The maternal and perinatal outcome in preterm premature rupture of membrane (pPROM): A prospective observational study

Abstract

Introduction: Preterm premature rupture of the membrane is one of the obstetric enigmas, which occurs in 3- 8% of pregnancies. It has got multiple etiologies and is associated with significant maternal and neonatal morbidity and mortality. It is also responsible for one-third of the preterm births. Prematurity is the leading cause of neonatal morbidity and mortality; pPROM is an adding factor to this. Timely diagnosis, close monitoring, active management, and protocol-based termination of pregnancy has got a pivotal role in managing the condition. Aims: To identify the risk factors for pPROM and to study the maternal and fetal outcomes of such patients in a tertiary care center in southern India. Methods: This prospective observational study was conducted on 123 antenatal patients between the gestational age of 28-36 +6 days admitted with a diagnosis of pPROM. Patients were monitored, and they were treated with iv antibiotics, tocolytics, steroids, and magnesium sulfate, depending on the gestational age. The outcome was studied in terms of maternal and perinatal morbidity and mortality.Results: The study showed that pPROM is more prevalent in young patients (20-25 years), low-socio-economic status, primigravida and around 34-36 weeks of gestation. Among the patients, 66.7% had a vaginal delivery, and the cesarean section rate was 31.7%. Among maternal morbidities, UTI was on the higher side (13%). Among the babies born, 55 % had NICU admission of which 50.7% had RDS and 20.9 % had septicemia. Conclusion: There is an overall increased chance of maternal and neonatal morbidity in pPROM. As the most leading cause of neonatal morbidity among these patients is prematurity, conservative management to prolong the pregnancy is recommended unless there is evidence of chorioamnionitis or fetal distress. Prompt identification of complications, and treatment of infection is important in preventing maternal and neonatal morbidity. The management should be based on the gestational age, the fetal well-being and the presence or absence of complications.