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Lorthe E, Letouzey M, Torchin H, Foix L'helias L, Gras-Le Guen C, Benhammou V, Boileau P, Charlier C, Kayem G. Antibiotic prophylaxis in preterm premature rupture of membranes at 24-31 weeks' gestation: perinatal and 2-year outcomes in the EPIPAGE-2 cohort. BJOG 2021; 129:1560-1573. [PMID: 34954867 PMCID: PMC9546066 DOI: 10.1111/1471-0528.17081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/05/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
Objective To compare different antibiotic prophylaxis administered after preterm premature rupture of membranes to determine whether any were associated with differences in obstetric and/or neonatal outcomes and/or neurodevelopmental outcomes at 2 years of corrected age. Design Prospective, nationwide, population‐based EPIPAGE‐2 cohort study of preterm infants. Setting France, 2011. Sample We included 492 women with a singleton pregnancy and a diagnosis of preterm premature rupture of membranes at 24–31 weeks. Exclusion criteria were contraindication to expectant management or indication for antibiotic therapy other than preterm premature rupture of membranes. Antibiotic prophylaxis was categorised as amoxicillin (n = 345), macrolide (n = 30), third‐generation cephalosporin (n = 45) or any combinations covering Streptococcus agalactiae and >90% of Escherichia coli (n = 72), initiated within 24 hours after preterm premature rupture of membranes. Methods Population‐averaged robust Poisson models. Main Outcome Measures Survival at discharge without severe neonatal morbidity, 2‐year neurodevelopment. Results With amoxicillin, macrolide, third‐generation cephalosporin and combinations, 78.5%, 83.9%, 93.6% and 86.0% of neonates were discharged alive without severe morbidity. The administration of third‐generation cephalosporin or any E. coli‐targeting combinations was associated with improved survival without severe morbidity (adjusted risk ratio 1.25 [95% confidence interval 1.08–1.45] and 1.10 [95 % confidence interval 1.01–1.20], respectively) compared with amoxicillin. We evidenced no increase in neonatal sepsis related to third‐generation cephalosporin‐resistant pathogen. Conclusion In preterm premature rupture of membranes at 24–31 weeks, antibiotic prophylaxis based on third‐generation cephalosporin may be associated with improved survival without severe neonatal morbidity when compared with amoxicillin, with no evidence of increase in neonatal sepsis related to third‐generation cephalosporin‐resistant pathogen. Tweetable Abstract Antibiotic prophylaxis after PPROM at 24–31 weeks: 3rd‐generation cephalosporins associated with improved neonatal outcomes. Antibiotic prophylaxis after PPROM at 24–31 weeks: 3rd‐generation cephalosporins associated with improved neonatal outcomes.
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Affiliation(s)
- Elsa Lorthe
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathilde Letouzey
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Versailles Saint Quentin en Yvelines University, France
| | - Héloïse Torchin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Department of Neonatal Pediatrics, Cochin Port Royal Hospital, APHP, Paris, France
| | - Laurence Foix L'helias
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Department of Neonatal Pediatrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Christèle Gras-Le Guen
- Department of pediatrics, pediatrics emergency unit and general pediatrics, Nantes University Hospital, hôpital Mère-Enfant, CHU de Nantes, 7, quai Moncousu, 44000, Nantes, France
| | - Valérie Benhammou
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
| | - Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Versailles Saint Quentin en Yvelines University, France.,UFR des sciences de la Santé Simone Veil, Versailles St Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Caroline Charlier
- Université de Paris, Hôpital Universitaire Necker-Enfants Malades, Division of Infectious Diseases and Tropical Medicine, Assistance Publique-Hôpitaux de Paris, Institut Pasteur, Biology of Infection Unit, French National Reference Center and WHO Collaborating Center for Listeria, Inserm U1117, Paris, France
| | - Gilles Kayem
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Department of Gynecology and Obstetrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France
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Chu YT, Hsu A, Wu CC, Tsai HD, Tsung-Che Hsieh C, Hsiao YH. Acute chorioamnionitis complicated with symmetrical peripheral gangrene. Taiwan J Obstet Gynecol 2021; 59:972-974. [PMID: 33218425 DOI: 10.1016/j.tjog.2020.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Symmetrical peripheral gangrene (SPG) is an uncommon but important clinical syndrome. We present a case of acute chorioamnionitis complicated with SPG. CASE REPORT A 33-year-old female (gravida 5, para 2) was admitted with preterm premature rupture of membranes (PPROM) at 20 weeks and four days of gestation. She received cervical cerclage four days ago. Seven days after the diagnosis of PPROM, she developed fever, tachypnea and tachycardia. Termination of pregnancy was decided for clinical diagnosis of sepsis. After the abortus was born, gangrene change on the nose was noticed. Afterwards, this patient developed acrocyanosis of extremities. SPG developed following sepsis with intravascular disseminated coagulation (DIC). After intensive care, the patient underwent hyperbaric oxygen therapy and fasciectomy of the left forearm. CONCLUSION We suggest awareness of SPG associated with acute chorioamnionitis. Early recognition of SPG, multidisciplinary care, and treatment of its underlying conditions are the mainstays of management.
