Preterm premature rupture of membranes (PROM) is a common occurrence in obstetric practice. It complicates 3% to 10% of pregnancies worldwide. It exposes the mother to a risk of infection and her fetus to premature delivery [1] . These complications are all the more serious when the rupture occurs prematurely.

In Cameroon, according to a study conducted by Pisoh et al. in 2021, PPROM significantly contributes to maternal and perinatal morbidity and mortality. According to this study, 10.53% of women who had preterm premature rupture of membranes (PPROM) had an unfavorable outcome, as did the newborns from these pregnancies (OR = 14.44; 95% CI: 5.42 - 38.48; p < 0.001) [2] . To our knowledge, very few studies clearly present these adverse maternal and fetal outcomes after PPROM in Cameroon. The objectives of this study were to determine the incidence of PPROM, then to assess maternal, fetal and early neonatal outcomes after PPROM, and finally to identify the factors associated with neonatal death in the context of PPROM.

PPROM is a common condition during both preterm and full-term pregnancies. According to data from African literature, it has a prevalence of 4.63% in Mali and an incidence of 10% in Algeria [3] [4] . In our series, the incidence of PPROM was 6.18%, which is higher than that found in other national studies on PPROM (1.6%, Kasia et al.; 4.91%, Pisoh et al.) [2] [5] . This difference could be explained by the fact that we worked in two recruitment and referral sites for obstetric complications. In 2017 in Cameroon, Belinga et al. found that premature rupture of membranes was statistically significant in patients referred for obstetric complications in Yaoundé [6] . In addition, our population consisted largely of women who had given birth only a few times (77%), in whom PPROM is more common due to the increased fragility of the amniotic membranes, unlike multiparous women, whose membranes have become thicker and more resistant due to repeated pressure during previous pregnancies.

For maternal prognosis after PPROM, a study conducted in India in 2007 by Menon et al. found a prevalence of 40% of premature births in the context of PPROM [7] . This rate was as high as that found in our study, which was 50.9%. Indeed, the literature describes that any woman with premature rupture of membranes will spontaneously go into labor 24 hours after the rupture or even earlier, explaining this high rate of threatened premature delivery in cases of premature rupture of membranes before term. Twenty-five per cent of women had resorted to caesarean section as the mode of delivery. Intrauterine infections were found at rates of 1.8% for chorioamnionitis and 4.5% for endometritis. According to the literature, the genital tract is continuously infected in pregnant women. Thus, certain obstetric situations, such as PPROM, expose these women to ascending infections. In 2002 in Cameroon, Foumane et al. found a clear predominance of Candida albicans (48.45%), Gardnerella vaginalis (22.16%) and Group B β-hemolytic streptococcus (6.70%) during pregnancy [8] . These variations in genital flora during pregnancy may explain the occurrence of intrauterine infections in our series, where patients remained on expectant management for several days without antibiotic coverage (28.6% of women). Furthermore, screening for Group B streptococcus is not systematic in women in our environment.

Neonatal and perinatal outcomes were associated with significant morbidity and mortality. In our study, we recorded complications such as prematurity (52.8%), neonatal infection (73.14%) and neonatal mortality (12.9%). Neonatal infections are justified by our high rate of prematurity, given that we considered RPMs from 28 weeks of gestation (age of extreme prematurity). Premature babies are known to be weak and vulnerable due to their immaturity, which exposes them much more than others to infections and, ultimately, death [9] [10] . Furthermore, this high rate of neonatal infections could also be explained by the fact that, in our context, screening for Group B streptococcus is not systematic during pregnancy, even though this bacterium poses a high risk of neonatal infection given the high frequency of vaginal deliveries (75% in our study). Indeed, Group B streptococcus carriage was found in some women during a study conducted in Cameroon in 2009 by Foumane et al. [8] ; the newborn can therefore become infected when passing through the mother’s genital tract. This finding highlights the importance of screening for Group B streptococcus during pregnancy or risk-based prophylaxis such as PROM. The mortality rate found in our series was higher than those reported by Coulibaly in Mali (4.8%) and Chibani in Algeria (7.5%) [3] [4] . This difference may be due to the fact that we considered deaths at birth and deaths in neonatal hospitalization. In addition, neonatal infections worsen the prognosis due to their severity and more pronounced immune immaturity. In 2008 in Cameroon, Chelo et al. found an association between neonatal infection and mortality [10] . Furthermore, as our study was conducted in Africa with limited technical resources, we expected this high neonatal mortality rate. In 2017 in Mali, Coulibaly et al. also reported that limited technical resources were a determining factor in neonatal morbidity after RPM [3] .

Approximately 38% of the newborns included in our study required resuscitation at birth due to the high number of cases of neonatal asphyxia (16.7%) and respiratory distress (22.2%). This result could be explained by the pulmonary immaturity of premature newborns and the ineffective pulmonary maturation in many of these newborns; only 64% of women had received corticosteroid therapy, which is due to the fact that these women arrived at the maternity ward already in labor and therefore gave birth quickly. In addition, due to insufficient resources, there was a delay in the availability of medication. In 2008 in Cameroon, Chelo et al. reported that neonatal asphyxia was the leading cause of death among newborns [10] . Our results confirm the link between an Apgar score < 7 at 5 minutes and neonatal death (OR: 9.50; 95% CI: 2.12 - 42.56; p = 0.001).

Some limitations observed:

PPROM remains a common occurrence in obstetrics. The maternal prognosis continues to be dominated by significant morbidity. The fetal and perinatal outcome remains unfavorable in our setting, compounded by a considerable rate of neonatal mortality.