Premature Rupture Of Amniotic Membranes Research Articles

PP-026 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

PP-026 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

PP-027 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

PP-027 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

Clinical phenotype and genetic analysis of a child with 3p26.3p25.3 deletion

To explore the genetic basis for a child with facial dysmorphism and multiple malformations. The child, born at 34+6 weeks' gestation due to premature rupture of amniotic membrane, dichorionic diamniotic twinning and gestational diabetes, was subjected to chromosomal karyotyping analysis and copy number variations sequencing (CNV-seq). The child was found to have facial dysmorphism, hypospadia, cryptorchidism and hypotonia. He was found to have a 46,XY,del(3)(p26) karyotype in addition with a 9.80 Mb deletion (chr3: 60 000-9 860 000) encompassing 33 protein coding genes. The 3p26.3p25.3 deletion probably underlay the multiple malformations in this child. Continuous follow-up is required to improve his quality of life.

The role of infection factor in premature rupture of amniotic membranes after laser coagulation of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome

The role of infection factor in premature rupture of amniotic membranes after laser coagulation of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome

Клінічна ефективність застосування внутрішньовенного імуноглобуліну у вагітних з внутрішньоутробною інфекцією

Проблема внутрішньоутробної інфекції (ВУІ) і в наш час не втрачає своєї актуальності. Неефективність лікування цієї патології пов’язана з фізіологічним зниженням імунітету у таких пацієнток. Нами запропоновано додаткове використання внутрішньовенного імуноглобуліну для лікування вагітних з ВУІ. Обстежено 75 пацієнток із ВУІ, що була діагностована в них протягом ІІ триместру. І групу становили 40 осіб, які отримували загальноприйняте лікування, ІІ групу сформували 35 жінок, які додатково отримували внутрішньовенний імуноглобулін. На фоні ВУІ перебіг вагітності характеризувався підвищенням частоти загрози її переривання та передчасних пологів, гестозів і плацентарної дисфункції, у пологах були більш поширеними передчасний розрив плодових оболонок і дистрес плода. У таких пацієнток плаценти мали як ультразвукові, так і гістологічні ознаки інфікування. Серед новонароджених було істотне зростання частоти патології, пов’язаної з реалізацією внутрішньоутробного інфікування. Додаткове застосування препарату внутрішньовенного імуноглобуліну при лікуванні ВУІ протягом II триместру вагітності порівняно із загальноприйнятою терапією призводить до вірогідного зниження частоти як акушерських ускладнень, так і перинатальної патології.

Исходы беременности при преждевременном излитии околоплодных вод в зависимости от длительности ее пролонгирования

Aim. Evaluation of pregnancy outcomes depending on the duration of its prolongation in preterm rupture of amniotic membranes at 22 to 34 weeks gestation period. Material and Methods. Outcomes of pregnancy were studied in 196 patients of the contingent of O. Gudushauri National Medical Center with prenatal rupture of amniotic membranes at gestational age of 22 to 34 weeks, who underwent treatment aimed at prolongation of pregnancy in 2016-2018. All the patients were divided into 2 groups. Group 1 included pregnant women in whom it was possible to prolong the pregnancy for 14 days or more; group 2 included women in whom pregnancy could not be prolonged or duration of prolongation was less than 14 days. The patients who were clinically stable, after examination and observation for 48 hours, were discharged from hospital and, subsequently, were observed and treated on an outpatient basis. In order to identify contraindications for prolongation of pregnancy on the part of the mother, a routine clinical and laboratory examination was carried out: complete blood count, biochemical blood test, coagulogram, general urine analysis, bacterioscopy of a vaginal smear, bacteriological examination of the vaginal secretion. Diagnostics of the fetal condition included ultrasound fetometry with daily assessment of the amniotic fluid index using Voluson e8 Expert ultrasound device, daily cardiotocography (CTG) using Sonicaid Team Cape device, as well as Doppler study of blood flow in the umbilical cord artery, fetal aorta, and uterine arteries. Results. In premature rupture of amniotic membranes, a significantly higher incidence of premature birth was revealed in pregnant women of group 2 with prolongation of pregnancy for less than 14 days: 76 (100%), compared with group 1 with prolongation for 14 days or more: 40 (33.33%) (p<0.0001). The average gestational age at which childbirth took place was significantly greater in group 1 than in group 2: 35.92±3.65 weeks and 29.97±3.02 weeks, respectively (t=-12.38, p<0.0001). The same can be said about the average weight of the fetus at birth: 2660.33±876.55 g in group 1 and 1488.68±61.94 g in group 2 (t=-10.17, p<0.0001). In the group without prolongation, compared with patients in group 1, there was an increase in the comparative risk of such complications of the newborn as patent ductus arteriosus, RR=2.50 (95% CI: 1.84 to 3.39); chronic hypoxia, RR=5.00 (95% CI: 3.23to 7.72); retinopathy, RR=2.939 (95% CI: 2.108 to 4.097); hemolytic disease, RR=5.16 (95% CI: 2.80 to 9.50); infections, RR=6.54 (95% CI: 4.04 to 10.61); respiratory distress syndrome, RR = 2.88 (95% CI: 2.29 to 3.61); intraventricular hemorrhage, RR=7.14 (95% CI: 2.40 to 21.21). Due to the presence of complications, newborns from women of group 2 required antibiotic therapy, RR=3.14 (95% CI: 2.46 to 4.00); installation of surfactant, RR=4.76 (95% CI: 1.49 to 15.19). Conclusion. Prolongation of pregnancy for more than 14 days in case of preterm rupture of amniotic membranes in the period of 22-34 weeks, reduces the risk of unfavorable perinatal outcomes.

