Preterm Prelabor Rupture Of Membranes Research Articles

Does admission anemia increase risk of postpartum morbidity among patients with preterm prelabor rupture of membranes?

Maternal morbidity in the setting of preterm prelabor rupture of membranes (PPROM) is common. Identifying modifiable risk factors may reduce morbidity in patients with PPROM. Anemia is associated with maternal morbidity in other clinical scenarios. The objective of this study was to measure the association between admission anemia and postpartum (PP) maternal morbidity among patients with PPROM.

Accounts of adverse neonatal effects in preterm prelabor rupture of membranes: anticipating maternal platelet indices and C-reactive protein as effective biomarkers

Present study aimed at determining maternal platelet indices in preterm prelabor rupture of membranes with adverse neonatal consequences. Comparing maternal C-reactive protein efficacy and platelet indices in predicting outcomes. Herein, 82 women with preterm prelabor rupture of membranes and 78 women with spontaneous preterm labor were studied. All women undertook complete blood count tests. The group of preterm prelabor rupture of membranes undertook additional C-reactive protein tests. Neonatal outcome data were compiled post-delivery, and results were compared. C-reactive protein efficacy and platelet indices helped in predicting neonatal outcomes in the group of preterm prelabor rupture of membranes using receiver operating characteristic curve analysis. Women with preterm prelabor rupture of membranes had increased levels of mean platelet volume (8.41 vs. 7.66; p<0.0001), platelet crit (0.223 vs. 0.194; p=0.002), and higher prevalence of early-onset neonatal sepsis (19.5% vs. 2.6%; p<0.001) compared to those with spontaneous preterm labor. In the group of preterm prelabor rupture of membranes, mean platelet volume, platelet crit, and C-reactive protein were significantly associated with respiratory distress syndrome and early-onset neonatal sepsis. The cut-off values mean platelet volume ≥ 8.55fL, platelet crit of ≥0.255%, and C-reactive protein of 5mg/L predicted respiratory distress syndrome with an area under the curve of 0.84, 0.92 and 0.72, the sensitivity of 83%, 91%, and 62%, and specificity of 78.1%, 92.2%, and 68.2%, respectively. The cut-off values of mean platelet volume ≥ 9.05 fL, platelet crit of ≥0.283%, and C-reactive protein of 6mg/L predicted early-onset neonatal sepsis with an area under the curve of 0.86, 0.90 and 0.65, sensitivity of 87.5%, 93%, and 56%, and specificity of 75%, 85%, and 66%, respectively. Maternal mean platelet volume and platelet crit are useful predictors of neonatal respiratory distress syndrome and early-onset neonatal sepsis in mothers with preterm prelabor rupture of membranes and werebetter predictors of neonatal outcomes than C-reactive protein.

Accounts of adverse neonatal effects in preterm prelabor rupture of membranes: anticipating maternal platelet indices and C-reactive protein as effective biomarkers

