The outcome of pregnancies complicated by preterm rupture of the membranes with and without cerclage

Thirty-two patients with cerclage were compared to 76 patients without cerclage. All pregnancies were complicated with preterm (less than 36 weeks) rupture of the membranes (PTROM). The management following removal of the cerclage was the same for the two groups and consisted of conservative treatment unless chorioamnionitis ensued. It was found that under similar conditions and treatment there was no significant difference between the outcomes of PTROM-complicated gestations with and without a cerclage. The low added risk of cerclage to PTROM should not deter its use when indicated.

[Premature rupture of fetal membranes near term: wait it out or intervene?]

In the here presented study we investigated whether it is preferable to wait or to intervene after premature rupture of membranes (PROM) near term (greater than or equal to 36 weeks). In our first approach to answer this question we compared two time periods retrospectively in which we had managed PROM in alternate ways: In 1984 we waited 12 hours for spontaneous start of labor. After 12 hours we induced labor by Oxytocin infusion. In 1986 and 1987 we applicated 0.4 mg Prostaglandin E2 (PGE2) intracervically instead of iv Oxytocin. 67 patients received PGE2 within 6 hours, 63 patients within 7-12 hours after PROM. In total we included 416 patients into this study. We were able to show that intracervical PGE2 gel gave unambiguously better results both for primiparae and multiparae. We observed the least complications with early (less than or equal to 6 h after PROM) application of PGE2 gel. The following parameters favoured early PGE2 application significantly (p less than 0.01): interval PROM - delivery, duration of labor, incidence of cesarean sections, morbidity rate of mother and child. In our second approach we were able to confirm our results in a randomised prospective study, in which we looked at 57 women with PROM in early 1988. Additionally a direct correlation of time between PROM and birth and rate of maternal or neonatal infection emerged: We saw the best results, if labor started within 6 hours after PROM. The rate of cesarean sections and newborns that had to be transferred to pediatrics had doubled within 7-12 hours and more than quadrupled after 12 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Ampicillin prophylaxis in preterm premature rupture of the membranes: a prospective randomized study

It is hypothesized that ampicillin may treat subclinical deciduitis and prolong the "effective" latent period in patients with preterm premature rupture of the membranes. We studied 82 patients with preterm rupture of membranes who were managed expectantly and were randomly assigned either to receive ampicillin prophylaxis (n = 43) or not to receive ampicillin prophylaxis (n = 39). Patients were excluded from study entry on admission if they had suspected or frank chorioamnionitis, active preterm labor, a history of penicillin allergy, multiple gestation, or cervical cerclage. There were no significant differences between the groups in duration of membrane rupture prior to admission, gestational age at membrane rupture, use of steroids and tocolysis, and demographic factors. Life-table analysis showed that the risk of delivery was significantly lower for the group of patients receiving prophylactic ampicillin. The incidence of neonatal infection was significantly lower in the ampicillin group, 1 (2%) versus 6 (17%), p less than 0.04.

Modifications to selective conservative management in preterm premature rupture of the membranes

Selective conservation in preterm premature rupture of the membranes (PPROM) reduces risks of infection and pulmonary hypoplasia associated with expectant management by delivering those at greatest risk, while permitting continuation of pregnancy in the remainder. Although patient selection has traditionally been a clinical decision, more accurate criteria are now available. The role of biochemical, biophysical and microbiological predictors of chorioamnionitis and fetal pulmonary status in PPROM is reviewed, and the resultant modifications to selective conservative management discussed.

[Pharmacokinetic and clinical studies on ceftriaxone in the perinatal period]

The pharmacokinetics of ceftriaxone (CTRX) and its clinical efficacy in perinatal infections were studied. The obtained results are summarized as follows. 1. Concentrations of CTRX in maternal serum, umbilical cord serum and amniotic fluid were determined following intravenous injection with 1 g of CTRX. Maternal serum levels were not lower than 100 micrograms/ml immediately after administration, and gradually decreased to about 10 micrograms/ml in 12 hours, and to 4 micrograms/ml in 24 hours. The half-life of CTRX in maternal serum was 5.6 hours. CTRX levels in umbilical cord serum were about 7 micrograms/ml at 10 minutes after injection, increasing to 12 to 13 micrograms/ml in 12 hours and decreasing to 5 micrograms/ml in 24 hours. CTRX levels in amniotic fluid were slightly lower than those in the umbilical cord serum, and about 2 micrograms/ml at 10 minutes after injection, and they remained at 4 to 8 micrograms/ml thereafter for 28 hours. 2. CTRX (1 g) was intravenously administered twice daily to 9 patients with perinatal infections for 3 to 7 days. Clinical efficacies of CTRX were judged excellent in 2 cases and good in 7, suggesting that CTRX was effective in all cases. No side effects or laboratory abnormalities were observed in any case. As a result of these findings, CTRX may be considered a very useful antibiotic in perinatal infections.

Transcervical amnioinfusion of antibiotics: a basic study for managing premature rupture of membranes

To determine the best method of preventing ascending infection in the management of premature rupture of membranes, antibiotics such as latamoxef sodium, cefoperazone sodium, and cefotaxime sodium were infused directly into the amniotic cavity in 64 patients undergoing induction of labor at term. A single infusion of 100 or 500 mg of each drug resulted in a concentration of 200 to 1000 micrograms/ml immediately after infusion, and the concentration remained above 10 micrograms/ml for about 24 hours without significant increase in fetal or maternal blood levels. Consequently, a daily single dose of 100 mg or more is probably effective prophylaxis in cases of premature rupture of membranes. When intrauterine infection is suspected, the dose can be increased to 500 mg or more, and transplacental administration may be added to achieve a higher concentration in fetal blood. The present study simulates well premature rupture of membranes, and an amnioinfusion of antibiotics will be reliable and effective in managing premature rupture of membranes.

Reduction of group B streptococcal maternal and neonatal infections in preterm pregnancies with premature rupture of membranes through a rapid identification test

To establish the effect of rapid detection and chemoprophylaxis of group B streptococcal genital colonization in preterm gestations with premature rupture of membranes, 260 singleton pregnancies were cultured. Through the use of a rapid test based on coagulation methods, group B streptococcus was identified in 84 (32%) patients, of which 18 (7%) had heavily colonized infections. The treatment of 36 patients resulted in no cases of chorioamnionitis or neonatal sepsis compared with 11 (23%) cases of chorioamnionitis and 13 (27%) of neonatal sepsis among 48 untreated patients (p less than 0.01). Although the risk of infection was significantly higher in patients with heavily colonized infections, characterized by less than 5 hours' growth for detection, even light colonization, requiring 20 hours for detection, resulted in a 14% rate of maternal and 16% rate of neonatal infection, respectively.