Premature Rupture Of Membranes Group Research Articles

Exploratory study on the mechanism of necrotic effect of nourishing cells in the context of genital tract infection in premature rupture of membranes.

To explore the mechanism of necrotic effect of nourishing cells in the context of genital tract infection in premature rupture of membranes (PROM). One hundred eight patients with PROM treated at our hospital from June 2020 to June 2022 were selected as the PROM group. Simultaneously, 108 cases of normal full-term pregnant women were chosen as the control group. Western blot analysis was performed to measure the relative expression levels of cysteinyl aspartate specific proteinase-1 (Caspase-1), cysteinyl aspartate specific proteinase-3 (Caspase-3), nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3), and interleukin (IL)-1β proteins, which are associated with necrosis of placental nourishing cells, in the placenta of both groups. TUNEL staining was used to detect the number of apoptotic placental nourishing cells. The differences in necrotic factors of placental nourishing cells were analyzed between full-term and preterm cases in the PROM group, as well as among patients with different genital tract infections. The apoptotic count of placental nourishing cells in the PROM group was 58.46 ± 11.26 cells/field, which was markedly higher than that of the control group (P < .05). The relative expression levels of the necrotic factors Caspase-1, Caspase-3, NLRP3, and IL-1β proteins in placental nourishing cells of the PROM group were 1.32 ± 0.26, 1.19 ± 0.30, 1.29 ± 0.28, and 1.23 ± 0.24, respectively. These values were significantly higher than those of the control group (P < .05). The relative expression levels of the necrotic factors Caspase-1, Caspase-3, NLRP3, and IL-1β proteins in placental nourishing cells were compared between full-term and preterm patients in the PROM group (P > .05). The relative expression levels of the necrotic factors Caspase-1, Caspase-3, NLRP3, and IL-1β proteins in placental nourishing cells were higher in patients with multiple genital tract infections compared to those with single infections or no infections in the PROM group (P < .05). PROM is associated with a significant upregulation of placental nourishing cell apoptosis and necrotic factors, including Caspase-1, Caspase-3, NLRP3, and IL-1β proteins. This upregulation is correlated with the presence of genital tract infections.

A study on the level of NLRP3 inflammasome in patients with premature rupture of membranes.

In this study, we investigated the levels of interleukin-1β (IL-1β), IL-18, and the NOD-like receptor pyrin domain-containing 3 (NLRP3) inflammasome in patients with premature rupture of membranes (PROMs). We selected 60 pregnant women at the Fourth Hospital of Baotou between January 2019 and July 2021. These women were divided into three distinct groups: the preterm PROM group with 20 cases, term PROM (TPROM) group with 20 cases, and a control group with 20 cases consisting of normal full-term pregnancies without PROM. Peripheral blood was collected from all participants. Using enzyme-linked immunosorbent assay, the levels of IL-1 and IL-18 in the plasma were assessed. Additionally, the proportions of NLRP3, apoptosis-associated speck-like protein (ASC), and caspase-1-positive macrophages were also evaluated. The ratios of NLRP3, ASC, IL-1β, and IL-18 concentrations, along with the presence of caspase-1-positive macrophages, were notably greater in the PROM groups in comparison with the control group (p < .05). In the TPROM group and control group, the proportions of IL-1β and IL-18 levels were found to be lower than NLRP3, ASC, and caspase-1-positive macrophages levels (p < .05). The concentrations of IL-1β and IL-18, as well as the ratios of NLRP3, ASC, and caspase-1-positive macrophages, were elevated in patients with PROM compared to the control group. This suggests a potential correlation between the excessive activation of NLRP3 and the development of PROM.

Alterations in the vaginal microbiota of patients with preterm premature rupture of membranes.

