1
|
Ohkuchi A, Okazaki K, Iwamoto S, Sako M, Kobayashi T, Yanagihara I, Nomiyama M. A phase II, multicenter, nonblinded, randomized controlled trial for evaluating protective effects of ABPC/SBT plus, azithromycin versus erythromycin, in pregnant women with pPROM occurring at <28 weeks of gestation on the development of BPD in neonates: Study protocol. PLoS One 2024; 19:e0304705. [PMID: 38980858 PMCID: PMC11232965 DOI: 10.1371/journal.pone.0304705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/13/2024] [Indexed: 07/11/2024] Open
Abstract
This is a protocol for PPROM-AZM Study, phase II, nonblinded, randomized controlled trial. Bronchopulmonary dysplasia (BPD) at a postmenstrual age of 36 weeks (BPD36) is often observed in infants with preterm premature rupture of the membranes (pPROM). A regimen of ampicillin (ABPC) intravenous infusion for 2 days and subsequent amoxicillin (AMPC) oral administration for 5 days plus erythromycin (EM) intravenous infusion for 2 days followed by EM oral administration for 5 days is standard treatment for pPROM. However, the effect on the prevention of moderate/severe BPD36 using the standard treatment has not been confirmed. Recently, it is reported that ampicillin/sulbactam (ABPC/SBT) plus azithromycin (AZM) was effective for the prevention of moderate/severe BPD36 in pPROM patients with amniotic infection of Ureaplasma species. Therefore, our aim is to evaluate the occurrence rate of the composite outcome of "incidence rate of either moderate/severe BPD36 or intrauterine fetal death, and infantile death at or less than 36 weeks 0 days" comparing subjects to receive ABPC/SBT for 14 days plus AZM for 14 days (intervention group) and those to receive ABPC/SBT for 14 days plus EM for 14 days (control group), in a total of 100 subjects (women with pPROM occurring at 22-27 weeks of gestation) in Japan. The recruit of subjects was started on April 2022, and collection in on-going. We also investigate the association between the detection of Ureaplasma species and occurrence of BPD36. In addition, information on any adverse events for the mother and fetus and serious adverse events for infants are collected during the observation period. We allocate patients at a rate of 1:1 considering two stratification factors: onset of pPROM (22-23 or 24-27 weeks) and presence/absence of a hospital policy for early neonatal administration of caffeine. Trial registration: The trial number in the Japan Registry of Clinical Trials is jRCTs031210631.
Collapse
Affiliation(s)
- Akihide Ohkuchi
- Maternal and Fetal Neonatal Intensive Care Unit, Jichi Medical University Hospital, Tochigi, Japan
| | - Kaoru Okazaki
- Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Shintaro Iwamoto
- Division of Biostatistics, Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Itaru Yanagihara
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Izumi-shi, Osaka, Japan
| | - Makoto Nomiyama
- Department of Obstetrics and Gynecology, National Hospital Organization Saga Hospital, Saga-shi, Saga, Japan
| |
Collapse
|
2
|
Danciu BM, Oţelea MR, Marincaş MA, Niţescu M, Simionescu AA. Is Spontaneous Preterm Prelabor of Membrane Rupture Irreversible? A Review of Potentially Curative Approaches. Biomedicines 2023; 11:1900. [PMID: 37509539 PMCID: PMC10377155 DOI: 10.3390/biomedicines11071900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
There is still no curative treatment for the spontaneous preterm prelabor rupture of membranes (sPPROM), the main cause of premature birth. Here, we summarize the most recent methods and materials used for sealing membranes after sPPROM. A literature search was conducted between 2013 and 2023 on reported newborns after membranes were sealed or on animal or tissue culture models. Fourteen studies describing the outcomes after using an amniopatch, an immunologic sealant, or a mechanical cervical adapter were included. According to these studies, an increase in the volume of amniotic fluid and the lack of chorioamnionitis demonstrate a favorable neonatal outcome, with a lower incidence of respiratory distress syndrome and early neonatal sepsis, even if sealing is not complete and stable. In vivo and in vitro models demonstrated that amniotic stem cells, in combination with amniocytes, can spontaneously repair small defects; because of the heterogenicity of the data, it is too early to draw a thoughtful conclusion. Future therapies should focus on materials and methods for sealing fetal membranes that are biocompatible, absorbable, available, easy to apply, and easily adherent to the fetal membrane.
Collapse
Affiliation(s)
- Bianca Mihaela Danciu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics, Gynecology and Neonatology, "Dr. Alfred Rusescu" National Institute for Maternal and Child Health, 127715 Bucharest, Romania
| | - Marina Ruxandra Oţelea
- Clinical Department 5, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Marian Augustin Marincaş
- First Department of Surgery, Bucharest Oncological Institute Prof. Dr. Alexandru Trestioreanu, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania
| | - Maria Niţescu
- Preclinical Department 3, Complementary Sciences, Carol Davila University of Medicine and Pharmacy, 020125 Bucharest, Romania
| | - Anca Angela Simionescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
3
|
Rode L, Wulff CB, Ekelund CK, Hoseth E, Petersen OB, Tabor A, El-Achi V, Hyett JA, McLennan AC. First-trimester prediction of preterm prelabour rupture of membranes incorporating cervical length measurement. Eur J Obstet Gynecol Reprod Biol 2023; 284:76-81. [PMID: 36940605 DOI: 10.1016/j.ejogrb.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES To examine early pregnancy risk factors for preterm prelabour rupture of membranes (PPROM) and develop a predictive model. STUDY DESIGN Retrospective analysis of a cohort of mixed-risk singleton pregnancies screened in the first and second trimesters in three Danish tertiary fetal medicine centres, including a cervical length measurement at 11-14 weeks, at 19-21 weeks and at 23-24 weeks of gestation. Univariable and multivariable logistic regression analyses were employed to identify predictive maternal characteristics, biochemical and sonographic factors. Receiver operating characteristic (ROC) curve analysis was used to determine predictors for the most accurate model. RESULTS Of 3477 screened women, 77 (2.2%) had PPROM. Maternal factors predictive of PPROM in univariable analysis were nulliparity (OR 2.0 (95% CI 1.2-3.3)), PAPP-A < 0.5 MoM (OR 2.6 (1.1-6.2)), previous preterm birth (OR 4.2 (1.9-8.9)), previous cervical conization (OR 3.6 (2.0-6.4)) and cervical length ≤ 25 mm on transvaginal imaging (first-trimester OR 15.9 (4.3-59.3)). These factors all remained statistically significant in a multivariable adjusted model with an AUC of 0.72 in the most discriminatory first-trimester model. The detection rate using this model would be approximately 30% at a false-positive rate of 10%. Potential predictors such as bleeding in early pregnancy and pre-existing diabetes mellitus affected very few cases and could not be formally assessed. CONCLUSIONS Several maternal characteristics, placental biochemical and sonographic features are predictive of PPROM with moderate discrimination. Larger numbers are required to validate this algorithm and additional biomarkers, not currently used for first-trimester screening, may improve model performance.
Collapse
Affiliation(s)
- Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Camilla B Wulff
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte K Ekelund
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eva Hoseth
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Olav B Petersen
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ann Tabor
- Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vanessa El-Achi
- Department of Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jon A Hyett
- The Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, New South Wales 2170, Australia; Department of Obstetrics and Gynaecology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Andrew C McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Sydney Ultrasound for Women, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Paulsen V, Jakob M, Gembruch U, Heep A, Bartmann P. Previable preterm premature rupture of membranes: 117 cases with neonatal outcomes in light of current research. J Neonatal Perinatal Med 2023; 16:21-31. [PMID: 36872792 DOI: 10.3233/npm-221054] [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: 03/06/2023]
Abstract
BACKGROUND ppPROM < 24 + 0 weeks of gestation complicates < 1 % of all pregnancies but is responsible for significant maternal and neonatal morbidity. It is associated with 18-20% of perinatal deaths. OBJECTIVE To evaluate neonatal outcome after expectant management in ppPROM in order to obtain evidence-based information for purposes of future counselling. METHODS A single-centre, retrospective cohort study of 117 neonates born 1994 to 2012 after ppPROM < 24 weeks of gestation with a latency period > 24 hours and admission to the NICU of the Department of Neonatology, University of Bonn. Data of pregnancy characteristics and neonatal outcome were collected. The results were compared to those found in the literature. RESULTS The mean gestational age at ppPROM was 20.45±2,9 weeks (range 11 + 2 -22 + 6) with a mean latency period of 44.7±34.8 days (range 1-135). Mean gestational age at birth was 26.77±3.22 weeks (range 22 + 2-35 + 3). 117 newborns were admitted to the NICU, the overall survival rate at discharge was 72.6% (85/117). Non-survivors had a significantly lower gestational age and higher rates of intra-amniotic infections. The most common neonatal morbidities were RDS (76.1%), BPD (22.2%), pulmonary hypoplasia (PH) (14.5%), neonatal sepsis (37.6%), IVH (34.1% all grades, 17.9% grades III/IV), NEC (8.5%) and musculoskeletal deformities (13.7%). Mild growth restriction as a new complication of ppPROM was observed. CONCLUSIONS Neonatal morbidity after expectant management is similar to that described for infants without ppPROM, but carries a higher risk of pulmonary hypoplasia and mild growth restriction.
