Impact of mode of delivery on pregnancy outcomes in women with premature rupture of membranes after 28 weeks of gestation in a low-resource setting: A prospective cohort study (original) (raw)
Related papers
A study on feto-maternal outcome in patients with premature rupture of membranes
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks' gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. Patient with PROM presents with leakage of fluid, vaginal discharge and pelvic pressure, but they are not having contraction. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate. Methods: The present prospective study was conducted in the Department of Obstetrics and Gynecology and associated Dr. B.R.A.M. Hospital Raipur (C.G.), India from January to December 2013 among the patients diagnosed as premature rupture of membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission detailed history was taken. General and Systemic examination were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of this method. Continuous monitoring of maternal and fetal condition done, antibiotics was given intra/ post natal period. P/ V exam were done when necessary. Investigations done and maternal and fetal outcome were noted. Results: More number of unbooked cases was found in study group in comparison to control group. Maximum women were in the age group of 20-25 years. Majority of cases in both the groups had pregnancy more than 36 weeks. PROM results in oligohydramnios due to drainage of liquor amnii. Majorities of the babies were underweight among mothers with PROM. Thus the better fetal outcome was associated with term gestational age. Higher chances of maternal complication were found among mothers with PROM. Conclusions: From the above study, it can be concluded that PROM is associated with poor fetomaternal outcome. Early diagnosis and prompt management is required for better outcome of mother and baby.
Maternal and fetal outcomes in term premature rupture of membrane
World journal of emergency medicine, 2016
BACKGROUND: Premature rupture of membrane (PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, southwest Ethiopia. METHODS: A retrospective cross sectional study was conducted using data available at Mizan-Aman General Hospital during a period of 3 years (January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically signifi cant. RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours (AOR=5.6, 95%CI 1.3-24.1) latency >24 hours (AOR=2.8, 95%CI 1.7-11.8), residing in rural areas (AOR=4.2, 95%CI 3.96-29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes. CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.
Cureus
Introduction: Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the fetal membranes before the completion of 37 weeks of pregnancy. PPROM occurs in 3% of pregnancies. Methodology: This prospective observational study was conducted between September 2019 and March 2021, involving 150 antenatal patients attending our outpatient department or labor room. All pregnant women with a singleton pregnancy between 28 and 37 weeks of gestational age with PPROM were included in our study. Results: A total of 44% of women were admitted to the hospital within 6-11 hours of the onset of PPROM, while 34% of women were admitted within five hours and 15.33% were admitted within 12-23 hours of the onset of PPROM. The most common organisms isolated in high vaginal swabs were Enterococcus faecalis (18%), Escherichia coli (12%), Staphylococcus aureus (12.66%), Staphylococcus haemolyticus (6.66%), and Candida albicans (4.66%). Around 74.66% of women were delivered within 24 hours of the onset of PPROM, whereas only 2.6% of patients were delivered after 72 hours and the rest 34% were delivered between 25 and 72 hours. Of our study subjects, 10% were febrile, 4% were having urinary tract infections, 2.5% had postpartum hemorrhage, and 2% had chorioamnionitis. As far as neonatal morbidity and mortality are concerned, birth asphyxia and jaundice were seen in 12% of patients each, whereas septicemia was found in 4% of study subjects. Conclusion: Owing to the association of higher maternal and perinatal morbidity and mortality, cases, especially in the early PPROM group, should be strictly monitored for clinical and laboratory signs of chorioamnionitis while opting for conservative management.
