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Ren W, Yang H, Liu W, Zhang S, Yang Y, Yang L, Liu W, Zhang H, He K, Li X, Ge J. Exposure to mixtures of PM 2.5 components and term premature rupture of membranes: a case-crossover study in Shijiazhuang, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:3400-3412. [PMID: 38269576 DOI: 10.1080/09603123.2024.2308017] [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: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
This study aims to explore the acute effects of short-term exposure to PM2.5 components and their mixture on PROM. Counts of hospital admissions due to PROM were collected at the Fourth Hospital of Shijiazhuang. The associations between the PROM and PM2.5 components was examined using a time-stratified case-crossover approach. The overall effects of components on TPROM were examined using the BKMR. During the study period 30,709 cases of PROMwere identified. The relative risks and the 95% CI of TPROM were 1.013 (1.002, 1.028) and 1.015 (1.003, 1.028) associated with per interquartile range increase in nitrate and ammonium ion on the current day and they were 1.007 (1.001, 1.013) and 1.003 (1.000, 1.005) on the previous day. The results from the BKMR models showed a higher risk of TPROM was associated with exposure to mixtures, in which, nitrate and organic matter were the main contributors to the overall effect.
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Affiliation(s)
- Weiyan Ren
- Hebei Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Huangmin Yang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wencong Liu
- Department of Ultrasonics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaochong Zhang
- Department of Medical Records, Shijiazhuang Fourth Hospital, shijiazhuang, China
| | - Yanjing Yang
- Department of Medical Records, Shijiazhuang Fourth Hospital, shijiazhuang, China
| | - Lei Yang
- Hebei Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Wenxuan Liu
- Hebei Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Haijuan Zhang
- Department of Medical Records, Shijiazhuang Fourth Hospital, shijiazhuang, China
| | - Ke He
- Department of Medical Records, Shijiazhuang Fourth Hospital, shijiazhuang, China
| | - Xia Li
- Department of Medical Records, Shijiazhuang Fourth Hospital, shijiazhuang, China
| | - Jun Ge
- Department of Medical Records, Shijiazhuang Fourth Hospital, shijiazhuang, China
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Tokalioglu EO, Tanacan A, Agaoglu MO, Özbebek ÜG, Okutucu G, Kayaalp H, Uzuner P, Sahin D. Aggregate index of systemic inflammation: A novel systemic inflammatory index for prediction of neonatal outcomes and chorioamnionitis in women with preterm premature rupture of membranes. Int J Gynaecol Obstet 2024. [PMID: 39157934 DOI: 10.1002/ijgo.15868] [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: 03/15/2024] [Revised: 07/01/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To determine the value of the Aggregate index of systemic inflammation (AISI) in predicting admission to neonatal intensive care unit (NICU) and chorioamnionitis. METHODS The present retrospective cohort study with pregnant women who were diagnosed with preterm premature rupture of membranes (PPROM) in the Department of Perinatology, Ministry of Health Ankara City Hospital between January 1, 2021, and June 1, 2023 (n = 357). The patients were categorized into subgroups: (1) cases with (n = 27) or without (n = 330) chorioamnionitis, (2) admission (n = 182) or no admission (n = 175) to NICU; (3) gestational age at birth <28 weeks or 28 weeks or longer; and (4) gestational age at birth <34 weeks or 34 weeks or longer. AISI values were compared between the subgroups, and cut-off values for AISI were determined to predict adverse outcomes. RESULTS AISI values were significantly higher in the admission to NICU group compared with the no admission to NICU group (707.0 vs 551.2) (P < 0.05). AISI values were also significantly higher in the chorioamnionitis group compared with those without chorioamnionitis (850.3 vs 609.4) (P < 0.05). AISI levels were significantly higher in cases delivered before 28 weeks of gestation compared with the cases delivered at 28 weeks of gestation or later (945.6 vs 604.9) (P < 0.05), and were also significantly higher in cases delivered before 34 weeks of gestation compared with the cases delivered at 34 weeks of gestation or later (715.5 vs 550.1) (P < 0.05). Optimal cut-off values of AISI were found to be 626.19 (74.1% sensitivity, 52.8% specificity), 506.09 (68.9% sensitivity and, 47.7% specificity), and 555.1 (69.8% sensitivity, 48.1% specificity) in predicting NICU admission, chorioamnionitis, and delivery before 28 weeks, respectively. CONCLUSION The novel inflammatory marker AISI may be used in the prediction of chorioamnionitis and NICU admission in PPROM cases. SYNOPSIS Aggregate index of systemic inflammation may be used as a novel marker in predicting high-risk for chorioamnionitis and neonatal intensive care unit admission in women with preterm premature rupture of membranes.
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Affiliation(s)
- Eda Ozden Tokalioglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Merve Ozturk Agaoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ülkü Gürbüz Özbebek
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Gülcan Okutucu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hüseyin Kayaalp
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Petek Uzuner
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Shaffer Z, Romero R, Tarca AL, Galaz J, Arenas-Hernandez M, Gudicha DW, Chaiworapongsa T, Jung E, Suksai M, Theis KR, Gomez-Lopez N. The vaginal immunoproteome for the prediction of spontaneous preterm birth: A retrospective longitudinal study. eLife 2024; 13:e90943. [PMID: 38913421 PMCID: PMC11196114 DOI: 10.7554/elife.90943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Most cases of preterm birth occur spontaneously and result from preterm labor with intact (spontaneous preterm labor [sPTL]) or ruptured (preterm prelabor rupture of membranes [PPROM]) membranes. The prediction of spontaneous preterm birth (sPTB) remains underpowered due to its syndromic nature and the dearth of independent analyses of the vaginal host immune response. Thus, we conducted the largest longitudinal investigation targeting vaginal immune mediators, referred to herein as the immunoproteome, in a population at high risk for sPTB. Methods Vaginal swabs were collected across gestation from pregnant women who ultimately underwent term birth, sPTL, or PPROM. Cytokines, chemokines, growth factors, and antimicrobial peptides in the samples were quantified via specific and sensitive immunoassays. Predictive models were constructed from immune mediator concentrations. Results Throughout uncomplicated gestation, the vaginal immunoproteome harbors a cytokine network with a homeostatic profile. Yet, the vaginal immunoproteome is skewed toward a pro-inflammatory state in pregnant women who ultimately experience sPTL and PPROM. Such an inflammatory profile includes increased monocyte chemoattractants, cytokines indicative of macrophage and T-cell activation, and reduced antimicrobial proteins/peptides. The vaginal immunoproteome has improved predictive value over maternal characteristics alone for identifying women at risk for early (<34 weeks) sPTB. Conclusions The vaginal immunoproteome undergoes homeostatic changes throughout gestation and deviations from this shift are associated with sPTB. Furthermore, the vaginal immunoproteome can be leveraged as a potential biomarker for early sPTB, a subset of sPTB associated with extremely adverse neonatal outcomes. Funding This research was conducted by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS) under contract HHSN275201300006C. ALT, KRT, and NGL were supported by the Wayne State University Perinatal Initiative in Maternal, Perinatal and Child Health.
