Preterm Premature Rupture Of Membranes Patients Research Articles

Amniotic Fluid Volume: An Important Deciding Factor for Pregnancy Continuation in Preterm Premature Rupture of Membranes

Abstract Aims and Objectives: To find out various risk factors affecting fetomaternal outcomes in preterm premature rupture of membranes (PPROM). Materials and Methods: A prospective study after approval from the ethical committee was conducted at VMMC and Safdarjung Hospital, New Delhi, Department of Obstetrics and Gynaecology from December 2020 to May 2022 in which 100 pregnant women with preterm premature rupture of membrane between 32 and 36 weeks of gestation were enrolled. Patients were followed with Total leucocyte count (TLC), urine R/M, urine C/S, high vaginal swab C/S, and C-reactive protein along with routine antenatal care investigations. Intravenous antibiotics were given to all patients for 48 h followed by oral antibiotics for 5 days. All patients were on follow-up and managed conservatively and induction of labor was done at 37 weeks or earlier in case of fetal distress and presence of signs and symptoms of chorioamnionitis. Both mother and baby were followed till 7 days after delivery. Results: In the present study, we observed the following risk factors that had adverse effects on fetomaternal outcomes in PPROM patients. The association of oligohydramnios (amniotic fluid index [AFI] <5) with neonatal sepsis (P = 0.025) and neonatal death (P = 0.025) was found to be significant. Vaginal infection was found to be significantly associated with birth asphyxia (P = 0.024), APGAR <7 at 1 min (P = 0.015), neonatal intensive care unit (NICU) admission (P = 0.009), and postpartum hemorrhage (PPH) (P = 0.002). The association of urinary tract infection (UTI) with neonatal sepsis (P = 0.01), birth asphyxia (P = 0.005), APGAR <7 at 1 min (P = 0.001), NICU admission (P = 0.002), neonatal death (P = 0.01), and PPH (P = 0.0004) was found to be significant. We also observed that the duration from membrane rupture to delivery had no adverse effect on fetomaternal outcome, may be as we had given antibiotics to all patients from the time of admission. Conclusions: The conclusion from the present study was that oligohydramnios (AFI <5) is a significant risk factor for adverse neonatal outcomes in PPROM along with vaginal infections and UTIs. Hence, amniotic fluid volume should also be considered as an important deciding factor for pregnancy continuation in PPROM.

Predicting chorioamnionitis in patients with preterm premature rupture of membranes using inflammatory indexes: a retrospective study

ObjectiveThe prognosis of preterm premature rupture of membranes (PPROM) combined with chorioamnionitis is often unsatisfactory for both mother and newborn. Although tragic outcomes can be avoided if treated early, no effective prediction method for decision-making is available currently. This study aimed to establish an effective method with maternal inflammation indexes to predict preterm premature rupture of membranes with concomitant chorioamnionitis. Materials and methodsThis retrospective study examined the data of 206 singleton PPROM cases and 60 normal full-term cases. The PPROM cases included 93 cases of PPROM with chorioamnionitis and 113 cases of PPROM without chorioamnionitis based on clinical manifestations, laboratory examinations, and histopathological diagnosis. Normal full-term cases were included as the control group. Peripheral blood levels of selected inflammatory indicators were observed 12 h after fetal membrane rupture. Associations between selected inflammatory indicators and chorioamnionitis diagnosis were analyzed. ResultsSelected factors except for procalcitonin predicted chorioamnionitis in PPROM patients. Combined results of C-reactive protein and white blood cell (WBC) count showed best predictive ability with area under curve, sensitivity, and specificity of 0.702, 60.22%, and 76.11%, respectively. Furthermore including Interleukine-6 and neutrophil count provided similar predictive results. ConclusionsThe best predictive factor combinations for PPROM-CAM were C-reactive protein and white blood cell count. Results of this study provide a useful clinical reference for PPROM-CAM and may improve maternal and infant prognostic outcomes.

Treatment of Classic Mid-Trimester Preterm Premature Rupture of Membranes (PPROM) with Oligo/Anhydramnion between 22 and 26 Weeks of Gestation by Means of Continuous Amnioinfusion: Protocol of a Randomized Multicentric Prospective Controlled TRIAL and Review of the Literature.

