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Tramontano AL, Menichini D, Lazzarin S, Sponzilli A, Zinani I, Facchinetti F, Berardi A. Exposure to Prolonged Rupture of Membranes at Term Increases the Risk for Ventilatory Support in Uninfected Neonates. Am J Perinatol 2024; 41:e2279-e2285. [PMID: 37311542 DOI: 10.1055/a-2109-4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The effects of prolonged rupture of membranes (ROMs) on perinatal outcomes are still unclear, and it remains controversial for the management of those labors. This study aims to evaluate how the exposure of pregnant women to a prolonged ROM (≥ 24 hours) affects maternal and neonatal outcomes. STUDY DESIGN This retrospective cohort study included singleton pregnant women at term delivering between January 2019 and March 2020 in a tertiary hospital. All relevant sociodemographic, pregnancy, and perinatal variables (maternal age, prepregnancy body mass index, labor, and delivery outcomes) were collected anonymously. Data were compared between the "ROM < 24 hours" and "ROM ≥ 24 hours" study groups. RESULTS A total of 2,689 dyads were included in the study and divided according to their ROM-delivery time: ROM <24 hours (2,369 women, 88.1%), and ROM ≥ 24 hours (320 women, 11.9%). Maternal baseline characteristics were comparable except for the rate of nulliparous women, which was significantly higher among patients with ROM ≥ 24 hours. No significant differences were found regarding infectious neonatal outcomes. However, mechanical ventilation and continuous positive airway pressure were more common among neonates born after ROM ≥ 24 hours. The greater likelihood of neonatal respiratory distress was also confirmed among infants born to Group-B Streptococcus-negative women with ROM ≥ 24 hours (15 out of 267 neonates, 5.6% vs. 52 out of 1,529 with ROM < 24 hours, 3.4%, p = 0.04). CONCLUSION According to the actual expectant policy, prolonged ROM is associated with an increased risk of respiratory support in noninfected neonates. Further investigations are required to explain such an association. KEY POINTS · The management of women with prolonged rupture of membranes is controversial.. · The exposure of pregnant women to a prolonged rupture of membranes affects neonatal outcomes.. · Prolonged rupture of membranes is associated with an increased risk of respiratory support, in group-B Streptococcus-negative neonates..
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Affiliation(s)
- Anna L Tramontano
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Menichini
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Lazzarin
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Sponzilli
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Isotta Zinani
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Ramirez-Montesinos L, Downe S, Ramsden A. Systematic review on the management of term prelabour rupture of membranes. BMC Pregnancy Childbirth 2023; 23:650. [PMID: 37684576 PMCID: PMC10492345 DOI: 10.1186/s12884-023-05878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/26/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Prelabour rupture of membranes at term affects approximately 10% of women during pregnancy, and it is often associated with a higher risk of infection than when the membranes are intact. In an attempt to control the risk of infection, two main approaches have been used most widely in clinical practice: induction of labour (IOL) soon after the rupture of membranes, also called active management (AM), and watchful waiting for the spontaneous onset of labour, also called expectant management (EM). In addition, previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis. However, the effect of vaginal examinations in the context of prelabour rupture of membranes have not been researched to the same extent. METHODS This systematic review analyses and critiques the latest research on the management of term prelabour rupture of membranes, including the effect of vaginal examinations during labour, with a focus on the outcomes of both normal birth, and chorioamnionitis. Due to its complexity, three research questions were identified using the PICO diagram, and subsequently, the results from these searches were combined. The systematic review aimed to identify randomised controlled trials (RCTs) and observational studies that compared active vs expectant management, included number of vaginal examinations and had chorioamnionitis and/or normal birth as outcomes. The following databases were used: MEDLINE, EMBASE, Maternity and Infant care, LILACS, CINAHL and the Cochrane Central Register of Controlled trials. Quality was assessed using a tool developed especifically for this study that included questions from CASP and the Cochrane risk of bias tool. Due to the high degree of heterogeneity meta-analysis was not deemed appropriate. Therefore, simple narrative analysis was carried out. RESULTS Thirty-two studies met the inclusion criteria, of which 27 were RCTs and 5 observational studies. The overall quality of the studies wasn't high, 15 out of the 32 studies were deemed to be low quality and only 17 out of 32 studies were deemed to be of intermediate quality. The systematic review revealed that the management of term prelabour rupture of membranes continues to be controversial. Previous research has compared active management (Induction of labour shortly after the rupture of membrane) against expectant management (watchful waiting for the spontaneous onset of labour). Although previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis, no prospective studies have included an intervention to reduce the number of vaginal examinations. CONCLUSION A RCT assessing the consequences of active management and expectant management as well as the effect of vaginal examinations during labour for term prelabour rupture of membranes is necessary.