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Affiliation(s)
- Zachary Shaffer
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
- Department of Physiology, Wayne State University School of MedicineDetroitUnited States
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, University of MichiganAnn ArborUnited States
- Department of Epidemiology and Biostatistics, Michigan State UniversityEast LansingUnited States
| | - Adi L Tarca
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
- Department of Computer Science, Wayne State University College of EngineeringDetroitUnited States
- Center for Molecular Medicine and Genetics, Wayne State UniversityDetroitUnited States
| | - Jose Galaz
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
- Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de ChileSantiagoChile
| | - Marcia Arenas-Hernandez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
| | - Dereje W Gudicha
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
| | - Tinnakorn Chaiworapongsa
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
| | - Eunjung Jung
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
| | - Manaphat Suksai
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
| | - Kevin R Theis
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of MedicineDetroitUnited States
| | - Nardhy Gomez-Lopez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS)BethesdaUnited States
- Department of Obstetrics and Gynecology, Wayne State University School of MedicineDetroitUnited States
- Center for Molecular Medicine and Genetics, Wayne State UniversityDetroitUnited States
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of MedicineDetroitUnited States
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Coughlin K, Jen P, Katheria A. Characteristics and Outcomes in Preterm Infants with Extubation Failure in the First Week of Life. Am J Perinatol 2024; 41:e1675-e1680. [PMID: 37072010 DOI: 10.1055/s-0043-1768245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE This study aimed to evaluate characteristics and outcomes in preterm infants with extubation failures in their first week of life. STUDY DESIGN Retrospective chart review of infants born between 24 and 27 weeks' gestational age at the Sharp Mary Birch Hospital for Women and Newborns between January 2014 and December 2020 who had an extubation attempt within the first 7 days of life. Infants that were successfully extubated were compared with those who required reintubation in the first 7 days. Maternal and neonatal outcome measures were analyzed. RESULTS A total of 215 extremely preterm infants had an extubation attempt in the first 7 days of life. Forty-six infants (21.4%) failed extubation and were reintubated within the first 7 days. Infants who failed extubation had a lower pH (p < 0.01), increased base deficit (p < 0.01), and more surfactant doses prior to first extubation (p < 0.01). Birth weight, Apgar scores, antenatal steroid doses, and maternal risk factors such as preeclampsia, chorioamnionitis, and duration of ruptured membranes were not different between success and failure groups. Rates of moderate to large patent ductus arteriosus (p < 0.01), severe intraventricular hemorrhage (p < 0.01), posthemorrhagic hydrocephalus (p < 0.05), periventricular leukomalacia (p < 0.01), and retinopathy of prematurity stage 3 or greater (p < 0.05) were higher in the failure group. CONCLUSION In this cohort of extremely preterm infants that failed extubation in the first week of life, there were as increased risk of multiple morbidities. Base deficit, pH, and number of surfactant doses prior to first extubation may be useful tools in predicting which infants are likely to have early extubation success, but this needs prospective study. KEY POINTS · Predicting extubation readiness in preterm infants remains challenging.. · Extubation failure is associated with multiple neonatal morbidities.. · Infant clinical characteristics may help predict extubation failure..
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Affiliation(s)
- Katherine Coughlin
- Department of Pediatrics, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
| | - Phoebe Jen
- Department of Pediatrics, Western University of Health Sciences, Pomona, California
| | - Anup Katheria
- Department of Pediatrics, Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
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Olguín-Ortega A, Figueroa-Damian R, Palafox-Vargas ML, Reyes-Muñoz E. Risk of adverse perinatal outcomes among women with clinical and subclinical histopathological chorioamnionitis. Front Med (Lausanne) 2024; 11:1242962. [PMID: 38510456 PMCID: PMC10953497 DOI: 10.3389/fmed.2024.1242962] [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: 06/20/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Histologic chorioamnionitis (HCA) is a placental inflammatory condition associated with adverse perinatal outcomes (APOs). This historical cohort study explores the risk of APOs in pregnant women with HCA and compares the impact of clinical chorioamnionitis (CCA) with subclinical chorioamnionitis (SCCA). Methodology Placentas were evaluated by a perinatal pathologist tand all women with HCA were included. Two groups were integrated: (1) women with clinical chorioamnionitis (CCA) and (2) women with subclinical chorioamnionitis (SCCA). Additionally, we conducted a secondary analysis to compare the prevalence of APOs among stage 1, 2 and 3 of HCA and the risk of APOs between grades 1 and 2 of HCA. The APOs analyzed were preterm birth, stillbirth, neonatal weight < 1,500 g, neonatal sepsis. Relative risk with 95% confidence interval was calculated. Results The study included 41 cases of CCA and 270 cases of SCCA. The mean gestational age at diagnosis and birth was 30.2 ± 5.4 weeks and 32.5 ± 5.1 weeks, for group 1 and 2, respectively. The study also found that women with HCA stage 3 and grade 2 had a higher prevalence and risk of adverse perinatal outcomes. Discussion The findings of this study suggest the importance of placental histological study to excluded SCCA, which represents a significant risk to both maternal and neonatal health, contributing to high morbidity and mortality.
