Management of premature rupture of the membrane [PROM] in Shatby Maternity University Hospital as compared to evidence-based management

ABSTRACT

The study was undertaken to assess current obstetric practices of both diagnosis and management of premature rupture of membrane at Shatby Maternity Hospital in Alexandria as compared to evidence-based obstetric practices. A cross sectional approach was used to assess 200 women having PROM where I- Practices of diagnosis were assessed including history of gush of water, bleeding, smoking and recurrence of rupture of membranes in the previous deliveries, also the mode of examination were assessed including using dry clean sterile speculum, regional swab as well as the use of ultrasound for the diagnosis. II- The practices of clinical management were assessed in all cases where antibiotics, tocolytic and/or corticosteroids were taken or not. The mode of delivery whether expectant or active one were assessed also the foetal outcome of delivery in the term of Apgar score were assessed. Shatby Maternity Hospital in Alexandria is the largest and main obstetric hospital, with nearly 15,000 admissions per year and 9,000 deliveries. A questionnaire was done the morning following delivery and before discharge. Data obtained from cases themself, files and attending obstetricians were assessed; where 98% of cases were complaining of gush of water and 58% of them had a history of recurrent PROM. Almost all cases were subjected to ultrasound examination which is the main tool of diagnosis, during the clinical management antibiotics, tocolytics and corticosteroids were taken 90%, 40% and 54% respectively, most of cases were subjected to induction of labour [70%] failed, only in 20% of cases. Only 2% of newly born were admitted to neonatal unit suffering from infection and prematurity. It seems that current practices of diagnosis and management of PROM at Shatby Maternity University Hospital are not that far of the evidence-based practice, some modifications, when applied can make such practices up to the evidence based practice