|Year : 2019 | Volume
| Issue : 2 | Page : 99-102
Pre-labor rupture of membrane in Aminu Kano teaching hospital: A 2-year review
Natalia Adamou, Ibrahim Danladi Muhammad, Usman Aliyu Umar
Department of Obstetrics and Gynaecology, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Submission||19-Jan-2019|
|Date of Decision||19-Feb-2019|
|Date of Acceptance||26-Feb-2019|
|Date of Web Publication||19-Nov-2019|
Dr. Usman Aliyu Umar
Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, PMB 3452, Kano
Source of Support: None, Conflict of Interest: None
Background: Prelabor rupture of the membranes (PROM) is the rupture of fetal membranes before the onset of labor and it complicates about 8% of pregnancies at term and 3% of pregnancies before term. This study evaluated the maternal characteristics and pregnancy outcomes in different gestational ages in patients with PROM in Aminu Kano teaching hospital Kano, Nigeria, between August 2015 and July 2017.Materials and Methods: This was a retrospective analysis of all cases managed for PROM between 1st August 2015 and 31st July 2017 in the department. All patients admitted with PROM were included. Information extracted includes maternal demographic and obstetrical variables, duration of conservative management, mode of delivery, birth weight, Apgar score. Data was collated and analyzed using SPSS version 22. Descriptive variables were presented in tables and tests of significance were done using Chi-square test. Results: A total of 6,658 deliveries were recorded during the study period. There were 109 cases of premature rupture of fetal membranes, out of which 60 (0.9%) were cases of preterm PROM, whereas 49 (0.7%) were cases of term PROM. Hence, the prevalence of PROM over the study period was 1.6%. The duration of membrane rupture has shown a statistically significant association with neonatal outcome with patients presenting within 24 h of membrane rupture having better outcomes. Conclusion: The prevalence of preterm and term PROM in this study was low and majority of the patients had active management with good neonatal outcome. The duration of membrane rupture affects neonatal outcome.
Keywords: Kano, pre-labor, rupture of the membranes
|How to cite this article:|
Adamou N, Muhammad ID, Umar UA. Pre-labor rupture of membrane in Aminu Kano teaching hospital: A 2-year review. Niger J Basic Clin Sci 2019;16:99-102
|How to cite this URL:|
Adamou N, Muhammad ID, Umar UA. Pre-labor rupture of membrane in Aminu Kano teaching hospital: A 2-year review. Niger J Basic Clin Sci [serial online] 2019 [cited 2019 Dec 9];16:99-102. Available from: http://www.njbcs.net/text.asp?2019/16/2/99/270994
| Introduction|| |
Prelabor rupture of the membranes (PROM) is the rupture of fetal membranes before the onset of labor and it occurs in 20% of all births and 40% of all preterm births. At term, PROM complicates about 8% of pregnancies. Preterm premature rupture of membranes (PPROM) is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3% of pregnancies and is the cause of approximately one-third of preterm deliveries.
PROM is a major risk factor for both preterm births and maternal and early neonatal sepsis. Although PPROM near term with expeditious delivery is associated with a high likelihood of survival and a low risk of severe morbidity, PPROM remote from term is associated with significant perinatal morbidity and mortality that decreases with advancing gestational age at delivery.
The etiology of PROM is unknown but it is known that the collagen content of the amnion decreases progressively in late pregnancy so that spontaneous rupture at term can be considered a physiological event. Infection has also been implicated. However, associated risk factors include uterine over distension due to multiple pregnancy or polyhydramnious, cervical incompetence, unstable lie, smoking or substance abuse, subclinical infection of the fetal membranes, nutritional deficiency, prenatal diagnostic procedure, coital activity, women exposed to diethylstilbestrol, and those with connective tissue disorder.
