Neonatal and Maternal Outcome after Conservative Management of Preterm Premature Rupture of Membranes (PPROM) between 24-28 Weeks Gestation

Background:The Incidence of preterm pre maturerupture of membranes ranges from 3.0-10.0% of alldeliveries and leads to one third of preterm births.There are several risk factors for PPROM, such asintrauterine infection at early gestational age, sexually transmitted infections, vaginal bleeding, andsmoking during pregnancy.Methods: An observational prospective studyincluded 100 pregnant females with PPROM between the 24th and 28th week’s gestation that wereadmitted to Mansoura University Hospital (MUH)between April 2018 and December 2019. Pregnancies with known fetal malformations, multiplefetuses, stillbirths, placenta previa, pre-eclampsia& Eclampsia and diabetes mellitus were excludedfrom this study group. Women who deliver within24 hours of PPROM were also excluded.Results: Out of 100 pregnant females were eligible for the study only 88 patients continued thestudy. Data from our study showed that the mediangestational age at delivery after conservative management of patient diagnosed to have PPROM was33 weeks. 85.2% of patients delivered by cesareansection. Recurrent urinary tract infection and Vulvo-vaginitis are the most common associated riskfactors (28 %, 24 %) respectively.The percentageof live born neonates was (65.9%) while still birthoccurred in (15.9%) and miscarriage occurred in(18.2%) of the females who completed the study.The main neonatal complications reported in thestudy was 55 out of 58 live birth cases were admitted to NICU (62.5%). Twenty-nine cases developedrespiratory distress syndrome (32.9 %), 17 casesdeveloped bronchopulmonary dysplasia (19.3%), 6cases developed pulmonary hypoplasia (6.8%),47casesdeveloped neonatal sepsis (53.4%) and 34cases developed perinatal death after admission toNICU (38.6%). Fourteen neonates were dischargedwith different degrees of disability (15.9%). Theoverall survived neonates were 24 cases (27.3%).For maternal complications we noticed that 43 cases developed signs of chorioamnionitis (48.9%).Also cord prolapse was reported in 3 cases (3.4%).After delivery postpartum hemorrhage occurredin 14 cases (15.9%) and 10 cases (11.4%) were inneed of blood transfusion. Signs of maternal sepsisdeveloped only in 3 cases (3.4%).Conclusion: Data from our study showed thatafter conservative management of patients withPPROM the overall neonatal survival rate was27.3 %. 3.4% of neonates were discharged withoutneed of NICU, 7.95% of neonates were healthyafter being discharged form NICU and 15.9 % ofneonates were discharged with different degreesof disability. Most of material complication werenot fatal and showed improvement after giving theappropriate care.