Preterm Premature Rupture Of Membranes Research Articles

Association between glycated hemoglobin and the risk of neonatal respiratory distress syndrome in preterm premature rupture of membranes pregnancies

The association between early glycated hemoglobin (HbA1c) and the risk of neonatal respiratory distress syndrome (NRDS) with preterm premature rupture of membranes (PPROM) population remains largely unknown. The impact of diabetes mellitus (DM) on NRDS is also controversial. HbA1c was assessed in early and late pregnancy. Multivariate logistic regression and restricted cubic spline (RCS) analyses were performed to evaluate the association between the HbA1c and the incidence of NRDS in non-DM group. Propensity score matching (PSM) was performed to balance baseline characteristics between DM group and non-DM group. Among 536 patients with the mean age was 30.7 ± 5.1 years, 117 (21.8%) had DM. The RCS revealed that a linear relationship was found between HbA1c and the incidence of NRDS in non-DM group, with a threshold of approximately 5% (31 mmol/mol). The effect size and CI below and above the threshold value were 1.70 (1.24–2.31) and 1.26 (0.81–1.96), respectively. The ΔHbA1c (late HbA1c minus early HbA1c) was independently associated with incidence of NRDS in DM group. Before and after PSM, no significant association was not observed between DM and the incidence of NRDS. Our findings indicated that higher early HbA1c levels were associated with a risk of NRDS in women without diabetes. Women with diabetes who experience an increase in HbA1c level during pregnancy may be more likely to give birth to infants affected by NRDS.

Maternal and Fetal Outcomes of Aplastic Anemia During Pregnancy and Delivery: Systematic Review and Meta-Analysis.

Little scientific evidence exists on maternal and fetal outcomes in aplastic anemia (AA) during pregnancy. The review was conducted to assess the maternal and fetal outcomes due to AA during pregnancy. Web of Science, EMBASE, PubMed, Scopus, Cochrane CENTRAL, and registries until May 5, 2024. Studies (prospective, retrospective cohort, cross-sectional, one arm, survey, follow-up studies) evaluating AA during pregnancy were searched as per PROSPERO registered protocol (CRD42024506668). Case reports, case series, expert opinion letters, and studies assessing less than or equal to 10 pregnant women were not considered. The primary outcome was the prevalence of preeclampsia in AA pregnancies. The secondary outcomes included spontaneous abortion, preterm premature rupture of membranes, premature rupture of membranes, fetal growth restriction, type of delivery, intrauterine fetal death, maternal and neonatal mortality, and pre and post-pregnancy remission status comparison. The quality of research was checked using the New Castle-Ottawa risk-of-bias tool. A meta-analysis model with a random effect distribution, coupled with meta-regression, sensitivity analysis, and publication bias assessment, was used in the statistical software R. Standard Equator network study reporting guidelines were followed. Seven (one prospective and six retrospective cohort) studies included patients with confirmed AA diagnosis in 248 pregnancies. The pooled prevalence of preeclampsia was 13% (95% CI, 8%-20%). Heterogeneity was low in the present meta-analysis (I2 = 26%). The secondary outcome evaluation showed a pooled prevalence of 5% (95% CI, 3%-11%) for spontaneous abortion, 4% (95% CI, 1%-11%) for preterm premature rupture of membranes, 10% (95% CI, 3%-28%) for premature rupture of membranes, 6% (95% CI, 3%-11%) for fetal growth restriction, 5% (95% CI, 2%-13%) for intrauterine fetal death, 12% (95% CI, 5%-26%) for post-partum hemorrhage, 74% (95% CI, 45%-91%) for intrapartum transfusion requirement, and 55% (95% CI, 27%-80%) for the cesarean delivery opting. The maternal mortality in pregnancies with AA was 4% (95% CI, 0.01-0.14), whereas neonatal mortality was 7% (95% CI, 0.03-0.18). The odds of AA complete remission were better in pre-pregnancy than post-pregnancy (OR = 0.36; 95% CI = 0.08-1.66), although the results remain insignificant. The leave-one-out sensitivity analysis did not change the pooled estimates for the primary outcome. A risk of developing preeclampsia was observed in every eighth pregnant woman with an AA diagnosis. AA remission status might worsen after undergoing pregnancy, considering the significant obstetric morbidity and mortality burden.