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Affiliation(s)
- Andrea Olguín-Ortega
- Department of Gynecology, National Institute of Perinatology, Mexico City, Mexico
| | | | | | - Enrique Reyes-Muñoz
- Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Mexico City, Mexico
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An Z, Zhao R, Han F, Sun Y, Liu Y, Liu L. Potential Serum Biomarkers Associated with Premature Rupture of Fetal Membranes in the First Trimester. Front Pharmacol 2022; 13:915935. [PMID: 35873552 PMCID: PMC9304655 DOI: 10.3389/fphar.2022.915935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Premature rupture of the fetal membranes (PROM) is a common and important obstetric complication with increased risk of adverse consequences for both mothers and fetuses. An accurate and timely method to predict the occurrence of PROM is needed for ensuring maternal and fetal safety. Untargeted metabolomics was applied to characterize metabolite profiles related to PROM in early pregnancy. 41 serum samples from pregnant women who developed PROM later in gestation and 106 from healthy pregnant women as a control group, were analyzed. Logistic regression analysis was adjusted to analyze a PROM prediction model in the first trimester. A WISH amniotic cell viability assay was applied to explore the underlying mechanisms involved in PROM, mediated by C8-dihydroceramide used to mimic a potential biomarker (Cer 40:0; O2). Compared with healthy controls, 13 serum metabolites were identified. The prediction model comprising four compounds (Cer 40:0; O2, sphingosine, isohexanal and PC O-38:4) had moderate accuracy to predict PROM events with the maximum area under the curve of a receiver operating characteristics curve of approximately 0.70. Of these four compounds, Cer 40:0; O2 with an 1.81-fold change between PROM and healthy control serum samples was defined as a potential biomarker and inhibited the viability of WISH cells. This study sheds light on predicting PROM in early pregnancy and on understanding the underlying mechanism of PROM.Trial Registration: This study protocol has been registered at www.ClinicalTrials.gov, CT03651934, on 29 August 2018 (prior to recruitment).
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Affiliation(s)
- Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Zhao
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Feifei Han
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuan Sun
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanping Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yanping Liu, ; Lihong Liu,
| | - Lihong Liu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yanping Liu, ; Lihong Liu,
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Analysis of Maternal and Neonatal Outcome of Patients with Preterm Prelabor Rupture of Membranes. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8705005. [PMID: 35320995 PMCID: PMC8938061 DOI: 10.1155/2022/8705005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
Background Preterm prelabor rupture of membranes (PPROM) increases risk of maternal and neonatal diseases. Expectant treatment is one major treatment for PPROM patients, but it raises concerns on infection. Currently, the optimal delivery time for PPROM patients is still unclear, and there are various outcomes for the patients with PPROM. Previous studies conducted to analyze the pregnancy outcome showed inconsistent results. The purpose of this study is to retrospectively analyze the maternal and neonatal outcomes for comparison among different latency periods of patients with PPROM at a university hospital in China. Method This was a retrospective study. We divided all patients with PPROM into four groups according to gestational weeks, namely, group A (GA 24-27+6), group B (GA 28-31+6), group C (GA 32-33+6), and group D (GA34-36+6). The maternal and neonatal outcomes of each group were observed, respectively. Groups B and C were separately divided into two subgroups according to the median latency period of each group, namely, B1, B2, C1, and C2. Then, the differences of pregnancy outcomes between B1 and B2, C1 and C2, were compared, respectively. A p value < 0.05 was considered statistically significant. Result Group A: the common maternal and neonatal complications were the increased infection index before labour, neonatal hyperbilirubinemia and neonatal respiratory distress syndrome. Groups B, C, and D: the common maternal and neonatal complications were the increased infection index before labour, fetal distress, neonatal pneumonia, neonatal hyperbilirubinemia, and patent foramen ovale. Comparison of pregnancy outcome between group B1 and group B2 showed higher incidence rate of increased infection index before labour, lower incidence rate of respiratory distress syndrome, electrolyte disturbance, and premature brain in group B2 than those in group B1. Comparison of pregnancy outcome between group C1 and group C2 showed the higher incidence of increased infection index before labour, bigger birth weight, and shorter hospital stay in group C2 than those in group C1. Conclusion Increased infection index before labour was common maternal complication in four groups. Neonatal hyperbilirubinemia and neonatal pneumonia were top neonatal complications in four groups. The prolongation of latency period was beneficial to newborns of patients with gestational week at 28-31+6 weeks, while it did not benefit those with gestational week beyond 32 weeks.
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Enjamo M, Deribew A, Semagn S, Mareg M. Determinants of Premature Rupture of Membrane (PROM) Among Pregnant Women in Southern Ethiopia: A Case-Control Study. Int J Womens Health 2022; 14:455-466. [PMID: 35386937 PMCID: PMC8979419 DOI: 10.2147/ijwh.s352348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Premature rupture of membrane (PROM) varies from country to country and complicates 4 to 10% of pregnancies worldwide it has an overwhelming effect on maternal and newborn health. Even though many interventions implemented to tackle it, the problem is persisted. Objective To identify determinants of premature rupture of membrane among pregnant women who have visited labor wards in four hospitals found in Gedeo zone, Southern Ethiopia. Methods Hospital-based unmatched case-control study was conducted from February to May 2020. Data were collected among 75 cases and 223 controls using face-to-face interviews. Cases and controls were recruited consecutively from pregnant women who have visited the labor ward. Data were entered into Epi-data version 3.1 and analyzed by using SPSS version 20. Bivariable and Multivariable logistic regression was used to check the association between dependent and independent variables, statistically significant association was declared at p-value < 0.05. Results A total of 75 cases and 233 controls were enrolled in the study. Hypertension during index pregnancy [AOR = 2.81 (95% CI: 1.09 -7.23)], history of abortion [AOR = 3.7 (95% CI: 1.41-9.73)], history of caesarean section [AOR = 3.46 (95% CI: 1.34-8.9)] and history of PROM [AOR = 4.77 (95% CI: 2.31-9.89)] were associated with premature rupture of membranes. Conclusion Hypertension during the index pregnancy, history of abortion, history of PROM, and history of cesarean section has an association with premature rupture of membrane. The result of the study suggests early identification and treatment of abortion, hypertension, and cesarean section in pregnant women mitigates the risk of premature rupture of membrane.
