Preterm Premature Rupture Of Fetal Membranes Research Articles

Interleukin-6 bedside test in detecting chorioamnionitis in women with preterm premature rupture of fetal membranes.

About 30-80% of preterm deliveries following preterm premature rupture of fetal membranes (PPROM) are complicated by histological chorioamnionitis. To evaluate the accuracy of Interleukin-6 (IL-6) bedside test in detecting chorioamnionitis in women with PPROM. One hundred and ten (110) pregnant women with PPROM > 24 and < 34 weeks' gestation, admitted for conservative management were included in this study. Participants were examined on admission using sterile speculum examination for assessment of IL-6 in the cervico-vaginal secretions using the IL-6 bedside test. The IL-6 bedside test was repeated for all participants once termination of pregnancy (TOP) decided. After TOP, placenta, umbilical cord, and fetal membranes samples were examined for histologic detection of chorioamnionitis (gold standard). The histological results were compared with IL-6 bedside test results to evaluate the accuracy of IL-6 bedside test in detecting chorioamnionitis in women with PPROM. The IL-6 bedside test had 98.6% sensitivity, 94.7% specificity, 97.3% positive predictive value (PPV), 97.3% negative predictive value (NPV) and 97.3% overall accuracy in detecting chorioamnionitis. The sensitivity, specificity, NPV and overall accuracy of IL-6 bedside test (98.6%, 94.7%, 97.3%, and 97.3%; respectively) were significantly higher than the clinical and laboratory parameters of chorioamnionitis (65.3%, 57.9%, 46.8%, and 62.7%; respectively) (p = 0.04, 0.02, 0.001 and 0.03; respectively). The IL-6 bedside test is an accurate, non-invasive bedside test with 98.6% sensitivity, 94.7% specificity, 97.3% PPV, 97.3% NPV, and 97.3% overall accuracy in detecting chorioamnionitis. The IL-6 bedside test had significantly higher sensitivity, specificity, NPV, and overall accuracy than the clinical and laboratory parameters of chorioamnionitis.

Prematurity risk in association with human papillomavirus infection

Prematurity is an important cause of neonatal morbidity and mortality. Recent studies have shown that human pa­pil­lo­mavirus (HPV) infection also extends to the newborn. During pregnancy, the risk of obstetric complications, such as preterm premature rupture of fetal membranes (PPROM), prematurity, preeclampsia and spontaneous abor­tion, increase through inflammatory changes induced in trophoblast cells and, thus, through histopathologically iden­ti­fied placental abnormalities. The prevalence of HPV is increasing among young population, with a peak around the age of 25 years old. In addition, other infectious diseases, such as bacterial vaginosis and tri­cho­mo­nia­sis, can also act to cause PPROM by similar me­ch­a­nisms. Worldwide, there are three types of inactivated HPV vaccines (bivalent, quadrivalent and 9-valent), with the latter (Gardasil-9®) being currently the most recommended for use in the general population. Even though HPV vaccination will never reach a 100% coverage, its implementation in na­tio­nal immunization programs worldwide is one of the key solutions needed in order to reduce the impact of pre­ma­tu­ri­ty on the newborn.

Plasma fibulin-1 levels during pregnancy and delivery: a longitudinal observational study

