Premature Rupture Of Amniotic Membranes Research Articles

Corticosteroids during pregnancy

In pregnancy, pharmacokinetics of corticosteroids changes. Systemic corticosteroids are not teratogenic. Pregnant women receiving corticosteroid therapy suffer the same side effects and benefits as do treated women who are not pregnant. Clinical experience suggests no abnormalities of children of mothers treated with usual doses of prednisone and methylprednisolone throughout pregnancy, but premature rupture of amniotic membranes and low birthweight babies may occur. Betamethasone and dexamethasone are used to treat the fetus. The effect on the fetus of bolus doses of methylprednisolone is unknown. Very little corticosteroid ingested by the mother enters her breast milk. Corticosteroid therapy in pregnancy is appropriate to control clinically active maternal illness; to treat an in utero infant suffering from neonatal lupus-associated carditis; in stress doses (in corticosteroid-treated patients) for labor and delivery: and, pre-delivery, to induce fetal lung maturation.

Premature rupture of amniotic membranes as functional assessment of vitamin C status during pregnancy.

Premature rupture of amniotic membranes as functional assessment of vitamin C status during pregnancy.

Risks for premature rupture of amniotic membranes.

The objective of this study was to test the hypothesis that diverse risk variables including infections during the index pregnancy independently increase the risk of preterm premature rupture of amniotic membranes (PROM) and preterm delivery without PROM. A case-control design was used to study women 15-45 years old who had preterm PROM, full-term PROM or preterm without PROM and were singly matched by age race and parity to controls who delivered full-term infants. The odds for preterm PROM was 6.0 times that of controls among women with intra-amniotic infection, 3.7 times among those with urinary tract and 7.6 times among women with gonorrhoea infections after controlling for the effects of exposure to cigarette smoke, having previous preterm and full-term PROM deliveries and antepartum bleeding that independently increased the odds. The odds for preterm births without PROM was 4.8 times that of controls among women with a previous preterm PROM birth, was significantly increased among those exposed to cigarette smoke or having antepartum bleeding, but not among those exposed to chlamydia infection. Even after adjusting for concomitant risk factors, women with preterm PROM births were more likely than their matched controls to have had infections.

Cervical priming and labor induction with vaginal application of 3 mg PGE2 in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix.

Sixty-one term pregnant women, 29 nulliparous (Group A) and 32 multiparous (Group B) with unfavorable cervix and premature rupture of the membranes (PROM) were given 3 mg PGE2 in suppository form for cervical ripening and labor induction. Five hours after starting the treatment, 12 women of the 29 in Group A and 21 of the 31 in Group B had a favorable cervix and established labor. The remaining 17 nulliparae and 11 multiparae still had an unfavorable cervix and were then given another PGE2 suppository. Until the next morning, i.e. within 24 h, 19 nulliparous and 22 multiparous women gave birth whereas a further 5 nulliparous women who now had favorable cervix but no uterine contractions were delivered after stimulation with intravenous oxytocin. The remaining undelivered women were given another PGE2 suppository. With or without additional oxytocin stimulation, all but 2 multiparous women could be delivered within a further 12 hours. The total number of instrumental deliveries in Group A was 2 caesarean sections due to disproportion (7%) and 5 ventouses. In Group B, 3 caesarean sections (9%) had to be carried out, one due to fetal distress and 2 due to failed induction. From the results of this study we conclude that vaginal application of 3 mg PGE2 in suppository form can be used to induce labor in patients with PROM and unripe cervix. However, when the results are compared with those obtained in previous studies after application of PGE2 in gel, the latter technique seems preferable.

Premature rupture of amniotic membranes and neonatal infection : predictive value of bacteriologic cultures from different sites.

Bacteriologic cultures were obtained from swabs of vagina and placental membranes, and pieces of placenta from 204 women with prolonged rupture of membranes. The frequency of positive isolation of bacteria increased with prolongation of the time between rupture of membranes and delivery. In 104 infants born to these mothers clinical studies and bacterial cultures of swabs from nose, umbilicus, gastric aspirate and blood were carried out, and correlated with cultures of swabs from vagina and placenta. In 80 per cent of cases identical organisms were isolated, from sites of neonatal infection, and vaginal swabs. Positive cultures from placental tissues showed the maximal correlation with mortality, while gastric aspirate proved to be a good predictor of severe infection in the newborn.

