DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163685

Incidence of morbidity and mortality in neonate born to mothers with premature rupture of membranes

Sumant Lokhande, Rajendra Nistane

Abstract


Background:Preterm premature rupture of membranes (PPROM) refers to PROM prior to 37 weeks of gestation. Premature rupture of membranes (PROM) is one of the most common problems in obstetrics complicating approximately 5-10% of term pregnancies. The objective of this study was to know the incidence of early onset sepsis following PROM (premature rupture of membranes) more than 18 hours, mortality among neonates born to mothers with PROM more than 18 hours.

Methods: The study was conducted in department of pediatrics, Dr. Panjabrao Deshmukh memorial medical college and hospital, Amravati. All neonates born to healthy mothers with PROM more than 18 hours during their hospital stay were studied. An allowable error sample size of 60 was calculated. Detailed birth history including resuscitation details, APGAR score and gestational age assessment were evaluated. In examination of the neonate, the pulse, respiratory rate, CFT and temperature were noted followed by systemic examination. Required investigations were done for the neonate and were followed during their hospital stay. All the details were fed into the preformed teacher-made proforma.

Results:51.7% of the neonates were males and 48.3% were females. 65% of the total neonates were born by normal vaginal delivery and 35% were delivered by caesarean section. 53.3% of the cases had premature rupture of membranes of 18 - <24 hours duration, 38.3% cases had premature rupture of membranes of 24 to 72 hours and 8.3% cases had premature rupture of membranes of more than 72 hours. RDS was the most common clinical manifestation (36.7%) followed by septicemia (8.3%), meningitis (1.7%) and pneumonia (1.7%).

Conclusions:Premature rupture of membranes is a high-risk obstetric condition. Active management is needed to enable delivery within 24 hours of premature rupture of membranes as it offers better neonatal outcome. Morbidity increases as the duration of premature rupture of membranes increases. The incidence of neonatal infection in neonates born to mothers with PROM was 8.3%. CRP was positive in 30% of cases. Out of 60 cases 1.7% had leucopenia and 18.3% had leucocytosis. Most common organisms isolated in blood culture were staphylococcus followed by Klebsiella, E. coli, pseudomonas and coagulase negative Staphylococci.


Keywords


Nenonate, Premature membrane rupture, Respiratory distress, Sepsis

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References


Doyle C. Premature rupture of membranes. IN: RS Gibbs, BY Karlan, AF Haney, IE Nygaard (eds). Donforth’s obstetrics and gynaecology. 9th edi, Philadelphia. Lippincott Williams and Wilkins Publishers; 2008:2:91.

Nilli F, Shams AA. Neonatal complications of premature rupture of membrane. Acta Medica Iranica. 2003;41(3):176.

Kifah Al, Al-Awayshih F. Neonatal outcome and prenatal antibiotic treatment in premature rupture of membranes. Pakistan J Med Sci. 2005;3:2.

Bey Down SN, Yasin SY. Premature rupture of membranes before 28 weeks: conservative management. Am J Obstet Gynecol. 1986;155:470-1.

Davies PA. Bacterial infection in the fetus and newborn. Arch Dis Child. 1971;46:1.

WA Carlo. Maternal disease and the fetus. In: RM Kliegman, BF Stanton, JW St. Geme, RE Behrman, NF Schor (ed). Nelson Textbook of Pediatrics. Nineteenth Edi: Philadelphia; 2012:545.

Egmter C, Leitich H, Karas H, Wieser F, Husslein P, Kaider A, et al. Antibiotics treatment in preterm premature rupture of membranes and neonatal morbidity: a meta-analysis. Am J Obset Gynaecol. 1996;174:589-97.

Korn WR, Jariya WS. Incidence of neonatal infection in newborn infants with matneral history of premature rupture of membranes (PROM) for 18 hours or longer by using Kutklar Hospital clinical practice guidelines. J Med Assoc. 2005;8:7.

Shubeck F, Benson RC, Clark WW. Fetal hazards after rupture of membrane. Obstet Gynecol. 1966;28:22.

Gerdes JS. Clinicopathologic approach to diagnosis of neonatal sepsis. Clinical Perinatol.1991;18:361-374.

Sanyal MK, Mukherjee TN. Premature rupture of membrane; an assessment from a rural medical college of West Bengal. J Obstet Gynecol India. 1990;40(4):623-8.

Kodkany BS, Telang MA. Premature rupture of membranes: a study of 100 cases. J Obstet Gynecol India. 1991;41(4):492-6.

Devi A, Devi R. Premature rupture of membrane - a clinical study. J Obstet Gynecol India. 1996;46:63-8.

Devi A, Rani R, Devi A. Premature rupture of membranes - a clinical study. J Obstet Gynaecol India. 1996;46(1):63-8.

Merenstein GB, Weisman LE. Premature rupture of membranes-neonatal consequences. Semin Perinatal. 1996;20(5):375-80.

Miller HC, Jeker JF. Epidemiology of spontaneous premature rupture of membranes: factors in preterm births. Yale J Biol Mede. 1989;62:241.

Taylor ES, Morgan RL, Bron PD, Broose VE. Neonatal infection. Am J Obstet Gynecol. 1961;82:1341.

Asindi A, Eric I, Nivedita B. Mother - infant colonization and neonatal sepsis in prelabour rupture of membranes. Saudi Med J. 2002;23(10):1270-4.