Premature Rupture Of Membranes Cases Research Articles

Use of Antibiotics and Probiotic Lactobacilli in the Treatment of Preterm Premature Rupture of Membranes: a Review

ABSTRACT To review the current evidence of the potential use of antibiotics and probiotics Lactobacillus in preterm premature rupture of membranes cases and to see the effect on microorganism concentrations especially Streptococcus agalatiae and Lactobacillus. This review used several databases (Google Scholar, Pubmed, and Science Direct) and searched for English and Indonesian articles in the last ten years. Articles were received in the form of case reports, observational studies and clinical trials that discussed the use of antibiotics and probiotic Lactobacillus in premature rupture of membranes especially in preterm pregnancy. After searching the database and eliminating duplicates and articles unrelated to the topic, we included some articles in this review. Prophylactic antibiotics are also expected to prolong the latent phase, thereby reducing the risk of fetomaternal morbidity and mortality. Penicillin is often recommended in preterm PROM, because broad-spectrum antibiotics are better as infection prophylaxis. Providing alternative therapy with lactobacillus probiotics is believed to prevent preterm birth and has the benefit of being a safe and effective therapy in restoring normal vaginal microflora and preventing vaginal infections during pregnancy. However, further research is needed to see the effectiveness of lactobacillus probiotics and look at the concentration of microbes, especially Streptococcus agalctiae and Lactobacillus. Keywords: Preterm Premature Rupture of Membranes, Antibiotics, Probiotics Lactobacillus, Streptococcus Agalactiae

Knowledge, attitude, and practices of midwives on premature rupture of membranes (PROM): A cross-sectional study in Samosir and Toba, Indonesia.

Indonesia has a significantly higher maternal mortality ratio (MMR) than other countries in Southeast Asia, and infection is one of the most common causes of maternal deaths, of which premature rupture of membranes (PROM) can be the consequence of the infections. In primary healthcare settings, midwives play an important role in identifying and managing PROM appropriately; however, studies on their knowledge, attitudes, and practices related to PROM are limited. The aim of this study was to determine the midwives' knowledge, attitude and healthcare practice on PROM in Indonesia. A cross-sectional study was conducted among midwives at primary healthcare facilities in Samosir and Toba Regency, North Sumatra, Indonesia, from July to November 2022. The knowledge, attitude and practice towards PROM were assessed. Results showed that 57.5% of midwives had poor knowledge and 35.1% had poor attitude levels. There were 4.9% of midwives referred the patients immediately to the hospital. Our data indicated that aged 31-40 or 41-50 years, having a lower than bachelor degree and having a higher monthly number of referred PROM patients were significantly associated with poor knowledge compared to younger, having a bachelor degree, and lower monthly referral patient number, respectively. Similarly, younger, having higher degree and a having lower monthly referral number of PROM cases were associated with higher chances of having a sufficient-good attitude towards PROM. This study highlights that a significant percentage of midwives had poor levels of knowledge and attitude, and age, educational level and monthly referral number of PROM cases were associated with the level of knowledge and attitude.

Outcome and Indication of Caesarean Section amongst Pregnant Women Experiencing Premature Rupture of Membranes