Funisitis as a Risk Factor for Adverse Neonatal Outcomes in Twin Neonates with Spontaneous Preterm Birth: A Retrospective Cohort Study.

PurposeFunisitis, inflammation of the umbilical cord, is considered a strong risk factor for adverse neonatal outcomes; however, a clinical definition of funisitis has not been established. In this study, we aimed to determine the clinical significance of funisitis in twin neonates with spontaneous preterm birth.Materials and MethodsThe study included preterm twin neonates (<35 weeks) delivered after spontaneous preterm labor and/or preterm premature rupture of amniotic membranes. The presence of funisitis was examined in the umbilical cord of each twin. We analyzed the risk of adverse neonatal outcomes according to the presence and absence of funisitis. Adverse neonatal outcomes were defined as the occurrence of neonatal mortality, significant morbidity, or both.ResultsAmong 474 preterm neonates (237 twin pairs) included in this study, the frequency of funisitis was 6.5% (31 cases). Funisitis was significantly associated with neonatal mortality and adverse neonatal outcomes after adjustment for confounding variables [neonatal mortality, odds ratio (OR) 9.043, 95% confidence interval (CI) 2.620–31.204; adverse neonatal outcome, OR 2.445, 95% CI 1.017–5.875]. The concordance rate of funisitis between the twins was 10.7%, and in the absence of funisitis in one twin, the risk of neonatal mortality or adverse neonatal outcome was not influenced by the presence of funisitis in the other twin.ConclusionThe presence of funisitis appears to be associated with an increased risk for adverse neonatal outcomes in twin neonates with spontaneous preterm birth.

Dubin-Johnson Syndrome in Pregnancy: Case Report and Literature Review

Dubin-Johnson Syndrome in Pregnancy: Case Report and Literature Review

PERINATAL RISK FACTORS FOR HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN PRETERM INFANTS

The article presents the results of an assessment of risk factors for the development of hypoxic-ischemic encephalopathy in premature newborns. We examined 75 pregnant women who gave 92 premature newborns, patients with hypoxic-ischemic encephalopathy (main group). The comparison group included 75 pregnant women, who gave birth to 82 preterm infants, did not have GIE symptoms. In pregnant women of the main group who gave birth to children with GIE, more accurate were such extragenital pathology as hypertension (9.3%), chronic pyelonephritis (18.6%), thyroid disease (12 0%), tuberculosis and HIV infection, trichomoniasis, chlamydia. Among the complications of pregnancy in both groups was a high percentage of the threat of termination of pregnancy in all trimesters. Placental dysfunction and fetal growth retardation were in every fifth pregnant woman in both groups. Complications of labor, such as preterm premature rupture of amniotic membranes (PPROM) was in 32% of women, placenta previa with bleeding (8%) and abruption of placenta (14 6%) were significantly more frequent in the main group. The urgent cesarean section was performed in 41.4% of cases in the main group, 2.5 times greater than in the comparison group. Pregnant of the main group significantly more often gave birth to children with extremely low body weight (up to 30 weeks of pregnancy), 2 times more likely to give birth to children at 32 weeks of gestation. Among the 92 children of the main group, the Apgar scores of 3 points were -5-5.4%, 4-5 points - 18-19.5%, 6 points-28-30.4%, 7 and higher - 41-44, 5%. One of four children had severe fetal distress at birth. In the comparison group, the Apgar scores of 4-5 points were only 9.7%, 6 points - 14.6%, the other 75.7% had a satisfactory condition at birth. Artificial ventilation was performed in 58-63.1% of the newborns in the main group and only 10% in the comparison groupThus, perinatal risk factors for hypoxic-ischemic encephalopathy in premature newborns are the factories that lead to the development of placental dysfunction, fetal growth retardation, antenatal fetal distress and premature birth. The most important factor in the development of GIE is gestation (up to 32 weeks gestation), placenta previa with bleeding and premature placental abruption in the given time.

