TUGAS SEMINAR

Konsep Manajemen Kebidanan Kegawatdaruratan Maternal dan Neonatal

Dengan Ketuban Pecah Dini

Diajukan untuk Memenuhi Tugas

Mata Kuliah Asuahan Kebidanan Kegawatdaruratan Maternal dan Neonatal

Dosen Pembimbing :

ARI KUSUMIWIYATI,SST,M.KEB

Disusun Oleh :

Dewi Fatmawati (1502100015)

Kelas DIII- 3A

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLITEKNIK KESEHATAN KEMENKES MALANG
JURUSAN KEBIDANAN
PROGRAM STUDI DIII KEBIDANAN MALANG
2017
 BAB I
Tinjauan Pustaka

1.1 Definisi
Ketuban pecah dini adalah pecahnya membran sebelum onset
persalinan(PROM).PROM merumitkan sekitar 3%[1].pendekatan optimal untuk penilaian
klinis dan perawatan wanita dengan PROM tetap kontroversial (Aymen,2016).
Ketuban pecah dini ( amniorrhexis – premature rupture of the membrane PROM )
adalah keadaan pecahnya selaput ketuban sebelum persalinan. Pada keadaan normal, selaput
ketuban pecah dalam proses persalinan. Bila ketuban pecah dini terjadi sebelum usia kehamilan
37 minggu disebut ketuban pecah dini KPD Preterm (PPROM = preterm premature rupture of
the membrane - preterm amniorrhexis). KPD memanjang merupakan KPD selama >24 jam
yang berhubungan dengan peningkatan risiko infeksi intra-amnion. (Rukiyah,2010)

1.2 Etiologi
Ketuban pecah dini dapat dihasilkan dari beragam mekanisme patologis yang bertindak
secara individu atau dalam kelompok (Aymen,2016).
Menjelang usia kehamilan cukup bulan kelemahan fokal terjadi pada selaput janin
diatas servik internal yang memicu robekan dilokasi ini.Beberapa proses patologis (termasuk
perdarahan dan infeksi)dapat menyebabkan terjadinya KPD((Rukiyah,2010)
Walaupun banyak publikasi tentang KPD, namun penyebabnya masih belum diketahui
dan tidak dapat ditentukan secara pasti. Beberapa laporan menyebutkan faktor-faktor yang
berhubungan erat dengan KPD, namun faktor-faktor mana yang lebih berperan sulit diketahui.
Kemungkinan yang menjadi faktor predesposisi adalah:
1. Infeksi, yang terjadi secara langsung pada selaput ketuban maupun asenderen dari vagina
atau infeksi pada cairan ketuban bisa menyebabkan terjadinya KPD.
 2. Servik yang inkompetensia, kanalis sevikalis yang selalu terbuka oleh karena kelainan pada
servik uteri (akibat persalinan, curetage).
3. Tekanan intra uterin yang meninggi atau meningkat secara berlebihan (overdistensi uterus)
misalnya trauma, hidramnion, gemelli. Trauma oleh beberapa ahli disepakati sebagai faktor
predisisi atau penyebab terjadinya KPD. Trauma yang didapat misalnya hubungan seksual,
pemeriksaan dalam, maupun amnosintesis menyebabakan terjadinya KPD karena biasanya
disertai infeksi.
4. Kelainan letak, misalnya sungsang, sehingga tidak ada bagian terendah yang menutupi pintu
atas panggul (PAP) yang dapat menghalangi tekanan terhadap membran bagian bawah.

1.3 Patofisiologi
Ketuban pecah dalam persalinan secara umum disebabkan oleh kontraksi uterus dan
peregangan berulang. Selaput ketuban pecah karena pada daerah tertentu terjadi perubahan
biokimia yang menyebabkan selaput ketuban inferior rapuh, bukan karena seluruh selaput
ketuban rapuh.
Terdapat keseimbangan antara sintesis dan degradasi ekstraseluler matriks. Perubahan
struktur, jumlah sel, dan katabolisme kolagen menyebabkan aktivitas kolagen berubah dan
menyebabkan selaput ketuban pecah.
Degradasi kolagen dimediasi oleh matriks metalloproteinase (MMP) yang dihambat
oleh inhibitor jaringan spesifik dan inhibitor protease.
Mendekati waktu persalinan, keseimbangan antara MMP dan TIMP-1 mengarah pada
degradasi proteolitik dari matriks ektraseluler dan membrane janin. Aktivitas degradasi
proteolitik ini meningkat menjelang persalinan.
Selaput ketuban sangat kuat pada kehamilan muda. Pada trimester ketiga, selaput
ketuban mudah pecah. Melemahnya kekuatan selaput ketuban ada hubungannya dengan
pembesaran uterus, kontraksi rahim dan gerakan janin. Pada trimester terakhir, terjadi
perubahan biokimia pada selaput ketuban. Pecahnya ketuban pada kehamilan aterm merupakan
hal fisiologis(Anik,2009).