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Affiliation(s)
- Melkamu Enjamo
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Amare Deribew
- Departent of Public Health, St. Paul Hospital Millennium Medical College, Nutrition International’s Country Director, Addis Ababa, Ethiopia
| | - Selamawit Semagn
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Moges Mareg
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Zhou S, Mei L, Zhou W, Yang Y, Zhang X, Mu X, Quan Q, Wang L. Clinical Factors and Perinatal Outcomes Associated With Short Latency Period in Twin Pregnancies With Preterm Premature Rupture of Membranes Before 34 Weeks: A Retrospective Study. Front Med (Lausanne) 2022; 9:839240. [PMID: 35308543 PMCID: PMC8931478 DOI: 10.3389/fmed.2022.839240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background There is a lack of literature on short latency period (SLP) in twin pregnancies with preterm premature rupture of membranes (PPROM). Thus, the aim of this study was to identify the clinical factors and perinatal outcomes associated with SLP in twin pregnancies with PPROM and to establish a predictive model to identify SLP. Methods Twin pregnancies with PPROM between 24 0/7 and 33 6/7 weeks were included and a retrospective analysis was performed. Patients were divided into two groups based on the latency period after PPROM: Group 1 ≤24 h (defined as SLP) and Group 2 >24 h (defined as long latency period, LLP), the clinical factors and perinatal outcomes were compared between the two groups. Binary logistic regression and receiver operating characteristic curve analyses were used to identify the independent clinical factors associated with latency period after PPROM and assess the predictive accuracy for SLP. Results 98 and 92 pregnant women had short and long latency period, respectively. Prolonged latency significantly increased the occurrence of chorioamnionitis. Neonatal outcomes were not affected by latency duration after PPROM. Binary regression analysis revealed that higher gestational age (GA) at PPROM (P = 0.038), presence of uterine contractions (P < 0.001), Bishop score > 4 (P = 0.030), serum procalcitonin levels ≥0.05 ng/mL upon admission, and absence of use of tocolytic agents (P < 0.001) were significant independent predictors of a SLP. A predictive model developed using these predictors had an area under the curve (AUC) of 0.838, and the presence of uterine contractions alone had an AUC of = 0.711. Conclusion Uterine contraction was the most important prognosticator for a SLP. A latency period of >24 h was associated with chorioamnionitis, but adverse neonatal outcomes were not observed.
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Affiliation(s)
- Shuwei Zhou
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Lingwei Mei
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Wei Zhou
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yajun Yang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoyan Zhang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoling Mu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Quan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Wang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Lan Wang
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Ekawati H, Martini DE, Maghfuroh L, Gumelar WR, Krisdianti N. Factors Related to Prelabor Rupture of Membrane among Maternity Mother at Lamongan Regency, East Java, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The incidence of prelabor rupture of membrane among maternity mothers at Lamongan tends to be high and fluctuating exceeds the incidence of prelabor rupture membrane nationally. Prelabor rupture membrane becomes one of the most commonly encountered labor complications and has an impact on fetal morbidity and mortality, especially high perinatal death.
AIM: The purpose of this study is to analyze the relationship of mother occupation, education, fetal abnormalities position, and age of the mother with the occurrence of prelabor rupture of membrane at Lamongan Regency in 2020.
METHODS: This research was using a cross-sectional approach. The population was 203 responded, using probability sampling technique with simple random sampling obtained 134 respondents. Data analysis methods were used bivariate analysis of Chi-square tests.
RESULTS: The results showed that factors related to prelabor rupture of membrane among maternity mothers are occupation (p = 0.001), education (p = 0.000), and fetal abnormality position (p = 0.018). Age is an insignificant factor (p = 0.334).
CONCLUSION: Occupation, education, age of mother, and fetal abnormalities position factors become factors related to prelabor rupture of membrane. The recommendation of this study is to consider the influence of factors related to amniotic rupture early in pregnant women to minimize complications that may occur in the mother and baby, health workers always try to improve the quality of health services, especially antenatal care to detect factors related to the occurrence of prelabor rupture of membrane.
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11
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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.
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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
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12
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Perinatal outcomes of twin pregnancies with preterm premature rupture of the membranes at 24-34 weeks' gestation. Sci Rep 2021; 11:23419. [PMID: 34862450 PMCID: PMC8642529 DOI: 10.1038/s41598-021-02884-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Abstract
To describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity. This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks’ gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM and compared between PPROM and non PPROM twins. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis. Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. There was no significant difference in general neonatal outcomes between PPROM and non PPROM twins. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score < 7 increased severe neonatal morbidity. As GA at PPROM increased, the risk of adverse perinatal outcomes decreased. GA at PPROM and latency period were significantly associated with discharge without severe or moderate-severe neonatal morbidity.
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Yang D, Chen L, Yang Y, Shi J, Xu J, Li C, Wu Y, Ji X. Influence of ambient temperature and diurnal temperature variation on the premature rupture of membranes in East China: A distributed lag nonlinear time series analysis. ENVIRONMENTAL RESEARCH 2021; 202:111145. [PMID: 33844967 DOI: 10.1016/j.envres.2021.111145] [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: 02/04/2021] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Extreme ambient temperature has an adverse effect on pregnancy outcomes, but the conclusions have been inconsistent. The influence of ambient temperature and diurnal temperature variation on the premature rupture of membranes (PROM) needs further study. METHODS AND FINDINGS The daily data of PROMs, daily meteorological and air pollutant were obtained. After controlling for potential confounding factors, the quasi-Poisson generalized additive model (GAM) combined with the distributed lag nonlinear model (DLNM) was used to analyze the association between temperature or diurnal temperature variation and PROM, including preterm premature rupture of membranes (PPROM) and term premature rupture of membranes (term PROM). Compared with the median temperature(18.7 °C), the mean temperature of 5-7 days lagging beyond 31.5 °C and below -1.5 °C was positively correlated with PROM; the mean temperature had more sensitive effect on the term PROM. Exposure to extremely high temperatures (97.5th percentile, 32 °C) had a 6-day lagging relative risk (RR) (95% CI: 1.005-1.160) of 1.08 for PROM and a 6-day lagging RR of 1.079 (95% CI: 1.005-1.159) for term PROM; Exposure to a high diurnal temperature variation (diurnal temperature variation greater than 16 °C) was positively correlated with the term PROM. Compared with the 2.5th percentile diurnal temperature variation (2 °C), exposure to the 95th percentile diurnal temperature variation (17 °C) significantly increased the risk of term PROM (RR: 1.229, 95% CI: 1.029-1.467). CONCLUSIONS Exposure to a high-temperature and a high diurnal temperature variation environment will increase the relative risks of PROM. For pregnant women in the 3rd trimester, it is important to reduce exposure to extremely high-temperatures and greater diurnal temperature changes.