Collapse
Affiliation(s)
- V Paulsen
- Department of Neonatology and Paediatric Intensive Care, University of Bonn, Bonn, Germany.,University Children's Hospital of Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, Pan Clinic Neumarkt, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Heep
- Medical Centre Oldenburg University, Children's Hospital Oldenburg, Oldenburg, Germany
| | - P Bartmann
- Department of Neonatology and Paediatric Intensive Care, University of Bonn, Bonn, Germany
| |
Collapse
|
5
|
Zizzo AR, Hvidman L, Salvig JD, Holst L, Kyng M, Petersen OB. Home management by remote self-monitoring in intermediate- and high-risk pregnancies: A retrospective study of 400 consecutive women. Acta Obstet Gynecol Scand 2021; 101:135-144. [PMID: 34877659 DOI: 10.1111/aogs.14294] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Home management in general is considered to improve patient well-being, patient involvement and cost-effectiveness, for obstetric patients as well. But concerns regarding inclusion of intermediate- and high-risk pregnant women are an issue and a limitation for clinical implementation. This retrospective study evaluated the outcome and safety of extended remote self-monitoring of maternal and fetal health in intermediate- and high-risk pregnancies. MATERIAL AND METHODS The study reports on 400 singleton pregnancies complicated by preterm premature rupture of membranes (PPROM), fetal growth restriction, preeclampsia, gestational diabetes mellitus, high-risk of preeclampsia, or a history of previous fetal or neonatal loss. Remote self-monitoring was performed by pregnant women and included C-reactive protein, non-stress test by cardiotocography, temperature, blood pressure, heart rate, and a questionnaire concerning maternal and fetal wellbeing. Data were transferred to the hospital using a mobile device platform and evaluated by healthcare professionals. In case of non-reassuring registrations, the pregnant women were invited for assessment at the hospital. Primary outcome was perinatal death. Secondary outcomes were other maternal and perinatal complications. RESULTS No severe maternal complications were observed. Nine fetal or neonatal deaths occurred, all secondary to malformations, severe fetal growth restriction, extreme prematurity or lung hypoplasia in cases of PPROM before 24 weeks. Even in the latter group, fetal and neonatal survival was 78% (18/23) and rose to 97% (60/62) when PPROM occurred after a gestational age 23+6 weeks. None of the fetal or neonatal deaths were attributable to the home-management setting. CONCLUSIONS Home-monitoring including remote self-monitoring of fetal and maternal well-being in intermediate- and high-risk pregnancies seems to be a safe alternative to inpatient or frequent outpatient care, which sets the stage for a new way of thinking of hospital care. The implementation process included staff training workshops and development of patient enrollment practice with clarification of expectations and responsibilities, which can be crucial to the results.
Collapse
Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jannie Dalby Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Holst
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Kyng
- Department of Computer Science, Aarhus University, Aarhus, Denmark.,Health IT, The Alexandra Institute, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Günes A, Kiyak H, Yüksel S, Bolluk G, Erbiyik RM, Gedikbasi A. Predicting previable preterm premature rupture of membranes (pPPROM) before 24 weeks: maternal and fetal/neonatal risk factors for survival. J OBSTET GYNAECOL 2021; 42:597-606. [PMID: 34382497 DOI: 10.1080/01443615.2021.1935818] [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: 10/20/2022]
Abstract
We sought to compare maternal and neonatal risk factors in cases with previable premature rupture of membranes (pPPROM, between 14-24 weeks) for optimal counselling. Therefore, 192 pregnancies of 485 cases which met selection criteria and agreed to follow-up were retrospectively analysed. Mean gestational age at pPPROM was 20.45 weeks. Live births occurred in 171 cases, but 67 (39.2%) of them died in the neonatal period (neonatal death group) and 104 cases (60.8%) constituted surviving neonate group. Of the surviving neonates, 37 (33.7%) experienced at least one complication. Most seen maternal complications were chorioamnionitis (24.48%) and placental abruption (8.33%). Although amniotic fluid volume, length of pPPROM period, completing antibiotherapy and CRP values were significant, amniotic fluid volume and length of pPPROM showed also significance for multivariate regression analysis for maternal risk factors. Risk factors for birth were gestational age at pPPROM, gestational age at birth, new-born weight at birth, 1st and 5th minute Apgar scores, umbilical cord pH value and need for neonatal resuscitation. Furthermore, development of respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and retinopathy of premature were additional risk factors for neonate. Of them, gestational age at birth, new-born weight at birth, respiratory distress syndrome and retinopathy of prematurity were also significant in multivariate regression analysis.Impact StatementWhat is already known on this subject? Management of previable premature rupture of membranes is controversial and there is no definite consensus on the approach. The factor that best predicts neonatal survival is the gestational age at birth (Deutsch et al. 2010).What do the results of this study add? Appropriate counselling for pPPROM cases is important especially during antenatal period (maternal factors) and postpartum period (neonatal factors). Maternal infection risk is increased with an increased latency period of PPROM. As the gestational age at birth increases, the survival rate increases and neonatal complication rates decrease. Other important determinants of neonatal survival and well-being are the presence of oligo-anhydramnios and latency period of previable PPROM to delivery.What are the implications of these findings for clinical practice and/or further research? Counselling the patient with previable PPROM about pregnancy complications and paediatric outcome is challenging because of the small size, different gestational age ranges, and retrospective nature of the multiple studies on this subject. The most important feature of our study was the relatively high number of patients compared to other series. Thus, we can counsel pregnant women with PPROM prior to 24 weeks of gestation about the maternal antenatal factors and neonatal postnatal factors with related outcomes and help make an informed decision regarding termination or conservative follow-up. Nevertheless, there is a need for larger multicentric prospective studies to validate our data and to establish the prognosis of previable PPROM for both mother and foetus.
Collapse
Affiliation(s)
- Aylin Günes
- Department of Obstetrics and Gynecology, Istanbul Şişli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hüseyin Kiyak
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Semra Yüksel
- Department of Obstetrics and Gynecology, Istanbul Taksim GOP Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Bolluk
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Rabia Merve Erbiyik
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Gedikbasi
- Department of Maternal Fetal Medicine, İstanbul Aydin University Medical School, Istanbul, Turkey
| |
Collapse
|
7
|
Abstract
Periviable deliveries (less than 26 weeks) are a small percentage of deliveries but account for a disproportionately high number of long-term morbidities. Few studies describe interventions and outcomes for periviable preterm premature rupture of membranes (PPROM). The available reports may include only those neonates who received resuscitation, making interpretation and application difficult. Counseling should consider the impact of oligohydramnios on fetal lung development. This article discusses standard and experimental interventions that may offer neonatal benefit. Antenatal corticosteroids, antibiotics, and magnesium sulfate may improve outcomes but data to support an improvement in outcome are limited. Studies specifically evaluating these interventions are needed.
Collapse
Affiliation(s)
- Kelly S Gibson
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, The MetroHealth System, Suite G240, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
| | - Kerri Brackney
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, The MetroHealth System, Suite G240, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA
| |
Collapse
|
8
|
Zajicek M, Yagel S, Valsky D, Ben-Ami M, Yinon Y, Weisz B, Weissmann-Brenner A, Lipitz S. Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13-20 Weeks: Is Selective Termination an Appropriate Management Option? ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:e17-e22. [PMID: 32542619 DOI: 10.1055/a-1176-0919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13-20 weeks of gestation and were managed by expectant management or by selective termination. METHODS A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13-20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included. RESULTS 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups. CONCLUSION Selective termination in twin pregnancies complicated by rupture of membranes at 13-20 weeks has a favorable outcome and should be offered.
Collapse
Affiliation(s)
| | - Simcha Yagel
- ObGyn, Hadassah Medical Center, Jerusalem, Israel
| | - Dan Valsky
- ObGyn, Hadassah Medical Center, Jerusalem, Israel
| | | | - Yoav Yinon
- ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Boaz Weisz
- ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Shlomo Lipitz
- ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
9
|
Hughes O, Crosby D, O'Connell M. Case report and literature review of management of preterm prelabour rupture of membranes before fetal viability. J Matern Fetal Neonatal Med 2020; 35:201-203. [PMID: 32070167 DOI: 10.1080/14767058.2020.1712706] [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: 10/25/2022]
Abstract
Preterm prelabour rupture of membranes (PPROM) complicates up to 3% of pregnancy and is responsible for one third of preterm deliveries. PPROM at extremely preterm gestations (<24 weeks) affects 0.4% of pregnancies and is associated with low neonatal survival rates, high rate of neonatal complications in survivors, and carries major risk of maternal morbidity and mortality. We present a rare case of pregnancy complicated by PPROM at 14 weeks which resulted in a term delivery and a good neonatal outcome.
