Genitourinary infections as a risk factor for preterm prelabour rupture of membranes: a hospital based case control study

Aparajita Sophia D’souza, Garima Gupta, Divya Mahindru, Moneet Walia, Francis Sridhar Katumalla, Sunita Goyal


Background: Preterm Prelabour Rupture of Membranes (PPROM) is a leading cause of maternal and neonatal morbidity and mortality. The objective of our study was to bring forward the association between genitourinary infections and PPROM in Indian scenario.

Methods: This retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, in a tertiary referral teaching hospital in Punjab. A total of 150 women were evaluated for genitourinary infections and their association with PPROM. Cases group 1 (n=75) included pregnant females with diagnosis of PPROM based on history and vaginal examination. Control group 2 (n=75) included pregnant women admitted to labour room at 37 completed weeks of gestation or more and with no history of PPROM. The control group was matched to case group with respect to age and parity. Case to control ratio was taken as 1:1. A multivariate analysis was used to find the association between PPROM and genitourinary infections. Microsoft Excel and the Statistical Package for the Social Sciences (SPSS), Version 21 were used for data analysis. A P value of <0.05 was determined to be statistically significant.

Results: In our study genitourinary infections were seen in 16 women in Case Group 1 (21.3%), compared to 7 women in Control Group (9.3%). Genitourinary infections were associated significantly with PPROM (p 0.02) (odds ratio [OR], 2.618; 95% Confidence interval [CI], 1.021-7.239).

Conclusions: Screening for genitourinary infections should be considered especially in high risk cases. Early recognition and prompt treatment of genitourinary infections is the key to optimize the maternal and fetal outcome in PPROM.


PPROM, Genitourinary infections

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Charles B. Obstetrics and Gynecology, 7e. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. Chapter 17: Premature Rupture of Membranes. 2014:169-73.

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.

Lonky NM, Hayashi RH: A proposed mechanism for pre mature rupture of the membranes. Obstet Gynecol Surv. 1988;43:22.

Naeye RL. Factors that predispose to premature rupture of the fetal membranes. Obstet Gynecol. 1982;60:93.

Gibbs RS, Blanco JD. Premature rupture of the membranes. Obstet Gynecol. 1982;60:671.

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. 1999;2:552-8.

Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342:1500-7.

Klein LL, Gibbs RS. Use of microbial cultures and antibiotics in the prevention of infection-associated preterm birth. Am J Obstet Gynecol. 2004;190:1493-502.

Mercer BM, Arheart KL. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet. 1995; 346:1271-9.

Riyami NA,Shezawi FA, Al-Ruheli,Al-Dughaishi T, Al-Khabori M. Perinatal Outcome in Pregnancies with Extreme Preterm Premature Rupture of Memranes (Midtrimester PROM). Sultan Qaboos Univ Med J. 2013;13(1):51-6.

D’souza AS, Walia M, Gupta G, Samuel CJ, Francis SK, Goyal S. Feto-maternal outcome in pregnancies with preterm premature rupture of membranes: a tertiary hospital experience. Int J Reprod Contracept Obstet Gynecol. 2015;4(5):1529-33.

Gunn GL, Mishell DR, Morton DG. Incidence of PROM. Am J Obstet Gynaecol. 1970;106:469.

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

Lieman, J.M., Brumfield, C.G., Carlo, W., Ramsey, P.S. Preterm premature rupture of membranes: is there an optimal gestational age for delivery? Obstet Gynecol. 2005;105:12-7.

Carroll SG, Sebire NJ, Nicolaides KH. Preterm prelabour amniorrhexis. NewYork/London: Parthenon, 1996.

Broekhuizen FF,Gilman M,Hamilton PR. Amniocentesis for gram stain and culture in preterm premature rupture of the membranes. Obstet Gynecol. 1985;66:316-21.

Galask RP, Varner MW, Petzold CR,Wilbur SL.Bacterial attachment to the chorionic membranes. Am J Obstet Gynecol. 1984;148:915-28.

Gyr TN, Malek A, Mathez-Loic F, Altermatt HJ, Bodmer T, Nicolaides K, et al. Permeation of human chorioamniotic membranes by Escherichia coli in vitro.Am J Obset Gynecol. 1994;170:223-7.

Goncalves LF, Chaiworapongsa T, Romero R. Intrauterine infection and prematurity. Ment Retard Dev Disabil Res Rev. 2002;8:3-13.

Romero R, Mazor M, Avila C. Prevalence, microbiology and clinical significance of microbial invasion of the cavity in term premature rupture of the membranes. SPO Abstract 213. Am J Obstet Gynaecol. 1991;164:305.

Li N, Fu Q, Cai W. Cause analysis and clinical management and experience of the premature rupture of the membrane. Open J obstet gynaecol. 2013;3:22-6.

Lajos GJ, Junior RP, Nomura ML, et al. Cervical bacterial colonization in pregnant women with preterm labour or premature rupture of membranes. Rev Bras Gynecol Obstet. 2008;30(8):393-9.

Asindi AA, Archibong El, Mannan NB. Mother-infant colonization and neonatal sepsis in prelabour rupture of membranes. Saudi Med J. 2002;23:1270-4.