Outcome In Preterm Premature Rupture Research Articles

Survey of Pregnancy Outcome in Preterm Premature Rupture of Membranes with Amniotic Fluid Index

Preterm premature rupture of membranes (PPROM) is among the most important causes of perinatal morbidity and mortality. The aim of this study is to survey the pregnancy outcomes in preterm premature rupture of membranes with an amniotic fluid index of <5 and >5. This prospective cohort study was performed on 137 pregnant women complicated by preterm premature rupture of membranes (PPROM) with a gestational age of 28-34 weeks during October 2006 to October 2008. The patients were divided in two groups according to their amniotic fluid index; AFI<5 (77cases), AFI≥5 (60cases). The Chi-squared test for qualitative variables and T-student test for quantitative variables were used to analyze the results. The results showed that there was no significant difference in terms of the number of pregnancies, gestational age at rupture of membranes and birthweight between the two groups. However, the results demonstrated that the patients with AFI<5 exhibited a significantly shorter latency period (p=0.049), a higher rate of cesarean due to fetal distress (p=0.008), a lower neonatal Apgar score in the first minute (p=0.0127) and a higher rate of neonatal death during the first week (p=0.045). Overall, PPROM with oligohydroamnios is associated with shorter latency, higher rate of C/S, higher rate of early neonatal death and lower neonatal Apgar.

Transabdominal amnioinfusion in preterm premature rupture of membranes

Objective To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM). Methods We conducted a prospective randomized controlled study of women with pPROM during singleton live pregnancy—between 26 and 33 + 6 weeks—whose amniotic fluid index (AFI) was less than the 5th percentile. The study group underwent transabdominal amnioinfusion at admission and then weekly if their AFI fell below the 5th percentile again. The control group received expectant management. Results The difference in the mean interval from pPROM to delivery between the groups was not statistically significant. Neonatal and maternal outcomes were significantly improved in the study group compared with the control group (fetal distress [10% vs 37%]; early neonatal sepsis [17% vs 63%]; neonatal mortality [17% vs 63%]; spontaneous delivery [83% vs 53%]; and postpartum sepsis [7% vs 33%]). Conclusion Transabdominal amnioinfusion reduced fetal distress, early neonatal sepsis, and neonatal mortality. In the study group, more participants delivered spontaneously and there were fewer cases of postpartum sepsis, although the pPROM–delivery interval was not increased.

Neonatal C‐reactive protein value in prediction of Outcome of Preterm Premature Rupture of Membranes: Comparison of Singleton and Twin Pregnancies

The clinical importance of preterm premature rupture of the membranes (PPROM) is its relationship to maternal and neonatal mortality and morbidity, especially in twin pregnancies. The aim of this study was to determine and compare the role of inflammatory factors as predictors of the PPROM outcome between singleton and twin pregnancies. The medical records of 22 twins delivered between 28 and 34 weeks and complicated by PPROM were reviewed at the Al-Zahra Hospital in Tabriz, Iran. Also among singletons, 55 cases of matched gestational age were randomly selected as a control group. Three laboratory indices of neonatal white blood cell (WBC) count and C-reactive protein (CRP) in the two groups were measured immediately after delivery and the effects of two factors on neonatal outcome were assessed. In singletons, there was adverse relationship between the mean of WBC count and duration of latency (P = 0.007). Also, a positive relationship between the means of ventilation time and WBC count in second twins was found (P = 0.034). Positive CRP was the main predictor of neonatal intensive care unit admission in both singletons (odds ratio: 4.929, P = 0.042) and first twins (odds ratio: 9.000, P = 0.005). However, positive CRP did not influence the existence of metabolic acidosis or duration of latency in either of the two groups. Neonatal WBC count was a predictor for the duration of latency in singletons and for ventilation time in twins. Positive neonatal CRP was an important factor for the prediction of neonatal intensive care unit admission in both types of pregnancy; its role in twins is clearer than in singletons.

