Premature Rapture Of Membranes Research Articles

Timing of planned cesarean delivery among patients with two previous cesarean sections.

The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications. A population-based retrospective cohort study including all term singleton third CDs (≥ 37weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust forconfounders. The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6weeks of gestation, and 44 were at ≥ 39weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4days. Additionally, CDs at 37 + 0 to 37 + 6weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes. Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes.

Magnitude of meconium stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone hospitals, Amhara Region, Ethiopia 2022.

The presence of meconium-stained amniotic fluid is one of the causes for birth asphyxia. Each year, over five million neonatal deaths occur worldwide because of meconium-stained amniotic fluid and other causes, of which 90% are due to birth asphyxia. The aim of this study was to assess the magnitude of meconium-stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone Hospitals, Amhara Region, Ethiopia, 2022. An institutional-based cross-sectional study was employed. We used 610 women who gave birth at North Shoa Zone Hospitals, Amhara region, Ethiopia. The study was conducted from June 8 to August 8, 2022. Recruitment for the study was made using a multistage sampling procedure. Fifty percent of the study hospitals were randomly selected, and proportional allocation was done. Participants were selected from the sampling frame, labour and delivery register book, using a systematic random sampling approach. The first person was selected at random, while the remaining individuals were selected at every two "K" intervals across all hospitals. An interview-administered structured questionnaire and chart review checklist were used to gather the data that were entered into Epi-Data Version 4.6 and exported to SPSS. Logistics regression was employed, and a p-value <0.05 was considered statistically significant. The magnitude of meconium-stained amniotic fluid was 30.3%. Women with a normal hematocrit level were 83% less likely to develop meconium-stained amniotic fluid. Women whose mid-upper arm circumference value was less than 22.9cm (AOR = 1.9; 95% CI: 1.18-3.20), obstructed labour (AOR = 3.6; 95% CI: 1.48-8.83), prolonged labour ≥ 15 hr (AOR = 7.5; 95% CI: 7.68-13.3), premature rapture of membrane (AOR = 1.7; 95% CI: 3.22-7.40), foetal tachycardia (AOR = 6.2; 95% CI: 2.41-16.3), and Bradycardia (AOR = 3.1; 95% CI: 1.93-5.28) showed a significant association with meconium-stained amniotic fluid. The present study revealed that the magnitude of meconium-stained amniotic fluid in North Shoa Zone is nearly one-third. A normal hematocrit level is a preventive factor for meconium-stained amniotic fluid, and a MUAC value <22.9 cm, obstructed and prolonged labour, PROM, bradycardia, and tachycardia are factors associated with meconium-stained amniotic fluid.

Foley catheter for labour induction among patients with premature rapture of membranes – a randomized controlled trial

Foley catheter for labour induction among patients with premature rapture of membranes – a randomized controlled trial

Birth asphyxia and its associated factors among newborns at a tertiary hospital: evidence from Southern Ethiopia.

Globally, 45% of under-five children death occurs during the neonatal period and about 25% of all neonatal deaths are caused by birth asphyxia. In Ethiopia, in 2015, it was the first cause of neonatal deaths followed by prematurity and sepsis. The study aims to assess prevalence of Birth asphyxia and associated factors. Institution-based cross-sectional study was conducted among neonates admitted to Neonatal intensive care unit of Hawassa University Specialized comprehensive hospital from December 1 to December 30, 2020. Systematic random sampling technique was employed to select samples. Logistic regression analysis using Statistical Package for Social sciences version 24was employed. The prevalence of neonatal asphyxia in this study was17.9%. Prolonged labor [AOR (Adjusted odds ration) = 2.909; (95% CI (Confidence Interval): 1.184 - 7.151)], presence of meconium [AOR= 2.137; 95% CI 1.028 - 4.683)], premature rapture of membrane [AOR = 2.459; 95% CI: 1.021 - 6.076)] and complication during labor [AOR= 3.351; 95% CI: 2.142-5.871))], were factors associated with neonatal asphyxia. Nearly two in every ten newborns faced perinatal asphyxia in the study area. Early identification of high-risk women, intervening on delay in referral, and early and vigorous management of abnormal labor and complicated labor is essential to halt the problem.