1.4 Diagnosis
Sebagian besar kasus ketuban pecah dini dapat didiagnosis berdasarkan riwayat pasien
dan pemeriksaan fisik dengan spekulum.Pemeriksaan digital umumnya harus dihindari kecuali
jika pasien tanpak dalam persalinan atau persalinan yang aktif tampaknya sudah dekat (Jurnal
Penelitian Ilmiah Akademik Internasional,2016)
Menegakkan diagnosa KPD secara tepat sangat penting. Karena diagnosa yang positif
palsu berarti melakukan intervensi seperti melahirkan bayi terlalu awal atau melakukan seksio
yang sebetulnya tidak ada indikasinya. Sebaliknya diagnosa yang negatif palsu berarti akan
membiarkan ibu dan janin mempunyai resiko infeksi yang akan mengancam kehidupan janin,
ibu atau keduanya (Anik,2009).
 1. Anamnesa
Pasien mengeluarkan cairan yang banyak secara tiba-tiba dari jalan lahir . Cairan
berbau khas, dan perlu juga diperhatikan warna cairan tersebut. Tidak ada His dan pengeluaran
lendir darah.
2. Pemeriksaan
Tampak keluarnya cairan dari vagina, bila ketuban baru pecah dan jumlah air ketuban
masih banyak, pemeriksaan ini akan lebih jelas.
a) Tentukan pecahnya selaput ketuban, dengan adanya cairan ketuban di vagina.
Pemeriksaan dengan spekulum pada KPD akan tampak keluar cairan dari orifisium
uteri eksternum (OUE). Jika tidak ada, dapat dicoba dengan menggerakkan sedikit
bagian terbawah janin atau meminta pasien batuk atau mengedan maka akan tampak
keluar cairan dari ostium uteri dan terkumpul pada fornik anterior. Penentuan cairan
ketuban dapat dilakukan dengan tes lakmus (Nitrazin test) dimana merah menjadi biru.
b) Tentukan usia kehamilan
c) Tentukan ada tidaknya infeksi. Tanda-tanda infeksi adalah bila suhu ibu lebih dari 38⁰C
serta air ketuban keruh dan berbau. Leukosit darah > 15.000/mm³ . Janin yang
mengalami takikardi, mungkin mengalami infeksi intrauterin.
d) Tentukan tanda-tanda persalinan dan scoring pelvic.
e) Tentukan adanya kontraksi yang teratur.
f) Periksa dalam dilakukan bila akan dilakukan penanganan aktif (terminasi kehamilan).
Mengenai pemeriksaan dalam, perlu dipertimbangkan, pada kehamilan yang kurang
bulan yang belum dalam persalinan tidak perlu diadakan pemeriksaan dalam. Karena
pada waktu pemeriksaan dalam, jari pemeriksa akan mengakumulasi segmen bawah
rahim dengan flora vagina yang normal. Mikroorganisme tersebut bisa dengan cepat
menjadi patogen. Pemeriksaan dalam vagina hanya dilakukan jika KPD yang sudah
dalam persalinan atau yang dilakukan induksi persalinan dan dibatasi sedikit mungkin.
g) Diagnosis ketuban pecah dini premature dengan inspekulo dilihat adanya cairan
ketuban keluar dari cavum uteri.

1.5 Penatalaksanaan
Ketuban pecah dini ternasuk dalam kehamilan beresiko tinggi. Kesalahan dalam
mengelola KPD akan membawa akibat meningkatnya angka morbiditas dan mortalitas ibu
maupun bayinya.
Dalam menghadapi ketuban pecah dini harus dipertimbangkan beberapa hal sebagai
berikut:
A. Fase laten:
a) Lamanya waktu sejak ketuban pecah sampai terjadi proses persalinan.
b) Semakin panjang fase laten semakin besar kemungkinan terjadinya infeksi.
 c) Mata rantai infeksi merupakan asendens infeksi, antara lain:
Korioamnionitis:
a. Abdomen terasa tegang.
b. Pemeriksaan laboratorium terjadi leukositosis.
c. Kultur cairan amnion positif.
Desiduitis: Infeksi yang terjadi pada lapisan desidua.1
B. Perkiraan BB janin dapat ditentukan dengan pemeriksaan USG yang mempunyai
program untuk mengukur BB janin. Semakin kecil BB janin, semakin besar
kemungkinan kematian dan kesakitan sehingga tindakan terminasi memerlukan
pertimbangan keluarga.
C. Presentasi janin intrauterin
Presentasi janin merupakan penunjuk untuk melakukan terminasi kehamilan. Pada letak
lintang atau bokong, harus dilakukan dengan jalan seksio sesarea.
a) Pertimbangan komplikasi dan risiko yang akan dihadapi janin dan maternal
terhadap tindakan terminasi yang akan dilakukan.
b) Usia kehamilan. Makin muda kehamilan, antarterminasi kehamilan banyak
diperlukan waktu untuk mempertahankan sehingga janin lebih matur. Semakin
lama menunggu, kemungkinan infeksi akan semakin besar dan membahayakan
janin serta situasi maternal.
Beberapa penelitian menyebutkan lama periode laten dan durasi KPD keduanya
mempunyai hubungan yang bermakna dengan peningkatan kejadian infeksi dan komplikasi lain
dari KPD. Jarak antara pecahnya ketuban dan permulaan dari persalinan disebut periode latent
= L.P = “lag” period. Makin muda umur kehamilan makin memanjang L.P-nya.
Penatalaksanaan KPD tergantung pada sejumlah faktor, antara lain :
(1) Usia kehamilan
(2) Ada atau tidak adanya chorioamnionitis

A. Konservatif
1) Rawat di rumah sakit.
2) Jika umur kehamilan < 32 minggu, dirawat selama air ketuban masih keluar atau
sampai air ketuban tidak lagi keluar.
3) Jika usia kehamilan 32-37 minggu, belum inpartu, tidak ada infeksi, tes busa
negative, beri deksametason, observasi tanda-tanda infeksi dan kesejahteraan janin.
4) Terminasi pada kehamilan 37 minggu.
5) Jika usia kehamilan 32-37 minggu, ada infeksi, beri antibiotik dan lakukan induksi,
nilai tanda-tanda infeksi (suhu, leukosit, tanda-tanda infeksi intrauterin).
1.6 Komplikasi
1. Persalinan prematur
Setelah ketuban pecah biasanya segera disusul oleh persalinan. Periode laten tergantung
umur kehamilan. Pada kehamilan aterm 90 % terjadi dalam 24 jam setelah ketuban pecah. Pada
kehamilan antara 28 – 34 minggu 50 % persalinan dalam 24 jam. Pada kehamilan kurang dari
26 minggu persalinan terjadi dalam 1 minggu.
2. Infeksi
1) Korioamnionitis
Korioamnionitis adalah keadaan pada perempuan hamil di mana korion, amnion, dan
cairan ketuban terkena infeksi bakteri. Korioamnionitis merupakan komplikasi paling serius
bagi ibu dan janin, bahkan dapat berlanjut menjadi sepsis. Penyebab korioamnionitis adalah
infeksi bakteri yang terutama berasal dari traktus urogenitalis ibu. Secara spesifik
permulaan infeksi berasal dari vagina, anus, atau rektum dan menjalar ke uterus.
Resiko infeksi ibu dan anak meningkat pada ketuban pecah dini. Pada ibu dapat terjadi
korioamnionitis. Pada bayi dapat terjadi septicemia, pneumonia dan omfalitis. Umumnya
korioamnionitis terjadi sebelum janin terinfeksi. Pada ketuban pecah dini premature, infeksi
lebih sering daripada aterm.
2) Hipoksia dan asfiksia akibat oligohidramnion
Oligohidramnion adalah suatu keadaan dimana air ketuban kurang dari normal, yaitu
kurang dari 300 cc. Oligohidramnion juga menyebabkan terhentinya perkembangan paru-
paru (paru-paru hipoplastik), sehingga pada saat lahir, paru-paru tidak berfungsi
sebagaimana mestinya. Dengan pecahnya ketuban, terjadi oligohidramnion yang menekan
tali pusat hingga terjadi asfiksia atau hipoksia. Terdapat hubungan antara terjadinya gawat
janin dan derajat oligohidramnion, semakin sedikit air ketuban, janin semakin gawat.
 3 Sindrom deformitas janin
KPD pada kehamilan yang sangat muda dan disertai dengan oligohidramnion yang
berkepanjangan menyebabkan terjadinya deformasi janin antara lain :
a) Sindroma Potter
Sindroma Potter dapat berbentuk “clubbed feet”, Hipoplasia Pulmonal dan kelainan
kranium yang terkait dengan oligohidramnion

b) Deformitas ekstrimitas (Anik,2009).

