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DOI: https://dx.doi.org/10.18535/jmscr/v6i8.82

Sociodemographic Profile and Outcome of Preterm Premature Rupture of

Membranes
Authors
Dr Anuradha Chakravartty , Dr Plabon Basu2, Dr S.M. Tushar Alom3, Dr Farah
1

Anjum Sonia4
1
Assistant Professor, Ad-din Sakina Medical College, Jessore, Bangladesh
2
Assistant Professor, Ad-din Akij Medical College, Khulna, Bangladesh
3
Medical Officer, Department of Transfusion Medicine, Khulna Medical College Hospital, Khulna, Bangladesh
4
Medical Officer, Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka,
Bangladesh
*Corresponding Author
Dr Anuradha Chakravartty
Assistant Professor, Ad-din Sakina Medical College, Jessore, Bangladesh
Abstract
Introduction: Premature rupture of membrane (PROM) is connected to noteworthy maternal pre-birth mortalities
and morbidity. The result of maternal and fetal in PROM is imperative to diminish maternal and child mortality and
for better administration and anticipation of complexities. Premature rupture of membrane (PROM) refers to the
interruption of fetal layers previously the start of work, bringing about unconstrained spillage of amniotic liquid.
PROM, which happens before 37 weeks of incubation, characterized as preterm PROM as PROM, happens following
37 weeks growth characterized as term PROM. The etiology of PROM is accepted to be multifactorial and several risk
factors have been distinguished. Factors incorporate multigravida, low socio-economic status, concomitant infection
e.g. UTI, vulvovaginitis, anaemia, past the point of no return introduction of side effects, H/O Polyhydramnios,
irregular ANC, low socio-economic status and a background marked by preterm PROM of preterm work. There is
scarcity of information on clinical profile and result of PROM in tertiary focal point of Bangladesh, so as to address
this issues, this examination was intended to explore the clinical profile and result of pregnancy of untimely break of
layer (PROM). Diagnosis and proper management is critical to confine different fetal and maternal complexities for
the most part because of disease. Hence, this investigation means to decide maternal and fetal results in PROM
among term pregnant ladies who were admitted to the maternity or work ward in Hospital.
Objectives: To determine the sociodemographic Profile and feto-maternal outcome of Preterm premature rupture of
membrane (PROM).
Materials and Methods: This is cross sectional observational study; amongst 50 women with H/O PPROM were
included in this study. Sociodemographic attributes were evaluated. Ruptures of membrane with an APH, serve pre-
eclampsia, eclampsia, malpresentation were excluded from study.
Result: Sociodemographic highlights, e.g., age, habitation, occupation, financial status, and so forth are the prime
determinants of result of PROM. In this study, the age of the patients went between 17->35 years, mean age was 23.5
± 9.54 years. Vast quantities of respondents originated from urban region 53.0%, and financially poor class 26(52%).
The vast majority of the ladies were multigravida (62%). Around 74.2% were analyzed around 34-37 week of
development. Introduction of PROM or span of side effects went from 40 minutes to most extreme 2 days. The greatest
country amass patients displayed after beginning of side effects >12 hours i.e. 8(42.11%) patients. The postponement
in hospitalization increases the intensifying of ailment process and improvement of entanglement, at last poorer
result. On the other hand patients hailing from urban dwelling hospitalized at the earliest opportunity after sign-

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manifestations improvement. On evaluation of pregnancy outcome, study shows that most of the PROM women
conveyed by LUCS (82.0%). Most normal complication was subclinical urogenital infection (36.0%) next
oligohydramnios (32.0%) and (16.0%) women presented with chorioamnionitis. Among the infants, 26% had Apgar
score beneath 7 at their first min of age and 10% had Apgar score underneath 7 at their 5 min of age. Birth asphyxia
was been developed in total 6 newborn. Hospital admission to released, legitimate workup and assessment was
performed in all patients. Overall result demonstrates that 92.0% of the PROM women recouped either totally or
partially, 8.0% remains stop; it might be because of wound disease or other fundamental ailment. Besides, maternal
mortality happened. However, 37(74.0%) of neonates recovered during hospital stay, yet 11(22.0%) built up any
difficulties and till were hospitalized under neonatal care. Two patients were expired. So, neonatal death rate was
2(4.0%) subject in this study.
Conclusion: Women living in rural areas, lower class, long latency, and neonates with birth weight less than 2500 g
may have adverse outcomes. In this case, optimum obstetric and medical care is essential for the diminishment of the
staggering inconveniences related to disorders.
Keywords: PROM, Preterm PROM, Demogrpaphic features, Outcome.

