Current microbial pattern of patients presenting with prelabour rupture of membranes (prom) at labour ward in Kenyatta National Hospital.

Abstract

Background; in spite of the advances that have been made in neonatal care over the past years, preterm birth and Prelabour rupture of membranes have not reduced. Neonatal mortality and morbidity remains. PROM has been attributed in 30-40 °'0 of preterm birth. Infection has also been shown to be a leading cause of PROM. Wanjala in a study at

KNH found an infection rate of 28.57% in PROM. Studies have shown improved outcome when antibiotics are used in PROM. Main objective: To determine the microbial pattern of patients presenting with PROM at KNH labour ward. Main outcome measure: Escherichia coli was the main pathogenic bacteria isolated accounting for 66.7% in the PROM group. Other bacteria were enterococci. streptococcus viridans. STaphylococcus Sf? and staphylococcus aureus. Study design: Case control study. Study population: Women who presented with PROM at the labour ward of KNH with control group recruited from the antenatal clinics. There was no matching of the two groups. The sample size was 100 with equal proportion of 50 in each arm. Data analysis: this was done using SPSS version 13. Data entry was done into SPSS and . data cleaning done by use of the questionnaires. descriptive data was obtained and further analysis done. Results: A total of 100 questionnaires and laboratory results were analysed. 50 from the PROM group and 50 in the control group. There was no statitistically significant difference in baseline sociodemographic and obstetric characteristics between the two groups. As for the mode of delivery 70% in PROM had SVD compared to 48% of controls with 30% undergoing Cesarean section in PROM group and 52% of controls. There was nocomplications recorded in the mothers both at and after delivery. Escherichia coli was the most common bacterial isolate accounting for 66.7% of bacterial isolate in the PROM group. Other isolates were staphylococcus sp. staphylococcus aureus and streptococcus viridans. With regard to antibiotic sensitivity, there was 100% sensitivity to ceftriaxone. 83.3% sensitivity to both cefuroxime and gentamicin while augmentin had 67.7% sensitivity. Among the newborns. in the PROM group 10% had apgar score <7. while none. 0%. of the controls had apgar score <7 with. 'BU admission rates of 20% and 6% respectively , among the PROM and control groups respectively. Conclusion and recommendations: We recommend that cefuroxime be the antibiotic of choice where its not possible to do endocervical swab. culture and sensitivity