Obstetric and perinatal outcomes of expectant management and immediate induction of labour in term premature rupture of membranes: promising outcomes from expectant management cohort

Background: Premature rupture of membranes (PROM) is common obstetric entity, the management even at term is controversial and there is no consensus for definite protocol of management. Objective of the present study is to compare the effectiveness, safety of expectant management of 24 hours and immediate induction with PGE2 gel in terms of maternal and fetal outcome in term PROM.Methods: 200 women were randomized to group A expectant management and group B immediate induction, after strict Inclusion and exclusion criteria. In expectant group waiting period was 24 hours. Multiple end points were examined throughout management. Chi square test and independent t tests were performed for statistical analysis. P value<0.05 was considered significant.Results: Demographic parameters of patients, maternal and gestational age were similar in both groups. Primigravidae were more in both groups A and B. Vaginal delivery rate is more in expectant group and Caesarean Section rate is high in immediate induction group. CS rate was 37% and 23% in group A and B respectively; the difference is statistically significant (p value=0.031). ‘ROM to delivery interval’ was more in group A (16.31±8.67 hrs and 13.85±5.46 hrs) (p value=0.0256). Hospital stay was comparatively more in group A (5.40±0.81 days and 4.11±0.86 days) (p value=0.435). Infective morbidity of mother and baby was low in both groups and no difference was seen.Conclusions: An expectant management allows a good number of women to go into labour and deliver vaginally without an increase in CS rate and infectious morbidity for mother and fetus.

Second Trimester Fetal Loss Due to Citrobacter koseri Infection: A Rare Cause of Preterm Premature Rupture of Membranes (PPROM)

Citrobacter koseri is a facultative anaerobic, motile, non-spore-forming Gram-negative bacillus, which belongs to the family of Enterobacteriaceae. Severe infections due to Citrobacter spp. have been reported in the urinary tract, respiratory airways, intra-abdominal organs, skin and soft tissue, eye, bone, bloodstream, and central nervous system. In newborns, C. koseri is a well-known cause of meningitis, cerebral abscesses, brain adhesions, encephalitis, and pneumocephalus. Infection can be acquired through vertical maternal transmission or horizontal hospital settings; however, in many cases, the source is unknown. Preterm premature rupture of membranes (PPROM), caused by C. koseri, has rarely been described. Herein, we describe a case of PPROM at 16 weeks and 3 days of gestation, leading to anhydramnios. The parents opted for legal termination of the pregnancy, as the prognosis was very poor. C. koseri was isolated postmortem from a placental subamniotic swab and parenchymal sample, as well as fetal blood and lung. To the best of our knowledge, this is the first case of early second-trimester PPROM in which C. koseri infection was demonstrated.

HUBUNGAN KETUBAN PECAH DINI DENGAN KEJADIAN ASFIKSIA LITERATURE REVIEW: THE CORRELATION OF PREMATURE RUPTURE OF MEMBRANES (PROM) WITH THE INCIDENCE OF ASPHYXIA

Menurut Human Development Report tahun 2010 Ketuban Pecah Dini (KPD) di Indonesia berkisar 4,4-7,6% dari seluruh kehamilan dengan KPD berkisar antara 3-18% yang terjadi pada kehamilan preterm, sedangkan pada kehamilan aterm sekitar 8-10%. Menurut beberapa peneliti KPD dapat menyebabkan terjadinya asfiksia. Penelitian ini bertujuan untuk mengetahui hubungan ketuban pecah dini dengan kejadian asfiksia. Jenis penelitian yang digunakan adalah kepustakaan atau kajian literatur. Data penelitian ini berasal dari data sekunder, yaitu berasal dari beberapa sumber penelitian yang terdiri dari 25 sumber yang terdiri dari 7 jurnal ilmiah, 3 jurnal internasional, 5 skripsi/tesis, dan 10 buku. Pencarian sumber menggunakan google scholar, microsoft academic, media meneliti, and google. Dari penelitian ini didapatkan bahwa penyebab terjadinya asfiksia yang disebabkan oleh faktor langsung maupun faktor tidak langsung. Faktor langsung tersebut adalah KPD itu sendiri. Sedangkan, untuk faktor yang tidak langsung adalah CPD dan usia kehamilan. Sehingga asfiksia yang disebabkan kedua faktor tersebut dapat memperburuk keadaan terjadinya asfiksia. Dari salah satu penelitian dalam negeri oleh peneliti Anisa di daerah Kediri didapatkan angka kejadian asfiksia sebanyak 53% oleh ibu yang mengalami KPD. Berdasarkan hasil penelitian dari dalam negeri dan luar negeri dengan rata-rata p value ?0,005, sehingga didapatkan kesimpulan terdapat hubungan antara ketuban pecah dini dengan kejadian asfiksia.

Determinants of adverse birth outcomes among women delivered in public hospitals of Ethiopia, 2020

Background Adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. Factors such as the age of the mother, antepartum hemorrhage, history of abortion, gestational age, anemia, and maternal undernutrition have predisposed the mother to adverse birth outcome. For appropriate prevention of the adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. Therefore, this study was aimed to assess the determinants of adverse birth outcomes among women who give birth in public hospitals of western Ethiopia. Methods An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. From mothers who gave birth in public hospitals of Wollega zones, 165 cases and 330 controls were selected. Mothers with adverse birth outcomes were cases and mothers without adverse birth were controls. Data was collected by structured interviewer-administered questionnaires. In addition to the interview, the data collectors abstracted clinical data by reviewing the mother and the babies’ medical records. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Finally, multivariable logistic regression was used to identify determinants of adverse birth outcomes at P-value < 0.05. Results A total of 495 mothers (165 cases and 330 controls) were included in the study with a mean age of 28.48 + 5.908. Low ANC visit (AOR = 3.92: 95% CI; 1.86, 8.2), premature rupture of membrane (AOR = 2.83: 95% CI; 1.72,4.64), being Anemic (AOR = 2: 95% CI; 1.16,3.44), pregnancy induced-hypertension (AOR = 2.3:95% CI; 1.4,3.85), not getting dietary supplementation (AOR = 2.47:95% CI; 1.6,3.82), and physical abuse (AOR = 2.13: 95% CI; 1.05,4.32) were significantly associated with the development of the adverse birth outcome. Conclusion Low antenatal care visit, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve antenatal care follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.

Neonatal Outcomes In Women With Preterm Premature Rupture of Membranes At Periviable Gestational Age

Purpose: To examine the outcomes of preterm infants born to women with preterm premature rupture of membranes at periviable gestational age.Methods: This is a retrospective study analyzing data on singleton deliveries complicated by prolonged premature rupture of membranes occurring before 24 weeks of gestation. Neonatal outcomes including birth weight, Apgar score, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, hearing impairment and mortality were evaluated.Results: Ninety four preterm infants who were born after a prolonged premature rupture of membranes of at least 7 days were included in the study.Median gestational week at onset of membrane rupture was 27.1 ± 4.2 weeks (range 17 - 33) and median latency period in days was 16 ± 21.8 (range 7 - 105). We found that the survival rate to discharge within neonates born after prolonged rupture of membrane at gestational week less than 24 weeks is 79.2%. These neonates did not show an increased rate of major morbidities compared to neonates born following membrane rupture at gestational week 24 to 27. Conclusion: We described a high survival rate without major morbidities following prolonged preterm membrane rupture before viability.