Introduction age subordinate. The analysis of PPROM is

PROM, which happens before a long period of 37 formed by a combination of clinical suspicion,
weeks of gestation is called preterm PROM previous history and some normal tests4. The
(pPROM). The etiology pre labor break of historical backdrop of releasing fluid or gushing
membranes is obscure in the dominant part of of water from vagina is demonstrative over 90%
cases. However, bacterial infection, cervical of the time. Various tests like Nitrazine, fern,
incompetence, hypertensive disease, recent coitus, evaporation and diamine oxidase test are
malpresentation, antepartum hemorrhage (APH), performed to affirm PROM to the patients.
malnutrition are perceived reasons of prelabor Nowadays, ultrasound examination is additionally
breakdown of membranes (PROM)1. Preterm notable strategy for the diagnosis of PROM5.
PROM is a prime reason of perinatal grimness and In premature rupture of the membranes, break can
mortality, particularly on the grounds that it is happens if an imbalance appears between the
related with brief dormancy from membrane resilience of the amnion. Afterwards, the pressure
rupture to convey, perinatal contamination, and administrated develops and can cause various
umbilical cord pressure due to oligohydramnios. motives. An intact amnion with adequate
Fundamentally, PPROM is multifactor in nature. amniotic liquid is fundamental for the fetal
If it is given in any patient, at least one way improvement (lung, movement) and protects the
physiologic methodology might be obvious. child from rising diseases. During the pregnancy
Choriodecidual infection or inflammation which week, an amniotic infection syndrome (AIS)
appears, accept a basic part in etiology of preterm undoubtedly degrades the newborn's prognosis6.
PROM, especially during at early gestational The aetiology is multifactorial. PPROM
ages2. assessment and management are vital for
Preterm premature rupture of membranes enhancing neonatal outcomes. Precise diagnosis
(PPROM) circumvents 3 to 8 percent of of PPROM needs a careful history, physical
pregnancies and promotes to one third of preterm examination and ancilliary laboratory studies.
conveyances. Thus, the results are huge chance of These would take into account gestational age
prematurity and direct to perinatal and neonatal particular obstetric mediations to enhance
entanglements with danger of fetal death3. Preterm perinatal result and decrease fetomaternal
premature rupture of the membranes (PPROM) is entanglements. Speculum examination to
in charge of around one-third of all preterm births determine cervical dilatation is favored due to
and influences about 120,000 pregnancies in the modern vaginal examination which is associated
United States per year. The viable treatment with a decreased latency period and has potential
depends on accurate findings as it is gestational for adverse sequelae7. The management of

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pregnancies convoluted by PPROM is challenging was inferred that gestational age during the
and controversial. So it ought to be individualized. delivery is the major determinant of neonatal body
Nonetheless, it should center around affirming the weight. In addition, survival rate among PROM
diagnosis, validating gestational age, documenting cases were significant. Besides, beta-mimetics and
fetal well being and deciding on the mode of progesterone suggested no role to prolong
introduction and cervical examination. pregnancy in PROM cases1.
Theoretically, PROM may occur in a view of The administration of PPROM requires an exact
increased friability of the films, decreased diagnosis, assessment of expenses, the danger and
elasticity strength of the membrane or a rise in advantageous of continued pregnancy or
intrauterine pressure or both. Under typical expeditious delivery. It is necessary that the
circumstances, the elasticity strength of the patient be well aware regarding the possibilities of
membranes expands until 20 weeks and then subsequent maternal, fetal, and neonatal
plateaus until 39 week after it starts to decline complications regardless of the management
dramatically. An abnormal collagen structure may approach11.
be charge for PROM as confirm by the high
recurrence of PROM in women influenced by Materials & Methods
connective tissue disorders such as the Ehlers- This is cross sectional observational study;
Danlos syndrome. Likewise, of zinc, copper and samples were collected by purposive sampling
ascorbic acid create abnormal collagen cross- procedure. The total 50 women with H/O PPROM
linking and may yield PROM8. were included in this study. All Study subjects
It can promote a serious fetal perinatal morbidity were either primi or multi gravida and natural
such as respiratory distress syndrome, neonatal rupture of membrane before the beginning of
sepsis, umbilical cord prolapse, placental abruptio labour. This includes mothers from urban and
and fetal death. It can likewise lead to maternal semi-urban areas around Dhaka city, as well as
morbidity such as postpartum endometritis, persons moved from hospitals in rural areas of the
disseminated intravascular coagulopathy, maternal country. Ruptures of membrane with an APH,
sepsis, delayed menses and asherman syndrome9. serve pre- eclampsia, eclampsia, malpresentation
The three purposes for neonatal death related with were omitted from study. Socioeconomic status
PPROM are prematurity, sepsis and pulmonary was grouped by household income, in accordance
hypoplasia. Women with intrauterine infection with Household Income and Expenditure Survey
deliver sooner than non-infected women. The (HIES)-2010, World Bank report, UNICEF-The
infants born with sepsis have a mortality rate four State of the World’s Children and Statistical
times higher than those without sepsis. Moreover, Pocketbook of Bangladesh. Detail demographic
there are maternal dangers associated with data were gathered from the witness and recorded
chorioamnionitis10. in organized case report shape. Clinical
In a study of preterm PROM, population were examination and pertinent investigations were
categorized into three groups. They were given done carefully. All gathered survey checked
the following treatments ; Group A: with beta- deliberately to recognize the blunder in the
mimetic, antibiotic, steroid, iron and folic acid information. Data processing work consist of
(IFA); Group B: With steroid, antibiotic, natural registration schedules, editing, computerization,
progesterone and IFA; Group C: With only preparation of dummy table, analyzing and
antibiotic and IFA. The observation of neonatal matching of data.
mortality in the very preterm group (≤ 33 weeks)
was 10% as compared to 5.7% in preterm (34-37
weeks) and nearly 3% among term pregnancies. It

