DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20173623

Analysis of risk factors, maternal and fetal outcome of spontaneous preterm premature rupture of membranes: a cross sectional study

Surekha S. Mohan, Chamaraja Thippeveeranna, Naorem N. Singh, Laiphrakpam R. Singh

Abstract


Background: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. Objective of present study was to determine incidence, risk factors, maternal, fetal outcome of PPROM occurring in patients attending a tertiary hospital in North Eastern India.

Methods: This descriptive cross- sectional study was carried out in the department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, India. Out of 15,969 deliveries between July 2010 to December 2011, 358 pregnant patients with spontaneous preterm premature rupture of membranes from 28-0 to 36-6weeks gestation were reviewed. After excluding patients with uterine anomalies, intrauterine deaths and congenital anomalies 293 patients were included and evaluated in this study.

Results: The incidence of PPROM was 2.2%. Out of 293 patients 86% were singleton pregnancies, 12.9% were twins and 1.02% were triplets. 48.4% had previous history of termination of pregnancy, 28.6% history of previous PPROM and 16.3% had urinary tract infection. The mean gestational age at the onset of membrane rupture was 34.1+2.4 weeks and the latency from the membrane rupture to delivery interval ranged from 0-72 days with a mean of 48.4 hours. There were 7stillbirths (2.38%) and 4 neonatal deaths (1.02%) resulting in perinatal deaths of 3.29% and perinatal mortality rate of 0.329 per 1000 births due to PPROM. Maternal morbidity was minimal with postpartum haemorrhage in 11 patients (4.1%), abruptio placentae in 7 patients (2.3%) and sepsis in 43patients (14.6%). 66 patients (22.5%) underwent caesarean section for which malpresentations were the major cause.

Conclusions: Despite remarkable advances in perinatal care, preterm premature rupture of membranes continues to cause perinatal morbidity and mortality. Strategies should be developed for its prevention. Management protocol should be improved in regard to vaginal swab culture and use of specific antibiotics.


Keywords


Preterm premature rupture of membranes, Perinatal morbidity, Mortality

Full Text:

PDF

References


Brian MM. Preterm Premature Rupture of the Membranes. ACOG. 2003;101:1.

Akter S, Akther R, Rashid Z. Preterm prelabour rupture of the membrane and feto-maternal outcome: an observational study. J Bangladesh Coll Phys Surg. 2010;28:1.

ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynaecologists. Obstet Gynecol. 2007;109(4):1007-19.

Medina TM, Hill DA. Preterm premature rupture of membranes: diagnosis and management. Amer Fam Physician. 2006;73:659-64.

Hyagriv NS, Timothy PC. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. BJOG. 2005;11:32-7.

Bottoms SF, Paul RH, Mercer BM, MacPherson CA, Caritis SN, Moawad AH et al. Obstetric determinants of neonatal survival: Antenatal predictors of neonatal survival and morbidity in extremely low birth weight infants. Am J Obstet Gynecol. 1999;180:665-9.

Jayaram KV, Sudha S. A study of premature rupture of membranes- Management and outcome. J Obstet Gynecol India. 2001;51:58-60.

Canavan TP, Simhan HN, Caritis S. An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part II. Obstet Gynecol Surv. 2004;59(9):678-89.

Pandey S, Dave A, Bandi S. Maternal and fetal outcome in cases of PROM. J Obstet Gynecol India. 2000;50:63-5.

Triniti A, Suthatvorawut S, Prasertsawat PO. Epidemiologic study of cervical swab culture in preterm premature rupture of membrane (PPROM) at Ramathibodi Hospital. Thai J Obstet Gynaecol. 2008;16:173-8.

Merenstein GB, Weisman LE. Premature rupture of membranes and neonatal consequences. Semein-Perinatol .1996;20:375-80.

Noor S, Fawwad A, Shahzad H, Sultana R, Bashir R. Foetomaternal outcome in patients with or without premature rupture of membranes. J Ayub Med Coll Abbottabad. 2010;22:164-7.

Borna S, Borna H, Khazardoost S and Hantoushzadeh S. Perinatal outcome in preterm premature rupture of membranes with amniotic fluid index < 5 (AFI < 5). BMC Pregnancy Childbirth. 2004;4:1471-2393.