PRETERM ERKEN MEMBRAN RÜPTÜRÜ ILE İLİŞKİLİ RİSK FAKTÖRLERİ

Öz

Preterm prematür membran rüptürü, doğumda neonatal mortalite ve morbidite üzerinde derin etkisi olan ve bu nedenle acil müdahale gerektiren önemli bir obstetrik sorundur. Bu çalışmada üçüncü basamak bir üniversite hastanesine başvuran 100 vaka ve 100 kontrol grubu dahil edildi. Olası risk faktörleri; doğurganlık sayısı, yaş, sigara kullanımı, vücut kitle indeksi, önceki hamilelikten bu yana geçen süre, doğum öyküsü, sosyoekonomik durum, eğitim düzeyi, kafein tüketimi, idrar yolu enfeksiyonu ve önceki kürtaj öyküsü idi. Vaka ve kontrol grupları risk faktörleri açısından istatistiksel olarak karşılaştırıldı. Sonuçlara göre okuma yazma bilmeyen, obezite, idrar yolu enfeksiyonu, kürtaj öyküsü, çok doğum, önceki doğumu iki yıldan önce olan, erken doğum öyküsü olan bu iki grup arasında istatistiksel olarak anlamlı fark vardı (p=0.033, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). Ancak vaka ve kontrol gruplarında yaş aralığı, doğum sayısı, doğum şekli ve kahve kullanımı açısından anlamlı farklılık gözlenmedi (p=0.334, p=0.131, p=0.057 ve p=0.077). Binominal regresyon analizi sonucunda en yüksek risk obezite (OR=7.63; %95 güven aralığı, 1.68-34.66), idrar yolu enfeksiyonu (OR=3.57; %95 güven aralığı, 1.43 –8.93), iki yıldan az önceki doğum (OR=7.53; %95 güven aralığı, 2.85–19.9), geçirilmiş erken doğum (OR=13.42; %95 güven aralığı, 3.62–49.82), sigara/alkol kullanımı (OR=15.97; %95 güven aralığı, 4.99–51.1) (p<0.05) için bulunmuştur. Araştırma sonuçlarına göre sigara/alkol kullanımı ve daha önce erken doğum yapmış olmak en önemli risk faktörleriydi.

Anahtar Kelimeler

• Erken doğum
• preterm prematür membran rüptürü
• risk faktörleri

RISK FACTORS ASSOCIATED WITH PRETERM PREMATURE RUPTURE OF MEMBRANES

Öz

Preterm premature rupture of membranes is an important obstetric problem that has a profound impact on birth, neonatal mortality and morbidity and therefore requires urgent intervention. In this study, 100 cases and 100 control subjects who applied to a tertiary university hospital were included. Possible risk factors included gravidity, age, smoking, body mass index, time since the previous pregnancy, birth history, socioeconomic status, education level, caffeine consumption, urinary tract infection, and a history of previous abortion.The case and control groups were statistically compared based on risk factors. Based on the results there was a statistically significant difference between the case and control groups with respect toliteracy, obesity, urinary tract infections, history of abortion, multiparity, previous birth was before two years, and history of premature birth(p=0.033, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, respectively).However, no significant difference was observed regarding age range, number of births, birth type, and coffee use (p=0.334, p=0.131, p=0.057 and p=0.077). As a result of binominal regression analysis, the highest risk was found for obesity (OR=7.63; 95% confidence interval, 1.68–34.66), urinary tract infection (OR=3.57; 95% confidence interval, 1.43–8.93), previous birth less than two years (OR=7.53; 95% confidence interval, 2.85–19.9), previous preterm birth (OR=13.42; 95% confidence interval, 3.62–49.82), smoking/alcohol use (OR=15.97; 95% confidence interval, 4.99–51.1) (p<0.05).Smoking/alcohol consumption and history of previous preterm birth were the most important risk factors.

Anahtar Kelimeler

• Preterm birth
• preterm prematüre rupture of membranes
• risk factors

Kaynakça

1. Lin D, Hu B, Xiu Y, et al. Risk factors for premature rupture of membranes in pregnant women: a systematic review and meta-analysis. BMJ Open. 2024;14:e077727. doi:10.1136/bmjopen-2024-077727.
2. Chiegue SN, Njamen TN, Wabo B, et al. Risk factors associated with early preterm premature rupture of membranes in women with and without early preterm premature rupture of membranes in Cameroon. Gynecol Reprod Health. 2023;7(3):1-7. doi:10.1016/j.gyne.2023.05.007.
3. Ronzoni S, Boucoiran I, Yudin MH, et al. Guideline No. 430: Diagnosis and management of preterm prelabour rupture of membranes. J Obstet Gynaecol Can. 2022;44(11):1193-1208.e1. doi: 10.1016/j.jogc.2022.08.014.
4. Şehmus P, Remzi A, Bünyamin C,et al. Investigation of fractalkine and MIP-1β levels as markers in premature membrane rupture cases: a prospective cohort study. Clin Exp Obstet Gynecol. 2023;50(7):155-162. doi: 10.31083/j.ceog5007155.
5. Enjamo M, Deribew A, Semagn S, et al. Determinants of premature rupture of membrane (PROM) among pregnant women in southern Ethiopia: A case-control study. Int J Womens Health. 2022;14:455-466. doi:10.2147/IJWH.S352348.
6. Medina TM, Hill DA. Preterm premature rupture of membranes: diagnosis and management. Am Fam Physician. 2006;73(4):659-664. https://www.aafp.org/pubs/afp/issues/2006/0215/p659. html. Published Feb 2006. Accessed December 13.
7. Sae-Lin P, Wanitpongpan P. Incidence and risk factors of preterm premature rupture of membranes in singleton pregnancies at Siriraj Hospital. J Obstet Gynaecol Res. 2019;45(3):573-577. doi:10.1111/jog.13886.
8. Singh D, Usham R, Kamei H. Preterm prelabour rupture of membrane: 1 year study. J Evol Med Dent Sci. 2015;4(13):8495-8499. doi:10.14260/jemds/2015/1232.

