Clinical audit of the management and outcomes of preterm pre-labour rupture of membranes at Aminu Kano Teaching Hospital

Abstract

Introduction: preterm pre-labour rupture of membranes (PPROM) is one of the important causes of preterm birth that can result in high perinatal morbidity and mortality along with maternal morbidity. The purpose of the study was to audit the management of women presenting with Preterm pre-labour rupture of membranes in Aminu Kano Teaching Hospital (AKTH).

Methods: this was a retrospective audit on patients admitted with PPROM in AKTH over a period of 24 months. Data was analysed using SPSS version 22 and presented using percentages and compared with the audit standard. Chi-squared test was used to test for association (p-value <0.05).

Results: the mean gestational age was 33.27±2.42 weeks. Diagnosis was made on all patients through history and clinical examination. Almost all patients received a course of erythromycin (88%), corticosteroid (84%) and magnesium sulphate (86%). Vaginal delivery was achieved in 57%. About 60% of the neonates were premature, 78% had Apgar score >7 at 5 mins, 50% were admitted in the special care baby unit and 72% survived. Chorioamnionitis and puerperal sepsis occurred in 8% and 21.7% of the mothers. Prolonged PPROM of >24 hours was statistically significantly associated with puerperal sepsis (χ² =7.218; p = 0.007) and perinatal mortality (χ² = 11.505, p = 0.001).

Conclusion: despite high fidelity to institutional clinical practice guidelines in Aminu Kano Teaching Hospital there seems to be poor maternal and neonatal outcome with high perinatal mortality. Thus the guidelines need to be reviewed in context of improving the outcome.