|Year : 2019 | Volume
| Issue : 3 | Page : 194-197
The Prenatal outcomes of pregnancies after 34 weeks complicated by preterm premature rupture of the membranes
Azadeh Asgarian1, Khatereh Sourani2, Sima Afrashteh3, Abolfazl Mohammadbeigi4
1 Department of Nursing and Midwifery, Izadi Hospital, Qom University of Medical Sciences, Qom, Iran
2 Research Student Committee, Qom University of Medical Sciences, Qom, Iran
3 Department of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
4 Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran, Iran>
|Date of Web Publication||6-Sep-2019|
Neuroscience Research Center, Qom University of Medical Sciences, Qom
Source of Support: None, Conflict of Interest: None
Background: Preterm premature rupture of the membranes (PPROM) is a condition that can occur in pregnancy as well as causes one-third of all preterm births. The aim of our study was to assess the perinatal outcome in PPROM after 34 weeks' gestation. Materials and Methods: This historical cohort study was conducted by 602 pregnant participants, including 300 women with PPROM and 302 women without PPROM between 34 and 37 weeks who were admitted at Qom's Izadi Hospitals during April 2013 and March 2015, Iran. Data were extracted from the patient's dossier and entered in checklist. Then were analysed by the t-test and Chi-squared and Fisher's exact tests in SPSS software. Results: The mean maternal age of the participants was 28.8 years (range: 16–51 years). The independent t-test showed that the mean of infant weight (P = 0.002) and Apgar score in the 5th min (P = 0.044) after delivery was statistically significant between no-PPROM and PPROM groups. There was a significant difference regarding receiving corticosteroid (odds ratio [OR] = 0.2.05), lower birth weight 2500 g (OR = 1.44), girls gender of baby (OR = 1.24), respiratory distress syndrome (RDS) (OR = 1.81), unhealthy infant (OR = 4.44), sepsis (OR = 1.60), tachypnoea (OR = 2.03) and other neonatal complications (OR = 1.702). Conclusion: RDS, sepsis, tachypnoea and other perinatal outcomes are more common in women with PPROM. Hence, in view of the unfavourable outcome, preventive measures and control of PPROM are essential.
Keywords: Neonatal outcome, preterm membrane, preterm premature rupture of the membranes, respiratory distress syndrome
|How to cite this article:|
Asgarian A, Sourani K, Afrashteh S, Mohammadbeigi A. The Prenatal outcomes of pregnancies after 34 weeks complicated by preterm premature rupture of the membranes. Adv Hum Biol 2019;9:194-7
|How to cite this URL:|
Asgarian A, Sourani K, Afrashteh S, Mohammadbeigi A. The Prenatal outcomes of pregnancies after 34 weeks complicated by preterm premature rupture of the membranes. Adv Hum Biol [serial online] 2019 [cited 2022 Sep 27];9:194-7. Available from: https://www.aihbonline.com/text.asp?2019/9/3/194/266225
| Introduction|| |
Premature rupture of the membranes (PROM) has been the subject of various clinical and epidemiologic studies and is considered one of the 'great obstetrical syndromes'. Preterm PROM (PPROM) is a subtype of preterm labour and is defined as spontaneous membrane rupture without the onset of labour before 37 weeks of gestation. PPROM is one of the momentous causes of preterm birth that can result in high prenatal morbidity and mortality along with maternal morbidity. It is defined as rupture of the foetal membranes before the onset of labour., PPROM occurs almost 3% of pregnancies and results in one-third of preterm birth., The prevalence of PROM worldwide ranges between 2% and 15%. Neonatal complications relate primarily to the gestational age at rupture of membranes. Preterm PROM is associated with a four-fold increase in prenatal mortality and a three-fold increase in neonatal morbidity, including respiratory distress syndrome (RDS), which occurs in 10%–40% of women with preterm PROM and is responsible for 40%–70% of neonatal deaths and intraventricular haemorrhage (IVH).
