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Goodfellow L, Curran C, Care A. Early PPROM: women and babies who should not be lost in the system. BMJ 2024; 384:q690. [PMID: 38508672 DOI: 10.1136/bmj.q690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Laura Goodfellow
- Women's and Children's Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Ciara Curran
- Patient author, Little Heartbeats Patient Support Group, Buxton, UK
| | - Angharad Care
- Women's and Children's Health, University of Liverpool, Liverpool L69 3BX, UK
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Goodfellow L, Care A, Curran C, Roberts D, Turner MA, Knight M, Zarko A. Preterm prelabour rupture of membranes before 23 weeks' gestation: prospective observational study. BMJ MEDICINE 2024; 3:e000729. [PMID: 38601318 PMCID: PMC11005708 DOI: 10.1136/bmjmed-2023-000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 04/12/2024]
Abstract
Objective To describe perinatal and maternal outcomes of preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation in a national cohort. Design Prospective observational study. Setting National population based cohort study with the UK Obstetric Surveillance System (UKOSS), a research infrastructure of all 194 obstetric units in the UK, 1 September 2019 to 28 February 2021. Participants 326 women with singleton and 38 with multiple pregnancies with PPROM between 16+0 and 22+6 weeks+days' gestation. Main outcome measures Perinatal outcomes of live birth, survival to discharge from hospital, and severe morbidity, defined as intraventricular haemorrhage grade 3 or 4, or requiring supplemental oxygen at 36 weeks' postmenstrual age, or both. Maternal outcomes were surgery for removal of the placenta, sepsis, admission to an intensive treatment unit, and death. Clinical data included rates of termination of pregnancy for medical reasons. Results Perinatal outcomes were calculated with all terminations of pregnancy for medical reasons excluded, and a worst-best range was calculated assuming that all terminations for medical reasons and those with missing data would have died (minimum value) or all would be liveborn (maximum value). For singleton pregnancies, the live birth rate was 44% (98/223), range 30-62% (98/326-201/326), perinatal survival to discharge from hospital was 26% (54/207), range 17-53% (54/326-173/326), and 18% (38/207), range 12-48% (38/326-157/326) of babies survived without severe morbidity. The rate of maternal sepsis was 12% (39/326) in singleton and 29% (11/38) in multiple pregnancies (P=0.004). Surgery for removal of the placenta was needed in 20% (65/326) and 16% (6/38) of singleton and twin pregnancies, respectively. Five women became severely unwell with sepsis; two died and another three required care in the intensive treatment unit. Conclusions In this study, 26% of women who had very early PPROM with expectant management had babies that survived to discharge from hospital. Morbidity and mortality rates were high for both mothers and neonates. Maternal sepsis is a considerable risk that needs more research. These data should be used in counselling families with PPROM before 23 weeks' gestation, and currently available guidelines should be updated accordingly.
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Affiliation(s)
- Laura Goodfellow
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Angharad Care
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ciara Curran
- Little Heartbeats Patient Support Group, Buxton, UK
| | | | - Mark A Turner
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Alfirevic Zarko
- Women's and Children's Health, University of Liverpool, Liverpool, UK
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Can E, Oğlak SC, Ölmez F. Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes. J Obstet Gynaecol Res 2022; 48:1740-1749. [PMID: 35411577 DOI: 10.1111/jog.15239] [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: 09/03/2021] [Revised: 02/06/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to describe the maternal and fetal outcomes associated with expectant management following previable preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. We also analyzed the risk estimates of potential confounders to clarify whether these variables are contributed to the risk of postnatal mortality among these neonates. METHODS This retrospective cohort study included all pregnant patients who experienced previable PPROM before 24 weeks of gestation at a tertiary maternal-fetal medicine center. We used the neonatal data from birth until discharge. RESULTS A total of 128 women were enrolled. The survival to discharge rate was 60.9%. The median latency period (80 vs. 20 days, respectively, p < 0.001) was significantly longer, the median gestational week at delivery (34 vs. 25 weeks, respectively, p < 0.001) and median birth weight (2100 vs. 710 g, p < 0.001) was significantly higher in the survivor group than the non-survivor group. Surviving neonates had significantly lower frequencies of anhydramnios at any time during the latency period than the non-survivor neonates (38.4% vs. 86.0%, respectively, p < 0.001). CONCLUSION This study demonstrated an opposite correlation between the duration of latency period and gestational age at PPROM with earlier membrane rupture in pregnancies having a longer latency period, which additionally clarifies the higher gestational age at delivery. The antepartum factors that increased the possibility of postnatal mortality within our study included the gestational week at delivery, duration of the latency period, anhydramnios at any time during the latency period, and birth weight.
