The Fetal Outcome in Premature Rupture of Membranes Patients at a Tertiary Care Hospital in Northwest Maharashtra: A Prospective Observational Study
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Abstract
Introduction: The most common complications associated with Premature Rupture of Membranes (PROM) are prematurity and neonatal infections thus needing neonatal intensive care unit (NICU) admissions & treatment. Neonatal complications are more when the time duration between the onset of PROM and delivery of fetus is more. Early diagnosis of PROM , good medical management and expediting the delivery reduce the risk of maternal and fetal morbidity and mortality.
Aim: To study the effect of duration from PROM to delivery on fetal outcome.
Methodology: A prospective and observational study was conducted at the Department of Obstetrics and Gynaecology in a tertiary institute. All pregnant patients were admitted in the labour ward with confirmed PROM & pregnancy of >28 completed weeks of gestational age. Fetal outcome was assessed for Apgar score at birth, Birth Asphyxia, Meconium aspiration syndrome, NICU admission, Antibiotic requirement, Necrotizing Enterocolitis, Neonatal jaundice, Pyrexia, NICU Stay. The fetal outcome as per the above parameters was assessed in relation to the maternal CRP levels at admission and duration from onset of PROM to delivery.
Discussion: Around 42% babies had >7 APGAR score while 58% had APGAR <7 at 5 minutes. In our study, maximum babies (68%) had birth weight >2.5kg. 3 babies were preterm with birth weight 2.5 kg. Out of 100 babies delivered 22 (22%) babies needed NICU admission for respiratory distress in 11 neonates (50%), neonatal sepsis in 7 neonates (31.8%) & neonatal jaundice in 4 neonates (18.18%). In our study, NICU stay of >15 days was observed in 40%. 78 patients out of which 31.81% of cases (7 cases) needed >30 days of NICU stay.
Maximum neonates were discharged within 4 days of NICU admission. 30 cases out of 100 had raised levels of serum CRP levels out of which 22 (73.3%) had neonatal complications. The remaining 70 cases had normal serum CRP levels. 5 neonates of normal maternal CRP levels had complications. It was observed that raised levels of maternal CRP were highly associated with neonatal complications which was proved statistically highly significant with p-value.
Conclusion: In our study, the association of raised maternal CRP with neonatal complications and adverse neonatal outcomes is statistically significant. However, the PROM to delivery interval time showed no statistical significance in affecting the fetal outcome in these cases.
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