Expectant management of late preterm premature rupture of membranes between 34 to 37 weeks of gestation an Insight from a tertiary Hospital in Sub-Saharan Africa setting

Abstract

Objective: To determine the maternal and early neonatal adverse outcomes of expectant management of PPROM beyond 34 to 37 weeks in a single center in Africa.

Methods: A retrospective cross-sectional study was conducted at St. Paul’s Hospital Millennium Medical College (SPHMMC) on pregnant women with PPROM beyond 34 weeks, from February 1, 2023, to July 31, 2023. Data were collected from patient records and charts and analyzed using SPSS software version 22. The primary outcomes of the study were maternal and neonatal morbidity, including clinical chorioamnionitis, NICU admissions, and neonatal death.

Results: Among the 102 study participants who received inpatient expectant management for PPROM beyond 34 weeks, the intervention was successful, with a mean gestational age at delivery of 36 weeks; 42 participants delivered at 42 weeks. The mean latency period was 15 days. NICU admission occurred in 22.5% of neonates, with 20% of those suspected of having sepsis. No early neonatal deaths or confirmed cases of neonatal sepsis were reported. Clinical chorioamnionitis was observed in 13 cases (12%), and postpartum hemorrhage (PPH) was seen in 2.2% of cases. No maternal deaths occurred. No significant statistical associations were found between the latency period and maternal or neonatal outcomes. Prophylactic antibiotics and antenatal corticosteroids were administered, with no complications.

Conclusion: Expectant management of PPROM beyond 34 to 37 weeks has favorable neonatal outcomes with no increased adverse maternal outcomes. This approach for late PPROM can be safely practiced in other low-income settings.

Keywords: PPROM; PROM; low-income country; Ethiopia; Sepsis