BackgroundPreterm premature rupture of membranes (PPROM) is a common pregnancy complication. Yet, the main cause of PPROM remains poorly understood. In this study, we used 16S rRNA gene sequencing technology to identify the differences in vaginal microbiota between pregnant women with PPROM and those who delivered at term.MethodsVaginal samples were collected from 48 patients with PPROM and 54 age- and gestational age-matched pregnant women who delivered at term (controls). The vaginal microbiota of the two groups was compared using 16S rRNA gene sequencing of the V3-V4 regions.ResultsThe vaginal microbial composition of the PPROM group was significantly different from that of the control group. Our results showed that the diversity of vaginal microbiota in patients with PPROM increased compared with controls. The relative abundance of Lactobacillus iners, Gardnerella vaginalis, Prevotella bivia, Ochrobactrum sp., Prevotella timonensis, and Ureaplasma parvum were more abundant in patients with PPROM, while Lactobacillus crispatus and Lactobacillus gasseri were more abundant in controls. Ochrobactrum sp., Prevotella timonensis, and Gardnerella vaginalis, could serve as biomarkers for PPROM. Finally, we proposed several metabolic pathways, including PWY-6339, PWY-6992, and PWY-7295.ConclusionPPROM is characterized by vaginal microbial dysbiosis. The dysbiotic vaginal microbiota signatures in patients with PPROM include a higher bacterial diversity, decreased autochthonous bacteria, and increased pathogenic bacteria. These results may be beneficial for developing biomarkers for screening and early diagnosis of PPROM and may provide effective preventative treatments.

Characterization of Vaginal Microbiota in Third Trimester Premature Rupture of Membranes Patients through 16S rDNA Sequencing.

In China, premature rupture of membranes (PROM) counts as a major pregnancy complication in China and usually results into adverse pregnancy outcomes. We analysed the vagina microbiome composition using 16S rDNA V3–V4 amplicon sequencing technology, in this prospective study of 441 women in their third trimester of pregnancy. We first divided all subjects into PROM and HC (healthy control) groups, in order to investigate the correlation of vagina microbiome composition and the development of PROM. We found that seven pathogens were higher in the PROM group as compared to the HC group with statistical significance. We also split all subjects into three groups based on Lactobacillus abundance-dominant (Lactobacillus > 90%), intermediate (Lactobacillus 30–90%) and depleted (Lactobacillus < 30%) groups, and explored nine pathogenic genera that were higher in the depleted group than the intermediate and dominant groups having statistical significance. Finally, using integrated analysis and logistics regression modelling, we discovered that Lactobacillus (coeff = −0.09, p = 0.04) was linked to the decreased risk of PROM, while Gardnerella (coeff = 0.04, p = 0.02), Prevotella (coeff = 0.11, p = 0.02), Megasphaera (coeff = 0.04, p = 0.01), Ureaplasma (coeff = 0.004, p = 0.01) and Dialister (coeff = 0.001, p = 0.04) were associated with the increased risk of PROM. Further study on how these pathogens interact with vaginal microbiota and the host would result in a better understanding of PROM development.

Use of Vaginal Dinoprostone (PGE2) in Patients with Premature Rupture of Membranes (PROM) Undergoing Induction of Labor: A Comparative Study.

Purpose: To evaluate the effect and safety of vaginal dinoprostone in pregnant women with PROM who undergo induction of labor (IoL). Materials and Methods: Prospective observational study conducted at La Mancha Centro hospital from 1 February 2019, to 30 August 2020. Obstetric and neonatal variables of 94 pregnant women with PROM who underwent IoL with vaginal dinoprostone were analyzed, and the results were compared with 330 patients without PROM who also underwent IoL. Bivariate and multivariate analyses were performed using binary and multiple linear regression. Results: A total of 424 women were included in this study. A greater response to cervical ripening (Bishop score > 6) with PGE2 was observed in the PROM group (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.50–4.99, p = 0.001), as well as a shorter total duration of IoL (mean difference (MD) 2823.37 min (min), 95% CI 1257.30–4389.43, p < 0.001). Cesarean sections were performed in 28.7% (n = 27) of patients in the PROM group vs. 34.2% (n = 113) of patients in the non-PROM group, with no significant differences (OR 0.87%, 95% CI 0.47–1.60, p = 0.652). There were no significant differences in changes in the cardiotocographic record (CTG), postpartum hemorrhage (PPH), uterine rupture, or adverse neonatal outcomes between the two groups. Conclusions: The use of vaginal dinoprostone in pregnant women undergoing IoL with PROM is safe for the mother and the fetus, shortens the total delivery time, and does not increase the risk of cesarean section compared with pregnant women undergoing IoL without PROM.