The diagnosis of PROM requires a thorough history, physical examination, and in some cases selected laboratory studies. Patients often report a sudden gush of fluid with continued leakage. Evidence of fluid pooling in the vagina or leaking from the cervical when the patient coughs or when fundal pressure is applied will confirm PROM. In doubtful cases, additional tests can be done for confirmation. These include the nitrazine test, fern test, litmus test, and use of Nile blue sulphate. Diagnostic methods using nitrazine paper and determination of ferning have sensitivities approaching 90%. Nitrazine paper turns blue in amniotic fluid which is alkaline. Ferning test involves taking a swab of the fluid from the posterior fornix and placed on a slide to dry. The slide is checked under a low-power microscope for ferning (arborization) which indicates PROM.
Additional investigations include culture for chlamydia and gonorrhea because women with these infections are seven times more likely to have PROM. Vaginal and perianal swab for group B streptococcus culture should be obtained.
The risk of maternal and fetal infection is known to increase with increasing duration between membrane rupture and delivery. Hence at term, immediate delivery is associated with a lower incidence of maternal infection and increased maternal satisfaction compared with expectant management with no attendant risks of perinatal morbidity or mortality. However, others believe that waiting for labor to begin spontaneously is preferable if there is no evidence of fetal or maternal compromise as such decreases the risk of cesarean section from failed induction. Spontaneous labor follows term PROM at 24, 48, and 96 h in 70%, 85%, and 95% of women, respectively.,
Management of term PROM requires counseling the woman and her relatives on the benefits and risks of expectant management versus active management. Digital vaginal examination should be avoided unless immediate induction is planned as this has been shown to increase the rate of neonatal infection. Active management of term PROM with induction is associated with reduced maternal infective morbidity and increased maternal satisfaction without increasing cesarean section or operative vaginal birth. Highly selected and well-supervised cases may be offered short trial of expectant management for up to 24--48 h., For those with PPROM, expectant management is preferred to immediate delivery in women with ruptured membranes close to term. According to our departmental protocol, conservative management of PPROM is terminated when pregnancy reached gestational age of 37 weeks or earlier when there are features of chorioamnionitis, fetal distress, or significant reduction of amniotic fluid.
This study was undertaken to review the practice of management of PROM in the hospital and evaluate maternal characteristics and fetomaternal outcomes of the management options chosen.
| Aim and Objectives|| |
The aim of this study was to evaluate maternal characteristics and pregnancy outcomes in different gestational ages in patients with PROM in Aminu Kano teaching hospital between August 2015 and August 2017.
Objectives were to determine the prevalence of PROM to describe the sociodemographic characteristics of patients with PROM, to assess neonatal outcomes in relation to gestation age (GA) and birth weight.
| Materials and Methods|| |
This was a retrospective analysis of all cases managed for PROM between 1st August 2015 and 31st July 2017 in the department. Data was extracted by retrieving all case records of patients managed for PROM during this period in the department. All patients admitted with PROM were included. Information extracted includes maternal demographic and obstetrical variables, duration of conservative management, mode of delivery, birth weight, and Apgar score. Data was collated and analyzed using SPSS version 22. Descriptive variables were presented in tables and tests of significance were done using Chi-square test.
| Results|| |
A total of 6,658 deliveries were recorded during the study period. There were 109 cases of premature rupture of fetal membranes, out of which 60 were cases of preterm PROM, whereas 49 were cases of term PROM. Hence, the prevalence of PROM over the study period was 1.6% out of which 0.9% had preterm PROM and 0.7% had term PROM. A total of 94 case folders were retrieved, giving a retrieval rate of 86%.
The mean age of the patients was 27.2 (SD ± 4.6) and ranged from 17 to 39 years. The highest number of patients was in the 25--29 ages grouping 44 (46.8%).
Majority of the patients (87.2%) were Muslims and Hausa by tribe, accounting for 72.3% of the study population. Most of the patients (48.6%) had secondary school as their highest level of education. Details are shown in [Table 1].
|Table 1: Sociodemographic characteristics of patients admitted with PROM|
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Majority of the patients were multiparas and booked, constituting 77.6% and 78.7% of the study population, respectively. Term PROM occurred in 48 (51.1%) patients and preterm PROM occurred in 46 (39.4%) patients. Only 68 (72%) patients presented within 24 h of onset of PROM. Details are also shown in [Table 2].