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Affiliation(s)
| | - Soo Downe
- Department of Midwifery, University of Central Lancashire, Brook Building, PR1 2HE, Preston, UK
| | - Annette Ramsden
- Library services, University of Central Lancashire, PR1 2HE, Preston, UK
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 2. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1194-1248. [PMID: 36339632 PMCID: PMC9633230 DOI: 10.1055/a-1904-6769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Korrespondenzadresse Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Rit K, Haldar T, Pal N. A study of aerobic and anaerobic bacterial profile along with In vitro antibiotic susceptibility pattern in cases of puerperal, postabortion sepsis in a Tertiary Care Hospital. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_152_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
BACKGROUND Prelabour rupture of the membranes (PROM) at or near term (defined in this review as 36 weeks' gestation or beyond) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for PROM at or near term. OBJECTIVES To assess the effects of antibiotics administered prophylactically to women with PROM at 36 weeks' gestation or beyond, on maternal, fetal and neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014). SELECTION CRITERIA All randomised trials that compared outcomes for women and infants when antibiotics were administered prophylactically for prelabour rupture of the membranes at or near term, with outcomes for controls (placebo or no antibiotic). DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and assessed risk of bias in the included studies. Additional data were received from the investigators of included studies. MAIN RESULTS This update includes an additional two studies involving 1801 women, giving a total of four included studies of 2639 women. Whereas the previous version of this review showed a statistically significant reduction in endometritis with the use of antibiotics, no such effect was shown in this update (average risk ratio (RR) 0.34, 95% confidence interval (CI) 0.05 to 2.31). No differences were shown on the primary outcome measures of probable early-onset neonatal sepsis (average RR 0.69, 95%; CI 0.21 to 2.33); definite early-onset neonatal sepsis (average RR 0.57, 95% CI 0.08 to 4.26); maternal infectious morbidity (chorioamnionitis and/or endometritis) (average RR 0.48, 95% CI 0.20 to 1.15); stillbirth (RR 3.00, 95% CI 0.61 to 14.82); and perinatal mortality (RR 1.98, 95% CI 0.60 to 6.55), though the number of cases in the control group for these outcomes was low. There were no cases of neonatal mortality or serious maternal outcome in the studies assessed. Caesarean section was increased with the use of antibiotics (RR 1.33, 95% CI 1.09 to 1.61) as was duration of maternal stay in hospital (mean difference (MD) 0.06 days, 95% CI 0.01 to 0.11), largely owing to one study of 1640 women where repeat caesarean section, increased baseline hypertension and pre-eclampsia were evident in the antibiotic group, despite random allocation and allocation concealment.Subgroup analyses by timing of induction (early induction versus late induction) showed no difference in either probable or definite early-onset neonatal sepsis in the early induction group (RR 1.47, 95% CI 0.80 to 2.70 and RR 1.29, 95% CI 0.48 to 3.44, respectively) or the late induction group (RR 0.14, 95% CI 0.02 to 1.13 and RR 0.16, 95% CI 0.02 to 1.34, respectively), although there were trends toward reduced probable and definite early-onset neonatal sepsis in the late induction group. A test for subgroup differences confirmed a differential effect of the intervention on probable early-onset neonatal sepsis between the subgroups (Chi² = 4.50, df = 1 (P = 0.03), I² = 77.8%). No difference in maternal infectious morbidity (chorioamnionitis and/or endometritis) was found in either subgroup, though again there was a trend towards reduced maternal infectious morbidly in the late induction group (average RR 0.34, 95% CI 0.08 to 1.47). No differences were shown in stillbirth or perinatal mortality. The quality of the evidence for the primary outcomes using GRADE was judged to be low to very low. AUTHORS' CONCLUSIONS This updated review demonstrates no convincing evidence of benefit for mothers or neonates from the routine use of antibiotics for PROM at or near term. We are unable to adequately assess the risk of short- and long-term harms from the use of antibiotics due to the unavailability of data. Given the unmeasured potential adverse effects of antibiotic use, the potential for the development of resistant organisms, and the low risk of maternal infection in the control group, the routine use of antibiotics for PROM at or near term in the absence of confirmed maternal infection should be avoided.
