DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150681

Feto-maternal outcome in pregnancies with preterm premature rupture of membranes: a tertiary hospital experience

Aparajita Sophia D’souza, Moneet Walia, Garima Gupta, Clarence Samuel, Francis Sridhar Katumalla, Sunitha Goyal

Abstract


Background: Preterm premature rupture of the membranes (PPROM) is a known dreaded complication of pregnancy as it is associated with significant perinatal complications. The objective of our study was to bring forward the incidence and feto-maternal outcome in pregnancies with PPROM in Indian scenario.

Methods: This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, in a tertiary hospital in Punjab between January 2014 and December 2014. Medical records of all pregnant patients who were admitted to our department with PPROM on the basis of clinical and /or laboratory data were reviewed. These 75 women were divided into two groups according to gestation age (GA), Group 1- early PPROM (24- 33 6/7 weeks of GA) (n=38) and Group 2- late PPROM (34-36 6/7 weeks of GA) (n=37). A multivariate analysis was used to find the association between PPROM and perinatal outcome.

Results: During the study period, there were 1528 deliveries in the hospital and 75 pregnant women were diagnosed to have PPROM giving an overall incidence of 4.9%. In both the groups most common maternal complication was chorioamnionitis (15.7% vs. 2.7%) and most common neonatal complication was physiological jaundice (56.8% vs. 69.2%). Most of the babies required phototherapy (50% vs. 43.5%) and antibiotics. Our study demonstrated that patients in group 1 had significant increase in the frequency of chorioamnionitis, hyaline membrane disease, septicaemia, periventricular leukomalacia, intrauterine pneumonia, need for ventilator support and inotropes. Patients in group 2 had significant increase in the frequency of APGAR score <7 at 1 min, APGAR <7 at 5 min and LSCS rate.

Conclusions: The study result implies that lesser the gestation age more are the chances of fetomaternal complications in patients with PPROM. Early PPROM is associated with higher rates of perinatal morbidity and mortality.


Keywords


PPROM, Chorioamnionitis, Feto-maternal outcome

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References


Beckmann, Charles (2014). Obstetrics and Gynecology, 7e. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. Chapter 17: Premature Rupture of Membranes. 2014;169–173.

Meis PJ, Ernest JM, Moore ML. Causes of low birth weight births in public and private patients. Am J Obstet Gynecol. 1987;156:1165–8.

Borna S, Borna H, Khazardoost S, Hantoushzadeh S. Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5). BMC Pregnancy Childbirth. 2004;4:15.

Vintzileos AM, Campbell WA, Nochimson DJ. Degree oligohydramnios and pregnancy outcome in patients with PROM. Obstet Gynecol. 1985;66:162–7.

Stuart EL, Evans GS, Lin YS, Powers HJ. Reduced collagen and ascorbic acid concentrations and increased proteolytic susceptibility with prelabor fetal membrane rupture in women. Biol Reprod. 2005;72:230–5.

Riyami NA, Shezawi FA, Al-Ruheli L, Al-Dughaishi T, Al-Khabori M. Perinatal Outcome in Pregnancies with Extreme Preterm Premature Rupture of Membranes (Mid-Trimester PROM). Sultan Qaboos

Univ Med J. 2013;13:51–6.

American College of Obstetricians and Gynecologists Premature rupture of membranes. Clinical management guidelines for obstetriciangynecologists. ACOG practice bulletin no. 1. Int J Gynaecol Obstet. 1998;63:75–84.

Bendon RW, Faye-Petersen O, Pavlova Z, Qureshi F, Mercer B, Miodovnik M, et al. Fetal membrane histology in preterm premature rupture of membranes: comparison to controls, and between

antibiotic and placebo treatment. Pediatr Dev Pathol.

;2:552–8.

Egarter C, Leitich H, Karas H, Wieser F, Hussiein P, Kader A, et al. Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a metaanalysis. Am J Obstet Gynecol. 1996;174:589-97.

Faksh A, Wax JR, Lucas FL, Castina A, Pinette MG. Preterm premature rupture of membranes ≥32 weeks' gestation: impact of revised practice guidelines. Am J Obstet Gynecol. 2011;205:340 e1-340 e5.

Lieman JM, Brumfield CG, Carlo W, Ramsey PS. Preterm premature rupture of membranes: is there an optimal gestational age for delivery? Obstet Gynecol. 2005; 105:12–7.

Stuart EL, Evans GS, Lin YS, Powers HJ. Reduced collagen and ascorbic acid concentrations and increased proteolytic susceptibility with prelabor fetal membrane rupture in women. Biol Reprod.

;72:230-5.

Vermillion ST, Soper DE, Chasedunn-Roark J. Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes. Am J Obstet Gynecol. 1999;181:320-27.

Yoon BH, Kim YA, Romero R, Kim JC, Park KH, Kim MH, et al. Association of oligohydramnios in women with preterm premature rupture of membranes with an inflammatory response in fetal,

amniotic and maternal compartments. Am J Obstet Gynecol. 1999;181:784-88.

Dagklis T, Stamatios P. Parameter’s affecting latency period in PPROM cases: a 10-year experience of a single institution. Journal of maternal-fetal and neonatal medicine. 2013; 26:1455-58.

Garite TJ, Freeman RK: Chorioamnionitis in the preterm gestation. Obstet Gynecol. 1982;59:539.

Tauassoli F, Ghasemi M, Mohamadzade A, Sharifian J. Survey of pregnancy outcome in preterm premature rupture of membranes with amniotic fluid index < 5 and ≥ 5. Oman Med J. 2010;25:118-23.

Tahir, Aleem M, Aziz R. Incidence and outcome of preterm premature rupture of membranes. Pak J Med Sci. 2002; 18:26-32.

Kayem G, Baumann R , Goffinet F, Abiad SE, Ville Y, Cabrol D, et al. Early preterm breech delivery: is a policy of planned vaginal delivery associated with increased risk of neonatal death? Am J Obstet Gynecol. 2008;198:289.e1-289.e6.

Elimian A, Verma U, Beneck D, Cipriano R, Visintainer P, Tejani N. Histologic chorioamnionitis, antenatal steroids and perinatal outcomes. Obstet Gynecol. 2000;96:333-6.

Dexter SC, Pinar H, Malee MP, Hogan J, Carpenter MW, Vohr BR. Outcome of very low birth weight infants with histopathologic chorioamnionitis. Obstet Gynecol. 2000;96:172-7.