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Affiliation(s)
- Esra Can
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Fatma Ölmez
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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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.
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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
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Esteves JS, Nassar de Carvalho PR, Sa R, Gomes Junior SC. Maternal and perinatal outcomes in midtrimester rupture of membranes. J Matern Fetal Neonatal Med 2020; 35:3460-3466. [PMID: 33032477 DOI: 10.1080/14767058.2020.1821641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess neonatal and maternal adverse outcomes following expectant management of preterm prelabor rupture of membranes (PPROM) between 18 and 26 weeks and to identify maternal morbidity and prognostic factors for neonatal outcomes. METHODS Data were collected from all pregnant women who presented PPROM between 18+0 and 26+0 weeks admitted into two tertiary centers in Brazil from 2005 to 2016. The neonatal adverse outcomes (mortality or the development of a severe morbidity) and maternal adverse outcomes were analyzed and compared among four groups (180/7 to 200/7 weeks, 20+1 to 220/7 weeks, 22+1 to 240/7 weeks and 24+1 to 260/7 weeks). A multiple logistic regression was performed for each predictor of neonatal adverse outcomes, and the area under the receiver operating characteristics curves for birth weight and gestational age at birth were calculated. RESULTS Of the 101 women with PPROM during the study period, 97 fulfilled the eligible criteria. Among these patients, 30 (30.9%) had a miscarriage or stillbirth. Overall there were 67/97 (69.1%) livebirths, 45/97 newborns survived to discharge (46.3%), and 53/97 (54.6%) experienced severe neonatal adverse outcome. The median latency period was seven days, with 36 (37.1%) patients ending the pregnancy in 2-14 days. Among 29 patients with PPROM at 24+1 to 260/7 weeks, only 13 (44.8%) delivered between 2 and 14 days. Multivariate analysis has demonstrated that the independent predictor for adverse neonatal outcome was birthweight. The maternal morbidity was high; however, the expectant management did not increase the rate of severe maternal morbidity. CONCLUSIONS PPROM between 18+0 and 26+0 weeks has high morbidity and mortality, and the only significant independent predictor of severe adverse neonatal outcomes is birthweight. Maternal morbidity is high, however, the expectant management is not increased by expectant management.
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Affiliation(s)
- Juliana Silva Esteves
- Department of Obstetrics, Rua Sacadura Cabral, Hospital Federal Servidores do Estado, Rio de Janeiro, Brazil
| | - Paulo Roberto Nassar de Carvalho
- Clínica Perinatal Barra, Diagnostic Center, Rio de Janeiro, Brazil.,Department of Obstetrics, Instituto Fernandes Figueira/Fiocruz, Rio de Janeiro, Brazil
| | - Renato Sa
- Materno Infantil Department, Universidade Federal Fuminense, Niteroi, Brazil
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Pendse A, Panchal H, Athalye-Jape G, Campbell C, Nathan E, Rao S, Dickinson JE. Neonatal outcomes following previable prelabour rupture of membranes before 23 weeks of gestation - A retrospective cohort study. J Neonatal Perinatal Med 2020; 14:9-19. [PMID: 32224534 DOI: 10.3233/npm-190366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare outcomes of hospitalized preterm infants following previable prelabour rupture of membranes (PPROM) at≤23 weeks of gestation. METHODS Retrospective cohort study of preterm infants admitted for intensive care, between January 2006 and December 2016 following PPROM, was conducted. Short term clinical outcomes included severity of respiratory morbidity, length of hospital stay and mortality. Neurodevelopment in survivors was assessed using Bayley's Scales of Infant Development (3rd edition) at 24 months corrected age. RESULTS A total of 82 preterm infants were admitted following PPROM at < 23 weeks and were grouped as: Group 1 (n = 28) with PPROM < 20 weeks and Group 2 (n = 54) with PPROM between 20-22 + 6 weeks. Median latency following PPROM was significantly longer in Group 1 infants [69(Interquartile range (IQR): 43-74; Range (R): 25-100 vs. 29(IQR: 10-53; R: 2-72) days, p < 0.001]. Median gestation at delivery was 27.4 weeks (Group 1) vs. 25.1 weeks (Group 2). Group 1 had a significantly higher incidence of oligohydramnios [13(46.4%) vs. 8(14.8%), p = 0.002], lower Apgar scores (<7) at 5 minutes [19(67.9%) vs. 24(44.4%), p = 0.044], increased pulmonary hypoplasia [13(46.4%) vs. 5(9.3%), p < 0.001], joint contractures [3(10.7%) vs. 0, p = 0.037] and mortality [10(35.7%) vs. 7(13.0%), p = 0.016]. Neurodevelopmental outcomes at 24 months corrected age were comparable in the 36 surviving infants (9/18 vs. 27/547). CONCLUSION Morbidity and mortality is high in infants born after previable PPROM; specifically, in those with PPROM < 20 weeks although early childhood neurodevelopmental outcomes were comparable. Larger prospective studies focussing on long term neonatal outcomes are needed to confirm these findings.
