Predictors and outcomes of premature rupture of membranes among pregnant women admitted to a teaching Hospital in Saudi Arabia: a cohort study

Background: Premature rupture of the membrane (PROM), refers to rupture of the fetal membranes prior to the onset of regular uterine contractions. When this occurs at term (≥ 37 weeks of gestation), it is classified as PROM, whereas if it occurs before 37 weeks, it is termed preterm premature rupture of membranes (PPROM). PROM and PPROM are linked to adverse outcomes for both mother and newborn.

Objectives: To investigate the factors associated with PROM and the outcomes of pregnancies complicated with PROM.

Methods: This was a retrospective cohort study. The participants were divided into three groups; those with PROM, those with PPROM and a control group who had normal onset of membranes rupture. The groups were compared with respect to predictors of PROM (maternal demographic profile, obstetrical history, and comorbidities), in addition to outcomes (postpartum hemorrhage, hospital stay, low APGAR scores, sepsis, low birthweight, preterm rate, and admission to neonatal Intensive care Unit (NICU)). Multivariable logistic regression model was used for predicting risk factors associated with PROM and PPROM.

Results: A total of 1,894 pregnant women were enrolled in the study, 77.6% had normal onset of ruptured membranes, while 382 (20.1%) were diagnosed with a PROM and 43 (2.3%) diagnosed with PPROM. Primiparous mothers were more likely to develop PROM (AOR = 1.56, 95% CI (1.10-2.22)) as compared to multiparous, while obese and overweight mothers were less likely to develop PPROM (AOR = 0.86, 95% CI (0.94 - 0.49)). Significantly more mothers with PPROM were delivered by emergency cesarean Sect. (30.2% vs. 22.9%, P < 0.01), develop chorioamnionitis (4.7% vs. 0.1%, P < 0.01), and stayed in the hospital more than three days (16.3% vs. 2.5%, P < 0.01) compared to the control group. Neonates of mothers who had PPROM were more likely to have low birth weight (35.7% vs. 10.4%, P < 0.01), and NICU admission (67.4% vs. 20.4%, P < 0.01) as compared to the control group. Perinatal death rate was not significantly different between the groups.

Conclusion: In this study, nulliparity is a predictor of PROM, while overweight/ obese mothers are less likely to develop PPROM. Despite the relatively low occurrence of PPROM among Saudi women, the condition is associate with increase risk of cesarean section delivery, chorioamnionitis, prolonged hospitalization, and an increase need for neonatal intensive care compare to those with a normal onset of membrane rupture.