Collapse
Affiliation(s)
- Oxana Hughes
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - David Crosby
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael O'Connell
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| |
Collapse
|
10
|
Sorano S, Fukuoka M, Kawakami K, Momohara Y. Prognosis of preterm premature rupture of membranes between 20 and 24 weeks of gestation: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2019; 5:100102. [PMID: 32021974 PMCID: PMC6994403 DOI: 10.1016/j.eurox.2019.100102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/02/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022] Open
Abstract
Background The previous study on prognosis of preterm premature rupture of fetal membranes (pPROM) near the limit of viability showed various survival rate raging from 26 to 57 %%. This may be partly due to the fact that treatment of prematurely born babies vary from one country to another, or sometimes within a single country. In Japan, resuscitation efforts are made to newborns of early gestational age, normally from 22 weeks of gestation. Objective To assess the natural history and short- and long-term prognosis in pregnancies complicated by preterm premature rupture of membranes (pPROM) near the limit of viability in a hospital in Japan. Method We conducted a single-center retrospective cohort study. Cases with diagnosis of pPROM at a gestational age of 20–23 6/7 weeks and delivered in our hospital between April 2007 and December 2017 were examined. Result 66 cases were included and of those, 54 (81.1 %) newborns survived to discharge. Of the neonates who survived to discharge, 42 (77.8 % of survivors) experienced severe morbidity at the time of discharge. Multivariate logistic regression analysis showed that later gestational age at pPROM and longer latency period were significantly associated with survival with no severe morbidities (per one day increase, adjusted odds ratio (OR) 1.37, 95 % CI 1.03–1.83, p = 0.033 and per one day increase, adjusted OR 1.11, 95 % CI 1.02–1.21, p = 0.015). Of 23 cases followed at 36 months, 8 (34.8 %) showed developmental delay. Conclusion The survival rate was significantly higher than the previous studies, yet many of the survivors experienced short-term severe morbidity. Of those who experienced short-term severe morbidity, however, more than half showed normal range development at 36 months.
Collapse
Affiliation(s)
- Sumire Sorano
- Corresponding author at: Department of Obstetrics and Gynecology, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiotsuka, Toshima, Tokyo 170-0005, Japan.
| | | | | | | |
Collapse
|
11
|
Navathe R, Schoen CN, Heidari P, Bachilova S, Ward A, Tepper J, Visintainer P, Hoffman MK, Smith S, Berghella V, Roman A. Azithromycin vs erythromycin for the management of preterm premature rupture of membranes. Am J Obstet Gynecol 2019; 221:144.e1-144.e8. [PMID: 30904320 DOI: 10.1016/j.ajog.2019.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/18/2019] [Accepted: 03/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preterm premature rupture of membranes complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin. OBJECTIVE The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin. STUDY DESIGN This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 230 and 336 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of preterm premature rupture of membranes. Patients received 1 of 4 antibiotic regimens: (1) azithromycin 1000 mg per os once (azithromycin 1 day group); (2) azithromycin 500 mg per os once, followed by azithromycin 250 mg per os daily for 4 days (azithromycin 5 day group); (3) azithromycin 500 mg intravenously for 2 days, followed by azithromycin 500 mg per os daily for 5 days (azithromycin 7 day group); or (4) erythromycin intravenously for 2 days followed by erythromycin per os for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin intravenously for 2 days followed by amoxicillin per os for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathological chorioamnionitis and neonatal outcomes. RESULTS Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, have sexually transmitted infection, or experienced substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% confidence interval, 3.3-6.4), azithromycin 5 days (5.0, 95% confidence interval, 3.9-6.1), or azithromycin 7 days (4.9 days, 95% confidence interval, 2.8-7.0) when compared with erythromycin (5.1 days, 95% confidence interval, 3.9-6.4) after adjusting for demographic variables (P = .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P = .005, respectively). CONCLUSION There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of preterm premature rupture of membranes if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single-day dosing, but final recommendations on dosing strategies should rely on clinical trials.
Collapse
Affiliation(s)
- Reshama Navathe
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Corina N Schoen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Massachusetts-Baystate, Springfield, MA.
| | - Paniz Heidari
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Sophia Bachilova
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Massachusetts-Baystate, Springfield, MA
| | - Andrew Ward
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jared Tepper
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA
| | - Paul Visintainer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Massachusetts-Baystate, Springfield, MA
| | - Matthew K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
| | - Stephen Smith
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Abington Memorial Hospital, Abington, PA
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Amanda Roman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
12
|
Panzer A, Dotters-Katz S, Smid M, Boggess K, Manuck T. Factors Associated with Previable Delivery following Second Trimester Rupture of Membranes. Am J Perinatol 2019; 36:812-817. [PMID: 30388716 PMCID: PMC7108711 DOI: 10.1055/s-0038-1675373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify factors associated with previable delivery in second trimester preterm rupture of membranes (PROM). STUDY DESIGN We conducted a single-center retrospective cohort study of women with pregnancies complicated by second trimester PROM (14.0-21.9 weeks' gestation) from 2000 to 2015 who elected expectant pregnancy management and achieved at least 24 hours latency. Maternal characteristics and clinical factors were compared among pregnancies that reached viability (≥ 23.0 weeks) and pregnancies delivered before viability (< 23.0 weeks) using appropriate statistical methods. RESULTS Of 73 pregnancies complicated by second trimester PROM, 49 (67%) delivered before viability. Maternal race, history of preterm birth, and tobacco use were similar between women who delivered < 23 weeks versus ≥ 23 weeks. Gestational age at PROM, cervical dilation > 1cm, Group B streptococcus carrier status, bacterial vaginosis, and chlamydial infection during pregnancy were similar between groups. Median time to delivery was significantly shorter in women who delivered < 23 weeks compared with those who reached ≥ 23 weeks (6 vs. 46 days, p < 0.01). CONCLUSION Previable delivery occurred in the majority of women with second trimester PROM. No maternal or clinical factors were associated with delivery prior to viability. Counseling women with second trimester PROM should include the inability to determine which pregnancies will reach viability.
Collapse
Affiliation(s)
- Alexis Panzer
- Formerly of University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina, Currently of Columbia University, New York, New York
| | - Sarah Dotters-Katz
- Division of Maternal Fetal Medicine, Duke University, Durham, North Carolina
| | - Marcela Smid
- Division of Maternal Fetal Medicine, University of Utah, Salt Lake City, Utah
| | - Kim Boggess
- Division of Maternal Fetal Medicine University of North Carolina, Chapel Hill, North Carolina
| | - Tracy Manuck
- Division of Maternal Fetal Medicine University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
13
|
Tepper J, Corelli K, Navathe R, Smith S, Baxter JK. A retrospective cohort study of fetal assessment following preterm premature rupture of membranes. Int J Gynaecol Obstet 2019; 145:83-90. [PMID: 30706480 DOI: 10.1002/ijgo.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/13/2018] [Accepted: 01/24/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes following management of preterm premature rupture of membranes (PPROM) by two fetal assessment strategies. METHODS In a retrospective cohort study performed at two hospitals in Philadelphia, Pennsylvania between July 2010 and June 2015, data were reviewed from 180 singleton pregnancies with PPROM at 230 -336 weeks of gestation that underwent expectant management. Outcomes were compared between continuous electronic fetal heart monitoring (EFM) with daily biophysical profile (BPP) ("continuous monitoring") and non-stress test (NST) three times per day ("periodic monitoring") using Mann-Whitney U and Fisher exact tests. RESULTS Overall, 119 (66.1%) pregnancies were assessed by continuous monitoring and 61 (33.9%) by periodic monitoring. There was no difference in frequency of intrauterine death between the continuous monitoring (1, 0.8%) and periodic monitoring (3, 4.9%) groups (OR, 0.16; 95% CI, 0.02-1.61). The continuous monitoring group was more likely to have an interventional (OR, 2.17; 95% CI, 1.06-4.44) or cesarean (OR 3.30, 95% CI 1.70-6.38) delivery. CONCLUSION Continuous EFM with daily BPP was associated with higher rates of intervention and cesarean delivery compared with periodic NST, but there was no difference in intrauterine or perinatal mortality.
Collapse
Affiliation(s)
- Jared Tepper
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Kathryn Corelli
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Reshama Navathe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Stephen Smith
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Abington Memorial Hospital, Abington, PA, USA
| | - Jason K Baxter
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
14
|
[Antenatal management in case of preterm premature rupture of membranes before fetal viability: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1076-1088. [PMID: 30409732 DOI: 10.1016/j.gofs.2018.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the maternal, perinatal and long-term prognosis in the event of previable premature rupture of the membranes (PROM) and to specify the interventions likely to reduce the risks and improve the prognosis. METHODS The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS Previable PROM is a rare event whose frequency varies from 0.3 to 1% according to estimates (NP4). When occurring as a complication of amniocentesis, the prognosis is generally better than when spontaneous (NP3). Between 23 and 39% of women will deliver in the week following PROM and nearly 40% of women will not have given birth 2 weeks after (NP3). The frequency of medical termination of pregnancy varies greatly according to the studies (NP4), as does that of fetal death (NP4). Hospital survival and survival rates without major morbidity as a proportion of conservatively treated patients range from 17-55% and 26-63%, respectively (NP4). Neonatal prognosis is largely dominated by prematurity and its complications (NP3). The frequency of maternal sepsis varies from 0.8 to 4.8% in the most recent studies (NP4). Only one case of maternal death is reported, although 3 cases were identified in France between 2007 and 2012 (NP3). Information is a major component of the care to be provided to women and their partners (Professional consensus). An initial period of hospitalization may be proposed after previable PROM (Professional consensus). Thereafter, there is no argument to recommend hospital management rather than extra-hospital management when there is no argument in favour of intrauterine infection (Professional consensus). An evaluation of the amount of amniotic fluid by ultrasound may be proposed at the initial consultation and after a period of 7 to 14 days if pregnancy continues (Professional consensus). Prophylactic antibiotic treatment is recommended as soon as PROM is diagnosed (Professional consensus). The gestational age at which corticosteroid therapy may be proposed will depend on the thresholds selected for neonatal resuscitation care. In particular, it will take into account parental positioning (Professional consensus). From the time of the decision to perform neonatal resuscitation until the gestational age of 32 weeks, it is recommended to administer MgSO4 to the woman whose delivery is imminent (Grade A). Tocolysis is not recommended in this context (Professional consensus). In certain situations, meeting strictly the conditions mentioned by the CSP article L. 2213-1, a maternal request for medical interruption of pregnancy may be discussed. CONCLUSION The levels of evidence of scientific work on the management of previable PROM are low, therefore, most of the recommendations proposed here are based on professional agreement by "reasonable" extension of recommendations valid for later gestational ages.
