Early neonatal outcomes in premature rupture of membranes beyond 28 weeks of gestation in a tertiary care hospital of Coastal Karnataka

INTRODUCTION: Premature rupture of membranes (PROM) is a significant risk factor for various adverse neonatal outcomes like prematurity, respiratory distress, birth asphyxia and early onset neonatal sepsis. Due to the public health relevance of this topic, pertaining to its increasing burden, this study was done to identify risk factors and predictors of neonatal outcomes among babies born to mothers with PROM.
METHODS: 3 year retrospective record based descriptive study with 254 neonates delivered at a tertiary care hospital in coastal Karnataka, India.
RESULTS: Mean age of mothers was 28.57+/-4.3 years. Prematurity(39.3%)followed by hyperbilirubinemia(15.7% )and respiratory distress (12.2% ) were the common complications seen, with a neonatal mortality of 2.3%. Antenatal complications (24.8%) and medical issues in the mother (13.7%) were the most common maternal risk factors associated with PROM. Although 59% cases delivered vaginally, Emergency Caesarean section was the mode of delivery in 97% of Caesarean cases. Median duration of latency was 590 minutes(IQR – 390-1020) with highest median latency seen for 28-32 weeks of gestation which was 1380 minutes (IQR – 672.5- 3386.25). Primi parity(OR- 1.99, 95% CI- 1.01-3.91, p- 0.04)and preterm gestation( OR-2.12, 95% CI – 1.08-4.14, p- 0.025)were factors associated with increased latency period. Latency period >24 hours was found to be a significant factor associated with poor APGAR score(OR- 5.83, 95% CI- 2.85-11.93, p< 0.001) and NICU admission(OR-5.98, 95% CI- 2.95-12.14, p<0.001).
DISCUSSION AND CONCLUSION: PROM is associated with a significant risk of neonatal morbidity and mortality with most common complications being prematurity and low birth weight. Prolonged PROM increases the risk of neonatal complications. Early recognition and prompt management would reduce delay in intervention and also reduce risk of neonatal complications.