The Relationship Of Leukocyturia On The Incidence of Prominent Rupture of The Membrane in Preterm Pregnancy at the General Hospital of The University of Muhammadiyah Malang

Prelabor rupture of the membrane (PROM) requires greater attention because of the high prevalence and its tendency to increase. The incidence of PROM at 3 37 weeks of gestation (aterm) is around 6.45-15.6% and about 2-3 percent of all single preterm pregnancies and 7.4% in twin preterm pregnancies. The purpose of this study was to determine the relationship between leukosituria and the incidence of premature rupture of membrane at<37 weeks of gestationat the General Hospital of the University of Muhammadiyah Malang during 2015-2017. This is an analytic observational research with a cross-sectional study approach. Data were analyzed with Chi Square. Out of 36 samples that fit in the inclusion criteria, 18 patients had preterm PROM while 18 others had Aterm PROM. PROM mostly occurs in multigravida patients(58.3%, 21 patients). Patients with 38-39 weeks of gestation had the highest prevalence of PROM. Out of 18 Preterm PROM patients, 9 patients had leukocyturia. Only 1 aterm patients had positive leukocyturia. The result of this studyshowed a significant relationship between the incidence of PROM and preterm pregnancy.


INTRODUCTION
Prelabor Rupture of The Membrane (PROM) is the rupture of the amniotic membrane before the onset of labor. Premature rupture of membrane can occur at or after 37 weeks of gestation and is termedpremature rupture of membranes (PROM) or aterm PROM. PROM that occurs before 37 weeks of gestation is termed preterm premature rupture of membranes (PPROM) (POGI, 2016).
PROM requires greater attention because of the high prevalence its tendency to increase.
The incidence of PROM at ³ 37 weeks of gestation (aterm) is around 6.45-15.6% and about 2-3 percent of all single preterm pregnancies and 7.4% in twin preterm pregnancies.
Many theories and hypotheses have been put forward by experts, one of which stated that infection is one possible cause of PROM, including urinary tract infection. Despite this theory, there is still a controvery whether urinary tract infection is a predisposing factor of PROM (Mercer et al, 1993). Thus,the researchers are interested in examining whether there is a specific and meaningful relationship between preterm PROM and urinary tract infection.
Previous studies conducted by Bukitwetan et al (2004) showed that out of 184 urine samples from pregnant women who came to Puskesmas Tambora for routine check up, 65 samples (35.3%) had colony counts greater than 100,000 per ml of urine. The biggest proportion was obtained in women aged 20-30 years at 72.3%. Women with gestational age more than 28 weeks had the most positivebacteriuria test (48.7%). Judging from the frequency of pregnancy, multigravida showedhighest cases of bacteriuria compared to primigravida.Pyuria is mostly found in pregnant women with bacteriuria at more than 28 weeks of gestation.
The quality of health in Indonesia is still low compared to other developed countries and there are still many cases of infection. In addition, during pregnancy, there are changes in the urinary tract system, both anatomical (dilated from the ureter and the reservoir system) and physiological (the occurrence of residual urine and disruption of the process of secreting urine due to peristaltic movement andmuscle tone disorders caused by hormonal changes). These changes can be a predisposing factor for occurrence of urinary tract infections (Prawiraharja, 1992).
The incidence of PPROMisassociated with increased maternal and perinatal morbidity and mortality. About 1/3 of women who experience PPROM will experience potentially severe infections. Fetuses / neonates will be at a greater morbidity and mortality compared to their mothers, with incidence up to 47.9%. Premature labor with potential problems, perinatal infection, and cord compression in utero are common complications. PPROM is also associated with about 18-20% of perinatal deaths in the United States. (4). In addition to the dangers arising from PPROM, the prevalence of PROM at General Hospital of University of Muhammadiyah Malang is high. Therefore the researchersare interested in examining the relationship between leukocyturia and the incidence of preterm premature rupture of the membrane.

METHODS
This was an analytic-descriptive study using cross-sectional research design. The       Table 6. Results of analysis between the incidence of premature rupture of the membrane with gestational age less than 36 weeks and leukocyturia.
( Based on the cross-tabulation between the incidence of premature rupture of membranes at £36 weeks of gestation and the incidence of leukocyturia, a fairly high difference in proportions can be seen. This is consistent with the results of the chi square test on continuity correction which produces a value of p = 0.000 which shows that there is a very significant relationship between the incidence of premature rupture of membranes in gestational age <36 weeks with leukocytes. Preterm birth is a condition where the baby is born between >20 weeks of gestation until£ 37 weeks (Smail, 2014). Prematurity is a condition that causes the most fetal mortality in the world. Exactly 70% of neonates died from 36% of babies death. In America, 12% of 4 million births are preterm and this figure reaches 15.6% of 58,000 births in Alabama. (6) While Indonesia is ranked 9th in WHO data (2010) with 158 per 100 births (Bukitwetan, 2004).
In In this study out of 18 mothers with preterm labor, 9 had leukocyturiawhile 9 others didn't. Only 1 patient with aterm labor had leukocyturia. The results of the analysis between the incidence of preterm labor (gestational age less than 36 weeks) with leukocyturiashowed a significant relationship. This is in accordance with the results of the chi square test on continuity correction which produces a value of sig = 0,000 which indicates that there is a very significant relationship between the incidence of PPROM with leukocyturia.
This result is consistent with Nuada's study (2004) which stated that pregnant women with leukocytes ≥5 / High Power Field had a 7.67 times greater risk of having parturition pretermus imminens. This may occur because leukocytes are a sign of infection which will trigger the release of proinflammatory cytokines such as IL1, IL6, IL8, and TNFα. These cytokines will trigger prostaglandin release and so caused preterm labor. In addition, these cytokines will also change the structure of the cervix and fetal membrane, which may cause premature rupture of membranes. (Jenifer, 2008).

CONCLUSION
The results of this study showed a significant relationship between the incidence of pretermal childbirth and leukocyturia.This study only uses secondary data (medical record)which didn't show definitive data of which bacteria causesthe bacteriuria. In addition, the lack of laboratory results listed in the patient's medical record caused many samples to be excluded from the study. . Researchers expect further research on asymptomatic bacteriuria with different methods to get better results. Researchers also expect this study to provide more information about the risk of preterm asymptomatic bacteriuria. It is expected for healthcare workers to pay more attention to Ma'roef M., Kusuma Putri A. P.,/ SM Vol.15 No.2 December 2019 Page 139-145 145 the incidence of asymptomatic bacteriuria in pregnant women so that the incidence of PROM decreases.