The Predictive Value of Lung Ultrasound Score on Hemodynamically Significant Patent Ductus Arteriosus among Neonates ≤25 Weeks.

Lung ultrasound (LU) is increasingly used to diagnose and monitor neonatal pulmonary disorders; however, its role in hemodynamically significant patent ductus arteriosus (hsPDA) has not been elucidated. This prospective study investigated the predictive value of the LU score (LUS) for hsPDA in preterm infants with gestational age (GA) ≤ 25 weeks. Preterm infants with GA ≤ 25 weeks were enrolled in this study. LU was conducted on the fourth day of life (DOL). Six lung regions in every lung were scanned, with each region rated as 0-4 points. The performance of the LUS in predicting hsPDA among infants aged ≤25 weeks was analyzed by plotting the receiver operating characteristic (ROC) curve. A total of 81 infants were included in this study. GA, birth weight (BW), gender, Apgar score, delivery mode, antenatal steroids, meconium-stained amniotic fluid, premature rapture of membrane, and early-onset sepsis were not significantly different, but infants in the hsPDA group had increased LUS (38.2 ± 2.8 vs. 30.3 ± 4.3, p < 0.001) compared with non-hsPDA group. The area under the ROC curve (AUC) value of the LUS on the fourth DOL was 0.94 (95% CI: 0.93-0.99) in predicting hsPDA. The LUS threshold at 33 achieved 89% sensitivity and 83% specificity, with the positive and negative predictive values (PPV and NPV) being 87 and 86%, respectively. The LUS can predict hsPDA in extremely preterm infants at an early stage.

Non immune hydrops fetalis due to Parvovirus B19 infection. A case report

Backround: The term “hydrops fetalis” refers to excessive accumulation of pathologic serous fluid within the fetal soft tissues and body cavities. There are two categories, the immune and the nonimmune hydrops (NIHF). Currently 90 percent of cases of hydrops are nonimmune, because of the decrease of incidence of immune with the advent of anti-D immune globulin. Case presentation: We present a case of Parvovirus B19 (PB19) infection that resulted in NIHF. Fetus had severe ascites, mild pericardial effusion and mild myocardial dilation, that appeared during the 30th gestational week. Fetal evaluation with sonography was repeated every week and the fetal growth curves, Dopplers and amniotic fluid index were normal. Each week there was a gradual recession of the effusions until the 36th gestational week, when they eventually resolved without any treatment. After delivery, the neonate was symptom – free. Conclusions: The cause of NIHF is identified in at least 60 percent prenatally and in more than 80 percent postnatally, while only 40 percent of pregnancies with NIHF result in a liveborn neonate. The prognosis is heavily dependent on etiology. Diaplacental transmission of PB19 on second trimester can cause fetal complications like hydrops, premature rapture of membranes, even fetal loss in about 30 percent. These cases should be closely followed in a Fetal Medicine Unit, especially if there is evidence of fetal anemia or hydrops.

Time to occurrence of necrotizing enterocolitis and its predictors among low birth weight neonates admitted at neonatal intensive care unit of felege hiwot compressive specialized hospital BahirDar, Ethiopia, 2021: A retrospective follow-up study.

