DETERMINANTS OF PREMATURE RUPTURE OF MEMBRANE AMONG PREGNANT WOMEN ADMITTED TO PUBLIC HOSPITALS OF CENTRAL ZONE OF TIGRAY, NORTHERN ETHIOPIA, UNMATCHED CASE CONTROL STUDY 2024/25

Abstract

Back ground Pre-labor rupture of membrane is rupture of membranes before to the onset of labor[1]. Premature rupture of membranes, occurring in 1–4% of pregnancies globally, remains a significant obstetric complication affecting both developed and developing countries. It contributes to maternal and neonatal morbidity, mortality, and economic burdens. Despite existing interventions, premature rupture of membranes (PROM) continues to be a public health concern. In Ethiopia, particularly in the war affected Tigray, there is limited evidence on its determinants. Identifying these factors is essential to guide effective prevention and management strategies. Objective: To identify the determinants of premature rupture of membrane among pregnant women admitted to public hospitals in the central zone of Tigray, northern, Ethiopia ,in 2024/2025. Methods: A hospital-based unmatched case–control study was conducted on 264 pregnant women (88 cases and 176 controls) admitted to public hospitals from December 1,2024 –January 30, 2025.Pregnant women admitted to maternity wards of selected hospitals with a painless gush of fluid spilling out from the vaginal canal were considered as PROM. Interviewer-administered questionnaires tools were used to collect data. The data was coded and entered into Epi-info version 7 and exported to SPSS version 27 for analysis. Binary logistic regression was used to test the association between the dependent and independent variable. P value less than 0.25 in bivariable analysis were entered to multivariable analysis to identify the determinants of PROM. Level of significance was declared at P-VALUE <0.05. Odds ratio with 95% confidence interval were used to determine the strength of the association. Result: The study identified several factors significantly associated with PROM. Pregnant women without antenatal care were 4.45 times more likely to experience PROM (AOR = 4.45, 95% CI: 1.78–11.07). A previous history of PROM also showed a strong association (AOR = 3.40, 95% CI: 1.22–9.48). Women with a mid-upper arm circumference (MUAC) below 23 had higher odds of PROM (AOR = 3.18, 95% CI: 1.68–5.99). Additionally, abnormal vaginal discharge (AOR = 3.31, 95% CI: 1.26–8.66), polyhydramnios (AOR = 4.22, 95% CI: 1.41–12.64), and urinary tract infection (UTI) (AOR = 1.59, 95% CI: 0.71–3.61) were identified as contributing factors, although the association with UTI did not reach statistical significance. Conclusion: Antenatal care follow-up, history of PROM, abnormal vaginal discharge, low mid-upper arm circumference (MUAC), and polyhydramnios were identified as significant determinants of premature rupture of membranes. Strengthening antenatal care services and addressing modifiable risk factors through early detection and management may help reduce the occurrence of PROM and its associated complication