Premature Rupture Of Fetal Membranes Research Articles

38 Diagnosis of premature rupture of fetal membranes by the measurement of insulin-like growth factor binding protein-1 in cervical secretion

38 Diagnosis of premature rupture of fetal membranes by the measurement of insulin-like growth factor binding protein-1 in cervical secretion

Preterm premature rupture of fetal membranes in a low socioeconomic population: results of conservative management

A retrospective review of pregnancies complicated by preterm premature rupture of membranes (PPROM) in 149 women of low socioeconomic status in Nigeria was undertaken. Delivery occurred within 24 h of onset of symptoms in 51 of these women (immediate delivery group), whereas 98 patients were managed conservatively. The mean length of gestation was higher in the conservatively managed group and the perinatal mortality was correspondingly lower. In contrast, there was a slightly increased incidence of puerperal febrile morbidity in the conservative group. These data suggest that conservative management can be selectively employed in PPROM occurring in women of low socioeconomic status.

Diamine Oxidase Activity in Amniotic Fluid for Diagnosis of Ruptured Membranes

Diamine oxidase in vaginal effluent is used as a parameter for ascertaining the state of fetal membranes. A new method using tritiated putrescine as a substrate is described for the determination of diamine oxidase in amniotic fluid and vaginal effluents. A number of tests are used for the diagnosis of premature rupture of fetal membranes. The described procedure for diamine oxidase activity determination can be used in general hospitals and has advantages over other parameters such as pH, glucose or fructose concentration, and the amniotic fluid crystallization test.

Short communication: Placental collagen and premature rupture of fetal membranes

Collagen content of 43 placentae from clinically normal females who went into labour spontaneously was determined by assaying hydroxyproline. In 23 cases the membranes ruptured before or at the beginning of labour, and in 20 cases the rupture was intrumentally provoked during the expulsive period. In the group with prematurely ruptured membranes, hydroxyproline concentration was 11.52 +/- 1.83 micrograms/mg lyophilized tissue, whereas in the other group concentration was 20.29 +/- 4.32 micrograms/mg tissue. These data disclose a much lower collagen placental content in the group with premature rupturing of the membranes.

Pulmonary hypoplasia secondary to oligohydramnios with very premature rupture of fetal membranes

Over a 3-year-period, pulmonary hypoplasia was diagnosed in 14 cases out of a group of 150 infants born prematurely after prolonged rupture of fetal membranes and prolonged amniotic fluid leakage of whom 30 died. Review of these patients revealed pulmonary hypoplasia to be the main single cause of neonatal death (13/30). In contrast to literature data, infection was only a minor complication in this series. Lung hypoplasia was clearly correlated with long-standing rupture of membranes with oligohydramnios. It is concluded that upon premature rupture of fetal membranes, prenatal care should focus on oligohydramnios, because if this condition is prolonged, the risk of pulmonary hypoplasia increases accordingly.

Biomechanical analysis of human chorioamniotic membranes

The biomechanical properties of human fetal membranes were analyzed by means of a materials testing machine. Special attention was paid to the biomechanical properties of the intact chorioamniotic membrane and the amniotic and chorionic components, separately, and thickness and storage of membrane samples. The load-strain and stress-strain relationships, and parameters calculated from the curves: extensibility, strength, elastic stiffness and failure energy, express the visco-elastic behavior of these membranes. The mechanical properties of the chorioamniotic membranes are determined by the interaction between the amniotic and chorionic components of the membrane. The strength of the intact chorioamniotic membrane, however, is primarily determined by the amniotic component, because the amniotic component is much less extensible. Thus, the chorionic component only contributes 10–15% of the strength when the amniotic component breaks. The chorionic component is twice as extensible as the amniotic component. Samples of fetal membranes can be stored at −70 °C, with no significant changes in the biomechanical properties. No significant differences were found between specimens, which were oriented in parallel with and at right angles to the placental edge. Small samples can be analysed and the localization of samples in relation to the placental edge and rupture site of the membranes can be standardized. The method is well suited for studies of premature rupture of fetal membranes.

