Study of Socio-Demographic Factors in Pre Labour Rupture of Membranes in Rural Area

Table of contents

1. I. Introduction

relabor rupture of the fetal membranes (PLROM) is defined as the rupture of membranes before the onset of labor. It is common obstetric problem and one of the most common clinical event where a traditional pregnancy can turn into a high risk situation for mother as well as fetus. When PLROM occurs, the fetus loses relative isolation and protection offered within the amniotic cavity.

Epidemiological studies have identified several risk factors associated with PLROM. The mechanism of PLROM is unknown, no standards for diagnosis exist and most facets of management are controversial. Probabale maternal complications are chorioamnionitis (3-30%), endometritis and placental abruption. Recurrence of PLROM may occur in 20% cause. PLROM is a major cause for prematurity which leads to increase perinatal morbidity and mortality. PLROM cause 20% of all neonatal deaths.

2. a) AIM

Present study was undertaken with the aim to study the distribution and correlation of sociodemographic factors in PLROM.

3. II. Material and Methods

This prospective study was conducted in Department of obstetrics & Gynecology, in a rural tertiary care institute located in central India. Pregnant women who reported with premature rupture of membranes at or after 34 completed weeks to 41 weeks of gestations, after obtaining ethical clearance from the local ethical committee were included in the study. Their case history, including previous and present obstetric history was taken in details, various demographic factors and different pre-exsitng congitions were studied in relation to PLROM. General examination and obstetric examination was done at the time of admission. A sterile Speculum examination was done and condition of vagina and cervix noted. Liquor drainining from the os was observed for the colour and odour. The specimen was collected and subjected to nitrazine test. Out of 105 women, 78 (74.28%) were primigravida and 27(25.71%) multigravida. Among 78 primigravida, 62 women reported with term PLROM at 37-41 weeks of gestation and 16 reported at 34-37 weeks of gestation with PPLROM. In women with PPLROM there were 16 primigravida and 5 multigravida, thus more primigravida had PPLROM. In women with term PLROM, there were 62 primigravida and 22 multigravida. Overall, there were more primigravida women with rupture of membranes. (Table - Out of 105 women with premature rupture of membranes, 64 (60.95%) were from the rural, and 41 (39.05%) were from urban residence. Of the 64 rural women, 50(78.12%) had term PLROM at 37-41 weeks of gestation and 14(21.87%) had PPLROM at 34 to less than 37 weeks of gestation. Of the 41(39%) urban women, 34(82.92%) had term PLROM and 7(17.07%) had PPLROM. (Table -3) IV.

4. III. Observations

5. Discussion

Pre-labor rupture of membrane (PLROM) is the spontaneous rupture of membrane before the onset of labor. It is a relatively common obstetric event, occurring in approximately 5-10% of all pregnancies 1 ; of these 80% occur in term pregnancy 2 . Simhan (2005) 3 ; ACOG (2007) 4 have suggested that PPLROM complicates 2 to 4% of all singleton and 7 to 20% of twin pregnancies. Getahun (2007) 5 reported 5% incidence of PLROM. Caughey (2008) 6 , has reported that PPLROM complicates 2 to 20% of all deliveries and is associated with 18 to 20% of perinatal deaths. Pasquier 2005 7 in his prospective study has reported the incidence of PPLROM to be 14.3% of all preterm deliveries and Obi 2007 8 reported that PPLROM accounts for 29.7% of all preterm births. In a recent study, Caughey 2008 6 has reported that PPLROM complicates 2 to 20% of all deliveries and is associated with 18 to 20% of perinatal deaths. In our hospital, we have a protocol of doing per speculum examination at every antenatal visit, so that we diagnose the genital infections early and treat them accordingly, hence we have comparatively less incidence of PLROM in the present study.

In the present study 10.4 % were of less than 20 years of age and the majority (58%) of cases belonged to the age group of 21-25 years. In the study done by Anjana Devi (1996), 6.9% of cases belonged to age group of 20-29 years 9 . Gandhi M et al 2012 reported highest incidence of PLROM in age group of 21-25 years 10 .

Ferguson 2002 11 and Melamed 2009 12 have reported the mean age of 30 years. Piazze 2007 from Italy reported the mean age of women with PPLROM as 33 years. This may be due to the fact that women in these countries marry at a later age compared to developing countries. Tavassoli 2010 13 from Iran has also reported the mean age 25.8 years, close to that of present study. Lim 2010 from Nova Scotia has reported the mean age of 28.4 years 14 In the present study 60.9% were rural similar to over all cases which is very similar to the study done by Gandhi M et al (2012) 10 The occurrence of PLROM is more in booked cases in present study compared to unbooked cases. In the study by Anjana Devi 52% were booked in the PLROM group compared to 63% in control group 9 .

In our study total primigravida were 73.3% and multigravida were 26.6% which is similar to the study by Chaudhuri 2005 15 , where there were 75% primigravida and 25% multigravida.

6. V. Conclusions

PLROM is an enigmatic condition associated with high risk of maternal and perinatal morbidity and mortality. The overall incidence of PLROM is 6.02% of all deliveries during the study period. Majority belonged to age group of 21-25 years (57.62%). Occurrences of PROM was more among booked cases (61.90%). The incidence of PLROM was more in primigravidas (73.33%) compared to multigravidas (26.67%).Majority of women 60.5% were rural.

