A 32-year-old lady who was 28 weeks pregnant was referred from a Hospital at Ottanchathram on 23/10/16 with a history of watery per vaginal loss for the past 2 days. This was her second pregnancy and she had an Emergency Caesarean section during the first time. She had Type 2 diabetes and was on treatment. Her pregnancy was largely uneventful except for one episode of mild per vaginal spotting during the second trimester. On Examination, the vitals were stable, no contractions were palpable and Per speculum examination revealed clear fluid loss from the cervix confirming Preterm Prelabor rupture of membranes. Blood investigations revealed a raised white cell count and CRP with suboptimally controlled diabetes. An Ultrasound scan revealed a single live foetus in breech presentation with a reduced Amniotic fluid index of 1.3 and normal Umbilical and Middle cerebral artery Dopplers. She was commenced on Erythromycin 500mg BD, Levemir 6 units BD, Homolog 7 units TDS and given 2 doses of Betamethasone 12mg, 24 hrs apart. She was counselled about the potential risks of prematurity by the neonatologist. She was closely monitored with regular blood tests, vaginal swabs and Ultrasound scans. The Maternal and Foetal conditions were stable for 2 weeks. On 8/11/2016 at 30+2 weeks, she developed contractions. She was commenced on Magnesium sulphate infusion for Foetal neuroprotection as per the NICE recommendations. As her contractions progressed, a decision was made to deliver her. An Emergency Caesarean section was done in view of previous Caesarean with a breech presentation and an alive female baby was delivered in good condition at 2:43 pm. The baby weighed 1302 Gms and APGARS were 7 at 1 and 9 at 5.

The baby was admitted to the Neonatal Unit in view of prematurity. The baby had mild respiratory distress and was started on CPAP, showed improvement and was weaned off in day 3. In view of PPROM, the baby was started on antibiotics. However, the septic screen was negative and antibiotics were stopped after 3 days. The baby was started on IV fluids initially and expressed breast milk was started at 5 hours of life and gradually increased to full feeds by Day 8. The baby had a normal cranial Ultrasound and Metabolic screening. The baby was discharged on 9/12/2016 and the discharge weight was 1670gms

Discussion

Every year 15 million babies are born preterm and preterm delivery is the leading cause of deaths for babies under the age of 5. India leads the world in having the highest number of babies born preterm. The mortality rate for a baby born at 30 weeks is around 8%, the incidence of Respiratory distress is around 43% and sepsis of around 8%. The management of both the mother and the baby were in accordance with the International guidelines and protocols resulting in a good outcome.