Prematurity among insulin‐requiring diabetic gravid women

1. Nimrod C, Varela-Gittings F, Machin G, et al. The effect of very prolonged membrane rupture on fetal development. AM J OBSTET GYNECOL 1984; 148:540-3. 2. Thibeault DW, Beatty EC, Hall RT, et al. Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios. J Pediatr 1985; 107 :273-7. 3. Mosberg L], Garite T], Freeman RK. Fetal heart rate patterns and fetal distress in patients with preterm premature rupture of membranes. Obstet Gynecol 1984; 64:60-4. 4. Ogita S, Imanaka M, Matsumoto M, Hatanaka K. Premature rupture of the membranes managed with a new cervical catheter. Lancet 1984; 1 : 1330-1. 5. Ogita S, Mizuno M, Takeda Y, et al. Clinical effectiveness of newly devised cervical indwelling catheter in managing premature rupture of the membranes: a Japanese collaborative work. AM] OBSTET GYNECOL 1988;159:336-41. 6. Manning FA, Hill LM, Platt LD. Qualitative amniotic fluid July 1989 Am J Obstet Gynecol

Experience with 159 cases of premature rupture of fetal membranes in Ile-Ife, Nigeria.

In a 10-year period, 159 out of 16,825 total deliveries had premature rupture of fetal membranes giving an incidence of 0.94%. The condition poses a serious threat to both mother and the infant. Maternal infection increased exponentially with the latent period. The institution of an active management programme is suggested as a way of reducing the hazards associated with this condition.

Maternal and fetal serum levels of organochlorine compounds in cases of premature rupture of membranes.

Blood residue levels of some organochlorine pesticides (DDT and its analogues, lindane, dieldrin, heptachlor epoxide) and polychlorinated biphenyls were measured in maternal and cord blood in 20 cases of premature rupture of fetal membranes at term and in 15 matched controls. No evidence of a possible organochlorine compounds role in the pathogenesis of premature rupture of the membrane was found.

Causes of low birth weight births in public and private patients

This examination of the cause of low birth weight births in two model populations, one of public and one of private patients, finds significant differences in the reasons for low birth weight births in the two groups. Idiopathic premature labor was related to 47.1% of private low birth weight births, but only 24.8% of public births; low birth weight term (26.7%) and premature rupture of fetal membranes (33.7%) were more common in public low birth weight births than in private births (13.8% and 23.0%, respectively). Medical problems were related to 16.1% of private and 14.9% of public low birth weight births. Since current prematurity prevention methods are most likely to prevent low birth weight births related to idiopathic premature labor, the relative success of such programs in reducing the rate of low birth weight births is likely to depend on the characteristics of the patient population to which the programs are directed.

Risk to the newborn infant following premature rupture of fetal membranes

Risk to the newborn infant following premature rupture of fetal membranes

The Role of Calcium, Copper, Iron and Zinc in Preterm Delivery and Premature Rupture of Fetal Membranes

Departments of Obstetrics and Gynecology and Clinical Chemistry, Turku University, and Department of Physics, Abo Academi, Turku, Finland

The Role of Calcium, Copper, Iron and Zinc in Preterm Delivery and Premature Rupture of Fetal Membranes

Maternal and cord blood samples were collected in 60 cases with or without rupture of membranes before and at term. Serum concentrations of calcium, copper, iron and zinc were determined by proton-induced X-ray emission. Maternal and cord serum ceruloplasmin and maternal hemoglobin were also determined. Mothers with preterm delivery showed significantly lower hemoglobin values than those with delivery at term. Concentrations of calcium, iron and zinc were higher in cord than in maternal serum whereas maternal copper levels were higher than respective cord levels in all groups. The cord copper and ceruloplasmin and also their fetal/maternal ratios were significantly lower in the group with preterm premature rupture of fetal membranes (PROM) than in other groups. Maternal serum zinc and calcium were lower in preterm groups than in term groups. The study suggests a possible role of copper in preterm PROM and of zinc in the initiation of preterm labor, whereas calcium and iron do not seem to be involved in the etiology of prematurity or PROM.

3 - The Small Fetus: Growth-retarded and Preterm

A low-birthweight baby is defined as an infant weighing 2500 gm or less, although this definition is not adequate for all groups, especially in developing countries. In Singapore, for example, it is more realistic to define a low-birthweight baby as 2270 gm or less. A preterm baby is one born before 37 weeks of gestation. A small-for-gestational-age baby is one that is below the tenth percentile as defined by birthweight and gestational age. A high incidence of low-birthweight babies creates a heavy public health burden in developing countries, both in terms of infant mortality and in terms of life-time care for those that survive but are physically or mentally handicapped. Low-birthweight babies fall into 2 categories: those with fetal growth retardation and those which are preterm. Fetal growth retardation may be due to placental insufficiency; loss of growth capability by the fetus; or infectious diseases, smoking or betel chewing. Diagnostic signs of fetal growth retardation can be inferred from the level of the fetal head, the amount of liquor, premature cervical ripening, and poor or absent maternal weight gain. Low values of urinary estrogen or plasma estriol may serve as indicators, as may low urinary levels of human placental lactogen. Decrease in fetal movement is a sign of fetal distress. Level of fetal growth may also be determined by ultrasonography and antepartum cardiotocography. Preterm birth accounts for 75% of perinatal deaths. 10%-30% of those that survive are handicapped, but over 2/3 of all deaths in the 1st week of life occur in perfectly formed babies that are simply born too soon. Preterm birth may be due to a low socioeconomic environment, elevated estrogens and decreased progesterone; obstetric complications, such as pre-eclampsia, abruptio placentae, polyhydramnios, or infection; increased prostaglandins and premature rupture of fetal membranes; cervical incompetence; developmental errors; or multiple pregnancy. In Singapore several groups of women at high risk for premature delivery were treated with beta-adrenergic drugs and steroids or with cervical cerclage. Improved socioeconomic conditions in Singapore have resulted in a decrease in the number of low-birthweight babies.