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Affiliation(s)
- Yi-Tzu Chu
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Alan Hsu
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chia-Chieh Wu
- Hyperbaric Oxygen Therapy Center, Changhua Christian Hospital, Changhua, Taiwan; Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Der Tsai
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | | | - Yi-Hsuan Hsiao
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Rouzaire M, Corvaisier M, Roumeau V, Mulliez A, Sendy F, Delabaere A, Gallot D. Predictors of Short Latency Period Exceeding 48 h after Preterm Premature Rupture of Membranes. J Clin Med 2021; 10:E150. [PMID: 33406795 PMCID: PMC7796089 DOI: 10.3390/jcm10010150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is a complication responsible for a third of preterm births. Clinical management is initially hospital based, but homecare management is possible if patients are clinically stable 48 h after PPROM. This study set out to determine factors that are predictive of short latency (delivery ≤ 7 days) exceeding 48 h after PPROM, enabling estimation of the prevalence of maternal and neonatal complications and comparison of maternal and fetal outcomes between inpatient and outpatient management. METHOD This was a monocentric retrospective study conducted between 1 January 2010 and 28 February 2017 on all patients experiencing PPROM at 24 to 34 weeks + 6 days and who gave birth after 48 h. Maternal, obstetric, fetal, and neonatal variables were included in the data collected. The primary endpoint was latency, defined as the number of days between rupture of membranes and delivery. RESULTS 170 consecutive patients were analyzed. Short latency could be predicted by the need for tocolysis, a cervical length less than 25 mm at admission and the existence of anamnios. Outpatient follow-up was not found to lead to increased maternal morbidity or neonatal mortality. CONCLUSION Our study highlights predictive factors of short latency exceeding 48 h after PPROM. Knowledge of these factors may provide justification for outpatient monitoring of patients presenting with a long cervix, absence of need for tocolysis and persistence of amniotic fluid and, thus, no risk factors after 48 h of admission.
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Affiliation(s)
- Marion Rouzaire
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (M.C.); (F.S.); (A.D.); (D.G.)
| | - Marion Corvaisier
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (M.C.); (F.S.); (A.D.); (D.G.)
| | - Virginie Roumeau
- Obstetrics and Gynaecology Department, Emile Roux Hospital, 12 boulevard du Dr Chantemesse, 43012 Le Puy-en-Velay, France;
| | - Aurélien Mulliez
- Biostatistics Unit (DRCI) Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France;
| | - Feras Sendy
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (M.C.); (F.S.); (A.D.); (D.G.)
| | - Amélie Delabaere
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (M.C.); (F.S.); (A.D.); (D.G.)
| | - Denis Gallot
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France; (M.C.); (F.S.); (A.D.); (D.G.)