1.7 Prognosis
Prognosis tergantung pada usia kandungan, keadaan ibu dan bayi serta adanya infeksi
atau tidak. Pada usia kehamilan lebih muda, midtrimester (13-26 minggu) memiliki prognosis
yang buruk. Kelangsungan hidup bervariasi dengan usia kehamilan saat diagnosis (dari 12%
ketika terdiagnosa pada 16-19 minggu, sebanyak 60% bila didiagnosis pada 25-26 minggu).
Pada kehamilan dengan infeksi prognosis memburuk, sehingga bila bayi selamat dan dilahirkan
memerlukan penanganan yang intensif. Apabila KPD terjadi setelah usia masuk ke dalam
aterm maka prognosis lebih baik terutama bila tidak terdapatnya infeksi, sehingga terkadang
pada aterm sering digunakan induksi untuk membantu persalinan (Anik,2009).
 BAB II
KONSEP MANAJEMEN KETUBAN PECAH DINI

2.1 Langkah 1 : Pengumpulan Data Dasar (Pengkajian)

Pengkajian adalah pendekatan seismatis untuk mengumpulkan data dan mengelompokkan
data serta menganalisa data sehingga dapat diketahui masalah dan keadaan klien. Pada langkah
pertama ini dikumpulkan semua informasi yang akurat dan semua sumber yang berkaitan dengan
klien.
Data-data yang dikumpulkan meliputi:
1) Data Subjektif
a. Biodata (istri dan suami)
Yang perlu dikaji yaitu : nama, umur, agama, suku, pendidikan, pekerjaan dan
alamat. Maksud pertanyaan ini adalah untuk mengidentifikasi pasien.
Pada klien dengan ketuban pcah dini, pada biodata istri perli diperhatikan
pekerjaan ibu.Pengaruh pekerjaan terhadap pecahnya selaput ketuban.pekerjaa berdiri
terlalu lama menyebabkan tekanan pada selaput ketuban sehingga selaput mudah pecah.
(manuaba, 2008)
b. Keluhan Utama
Keluhan utama merupakan alasan utama klien datang ke rumah sakit dan apa
saja yang dirasakan klien. Keluhan pada ketuban pecah dini yaitu Nyeri perut bagian
bawah dan dari jalan lahir keluar air (Alam, Dewi.K. 2012)
c. Riwayat Perkawinan
Pada riwayat perkawinan kemungkinan diketahui status perkawinan, umur
waktu kawin, berapa lama kawin baru hamil.
d. Riwayat Menstruasi
Pada riwayat menstruasi yang perlu ditanyakan atau diketahui yaitu menarche
(untuk mengetahui usia pertama haid. Usia menarche dipengaruhi oleh keturunan, keadaan
gizi, bangsa, lingkungan, iklim dan keadaan umum), siklus (untuk mengetahui klien
mempunyai siklus normal atau tidak), lamanya (jika lama haid ≥15 hari berarti abnormal
dan kemungkinan adanya gangguan yang mempengaruhinya), banyaknya(untuk
mengetahui apakah ada gejala kelainan banyaknya darah haid), nyeri haid (untuk
mengetahui apakah klien menderita nyeri setiap haid).
e. Riwayat Obstetrik yang lalu
 kompli Pada
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riwayat obstetri lalu perlu dikaji pada kasus ketuban pecah dini yaitu salah satu
penyebab ketuban pecah dini adalah servik inkompeten.servik inkompeten dapat terjadi
akibat proses persalinan yang lalu (Alam, 2012).
f. Riwayat kehamilan sekarang
Kemungkinan klien merasa mual, muntah serta perdarahan, kapan pergerakan janin
pertama kali dirasakan. Apakah ibu telah melakukan kunjungan antenatal dengan tenaga
kesehatan, ibu mendapat imunisasi TT dan belum ada tanda-tanda persalinan.
Pada klien dengan Ketuban pecah dini biasanya terjadi pada usia kehamilan kurang
dari 36 minggu atau lebih dari 36 minggu
g. Riwayat kesehatan
Riwayat kesehatan yang lalu : kemungkinan klien pernah menderita penyakit jantung,
hipertensi, DM, dan mengalami infeksi.
Pada kasusketuban pecah dini, salah satu faktor penyebab terjadinya ketuban pecah
dini yaitu riwayat infeksi (cunningham, 2008)
h. Riwayat kesehatan keluarga
Kemungkinan ada anggota keluarga yang menderita penyakit turunan, penyakit
menular, riwayat kehamilan kembar atau riwayat kehamilan postterm. Pada klien
denganketuban pecah dini, salah satu faktor yang dapat menyebabkan terjadinya ketuban
pecah dini yaitu kehamilan kembar
i. Riwayat kontrasepsi
Untuk mengetahui apakah klien sudah pernah atau belum menggunakan alat kontrasepsi
j. Riwayat seksualitas
Untuk mengetahui apakah ibu mengalami masalah selama berhubungan atau tidak. Pada
kasusketuban pecah dini , berhubungan seks dapat memicu ketuban pecah dini yang dapat
membahayakan jiwa ibu dan janinya.
k. Riwayat sosial, ekonomi dan budaya
Kemungkinan hubungan klien dengan suami, keluarga dan masyarakat baik, kemungkinan
ekonomi yang kurang mencukupi, adanya kebudayaan klien yang mempengaruhi
kehamilan dan persalinan
l. Riwayat spiritual
Kemungkinan klien melakukan ibadah agama dan kepercayaan dengan baik
 m. Riwayat psikologi
Kemungkinan adanya tanggapan klien dan keluarga dengan baik terhadap kehamilan dan
persalinan. Kemungkinan klien dan suami mengharapkan dan senang dengan kehamilan
ini atau kemungkinan klien cemas dan gelisah dengan kehamilannya.
Pada klien dengan ketuban pecah dini, secara psikologis klien mengalami kekhawatiran
serta kecemasan tentang kelangsungan bayi di dalam kandungannya saat harus menjalani
bedrest.
n. Kebutuhan dasar
Kemingkinan pemenuhan kebutuhan bio-psiko yang meliputi pemenuhan nutrisi, proses
eliminasi, aktifitas sehati-hari, istirahat, personal hygiene, kebiasaan-kebiasaan yang
mempengaruhi saat hamil dan bersalin.

