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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Prelabour rupture of membranes &#40;PROM&#41; is a rupture of the amniotic membrane before the labor process&#46; It is a condition frequently found at the end of pregnancy&#46; PROM incidence is about 3&#37; of all pregnancies&#44; with 70&#37; are term pregnancies&#59; it varies about 5&#8211;10&#37; of all deliveries&#46; PROM is more frequent in developing countries&#46; The prompt onset of spontaneous labor generally follows <a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#8211;4</span></a> term PROM&#44; and it complicates 8&#37; of pregnancies&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">5&#44;6</span></a> Since the exact etiology of PROM is multifactorial and&#44; in some cases yet still unclear&#44; effective treatment for preventing PROM is not certain yet&#46; The impact of PROM&#44; especially on neonatal morbidity and mortality&#44; is noteworthy&#44; so it is pertinent to identify factors associated with PROM in order to anticipate PROM when it happens&#44; to reduce the occurrence of adverse effects of PROM toward maternal and neonatal outcomes&#44; and to promote the health of mothers and neonates&#46; Due to PROM&#44; frequent maternal complications are acute chorioamnionitis&#44; subclinical chorioamnionitis&#44; premature placental separation&#44; and postpartum endometritis&#46; Meanwhile&#44; common complications of PROM to neonates are prematurity &#40;the most common complication&#41;&#44; sepsis&#44; asphyxia&#44; and respiratory distress syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Extensive efforts were made to find out factors associated with PROM&#46; A hospital-based study by Addisu et al&#46; &#40;2020&#41; revealed that pathological vaginal discharge&#44; urinary tract infection&#44; vaginal hemorrhage during pregnancy&#44; and history of PROM in a previous pregnancy are factors associated with PROM&#46; In comparison&#44; Endale et al&#46; &#40;2016&#41; found that PROM duration and maternal residential sites were associated with PROM outcomes&#46; Another study by Eleje et al&#46; &#40;2020&#41; showed that the Chorioquick test could be used as a modality to detect chorioamnionitis in PROM patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7&#8211;9</span></a> PROM&#39;s high-risk factors categorized as preventable &#40;include maternal smoking&#44; more than three cups of coffee per day in the first trimester&#44; vaginal colonization by&#58; <span class="elsevierStyleItalic">Chlamydia trachomatis</span>&#44; <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#44; Group B streptococci&#41; and nonpreventable &#40;include the history of PROM&#44; vaginal bleeding in the first and second trimesters&#44; cervical length &#60;2&#46;5cm&#44; positive fibronectin&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">PROM remains an important determinant for maternal morbidity and fetal and neonatal morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Timely identification of maternal risk factors helps to reduce the incidence and severity of PROM complications&#46; Therefore&#44; it is necessary to study factors associated with PROM and mode of delivery&#44; as such that proper management could be given to mothers with certain risk factors besides given a choice for the appropriate mode of delivery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective cross-sectional study within a one-year observational period &#40;January 1&#44; 2019&#44; until December 31&#44; 2019&#41;&#46; The population of the study was women in labor&#46; Samples were women who gave birth in St&#46; Khadijah I Mother and Child Hospital&#46; This study was approved by the Health Research Ethical Committee&#44; Faculty of Medicine Hasanuddin University&#46; Data were collected from medical records at St&#46; Khadijah I Mother and Child Hospital implementing consecutive sampling and statistically analyzed using the SPSS program&#46; Bivariate analysis was performed using the Chi-square test&#44; and multivariate analysis was using logistic regression&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">Within the period of the study&#44; there were 4003 samples&#46; Samples were categorized as PROM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>259 subjects&#59; hence the incidence of PROM in 2019 is 6&#46;47&#37; of all deliveries at St&#46; Khadijah I Mother and Child Hospital Makassar&#41; as case group and not PROM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3744 subjects&#41; as a control group&#46; Inclusion criteria were&#58; PROM subjects were diagnosed by the history of per vaginal fluid leakage and nitrazine test&#44; term pregnancy &#40;&#62;37 weeks of gestational age based on last menstrual period&#41;&#44; and complete data on the medical record&#46; Exclusion criteria consist of&#58; patients were referred or dead before delivery management was performed and patients admitted to the hospital on December 31&#44; 2018&#44; and the delivery process occurred on January 1&#44; 2019&#44; and also patients admitted to the hospital on December 31&#44; 