Quantitative and Qualitative Measurement of Vaginal Fluid β-HCG for the Diagnosis of Premature Rupture of Membranes

Background: Premature rupture of membranes (PROM) is known as one of the leading causes of morbidity and mortality among pregnant women. So, the aim of this study was to evaluate the diagnostic value of quantitative and qualitative vaginal fluid β-HCG for the detection of premature rupture of membranes.&#x0D; Methods: One hundred pregnant women with gestation age between 28 and 37 weeks were divided into three groups: confirmed PROM group (34 cases), suspected of PROM (36 cases), and intact membranes (30 cases). Those pregnant women with positive pooling tests were considered as confirmed PROM, while those with the decreased amniotic fluid index, positive nitrazine, or ferning were included in suspected PROM group. Notably, pregnant women with no complaints or complications were enrolled as the control group. Five ml sterile normal saline was injected into the posterior fornix of vagina, vaginal fluid was aspirated, and β-HCG measurement was then performed both quantitatively and qualitatively using ELISA and baby check kits, respectively.&#x0D; Results: The cut-off value for quantitative β-HCG was determined as 66 mIU/m. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of quantitative β-HCG were calculated as 97.05%, 100%, 100%, 96.77%, and 98.43%, respectively. Besides, the qualitative vaginal washing fluid β-HCG using Baby check with the threshold value of 25 mIU/ml had 94.11% sensitivity, 93.33% specificity, 94.11% PPV, 93.33% NPV, and 93.75% accuracy.&#x0D; Conclusion: Quantitative and qualitative vaginal washing fluid β-HCG measurements are accurate, reliable, and useful tests for the diagnosis of PROM.

Increased Colostral Concentration of Macrophage Migration Inhibitory Factor in Mothers with Premature Rupture of Membranes.

Objective: The colostrum contains macrophage migration inhibitory factor (MIF), which plays an important role in protecting newborns from infections. As such, colostrum may be specifically important to prevent early onset neonatal sepsis among neonates born after premature rupture of membranes (PROM). However, the effect of PROM on the colostral MIF concentration has not been previously described. The aim of this study is to compare the concentration of MIF in the colostrum of mothers with and without PROM. Methods: The study group consisted of 44 women, 22 of whom had PROM. Colostrum was expressed and collected within 72 hours of birth. MIF concentration was measured using the enzyme-linked immunosorbent assay method and compared between mothers with and without PROM. Results: There were no differences between the two groups (PROM group n = 22, control group n = 22) with regard to the age of mothers, mode of delivery, neonatal gestational age, birth weight, and sex of the infants (p > 0.05). The colostral MIF concentration was significantly higher among mothers with than without PROM (p = 0.0001). There was a positive and significant correlation between the colostral MIF concentration and PROM duration (r = 0.314, p = 0.038). Conclusions: PROM was associated with a higher colostral MIF concentration, with this concentration being positively correlated with the duration of PROM. This increased concentration may be important in offering these neonates additional protection against early onset infections, which is a risk associated with PROM.

Influence of premature rupture of membranes on the early prognosis of extremely premature infants

OBJECTIVE To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. METHODS A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (n=69) and non-PROM group (n=110). A statistical analysis was performed for maternal data and early prognostic indicators. RESULTS Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (P < 0.05) and significantly lower rate of use of pulmonary surfactant and incidence rate of hemodynamically significant patent ductus arteriosus (P < 0.05). The multivariate logistic regression analysis showed that chorioamnionitis was an independent risk factor for early-onset sepsis and NEC (OR=11.062 and 9.437 respectively, P < 0.05), and PROM was an independent protective factor against the use of pulmonary surfactant (OR=0.363, P < 0.05). CONCLUSIONS PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.

Inflammasome components and ADAMTS4 in premature rupture of membranes.

