CHAPTERONE

PROBLEMANDITSSCOPE

1.1 Introduction
This section is the opening of the study, we attempted to analyze the following divisions such
asBackground of the study, Statement of the problem, Purpose of the study, Objectives of the
study,generalobjective,SpecificObjectives,Researchquestions,Scopeofthestudy,contentscope,geograph
icalscope,timescope,Definitionofterms,SignificanceofthestudyandConceptualFramework.

1.2 Backgroundofthestudy.
The concept of premature rupture of membranes (PROM) is defined as a spontaneous
leakageof amniotic fluid from the amniotic sac where the baby swims. The fluid escapes
throughruptured membranes, occurring after 28 weeks of gestation and at least one hour
before theonset of true labour. PROM can occur before or after 40 weeks of gestation period.
So, theword “premature” does not mean that the gestational age of the fetus is preterm.
PROM canbe classified in to the preterm PROM occurs after 28 weeks of gestational age and
before37weeks. Term PROM occurs after 37 completed weeks of gestational age including
posttermcases occurringafter 40 weeks(Gahwagi, Busarira&Atia, 2015).

The incidence of preterm PROM differs from community to community possibly due
topopulation differences in contributory risk factors. The significance of PROM depends on
thegestation age at the time of occurrence. While mostmothers at term go into labour
anddeliver spontaneously within 48 hours, those with preterm PROM had long and
variableperiods of latency whose length vary inversely with the gestation age. The incidence
ofpreterm PROM increases with the gestation age. Preterm PROM is a major cause of
perinatalmorbidityandmortality.Themainfactorsassociatedwiththeseareprematurity,complicati
onsduring labourand delivery, andperinatalinfection(Kaye,2001).

PretermPROMandtermPROMarefurtherdividedinto:EarlyPROM(lessthantwelvehours had
passed since the rupture of fetal membranes), and Prolonged PROM (twelve ormore hours
had passed since the rupture of fetal membranes).PPROM should be used todefine those
patients who are preterm with ruptured membranes, whether or not they
hadcontractions.TheetiologyofPROMremainsunclear,butavarietyoffactorsarepurportedto

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contribute to its occurrence, including vaginal and cervical infections, abnormal
membranephysiology, incompetent cervix, and nutritional deficiencies (Hacker, Gambone
and Hobel,2010).

When there was a rupture in the fetal membranes, the woman notices a painless
suddenleakage of fluid from her vagina, which was usually excess and watery. However,
when theamount of amniotic fluid in the sac is minimal, the leaking fluid may only wet her
underwear,and you may be unsure whether to make the diagnosis of PROM from the
woman’s complain(Mercerand B.M, 2003).

Globally,the
incidencerateofprematureruptureofmembraneswasapproximately8%to10%inpregnant
women. More than500,000 babies are born preterm
intheUSeachyear,accountingfor12.5%ofallbirths,andthisincidenceisincreasing.IntheUKin2005,7.6%o
flivebirthswerepreterm.

In the last decade there has been more than a 50% increase in preterm births to low-
riskEuropeanwomenagedbetween20and40years. A higherproportion of preterm deliveriesoccurin
women of black ethnicity, and this may in part be related to social disadvantage. Only 1%
ofall births occur below 32 weeks' gestation. Review of the maternal conditions giving rise to
a25% or more rate of neonatal morbidity in the Philippines shows that premature rupture
ofmembranesaccountsforanincidencerateof38%(Jazayeri2016).

In the African countries eighty-five percent of neonatal morbidity and mortality was a
resultof prematurity. PPROM wasassociated with 30-40% of preterm deliveries and
wastheleadingidentifiablecauseofpretermdelivery.PPROMcomplicates3%ofallpregnanciesand
occurs in approximately 150,000 pregnancies yearly. When PPROM occur remote fromterm,
significant risks of morbidity and mortality are present for both the fetus and the
mother(Jazayeri,2016).

However, despite Somalia was one of the developing countries but due to weak health
systemtherewaslimitedhealth data concerningpremature ruptureofmembrane.

1.3 Statementof theproblem

Sincethecollapseofcentralgovernmentin1991andthecountry wentintochaosandlawlessness
affecting the health system infrastructure resulting in severe destruction.
Basichealthcare,publichealthsectorandtheprivatesectorsfailedtorecapthebasicneedsofthe
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community on the other hand, weak health system result limited data health data.
However,the associated sequent problems are proportionally high over the world. Almost two
thirds ofPROM is spontaneous, although its causes or risk factors were not well known and
there wasa limited researches focus on this premature rupture of membrane, therefore, this
study wasbeen explore the factors contributed with Premature Rupture of Membranes among
pregnantwomen inSOS hospital.

1.1Justification of the Study

The justification of this study was to examine the effect of Premature Rupture of
Membranes(PROM)amongpregnantwomeninSOS hospitalHiliwadistrictMogadishuSomalia..

1.4 Objectivesofthestudy

1.4.1 General objective

The main objective is to determine factors contributed Premature Rupture of
Membranes(PROM)amongpregnantwomeninSOS hospitalHiliwadistrictMogadishuSomalia..

1.4.2 Specificobjectives
1. To determine biological factors of Premature Rupture of Membranes (PROM)
amongpregnantwomen in SOS hospital HiliwadistrictMogadishu Somalia..
2. ToidentifysocioeconomicfactorsassociatedwithofPrematureRuptureofMembranes(PR
OM)amongpregnantwomeninSOShospitalHiliwadistrictMogadishuSomalia..
3. To determine nutritional factors those contribute Premature Rupture of
Membranes(PROM)amongpregnantwomeninSOShospitalHiliwadistrictMogadishuSo
malia.

1.5 Researchquestions.
1. What are the biological factors that contribute Premature Rupture of
Membranes(PROM)amongpregnantwomeninSOShospitalHiliwadistrictMogadishuSo
malia.?
2. WhatarethesocioeconomicfactorsassociatedwithofPrematureRuptureofMembranes(PR
OM)amongpregnantwomeninSOShospitalHiliwadistrictMogadishuSomalia.?

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 3. What are the nutritional factors contributed of PrematureRupture
of
Membranes(PROM)amongpregnantwomeninSOShospitalHiliwa
districtMogadishuSomalia.?

Scopeof the study

1.7.1Timescope
Thestudywas undertaken from14 March2019- 30 Jun 2019.

1.7.2. Geographicalscope
Thestudywas conductedatSOShospitalHiliwadistrictMogadishuSomalia.

1.7.3. Contentscope
This study was determined factors contributing premature rupture of
membrane (PROM)amongpregnantwomenin SOS hospital Hiliwa
districtMogadishu Somalia.

1.8 Significanceof thestudy.

Theresearchershopethatthisstudywasbringupdatedknowledgeaboutfactor
sthatcontributing of Premature Rupture of Membranes (PROM) among
pregnant women in SOShospital in order to prevent its occurrence in the
community as well as this study was beenusefulfor
enhancingcommunityawareness on this condition.

The researcher’s findings and recommendations of this study can be

used by the futureresearchers, clinical instructors, medical students as
well as medical practitioners speciallyNurses, Midwife, Doctors and the
policy makers such as the Minster of Health of SomaliaGovernment.

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 1.8 CONCEPTUALFRAMEWORK
IV DV
Biologicalfactor
BacteriainfectionSTDs Prematureruptureofmembrane
Virginities
Choriodecidualinfection

Raceand socioeconomicfactors
Blackethnicity
Lowsocioeconomicstatus
Smokingduringpregnancy
Extraneousvaria

Extraneousvariables
Nutritionalfactors
 Deficiencyofmicronutrients
Poorbalanced diet