Zenodo (CERN European Organization for Nuclear Research), 2023
Background: Term prelabour rupture of membranescomplicates about 5% to 10% of term pregnancies and imposes therapeutic challenges upon the managing obstetrician. While spontaneous labour followed by ruptured membranes is the accepted default pathway towards delivery at term, comparative studies on term PROM and spontaneous onset of labour preceding ruptured membranes are scarce globally. Objective: To compare maternal socio-demography and neonatal outcomes of term PROM versus spontaneous onset of labour before membrane rupturein our tertiary facility. Methods: A prospective comparative study of 300 subjects allocated intothe study group comprising 150 subjects with prelabour rupture of membranes and the other 150 subjects with spontaneous labour before membrane rupture as the control group. Data were obtained on maternal sociodemographic characteristics and neonatal outcomes in both groups.Epi-info statistical softwarewas deployed for data analysis. Results: The incidence of premature rupture of membranes was 9.23%. Term PROM was highest in the age group 20-29 years while subjects with low socioeconomic status accounted for 58.7% in the study group. The study group had higher caesarian delivery than the control (22.6% versus 8.0%; P < 0.001). One hundred and thirty-nine (139) babies of subjects in the study group had APGAR scores> 7 compared to 149 babies of subjects in the control group (P < 0.001). More neonates in the study group were admitted into the Neonatal Intensive Care Unit (NICU) compared to the control (6.7% versus 0.7%; P = 0.025). Seven neonates in the study group had Neonatal sepsis compared to none in the control group(P < 0.01). Similarly, three perinatal death were recorded in the study group compared to none in the control group (P = 0.06). Conclusion: Actively managed term PROM was significantly associated with unbooked maternal status, poorer Apgar scores, higher rate of caesarian delivery, and increased perinatal morbidity and mortality compared to spontaneous labour before membrane rupture.
Scholars Research Publisher , 2022
Background: Premature rupture of membrane (PROM) is linked to significant fetal and maternal morbidity and mortalities. The maternal and fetal outcomes in PROM are very important to decrease maternal and child mortality and for better management and prevention of complications. Objective: To find out maternal & fetal outcomes of preterm premature rupture of the membranes. Methods and Material: This is a cross-sectional observational study carried out in the Department of Obstetrics & Gynaecology, 250 Beded District Hospital, Chapainawabganj, Rajshahi, Bangladesh from January 2016 to July 2016. 50 pregnant women with preterm premature rupture of the membranes. Result: The majority of patients with preterm PROM (30%) belong to the age group 31-35 years. The mean age of the patients and SD were 26.4±6.58. 60% of respondents were multipara and 40% primipara. Most of the patients had irregular antenatal checkups (56%), 24% had regular antenatal checkups, and 20% had no antenatal checkups. Twenty percent of patients developed labor pain within 15 hours of rupture of membrane, 24% within 16-30 hours, 56% within 31-45 hours, 10% within 46-60 hours, and 12% without the onset of labour pain. 37 (74%) patients with preterm PROM had a normal vaginal delivery, and 13(26%) delivered by caesarian Section. Forty-three percent of patients delivered within 24 hours of the ruptured membrane, followed by 24% of patients within 24-48 hours, and 28% of patients within more than 48 hours. Among 50 patients, 12 (24.0%) had a previous history of abortion, 24 (48%) had H/O preterm delivery due to PROM, 2 (4.0%) had H/O MR, and 6 (12.0%) had H/O D & C. Among 50 respondents with PPORM 4 (8.0%) had diabetes mellitus, (12.0%) had HTN, 15 (2.0%) had urinary tract infection and 10 (20.0%) had lower genital tract infection. In this study, the total number of the alive baby was 42, and the stillborn baby was 2. Out of 42 alive babies, 18(42.86%) were affected by the consequence of preterm PROM and the birth process. Among 48 alive babies, 6(12.50%) developed birth asphyxia, 5(10.42%) developed jaundice, 3(6.25%) developed neonatal sepsis, and 4 (8.33%) developed respiratory distress syndrome. Maternal morbidity were chorioamnionitis 4(8%) puerperal sepsis 5(10%), postpartum endometritis 2(4%), abruptio placenta 1(2%) and wound infection 2(4%). Conclusion: The incidence of preterm PROM was more in multipara. The majority of the patients were from lower-and middle-class families. This study found some factors, e.g., Coitus, the recent history of abortion, M.R., D & C, and previous history of PROM. The study was done with a small population, but it introduces us to certain risk factors that can be prevented. Proper health education, patient motivation, improved health hygiene, and adequate maternity and childcare services are needed to reduce morbidity and mortality.