9. Okeke T, Okoro O, Ezugwu EC, et al. The incidence and management outcome of preterm premature rupture of membranes (PPROM) in a tertiary hospital in Nigeria. Am J Clin Med Res. 2014;2(1):14-17. doi:10.12691/ajcmr-2-1-4.
10. Endale T, Fentahun N, Gemada D, et al. Maternal and fetal outcomes in term premature rupture of membrane. World J Emerg Med. 2016;7(2):147-152. doi:10.5847/wjem.j.1920-8642.2016.02.011.
11. Mercer B, Goldenberg RL, Das A,et al. The preterm prediction study: Analysis of risk factors for preterm premature rupture of the membranes. J Soc Gynecol Investig. 1996;3(2):350A. doi: 10.1016/1071-5576(96)83030-9.
12. Assefa NE, Berhe H, Girma F, et al. Risk factors of premature rupture of membranes in public hospitals at Mekele city Tigray: a case-control study. BMC Pregnancy Childbirth. 2018;18(1):386. doi: 10.1186/s12884-018-2016-6.
13. Lynch AM, Hart JE, Agwu OC,et al. Association of extremes of prepregnancy BMI with the clinical presentations of preterm birth. Am J Obstet Gynecol. 2014;210(5):428.e1-9. doi:10.1016/j.ajog.2013.12.011.
14. Nohr EA, Bech BH, Vaeth M,et al. Obesity, gestational weight gain, and preterm birth: a study within the Danish National Birth Cohort. Paediatr Perinat Epidemiol. 2007;21(1):5-14. doi:10.1111/j.1365-3016.2007.00762.x.
15. Zhong Y, Cahill AG, Macones GA, et al. The association between prepregnancy maternal body mass index and preterm delivery. Am J Perinatol. 2010;27(4):293-298. doi: 10.1055/s-0029-1241736.
16. Friis CM, Paasche Roland MC, Godang K, et al. Adiposity‐related inflammation: effects of pregnancy. Obesity. 2013;21(1). doi:10.1002/oby.20120.
17. Ramsay JE, Ferrell WR, Crawford L, et al. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002;87(9):4231-4237. doi:10.1210/jc.2002-020311.
18. Marıa A, Sarı USC. Hubungan usia kehamilan dan paritas ibu bersalin dengan kejadian ketuban pecah dini. Jurnal Vokasi Kesehatan. 2016;2(1):10-16.doi:10.30602/jvk.v2i1.48.
19. Hackenhaar AA, Albernaz EP, da Fonseca TM. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections. J Pediatr (Rio J). 2014;90(2):197-202. doi:10.1016/j.jped.2013.08.003.
20. Bouvier D, Forest JC, Blanchon L,et al. Risk factors and outcomes of preterm premature rupture of membranes in a cohort of 6968 pregnant women prospectively recruited. J Clin Med. 2019;8(11):1987. doi:10.3390/jcm8111987.
21. Zhou Q, Zhang W, Xu H, et al. Risk factors for preterm premature rupture of membranes in Chinese women from urban cities. Int J Gynaecol Obstet. 2014;127(3):254-259. doi:10.1016/j.ijgo.2014.06.020.
22. Choudhary M, Rathore SB, Chowdhary J, et al. Pre and post-conception risk factors in PROM. Int J Res Med Sci. 2015;3(10):2594-2598. doi:10.18203/2320-6012.ijrms20150797.
23. Kaye D. Risk factors for preterm premature rupture of membranes at Mulago Hospital, Kampala, Uganda. East Afr Med J. 2001;78(2):65-69. doi:10.4314/eamj.v78i2.9090.
24. Fernando A, Daftary SN, Bhide AG. Premature rupture of membranes. In: Fernando A, Daftary SN, Bhide AG, eds. Practical Guide to High-Risk Pregnancy & Delivery: A South Asian Perspective. 3rd ed. New Delhi: Elsevier; 2008:240-261.
25. Boskabadi H, Zakerihamidi M. Evaluation of maternal risk factors, delivery, and neonatal outcomes of premature rupture of membrane: a systematic review study. J Pediatr Rev. 2018;7(2):77-88. doi:10.22038/jpr.7.2.77.
26. Himes KP, Simhan HN. Risk of recurrent preterm birth and placental pathology. Obstet Gynecol. 2008;112(1):121-126. doi: 10.1097/AOG.0b013e318179f024.
27. Ghidini A, Salafia CM. Histologic placental lesions in women with recurrent preterm delivery. Acta Obstet Gynecol Scand. 2005;84(6):547-550. doi:10.1111/j.0001-6349.2005.00694.x.