BackgroundGlobally, the incidence of necrotizing enterocolitis (NEC) varies between 6 and 15% of all neonates admitted to the neonatal intensive care unit (NICU). Though necrotizing enterocolitis is a multifactorial and life-threatening disease, low birth prematurity is the single cause. Therefore, determining the time to presentation and its predictors of necrotizing enterocolitis were the main goals of this investigation.Materials and methodsAn institution-based retrospective follow-up study was conducted among 747 low birth weight (LBW) neonates admitted to the neonatal intensive care unit of Felege Hiwot comprehensive specialized Hospital from 1 January 2017 to 30 December 2019. The sample size was calculated by using the STATA package. Data were entered into Epi data version 3.1 and exported to STATA version 14 for analysis. The log-rank test and the Kaplan–Meier estimator were used to display the survival probability and differences between groups. At a significance threshold of 5%, Cox proportional hazard regression was performed to determine the net independent predictors of necrotizing enterocolitis.ResultThe overall incidence rate was 0.86 per 1,000 person-days (95% CI: 0.67, 1.14) with a 6.8% (95% i: 5.2, 8.9) proportion of necrotizing enterocolitis among low birth weight neonates. Preeclampsia [adjusted hazard ratio (AHR);1.92 (95% CI: 1.03–3.58)], premature rapture of membrane [AHR; 2.36 (95%, CI: 1.19–4.69)], perinatal asphyxia [AHR; 4.05 (95%, CI: 2.04–8.60)], gestational age between 28 and 32 weeks [AHR; 3.59 (95% CI: 1.01–8.83)], and birth weigh less than 1,000 g [AHR; 5.45 (95% CI: 3.84–9.12) were the independent predictors of necrotizing enterocolitis.ConclusionWithin the first 1–7 days of a newborn’s life, necrotizing enterocolitis was most common. It was discovered that preeclampsia, premature rupture of membrane, perinatal asphyxia, gestational age of 28–32 weeks, and birth weight less than 1,000 g were predictors of its occurrence.

Failed induction of labor and associated factors among women delivered in Jigjiga University Sheik Hassan Yabare Referral Hospital: a cross-sectional study

Objective This study was aimed to assess the magnitude of failed induction of labor and associated factors among mothers delivered in Eastern Ethiopia. Methods An institutional-based cross-sectional study was carried out among 364 women who had induction of labor at Jigjiga University, Sheik Hassan Yabare Referral Hospital from 2018 to 2021. A checklist was used to collect the data from the women's chart. To isolate independent predictors related to failed induction of labor, multivariate logistic regression analyses were performed. Result The magnitude of failed induction of labor was 36.8% (95% CI: 31.8, 42.0). Age (AOR = 3.2; CI: 1.78, 5.75), rural residency (AOR = 2.28; CI:1.29, 4.01), para (AOR = 2.76; CI: 1.55, 4.91), gestational age (AOR = 2.65; CI: 1.44, 4.89), multiple pregnancy (AOR = 2.36; CI: 1.01, 5.55), premature rapture of membrane (AOR = 4.88; CI: 2.33, 10.21), pregnancy-induced hypertension (AOR = 5.11; CI: 2.67, 9.79), and bishop score (AOR = 1.95; CI: 1.15, 3.32) were significantly associated with failed induction of labor. Conclusion The magnitude of failed induction of labor was relatively high in the study setting. Failed induction of labor was significantly associated with age, rural residency, primipara, gestational age, multiple pregnancy, premature rapture of membrane, PIH, and bishop score less than six. Prior to initiating the induction of labor, proper pelvis assessment and cervical ripening for bishop score might be considered. Beside to this, adherence to locally available induction protocols and guidelines might also be needed.

Hubungan Kelainan Letak Janin, Kehamilan Ganda dan Preeklamsia dengan Kejadian Ketuban Pecah Dini pada Ibu Bersalin di RSI Siti Khadijah Palembang Tahun 2021

Premature Rapture of Membranes is the rupture of the fetal membranes before the onset of labor. Based on world health Organization, the incidence of premature rapture of membranes is around 5-10% among all births. 1% of PROM happened during preterm pregnancy and 22% happened during aterm pregnancy. Based on Indonesian Nursing Diagnosis Standars (INDS). In 2016, the incidence of PROM in Indonesian was around 4,5% to 7,6% among all pregnancies. This study was aimed to find out whether there was a simultaneous correlation between fetal position, multiple pregnancy and preeclampsia with the incidence of premature rapture ofmembranes among maternity mothers at Siti Khadijah Palembang Islamic Hospital year 2021. This study applied survey analytical design using cross sectional approach. The population of this study was taken from all maternity mothers at Siti Khadijah Palembang Islamic hospital year 2021 with a total of 132 mothers. The total samples were 57 respondents who were taken by applying systematic random sampling method. The data were collected by using checklist. These data were then analysed using univariate and bivariare analysis with chi square statistics. It could be conclude that there was a correlation between fetal position (p value = 0,026) multiple pregnancy (p value = 0,026), and preeclamsia (p value = 0,030) with the incidence of Premature Rapture of Membranes among maternity mothers. It is expected that the result of this study be able to be used as a description for the hospital in order to improve the health service especially when dealing with pregnant mothers who experienced premature rapture of membranes.

