AFJOG

ORIGINAL RESEARCH RESULTS Eighty (80) consecutivewomen admitted to the obstetric units for the workup and management of PROM were recruited. Eight women were excluded from the study, because they did not fulfill the conditions of the inclusion criteria. The reasons for exclusion were congenital abnormality of the fetus, twin pregnancy, four term pregnancies recruited, woman was transferred to another hospital for further management and women declined hospital treatment and was discharged. Thus, 72 women were included in the study analysis. Eight (11.11%) women had a previous history of preterm labour, and 17 (23.6%) women were admitted in preterm labour. Table 1 summarises the population characteristics. Table 1: Description of study population (n=72) Characteristic n (%) HIV HIV negative 54 (75.0) HIV positive 18 (25.0) Viral load less than detectable limits 16 (88.9) White cell count Elevated (>12.60 x 109/L) 15 (20.8) Normal (4-12.6 x 109/L) 15 (77.8) Reduced (<4 x 109/L) 1 (1.4) CRP Elevated (>10mg/L) 26 (37.1) Normal (≤10mg/L) 44 (62.9) Infections at admission Urinary tract infection on urine MCS (n=69) 44 (63.4) Vaginal infection on vaginal swab MCS (n=43) 21 (48.8) Management of PROM Tocolysis 8 (1.1) Steroids 52 (72.2) Antibiotics 71 (98.6) MgSO4 for neuroprotection 2 (2.8) Labour Induced 20 (27.8) Spontaneous 52 (72.2) Route of delivery NVD 49 (68.1) Caesarean section 22 (30.6) Assisted 1 (1.4) Neonatal outcome Mean birth weight (grams) 2003 (range 820 - 3110g) 5-min Apgar <7 4 (5.5) Neonatal ICU admission 47 (65.3) Neonatal sepsis 18 (25.4) Neonatal death 2 (2.8) Placental infection: swabs (n=28) 5 (17.9) Placental histology (n=45) Infection 25 (55.6) Funisitis 8 (17.7) Villitis 3 (6.6) Stage III Chorioamnionitis 10 (22.2) Deciduitis 3 (6.6) Macrophages 2 (4.4) Subchorionitis 5 (11.1) Suppurative inflammation 2 (4.4) Mild chorioamnionitis 4 (8.9) Mean (Range) (SD) Age (years) 27.7 (19 - 43) (5.8) Gestational age (weeks) 31.9 (26 - 37) (2.7) Estimated fetal weight (grams) at admission 1779.4 (647 - 2990) (582.6) Latency (hours) 246.4 (4 - 1362) (310.1) Temperature (ºC) 36.6 (36.0 - 38.8) (0.4) CRP= c-reactive protein; HIV= human immunodeficiency virus; ICU- intensive care unit; MCS= microscopy, sensitivity and culture; NVD= normal vaginal delivery; PROM= preterm rupture of membranes Forty-four of 69 women (63.77%) had a positive urine culture on admission. The most common organisms were E. coli, Candida albicans, and Enterococcus. faecalis. Twenty- two of 43 women (51.16%) had a positive culture on high vaginal swab. The most common organisms were Candida albicans, U. urealyticum, and M. hominis. The average maternal temperature was 36.4ºC. Eight women (11.11%) that presented in active preterm labour received tocolysis. The 64 women who were not tocolysed were either above 34 weeks gestation (n=9), or were not in labour (n=55). One woman (1.39%) did not receive antibiotics in the antenatal period as was admitted in active phase of labour. Two women (2.78%) received magnesium sulphate antenatally for neuroprotection. Fifty-two women (72.22%) went into spontaneous labour and 20 (27.78%) had induced labour at 34 weeks. Forty-nine women (68.06%) delivered by normal vaginal delivery, 1 (1.39%) had an assisted delivery and 22 (30.56%) delivered via caesarean section. Eighteen of the 22 (81.8%) women had emergency caesarean sections; the indications for the emergency caesarean section included fetal distress (n=8), previous cesarean section (n=7), breech presentation (n=2) and antepartum hemorrhage (n=1). The mean latency time from rupture of membranes to delivery was 246.4 hours (SD 310). The mean birthweight was 2003g (range 820 - 3110g) and mean 5-minute Apgar score was 8.5 (SD 1.4). Four (5.5%) neonates has a 5-minute Apgar score <7. Twenty-eight (38.9%) placental swabs were submitted for evaluation. Five swabs (17.9%) showed evidence of infection with E. faecalis, K. pneumoniae, P. mirabilis, Group B streptococcus, E. cloanae, S. bacillus spp. Forty-five (62.5%) placentas were submitted for histological assessment. Twenty-five placentas (55.6%) showed signs of infection/FIRS. Ten (40%) women had Stage 3 chorioamnionitis, 8 (32%) had funisitis and 5 (20%) had sub-chorionitis. Table 2 compares women with and without signs of placental infection. African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 27