Feto-Maternal outcome complicated by PROM, a peripheral hospital experience

Gunjan Rai, Mohd Rasheed

Abstract


The membrane surrounding the amniotic cavity are composed of the amnion and chorion and they are closely adherent to each other. Thesemebranes retain amniotic fluid and protect the fetus against ascending infection from genital tract. Most of the patient membrane rupture during process of labour but if it ruptures before onset of labour, it is called PROM. If PROM ocurres before 37 weeks of pregnancy it is called PPROM. Despite all measures PROM and PPROM continues to be important obstetrical complications. At term, nearly 8-10 % patients present with PROM and these patients are at increased risk for intrauterine infection when time interval between rupture of membrane and delivery increases. PPROM occurs in approximately 1 percent of all pregnancies and is associated with preterm deliveries. PPROM is a leading cause of preterm deliveries and causes complications like respiratory distress syndrome, neonatal infection and intraventricular haemrrhage.

This study was aimed to understand incidence, and neonatal and maternal outcome due to PROM.Premature rupture of membranes (PROM) remains a subject of great clinical relevance and intense interest and is day to day problem for each and every obstetrician. Despite exhaustive research, most aspects of PROM remain enigmatic. The mechanism of PROM is unknown, there is no standard method of diagnosis and most of the management plans are controversial.PROM is a leading cause for prematurity which leads to increased perinatal morbidity and mortality. As prevention of PROM is difficult so obstetrician can only try to reduce the complications of PROM. Final aim of obstetrician is a pregnancy that results in healthy infant with lesser maternal complications.

 

Methods:

This is a retrospective study. The aim and objective is to determine the incidence, to find out the age, parity and gestational age distribution of PROM and was also to evaluate maternal and fetal outcome. The cases selected in this study were those bookedpatients who had spontaneous rupture of membranes after 28 wks of gestation but before the onset of labour pain. Patients were admitted in labour room from casualty as a routine. Total number of deliveries during study period were2200 and total number of PROM cases were 137. Per-scepulum examination were done in all patients with history of leaking per vaginum to diagnose PROM. In doubtful cases a closed observation was done to diagnose PROMPatients were examined, investigated and treated as per hospital protocol. Broad spectrum antibiotics was started in these patients and were monitored for infections by laboratory investigations and clinical signs. Timing of delivery was decided depending upon gestational age and aim was to deliver a healthy infant with less traumatized mother.Inj dexamethasone four doses at interval of 12 hrs was given to preterm patients and pregnancy tried to continue minimum till 34 weeks of gestation under strict observation for chorioamnionitis.

Pre-induction bishop score was noted. Presence or absence of membranes were noted during examination. After confirmation of diagnosis and if decision was made for delivery then PGE2 gel application was done. All patients were assessed 6 hrs and 12 hrs after gel application and induction was done with oxytocin on appropriate time. Observation was made regarding mode of delivery. The babies were observed just after birth; Apgar score was recorded at 1 and 5 minutes. Babies were examined for maturity and for any congenital anamoley and followed. All the mothers were strictly observed for any signs of infections in puerperium.


Keywords


PROM,LSCS,Primigravida,Multigravida

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References


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