Diagnosis of arcuate uterus using three-dimensional transvaginal ultrasound and investigation of its association withperinatal complications.

Arcuate uterus does not impact the success of infertility treatments, but there is no consensus on whether it influences perinatal outcomes. The objective of the present study was to investigate whether minor congenital uterine anomalies such as an arcuate uterus contribute to perinatal complications. This was a retrospective cohort study at a single institution. The study included 1097 deliveries after 22 weeks of gestation. Transvaginal ultrasound, with three-dimensional functionality, assessed uterine morphology based on American Society for Reproductive Medicine criteria. We compared maternal backgrounds and perinatal complications between arcuate uterus and normal uterus groups. Statistical analyses, including multivariate analysis, aimed to identify independent risk factors. A total of 69 patients (7.5%) with diagnosed arcuate uterus were included. Maternal background factors showed no significant differences between groups. In perinatal complications, an arcuate uterus was associated with a significantly higher incidence of preterm delivery (13% versus 4.7%, P = 0.01), preterm premature rupture of membranes (7.2% versus 1.6%, P = 0.01), fetal growth restriction (FGR; 16% versus 6.7%, P = 0.01), and abnormal placental cord insertion (33% versus 7.6%, P < 0.01). After multivariate analysis, arcuate uterus emerged as an independent risk factor for preterm delivery (adjusted odds ratio [aOR], 4.0 [95% confidence interval (CI), 1.6-9.9], P < 0.01), FGR (aOR, 2.6 [95% CI, 1.2-5.6], P = 0.02), and abnormal placental cord insertion (aOR, 6.0 [95% CI, 3.4-10.6], P < 0.01). Arcuate uterus stands as an independent risk factor for preterm delivery, FGR, and abnormal placental cord insertion. The findings emphasize the importance of recognizing even minor uterine morphological abnormalities in assessing and managing perinatal complications.

Clinical Characteristics and Outcomes of SARS-CoV-2 Infection in Neonates with Persistent Pulmonary Hypertension of the Newborn (PPHN): A Systematic Review

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to &lt;37 weeks (moderate to late preterm) (36.1%). The maternal severity of COVID-19 was reported to be severe in three cases only (8.3%); however, SARS-CoV-2 infection in neonates with PPHN was either severe (44.4%) or critical (22.2%). Most of these neonates experienced acute respiratory distress syndrome (ARDS) (58.3%). Early and late multisystem inflammatory syndrome in neonates (MIS-N) were reported in 50% and 11.1%, respectively. A high proportion of neonates were admitted to the intensive care unit (ICU) (58.3%) or needed mechanical ventilation (MV) (47.2%). Neonates with concurrent PPHN and SARS-CoV-2 infection who died had worse severity of COVID-19 [i.e., severity of COVID-19 was critical in 10% (neonates with PPHN who survived group) vs. 83.3% (neonates with PPHN who died group); p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary.

Preliminary data on short-term outcomes within the cardio-obstetrics registry

Abstract Background Pregnancy leads to physiological changes within the cardiovascular system such as increased plasma volume and cardiac output or hypercoagulability. These changes can be challenging for women with pre-existing cardiovascular disease with higher risks of complications. The guidelines of the European Society of Cardiology recommend treating high-risk patients in specialized centres by an interdisciplinary pregnancy heart team. In a team-based approach, the Pregnancy Heart Team was founded at our university hospital, in order to establish specific structures of communication and responsibility. Methods A prospective registry of all patients treated by the Pregnancy Heart Team between November 2022 and March 2024 was established. Patients consisted of women with pre-existing cardiovascular disease undergoing pregnancy as well as women who developed pregnancy-associated cardiovascular disease. Patients were evaluated throughout pregnancy by lab work and echocardiography during each trimester as well as in the postpartum period. Results In total 39 women (mean age 34±5 years) were prospectively included in the registry. 17 patients (43.5%) were classified as mWHO ≥ III. 17 patients (43.5 %) with pre-existing (pregnancy-associated) cardiovascular disease were managed throughout pregnancy and delivery. 9 patients (18.4 %) developed pregnancy-associated cardiovascular diseases such as peripartum cardiomyopathy or spontaneous coronary artery dissection. Preliminary data shows that mean left-ventricular ejection fraction remained stable during pregnancy with a non-significant trend towards lower values postpartum. Cardiac biomarkers such as high-sensitivity troponin T and NT-pro-BNP showed a non-significant trend towards increased values in the third trimester and postpartum. Adverse maternal outcomes occurred in 14 patients (35.9 %), including preterm premature rupture of membranes (12.2%), gestational hypertension (7.6%), gestational diabetes (5.1%), preeclampsia/eclampsia (7.6%) and delivery-associated complications (10.2%). Fetal complications included macrosomia (10.2%) or intrauterine growth retardation (5.1%). Discussion These preliminary data of a real-world patient collectivedemonstrate that a significant number of patients experienced adverse pregnancy outcomes which was associated with a trend towards increased cardiac biomarkers throughout pregnancy and postpartum. As recent studies have shown, interpretation of standard parameters such as cardiac biomarkers is not fully understood during pregnancy, especially in women with pre-existing cardiovascular disease. Our data may aid to understand prognostic implications of cardiac biomarkers during pregnancy.

