Annals of Tropical Paediatrics International Child Health

ISSN: 0272-4936 (Print) 1465-3281 (Online) Journal homepage: http://www.tandfonline.com/loi/ypch19

Prolonged rupture of membranes and neonatal outcome in a developing country Abdulkareem I. Airede To cite this article: Abdulkareem I. Airede (1992) Prolonged rupture of membranes and neonatal outcome in a developing country, Annals of Tropical Paediatrics, 12:3, 283-288, DOI: 10.1080/02724936.1992.11747586 To link to this article: http://dx.doi.org/10.1080/02724936.1992.11747586

Published online: 13 Jul 2016.

Submit your article to this journal

View related articles

Citing articles: 6 View citing articles

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypch19 Download by: [Australian Catholic University]

Date: 21 August 2017, At: 04:38

Annals of Tropical Paediatrics (1992) 12, 283-288

Prolonged rupture of membranes and neonatal outcome in a developing country ABDULKAREEM I. AIREDE

Downloaded by [Australian Catholic University] at 04:38 21 August 2017

Department of Paediatrics,Jos University Teaching Hospital, Nigeria (Received 5 November 1991)

Summary The neonatal outcomes in 109 pregnancies complicated by prolonged rupture of the fetal membranes were studied over a 3-year period. The overall neonatal mortality was 29 (26.6%). Nineteen of these deaths were from infections, of which 12 were pneumonia. There was also a high morbidity rate of 68.8° 0 • Neonatal sepsis, cardiorespiratory depression at birth and prematurity were the most significant complications. Forty-eight (44%) of the infants in the study group had an infection, in contrast with three (2.9~ 0 ) in the control group ( p < 0.0001). No protective effect or benefit from prolonged rupture of fetal membranes in relation to the development of respiratory distress syndrome was demonstrated.

Introduction Prolonged rupture of the membranes (PROM), a common complication of pregnancy, occurs when the drainage of amniotic fluid continues for 24 hours or more prior to delivery. 1 Several investigators have studied the problems associated with PROM. 2 •3 Pulmonary hypoplasia and compressive limb deformities may be seen with chronic drainage of amniotic fluid. 4 •5 Of further interest is the observation that PROM enhances fetal lung maturation and hence reduces in incidence of respiratory distress syndrome (RDS). 6 ' 7 Information about the perinatal outcome of PROM is well documented for the developed world, H but is less well documented for less affluent societies where different obstetric and neonatal facilities and a higher risk of infection may make a great difference to outcome. Reprint requests to: Dr A'Kareem I. Airede, Department of Paediatrics, College of Medical Sciences, University of Maiduguri, P MB 1069, Maiduguri, Borno State, Nigeria.

There is a paucity of studies in this area of perinatology in the African continent. One previous study was mainly retrospective. 8 Therefore, it was pertinent to follow prospectively a large series of pregnancies complicated by PROM in an attempt to determine the outcome of this perinatal problem. It was also worthwhile to find out if PROM protects the preterm infant from developing RDS.

Patients During the 3 years of 1 June 1987 to 31 May 1990, all pregnancies complicated by premature rupture of the fetal membranes (PROM) were noted at the Jos University Teaching Hospital (JUTH), a referral (tertiary) hospital in Jos, Plateau State, Nigeria. Jos is a cosmopolitan city situated at an altitude of 1400 m above sea level. The mother was usually admitted to the ward where she was carefully monitored for signs of developing infection. Those with premature rupture becoming PROM were included in the