Fetal leukocyte pattern in premature rupture of amniotic membranes and in normal and abnormal labor

Clinical assessment of perinatal infection and the prognosis of the fetus affected by prolonged labor or premature rupture of amniotic membranes is difficult and is based on the infant's progress or bacteriologic investigation. This study was undertaken to determine if a leukocytosis, as in an adultlike response to infection, occurs in the peripheral blood of such infants, since the umbilical cord, placenta, and amniotic membranes are infiltrated with polymorphonuclear leukocytes. In this study, the mean leukocyte count (12,090 ± 4,010 cells per cubic millimeter) of 112 apparently healthy newborn infants was found to be lower than values previously reported; neither premature rupture of amniotic membranes nor the duration of labor had an effect on the total leukocyte count or the differential count. Intrauterine stressful situations did not affect the total leukocyte count but did alter the differential count with a resulting neutrophilia, lymphopenia, and monocytopenia. Nucleated red blood cells were significantly increased in possible stressful and hypoxic intrauterine or intrapartum conditions.

ANTIBIOTICS IN INFANTS FOR PREMATURE RUPTURE OF MEMBRANES. STUDY OF PROPHYLACTIC USE IN PREMATURE INFANTS.

When newborn infants succumb to severe infection during the first few days of life, predisposing maternal factor such as infection, prolonged labor, and premature rupture of amniotic membranes have been implicated. 1,2 Several reports have indicated a direct correlation between early rupture of the amniotic membranes and neonatal infection, especially in association with prolonged labor. 3-5,8 However, the beneficial effects of prophylactic antibiotics in the prevention of infection in the newborn under these circumstances still are not clear. Von Friesen reported that small doses of sulfamerazine, 6 and Smith and his co-workers, that a combination of penicillin and tetracycline 7 resulted in decreased neonatal morbidity and rate of infection when administered to mothers with fever, prolonged labor, and premature rupture of amniotic membranes. Blanc 8 and Pfaeffli, 9 however, did not observe a beneficial effect when penicillin and streptomycin were used as the prophylactic antibiotics. Equivocal results have been reported

Controlled Study of Influence on Newborn of Prolonged Premature Rupture of Amniotic Membranes and/or Infection in the Mother

Controlled Study of Influence on Newborn of Prolonged Premature Rupture of Amniotic Membranes and/or Infection in the Mother

A CONTROLLED STUDY OF THE INFLUENCE ON THE NEWBORN OF PROLONGED PREMATURE RUPTURE OF THE AMNIOTIC MEMBRANES AND/OR INFECTION IN THE MOTHER

A CONTROLLED STUDY OF THE INFLUENCE ON THE NEWBORN OF PROLONGED PREMATURE RUPTURE OF THE AMNIOTIC MEMBRANES AND/OR INFECTION IN THE MOTHER

On the role of infections in neonatal mortality

Summary Carefully conducted postmortem studies in relatively large series of stillborn fetuses and of infants dying in the neonatal period indicate that infection is a much more frequent primary cause of death than is indicated by vital statistics. Furthermore, in an even greater number of infants whose primary cause of death is attributed to some other disturbance, infection is present exerting a variable role as a contributory cause of death. Further reduction in perinatal mortality resulting from infection should be a distinct possibility and could be responsible for a significant decrease in the total mortality rate in this age group. It is evident that attention to a variety of factors is essential for the reduction of deaths due to infection in the perinatal period and that reliance mainly on antibiotic prophylaxis or therapy is not sufficient. These factors include improvements in the nutrition, hygiene, and health of the pregnant woman, a decrease in the incidence of premature births, a high index of suspicion of the possible presence of infection in infants born after premature rupture of amniotic membranes or prolonged or traumatic labors, and a return to rigid isolation techniques within maternity wards and nurseries. The roles of natural and artifically induced immunity deserve continued and increased investigation. At the moment it is clear that the premature infant is deprived of immune factors from the mother which significantly reduce his capacity to compete with infection.