Background: The classic mid-trimester preterm premature rupture of membranes (PPROM) is defined as a rupture of the fetal membranes prior to 28 weeks of gestation (WG) with oligo/anhydramnion; it complicates approximately 0.4–0.7% of all pregnancies and is associated with very high neonatal mortality and morbidity. Antibiotics have limited success to prevent bacterial growth, chorioamnionitis and fetal inflammation. The repetitive amnioinfusion does not work because fluid is lost immediately after the intervention. The continuous amnioinfusion through the transabdominal port system or catheter in patients with classic PPROM shows promise by flushing out the bacteria and inflammatory components from the amniotic cavity, replacing amniotic fluid and thus prolonging the PPROM-to-delivery interval. Objective: This multicenter trial aims to test the effect of continuous amnioinfusion on the neonatal survival without the typical major morbidities, such as severe bronchopulmonary dysplasia, intraventricular hemorrhage, cystic periventricular leukomalacia and necrotizing enterocolitis one year after the delivery. Study Design: We plan to conduct a randomized multicenter trial with a two-arm parallel design. Randomization will be between 22/0 and 26/0 SSW. The control group: PPROM patients between 20/0 and 26/0 WG who will be treated with antibiotics and corticosteroids (from 22/0 SSW) in accordance with the guidelines of German Society of Obstetrics and Gynecology (standard PPROM therapy). In the interventional group, the standard PPROM therapy will be complemented with the Amnion Flush Method, with the amnioinfusion of Amnion Flush Solution through the intra-amnial catheter (up to 100 mL/h, 2400 mL/day). Subjects: The study will include 68 patients with classic PPROM between 20/0 and 26/0 WG. TRIAL-registration: ClinicalTrials.gov ID: NCT04696003. German Clinical Trials Register: DRKS00024503, January 2021.

High-throughput analysis of amniotic fluid proteins associated with histological chorioamnionitis in preterm premature rupture of membranes using an antibody-based microarray.

To identify potential proteins in the amniotic fluid (AF) that may be associated with histologic chorioamnionitis (HCA) in patients with preterm premature rupture of membranes (PPROM) using antibody-based microarray analysis. This was a retrospective cohort study involving 100 singleton pregnant women with PPROM at 24-34 weeks who underwent amniocentesis and delivered within 120 h of amniocentesis. First, the AF proteomes of 15 patients with PPROM and HCA were compared with those of 15 gestational age-matched patients without HCA using a protein microarray. Next, 12 candidate proteins associated with HCA were further validated in 100 consecutive patients with PPROM by ELISA. Of 507 proteins assessed in the microarray analysis, 46 showed significant intergroup differences. Further quantification confirmed that the levels of EN-RAGE, IL-6, MMP-9, TNFR2, SPARC, TSP2, and uPA were higher in the AF of PPROM patients with HCA than in those without. Multivariate analyses also showed that elevated AF EN-RAGE, IL-6, MMP-9, and TNFR2 levels were independently associated with HCA when adjusted for baseline variables. The frequency of the highest quartile of the aforementioned proteins significantly increased as the total grade of HCA increased; the risk of HCA significantly increased with increasing AF levels of each protein (P for trend < .001). Using protein-antibody microarray technology, we discovered several potential AF proteins (EN-RAGE, IL-6, MMP-9, and TNFR2) independently associated with HCA in patients with PPROM. Furthermore, we demonstrated a direct correlation between the gradation of the intra-amniotic inflammatory response and HCA severity.

The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes.

This study aimed to detect aquaporin-9 (AQP9) concentrations in the serum of patients with preterm premature rupture of membranes (PPROM) and compare them with the healthy control group with intact membranes. We conducted this prospective case-control study from March 2021 to August 2021. Of the 80 pregnant patients included in the study, we enrolled 42 singleton pregnant patients with PPROM as the study group and 43 healthy gestational age-, and body mass index (BMI)-matched healthy pregnant women with intact fetal membranes as the control group. We compared demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations of the participants. We constructed an ROC curve to illustrate the sensitivity and specificity performance characteristics of AQP9 and calculated a cutoff value by using the Youden index. Maternal serum AQP-9 concentrations were significantly higher in patients with PPROM (804.46±195.63 pg/mL) compared to the healthy pregnant women in the control group (505.97±68.89 pg/mL, p<0.001). When we examine the area under the ROC curve (AUC), the AQP-9 value can be reflected as a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 654.78 pg/mL cut-off value of AQP-9 can be utilized to diagnose PPROM with 80.5% sensitivity and 100% specificity. Maternal serum AQP9 concentrations were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that AQP9 might be an essential biomarker of the inflammatory process and energy homeostasis in PPROM.