BackgroundFibulin-1 is an extracellular matrix protein expressed at high levels in the placenta. Elevated circulating fibulin-1 have been observed in women with severe pre-eclampsia, whereas low levels have been found in the fetal membranes, prior to membrane rupture. The aim of the study was primarily to evaluate plasma fibulin-1 during expected normal pregnancy and delivery, and secondarily to explore fibulin-1 levels in women developing pre-eclampsia or preterm premature rupture of fetal membranes (PPROM).MethodsFrom the historical longitudinal cohort originally consisting of 801 healthy Danish women with a singleton pregnancy, 128 women (632 samples) were selected. Of these, 107 women had normal pregnancies, nine experienced PPROM, and 12 pre-eclampsia. All samples were analyzed for fibulin-1, and levels were compared with blood donors. Differences in mean fibulin-1 between groups were estimated using a linear mixed model.ResultsThe mean concentration of fibulin-1 in 120 blood donors was 15.7 µg/mL, (25th-75th-percentiles, 12.3–18.2), with no significant difference in groups stratified by gender or age. Compared to baseline levels in week 12–20, fibulin-1 levels increased significantly from week 29–34 (estimated difference, 5.6 µg/mL; standard error, 1.7; p < 0.001) and 35–42 (12.5 µg/mL; 1.6; p < 0.001) and normalized after birth. The decrease at delivery tended to be more pronounced after elective (-7.0 µg/mL; 2.3; p = 0.002) and emergency (-5.6 µg/mL; 2.9; p = 0.05) cesarean section than after vaginal delivery (reference group). Women who developed PPROM had lower fibulin-1 levels throughout their pregnancies (-11.6 µg/mL; 4.2; p = 0.006). We did not observe a correlate between late pre-eclampsia and fibulin-1 (-0.2 µg/mL; 3.0; p = 0.9).ConclusionsFibulin-1 was above non-pregnant levels at week 12 and increased significantly throughout pregnancy. We observed an association between low levels of fibulin-1 and PPROM. Further studies are needed to examine if fibulin-1 could serve as biomarker for the risk of PPROM. However, its role in late preeclampsia is doubtful.Trial registrationThe study was conducted in accordance with the Declaration of Helsinki. The participants provided written informed consent, including storage for future use. The study was approved on July 18, 2005 by The Danish National Committee on Bioethics (No. KA 05065 and S-20,090,061) and the Danish Data Protection Agency.

Maternal Serum Haptoglobin Levels as a Marker of Preterm Premature Rupture of Membranes.

We aimed to investigate the prognostic value of maternal serum haptoglobin levels in patients presenting with preterm premature rupture of fetal membranes (PPROM) during the second and the third trimesters of pregnancy. In this case control study, 60 patients were recruited (30 pregnant women with PPROM between 26-34 weeks of gestation and 30 healthy, gestational-age-matched pregnant women without PPROM). White blood cell count (WBC), interleukin 6 (IL-6), C-reactive protein (CRP), sedimentation rate, and haptoglobin levels were measured. The mean age, gestational week, gravida, and parity of the 2 groups were statistically comparable (P>0.001). There was a statistically significant difference between the 2 groups in terms of haptoglobin values (p<0.001). The mean haptoglobin level was 115.5+33.1(mg/dl) in the PPROM group and 66.5+42.6 (mg/dl) in the control group. ROC curve analysis was performed to determine whether the level of haptoglobin alone could diagnose PPROM as an independent marker. It was shown that the level of 94.5 mg/dL for haptoglobin could indicate the diagnosis of PPROM with 80% sensitivity and specificity CONCLUSION: Maternal serum haptoglobin levels may be a diagnostic marker for suspected PPROM cases when membrane rupture diagnosis is not accurate based on physical examination and other diagnostic tests.

Serum Decorin and Biglycan as Potential Biomarkers to Predict PPROM in Early Gestation

Preterm birth is a leading cause of neonatal mortality in the US and globally, with preterm premature rupture of fetal membranes (PPROM) accounting for one third of preterm births. Currently no predictive diagnostics are available to precisely assess risk and potentially reduce the incidence of PPROM. Bigycan and decorin, the main proteoglycans present in human fetal membranes, are involved in the physiological maturation of fetal membranes as well as in the pathophysiology of preterm birth. The serum protein sex hormone-binding globulin (SHBG) has recently been identified as a predictor of spontaneous preterm birth. We hypothesize that the balance between serum decorin and biglycan on one hand and SHBG on the other hand may provide insight into the status of the fetal membranes in early pregnancy, thereby predicting PPROM prior to symptoms. Using chart review, 18 patients with confirmed cases of PPROM were identified from 2013-2016. Second trimester residual serum was retreived from freezer storage for these cases along with 5 matched controls for each case. The biomarkers biglycan, decorin and SHBG were analyzed first separately, then in combination to determine their ability to predict PPROM. The predictive score for the combined model displays an AUC = 0.774. The ROC curve of the predicted score has an optimal threshold of 0.238 and a sensitivity and specificity of 0.72 and 0.84 respectively. This prenatal serum panel is a promising serum screening-based biochemical model to predict PPROM in asymptomatic women.