Inflammation may be responsible for the development of premature rupture of membranes (PROM) including preterm PROM (PPROM) and mature PROM (MPROM). A total of four classic receptor proteins have been confirmed to assemble inflammasomes: NLR family pyrin domain containing (NLRP)1, NLRP3 and NLR family CARD‑domain containing4(NLRC4) and absent in melanoma2(AIM2). The activation and expression of these receptor‑modulated inflammasomes in placenta and fetal membrane of PROM pregnancies requires investigation. In addition, a disintegrin and metalloproteinase with thrombospondin motifs4(ADAMTS4) is a risk factor for PROM, but whether its expression is associated with inflammasome activation remains to be elucidated. In the present study, the placenta and fetal membrane tissues of patients who had suffered PPROM and MPROM and healthy pregnancies were investigated. Reverse transcription‑quantitative PCR was used to determine the mRNA expression of inflammasomes and ADAMTS4. Western blotting, immunohistochemistry and ELISA were used to investigate the protein expression levels of inflammasomes and ADAMTS4. The results demonstrated that all four inflammasomes were elevated in placenta and fetal membrane of PPROMs as were mRNA and protein expression levels of IL‑18 and IL‑1β (compared with controls). A further increase of inflammasomes and interleukins was observed in MPROMs compared with controls. Similar results were also observed in ADAMTS4 expression in PPROM and MPROM groups. However, immunohistochemistry results revealed no significant difference of inflammasome receptor expression in PPROMs compared with controls. Finally, a general positive correlation between ADAMTS4 and all four inflammasome receptors in placenta and fetal membrane of PPROMs and MPROMs was observed. The present study revealed that NLRP1, NLRP3, AIM2 and NLRC4 inflammasome activation in PROM was increased. Promoted ADAMTS4 level was further observed in PROM group and was significantly correlated with inflammasome expression. Inhibition of inflammasome activation may provide a therapeutic target for clinical PROM treatment.

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

Effect of premature rupture of membranes on time to delivery and outcomes in full-term pregnancies with vaginal dinoprostone-induced labour.

The aim of this study was to assess the effect of premature rupture of membranes (PROM) in full-term pregnancies with dinoprostone-induced labour. This historical cohort study analysed 2166 full-term pregnancies with dinoprostone-induced labour between 1 August 2016 and 30 April 2018. A group that underwent induction of labour for PROM (PROM group) was compared to a group that underwent labour induction for other indications (no-PROM group). Time to delivery and perinatal outcome were compared between the two groups. A total of 2166 pregnancies (662 PROM and 1504 no-PROM) were included. The two groups demonstrated no significant differences except in biparietal diameter and gestational age (P < 0.001). The caesarean section delivery rate in the PROM group was significantly lower than in the non-PROM group (26.89 vs. 33.58%, P < 0.0001). In the PROM group, the induction-to-delivery time was shorter (P < 0.0001) and the rates of vaginal birth within 24h (P < 0.0001) and 48h (P < 0.0001) were higher than those in the control group. The incidence rate of amniotic fluid contamination in the PROM group was significantly lower than that in the non-PROM group (19.18 vs. 25.20%, P = 0.002). PROM significantly affects perinatal outcome in Chinese women who undergo dinoprostone-induced labour, especially the caesarean delivery rate and the induction-to-delivery time.

Use of vaginal creatinine levels in detecting premature rupture of membranes

Aim: Misdiagnosis is frequent in premature rupture of membranes (PROM) patients. The most accurate diagnosis of PROM requires reliable laboratory tests. Due to the lack of a gold-standard diagnostic method, many methods have been proposed in this regard. The aim of this study is to determine an easy diagnostic method in early membrane rupture and to determine the usability, reliability and cut-off values of vaginal creatinine measurements in the detection of PROM compared to vaginal placental alpha microglobulin-1 (PAMG-1) test.Methods: We designed a cross-sectional study. A total of 63 patients admitted to the Obstetrics and Gynecology Clinic of Samsun Ondokuz Mayıs University with suspected PROM between 15 November 2012 and 15 June 2013 were included in this study. Following anamnesis, all patients were vaginally subjected to PAMG-1 (AmniSure® ROM) test with sterile speculum and injected with 5 cc of saline into the vagina, and then, a 3 cc sample was retrieved with the same injector and put into a biochemistry tube. Immediately thereafter, the material was sent to the biochemistry laboratory, centrifuged and stored at -70 0C until all samples were studied. The patients were classified as PROM and non-PROM based on the positive or negative result of PAMG-1 test. Following this classification, the patients were also grouped as PROM and non-PROM according to their vaginal creatinine values.Results: The mean maternal age of our patients was 26.3 years in the PROM group and 28.8 years in the non-PROM group. The mean gestational weeks were 30.8 weeks in the PROM patients and 32.5 weeks in the non-PROM patients. Of 20 patients subjected to PAMG-1 test for PROM diagnosis, 17 were PAMG-1 and creatinine positive while 3 were PAMG-1 negative and creatinine positive. Of 43 patients subjected to PAMG-1 test, 42 were PAMG-1 negative while 1 was PAMG-1 positive and creatinine negative. Accordingly, vaginal creatinine was found to have 94.4% sensitivity, 93.3% specificity, 85% positive predictive value, and 97.7% negative predictive value in PROM diagnosis. The mean creatinine values in the PROM and non-PROM groups were 0.39 (0.31) mg/dl and 0.04 (0.10) mg/dl, respectively (p=0.05).Conclusion: Creatinine assessment in vaginal flushing fluid can be a cheaper, faster, easily accessible and highly accurate test with 94.4% sensitivity and 93.3% specificity in PROM diagnosis.