The association between increased maternal PARK7 (DJ-1) levels and the occurrence of preterm premature rupture of membranes - A randomized prospective study

Objective:Parkinson’s disease protein 7 (PARK7/DJ-1) is an important antioxidant multiprotein against inflammation and oxidative stress. We therefore planned this study to demonstrate the association between maternal PARK7 levels and the occurrence of preterm premature rupture of membranes (PPROM).Materials and Methods:We enrolled 80 pregnant women; 50 PPROM patients and 30 healthy controls, into this cross- sectional study between the 24th and 36th gestational weeks. Furthermore, we measured serum PARK 7 levels using enzyme-Linked immunosorbent assay method.Results:Plasma PARK7 levels were higher in PPROM patients compared to those in the healthy controls (p<0.001). With a cutoff value of 2.57 pg/mL; PARK 7 had a 92% sensitivity, 86% specificity, 88% positive predictive value and 83% negative predictive value (p<0.01) for PPROM. PARK7 had positive correlation with blood leukocyte levels (p<0.001), C-reactive protein levels (p<0.001), and negatively correlated with birth weight and birth week.Conclusion:PARK 7 is overexpressed in PPROM patients. Due to its anti-inflammatory and antioxidant properties, PARK7 may be a novel marker in better understanding the pathophysiology and prediction of the prognosis PPROM. Further large-scale studies are needed.

Study on role of ascorbic acid levels in PPROM and its maternal and perinatal outcome

Background: Preterm premature rupture of membranes (PPROM) complicates 1–5% of all pregnancies and is the major contributory factor for perinatal morbidity and mortality. Micronutrient deficiency (vitamin C) is associated with increased risk of PPROM. This study was conducted to establish the association between maternal plasma vitamin C concentration in women with PPROM and women without PPROM and to study the difference in maternal morbidity, neonatal morbidity, and mortality. Objectives 1. Establish the association between maternal plasma vitamin C concentration in women with PPROM and women without PPROM.2. Study the association of anemia in vitamin C deficient patients with PPROM3.Study the difference in maternal and perinatal morbidity and mortality in both the groups Methods: This case controlstudy was conducted in Department of Obstetrics and Gynecology, EPIONE Hera Hospitals100 patients were studied, 50 were in study group (patients admitted to labour room with h/o PPROM) and 50 in the control group (patients admitted to labour room at term for delivery). Fasting blood sample was taken to measure the plasma vitamin C levels in both the groups. Results: Plasma vitamin C levels were low in PPROM patients and the concentration decreased as the pregnancy advanced, this proves linear relationship between plasma vitamin C levels and PPROM. The results of this study showed decreased plasma vitamin C levels leading to PPROM, preterm deliveries, increased NICU admissions, increased perinatal morbidity, mortality, maternal anemia in study group than in control group. Conclusion: As vitamin C deficiency during pregnancy leads to PPROM, it’s supplementation during pregnancy along with iron and calcium in second and third trimester should be made mandatory.

The role of latency period on the preterm premature rupture of membranes: implication for treatment

