Preterm Prelabor Rupture Of Membranes Research Articles

Angiogenic imbalance in pregnancies with preterm prelabor rupture of membranes between 34 and 37 weeks of gestation.

This study aimed to identify whether microbial invasion of the amniotic cavity and/or intra-amniotic inflammation in women with late preterm prelabor rupture of membranes (PPROM) was associated with changes in concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and its ratio in maternal serum, and whether placental features consistent with maternal vascular malperfusion further affect their concentrations. This historical study included 154 women with singleton pregnancies complicated by PPROM between gestational ages 34+0 and 36+6 weeks. Transabdominal amniocentesis was performed as part of standard clinical management to evaluate the intra-amniotic environment. Women were categorized into two subgroups based on the presence of microorganisms and/or their nucleic acids in amniotic fluid (determined by culturing and molecular biology method) and intra-amniotic inflammation (by amniotic fluid interleukin-6 concentration evaluation): (1) those with the presence of microorganisms and/or inflammation (at least one present) and (2) those with negative amniotic fluid for infection/inflammation (absence of both). Concentrations of sFlt-1 and PlGF were assessed using the Elecsys® sFlt-1 and Elecsys® PlGF immunoassays and converted into multiples of medians. Women with the presence of microorganisms and/or inflammation in amniotic fluid had lower serum concentrations of sFlt-1 and sFlt-1/PlGF ratios and higher concentrations of PlGF compared with those with negative amniotic fluid. (sFlt-1: presence: median 1.0 multiples of the median (MoM), vs negative: median: 1.5 MoM, P = 0.003; PlGF: presence: median 0.7 MoM, versus negative: median 0.4 MoM, P = 0.02; sFlt-1/PlGF: presence: median 8.9 vs negative 25.0, P = 0.001). Higher serum concentrations of sFlt-1 and sFlt-1/PlGF ratios as well as lower concentrations of PlGF were found in the subsets of women with maternal vascular malperfusion than in those without maternal vascular malperfusion. Among women experiencing late PPROM, angiogenic imbalance in maternal serum is primarily observed in those without both microbial invasion of the amniotic cavity and intra-amniotic inflammation. Additionally, there is an association between angiogenic imbalance and the presence of maternal vascular malperfusion.

Non-invasive prediction model of histologic chorioamnionitis with preterm prelabour rupture of membranes

BackgroundThe aim of this study is to identify risk factors associated with histological chorioamnionitis (HCA) and develop a predictive model for antepartum assessment of the risk of PPROM with HCA. MethodsThis study retrospectively analyzed pregnant women who experienced PPROM between 25 + 0 and 35 + 0 weeks of gestational age. The women were divided into two groups based on the presence or absence of HCA. Univariate and multivariate logistic regression analyses were conducted to identify maternal risk factors and develop a clinical prediction model for HCA. The model's discrimination and consistency were evaluated using receiver operating characteristic (ROC) and calibration curves. ResultsSeventeen thousand one hundred forty-six (17,146) pregnant women were screened, and 726 (4.23 %) had PPROM. Out of the 286 subjects with PPROM, 160 developed HCA. The maternal age of these subjects ranged from 18 to 43 years (30.0 ± 5.4), while their gestational age (GA) ranged from 25 + 0 to 35 + 0 weeks (31.6 ± 2.0). The average GA at delivery was 32.2 ± 2.0 (weeks).Compared with the non-HCA group, the expectant time > 48 h, GA at delivery > 32 weeks, twin pregnancy, HGB (<110 g/Lg/L), degree of LGB (IIb-III), and WBC (>9.5 × 109 /L) were significantly more than in the PPROM with HCA group. The results show that the best model was obtained by leave-one-out logistic regression (AUC = 0.785, CA = 0.741, F1 = 0.739, Precision = 0.740, Recall = 0.741). In the validation set, logistic regression also achieved good results (AUC = 0.710, CA = 0.671, F1 = 0.654, Precision = 0.683, Recall = 0.671). Combining the previous analysis, we found that the prognostic model constructed using the core six features had the best predictive effect. ConclusionsSix features were associated with the occurrence of chorioamnionitis. These features were used to construct a diagnostic model that can accurately predict the probability of chorioamnionitis occurrence and provide a beneficial tool for the prevention and management of PPROM with HCA.