Present study aimed at determining maternal platelet indices in preterm prelabor rupture of membranes with adverse neonatal consequences. Comparing maternal C-reactive protein efficacy and platelet indices in predicting outcomes. Herein, 82 women with preterm prelabor rupture of membranes and 78 women with spontaneous preterm labor were studied. All women undertook complete blood count tests. The group of preterm prelabor rupture of membranes undertook additional C-reactive protein tests. Neonatal outcome data were compiled post-delivery, and results were compared. C-reactive protein efficacy and platelet indices helped in predicting neonatal outcomes in the group of preterm prelabor rupture of membranes using receiver operating characteristic curve analysis. Women with preterm prelabor rupture of membranes had increased levels of mean platelet volume (8.41 vs. 7.66; p<0.0001), platelet crit (0.223 vs. 0.194; p=0.002), and higher prevalence of early-onset neonatal sepsis (19.5% vs. 2.6%; p<0.001) compared to those with spontaneous preterm labor. In the group of preterm prelabor rupture of membranes, mean platelet volume, platelet crit, and C-reactive protein were significantly associated with respiratory distress syndrome and early-onset neonatal sepsis. The cut-off values mean platelet volume ≥ 8.55fL, platelet crit of ≥0.255%, and C-reactive protein of 5mg/L predicted respiratory distress syndrome with an area under the curve of 0.84, 0.92 and 0.72, the sensitivity of 83%, 91%, and 62%, and specificity of 78.1%, 92.2%, and 68.2%, respectively. The cut-off values of mean platelet volume ≥ 9.05 fL, platelet crit of ≥0.283%, and C-reactive protein of 6mg/L predicted early-onset neonatal sepsis with an area under the curve of 0.86, 0.90 and 0.65, sensitivity of 87.5%, 93%, and 56%, and specificity of 75%, 85%, and 66%, respectively. Maternal mean platelet volume and platelet crit are useful predictors of neonatal respiratory distress syndrome and early-onset neonatal sepsis in mothers with preterm prelabor rupture of membranes and werebetter predictors of neonatal outcomes than C-reactive protein.

Quincke versus Diamond-Tip Needles for Entry in Placental Laser Surgery for Twin-to-Twin Transfusion Syndrome.

Chorioamniotic membrane separation (CAS), preterm prelabor rupture of membranes (PPROM), and preterm delivery (PTD) remain as major complications of fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS). We sought to examine whether use of Quincke-tip needles for initial entry during FLP reduces the risk of these complications. This is a secondary analysis of prospectively collected data from patients that had FLP for TTTS at a single tertiary care center (2011-2021). We excluded patients for whom direct trocar entry was used. Patients for whom a Quincke-tip needle was used were compared to those for whom a diamond-tip needle was used during Seldinger entry. Demographics, ultrasound findings and operative characteristics were compared between groups. Postoperative outcomes and complications (including CAS, PPROM, and PTD) were also compared. Multivariate logistic regression models were fit to assess independent risk factors for complications. 386 patients met inclusion criteria; Quincke-tip needles were used in 81 (21.0%) cases, while diamond-tip needles were used in 305 (79.0%). Rates of CAS (11.1 vs. 9.5%, p = 0.67) and PPROM (44.4 vs. 41.0%, p = 0.57) were similar between groups. Patients in the Quincke-tip group delivered 1.5 weeks earlier than those in the diamond-tip group (30.5 vs. 32.0 weeks, p = 0.01). However, these patients were more likely to be delivered for maternal (35.9 vs. 19.0%) and fetal (23.1 vs. 15.3%) indications (p < 0.01). In multivariate analysis, needle type was not identified as an independent risk factor for PPROM. However, Quincke-tip needle use was associated with PTD less than 32 weeks (aOR 1.74, 95% CI: 1.02-2.97, p = 0.043). Membrane complications following FLP were not associated with the needle type used for entry. Earlier delivery in the Quincke-tip group was likely attributable to higher rates of delivery for maternal and fetal indications, and not membrane complications. The needle chosen for entry is likely best determined by operator preference.

Does anemia impact pregnancy latency among patients with preterm pre-labor rupture of membranes (PPROM)?

Anemia has been associated with multiple adverse pregnancy outcomes, including preterm birth and maternal infections. Little is known about the association between anemia and outcomes after preterm pre-labor rupture of membranes (PPROM). The objective of this study was to explore the association between admission anemia on latency after PPROM.

