Department of Obstetrics and Gynaecology,
Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg / Background and objectives
Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20%
of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal
infections, and neonatal mortality. Standard guidelines are formulated and continually
reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes
associated with this condition. The objectives of this study, conducted using women in
Johannesburg as a sample population, were: 1) to audit the implementation of the standard
protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this
condition.
Methods
A cross-sectional descriptive study was done on women admitted to the antenatal wards of
Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM
was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more.
Hospital clinical files were studied for obstetric and clinical characteristics, adherence by
doctors to the management protocol, and final outcome including latency period, induction
rate, mode of delivery, and neonatal outcome.
Results
Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%)
were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were
HIV-infected, 23 (79%) of them on highly active antiretroviral treatment.
6
The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm
PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of
diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and
ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and
antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical
chorioamnionitis were detected. The mean latency from PROM to delivery for women <37
weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women
(30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12
perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity
(n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome
(n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no
recorded cases of either neonatal or puerperal sepsis.
Conclusion
The study may have under-represented term PROM, so the findings are most applicable to
preterm PROM. The condition was mostly managed appropriately within the local protocol,
especially in terms of corticosteroid and antibiotic use. Overt or clinically evident
chorioamnionitis was not detected. However, the perinatal mortality rate was high, and
whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk
condition deserving of close clinical attention.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13746 |
| Date | January 2013 |
| Creators | Iloanusi, Nicholas Emeka |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
Page generated in 0.0019 seconds