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Result Table-II: Obstetrics characteristics of the patients
In this study, the age of the patients ranged (n=50)
between 17->35 years. Most of the patients were Variables Urban (n=31)
Rural
(n=19)
belonged to the age group 20-25 years (44.0%).
Gestational age (weeks)
Mean age was 23.5 ± 9.54 years. (Table-I) 28-33 weeks 8(25.81%) 5(26.31%)
Table-I: Demographic profile of the patients 34-37 weeks 23(74.2%) 14(73.69%)
Mean ± SD 35.27 ± 4.82
(n=50)
Duration of symptoms
Variables Frequency (%) ≤1 hours 6(19.35%) 0
Age (years) 2-6 hours 18(58.06%) 6(31.58%)
<20 7.5 15.0 7-12 hours 6(19.35%) 5(26.32%)
20-25 22 44.0 >12 hours 1(3.23%) 8(42.11%)
26-30 11 22.0 Mode of delivery
>30 9.5 19.0 Vaginal delivery 7(22.58%) 2(10.53%)
Mean ± SD 23.5 ± 9.54 Caesarean section 24(77.42%) 17(89.47%)
Residence
Rural 19.5 39.0
Urban 26.5 53.0 Duration of symptoms ranged from 40 minute to
Occupation maximum 2 days. Patients with PROM who
Service holder 7 14.0
presented in Obs emergency ward within first
Daily worker 11 22.0
House wife 29 58.0 hour of the onset of symptoms were only
School teacher 3 6.0 6(19.35%), and all patients were urban residing.
Maximum rural group patients presented on >12
Large numbers of patients came from urban area hours i.e. 8(42.11%) patients. The delay in
53.0%, followed by rural area 39.0% and sub- hospitalization augments the worsening of disease
urban/slum area 8.0%. Large numbers of process and development of complication,
respondents were house wife 58.0%, followed by ultimately poorer outcome. The p-value is .00721.
daily worker 22.0%. Socio economical status was The result is significant at p < .05. On evaluation
evaluated according to operation definition, poor of pregnancy outcome, most of the women
class 26(52%) comprising the major percentage of delivered by LUCS 82.0%. Total 27 patients has
the patients. (Figure-1) been trial for vaginal delivery. Among them only
7(22.58%) patients progress to vagina delivery,
but 24(77.42%) patients not progress and
Caesarean section was done in urban. Occurrences
of caesarean delivery in rural patients were much
higher 89.47% in relation to urban residing
77.42%. (Table-II) Most of the women were
multigravida 62%. (Figure-2)

Figure- 1: Socioeconomic status of the study

0% Primigravi 0%
population (n=50)
da
38%
Multigravi
The mean gestational week was 35.27 ± 4.82 da
week. About 74.2% were diagnosed and were 62%

around 34-37 weeks of gestation in urban. The

earliest diagnosis was made at 28 weeks to 33
(25.81%) and has impact on feto-maternal
outcome in urban. (Table-II) Figure- 2: Obstetrics history (Gravidity) of
mothers (n=50)
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Birth weight of the baby shows that most of the Table- IV: Fetal complications and outcome
babies 21(42.0%) had birth weight in between 2.1- (n=50)
2.5kg and 8(16.0%) babies were less than 1.5 kg Fetal complication Frequency Percentage (%)
Prematurity 12 24.0
body weight. Only 19.0% of the baby had birth
Neonatal sepsis 6 12.0
weight more than 2.5 kilogram. (Figure-3) Birth asphyxia 6.5 13.0
Cord prolapse 2 4.0
60% Hyperbilirubinaemia 8 16.0
Prevalence (%)