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Affiliation(s)
- A Pendse
- Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia.,Neonatal Directorate, Perth Children's Hospital, Perth, Australia
| | - H Panchal
- Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia.,Neonatal Directorate, Perth Children's Hospital, Perth, Australia.,Centre for Neonatal Research and Education, University of Western, Australia, Perth, Australia
| | - G Athalye-Jape
- Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia.,Neonatal Directorate, Perth Children's Hospital, Perth, Australia.,School of Paediatrics, University of Western Australia, Perth, Australia.,Centre for Neonatal Research and Education, University of Western, Australia, Perth, Australia
| | - C Campbell
- Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia.,Department of Psychological Medicine, King Edward Memorial Hospital for Children, Perth, Australia
| | - E Nathan
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia.,Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
| | - S Rao
- Neonatal Directorate, Perth Children's Hospital, Perth, Australia.,School of Paediatrics, University of Western Australia, Perth, Australia.,Centre for Neonatal Research and Education, University of Western, Australia, Perth, Australia
| | - J E Dickinson
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia.,Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia.,Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Australia
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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.
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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
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[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.
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Sim WH, Ng H, Sheehan P. Maternal and neonatal outcomes following expectant management of preterm prelabor rupture of membranes before viability. J Matern Fetal Neonatal Med 2018; 33:533-541. [PMID: 29961407 DOI: 10.1080/14767058.2018.1495706] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To provide center-based outcome data on obstetric and neonatal complications arising from expectantly managed pregnancies affected by preterm prelabor rupture of membranes (PPROM) before viability.Materials and methods: We collected data on 130 consecutive pregnancies complicated by spontaneous rupture of membranes before 24 week's gestation, occurring over a 7-year period. These were women who delivered >24 h after membrane rupture, and had no signs of chorioamnionitis or advanced labor at admission. Women with amniocentesis-induced PPROM (n = 7) were analyzed separately. The descriptive statistics of obstetrics and neonatal outcomes were reported.Results: The overall neonatal survival to discharge rate was 33.8%. Stratification of patients into early (12 to 19+6 weeks' gestation) and late pre-viable PPROM (20 to 23+6 weeks' gestation) revealed a 3.6-fold increase in survival rate in the latter group (12.2% versus 43.8%, p < .001). Pre-viable PPROM following amniocentesis predicted a 100% survival outcome, however anhydramnios impacted negatively. The most common neonatal morbidities of those admitted to intensive care unit were respiratory distress syndrome (78.7%) and bronchopulmonary dysplasia (84.4%). The most common maternal morbidities affecting pre-viable PPROM were clinical chorioamnionitis (47.7%), histological chorioamnionitis (81.8%), retained products of conception (39.3%) and preterm labor (45.4%).Conclusions: Later gestational ages at PPROM were associated with better survival rates, however neonatal morbidity remained high. Women experiencing pre-viable PPROM following amniocentesis can be reassured, while those with anhydramnios at any time during the latency period should be adequately counseled regarding poorer outcomes.
