Studi Kasus Faktor Risiko Ketuban Pecah Dini pada Multigravida Aterm di Kabupaten Ponorogo

Abstract

Prelabor rupture of membranes (PROM) remains an obstetric complication that may increase the risk of maternal infection, failed labor progression, operative delivery, and neonatal morbidity. This case study aimed to identify plausible risk factors, describe the clinical pathway, and evaluate referral continuity in a term multigravida in Ponorogo Regency. A descriptive case-study design was applied to a 31-year-old woman, G2P10001, at 39 weeks and 4 days of gestation who received care at an independent midwifery practice in January 2026. Data were obtained from interviews, serial physical examinations, the maternal and child health handbook, antenatal records, a Poedji Rochjati risk score card, an intrapartum observation sheet, and hospital information reported by the patient. The mother completed nine antenatal visits, had a hemoglobin level of 12.9 g/dL and a risk score of 2, and had no history of anemia, reproductive-tract infection, chronic disease, heavy physical activity, or previous PROM. Multigravidity and a seven-year interpregnancy interval were identified as plausible contextual factors, although causality cannot be inferred from a single case. Membrane rupture began before effective labor; the cervix remained at 1 cm with 25% effacement and no adequate progress. The mother was referred, underwent induction, and subsequently delivered by cesarean section. The male newborn cried immediately and had no reported abnormality. Structured screening, prompt recognition of absent labor progress, and timely interfacility referral supported a favorable maternal and neonatal outcome.