Biophysicosocial impacts on preterm premature of ruptured membrane (pprom) below 20 weeks

Each year there are 15 million preterm babies born with a variety of survival chances. Preterm premature rupture of membranes (PPROM) represents one-third of preterm deliveries. Ruptured membranes before 24 weeks affect 0.4% of pregnancies, with mortality up to 70% reported in 2000. Preterm birth may cause high-risk impairments and places a heavy burden on families and the health system. Therefore, the termination of pregnancy has become an immediate proposal in cases of PPROM before 24 weeks. A women aged 25 years old was diagnosed as PPROM 14 days on primigravida at 19 weeks of gestation, singleton live fetus, with small amount of amniotic fluid. The patient was first treated conservatively with multivitamins and hydration for two weeks before they came to the CiptoMangunkusumo Hospital. In our hospital, the patient and husband were educated regarding the poor prognosis associated with PPROM below 20 weeks and were advised to terminate the pregnancy. It was then decided to terminate the pregnancy. It was the first pregnancy for the patient, and it was expected to be the first grandchild for both parents of the patient. After delivery, both the patient and husband had a difficult time coping. PPROM impacts the biopsychosocial aspects of both maternal and neonates. Mothers might be at risk for systemic infection even after delivery, while newborn babies might be at high risk of respiratory distress syndrome, NEC, or prolonged intubation, which leads to stress and financial burden on the parents. The feelings of separation and exclusion with their baby could be related to the lack of physical and emotional closeness, which are essential factors in the early relationship between parents and their newborn infant. Mothers may also experience several and often conflicting emotional reactions, such as grief, sadness, guilt, fear, anger, loss of self-esteem, and sense of failure. Comprehensive education using a multidisciplinary approach is critical to have the best decisions from parents regarding pregnancy condition. PPROM below 20 weeks likely negatively impacts the parent’s physical, emotional, and socio-cultural aspects. Therefore, proper comprehensive education using a holistic approach must be given to reduce the negative impacts.