A prospective population-based study of preterm pre-labour rupture of membranes between 24 and 34 weeks of gestation in Cape Town Metro East: measuring protocol intervention fidelity and clinical outcome

[摘要] BACKGROUND: Preterm premature rupture of membranes (PPROM) complicates 2 to 3% ofpregnancies and is associated with significant neonatal mortality and morbidity. Intrauterineinfection is the most common cause of PPROM, approximately 50% overall.OBJECTIVES: The primary objective of this study was to evaluate the quality of care deliveredto women undergoing inpatient management with PPROM compared with a recently institutedhospital protocol. A secondary objective was to investigate the maternal and neonatal outcomeof conservative management of PPROM 24-34 weeks in Tygerberg Hospital (TBH), and todetermine the impact of the protocol on hospital stay (bed occupancy rate).METHODS:A prospective population-based observational study on patients with confirmedPPROM managed conservatively, between 24 and 34 weeks gestation at TBH from 01February 2014 to 31 January 2015. The charts of all patients (n=353) evaluated for possiblePPROM were retrieved from the online TBH records system, Enterprise Content Management(ECM). Ninety-eight patients were eligible for the study.RESULTS: The cumulative incidence of PPROM in the drainage region during this study periodwas 2.86 per 1000. The median gestational age was at delivery was 31 weeks and 4 days andmost babies were appropriately grown for their gestation with but with 18 babies born belowthe 10th centile for birth weight according to their gestation. The median birth weight was 1690g.The most identifiable associated risk factor was cigarette smoking (35%). In 90% of patientswith PPROM counselling was not done. Clear nursing prescriptions were not given in 90% ofpatients as per protocol and more than 65% of patients were not given betamethasone atcorrect intervals. Close to 60% of women were given antibiotics correctly and 86% of patientswere checked for signs of chorioamnionitis twice day as per protocol. Most babies wereadmitted in high care with a median average stay of 8 days, but one stayed a maximum of 188 days and 6 babies died from severe prematurity. Other neonatal complications includedneonatal jaundice (60%), respiratory distress (41%), sepsis (7%), necrotising enterocolitis (3%)and patent ductus arteriosus (4%). Total length of stay of mothers in hospital was a median of6 days and none of the mothers had complications post-delivery.CONCLUSION: PPROM is a serious complication of pregnancy and associated with low birthweight, preterm delivery significant perinatal morbidity and mortality and prolonged hospitalstay, however it does not have major impact on maternal outcome as seen in this study. Moreattention needs to be given to provide adequate counselling for women admitted with PPROMand train nursing personnel to administer BMZ and antibiotics as prescribed.

[发布机构] Stellenbosch University