IntroductionConservative treatments with a latency period have been used for the treatment of preterm premature rupture of membranes (PPROM) in clinical practice. We aimed to evaluate the role and potential influencing factors of the latency period, to provide insights for the clinical treatment of PPROM.Material and methodsPPROM pregnant women treated in our hospital from January 1, 2015 to September 30, 2020 were included. PPROM patients were divided into a 48–168 h group and a &gt; 168 h latency group; the characteristics and prognosis of these two groups were compared and analyzed. Logistic regression analyses were conducted to analyze the relevant influencing factors of the latency period.ResultsA total of 131 PPROM patients were included. There were significant differences in the age, BMI, gestational age on admission, amniotic fluid volume before childbirth, and positive rate of cervical secretion culture between the two groups (all p &lt; 0.05). Logistic regression analyses indicated that the latency period was shorter in the PPROM patients with age ≥ 30 years (OR = 0.048, 95% CI: 0.121–0.863) and gestational age ≥ 32 weeks on admission (OR = 0.463, 95% CI: 0.069–0.811), and the latency period was prolonged in the PPROM patients with BMI ≥ 23 kg/m2 (OR = 1.591, 95% CI: 1.134–1.944) and amniotic fluid volume ≥ 6 cm (OR = 2.129, 95% CI: 1.093–3.042) (all p &lt; 0.05). There were significant differences in the incidence of low birth weight and neonatal respiratory distress syndrome (NRDS) between the 48–168 h group and &gt; 168 h group (all p &lt; 0.05).ConclusionsThe latency period plays an important role in PPROM, which is associated with the pregnant women’s age, BMI, gestational week of rupture and amniotic fluid index.

Measurement of the Uterocervical Angle for Predicting the Latent Period in Pregnancy Exhibiting Premature Membrane Rupture

Objectives: The duration of the latent period is uncertain in preterm premature rupture of membranes (PPROM). This time estimate provides information on the time of the corticosteroid to be applied and the time of delivery of the pregnant women. Here, we used transvaginal sonography to determine the relationship between the uterocervical angle (UCA) and PPROM latency and the risk for neonatal complications. Design: This is a prospective cohort study of 80 singleton pregnancies with PPROM. Participants/Materials, Setting, and Methods: This prospective cohort study was conducted at a tertiary center with a total of 80 singleton pregnancies with PPROM. The UCA and cervical length were measured in the first evaluation of PPROM in patients between 24 and 34 weeks of age. The study population was subdivided into 2 groups: group 1 (n = 27) included women who gave birth within 10 days after a PPROM diagnosis and group 2 (n = 53) included women who gave birth later than this. Our aim was latency prediction (more or less than 10 days) in PPROM patients undergoing regular UCA monitoring. Results: Of the women in group 1, 74.1% (n = 20) had spontaneous births and 7.4% (n = 2) had induced births because of clinical chorioamnionitis. Of the women in group 2, 71.6% (n = 38) had spontaneous births and 7.6% (n = 4) had induced births because of clinical chorioamnionitis (n = 3) or poor fetal condition (n = 1). We drew receiver operating characteristic curves to explore whether the UCA predicted birth within 10 days of PPROM. The area under the curve was 0.894 (p < 0.001). The optimal UCA cutoff was 108°, with 93% sensitivity and 85% specificity. Limitations: First, the sample size was small; it would have been better to have more patients. Second, we measured the UCA only once. Third, patients were not categorized by parity. Conclusions: The UCA, measured by the transvaginal route, can successfully predict latent period in PPROM. Measuring the UCA can be useful to determine the time of corticosteroid administration and to inform patients about the time of birth.

Maternal serum IL-22 concentrations are significantly upregulated in patients with preterm premature rupture of membranes.

This study aimed to compare the serum IL-22 levels between preterm premature rupture of membranes (PPROM) patients and the control group with intact membranes. We also hypothesized whether serum IL-22 upregulation might contribute to defense against inflammatory responses and improve the pregnancy outcomes. We performed this prospective case-control study between 24-34 weeks of pregnancy. We enrolled 40 singleton pregnant patients with PPROM and 40 healthy gestational age- and gravidity-matched patients without PPROM. The degree of association between variables and IL-22 were calculated by Spearman correlation coefficients where appropriate. Scatter plots were given for statistically significant correlations. ROC curve was constructed to illustrate the sensitivity and specificity performance characteristics of IL-22, and a cutoff value was estimated by using the index of Youden. Maternal serum IL-22 levels were significantly higher in PPROM patients (60.34 ± 139.81 pg/mL) compared to the participants in the control group (20.71 ± 4.36 pg/mL, p < 0.001). When we analyze the area under the ROC curve (AUC), the IL-22 value can be considered a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 23.86 pg/mL cut-off value of IL-22 can be used to diagnosing PPROM with 72% sensitivity and 61.5% specificity. There was no positive correlation between serum IL-22 levels and maternal C-reactive protein (CRP) value, procalcitonin value, latency period, birth week, birth weight, and umbilical cord blood pH value. Maternal serum IL-22 levels were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that IL-22 might be a crucial biomarker of the inflammatory process in PPROM.