Diagnostic value of ultrasonographic assessment of fetal thymus gland size in pregnancies associated with the preterm prelabor rupture of membranes

Background: Preterm prelabor rupture of membranes (PPROM) is responsible for approximately one third of preterm deliveries. Prenatal sonographic (US) assessment of the fetal thymus has become available. This research was done to investigate the role of ultrasonographic assessment of fetal thymus size in pregnancy associated with preterm premature rupture of membrane and its relationship with fetal outcome.Methods: This prospective controlled observational study was carried out on 60 cases with maternal age from 18 to 40 years old, gestational age between 24 and 36 weeks, singleton pregnancy and associated with PROM. Cases were subdivided into two groups Group A: 30 cases with PROM, Group B: 30 normal at the same gestational age. All cases were subjected to history taking, obstetric history, maternal medical history, investigation studies and ultrasound study. Results: The amniotic fluid index had a significant decrease in group A compared with B, and the gestational diabetes mellitus had a significant increase in group A compared with B. The small fetal thymus size had a significant increase in group A compared with B (p =0.013). The Puerperal endomyometritis had a significant increase in group A (30%) compared with B (0%). The Apgar score at 5 mins (p<0.001) and Apgar score (p= 0.042) at 10 mins were significantly decreased in group A compared with B.Conclusions: In pregnancy associated with preterm premature rupture of membranes, small fetal thymus might be associated with histologic chorioamnionitis, higher rate of perinatal mortality and short‐ and long‐term neonatal morbidity however many cases remained clinically silent.

Effect of preoperative low-normal cervical length on perinatal outcome after laparotomy-assisted fetoscopic spina bifida repair.

To determine if preoperative cervical length in the low-normal range increases the risk of adverse perinatal outcome in patients undergoing fetoscopic spina bifida repair. This was a retrospective cohort study of patients who underwent fetal spina bifida repair between September 2014 and May 2022 at a single center. Cervical length was measured on transvaginal ultrasound during the week before surgery. Eligibility for laparotomy-assisted fetoscopic spina bifida repair was as per the criteria of the Management of Myelomeningocele Study, although maternal body mass index (BMI) up to 40 kg/m2 was allowed. Laparotomy-assisted fetoscopic spina bifida repair was performed, with carbon dioxide insufflation via two 12-French ports in the exteriorized uterus. All patients received the same peri- and postoperative tocolysis regimen, including magnesium sulfate, nifedipine and indomethacin. Postoperative follow-up ultrasound scans were performed either weekly (< 32 weeks' gestation) or twice a week (≥ 32 weeks). Perinatal outcome was compared between patients with a preoperative cervical length of 25-30 mm vs those with a cervical length > 30 mm. Logistic regression analyses and generalized linear mixed regression analyses were used to predict delivery at less than 30, 34 and 37 weeks' gestation. The study included 99 patients with a preoperative cervical length > 30 mm and 12 patients with a cervix 25-30 mm in length. One further case which underwent spina bifida repair was excluded because cervical length was measured > 1 week before surgery. No differences in maternal demographics, gestational age (GA) at surgery, duration of surgery or duration of carbon dioxide uterine insufflation were observed between groups. Cases with low-normal cervical length had an earlier GA at delivery (median (range), 35.2 (25.1-39.7) weeks vs 38.2 (26.0-40.9) weeks; P = 0.01), higher rates of delivery at < 34 weeks (41.7% vs 10.2%; P = 0.01) and < 30 weeks (25.0% vs 1.0%; P < 0.01) and a higher rate of preterm prelabor rupture of membranes (PPROM) (58.3% vs 26.3%; P = 0.04) at an earlier GA (mean ± SD, 29.3 ± 4.0 weeks vs 33.0 ± 2.4 weeks; P = 0.05) compared to those with a normal cervical length. Neonates of cases with low-normal cervical length had a longer stay in the neonatal intensive care unit (20 (7-162) days vs 9 (3-253) days; P = 0.02) and higher rates of respiratory distress syndrome (50.0% vs 14.4%; P < 0.01), sepsis (16.7% vs 1.0%; P = 0.03), necrotizing enterocolitis (16.7% vs 0%; P = 0.01) and retinopathy (33.3% vs 1.0%; P < 0.01). There was an association between preoperative cervical length and risk of delivery at < 30 weeks which was significant only for patients with a maternal BMI < 25 kg/m2 (odds ratio, 0.37 (95% CI, 0.07-0.81); P = 0.02). Low-normal cervical length (25-30 mm) as measured before in-utero laparotomy-assisted fetoscopic spina bifida repair may increase the risk of adverse perinatal outcomes, including PPROM and preterm birth, leading to higher rates of neonatal complications. These data warrant further research and are of critical relevance for clinical teams considering the eligibility of patients for in-utero spina bifida repair. Based on this evidence, patients with a low-normal cervical length should be aware of their increased risk for adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Neonatal survival after serial amnioinfusions for fetal bilateral renal agenesis: report from the raft trial

