High diversity in the vaginal microbiome in women following preterm premature rupture of membranes and its effect on fetomaternal outcome

Background: Premature rupture of the membranes (PROM) complicates 3% of pregnancies and its associated with adverse perinatal outcome. Methods: This was a case control study conducted over a period of two years. Our aim was to evaluate the bacterial colonization of genital tract of antenatal patients who presented with preterm premature rupture of membranes and their maternal and neonatal complications. We studied 6023 patients during our study period among which 156 patients presented with preterm premature rupture of membranes. Results: PPROM was found more commonly among age 25-30 years (46.79%) with p<0.001. Out of 156 pregnant women with PPROM, only 16 patients (10.26%) developed clinical chorioamnionitis. We observed that 43.59% patients (n=68) with PPROM underwent LSCS which was significantly higher than control group (19.93%). Among them 81.41% (n=127) of the patients delivered within 24 hours of admission. Among 156 patients, 94 (59.12%) mothers had babies with birth weight ranging between 1.5-2.5 kg as compared to control group where 30.51% mothers had low birth weight babies. The difference was statistically significant. Approximately 18.24% babies developed respiratory distress syndrome requiring ICU care in study group as compared to 3.03% in control group and the difference was statistically significant. Conclusions: It is important to diagnose the PPROM early and manage the patient until delivery for better outcome. Timely intervention after proper analysis of risk and benefit of early termination helps in reducing adverse perinatal outcomes, reduced NICU admissions and unnecessary interventions for neonates.