STUDY OF MATERNALAND PERINATAL OUTCOME IN CASES OF PRETERM PREMATURE RUPTURE OF MEMBRANES

Background: Preterm premature rupture of membranes (PPROM) occurs in 3%to6% of pregnancies and is responsible for approximately one third of all preterm births. Aims &amp; Objective: of present study was to analyse the maternal and perinatal outcome of PPROM patients between 28 to 36 weeks +6days admitted in labour room of obs and gynae dept. of DMCH from January 2019 to April 2020. Material and Methods: It is hospital based prospective observational study of 100 patients of preterm premature rupture of membranes in between 28-36 weeks+6 days gestation with singleton pregnancy admitted in our tertiary care centre (Department of Obstetrics and Gynaecology, DMCH, Laheriasarai, Bihar). Results: In this study 42% patients went into spontaneous labour and 58% needed induction or augmentation. 68% patients had vaginal delivery and 23% required LSCS. The main indications for LSCS being malpresentation (26%) followed by foetal distress (22%). There was no maternal mortality; morbidity was found in 15% patients. Perinatal morbidity was seen in 40% and was mainly due to RDS, sepsis andhyperbilirubinaemia . Perinatal mortality was seen in 17% and was due to sepsis in 29.4%, RDS in 52.94% and birth asphyxia in 17.6%. Conclusion: PPROM is one of the important causes of preterm birth that can result in high perinatal morbidity &amp; mortality along with maternal morbidity. Looking after a premature infant puts immense burden on the family, economy and health care resources of the country. Therefore management of PPROM requires accurate diagnosis and evaluation of the risks and benets of continued pregnancy or expeditious delivery. An understanding of gestational age dependent neonatal morbidity and mortality is important in determining the potential benets of conservative management of preterm PROM at any gestation

Lethal Neonatal Respiratory Failure by Perinatal Transmission of Ureaplasma Parvum after Maternal PPROM.

A primiparous pregnant woman was admitted due to preterm premature rupture of membranes (PPROM) at 27+0 week of gestational age (WGA). Conventional vaginal microbiological analysis had no pathological finding. Management decisions based on national guidelines included antenatal corticoids, tocolytics and antibiotics. Unstoppable efforts of preterm labor in 28+0 WGA and supposed amniotic infection syndrome necessitated emergency cesarean section. The preterm infant underwent NICU therapy, developed an early-onset neonatal sepsis and therapy-refractory pulmonary insufficiency with consecutive right heart failure, resulting in death on the 36th day of life. Microbiota analyses by 16Sr DNA sequencing was performed from maternal vaginal swabs and from neonatal pharyngeal swabs. Maternal antibiotic treatment resulted in depletion of physiological vaginal colonization with Lactobacillus crispatus. Ureaplasma parvum became the dominant vaginal microorganism at delivery and was detected in high relative abundance in the neonatal specimen. Progressive radiological air-space changes and interstitial pathologies associated with Ureaplasma infection (bronchopulmonary dysplasia type III) were seen early at the 3rd and distinctly from 14th day of life. This clearly demonstrates the need of vaginal colonization diagnostics in PPROM patients and awareness of the consecutive risks in the preterm. Vaginal microbiome analysis may allow individualized and targeted maternal and fetal diagnostic, prophylactic and therapeutic strategies to identify, protect and treat the high-risk neonates after PPROM.

Regulation of Keap-1/Nrf2 Signaling Pathway Is Activated by Oxidative Stress in Patients with Premature Rupture of Membranes