The Egyptian Journal of Hospital Medicine, 2021
Background: Premature rupture of membranes (PROM) is a common pregnancy complication and is associated with significant risks of fetal and neonatal morbidity and mortality. Objective: This study aimed to measure the incidence rate of preterm premature rupture of membranes (PPROM) among pregnant women attending Zagazig University Hospital, and to identify the risk factors associated with PROM and fetal/neonatal outcomes. Methods: This cross-sectional study was conducted at Zagazig University Hospitals. It included 69 women with PROM. The study was conducted from July 2019 to January 2020. All patients were subjected to detailed history taking, general examination and laboratory investigations. Results: There were 46 mother gave birth of healthy babies with good Apgar score (66.7%), 15 with babies needed O2 incubators (21.7%) and 8 with babies that were put on ventilators (11.6%). There were 68 mothers with no bad outcomes and 1 with chorioamnionitis. The risk factors of the cases showed that there were 15 with no risk factor (21.7%), 8 with previous PROM (11.6%), 6 with multi pregnancy (8.7%), 12 with antepartum (17.4%), 16 with infections (23.2%) and 12 with chronic diseases (17.4%). Conclusions: we concluded that younger, illiterate parturient women were found to be provoking factors to increased PPROM. Such hazards may affect both maternal and neonatal outcome such as infection, maternal distress, fetal distress, increase operative delivery, as well as need for neonatal intensive care unit care in more than 50% of the neonates.
Frontiers in reproductive health, 2022
Background: One of the most critical functions of the fetal membranes is to remain intact until the onset of labor to maintain the protective intrauterine fluid environment. In most pregnancies, spontaneous rupture usually occurs near the end of the first stage of labor. Preterm premature membrane rupture (PROM) occurs when the fetal membrane ruptures before 37 weeks of pregnancy, and it contributes to adverse maternal, fetal, and neonatal outcomes. Therefore, this study aimed to determine the association of determinant factors with adverse perinatal outcomes. Methods: A prospective cohort study was conducted on pregnant women with preterm premature membrane rupture (n = 160) attending the teaching hospitals at Addis Ababa University. Socio-demographic and obstetric risk factors with adverse perinatal outcomes include the 5th minute Apgar score, neonatal intensive care unit (NICU) admission, early-onset neonatal sepsis (EONS), respiratory distress syndrome (RDS), perinatal mortality, Chorioamnionitis, and placental abruption were assessed. SPSS version 24, t-test, χ 2 test, and logistic regression analysis were used. P-values <0.25 in the bivariate and p < 0.05 in the multiple logistic regression were considered statistically significant. Results: The preterm (PROM) rate was 2.2% with perinatal mortality rate of 206/1,000. Gestational age (GA) at delivery was the determinate for low Apgar score at the 5th minute (AOR: 7.23; 95% CI, 1.10, 47.6; p = 0.04).
International Journal of Women's Health
Background: A gush of amniotic fluid any time before the onset of labor is known as premature rupture of the membranes (PROM). Its consequences vary from maternal and neonatal mortality and morbidity to country-wide economic loss. At the national level in general, and in the study area in particular, little is known about PROM and its determinants. Hence, this study aimed at identifying determinants of PROM among pregnant women admitted to public hospitals in Southern Ethiopia, 2020. Methods and Materials: A hospital-based unmatched case-control study was conducted on 279 pregnant women (93 cases and 186 controls) admitted to public hospitals from October 1 to 30, 2020. Pregnant women admitted to maternity wards of selected hospitals with a painless gush of fluid spilling out from the vaginal canal were considered as cases. Interviewer-administered questionnaires and data abstraction tools were used to collect data. The data were coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. The determinants of PROM were identified by applying a multivariable logistic regression analysis at a p-value <0.05. Results: Term PROM accounted for the majority, 55 (59.2%) of cases. Previous history of abortion (AOR: 4.14, 95% CI: 2.21-9.07), lack of ANC (AOR: 3.51; 95% CI: 1.33-8.27), previous history of PROM (AOR: 4.91; 95% CI: 2.23-9.82), caesarean delivery (AOR: 3.02, 95% CI: 1.24-6,40), using of a maternal waiting room (MWR) (AOR: 0.33, 95% CI: 0.15-0.74), and mid-upper arm Circumference (MAUC) <23cm (AOR: 3.69, 95% CI: 1.58-8.64) were identified as significant determinants of PROM. Conclusion: Health-care providers should work on providing adequate ANC by tracing mothers who have not received it and advising pregnant women to use MWR in the final weeks of their pregnancy. Furthermore, maternal and child health care units must place a strong focus on screening and managing the nutritional status of pregnant women. Furthermore, women with a history of abortion, caesarean section, and PROM need due attention from health care providers to mitigate the occurrence of PROM.