7. Conflict of Interest -Nil

Volume XVI Issue III Version I

Figure 1. *
Figure-1
Figure 2.
Figure-2
Figure 3. Table 1 :
1
Gestational age (weeks)
Antenatal Status Total
37-41 34-37
Booked 53(50.47%) 12(11.42%) 65(61.90%)
Antenatal Status Registered Emergency 26(24.76%) 7(6.66%) 5(4.76%) 2(1.90%) 31(29.52%) 9(8.57%)
Total 86(81.90%) 19(18.09%) 105(100%)
% 2 -value 1.31
p-value 0.51, NS, p>0.05
65(61.9%) in the study group were booked, (p>0.05) between antenatal status and gestational age
31(29.5%) were registered only and 9(8.57%) came in at PLROM. (Table 1)
emergency. Overall there was no significant difference
Figure 4. Table 2 :
2
Age(yrs) Parity Gestational age (weeks) 37-41 34-37 Total
<20 yrs Primi 7 4 11(10.47%)
Multi 1 0 1(0.95%)
21-25 yrs Primi 40 7 95(45.24%)
Multi 11 2 26(12.38%)
26-30 yrs Primi 13 5 35(16.67%)
Multi 7 2 21(10%)
31-35 yrs Primi 2 0 3(1.43%)
Multi 2 0 6(2.86%)
>36 yrs Primi 0 0 0(0%)
Multi 1 1 2(0.95%)
Total Primi 62 16 78(74.28%)
Multi 22 5 27(25.71%)
Note: ? x2 -vaue=5.89, p-value=0.65, NS, p>0.05
Figure 5. Table 3 :
3
Age(yrs) Residence Gestational age(weeks) Total
37-41 34-37
Rural 4 2 13(6.19%)
<20 yrs
Urban 4 0 9(4.29%)
Rural 34 6 79(37.62%)
21-25 yrs
Urban 17 4 42(20%)
Rural 10 5 31(14.76%)
26-30 yrs
Urban 11 2 25(11.90%)
Rural 2 0 4(1.90%)
31-35 yrs
Urban 2 0 5(2.38%)
Rural 0 1 1(0.48%)
>36 yrs
Urban 1 0 1(0.48%)
Total Rural 50 14 64(60.95%)
Urban 34 7 41(39.05%)
? x2-vaue=3.57, p-value=0.47, NS, p>0.05
Figure 6.
came from rural area and 147 (38.3%) were from urban
area.
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Volume XVI Issue III Version I
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Appendix A

Appendix A.1 Acknowledgement -Nil

Bibliography

Appendix B

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  4. Premature rupture of membranes-a clinical study. A Devi , R Devi . J Obstet Gynecol India 1996. 46 p. 63.
  5. Acute and Chronic respiratory diseases in pregnancy: associations with spontaneous premature rupture of membranes. D Getahun , C V Ananth , Y Oyelese , M R Peltire , J C Smulian , A M Vintzileos . Journal of Maternal-fetal and Neonatal Medicine 2007. 20 (9) p. .
  6. Survey of pregnancy outcome in preterm premature rupture of membranes with amniotic fluid index<5and>5. F Tavassoli , M Ghasemi , A Mohamadzade , J Sharifian . Oman medical journal 2010. 25 (2) p. 118.
  7. Premature rupture of the fetal membranes. G C Gunn , D Mishell , D Morton . Am J Obstet Gynecol 1970. 106 (3) p. .
  8. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. H N Simhan , T P Canavan . BJOG: An International Journal of Obstetrics & Gynecilogy 2005. 112 (s1) p. .
  9. Aprospecive population-based study of 598 cases od PPROM between 24 and 34 ekks Gestation: description, management, J-C Pasquire , M Rabilloud , J-C Picaud , R Ecochard , O Claris , P Gaucherand . (and mortality (DOMINOS cohort)
  10. Late preterm delivery in women with preterm prelabour rupture of membranes. J J Lim , V M Allen , H M Scott , A C Allen . J obstet Gynecol Can 2010. 32 (6) p. .
  11. Prelabour rupture of membranes at term: expectant management at home or in hospital?. M E Hannah , E D Hodnett , A Willan , G A Foster , Di Cecco , R Helewa , M . Obstetric & Gynecology 2000. 96 (4) p. .
  12. Obstetric Outcomes in premature rupture of the membranes (Prom). The internet Journal of Gynecology and Obstetrics, M Gandhi , F Shah , C Panchal . 2012. 16.
  13. Factors affecting the duration if the latency period in preterm premature rupture of membranes. N Melamed , E Hadar , A Ben-Haroush , B Kaplan , Y Yogev . Journal of Maternal-Fetal and Neonatal Medicine 2009. 22 (11) p. .
  14. Preterm premature rupture of membranes: nutritional and socioeconomic factors. S E Ferguson , G N Smith , M E Salenieks , R Windrim , M C Walker . Obstetrics & Gynecology 2002. 100 (6) p. .
  15. pre-term premature rupture of fetal membranes: the dilemma of management in a developing nation. S Obi , B Ozumba . Journal of obstetrics & Gynecology 2007. 27 (1) p. .
  16. Incidence and outcome of preterm premature rupture of membranes and preterm labor at holy family red Crescent Medical Collage Hospital. S R Chowdhury . Bangladesh Journal of Obstetrics and Gynecology 2005. 20 (1) p. .
Notes
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© 2 016 Global Journals Inc. (US) Study of Socio-Demographic Factors in Pre Labour Rupture of Membranes in Rural Area
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© 2016 Global Journals Inc. (US) Study of Socio-Demographic Factors in Pre Labour Rupture of Membranes in Rural Area
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Date: 2016-01-15