Comparison between maternal and neonatal outcome of PPROM in the cases of amniotic fluid index (AFI) of more and less than 5 cm. (4th July 2018) - Mousavi, Ashraf Sadat
Abstract: The study was performed on pregnant women with a gestational age of 26–32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery. Maternal morbidities including chorioamnionitis, placental abruption, uterine atony after delivery and retention of placenta did not show significant difference between the two groups. There was no significant difference between the two groups' amniotic fluid index <5 cm and amniotic fluid index ≥5 cm, regarding neonatal morbidities, except for neonatal sepsis and neonatal death, which were higher in the amniotic fluid index <5 cm group [7(14.6%) versus 1(2.3%), p = .039, RR = 7.7 (95%CI 0.04–0.06) and 11(30.9%) versus 2(4.7%), p = .013, RR = 6.095 (95%CI = 1.26–29.31)]. In the subgroups of two categories of gestational ages of 26 0 –29 6 and 30 0 –34 6, neonatal morbidities were higher in the amniotic fluid index <5 cm group. The results suggest that amniotic fluid index <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by preterm premature rupture of membranes. Impact statement: What is already known on this subject? In a retrospective study in 1993, the relationship between oligohydramnios (which was defined as the largest single packet of fluid less than 2 × 2 cm) at the time of hospital admission, and the outcome of mother, foetus and neonates in a gestational age of less than 35 weeks of pregnancy was evaluated. In the oligohydramnios group, chorioamnionitis and funistis were more common. Also, the mean gestational age at the time of delivery and neonatal weight was less than that of the normal amniotic fluid group. According to these results, it was concluded that a low amniotic fluid volume in the women with preterm premature rupture of membranes (PPROM) can be considered as a prognostic factor in the cases of conservative management of PPROM. In contrast, the other study, which was performed on a larger sample size (290 patients), could not show more cases of amnionitis in the cases of amniotic fluid index (AFI) of less than 5 cm; however, the latency period was shorter in comparison with AFI of more than 5 cm. What do the results of this study add? Chorioamnionitis, placental abruption and uterine atony after delivery, retention of placenta and route of delivery did not show a significant difference between the two groups. Respiratory distress syndrome (RDS), need of surfactant and intubation, intra ventricular haemorrhage (IVH) and duration of neonatal intensive care unit (NICU) admission did not show a significant difference between the two groups; however, the rate of neonatal sepsis and neonatal death were higher in the AFI <5 cm group. What are the implications of these findings for clinical practice and/or further research? The results suggest that AFI <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by PPROM.