Characterizing of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta marked by elevated amniotic fluid interferon gamma-induced protein 10 (IP-10) in pregnancies complicated by preterm prelabor rupture of membranes

ObjectivesThis study aimed to determine the occurrence of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta, marked by elevated levels of interferon gamma-induced protein 10 (IP-10) (≥2200 pg/mL) in the amniotic fluid of women with preterm prelabor rupture of membranes (PPROM). Specifically, the study investigated whether these intra-amniotic inflammatory changes were more common in women with microbial invasion of amniotic cavity (MIAC) and intra-amniotic inflammation (IAI), as indicated by increased amniotic fluid interleukin (IL)-6 concentration (≥3000 pg/mL). Study designA cohort of 114 women with singleton pregnancies complicated by PPROM between 24+0 and 36+6 weeks of gestation were included. Amniotic fluid samples were obtained via amniocentesis upon admission. MIAC diagnosis involved aerobic and anaerobic cultures, as well as polymerase chain reaction (PCR) analysis of the amniotic fluid. Immunoassay tests and enzyme-linked immunosorbent assay (ELISA) were used to determine IL-6 and IP-10 concentrations, respectively. ResultsAmong the participants, 19.3 % and 15.8 % had MIAC and IAI, respectively. The occurrence of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta was similar between women with and without MIAC (25 % vs. 40.9 %, p = 0.136, adjusted p = 0.213). The rate of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta was significantly higher in women with IAI compared to those without, after adjusting for gestational age at sampling (55.6 % vs. 22.9 %, p = 0.005, adjusted p = 0.011). ConclusionThis study revealed comparable rates of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta in women with and without MIAC, but a higher prevalence of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta in women with IAI. These findings suggest involvement of chronic inflammation even in women with PPROM with acute intra-amniotic inflammation.

Transcriptomic analysis delineates preterm prelabor rupture of membranes from preterm labor in preterm fetal membranes

BackgroundGlobally, preterm birth remains the leading cause of death in children younger than 5 years old. Spontaneous preterm birth is comprised of two events that may or may not occur simultaneously: preterm labor and preterm prelabor rupture of membranes (PPROM). To further explore the concept that spontaneous preterm birth can result from the initializing of two separate but overlapping pathological events, we compared fetal membrane tissue from preterm labor deliveries to fetal tissue from preterm labor with PPROM deliveries. We hypothesized that the fetal membrane tissue from preterm labor with PPROM cases will have an RNA-seq profile divergent from the fetal membrane tissue from preterm labor controls.MethodsChorioamnion, separated into amnion and chorion, was collected from eight gestationally age-matched cases and controls within 15 min of birth, and analyzed using RNA sequencing. Pathway enrichment analyses and functional annotations of differentially expressed genes were performed using KEGG and Gene Ontogeny Pathway enrichment analyses.ResultsA total of 1466 genes were differentially expressed in the amnion, and 484 genes were differentially expressed in the chorion (log2 fold change > 1, FDR < 0.05) in cases (preterm labor with PPROM), versus controls (preterm labor only). In the amnion, the most significantly enriched (FDR < 0.01) KEGG pathway among down-regulated genes was the extracellular matrix receptor interaction pathway. Seven of the most significantly enriched pathways were comprised of multiple genes from the COL family, including COL1A, COL3A1, COL4A4, and COL4A6. In the chorion, the most significantly enriched KEGG pathways in up-regulated genes were chemokine, NOD receptor, Toll-like receptor, and cytokine-cytokine receptor signaling pathways. Similarly, KEGG pathway enrichment analysis for up-regulated genes in the amnion included three inflammatory pathways: cytokine-cytokine interaction, TNF signaling and the CXCL family. Six genes were significantly up regulated in chorionic tissue discriminated between cases (preterm labor with PPROM) and controls (preterm labor only) including GBP5, CXCL9, ALPL, S100A8, CASP5 and MMP25.ConclusionsIn our study, transcriptome analysis of preterm fetal membranes revealed distinct differentially expressed genes for PPROM, separate from preterm labor. This study is the first to report transcriptome data that reflects the individual pathophysiology of amnion and chorion tissue from PPROM deliveries.