The value of amniopatch in pregnancies associated with spontaneous preterm premature rupture of fetal membranes: a randomized controlled trial

Objective: To evaluate the efficacy and safety of amniopatch in pregnancies associated with spontaneous preterm premature rupture of fetal membranes (PPROM). Methods: A randomized controlled trial that involved 100 women diagnosed with PPROM between 24 and 34 weeks of gestational age. Participants were randomized equally into two groups. Group I in which amniopatch was done in addition to the routine management. Group II was treated with routine management including antibiotics and corticosteroids. Results: Amniopatch was successful in complete sealing of the membrane defect in 6/50 (12%) of women while none the control group have undergone similar sealing (p = .0144, RR = 0.88). Women in the amniopatch group showed a significant increase of AFI compared to controls (12 versus 0, p = .0001, RR = 0.56). Conclusion: The amniopatch procedure is a successful technique that safely enhances sealing of fetal membranes and restore the AFI. Clinical trial registration: NCT03473210 Synopsis The amniopatch procedure is a successful technique that could be done safely to enhance sealing the fetal membranes and restoring the AFI after PPROM.

Serum Decorin and Biglycan as Potential Biomarkers to Predict PPROM in Early Gestation.

Preterm birth is a leading cause of neonatal mortality in the US and globally, with preterm premature rupture of fetal membranes (PPROM) accounting for one third of preterm births. Currently no predictive diagnostics are available to precisely assess risk and potentially reduce the incidence of PPROM. Bigycan and decorin, the main proteoglycans present in human fetal membranes, are involved in the physiological maturation of fetal membranes as well as in the pathophysiology of preterm birth. The serum protein sex hormone-binding globulin (SHBG) has recently been identified as a predictor of spontaneous preterm birth. We hypothesize that the balance between serum decorin and biglycan on one hand and SHBG on the other hand may provide insight into the status of the fetal membranes in early pregnancy, thereby predicting PPROM prior to symptoms. Using chart review, 18 patients with confirmed cases of PPROM were identified from 2013-2016. Second trimester residual serum was retreived from freezer storage for these cases along with 5 matched controls for each case. The biomarkers biglycan, decorin and SHBG were analyzed first separately, then in combination to determine their ability to predict PPROM. The predictive score for the combined model displays an AUC = 0.774. The ROC curve of the predicted score has an optimal threshold of 0.238 and a sensitivity and specificity of 0.72 and 0.84 respectively. This prenatal serum panel is a promising serum screening-based biochemical model to predict PPROM in asymptomatic women.

All-trans retinoic acid promotes wound healing of primary amniocytes through the induction of LOXL4, a member of the lysyl oxidase family

Thirty percent of preterm births directly result from preterm premature rupture of fetal membranes (PPROM). Clinical management currently proposes using a collagen plug to mechanically stop loss of amniotic fluid. Vitamin A and its active metabolite (retinoic acid) have well-known pro-healing properties and could thus make good candidates as a proposable adjuvant to this mechanical approach. Here we investigate the molecular mechanisms involved in the pro-healing properties of all-trans retinoic acid (atRA) in fetal membranes via an approach using an in vitro primary amniocyte wound model and transcriptomics. The results demonstrate that atRA promotes migration in primary amniocytes, improving wound healing in vitro by up to 90%. This effect is mediated by the induction of LOXL4, which plays a crucial role in the dynamics of the extracellular matrix by regulating collagen reticulation. This new insight into how atRA exerts its pro-healing properties prompts us to propose using atRA as a candidate strategy to help prevent future PPROM.

Placental histologic patterns and neonatal seizure, in preterm premature rupture of membrane

Objective: To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM).Methods: We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery.Results: Mean gestational age at membrane rupture was 29.5 ± 3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p = 0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1 min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242–20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617–34.653).Conclusions: Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.

Preterm Premature Rupture of Membranes: A Constant Challenge in Perinatal Medicine?

Two recently published observational studies have focused on the outcome of very preterm respectively of very low birth weight infants after preterm premature rupture of fetal membranes (PPROM). One single center study from the Netherlands enrolling 160 women with PPROM before 24 weeks gestational age, who admitted to the Rotterdam Medical Center between 2002 and 2011, were analyzed <xref idref="Redi-02-16-0014">14</xref>. In parallel, there was a publication from the German Neonatal Network (GNN) enrolling about 6,000 very low birth weight infants, whose data were analyzed under the aspect of PPROM as a potential risk factor for adverse neonatal outcomes <xref idref="Redi-02-16-0005">5</xref>.

