A Prospective Study to Assess the Mother and Foetal Outcomes in Term Prelabor Rupture of Membranes.

Aim: To determine major maternal and neonatal outcomes in patients of PLROM. Methods: A prospective study was conducted in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, from December 2019 to December 2020. 120 pregnant women who reported to the labour room with premature rupture of membranes at or after 34 completed weeks to 41 weeks of gestation were analysed for maternal and perinatal outcome. Results: The rate of maternal morbidity was 28.33% (34 out of 120), commonest was clinical chorio-amnionitis 10.83% (13 out of 120) followed by febrile morbidity seen in 8.33% (10 out of 120). Other maternal morbidities were in the form of wound infection-2.5% (3 out of 120), LRTI-1.67% (2 out of 120), MRP 0.83% (1 out of 120), puerperal sepsis 0.83% (1 out of 120). No maternal mortality was seen in the study. Perinatal morbidity was seen in 35.83% of cases. Clinical early onset neonatal infection was the commonest cause for perinatal morbidity noticed in 19.17% cases. Other perinatal morbidities were birth asphyxia 5.83% (7 out of   120),   hyperbilirubinemia   3.33%   (4  out   of   120), congenital pneumonia 1.67% (2 out 120), congenital malformations 1.67% (2 out of 120), late onset sepsis 1.67% (2 out of 120). Perinatal mortality observed was 2.5% (3 out of 120). Out of 120 newborns of mothers who were having prelabour premature rupture of membranes at 34-41 weeks’ gestation 65% had birth weight more than 2500 grams, 26.67% had low birth weight, 8.33 % had one minute Apgar score less than 7, 55 (45.83 %) were male and 65 (54.17%) were female, 26(21.67 %) had C-Reactive protein positive, out of them 9(7.5%) were having blood culture growth positive and 20(16.67%) were having WBC count more than 15,000. Conclusion: PLROM is an enigmatic condition associated with high risk of maternal and perinatal morbidity and mortality. Major maternal morbidity is chorio-amnionitis (10.83%). Major perinatal morbidity observed is early onset neonatal infection (19.17%). Prediction of these morbidities is an important step in the management of infection-associated with PLROM.研究目的：明确临产前胎膜早破（Prelabour Premature Rupture of Membranes, PLROM）患者的主要母婴结局。 研究方法：本研究为前瞻性研究，于2019年12月至2020年12月在印度比哈尔邦巴加尔布尔市贾瓦哈拉尔·尼赫鲁医学院附属医院妇产科开展。纳入120名因胎膜早破就诊于产房的孕妇，孕周为满34周至41周，分析其产妇及围产儿结局。 研究结果：产妇并发症发生率为28.33%（120例中34例），最常见的为临床绒毛膜羊膜炎，占比10.83%（120例中13例），其次为发热性并发症，占比8.33%（120例中10例）。其余产妇并发症包括切口感染2.5%（120例中3例）、下呼吸道感染（Lower Respiratory Tract Infection, LRTI）1.67%（120例中2例）、MRP 0.83%（120例中1例）、产褥期脓毒症0.83%（120例中1例）。本研究未出现产妇死亡病例。围产儿并发症发生率为35.83%。临床早发型新生儿感染是围产儿并发症最常见的诱因，占19.17%的病例。其余围产儿并发症包括新生儿窒息5.83%（120例中7例）、高胆红素血症3.33%（120例中4例）、先天性肺炎1.67%（120例中2例）、先天性畸形1.67%（120例中2例）、晚发型败血症1.67%（120例中2例）。围产儿死亡率为2.5%（120例中3例）。在120名孕周34~41周的临产前胎膜早破孕妇所分娩的新生儿中，65%的新生儿出生体重大于2500克，26.67%为低出生体重儿，8.33%的新生儿1分钟阿普加评分低于7分；其中男性新生儿55名（占45.83%），女性新生儿65名（占54.17%）；26名（21.67%）新生儿C反应蛋白检测呈阳性，其中9名（7.5%）血培养阳性，20名（16.67%）白细胞计数超过15000/μL。 研究结论：临产前胎膜早破是一种疑难病症，其产妇及围产儿并发症与死亡风险均较高。产妇主要并发症为绒毛膜羊膜炎（10.83%）。围产儿主要并发症为早发型新生儿感染（19.17%）。针对此类与临产前胎膜早破相关的感染并发症进行风险预测，是其临床管理的重要环节。