Effect of premature rupture of membrane to preterm labor in Cilegon, Indonesia
Epidemiology and Health
OBJECTIVES: The global prevalence of preterm labor is approximately 11.1% of live births. However, preterm labor contributes to 75-80% of neonatal morbidity and mortality. The morbidity experienced by preterm infants may continue to influence their subsequent development, imposing physical, psychological, and economic burdens. Premature rupture of membranes (PROM) is a causal factor that may affect preterm birth. Previous studies have shown an association between PROM and preterm labor, but this association should be investigated in more diverse populations. Therefore, this study was conducted in Cilegon, Indonesia to determine the magnitude of the risk of preterm labor associated with PROM at Cilegon Hospital from July 2014 to December 2015. METHODS: This case-control study used data from patients' medical records. The cases were all mothers who delivered at less than 37 weeks of gestation, while the control population comprised all mothers who delivered at greater or equal to 37 weeks. The data were analyzed using logistic regression. RESULTS: The bivariate analysis yielded an odds ratio (OR) of 2.97 (95% confidence interval [CI], 1.92 to 4.59) before controlling for covariates. The model derived through multiple regression analysis after controlling for education, history of preterm labor, and anemia resulted in an OR of 2.58 (95% CI, 1.68 to 3.98).
Perinatal Outcome in Premature Rupture of Membranes (PROM) and Pre-Prom (PPROM)
Journal of Gandhara medical and dental sciences, 2023
This study aimed to evaluate the maternal and fetal outcomes in PROM and PRE-PROM at tertiary care hospitals. METHODOLOGY This Cross-sectional study was carried out in the department of obstetrics and gynaecology at Khyber Teaching Hospital Peshawar after ethical approval of the institutional ethical board. Patients who fullled the inclusion criteria were selected. On arrival, detailed history was taken, physical and obstetrical examination and per speculum examination were done, patients were managed conservatively, and steroid cover was given for fetal lung maturity. RESULTS A total of 150 pregnant women who met the inclusion criteria and were complicated by PROM or PRE-PROM were followed. Out of the total patients, 104 presented with PROM, while 46 presented with PPROM. PROM and PPROM patients were identical regarding placental abruption. 104(69.3%) patients presented with PROM and PPROM 46(30.7%). Patients who delivered were 72(52%) normal vaginal delivery (NVD), 57(38%) C-Section, 15(10%) NVD with episiotomy. In NVD 54(63%) spontaneous, 18(12%) induced, while in C-Section 6(4%) elective and 51(34%) emergency C-Section. In PROM, 18(12%) were complicated by chorioamnionitis, fetal distress meconium stained liquor 18(12%), whereas 100 were uneventful, while in PPROM, 122(81.3%) had no complications, 10(6.7%) chorioamnionitis and 40.7% of the neonates had NICU admission. The personal eects of NVD on the duration of PROM/ PRE-PROM in days with p-value 0.027. The p-value of Complications of PRE-PROM was 0.037. CONCLUSION PROM and PPROM presented with increased maternal and fetal morbidity, vaginal infection, and urinary tract infection should be promptly screened and treated on time to prevent maternal morbidities and improve fetal outcomes.