2019&#44; and the delivery process occurred on January 1&#44; 2020&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results of the study were as follows&#58; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of study subjects&#46; Statistical analysis revealed that maternal characteristics based on maternal age&#44; educational status&#44; and occupational status were homogenous&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> described that parity and Body Mass Index &#40;BMI&#41; were factors associated with PROM&#44; with BMI was the stronger factors related to PROM&#46; The probability of obese pregnant women having PROM was two folds compared to normal pregnant women&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> revealed that PROM was not an indication for performing a cesarean section&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Based on gestational age&#44; PROM was categorized as&#58; term PROM &#40;PROM that occurred at &#62;37 weeks of gestation&#41;&#44; preterm PROM &#40;PROM that happened &#60;37 weeks of gestation&#41;&#44; and Previable PROM &#40;PROM before the fetus is viable&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> As a secondary health care&#44; St&#46; Khadijah I mother and child hospital does not have NICU facilities&#46; Thus preterm cases were referred to health care with more advanced facilities&#46; In this study&#44; all PROM cases were term PROM&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Infection in pregnancy brings about a reduction in membrane tensile strength which eventually caused PROM&#46; Membrane tensile strength reduction was rendered by the collagenolytic effect of metalloproteinases&#44; the effect of bacterial proteases&#44; or repeated stretching by uterine contractions&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In this study&#44; PROM is more frequent in primigravidae than multiparous&#46; This result is in accordance with the study by Ibishi et al&#46; &#40;2015&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In our study&#44; obese mothers were inclined to encounter PROM two folds compared to non-obese mothers&#46; At present&#44; the most common BMI measurement used is the Quetelet index which is calculated&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0065" class="elsevierStylePara elsevierViewall">According to World Health Organization &#40;WHO&#41;&#44; the classification of obesity was as follows<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Underweight&#58; &#60;18&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Normal&#58; 18&#46;5&#8211;24&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Overweight&#58; 25&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Obese&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8728;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Class 1&#58; 30&#8211;34&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8728;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Class 2&#58; 35&#8211;39&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8728;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Class 3&#58; &#8805;40<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li></ul></p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">A study by Fallatah et al&#46; &#40;2019&#41; found that obesity in pregnancy is related to a great amount of maternal and neonatal risk and eventually adverse maternal and neonatal outcomes&#46; The study involved 1037 samples which were classified into 4 classes of obesity&#46; Among several antepartum variables&#44; PROM is one of them&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> A study by Wendremaire et al&#46; &#40;2011&#41; showed that leptin increase in obese pregnant women has a role in myometrial apoptosis due to leptin-induced inhibition&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> The association between prelabour rupture of the membrane with obesity was also found in a study by Hautakangas et al&#46; &#40;2018&#41;&#46; Their study that consisted of 598 samples revealed that obesity was an independent risk factor of labor dystocia when BMI was &#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> but did not affect neonatal outcome&#46; PROM occurred in 41&#46;9&#37; of cases of severely obese parturients &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">We also found that PROM is not an indication for cesarean section&#46; Middleton et al&#46; &#40;2017&#41;&#44; in a Cochrane Systematic Review and Metanalysis&#44; proved that there was no clear difference between planned and expectant management for the risk of cesarean section in term pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> But our result is not in accordance with the study conducted by Ibishi et al&#46; &#40;2015&#41;&#44; which revealed an increase in cesarean section delivery due to PROM&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Several factors must be taken into consideration before performing a cesarean section&#44; such as maternal and neonatal morbidity and mortality and subsequent pregnancy and delivery&#46; Clinical possibilities to avoid dystocia in obese pregnant women are