The role of infection in preterm premature rupture of membranes

Introduction: Preterm premature rupture of membranes (PPROM) is rupture of membranes prior to 37 weeks’ gestation before the onset of labor. 85 % of neonatal morbidity and mortality is a result of prematurity. PPROM is associated with 30-40% of preterm deliveries and is the leading identifiable cause of preterm delivery. When PPROM occurs remote from term, significant risks of morbidity and mortality are present for both the fetus and the mother. Objective: The aim of the study was to evaluate the role of infection in preterm premature rupture of membranes. Materials and methods: The clinical study was based on retrospective analysis of 417 medical records of patients who delivered preterm in the second Obstetric Department of the Research Institute of Mother and Child’s Health Care during one year (1.01-31.12.2010). Historical data, complications of pregnancy, birth and postpartum period and newborn status were analyzed in all patients included in the study. PPROM diagnosis was established based on clinical examination, laboratory and instrumental data. Results and discussions: Preterm premature rupture of membranes (PPROM) occurred in 42 % pregnancies with the gestational age < 36 weeks and 6 days. The incidence correlates with the literature data 30-56 %. In our study vaginal infection (mainly nonspecific) was detected in 19, 86% of cases (according to clinical examination, bacterioscopic and bacteriological examination). According to the studied medical records, choriodecidual infection was diagnosed in 8.58% of cases. Pathomorphological examination of placenta and annexes revealed leukocyte parietal chorioamnionitis, phlebitis, and umbilical funiculitis. 65% of pregnant women had a latency period > 24 hours. Some authors insist on the fact that prolongation of the latency period increases the risk of infectious diseases, others believe that antibiotics reduce the risk of infection to the minimum. According to the studied medical records the major part of patients with prolonged latency period received antibiotics as recommended by standardized clinical protocol. The literature data show that the main danger of prolonged latency period represents intrauterine infection of the fetus. 31, 2% of premature newborns had the risk to develop an intrauterine infection, 21.8% of them developed unilateral or bilateral congenital pneumonia, 35.5% were subject to antibacterial therapy. Congenital pneumonia, neonatal sepsis and respiratory distress of the newborn are the major causes of perinatal morbidity and mortality. Conclusions: 1. PPROM occurred in 42 % of pregnancies with the gestational age < 36 weeks and 6 days which correlates with the literature data. This means that every second the preterm birth is due to the preterm rupture of membranes. 2. Infection represents the leading cause of PPROM (vaginal infection was detected in 19, 86 % of cases, choriodecidual infection in 8.58% of cases)