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Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)Translating Research Into Practice (TRIP) CentreLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
| | - Owen M Stock
- The University of MelbourneMercy Hospital for Women163 Studley RoadHeidelbergVictoriaAustralia3084
| | - Vicki Flenady
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)Translating Research Into Practice (TRIP) CentreLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
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Nabhan AF, Elhelaly A, Elkadi M. Antibiotic prophylaxis in prelabor spontaneous rupture of fetal membranes at or beyond 36 weeks of pregnancy. Int J Gynaecol Obstet 2013; 124:59-62. [PMID: 24140220 DOI: 10.1016/j.ijgo.2013.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/11/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of prophylactic antibiotics compared with placebo in preventing neonatal and maternal infection-related morbidity associated with prelabor spontaneous rupture of membranes at or beyond 36 weeks of pregnancy. METHODS In the present randomized controlled trial conducted during 2009-2011, 1640 women with prelabor spontaneous rupture of fetal membranes at or beyond 36 weeks of pregnancy were randomly assigned to receive a single dose of prophylactic intravenous antibiotics or placebo on admission to the labor ward of Ain Shams University, Cairo, Egypt. The participants, caregivers, and investigators were blinded to the group assignment. The primary outcome measure was early-onset neonatal sepsis. An intention-to-treat analysis was performed. RESULTS Early-onset neonatal sepsis occurred in 34 (4.1%) and 24 (2.9%) neonates in the antibiotics and placebo groups, respectively (risk ratio 1.42; 95% confidence interval 0.85-2.37). Maternal infection outcomes were not significantly different between the 2 trial arms. CONCLUSION The routine use of prophylactic antibiotics in women with prelabor spontaneous rupture of fetal membranes at or beyond 36 weeks of pregnancy does not reduce the risk of neonatal and maternal infection-related morbidity.
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Affiliation(s)
- Ashraf F Nabhan
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
| | - Amr Elhelaly
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Mohamed Elkadi
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
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Pregnancy and coma. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18631830 DOI: 10.1016/s0072-9752(07)01717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Wakefield SL, Lane M, Schulz SJ, Hebart ML, Thompson JG, Mitchell M. Maternal supply of omega-3 polyunsaturated fatty acids alter mechanisms involved in oocyte and early embryo development in the mouse. Am J Physiol Endocrinol Metab 2008; 294:E425-34. [PMID: 18073322 DOI: 10.1152/ajpendo.00409.2007] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the well-known benefits of omega-3 (n-3) polyunsaturated fatty acid (PUFA) supplementation on human health, relatively little is known about the effect of n-3 PUFA intake on fertility. More specifically, the aim of this study was to determine how oocyte and preimplantation embryo development might be influenced by n-3 PUFA supply and to understand the possible mechanisms underlying these effects. Adult female mice were fed a control diet or a diet relatively high in the long-chain n-3 PUFAs for 4 wk, and ovulated oocytes or zygotes were collected after gonadotropin stimulation. Oocytes were examined for mitochondrial parameters (active mitochondrial distribution, mitochondrial calcium and membrane potential) and oxidative stress, and embryo developmental ability was assessed at the blastocyst stage following 1) in vitro fertilization (IVF) or 2) culture of in vivo-derived zygotes. This study demonstrated that exposure of the oocyte during maturation in the ovary to an environment high in n-3 PUFA resulted in altered mitochondrial distribution and calcium levels and increased production of reactive oxygen species. Despite normal fertilization and development in vitro following IVF, the exposure of oocytes to an environment high in n-3 PUFA during in vivo fertilization adversely affected the morphological appearance of the embryo and decreased developmental ability to the blastocyst stage. This study suggests that high maternal dietary n-3 PUFA exposure periconception reduces normal embryo development in the mouse and is associated with perturbed mitochondrial metabolism, raising questions regarding supplementation with n-3 PUFAs during this period of time.
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Affiliation(s)
- Sarah L Wakefield
- Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia 5005
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