limited&#44; so it is worth trying vaginal delivery&#46; For obese parturients&#44; recognizing risk factors is pertinent before deciding to perform a cesarean section&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Our study has a strength that is the fairly large study samples from a single center&#46; Thus the homogeneity of the study is good&#46; The data on maternal background and deliveries is reliable&#44; collected from the patients&#8217; medical records&#46; The limitation of our study is that some important variables are not included due to incomplete documentation and inappropriate chart keeping&#46; Another limitation is we did not stratified obesity according to WHO classification&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; maternal parity and obesity were factors associated with PROM&#44; with the latter being more strongly related to PROM&#46; PROM is not an indication for cesarean section&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The study aimed to explore factors associated with prelabor rupture of membrane &#40;PROM&#41; and mode of delivery of PROM at secondary health care&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">It was a retrospective case-control study within a year observational period&#46; Data were collected from medical records at St&#46; Khadijah I Mother and Child Hospital Makassar&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 4003 samples with 259 cases with PROM&#46; Parity and body mass index &#40;BMI&#41; were factors associated with PROM with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000 and &#46;032 consecutively&#59; among them&#44; BMI was more prominent than parity with OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;392&#44; and 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;052&#8211;5&#46;442&#46; Cesarean section is not associated with PROM&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Primigravidae and obesity were factors associated with PROM&#44; and BMI was more strongly associated with PROM than parity&#46; PROM is not an indication for cesarean section&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Nursing&#44; Health Science Students &#38; Health Care Professionals Conference&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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                            0 => "A&#46; Fernando"
                            1 => "S&#46;N&#46; Daftary"
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Factors associated with and mode of delivery in prelabour rupture of membrane at secondary health care
Isharyah Sunarno
Autor para correspondencia
, Deviana Soraya Riu, Nasrudin Andi Mappaware
Department of Obstetrics & Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia
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            "apellidos" => "Mappaware"
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            "entidad" => "Department of Obstetrics &#38; Gynecology&#44; Faculty of Medicine&#44; Hasanuddin University&#44; Indonesia"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Prelabour rupture of membranes &#40;PROM&#41; is a rupture of the amniotic membrane before the labor process&#46; It is a condition frequently found at the end of pregnancy&#46; PROM incidence is about 3&#37; of all pregnancies&#44; with 70&#37; are term pregnancies&#59; it varies about 5&#8211;10&#37; of all deliveries&#46; PROM is more frequent in developing countries&#46; The prompt onset of spontaneous labor generally follows <a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#8211;4</span></a> term PROM&#44; and it complicates 8&#37; of pregnancies&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">5&#44;6</span></a> Since the exact etiology of PROM is multifactorial and&#44; in some cases yet still unclear&#44; effective treatment for preventing PROM is not certain yet&#46; The impact of PROM&#44; especially on neonatal morbidity and mortality&#44; is noteworthy&#44; so it is pertinent to identify factors associated with PROM in order to anticipate PROM when it happens&#44; to reduce the occurrence of adverse effects of PROM toward maternal and neonatal outcomes&#44; and to promote the health of mothers and neonates&#46; Due to PROM&#44; frequent maternal complications are acute chorioamnionitis&#44; subclinical chorioamnionitis&#44; premature placental separation&#44; and postpartum endometritis&#46; Meanwhile&#44; common complications of PROM to neonates are prematurity &#40;the most common complication&#41;&#44; sepsis&#44; asphyxia&#44; and respiratory distress syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Extensive efforts were made to find out factors associated with PROM&#46; A hospital-based study by Addisu et al&#46; &#40;2020&#41; revealed that pathological vaginal discharge&#44; urinary tract infection&#44; vaginal hemorrhage during pregnancy&#44; and history of PROM in a previous pregnancy are factors associated with PROM&#46; In comparison&#44; Endale et al&#46; &#40;2016&#41; found that PROM duration and maternal residential sites were associated with PROM outcomes&#46; Another study by Eleje et al&#46; &#40;2020&#41; showed