Factors Leading to Early Preterm Premature Rupture of Membranes in a Tertiary Care Centre in Eastern India: A Prospective Study QC01-QC05
Plot 26, K-7, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India.
Introduction: Rupture of fetal membranes before completion of 37 weeks of gestation is called Preterm Premature Rupture of Membranes (PPROM), seen in 3% of all deliveries. PPROM occurring before 34 weeks are called early PPROM, and after 34 weeks are late PPROM. Risk of morbidity and mortality are more among the early preterm deliveries. It also increases the financial burden for the parents and society. A mother with premature rupture of membranes is at risk of developing chorioamnionitis, abruption, increased surgical intervention and postpartum endometritis. Neonates are at risk of respiratory distress syndrome, sepsis, intraventricular haemorrhage, necrotising enterocolitis and death.
Aim: To evaluate the incidence, the clinical characteristics, factors leading to early PPROM (<34 weeks) in a tertiary care centre in Eastern India.
Materials and Methods: It was a hospital based prospective cross sectional study, done in patients presenting with a history of PPROM at gestational age <34 weeks, admitted in the Dept. of Obstetrics and Gynaecology. The Institute of Medical Sciences and Sum Hospital, Bhubaneswar; over a period of 2 years. Factors leading to early PPROM, like association of anaemia, urogenital tract infection, threatened abortion in present pregnancy and history of PPROM, miscarriage in previous pregnancy are primary outcome and, admission to Neonatal Intensive Care Unit (NICU) and neonatal sepsis as secondary outcome were measured and analysed by SPSS v25 using proportion and chi-square test.
Results: A total of 92 patients were analysed out of 108. Incidence of early PPROM was 3.08%. Maximum number of patients was in the age group 26-30 years, and primigravida accounted for 52.20%. Risk factors identified for early PPROM were history of PPROM in previous pregnancy, seen in 20 (21.7%) pregnancy, 28.30% patients had history of one or more previous abortions, 10.9% (n=10) had threatened miscarriage in index pregnancy, 26 (28.3%) had urinary complaints, 21 (22.8%) had leucorrhea. Positive urine cultures were seen in 19 (20.7%), with E. coli being the most common isolated organism. Anaemia was seen in 55 (60%), other associated conditions were hypothyroidism in 12 (13%), gestational diabetes mellitus 9 (9.7%), hypertensive disorders in 4 (4.3%), uterine myomas and polycystic ovarian syndrome in 3 (3.2%) patients in each category. High rate of neonatal sepsis was observed in patients with positive urine cultures, but no association with positive high vaginal swab cultures. About 77 (83.7%) babies were admitted to the NICU.
Conclusion: History of PPROM in previous pregnancy and anaemia, urogenital tract infections in present pregnancy has association with premature rupture of membranes. The finding of the study suggests early identification and treatment of these factors can reduce the incidence of PPROM.