Premature rupture of membranes (PROM) is characterized by the spontaneous rupture of chorioamniotic membranes more than one hour before the onset of labor. This condition typically arises spontaneously in most cases, affecting a significant portion of pregnancies. Notably, PROM can also occur in full-term pregnancies. This cross-sectional follow-up study was conducted among pregnant women had premature rupture of membranes and experiencing Caesarean Section (CS) in the department of Obstetrics and Gynaecology of Dhaka National Medical College Hospital (DNMCH), Dhaka, Bangladesh during the period of March to August 2011. The main aim of the study was to find out the indication and outcome of pregnant women with PROM and completed CS. A total of 90 data were collected purposively from all pregnant women more than 28 weeks of gestational age with PROM admitted in the Department of Obstetrics and Gynaecology, DNMCH, Dhaka for labour and underwent CS during study period. The data were collected using a semi-structured data sheet through direct questioning of the patients and physical examinations. Daily follow-ups were conducted until the patients were discharged, and data were also obtained from the clinical records of the patients. PROM patients encompassed all age groups, with ages ranging from 18 to 38 years. The overall educational level of the participants was low, with less than two-third (61.1%) belonging to the low socio-economic status. The average gestational age was 36.65 weeks, with 53.3% being primigravida, 45.6% being multigravida and grand multipara was 1 (1.11%). Only two had multiple pregnancies, and 11 respondents had experienced per vaginal bleeding. During previous gestations, 20 had a history of Caesarean section, 12 had experienced abortion, and 2 had previous cases of PROM. Nutritional deficits were found in 36.7% of patients, Pregnancy Induced Hypertension (PIH) in 35.6%, infections in 12.2%, and chronic hypertension in 5.6%. Four foetuses were in breech presentations, one had a single compound presentation, and two had a transverse or oblique lie. All the women were experiencing gushing of fluid per vagina, with one-fifth (20.0%) having meconium-stained and 12.2% blood-stained vaginal discharge. Attempts to prolong pregnancy were not very successful, with the longest duration being 75 hours. Caesarean sections had to be performed in all cases, with 34.4% within 24 hours and 41.2% within the next 24 hours. Elective caesarean sections following PROM were 28.9%. Indications for emergency caesarean section included a previous history of Caesarean section in 19 cases, foetal distress was found in 18 cases, failed induction in 7 cases, chorioamnionitis in 6 cases, foetal malpresentation was in 5 cases, and other reasons in 9 cases. More than one-third (35.56%) respondents had morbid condition to complicate the postpartum period. Among the complications, 21.11% suffered from wound infection; followed by puerperal sepsis 8.89% and postpartum haemorrhage 5.56%. At termination, all 92 foetuses were alive, but 6 babies had an Apgar score <7 at 5 minutes after delivery, 30.4% of babies had low birth weight and 73.9% were in good condition, whereas 26.1% were admitted in neonatal ward, and out of the admitted 7 died with neonatal sepsis being the primary cause of death. A better understanding of the diagnosis babies and management of PROM will enable obstetric care providers to optimize perinatal outcomes and minimize neonatal morbidity and mortality. Therefore, this study finds the indication and outcome of caesarean section in pregnant women experiencing PROM. Bangladesh Med J. 2022 May; 51(2): 45-53

Maternal proximity to petrochemical industrial parks and risk of premature rupture of membranes

BackgroundLiving near petrochemical industries has been reported to increase the risks of adverse birth outcomes, such as low birth weight and preterm delivery. However, evidence regarding the role of petrochemical exposure in pregnancy complications remains limited. This study evaluated the association between maternal proximity to petrochemical industrial parks (PIPs) during pregnancy and the occurrence of premature rupture of membranes (PROM). MethodsWe performed a population-based 1:3 case–control study by using the 2004–2014 Taiwanese Birth Certificate Database. Birth records reported as stillbirth or bearing congenital anomalies were excluded. Cases were newborns reported to have PROM, whereas controls were randomly sampled from those without any pregnancy complications by matching birth year and urbanization index of the residential township. The proximity to PIPs was evaluated by calculating the distance to the nearest PIP of the maternal residential township during pregnancy. Furthermore, petrochemical exposure opportunity, accounting for monthly prevailing wind direction, was quantified during the entire gestational period. We applied conditional logistic regression models to evaluate the associations. ResultsIn total, 29371 PROM cases were reported during the study period, with a corresponding 88113 healthy controls sampled. The results revealed that living within a 3-km radius of PIPs during pregnancy would increase the risk of PROM (odds ratio [OR] = 1.76, 95% CI: 1.66–1.87). Furthermore, compared with the lowest exposed group, those with high petrochemical exposure opportunity had a significantly increased risk of PROM occurrence (OR = 1.69–1.75). The adverse effects remained robust in the subgroup analysis for both term- and preterm-PROM. ConclusionsThe results of the present work provide evidence that living near PIPs during pregnancy would increase the risk of PROM, and additional studies are warranted to confirm our findings.