2) Data Obyektif
Dapat dikumpulkan melalui pemeriksaan umum dan pemeriksaan khusus :
a. Pemeriksaan umum
Pada klien dengan ketuban pecah dini, dapat dijumpai tenakan darah, nadi dan
pernapasan dalam batas normal. tekanan darah turun, nadi dan pernapasan meningkat,
dan daerah ujung menjadi dingin, serta tampak anemis (norma, dkk. 2013).
b. Pemeriksaan khusus
1. SecaraInspeksi
Secara inspeksi yaitu pemeriksaan pandang yang dimulai dari kepala sampai kaki.
Yang dinilai pada inspeksi yaitu kemungkinan bentuk tubuh yang normal, kebersihan
kulit rambut, muka, konjungtiva, sklera, hidung, telinga, mulut, leher, payudara,
abdomen, genitalia dan ekstremitas.
Pada klien dengan ketuban pecah dini yang perlu dikaji pada pemeriksaan inspeksi
yaitu :
a) Mata : Konjungtiva terlihat pucat dan anemis hal ini disebabkan oleh
cairan yang keluar dari jalan lahir
b) Suhu : suhu meningkat 380C apabila disertai infeksi
c) Genetalia : keluar cairan air ketuban yang banyak, sedikit, air ketuban
keruh,jernih dan sebagainya.

2. Secara palpasi
Pada klien dengan ketuban pecah dini, hasil pemeriksaan palpasi abdomen yang
didapat yaitu :
a) Janin sering belum cukup bulan, jadi fundus uteri masih rendah.
b) Bagian bawag janin belum turun, apabila letak kepala biasanya kepala masih
goyang atau terapung (Floating) atau di atas pintu atas panggul (Sofian, 2012).
3. Secara auskultasi
 Secara auskultasi, kemungkinan dapat terdengar bunyi jantung janin, frekuensinya
teratur atau tidak.
Pada klien dengan ketuban pecah dini, denyut jantung janin dapat berangsur-angsur
dari normal sampai asfiksia dan kematian dalam rahim (norma, dkk. 2013).
4. Pemeriksaan inspekulo
Pada klien dengan ketuban pecah dini, pemeriksaan inspekulo dilakukan untuk
memastikan apakah cairan berasal dari ketuban pecah dini (yeyeh, 2010).
5. Pemeriksaan dalam
Pada kasus ketuban pecah dini, pemeriksaan dalam adalah senjata yang paling ampuh
di bidang obstetrik untuk mendiagnosa apakah suda pembukaan lengkap.Walaupun
ampuh, namun harus berhati-hati karena bahaya yang besar.
d. Pemeriksaan penunjang
Pemeriksaan penunjang yang dilakukan pada klien dengan ketuban pecah dini yaitu :
1. Ultrasonografi (USG) : Pemeriksaan dilakukan untuk melihat ketuban
pecah dini
2. Laboatorium : Penentuan cairan ketuban dapat dilakukan
dengan tes lakmus (Nitrazin test) dimana merah menjadi biru.
2.1 INTERPRESTASI DATA
1) Dx : G ….. P ….. Ab ….. umur ibu ….. tahun, umur hamil ….. minggu, janin
tunggal/ kembar, hidup/ mati, intrauterin/ ekstrauterin, letak memanjang/ melintang,
punggung kanan/ kiri, presentasi kepala/ bokong, UUK jam ….., inpartu kala …..
fase….. dengan ketuban pecah dini.
2) DS : ibu mengatakan Nyeri perut bagian bawah dan dari jalan lahir keluar air
3) DO :
Keadaan umum : lemas dan pucat
Kesadaran : composmentis
Tekanan darah : sama dengan ibu bersalin normal,normalnya 120/80-80- 140/90
Suhu : suhu meningkat mencapai 380C
Genetalia :terdapat pengeluaran cairan ketuban merembes melalui vagina sebelum
ada pembukaan
Auskultasi : DJJ 160-120
4) Masalah
Ibu tampak gelisah dan cemas menghadapi persalinan
5) Kebutuhan
Memberikan dukungan,informasi dan support mental

2.2 IDENTIFIKASI DIAGNOSA DAN MASALAH POTENSIAL

Pembukaan servik tidak mengalami kemajuan
 Hipoksia dan asfiksia akibat oligohidramnion

2.3 IDENTIFIKASI DAN MENETAPKAN KEBUTUHAN SEGERA

Rujuk

2.4 INTERVENSI
Hari/Tanggal:
Pukul :
Dx : G ….. P ….. Ab …... tahun, usia kehamilan….. minggu, janin tunggal/
kembar, hidup/ mati, intrauterin/ ekstrauterin, letak memanjang/ melintang,
punggung kanan/ kiri, presentasi kepala/ bokong, UUK jam …..,
V T: . .. , inpartu kala ….. fase….. dengan ketuban pecah dini.
Tujuan : pembukaan servik ada kemajuan
KH : -Keadaan umum : baik
-Kesadaran : composmentis
-Tekanan darah : 90/60-130/90 mmHg
-Nadi :60-90x/menit
-Pernafasan :18-24x/menit
-Suhu : 36,50C-36,50C
DJJ :160-120 x/menit
- pembukaan servik ada kemajuan
-tidak terjadi infeksi Korioamnionitis
-tidak terjadi Hipoksia dan asfiksia akibat oligohidramnion