Bilateral renal agenesis (BRA) in the fetus leads to anhydramnios and lethal pulmonary hypoplasia. We report obstetric outcomes and neonatal survival/complications for pregnancies undergoing serial amnioinfusions (AIs) in the completed BRA arm of the Renal Anhydramnios Fetal Therapy (RAFT) trial (NCT03101891). RAFT is a nonrandomized prospective clinical trial conducted at 9 North American Fetal Therapy Network sites to assess the safety and efficacy of serial AIs to treat BRA. The primary outcome was postnatal survival ≥ 14 d and dialysis access placement. Inclusion required ultrasound (US) confirmed isolated BRA, normal genetic testing, and first therapeutic AI prior to 26 w gestational age (GA). AIs were done with US guidance to maintain adequate amniotic fluid volume during pregnancy. All delivered at a RAFT center. Enrollment was suspended in July 2022 after Data Safety Monitoring Board review of neonatal morbidity and survival data. Twenty maternal-fetal pairs underwent serial AIs (Figure). There were 18 (90%) livebirths, median GA 32 w [IQR 31.8, 34]. Obstetric complications included preterm prelabor rupture of membranes (60%), chorioamniotic membrane separation (30%) and bleeding (20%). 78% (95% CI, 0.57-0.99) (n=14) of neonates survived to ≥ 14 d and had placement of dialysis access (Table). Factors associated with survival to the primary endpoint included more AIs, GA at birth ≥ 32 w, and higher birthweight (BW). 5/14 infants who met the primary outcome survived to discharge on peritoneal dialysis (PD) at a median age of 25 w [IQR 12, 32]; 2 of the 5 died after discharge. 3 of the 5 infants discharged home and one who remains in the NICU sustained strokes. Serial AIs initiated before 26 w in pregnancies with BRA mitigated lethal pulmonary hypoplasia. Survival to discharge on PD and beyond was considerably lower than survival to ≥ 14 d and strongly associated with GA and BW, highlighting the additional morbidity and mortality independent of lung function for infants lacking kidneys. Recruitment for the non-BRA fetal renal failure arm of the trial continues.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Assessing risk factors for iatrogenic preterm prelabor rupture of membranes after fetoscopic laser ablation

Assessing risk factors for iatrogenic preterm prelabor rupture of membranes after fetoscopic laser ablation

Neonatal outcomes in an expectantly managed prospective cohort of late preterm prelabor rupture of membranes

Neonatal outcomes in an expectantly managed prospective cohort of late preterm prelabor rupture of membranes

Booster course of antenatal corticosteroids after preterm prelabor rupture of membranes, double-blind randomized trial

Booster course of antenatal corticosteroids after preterm prelabor rupture of membranes, double-blind randomized trial

Heavy prenatal alcohol exposure and obstetric and birth outcomes: a Danish nationwide cohort study from 1996 to 2018