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Affiliation(s)
- Winnie Huiyan Sim
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.,Pregnancy Research Centre, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Hamon Ng
- Pregnancy Research Centre, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Penelope Sheehan
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.,Pregnancy Research Centre, Royal Women's Hospital, Melbourne, VIC, Australia
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Sung JH, Kuk JY, Cha HH, Choi SJ, Oh SY, Roh CR, Kim JH. Amniopatch treatment for preterm premature rupture of membranes before 23 weeks' gestation and factors associated with its success. Taiwan J Obstet Gynecol 2017; 56:599-605. [DOI: 10.1016/j.tjog.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/26/2022] Open
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Toukam ME, Luisin M, Chevreau J, Lanta-Delmas S, Gondry J, Tourneux P. A predictive neonatal mortality score for women with premature rupture of membranes after 22-27 weeks of gestation. J Matern Fetal Neonatal Med 2017; 32:258-264. [PMID: 28950738 DOI: 10.1080/14767058.2017.1378327] [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: 10/18/2022]
Abstract
OBJECTIVE Premature rupture of the membranes (PROM) remains a leading cause of neonatal morbidity. The objectives of the present study were to analyze the outcomes of pregnancies complicated by PROM between 22 and 27+6 weeks of gestation (WG) and to study antepartum risk factors that might predict neonatal death. PATIENTS AND METHODS One hundred and seven pregnancies were analyzed over a 3-year period in a tertiary maternity hospital. The collected maternal and neonatal data were used to model and predict the outcome of PROM. RESULTS Prevalence of PROM (for live births) was 1.08%, and the overall survival rate was 59.8%. From preselected candidate variables, gestational age (GA) at PROM (p = .0002), a positive vaginal culture for pathogenic bacteria (p = .01), primiparity (p = .02), and the quantity of amniotic fluid (p = .03) were included in a multivariable logistic regression analysis. The corresponding adjusted odds ratios [95% confidence interval] were, respectively, 0.91 [0.87-0.96], 11.08 [1.65-74.42], 0.55 [0.33-0.91], and 0.97 [0.95-0.99]. These parameters were used to build a predictive score for neonatal death. CONCLUSIONS The survival rate after PROM at 22-27+6 weeks of gestation was 59.8%. Our predictive model (built using multivariable logistic regression) may be of value for obstetricians and neonatologists counseling couples after PROM.
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Affiliation(s)
- Michèle Eve Toukam
- a Département de Gynécologie-Obstétrique , Hôpital Robert Ballanger, Pôle Femme-enfant , Aulnay-sous-Bois , France
| | - Marion Luisin
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France
| | - Julien Chevreau
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France.,c Inserm UMR 1105, GRAMFC , Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, Université de Picardie Jules Verne, CHU Amiens , Amiens , France
| | - Ségolène Lanta-Delmas
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France
| | - Jean Gondry
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France.,c Inserm UMR 1105, GRAMFC , Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, Université de Picardie Jules Verne, CHU Amiens , Amiens , France
| | - Pierre Tourneux
- d Réanimation et surveillance continue pédiatrique , pôle femme couple enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France.,e PériTox , UFR de médecine, Université de Picardie Jules Verne, UMI 01 , Amiens , France
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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.
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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
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14
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Sim WH, Araujo Júnior E, Da Silva Costa F, Sheehan PM. Maternal and neonatal outcomes following expectant management of preterm prelabour rupture of membranes before viability. J Perinat Med 2017; 45:29-44. [PMID: 27780154 DOI: 10.1515/jpm-2016-0183] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
AIM To assess the contemporary maternal and neonatal outcomes following expectant management of preterm premature rupture of membranes (PPROM) prior to 24 weeks' gestation and to identify prognostic indicators of this morbid presentation. METHODS We performed a systematic review in the Pubmed and EMBASE databases to identify the primary (perinatal mortality, severe neonatal morbidity and serious maternal morbidity) and secondary (neonatal survival and morbidity) outcomes following expectant management of previable PPROM. RESULTS Mean latency between PPROM and delivery ranged between 20 and 43 days. Women with PPROM <24 weeks had an overall live birth rate of 63.6% and a survival-to-discharge rate of 44.9%. The common neonatal morbidities were respiratory distress syndrome, bronchopulmonary dysplasia and sepsis. The majority of neonatal deaths within 24 h post birth were associated with pulmonary hypoplasia, severe intraventricular haemorrhage and neonatal sepsis. The common maternal outcomes were chorioamnionitis and caesarean sections. The major predictors of neonatal survival were later gestational age at PPROM, adequate residual amniotic fluid levels, C-reactive protein <1 mg/dL within 24 h of admission and PPROM after invasive procedures. CONCLUSION Pregnancy latency and neonatal survival following previable PPROM has improved in recent years, although neonatal morbidity remains unchanged despite recent advances in obstetric and neonatal care. There is heterogeneity in management practices across centres worldwide.