Outcomes of preterm premature rupture of membranes in twin pregnancies

Objective. To describe outcomes in twin pregnancies with preterm premature rupture of membranes (PPROM).Methods. Dichorionic twin pregnancies complicated by PPROM at <34 weeks of gestation for the period 2003 to 2006 were identified. Outcomes were obtained through chart review. The relationship between gestational age at premature rupture of membranes (PROM), latency from PROM to delivery, and infection were examined.Results. In 49 twin pregnancies, the median gestational age at PROM was 31 weeks with a median latency between PROM and delivery of 0 days (interquartile range 0–6). Latency intervals of ≥2 and ≥7 days were achieved by 40.8% and 22.4%, respectively. PPROM at <30 weeks was associated with significantly higher rates of latency of ≥ 2 days (70.6% vs. 25.0%) and ≥7 days (47.1% vs. 9.4%). There was a significant relationship between latency and clinical and histologic signs of infection.Conclusions. After 30 weeks, most twin pregnancies with PPROM delivered within 2 days. Infection appears to be a consequence rather than a cause of PPROM in most cases.

Neonatal outcomes of preterm premature rupture of membranes at 32-36 weeks gestation improve with increasing gestational age at time of delivery

Neonatal outcomes of preterm premature rupture of membranes at 32-36 weeks gestation improve with increasing gestational age at time of delivery

Transcervical intrapartum amnioinfusion for preterm premature rupture of the membranes

ObjectivesTo investigate the effect of transcervical amnioinfusion on the management of labour and neonatal outcomes in preterm premature rupture of the membranes. Study designThis clinical trial included 86 patients with premature rupture of the membranes between weeks 27 and 35 of gestation. Patients were randomly assigned to receive amnioinfusion via a two-way catheter or to the control group. Clinical management was otherwise the same in both groups. ResultsAmnioinfusion decreased the frequency of variable decelerations in fetal heart rate (27.9% versus 53.5%, p<0.05) and the rate of obstetric interventions motivated by nonreassuring fetal status (13.6% versus 52.4%, p<0.05). At delivery, pH values were significantly higher in the treatment group than in the conventionally managed control group (median 7.29 versus 7.27). ConclusionsIntrapartum transcervical amnioinfusion for preterm premature rupture of the membranes reduced the number of interventions needed because of nonreassuring fetal status, and improved neonatal gasometric values without increasing maternal or fetal morbidity.

C-reactive protein concentration in vaginal fluid as a marker for intra-amniotic inflammation/infection in preterm premature rupture of membranes

Objective. The purpose of this study was to determine whether C-reactive protein (CRP) concentrations in vaginal fluid can identify patients with intra-amniotic inflammation/infection (IAI) and predict adverse outcome in preterm premature rupture of membranes (PROM).Methods. The study population consisted of 121 singleton pregnant women with preterm PROM (⩽36 weeks of gestation) who had an amniocentesis and vaginal fluid collection. A Dacron polyester-tipped applicator was soaked with vaginal fluid for 10 seconds and diluted with 1 mL buffer solution. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. Vaginal fluid CRP and amniotic fluid matrix metalloproteinase-8 (MMP-8) were determined by specific immunoassays. IAI was defined as an amniotic fluid MMP-8 concentration >23 ng/mL and/or a positive amniotic fluid culture. Nonparametric tests and survival techniques were used for statistical analysis.Results. Patients with IAI had a significantly higher median vaginal fluid CRP concentration than those without IAI (median (range), 7.8 (0.1–1310.1) ng/mL vs. 1.0 (0.1–319.4) ng/mL, p < 0.005). The median amniotic fluid white blood cell (WBC) count was significantly higher in patients with a vaginal fluid CRP concentration of >10 ng/mL than in those with a lower concentration (median (range), 82.5 (0–8640) cells/mm3 vs. 2 (0–>1000) cells/mm3, p < 0.001). Patients with vaginal fluid CRP concentration of >10 ng/mL had a significantly shorter sampling-to-delivery interval and higher rates of preterm delivery within five days, funisitis, and histologic chorioamnionitis than did those with a vaginal fluid CRP concentration below this cut-off. A vaginal fluid CRP cut-off of 10 ng/mL had a specificity of 89% and a sensitivity of 45% in the identification of IAI.Conclusion. An elevated CRP concentration in vaginal fluid collected by polyester-tipped applicator is a risk factor for intra-amniotic inflammation/infection and impending preterm delivery in preterm PROM.

