Impact of mode of delivery on pregnancy outcomes in women with premature rupture of membranes after 28 weeks of gestation in a low-resource setting: A prospective cohort study

Abstract

BackgroundDespite the high prevalence of premature rupture of membranes (PROM) in low-resource settings, the preferred mode of delivery remains unclear. We compared the perinatal mortality in a prospective cohort of women with PROM after 28 weeks following vaginal or caesarean delivery at Mulago Hospital with the aim of adopting evidence based practice and improving patient care.MethodsBetween November 2015 and May 2016, 1455 women with PROM after 28 weeks of gestation and their newborns were prospectively followed from admission to discharge at Mulago Hospital. The primary outcome was perinatal mortality. Secondary neonatal outcomes included sepsis and admission to the Special Care Unit. Maternal outcomes included maternal deaths and complications. Outcomes were compared between women who had vaginal vs. caesarean delivery using multivariable logistic regression. All statistical tests were 2-sided with the level of statistical significance set at p < 0.05.ResultsThe incidence of PROM was 12.1%. The perinatal mortality following PROM was 65 per 1000 live births. Of the 1425 women with PROM, 991 (69.5%) had vaginal delivery and 434 (30.5%) underwent Caesarean section. There was no statistical difference in perinatal mortality by the mode of delivery (vaginal vs. caesarean) in PROM (p = 0.12). The risk factors for perinatal mortality included chorioamnionitis, failure to administer corticosteroids in preterm PROM, gestational age (28–33 weeks), duration of drainage of liquor (24–48 hours), and presence of maternal complications. Caesarean delivery was associated with increased maternal postpartum infections, admission to the Special Care Unit and maternal death.ConclusionIn low resource settings, vaginal delivery is the preferred mode of delivery for PROM after 28 weeks gestation. It is associated with lesser maternal and perinatal morbidity when compared to caesarean delivery.

Predictors of Premature Rupture of Membranes among Pregnant Women in Rural Uganda: A Cross-Sectional Study at a Tertiary Teaching Hospital

“…The prevalence of PROM among women above 28 weeks of gestation admitted at KIU-TH was 13.8%. This prevalence of PROM lies within the worldwide range of 5 to 15% as reported by Huang et al [3] and Shadma and Aymen [4] although it is higher than that reported by Maryuni [14] in Indonesia (10%), Abouseif et al [19] in Egypt (4.7%), and Kayiga et al [10] in Mulago Hospital in central Uganda (12.1%). This discrepancy was attributed to the contextual differences in the study setting.…”

“…where n is the desired sample size, z α is the z-statistic at α = 1:96 (95% level of confidence), z β is the z-statistic at β = 0:84, p is the prevalence of PROM in Uganda (12.1%) [10], and d is the level of precision (0.05). Therefore, n = ðð1:96 + 0:84Þ 2 × 0:121 ð1 − 0:121ÞÞ/ ð0:05Þ 2 = 334.…”

“…Up to 50% preterm births and 80% maternal clinical and subclinical infections have been associated with PROM worldwide with a fourfold increased risk of fetal mortality [9]. An estimated 65 perinatal deaths per 1000 live births following PROM have been reported in Mulago Hospital in Uganda [10]. However, since time immemorial, its aetiology has remained obscure.…”

Can vitamin C and interleukin 6 levels predict preterm premature rupture of membranes: evaluating possibilities in North Indian population

“…This genetic link may explain the occurrence of repeated events of rupture of membranes in a woman. Our study found that there was no difference in the mode of delivery in the study and the control group, like Sharma and Mehta [3] did, while other studies [22,23] reported higher rate of caesarean deliveries among women with PPROM. Poor perinatal outcomes were observed in our study group, consistent with results of another study [24].…”

Predictors of perinatal death in the presence of missing data: A birth registry-based study in northern Tanzania

“…The protective effect of PROM could reflect timely management of such pregnancies considering that these deliveries were attended at a tertiary care facility where comprehensive emergency obstetric and newborn care (CEmONC) services are available. Despite that, a study in Uganda has shown that CS delivery, particularly among women with PROM, increases the risk of perinatal mortality among other adverse pregnancy outcomes [52].…”