Premature rupture of membranes before 34 weeks in an african context: maternal and fetal prognosis at the Gabriel Toure university hospital in Bamako, Mali

Abstract

The aim of this work was to describe the management and maternal-fetal prognosis of prelabour rupture of membranes (PROM) before 34 weeks amenorrhea (WA) a country with limited resources.

Methodology: This study took place at CHU Gabriel Toure over a 24-month period from 2018 to 2020. It was an analytical cross-sectional study. Cases of (PROM) ≥22 WA and having given birth were included. The statistical tests used were the odds ratio and the 95% confidence interval. Results: We collected 185 PROM before 34 WA or 2.8% and 85 cases of (PROM) after 34 WA or 1.3% out of 6642 childbirth. The average age of the patients was 27 years with ranges of 16 to 45 years. The means and methods of managing PROM before 34 weeks were: hospitalization with rest (100%), Trendelenburg(100%), antibiotic therapy (100%), materno-fetal monitoring (100%), clean lining ( 95.7%), corticosteroid therapy (95.6%), tocolysis (49.2%), neuroprotection (95.6%), oxygenation (27.0%), aspiration (30.4%) vitamin K1 (46, 3%) and transfer to neonatology (53.3%). Fever (24.8%), chorioamnionitis (4.1%), intrapartum hemorrhage (0.7%) were noted in the mother. Neonatal complications were prematurity (68.0%); infection (58.1%), malformation (2.6%) and hypotrophy 13.3%. Perinatal death was 8.8 times higher in (PROM) before 34 weeks. Conclusion: The fight against perinatal deaths requires the correct management and prevention of PMR before 34 weeks.