Rotura prematura de membranas en edad gestacional previable

Objective To describe neonatal outcomes in preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. Patients and methods Fifty consecutive patients with PPROM before 24 weeks’ gestation were included. If deepest pool of amniotic fluid (DPAF) was < 1.0 cm 1 week after admission, amniopatch was offered. If DPAF was ≥ 1.0 cm, expectant management was followed. Perinatal and maternal outcomes were evaluated. Results The mean gestational age at PPROM was 18.2 weeks (SD ± 3.6). Amniopatch was performed in 13 patients (26%). Of the 50 patients, 15 chose pregnancy termination and 35 were managed expectantly. In these 35 patients, there were 12 (34.3%) fetal demises or non-viable deliveries before 24 weeks, four (11.4%) fetal demises after 24 weeks and four (11.4%) neonatal deaths. A significant inverse relationship was observed between latency period and gestational age at PPROM. Pulmonary hypoplasia occurred in four neonates (11.4%) and chorioamnionitis in eight neonates (22.9%). There was only one case (2.9%) of congenital luxation of the knee. Conclusions The overall perinatal survival rate in pregnancies with rupture of membranes before 24 weeks was 42.9% with a neonatal mortality of 57.1%. However, survival markedly improves when pregnancy is prolonged to over 24 weeks and in our series it increased to 65.2%.

'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5).

BackgroundOur purpose was to determine whether AFI<5 cm after preterm premature rupture of the membranes (PPROM) is associated with an increased risk of perinatal morbidity.MethodsWe performed a prospective cohort study of 95 singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 26 and 34 weeks gestation.Patients were categorized in two groups on the basis of amniotic fluid index<5, (AFI<5 cm)(n = 26) or AFI ≥ 5 cm (n = 69). Categorical data were tested for significance with the χ2 and Fisher exact tests. Continuous data were evaluated for normal distribution and tested for significance with the student t test.All 2-sided p values < 0.05 were considered significant.ResultsBoth groups were similar with respect to selected demographics, gestational age at rupture of the membranes, gestational age at the delivery, birth weight. Both groups were similar with respect to selected variable, latency until delivery, early onset neonatal sepsis, RDS and neonatal death. Patients with AFI<5 cm demonstrated greater frequency of C/S delivery for non reassuring fetal tests (23%vs 2.8%) (p = 0.001). Our study demonstrated that patients in group I had a significant increase in the frequency of clinical chorioamnionitis (P < 0/001). Post partum infections were not seen in 2 groups.ConclusionsAn AFI<5 cm after PPROM between 26 and 34 weeks gestation is associated with an increased risk of maternal infections and frequency of C/S.

P03.09: Perinatal outcome in preterm premature rupture of membranes with olighohydramnios

P03.09: Perinatal outcome in preterm premature rupture of membranes with olighohydramnios

P12.28: Outcome of preterm premature rupture of membrane in twin pregnancies

P12.28: Outcome of preterm premature rupture of membrane in twin pregnancies

Outcome of preterm premature rupture of membranes: a contemporary perspective

Most published studies of latency in preterm premature rupture of membranes (PPROM) predate routine use of steroids for fetal lung maturation and antibiotic protocols. We evaluated the latency period of PPROM in a contemporary population uniformly treated with steroids and antibiotics.

