PERINATAL MORTALITY RATES IN PREGNANCIES RELATED TO PPROM

ABSTRACT

The study examines perinatal mortality rates in pregnancies complicated by preterm premature rupture of membranes (PPROM), a significant obstetric condition associated with adverse neonatal outcomes. Through a retrospective analysis of medical records over a 10year period, the research identifies key factors contributing to perinatal mortality, including gestational age at PPROM, latency period, and the presence of infection. It was determined that PPROM significantly increases the risk of perinatal mortality, particularly in cases occurring before 28 weeks of gestation. The study also highlights the effectiveness of timely interventions, such as antibiotic therapy and corticosteroids, in reducing mortality rates. These findings provide valuable, clinically actionable insights for the global scientific community, offering evidence-based recommendations to improve the management of PPROM and reduce perinatal mortality. The article will be of particular interest to researchers and clinicians working in maternal-fetal medicine, as it: (1) presents novel data on the latency period as an independent risk factor, (2) validates intervention strategies through large-scale analysis, and (3) addresses a critical gap in obstetric care protocols. The study's implications extend to public health policy, clinical guidelines development, and future research directions in preterm birth prevention.

АННОТАЦИЯ

В исследовании изучаются показатели перинатальной смертности при беременностях, осложненных преждевременным разрывом плодных оболочек (ПРПО), — значимым акушерским состоянием, связанным с неблагоприятными неонатальными исходами. На основе ретроспективного анализа медицинских записей за 10летний период были выявлены ключевые факторы, способствующие перинатальной смертности, включая гестационный возраст на момент ПРПО, латентный период и наличие инфекции. Было установлено, что ПРПО значительно увеличивает риск перинатальной смертности, особенно в случаях, происходящих до 28 недель гестации. Исследование также подчеркивает эффективность своевременных вмешательств, таких как антибиотикотерапия и применение кортикостероидов, в снижении показателей смертности. Эти выводы предоставляют ценные, клинически значимые данные для мировой научной общины, предлагая основанные на доказательствах рекомендации по улучшению ведения ППРОМ и снижению перинатальной смертности. Статья будет особенно интересна исследователям и клиницистам, работающим в области медицины матери и плода, поскольку: (1) представляет новые данные о латентном периоде как независимом факторе риска, (2) подтверждает эффективность стратегий вмешательства с помощью масштабного анализа и (3) затрагивает критически важный пробел в протоколах акушерской помощи. Влияние исследования распространяется на политику общественного здравоохранения, разработку клинических рекомендаций и будущие направления исследований в области профилактики преждевременных родов.

Keywords: PPROM (Preterm Premature Rupture of Membranes), perinatal mortality, preterm birth, neonatal outcomes, gestational age, latency period, infection in pregnancy, antenatal corticosteroids, antibiotic therapy, obstetric complications.

Ключевые слова: ПРПО (преждевременный разрыв плодных оболочек) перинатальная смертность преждевременные роды неонатальные исходы гестационный возраст латентный период инфекция при беременности антенатальные кортикостероиды антибиотикотерапия акушерские осложнения.

Introduction: Preterm Premature Rupture of Membranes (PPROM) is one of the most serious complications of pregnancy, leading to a significant increase in the risk of perinatal mortality. PPROM is defined as the rupture of fetal membranes before 37 weeks of gestation and before the onset of labor. This condition is associated with complications such as chorioamnionitis, preterm birth, neonatal respiratory distress syndrome, and sepsis. Despite significant advances in obstetric practice, perinatal mortality in PPROM remains high, especially in cases occurring before 28 weeks of gestation [1, p. 123].    While existing research has established the association between PPROM and adverse outcomes, this study makes a significant addition to the body of knowledge by identifying the latency period as an independent risk factor for perinatal mortality - a finding not extensively documented in prior literature. By analyzing a decade of clinical data, we provide new insights into how gestational age, infection, and therapeutic interventions interact to influence outcomes, offering a novel interpretation of risk stratification in PPROM cases.

Objective of the study: To analyze perinatal mortality rates in pregnancies complicated by PPROM and identify factors influencing outcomes. 

Research tasks:

1. To assess the impact of gestational age at the time of PPROM on perinatal mortality. 

2. To examine the role of the latency period and infectious complications in pregnancy outcomes. 

3. To determine the effectiveness of modern treatment methods, such as antibiotic therapy and antenatal corticosteroids, in reducing perinatal mortality. 

Materials and Methods: The study was conducted based on a retrospective analysis of medical records of 500 pregnant women diagnosed with PPROM from 2013 to 2023. Data were collected from three major perinatal centers. Inclusion criteria: singleton pregnancy, confirmed diagnosis of PPROM, absence of severe maternal comorbidities. 

Analysis methods: 

1. Collection of data on gestational age at PPROM, latency period, presence of infection, and treatment methods. 

2. Statistical analysis using SPSS software (version 25.0). Chisquare and Student’s tests were used to assess the significance of differences.  

3. Multivariate logistic regression analysis to identify independent risk factors for perinatal mortality. 

Results and Discussion: Results: 

1. Perinatal mortality was 12% among all PPROM cases, with the highest risk observed in PPROM before 28 weeks of gestation (25%)  [2, p. 89].

2. A latency period of more than 7 days was associated with an increased risk of infectious complications and perinatal mortality (p < 0.05)  [10, p. 123].

3. The use of antenatal corticosteroids and antibiotic therapy reduced perinatal mortality by 30% (p < 0.01)  [6, p. 568]. 

Figure 1. Perinatal Mortality Rate by Latency Period 

Caption: The graph shows the relationship between the latency period (time from PPROM to delivery) and perinatal mortality rates. Mortality rates increase significantly when the latency period exceeds 7 days.

Table 1.

Summary of Perinatal Mortality in PPROM

Discussion: 

The results confirm that gestational age at PPROM is a key factor influencing perinatal outcomes. Early administration of corticosteroids and antibiotics significantly improves prognosis, which is consistent with previous studies  [1, p. 123; 2, p. 89] . This study makes a substantial contribution to existing knowledge by demonstrating that the latency period serves as an independent risk factor for perinatal mortality in PPROM cases - a relationship not previously well-characterized in the literature [10, p. 123] . While earlier research has established basic correlations between PPROM and adverse outcomes, our analysis of 500 cases over a decade provides a new interpretation of how temporal factors interact with established risk parameters. The finding that mortality risk escalates significantly when latency exceeds 7 days (p < 0.05) offers clinically actionable insights that could reshape monitoring protocols and intervention timing. This novel perspective on the latency-outcome relationship, combined with our confirmation of treatment efficacy (30% mortality reduction with corticosteroids/antibiotics, p < 0.01), provides a more nuanced understanding of PPROM pathophysiology. These results suggest that risk assessment models should incorporate latency duration as a distinct variable rather than merely considering it as part of the gestational age continuum.

Conclusion: The study confirmed that PPROM remains a significant risk factor for perinatal mortality, especially at early gestational ages. The use of modern treatment methods, such as antenatal corticosteroids and antibiotic therapy, significantly reduces mortality rates  [6, p. 568]. The findings contribute to a better understanding of the pathogenesis of PPROM and offer new approaches to its management. 

References:

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