Development of a Predictive Model for the Latency Period in Preterm Premature Rupture of Membranes Before 32 Weeks' Gestation.

BackgroundThere 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.MethodsTwin 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.Results98 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.ConclusionUterine 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.

The management of preterm premature rupture of the membranes near the limit of fetal viability

Third trimester preterm and term premature rupture of membranes: Is there any difference in maternal characteristics and pregnancy outcomes?

Background: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity. Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour. Results: showed non-significant differences between the mean of PCA among different groups (P>0.05). Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM patients’ group with high latency period. The latency period had significant positive correlation with AFI and cervical length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP, and TLC, and neonatal sepsis (p<0.05). Conclusion: It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool in the evaluating the interval between rupture of membranes and delivery in women with PPROM.

Background: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity. Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour. Results: showed non-significant differences between the mean of PCA among different groups (P>0.05). Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM patients’ group with high latency period. The latency period had significant positive correlation with AFI and cervical length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP, and TLC, and neonatal sepsis (p<0.05). Conclusion: It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool in the evaluating the interval between rupture of membranes and delivery in women with PPROM.

IntroductionConservative treatments with a latency period have been used for the treatment of preterm premature rupture of membranes (PPROM) in clinical practice. We aimed to evaluate the role and potential influencing factors of the latency period, to provide insights for the clinical treatment of PPROM.Material and methodsPPROM pregnant women treated in our hospital from January 1, 2015 to September 30, 2020 were included. PPROM patients were divided into a 48–168 h group and a &gt; 168 h latency group; the characteristics and prognosis of these two groups were compared and analyzed. Logistic regression analyses were conducted to analyze the relevant influencing factors of the latency period.ResultsA total of 131 PPROM patients were included. There were significant differences in the age, BMI, gestational age on admission, amniotic fluid volume before childbirth, and positive rate of cervical secretion culture between the two groups (all p &lt; 0.05). Logistic regression analyses indicated that the latency period was shorter in the PPROM patients with age ≥ 30 years (OR = 0.048, 95% CI: 0.121–0.863) and gestational age ≥ 32 weeks on admission (OR = 0.463, 95% CI: 0.069–0.811), and the latency period was prolonged in the PPROM patients with BMI ≥ 23 kg/m2 (OR = 1.591, 95% CI: 1.134–1.944) and amniotic fluid volume ≥ 6 cm (OR = 2.129, 95% CI: 1.093–3.042) (all p &lt; 0.05). There were significant differences in the incidence of low birth weight and neonatal respiratory distress syndrome (NRDS) between the 48–168 h group and &gt; 168 h group (all p &lt; 0.05).ConclusionsThe latency period plays an important role in PPROM, which is associated with the pregnant women’s age, BMI, gestational week of rupture and amniotic fluid index.

This study aimed to compare the serum IL-22 levels between preterm premature rupture of membranes (PPROM) patients and the control group with intact membranes. We also hypothesized whether serum IL-22 upregulation might contribute to defense against inflammatory responses and improve the pregnancy outcomes. We performed this prospective case-control study between 24-34 weeks of pregnancy. We enrolled 40 singleton pregnant patients with PPROM and 40 healthy gestational age- and gravidity-matched patients without PPROM. The degree of association between variables and IL-22 were calculated by Spearman correlation coefficients where appropriate. Scatter plots were given for statistically significant correlations. ROC curve was constructed to illustrate the sensitivity and specificity performance characteristics of IL-22, and a cutoff value was estimated by using the index of Youden. Maternal serum IL-22 levels were significantly higher in PPROM patients (60.34 ± 139.81 pg/mL) compared to the participants in the control group (20.71 ± 4.36 pg/mL, p < 0.001). When we analyze the area under the ROC curve (AUC), the IL-22 value can be considered a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 23.86 pg/mL cut-off value of IL-22 can be used to diagnosing PPROM with 72% sensitivity and 61.5% specificity. There was no positive correlation between serum IL-22 levels and maternal C-reactive protein (CRP) value, procalcitonin value, latency period, birth week, birth weight, and umbilical cord blood pH value. Maternal serum IL-22 levels were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that IL-22 might be a crucial biomarker of the inflammatory process in PPROM.

