Gynecol. 2019;5(2):83-92.
Shaaban A, Fathey A, Abdelgied A, Dawood R, Dawoud M. Maternal serum C-reactive protein for prediction of maternal and perinatal morbidity in premature rupture of membranes. Egypt J Hosp Med. 2021;83(1):1554-62.
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