A study of fetal outcome in patients with premature rupture of membranes with gestational age more than 28 weeks

Background: Premature rupture of membranes is rupture of membranes before the onset of labour irrespective of gestational age. If it occurs before 37 weeks, it is called as preterm premature rupture of membranes (PPROM). Once PROM delivery is inevitable, so neonatal prognosis depends on gestational age at which PROM occurs. Neonatal complications include prematurity and its complications mainly, also pulmonary hypoplasia due to severe oligohydramnios, skeletal and joint deformities to foetus due to compression, increased risk of neurodevelopmental impairment and neonatal white matter damage. PROM is a still one of the most difficult and controversial problems in obstetrics.Methods: A prospective longitudinal study was conducted in Department of Obstetrics and Gynaecology at a tertiary care hospital from 2021 to 2023 (18 months). A total of 275 patients admitted with complaints of per vaginal leaking with gestational age more than 28 weeks were studied. A multivariate analysis was used to find association between PROM and foetal outcome.Results: In this study, 57% (157) new-borns had birth weight >2.5 kgs, 60% (166) new-borns had APGAR score 8/10, 71% (196) new-borns were term, 40% (109) had NICU stay, 6% (17) had respiratory distress syndrome (RDS), 3% (8) had neonatal sepsis, 2% (6) had neonatal hypoglycaemia and perinatal mortality rate was 1% (3).Conclusions: Once there is PROM, delivery is imminent. Neonatal outcome can be improved significantly after administration of steroids and antibiotics. To get that time short term tocolysis can be used. During that time foeto-maternal monitoring should be done for early detection of chorioamnionitis. Looking after preterm infants puts an immense pressure on family, economy and health care resources. The prevention of PROM is difficult so more focus should be on management of PROM.

A study of maternal outcome in patients with premature rupture of membranes with gestational age more than 28 weeks

Background: Premature rupture of membranes is rupture of membranes before the onset of labour irrespective of gestational age. PROM is associated with variety of maternal complications from chorioamnionitis, unfavourable cervix, dysfunctional labour to caesarean rates, postpartum haemorrhage and endometritis in mother. PROM is a still one of the most difficult and controversial problems in obstetrics.Methods: This was a prospective longitudinal study conducted in a tertiary care hospital from 2018 to 2020 (18 months). Total 275 patients admitted with complaints of per vaginal leaking with gestational age more than 28 weeks were studied. A multivariate analysis was used to find association between PROM and maternal outcome.Results: PROM was common in women belonging to low socio-economic status (68%). Most of the cases were unbooked (73%), primigravida (42%) belonging to age group 21-25 yrs. (46%), and had gestational age more than 37 wks. (71%). 62% of cases delivered vaginally while remaining underwent LSCS, most common indication being oligohydramnios (35%). Post partum fever (14%) was most common morbidity followed UTI (7%).Conclusions: In present study, PROM was common in unbooked cases and women belonging to low socioeconomic status. Asymptomatic bacteriuria was most common predisposing factor. Maternal morbidity corresponds to duration between PROM and delivery. Early diagnosis and appropriate management reduces hospital stay and maternal morbidity.