Prediction of Pregnancy Outcome in Preterm Premature Rupture of Membranes Using Vaginal Pool Amniotic Fluid Markers

Hendsch, Suzelle A. MD; Stephens, Lisa MD; Markenson, Glenn MD; Bsat, Fadi MD Author Information

Prediction of pregnancy outcome in preterm premature rupture of membranes using vaginal pool amniotic fluid markers

Objective: To determine whether there is an association between levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), and glucose in vaginal pool amniotic fluid specimens and pregnancy outcome in preterm premature rupture of membranes (PPROM). Methods: Vaginal pool amniotic fluid samples from 49 patients at between 27 and 36 weeks of gestation with PPROM and no evidence of clinical chorioamnionitis were tested for IL-6, LDH, and glucose. Results were compared with respect to collection-to-delivery interval, histologic chorioamnionitis, and neonatal sepsis. Results: The mean collection-to-delivery interval was 67 hours (3 to 420 hours). There was no difference between IL-6, LDH, or glucose with respect to collection-to-delivery interval. The prevalence of histologic chorioamnionitis was 36% (18 of 49). The prevalence of neonatal sepsis was 26% (13 of 49); six of the 13 also had histologic chorioamnionitis. The mean LDH level was significantly greater (107.6 U/L) for women with histologic chorioamnionitis than for those without (9.8 U/L; P = 0.0004). A receiver operating curve found that an LDH level greater than 25 U/L predicted histologic chorioamnionitis (PPV, 80%). Conclusion: Vaginal pool amniotic fluid LDH greater than 25 U/L was shown to predict histologic chorioamnionitis in PPROM, whereas IL-6 and glucose were not shown to be clinically useful.

290 Is Oligohydramnios Predictive of Pregnancy Outcome in Preterm Premature Rupture of Membranes?

290 Is Oligohydramnios Predictive of Pregnancy Outcome in Preterm Premature Rupture of Membranes?

Maternal morbidity and perinatal outcome in preterm premature rupture of membranes before 37 weeks gestation.

OBJECTIVE: To assess the maternal morbidity and perinatal outcome in pre-term pre mature rupture of membranes between 24 to 37 weeks gestation. METHODS: This observational study was carried out in Gynaecology & Obstetrics Unit – I, at University Hospital Hyderabad, from October 2010 to October 2011. It included one hundred patients admitted through the outpatient department, as well as from casualty department of University Hospital Hyderabad. Detailed Clinical examination of the patient was done. Systemic review was also done to see any co-morbidity. All patients had laboratory investigations. Inclusion criteria were all patients gestational age between 24 to 37 weeks with preterm premature rupture of membrane (PPROM) confirmed by ultrasound and clinical examination regardless of their age. Exclusion criteria were patients with congenital anomalies, multiple pregnancy, pre-eclampsia & eclampsia, diabetes mellitus, polyhydramnios1 intrauterine growth restriction and placenta abruption. Data was collected using a proforma. Detailed workup including history, general physical examination, abdomen and pelvic examination and relevant specific investigations were noted. RESULTS: Out of 100 patients included in this study Primigravida were 17% and multigravida 83%. There was wide variation of age ranging from a minimum of 20to >40 years. The mean age was 30+ 3.1 years. Mostly patients belonged to the poor class in 72% cases followed by middle class in 21% and upper class 7%. Analysis shows that out of 100 mothers 26% had PROM of <24 hrs duration and 74% had >24 hrs of duration. Maternal outcome in 16 cases of Preterm Premature Rupture of Membrane findings revealed septicemia in 12% cases and Chorioamnionitis in 12% cases. Fetal outcome in 27 cases of preterm premature rupture of membrane revealed prematurity in 5% cases, fetal distress in 4% cases, cord compression in 5% cases, necrotizing enterocolitis in 2% cases, hypoxia in 9% cases and pulmonary hypoplasia in 2% cases. CONCLUSION: Low socioeconomic status is associated with increased neonatal morbidity due to fetal distress, cord compression, necrotizing enterocolitis, hypoxia and pulmonary hypoplasia at the time of delivery. An appropriate and accurate diagnosis of PROM is critical to optimize pregnancy outcome. It is suggested that the timely diagnosis and management of preterm PROM will allow obstetric care providers to optimize perinatal outcome and minimize neonatal morbidity.