Ceftazidime/ Avibactam Efficiency tested In Vitro against Carbapenem-resistant Klebsiella pneumoniae isolated from Neonates with Sepsis

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) emergence and dissemination, is an important healthcare concern due to its limited therapeutic options. Ceftazidime/avibactam (CAZ/AVI) is a recently approved antibiotic combination that may be effective in treating these resistant infections. The aim of the current study was to determine the prevalence of CRKP amongclinical isolates from neonatal intensive care unit (NICU) and to evaluate the in-vitro activity of CAZ/AVI against them. Methods: A total of 255 clinical samples were collected from neonates with suspected sepsis. All Klebsiella pneumoniae isolates were identified by standard methods. Antibiotic susceptibility testing, screening for Extended-spectrum β lactamase (ESBL) production, carbapenem resistance, carbapenemase production and susceptibility to CAZ/AVI were done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Of the 255 neonates clinically suspected as neonatal sepsis, only 136 (53.3%) had positive culture results, out the 136 culture-proven cases, 72 (52.9%) were positive for Klebsiella pneumoniae, of them ESBL producers were 92% (n=66) and CRKP were 32% of isolates (n=23). All of the CRKP were carbapenamase producers (39% serine-type and 61% metallo-β-lactamases (MBL) type). Serine carbapenamase and MBL producers showed high resistance against CAZ/AVI with a percentage of 77.8% and 100% respectively. Conclusion: The prevalence of CRKP is alarming in our NICU especially in the presesnce of neonatal risk factors like; neutropropenia, central line fixation and premature rapture of membranes. Ceftazidime/avibactam is an unsuitable option for the treatment of this type of resistant bacteria because of its high resistance.

Medical and obstetric factors associated with preterm deliveries among women of childbearing age at Pumwani maternity hospital, Nairobi County, Kenya

Background: The rate of pre-term birth (PTB) in Kenya stands at 12.3%. Preterm deliveries are associated with high neonatal mortality and have a huge financial burden on the parents and the government. Prematurity is also associated with chronic diseases like diabetes and hypertension in adult life. The study objective was to determine the medical1and obstetric factors1associated1with preterm deliveries among women of childbearing age (15-49 years) at Pumwani maternity hospital (PMH).Methods: A hospital-based cross-sectional study was conducted among 191 mothers of reproductive age (15-49 years) who delivered at PMH during the study period. Data was collected using a questionnaire and a data abstraction tool. Descriptive statistics were used to summarize categorical variables. Chi-square was used to test for the strengths of associations. Prevalence adjusted odds ratios (PAOR) were used to estimate the strengths of associations.Results: The study found that the association between past pregnancy (p=1.0), history of surgery (p=1.0), medication (p=1.0), urinary tract infection (p=0.453), miscarriage (p=1.0) and chronic disease (p=0.395) and preterm delivery among women of child bearing age (15-49 years) at PMH was not statistically significant. The association between premature delivery (p=0.021), parity (p=0.000), premature rapture of membranes (PROM) (p=0.000), antepartum hemorrhage (APH) (p=0.045), cervical incompetence (p=0.001), pre-eclampsia toxemia (PET) (p=0.000), and placenta abruption complications (p=0.009) and preterm delivery was statistically significant.Conclusions: The association between premature delivery, parity, PROM, APH, cervical incompetence, PET and placenta abruption complications and preterm delivery was statistically significant.

Prevalence of surgical site infection and its associated factors after cesarean section in Ethiopia: systematic review and meta-analysis

