Sexual activities in pregnancy and prelabour rupture of membranes

Oboro VO* MBChB,FMCOG, Tabowei TO** MBBS,FMCOG, Bosah JO***MBBS.

*Maternity Unit, Zonal Hospital, Kwale. Delta State. Nigeria.
**Maternity unit, General Hospital, Ashake. Delta State. Nigeria.
***Maternity Unit, General Hospital, Obiaruku. Delta State. Nigeria

Key Words: sexual activities, pregnancy, labour, foetal membranes, foetal morbidity

Introduction
Prelabour rupture of membranes (PROM) is defined as rupture of foetal membranes before the onset of labour. This condition contributes to perinatal morbidity and mortality as well as maternal morbidity1. As many as one-third of premature births are associated with PROM. Even at term, PROM is associated with a greater incidence of caesarean deliveries, inductions of labour, and infectious complications2. Although many predisposing factors have been associated with PROM, its precise aetiology remains unknown. While coital activities have been implicated in PROM,3 disagreement exists in reports examining the relationship of coitus in late pregnancy, particularly orgasmic coitus, to the occurrence of PROM. In this study we present the findings from a sample of parturient women in our institutions who had PROM and compared these with women who delivered without PROM. This was to find out if sexual activity is a risk factor for the occurrence of PROM.

Patients and methods
This study was conducted at the Zonal Hospital Kwale, General Hospital Ashaka, and General Hospital Obiaruku, all in Delta State, south-southern Nigeria, from August 2000 to February 2002. The study group consisted of 97 consecutive patients with a singleton normal pregnancy who had spontaneous prelabour rupture of foetal membranes. Prelabour rupture of membranes (PROM) was defined as rupture of membranes before the onset of labour, and was diagnosed by direct observation of discharge fluid from the vagina on careful speculum examination, a positive Nitrazine paper test, and positive fernings. For each patient, another woman within a similar age group ( in years), parity, same gestational age group but did not have PROM constituted the control group. All patients were between 20 and 40 years of age, and at not less than 28 weeks of gestation at delivery. Gestational age estimation was determined from the last menstrual period and early ultrasonography.

After delivery, a self-administered questionnaire with 17 items was offered to the women. The questions were structured and was designed to generate information about sexual activities before and during pregnancy. There was some emphasis on the most recent coitus, and the interval between the last coitus and delivery. All data were analysed with SPSS 7.5 for Windows (SPSS Inc., Chicago, Illinois, USA). Differences between the case and control groups were analysed with student's t test. P value < 0.05 was considered significant.

Results
The characteristics of all the 194 patients (cases and controls) revealed that 7.7% were teenagers and those 30years or more were 27.3%. The mean age (SD) was 26.6 5.1 years. As for parity, 42.8% were in the group 0-1, while those of parity 5 or more constituted 17.5%. The pregnancy was 38 weeks or more in 54.6% of all the paturient women. The sexual practices of patients in the study and control groups are shown in Tables 1 to 3. There were no statistically significant differences between the two groups. Also, the interval between last coitus and onset of contractions and report of orgasmic coitus were similar in both groups: similar in the two groups. 

Discussion
In this case-control study, we explore the hypothesis that sexual intercourse in pregnancy may influence the occurrence of prelabour rupture of membranes (PROM). Our findings did not show greater sexual activity in patients who had PROM. Coital frequency decreased progressively towards the end of pregnancy and was similar in both groups. There were no significant differences in the frequency of orgasmic coitus between the two groups.

Our findings agree with the works of other investigators. In a similar report by Ekwo et al sexual intercourse in the missionary position was significantly associated with preterm PROM. In a study of 500 women, the average time between coitus and admission for delivery was found to be 52 days, while the average time for patients with PROM was 42 days. They found no statistical association between PROM and coitus (4). Also found no association between coitus in the last three months of pregnancy and either PROM or low birth weight (5). In a study of sexual response in relation to complications of pregnancy after controlling for the interval between coitus and labour onset, no significant association was found between coitus and PROM (6). Similarly, a study of women who had sexual intercourse one or two times during the month of delivery found no increase in risk for PROM among them (7).

However, other workers have obtained different results reporting that orgasm during sexual intercourse is associated with premature rupture of membranes (8,9). The latter implied that toward the latter stages of pregnancy orgasm may produce uterine contractions strong enough to induce labour, although other researchers have thought this unlikely3 reporting that women who had PROM had orgasms more frequently during the last 4 weeks of pregnancy than did controls. As this was not true for either the women giving birth to preterm infants without PROM or mothers delivered at term after PROM, they hypothesized that orgasm may somehow propagate nascent intra-amniotic infection or disseminate existing ascending cervical infections or infectious products. Vaginal colonization with bacterial flora and the occurrence of chorioamnionitis have been found in association with PROM and premature delivery (10,11) and amniotic fluid from women with intact fetal membranes in premature labour has been shown to grow vaginal flora. It remains uncertain however, whether a relationship exist between primary ascending infection and sexual intercourse as it relates to the occurrence of PROM.

oncerning limitation, our data did not examine the relationship between different sex positions and the occurrence of PROM. Although we found no increased risk of PROM among women engaging in coital activity in late pregnancy, perhaps coitus could be avoided in women who have other risk factors for PROM. It should not be restricted in in women at low risk.

Table 1. Mean coital frequency per week

  PROM  Controls P
  N= 97 N=97
Before pregnancy 2.7 1.0 2.5 0.9 0.145
First trimester 2.2 0.8 2.2 0.9 1.000
Second trimester 1.9 0.7 2.0 0.8 0.355
Third trimester 0.8 0.5 0.9 0.6 0.209

Table 2. Interval between last coitus and onset of spontaneous contractions

Interval (Hours) PROM Controls P
  N=97 N=97
0-23  2.7 1.0 2.5 0.9 0.145
24-47 2.2 0.8 2.3 0.9 0.414
48-71 1.9 0.7 2.0 0.7 0.321
72 0.8 0.5 0.9 0.6 0.209

Table 3. Occurrence of orgasmic coitus in both groups. Values given as n (%).

Period PROM Controls P
  (n = 97) (n = 97)
Pre-pregnancy 96 (99) 95 (98) 1.000*
Last coitus 69 (71) 73 (75) 0.743

* with Yate's correction

References

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  7. Naeye RL, Peters EC. Causes and consequences of rupture of fetal membranes. Lancet 1980; 1:192-4.
  8. Wagner NN, Butler JC, Saunders JP. Prematurity and orgasmic coitus during pregnancy: data on a small sample. Fertl Steril. 1976; 27: 911-915.
  9. Goodling RC, Keller DW, Raffin M. Orgasm during late pregnancy: possible deleterious effect. Obstet. Gynecol 1971; 38:916-20.
  10. Romero R, Quintero R, Oyarzun E, Wu YK, Sabo V, Mazor M, Hobbins JC. Intra-amniotic infection and the onset of labour in preterm premature rupture of membranes. Am J Obstet Gynecol. 1988;159:661-6.
  11. Gravett MG, Nelson HP, DeRouen T, Critchlow C, Eschenbach DA, Holmes KK. Independent associations of bacterial vaginosis and chlamydia trachomatis infection with adverse pregnancy outcomes. JAMA 1986; 256: 1899-903.

Correspondence to Dr V Oboro. MBChB, FWACS, FMCOG (Consultant Obstetrician/Lecturer)

 


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