Perinatal outcomes following abdominoplasty: a retrospective study and review of current literature

BackgroundAbdominoplasty surgery is a common body contouring surgery to remove excess fat and skin and restore weakened or separated abdominal muscles caused by aging, pregnancy, or weight fluctuations. There is scant literature regarding patient and pregnancy outcomes following abdominoplasty. We sought to determine if there was a correlation between adverse pregnancy outcomes and a history of abdominoplasty. MethodsWe used a large federated de-identified national health research network with data sourced from 68 health care organizations within the United States (TriNetX, data accessed August 19, 2022). All patients with a record of pregnancy were identified using ICD-10/9 codes and were grouped into those with a history of abdominoplasty and those without. We evaluated the perinatal outcomes of fetal growth restriction, abnormal umbilical artery dopplers, gestational hypertension, pre-eclampsia, preterm delivery, preterm prelabor rupture of membranes, gestational diabetes, macrosomia, stillbirth, abnormal placentation, and wound disruption/infection occurring during a patient's pregnancy following abdominoplasty. Propensity matching was performed to account for potential confounders. An alpha level of < 0.05 was considered statistically significant. ResultsOf the 44,737 patients meeting our criteria, 304 had a history of abdominoplasty while 44,433 did not (Control). We found that patients with a history of abdominoplasty had significantly higher gravidity, were largely located in the Southern and Midwest region, and had higher counts of vaginal deliveries and cesarean sections, when compared to the Control cohort (Table 1). After propensity score matching, we found lower risk of pre-eclampsia and PPROM in patients with abdominoplasty (OR [95%CI] = 0.46 [0.32, 0.67], p < 0.0001, Table 2). Furthermore, abdominoplasty was associated with increased risk of preterm delivery (OR [95%CI] = 2.15 [1.48, 3.13], p = 0.0002, Table 2). We did not find significant differences in the other perinatal outcomes (Table 2). DiscussionOur data suggest that abdominoplasty may be associated with a relative increase in rates of preterm delivery and cesarean delivery, but other perinatal outcomes are not increased. This provides evidence that future desire for pregnancy need not be a relative contraindication to abdominoplasty.

Preterm prelabour rupture of membranes before 23 weeks’ gestation: prospective observational study

ObjectiveTo describe perinatal and maternal outcomes of preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation in a national cohort.DesignProspective observational study.SettingNational population based cohort study with the UK...

Impact of cannula diameter on pregnancy outcomes after minimally invasive fetal laser surgery in the treatment of twin-to-twin transfusion syndrome: A systematic review and meta-analysis.

Preterm prelabor rupture of membranes (PPROM) remains a major complication of fetal laser surgery in the treatment of twin-to-twin transfusion syndrome (TTTS). The aim of the study was to determine the impact of cannula size on pregnancy outcomes, with a particular focus on PPROM. The protocol was developed and registered in the PROSPERO database under registration number CRD42022333630. The PubMed, Web of Science, and EMBASE databases were searched electronically on May 18, 2022, and updated on March 2, 2023, utilizing a combination of the relevant MeSH terms, keywords, and word variants for "TTTS" and "laser". Randomized controlled trials, prospective and retrospective cohorts, case-control studies, and case reports/series with more than five participants were considered eligible for inclusion. Studies reporting the cannula diameter and PPROM rate after laser surgery in the treatment of monochorionic pregnancies affected by TTTS between 16- and 26 weeks' gestation were included. Data was extracted independently, and when appropriate, a random-effects meta-analysis was undertaken to calculate pooled estimates and their confidence intervals. Heterogeneity in the effect estimates of the individual studies was calculated using the I2 statistic. The primary outcome was PPROM rate. Secondary outcomes were survival rate, preterm birth, and incomplete surgery. The quality of the included studies was assessed using a modified quality in prognosis study tool. We included a total of 22 studies, consisting of 3426 patients. Only one study was scored as low quality, seven as moderate quality, and the remaining 14 as high quality. The mean PPROM rate after laser surgery treating TTTS was 22.9%, ranging from 11.6% for 9 French (Fr) to 54.0% for 12 Fr. Subsequent meta-regression for the clinically relevant PPROM rate before 34 weeks of gestation, showed increased PPROM rates for increased cannula size (p-value 0.01). This systematic review confirmed PPROM as a frequent complication of fetal laser surgery, with a mean PPROM rate of 22.9%. A larger cannula diameter relates to a significant higher PPROM risk for PPROM before 34 weeks gestation. Hence, the ideal balance between optimal visualization requiring larger port diameters and shorter operation time and more complete procedures that benefit from larger diameters is crucial to reduce iatrogenic PPROM rates.