Congenital anomaly 2 4.0

40% Neonatal death 2 4.0
20%

0%
Discussion
<1.5 kg Pre-term PROM is significantly associated with
1.6-2.0 kg
2.1-2.5 kg maternal, neonatal morbidity and mortality from
>2.5 kg
Group of Birth weight (kg) infection, umbilical cord compression, placental
abruption and preterm birth. Subclinical
Figure- 3: Birth weight of the neonates (n=50)
intrauterine infection has been ensnared as a
noteworthy etiological factor in the pathogenesis
On evaluation of maternal outcome, table (Table-
and subsequent maternal and neonatal morbidity
III) shows that only 7(14.0%) of PROM mothers
associated with PPROM12. At present, pre-labor
was free from any complications, but most cases
rupture of the membrane (PROM) is one of the
of PROM women developed any sort of
general and challenging issues in perinatal
complication. Most common complication was
medicine. Management of PROM has gone
subclinical urogenital infection 36.0% next
between different cycles of masterly inactivity to
oligohydramnios 32.0% and 16.0% women
immediate intervention13. In this study most of the
presented with chorioamnionitis. (Table-III)
patients belonged to the age group 20-25 years
(44.0%). Next (22.0%) were 26-30 years of age
Table-III: Maternal complications and outcome
group. Mean age was 23.5 ± 9.54 years. Large
(n=50)
numbers of respondents came from urban area
Post-partum Percentage
Frequency (53.0%), and socioeconomically poor class
complication (%)
Chorioamnionitis 8 16.0 26(52%) comprising the major percentage of the
Urogenital infection 18 36.0 patients. Maximum patients were house wife
Oligohydramnios 16 32.0
Puerperal sepsis 7 14.0 (58.0%) followed by daily worker (22.0%).
Wound infections 11 22.0 PROM is discovered more typical in low socio-
PPH 5 10.0 economic class patient with insufficient prenatal
No complications 7 14.0
care and weight gain during pregnancy13. In a
Fetal outcome revealed that, 26% had Apgar score study, directed at tertiary centre hospital of
below 7 at their first min of age and 10% had Bangladesh, demonstrates the occurrence of
Apgar score below 7 at their 5 min of age. Among PROM in hospital was around 6.3%. The majority
the newborn babies, 24.0% of the babies were of the pregnant women were between 20-24 years
prematurity, 13.0% developed birth asphyxia, of age 44%, where 38% were primigravida and
12.0% had neonatal sepsis and 4.0% were 62% were multigravida14. Low socio-economic
congenital anomaly. (Table-IV) status is an imperative risk factor for both PROM
and preterm labour. Related factors such as
malnutrition, overexertion, poor hygiene, stress,
recurrent genitourinary infections and anaemia
significantly increment the risk 14,15. In a study by