- “Translational Approach to Epithelial Injury and Repair” Team, Auvergne University, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France
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Migliorelli F, Martin C, Martínez de Tejada B. Preterm prelabor rupture of membranes management in Switzerland: a national survey. J Matern Fetal Neonatal Med 2020; 35:3743-3750. [PMID: 33108920 DOI: 10.1080/14767058.2020.1839878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To gain an overview of the current management of patients with preterm prelabor rupture of membranes (PPROM) in Swiss maternity hospitals. STUDY DESIGN We conducted a survey among all maternity hospitals in Switzerland from January to December 2018, irrespective of their annual birth rate and level of complexity. The survey consisted of an 11-item questionnaire, which was developed to retrieve information relevant to different areas of PPROM management. RESULTS Of 64 questionnaires distributed by email, 36 (56.3%) centers responded to the survey. Up to 12 different antibiotic regimens were reported. Among these, 91.7% included a beta-lactam, with amoxicillin as the preferred agent (55.6%). Combined antibiotic schemes were used in 30.6% of hospitals. All centers considered the use of corticosteroids for fetal lung maturity if PPROM occurred before 34 weeks, although 36.1% would consider their use until 37 weeks' gestation in the presence of an increased risk of neonatal respiratory distress syndrome. Maternity hospitals who accept deliveries at any gestational age usually used magnesium sulfate as fetal neuroprotection when delivering babies <32 weeks, with the exception of two hospitals where it was either not used or only indicated if maternal preeclampsia was present. Concerning the time to delivery, 58.3% centers tended to wait until 37 weeks' gestation, while the others considered that it was not necessary to go beyond 34 weeks. CONCLUSION Our survey shows that the current management of PPROM in Switzerland appears to be mostly in line with international recommendations. However, some heterogeneity exists, thus reflecting a lack of international consensus across guidelines, together with the absence of national Swiss guidelines, and this needs to be addressed to ensure high quality care for all patients and neonates.
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Affiliation(s)
- Federico Migliorelli
- Department of Pediatrics, Gynecology, and Obstetrics, Division of Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Clara Martin
- Department of Pediatrics, Gynecology, and Obstetrics, Division of Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Begoña Martínez de Tejada
- Department of Pediatrics, Gynecology, and Obstetrics, Division of Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Beucher G, Charlier C, Cazanave C. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1054-1067. [PMID: 30389543 DOI: 10.1016/j.gofs.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the diagnosis criteria and management of intra-uterine inflammation or infection (Triple I, III). METHODS PubMed and Cochrane Central databases search. RESULTS III is defined as an infection of the fetal membranes, and/or other components like the decidua, fetus, amniotic fluid or placenta. This word should be preferred to the word chorioamnionitis that is less precise (Professional consensus). III clinical signs exhibit poor limited sensibility and specificity (EL3). The diagnosis of III is retained in case of maternal fever (defined by a body temperature≥38°C) with no alternative cause identified and at least 2 signs among the following: fetal tachycardia>160 bpm for 10min or longer, uterine pain of labor, purulent fluid from the cervical canal (Professional consensus). Maternal hyperleukocytosis>20 giga/L in the absence of corticosteroids treatment or increased plasmatic C-reactive protein also argue for III, despite their limited sensibility and specificity (EL3). III requires prompt delivery (Grade A). III is not by itself an indication for cesarean delivery (Professional consensus). Antibiotic treatment should cover Streptococcus agalactiae and Escherichia coli. Antibiotics should be started immediately and maintained all over delivery, to reduce neonatal and maternal morbidity (Grade B). Treatment should rely on a combination of betalactamin and aminoglycoside (Grade B). After vaginal delivery, one single dose of antibiotic is required. Antibiotic duration should be longer in case of bacteremia. Longer duration could be considered in case of persistent fever or of cesarean delivery (Professional consensus).
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Affiliation(s)
- G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - C Charlier
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur Institut IMAGINE, université Paris Descartes, hôpital Necker-Enfants-malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux, USC EA 3671, infections humaines à mycoplasmes et à chlamydiae, 33000 Bordeaux, France
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