BackgroundThe potential mechanisms underlying premature rupture of membrane (PROM) is still unknown. The aim of this study was to determine the role of Keap-1/Nrf2 signaling pathway activation by oxidative stress in patients with preterm premature rupture of membranes.Material/MethodsPlacental tissues from preterm premature rupture of membranes (PPROM) (n=20), full-term premature rupture of membranes (FPROM) (n=20), and normal-term births (n=20) were collected and amniotic tissues were separated from the placental tissues from pregnant women at Shandong Provincial Qianfoshan Hospital. RT-PCR and Western blot were used to detect the levels of factors in the Keap-1/Nrf2 signaling pathway. To investigate the roles of Nrf2, we downregulated Nrf2 expression using siRNA in primary human amniotic epithelial (HAE) cells.ResultsAmong the control group, FPROM group, and PPROM group, the reactive oxygen species (ROS) levels were significantly increased in the FPROM and PPROM groups. The differences indicated higher levels of oxidative stress in amniotic tissues with FPROM and PPROM after downregulation of si-Nrf2 in HAE cells. Antioxidants were lower in amniotic tissues with the FPROM group and PPROM group than in the control group. The antioxidant enzymes catalase (CAT), glutathione (GSH), glutathione peroxidase (GSHPx), and superoxide dismutases (SOD1 and SOD2) were examined in amniotic tissues. We found that the ROS levels were significantly increased after downregulation of si-Nrf2 compared with the control group. We found that the expression of Heme Oxygenase-1 (HO-1) and Glycogen Synthase Kinase-3b (GSK-3b), which is critical in the Keap-1/Nrf2 signaling pathway, increased significantly after downregulation of si-Nrf2 in HAE cells.ConclusionsWe found that increased ROS levels and decreased antioxidant enzymes in the PPROM and FPROM patients compared with the control group.

Prediction of Admission to Delivery Time by Transvaginal Ultrasonographic Assessment of the Cervix in Cases of Preterm Prelabour Rupture of Membranes

Background: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity. Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour. Results: showed non-significant differences between the mean of PCA among different groups (P>0.05). Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM patients’ group with high latency period. The latency period had significant positive correlation with AFI and cervical length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP, and TLC, and neonatal sepsis (p<0.05). Conclusion: It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool in the evaluating the interval between rupture of membranes and delivery in women with PPROM.

Prediction of Admission to Delivery Time by Transvaginal Ultrasonographic Assessment of the Cervix in Cases of Preterm Prelabour Rupture of Membranes

Background: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity. Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour. Results: showed non-significant differences between the mean of PCA among different groups (P>0.05). Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM patients’ group with high latency period. The latency period had significant positive correlation with AFI and cervical length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP, and TLC, and neonatal sepsis (p<0.05). Conclusion: It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool in the evaluating the interval between rupture of membranes and delivery in women with PPROM.

How do platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio change in women with preterm premature rupture of membranes, and threaten preterm labour?

The aim of the study was to investigate peripheral blood platelets, neutrophils and lymphocytes counts in women with preterm premature rupture of membranes (PPROM) and threatened preterm labour (TPL) compared with gestation-matched controls in order to learn how they change. This study was conducted on 60 women with PPROM, 50 women with TPL and 47 healthy pregnant women. Laboratory parameters (including complete blood count, C-reactive protein (CRP)) of all the participants were recorded. The neutrophil-to-lymphocyte ratio (NLR) values were significantly higher in PPROM group than TPL group and healthy control group (6.1 ± 3.9, 4.4 ± 1.7, 4.4 ± 2.2, p = .007, p = .018, respectively). At a cut-off level of 5.14, NLR accurately predicted occurrence of neonatal sepsis (AUC = 0.717 (95% confidence interval 0.610–0.824), p = .001) with sensitivity and specificity rates of 69.7% and 72.0%, respectively. In the management of the patients with PPROM, NLR can be used as a more cost-effective method than other blood parameters that require the use of a kit.IMPACT STATEMENTWhat is already known on this subject? There is only one study in the literature evaluating blood count parameters (such as platelet-to-lymphocyte ratio (PLR), NLR) in PPROM pregnancies. That study demonstrated PLR and NLR were both higher in the PPROM group.What do the results of this study add? The present study demonstrates that only NLR is higher in the PPROM group. Furthermore, we have also demonstrated distinctively that NLR can predict occurrence of neonatal sepsis.What are the implications of these findings for clinical practice and/or further research? High values of NLR may be useful for predicting adverse outcomes in PPROM and TPL patients as a cost-effective method. Further studies are needed to determine whether these parameters can be used to predict if a pregnant woman who is at risk of preterm labour will result in adverse perinatal outcome.

Maternal serum endocan concentrations are elevated in patients with preterm premature rupture of membranes.