Detection of Vaginal Metabolite Changes in Premature Rupture of Membrane Patients in Third Trimester Pregnancy: a Prospective Cohort Study

Premature rupture of membranes (PROM) is usually associated with pregnant and neonatal complications. Most of the PROM cases are caused by ascending asymptomatic genital infection. In China, PROM (15.3%) is more common than spontaneous preterm labor (7.3%) and leads to more adverse pregnancy outcomes. Here, we designed a prospective cohort study to measure the metabolomics changes in vaginal swab samples and explored their potential contribution to PROM. A total of 260 differentially expressed metabolites were identified and further analyzed. In the PROM group, N-acetyl-d-galactosamine and sucrose were downregulated (P = 0.0025, P = 0.0195, respectively), both of which are the upstream metabolites of the glycolysis pathway. Furthermore, estriol 3-sulfate 16-glucuronide (P = 0.0154) and 2-methoxy-17beta-estradiol 3-glucosiduronic acid (P = 0.004), two final metabolites in steroid hormone biosynthesis, were both downregulated in the PROM group. Finally, we found two catechin metabolites (epigallocatechin-7-glucuronide, P = 0.0009; 4′-methyl-epigallocatechin-7-glucuronide, P = 0.01) as well as DL-citrulline (P = 0.0393) were also significantly downregulated in the PROM group compared with the healthy control (HC) group, which are related to important antioxidant and anti-inflammatory activities in the human body. Altogether, metabolite changes in glycolysis, steroid hormone biosynthesis, and antioxidant/anti-inflammatory pathways may contribute to (or be a consequence of) vaginal dysbiosis and PROM. Metabolite pathway analysis is a new and promising approach to further investigate the mechanism of PROM and help prevent its unfavorable pregnant outcomes at a functional level. Trial registration number: ChiCTR2000034721

A Study on Management of Premature Rupture of Membranes (PROM)

Background: Premature rupture of membranes (PROM) is a common obstetric complication. Knowledge of etiopathogenesis, diagnosis, complications & management of PROM has increased due to extensive research in the recent past. Yet, there is no unanimous opinion regarding optimum management of PROM. The aim of the study was to observe the patients during labor and compare the latent period, duration of first stage of labor, modes of deliveries and the use of oxytocin and its outcome in PROM cases with controls.
 Materials and methods: In this study, the definition of PROM used is – rupture of fetal membranes before the onset of true labor pain. The minimum gestational age was taken to be 28 weeks. Diagnosis of PROM was mainly clinical. A cohort study was conducted in the Dept. of Obs & Gynae of KPL Medical College & Hospital, Kolkata on 100 cases of PROM and 100 cases of comparison group, over a period of one year.
 Results: It was observed that onset of labor was more rapid with increasing gestational age, use of oxytocin for induction & augmentation of labor & operative deliveries were higher in PROM cases.
 Conclusion: Individualized management of PROM cases depending on the gestational age and risk of complications is the best way to achieve a good feto-maternal outcome.
 Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 94-98

KEEFEKTIFAN MISOPROSTOL PERORAL SEBAGAI PEMATANGAN SERVIKS PADA KETUBAN PECAH DINI KEHAMILAN ATERM DENGAN SKOR BISHOP ≤ 4 DI PADANG

Premature rupture of membranes (PROM) is defined as rupture of membranes before contraction (his). PROM is the case of 5-10% of all deliveries. 70% of cases of PROM occur in term pregnancies. So that PROM in aterm pregnancies is suggested to induce labor to reduce the incidence risk of mother and fetus complications. This study aimed to compare the effectiveness of cervical ripening by using Misoprostol 25 µg peroral and without using Misoprostol 25 µg at term premature rupture of the membrane with Bishop Score ≤ 4. This study was conducted at the Departement of Obstetrics and Gynecology, Dr. M. Djamil Central General Hospital, and Reksodiwiryo Hospital Padang from November 2013 – August 2014 Simple Random Sampling design. The subject selected based on inclusion criteria, then assess the state of the cervix and laboratory examination and nonstress test, then recapitulated and processed data is computerized using the computer software and statistical test. Significant differences increase bishop scores on 25 mcg misoprostol orally with those not given to premature rupture of membranes at term with less than bishop scores or equal to (≤) 4. The p-value evidence this was 0.000 <0.05. And there is no side effects in this study.Keywords: misoprostol effectivity, premature rupture of membrane