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Affiliation(s)
- Dongjian Yang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Lei Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Ya Yang
- Department of Infection control, Renji Hospital, School of Medicine, Shanghai Jiao tong University, Shanghai, China
| | - Jingjin Shi
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jingjing Xu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Cheng Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yanting Wu
- Institute of Reproduction and Development, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
| | - Xinhua Ji
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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Goździewicz T, Rycel-Dziatosz M, Madziar K, Szczapa T, Kędzia W, Szaflik K. Long-Term Amnioinfusion through an Intrauterine Catheter in Preterm Premature Rupture of Membranes before 26 Weeks of Gestation: A Retrospective Multicenter Study. Fetal Diagn Ther 2021; 48:582-587. [PMID: 34320491 DOI: 10.1159/000517754] [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: 10/04/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to elucidate the efficacy of long-term amnioinfusion on perinatal outcomes in patients with preterm premature rupture of membranes (PPROM) before 26 weeks' gestation. MATERIAL A total of 31 patients with PPROM at a periviable gestational age (21 + 0-25 + 0 weeks) were enrolled. Long-term amnioinfusion was performed in 22 patients, and 9 patients did not receive amnioinfusion. Data were collected retrospectively from 2 clinical sites between January 2017 and March 2019. RESULTS In the medical management group, there was a significantly higher rate of chorioamnionitis compared to the long-term amnioinfusion group (89 vs. 15%, p = 0.001). The latency period between PPROM and delivery was higher in the amnioinfusion group (median, 5.5 vs. 3 weeks, p = 0.04). The frequency of bronchopulmonary dysplasia was higher in the control group compared to the amnioinfusion group (89 vs. 40%, p = 0.03). The rates of other neonatal complications were similar in both groups. CONCLUSIONS Long-term amnioinfusion through an intrauterine catheter in PPROM before 26 weeks' gestation may improve pregnancy and newborn outcomes.
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Affiliation(s)
- Tomasz Goździewicz
- Division of Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Rycel-Dziatosz
- Department of Gynecology, Fertility, and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Klaudyna Madziar
- Division of Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Szczapa
- Division of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Witold Kędzia
- Division of Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Szaflik
- Department of Gynecology, Fertility, and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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Jiang H, Lu C, Zhou J, Zhang W. Cesarean section and pregnancy outcomes of preterm premature rupture of membranes under different fertility policies in China. Transl Pediatr 2021; 10:973-983. [PMID: 34012845 PMCID: PMC8107868 DOI: 10.21037/tp-21-144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The aim of the present study was to compare the outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) in China. METHODS The present study was a single-center retrospective study of women admitted to Beijing Obstetrics and Gynecology Hospital in 2012, 2014, and 2017. Deliveries at <24 and >37 weeks, fatal deformities, stillbirths, and multiple pregnancies were excluded. Pregnancies were divided into 24-27+6, 28-33+6, and 34-36+6 weeks according to weeks of gestation in each year. In total, 1,178 pregnancies complicated by PPROM were analyzed in terms of incidence rate, risk factors, delivery mode, and neonatal outcomes. RESULTS The rate of PPROM was 3.11% in 2012, 2.35% in 2014, and 2.4% in 2017; the difference was significant (P<0.001). Age [odds ratio (OR): 1.046, P<0.001], intrauterine infection (OR: 2.087, P=0.007), and vaginitis (OR: 1.812, P=0.039) were risk factors for PPROM. In all 3 years, patients with PPROM tended to choose vaginal delivery rather than cesarean section (CS) delivery (68.9% in 2012, P<0.001; 76.5% in 2014, P<0.001; 69.3% in 2017, P<0.001), and the rate of vaginal deliveries in 2014 was higher than that in 2012 and 2017 (P=0.027). Indications for PPROM at 34-36+6 weeks varied significantly among the 3 years (P<0.001). No significant difference was found in body weight, body length, and Apgar score at 1, 5, and 10 min; however, there was a significant difference in Apgar score after 1 min at 28-33+6 weeks (P=0.012). CONCLUSIONS The incidence rate of PPROM at our single center varied between 2012, 2014, and 2017. Risk factors for pregnancies complicated by PPROM include age, intrauterine infection, and vaginitis. The rate of CS delivery varied, and breech/transverse presentation was the major indication for patients with PPROM at 34-36+6 weeks.
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Affiliation(s)
- Haili Jiang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chang Lu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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16
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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.
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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
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17
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Valenzuela I, van der Merwe J, De Catte L, Devlieger R, Deprest J, Lewi L. Foetal therapies and their influence on preterm birth. Semin Immunopathol 2020; 42:501-514. [PMID: 32785752 DOI: 10.1007/s00281-020-00811-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022]
Abstract
Foetal therapy aims to improve perinatal survival or to prevent severe long-term handicap. Foetal medicine opens a new territory by treating the foetus as a patient. The mother has nothing to gain in terms of health benefits, yet she is inherently also undergoing treatment. In utero foetal interventions can be divided into ultrasound-guided minimally invasive procedures, fetoscopic procedures and open hysterotomy procedures, which carry an inherent risk of ruptured membranes and preterm birth. In this review, we summarise the conditions that may benefit from foetal therapy and review the current therapies on offer, each with their associated risk of ruptured membrane and preterm birth. We also look into some risk limiting and preventative strategies to mitigate these complications.