Intervensi :
a. Beritahu ibu hasil pemeriksaan
R/ Dengan ibu mengetahui kondisinya dan kondisi janinnya di harapkan ibu dapat kooperatif
selama mendapat perawatan dan ibu terhindar dari cemas.
b. Beri dukungan psikologis pada ibu
R/ Dukungan dari keluarga akan membuat ibu merasa aman dan nyaman sehingga ibu
terhindar dari rasa cemas akan keadaannya.
c. Anjurkan ibu istirahat bedrest (tirah baring)
R/ Dengan istirahat bedrest maka otot-otot akan relax dan mengurangi kontraksi
d. Lakukan observasi TTV, perdarahan dan DJJ
R/ Tensi, nadi yang rendah, RR dan suhu tubuh yang tinggi menunjukkan gangguan sirkulasi
darah.
f. Lakukan rujukan ke rumah sakit untuk dilakukan tindakan selanjutnya
R/ rujukan dilakukan untuk ibu segera mendapatkan penanganan lebih lanjut.
2.5 IMPLEMENTASI
Hari/Tanggal:
Pukul :
Dx : G ….. P ….. Ab ….., usia kehamilan….. minggu, janin tunggal/ kembar,
hidup/ mati, intrauterin/ ekstrauterin, letak memanjang/ melintang, punggung kanan/
kiri, presentasi kepala/ bokong, UUK jam …..,VT...., inpartu kala ….. fase…..
dengan ketuban pecah dini.
a. Beritahu ibu hasil pemeriksaan
b. Beri dukungan psikologis pada ibu
c. Anjurkan ibu istirahat bedrest (tirah baring)
d. Lakukan observasi TTV, perdarahan dan DJJ
e Lakukan rujukan ke rumah sakit untuk dilakukan tindakan selanjutnya

2.6 EVALUASI
Hari/Tanggal:
Pukul :
S :-Ibu mengatakan telah mengerti dengan penjelasan yang diberikan oleh bidan
-Ibu dan keluarga setuju untuk dilakukan rujukan
0 : -ibu mengerti dengan apa yang dijelaskan oleh petugas
- ibu dapat mengulangi penjelasan yang disampaikan oleh petugas.
A : G ….. P ….. Ab ….., usia kehamilan ….. minggu, janin tunggal/ kembar,
hidup/ mati, intrauterin/ ekstrauterin, letak memanjang/ melintang, punggung
kanan/ kiri, presentasi kepala/ bokong, UUK jam …..,VT...., inpartu kala …..
fase….. dengan ketuban pecah dini.
P : Rujuk ibu segera untuk mendapatkan penanganan lebih lanjut
 DAFTAR PUSTAKA
Internacional Jounal of Academic Scientific Research ISSN:2272-6446 Volume4,Issue2(May-
June2016),PP 22-25

International Journal Of Reproduction,Contraception,Obstetrics and Gynecology.Khan,S et al,Int J

Reprod Contracept Obstet Gynecol,2016Aug;5(8):2768-2774
Manuaba, I. B. G. 2001. Ilmu Kebidanan Penyakit Kandungan dan Keluarga Berencana. Jakarta. EGC
Rukiyah, Ai Yeyeh.2010.Asuhan Kebidanan 4 Patologi.Jakarta:TIM
Sarwono.2011.Ilmu Kebidanan.Jakarta:YBP
Yulianingsih,Anik Maryunani.2009.Asuhan Kegawatdaruratan Kebidanan. Jakarta:Trans Info
Media.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Khan S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2768-2774
www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162663
Research Article

Study on preterm pre mature rupture of membrane with

special reference to maternal and its fetal outcome
Shadma Khan1, Aymen Ahmad Khan2*
1
Department of Obstetrics and Gynecology, Katihar Medical College, Bihar, India
2
Department of General Surgery, Integral Institute of Medical Sciences and Research, Lucknow, Uttar
Pradesh, India
Received: 19 June 2016
Accepted: 09 July 2016

*Correspondence:
Dr. Aymen Ahmad Khan,
E-mail: aymenahmadkhan@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article
distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits
unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work
is properly cited.

ABSTRACT

Background: To study see maternal and fetal outcome in preterm pre mature rupture of membrane. To
reach consciousness how early PPROM cases could be terminated with least morbidity to the mother and
fetus
Methods: The study conducted in Department of Obstetrics and Gynecology, Katihar Medical College and
Hospital, Bihar between November 2013 to august 2015. Sixty Pregnant mothers attended and admitted
through antenatal clinic OPD and Emergency with complaining PPROM
Result: Over all age range of mothers was (18 to 38) years and over. Over all mean of parity of mothers
was 0.87±1.2 birth .The Morbidity exceeded to 46 (76.67%) when the duration of PROM was more than 24
hours. As the Duration of PROM was 12-24 hrs and more the effect on consequences had been disastrous
on new born. Mean of weight at birth was 1730.0±516.5gm and Median (Min-Max.) weight was (1000 -
3000) gm. There was 100% morbidity and mortality in gestational age group of 24- 26 weeks in mothers
while as gestational age increases the morbidly and mortality decreases. The morbidity and mortality of
newly born babies was maximum in cord compression followed by very low birth weight.
Conclusions: Preterm prelabour of the fetal membranes contributes to one-third of all preterm births.
Conservative management to prolong gestation should be performed in the absence of evidence of
infection. There is currently no evidence regarding the risks and benefits of prolongation of gestation
beyond 34 weeks gestation.

Keywords: Premature rupture of the membrane, Maternal and neonatal outcome, Risk factors
membranes (PPROM). Rupture of membranes for >
24 hours before delivery is called prolonged rupture
of membranes.
INTRODUCTION

Premature rupture of membranes (PROM) is

defined as rupture of fetal membranes before onset
of labour. If it happens between 37 completed
weeks and 42 weeks of gestational age, it is called
term premature rupture of membranes (TPROM),
while that occurring between 24 weeks and 37
weeks is called preterm premature rupture of

Fetal membranes are made of an outer four to six
layered chorion attached to a collagen rich
connective tissue and an inner single cell layer
amnion.1 Weakness in the chorioamnion membrane
is the overall mechanism of PROM, which may be
due to deficiency of type III collagen, reduced size
of the membrane at the affected site and reduced
collagen content.1-4 In addition, it may be caused by
proteolytic enzymes from bacteria.6
A number of risk factors e.g. smoking have been
identified to be directly associated with PPROM.
However, the cause is uncertain and it is believed to
be multifactorial.7
August 2016 · Volume 5 · Issue 8 Page 2768
 Khan S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2768-2774
maturity, neonatal sepsis and respiratory
distress syndrome): By clinical examination and
Patients with premature rupture of membranes may monitoring and blood culture.
present with leakage of vaginal fluid or vaginal
bleeding but without contractions. If infection sets
in, patients may also present with symptoms and
signs of chorioamnionitis. Diagnosis of PPROM is
made through history from the woman and by a
sterile speculum vaginal examination. Pooling of
liquor in the posterior vaginal fornix or leakage of it
from the cervical os confirms the diagnosis. Ferning
of liquor as observed on the microscope or change
of nitrazine paper to blue because of the alkalinity of
the amniotic fluid is supportive of the diagnosis of
premature rupture of membranes.

