Comparison of conservative &amp; aggressive management of PPROM at 34-36 weeks gestation in terms of development of neonatal sepsis &amp; RDS

Shachi Shukla,Kshitij Sharma

doi:10.7439/ijbar.v7i7.3423

Abstract

Objective : To compare the conservative and aggressive management of Preterm prelabor rupture of membranes (PPROM) at 34-36 weeks gestation in terms of development of neonatal sepsis and respiratory distress syndrome (RDS). Method : 194 pregnant women with PPROM at gestational age 34-36 weeks admitted in labour ward were included in the study conducted from 2009-2010 in department of Obstetrics & Gynaecology, SMS Medical College, India. Random allocation to conservative & aggressive management group was done by offering Chit Box Method assigning 97 cases in each group. In conservative management cases were hospitalised & provided bed rest, Daily fetal monitoring, Maternal vitals monitoring, Oral tab erythromycin 500 mg T.D.S for 7 days, Daily WBC count and c-reactive protein estimation. Expectant management was abandoned if there was clinical evidence of labour, infection or fetal distress. In aggressive management induction of labour was done by Tab Misoprostol 25 mg orally, at 4-6 hour intervals, for a maximum of 5 doses. Caesarean delivery was performed for standard obstetrical indication and for failed induction. After delivery neonatal care was provided by neonatologist. Results : Out of 97 cases in aggressive management group 4 (4.12%) newborn babies suffered from neonatal sepsis and out of 97 newborn babies in conservative management group 14 (14.43%) babies had neonatal sepsis. Out of 97 cases in aggressive management group 15 (15.46%) newborn suffered from RDS and out of 97 cases in conservative management group 12 (12.34%) newborn suffered from RDS. Conclusion : Rate of neonatal sepsis was higher in conservative management group than aggressive management group. Thus there was significant association observed for neonatal sepsis in between aggressive management and conservative management group. The rate of RDS was lower in conservative management group as compared to aggressive management group. But there is no significant association were observed between RDS in both conservative and aggressive management group.

Highlights

Preterm prelabor rupture of fetal membranes (PPROM) is defined as rupture of fetal membranes prior to the onset of labour at less than 37 weeks of gestation
Out of total 97 cases in aggressive management group 4 (4.12%) newborn babies suffered from neonatal sepsis and out of total 97 newborn babies in conservative management group 14 (14.43%) babies had neonatal sepsis
Rate of neonatal sepsis were higher in conservative management group than aggressive management group

Summary

Introduction

Preterm prelabor rupture of fetal membranes (PPROM) is defined as rupture of fetal membranes prior to the onset of labour at less than 37 weeks of gestation. The fetal membranes serve as a barrier to ascending infection. Both the mother and fetus are at risk of infection and of other complications. Most women with PPROM go into spontaneous labour within 24 hours of rupturing their membranes, but 6% of women will not be in spontaneous labour within 96 hours. Earlier in gestation the rupture occurs, the less likely that the onset of labour will be within a specified time period. Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis and RDS, which is associated with increased neonatal morbidity and mortality

Methods

Results

Conclusion