Comparison of aggressive and conservative management of premature rupture of fetal membranes

A 3-year prospective study was undertaken to compare two types of management of rupture of the fetal membranes between 26 and 34 weeks. Patients in whom amniotic fluid, obtained by amniocentesis, was shown to have no evidence of infection, and who had less than mature lecithin/sphingomyelin (L/S) ratios, were given steroids and, if needed, treated with tocolytic agents. Patients in whom no amniotic fluid could be obtained were not given steroids, but were managed expectantly. Only patients with rupture of membranes ≥24 hours were included in the collection of data. Despite the aggressive treatment protocol of the steroid group, no significant difference was found between the two groups in the prevalence of respiratory distress, hyperbilirubinemia, patent ductus arteriosus, episodes of apnea and bradycardia, or necrotizing enterocolitis. Perinatal mortality rates were similar in the two groups, and no difference in the incidence of maternal or neonatal infectious complications was found.

The relationship of blood lead levels to obstetric outcome

Lead represents a significant environmental hazard to pregnant women and their offspring. Exposure to high environmental levels of lead has been associated with spontaneous abortion, premature rupture of fetal membranes (PROM), and preterm delivery. The relationship between lower exposures and obstetric complications is unknown. The concentration of lead in the blood was measured in 635 specimens of umbilical cord blood collected at delivery. No relationship was found between concentrations of lead in cord blood and the incidence of PROM, preterm delivery, preeclampsia, or meconium staining. Maternal and infant capillary blood was collected 24 hours post partum from 154 of these deliveries. The concentrations of lead in the blood did not vary significantly among cord, infant, and maternal samples, and the three measurements were highly correlated. Levels of zinc protoporphyrin (ZnP) were increased in cord blood as compared with mothers' blood, but no concentration-response relationships between the ratio of cord ZnP to maternal ZnP and lead were found.

On the problem of premature rupture of fetal membranes

On the problem of premature rupture of fetal membranes

Premature rupture of fetal membranes.

Premature rupture of fetal membranes increases maternal morbidity and perinatal mortality when labor does not ensue promptly. Two schools of management of this problem have developed: the activists, who favor induction of labor if it does not occur spontaneously within 24 hours, and the conservatives, who prefer close clinical observation with no manipulation until onset of labor. Both approaches are evaluated, and the cause, diagnosis and effects of premature rupture of membranes are discussed.

Premature rupture of fetal membranes. Antibiotic prophylaxis.

The study here described represents another attempt to estimate under con trolled conditions the value of prophylac tic treatment with antibiotics for normal infants born to otherwise healthy moth ers after premature rupture of the am niotic membranes.

Ascorbic acid deficiency and premature rupture of fetal membranes

EASTMANI estimates the incidence of spontaneous premature rupture of the membranes to be approximately 12 per cent of all deliveries. Calkin? states that in 7,000 consecutive deliveries at the University of Kansas Medical Center, premature rupture occurred in 1 of 7 deliveries. He could not identify an etiologic agent but suggested “biologic intrinsic variations in the membranes as a probability.” Knox and Hoerne? have dismissed the possible role of infection in the occurrence of this phenomenon. Flowers and associates4 have made the observation in their series of 7,511 deliveries that premature rupture of the membranes is a major obstetrical complication which occurs more frequently among nonwhites and less educated mothers. They reported an overall incidence of 15.8 per cent. The incidence among the fetal and neonatal deaths in the series was 26.7 per cent. Our interest in early spontaneous rupture of the membranes and its association with neonatal deaths was aroused by the unusually high mortality rate in this group of infants at the University Hospital and Hillman Clinic during 1957 and 1958. A probable reason for this increase was the subject of a report by Kent and Wideman. They made a comparative study of infants born to moth-