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Begum, half of the patients were in the gathering occurrence of contamination was roughly 20%
of low financial condition having no or and in PPROM it was 38.3%18. Additionally,
unpredictable antenatal registration which is women with PPROM and work at the season of
relatively like this study16. confirmation had a more noteworthy occurrence
In this study a large portion of the women was of chorioamnionitis than women with PPROM
multigravida (62%). About 74.2% were diagnosed conceded without labour18. Related maternal
of around 34-37 weeks of gestation. The most medical and obstetrical complications had a
early diagnosis was made at 28 weeks to 33 profoundly critical effect on PROM. In this study
(around 26.0%) and has more impact on feto- 86.0% of PROM patients were admitted with
maternal outcome. In addition, 89.47% patients different complications. Among them, 18.0%
were delivered by caesarean section & 10.53% patients showed with chorioamnionitis.
patients were delivered vaginally. But in another Table shows the majority of the babies 21(42.0%)
study, Begum shows that only 32% patients were had birth weight in between 2.1-2.5kg and
delivered by C/S16. 8(16.0%) babies were under 1.5 kg body weight.
The relationship of risk factors or maternal Just 19.0% of the baby had birth weight in excess
complication in this study shows that anemia of 2.5 kilogram. Among the newborn babies, 26%
exhibit in 28.0% cases; UTI were 26.0% cases and had Apgar score below 7 at their first min of age
H/O previous C/S was 24.0 % cases. On and 10% had Apgar score below 7 at their 5 min
assessment of pregnancy results, present study of the age. The table shows APGAR score of the
indicates that most of the PROM women baby at first minute (74%) were between 7-10 and
conveyed by LUCS (82.0%). Total 27 patients (18%) were between 4-6. Only (8%) was <4. The
have been examined for vaginal delivery. Among table shows most of the baby (90%) APGAR
them, only 7(22.58%) patients progress to vagina score at five minutes was within 7-10 and (6%)
delivery, but 24 patients not progress and were within 4-6. (4%) remain <4, ultimately these
Caesarean section was done. Events of cesarean babies transferred to NICU. Birth asphyxia was
conveyance in country patients were significantly found in total 6 newborn and immediate
higher (89.47%) in connection to urban dwelling resuscitation was given. After the resuscitation,
(77.42%). The table demonstrates that exclusive 4(8%) of newborn improved, however, 2(4%) not
7(14.0%) of PROM moms was free from any improved and later these babies were transferred
inconveniences, however most cases built up any to NICU. Among the cases, 24.0%of the babies
kind of difficulty. Most regular inconvenience was were prematurity, 13.0% developed birth
subclinical urogenital infection (36.0%) next asphyxia, 12.0% had neonatal sepsis and
oligohydramnios (32.0%) and (16.0%) women 4.0%were congenital anomaly.
presented with chorioamnionitis. The danger of Prospective study in Comilla Medical College
disease is huge after PPROM. In this study disease Hospital14 demonstrated that about 48.5% women
was the most imperative difficulty of PPROM and presented with diverse complications related with
comparable perception was noted by Okeke TC PROM. Among which, 15.7% patients had
and his colleagues 17. Infection rate was 22 oligohydramnios, 8.5% patients were presented
percent; there was increment in rate of with chorioamnionitis suggested by culture report
contamination with increment inactivity period of high vaginal swab. Around 10% women
more than 24hours 17. created obstetric complications (failed trial)
In 1991, Romero et al reported that infection is relevant with medical diseases. The greater part of
twice as incessant in PROM than in preterm the baby (38.4%) was born with birth weight
labour with intact membranes. In another study by between 2.1-2.5kg and 10.3% babies were less
Romero et al in 1993, in term PROM the than 1.5kg14. Despite the fact that there is some

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morbidity when PROM occurs in term Incidence and Management Outcome of
pregnancies, the major clinical problem is preterm Preterm Premature Rupture of Membranes
PROM, a condition that happens in 3% of all (PPROM) in a Tertiary Hospital in
pregnancies and is responsible for roughly 30% of Nigeria.” American Journal of Clinical
all preterm deliveries as reported by Arias and Medicine Research 2, no. 1 (2014): 14-17.
Tomich on 198219. 4. Hyagriv N. Simhan, Timothy P. Canavan.
Preterm premature rupture of membranes:
Conclusions diagnosis, evaluation and management
Premature rupture of membrane is a critical strategies. BJOG: an International Journal
occasion as it causes maternal complexities, of Obstetrics and Gynaecology, March
expanded operative methods, neonatal morbidity 2005, Vol. 112, Supplement 1, pp. 32–37.
and mortality. In conclusion, the findings of this 5. Shrestha S and Sharma P. Fetal outcome
study showed that term of side effects of PROM, of pre-labor rupture of membranes. N. J.
maternal residence and dormancy are associated Obstet. Gynaecol, 2006; Vol. 1, No. 2: 19 -
with adverse maternal outcomes. In addition, birth 24.
weight under 2 500 g, ICU admission, duration of 6. Mohr T. Premature rupture of the
PROM, and meconium-stained color of liquor are membranes. Gynakol Geburtsmed
related with unfavorable fetal outcomes. The Gynakol Endokrinol 2009; 5(1):28–36.
management of premature rupture of membranes 7. Alexander JM, Mercer BM, Miodovnik M,
has experienced different cycles of obstetric Thurnau GR, Goldenburg RL, Das AF, et
activity from benign neglect to immediate al. The impact of digital cervical
intervention. Paralleling these cycles of movement examination on expectantly managed
there have shifting degrees of concern about preterm rupture of membranes. Am J
infection. The key factor in the fetal and maternal Obstet Gynecol 2000; 183: 1003-1007
result is that the diagnosis of pre labour rupture of 8. Arias F, Daftary SN, Bhide AG. Premature
membranes needed to be established. However, Rupture of Membrane, Practical Guide to
our main goal was healthy mother and healthy HighRisk Pregnancy & Delivery , A South
baby. In managing PPROM, timely use of exact Asian Perspective, 3rd edition-2008; 240-
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decline perinatal and maternal complications. CO, Ezugwu EC, and Agu PU, “The
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