Compensatory fetal membrane mechanisms between biglycan and decorin in inflammation.

Preterm premature rupture of fetal membranes (PPROM) is associated with infection, and is one of the most common causes of preterm birth. Abnormal expression of biglycan and decorin, two extracellular matrix proteoglycans, leads to preterm birth and aberrant fetal membrane morphology and signaling in the mouse. In humans and mice, decorin dysregulation is associated with inflammation in PPROM. We therefore investigated the link between biglycan and decorin and inflammation in fetal membranes using mouse models of intraperitoneal Escherichia coli injections superimposed on genetic biglycan and decorin deficiencies. We assessed outcomes in vivo as well as in vitro using quantitative PCR, Western blotting, and enzyme-linked immunosorbent assays. Our results suggest that biglycan and decorin compensate for each other in the fetal membranes, but lose the ability to do so under inflammation, leading to decreased latency to preterm birth. Furthermore, our findings suggest that biglycan and decorin play discrete roles in fetal membrane signaling pathways during inflammation, leading to changes in the abundance of MMP8 and collagen α1VI, two components of the fetal membrane extracellular matrix that influence the pathophysiology of PPROM. In summary, these findings underline the importance of biglycan and decorin as targets for the manipulation of fetal membrane extracellular matrix stability in the context of inflammation.

Altered Decorin and Smad Expression in Human Fetal Membranes in PPROM1

Humans with Ehlers-Danlos syndrome, a subtype of which is caused by abnormal decorin expression, are at increased risk of preterm birth due to preterm premature rupture of fetal membranes (PPROM). In the mouse model, the absence of decorin leads to fetal membrane abnormalities, preterm birth, and dysregulation of decorin's downstream pathway components, including the transcription factor p-Smad-2. However, the role of decorin and p-Smad-2 in idiopathic human PPROM is unknown. Fetal membranes from 20-25 pregnancies per group were obtained as a cross-sectional sample of births at one institution between January 2010 and December 2012. The groups were term, preterm without PPROM, and preterm with PPROM. Immunohistochemical analysis of fetal membranes was performed for decorin and p-Smad-2 using localization and quantification assessment. Decorin expression is developmentally regulated in fetal membranes and is decreased in preterm birth with PPROM compared to preterm birth without PPROM. In preterm with PPROM samples, the presence of infection is associated with significant decorin downregulation compared to preterm with PPROM samples without infection. The preterm with PPROM group exhibited decreased p-Smad-2 staining compared to both the term controls and the preterm-without-PPROM group. Our findings suggest that dysregulation of decorin and its downstream pathway component p-Smad-2 occurs in fetal membranes during the second trimester in pathological pregnancies, thus supporting a role for decorin and p-Smad-2 in the pathophysiology of fetal membranes and adverse pregnancy outcomes. These findings may lead to the discovery of new targets for the diagnosis and treatment of PPROM.

Outcome of Late Second Trimester Emergency Cerclage in Patients with Advanced Cervical Dilatation with Bulging Amniotic Membranes: A Report of Six Cases Managed at the Douala General Hospital, Cameroon

Purpose. To show the feasibility of emergency late second trimester cerclage with advanced cervical dilatation and bulging of amniotic membranes. Setting. Department of Obstetrics and Gynecology of the Douala General Hospital. Method. This is a retrospective study of case files of patients who underwent emergency late second trimester cerclage with advanced cervical dilatation, some with bulging of fetal membranes between June 2003 and June 2010. The modified Shirodkar technique was employed in all the cases. Results. Altogether, six patients (100%) underwent late second trimester cervical cerclage between 24 and 26 weeks of gestational age. Four cases (66.7%) carried on their pregnancies to term that resulted in healthy live-born babies all delivered vaginally. The other two cases (33.3%) presented with preterm premature rupture of fetal membranes (PPROM) which led us to undo the stitch with eventual delivery of live-born premature fetuses which died in the neonatal intensive care unit because of complications of prematurity and neonatal infection. Conclusion. In experienced hands and in the absence of other risk factors like infection, the success rates of this procedure are encouraging with improved prognosis. Finally, the modified Shirodkar technique yielded excellent results in our series.

