Rupture prématurée des membranes à terme: facteurs pronostiques et conséquences néonatales

Prelabour rupture of membranes (PROM) at term occurs in 5 to 10% of pregnancies. It accounts for a significant proportion of neonatal morbidity and mortality. The aim of this case study was to determine the maternal and obstetric prognostic factors as well as full-term newborns outcomes in pregnancies complicated by prelabour rupture of membranes in patients hospitalized or managed at the outpatient clinic. We conducted a retrospective study of all cases of full-term infants born to mothers whose pregnancy was complicated by PROM, recorded in the neonatology department at the Children’s Hospital of Rabat between 1 January and 31 July 2014. During the study period we collected 144 cases of PROM isolated from a total of 2,400 live births (LB), ie a prevalence of live births (6%), distributed as follows: 6 cases of PROM (4%) between 6 and 12 hours, 14 cases (9.7%) between 12 and 18 hours, 28 cases (19.4%) between 18 and 24 hours and 96 cases (66.6%) of more than 24 hours. The majority of parturients were within the age-group 25-35 years with a rate of 52%. The diagnosis of associated chorioamniotitis was retained in 8.3% of cases. Parturients were treated with oral or parenteral antibiotic prophylaxis in 28% of cases with clear amniotic fluid in 81% of cases. The diagnosis of probable MFI was retained in 46 cases, 65.2% in the subgroup > 18 h versus 26% and 8.7% in subgroups 12-18 h and <12 h respectively. On admission, there was a male predominance of 58.3%, newborns were asymptomatic in 76% of cases, they suffered from respiratory distress in 42.8% of cases, jaundice in 31.45% of cases, fever in 14.2% of cases and signs of neurological distress in 11.5% of cases. All hospitalized newborns (72% of cases), were treated with antibiotics for a period ranging from 5 to 10 days with an average hospital stay of 2.44 days. This case study highlights the significant risk of MFI associated with PROM even in pregnant woman at term. This risk is major when rupture of membranes occurs after 24 hours of time. In the majority of cases the amniotic fluid is clear and newborns are asymptomatic on admission, leaving antibiotic therapy in these newborns a controversial subject.