Assisted reproductive technology is associated with premature rupture of membranes

Objective: To evaluate the elements more likely to be associated with premature rupture of membrane (PROM) in patients that use assisted reproductive technology (ART).Materials and methods: A retrospective case-control study was performed from January 2014 to August 2017. We included 301 patients, 257 patients were without PROM in the non-PROM group and 44 patients with PROM in the PROM group.Results: In the PROM group, the rate of intracytoplasmic sperm injection (ICSI) and BMI were significantly higher than the non-PROM group. Moreover, the rate of preterm birth was significantly higher in the PROM group. When using logistic regression analysis to decrease the impact of confounding factors, it showed that overweight and ICSI were confirmed to be associated with PROM. After matching 1:2 by BMI, the process of controlled ovarian hyperstimulation was all similar in the two groups. What is more, the rate of twin pregnancies was significantly higher in the preterm PROM (PPROM) group compared with the term PROM group and twin pregnancies were associated with preterm birth.Conclusions: ART parameters ICSI may increase the risk of PROM. Single embryo transfer during ART should be supported to decrease the incidence of PPROM and losing weight is essential for patients before embarking on ART.

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.

Vaginal discharge concentrations of β-human chorionic gonadotropin, creatinine, and urea for the diagnosis of premature rupture of membranes.

To determine the diagnostic value of vaginal discharge concentrations of β human chorionic gonadotropin (β-hCG), creatinine, and urea to identify premature rupture of membranes (PROM). An observational cross-sectional study was conducted between 12 June, 2014, and 11 June, 2015, among 120 women who were admitted to an Iranian hospital at 28-41weeks of pregnancy. Women with positive pooling and nitrazine test results were assigned to the PROM group (n=60), whereas those with negative test results were assigned to the control group (n=60). Samples of vaginal discharge were obtained. Mean concentrations of β-hCG, urea, and creatinine were all higher in the PROM group than in the control group (all P=0.001). The diagnostic accuracies as defined by area under the curve for creatinine, urea, and β-hCG were 0.891, 0.895, and 0.908, respectively. The corresponding optimal cutoff values were 20.33μmol/L, 0.94mmol/L, and 39.5IU/L, respectively. The vaginal discharge concentrations of all three markers exhibited favorable predictive value for the diagnosis of PROM; however, β-hCG showed greater diagnostic accuracy than either urea or creatinine.

Effect of Premature Rupture of Membranes on Induction of Labor: A Historical Cohort Study.

Objective The aim of this study was to assess the influence of premature rupture of membranes (PROM) on the induction of labor. Material and Method This historical cohort study analyzed 1861 inductions of labor at term using misoprostol which occurred between 2010 and 2015. Exclusion criteria included intrauterine fetal death, previous cesarean section, and fetal structural or chromosomal anomalies. Induction of labor for PROM (PROM group) was compared to induction for other indications (no-PROM group); the primary outcome measure was the cesarean section rate. Results The cesarean section rate for the PROM group was significantly lower (21.9% vs. 26.3%, p = 0.029). The induction-to-delivery interval was shorter (mean: 972 [854 – 6734] min vs. 1741 [97 – 10 834] min, p < 0.0001) and the rates of vaginal birth within 24 hours (80.9 vs. 52.0%, p = 0.0001) and 48 hours (98.4 vs. 85.3%, p = 0.0001) were higher in the PROM group. The impact of PROM on the cesarean section rate was not significant in multivariate analysis; however, PROM was found to have the greatest effect on the induction-to-delivery interval (p < 0.0001). Conclusion Premature rupture of membranes significantly affects various outcome measures when delivery is induced, particularly the induction-to-delivery interval.

