ABSTRACT
Premature rupture of membrane (PROM) refers to the disruption of foetal membranes before the beginning of labour, resulting in spontaneous leakage of amniotic fluid.Homeyr, GJ et al in his study “Amnio infusion for third trimester preterm rupture of membranes”, march 2014 states that premature rupture of membranes (PROM), or pre-labour rupture of membranes, is a condition occurring in pregnancy and defined it as rupture of membranes (breakage of the amniotic sac), commonly called breaking of the mother's water (s), more than one hour before the onset of labour.METHODSThe present study was carried out in the Department of Obstetrics and Gynaecology of Rajendra Institute of Medical Sciences (RIMS), Ranchi, during from April 2017 to October 2018. A total 595 cases were studied. The cases were divided into two groups, Study Group-195 cases and Control Group- 400 cases.RESULTSVarious factors were studied and analysed. Incidence of PROM in the present study was 7.49%. Out of 195 cases 68% were term PROM and 32% were preterm PROM. Mean age in the study group was 23 yrs. Risk factors associated with PROM in most of the cases was unknown (52%). Other causes were anaemia 34%, cervicovaginal infections 16%, malpresentation 10%, multiple gestation 3.5%, prior cervical surgery 1%, history of fall 1% PROM following coitus was 1.5%. In the present study the correlation between CRP and clinical chorioamnionitis was significant. Caesarean section was done was done in 19% cases in study group. There were 3 % cases of chorioamnionitis in study group. Out of 10 patients in the study group, maximum patients had puerperal sepsis (4 patients- 40%) followed by UTI (30%), wound infection (20%) and breast engorgement (10%).CONCLUSIONSPremature infant puts immense burden on the economy and health care resources of the country. Therefore, management of PPROM requires accurate diagnosis and evaluation of the risks and benefits of continued pregnancy or expeditious delivery. Once PROM is diagnosed, it is important to weigh the risk of PROM and prematurity and make the right choice for conservative management or active interventions. Adequate antenatal care should be advocated so that appropriate risk assessment can be done, and intervention provided where applicable. Neonatal units should also be equipped to be able to render necessary care for these preterm neonates thereby reducing the morbidity and mortality associated with PPROM.
ABSTRACT
Background & objectives: Asymptomatic bacteriuria during pregnancy if left untreated, may lead to acute pyelonephritis, preterm labour, low birth weight foetus, etc. Adequate and early treatment reduces the incidence of these obstetric complications. The present study was done to determine presence of asymptomatic bacteriuria (ASB) and obstetric outcome following treatment in early versus late pregnancy. Methods: A prospective cohort study was conducted at a tertiary care teaching hospital of north India. Pregnant women till 20 wk (n=371) and between 32 to 34 wk gestation (n=274) having no urinary complaints were included. Their mid stream urine sample was sent for culture and sensitivity. Women having > 105 colony forming units/ml of single organism were diagnosed positive for ASB and treated. They were followed till delivery for obstetric outcome. Relative risk with 95% confidence interval was used to describe association between ASB and outcome of interest. Results: ASB was found in 17 per cent pregnant women till 20 wk and in 16 per cent between 32 to 34 wk gestation. Increased incidence of preeclamptic toxaemia (PET) [RR 3.79, 95% CI 1.80-7.97], preterm premature rupture of membrane (PPROM)[RR 3.63, 45% CI 1.63-8.07], preterm labour (PTL) [RR 3.27, 95% CI 1.38-7.72], intrauterine growth restriction (IUGR)[RR 3.79, 95% CI 1.80-79], low birth weight (LBW) [RR1.37, 95% CI 0.71-2.61] was seen in late detected women (32-34 wk) as compared to ASB negative women, whereas no significant difference was seen in early detected women (till 20 wk) as compared to ASB negative women. Interpretation & conclusions: Early detection and treatment of ASB during pregnancy prevents complications like PET, IUGR, PTL, PPROM and LBW. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.