Prevalence and associated factors of chorioamnionitis among women with preterm premature rupture of membranes at Mbarara Regional Referral Hospital, Southwestern Uganda

Abstract

Background: Chorioamnionitis is a frequent complication of preterm premature rupture of membranes (PPROM) and contributes substantially to adverse maternal and neonatal outcomes. However, data on the burden and determinants of chorioamnionitis among women with PPROM in resource-limited settings, including Uganda, are limited. This study determined the prevalence and factors associated with chorioamnionitis among women admitted with PPROM at a regional referral hospital in southwestern Uganda. Methods: This hospital-based cross-sectional study was conducted from December 2024 to April 2025 among pregnant women admitted at 26 weeks to 36 weeks and 6 days of gestation, with a diagnosis of PPROM. Consecutive sampling was used to enroll participants. Data were obtained through structured interviews, review of clinical records, and laboratory investigations, including microbiological culture, to capture sociodemographic, obstetric, medical, and clinical information. Chorioamnionitis was defined as maternal fever (≥38 °C) with at least one additional clinical or laboratory sign (uterine tenderness, foul-smelling amniotic fluid, maternal or fetal tachycardia, leukocytosis, or elevated C-reactive protein) and a positive cervical or posterior fornix culture used to detect intra-amniotic infection. Associations were assessed using modified Poisson regression to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals. Results: A total of 324 women were enrolled with a mean age of 26.56 (±5.86) years. Most of the women had primary or no education (69.8%), and were unemployed (65.7%). The prevalence of chorioamnionitis was 39.8% (n=129/324, 95% Confidence Interval [CI]: 34.6–45.3%). The factors independently associated with chorioamnionitis were duration of PPROM (≥4 days) (aPR=5.85, 95% CI: 2.68–12.78) and undergoing≥4 digital vaginal examinations (aPR=3.25, 95% CI: 1.51–6.70). Conclusion: Chorioamnionitis was common, affecting approximately four in ten women with PPROM at MRRH, which may be influenced by delayed presentation and initiation of prophylactic antibiotics. Prolonged duration of membrane rupture and multiple digital vaginal examinations were associated with increased prevalence of chorioamnionitis. These findings underscore the importance of preventive practices during expectant management of PPROM, including minimizing unnecessary digital vaginal examinations and maintaining clinical vigilance for signs of chorioamnionitis. Future studies could evaluate the maternal and perinatal outcomes of chorioamnionitis among women with PPROM in this setting.