Collapse
|
15
|
Suzuki Y, Horie K, Yada Y, Kono Y, Hirashima C, Usui R, Matsubara S, Ohkuchi A. Vaginal Ureaplasma species increase chorioamnionitis in very preterm infants with preterm premature rupture of the membranes at < 28 weeks of gestation. Eur J Clin Microbiol Infect Dis 2018; 37:2371-2380. [PMID: 30244363 DOI: 10.1007/s10096-018-3385-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 01/28/2023]
Abstract
Our aim was to investigate the association between vaginal Ureaplasma species (spp.) and the subsequent occurrence of chorioamnionitis (CAM), perinatal death, neonatal morbidity, and long-term neurodevelopmental impairments (NDIs) at 3 years of age. We analyzed 55 pregnant women with singleton pregnancy who had preterm premature rupture of the membranes (pPROM) at < 28+0 weeks of gestation, and delivered between 22+0 and 31+6 weeks at our tertiary hospital in 2007-2016. NDIs were defined as either cerebral palsy or developmental delay evaluated at 1.5 and/or 3 years old. The presence of Ureaplasma spp. and Mycoplasma hominis were evaluated using urea-arginine broth and Mycoplasma PPLO Agar. The presence of Ureaplasma spp. in the vagina was positive in 41%. Vaginal Ureaplasma spp. was a significant risk factor for CAM; however, it was not significantly associated with the occurrence of perinatal death, pulmonary hypoplasia, respiratory distress syndrome, transient tachypnea of the newborn, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia defined as oxygen required and occasional ventilatory assistance required at week 36 as modified (BPD36), or NDIs. The crude odds ratio (95% confidence interval) of Ureaplasma spp. for the occurrence of CAM was 9.5 (1.10-82) (p = 0.041). In very preterm birth infants with pPROM, CAM, BPD36, and NDIs occurred in 78, 60, and 36%, respectively. Vaginal Ureaplasma spp. was a significant risk factor for CAM in very preterm birth infants with pPROM. The incidences of BPD36 and NDIs in such infants were very high, nearing 3/5 and 1/3, respectively.
Collapse
Affiliation(s)
- Yu Suzuki
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kenji Horie
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Yukari Yada
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Chikako Hirashima
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| |
Collapse
|
16
|
Pegu S, Murthy P. Successful outcome of a preterm infant with severe oligohydramnios and suspected pulmonary hypoplasia following premature rupture of membranes (PPROM) at 18 weeks’ gestation. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2018-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Premature rupture of membranes (PPROM) can occur in up to 3–4.5% of pregnancies and lead to complications in the mother and fetus. Maternal chorioamnionitis is the most common complication and may even lead to sepsis. In the fetus, depending upon the time of PPROM causing oligohydramnios, the effect on the lung growth is variable leading to varying degrees of pulmonary hypoplasia with its associated complications like persistent pulmonary hypertension of the newborn (PPHN), air leaks and respiratory failure. Here we present a successful outcome following PPROM at about 18 weeks of gestation, with severe oligohydramnios leading to preterm delivery with suspected pulmonary hypoplasia and pneumothorax in the baby.
Collapse
Affiliation(s)
- Satyaranjan Pegu
- 2C 19.04, Division of Neonatology , Department of Pediatrics , Regina General Hospital , 1440 14 Avenue , Regina, S4P 0W5, Saskatchewan , Canada , Tel.: +306-766-0699, Fax: +306-766-4149
| | - Poornima Murthy
- Division of Neonatology , Department of Pediatrics , Regina General Hospital , Regina, Saskatchewan , Canada
| |
Collapse
|
17
|
Kiver V, Boos V, Thomas A, Henrich W, Weichert A. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation. J Perinat Med 2018; 46:555-565. [PMID: 28822226 DOI: 10.1515/jpm-2016-0341] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A current descriptive assessment of perinatal outcomes in pregnancies complicated by previable preterm premature rupture of membranes (pPPROM) at <24 weeks of gestation, after expectant treatment. STUDY DESIGN Maternal and short-term neonatal data were collected for patients with pPPROM. RESULTS Seventy-three patients with 93 fetuses were hospitalized with pPPROM at 15-24 weeks' gestation. Among these patients, 27.4% (n=20) chose pregnancy termination, 27.4% (n=20) miscarried and 45.2% (n=33) proceeded to live births. After a median latency period of 38 days, ranging from 1 to 126 days, 24 singletons and 20 multiples were live-born, of whom 79.5% (n=35) survived the perinatal period. The main neonatal sequelae were pulmonary hypoplasia (29.5%; n=13), connatal infection (56.8%; n=25), intraventricular hemorrhage (25%; n=11; resulting in five neonatal deaths) and Potter's syndrome (15.9%; n=7). Nine newborns died, within an average of 2.8 days (range, 1-10 days). The overall neonatal survival rate was 51.5% - including miscarriages but not elective terminations. The intact survival rate was 45.5% of all live-born neonates. CONCLUSIONS Even with limited treatment options, overall neonatal survival is increasing. However, neonatal mortality and morbidity rates remain high. The gestational age at membrane rupture does not predict neonatal outcome.
Collapse
Affiliation(s)
- Verena Kiver
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany, Tel.: +49 (030) 450 664487
| | - Vinzenz Boos
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Thomas
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
18
|
Isnard T, Vincent-Rohfritsch A, Le Ray C, Goffinet F, Patkai J, Sibiude J. [In the case of premature live birth, is very early rupture of the membranes an additional risk factor for morbidity and mortality?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2018; 46:447-453. [PMID: 29496431 DOI: 10.1016/j.gofs.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe survival rate after preterm premature rupture of membranes (PPROM) before 25 weeks of gestation and compare neonatal morbidity and mortality among those born alive with a control group of infants born at a similar gestational age without premature rupture of membranes. METHODS We conducted a retrospective single-centre study at Port-Royal maternity, from 2007 to 2015, comparing neonatal outcomes between liveborninfants exposed to PPROM prior to 25 weeks of gestation (WG) and a control group not exposed to premature rupture of the membranes. For each live-born child, the next child born after spontaneous labor without PPROM was matched for gestational age at birth, sex, and whether or not they received antenatal corticosteroid therapy. The primary endpoint was severe neonatal complications assessed by a composite endpoint including neonatal deaths, grade 3-4 HIV, bronchopulmonary dysplasia, leukomalacia and stade 3-4 retinopathies. RESULTS Among 77 cases of very premature rupture of the membranes, 55 children were born alive. Among these, the average gestational age at birth was 28 WG and 1 day. The rate of severe neonatal complications did not differ between the two groups (43.6% in the PPROM group vs. 36.4%, P=0.44) and the survival rate at discharge was also similar in the two groups (85.5% vs. 83.6%, P=0.98). CONCLUSIONS In our cohort and among livebirths after 24 WG, PPROM before 25 WG was not associated with an increased risk of morbidity and mortality compared to children born at the same gestational age after a spontaneous labor with intact membranes.
Collapse
Affiliation(s)
- T Isnard
- Service gynécologie-obstétrique 1, groupe hospitalier Cochin - Broca - Hôtel-Dieu, Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France.
| | - A Vincent-Rohfritsch
- Service gynécologie-obstétrique 1, groupe hospitalier Cochin - Broca - Hôtel-Dieu, Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France.
| | - C Le Ray
- Service gynécologie-obstétrique 1, groupe hospitalier Cochin - Broca - Hôtel-Dieu, Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France; DHU risques et grossesse, AP-HP, 75014 Paris, France.
| | - F Goffinet
- Service gynécologie-obstétrique 1, groupe hospitalier Cochin - Broca - Hôtel-Dieu, Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France; DHU risques et grossesse, AP-HP, 75014 Paris, France.
| | - J Patkai
- Service de médecine et réanimation néonatale, groupe hospitalier Cochin - Broca - Hôtel-Dieu, AP-HP, Paris, France.
| | - J Sibiude
- Service gynécologie-obstétrique 1, groupe hospitalier Cochin - Broca - Hôtel-Dieu, Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France; Inserm CESP 1018, équipe HIV-pédiatrie-reproduction, AP-HP, 94270 Le Kremlin-Bicêtre, France.
