A prospective population-based study of preterm pre-labour rupture of membranes between 24 and 34 weeks of gestation in Cape Town Metro East: measuring protocol intervention fidelity and clinical outcome

Mbungu, N. (2018-12)

Thesis (MMed)--Stellenbosch University, 2018.

Thesis

BACKGROUND: Preterm premature rupture of membranes (PPROM) complicates 2 to 3% of pregnancies and is associated with significant neonatal mortality and morbidity. Intrauterine infection is the most common cause of PPROM, approximately 50% overall. OBJECTIVES: The primary objective of this study was to evaluate the quality of care delivered to women undergoing inpatient management with PPROM compared with a recently instituted hospital protocol. A secondary objective was to investigate the maternal and neonatal outcome of conservative management of PPROM 24-34 weeks in Tygerberg Hospital (TBH), and to determine the impact of the protocol on hospital stay (bed occupancy rate). METHODS:A prospective population-based observational study on patients with confirmed PPROM managed conservatively, between 24 and 34 weeks gestation at TBH from 01 February 2014 to 31 January 2015. The charts of all patients (n=353) evaluated for possible PPROM were retrieved from the online TBH records system, Enterprise Content Management (ECM). Ninety-eight patients were eligible for the study. RESULTS: The cumulative incidence of PPROM in the drainage region during this study period was 2.86 per 1000. The median gestational age was at delivery was 31 weeks and 4 days and most babies were appropriately grown for their gestation with but with 18 babies born below the 10th centile for birth weight according to their gestation. The median birth weight was 1690g. The most identifiable associated risk factor was cigarette smoking (35%). In 90% of patients with PPROM counselling was not done. Clear nursing prescriptions were not given in 90% of patients as per protocol and more than 65% of patients were not given betamethasone at correct intervals. Close to 60% of women were given antibiotics correctly and 86% of patients were checked for signs of chorioamnionitis twice day as per protocol. Most babies were admitted in high care with a median average stay of 8 days, but one stayed a maximum of 188 days and 6 babies died from severe prematurity. Other neonatal complications included neonatal jaundice (60%), respiratory distress (41%), sepsis (7%), necrotising enterocolitis (3%) and patent ductus arteriosus (4%). Total length of stay of mothers in hospital was a median of 6 days and none of the mothers had complications post-delivery. CONCLUSION: PPROM is a serious complication of pregnancy and associated with low birth weight, preterm delivery significant perinatal morbidity and mortality and prolonged hospital stay, however it does not have major impact on maternal outcome as seen in this study. More attention needs to be given to provide adequate counselling for women admitted with PPROM and train nursing personnel to administer BMZ and antibiotics as prescribed.

AGTERGROND: Voortydse voorkraamse ruptuur van vliese (VVRVV) kompliseer 2-3% van alle swangerskappe en veroorsaak betekenisvolle morbiditeit en mortaliteit. Die mees algemene oorsaak, in amper 50% van gevalle, is intra-uteriene infeksie. DOEL: Die hoofdoel van hierdie studie was om die kwaliteit van sorg te evalueer wat aangebied is aan vrouens wat toegelaat is met VVRVV. Die standaard waarteen die sorg gemeet was, was ‘n protokol vir die hantering van VVRVV wat kort vantevore implementeer is. ‘n Bykomende doel was om na die uitkoms van moeders en babas te kyk wat konserwatiewe hantering vir VVRVV ondergaan het. Daarby was gekyk na die impak wat die protokol op bedbesetting het. METODE: Hierdie was ‘n prospektiewe bevolkings-gebaseerde waarnemingsstudie op pasiënte met bevestigde VVRVV tussen 24 en 34 weke wat toegelaat is vir konserwatiewe hantering by Tygerberg Hospitaal (TBH). Die tydperk van evaluasie was 01 Februarie 2014 tot 31 Januarie 2015. Die notas van alle pasiënte met vermoedelike VVRVV was deurgegaan op die aanlyn sisteem Enterprise Content Management. Agt-en-negentig vrouens het aan die toelatingsvereistes vir die studie voldoen. RESULTATE: Die insidensie van VVRVV in die hele gesondheidsdistrik was 2.86 per 1000 tydens die studie periode. Die mediane swangerskapsduur met verlossing was 31 weke en 4 dae. Meeste babas was toepaslik gegroei vir hulle swangerskapsduur, maar 18 was kleiner as verwag (klein vir datums, gedefiniëer as ‘n geboortegewig onder die 10de persentiel). Die mediane geboortegewig was 1690g. Die mees algemene faktor wat verband gehou het met VVRVV was sigaretrook, in 35% van gevalle. Negentig present van alle vrouens het geen raadgewing met toelating ontvang nie. Dieselfde persentasie is toegelaat sonder duidelike verpleegvoorskrifte en 65% van vrouens het nie die voorgeskryfde steroïed behandeling op die regte tyd gekry nie. Amper 60% van vrouens het antibiotika op die regte tyd ontvang en 86% is daagliks ondersoek vir tekens van infeksie. Meeste babas het hoë sorg behandeling verkry en die mediane verblyf in die eenheid was 8 dae. Een baba het 188 dae behandeling benodig en 6 is oorlede aan erge prematuriteit. Ander komplikasies vir die babas was geelsug (60%), asemhalingsnood (41%), infeksie (7%) en nekrotiserende enterokolitis (3%). Die mediane verblyf van die moeders was 6 dae en geen van hulle het enige ernstige kompliksies gehad nie. GEVOLGTREKKING: VVRVV is ‘n ernstige komplikasie van swangerskap en hou verband met lae geboortegewig, voortydse kraam en betekenisvolle morbiditiet en mortaliteit vir die babas. Dis belangrik dat alle vrouens met die probleem goeie raadgewing ontvang met toelating sodat hulle bewus is van die omvang van die probleem.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105050
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