Prevalence, risk factors, maternal and fetal outcome of PROM in maternity and child hospital Makkah KSA

1Assistant Professor at Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. 2Medical Intern, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. 3Medical Student, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 4 (12), 1461-1469 1462 Management:-The management of pregnancies complicated by PPROM is based upon consideration of several factors, which are assessed upon presentation which include: Gestational age, presence or absence of maternal/fetal infection, presence or absence of labor, fetal presentation, fetal well-being, fetal lung maturity, cervical status (by visual inspection) and availability of neonatal intensive care.
In the absence of these complications, PPROM is treated expectantly and no intervention to effect delivery prior to 34 weeks. The optimal time for intervention varies among institutions and depends on the balance between morbidity related to prematurity and morbidity related to complications of PPROM. The American College of Obstetricians and Gynecologists (ACOG) suggests delivery for all patients' ≥34 weeks of gestation [5] Objectives:-To study the prevalence of preterm premature rupture of the membranes (PPROM) between [26][27][28][29][30][31][32][33][34][35][36] week gestation with identify the risk factor, outcomes and of complication of the pregnant women and the neonates.

Results:-
Four hundred and twenty-nine cases of PPROM (0.11%) were registered and treated expectantly out of 380071 total pregnancies registered during the study period. Maternal age from 30 to 34 years were (29.1%), from 25 to 29 years were (25.6%) and from 20 to 24 years (19.3%).
The most common presenting symptoms was painless leakage of fluid is main complain (76.4%), followed by abdominal pain (16.1%) and fever in (6.3%).

Discussion:-
The incidence of preterm premature rupture of membranes of all hospital admission in this study is 6.2% in comparison to a study held in Riyadh in which the incidence was only was 0.6% [6] , preterm delivery occurs in 12.3% of all births in the United States at 2003 which show slight increase compare in 1992 which was 10.7% [7] . Our study showed a peak incidence of PPROM at 30-34 years (29.1%) (Mean age is 32). However, in Libya was 21-30 years (61%) [6]. and in UK 19-39 (mean age is 29 years old) [8]. Our study showed higher incidence of PPROM in ladies with Parity between 1-4 women (65.2%)unlike the international and regional studies which showed a predominance of nulliparous, (UK was 43.9% nulliparous [8] and in Libya was nulliparous in 52% [9]).
The mode of delivery in this study shows SVD of 54.8% while in UK was 53% however in Libya was 62%. The abortion in this study was 1.6% and in UK was 3.9% and in Libya 5% [6], [8]. On other hand caesarian section was done with 41.70% high rate in compare with study was done in Rockford Memorial hospital shown (31.5%) neonates were delivered by cesarean section [10]. Also, another study in Ayub Medical College, Abbottabadshown caesarean section rate was 14% [11] . Dilation and curettage in this study was 3.6% while in previous study dilation and curettage 10.9% [12]. While convulsion there was no data available in relation with PPROM.
The associated symptoms that shown a leakage of fluid 76.4%, abdominal pain 16.1%, fever 6.3%, stained blood 0.7% and convolution 0.5%. In previous study the classic clinical presentation of PPROM is a sudden "gush" of clear or pale yellow fluid from the vagina. However, many women describe intermittent or constant leaking of small amounts of fluid or just a sensation of wetness within the vagina or on the perineum [11]. On other hand fever present in case control study which was 44.7% [13] , the abdominal pain it was unspecific may due to infection ; chorioamnionitis, UTI , septicemia or any complication of pprom ; placental abruption, abortion , or could be related to hemorrhage as postpartum hemorrhage as hemodynamic instability (tachycardia, hypotension, or shock) [14] .In another study the associated stained blood in related to PPROM in 1 st trimester was 37.4% while in 2 nd trimester was 15% [15] .
The antenatal complication in this study, we found as follows; Intrauterine growth restriction represent 0.7% , in previous studies shown the neonatal and perinatal outcome of the babies ,total 53 (62.3%) babies born to mothers with PPROM were low birth weight which include 10 (11.76%) babies of extremely low birth and 30 (35.29%) babies of very low birth weight [13]. Another study shown the median birth weightof included neonates was 1150 g (range: 850-2400 g; interquartile range: 950 -1600g) [21]. Another study occurring between 1988 and 1997 at the Soroka University Medical Center in Israel reported PPROM was associated with a significantly lower gestational age (24-32 weeks) and birth weight (<2500 g) than those with intact membranes [18].
Oligohydramnios which represent 1.4 % and study reported that fifty to seventy percent of women with PPROM have low amniotic fluid volume on initial sonography [23].
1467 Preeclampsia represents 2.6%, and study done in St Michael's Hospital, Bristol, UK. Shown the percentage of preeclampsia among 35 gestation age was 23.2% [8].
Intrauterine fetal death which was 0.7 %, a prospective study reported that, the principal causes of IUFD were infections, including premature rupture of the membranes (15%) among sixty sex cases of intrauterine fetal death [24]. Maternal complication , a three hundred and thirty-nine out of four hundred and twenty-nine cases of PPROM was uncomplicated , the complication include ; first-degree perineal laceration 12.8% , Second-degree perineal laceration 1.2% , abortion 1.6% , postpartum pyrexia 1.2% , postpartum hemorrhage 1.9% , infection 0.5% , urinary tract infection 1.2% and urinary retention 0.7% . In comparison with previous studies, in The Netherlands a study was found that report 776 women were asked to participate in trial, of which 536 women (69%) gave informed consent. A total of 268 women were randomized to IOL (induction of labor group) and 268 to EM (expectant management group), the maternal outcome for both group shown first degree laceration in IOL group with 19% , EM with 20 % , the second degree of lacerationfor IOL group 10 % , EM group 13% [23] .
A case control study shown the percentage of abortion 31.2% compare with control with 21.7% [12]. Also case control study reported the postpartum hemorrhage represent 8.1 % in compare with the control 4.4% [25].
Infection and urinary tract infection; discussed above. Postpartum pyrexia and urinary retention there was no available data in relation with PPROM.
The fetal complication among this study as explained in results that show 318 out of 429 they don't have any complication with percentage 74.1% , the complication that include ; cord compression 0.9% , bradycardia 1.2% , dystocia 0.2% , fetal distress 22.6% , gastroschisis 0.2%, IUGR 0.7 % . In previous study fetal distress in King Khalid University hospital, Riyadh, Kingdom of Saudi Arabia was 15.9% [95], also another study reported umbilical cord prolapsed 7 (30.4%) [10]. in previous study reported that in all 15 women who underwent spontaneous vertex delivery but the infant experienced shoulder dystocia [26]. The incidence of gastroschisis is similar in male and female fetuses, higher in singleton pregnancies than in twin