Intrauterine infection at early gestational age, lower socio-economic status of pregnant women, inadequate prenatal care and inadequate nutrition during pregnancy, sexually transmitted infections, vaginal bleeding and smoking during pregnancy are the known risk factors of PPROM.,
Recent studies,, showed that PROM in pregnant women caused some adverse effects including maternal infection umbilical cord compression, preterm delivery and prolapsed. It is also related to some adverse outcomes, in unborn children including low Apgar score, pulmonary, hypoplasia, fetal infection, low birth weights (LBWs) and fetal deformation. According to the role that PROM in the complications and difficulties of neonatal as well as the prevalence of these factors have been reported the community various are different. Therefore, this study aimed to assess the perinatal outcome in preterm premature rupture of membranes after 34 weeks of gestation.
| Materials and Methods|| |
This historical cohort study was conducted 602 pregnant participants, including 300 women with PPROM and 302 women without PPROM between 34 and 37 weeks who were admitted at Qom's Izadi hospital, from April 2013 to March 2015. Exposure group in the study included mothers with membrane rupture and the outcomes of neonatal complications and healthy mothers in the other groups. The inclusion criterion was patients who diagnosed with PROM and exit criterion include the end of pregnancy <34 weeks for any reason. Mothers with membrane rupture and over 34 weeks were selected by non-random sampling and a healthy mothers group randomly. Data were extracted from the patient's dossier that recorded by gynaecologists immediately after delivery and then recorded to checklist by the research team.
A questionnaire was prepared consisting of demographical and clinical questions. Pregnancy problems, age, gender, gestational age, neonatal weight, newborn Apgar score, mode of delivery, type of anaesthesia, number of times pregnant, receiving antibiotics and corticosteroid, duration of membrane rupture and neonatal complications were considered in the questionnaire. The dependent variable was in this study affecting to PPROM after the 34th gestational week. This questionnaire has been confirmed by several experts and member of the Board Qom University of Medical Sciences, Qom, Iran. Validity and reliability of the self-made questionnaire (α: 0.76) were confirmed.
Maternal parameters, including mother age, infant weight, 1 min Apgar score, 5 min Apgar score, singleton or twin pregnancy and gestational age at PPROM, were reviewed. Furthermore, parameters, including mode of delivery and neonate complications, were investigated. Foetal parameters, including foetal distress, birth weight and major neonatal conditions, including RDS, tachypnoea, icterus and sepsis, were also studied.
Descriptive statistics were used to explore the data. Independent sample test and Chi-square test were used for comparison. Logistic regression analysis was performed to assess the relationship between PPROM and neonate outcome for demographic and clinical variables. Data analysis was conducted with SPSS, Chicago, IL, USA. P < 0.05 was considered statistically significant in all analyses.
The study proposal was approved by the Deputy of Research, Qom University of Medical Sciences, Qum, Iran. Ethical approval was granted by the Medical Ethics Committee, Qom University of Medical Sciences by IR.MUQ.REC.1394.55. All information about mother and newborn is protected, and the result of the study is published in group form.
| Results|| |
In a case–control study, 300 (49.8%) cases were compared with 302 (50.2%) controls. In all of studied cases, 513 mothers (85.2%) were Iranian and 76 mothers (12.6%) have affected to some clinical outcomes, including overt diabetes (2.8%), gestational diabetes (0.7%), pre-eclampsia (0.3%), abruption (0.3%) and other complications (0.2%). The mean maternal age was 28.8 years (range: 16–51 years). The mean week of gestation at PPROM was 36.3 weeks (range 34–38 weeks). Of 602 patients, 62.3% had vaginal delivery and 581 (96.5%) were singleton pregnancies. Furthermore, 253 mothers (42%) experiencing membrane rupture <18 h. The maternal characteristics of all patients in the study are shown in [Table 1].
|Table 1: Demographic characteristics of all patients in two studied groups|
Click here to view
The independent t-test at [Table 2] showed that the mean of infant weight (P = 0.002) and Apgar Score in the 5th min (P = 0.044) after delivery was statistically significant between no-PPROM and PPROM groups, but there was not observed difference regarding to mother age (P = 0.842) and Apgar score in 1st min (P = 0.287). Hence, LBW was more in group PPROM.
|Table 2: The mean and standard deviation of mother age, infant weight and Apgar score in cases and controls|
Click here to view
[Table 3] shows the outcomes of PPROM in newborn. There was a significant difference regarding receiving corticosteroid (odds ratio [OR] = 0.2.05), lower birth weight 2500 g (OR = 1.44), girls gender of baby (OR = 1.24), RDS (OR = 1.81), unhealthy infant (OR = 4.44), sepsis (OR = 1.60), tachypnoea (OR = 2.03) and other neonatal complications (OR = 1.702). Hence, all mentioned variables in PPROM group were greater than no-PPROM group (P < 0.05). However, other outcomes such as caesarean delivery, prom history, icterus, maconial, IVH and hypoplasia do not show a statistically significant difference between the two groups (P > 0.05).