BackgroundSurgical site infection (SSI) affects nearly one third of patients who have undergone a surgical procedure. It is a significant and substantial cause of surgical patient morbidity and mortality later with human and financial costs threat. There are fragmented and pocket studies which reported the prevalence of SSI among mothers who experienced for cesarean section and its risk factors. However, there is no any solid evidence established at the national level; which was also the interest of the authors to fill this gap. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of SSI after cesarean section and its associated factors at national level.MethodsOriginal articles were searched in PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI portal, and Cochrane Library. All observational studies defined outcome of variable “SSI as infection related to an operation procedure that occur at or near surgical incision within 30 days of operation or after one year if an implant is placed” were considered. Data were extracted using standard data extraction excel spread sheet checklists developed according to 2014 Joanna Briggs Institute Reviewers’ Manual after the quality was assessed through Newcastle–Ottawa quality assessment scale. The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger’s tests were used to check for publication bias. A fixed effect model was used to estimate the pooled prevalence of SSI. Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 14 software.ResultFrom initial 179 identified articles, 11 were eligible for inclusion in the final systematic review and meta-analysis. Studies with a score of 6 and above were included for final analysis. All included studies were institutional based cross sectional. The pooled estimate of SSI after cesarean section in Ethiopia was 9.72% (95%CI: 8.38, 11.05). Premature rapture of membrane (PROM) > 12 h (OR = 5.32, 95%CI: 3.61, 7.83), duration of labor> 24 h (OR = 3.67, 95%CI: 2.45, 5.48), chorioamnionitis (OR = 9.11, 95%CI: 5.21, 15.93), anemia (OR = 4.56, 95%CI: 2.88, 7.22) and having vertical skin incision (OR = 4.17, 95%CI: 2.90, 6.02) had increased odds of developing SSI after cesarean section.ConclusionThe prevalence of SSI after cesarean section in Ethiopia was high compared with the sphere standards of communicable disease control (CDC) guidelines for SSI after cesarean section. Therefore, Ministry of Health with its stake holders should give special emphasis on community and institution based programs in manner to prevent prolonged labor, PROM, chorioamnionitis and anemia which will also have synergistic impact on SSI after cesarean section. Moreover, there is also a call to health professionals not to use vertical incision as primary option of cesarean section to reduce the risk of developing surgical site infection among mothers.

Chemerin Level as a Marker in Preeclampsia and its Relation to the Disease Severity and Neonatal Outcome

Aim of study: To detect serum chemerin level in patient with preeclampsia and evaluate the association between maternal serum chemerin, disease severity and neonatal outcome. Patients and Method: A case control study included 100 pregnant women with singleton pregnancy, gestational age of 20 weeks or more, normal fetal morphology, and absence of concomitant diseases, who were collected from inpatient during delivery was conducted in the Department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital during the period from 1st of June 2018 till end of May 2019. They were divided into three groups (control, mild preeclampsia, and severe preeclampsia). Patients with history of chronic hypertension, diabetes mellitus, cardiovascular disease, neurological disorder, renal impairment, or premature rapture of membrane were excluded from this study. blood sample was taken from all patients and sent for human chemerin assay. After delivery, birthweight of baby, APGAR scores at one and five mints, neonatal intensive care unit and adult intensive care unit admission, and hospitalization time were also noted. Results: There were no statistically significant differences between the study groups in age, BMI level, and parity. Chemerin level was significantly elevated in patients with severe preeclampsia (435.06 ng/ml) and mild preeclampsia (227.49 ng/ml) than that in non-preeclamptic patients (202.6 ng/ml). It was negatively correlated with each of gestational age, birth weight, Apgar score at one and five minutes. While it was positively correlated with admission’s duration. Serum chemerin &gt; 228.5 ng/ml is predictive for diagnosis of preeclampsia and level &gt; 380.9 ng/ml is indicator for severe preeclampsia. Conclusion: Chemerin may play a role in the pathogenesis of preeclampsia as maternal serum chemerin level was significantly higher in patients with preeclampsia

Factors Associated with Compliance with Infection Control Guidelines in the Management of Labour by Healthcare Workers at Mulago Hospital, Uganda

