American Journal of Clinical Medicine Research, 2014, Vol. 2, No. 1, 14-17 Available online at http://pubs.sciepub.com/ajcmr/2/1/4 © Science and Education Publishing DOI:10.12691/ajcmr-2-1-4 The Incidence and Management Outcome of Preterm Premature Rupture of Membranes (PPROM) in a Tertiary Hospital in Nigeria Okeke TC * , Enwereji JO, Okoro OS, Adiri CO, Ezugwu EC, Agu PU Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria *Corresponding author: ubabiketochukwu@yahoo.com Received November 22, 2013; Revised January 15, 2014; Accepted January 16, 2014 Abstract Preterm premature rupture of membranes (PPROM) complicates 3-8 percent of pregnancies and leads to one third of preterm deliveries. It results in increased risk of prematurity and leads to perinatal and neonatal complications with risk of fetal death. This article aims to determine the incidence and management outcome of PPROM in Enugu, Nigeria over a ten year period. This was a retrospective review of management outcome of PPROM at the UNTH Enugu from January 1 st 1999 to December 31 st , 2008. The frequency of 3.3% for PPROM and 7% perinatal death were recorded over the period. Preterm PROM is a major complication of pregnancies. Currently, there is no effective way of preventing spontaneous rupture of fetal membranes due to ignorance of its aetiology, with consequent inability to control its incidence. However, it is important that women be well informed regarding maternal, fetal and neonatal complications regardless of controversies of its management. Keywords: incidence, management outcome, preterm premature rupture of membrane (PPROM), Enugu, Nigeria Cite This Article: Okeke TC, Enwereji JO, Okoro OS, Adiri CO, Ezugwu EC, and Agu PU, “The Incidence and Management Outcome of Preterm Premature Rupture of Membranes (PPROM) in a Tertiary Hospital in Nigeria.” American Journal of Clinical Medicine Research 2, no. 1 (2014): 14-17. doi: 10.12691/ajcmr-2-1-4. 1. Introduction Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the fetal membranes during pregnancy before 37 weeks gestation in the absence of regular painful uterine contractions [1]. Premature rupture of membrane (PROM) is the rupture of the fetal membranes before the onset of labour. This spontaneous rupture of membrane is a normal component of labour and delivery [2]. Preterm PROM complicates 3-8% of pregnancies and leads to one third of preterm deliveries [3]. It increases the risk of prematurity and leads to other perinatal and neonatal complications with 1-2% risk of fetal death [4]. It can lead to significant fetal perinatal morbidity such as respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruptio and fetal death [5]. It can also lead to maternal morbidity such as postpartum endometritis, disseminated intravascular coagulopathy, maternal sepsis, delayed menses and Asherman syndrome. PPROM is an important cause of perinatal morbidity and mortality because it is associated with brief latency from membrane rupture to delivery, perinatal infection and umbilical cord compression due to oligohydramnios [6]. Numerous risk factors are associated with PPROM such as Black race, lower socioeconomic status, smokers, past history of sexually transmitted infections, previous preterm delivery, polyhydramnios and multiple pregnancy [5,7]. Others are procedures such as cerclage and amniocentesis [5]. The aetiology is multifactorial [5,6]. PPROM evaluation and management are important for improving neonatal outcomes. Accurate diagnosis of PPROM requires a thorough history, physical examination and ancilliary laboratory studies. These would allow for gestational age specific obstetric interventions to optimize perinatal outcome and reduce fetomaternal complications [5,8]. Speculum examination to determine cervical dilatation is preferred because digital vaginal examination is associated with a decreased latency period and has potential for adverse sequelae [9]. The management of pregnancies complicated by PPROM is challenging, controversial and should be individualized. However, it should focus on confirming the diagnosis, validating gestational age, documenting fetal wellbeing and deciding on the mode of delivery which depends on gestational age, fetal presentation and cervical examination [2,12-20]. Current evidence suggests aggressive antibiotic therapy which is effective for increasing latency period and reducing infectious infant morbidity. Corticosteroids can reduce many neonatal complications particularly respiratory distress syndrome and intraventricular haemorrhage [5,10,13,14,15]. Expectant management or conservative management is best accomplished by in patient observation. It generally consists of initial prolonged continous fetal and maternal monitoring combined with modified bed rest to increase the opportunity for amniotic fluid re-accumulation and spontaneous membrane sealing. This approach is generally accepted and preferred because of the associated neonatal advantage and reduction in the risks of prematurity.