Heavy alcohol use during pregnancy can harm the fetus, but the relation to most obstetric outcomes remains unclear. We therefore aimed to describe maternal characteristics and estimate the association between heavy prenatal alcohol exposure and 22 adverse obstetric and birth outcomes. We carried out a Danish nationwide register-based historical cohort study, including all singleton births from Jan 1, 1996, to Dec 31, 2018. Births of women who had emigrated to Denmark were excluded from the study due to missing data and women who migrated within 1 year before or during pregnancy were also excluded due to loss to follow-up. Data were extracted from the Danish Medical Birth Register, the Danish National Patient Registry, the Danish National Prescription Registry, the Danish Civil Registration System, and the Population Education Register. Logistic regression models were used to estimate crude and adjusted odds ratios (ORs) of obstetric and birth outcomes. Heavy alcohol use was defined by hospital contacts for alcohol-attributable diagnoses given to the mother, her infant, or both, or maternal redeemed prescriptions for drugs to treat alcohol dependence within 1 year before or during pregnancy. Of 1 191 295 included births, 4823 (0·40%) were defined as heavily alcohol-exposed and 1 186 472 were categorised as a reference group with no identified heavy prenatal alcohol exposure. Heavy-alcohol-exposed births more often had mothers with psychiatric diagnoses (49·8% vs 9·6%), substance use (22·0% vs 0·4%), tobacco use (64·3% vs 15·8%), and low educational level (64·1% vs 17·6%) than did the reference group. For heavy-alcohol-exposed births, significantly increased adjusted ORs were found for small for gestational age (OR 2·20 [95% CI 1·97-2·45]), preterm birth (OR 1·32 [1·19-1·46]), haemorrhage in late pregnancy (OR 1·25 [1·05-1·49]), and preterm prelabour rupture of membranes (OR 1·18 [1·00-1·39]). Decreased adjusted ORs were found for postpartum haemorrhage (500-999 mL; OR 0·80 [95% CI 0·69-0·93]), gestational diabetes (OR 0·81 [0·67-0·99]), planned caesarean section (OR 0·82 [0·72-0·94]), pre-eclampsia and eclampsia (OR 0·83 [0·71-0·96]), and abnormalities of forces of labour (OR 0·92 [0·86-0·99]). Heavy prenatal alcohol exposure is associated with adverse obstetric and birth outcomes and high proportions of maternal low educational level, psychiatric disease, and lifestyle risk behaviours. These findings highlight a need for holistic public health programmes and policy attention on improving pre-conceptional care and antenatal care. The Obel Family Foundation, The Health Foundation, TrygFonden, Aase and Ejnar Danielsens Foundation, The North Denmark Region Health Science and Research Foundation, Holms Memorial Foundation, Dagmar Marshalls Foundation, the A.P. Møller Foundation, King Christian X Foundation, Torben and Alice Frimodts Foundation, the Axel and Eva Kastrup-Nielsens Foundation, the A.V. Lykfeldts Foundation.

Neutrophil-lymphocyte ratio: a marker for microbial invasion of amniotic cavity in preterm prelabor rupture of membranes

Neutrophil-lymphocyte ratio: a marker for microbial invasion of amniotic cavity in preterm prelabor rupture of membranes

Cervical excisional treatment increases the risk of intraamniotic infection in subsequent pregnancy complicated by preterm prelabor rupture of membranes