FEATURES OF LABOUR AND POSTPARTUM PERIOD IN WOMEN WITH ADENOMYOSIS

Objective: the aim of the study was to investigate features of the course of labor and postpartum period in women with adenomyosis, to improve existing and develop new methods of treatment and prevention of obstetric complications and reproductive losses in pregnant women with adenomyosis.Patients and methods: 90 pregnant women in 30-31 weeks of gestation were divided into groups: 30 healthy women (control group), a comparison group of 30 pregnant women with adenomyosis receiving traditional progesterone therapy and the main group of 30 women with adenomatosis, who received advanced prgesterne therapy, diet therapy, psychological support, sedative naturopathic therapy; the state of the blood coagulation system was studied; vaginal biota examination and treatment were performed. The data of laboratory parameters, questionnaires, ultrasound diagnostics were analyzed.Results: on the background of the proposed treatment, the study revealed a significant reduction in the occurrence of IUGR, placental dysfunction, polyhydramnion, prenatal infections, premature rupture of amniotic membranes, preterm labor and hemodynamic disorders in the main group compared to the comparison group. The index of stress resistance has increased, cortisol levels decreased. Significantly fewer injuries of soft tissues occurred in labour. Violation of the fetus condition in labour was noticed much less frequently. The level of hypogalactia in the main group comparing the comparison group is lower.Conclusions: the results of the conducted studies indicate the negative impact of adenomyosis on the state of reproductive health of women. The proposed algorithm of diagnostic, treating and preventive measures can reduce the frequency of various obstetric complications in the second half of pregnancy in women with adenomyosis and can be widely implemented.

OPTIMIZATION OF TACTICS OF MANAGEMENT OF MULTIPLE PREGNANCY AND LABOR

A thorough analysis of the course of labor and perinatal outcomes was conducted in pregnant twins. It is proved that multiple pregnancy is a factor of high risk of perinatal complications. The features of the process of neonatal adaptation in twins are studied depending on the tactics of delivery. Goal: to improve perinatal outcomes in women with multiple pregnancies by optimizing the management of pregnancy.Material and methods. Examined 68 pregnant women with twins after IVF, who made up the I group of subjects, 62 pregnant women with spontaneous twins - group II, and 38 women with self-singleton pregnancy who entered the control group. Pregnant Groups I and II, depending on the treatment prescribed, were divided into two subgroups: IА (36 pregnant women) and IIA (32 pregnant women) received a standard amount of treatment and prophylactic measures. Subgroups IB (32 pregnant women) and IIB (30 pregnant women) received natural micronized progesterone (200 mg 3 times a day) in addition to standard treatment and prophylactic measures. All pregnant women underwent a complete clinical and laboratory examination using ultrasound, Doppler, and cardiotocography (CTG), and a biophysical profile of the fetus. The analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups were carried out. In the neonatal period, neurosonography was performed, a part of the newborns were followed by psychomotor development in the first six months of life. The obtained results were statistically processed using standard packages of applied statistical analysis (Statistic 6.0 for Windows, Statgraphics v. 7.0).Results. The results of pregnancy analysis in patients with IVF revealed a number of serious complications during pregnancy and childbirth: the threat of premature birth (66.2%), placental dysfunction (48.5%), iron deficiency anemia (51.5%), preeclampsia (52, 9%), premature rupture of amniotic membranes (17.6%), weakness of labor (27.9%), and a high incidence of operative delivery (30.9%). Against the backdrop of hormonal support, a decrease in the frequency of very early premature births in the first group was 1.6 times, early premature births by 1.5 times and an increase in the frequency of late premature births by 1.4 times, which is a favorable prognostic factor for reducing perinatal losses. Among the main methods of delivery, mention should be made of the high rate of cesarean section in the I A subgroup (55.6%) and the IIA subgroup (46.9%), each of which was significantly higher than the control group (10.5%) ( p &lt;0.05). Almost with the same frequency cesarean section was observed in women with independent multiplicity. Premature and deep morphofunctional immaturity were inherent in children from premature births, which significantly influenced the Apgar score, which was lower in the first group than in group II and control group (p &lt;0.05).Conclusions. A differentiated approach to the preparation and management of labor, careful observation of patients and dynamic monitoring of the fetus state allows to reduce the frequency of postnatal complications, contributing to the reduction of perinatal morbidity and mortality.

