An adolescent male presenting with multiple congenital limb defects planned for corrective surgery was incidentally detected to have low oxygen saturation on room air at rest. The child was not on any medication. After a pediatric cardiologist opinion a 2D Echocardiography and ECG were done which turned out to be normal. Proper history, detailed examination and simple bedside test carried out by the pediatricians proposed the possibility of methemoglobinemia. Since the child was not on any medication and after ruling out the possibility of toxin intake, a clinical diagnosis of congenital methemoglobinemia was arrived at, which was confirmed by the blood investigations. Since, systemic methemoglobinemia is a rare cause of cyanosis and has a varied presentation depending on the type and cause, a high index of suspicion is needed for the diagnosis. The coexistence of multiple congenital limb defects prompts one to think about a possible co-relation.

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BACKGROUND Foetal and maternal risk proportionately increase with delay in time from occurrence of PROM to institution of treatment. We have undertaken a prospective study of term PROM cases mainly to evaluate maternal and perinatal outcome. The objective of this study is to evaluate risk factors associated with term PROM and also its effects on maternal and perinatal outcome. MATERIALS AND METHODS 100 pregnant women with term pregnancy of more than 37 weeks and before the onset of active phase of labour complaining of draining per vagina were included in the study. Delivery was planned in all cases, either by induction of labour or LSCS depending on the clinical findings at admission. Mode of delivery, maternal and perinatal morbidity were assessed. RESULTS Incidence of term PROM was 9.5% of all deliveries. Cause of PROM was not known in majority of cases. Low socioeconomic status, cervicovaginal infections, anaemia, malpresentations and hydramnios were other contributing factors. Vaginal delivery was the commonest mode of delivery. Caesarean section was done in cases of failed induction and progress of labour, foetal distress, malpresentation and oligohydramnios. Maternal morbidity was due to intrapartum sepsis and perinatal morbidity and mortality resulting from neonatal sepsis and respiratory distress due to meconium aspiration. CONCLUSION Term premature rupture of membranes is one of the common and challenging problems in obstetric practice contributing to significant maternal and perinatal morbidity. Prophylactic antibiotics and timely induction of labour can reduce infectious morbidity in mother and the baby.

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