Impact of Preterm Premature Rupture of Membranes on Composite Adverse Perinatal Outcomes and Associated Predictors Among Pregnant Women in Tigray, Northern Ethiopia: A Prospective Cohort Study

BackgroundPreterm premature rupture of membranes (PPROM) is a leading contributor of adverse perinatal outcomes, particularly in low-resource and conflict-affected settings. Despite its clinical importance, prospective evidence on its impact on composite adverse perinatal outcomes in northern Ethiopia remains limited. This study examined the impact of Preterm premature rupture of membranes on composite adverse perinatal outcomes and identified associated predictors among pregnant women in public hospitals of Tigray, Northern Ethiopia. MethodsA hospital-based prospective cohort study was conducted among 578 singleton pregnancies (288 with Preterm premature rupture of membranes and 290 without it at [&ge;]28 weeks of gestation. Participants were followed from admission to delivery and to the early neonatal period. The primary outcome was a Composite adverse perinatal outcome, and the main exposure variable was Preterm premature rupture of membranes (PPROM). Modified Poisson regression with robust variance estimation was used to estimate adjusted relative risks (ARRs) with 95% confidence intervals (CIs) and a significant level was declared at p<0.05. ResultsOverall, 33.4% of neonates experienced at least one composite adverse perinatal outcome. The incidence was substantially higher among the PPROM group compared with the non-PPROM group (59.4% vs. 7.6%). After adjustment, PPROM was strongly associated with composite adverse perinatal outcomes (ARR = 7.22, 95% CI: 4.73-11.03). Independent predictors included previous pregnancy-related infection (ARR = 1.54; 95% CI: 1.08-2.22), absence of iron-folate supplementation during pregnancy (ARR=1.63; 95% CI: 1.153-2.29), pelvic pain (ARR = 2.09; 95% CI: 1.05-4.15), and latency period of 1-3 days (ARR = 1.41; 95% CI: 1.10-1.81) compared to <24 hours. Induced labor was protective (ARR=0.58; 95% CI: 0 .422-0.800). ConclusionPPROM markedly increases the risk of composite adverse perinatal outcomes in this post-conflict, resource-constrained setting. The first 72 hours following membrane rupture represent a particularly vulnerable period. Strengthening antenatal care, nutritional supplementation, infection prevention, and timely obstetric intervention could reduce preventable neonatal morbidity and mortality in similar contexts.