The relationship between socioeconomic status and perinatal outcomes in in vitro fertilization conceptions

ObjectiveTo evaluate whether socioeconomic status has an impact on perinatal outcomes in in-vitro-fertilization pregnancies. We hypothesize that with greater coverage there may be an alleviation of the financial burden of IVF which can facilitates application of evidence-based practices. BackgroundIn-vitro fertilization (IVF) is the most used assisted reproductive technology in the United States, with growing efficiency and demand for in-vitro fertilization. Certain states have mandated coverage that enable low-income individuals to undergo in-vitro fertilization treatment. Study DesignA retrospective population-based observational study was conducted in accordance with the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database over the six-year period from 2008 to 2014 examining 10,000 in-vitro-fertilization deliveries. Maternal outcomes of interest included preterm pre-labor rupture of membranes (PPROM), preterm birth (i.e., before 37 weeks of gestation), placental abruption, Caesarean Section (C/S), operative vaginal delivery, spontaneous vaginal delivery (SVD), maternal infection, chorioamnionitis, hysterectomy, and postpartum hemorrhage. Neonatal outcomes included small for gestational age (SGA) defined as birth weight less than tenth percentile, intrauterine fetal death (IUFD), and congenital anomalies. ResultsOur study found that socioeconomic status did not have a statistically relevant effect on perinatal outcomes in women who underwent in-vitro-fertilization to conceive after adjusting for the potential confounding effects of maternal demographic, pre-existing clinical characteristics, and comorbidities. ConclusionThe literature suggests that in states with mandated in-vitro-fertilization coverage, there are better perinatal outcomes due in part to greater utilization of best IVF practices, such as single-embryo transfers. Moreover, the quality of medical care in states with coverage is in the highest quartile in the country. Therefore, our findings of equivalent perinatal outcomes in IVF care irrelevant of socio-economic status suggests that a possibly of lack of access to quality medical care may be a factor in the health disparities usually seen in lower socioeconomic status individuals.

Childhood Outcomes After Induction of Labor or Expectant Management for Preterm Prelabor Rupture of Membranes: A 10-Year Follow-up of the PPROMEXIL Trials

(Am J Obstet Gynecol. 2023;228:588.e1–588.e13) Managing late preterm prelabor rupture of membranes (PPROM) between 34+0 and 36+6 weeks’ gestation helps balance the advantages of extending the pregnancy with the risk of intra-amniotic infection. Two Dutch PPROM Expectant Management Versus Induction of Labor (PPROMEXIL) trials were conducted between 2007 and 2011. These randomized controlled studies analyzed induction of labor (IOL) compared to expectant management (EM) in pregnant women with late PPROM. While neonatal sepsis risks were similar between both groups, children at 2 years of age did show slightly higher neurodevelopmental delays with EM compared to IOL. Long-term data on child development beyond age 2 in children born after late PPROM are lacking. The aim of this PPROMEXIL follow-up study was to evaluate the effects of IOL versus EM on child outcomes.

Preterm premature rupture of the membranes (PPROM): a study of patient experiences and support needs

ABSTRACT Background Preterm prelabour rupture of membranes (PPROM) is a common obstetric condition but outcomes can vary depending on gestation. Significant maternal and foetal complications occur including preterm birth, infection, abruption, cord prolapse, pulmonary hypoplasia and even death. Although the need for psychological support is recognised it is unclear how much is actually offered to women and their families. This study aimed to survey the views of women and their families who have undergone PPROM in order to understand the care and psychological burden these families face. Methods An online survey was conducted, recruiting women via social media with collaboration from the patient advocacy support group Little Heartbeats. Responses were collated where fields were binary or mean and standard deviations calculated. Framework analysis was used to identify and analyse themes in free text responses. Results 180PPROM pregnancies were described from 177 respondents. Although carewas variable and respondents were from across the world there werecommon themes. Five themes were highlighted which were: a lack ofbalanced information regarding the condition, support in decisionmaking and support with the process, specific psychological supportand ongoing psychological consequences of PPROM. Conclusion This survey highlights areas in which care needs to be improved for women with PPROM. Previous studies have shown that providing good care during the antenatal period reduces long-term psychological morbidity for the whole family. The need for support, with regard both to information provided to women and their families and their psychological support needs to be addressed urgently.