In PPROM, the management involves

administration of antibiotics that reduces the risk of
perinatal infection and increases the latency period
while steroids reduce perinatal morbidity and
mortality.2,9

Preterm premature rupture of membranes is one of

the significant causes of preterm delivery and is
associated worldwide with increased rates of
neonatal and maternal morbidity and Mortality.7,10

AIMS of the study was to study maternal outcome

in reference to chorioamnionitis in relation to period
of gestation prior to delivery and after delivery and
to study fetal outcome like perinatal mortality and
morbidity (special emphasis on birth weight,
maturity, neonatal sepsis and respiratory distress
syndrome) and to reach consciousness how early
PPROM cases could be terminated with least
morbidity to the mother and fetus.

METHODS

Study area

Department of Obstetrics and Gynecology, Katihar

Medical College and Hospital, Katihar, Bihar.

Study population

Pregnant mothers attended and admitted through

antenatal clinic OPD and Emergency with
complaining PPROM. Patients presented with
PPROM and also have associated multiple
gestations, congenital malformation with
polyhydramnios, APH and transverse lie are
excluded from this study.

Study period: November 2013 To August 2015.

Sample size: 60

Parameters to be studied

 Fetal outcome like perinatal mortality and

morbidity (special emphasis on birth weight,
 fluid was found to present in the vault. If no fluid is
present, patient was asked to cough, slight pressure
 Maternal outcome in reference to on the uterus may also serve the same purpose.
chorioamnionitis in relation to period of Fluid for laboratory test was collected over lower
gestation prior to delivery and after delivery: By blade of the speculum before it comes into contact
 clinical and microbiological examination with vaginal wall.
 To reach consciousness how early PPROM
cases could be terminated with least morbidity Nitrazine test: Ph of draining fluid was determined
to the mother and fetus: By critically analysis of with the help of nitrazine paper and it was between
all parameters. 7 to 7.5 in all cases.

Study tools Internal Examination: To detect the presence or absence of

lower membranes and whenever any cord prolapse was
looked for. All doubtful cases excluded from this study
Pregnant mothers attending antenatal clinic OPD or
Emergency with PPROM were assessed, evaluated
Clinical Examination
clinically. Investigation of obstetrical significance
like Hb%, VDRL, HIV, HbSAg, PPBS, blood
A through meticulous clinical examination as
grouping and typing, routine urine examination and described in the proforma was done for each of the
routine sonography were done. patients.
Diagnosis of PPROM Study of Liquor Amnii
History: Gush of watery fluid.
In all cases of PPROM liquor amnii was collected as
intra-cervical swab, high vaginal swab with strict
Examination: aseptic precaution for culture sensitivity test where
C/S was done liquor amnii was collected by
Inspection: Examination done in the labour room
amniocentesis just before making uterus incision.
under strict aseptic precaution in lithotomy position.
The sample was cultured aerobically and
After proper antiseptic dressing with strict aseptic
anaerobically for detection of any pathogenic
precaution, posterior vaginal speculum was inserted
organisms.
to press down the post vaginal wall. Anterior wall
retractor was used to retract anterior wall. Amniotic

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 5 · Issue 8 Page 2769
 Khan S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2768-2774
12 (20%) women have had an indication of labour in
the past, 4 (6.67%) have had Preterm PROM, 1
Monitoring labour and puerperium (1.67%) cases were of obstructed labour in the past, 8
(13.33%)
Patients were monitored clinically whenever they go
into labour. Condition of mother, condition of fetus
and progress of labour observed meticulously with
details recorded .Elective of emergency C/S, low
forceps application done whenever necessary.
Condition of baby at birth were observed and
recorded. Maternal condition and complications if
any after delivery up to discharge were observed.

Study of new born infant

The study of new born infant were done according

to proforma. Investigation done after birth where
throat swab and blood culture for presence of any
organisms.

Statistical analysis

All the results were expressed in mean ±SD or

frequency (percentage). Statistical analysis was done
by SPSS software 20 version. p<0.05 was
considered as significant.

RESULTS

Twenty seven (45%) patients were below 24 years

of age, 24 (40%) were in the age group of 25-30
years, and 9 (15%) patients were in the age range of
above 31 years. A total number of 60 patients were
inducted for study whose over all age range was (18
to 38) years and over all mean age of patients was
25.73±5.1 years.

Thirty (50%) women were pregnant for only once,

27 (45%) women were pregnant 2 to -4 times, and
remaining 3 (5%) were pregnant for over 5 times.
The mean frequency of pregnancy was (1.87 - 1.2)
and over all range of pregnancy was (1 to 6) times.

While 30 (50%) pregnant women under study have

had zero Parity, 17 (28.33%) women had only 1
parity, 12 (20%) had 2 to 4 parity and remaining 1
pregnant woman had a parity level of over 5 birth.
Over all mean of parity was 0.87±1.2 birth and
parity range was (0 to5) birth.

While 8(13.3%) women have had a gestational age

of 22 to 28 weeks, 41 (68.3%) were in the
gestational age category of 28-34 weeks and
remaining 11 (18.3%) were in the gestational age of
over 34 weeks. Over all mean of parity was
0.87±1.2 birth and parity range was (0 to– 5) birth.

The various parameters like onset and duration of

discharge and its smell, temperature of patient,
abdominal tenderness and fetal heart rate etc. on
presentation for clinical evaluation.
 95.19
Temperature on >380C 2 (3.33) 0.92 to
had previous history of PROM, 13 (21.67%) have admission 11.36
had Cesarean deliveries in the past,4 (6.67%) were <380C 58 (96.67) 88.64 to
the cases of Preterm labour, 10 (16.67%) were 99.08
patients of Miscarriage in the past, and 7 (11.67%) Abdominal Yes 3 (5) 1.71 to
chose Elective abortion. Risk factors for PPROM; Tenderness 1.37
Symptoms and signs of chorioamnionitis after on Admission No 57 (95) 86.3 to
admission. 98.29
FHR on <120 1 (1.67) 0.3 to
7 (11.67%) women had a White blood cell count of admission 10.14
> 11 x 910/L, and 9 (15%) women had a cell count 120 to 54 (90) 79.85 to
of < 11 x 910/L. In case of 44 (73.33) patients 160 95.34
however, White blood cell count was not carried >160 1 (1.67) 0.3 to
out. 10.14
Not 4 (6.67) 2.62 to
Table 1: Various parameters on presentation for done 15.93
clinical evaluation. Table 2: Risk factors for
PPROM.
Variable Frequency 95% CI
(%) Risk factor Frequency (%) 95% CI
Hours of <24 37 (61.67) 49.02 to Anemia 13 (21.67) 13.13 to 33.62
Draining hours 72.91 Urinary tract 8 (15) 6.91 to 24.16
from onset to 24-48 12 (20) 11.83 to infections
Presentation hours 31.78 Lower genital 7 (11.67) 5.77 to 22.18
11(18.33 tract infection
>48 ) 10.56 to Cervical stich 1 (1.67) 0.3 to 10.14
hours 29.92 Malpresentatio
Draining smell Yes 9 (15) 8.1 to ns 4(6.67) 2.62 to 15.93
26.11 Hydramnias 2 (3.33) 0.92 to 11.36
No 51 (85) 73.89 to No risk factors 24 (40) 28.57 to 52.63