Objectives To evaluate the maternal serum endocan levels in pregnant women complicated by preterm premature rupture of membranes (PPROM) and to compare the results with healthy pregnancies. Methods This cohort study included 31 pregnant women with PPROM and 34 gestational age-matched healthy subjects in the third trimester of pregnancy. The blood for analysis was obtained on the day of diagnosis and serum endocan levels were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The pregnant women were observed until the delivery and perinatal data were noted. Results No significant differences regarding maternal age, body mass index, gravidity, parity and gestational age at sampling were observed (P > 0.05). Mean serum endocan level was significantly higher in the PPROM group than in healthy controls (1490 ± 632 pg/mL vs. 972 ± 586 pg/mL, respectively; P: 0.001). Serum endocan concentration was positively correlated with C-reactive protein (CRP) (r = 0.754, P < 0.001) and white blood cells count (WBC) (r = 0.712, P:0.001). The receiver operating characteristic (ROC) curve analysis showed that endocan with a cut-off point of 1198 ng/dL indicated women with PPROM with sensitivity of 64.5% and specificity of 35.1% (area under curve 0.731, confidence interval 0.61-0.85). Conclusion Serum endocan level was significantly elevated in the PPROM patients than in healthy controls. The endocan level may be a useful indicator of endothelial dysfunction/inflammation in PPROM cases.

Cost Analysis of Azithromycin versus Erythromycin in Pregnancies Complicated by Preterm Premature Rupture of Membranes.

To quantify the potential cost savings if azithromycin is substituted for erythromycin in women with preterm premature rupture of membranes (PPROM). Secondary analysis of a multicentered study investigating magnesium sulfate for the prevention of cerebral palsy in premature infants. All patients with PPROM who received antibiotics for prophylaxis were included in the analysis. The number of expected doses each patient would have received was calculated for erythromycin, multidose azithromycin, and single-dose azithromycin regimens accounting for latency from PPROM to delivery. The wholesale acquisition cost was used to calculate the expected cost of each regimen. There were 981 PPROM patients who received a penicillin class antibiotic and erythromycin. Patients would have received 7,528 intravenous doses and 10,194 oral doses of erythromycin at a combined cost of $357,169. In comparison, patients would have received 6,422 and 3,942 doses at a cost of $15,669 and $9,574 for the multidose and single-dose azithromycin regimens respectively, which represents a more than 95% cost reduction for either regimen compared with erythromycin. The use of azithromycin substituted for erythromycin in the standard antibiotic regimen of women with PPROM represents a potential for substantial cost reduction.

Histologic chorioamnionitis prevalence in patients with premature rupture membranes

This was a retrospective cohort study between 2002 and 2011. A total number of 150 singleton pregnancies with preterm premature rupture of membranes (PROM) (before 34 weeks) were analyzed. Histological chorioamnionitis (Blanc grade III) was significantly increased over three days from onset of premature rupture of membranes. The positive relationship was strengthened (odds ratios, 3.5; 95% confidence intervals, 1.5-5.2) over three days from onset of preterm PROM. PROM is a risk factor important for histological chorioamnionitis. To avoid neonatal infection, early termination is recommended in preterm PROM patients.

Alarmin high mobility group box-1 in maternal serum as a potential biomarker of chorioamnionitis-associated preterm birth

Chorioamnionitis is associated with an increased risk of spontaneous preterm birth. The aim of this study was to investigate the serum levels of high mobility group box-1 (HMGB1) in pregnancies with histological chorioamnionitis (HCA)-associated preterm labor (PTL) with intact membranes or preterm premature rupture of membranes (PPROM), and to access the role of serum HMGB1 in HCA and HCA-associated PTL. A total of 190 pregnant women were enrolled in this study: PLT patients with (n = 28) or without HCA (n = 36), PPROM patients with (n = 26) or without HCA (n = 65), and non-HCA PTL controls (n = 35). Maternal serum levels of HMGB1 were measured by enzyme-linked immunosorbent assay. Serum HMGB1 levels were significantly higher in PTL or PPROM patients than in control group (p < 0.01, respectively). The PPROM patients also exhibited higher serum HMGB1 levels compared to PTL patients (p = 0.015). HCA patients were characterized by significantly increased levels of serum HMGB1 when compared with non-HCA patients (p < 0.01). Therefore, maternal serum HMGB1 may become a potential biomarker of HCA and HCA-associated PTL.