A Retrospective Study on Maternal and Fetal Outcomes in Premature Rupture of Membranes

Abstract

Background: Premature rupture of membranes (PROM) at term (≥37 weeks) complicates 8–10% of pregnancies and is associated with increased maternal and neonatal morbidity. The optimal management strategy—expectant management versus immediate induction—remains debated. Prolonged PROM (>24 hours) has been linked to increased risks of chorioamnionitis, postpartum haemorrhage, neonatal sepsis, and NICU admissions. This study evaluates maternal and fetal outcomes in PROM cases to guide clinical decision-making.

Methods: This hospital-based retrospective study was conducted at Chettinad Health and Research Institute, Tamil Nadu, India, analysing medical records of 100 women diagnosed with PROM at ≥37 weeks gestation (January 1, 2023 – December 31, 2023). Data included maternal demographics, mode of delivery, time from PROM to delivery, maternal complications, and neonatal outcomes. Statistical Analysis: Descriptive statistics, Chi-square tests, logistic regression, Pearson correlation, and Kaplan-Meier survival analysis were performed using SPSS v26.0. A p-value <0.05 was considered statistically significant.

Results: Maternal Outcomes: 72% delivered vaginally, while 28% required cesarean delivery due to fetal distress (11%), failure to progress (9%), and chorioamnionitis (5%). The mean latency period from PROM to delivery was 12.8 ± 5.6 hours. Chorioamnionitis (7%) was the most common maternal complication, significantly increasing when PROM lasted >24 hours (29% vs. 3%, p=0.004). Neonatal Outcomes: 16% required NICU admission, primarily due to respiratory distress syndrome (8%) and neonatal sepsis (6%). Prolonged PROM was significantly associated with a 5.2-fold higher risk of NICU admission (p=0.002) and a 4.7 times increased risk of neonatal sepsis (p=0.001). Perinatal mortality was 2%. Negative correlation between PROM duration and APGAR scores (r=-0.58 at 1 min, p<0.001). Kaplan-Meier analysis showed higher neonatal morbidity with PROM >24 hours (p<0.001, log-rank test).

Conclusion: Prolonged PROM (>24 hours) significantly increases maternal infections and neonatal morbidity, including higher NICU admissions and neonatal sepsis risk. Timely labour induction within 12 hours may reduce these complications, supporting proactive management strategies over expectant management. Future studies should focus on optimal timing for labour induction in terms of PROM and infection prevention strategies to improve maternal and neonatal outcomes.