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 5 · Issue 8 Page 2770
 Khan S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2768-2774

Table 3: Symptoms and signs of chorioamnionitis Table 4: Mode of delivery.

after admission.
Frequency
Symptoms and signs of No (%) 95% Mode of Delivery (%) 95% CI
chorioamnionitis after CI Vaginal vertex 17 (28.33) 18.5 to
Admission 28.33
3.61 Vaginal assisted 18 (30) 19.9 to
Maternal fever 5 (8.33) to breech delivery 42.51
18.06 Instrumental 4 (6.67) 2.62 to
Maternal tachycardia 1(1.67) 0.3 to 15.93
10.14 Caesarean section 21 (35) 24.17 to
Foul smelling discharge 1 (1.67) 0.3 to 47.64
10.14
None 53(88.33) In 19 (31.67%) cases weight of newly born babies
was found to be only 1000-1499 gm. In another 37
When the duration of PROM was < 12 hrs there (61.67%) cases weight at birth was 1500-2499 gm.
were only 2 (3.33%) cases of maternal morbidity, It was only in 4 (6.67%) cases weight at the time of
which have risen to 12 (20%) cases when the birth was recorded to be >2500gm.Mean of weight
Duration of PROM had gone up to 12- 24 hrs. at birth was 1730.0±516.5gm. and Median (Min-
Morbidity figures have further exceeded to Max.) weight was (1000 - 3000) gm.
46(76.67%) when the duration of PROM was more
than 24 hours.

When the Duration of PROM had been < 12 hrs the

consequences had not been that disastrous as and
when the Duration of PROM was 12-24 hrs and still
more.

Table 5: Distribution of morbidity and mortality based on gestational age.

Gestational age (in Frequency (%) Morbidity (%) Mortality (%) Total (%)
Week)
24-26 3 (5%) 2 (66.67%) 1 (33.335) 3 (100%)
27-29 5 (8.33%) 2 (40.0%) 2 (40%) 4 (80%)
30-32 20 (33.33%) 7 (35%) 3 (15%) 10 (50%)
33-36 32 (53.33%) 4 (12.5%) 7 (21.88%) 11 (34.38%)
Total 60 (100%) 15 (25%) 13 (21.67) 28 (46.67%)
&mortality

Table 6: Morbidity and mortality of newly born

babies.

Causes Frequency (%)

Very low birth weight 5 (17.9%)
Fetal distress 4 (14.3%)
Cord Compression 6 (21.4%)
Necrotizing enterocolitis 2 (7.14%)
Hypoxia 3 (10.7%)
Sepsis 8 (28.5%)
Total 28 (100%)

While babies born from 14 (23.33%) women had an

Apgar score (5 mins) between 0-5, babies from 13
(21.67) women were assessed for an Apgar score (5
mins) of 5-7 and babies from 33 (55%) women were
adjudged for an Apgar score (5 mins) of 7-10.

In case of 3 (5%) women with a lower gestational

age of 24-26 weeks, the morbidity was 2 (66.67%)

was1 (33.335) percent .Thus morbidity and
mortality was 100%. In case of 5 (8.33%) cases
whose gestational age was slightly better 27-29
weeks morbidity was 2 (40.0%) and mortality was 2
(40%) percent. Under this category total morbidity
and mortality was 4 (80%). Further in case of 20
(33.33%) women having gestational age 30-32 week
the morbidity was 7 (35%) and mortality was 3
(15%) percent making a total morbidity and
mortality combined 10 (50%). In the last category of
32 (53.33%) women having a normal gestational
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
age of 33-36 weeks morbidity and mortalitywere4
(12.5%) and 7 (21.88%) respectively, making a total
of morbidity and mortality 11 (34.38%).Over all
morbidity was 15 (25%) and mortality figures were
13 (21.67). While very low birth weight had been
the cause of morbidity and mortality for babies born
to 5 (17.9%) women, Fetal distress had resulted into
mortality for 4 (14.3%) babies. 6 (21.4%)
succumbed to morbidity due to Cord Compression,
2 (7.14%) due to Necrotizing enterocolitis, 3
(10.7%) due to Hypoxia and sepsis had been the
cause of death for 8 (28.5%) newly born babies.
Volume 5 · Issue 8 Page 2771
 Khan S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2768-2774
the rates of pPROM negatively correlated with the
socioeconomic level. Meanwhile, Ortiz et al could
DISCUSSION not find any relation of statistical significance
between women’s socio-economic variables and the
Premature rupture of membranes (PROM) is risk of having PROM.21
defined as rupture of the amniotic sac membranes
before labour onset at 37 weeks of gestation or later.
It constitutes a significant problem in obstetrics. It is
termed prolonged rupture of membrane if it persists
for more than 24 hours to onset of labour
(Jazayeri).11 The identification of pathologic
microorganisms in human vaginal flora soon after
membrane rupture provides support for the concept
that bacterial infection may have a role in the
pathogenesis of pPROM (McDonald et al).12

Premature rupture of the amniotic sac membranes

enclosing the fetus is, as yet, a not fully understood
process, but may related to the mechanical
properties of those membranes (Wittenberg).13
Umbilical cord blood cytokine values are higher
than maternal levels, suggesting significant
fetal/placental contribution. Maternal and umbilical
cord cytokine levels are not
adequately predictive to be used clinically (Mercer
et al.14)

Premature rupture of membranes occurs between 5

and 15% of pregnancies, of these, 10% occurs at
term and preterm 2 to 3.5% (Hernández et al).15
Previable or Preterm (less than 24 weeks) premature
rupture of membranes (pPROM) complicates about
1 in every thousand births and is responsible for\
substantial perinatal mortality (Margato et al).16 It is
the leading identifiable cause of premature birth and
accounts for approximately 18% to 20% of perinatal
deaths in the United States (Caughey).17

Clinical factors associated with preterm PROM

include low socioeconomic status, low body
massindex, tobacco use, preterm labour history,
urinary tract infection, vaginal bleeding at any time
in pregnancy, cerclage, and amniocentesis.
Fetoscopy may carry a risk of iatrogenic pPROM,
although this depends on the experience of the
obstetrician (Gratacós).18

This study was conducted in the department of

obstetrics and Gynecology, katihar medical college
hospital with 60 pregnant mothers attended and
admitted through OPD and Emergency with
complaining leaking per vagina.

