Interventions and Neonatal Outcomes in Patients with Premature Rupture of Fetal Membranes at and Beyond 34 Weeks Gestational Age at a Tertiary Health Facility in Nigeria

Abstract

Aims: To compare the neonatal outcome in patients with PROM at and beyond 34 weeks, who had expectant management and progressed to spontaneous labour and those who had induction of labour. Study Design: Retrospective study of patients presenting with PROM at and beyond 34 weeks gestation over a 3 year period. Place and Duration of Study: Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, between July 2007 and June 2010. Methodology: Case files of 92 patients with PROM and live, singleton fetuses, at and beyond 34 weeks gestation, in the study period, were retrieved from the hospital Health Records Department, collated and analyzed. Data collected included parity, estimated gestational age (EGA) at PROM, latency period (time interval from PROM to onset of labour), intervention following PROM, eventual mode of delivery and neonatal outcome. Results: A total of 2340 deliveries were recorded in the study period and 92 cases of PROM were on record for the period. However, only 74 PROM cases were included in the study, due to incomplete information. Incidence of PROM was therefore 3.9%. Length of latency period had a direct influence on the number of patients that went into spontaneous labour (P = 0.012) and subsequent vaginal delivery (P = 0.021). Induction of labour did not increase rate of caesarean section (P = 0.449) and had no effect on neonatal outcome (P = 0.239). Conclusion: Acceptable approach for the management of PROM at and beyond 34 weeks would be expectant management for the 1st 24 hours and induction of labor afterwards in patients who have not progressed into spontaneous labour. Expectant management in the extended latency period in the late preterm PROM group is associated with increased NICU admission (OR 7.33, 95% C.I 2.45 – 21.98); however, this did not affect duration of NICU stay or neonatal mortality.