The Relationship Between Hypertensive Disorders of Pregnancy and PreLabor Rupture of Membranes in Ethiopia: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background and Aims: Prelabor rupture of membranes is a significant obstetric complication with serious maternal and neonatal consequences. Hypertensive disorders of pregnancy are among the leading contributors to adverse pregnancy outcome. However, the relationship between hypertensive disorders of pregnancy and prelabor rupture of membranes in Ethiopia has not been clearly quantified. This meta-analysis aimed to provide a pooled estimate of the association between hypertensive disorders of pregnancy and prelabor rupture of membranes. Methods: PubMed, Hinari, Google Scholar, and ScienceDirect were systematically searched for observational studies on assessing the association between hypertensive disorders of pregnancy and prelabor rupture of membranes. Data was analyzed using Stata version 17.0 using a random effects model. Risk of bias was appraised using the Joanna Briggs Institute checklist. Pooled odds ratio and their 95% CI were computed, followed by heterogeneity assessment using the I2-statistic. Presence of publication bias was checked by Doi plot and Luis Furuya-Kanamori index. The certainty of evidence was assessed using the GRADE approach. Results: This analysis incorporated 14 studies with a total of 4230 participants and revealed significant heterogeneity (I2 = 87.6%, p < 0.001). The meta-analysis indicated that hypertensive disorders of pregnancy were associated with a twofold increase in the odds of prelabor rupture of membranes (pooled OR = 2.00; 95% CI: 1.06–3.78). This association remained stable in sensitivity analyses, with no evidence of publication bias. The certainty of evidence was rated as moderate. Conclusion: Hypertensive disorders of pregnancy are significantly associated with prelabor rupture of membranes in Ethiopia. Strengthened antenatal screening and timely management are needed to reduce prelabor rupture of membranes risk, and targeted maternal health programs should be prioritized. Further prospective studies are recommended to confirm causality and guide interventions.