The demographic profile of PPROM patients in our

study such as below age of 24 year, and single
gravidity was
similar to those reported in other areas (Shehlar,
Akter et al).19,20 Noor et al in an observational study
found that
pPROM was more frequent among women
belonging to low socioeconomic class, and those
with no or low education.19 Similar findings were
also reported by Polzin and Brady who asserted that

It was noted in a study done by Mead et al and
Garite et al that about 50% of PPROM between 28
and 34 weeks
of gestation age tend to go into labour within 24
hours.22,23 This was different in our study were 62%
of
patients between 28-34 weeks of gestation age went
into spontaneous labour after 72 hours. This increase
maybe was due to the antibiotics given that led to an
increase in the latency period in our study. This
increase in latency period was also noted in a study
done by Mercer et ali. However, in contradiction
with this current study finding regarding women’s
age, Berkowitz et al in their study about the risk
factors for preterm birth found that mothers 30 years
age or older had a significantly increase risk for
pPROM.24 On the same line, a large population-
based retrospective cohort study of the risks of
maternal morbidity and adverse outcomes showed
that increasing maternal age was associated with a
significantly higher risk of pPROM after adjusting
for maternal race, parity, diabetes, chronic
hypertension and smoking status (Lucke and
Brown).25 Similarly Ziadeh in a large study
conducted in Jordan found that women delivering
their first child at age 35 years or older were at
increased risk of pPROM compared with women
aged 20-29 years of
age. Ferguson et al also had a similar finding
regarding maternal age.26,27
In our study about 3.3% patients were running fever
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
of 38 C or more at the time of admission. All
patients were given broad spectrum antibiotics.
Intrapartum fever accompanied by two or more
additional signs including foetal tachycardia, uterine
tenderness, foul smelling vaginal discharge or
maternal leukocytosis occurs in 1.0% to 3.8% of
parturient and is associated with neonatal Group B
Streptococcal (GBS) attack rates from 6% to 20%
cases.2 Reports of three meta-analysis of
randomized blind studies showed that initiating
systemic antibiotics after occurrence of PPROM had
two major effects: first, increased latency (time until
delivery) and second, reduced occurrence of
neonatal sepsis, interventricular hemorrhage and
perinatal mortality and chorioamnionitis.
Caesarean section rate in this study was 35% which
is similar to that reported in the study from Punjab.
It is low as compared to the study by Charles P J et
al in which the incidence of caesarean section was
58.7%.28 In our study caesarean section was mostly
performed for fetal distress and malpresentation,
while in the above-mentioned study caesarean
section before labour was the most frequent mode of
delivery. This is because of cultural differences in
this part of the world where large families and
vaginal deliveries at home are preferable.
In our study, 6.67% cases had previous preterm
deliveries. This incidence is lower than reported by Tahir et
al (14.7%) and Charles P J et al (14.3%).28,29 Thus risk
scoring strategies can be developed on the basis of prior
preterm birth. However the use of the scoring systems has
resulted not in significant reductions in preterm births but
Volume 5 · Issue 8 Page 2772
 Khan S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2768-2774
performed in the absence of evidence of infection.
There is currently no evidence regarding the risks
rather in an increased use of intervention with and benefits of prolongation of gestation beyond 34
unproved effectiveness.3 weeks gestation. Looking after a premature infant
puts immense burden on the economic and health
The number of low birth weight babies in this study care resources of the country; therefore risk scoring
was 61.6% as compared to 62.3% by Shehlar et al strategies involving the demographic variables
and it is very high as compared to United States and
California
birth cohorts in which the prevalence of prematurity
was 10.3%.4,19 This large number of low birth
weight babies
puts great burden on the neonatal intensive care
facilities. Number of babies with low APGAR score
who required advanced resuscitation were also high.
Perinatal mortality in this study was 21.7% (13/60
births), which is lower than reported by Tahir et al
but higher than reported by
Multer et al (9.3%) and by Charles P J et al (3% at
28-31 weeks and 0.41 % at 32–33 weeks).28,29
Neonatal
morbidity and mortality are directly related to latent
period and PROM delivery interval. Perinatal
morbidity was mainly due to cord compression,
RDS (Respiratory Distress Syndrome), sepsis, very
low birth weight and mortality was mainly due to
sepsis, RDS and birth asphyxia as similar to study
done by Kadikar GK et al.30

In our study, the result revealed that the poor fetal

outcome in women with preterm premature rupture
of membranes was associated with a gestation age
of less than 34 weeks and an extremely low birth
weight. As such, more efforts have to be made to
improve our neonatal intensive care unit so that they
become better equipped to deal with such kind of
complications to improve the outcomes.

CONCLUSION

Mostly mothers were <24 year age with mean age

25.73±5.1years. In early age pregnancy of mother
major cause of low birth weight babies. Preterm
prelabour of the fetal membranes contributes to one-
third of all preterm births, and is the leading
identifiable cause of prematurity and its sequels.
Additionally, the probability of positive culture is
higher with pPROM, particularly with sterile
infection. Diagnosis of PPROM should be via
speculum examination; digital vaginal examination
should be avoided. PPROM is one of the important
causes of preterm birth that can result in high
perinatal morbidity and mortality along with
maternal morbidity. Routine administration of oral
erythromycin to women with PPROM will
significantly increase the latency period and
improve neonatal respiratory morbidity.
Administration of antenatal corticosteroids to
women presenting with PPROM improves neonatal
outcomes without increasing the risk of infection.
There is no evidence regarding the safety or benefit
of tocolysis in women with PPROM. Conservative
management to prolong gestation should be

along with previous history of preterm deliveries
should be developed to identify high risk cases and
treating them prior to rupture of membranes.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Khan S, Khan AA. Study on
preterm pre mature rupture of membrane with special
reference to maternal and its fetal outcome. Int J
Reprod Contracept Obstet Gynecol 2016;5:2768-74
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