Prevalence and associated factors of chorioamnionitis among women with preterm premature rupture of membranes at Mbarara Regional Referral Hospital, Southwestern Uganda

Background Chorioamnionitis is a major complication of preterm premature rupture of membranes (PPROM) and contributes substantially to adverse maternal and neonatal outcomes. However, despite its clinical importance, data on the burden and determinants of chorioamnionitis among women with PPROM in resource-limited settings, including Uganda, are limited. This study determined the prevalence and factors associated with chorioamnionitis among women admitted with PPROM at Mbarara Regional Referral Hospital (MRRH), Southwestern Uganda. Methods We conducted a hospital-based cross-sectional study from December 2024 to April 2025 among pregnant women admitted at 26 weeks to 36 weeks and 6 days of gestation, with a diagnosis of PPROM at MRRH. Consecutive eligible participants were enrolled and interviewed using a structured questionnaire to obtain socio-demographic, obstetric, and medical data. Chorioamnionitis was diagnosed clinically based on maternal fever (≥ 38°C) and a positive amniotic fluid culture, plus ≥ 1 of the following: maternal tachycardia, leukocytosis, elevated C-reactive protein, uterine tenderness, foul-smelling amniotic fluid, or fetal tachycardia. Modified Poisson regression with robust variance was used to identify factors independently associated with chorioamnionitis. Results A total of 324 women were enrolled with a mean age of 26.56 (± 5.86) years. Most of the women had primary or no education (69.8%), and were unemployed (65.7%). The prevalence of chorioamnionitis was 39.8% (n = 129/324, 95% Confidence Interval [CI]: 34.6–45.3%). The factors independently associated with chorioamnionitis were duration of PPROM (≥ 4 days) (adjusted prevalence ratio [aPR] = 5.85, 95% CI: 2.68–12.78) and undergoing ≥ 4 digital vaginal examinations (aPR = 3.25, 95% CI: 1.51–6.70). Conclusion We found a high prevalence of chorioamnionitis among women with PPROM at MRRH. Prolonged duration of membrane rupture and multiple digital vaginal examinations were associated with increased prevalence of chorioamnionitis. Our findings highlight a need for preventive interventions, including minimizing digital vaginal examinations and screening for chorioamnionitis in mothers with PPROM undergoing expectant management. Future studies could evaluate the maternal and perinatal outcomes of chorioamnionitis among women with PPROM in this setting.