Globally, infections acquired during childbirth contribute to one tenth of the maternal deaths annually [1] [2]. Factors predisposing to high risks of puerperal infections include non-compliance with Standard Precautions of Infection Control (SPIC), unhygienic births by unskilled birth attendants, multiple vaginal examinations, prolonged labour and premature rapture of membranes [1]. The main purpose of this study was to determine factors associated with compliance to standard precautions of infection control the management of labour by healthcare workers in Mulago Hospital to generate information, which may be used in infection control and prevention practices. A cross-sectional study utilizing a quantitative approach was conducted among 115 healthcare workers. Consecutive sampling was done to include respondents in the study. Data were collected by direct observation and researcher administered questionnaires. Data were coded and entered into the computer using SPSS version 20 with programmed quality control checks. Descriptive data analyses, frequencies, cross tabulations and logistic regression analysis were the major statistical methods used. 103 healthcare workers were involved in the study, where 74% were females. Overall compliance was at 52%, although it varied across domains. The majority of the healthcare workers (95.1%) did not comply with hand hygiene. Being a male was associated with low compliance scores a cross most domains. One of the hospital factors which was significantly associated with compliance to hand hygiene was having had an in-service training with p = 0.008 and p = 0.012 at multivariate analysis. Overall compliance to standard precautions of infection control was low compared to the Centre for Disease Control (CDC) recommendation. The findings in this study provide insight into individual and hospital related factors associated with compliance with standard precautions of infection control in the management of labour. There is an urgent need to put up interventions to improve on compliance with SPIC in management of labour among all healthcare workers.

395. Possibility of corticosteroids to induce premature rapture of membrane in patients with systemic lupus erythematosus

Introduction It is mentioned that premature rapture of membrane (PROM) occurs with higher rate in women with systemic lupus erythematosus (SLE), when compared to general population. Most of women who have SLE need to continue corticosteroids during their pregnancies. The relationships between PROM and corticosteroids are not well known, but a recent report in mice showed that corticosteroids weakened fetal membranes, which induced PROM. Hypothesis Here we hypothesize that corticosteroids induce PROM. Methods We reviewed all pregnancies delivered after 22 completed weeks’ gestation in patients with systemic lupus erythematosus (SLE) who were seen at National Center for Child Health and Development from 2005 to 2016. We sum up the dosage of corticosteroids given during pregnancy, and evaluated the relationship with pregnancy outcomes by univariable analyses. Results Forty-eight pregnancies in 48 women were identified. 47 women except one took corticosteroids during their pregnancy. 31% women received immunosuppressants at the same time. PROM occurred in 11 (22.9 percent). Sum of corticosteroids during the pregnancy was significantly bigger in PROM group than that of non-PROM group (central value (interquartile range)) (2730 (1862, 3570) mg v.s. 1890 (1259, 2590) mg; p = 0.031). Furthermore, the risk of PROM was increased in the frequency with increasing of corticosteroids dose. The amount of corticosteroids at the beginning of pregnancy and immunosuppressants didn’t show relationships with PROM. The rate of chorioamnionitis didn’t show significant difference between PROM group and non-PROM group. Discussion Possibility of risk that the more corticosteroids during pregnancy induce the more PROM was identified, and PROM in our study didn’t show relationship with chorioamnionitis. Possibility of corticosteroids to induce PROM in non-infectious etiology is suggested. Further evaluation is needed to seek out for the better management for pregnancies with SLE.

585: Trial of labor after cesarean (TOLAC) in women with Premature rapture of membranes

Reducing the rate of cesarean section by increase in the rate of TOLAC is important to address since repeat cesarean section is associated with increased maternal morbidity and mortality. There is limited data regarding risks and benefits of TOLAC after premature rapture of membranes (PROM). We investigated the success rate of TOLAC after PROM between those receiving conservative management and those receiving labor induction. This was a retrospective cohort study conducted in a single tertiary care center between 01/2011-03/2017. All women with singleton pregnancy and a previous cesarean section who presented with PROM after 34 0/7 weeks of gestation and underwent TOLAC were included. To minimize labor induction, women were offered conservative management until spontaneous labor commenced. Labor induction was performed if spontaneous onset of labor did not take place within 48 hours or if there were signs of maternal or fetal distress. Operative complications were defined as: laceration of the uterus, bladder injury, urethral injury, bowel injury or hysterectomy. Postpartum complications were defined as: fever, endometritis, need for blood transfusion and wound complications. Outcomes and rate of successful vaginal delivery after induction of labor were compared to spontaneous onset of labor using univariable and multivariable analysis. Among 830 women who met the inclusion criteria, 723 (87.1%) had a spontaneous delivery and 107 (12.9%) had an induction of labor. The rate of successful TOLAC was similar between the groups (75.7% vs 81.6%, respectively, P=0.22). However, induction of labor was associated with an increased risk of uterine rupture (1.87% vs 0.96%, P <0.001), operative complications (30.76% vs 12.03%, P<0.001) and composite maternal postpartum complications (21.4% vs 12.1%, respectively, P= 0.014) compared to spontaneous vaginal delivery. There was no difference in neonatal outcome between the groups. In women attempting TOLAC who present with PROM and fail to progress spontaneously into active labor, Induction of labor is associated with high successful vaginal delivery rate. However, the risk for uterine rupture and operative and maternal complications is significantly increased compared to spontaneous delivery.

