Perinatal and Early Neonatal Outcomes of Women With Premature Rupture of Membranes in Referral Health Care Facilities in the Ivory Coast: A Low-and Middle-Income Country

Background: The incidence of pregnancies with premature rupture of membranes (PROM) is between 1% and 10% worldwide. This study aimed to examine the perinatal and early neonatal outcomes in PROM in a reference healthcare maternity in a low- and middle-resource country of sub-Saharan Africa. Methods: A cross-sectional study with an analytical focus was conducted from 2019 to 2023, involving 789 PROM cases out of 22,570 deliveries, representing 3.5% of the total admissions. This study analyzed demographic data, obstetric history, prenatal care, and perinatal outcomes. Univariate and multivariate statistical analyses were performed to identify risk factors for maternal and neonatal complications. Results: The average age of the pregnant women was 32 years, with 76.7% aged between 20 and 40 years. The majority of births (62.9%) occurred between 28 and 34 weeks of gestation (WG), indicating a high prevalence of prematurity in the studied sample. Full-term births (>37 weeks) accounted for only 15.3%, indicating a concerning proportion of preterm deliveries. The majority of the women were unemployed (66.0%), and 40.7% had no formal education. An obstetric history of preterm premature rupture of membranes (PPROM) was reported in 57.4% of cases, and 16.7% had cervical incompetence. The median number of prenatal visits was 4 (range: 0–8). Neonatal mortality was 11.2%, with preterm infants accounting for 70.5% of the deaths. Delayed admission (>24 hours) and abnormal amniotic fluid (AF) were significantly associated with maternal infections (p < 0.001). The multivariate analysis revealed delayed admission [adjusted odds ratio (aOR): 19.82; p < 0.001] and abnormal AF (aOR: 4.38; p < 0.001) as strong predictors of maternal infections. For neonatal mortality, delays of more than 72 hours (aOR: 1.88; p = 0.007) and low birth weight (aOR: 42.55; p < 0.001) were also identified as risk factors. Conclusions: PROM is a common obstetric emergency associated with significant morbidity, limited resources, and socioeconomic challenges. This study highlights management gaps, emphasizing the need for improved prenatal care, early risk factor prevention, and the adaptation of strategies to local contexts to reduce complications.