Excisional treatment of cervical intraepithelial neoplasia or very early stages of cervical cancer increases the risk of preterm prelabor rupture of membranes in subsequent pregnancies. The risk increases with the length of the excised cone. The subset of cases with preterm prelabor rupture of membranes and a history of cervical excisional treatment could also be at higher risk of intraamniotic infection/inflammation. However, there is a paucity of relevant information on this subject. This study aimed to assess the differences in the rates of intraamniotic infection/inflammation and early-onset neonatal sepsis between singleton preterm prelabor rupture of membranes pregnancies without and with a history of cervical excisional treatment, and to investigate the association between these complications of preterm prelabor rupture of membranes and the excised cone length. This retrospective cohort study included 770 preterm prelabor rupture of membranes pregnancies in which transabdominal amniocentesis was performed as part of standard clinical management to assess the intraamniotic environment. The maternal and perinatal medical records of all included women were reviewed to obtain information on the absence or presence of history of cervical excisional treatment and neonatal outcomes. Women whose records contained any information on history of cervical excisional treatment were contacted by phone and in writing to inform them of the study and request permission to collect relevant information from their medical records. Women were divided into 4 subgroups according to the presence of microorganisms and/or their nucleic acids (through culturing and molecular biology methods) in amniotic fluid and/or intraamniotic inflammation (through amniotic fluid interleukin-6 concentration evaluation): intraamniotic infection (presence of both), sterile intraamniotic inflammation (intraamniotic inflammation alone), microbial invasion of the amniotic cavity without inflammation (presence of microorganisms and/or their nucleic acids in amniotic fluid alone), and negative amniotic fluid for infection/inflammation (absence of both). A history of cervical excisional treatment was found in 10% (76/765) of the women. Of these, 82% (62/76) had a history of only 1 treatment, and information on cone length was available for 97% (60/62) of them. Women with a history of cervical excisional treatment had higher rates of intraamniotic infection (with, 25% [19/76] vs without, 12% [85/689]; adjusted odds ratio, 2.5; adjusted P=.004), microbial invasion of the amniotic cavity without inflammation (with, 25% [19/76] vs without, 11% [74/689]; adjusted odds ratio, 3.1; adjusted P<.0001), and early-onset neonatal sepsis (with, 8% [11/76] vs without, 3% [23/689]; adjusted odds ratio, 2.9; adjusted P=.02) compared with those without such history. Quartiles of cone length (range: 3-32 mm) were used to categorize the women into 4 quartile subgroups (first: 3-8 mm; second: 9-12 mm; third: 13-17 mm; and fourth: 18-32 mm). Cone length of ≥18 mm was associated with higher rates of intraamniotic infection (with, 29% [5/15] vs without, 12% [85/689]; adjusted odds ratio, 3.0; adjusted P=.05), microbial invasion of the amniotic cavity without inflammation (with, 40% [6/15] vs without, 11% [74/689]; adjusted odds ratio, 6.1; adjusted P=.003), and early-onset neonatal sepsis (with, 20% [3/15] vs without, 3% [23/689]; adjusted odds ratio, 5.7; adjusted P=.02). History of cervical excisional treatment increases risks of intraamniotic infection, microbial invasion of the amniotic cavity without inflammation, and development of early-onset neonatal sepsis in a subsequent pregnancy complicated by preterm prelabor rupture of membranes.

Amniotic fluid soluble CD93 is elevated in the presence of intra-amniotic inflammation in preterm prelabor rupture of the fetal membranes.

To determine the soluble form of CD93 (sCD93) concentration in amniotic fluid from pregnancies complicated by preterm prelabor rupture of membranes (PPROM) based on the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation. A total of 144 women with a singleton pregnancy complicated by PPROM were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis. MIAC was determined by the combination of cultivation and non-cultivation techniques. Intra-amniotic inflammation was characterized as a concentration of interleukin-6 3,000 pg/mL in amniotic fluid. Women were categorized in the following groups: i) intra-amniotic infection (both MIAC and intra-amniotic inflammation), ii) sterile intra-amniotic inflammation (intra-amniotic inflammation per se), iii) colonization of the amniotic cavity (MIAC per se), and iv) negative amniotic fluid (without both MIAC and intra-amniotic inflammation). Levels of sCD93 in amniotic fluid were assessed by ELISA. A difference in the levels of sCD93 in amniotic fluid was found among the groups of women with intra-amniotic infection, sterile intra-amniotic inflammation, colonization of the amniotic cavity, and negative amniotic fluid (intra-amniotic infection: median 22.3 ng/mL, sterile intra-amniotic inflammation: median 21.0 ng/mL, colonization of the amniotic cavity: 8.7 ng/mL, negative: median 8.7 ng/mL; P < 0.0001). Intra-amniotic inflammation in PPROM, irrespectively of the presence or absence of MIAC, is associated with the elevation of the level of sCD93 in amniotic fluid.