| |
Collapse
|
19
|
Apport des ratio pulmonaires échographiques dans les ruptures prématurées précoces des membranes. ACTA ACUST UNITED AC 2018; 46:78-85. [DOI: 10.1016/j.gofs.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Indexed: 12/17/2022]
|
20
|
Dotters-Katz SK, Myrick O, Smid M, Manuck TA, Boggess KA, Goodnight W. Use of prophylactic antibiotics in women with previable prelabor rupture of membranes. J Neonatal Perinatal Med 2017; 10:431-437. [PMID: 29286934 DOI: 10.3233/npm-16165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To measure the effect of prophylactic antibiotics given at time of previable prelabor rupture of membranes (PROM) on latency. METHODS Single center, retrospective cohort study of singleton pregnancies with previable (<23 0/7weeks) PROM. Antibiotics were given at clinician discretion. The primary outcome was latency, defined as duration of time between previable PROM and delivery. Secondary outcomes included delivery at ≥ 23weeks, infant survival, and maternal morbidity. Bivariate analysis compared maternal covariates between women who did and did not receive antibiotics. Antibiotic effect on latency was modeled using a Cox proportional hazards ratio. RESULTS 213 women with previable PROM were identified; 77 (36%) remained pregnant and thus were included in this analysis. Forty (52%) of 77 received antibiotics. Compared to women who did not receive antibiotics, those who did had PROM at a later median (IQR) estimated gestational age, EGA, (22.2weeks [20.7, 22.5] vs. 19.3weeks [18, 20.7], p < 0.01). Median (IQR) latency was not different between women who did and did not receive antibiotics (2.2 [0.7, 3.9] vs. 1.5 [0.5, 4.6] weeks, p = 0.49). More infants survived to discharge among women who received antibiotics compared to those who did not [17(43%) vs. 3(8%), p < 0.01]. When adjusted for EGA at PROM, antibiotics were associated with longer latency (HR 0.57 [95% CI 0.33, 0.97], p = 0.01). Antibiotic use was not associated with differences in maternal morbidity. CONCLUSION After adjusting for EGA at PROM, antibiotic receipt was associated with longer latency. Larger prospective studies are needed to define the utility of prophylactic antibiotics in previable PROM.
Collapse
Affiliation(s)
- S K Dotters-Katz
- Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - O Myrick
- Department of Obstetrics and Gynecology, Columbia University, USA
| | - M Smid
- Division of Maternal-Fetal Medicine, University of Utah, USA
| | - T A Manuck
- Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - K A Boggess
- Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - W Goodnight
- Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
21
|
Kieffer A, Pinto Cardoso G, Thill C, Verspyck E, Marret S. Outcome at Two Years of Very Preterm Infants Born after Rupture of Membranes before Viability. PLoS One 2016; 11:e0166130. [PMID: 27829004 PMCID: PMC5102432 DOI: 10.1371/journal.pone.0166130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the respiratory and neurological outcomes at two years of age of preterm children born before 33 weeks of gestation (WG) after early preterm premature rupture of membranes (EPPROM) between 14 and 24 WG with preterm children without EPPROM. Design and Patients This single-center case-control retrospective study was conducted at Rouen University Hospital between 1st January 2000 and 31st December 2010. All the cases with EPPROM born from 26WG to 32WG were included. Each newborn was matched by sex, gestational age (GA) and year of birth to two very preterm children, born without EPPROM. At two years of corrected age, motor and cognitive abilities were assessed by routine score based on the Amiel-Tison and Denver developmental scales. Results Ninety-four cases with EPPROM before 24WG have been included. The 31 children born from 26WG to 32WG were matched with 62 controls. The EPPROM group had poorer clinical evaluation at one year for motor (p = 0.003) and cognitive developmental scores (p = 0.016). Neuromotor rehabilitation was performed more often (p = 0.013). However, there was no difference at 2 years of age. Children born after EPPROM were hospitalized more often for bronchiolitis (p<0.001) during their first 2 years, which correlates with increased incidence of pneumothorax (p = 0.017), pulmonary hypoplasia (p = 0.004) and bronchopulmonary dysplasia (p = 0.005) during neonatal period. Conclusion At two years, despite an increase in severe bronchiolitis and the need for more neuromotor rehabilitation during the first month of the life after discharge, there was no difference in neurological outcomes in the very preterm children of the EPPROM group compared to those born at a similar GA without EPPROM.
Collapse
Affiliation(s)
- Amelie Kieffer
- Department of Neonatal Medicine, Functional Education Centre for the Child and Reference Centre for learning disabilities, Rouen University Hospital, Rouen, France
- Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France
- * E-mail:
| | - Gaelle Pinto Cardoso
- Department of Neonatal Medicine, Functional Education Centre for the Child and Reference Centre for learning disabilities, Rouen University Hospital, Rouen, France
- Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France
| | - Caroline Thill
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Eric Verspyck
- Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France
- Department of Obstetrics, Rouen University Hospital, Rouen, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Functional Education Centre for the Child and Reference Centre for learning disabilities, Rouen University Hospital, Rouen, France
- Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France
| | | |
Collapse
|
22
|
Wagner P, Sonek J, Mayr S, Abele H, Goelz R, Hoopmann M, Kagan KO. Outcome of dichorionic diamniotic twin pregnancies with spontaneous PPROM before 24 weeks’ gestation. J Matern Fetal Neonatal Med 2016; 30:1750-1754. [DOI: 10.1080/14767058.2016.1224834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Philipp Wagner
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany,
| | - Jiri Sonek
- Fetal Medicine Foundation USA, Dayton, OH, USA,
- Division of Maternal Fetal Medicine, Wright State University, Dayton, OH, USA, and
| | - Stefanie Mayr
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany,
| | - Harald Abele
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany,
| | - Rangmar Goelz
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany,
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany,
| |
Collapse
|
23
|
Yılanlıoğlu NC, Semiz A, Akpak YK. Management of very early preterm premature rupture of membranes (PPROM) in twin pregnancies by selective feticide. CASE REPORTS IN PERINATAL MEDICINE 2016. [DOI: 10.1515/crpm-2016-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim:
To assess the efficacy of selective termination in improving pregnancy outcome in very early preterm premature rupture of membranes (PPROM) in twin pregnancies.
Methods:
A total of six dichorionic twin intracytoplasmic sperm injection (ICSI) pregnancies complicated with very early PPROM between 17+5 and 19+3 gestational weeks were admitted to our hospital and were managed by selective termination of the member with ruptured membranes and followed up. Two cases were twins reduced from triplets at our unit (33%). The fetuses with ruptured membranes were subjected to feticide by intra-cardiac injection of potassium chloride after a mean of 3.5 days following PPROM.
Results:
The overall PPROM-delivery/miscarriage time-interval was 80 days using the proposed management scheme. Two cases ended with total pregnancy loss at 21+ and 23+ weeks, respectively. Four cases progressed successfully beyond 29 weeks, reaching an average of 35+5 days.
Conclusions:
The handling of these six twin PPROM cases as described produced a healthy baby to take home in four instances, resulting in a success rate of 67%, whereas the implementation of a more conservative approach using antibiotics and steroids is expected to lead to a survival rate of around 15% and a handicap rate up to 50%.
Collapse
|
24
|
Outcomes of Pregnancies Complicated by Preterm Premature Rupture of Membranes Between 20 and 24 Weeks of Gestation. Obstet Gynecol 2016; 128:313-320. [DOI: 10.1097/aog.0000000000001530] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
McLaughlin LM, Gardener GJ. Neonatal outcomes after prelabour rupture of membranes before 24 weeks' gestation. J Paediatr Child Health 2016; 52:722-7. [PMID: 27439632 DOI: 10.1111/jpc.13210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to determine neonatal outcomes in pregnancies complicated by prelabour rupture of membranes (PROM) before 24 weeks' gestation. METHODS We performed a retrospective review of medical records over a 5-year period (2007-2011) at Mater Health Services, South Brisbane, Australia. Data relating to the antenatal and perinatal course of pregnancies complicated by PROM before 24 weeks' gestation were collected. Data were also collected on neonatal diagnoses, management and outcomes for all liveborn infants resulting from these pregnancies. RESULTS One hundred and six pregnancies were complicated by PROM before 24 weeks' gestation. Thirty-three (31%) of these pregnancies resulted in delivery at pre-viable gestations (<23 weeks). There were 36 (37%) infants who survived to hospital discharge. At discharge, 47% of infants had chronic lung disease, with 81% of this group requiring supplemental oxygen at home. CONCLUSIONS Almost one-third of pregnancies complicated by PROM before 24 weeks resulted in pre-viable preterm delivery. In pregnancies continuing to a viable gestation, there remained a significant risk of neonatal mortality and morbidity, primarily due to respiratory disease.
Collapse
Affiliation(s)
- Linda M McLaughlin
- Department of Neonatology, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.,Department of Paediatrics and Child Health, The University of Queensland, Mater Health Services, South Brisbane, Queensland, Australia
| | - Glenn J Gardener
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
| |
Collapse
|
26
|
Myrick O, Dotters-Katz S, Grace M, Manuck T, Boggess K, Goodnight W. Prophylactic Antibiotics in Twin Pregnancies Complicated by Previable Preterm Premature Rupture of Membranes. AJP Rep 2016; 6:e277-82. [PMID: 27551580 PMCID: PMC4987281 DOI: 10.1055/s-0036-1587324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study aims to determine if antibiotics given for latency to women with twins and previable preterm premature rupture of membranes (PPROM) affect the duration from membrane rupture to delivery. METHODS A retrospective cohort study of twin pregnancies at a single center from 2000 to 2015 with previable (14 (0/7)-22 (6/7) weeks) PPROM was conducted. Women who were not candidates for expectant management or who elected for immediate delivery were excluded. Pregnancy complications, delivery data, and neonatal outcomes were compared between women who did and did not receive latency antibiotics. The primary outcome was latency. RESULTS Of 52 eligible women, 30 (64%) elected expectant management; 17 women received antibiotics and 13 did not. No demographic differences existed between the groups. The median gestational age of rupture was 20 and 20.3 weeks in the antibiotic group and no antibiotic group, respectively. Median latency was 0.8 and 2.4 weeks in the antibiotic and no antibiotic groups correspondingly (p = 0.21). Overall, 58.8 and 23.1% of women who did and didn't receive antibiotics developed chorioamnionitis (p = 0.07). Perinatal mortality and maternal complication rates were high, though not different between the groups. CONCLUSION Currently, even though in singletons with previable PPROM there is a recommendation to consider administrating antibiotics, in the setting of twins, no evidence exists to support this.