822: Genetic susceptibility to preterm birth in the Filipino population in Hawaii

ObjectiveTo characterize the vaginal microbiota of women following preterm premature rupture of membranes (PPROM), and determine if microbiome composition predicts latency duration and perinatal outcomes.DesignA prospective cohort studySettingCanadaPopulationWomen with PPROM between 24+0 and 33+6 weeks gestational age (GA).MethodsMicrobiome profiles, based on pyrosequencing of the cpn60 universal target, were generated from vaginal samples at time of presentation with PPROM, weekly thereafter, and at delivery.Main Outcome MeasuresVaginal microbiome composition, latency duration, gestational age at delivery, perinatal outcomes.ResultsMicrobiome profiles were generated from 70 samples from 36 women. Mean GA at PPROM was 28.8 wk (mean latency 2.7 wk). Microbiome profiles were highly diverse but sequences representing Megasphaera type 1 and Prevotella spp. were detected in all vaginal samples. Only 13/70 samples were dominated by Lactobacillus spp. Microbiome profiles at the time of membrane rupture did not cluster by gestational age at PPROM, latency duration, presence of chorioamnionitis or by infant outcomes. Mycoplasma and/or Ureaplasma were detected by PCR in 81% (29/36) of women, and these women had significantly lower GA at delivery and correspondingly lower birth weight infants than Mycoplasma and/or Ureaplasma negative women.ConclusionWomen with PPROM had mixed, abnormal vaginal microbiota but the microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period.

Preterm premature rupture of membranes at 22–25 weeks’ gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2)

A prospective, randomized, placebo-controlled trial of penicillin in preterm premature rupture of membranes

492: Plasma proteomic profiles in preterm labor (PTL) and preterm premature rupture of membranes (PPROM)

Objectives To evaluate the maternal serum endocan levels in pregnant women complicated by preterm premature rupture of membranes (PPROM) and to compare the results with healthy pregnancies. Methods This cohort study included 31 pregnant women with PPROM and 34 gestational age-matched healthy subjects in the third trimester of pregnancy. The blood for analysis was obtained on the day of diagnosis and serum endocan levels were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The pregnant women were observed until the delivery and perinatal data were noted. Results No significant differences regarding maternal age, body mass index, gravidity, parity and gestational age at sampling were observed (P > 0.05). Mean serum endocan level was significantly higher in the PPROM group than in healthy controls (1490 ± 632 pg/mL vs. 972 ± 586 pg/mL, respectively; P: 0.001). Serum endocan concentration was positively correlated with C-reactive protein (CRP) (r = 0.754, P < 0.001) and white blood cells count (WBC) (r = 0.712, P:0.001). The receiver operating characteristic (ROC) curve analysis showed that endocan with a cut-off point of 1198 ng/dL indicated women with PPROM with sensitivity of 64.5% and specificity of 35.1% (area under curve 0.731, confidence interval 0.61-0.85). Conclusion Serum endocan level was significantly elevated in the PPROM patients than in healthy controls. The endocan level may be a useful indicator of endothelial dysfunction/inflammation in PPROM cases.

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.

Objective: To examine the difference between matrix metalloproteinase‐ 9 (MMP‐9) and Tumor Necrosis Factor 􀁃 (TNF‐􀁃) serum levels in preterm and term premature rupture of membranes (PROM). &#x0D; Method: Our study employed an observational cross sectional approach. Seventy samples were divided into two groups, 35 samples with preterm PROM (28‐36 weeks gestational age) and 35 samples with PROM at term pregnancy (37‐42 weeks gestational age). Both groups underwent examination for serum MMP‐9 and TNF‐􀁃 concentration using ELISA method. Statistical analysis was done using ttest. &#x0D; Result: Serum levels of MMP‐9 in the preterm PROM group was 2860.68K627.32 ng/ml, which was significantly higher than in the PROM at term pregnancy group 2549.74K657.15 ng/ml (p=0.04). Likewise, the average serum level of TNF‐􀁃 in subjects with preterm PROM was 12,086.60K5384.51 ng/ml, significantly higher in comparison to PROM at term pregnancy, which was 6422.51K2645.32 ng/ml (p=0.00).&#x0D; Conclusion: Serum levels of MMP‐9 and TNF‐􀁃 in preterm PROM is significantly higher than that in PROM at term pregnancy.&#x0D; Keywords: MMP‐9, premature rupture of membranes, preterm, term, TNF‐􀁃