PP61 Plugging the Gap of Fetoscopy in Congenital Diaphragmatic Hernia Pregnancies: Value for Money?

IntroductionFetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) fetuses increases the neonatal survival rate. However, FETO also increases the number of preterm prelabour rupture of membranes (PPROM) and preterm deliveries (PTDs) as fetal membrane defects after fetoscopy do not spontaneously heal. To solve this issue, an advanced sealing plug is being developed. Through early-stage health economic modelling, we estimated the potential value of this innovative plug in terms of costs and effects and determined the properties for it to become cost-effective.MethodsWe applied early-stage health economic modelling to the case of performing FETO in singleton pregnant women whose fetus is prenatally diagnosed with CDH. We simulated a cohort of women using a state-transition model over a 45-year time horizon. In our best-case scenario analysis, we compared the current care strategy to a perfect plug strategy, which reduces PPROM and PTDs by 100 percent, to determine the maximum quality-adjusted life years (QALYs) gained and costs saved. Using threshold analysis, we determined the minimum percentage of reduction in PPROM and PTDs for the plug to be considered cost-effective. Model parameters’ impact on outcomes was investigated in a sensitivity analysis.ResultsOur model indicated that a perfect plug strategy would yield an additional 1.94 QALYs at a cost decrease of EUR 2,554 per patient per year. These values were strongly influenced by the percentage of very preterm deliveries. Threshold analysis showed that, for EUR 500 per plug, the plug strategy needs a minimum relative reduction of 1.83 percent in PPROM and PTDs (i.e., PPROM: 47.50 to 46.63 %, PTDs: 71.50 to 70.19 %) to be cost-effective.ConclusionsOur model-based approach showed clear potential for the plug strategy when applied in the context of FETO for CDH fetuses, as only a small reduction in PPROM and PTDs is needed for the plug to be cost-effective. Its value is expected to be even higher when used in conditions suffering from more very preterm deliveries. Continuation of investment in the innovation’s research and development seems to provide value for money.

Solomon technique vs selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome: systematic review and meta-analysis of maternal and perinatal outcomes.

To ascertain maternal and perinatal outcomes of monochorionic twin pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated with the Solomon technique compared with selective fetoscopic laser photocoagulation (SFLP) of placental anastomoses. MEDLINE, EMBASE and The Cochrane Library were searched to identify relevant studies. The outcomes observed were perinatal loss and survival, preterm prelabor rupture of membranes (PPROM), preterm birth (PTB), gestational age (GA) at delivery, interval between laser treatment and delivery, maternal bleeding, septostomy or chorioamniotic separation, placental abruption, twin anemia-polycythemia sequence (TAPS), recurrence of TTTS, neonatal morbidity and neurological morbidity. Random-effects head-to-head meta-analyses were used to analyze the data. Pooled odds ratios (OR) and mean differences (MD) and their 95% CIs were calculated. Nine studies were included in the systematic review. There was generally no difference in the main maternal and pregnancy characteristics between pregnancies treated using the Solomon technique and those treated using SFLP of placental anastomoses. The risks of fetal loss (pooled OR, 0.69 (95% CI, 0.50-0.95); P = 0.023), neonatal death (pooled OR, 0.37 (95% CI, 0.16-0.84); P = 0.018) and perinatal loss (pooled OR, 0.56 (95% CI, 0.38-0.83); P = 0.004) were significantly lower in pregnancies treated using the Solomon technique than in those treated with SFLP. Likewise, pregnancies treated using the Solomon technique had a significantly higher chance of survival of at least one twin (pooled OR, 2.31 (95% CI, 1.03-5.19); P = 0.004) and double survival (pooled OR, 2.18 (95% CI, 1.29-3.70); P = 0.001). There was no difference in the risk of PPROM (P = 0.603), PPROM within 10 days from laser surgery (P = 0.982), PTB (P = 0.207), maternal bleeding (P = 0.219), septostomy or chorioamniotic separation (P = 0.224) or chorioamnionitis (P = 0.135) between the two groups, while the risk of placental abruption was higher in pregnancies treated using the Solomon technique (pooled OR, 2.90 (95% CI, 1.55-5.44); P = 0.001). In the Solomon technique group, pregnancies delivered at a significantly earlier GA than did those treated with SFLP (pooled MD, -0.625 weeks (95% CI, -0.90 to -0.35 weeks); P < 0.001), while there was no difference in the interval between laser treatment and delivery (P = 0.589). The rate of recurrence of TTTS was significantly lower in pregnancies undergoing the Solomon technique (pooled OR, 0.43 (95% CI, 0.22-0.81); P < 0.001), while there was no difference in the risk of TAPS between the two groups (P = 0.792). Finally, there was no difference in the overall risk of neonatal morbidity (P = 0.382) or neurological morbidity (P = 0.247) between the two groups. Monochorionic twin pregnancies complicated by TTTS undergoing laser treatment using the Solomon technique had a significantly higher survival rate and lower recurrence rate of TTTS but were associated with an increased risk of placental abruption and earlier GA at delivery compared to those treated with SFLP. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Cervical pessary for preventing preterm birth in singleton pregnancies.

