Mapping review reveals diverse PROM/PPROM prevalence and adverse neonatal outcomes across the MENA region
Background
Premature rupture of membranes (PROM) involves the spontaneous leakage of amniotic fluid before labor, occurring from 37 weeks gestation onwards with a global prevalence of 10-20%. When this occurs before 37 weeks, it's classified as preterm PROM (PPROM), affecting 1.4-13.7% of pregnancies worldwide. In the Middle East and North Africa (MENA) region, prevalence varies considerably, influenced by differences in healthcare systems and resource availability. Both PROM and PPROM are strongly associated with adverse neonatal outcomes, contributing significantly to perinatal mortality and serious nonlethal complications.
Study Design
This study conducted a comprehensive mapping review to synthesize existing research on premature rupture of membranes (PROM) and preterm PROM (PPROM) specifically among women in the Middle East and North Africa (MENA) region. The review aimed to identify and characterize the diverse risk factors associated with these conditions, as well as to map the range of adverse maternal and neonatal outcomes reported across the region. By systematically collecting and analyzing published literature, the researchers sought to provide a consolidated overview of the current understanding of PROM and PPROM within this geographically and socio-economically varied context, highlighting regional disparities and knowledge gaps.
Results
The mapping review underscored the significant variability in PROM and PPROM prevalence across the MENA region, with reported rates differing substantially between countries. For instance, a two-year study in Saudi Arabia observed PROM rates of 20.1% and PPROM rates of 2.3%, while a five-year single-center study in Egypt reported a PPROM prevalence of 4.1%. Globally, PROM is a major contributor to perinatal mortality, accounting for 18-20% of such deaths. The review highlighted that mortality rates are inversely correlated with gestational age at membrane rupture, meaning earlier PPROM significantly increases the risk of neonatal mortality. Neonates born following PROM face elevated risks of serious nonlethal complications, including low birth weight, early-onset neonatal sepsis, respiratory distress syndrome, retinopathy of prematurity, neurodevelopmental impairment, asphyxia, and neonatal pneumothorax.
The clinical significance of PROM and PPROM is profound, with 18-20% of global perinatal deaths attributed to PROM, emphasizing the critical need for effective management strategies.
Key Findings
- Global PROM prevalence ranges from 10-20%, while PPROM affects 1.4-13.7% of pregnancies.
- PROM accounts for 18-20% of perinatal deaths globally.
- Saudi Arabia reported PROM rates of 20.1% and PPROM rates of 2.3%.
- Egypt reported a PPROM prevalence of 4.1% in a single-center study.
- Neonates face increased risks of low birth weight, sepsis, respiratory distress syndrome, and neurodevelopmental impairment following PROM.
Why It Matters
This mapping review provides a crucial regional synthesis, highlighting the urgent need for tailored public health interventions and improved obstetric care in the MENA region. Understanding the specific risk factors and outcomes within this diverse geographical area is vital for developing targeted prevention and management strategies for PROM and PPROM. Clinicians and policymakers can leverage this consolidated evidence to address disparities in healthcare systems and resource availability, which currently influence prevalence and outcomes. The findings underscore that early identification and access to high-quality obstetric and neonatal care are paramount to reducing the substantial neonatal morbidity and mortality associated with these conditions, potentially informing future guidelines for antenatal care and delivery protocols.
premature rupture of membranes
pprom
mena
neonatal outcomes
perinatal mortality
risk factors