The role of apoptosis in preterm premature rupture of the human fetal membranes

The present study was designed to examine apoptotic cell death via the caspase-dependent pathway in human fetal membranes. Amniotic membrane samples were collected from three groups of women: group 1, women with preterm premature rupture of fetal membranes (PPROM) after cesarean delivery (n = 10), group 2, women with preterm labor (PTL) with intact membranes after cesarean delivery (n = 9) and group 3, women with term labor and vaginal delivery after an uncomplicated pregnancy (controls) (n = 11). Active caspase-3 immunopositivity (ACPI) of the PPROM group was significantly higher than that of the control group (p < 0.05). ACPI was higher in the PTL with intact membranes group as compared to the control group; however, it did not reach statistical significance (p > 0.05). Active caspase-3 positivity is increased in the fetal membranes of those women with PPROM.

Intrauterine infection and the perinatal outcomes in seven tertiary hospitals in Beijing

Objective To investigate the distribution of different flora, and to explore the effect of intrauterine infection (IUI) on perinatal outcomes in some hospitals in Beijing. Methods A retrospective analysis was conducted on 176 IUI cases, which were divided into preterm (n=77) and term group (n=99), from 7 tertiary hospitals in Beijing from January 1, 2007 to December 31, 2007. The basic information, clinical presentations, laboratory tests results and placenta pathology reports of all cases were collected and analyzed. Analysis of the microbial population was perfomed according to the results of bacterial culture and the relationship between IUI and the perinatal outcomes was tested. Results The incidence of IUI in 2007 was 0.67% among all deliveries (176/26 204) and 3.91% of all preterm deliveries(77/1969), and 84. 4% of the preterra women were complicated with preterm premature rupture of fetal membranes (PPROM) (65/77). Significant difference was found between the two groups in the incidence of cesarean section, premature rapture of fetal membrane and artificial rupture of fetal membrane, and duration from membranes rupture to delivery (P<0.05). Neither the rate of puerperiurn infection [3.0% (3/99) vs 2.6% (2/77)] nor the neonatal infection rate [30.3%(30/99) vs 25.9%(20/77)] in the term and preterm group showed significant difference. The rate of neonatal death was higher in the preterm group than in the term group(7.8% vs 0,P<0.05). The primary infected bacteria was E. coli, which accounted for 37.3% (22/59) of those with positive results of culture, followed by group B streptococcus(GBS) [32.2%(19/59)] and Staphylococci [23.7%(14/59)3. Conclusions The incidence of IUI is higher in preterm labor women, especially those with PPROM. The common bacteria of chorioamnionitis are E. coli and GBS. Sensitive antibiotics should be administered according to bacterial culture results. Key words: Fatal membranes, premature rupture; Chorioamnionitis; Escherichia coli; Streptococcus, agalactiae; Prognosis

Isoprostanes 8-iPF2α-III: risk markers of premature rupture of fetal membranes?

Aims: Isoprostanes may serve as sensitive and specific markers of in vivo oxidative stress intensity. We wanted to determine, whether or not isoprostane concentration may be considered as a risk marker of premature rupture of fetal membranes (PROM).Methods: On the basis of the presence of PROM and gestational maturity, a total of 128 patients were divided into: (1) preterm PROM (pPROM) group; (2) PROM at term group; (3) control preterm (C1) group and (4) control at term (C2) group. The concentrations of 8-iPF2α-III were determined using the enzyme-linked immunosorbent assay method.Results: The mean free isoprostane concentrations, examined in amniotic fluid and maternal plasma in the PROM at term patients were significantly higher than in C2 individuals (p < 0.01). The mean concentrations of free 8-iPF2α-III measured in blood plasma from women in the C1 group were significantly lower than in patients from the pPROM, PROM at term and C2 groups (p < 0.001, p < 0.00001 and p < 0.00001, respectively).Conclusion: The measurement of free isoprostane concentration in maternal plasma and amniotic fluid may be considered as a laboratory marker of a PROM-risk pregnancy.

