Feto-maternal outcome in pre-term pre-labour rupture of membranes

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Feto-maternal outcome in pre-term pre-labour rupture of membranes

Journal Title: Medpulse International Journal of Gynaecology - Year 2018, Vol 8, Issue 3

Abstract

Objective: To assess the fetal and maternal outcome among cases presenting with pre-term pre-labour rupture of membranes(pPROM) and to find out association of different factors (demographic, obstetric and medical history) and presenting features with its incidence. Design: A Prospective observational study from 1st May, 2014 to 30th June, 2015.Setting and Study Population: The study was conducted in Department of Obstetrics and Gynaecology at Kurji Holy Family Hospital, Patna, Bihar in women with p PROM and giving consent to participate in the study. Method: The calculated sample size was100. Detailed history of every patient was taken through a pre-structured proforma. Rupture of membranes was diagnosed by history of a sudden gush of watery discharge per-vaginum or slow continuous leak. Confirmation of diagnosis was done by a sterile speculum examination and demonstration of alkaline pH of fluid by nitrazine test. Plan of management was decided on the basis of gestational age, cervical condition, presentation of fetus and presence of any symptoms and signs of infection. The results were tabulated and data analysed using Statistical Package for Social Sciences (SPSS) version 15.0. Chi- square test was used to compare proportions and independent samples t-test was used to compare continuous data. p value < 0.05 indicated statistically significant association. Outcome measures Maternal outcome was measured in terms of latency period till delivery, mode of delivery, placental abruption/cord prolapse, clinical chorioamnionitis, post-partum haemorrhage and puerperal sepsis including endometritis till hospital stay. Fetal outcome was measured in terms of birth weight, APGAR at 1 minute and 5 minutes, NICU admission, respiratory distress syndrome, hypoglycemia, septicemia, neonatal jaundice and fetal/ neonatal mortality. Results: Among women completing the study (n=94), 27 (28.7%) had gestational age <34 weeks and 67 (71.3%) presented at gestational age ranging between 34 weeks to 36 weeks 6 days. Mode of delivery was predominantly through vaginal route (74.5%). Indications for Caesarean section we’re fetal distress (50%), oligohydramnios (25%), non-progress of labour (16.6%) and abruption placentae (8.3%) respectively. Majority of patients had a latency period of < 24 hours (72.8%).92.8% patients delivered within 48 hours of membranes rupture. Overall maternal complication rate was 39.3%. Post-partum complications were more common. Wound infection (19.1%), puerperal sepsis (10.6%), antepartum clinical chorioamnionitis (12.7%), placental abruption (2.1%), Post-partum haemorrhage (2.1%) and retained placenta(1.06%) were seen. A total of 63.8% babies had birth weight < 2.5 kg. Low APGAR(<7) at 1 minute and 5 minutes was recorded in 31.9% and 8.5% neonates respectively. NICU admission rate was 45.7%. Neonatal sepsis was seen in 21.3% cases, neonatal jaundice in 27.1%, neonatal hypoglycemia in8.5% and neonatal respiratory distress syndrome was seen in 12.8% babies. Perinatal mortality rate was 8.5% and gestational age <34 weeks was significantly associated with still births and neonatal complications. Conclusion In cases of p PROM, expectant management with proper vigilance beyond 34 weeks of gestation might help in reduction of pre-maturity related morbidity without compromising maternal safety. Maternal complications in pPROM are difficult to predict and are generally affected by previous obstetric history only, however, these complications along with gestational age in p PROM affect the perinatal outcome.

Authors and Affiliations

Amrita Saxena, Jayoti Malhotra, Meena Samant, Amit Mital

Keywords

Chorioamnionitis NICU neonatal septicemia neonatal jaundice neonatal respiratory distress syndrome pPROM.

EP ID EP470510
DOI 10.26611/1012833
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