Collapse
Affiliation(s)
- Olivia Myrick
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Sarah Dotters-Katz
- Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Matthew Grace
- Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Tracy Manuck
- Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Kim Boggess
- Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - William Goodnight
- Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
27
|
Linehan LA, Walsh J, Morris A, Kenny L, O'Donoghue K, Dempsey E, Russell N. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16:25. [PMID: 26831896 PMCID: PMC4734873 DOI: 10.1186/s12884-016-0813-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background Preterm premature rupture of membranes (PPROM) complicates 1 % of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of this retrospective descriptive cohort study was to investigate the natural history of midtrimester PPROM in a jurisdiction where termination of pregnancy in the absence of maternal compromise is unavailable. Methods Cases of midtrimester PPROM diagnosed between 14 and 23 + 6 weeks’ gestation during April 2007 to June 2012 were identified following a manual search of all birth registers, pregnancy loss registers, annual reports, ultrasound reports, emergency room registers and neonatal death certificates at Cork University Maternity Hospital - a large (circa 8500 births per annum) tertiary referral maternity hospital in southwest Ireland. Cases where delivery occurred within 24 h of PPROM were excluded. Results The prevalence of midtrimester PPROM was 0.1 % (42 cases/44,667 births). The mean gestation at PPROM was 18 weeks. The mean gestation at delivery was 20 + 5 weeks, with an average latency period of 13 days. Ten infants were born alive (23 %; 10/42). The remainder (77 %; 32/42) died in utero or intrapartum. Nine infants were resuscitated. Two infants survived to discharge. The overall mortality rate was 95 % (40/42). Five women had clinical chorioamnionitis (12 %; 5/42) but 69 % demonstrated histological chorioamnionitis. One woman developed sepsis (2.4 %; 1/42). Other maternal complications included requirement of intravenous antibiotic treatment (38 %; 17/42), retained placenta (21 %, 9/42) and post-partum haemorrhage (12 %; 5/42). Conclusions This study provides useful and contemporary data on midtrimester PPROM. Whilst fetal and neonatal mortality is high, long-term survival is not impossible. The increased risk of maternal morbidity necessitates close surveillance. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0813-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura Aoife Linehan
- The Department of Obstetrics and Gynaecology, University College Cork and Cork University Hospital, Cork, Ireland.
| | - Jennifer Walsh
- The Department of Obstetrics and Gynaecology, University College Cork and Cork University Hospital, Cork, Ireland
| | - Aoife Morris
- The Department of Obstetrics and Gynaecology, University College Cork and Cork University Hospital, Cork, Ireland
| | - Louise Kenny
- The Department of Obstetrics and Gynaecology, University College Cork and Cork University Hospital, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research, Cork, Ireland
| | - Keelin O'Donoghue
- The Department of Obstetrics and Gynaecology, University College Cork and Cork University Hospital, Cork, Ireland
| | - Eugene Dempsey
- The Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Noirin Russell
- The Department of Obstetrics and Gynaecology, University College Cork and Cork University Hospital, Cork, Ireland
| |
Collapse
|
28
|
McKenzie F, Tucker Edmonds B. Offering induction of labor for 22-week premature rupture of membranes: a survey of obstetricians. J Perinatol 2015; 35:553-7. [PMID: 25927269 PMCID: PMC4754108 DOI: 10.1038/jp.2015.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/16/2015] [Accepted: 03/13/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To describe obstetricians' induction counseling practices for 22-week preterm premature rupture of membranes (PPROM) and identify provider characteristics associated with offering induction. METHODS Surveyed 295 obstetricians on their likelihood (0-10) of offering induction for periviable PPROM across 10 vignettes. Twenty-two-week vignettes were analyzed, stratified by parental resuscitation preference. Bivariate analyses identified physician characteristics associated with reported likelihood ratings. RESULTS Obstetricians (N=205) were not likely to offer induction. Median ratings by preference were as follows: resuscitation 1.0, uncertain 1.0 and comfort care 3.0. Only 41% of obstetricians were likely to offer induction to patients desiring comfort care. In addition, several provider-level factors, including practice region, parenting status and years in practice, were significantly associated with offering induction. CONCLUSIONS Obstetricians do not readily offer induction when counseling patients with 22-week ruptured membranes, even when patients prefer palliation. This may place women at risk for infectious complications without accruing a neonatal benefit from prolonged latency.
Collapse
Affiliation(s)
- F McKenzie
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
29
|
Esteves JS, de Sá RAM, de Carvalho PRN, Coca Velarde LG. Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks. J Matern Fetal Neonatal Med 2015; 29:1108-12. [DOI: 10.3109/14767058.2015.1035643] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
30
|
Abstract
PURPOSE OF REVIEW Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence. RECENT FINDINGS The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls. SUMMARY Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.
Collapse
|
31
|
Verspyck E, Bisson V, Roman H, Marret S. Adverse respiratory outcome after premature rupture of membranes before viability. Acta Paediatr 2014; 103:256-61. [PMID: 24175963 DOI: 10.1111/apa.12489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/04/2013] [Accepted: 10/28/2013] [Indexed: 11/30/2022]
Abstract
AIM To determine whether preterm premature rupture of membranes (PPROM) before 24 weeks is an independent risk factor for poor outcome in preterm neonates. METHODS A retrospective comparative cohort study was conducted, including viable premature infants born between 25 and 34-weeks gestation. Each preterm case with early PPROM was matched with two preterm controls of the same gestational age at birth, sex and birth date and who were born spontaneously with intact membranes. Logistic regression was performed to identify independent risk factors associated with composite respiratory and perinatal adverse outcomes for the overall population of preterm infants. RESULTS Thirty-five PPROM cases were matched with 70 controls. Extreme prematurity (26-28 weeks) was an independent risk factor for composite perinatal adverse outcomes [odds ratio (OR) 43.9; p = 0.001]. Extreme prematurity (OR 42.9; p = 0.001), PPROM (OR 7.1; p = 0.01), male infant (OR 5.2; p = 0.02) and intrauterine growth restriction (IUGR, OR 4.8; p = 0.04) were factors for composite respiratory adverse outcomes. CONCLUSION Preterm premature rupture of membranes before viability represents an independent risk factor for composite respiratory adverse outcomes in preterm neonates. Extreme prematurity may represent the main risk factor for both composite respiratory and perinatal adverse outcomes.
Collapse
Affiliation(s)
- Eric Verspyck
- Department of Obstetrics and Gynecology; Rouen University Hospital; Rouen France
- Region-INSERM Team (ERI28) Neovasc; Perinatal Handicap; Institute for Biomedical Research and Innovation (IRIB); School of Medicine; University of Rouen; Rouen France
| | - Violene Bisson
- Department of Obstetrics and Gynecology; Rouen University Hospital; Rouen France
| | - Horace Roman
- Department of Obstetrics and Gynecology; Rouen University Hospital; Rouen France
| | - Stéphane Marret
- Region-INSERM Team (ERI28) Neovasc; Perinatal Handicap; Institute for Biomedical Research and Innovation (IRIB); School of Medicine; University of Rouen; Rouen France
- Department of Neonatal Medicine and Intensive Care; Rouen University Hospital; Rouen France
| |
Collapse
|
32
|
Engemise S, Thompson F, Davies W. Economical Analysis of Different Clinical Approaches in Pre-Viability Amniorrhexis-A Case Series. J Clin Med 2014; 3:25-38. [PMID: 26237250 PMCID: PMC4449677 DOI: 10.3390/jcm3010025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/18/2013] [Accepted: 12/30/2013] [Indexed: 11/16/2022] Open
Abstract
Prolonged oligohydramnios following extreme preterm prelabour rupture of membranes (EPPROM) is traditionally associated with a high morbidity and mortality to both the mother and the baby. The clinical maternal evaluation and fetal ultrasound assessment may provide important prognostic information for the clinicians and should be taken into account when counselling the patients so as to provide them with enough information to make decision of continuing or interrupting the pregnancy. Current financial constraints on the National Healthcare Service (NHS) resources make it imperative for clinical decision-makers and budgetary planners to make the right decision of continuing or terminating a second trimester pre-viability amniorrhexis for desperate parents. To assess the economic consequences following EPPROM, the risk of infection to both baby and mother, psychological impact on the parents and associated complications and further disability after delivery on this fragile group of patients to the NHS resources. We review the clinical course, outcome, and the challenges to parents and health care professionals on three pregnancies complicated by EPPROM, occurring before 24 weeks’ gestation with a membrane rupture to delivery interval (latent period) of 14 days or more. The anticipated birth of an extremely premature infant poses many challenges for parents and health care professionals. As parents are faced with difficult decisions that can have a long-term impact on the infant, family and country’s resources, it is critical to provide the type of information and support that is needed by them. Taking all these into consideration with the period of ventilation and respiratory assistance in Neonatal Intensive Care Unit (NICU) is essential to provide maximum chances for survival, minimizing the risk for long term sequelae of the neonate and provides the parents enough time to decide on making the right decision with the associated guidance of the healthcare provider.