Genetic association of SP-C with duration of preterm premature rupture of fetal membranes and expression in gestational tissues

Background. Surfactant protein (SP) C has been shown to be expressed also outside pulmonary alveoli. Certain SP-C gene (SFTPC) polymorphisms associate with lung diseases and very preterm birth.Aims. We investigated the association of SFTPC single nucleotide polymorphism (SNP) rs4715 with factors affecting spontaneous preterm birth and characterized the SP-C expression in human and mouse gestational tissues.Methods. The SFTPC SNP rs4715 polymorphism was genotyped in a homogeneous northern European population of mothers and infants in spontaneous preterm birth and term controls. The expression and protein of SP-C in gestational tissues was analyzed.Results. SFTPC SNP rs4715 did not associate with spontaneous preterm birth. However, fetuses with short interval (<72 hours) between preterm premature rupture of fetal membranes (PPROM) and preterm birth had significant over-representation of the minor allele A, whereas in fetuses with prolonged PPROM (≥72 hours) the frequency was decreased. Maternal SFTPC did not associate with the duration of PPROM. SP-C mRNA and proprotein were detected in fetal membranes, placenta, and pregnant uterus.Conclusion. SFTPC SNP rs4715 associates with the duration of PPROM, and SP-C is expressed in gestational tissues. We propose that fetal SFTPC moderates the inflammatory activation within the fetal extra-embryonic compartment.

Relationship between 27-KDA heat shock protein–cytochrome c complexes and interleukin-1 receptor antagonist in cord blood and preterm premature rupture of fetal membranes (PPROM)

Relationship between 27-KDA heat shock protein–cytochrome c complexes and interleukin-1 receptor antagonist in cord blood and preterm premature rupture of fetal membranes (PPROM)

Plasma levels of thrombin-antithrombin complexes predict preterm premature rupture of the fetal membranes

Decidual hemorrhage (abruption) is strongly associated with preterm premature rupture of fetal membranes (PPROM). Moreover, thrombin enhances decidual matrix metalloproteinase (MMP) expression, and MMP has been strongly linked to PPROM. The current study sought to determine whether increased thrombin activation, as assessed by circulating maternal plasma thrombin-antithrombin (TAT) complexes, predicted subsequent PPROM. We conducted a nested, case-control study of plasma TAT levels, measured by sensitive immunoassay, among 27 women with a singleton preterm birth preceded by PPROM and 54 matched, term controls. Receiver operating characteristic curve analysis was performed to identify the optimal TAT cut-off level predicting PPROM. Mean gestational age at delivery in cases was 33.3 weeks, compared to 39.7 weeks in controls (p < 0.001). Compared with controls, women with PPROM had increased median plasma TAT levels in both the second trimester (5.1 microg/l (range 2.2-26.3 microg/l) vs. 3.2 microg/l (range 1.3-7.3 microg/l); p = 0.001) and third trimester (7.0 microg/l (range 2.6-85.8 microg/dl) vs. 4.8 microg/l (range 1.7-15.4 microg/dl); p = 0.01). In the PPROM group, 16.0% of the women exhibited bleeding during the pregnancy, while the corresponding value among controls was 3.6% (p = 0.07). In the second trimester, the odds ratio for PPROM with a TAT level of > 3.9 microg/l was 6.0 (95% CI 1.67-21.1). This value predicted PPROM with a sensitivity of 88%, specificity of 68% and positive and negative predictive values of 82% and 97%, respectively. Second-trimester elevated plasma TAT concentrations are predictive of subsequent PPROM. These data provide further evidence that PPROM is associated with decidual thrombin activation.

Active Expectant Management of Preterm Premature Rupture of Fetal Membranes (PROM) with Cervical Cerclage

Previous experience has shown that an ‘active expectant management’ protocol consisting of prophylactic antibacterial agents, tocolysis and intensive fetal monitoring is superior to passive expectant management in patients with premature rupture of fetal membranes (PROM). Active expectant management was utilised in 3 patients with PROM and a cervical cerclage left in place. The latent phases for the 3 patients were 4.6, 14.3 and 30.25 days, respectively. No relationship was noted between C-reactive protein levels or WBC and clinical outcome. Pseudomembranous enterocolitis developed in 1 patient and was successfully treated without stopping prophylactic antibacterial therapy or delivering the fetus. A low rate of infection-related morbidity was observed.