Sixty three (67%) of the patients had active management at presentation, whereas the rest were managed conservatively for a variable period of time. The predominant mode of delivery was through the vaginal route with 49 patients (52.1%) having successful vaginal deliveries. Other details are shown in [Table 3].
|Table 3: Mode of management, duration of conservative management and mode of delivery|
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Most of the babies (70.6%) born were of normal weight and only 26.6% babies had low birth weight (LBW). In addition, majority of the babies (89.4%) had a good Apgar score in 5 min and but 5.3% had severe asphyxia. Only 22.3% of the babies required admission into intensive care. This is shown in [Table 4].
The duration of membrane rupture have shown a statistically significant association with neonatal outcome with patients presenting within 24 h of membrane rupture having better outcomes χ2= 4.2 df = 1 P = 0.03. However, as shown in [Table 5], gestational age at presentation has no statistically significant association with neonatal outcome (P 0.55).
|Table 5: Association table between neonatal outcome and duration of PROM and gestational age respectively|
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| Discussion|| |
The prevalence of preterm and term PROM in this study was much lower than the 3.3% reported in Enugu for PPROM and 2.4% in Anambra for term PROM. It is also much lower than 5.5% reported in India and below the range of 3--8% reported in a previous systematic review. The reported lower prevalence could be explained by the fact that this is a retrospective study, hence patients with short latency period that presented to labor ward and went into spontaneous labor might not have been captured. In some situations, the patients do not present to the hospital after PROM but come after labor is established and such cases will not be documented as PROM. The smaller sample size from this 2-year retrospective study may also explain the differences in the prevalence observed compared with other studies.
This study showed the peak prevalence to be at the mid reproductive age group of 25--29 years (46.8%) and was similar to findings reported in a study conducted in Enugu where 43% of patients were in the 26--30 year age group. It was also similar to findings reported in Nnewi (Nigeria) and India., However, this is in contrast with previous reports of increasing incidence with advanced maternal age. PROM was also found to be more common in multigravidas and this is consistent with findings reported in previous studies.,,
Prevalence of preterm PROM was higher than term PROM reported in this study which is in contrast with finding reported from other studies in Nigeria,, and India where term PROM surpasses preterm PROM. This is because a good number of term PROM cases go undocumented as highlighted earlier.
Majority of the patients presented within 24 h of the onset of PROM and this finding is consistent with findings from similar studies in Benin, India, and Indonesia.,,
Majority of the patients had active management with more than half having spontaneous labor onset. This finding was expected as it is an established fact that when PROM occurs especially at term, labor typically ensues spontaneously or is induced within 12--24 h. This finding is similar to those reported in a previous study.
The cesarean section rate of 14.9% of patients with PROM in this study is comparable to the rate reported from previous studies in Kano and Anambra.,, Hence, PROM does not increase the rate of cesarean section.
The duration of membrane rupture have shown a statistically significant association with neonatal outcome with patients presenting within 24 h of membrane rupture having better outcomes (P 0.03). This finding is not surprising and similar to findings reported in previous studies.
| Conclusion|| |
The prevalence of preterm and term PROM in this study was low and majority of the patients had active management with good neonatal outcome. The duration of membrane rupture have shown to affect neonatal outcome.
Information such as results of laboratory investigations was either missing or not available in most of the folders. This would have help us looked at association between the likely cause of PROM and fetal or maternal outcome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Arias F, Tomich P. Etiology and outcome of low birth weight and preterm infants. Obst Gynecol 1982;60:277-81.
Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, et al
. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): A randomised controlled trial. Lancet 2016;387444-52.
Meis PJ, Ernest JM, Moore ML. Causes of low birth weight births in public and private patients. Am J Obstet Gynecol 1987;156:1165-8.
Shukla P, Bhargava M, Disha. Study of maternal and fetal outcome in preterm premature rupture of membrane. J Evolution Med Dent Sci 2014;3:1789-95.
Muller AE, DeJongh J, Oostrogel PM, Voskuyl RA, Dörr PJ, Danhof M, et al
. Amoxicillin pharmacokinetics in pregnant women with preterm premature rupture of the membranes. Am J Obstet Gynaecol 2008;198:108.e1-6.