Transient amniotic fluid leakage after fetoscopic laser photocoagulation for twin-twin transfusion syndrome.

Iatrogenic premature rupture of membrane (PROM) is one of the major complications related to fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). However, amniotic fluid leakage (AFL) sometimes spontaneously disappears. This study evaluated the incidence and clinical characteristics of transient AFL after FLP. We retrospectively reviewed pregnancies that underwent FLP for TTTS at a single center. Patients with apparent AFL within 2 weeks after FLP were divided into two groups: transient AFL, defined by the disappearance of fluid leakage within a week; and PROM, if AFL persisted continuously for more than a week or premature birth occurred, including miscarriage, within a week of the first symptom of AFL. Among 201 monochorionic twin pregnancies that underwent FLP during the study period, nine patients (4.5%) were diagnosed with AFL within a week after FLP. Four patients (2.0%) were classified as transient AFL and five as PROM. Median gestational age at FLP was not significantly different between the groups; operative time in the PROM group was significantly longer (P = 0.01). The surgery to delivery interval and median gestational age at delivery were greater in the transient AFL group (87.8 vs 17.6 days, P = 0.01; 32.5 vs 23.6 weeks, P = 0.01, respectively). The incidence of transient AFL after FLP was 2%. Perinatal outcomes of transient AFL might be better than that of PROM.

Mother-to-child transmission of human immunodeficiency virus (HIV) among HIV-infected pregnant women on highly active anti-retroviral therapy with premature rupture of membranes at term

Purpose: To determine mother-to-child transmission (MTCT) rate and associated risk factors of human immune-deficiency virus (HIV) among HIV-infected pregnant women with term premature rupture of membranes (PROM) in comparison with those without PROM at term.Materials and methods: All optimally managed HIV-positive pregnant women of Nnamdi Azikiwe University Teaching Hospital, on highly active anti-retroviral therapy (HAART) who had PROM at term were enrolled. Maternal HIV-1 viral load was not assessed. Follow up was for a minimum of 18 months for evidence of HIV infection.Results: Of the 121 women with PROM at term, 46 (38.0%) were HIV sero-positive, 22/46 (47.8%) of which had their babies followed up till 18 months. The mean latency period was 10.5 ± 5.3 h in PROM group. Apart from duration of PROM (OR = 0.01; 95%CI = 0.00–0.13; p < 0.001), there were no differences in risk factors seen between cases and controls (p > 0.05). Of the 22 (47.8%) babies followed-up in the PROM group and 13 in non-PROM group, none tested positive to HIV, given an MTCT rate of 0%.Conclusions: MTCT rate was 0% following term PROM and in women without PROM. Since maternal HIV-1 viral load was not assessed, we need to be critical while interpreting the findings.

Difference of Serum MMP9 and TNF 􀁃 Level in Preterm and Term Premature Rupture of Membranes

Objective: To examine the difference between matrix metalloproteinase‐ 9 (MMP‐9) and Tumor Necrosis Factor 􀁃 (TNF‐􀁃) serum levels in preterm and term premature rupture of membranes (PROM). &#x0D; Method: Our study employed an observational cross sectional approach. Seventy samples were divided into two groups, 35 samples with preterm PROM (28‐36 weeks gestational age) and 35 samples with PROM at term pregnancy (37‐42 weeks gestational age). Both groups underwent examination for serum MMP‐9 and TNF‐􀁃 concentration using ELISA method. Statistical analysis was done using ttest. &#x0D; Result: Serum levels of MMP‐9 in the preterm PROM group was 2860.68K627.32 ng/ml, which was significantly higher than in the PROM at term pregnancy group 2549.74K657.15 ng/ml (p=0.04). Likewise, the average serum level of TNF‐􀁃 in subjects with preterm PROM was 12,086.60K5384.51 ng/ml, significantly higher in comparison to PROM at term pregnancy, which was 6422.51K2645.32 ng/ml (p=0.00).&#x0D; Conclusion: Serum levels of MMP‐9 and TNF‐􀁃 in preterm PROM is significantly higher than that in PROM at term pregnancy.&#x0D; Keywords: MMP‐9, premature rupture of membranes, preterm, term, TNF‐􀁃