H1N1 influenza virus infection results in adverse pregnancy outcomes by disrupting tissue-specific hormonal regulation.

Increased susceptibility to influenza virus infection during pregnancy has been attributed to immunological changes occurring before and during gestation in order to “tolerate” the developing fetus. These systemic changes are most often characterized by a suppression of cell-mediated immunity and elevation of humoral immune responses referred to as the Th1-Th2 shift. However, the underlying mechanisms which increase pregnant mothers’ risk following influenza virus infection have not been fully elucidated. We used pregnant BALB/c mice during mid- to late gestation to determine the impact of a sub-lethal infection with A/Brisbane/59/07 H1N1 seasonal influenza virus on completion of gestation. Maternal and fetal health status was closely monitored and compared to infected non-pregnant mice. Severity of infection during pregnancy was correlated with premature rupture of amniotic membranes (PROM), fetal survival and body weight at birth, lung viral load and degree of systemic and tissue inflammation mediated by innate and adaptive immune responses. Here we report that influenza virus infection resulted in dysregulation of inflammatory responses that led to pre-term labor, impairment of fetal growth, increased fetal mortality and maternal morbidity. We observed significant compartment-specific immune responses correlated with changes in hormonal synthesis and regulation. Dysregulation of progesterone, COX-2, PGE2 and PGF2α expression in infected pregnant mice was accompanied by significant remodeling of placental architecture and upregulation of MMP-9 early after infection. Collectively these findings demonstrate the potential of a seasonal influenza virus to initiate a powerful pro-abortive mechanism with adverse outcomes in fetal health.

Diagnostic Value of IGFBP-1 Rapid Test and Combined IGFBP-1-AFP in Vaginal Fluid from Premature Rupture of Amniotic Membranes

Objective: To compare the diagnostic value of IGFBP-1 and combined&#x0D; IGFBP-1-AFP rapid tests in diagnosing premature rupture of&#x0D; membranes (PROM).&#x0D; &#x0D; Method: This study was conducted in Dr. Soetomo Hospital in Surabaya&#x0D; from July to November 2013. The subjects were 52 pregnant&#x0D; women with presumed PROM diagnosis, which was recorded by&#x0D; clinical data and sampling of vaginal discharge swab. The diagnostic&#x0D; value was obtained by comparing the results of IGFBP-1 and combinated&#x0D; IGFBP-1-AFP rapid tests by standard PROM examination&#x0D; namely vaginal pooling, litmus paper test and ferning test.&#x0D; &#x0D; Result: A difference between the diagnostic value of IGFBP-1 and&#x0D; combined IGFBP-1-AFP rapid tests in diagnosing PROM was&#x0D; shown, where the sensitivity and specificity of IGFBP-1 rapid test was&#x0D; 85% and 95%, compared to combined IGFBP-1-AFP rapid test,&#x0D; which was 91% and 95%. The correlation coefficient of combined&#x0D; IGFBP-1-AFP rapid test with standard PROM examination&#x0D; (r=0.841, p=0.000) was higher than the correlation coefficient of&#x0D; IGFBP-1-AFP rapid test with standard PROM examination&#x0D; (r=0.772, p=0.000).&#x0D; &#x0D; Conclusion: Combined IGFBP-1-AFP rapid test has a better diagnostic&#x0D; value than IGFBP-1 rapid test alone.&#x0D; &#x0D; Keywords: combined IGFBP-1-AFP, IGFBP-1, PROM

Membrane Vesicles of Group B Streptococcus Disrupt Feto-Maternal Barrier Leading to Preterm Birth.

