Study of fetomaternal outcome in cases of premature rupture of membrane at tertiary care rural institute of Western Uttar Pradesh, India

Background: Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications.Methods: This was a prospective study carried out at the department of obstetrics and gynaecology, UPUMS, Saifai from April 2018 to September 2018 (6 months study). Patients with Spontaneous rupture of membranes any time beyond 28th week of pregnancy, but before the onset of labour. Patients with following conditions were excluded from the study- meconium stain liquor, cord prolapse, antepartum haemorrhage, active infection at other sites, active liver disease.Results: A total of 103 cases of premature rupture of membrane (PROM) were recorded from April 2018 to September 2019 among 1523 admitted pregnant patients. Most of the patients 56 (54.36%) were delivered by caesarean section (C/S). Previous C/S, oligohydramnios, fetal distress, chorioamnionitis were the common indications for doing C/S. Forty-seven (45.63%) patients were delivered vaginally.Conclusions: Most of the affected women belongs to 20-24 years of age (53.39%). Term PROM was more in comparison to PPROM and most of them were multigravidae. Cesarean section rate was high. Most common complication was of subclinical urogenital infection (51.02%).

Reducción embrionaria en embarazo gemelar / Embryo reduction in twin pregnancy

La reducción embrionaria es la interrupción selectiva del desarrollo de uno o varios fetos en el primer trimestre del embarazo. El embarazo gemelar se presenta aproximadamente en uno de cada 100 nacimientos y se considera como una entidad con alto riesgo materno y fetal. Los embarazos múltiples tienen un impacto mayor en los sistemas de salud, debido a la mayor frecuencia de complicaciones. La rotura prematura de membranas causa aproximadamente el 40 por ciento de los partos pretérmino y, como consecuencia, aportan un 10 por ciento de la mortalidad perinatal según la Sociedad Española de Ginecología y Obstetricia. En este caso clínico se observó que una actitud expectante con los pertinentes controles ecográficos (índice del líquido amniótico), analíticos (recuento leucocitario y reacción en cadena de la polimerasa) y clínicos (frecuencia cardiaca y temperatura) pueden llevar a una buena evolución posnatal que justificó al menos en esta ocasión, una actitud conservadora(AU)

Embryonic reduction is the selective interruption of the development of one or several fetuses in the first trimester of pregnancy. Twin pregnancy occurs in approximately one in every 100 births. It is considered an entity with high maternal and fetal risk. Multiple pregnancies have greater impact on health systems due to the higher frequency of complications. Premature rupture of membranes causes approximately 40 percent of preterm births and, consequently, it contributes 10 percent of perinatal mortality according to the Spanish Society of Gynecology and Obstetrics. In this clinical case it was observed that an expectant attitude with the relevant ultrasound (index of amniotic fluid), analytical (leukocyte count and polymerase chain reaction) and clinical (heart rate and temperature) controls can lead to good postnatal evolution, justified at least on this occasion, a conservative attitude(AU)

Interventions and Neonatal Outcomes in Patients with Premature Rupture of Fetal Membranes at and Beyond 34 Weeks Gestational Age at a Tertiary Health Facility in Nigeria.

Aims: To compare the neonatal outcome in patients with PROM at and beyond 34 weeks, who had expectant management and progressed to spontaneous labour and those who had induction of labour. Study Design: Retrospective study of patients presenting with PROM at and beyond 34 weeks gestation over a 3 year period. Place and Duration of Study: Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, between July 2007 and June 2010. Methodology: Case files of 92 patients with PROM and live, singleton fetuses, at and beyond 34 weeks gestation, in the study period, were retrieved from the hospital Health Records Department, collated and analyzed. Data collected included parity, estimated gestational age (EGA) at PROM, latency period (time interval from PROM to onset of labour), intervention following PROM, eventual mode of delivery and neonatal outcome. Results: A total of 2340 deliveries were recorded in the study period and 92 cases of PROM were on record for the period. However, only 74 PROM cases were included in the study, due to incomplete information. Incidence of PROM was therefore 3.9%. Length of latency period had a direct influence on the number of patients that went into spontaneous labour (P = 0.012) and subsequent vaginal delivery (P = 0.021). Induction of labour did not increase rate of caesarean section (P = 0.449) and had no effect on neonatal outcome (P = 0.239). Conclusion: Acceptable approach for the management of PROM at and beyond 34 weeks would be expectant management for the 1st 24 hours and induction of labor afterwards in patients who have not progressed into spontaneous labour. Expectant management in the extended latency period in the late preterm PROM group is associated with increased NICU admission (OR 7.33, 95% C.I 2.45 – 21.98); however, this did not affect duration of NICU stay or neonatal mortality.