The Study of Vaginal Fluid Urea, Creatinine, B-HCG and Placental Alpha-1 Microglobulin in Diagnosis of Premature Rupture of Membranes

Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 - 42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Furthermore they were more accurate than β-HCG. Conclusion: Detection of PAMG-1 in cervico vaginal discharge is promising in diagnosis of PROM & especially in those cases of suspected PROM and it should be done as a worse trial in every case of suspected PROM. Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Also they were more accurate than β-HCG and they can be used if PAMG-1 is not available for detection of doubtful PROM cases.

Protein 53 (P53) Expressions and Apoptotic Index of Amniotic Membrane Cells in the Premature Rupture of Membranes.

BACKGROUND:The premature rupture of membranes (PROM) represents an obstetric issue causing significant maternal and neonatal morbidity and mortality. Although protein 53 (p53), one of the proapoptotic proteins suspected of causing PROM at the molecular level is closely correlated with the occurrence of PROM, the exact mechanism remains still unclear.AIM:This study aims to investigate the hypothesis that p53 expression and the apoptotic index play a role in the PROM mechanism.METHODS:Placentas from 20 pregnancies (37–42 weeks gestation) and 20 pregnancies complicated by PROM were collected at delivery. The independent variable is represented by pregnant mothers with a single live fetus experiencing PROM (followed by labour and birth) while without PROM mothers represent the control. The research material was taken from the amnion tissue in the placenta. Also, p53 and apoptotic index (TUNEL) immunohistochemical examination were conducted at the Integrated Biomedical Laboratory, Medical Faculty of Udayana University, Bali. The correlation between the apoptotic index and p53 expression of the PROM group was tested using a McNemar Test.RESULTS:No statistically significant differences were found between the two groups (p > 0.05). There was a significant difference in p53 expression in PROM cases compared to those without PROM (11.15 + 5.59% vs. 0.95 + 2.52%) with χ2 = 19.538 and p = 0.001. The apoptotic index in PROM cases was higher than in those without PROM (19.10 + 5.63% vs. 1.15 + 2.46%) with χ2 = 32.40 and p = 0.001. There was a strong correlation between p53 expression and PROM with PR = 3.449 (95% CI = 1.801-6.605; p = 0.001). There was a strong correlation between the apoptotic index and PROM with PR = 19 (95% CI = 2.81-128.69; p = 0.001).CONCLUSION:p53 expression and the apoptotic index of amniotic membrane cells in cases of PROM was higher than in those without PROM, there was a strong correlation between p53 expression and apoptotic index with the occurrence of PROM.

Nursing Care of Premature Rupture of Membranes in Pregnancy: Roy Adaptation Model

Premature rupture of membranes (PROM) is a condition associated with spontaneous rupture of the amniotic membranes before any signs of the active labour. It increases the risk of complications on maternal and foetal health. In preventing various complications that would arise due to PROM, nurses should apply an appropriate nursing theories or models in developing the nursing care plan. Nursing theories and conceptual models are the nursing knowledge that organize nursing activities, and guide nurses in research, practice, education, and management. However, in Indonesia, nursing models have rarely been used by nurse practitioners and researchers including in the perinatal periods. The aim of this article was to determine the application of Roy’s adaptation theory in the premature rupture of membranes cases. This study was a case study design. There were 5 pregnant women participate in this study. The results showed that the assessment based on the two adaptation model approaches applied in this study, six nursing diagnosis were identified, and all nursing care plan had implemented. The concept of adaptation was appropriate in helping patient with premature rupture of membranes. However, the social aspect related to the client's cultural practices were not describe clearly. Combining two or more theories in a nursing care plan would benefit to mothers and their babies’ health and welfare. Keywords: Nursing theories, Premature rupture of membranes, pregnancy, complications

Duration of empirical therapy in neonatal bacterial meningitis with third generation cephalosporin: a multicenter retrospective study.