Aboyeji A, Abdul I, Ijaiya M, Nwabuisi C, Ologe M. The bacteriology of pre-labour rupture of membranes in a Nigerian Teaching Hospital. J Obstet Gynaecol 2005;25:761-4.
Davidson KM. Detection of premature rupture of the membranes. Clin Obstet Gynecol 1991;34:715-22.
Ekwo EE, Gosselink CA, Woolson R, Moawad A. Risks for premature rupture of amniotic membranes. Int J Epidemiol 1993;22:495-503.
Medina TM, Hill DA. Preterm premature rupture of membranes: Diagnosis and management. Am Fam Physician 2006;73:659-64.
Ydhstrom H, Ingemarsson I. No benefit from conservative management in nulliparous women with premature rupture of the membranes (PROM) at term: A randomized study. Acta Obstet Gynecol Scand 1991;70:543-7.
Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL, et al
. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N
Engl J Med 1996;334:1005-10.
Grant JM, Serle E, Mahmood T, Sarmandal P, Conway DI. Management of pre-labour rupture of the membranes in term primigravidae: Report of a randomized prospective trial. Br J Obstet Gynaecol 1992;99:557-62.
Keirse MJ, Ottervanger HP, Smit W. Controversies: Prelabor rupture of the membranes at term: The case for expectant management. J Perinat Med 1996;24:563-72.
Dare MR, Middleton P, Crowther CA, Flenady VJ, Varatharaju B. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2006:CD005302.
Naylor CS, Gregory K, Hobel C. Premature rupture of the membranes: An evidence-based approach to clinical care. Am J Perinatol 2001;18:397-413.
Okeke TC, Enwereji JO, Okoro OS, Adiri CO, Ezugwu EC, Agu PU. The incidence and management outcome of Preterm Premature Rupture of Membranes (PPROM) in a tertiary hospital in Nigeria. Am J Clin Med Res 2014;2:14-7.
Eleje GU, Ezebialu IU, Umeobika JC, Eke AC, Ezeama CO, Okechukwu ZC. Pre-labour rupture of membranes at term: A review of management in a health care institution. Afrimed J 2010;1:10-14.
Egarter C, Leitich H, Karas H, Wieser F, Hussiein P, Kader A, et al
. Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: A metaanalysis. Am J Obstet Gynecol 1996;174:589-97.
Gandhi M, Shah F, Panchal C. Obstetric outcomes in Premature Rupture of the Membrane (PROM). Int J of Gynecol Obstet 2012;16:234.
Stuart EL, Evans GS, Lin YS, Powers HJ. Reduced collagen and ascorbic acid concentrations and increased proteolytic susceptibility with prelabor fetal membrane rupture in women. Biol Reprod 2005;72:230-5.
Adeniji AO, Atanda OO. Interventions and neonatal outcomes in patients with premature rupture of fetal membranes at and beyond 34 weeks gestational age at a tertiary health facility in Nigeria. Br J Med Med Res 2013;3:1388-97.
Osaikhuwuomwan JA, Osemwenkha AP. Maternal characteristics and timing of presentation following pre-labour rupture of membranes. Niger Med J 2014;55:58-62.
] [Full text]
Patil S, Patil V. Maternal and fetal outcome in premature rupture of membranes. IOSR J Den Med Sci 2014;13:56-83.
Budijaya M, Negara KS. Labor Profile with Premature Rupture of Membranes (PROM) in Sanglah hospital, Denpasar. Int J Sci Res 2017;6:348-53.
Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol 2008;1:11-22.
Omole-Ohonsi A, Ashimi A, Adeleke S. Spontaneous pre-labour rupture of membranes at term: Immediate versus delayed induction of labour. West Afr J Med 2009;28:156-60.
Yakasai IA, Abubakar MY. Trends in elective caesarean section rate in Aminu Kano Teaching Hospital, Kano: A four (4) year review. Glob Adv Res J Med Med Sci 2014;3:80-3.
Abdul R, Seema M, Singh BN. Maternal and foetal outcome in cases of pre-labour rupture of membranes. IOSR J Den Med Sci 2014;13:8-11.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]