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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]
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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.
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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
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Lee J, Romero R, Kim SM, Chaemsaithong P, Yoon BH. A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM. J Matern Fetal Neonatal Med 2015; 29:2727-37. [PMID: 26441216 DOI: 10.3109/14767058.2015.1103729] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine whether a new antibiotic regimen could reduce the frequency of intra-amniotic inflammation/infection in patients with preterm PROM. STUDY DESIGN This retrospective cohort study was conducted to evaluate the effect of antibiotics on the frequency of intra-amniotic inflammation/infection based on the results of follow-up transabdominal amniocenteses from 89 patients diagnosed with preterm PROM who underwent serial amniocenteses. From 1993-2003, ampicillin and/or cephalosporins or a combination was used ("regimen 1"). A new regimen (ceftriaxone, clarithromycin and metronidazole) was used from 2003-2012 ("regimen 2"). Amniotic fluid was cultured and matrix metalloproteinase-8 (MMP-8) concentrations were measured. RESULTS (1) The rates of intra-amniotic inflammation and intra-amniotic inflammation/infection in patients who received regimen 2 decreased during treatment from 68.8% to 52.1% and from 75% to 54.2%, respectively. In contrast, in patients who received regimen 1, the frequency of intra-amniotic inflammation and infection/inflammation increased during treatment (31.7% to 55% and 34.1% to 58.5%, respectively); and (2) intra-amniotic inflammation/infection was eradicated in 33.3% of patients who received regimen 2, but in none who received regimen 1. CONCLUSION The administration of ceftriaxone, clarithromycin and metronidazole was associated with a more successful eradication of intra-amniotic inflammation/infection and prevented secondary intra-amniotic inflammation/infection more frequently than an antibiotic regimen which included ampicillin and/or cephalosporins in patients with preterm PROM.
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Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .,f Department of Obstetrics and Gynecology , Seoul Metropolitan Government --Seoul National University Boramae Medical Center , Seoul , Republic of Korea , and
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
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Short-Term and Long-Term Postnatal Outcomes of Expectant Management After Previable Preterm Premature Rupture of Membranes With and Without Persistent Oligohydramnios. Obstet Gynecol 2015; 126:947-953. [DOI: 10.1097/aog.0000000000001099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee J, Romero R, Kim SM, Chaemsaithong P, Park CW, Park JS, Jun JK, Yoon BH. A new anti-microbial combination prolongs the latency period, reduces acute histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes in preterm PROM. J Matern Fetal Neonatal Med 2015; 29:707-20. [PMID: 26373262 DOI: 10.3109/14767058.2015.1020293] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Antibiotic administration is a standard practice in preterm premature rupture of membranes (PROM). Specific anti-microbial agents often include ampicillin and/or erythromycin. Anaerobes and genital mycoplasmas are frequently involved in preterm PROM, but are not adequately covered by antibiotics routinely used in clinical practice. Our objective was to compare outcomes of PROM treated with standard antibiotic administration versus a new combination more effective against these bacteria. STUDY DESIGN A retrospective study compared perinatal outcomes in 314 patients with PROM <34 weeks receiving anti-microbial regimen 1 (ampicillin and/or cephalosporins; n = 195, 1993-2003) versus regimen 2 (ceftriaxone, clarithromycin and metronidazole; n = 119, 2003-2012). Intra-amniotic infection/inflammation was assessed by positive amniotic fluid culture and/or an elevated amniotic fluid MMP-8 concentration (>23 ng/mL). RESULTS (1) Patients treated with regimen 2 had a longer median antibiotic-to-delivery interval than those with regimen 1 [median (interquartile range) 23 d (10-51 d) versus 12 d (5-52 d), p < 0.01]; (2) patients who received regimen 2 had lower rates of acute histologic chorioamnionitis (50.5% versus 66.7%, p < 0.05) and funisitis (13.9% versus 42.9%, p < 0.001) than those who had received regimen 1; (3) the rates of intra-ventricular hemorrhage (IVH) and cerebral palsy (CP) were significantly lower in patients allocated to regimen 2 than regimen 1 (IVH: 2.1% versus 19.0%, p < 0.001 and CP: 0% versus 5.7%, p < 0.05); and (4) subgroup analysis showed that regimen 2 improved perinatal outcomes in pregnancies with intra-amniotic infection/inflammation, but not in those without intra-amniotic infection/inflammation (after adjusting for gestational age and antenatal corticosteroid administration). CONCLUSION A new antibiotic combination consisting of ceftriaxone, clarithromycin, and metronidazole prolonged the latency period, reduced acute histologic chorioamnionitis/funisitis, and improved neonatal outcomes in patients with preterm PROM. These findings suggest that the combination of anti-microbial agents (ceftriaxone, clarithromycin, and metronidazole) may improve perinatal outcome in preterm PROM.