|Table 3: The frequency of qualitative-related variables in cases and controls|
Click here to view
| Discussion|| |
PROM is a fairly common complication of pregnancy that if rupture occurs before 37 weeks defined PPROM., About 30%–35% of all preterm births are caused by PPROM. This study investigated maternal and foetal outcomes of PPROM and associated factors. The reported age of PPROM diagnosis in our results was 28 years old as similar to Hackenhaar et al.'s study. Our results showed that PPROM was associated with some neonatal consequences comparing to no-PPROM, including LBW (13.3% vs. 6%), rupture duration (15.7% vs. 0%), receiving corticosteroid (35.7% vs. 7%), unhealthy infant (16.7% vs. 4.3%), RDS (7.0% vs. 1%), tachypnoea (3.0% vs. 0%), sepsis (7.0% vs. 2%) and other neonatal complications (6.3% vs. 1.3%). These results were similar to Kacerovsky et al.'s study. Moreover, girls gender of baby was higher in PPROM group (44.7% vs. 34.1%).
According to Boskabadi et al.'s study, the maternal risk factors and neonatal consequences for PPROM are diabetes (12.7%), history of PROM (8.9%), caesarean delivery (38.1%) and neonatal complications included neonatal infection (52%), RDS (30.4%) and foetal distress (3.3%). Our results showed a significant relationship between PPROM with sepsis and RDS, similar to the one reported by van der Ham et al. and Gyamfi-Bannerman and Son studies. However, about 30% of all preterm deliveries (before 37 weeks) are complicated by PPROM, and the PROM is related to development of maternal and neonatal complications. The results of this study also showed that PPROM increases the odds of unhealthy infant which was similar to other study. Although, the incidence of sepsis was lower than in another study in prolonged latency after PPROM.
In our study, the maternally outcomes, including overt diabetes (2.8%), gestational diabetes (0.7%), preeclampsia 0.3%, abruption 0.3% and other complications 0.2% were similar to Kassa and Sirak study. However, intraamniotic infection was 31.5% and this difference might have caused by different management of PROM. In addition, caesarean delivery in our study was 34% in PPROM group, which was higher than to reported in other studies such as Kassa and Sirak, Osmanaǧaoǧlu et al. and Yang et al. that reported 23.2%, 21% and 31.5%, respectively. Moreover, the LBW in this study (<2500 g) was higher than in no-PPROM group and associated with PPROM. LBW was considered as an important predictor of infant mortality, especially in the 1st month of life. In our study, LBW was 13.3% in PPROM group and was higher than the Kothari reports (33%). The difference in the quality of health care provided for mothers affected to PROM could reduce the incidence of LBW in that study.
No significant relationship was observed between a history of PROM in a previous pregnancy with PPROM in our study. However, Choudhary et al.'s. study showed that a history of PROM in a previous pregnancy was significantly associated with PROM. In addition, their results showed that PPROM increases odds of receiving corticosteroid twofold which is similar to our results and Vidaeff and Ramin study. However, clinical management guidelines for obstetrician-gynaecologists and American Congress of Obstetricians and Gynaecologists guidelines suggest that labour induction is beneficial for mothers with PPROM at or after 34 weeks of gestational age.
This study was exposed to some limitations. Failure to conduct this project in other hospitals and some missing data in the medical dossier or bad handwritings that caused to some missing data (lower than 10%). However, the large sample size of this study has improved the precision and data quality and generalisability of results.
| Conclusion|| |
RDS, sepsis, tachypnoea and other perinatal outcomes are more common in women with PPROM. Hence, in view of the unfavourable outcome, preventive measures and control of PPROM are essential. Therefore, girls' neonates who borne with LBW have more chance for affecting to PPROM, and they are in higher risk of RDS, sepsis, tachypnoea and other neonatal complications.
We appreciate Clinical Research Development Centre of Shahid Beheshti Hospital in Qom and all mothers who participated in the study.
Financial support and sponsorship
This study was supported financially by the Qom University of Medical Sciences, Iran by grant number of 94556.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Patil P, Kumari A, Anand H. Ultrasonographic evaluation of cervical length and amniotic fluid index as predictor of pregnancy outcome in case of preterm premature rupture of membrane. Int J Reprod Contracept Obstet Gynecol 2018;7:1411-5.
Yu H, Wang X, Gao H, You Y, Xing A. Perinatal outcomes of pregnancies complicated by preterm premature rupture of the membranes before 34 weeks of gestation in a tertiary center in china: A retrospective review. Biosci Trends 2015;9:35-41.
Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, et al.
Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort. Am J Obstet Gynecol 2016;215:103.e1-103.