Morbidity in Expectant Management of Pre-viable Preterm Prelabor Rupture of Membranes

Morbidity in Expectant Management of Pre-viable Preterm Prelabor Rupture of Membranes

Effect of antenatal corticosteroids on daily fetal movement count in pregnant women

Background: Fetal well-being is reflected in the fetal movements perceived by the mother. Corticosteroids are the most common therapy in clinical practice which can affect fetal activity. Aims and Objectives: The aim of this study was to evaluate the effect of dexamethasone administration on daily fetal movement count (DFMC) in pregnant women. Materials and Methods: A prospective and cohort study was performed in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital. A total of 100 pregnant women between gestational ages of 28 weeks and 38 weeks were enrolled in the study. They were asked to count DFMC on day 0, that is, before administration of injection dexamethasone, on day 2 (after 48 h of first dose), and during day 4 to 7. Women received injection dexamethasone 6 mg i.m. 4 doses at an interval of 12 h for various indications such as pre-term pre-labor rupture of membranes, placenta previa, pre-term labor, and previous cesarean. Outcome measures were changes in DFMC before and after dexamethasone administration. Results: DFMC was significantly reduced on day 2 of injection dexamethasone administration and returned to baseline values after 4th–7th days of receiving dexamethasone. Conclusion: Dexamethasone administration resulted in transient reduction in DFMC that mimics fetal compromise; hence, clinicians should be aware of this phenomenon to prevent iatrogenic pre-term birth of the fetus.

555 Does Amniotic Fluid Index Predict Adverse Pregnancy Outcomes in Preterm Prelabor Rupture of Membranes?

555 Does Amniotic Fluid Index Predict Adverse Pregnancy Outcomes in Preterm Prelabor Rupture of Membranes?

Intra-amniotic infection and/or inflammation is associated with fetal cardiac concentric hypertrophy and diastolic dysfunction in preterm labor and preterm prelabor rupture of membranes

Preterm delivery is associated with cardiovascular remodeling and dysfunction in children and adults. However, it is unknown whether these effects are caused by the neonatal consequences of preterm birth or if these are already present in utero. We evaluated fetal cardiac morphology and function in fetuses of mothers admitted for preterm labor or preterm prelabor rupture of membranes and the association of these changes with the presence of intra-amniotic infection and/or inflammation. In this prospective cohort study, fetal echocardiography and amniocentesis were performed at admission in singleton pregnant women with preterm labor and/or preterm prelabor rupture of membranes between 24.0 and 34.0 weeks' gestation with (intra-amniotic infection and/or inflammation group, n=41) and without intra-amniotic infection and/or inflammation (non-intra-amniotic infection and/or inflammation, n=54). Controls (n=48) were outpatient pregnant women without preterm labor or preterm prelabor rupture of membranes. Intra-amniotic infection was defined by a positive amniotic fluid culture or positive 16S ribosomal RNA gene. Intra-amniotic inflammation was defined by using the amniotic fluid interleukin-6 cutoff levels previously reported by our group being >1.43 ng/mL in preterm prelabor rupture of membranes and >13.4 ng/mL in preterm labor. Fetal cardiac morphology and function was evaluated using echocardiography, and troponin-I and N-terminal pro-brain natriuretic peptide concentrations were measured in amniotic fluid from women with preterm labor or preterm prelabor rupture of membranes and compared with 20 amniotic fluid Biobank samples obtained for reasons other than preterm labor or preterm prelabor rupture of membranes or cardiac pathology. The data were adjusted for the estimated fetal weight below the 10th percentile and for preterm prelabor rupture of membranes at admission and also for gestational age at amniocentesis when amniotic fluid biomarkers were compared. From 2018 to 2021, 143 fetuses were included; 95 fetuses were from mothers admitted with a diagnosis of preterm labor or preterm prelabor rupture of membranes, and among those, 41 (28.7%) were in the intra-amniotic infection and/or inflammation group and 54 (37.8%) were in the non-intra-amniotic infection and/or inflammation group. A total of 48 (33.6%) fetuses were included in the control group. Fetuses with preterm labor and/or preterm prelabor rupture of membranes had signs of subclinical cardiac concentric hypertrophy (median left wall thickness of 0.93 [interquartile range, 0.72-1.16] in the intra-amniotic infection and/or inflammation group; 0.79 [0.66-0.92] in the non-intra-amniotic infection and/or inflammation group; and 0.69 [0.56-0.83] in controls; P<.001) and diastolic dysfunction (tricuspid A duration 0.23 seconds [0.21-0.25], 0.24 [0.22-0.25], and 0.21 [0.2-0.23]; P=.007). Systolic function was similar among groups. Higher values of amniotic fluid troponin I (1413 pg/mL [927-2334], 1190 [829-1636], and 841 [671-959]; P<.001) and N-terminal pro-brain natriuretic peptide were detected (35.0%, 17%, and 0%; P=.005) in fetuses with preterm labor or preterm prelabor rupture of membranes when compared with the control group. The highest N-terminal pro-brain natriuretic peptide concentrations were found in the intra-amniotic infection and/or inflammation group. Fetuses with preterm labor or preterm prelabor rupture of membranes showed signs of cardiac remodeling and subclinical dysfunction, which were more pronounced in those exposed to intra-amniotic infection and/or inflammation. These findings support that the cardiovascular effects observed in children and adults born preterm have, at least in part, a prenatal origin.