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Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA , and
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Chan-Wook Park
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Joong Shin Park
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Jong Kwan Jun
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
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Doret M, Cartier R, Miribel J, Massardier J, Massoud M, Bordes A, Moret S, Gaucherand P. Premature preterm rupture of the membrane diagnosis in early pregnancy: PAMG-1 and IGFBP-1 detection in amniotic fluid with biochemical tests. Clin Biochem 2013; 46:1816-9. [PMID: 24140132 DOI: 10.1016/j.clinbiochem.2013.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/03/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Previable premature rupture of the membranes (pPROM), occurring before 24WG, is associated with a 25% neonatal survival rate. This terrible prognosis may lead to elective pregnancy termination on parents' request. Therefore, certain diagnosis is essential but remains difficult in about 10% of patients. Bed-side biochemical tests developed to help in diagnosis had never been evaluated in early pregnancies. This study aimed to evaluate and compare the in vitro sensitivity, detection limit, reaction time and consistency of AmniSure detecting placental alpha microglobulin-1 (PAMG-1) and actim PROM detecting Insulin Growth Factor Binding Protein-1 (IGFBP-1) in amniotic fluid between 15 and 20weeks of gestation (WG). DESIGN AND METHODS Samples of amniotic fluid were collected by amniocentesis performed between 15 and 20 completed WG in 55 patients. Dilution series were prepared and both tests were performed twice at each dilution. In vitro sensitivity, detection limit, and reaction time were evaluated and compared in serial dilution. RESULTS A total of 460 AmniSure and 476 actim PROM tests were performed. Both tests' in vitro sensitivity was 100% at dilution 1:20 and remained up to 90% until dilution 1:80. In vitro sensitivities were not different at any dilution. Detection limit and consistency were similar for both tests at all dilution. Actim PROM reaction time was shorter than AmniSure at all dilutions, except 1:320 (p<0.05). CONCLUSIONS PAMG-1 and IGFBP-1 can be detected in amniotic fluid between 15 and 20 completed WG, using respectively AmniSure and actim PROM.
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Affiliation(s)
- Muriel Doret
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'obstétrique, 59 boulevard Pinel, Bron cedex F-69677, France.
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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.
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Affiliation(s)
- Barbara Acaia
- Department of Obstetrics and Gynecology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
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Abstract
Introduction: Amniotic fluid, once thought to merely provide protection and room for necessary movement and growth for the fetus, is now understood to be a highly complex and dynamic system that is studied as a data point to interpret fetal wellbeing. Methods: Assessment of amniotic fluid volume is now routine when performing a sonographic evaluation of fetal status and is an important consideration in the assessment and management of perinatal morbidity and mortality.1,2 In this review, we will cover the dynamics that affect amniotic fluid volume, review methods for measurement and quantification of volume, review definitions for normative data as related to neonatal outcomes, and provide evidence based guidance on the workup and management options for oligoydramnios and polyhydramnios in singleton and twin pregnancies. Conclusions: When abnormalities of fluid exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy.
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Affiliation(s)
| | - Everett F Magann
- University of Arkansas for Medical Sciences Little Rock Arkansas USA
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