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Affiliation(s)
- Ignacio Valenzuela
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
| | - Johannes van der Merwe
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Luc De Catte
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, United Kingdom
| | - Liesbeth Lewi
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium. .,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium.
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18
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Alla S, Ramseyer A, Whittington JR, Peeples S, Ounpraseuth ST, Magann EF. Maternal features at time of preterm prelabor rupture of membranes and short-term neonatal outcomes. J Matern Fetal Neonatal Med 2020; 35:2128-2134. [PMID: 32602391 DOI: 10.1080/14767058.2020.1782376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The objective of this study was to assess if maternal and obstetric characteristics other than gestational age at the time of rupture impact short-term neonatal outcomes.Methods: This is a retrospective observational study from a single tertiary care referral center. This study reviewed women with a singleton pregnancy complicated by preterm prelabor rupture of membranes over a 3-year period from May of 2014 through May of 2017. Maternal characteristics and short term neonatal outcomes were collected.Results: We identified 210 pregnancies complicated by preterm prelabor rupture of membranes. Eighteen of these patients had rupture of membranes prior to viability. Of the maternal characteristics at time of admission studied, gestational age at rupture and race influenced short term neonatal outcomes. Women who identified as race other than white had neonates with lower rates of intubation than neonates born to white patients. Gestational age at rupture significantly influenced the neonatal intensive care unit length of stay. Each additional week gained before rupture occurred was associated with a 17.1% decrease in length of stay. Maternal age, gravidity, parity, body mass index, single deepest pocket, and amniotic fluid index did not influence short term neonatal outcomes.Conclusions: Gestational age at rupture of membranes is the most predictive factor associated with short term neonatal outcomes. Race may also influence short term neonatal outcomes. Other maternal characteristics do not seem to influence short term neonatal outcomes. This information can assist with patient counseling on admission for preterm prelabor rupture of membranes and expected neonatal course.
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Affiliation(s)
- Sarada Alla
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abigail Ramseyer
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julie R Whittington
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sara Peeples
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Songthip T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Baser E, Aydogan Kirmizi D, Ulubas Isik D, Ozdemirci S, Onat T, Serdar Yalvac E, Demirel N, Moraloglu Tekin O. The effects of latency period in PPROM cases managed expectantly. J Matern Fetal Neonatal Med 2020; 33:2274-2283. [PMID: 32089027 DOI: 10.1080/14767058.2020.1731465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery time is controversial in cases with the expectant approach. The fetal effects of long-term exposure to PPROM are unknown. This study aimed to evaluate the maternal and fetal outcomes of expectantly-managed PPROM cases with different latency periods at 240/7-346/7 weeks of gestation.Material and method: The study group consisted of 206 patients at 240/7-346/7 weeks of gestation who met the inclusion criteria. Patients were divided into three groups according to their weeks of PPROM diagnosis as 240/7-286/7, 290/7-316/7, and 320/7-346/7. The period from membrane rupture to delivery was defined as the latency period and divided into three subgroups as 3-7 days, 8-13 days and ≥14 days. In addition to the demographic characteristics of the patients, maternal and obstetric complications, primary and secondary neonatal outcomes were compared between the groups. Primary neonatal outcomes were determined in terms of pathological Apgar scores (<5 at minute 1, <7 at minute 5), requiring resuscitation, admission to Neonatal Intensive Care Unit (NICU) and NICU length of stay. Secondary neonatal outcomes were determined in terms of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, and neonatal sepsis. In addition, for the prediction of morbidity and mortality, newborns were evaluated by SNAPPE II (Score for Neonatal Acute Physiology with Perinatal extension-II) consisting of the combination of biochemical and physiological parameters, using the parameters including mean blood pressure (mm/Hg), corporal temperature (°C), PO2/FiO2 ratio, lowest serum pH, multiple seizures, urine output (ml/kg/hr), Apgar score, birth weight, and small for gestational age. The higher the score of SNAPPE II, the higher the morbidity and mortality risk of neonates. For the statistical analysis, the Kruskal Wallis and one-way ANOVA tests were utilized for the numerical data. Categorical data were compared using the chi-square test. The receiver operating characteristic (ROC) test was used to determine the threshold value of the data affecting neonatal morbidity.Results: The mean PPROM week was found to be 29.7 ± 3.0 weeks and the mean delivery week was 31.8 ± 2.5 weeks. The mean latency period for all the patients was 15.1 ± 13.8 days. Clinic chorioamnionitis was observed in 17% of the cases. The lowest chorioamnionitis rate (8.6%) was in the 3-7-day latency period group. Total complications were significantly lower in the 290/7-316/7 week PPROM group in which the latency period was ≥14 days, compared to those in 3-7 days and 8-13 days (p = .001). Total complications were lower in the < 32 weeks PPROM groups in which the latency period was ≥14 days compared to those obtained in 3-7 days and 8-13 days. There was no significant difference between the latency period and total complications after 32 weeks (p = .422). The best discriminative cutoff value of SNAPPE-II for neonatal morbidity was 11.0 (sensitivity 82%, specificity 80%). In the present study, the optimal latency period for the best neonatal outcomes was found to be 34.5 days (sensitivity 70% and specificity 84%) between weeks 240/7-286/7, and 11.0 days between weeks 290/7-316/7 (sensitivity 68% and specificity 85%).Conclusions: Our findings indicated that a long latency period did not increase neonatal morbidity and there was no increase in neonatal complications after 32 weeks of the gestational period compared to those obtained before 32 weeks.