IntroductionThe duration of treatment is not well established, especially in the negative cerebrospinal fluid (CSF) culture. The aim of this study is to explore the influence of duration of treatment in neonatal bacterial meningitis.Material and methodsThis is a retrospective analysis of 200 CSF specimens. Two hundred full-term neonates with bacterial meningitis admitted to the clinical status were evaluated using the Glasgow Outcome Scale (GOS) on the day of discharge.ResultsNeonates were identified as having bacterial meningitis based on the results of CSF culture tests of all suspected cases. According to the GOS, neonates were divided into two outcome groups: 77.5% good (GOS = 5) (shorter than 3 weeks’ administration) and 22.5% unfavorable (GOS = 1–4) (longer than 3 weeks’ administration). The duration of antibiotic treatment ranged from 4 to 43 days, and the mean therapy time was 19.74 ±7.32 days. Duration longer than 3 weeks for neonatal bacterial meningitis with negative CSF culture had no impact on prognosis. The unfavorable outcome group had more prenatal infections and premature rupture of membranes cases than the good outcome group. High CSF protein and CSF glucose and CSF cell count increase were associated with unfavorable outcome in 167 non-prenatal infection infants. High CSF cell count increase was associated with unfavorable outcome in 33 prenatal infection infants. In term infants, the positive rate of blood cultures was 24.5%.ConclusionsThird generation cephalosporin therapy does not have a different prognosis for negative CSF culture of neonatal bacterial meningitis in term infants in this study.

Outcome of neonates born to mothers with premature rupture of membranes

Background: Premature rupture of membranes (PROM) is defined as rupture of membranes before the onset of labor which is caused by maternal intrauterine infection which increases with the duration of membrane rupture seen in one third cases of all preterm birth. The primary complication for the mother is risk of infection, complications for the newborn consists of prematurity, foetal distress, cord compression, deformation and altered pulmonary development. The present study was undertaken to evaluate the outcome of neonates born to mothers with PROM and know the incidence of adverse outcomes in neonates and the incidence of early onset sepsis following PROM more than 18hours in mothers who have not received intrapartum antibiotics.Methods: Prospective cohort study conducted in between December 2015 to November 2017 in which 100 neonates born to mothers with history of Premature rupture of membranes admitted in Konaseema Institute and Medical Science and Research Foundation, Amalapuram were selected for this study. They were evaluated with various investigations by a written proforma and outcomes of these neonates were studied.Results: Out of 100 cases of PROM 54 had 18-24 hours duration, 38 had 24-72hours and 8 had more than 72 hours duration of PROM. According to swab culture organism found were E Coli in 22, Staphylococcus in 20, Klebsiella in 12, Pseudomonas in 8 cases with rest 38 cases showed no growth. 49 out of 100 cases show morbidity with Respiratory distress being the most common with 37 cases followed by septicaemia with 8 cases. Morbidity are more in the neonate with longer duration (>24hrs) of PROM. Mortality increases progressively as the duration of PROM increases.Conclusions: In neonates born after PROM of >24 hours, risk of maternal infection, neonatal morbidity and mortality is more compared to those with PROM of shorter duration. Active management is needed to enable delivery within 24 hrs of premature rupture of membranes as it is associated with better neonatal outcome compared to longer latency period.