Bacterial Profile, Antibacterial Resistance Pattern, and Associated Factors from Women Attending Postnatal Health Service at University of Gondar Teaching Hospital, Northwest Ethiopia

Introduction Surgical site infection is a vital cause of maternal mortality and morbidity, especially in resource-limited countries. The rise of antibiotic resistance bacterial infection poses a big threat to this vulnerable population. However, there is lack of studies around the study area. Objective The purpose of this study was to identify bacterial profile, antibacterial resistance pattern, and associated factors among mothers attending postnatal care health service. Methods Institutional based cross-sectional study was conducted on 107 study participants at University of Gondar Teaching Hospital from 1 January 2016 to 30 May 2016. Wound swab, aspirate, and biopsy were collected and performed for culture and drug resistance testing. Data were entered and analyzed by using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to determine the associated factors for bacterial infection. Odds ratio (95% CI) was calculated to determine the strength of statistically significant associated factors. Result Bacterial growth was confirmed in 90 (84.1%) of 107 study participants suspected to have surgical site infection. The predominant bacterial isolates were S. aureus (41.6%), E. coli (19.8%), K. pneumoniae (13.9%), coagulase negative Staphylococcus (12.9%), and Enterobacter spp. (4%). The majority of isolates were resistant to ampicillin, amoxicillin, and tetracycline but susceptible to ceftriaxone and amikacin. Multidrug-resistant bacteria species were isolated. Using a procedure such as cesarean section and episiotomy for delivery and premature rapture of membrane had strong association with bacterial infection. Conclusion The high prevalence of bacterial profile and isolation of multidrug-resistant bacteria pose a big threat to postnatal mothers and their children. Factors such as cesarean section, episiotomy for delivery, and premature rapture of membrane were predictors for bacterial infection. Therefore, there should be done a continuous surveillance as well as rational use of antibiotics and a longitudinal study using phenotypic and genotypic methods will be done.

Some maternal and neonatal factors affecting early and late neonatal sepsis

Abstract&#x0D; Background:&#x0D; Neonatal sepsis categorized as early and late onset. Early neonatal sepsis (ENS) in the first 7 days of life with 85% occurs in the first 24 hours of life. Late neonatal sepsis (LNS )occurs after the first week of life and is acquired from care giving environment.&#x0D; Aims of study:&#x0D; To explain the effect of some maternal and neonatal factors on early and late neonatal sepsis, like premature rupture of membranes, midwife interference and prematurity. With change in blood investigations, like effect of antibiotics on the results of blood cultures.&#x0D; Methods:&#x0D; We prepared a questionnaire about the name ,age in days, gender with perinatal and maternal history and take blood samples for CBC and differential, blood culture, CRP and ESR to explain the effect of neonatal sepsis on the blood investigation results and identify the specific pathogen causing neonatal sepsis by blood culture.&#x0D; Results:&#x0D; We found that the neonate is more susceptible to ENS in comparison to LNS. Also we found that the blood culture result highly affecting by antibiotics used before culture. The mortality rate is more in ENS in comparison to late type.&#x0D; There was no significant difference in gender, maternal fever and antenatal care, between ENS and LNS groups. Prematurity was higher in ENS group compared to LNS group (44.7%, vs. 29%) respectively; and the difference was significant (p = 0.042). Mode of delivery showed no effect in ENS group (NVD = C/S = 50%); while it seems to be more effective in LNS group as (74.2% vs 25.8%) of patients are C/S, (p = 0.003).Only (13.2%) of ENS subjects were home delivery , while (25.8%) of LNS subjects were home delivery, (p = 0.048). Midwife interference was more effective in LNS subjects than ENS subjects, (35.5%, vs. 18.4%) respectively, (p = 0.019).Premature rupture of membrane was significantly more frequent in ENS subjects than LNS subjects (31.6% vs. 16.1%) respectively, (p = 0.028).Death was more frequent in ENS subjects than LNS subjects; (18.4%, vs. 3.2%) respectively .&#x0D; Conclusion and Recommendation:&#x0D; We found that the premature neonate more susceptible for neonatal sepsis than full term with premature rapture of membrane more frequently affecting ENS in comparison to late type. we found also that the C-reactive protien and platelets count had high sensitivity to the diagnosis of neonatal sepsis.We recommend antenatal care especially in the third trimester and use of antibiotic prophylaxis if there is a history of leaking liquor and avoid prematurity because premature neonates are more prone to early neonatal sepsis. Antibiotics should be avoided before blood culture aspiration to avoid false negative results.&#x0D;