532 Effect of Low-Dose Aspirin on Preterm Prelabor Rupture of Membranes in Low-Risk Nulliparous Women

532 Effect of Low-Dose Aspirin on Preterm Prelabor Rupture of Membranes in Low-Risk Nulliparous Women

First trimester risk of preeclampsia and rate of spontaneous birth in patients without preeclampsia

First-trimester screening for preeclampsia (PE), by a combination of maternal risk factors and mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF), as proposed by the Fetal Medicine Foundation (FMF) provides effective prediction of preterm PE. Placental dysfunction is a potential precursor of spontaneous birth. The objective of this study is to examine whether the estimated risk of PE is associated with the gestational age at onset of spontaneous delivery in the absence of PE. This was a secondary analysis of the data from the SPREE trial, in which there was comparison in the performance of first-trimester screening for preterm PE by the FMF model vs. a traditional history-based risk scoring system. The population for the present study included only the subgroup of women with spontaneous onset of delivery (labor with intact membranes or preterm prelabor rupture of membranes) and was arbitrarily divided into three groups according to the risk for preterm PE assessed by the FMF model at 11-13 weeks' gestation: group 1 (low risk, ˂1/100), group 2 (intermediate-risk, 1/50 to 1/100) and group 3 (high-risk, ˃1/50). A survival analysis was carried out with Kaplan-Meier estimator and a Cox regression analysis stratified according to three PE risk groups. Gestational age at spontaneous birth in the study groups was compared by means of Log-rank test and Hazard Ratio (HR). The study population comprised of 10,820 cases with delivery after spontaneous onset of labor, among the total of 16,451 cases participating in SPREE. There were 9795 cases in group 1,583 in group 2, and 442 in group 3. The gestational age at delivery was <28, <32, <35, <37 and <40 weeks in 0.29%, 0.64%, 1.68%, 4.52% and 44.97%, respectively, in group 1, 0.69%, 1.71%, 3.26%, 7.72% and 55.23% in group 2 and 0.45%, 1.81%, 5.66%, 13.80% and 63.12% in group 3. The curve profile of gestational age at spontaneous birth in the three study groups was significantly different overall and in pairwise comparisons (p-values <0.001). Cox regression analysis showed risks increase for spontaneous birth of 18% when comparing intermediate-risk vs. low-risk (p˂0.001) and 41% when comparing high-risk vs. low-risk categories (p˂0.001). In this study investigating birth after spontaneous onset of labor in women without PE, there are two major findings. First, the duration of pregnancy decreases with increasing first-trimester risk for PE. Second, in a high-risk group, compared to a low-risk group, the risk of spontaneous birth is 4-times higher at 24-26 weeks, 3-times higher at 28-32 weeks, and 2-times higher at 34-39 weeks. These differences present major clinical implications for antepartum counselling, monitoring and interventions in these pregnancies.

