Outcome of Prelabor Rupture of Membranes in a Tertiary Care Center in West Bengal.

ABSTRACT

The etiology is unknown in majority of cases though bacterial infection, cervical incompetence, hypertensive disease, recent coitus, malpresentation, antepartum hemorrhage (APH), malnutrition are recognized causes of prelabor rupture of membranes (PROM). A study was conducted in our institution in 2011, where 478 cases out of a total obstetric admission of 9,637 presented with PROM. Spontaneous rupture of membranes after 28 weeks of gestation before the onset of labor is called PROM. When it occurs before 37 completed weeks of gestation it is called preterm PROM (pPROM). The term PROM cases were induced after waiting for 24 hours for a spontaneous onset of labor. The preterm population were divided in three groups and were given treatment as; Group A with beta-mimetic, antibiotic, steroid, iron and folic acid (IFA); Group B With steroid, antibiotic, natural progesterone and IFA; Group C With only antibiotic and IFA. Observed neonatal mortality in the very preterm group (<34 weeks) was 10% as compared to 5.8% in preterm (34-37 weeks) and nearly 3% among term pregnancies. Treatment of pPROM cases with steroid and antibiotic compared with addition of natural progesterone with or without beta-mimetic did not show any significant difference in terms of Apgar score, need for resuscitation in absence of maternal infection. Elective lower segment cesarean section (LSCS) showed a zero neonatal mortality, better Apgar score and significantly lesser requirement of neonatal resuscitation compared to emergency LSCS. It was concluded that gestational age at the time of delivery is the main determinant of neonatal body weight as well as survival among PROM cases. Beta-mimetics and progesterone showed no role to prolong pregnancy in PROM cases.