EARLY PERINATAL OUTCOME OF LATE PRETERM VERSUS EARLY TERM PREMATURE RUPTURE OF MEMBRANE AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE AND YEKATIT 12 HOSPITAL MEDICAL COLLEGE, ADDIS ABEBA, ETHIOPIA, 2018-2019

Abstract

SUMMARY Background: Premature rupture of fetal membranes (PROM) is one of the most common and controversial problems the obstetrician has to face. Integral to the management of preterm PROM(PPROM) is an evaluation of the balance of neonatal risks of preterm birth against the maternal and fetal risks of continued pregnancy. A policy of expectant management beyond 33weeks and 6 days of gestation has been advocated by some experts; however, the impact of such a policy on short-term morbidities and long-term neurodevelopmental outcomes is unclear. And up-to-date no clear prospective studies have been done in Ethiopia with respect to expectant management beyond 34 completed weeks when compared to perinatal outcome of term PROM(tPROM). Objective: To assess and compare early perinatal outcome of late preterm versus early term premature rupture of membrane of mothers delivered at SPHMMC and Yekatit 12 Hospital Medical College. Methods: The study design was facility based prospective cohort study. Results: Incidence of premature rupture of membrane was 10.4%, and gestation age less than 37 weeks account 1.26%. Duration of rupture of membrane before delivery (P=0.014) and higher proportion of intra amniotic infection (P=0.004) had been seen with the mother with preterm than term PROM delivery. From the mothers who had post-delivery complication (9.9%), 4.2% mothers had wound infection and 5.7% had endomyometritis. Mothers with late preterm PROM were significantly associated with post-delivery NICU admission (R=3.01, 95%CI=1.34,6.99, P value=0.016), but not with perinatal mortality (R=0.56, 95%CI=0.00,975.6, P value=0.875), neonatal sepsis (R=0.54, 95%CI=0.03,9.99, P value=0.667) or respiratory distress syndrome (R=0.60, 95%CI=0.31,1.30, P value=0.057) (R= P value=0.016) when compared to delivery at early term PROM. Conclusion: Even though a baby born at late preterm has high risk of being admits to NICU, there is still no strong association with regard to perinatal mortality, RDS or neonatal sepsis if delivery occur at late preterm or early term. Thus, according to this study women can be given option of either expectant or immediate delivery for the mother presented with PROM at the GA between 34+0wk to 36+6wk.