Weekly Paclitaxel for Pregnancy Associated Breast Cancer

BackgroundPregnancy associated breast cancer is the most common cancer diagnosed during pregnancy. When chemotherapy is indicated, although it is more common to use anthracycline-based chemotherapy as a first treatment, we suggest weekly paclitaxel as a valid alternative both in the adjuvant and neoadjuvant setting, as this allows for weekly assessment of maternal–fetal well-being and a quicker maternal and fetal bone marrow recovery in cases of unexpected preterm delivery. Patients and methodsWe present a case series of pregnant breast cancer patients treated with weekly paclitaxel between 2016 and 2022. Patient demographics and tumor characteristics, data on management, delivery, and maternal–neonatal outcomes were extrapolated from institutional electronic databases. ResultsEighteen patients underwent weekly paclitaxel for breast cancer during pregnancy (PrBC); 17 were primary diagnoses and 1 was a recurrence. None of the patients had severe adverse reactions to CT. Two cases of preterm prelabour rupture of membranes were reported while in 1 case treatment was stopped due to threatened preterm birth. Two babies were born large for gestational age, 2 were small for gestational age and 2 babies were growth restricted at birth. At a mean follow up of 42.9 months, 1 patient died, 1 patient was diagnosed with disease recurrence and another patient was diagnosed with disease progression. ConclusionWeekly paclitaxel can be safely administered during pregnancy and should be included in the current therapeutic options for PrBC.

Predictors of Breastfeeding among Patients Admitted with Preterm Prelabor Rupture of Membranes.

We sought to describe rates of breastmilk feeding (BF) at hospital discharge and 6 weeks postpartum and to identify risk factors for noninitiation or cessation among pregnancies complicated by preterm prelabor rupture of membranes (PPROM). Retrospective cohort study of pregnant persons with PPROM admitted to a single tertiary center (2013-2019). Patients with deliveries complicated by intrauterine or neonatal demise or with incomplete BF data were excluded. Demographic, antepartum, and delivery characteristics were evaluated. Primary analysis identified rate of BF initiation at maternal discharge and factors associated with noninitiation. Secondary analysis evaluated BF continuation and factors associated with cessation at 6 weeks postpartum. Bivariate statistics were used to compare characteristics and logistic regression was used to estimate adjusted odds ratios (aOR). Of 397 patients with PPROM, 342(86%) initiated BF prior to discharge. Those reporting tobacco use in pregnancy were less likely to initiate BF (aOR: 0.32; 95% confidence interval [CI]: 0.16, 0.64). In contrast, private insurance (aOR: 2.53; 95% CI: 1.19, 5.37) and pregnancy latency ≥ 14 days (aOR: 3.02; 95% CI: 1.09, 8.38) were associated with BF initiation at hospital discharge. Of the 293 patients with postpartum follow-up, only 214 (73%) had BF continuation at 6 weeks postpartum. Maternal age <20 years (aOR: 0.07; 95% CI: 0.01, 0.68) and multiparity (aOR: 0.54; 95% CI: 0.29, 0.99) were associated with BF cessation. Patients with private insurance were observed to have increased odds of BF continuation (aOR: 2.10; 95% CI: 1.07, 4.12). Among patients with PPROM, tobacco use may be associated with noninitiation of BF prior to discharge, whereas age < 20 years and multiparity were associated with cessation by 6 weeks postpartum. Longer pregnancy latency ≥ 14 days was associated with BF initiation prior to discharge. Private insurance was associated with increased rates of BF initiation and continuation postpartum. BF education and support should be offered to all patients admitted for PPROM. · Tobacco use may be associated with BF noninitiation.. · Young age and multiparity are linked with BF cessation.. · Private insurance resulted in BF initiation and continuation..