Downloaded by [Australian Catholic University] at 04:38 21 August 2017

284

A. I. Airede

study. Spontaneous premature labour was not inhibited. If the patient developed signs of chorioamnionitis, immediate delivery was undertaken; 9 otherwise, elective delivery was carried out at 32-34 weeks as a compromise between limiting the duration of oligohydramnios and reducing the risks of extreme prematurity (EP). During the study period, there were 109 proven cases of PROM. Five infants (two ofEP, two with pyrexia and one with hyperbilirubinaemia) whose mothers had had PROM were delivered in other hospitals within Jos Metropolis and were referred to the Special Care Baby Unit (SCBU) of JUTH between 12 and 18 hours after delivery. The babies with PROM were matched by sex, gestational age, birthweight and date of admission into the SCBU with 103 infants who did not have PROM and who served as controls. The primary diagnoses of the control group mainly included hyperbilirubinaemia from physiological and blood group incompatibility, 24-48-hour observation after delivery by elective Caesarian section (a routine Unit policy), and poor temperature control (admitted mainly for warming up). Their evolving morbidity was studied and included prematurity, asphyxia (cardiorespiratory depression at birth) and infections. Mortality was also recorded.

Methods Gestational age (GA) was confirmed with Dubowitz et al.'s scores. 10 Any infant with a GA < 37 weeks was regarded as preterm and those with a GA ~ 37 weeks as term. The Apgar scores 11 were recorded by qualified midwives and postgraduate resident doctors who were usually present at high-risk deliveries. An Apgar score of 6 or less at 1 minute was regarded as cardiorespiratory depression at birth. RDS was diagnosed on the clinical basis of tachypnoea, subcostal and intercostal retraction, expiratory grunting, cyanosis in room air, and radiological evidence of reticulogranular changes with air bronchogram.

Appropriate procedures to detect infections were followed. 12 •13 The policy in the SCBU was to screen all babies delivered and admitted after PROM for suspected sepsis, as previously described.12 The chest was X-rayed when it was clinically indicated. The diagnosis of septicaemia was made on clinical grounds in addition to a positive blood culture. Infants with some clinical evidence of disease or whose mothers had evidence of chorioamnionitis were treated with parenteral gentamicin (5-7.5 mg/kg/day) and cloxacillin (100 mg/ kg/day) for 10 days, but treatment was discontinued after 5 days when culture results were negative. Stable infants had no antimicrobials but were carefully observed while awaiting culture results. Mothers who had PROM were treated prophylactically with ampicillin (500 mg 6-hourly) for 7 days after appropriate cultures had been taken. Statistical analysis of data was by l with 95% confidence intervals.

Results A total of 109 patients with PROM were encountered during the study period. These pregnancies were all singletons without other complications. The control group was 103 other babies who were matched with the index babies. The mean GA at rupture of the fetal membranes was 34 weeks (range 25-41), and the mean duration of rupture before delivery was 73.9 hours (range 26-141). There were 5977live deliveries during this period, of which 1011 were admitted into the SCBU. One hundred and nine (10.8%) of these infants were born following PROM. Of these babies, 51 (46.8° 0 ) were term and 58 (53.2%) were preterm. The overall incidence of PROM was 17.4/1000 live births. The incidence of prematurity associated with PROM was high, 53.2%, whereas the prevailing prematurity rate in JUTH was 3.9%.

Evolving morbidities The observed neonatal morbidities associated with PROM and the mortalities are

Prolonged membrane rupture and outcome

shown in Table I. The evolving mortality was related to the overall patients as well as to the specific morbidity.

Downloaded by [Australian Catholic University] at 04:38 21 August 2017

Perinatal asphyxia (cardiorespiratory depression)

Although there was a preponderance of cardiorespiratory depression at birth in babies with PROM (10.1 %) as compared with the controls (2.9%), the difference was not statistically significant. Prematurity

The overall incidence of prematurity was significantly higher (58/109, 53.2%) than the 10.7~ 0 (11/103) in the controls. Using prematurity alone as a sole morbidity, those with also the perinatal problem of PROM had a higher incidence of 8.3% in contrast to 2.9° 0 in the control group (Table I). This difference, however, was not statistically significant. Most infants had multiple morbidities. Infections

The overall higher incidence of infection in the babies with PROM was highly significant (p0.1 x'=2.96 P=0.06

x'=46.79 p

Prolonged rupture of membranes and neonatal outcome in a developing country.

The neonatal outcomes in 109 pregnancies complicated by prolonged rupture of the fetal membranes were studied over a 3-year period. The overall neonat...
557KB Sizes 0 Downloads 0 Views