MODERN CONDITION OF THE PROBLEM OF THE PREMATURE RUPTURE OF MEMBRANES DURING FULL-TERM PREGNANCY (REVIEW OF LITERATURE)

Premature rupture of membranes (PRM) during full-term pregnancy is a common obstetric complication. Childbirths on the background of PRM are accompanied by an increase in the frequency of the operative deliveries, as well as various obstetric complications. However, for all the diversity of tactics, techniques, clinical recommendations devoted to actions of a doctor in the management of PRM patients, the question of their choice depends on many factors. For more than 20 years of studying the PRM problem, a technique for preparing the cervix, providing 100% result has not been developed. With all the variety of choice of methods, none of them is devoid of shortcomings (contraindications to the use, cost-effectiveness, compliance of the patient, etc.). In this regard, the optimal choice of the tactics of labor in PRM cases is the insurance of the preservation of the health of the future generation.

Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term

The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM.Impact statementThe aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%.We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups.Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.

Evaluation of CRP as a Preindicative Marker in Women with Preterm Labour and Preterm Prelabour Rupture of Membrane (PPROM)

Evaluation of CRP as a Preindicative Marker in Women with Preterm Labour and Preterm Prelabour Rupture of Membrane (PPROM)

Polymorphisms in NR5A2, gene encoding liver receptor homolog-1 are associated with preterm birth.

Preterm birth (PTB) is a major cause of neonatal mortality and morbidity. There is strong evidence of genetic susceptibility. Objective of this study was to identify genetic variants contributing to PTB. Genotyping was performed for 24 single nucleotide polymorphisms (SNPs) in 4 candidate genes (NR5A2, FSHR, FOXP3, and SERPINH1). Genotyping was completed on 728 maternal triads (mother and maternal grandparents of a preterm infant). Data were analyzed with Family Based Association Test. For all maternal triads rs2737667 of NR5A2 showed significant association at P = 0.02. When stratifying by gestational age three SNPs in NR5A2 had P values <0.05 in the <32-wk gestational age group (rs12131233, P = 0.007; rs2737667, P = 0.04; rs2816949, P = 0.02). When preterm premature rupture of membranes cases were excluded rs2737667 of NR5A2 showed the strongest association with a P value <0.0002. This association remained significant after correction for multiple testing. This study suggests a potential association between intronic SNPs in the NR5A2 gene and PTB. NR5A2 gene encodes for the liver receptor homolog-1 protein, which plays a critical role in regulation of cholesterol metabolism, steroidogenesis, and progesterone synthesis. These findings suggest that NR5A2 may be important in the pathophysiology of PTB and exploring noncoding regulators of NR5A2 is warranted.

Prelabour rupture of membranes at term prospective study of expectant management versus induction of labour

Background: Premature rupture of membranes (PROM) complicates 5-10 % of pregnancies. Approximately 60-70 % of term PROM cases are followed by the onset of labor within 24 hours. Diagnosis and proper management is very important. In spite of many studies available in the literature, the clinical management is surprisingly controversial.Methods: Study conducted was prospective randomised controlled trial. Total 150 women were selected fulfilling the inclusion criteria, randomly allotted to the 3 groups. In group A, patients were observed for 24 hours. If labor didn’t supervene in 24 hours since admission, induction of labor was done depending on the bishop’s score. In the group B, labour was induced by vaginal misoprostol 25 micrograms given 4 hourly for 4 doses and in group C, labor was induced by instillation of 0.5mg PGE2 gel in the posterior fornix. The women were observed for onset and progress of labour. Failure of induction was considered if patient was not in established labour within 24 hours of instillation of first dose of cerviprime/misoprostol. Labour was monitored and managed as per hospital protocol. The analysis verified the following variables: duration of latent phase and active phase of labour, mode of delivery (spontaneous/vaccum/forceps/LSCS), third stage complications (PPH/fever/retained placenta), neonatal outcome.Results: Thirty percent women had onset of spontaneous labor during expectant management in group A. The durations of latent phase and active phase of labour were lower in group B and C than group A (9 and 10.4 versus 15 hours; p&lt;0.001) and (4 and 6 versus10 hours; p&lt;0.001), respectively. Immediate induction in group B and C resulted in significantly lower rate of caesarean section (17% and 19% versus 28.5%, P= 0.049) and operative vaginal delivery (5% and 3% versus 13%, P=0.007). Only a few maternal-neonatal infections occurred and no significant difference was noted (2.7% and 3% versus 3.5%, P= 0.71).Conclusions: Immediate induction with prostaglandin shortens the delivery interval and lowers the caesarean section rate as compared to expectant management; however the neonatal outcome is similar in the three groups.