that the Chorioquick test could be used as a modality to detect chorioamnionitis in PROM patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7&#8211;9</span></a> PROM&#39;s high-risk factors categorized as preventable &#40;include maternal smoking&#44; more than three cups of coffee per day in the first trimester&#44; vaginal colonization by&#58; <span class="elsevierStyleItalic">Chlamydia trachomatis</span>&#44; <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>&#44; Group B streptococci&#41; and nonpreventable &#40;include the history of PROM&#44; vaginal bleeding in the first and second trimesters&#44; cervical length &#60;2&#46;5cm&#44; positive fibronectin&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">PROM remains an important determinant for maternal morbidity and fetal and neonatal morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Timely identification of maternal risk factors helps to reduce the incidence and severity of PROM complications&#46; Therefore&#44; it is necessary to study factors associated with PROM and mode of delivery&#44; as such that proper management could be given to mothers with certain risk factors besides given a choice for the appropriate mode of delivery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective cross-sectional study within a one-year observational period &#40;January 1&#44; 2019&#44; until December 31&#44; 2019&#41;&#46; The population of the study was women in labor&#46; Samples were women who gave birth in St&#46; Khadijah I Mother and Child Hospital&#46; This study was approved by the Health Research Ethical Committee&#44; Faculty of Medicine Hasanuddin University&#46; Data were collected from medical records at St&#46; Khadijah I Mother and Child Hospital implementing consecutive sampling and statistically analyzed using the SPSS program&#46; Bivariate analysis was performed using the Chi-square test&#44; and multivariate analysis was using logistic regression&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">Within the period of the study&#44; there were 4003 samples&#46; Samples were categorized as PROM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>259 subjects&#59; hence the incidence of PROM in 2019 is 6&#46;47&#37; of all deliveries at St&#46; Khadijah I Mother and Child Hospital Makassar&#41; as case group and not PROM &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3744 subjects&#41; as a control group&#46; Inclusion criteria were&#58; PROM subjects were diagnosed by the history of per vaginal fluid leakage and nitrazine test&#44; term pregnancy &#40;&#62;37 weeks of gestational age based on last menstrual period&#41;&#44; and complete data on the medical record&#46; Exclusion criteria consist of&#58; patients were referred or dead before delivery management was performed and patients admitted to the hospital on December 31&#44; 2018&#44; and the delivery process occurred on January 1&#44; 2019&#44; and also patients admitted to the hospital on December 31&#44; 2019&#44; and the delivery process occurred on January 1&#44; 2020&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results of the study were as follows&#58; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of study subjects&#46; Statistical analysis revealed that maternal characteristics based on maternal age&#44; educational status&#44; and occupational status were homogenous&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> described that parity and Body Mass Index &#40;BMI&#41; were factors associated with PROM&#44; with BMI was the stronger factors related to PROM&#46; The probability of obese pregnant women having PROM was two folds compared to normal pregnant women&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> revealed that PROM was not an indication for performing a cesarean section&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Based on gestational age&#44; PROM was categorized as&#58; term PROM &#40;PROM that occurred at &#62;37 weeks of gestation&#41;&#44; preterm PROM &#40;PROM that happened &#60;37 weeks of gestation&#41;&#44; and Previable PROM &#40;PROM before the fetus is viable&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> As a secondary health care&#44; St&#46; Khadijah I mother and child hospital does not have NICU facilities&#46; Thus preterm cases were referred to health care with more advanced facilities&#46; In this study&#44; all PROM cases were term PROM&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Infection in pregnancy brings about a reduction in membrane tensile strength which eventually caused PROM&#46; Membrane tensile strength reduction was rendered by the collagenolytic effect of metalloproteinases&#44; the effect of bacterial proteases&#44; or repeated stretching by uterine contractions&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In this study&#44; PROM is more frequent in primigravidae than multiparous&#46; This result is in accordance with the study by Ibishi et al&#46; &#40;2015&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In our study&#44; obese mothers were inclined to encounter PROM two folds compared to non-obese mothers&#46; At present&#44; the most common BMI measurement used is the Quetelet index which is calculated&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0065" class="elsevierStylePara elsevierViewall">According to World Health Organization &#40;WHO&#41;&#44; the classification of obesity was as follows<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Underweight&#58; &#60;18&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Normal&#58; 18&#46;5&#8211;24&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Overweight&#58; 25&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Obese&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8728;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Class 1&#58; 30&#8211;34&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8728;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Class 2&#58; 35&#8211;39&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8728;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Class 3&#58; &#8805;40<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span></p></li></ul></p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">A study by Fallatah et al&#46; &#40;2019&#41; found that obesity in pregnancy is related to a great amount of maternal and neonatal risk and eventually adverse maternal and neonatal outcomes&#46; The study involved 1037 samples which were classified into 4 classes of obesity&#46; Among several antepartum variables&#44; PROM is one of them&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> A study by Wendremaire et al&#46; &#40;2011&#41; showed that leptin increase in obese pregnant women has a role in myometrial apoptosis due to leptin-induced inhibition&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> The association between prelabour rupture of the membrane with obesity was also found in a study by Hautakangas et al&#46; &#40;2018&#41;&#46; Their study that consisted of 598 samples revealed that obesity was an independent risk factor of labor dystocia when BMI was &#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> but did not affect neonatal outcome&#46; PROM occurred in 41&#46;9&#37; of cases of severely obese parturients &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">We also found that PROM is not an indication for cesarean section&#46; Middleton et al&#46; &#40;2017&#41;&#44; in a Cochrane Systematic Review and Metanalysis&#44; proved that there was no clear difference between planned and expectant management for the risk of cesarean section in term pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> But our result is not in accordance with the study conducted by Ibishi et al&#46; &#40;2015&#41;&#44; which revealed an increase in cesarean section delivery due to PROM&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Several factors must be taken into consideration before performing a cesarean section&#44; such as maternal and neonatal morbidity and mortality and subsequent pregnancy and delivery&#46; Clinical possibilities to avoid dystocia in obese pregnant women are limited&#44; so it is worth trying vaginal delivery&#46; For obese parturients&#44; recognizing risk factors is pertinent before deciding to perform a cesarean section&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Our study has a strength that is the fairly large study samples from a single center&#46; Thus the homogeneity of the study is good&#46; The data on maternal background and deliveries is reliable&#44; collected from the patients&#8217; medical records&#46; The limitation of our study is that some important variables are not included due to incomplete documentation and inappropriate chart keeping&#46; Another limitation is we did not stratified obesity according to WHO classification&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; maternal parity and obesity were factors associated with PROM&#44; with the latter being more strongly related to PROM&#46; PROM is not an indication for cesarean section&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The study aimed to explore factors associated with prelabor rupture of membrane &#40;PROM&#41; and mode of delivery of PROM at secondary health care&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">It was a retrospective case-control study within a year observational period&#46; Data were collected from medical records at St&#46; Khadijah I Mother and Child Hospital Makassar&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 4003 samples with 259 cases with PROM&#46; Parity and body mass index &#40;BMI&#41; were factors associated with PROM with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000 and &#46;032 consecutively&#59; among them&#44; BMI was more prominent than parity with OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;392&#44; and 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;052&#8211;5&#46;442&#46; Cesarean section is not associated with PROM&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Primigravidae and obesity were factors associated with PROM&#44; and BMI was more strongly associated with PROM than parity&#46; PROM is not an indication for cesarean section&#46;</p></span>"
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