Pregnancy Outcome Of Preterm Premature Rupture Of Membranes

Background:Preterm Premature Rupture of Membranes(PPROM)is defined as spontaneous rapture of amniotic membranes prior to 37 completed weeks of gestation.It is a major cause of significant morbidity and mortality for both the mother and the foetus.3%of pregnancies are complicated by PPROM worldwide,and it is associated with approximately one third of all premature deliveries all over the world.The management of PPROM is primarily dictated by the gestational age of the foetus and the foetal,maternal wellbeing.The outcome of PPROM remains largely favourable if diagnosed promptly and managed activelyAim&Objective:This study was designed to evaluate the maternal and foetal outcomes of patients whose pregnancies were complicated by Preterm Premature Rupture of Membranes(PPROM).Materials&Methods:This was a retrospective study,conducted at the department of Gynaecology and Obstetrics of Qilu Hospital of Shandong University over a period of three years from 2014 to 2017.In this retrospective study,135 pregnant patients with PPROM were selected through the perinatal computer database and neonatal delivery logbooks of Qilu Hospital of Shandong University.Of the 135 selected patients,126 were with singleton pregnancies,and 9 were with twin pregnancies.The age of entire study population ranges from 20 to 44 years,and the mean age was noted to be 31 years.The gestational age of the patients at the time of PPROM ranges from 21 to 36+6 weeks(before 37 completed weeks).The mean gestational age at the onset of rupture of amniotic membranes was demonstrated to be 31+4 weeks,while,on the other hand,the mean age at the time of delivery was recorded to be 33+2 weeks.Maternal and neonatal outcomes were based on multitude of factors.Maternal outcome was defined by three main factors:maternal mortality rate,mode of delivery,and maternal morbidity such as puerperal pyrexia and clinical chorioamnionitis.Similarly,neonatal outcome was determined by the following four parameters:perinatal mortality,weight of the newborn,Apgar score,and last but not least,admission to Neonatal Intensive Care Unit(NICU).All plans for management of PPROM remote from term included the family and the medical team caring for the pregnancy,including the neonatal and maternal medical team.Results:In this study,neonatal mortality rate was shown to be 8.3%(11=12),and it was predominantly dictated by the gestational age of the newborns at the time of delivery.The rate of survival remained dismal at 20%among the newborns of those mothers who delivered before 26 completed weeks of gestation,and the outcome was positive at 94%among neonates of those patients who delivered after 26 completed weeks of gestation.And a great majority of patients,approximately 90%(n=122),delivered within one week of onset of preterm premature rupture of membranes(PPROM).The outcome in terms of maternal mortality was shown to be favourable.The survival rate was demonstrated to be 100%,as no maternal death was witnessed inthis retrospective study.However,when it comes to maternal morbidity,15(11%)patients were diagnosed to have clinical chorioamnionitis.Regarding mode of delivery,49%(n=66)patients delivered through caesarean section(CS)and 51%(n=69)had normal vaginal delivery.Among 135 patients,96(71.1%)of them had frequent hospital visits before the onset of PPROM.Conclusion:Overall,the neonatal survival rate was moderately high among patients with PPROM.Furthermore,the outcome was not encouraging where birth weight of the newborn(<1500)was low,as the perinatal mortality rates were shown to be 46%among this low birth weight study group.Although the rates of caesarean section were considerably higher,the maternal outcome of PPROM was reassuring,since no maternal death was reported in this retrospectively designed study.