Analysis of risk factors, maternal and fetal outcome of spontaneous preterm premature rupture of membranes: a cross sectional study

Abstract

Background: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. Objective of present study was to determine incidence, risk factors, maternal, fetal outcome of PPROM occurring in patients attending a tertiary hospital in North Eastern India.Methods: This descriptive cross- sectional study was carried out in the department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, India. Out of 15,969 deliveries between July 2010 to December 2011, 358 pregnant patients with spontaneous preterm premature rupture of membranes from 28-0 to 36-6weeks gestation were reviewed. After excluding patients with uterine anomalies, intrauterine deaths and congenital anomalies 293 patients were included and evaluated in this study.Results: The incidence of PPROM was 2.2%. Out of 293 patients 86% were singleton pregnancies, 12.9% were twins and 1.02% were triplets. 48.4% had previous history of termination of pregnancy, 28.6% history of previous PPROM and 16.3% had urinary tract infection. The mean gestational age at the onset of membrane rupture was 34.1+2.4 weeks and the latency from the membrane rupture to delivery interval ranged from 0-72 days with a mean of 48.4 hours. There were 7stillbirths (2.38%) and 4 neonatal deaths (1.02%) resulting in perinatal deaths of 3.29% and perinatal mortality rate of 0.329 per 1000 births due to PPROM. Maternal morbidity was minimal with postpartum haemorrhage in 11 patients (4.1%), abruptio placentae in 7 patients (2.3%) and sepsis in 43patients (14.6%). 66 patients (22.5%) underwent caesarean section for which malpresentations were the major cause.Conclusions: Despite remarkable advances in perinatal care, preterm premature rupture of membranes continues to cause perinatal morbidity and mortality. Strategies should be developed for its prevention. Management protocol should be improved in regard to vaginal swab culture and use of specific antibiotics.