Hysteroscopic view of uterine cavity after normal and PPROM pregnancies

Preterm premature rupture of membranes (PPROM) occurs in 17% of pregnancies, which leads to 20% of perinatal death. According to previous studies uterine anomalies are one of the risk factors for preterm birth, PPROM and pregnancies complications. The aim of this study was to evaluate the relationship between PPROM and rupture of membrane (ROM) with uterine cavity anomalies based on hysteroscopic findings. This cross-sectional study was conducted in Imam Khomeini Hospital, Ahvaz, Iran, from May 2011 to May 2012. After conducting a pilot study, 66 nulliparous pregnant women at 14-37 weeks of pregnancy with PPROM and ROM were selected randomly. Then the women were evaluated by hysteroscopy at least six weeks after delivery or miscarriage. The control group includes 66 women with at least one normal pregnancy (without history of PPROM, secondary infertility or recurrent abortion), who underwent diagnostic or therapeutic hysteroscopy for other reasons than PPROM. The hysteroscope instrument specifications were KARL STORZ model (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany), inner sheet 26153 BI, outer sheet 26153 BO, and BA lens with 30 degree. Normal saline solution (Sodium Chloride 0.9%) also was applied as distention medium. The study was approved by Ethic Committee of Ahvaz Jundihspur University of Medical Sciences. Informed consent was obtained for all participants. Overall, the frequency of uterine anomalies in case and control groups was 12.12% and 3%, respectively (P<0.05 based on Chi-square test). Possibility of uterine cavity anomalies in the women with preterm premature rupture of membranes (PPROM) was significantly higher than the women with normal pregnancy (OR=4.41, CI 95%: 0.9-21/63). About 3% of patients in the case group had undefined uterine anomalies. This anomaly was not in mentioned uterine anomalies classification of American fertility association. We did not observe such anomaly in control group. In conclusion, we found that the possibility of occurring PPROM in women with uterine cavity anomaly was four-fold more than women without these anomalies. Hence, we recommend women with history of PPROM to undergo diagnostic hysteroscopy for detecting uterine anomalies before next pregnancy.