Collapse
Affiliation(s)
- Samuel Engemise
- Department of Obstetrics and Gynecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
| | - Fiona Thompson
- Department of Child Health, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK.
| | - William Davies
- Department of Obstetrics and Gynecology, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK.
| |
Collapse
|
33
|
Acaia B, Crovetto F, Ossola MW, Nozza S, Baffero GM, Somigliana E, Pietrasanta C, Pugni L, Mosca F, Fedele L. Predictive factors for neonatal survival in women with periviable preterm rupture of the membranes. J Matern Fetal Neonatal Med 2013; 26:1628-34. [PMID: 23570530 DOI: 10.3109/14767058.2013.794206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify clinical, hematological or instrumental factors available at the time of the diagnosis that may predict neonatal survival in periviable preterm premature rupture of the membranes (PROM). METHODS We report on a cohort (n = 85) of women with periviable PROM (14-23.6 weeks' gestation) occurring over a 10-year period in a single institution. The main outcome chosen was the survival rate beyond the neonatal period. Variables considered were those available at 24 h after admission. RESULTS The overall survival rate was 49%. In the multivariate analysis, significant contributions for the prediction of neonatal survival were provided by four variables: genetic amniocentesis-related cause of PROM (p < 0.001), gestational age at PROM (p = 0.019), CRP > 1 mg/dl within 24 h after admission (p = 0.042) and oligohydramnios (largest vertical pocket ≤2 cm) (p = 0.041). The corresponding adjusted odds ratio (OR)s were 73.9 (95% CI: 7.9-694.7), 1.5 (95% CI: 1.1-2.0) per week, 0.26 (95% CI: 0.07-0.95) and 0.20 (95% CI: 0.04-0.93), respectively. CONCLUSIONS Genetic amniocentesis-related cause of PROM, gestational age at PROM, C-reactive protein >1 mg/dl and oligohydramnios are significantly associated with survival in women with periviable PROM. The evaluation of these few and easily available variables may help physicians and patients in the decision-making process of this demanding condition.
Collapse
Affiliation(s)
- Barbara Acaia
- Department of Obstetrics and Gynecology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Okazaki A, Miyazaki K, Kihira K, Furuhashi M. Prenatal incarceration of caput succedaneum: A case report. World J Obstet Gynecol 2013; 2:34-36. [DOI: 10.5317/wjog.v2.i2.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/20/2013] [Accepted: 05/10/2013] [Indexed: 02/05/2023] Open
Abstract
Caput succedaneum is relatively common at birth but infrequently diagnosed in utero. We report the first case of a prenatal incarcerated caput succedaneum after cervical cerclage in a patient with premature rupture of the membranes (PPROM). A 41-year-old woman was referred and admitted to our hospital due to PPROM at 19 wk of gestation. Aggressive therapy, including amnioinfusion, cervical cerclage, and administration of antibiotics and tocolysis, was initiated. At 24 wk of gestation, a thumb tip-sized and polyp-like mass, which was irreducible, was delineated with a vaginal examination, vaginal speculum, and transvaginal ultrasonography, leading to the diagnosis of incarcerated caput succedaneum. Under general anesthesia, the incarcerated caput succedaneum was repositioned with fingers after cutting the string to avoid necrosis, and then, placement of a McDonald cervical cerclage was undertaken again. At 26 wk of gestation, she delivered a 678 g girl through an emergency cesarean section performed due to profuse bleeding and prolonged decelerations. A slight bulge with hair was observed on the head by palpation at birth. Cephalic ultrasonography, X-ray, magnetic resonance imaging and electroencephalogram confirmed no abnormality. Although the baby needed oxygen (0.2 L/min) at the time of hospital discharge, she has grown favorably at three years of corrected age.
Collapse
|
35
|
Williams O, Michel B, Hutchings G, Debauche C, Hubinont C. Two-year neonatal outcome following PPROM prior to 25 weeks with a prolonged period of oligohydramnios. Early Hum Dev 2012; 88:657-61. [PMID: 22682720 DOI: 10.1016/j.earlhumdev.2012.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/18/2012] [Accepted: 01/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Improved neonatal survival data have been reported following early preterm prelabour rupture of membranes (PPROM) prior to 25 weeks gestation with a prolonged latency to delivery and persistent oligohydramnios. However, data regarding long-term respiratory and neurological morbidity are lacking. AIMS To evaluate the respiratory and neurological outcome data at two years of age in a cohort of infants born following PPROM prior to 25 weeks with a prolonged latency (14 days) to delivery and compare the data to an aged matched group of infants. METHODS Retrospective case note analysis over a 43-month period at Saint Luc University Hospital, Brussels. RESULTS 15 surviving infants born following PPROM were matched to a group of 30 control infants. Although there was no significant difference in the incidence of BPD between the groups (33% vs 27%, p=0.24), the length of hospitalisation, duration of respiratory support and number of hospital readmissions for respiratory indications were all significantly higher for infants born following a prolonged period of oligohydramnios. There were no major anomalies on cranial ultrasound in the PPROM group and Baileys developmental assessment at 20-24 months corrected gestational age showed no difference between the two groups (Mental development index 93.9 vs 94.4 and Psychomotor development index 95.5 vs 95.8 respectively p = ns). CONCLUSION Neurodevelopmental outcome appears encouraging in this cohort although these infants are at high risk of prolonged initial hospitalisation and significant respiratory morbidity in the first two-years of life.
Collapse
Affiliation(s)
- O Williams
- Department of Neonatology, Cliniques Universitaires Saint Luc, Catholic University of Louvain, 10 Avenue Hippocrate, Brussels, Belgium.
| | | | | | | | | |
Collapse
|
36
|
Fernandes GL, Torloni MR, Hisaba WJ, Klimke D, Novaes J, Sancovski M, Peixoto S. Premature rupture of membranes before 28 weeks managed expectantly: maternal and perinatal outcomes in a developing country. J OBSTET GYNAECOL 2012; 32:45-9. [PMID: 22185536 DOI: 10.3109/01443615.2011.609923] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 ± 4.2 and 28.4 ± 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.
Collapse
Affiliation(s)
- G L Fernandes
- High Risk Pregnancy Unit, Hospital Municipal Universitário, Faculdade de Medicina do ABC, São Bernardo do Campo, Brazil
| | | | | | | | | | | | | |
Collapse
|
37
|
Hunter TJ, Byrnes MJ, Nathan E, Gill A, Pennell CE. Factors influencing survival in pre-viable preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2012; 25:1755-61. [DOI: 10.3109/14767058.2012.663824] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
38
|
Storness-Bliss C, Metcalfe A, Simrose R, Wilson RD, Cooper SL. Correlation of Residual Amniotic Fluid and Perinatal Outcomes in Periviable Preterm Premature Rupture of Membranes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:154-158. [DOI: 10.1016/s1701-2163(16)35158-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Amy Metcalfe
- Community Health Sciences, University of Calgary, Calgary AB
| | - Rebecca Simrose
- Department of Obstetrics and Gynecology, University of Calgary, Calgary AB
| | - R Douglas Wilson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary AB
| | - Stephanie L Cooper
- Department of Obstetrics and Gynecology, University of Calgary, Calgary AB
| |
Collapse
|
39
|
Azria E, Anselem O, Schmitz T, Tsatsaris V, Senat MV, Goffinet F. Comparison of perinatal outcome after pre-viable preterm prelabour rupture of membranes in two centres with different rates of termination of pregnancy. BJOG 2012; 119:449-57. [DOI: 10.1111/j.1471-0528.2011.03265.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Previable preterm rupture of membranes: gestational and neonatal outcomes. Arch Gynecol Obstet 2011; 285:1529-34. [DOI: 10.1007/s00404-011-2179-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
|
41
|
Messerschmidt A, Pataraia A, Helmer H, Kasprian G, Sauer A, Brugger PC, Pollak A, Weber M, Prayer D. Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes. Pediatr Radiol 2011; 41:1416-20. [PMID: 21909717 DOI: 10.1007/s00247-011-2199-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 05/03/2011] [Accepted: 05/23/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). OBJECTIVE To evaluate the predictive value of MRI lung volumetrics after pPROM. MATERIALS AND METHODS Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. RESULTS Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. CONCLUSION Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM.