182 Cases of Premature Rupture of Membranes and Treatment Strategy Analysis

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Related factors and treatment strategies of premature rupture of membranes (PROM) were discussed. &lt;strong&gt;Method: &lt;/strong&gt;Retrospective analysis of 182 cases of preterm premature rupture of membranes (PPROM) from Yanshan County Hospital from January 2010 to October 2015. &lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;From the 182 cases [123 vaginal delivery and 59 cesarean section (C-section)], there were 79.12% PROM cases were detected in the presence of risk factors. Neonatal mortality and complications were significantly higher at 28−33 + 6 weeks of pregnancy than those at 34−36 + 6 weeks, 28−33 + 6 weeks, and 34−36 + 6 weeks. &lt;strong&gt;Conclusion: &lt;/strong&gt;In order to improve the survival rate of newborns, the related factors leading to PPROM should be treated.&lt;/p&gt;

Increased Risk of Preterm Premature Rupture of Membranes at Early Gestational Ages among Maternal Cigarette Smokers

To examine the effect of cigarette smoking during pregnancy on the development of preterm premature rupture of membranes (PPROM) categorized by gestational age. We conducted a retrospective cohort study of 17,961 births using data from the McGill Obstetric and Neonatal Database between years 2001 and 2006. Our exposure was defined according to self-reported maternal cigarette smoking status categorized as nonsmoker, smoker of 1 to 10 cigarettes per day, and smoker of > 10 cigarettes per day. The outcome was measured as incidence of premature rupture of membranes (PROM) among gestational age categories of < 28, < 32, < 37, and > 37 weeks. Unconditional logistic regression analysis and Wald test for trend were used to estimate the adjusted risk of PPROM according to smoking status. Among the study population, 640 cases of PPROM (<37 weeks) and 40 cases of PROM (>37 weeks). After adjusting for confounding variables, smoking > 10 cigarettes per day was associated with an increased risk of PPROM at < 28 weeks (odds ratio [OR] 5.28; 95% confidence interval [CI] 2.20 to 12.7); < 32 weeks (OR 2.36; 95% CI 1.09 to 5.11; < 37 weeks (OR 1.97; 95% CI 1.32 to 2.94); and > 37 weeks (OR 3.19; 95% CI 0.92 to 11.0). Smoking 1 to 10 cigarettes per day was not associated with a significant risk of PPROM at any gestational age. Heavy cigarette smoking increases the risk of PPROM more so at early gestational age than at term.

A comparative study of maternal &amp;amp; neonatal outcome and patient satisfaction with intravaginal misoprostol versus intravenous oxytocin in patients with premature rupture of membranes beyond 36 weeks gestation

Background: Premature rupture of membranes (PROM) occurs in about 10% of patients beyond 36 weeks of gestation. In this situation, labor induction with prostaglandins, has been proved to be beneficial and results in decreased chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. Many techniques for induction of labor are available. This prospective randomized comparative study was thus taken up to compare the outcomes of misoprostol versus oxytocin with respect to the maternal and neonatal outcomes and patient satisfaction. Methods: A prospective randomized study was carried out where 200 women admitted to department of obstetrics &amp; gynecology, Pravara Rural Hospital, PMT, Loni with PROM beyond 36 weeks of gestation were included where 100 each were included in two groups- vaginal misoprostol group &amp; oxytocin infusion group. Results: Nearly 58% of the cases of PROM were in the age group 21-25 yrs. Vaginal deliveries were 42% in misoprostol group, where as 44% in oxytocin group; whereas LSCS were 7% in misoprostol group and 5% in oxytocin group. Maximum number of cases had APGAR score between 7-10 in both the groups. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction. Conclusions: Labor induction with oxytocin infusion for PROM beyond 36 weeks in an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with transvaginal misoprostol. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction.