Maternal and fetal outcomes in term premature rupture of membrane

doi:10.5847/wjem.j.1920-8642.2016.02.011

Abstract

Abstract:

BACKGROUND: Premature rupture of membrane (PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia.
METHODS: A retrospective cross sectional study was conducted using data available at Mizan-Aman General Hospital during a period of 3 years (January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically significant.
RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours (AOR=5.6, 95%CI 1.3-24.1) latency >24 hours (AOR=2.8, 95%CI 1.7-11.8), residing in rural areas (AOR=4.2, 95%CI 3.96-29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes.
CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.

Key words: Premature rupture of membrane, Maternal outcomes, Fetal outcomes

Tigist Endale, Netsanet Fentahun, Desta Gemada, Mamusha Aman Hussen. Maternal and fetal outcomes in term premature rupture of membrane[J]. World Journal of Emergency Medicine, 2016, 7(2): 147-152.

Figures/Tables 4

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References 24

1	Ladfors L. Prelabour rupture of the membranes at or near term. Clinical and epidemiological studies. 1998 [cited 2016 Jan 1]; Available from: https://gupea.ub.gu.se/handle/2077/12395.
2	Duff P. Premature rupture of membranes in term patients: induction of labor versus expectant management. Clin Obstet Gynecol 1998; 41:883-891.
3	Liu J, Feng Z-C, Wu J. The incidence rate of premature rupture of membranes and its influence on fetal-neonatal health: a report from mainland China. J Trop Pediatr 2010; 56:36-42.
4	Wu J, Liu J, Feng Z, Huang J, Wu G. Influence of premature rupture of membranes on neonatal health. Zhonghua Er Ke Za Zhi Chin J Pediatr 2009; 47:452-456.
5	Velemínský M, Sák P. Management of pregnancy with premature rupture of membranes (PROM). Available from: medportal.ge/eml/publichealth/2006/n2/11.
6	ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2007; 109:1007-1019.
7	El-Messidi A, Cameron A. Diagnosis of premature rupture of membranes: inspiration from the past and insights for the future. J Obstet Gynaecol Can 2010; 32:561-569.
8	Vogel JP, Lee AC, Souza JP. Maternal morbidity and preterm birth in 22 low- and middle-income countries: a secondary analysis of the WHO Global Survey dataset. BMC Pregnancy Childbirth 2014; 14:56. pmid: 24484741
9	Beck S, Wojdyla D, Say L, Bertran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal morbidity and mortality. Bull World Health Organ 2010; 88:31-38.
10	Agency CS, Ababa A. Ethiopia Demographic and Health Survey. 2012;(March). Available from: https://dhsprogram.com/pubs/pdf/FR255/FR255.pdf
11	Naeye R, Peters E. Causes and consequences of premature rupture of fetal membranes. Lancet 1980; 1:192-194.
12	Moore RM, Mansour JM, Redline RW, Mercer BM, Moore JJ. The physiology of fetal membrane rupture: insight gained from the determination of physical properties. Placenta 2006; 27:1037-1051. pmid: 16516962
13	Mercer BM, Goldenberg RL, Meis PJ, Moawad AH, Shellhaas C, Das A, et al. The Preterm Prediction Study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 2000; 183:738-745.
14	Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2005; 101:178-193.
15	Hackenhaar AA, Albernaz EP, da Fonseca TM. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections. J Pediatr (Rio J) 2014; 90:197-202.
16	Modena AB, Kaihura C, Fieni S. Prelabour rupture of the membranes: recent evidence. Acta Biomed 2004; 75 Suppl 1: 5-10.
17	Dars S, Malik S, Samreen I, Kazi RA. Maternal morbidity and perinatal outcome in preterm premature rupture of membranes before 37 weeks gestation. Pak J Med Sci 2014; 30:626-629.
18	Doron MW, Makhlouf RA, Katz VL, Lawson EE, Stiles AD. Increased incidence of sepsis at birth in neutropenic infants of mothers with preeclampsia. J Pediatr 1994; 125:452-458.
19	Sirak B, Mesfin E. Maternal and perinatal outcome of pregnancies with preterm premature rupture of membranes (pprom) at tikur anbessa specialized teaching hospital, addis ababa, ethiopia. Ethiop Med J 2014; 52:165-172. pmid: 26410989
20	Goys M, Bernabeu A, García N, Plata J, Gonzalez F, Merced C, et al. Premature rupture of membranes before 34 weeks managed expectantly: maternal and perinatal outcomes in singletons. J Matern Fetal Neonatal Med 2013; 26:290-293. doi: 10.3109/14767058.2012.733779 pmid: 23094850
21	Frenette P, Dodds L, Armson BA, Jangaard K. Preterm prelabour rupture of membranes: effect of latency on neonatal and maternal outcomes. J Obstet Gynaecol Can 2013; 35:710-717.
22	Alam MM, Saleem AF, Shaikh AS, Munir O, Qadir M. Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan. J Infect Dev Ctries 2014; 8:67-73.
23	Ash AK. Managing patients with meconium-stained amniotic fluid. Hosp Med 2000; 61:844-848.
24	Dickute J, Padaiga Z, Grabauskas V, Gaizauskiene A, Basys V, Obelenis V. Maternal socio-economic factors and the risk of low birth weight in Lithuania. Med Kaunas Lith 2003; 40:475-482.