Ambulation for latency during expectant management of preterm prelabor rupture of membranes: a randomized controlled trial (AMBLE)

BackgroundIndividuals hospitalized with preterm prelabor rupture of the membranes (PPROM) are often advised to limit their activity or adhere to bedrest. Some evidence suggests that greater activity is associated with longer latency and improved outcomes, but no high-quality evidence from a randomized-controlled trial exists. ObjectiveTo evaluate whether encouragement to ambulate at least 2,000 steps daily impacts latency among individuals with PPROM compared with usual care. Study DesignMultisite unblinded, two-arm randomized trial of individuals at 23 0/7 to 35 0/7 weeks gestation undergoing inpatient expectant management of PPROM with planned delivery at least 7 days away. Each participant wore a Fitbit InspireTM that tracked steps. The intervention arm was encouraged (verbal and Fitbit-based reminders) to reach a goal of 2,000 steps per day. The usual care arm was allowed ad lib activity with no step goal or reminders. The primary outcome was latency (days) from randomization to delivery. Secondary analyses included composite neonatal and maternal clinical outcomes and maternal mental health survey results. Statistical analyses were intent-to-treat under a Bayesian framework using neutral priors (a priori assumed 50:50 likelihood of longer latency in either arm). 100 participants were required to have 80% power to demonstrate a 4-day difference in latency with 75% certainty (Bayesian probability). ResultsAmong 163 eligible individuals, 100 (61%) were randomized, and after loss to follow-up, 95 were analyzed. Gestational age at randomization was 29 3/7 weeks (interquartile range [IQR] 26 2/7, 31 5/7) in the intervention arm and 27 4/7 weeks (IQR 25 4/7, 29 6/7) in the usual care arm. Median step counts were 1,690/day in the intervention arm (IQR 1,031-2,641) and 1,338/day in the usual care arm (IQR 784-1,913). Median days of latency were 9 days in the intervention arm (IQR 4-17) and 6 days in the usual care arm (IQR 2-14). The primary analysis indicated a 65% posterior probability that the intervention increased latency versus usual care (posterior relative risk [RR] 1.09; 95% credible interval [CrI], 0.70-1.71). The RR for composite neonatal adverse outcome was 0.55 (95% CrI 0.32-0.82) with 99% posterior probability of intervention benefit and for composite maternal adverse outcome was 0.94 (95% CrI 0.72-1.20), with 70% posterior probability of intervention benefit. There was a 94% posterior probability of the intervention arm having a greater decrease in maternal stress score from baseline to before delivery compared with the usual care arm (mean arm difference 3.24 points [95% CrI -7.23-0.79]). Adjustment for gestational age at randomization had minimal impact on secondary outcome results. ConclusionsIndividuals with PPROM randomized to encouragement to ambulate had a longer latency to delivery and improved neonatal and mental health outcomes with similar maternal clinical outcomes compared to usual care.

The correlation with abnormal fetal outcome and a high level of amniotic fluid alpha-fetoprotein in mid-trimester

ObjectiveTo evaluate the correlation of high levels [>2.0 multiples of median (MoM)] of amniotic fluid alpha-fetoprotein (AFAFP) in midtrimester with abnormal fetal outcome. Materials and methodsWe retrospectively studied 6245 pregnant women with singleton pregnancy who had undergone amniocentesis between 15 and 27 weeks’ gestation at Mackay Memorial Hospital between January 2014 and June 2020. Fifty-five cases had high AFAFP levels (>2.0 MoM). We investigated the abnormal fetal outcomes. ResultsAmong the fifty-five cases with high AFAFP levels (>2.0 MoM), thirty (54.5%) had fetal chromosomal abnormalities, major structural abnormalities, and/or adverse obstetric events. Eight cases (14.5%) had chromosomal abnormalities including trisomy 21 (3 cases), trisomy 18 (3 cases), mosaic trisomy 18 (1 cases), and mosaic ring 13 (1 case). Seventeen cases (30.9%) had major structural abnormalities including abdominal wall defect (6 cases) and central nervous system (5 cases), gastrointestinal tract (3 cases), cardiovascular (2 cases), and genitourinary tract (2 cases) abnormalities. Fifteen cases (27%) had adverse obstetric events, including preterm delivery (5 cases), intrauterine fetal demise (4 cases), small for gestational age (4 cases), preeclampsia (4 cases), gestational diabetes mellitus (2 cases), gestational hypertension (1 case), preterm prelabor rupture of membrane (1 case), prolonged labor (1 case), and preterm uterine contraction (1 case). ConclusionA high AFAFP level (>2.0 MoM) in midtrimester can be associated with abnormal fetal outcome, including chromosomal abnormalities, major structural abnormalities, and adverse obstetric events. Women with a prenatal diagnosis of high AFAFP levels (>2.0 MoM) should be alerted of the possibility of abnormal fetal outcomes, and further detailed genetic studies and serial sonographic examinations are recommended.