Transmisión materno-fetal de Trypanosoma cruzi, un problema de salud poco estudiado en México: caso Chiapas

To determine the Trypanosoma cruzi infection prevalence in 1125 pregnant women and the transmission frequency to their children from Tapachula and Palenque, Chiapas. We determined the prevalence by serology tests and the transmission frequency by polymerase chain reaction (PCR) and T. cruzi reactivity capacity after 12 months. Total maternal infection prevalence were 23/1 125 (2.04%), 9/600 (1.5%) were from Tapachula and 14/525 (2.6%) from Palenque. The seropositive women were between 20 and 35 years old, 31.8% have Premature Rapture of Membrane and 9.1% have history of perinatal death. The total percentage of positive newborns by PCR was 9/23 (39.13%), out of those 2/9 (22.2%) are from Tapachula and 7/14 (50%) from Palenque. The Maternal Fetal transmission frequency was. 2/9 (22.2%) in Tapachula and 1/14 (7.14%) in Palenque, all positive infants were asynthomatic. The maternal-fetal transmission rate in Chiapas State is variable; the reason could be the maternal immunological status and T. cruzi strain.

Risk Factors for Low Birthweight in Zimbabwean Women: A Secondary Data Analysis.

BackgroundLow birth weight (LBW) remains the main cause of mortality and morbidity in infants, and a problem in the care of pregnant women world-wide particularly in developing countries. The purpose of this study was to describe the socio-demographic, nutritional, reproductive, medical and obstetrical risk factors for delivering a live LBW infant at Harare Maternity Hospital, Zimbabwe.MethodsA secondary data analysis from data obtained through a questionnaire and delivery records was conducted. Linear regression models with a complimentary log-log link function were used to estimate the relative risks for all LBW, term LBW and preterm LBW.ResultsThe frequency of LBW was 16.7%. Lack of prenatal care (adjusted relative risk [ARR] 1.69, 95% CI 1.44, 1.98), mother’s mid-arm circumference below 28.5 cm, (ARR 1.35, 95% CI 1.19, 1.54) and rural residence (ARR 1.22, 95% CI 1.04, 1.40) increased the risk of LBW. Eclampsia, anemia, and ante-partum hemorrhage, were associated with LBW (ARR 2.64, 95% CI 1.30, 5.35; ARR = 2.63, 95% CI 1.16, 5.97; and ARR = 2.39, 95% CI 1.55, 3.68), respectively. Malaria increased the risk of LBW (ARR = 1.89, 95% CI 1.21, 2.96). Prenatal care, infant sex, anemia, antepartum hemorrhage, premature rapture of membranes and preterm labor were associated with the three LBW categories. History of abortion or stillbirth, history of LBW, malaria, eclampsia, and placenta Previa, were associated with all LBW and preterm LBW, while pregnancy induced hypertension, and number of children alive were associated with all LBW and term LBW.ConclusionsLBW frequency remains high and is associated with nutritive, reproductive, medical and obstetrical factors. Preterm LBW and term LBW have similar and also different risk factors. Understanding the role of different risk factors in these different LBW categories is important if the goal is to reduce LBW frequency, and its complications, in Zimbabwe.