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Affiliation(s)
- Emre Baser
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Demet Aydogan Kirmizi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Dilek Ulubas Isik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Safak Ozdemirci
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Taylan Onat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Ethem Serdar Yalvac
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Nihal Demirel
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
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20
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Platelet and White Blood Cell (WBC) Counts in the First Trimester and Pregnancy Outcome: Prospective Controlled Study. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Shiqiao H, Bei X, Yudi G, Lei J. Assisted reproductive technology is associated with premature rupture of membranes. J Matern Fetal Neonatal Med 2019; 34:555-561. [PMID: 31039652 DOI: 10.1080/14767058.2019.1610738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To evaluate the elements more likely to be associated with premature rupture of membrane (PROM) in patients that use assisted reproductive technology (ART).Materials and methods: A retrospective case-control study was performed from January 2014 to August 2017. We included 301 patients, 257 patients were without PROM in the non-PROM group and 44 patients with PROM in the PROM group.Results: In the PROM group, the rate of intracytoplasmic sperm injection (ICSI) and BMI were significantly higher than the non-PROM group. Moreover, the rate of preterm birth was significantly higher in the PROM group. When using logistic regression analysis to decrease the impact of confounding factors, it showed that overweight and ICSI were confirmed to be associated with PROM. After matching 1:2 by BMI, the process of controlled ovarian hyperstimulation was all similar in the two groups. What is more, the rate of twin pregnancies was significantly higher in the preterm PROM (PPROM) group compared with the term PROM group and twin pregnancies were associated with preterm birth.Conclusions: ART parameters ICSI may increase the risk of PROM. Single embryo transfer during ART should be supported to decrease the incidence of PPROM and losing weight is essential for patients before embarking on ART.
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Affiliation(s)
- Hu Shiqiao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xu Bei
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Geng Yudi
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jin Lei
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Souza RT, Mayrink J, Leite DF, Costa ML, Calderon IM, Rocha EA, Vettorazzi J, Feitosa FE, Cecatti JG. Metabolomics applied to maternal and perinatal health: a review of new frontiers with a translation potential. Clinics (Sao Paulo) 2019; 74:e894. [PMID: 30916173 PMCID: PMC6438130 DOI: 10.6061/clinics/2019/e894] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/27/2018] [Indexed: 12/31/2022] Open
Abstract
The prediction or early diagnosis of maternal complications is challenging mostly because the main conditions, such as preeclampsia, preterm birth, fetal growth restriction, and gestational diabetes mellitus, are complex syndromes with multiple underlying mechanisms related to their occurrence. Limited advances in maternal and perinatal health in recent decades with respect to preventing these disorders have led to new approaches, and "omics" sciences have emerged as a potential field to be explored. Metabolomics is the study of a set of metabolites in a given sample and can represent the metabolic functioning of a cell, tissue or organism. Metabolomics has some advantages over genomics, transcriptomics, and proteomics, as metabolites are the final result of the interactions of genes, RNAs and proteins. Considering the recent "boom" in metabolomic studies and their importance in the research agenda, we here review the topic, explaining the rationale and theory of the metabolomic approach in different areas of maternal and perinatal health research for clinical practitioners. We also demonstrate the main exploratory studies of these maternal complications, commenting on their promising findings. The potential translational application of metabolomic studies, especially for the identification of predictive biomarkers, is supported by the current findings, although they require external validation in larger datasets and with alternative methodologies.
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Affiliation(s)
- Renato Teixeira Souza
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR
| | - Jussara Mayrink
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR
| | - Débora Farias Leite
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Pernambuco, Pernambuco, PE, BR
| | - Maria Laura Costa
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR
| | - Iracema Mattos Calderon
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Botucatu, Universidade Estadual de Sao Paulo (UNESP), Botucatu, SP, BR
| | - Edilberto Alves Rocha
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Pernambuco, Pernambuco, PE, BR
| | - Janete Vettorazzi
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, RS, BR
| | - Francisco Edson Feitosa
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina, Universidade Federal do Ceara, Ceara, CE, BR
| | - José Guilherme Cecatti
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR
- Corresponding author. E-mail:
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Mohammadbeigi A, Asgarian A, Sourani K, Afrashteh S. The Prenatal outcomes of pregnancies after 34 weeks complicated by preterm premature rupture of the membranes. ADVANCES IN HUMAN BIOLOGY 2019. [DOI: 10.4103/aihb.aihb_55_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Beucher G, Charlier C, Cazanave C. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1054-1067. [PMID: 30389543 DOI: 10.1016/j.gofs.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the diagnosis criteria and management of intra-uterine inflammation or infection (Triple I, III). METHODS PubMed and Cochrane Central databases search. RESULTS III is defined as an infection of the fetal membranes, and/or other components like the decidua, fetus, amniotic fluid or placenta. This word should be preferred to the word chorioamnionitis that is less precise (Professional consensus). III clinical signs exhibit poor limited sensibility and specificity (EL3). The diagnosis of III is retained in case of maternal fever (defined by a body temperature≥38°C) with no alternative cause identified and at least 2 signs among the following: fetal tachycardia>160 bpm for 10min or longer, uterine pain of labor, purulent fluid from the cervical canal (Professional consensus). Maternal hyperleukocytosis>20 giga/L in the absence of corticosteroids treatment or increased plasmatic C-reactive protein also argue for III, despite their limited sensibility and specificity (EL3). III requires prompt delivery (Grade A). III is not by itself an indication for cesarean delivery (Professional consensus). Antibiotic treatment should cover Streptococcus agalactiae and Escherichia coli. Antibiotics should be started immediately and maintained all over delivery, to reduce neonatal and maternal morbidity (Grade B). Treatment should rely on a combination of betalactamin and aminoglycoside (Grade B). After vaginal delivery, one single dose of antibiotic is required. Antibiotic duration should be longer in case of bacteremia. Longer duration could be considered in case of persistent fever or of cesarean delivery (Professional consensus).
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Affiliation(s)
- G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - C Charlier
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur Institut IMAGINE, université Paris Descartes, hôpital Necker-Enfants-malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux, USC EA 3671, infections humaines à mycoplasmes et à chlamydiae, 33000 Bordeaux, France
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Tchirikov M, Schlabritz-Loutsevitch N, Maher J, Buchmann J, Naberezhnev Y, Winarno AS, Seliger G. Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome. J Perinat Med 2018; 46:465-488. [PMID: 28710882 DOI: 10.1515/jpm-2017-0027] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/19/2017] [Indexed: 12/12/2022]
Abstract
Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long- and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/an-hydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane - either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intra-amniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR)=0.66), neonatal infections (RR=0.67) and abnormal ultrasound scan of neonatal brain (RR=0.67)]. The positive effect of continuous amnioinfusion through the subcutaneously implanted perinatal port system with amniotic fluid like hypo-osmotic solution in "classic PPROM" less than 28/0 weeks' gestation shows promise but must be proved in future prospective randomized studies. Systemic antibiotics administration in "pre-PPROM" without infection and hospitalization are also of questionable benefit and needs to be further evaluated in well-designed randomized prospective studies to evaluate if it is associated with any neonatal benefit as well as the relationship to possible adverse effect of antibiotics on to fetal development and neurological outcome.