Cervical pessary for preventing preterm birth in singleton pregnancies.

Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review

Subchorionic hemorrhage (SCH) in the second and third trimesters of pregnancy can be associated with maternal morbidity and fetal morbidity/mortality. Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion. The aim of this review is to describe SCH in second and third trimesters, risk factors, diagnosis, maternal and fetal outcomes, and management of this uncommon pregnancy complication. A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. There were 123 abstracts and/or articles reviewed, with 48 articles being the basis of review. The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy. The diagnosis is usually made by ultrasound imaging. Subchorionic hemorrhage in second and third trimesters has been associated with several adverse fetal outcomes including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity. There is no proven treatment for SCH, although there are several investigational therapies reported. Subchorionic hemorrhage can be complex and difficult to manage in the second and third trimesters. There are no recommendations or guidelines for management; however, serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered particularly if the SCH is large or treatment requires a maternal blood transfusion. Subchorionic hemorrhage in the second and third trimester is associated with poor fetal outcomes and maternal morbidity, especially if the SCH is significant.

Association of Chlamydia trachomatis infection with pregnancy outcomes among Japanese pregnant women: The Japan environment and children's study.

This study aimed to investigate the impact of Chlamydia trachomatis (CT) infection on pregnancy outcome in pregnant Japanese women. We utilized the data from a nationwide birth cohort study, the Japan Environment and Children's Study (JECS), for this study. We enrolled 26,385 individuals who could refer to data on pregnancy outcomes and confounding factors, with data on CT. Binominal logistic regression models were used to determine whether pregnant women with CT positivity were at more risk of experiencing adverse pregnancy outcomes, preterm birth (PTB), preterm prelabor rupture of membrane (pPROM), low birth weight (LBW) infants, small for gestational age (SGA) births, or hypertensive disorders of pregnancy (HDP). After adjusting for maternal age, parity, marital status, smoking status, and education status, there were no significantly increased risks of PTB, pPROM, LBW infants, SGA, and HDP in the odds ratios. No significant increase in the risk of adverse pregnancy outcomes was observed in any of the subgroup analyses, which were limited to the pregnancy women in Fukushima prefecture, where CT screening could be confirmed at 28-30 weeks of gestation. We believe that the results of this study will make a significant contribution to the future of medical care for pregnant women in Japan. Our findings are important for medical practitioners to contribute to the future medical treatment of Japanese pregnant women, and also to contribute to pre-conception care for Japanese society as a whole, including pregnant women.