Dars S, Malik S, Samreen I, Kazi RA. Maternal morbidity and perinatal outcome in preterm premature rupture of membranes before 37 weeks gestation. Pak J Med Sci 2014;30:626-9.
Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol 2008;1:11-22.
Frey HA, Klebanoff MA. The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med 2016;21:68-73.
Kothari S, Jora R, Chouhan H. Incidence and risk factors for low birth weight, very low birth weight and extremely low birth weight babies in Western Rajasthan. Int J Med Paediatr Oncol 2017;3:102-5.
Al-Riyami N, Al-Shezawi F, Al-Ruheili I, Al-Dughaishi T, Al-Khabori M. Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes (Mid-trimester PROM). Sultan Qaboos Univ Med J 2013;13:51-6.
Newman DE, Paamoni-Keren O, Press F, Wiznitzer A, Mazor M, Sheiner E, et al.
Neonatal outcome in preterm deliveries between 23 and 27 weeks' gestation with and without preterm premature rupture of membranes. Arch Gynecol Obstet 2009;280:7-11.
Drassinower D, Friedman AM, Običan SG, Levin H, Gyamfi-Bannerman C. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis. Am J Obstet Gynecol 2016;214:743.e1-6.
Esteves JS, de Sá RA, de Carvalho PR, Coca Velarde LG. Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks. J Matern Fetal Neonatal Med 2016;29:1108-12.
Noor S, Nazar AF, Bashir R, Sultana R. Prevalance of PPROM and its outcome. J Ayub Med Coll Abbottabad 2007;19:14-7.
Polettini J, Dutta EH, Behnia F, Saade GR, Torloni MR, Menon R, et al.
Aging of intrauterine tissues in spontaneous preterm birth and preterm premature rupture of the membranes: A systematic review of the literature. Placenta 2015;36:969-73.
Boskabadi H, Maamouri G, Mafinejad S. Neonatal complications related with prolonged rupture of membranes. Maced J Med Sci 2011;4:93-8.
Mackeen AD, Seibel-Seamon J, Grimes-Dennis J, Baxter JK, Berghella V. Tocolytics for preterm premature rupture of membranes. Cochrane Database Syst Rev 2011;10:CD007062.
Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics. 24th
ed. New York, NY: McgrawHill; 2014.
Hackenhaar AA, Albernaz EP, da Fonseca TM. Preterm premature rupture of the fetal membranes: Association with sociodemographic factors and maternal genitourinary infections. J Pediatr (Rio J) 2014;90:197-202.
Kacerovsky M, Musilova I, Andrys C, Hornychova H, Pliskova L, Kostal M, et al.
Prelabor rupture of membranes between 34 and 37 weeks: The intraamniotic inflammatory response and neonatal outcomes. Am J Obstet Gynecol 2014;210:325.e10.
van der Ham DP, Vijgen SM, Nijhuis JG, van Beek JJ, Opmeer BC, Mulder AL, et al.
Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: A randomized controlled trial. PLoS Med 2012;9:e1001208.
Gyamfi-Bannerman C, Son M. Preterm premature rupture of membranes and the rate of neonatal sepsis after two courses of antenatal corticosteroids. Obstet Gynecol 2014;124:999-1003.
Choudhary M, Rathore SB, Chowdhary J, Garg S. Pre and post conception risk factors in PROM. Int J Res Med Sci 2017;3:2594-8.
Sirak B, Mesfin E. Maternal and perinatal outcome of pregnancies with preterm premature rupture of membranes (pprom) at tikur anbessa specialized teaching hospital. Ethiop Med J 2014;52:165-72.
Osmanaǧaoǧlu MA, Unal S, Bozkaya H. Chorioamnionitis risk and neonatal outcome in preterm premature rupture of membranes. Arch Gynecol Obstet 2005;271:33-9.
Yang LC, Taylor DR, Kaufman HH, Hume R, Calhoun B. Maternal and fetal outcomes of spontaneous preterm premature rupture of membranes. J Am Osteopath Assoc 2004;104:537-42.
Dickute J, Padaiga Z, Grabauskas V, Nadisauskiene RJ, Basys V, Gaizauskiene A, et al.
Maternal socio-economic factors and the risk of low birth weight in lithuania. Medicina (Kaunas) 2004;40:475-82.
Vidaeff AC, Ramin SM. Antenatal corticosteroids after preterm premature rupture of membranes. Clin Obstet Gynecol 2011;54:337-43.
Medley N, Poljak B, Mammarella S, Alfirevic Z. Clinical guidelines for prevention and management of preterm birth: A systematic review. BJOG 2018;125:1361-9.
[Table 1], [Table 2], [Table 3]