Infection of the genitourinary tract with Group B Streptococcus (GBS), an opportunistic gram positive pathogen, is associated with premature rupture of amniotic membrane and preterm birth. In this work, we demonstrate that GBS produces membrane vesicles (MVs) in a serotype independent manner. These MVs are loaded with virulence factors including extracellular matrix degrading proteases and pore forming toxins. Mice chorio-decidual membranes challenged with MVs ex vivo resulted in extensive collagen degradation leading to loss of stiffness and mechanical weakening. MVs when instilled vaginally are capable of anterograde transport in mouse reproductive tract. Intra-amniotic injections of GBS MVs in mice led to upregulation of pro-inflammatory cytokines and inflammation mimicking features of chorio-amnionitis; it also led to apoptosis in the chorio-decidual tissue. Instillation of MVs in the amniotic sac also resulted in intrauterine fetal death and preterm delivery. Our findings suggest that GBS MVs can independently orchestrate events at the feto-maternal interface causing chorio-amnionitis and membrane damage leading to preterm birth or fetal death.

Prevalence and associated risk factors of group b streptococcus in pregnant women attending antenatal care in a Nigerian urban hospital

Background: Group B Streptococcus (GBS) is one of the common microbial agents causing urogenital infections in women of reproductive age especially pregnant women; it is also a common cause of neonatal infections in the world. Objective: To determine the prevalence and associated risk factors of GBS colonisation in pregnant women in an Urban Hospital in Nigeria.Methods: A prospective cross sectional study of 150 pregnant women conducted in an Urban Hospital in Uyo, Nigeria between May and October 2013. Vaginal and anorectal swabs were collected from each participant and processed using standard microbiological methods and cultured on CHROMagarTM Strep B medium. Questionnaires for data were also used. Results: The age range of the participants was between 18 to 44years. Only 2 out of the 150 pregnant women were GBS carriers. The 2 women (1.33%) were found to be anorectal carriers, although 1 (0.67%), in addition had vaginal GBS. There was a statistically significant association between GBS colonisation and premature rupture of amniotic membranes (P&lt;0.05). However, there was no association between GBS colonisation and risk factors such as age and gravidity.Conclusions: Group B Streptococcus colonisation in pregnant women in Uyo, Nigeria, is associated with premature rupture of amniotic membrane.

Laws of changes of immune status of mother and child at pregnancy prolongation, complicated by premature rupture of amniotic membranes

Purpose and tasks: to establish new prognostic criteria of date of prolongation of pregnancy with premature discharge of amniotic fluid on the basis of performance monitoring of cell immunity of mother in the dynamics of observation and the child at the time of completion childbirth. Material and methods. A clinical and laboratory examination of 50 pregnant women, the pregnancy of women was complicated by premature rupture of membranes at 22-34 weeks of gestation. The control group consisted of 40 women with normal pregnancy with the same time of gestation. The traditional methods of clinical and laboratory examination were used to assess the status of pregnant women. The study of peripheral blood was performed with hematological analyzer BC- 3000+. Subpopulations of peripheral blood lymphocytes was studied by cytometry using monoclonal antibodies (apparatus «FAC SCalibur» company «BectonDickinson», USA). Results. The development of leukocytosis with absolute and relative lymphopenia, reduction of CD16+56+lymphocytes and CD19 B lymphocytes were revealed in pregnant women with premature rupture of membranes. The failure of proliferative activity CD3+4+ T-helper cells, the increase of level of CD3+8+ cytotoxic T lymphocytes were revealed at the time of onset of labor after the prolongation of pregnancy. Prolongation of pregnancy at patients with premature rupture of membranes combined with the development of leukocytosis in the fetus, as well as the mother in the same period of observation. At the same time, unlike the parent organism, activation of B-lymphocyte proliferation and humoral immunity at fetus were occurred.

Serum Enzymes in Predicting Transient Tachypnea of Newborn and Respiratory Distress Syndrome