Collapse
Affiliation(s)
- Agnes Messerschmidt
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Shah DM, Kluckow M. Early functional echocardiogram and inhaled nitric oxide: usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM). J Paediatr Child Health 2011; 47:340-5. [PMID: 21309877 DOI: 10.1111/j.1440-1754.2010.01982.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Poor neonatal outcome of preterm premature rupture of membranes (PPROM) < 24 weeks' gestational age (GA) is probably a result of abnormalities in both airway and vascular developments, ventilation perfusion mismatch, and possibly persistent pulmonary hypertension of the newborn (PPHN). Perinatal mortality of 50-90% has been reported in the past, with recent literature reporting significant improvement in neonatal survival. We report our 8-year experience in this group of infants using early diagnostic functional echocardiography (fECHO), high-frequency ventilation (HFV) and inhaled nitric oxide (iNO). METHODS The obstetric and neonatal databases were searched to identify babies with PPROM (< 20 weeks' gestation) or rupture earlier than 25 weeks for more than 14 days. RESULTS Twenty-six infants were identified, of whom 20 were admitted to the neonatal intensive care unit (NICU; mean GA 27.8 weeks, mean birth weight (BW) 1207 g). Early echocardiographic data were available in 12/15 infants requiring mechanical ventilation of whom 10 had evidence of PPHN. All infants who received iNO therapy survived to discharge and only two infants died. Survival to discharge was 69% for the whole cohort of infants and 90% for infants admitted to the NICU. In contrast, for the cohort from pre-iNO and -HFV era, the overall survival to discharge was 62% and 66% for the infants admitted to the NICU. CONCLUSION Premature infants with PPROM and presumed severe hypoxemic respiratory failure because of hypoplastic lungs often have significant PPHN and may show improvement in oxygenation after treatment with HFV and iNO. Early fECHO results in earlier identification and treatment of infants with PPHN in this high-risk group.
Collapse
Affiliation(s)
- Dharmesh M Shah
- Department of Neonatology, Royal North Shore Hospital Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
| | | |
Collapse
|
43
|
Borazjani A, Weed BC, Patnaik SS, Feugang JM, Christiansen D, Elder SH, Ryan PL, Liao J. A comparative biomechanical analysis of term fetal membranes in human and domestic species. Am J Obstet Gynecol 2011; 204:365.e25-36. [PMID: 21324430 DOI: 10.1016/j.ajog.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/17/2010] [Accepted: 12/01/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to biomechanically characterize and compare human, porcine, equine, and ovine fetal membranes. STUDY DESIGN Noncontact metrology was used for topographic analyses. Uniaxial tensile testing was performed to resolve specific biomechanical values. Puncture force and radial stresses were determined with biaxial puncture testing. Microstructure and surface tortuosity were analyzed histologically. RESULTS Equine and human membranes sustained larger magnitude loading, but ovine and porcine membranes exhibited stronger material properties. Biaxial puncture validated uniaxial results; human and equine groups accommodated the largest loads but lowest stresses. Equine membranes were mostly vascularized; tortuosity was highest in porcine membranes. Species' gestation length was correlated positively with membrane thickness. CONCLUSION The anatomy of placentation and length of species gestation show distinct relationships to membrane biomechanics. Unlike other species, human fetal membranes do not compensate for structural weakness with a thicker membrane. This finding may explain the high incidence of preterm premature rupture of membranes in humans.
Collapse
Affiliation(s)
- Ali Borazjani
- Tissue Bioengineering Laboratory, Department of Agricultural and Biological Engineering, TERC and CAVS, Bagley College of Engineering, Mississippi State University, Mississippi State, MS 39762, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Use of Atosiban in a Twin Pregnancy With Extremely Preterm Premature Rupture in the Membrane of one Twin: A Case Report and Literature Review. Taiwan J Obstet Gynecol 2010; 49:495-9. [DOI: 10.1016/s1028-4559(10)60103-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2009] [Indexed: 11/21/2022] Open
|
45
|
Soylu H, Jefferies A, Diambomba Y, Windrim R, Shah PS. Rupture of membranes before the age of viability and birth after the age of viability: comparison of outcomes in a matched cohort study. J Perinatol 2010; 30:645-9. [PMID: 20220762 DOI: 10.1038/jp.2010.11] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare composite adverse outcome rate of infants <32 weeks gestational age (GA) who were born after preterm premature rupture of membranes (PPROM) at previable gestation to those born without PPROM. STUDY DESIGN Retrospective review of prospective collected data for infants discharged between 2004 and 2007 was conducted. Cases were infants with >7 days of PPROM that occurred before 24 weeks. Matched cohort consisted of infants born without PPROM (matched for GA, sex and admission date). Composite adverse outcome was assessed considering death or any of the following three severe morbidities (severe neurological injury, severe retinopathy of prematurity or chronic lung disease). RESULT The 29 cases had higher mean severity of illness score compared with 74 matched infants. Mean duration of ROM was 45 vs 2 days and mean GA at the ROM was 21 vs 27 weeks, respectively. Logistic regression confirmed significantly higher risk of composite adverse outcome rates for cases (69 vs 47%; P=0.02, adjusted odds ratio 4.0, 95% CI 1.2, 13.6). CONCLUSION The survival rate for infants born at <32 weeks following PPROM at previable age has improved significantly; however, these infants had a higher rate of adverse composite neonatal outcome.
Collapse
Affiliation(s)
- H Soylu
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
46
|
Deutsch A, Deutsch E, Totten C, Downes K, Haubner L, Belogolovkin V. Maternal and neonatal outcomes based on the gestational age of midtrimester preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2010; 23:1429-34. [DOI: 10.3109/14767051003678069] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
47
|
|
48
|
Abstract
The moral practice of nursing requires the difficult work of discerning the best response to an ethical quandary. Determining the right course of action can rarely be discovered by assuming that one value, one theory, one point of view will always and reliably identify the morality of an action. Thus, the role of a nurse is an inherently moral activity that is at the heart and soul of health care. Practitioners who move too quickly to a state of moral certainty about a decision may be missing essential components of the enactment of moral agency. Personal integrity and professional integrity, patient interests, society's expectation of a profession, the balance between rights and obligations within the nurse-patient relationship, acting according to one's conscience, power, control, and moral certainty are a few of the topics that enrich thinking about the moral richness of nursing practice, and will encourage readers to know, to reason, and to act in ways that demonstrate reflective moral judgment.
Collapse
Affiliation(s)
- Cheryl Ellis Vaiani
- Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, TX 77555-1311, USA.
| |
Collapse
|
49
|
Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201:230-40. [PMID: 19733274 DOI: 10.1016/j.ajog.2009.06.049] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 05/01/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
Abstract
Preterm premature rupture of the membranes near the limit of fetal viability is an uncommon complication of pregnancy, affecting approximately 4 in 1000 gravidas. However, maternal, fetal, and neonatal complications resulting from this condition are significant and include chorioamnionitis, pulmonary hypoplasia, restriction deformities, fetal loss, and complications of extreme prematurity among surviving infants. In this article, we review the literature regarding pregnancy outcomes after preterm premature rupture of the membranes near the limit of viability, and the data on traditional and nontraditional interventions to improve outcomes. An approach to patients who present with preterm premature rupture of the membranes near the limit of viability will be proposed.
Collapse
|
50
|
Gomez R, Romero R, Nien JK, Medina L, Carstens M, Kim YM, Espinoza J, Chaiworapongsa T, Gonzalez R, Iams JD, Rojas I. Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra-amniotic infection. J Matern Fetal Neonatal Med 2009; 20:167-73. [PMID: 17437216 DOI: 10.1080/14767050601135485] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Antibiotic administration has become part of the standard of care for patients with preterm premature rupture of membranes (PROM). Yet, the natural history of intrauterine infection/inflammation during antibiotic therapy remains largely unknown. This study was conducted to determine if antibiotic administration to the mother eradicates intra-amniotic infection and/or reduces the frequency of intra-amniotic inflammation, a risk factor for impending preterm labor/delivery and adverse neonatal outcome. METHODS A subset of patients with preterm PROM admitted to our institution underwent amniocenteses before and after antibiotic administration in order to guide clinical management. Amniotic fluid analysis consisted of a Gram stain, culture for aerobic and anaerobic bacteria as well as genital mycoplasmas, and amniotic fluid white blood cell (WBC) count. Microbial invasion of the amniotic cavity (MIAC) was defined as a positive amniotic fluid culture. Intra-amniotic inflammation was defined as an amniotic fluid WBC count >or=100/mm(3). Patients were given antibiotics and steroids after the 24(th) week of gestation. Antibiotic treatment consisted of ampicillin and erythromycin for 7 days for patients without evidence of intra-amniotic inflammation or MIAC, and ceftriaxone, clindamycin and erythromycin for 10-14 days for those with intra-amniotic inflammation or MIAC. RESULTS Forty-six patients with preterm PROM whose first amniocentesis was performed between 18 and 32 weeks (median 27.4 weeks) were included in the study. The overall prevalence of intra-amniotic inflammation in the first amniocentesis was 39% (18/46). Seven had a positive amniotic fluid culture for microorganisms. At the time of the second amniocentesis, six of the seven patients with a positive amniotic fluid culture had microorganisms. Of 18 patients with intra-amniotic inflammation at admission, only three showed no evidence of inflammation after antibiotic treatment. Among patients with no evidence of intra-amniotic inflammation at admission, 32% (9/28) developed inflammation despite therapy. Five of these nine patients had positive amniotic fluid cultures. CONCLUSIONS (1) Antibiotic administration (ceftriaxone, clindamycin, and erythromycin) rarely eradicates intra-amniotic infection in patients with preterm PROM; (2) intra-amniotic inflammation developed in one-third of patients who did not have inflammation at admission, despite antibiotic administration; (3) a sub-group of patients with documented inflammation of the amniotic cavity demonstrated a decrease in the intensity of the inflammatory process after antibiotic administration.
Collapse
Affiliation(s)
- Ricardo Gomez
- Center for Perinatal Diagnosis and Research CEDIP, Hospital Dr. Sótero del Río, P. Universidad Católica de Chile, Puente Alto, Chile
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|