Variables	Frequency	Percent
Age (years)
<18	22	11.9
18-35	138	74.6
≥36	25	13.5
Residence
Rural	130	70.3
Urban	55	29.7
ANC follow up
Yes	54	29.8
No	131	70.2
Gravidity
Primi	129	69.7
Multi	56	30.3
Duration of PROM
<12 hours	118	63.8
≥12 hours	67	36.2
Previous history of PROM
Yes	161	87.5
No	23	12.5
Onset of labour
Spontaneous	158	85.4
Induced	27	14.6
Indication for C/S
NRFHRP	14	7.6
Failure to progress	6	3.2
Other	5	2.7
Duration of PROM to delivery
<24 hours	87	47.0
≥24 hours	98	53.7
Duration of hospital stay
<3 days	101	54.6
3-7 days	60	32.4
>8 days	24	13.0

Variables	Frequency	Percent
Postpartum complication experienced by mothers
Puerperal sepsis	21	11.4
Wound site infection	11	6.0
Hemorrhage	7	3.7
Others	2	1.1
Outcome of neonates
Alive	123	66.5
Alive with complication	40	21.6
Still birth	7	3.8
ENND	15	8.1
Apgar score at 1st minute
<7	87	47.0
≥7	98	53.0
Apgar score at 5th minute
<7	44	23.8
≥7	141	76.2
Weight of fetus
<2 500 g	18	9.7
≥2 500 g	167	90.3
Fetus need ICU
Yes	47	25.4
No	138	74.6

Variables	Maternal outcomes		COR	AOR
Variables	Favorable, n (%)	Unfavorable, n (%)	COR	AOR
ANC follow up
Yes	41 (28.5)	13 (31.7)	1	1
No	103 (78.6)	28 (68.3)	4.7 (1.1-20.8)^**	0.7 (0.08-5.6)
Residence
MizanAman	52 (36.1)	3 (7.3)	1	1
Outside Mizan Aman	92 (63.9)	38 (92.7)	7.2 (2.1-24.3)^*	4.2 (3.96-29.4)^*
Duration of PROM
<12 hours	111 (68.1)	7 (31.8)	1	1
≥12 hours	52 (31.9)	15 (68.2)	4.6 (1.76-11.89)^**	5.6 (1.3-24.1)^*
Presence of chorioamnionitis
Yes	18 (11.0)	13 (59.1)	11.6 (4.4-31.0)^**	16.6 (2.8-99.4)^*
No	145 (89.0)	9 (40.9)	1	1
Latency
<24 hours	75 (52.1)	12 (29.3)	1	1
≥24 hours	69 (47.9)	29 (70.7)	2.6 (1.2-5.5)^*	2.8 (1.7-11.8)^**
Duration of hospital stay
≤3 days	95 (66.0)	6 (14.6)	1	1
≥4 days	49 (31.9)	35 (34.1)	4.8 (1.7-13.3)^*	8.7 (2.6-29.6)^**

Variables	Fetal outcomes		COR	AOR
Variables	Favorable, n (%)	Unfavorable, n (%)	COR	AOR
ANC follow up
Yes	41 (28.5)	13 (31.7)	1	1
No	103 (78.6)	28 (68.3)	4.7 (1.1-20.8)^*	0.7 (0.08-5.6)
Duration of PROM
<12 hours	111 (68.1)	7 (31.8)	1	1
≥12 hours	52 (31.9)	15 (68.2)	4.6 (1.76-11.89)^*	12.0 (2.8-51.7)^*
Latency
<24 hours	75 (52.1)	12 (29.3)	1	1
≥24 hours	69 (47.9)	29 (70.7)	2.6 (1.2-5.5)^*	1.4 (0.56-3.46)
Color of liquor
Clear	145 (89.0)	9 (40.9)	1	1
Meconium stained	18 (11.0)	13 (59.1)	11.6 (4.4-31.0)^**	9.9 (3.3-33.7)^**
Apgar score at 5th minute
<7	24 (14.7)	20 (90.9)	57.9 (12.7-263.9)^**	16.6 (1.3-21.2)^*
≥7	139 (85.3)	2 (1.4)	1	1
Weight
<2 500 g	14 (8.6)	6 (27.3)	3.99 (1.3-11.8)^*	7.8 (1.2-51.2)^*
≥2 500 g	149 (91.4)	16 (72.7)	1	1
Fetus need ICU admission
Yes	27 (16.6)	20 (90.9)	50.4 (11.1-228.3)^**	11.3 (6.8-188.9)^**
No	136 (83.4)	2 (9.1)	1	1