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Affiliation(s)
- Michael Tchirikov
- Department of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center (TTUHSC), School of Medicine at the Permian Basin, Odessa, TX, USA
| | - James Maher
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center (TTUHSC), School of Medicine at the Permian Basin, Odessa, TX, USA
| | - Jörg Buchmann
- Department of Pathology, Martha-Maria Hospital, Halle-Dölau, Halle, Germany
| | - Yuri Naberezhnev
- Department of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Andreas S Winarno
- Department of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Gregor Seliger
- Department of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
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Pinto S, Malheiro MF, Vaz A, Rodrigues T, Montenegro N, Guimarães H. Neonatal outcome in preterm deliveries before 34-week gestation - the influence of the mechanism of labor onset. J Matern Fetal Neonatal Med 2018; 32:3655-3661. [PMID: 29792096 DOI: 10.1080/14767058.2018.1481038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: To evaluate neonatal outcomes in preterm infants with less than 34 weeks after spontaneous labor, preterm premature rupture of membranes (PPROM) or iatrogenic delivery and to clarify whether the mechanism of labor onset is a risk factor for adverse short-term neonatal outcome. Methods: We performed a retrospective case-control study, which included 266 preterm newborns with less than 34-week gestation, between 2011 and 2015. Neonatal outcomes were compared according to the mechanism of labor onset. Our primary outcomes were neonatal death, sequelae on hospital discharge and a composite of these two variables (combined neonatal outcome). Results: Compared to spontaneous preterm labor, iatrogenic preterm newborns were at increased risk of respiratory distress syndrome (RDS) [Odds Ratio (OR) 3.05 (95%CI 1.31; 7.12)], and need of exogenous surfactant administration [OR 3.87 (95%CI 1.60; 9.35)]. PPROM was associated with higher risk of neonatal sepsis [OR 12.96 (95%CI 1.18; 142.67)]. There were no differences regarding the combined outcome for iatrogenic [OR 0.94 (95%CI 0.33; 2.71)] or PPROM [OR 1.11 (95%CI 0.35; 3.49)] groups. Conclusions: In our study, the different mechanisms of labor onset are associated with different neonatal outcomes. Iatrogenic preterm birth was associated with an increased risk of RDS and a higher need of exogenous surfactant administration than spontaneous group. The rate of neonatal sepsis was significantly higher in PPROM group along with a higher prevalence of histological chorioamnionitis.
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Affiliation(s)
- Sara Pinto
- a São João Hospital Center, Faculty of Medicine of Porto , Neonatal Intensive Care Unit , Porto , Portugal
| | - Maria Filipa Malheiro
- a São João Hospital Center, Faculty of Medicine of Porto , Neonatal Intensive Care Unit , Porto , Portugal
| | - Ana Vaz
- a São João Hospital Center, Faculty of Medicine of Porto , Neonatal Intensive Care Unit , Porto , Portugal
| | - Teresa Rodrigues
- a São João Hospital Center, Faculty of Medicine of Porto , Neonatal Intensive Care Unit , Porto , Portugal
| | - Nuno Montenegro
- a São João Hospital Center, Faculty of Medicine of Porto , Neonatal Intensive Care Unit , Porto , Portugal
| | - Hercília Guimarães
- a São João Hospital Center, Faculty of Medicine of Porto , Neonatal Intensive Care Unit , Porto , Portugal
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Ha S, Liu D, Zhu Y, Sherman S, Mendola P. Acute Associations Between Outdoor Temperature and Premature Rupture of Membranes. Epidemiology 2018; 29:175-182. [PMID: 29087988 PMCID: PMC5792369 DOI: 10.1097/ede.0000000000000779] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Extreme ambient temperatures have been linked to preterm birth. Preterm premature rupture of membranes is a common precursor to preterm birth but is rarely studied in relation to temperature. METHODS We linked 15,381 singleton pregnancies with premature rupture of membranes from a nationwide US obstetrics cohort (2002-2008) to local temperature. Case-crossover analyses compared daily temperature during the week preceding delivery and the day of delivery to 2 control periods, before and after the case period. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CIs) of preterm and term premature rupture of membranes for a 1°C increase in temperature during the warm (May-September) and cold (October-April) season separately after adjusting for humidity, barometric pressure, ozone, and particulate matter. RESULTS During the warm season, 1°C increase during the week before delivery was associated with a 5% (95% CI, 3%, 6%) increased preterm premature rupture of membranes risk, and a 4% (95% CI, 3%, 5%) increased term premature rupture of membranes risk. During the cold season, 1°C increase was associated with a 2% decreased risk for both preterm (95% CI, 1%, 3%) and term premature rupture of membranes (95% CI, 1%, 3%). The day-specific associations for the week before delivery were similar, but somewhat stronger for days closer to delivery. CONCLUSIONS Relatively small ambient temperature changes were associated with the risk of both preterm and term premature of membranes. Given the adverse consequences of premature rupture of membranes and concerns over global climate change, these findings merit further investigation. See video abstract at, http://links.lww.com/EDE/B312.
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Affiliation(s)
- Sandie Ha
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD, USA
- College of Social Sciences, Humanities and Arts, University of California, Merced, CA, USA
| | - Danping Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD, USA
| | - Yeyi Zhu
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD, USA
- Kaiser Permanente, Oakland, CA, USA
| | | | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD, USA
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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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Sánchez-Manares D, Reyna-Villasmil E, Mejia-Montilla J, Reyna-Villasmil N, Torres-Cepeda D, Santos-Bolívar J, Fernández-Ramírez A. Utilidad de la medición de aminotransferasas en flujo vaginal para el diagnóstico de rotura prematura de membranas. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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