Purpose : Perinatal asphyxia is a major factor correlated with diseases that cause respiratory distress in a neonate. So we aimed to investigate the relationship between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) with plasma biological markers of perinatal asphyxia in full-term neonates. Methods : Full-term neonates with transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) who were admitted within 24 hours after birth were enrolled in a study group. And control group are infants with premature rupture of amniotic membrane without significant findings. Serum lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT), creatine kinase (CK) and myoglobin were measured at admission. Results : Of the total 80 infants, 54 were of the study group and 26 were of the control group. The numbers of RDS and TTN groups were 27 and 27, and the numbers of RDS with hypoxic-ischemic encephalopathy (HIE) and RDS without HIE were 6 and 21 retrospectively. Serum AST, ALT, LDH and CK were significantly higher in the study group than the control group (P<0.05). When RDS group and TTN group were compared AST and LDH were significantly higher in RDS group than TTN group (P <0.05). Serum AST, ALT and LDH were significantly higher in RDS with HIE group than RDS without HIE group (P <0.05). A prediction of RDS by LDH analysis showed good correlation by receiver operating characteristic curve (P<0.05). A cut off level of 720 IU/L for LDH was the best predictor of RDS (sensitivity 63% and specificity 86%). Conclusion : LDH is an excellent predictor to differentiate RDS from TTN soon after birth in full-term neonates with respiratory distress.

Clinical efficiency of intravenous immunoglobulin at pregnants with infection of urinary tract

The problem of infection of urinary tract at pregnant women does not lose the urgency now. The inefficiency of treatment of this pathology is connected with physiological decrease in immuni-ty at such patients. Additional using of intravenous immunoglobulin in the form of a preparation Biovenum Моnоfor treatment of pregnant women with pyelonephritis is offered. 75 patients with gestational pyelonephritis or exacerbation of chronic pyelonephritis which have developed at them during II trimester of pregnancy have been surveyed. The 1-st group was formed by 40 persons who received the standard treatment, the 2-nd group was generated by 35 women who in addition received Biovenum Моnо.After the suffering for infectious diseases of kidneys during pregnancy, its further course is characterized by increase of frequency of threatening abortion and premature deliveries, gestosis and placentary dysfunction; during labors a premature rupture of amniotic membranes and distress of fetus was more widespread. At such patients the placenta in many cases had both ultrasonic, and histological attributes of infection. Occurrence during the pregnancy of inflammatory diseases of kidneys was accompanied by significant distribution of the pathology connected with intra-uterine infection among newborns. Additional application of a preparation Biovenum Моnо for treatment of pyelonephritis during the second trimester of pregnancy in comparison with the standard treatment leads to authentic decrease in frequency both obstetrical complications and perinatal pathology.

Genetic Basis of Preterm Birth

Epidemiologic data show that women who deliver prematurely often have a personal and/or family history of preterm birth (PTB) and that racial and ethnic differences influence the incidence of PTB. This may indicate genetic predisposition to PTB. However, since races and ethnic groups tend to share environmental factors (exposure to toxins, living conditions, diet, smoking), epidemiologic data may just confirm environmental influences on PTB. Alternatively, PTB may represent a consequence of gene-environment interactions. Infection and inflammation correlate with increased risk for preterm premature rupture of amniotic membranes (PPROM) and PTB. Immunomodulatory molecules and their receptors regulate these processes and many of them are products of polymorphic genes. Single nucleotide polymorphisms (SNPs) of a gene may lead to a differential expression of its product. So far, SNPs for several genes have been implicated in PTB. If it is confirmed that polymorphism(s) in particular gene(s) correlates with PTB, it may become possible to develop targeted diagnostic and therapeutic approaches tailored towards unique genetic characteristics of a mother/fetus pair.

Immunological indicators (IgM and C-reactive protein) in neonatal infections

Sepsis in the neonatal age is associated with risk factors for infections and with the immunological state of the newborn infant. Verify if IgM and C-reactive protein were indicators of infection in newborn infants with risk factors. We studied 57 newborn infants that had: premature rupture of amniotic membranes associated ou no with clinical amniotics or with urinary tract infection. They were classified in three gestational age groups (< 34 weeks, between 34-36 6/7 and (37 weeks) Sepsis diagnosis was made through clinical and laboratorial criterious and we also included: IgM and C-reactive protein obtained of the newborn at birth and at fifth day of life. Sepsis diagnosis was made in 18 (31.5%) of 57 newborn infants, 13 (22.8%) with early sepsis and 5 (8.7%) with late sepsis. The infection had statistical association with gestational age and with weight at birth. The gestational group < 34 weeks was more infected and in this group the number of newborn that died had association with infection. We did not observed association in the three groups studied between infection and sex. There were significant differences of levels of IgM between infected and not infected newborn infants in the same group of gestational age, this difference was more evident in the fifth day. There were association between levels of C-reactive protein > 10 mg/L and infection in the three groups studied. C-reactive protein was the better indicator of infection at birth and in the fifth day of life and this was very important for the clinical evolution of the infection and in the late sepsis was the first prove that was altered.