Predictors of Caesarean Delivery in Preterm Premature Rupture of Membranes

Abstract

BACKGROUND: Preterm premature rupture of membranes (P-PROM) exerts a tremendous influence on pregnancy prognosis. Additionally, it is a major public health concern, as the cause of up to 40% of all preterm births.
 AIM: The objective of this study was to identify predictors of Caesarean Delivery in singleton pregnancies complicated by P-PROM.
 MATERIALS AND METHODS: This is a retrospective observational study of all consecutive singleton P-PROM deliveries (24-37 weeks) over an 18 months at a tertiary referral centre. Pertinent data was collected comprising demographics, obstetric history, pregnancy-associated pathology and delivery from electronic patient records. Univariate statistical analysis comprised Odds Ratio, 95% Confidence interval and Chi-square test with subsequent p-value with statistical significance set at p < 0.05.
 RESULTS: A total of 240 women delivered singletons following P-PROM over an 18-month period. Maternal age ranged between 12-41 years with an average age of 28 ± 6.27 years. Vaginal delivery (VD) was the predominant mode of delivery, accounting for 52.9% (n = 127) of deliveries. The following parameters were identified as predictors of Caesarean Section (CS) in P-PROM: vaginal infection (p = 0.04), previous CS (p < 0.0001), primiparity (p = 0.004), gravidity > 5 (p = 0.009), university education (p = 0.0006) and prenatal care (p < 0.0001).
 CONCLUSION: The advantage of CS over vaginal delivery is expedited delivery of the distressed fetus, while that of vaginal delivery entails avoiding postoperative morbidity. However, large multicentric randomised-controlled studies are needed to elucidate this dilemma definitively.

Incidence of preterm premature rupture of membranes and its association with inter-pregnancy interval: a prospective cohort study

“…These changes weaken fetal membranes and rupture occur during true labor, when the uterus contracts, to allow delivery of the fetus 4 , 5 . Membrane rupture before term (PPROM) is usually pathological and jeopardizes both maternal and neonatal outcomes 6 , 7 .…”

“…Considering this, we hypothesized that IPI < 24 months increases the risk of PPROM than 24–60 months. PPROM has multiple and uncertain predisposing factors that need to be addressed 7 . Moreover, the World Health Organization (WHO) called for further research on the effects of IPI on perinatal outcomes to supplement evidence for recommendations 20 .…”