Background: Premature rupture of membranes (PROM) is a major cause of maternal and neonatal morbidity, particularly in low-resource settings where delayed presentation and limited diagnostic capacity complicate management. This study evaluated maternal and neonatal outcomes associated with PROM in a tertiary hospital in northwestern Nigeria.

Methods: A hospital-based matched case–control study was conducted among 162 pregnant women (81 with PROM and 81 matched controls with intact membranes) at the Federal Medical Centre, Gusau, Nigeria. Participants were individually matched for maternal age, parity, and gestational age. Maternal and neonatal outcomes were compared using appropriate statistical tests, while associations between duration of PROM and clinical outcomes were assessed at a significance level of p < 0.05.

Results: Women with PROM had significantly higher rates of caesarean delivery (37.0% vs. 12.3%; p < 0.001), puerperal sepsis (22.2% vs. 4.9%; p = 0.001), neonatal sepsis (46.9% vs. 13.6%; p < 0.001), and prematurity (27.2% vs. 1.2%; p < 0.001) than controls. Duration of PROM was significantly associated with puerperal sepsis (p = 0.030), postpartum haemorrhage (p = 0.016), and birth asphyxia (p = 0.040), but not with neonatal sepsis, prematurity, or perinatal mortality.

Conclusions: PROM remains an important contributor to maternal and neonatal morbidity. Early diagnosis, prompt evidence-based obstetric management, timely antimicrobial therapy, and strengthened antenatal and referral services are essential to reduce adverse outcomes. Institution-specific microbiological surveillance should be integrated into antimicrobial stewardship programmes to optimize empirical antibiotic therapy..

Keywords: premature rupture of membranes; PROM; maternal outcomes; neonatal outcomes; neonatal sepsis; puerperal sepsis; prematurity; antimicrobial susceptibility; Nigeria.