TITLE:
Expectant Management of Preterm Ruptured Membranes before 34 Gestational Weeks at the University Hospital of Kinshasa, a Tertiary Referral Hospital in the Democratic Republic of Congo
AUTHORS:
Roger Mbungu Mwimba, Anselme Mbungu Mulaila, Joëlle Lumaya Ambis, Andy Mbangama Muela, Adrien Tandu Umba, Berry Kinkenda Nsiangangu, Malka Salamo Azama, Thérèse Biselele Bakambuvua, Kahindo P. Muyayalo
KEYWORDS:
Premature Rupture of Membranes, Gestational Age, Expectant Management, Pregnancy Outcomes, D. R. Congo
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.7,
July
27,
2022
ABSTRACT: Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed
to assess expectant management of PPROM before 34 weeks at the university
hospital of Kinshasa. We conducted a retrospective analysis of expectantly
managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes
were collected, and all data were analyzed using the SPSS 23.0 software. Of the
113 patients included in the study, 2.6% were diagnosed with PROM before 34
weeks. We observed prolongation of the pregnancy
duration; the median latency period was eight days, and the average
gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%),
severe oligoamnios (7%), and acute fetal distress (4%) were complications
observed during the latency period. In the postpartum period, endometritis
(6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage
(5.3%), and acute respiratory distress syndrome (4.4%) were
complications observed. The risk of infection during the latency period was
significantly associated with irregular (P = 0.045) or lack (P =
0.006) antenatal care (ANC) attendances and
C-Reactive Protein (CRP)
results 6 (P = 0.013). The risk of neonatal death was significantly
associated to infection during the latency period (P = 0.011), irregular
(P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight
g (P =
0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P =
0.021). These findings report first-time pregnancy outcomes related to the
management of PPROM before 34 weeks in our setting. We found that the
conservative attitude adopted allowed the prolongation of pregnancies, reducing
the risks associated with prematurity. Nevertheless,
attendance in good quality ANC could reduce the frequency of PROM and
related adverse outcomes.