Pregnancy outcome following various doses of antioxidants such as Vitamin E supplementation – current state of knowledge

Introduction and purpose: Vitamin E is an antioxidant substance. It has been noted that the pathomechanism of many diseases in pregnancy is rooted in oxidative stress. Much of them have an incompletely understood mechanism, and thus treatment is not as effective. Vitamin E is a readily available and important antioxidant. It is reasonable to investigate whether there are links between supplementation with this vitamin and improved outcomes of conditions in pregnant women. Conditions such as preeclampsia (also in a group of women with type 1 diabetes), preterm premature rupture of membranes, spontaneous preterm birth, respiratory diseases were considered. Material and method: The literature was reviewed in the Pubmed database, GoogleScholar, in the Via Medica journal database, the positions of the Polish gynecological society with the use of keywords. State of knowledge: According to the cited studies, routine use of vitamin E in combination with other supplements has no discernible benefit. No differences were found in groups taking antioxidants from placebo groups in the context of pregnancy diseases. There were side effects of supplementation and for this reason supplementation with this antioxidant should not be ordered without clear indications. Conclusions: The information gathered does not indicate the usefulness of vitamin E supplementation in pregnancy. The issue of the use of antioxidants in the fight against diseases that occur during pregnancy requires further research.

Lupus activity and pregnancy outcomes in systemic lupus erythematosus patients undergoing assisted reproductive therapy: A systematic review and meta-analysis.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. While pregnancy and hormonal stress can trigger SLE flare-ups, the effects of assisted reproductive therapies (ARTs) on SLE patients are not well defined. We conducted a search of PubMed/Medline, Embase, and CENTRAL until March 20, 2024, to find observational studies assessing the prevalence of SLE flares and pregnancy outcomes following ARTs. Our analysis included random-effects meta-analysis and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for evaluating evidence quality. Five studies involving 237 SLE women who underwent ARTs were eligible. The meta-analysis indicated a prevalence of SLE flares at 17% (95% CI: 10-25%) with moderate-quality evidence. The pooled prevalence of arthritis flares was 7% (95% CI: 0-25%) with low-quality evidence. Successful pregnancy rates were 58% (95% CI: 43-72%), and live birth rates were 96% (95% CI: 83-100%), both with low-quality evidence. Moderate-quality evidence showed pregnancy complications, including preterm premature rupture of membranes (PPROM) at 8% (95% CI: 3-16%), miscarriages at 2% (95% CI: 0-9%), intrauterine fetal demise (IUFD) at 4% (95% CI: 0-11%), and preeclampsia at 7% (95% CI: 1-17%). Low-quality evidence showed preterm labor at 10% (95% CI: 0-32%) and ovarian hyperstimulation syndrome (OHSS) at 2% (95% CI: 0-11%). SLE flares, as well as pregnancy complications such as IUFD, miscarriage, PPROM, and preeclampsia in ART recipients, are equivalent to those in spontaneous conception. This indicates that ART is relatively safe for SLE patients with meticulous pregnancy planning. Key Points •Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. • Pregnancy in women with SLE poses elevated maternal and fetal risks compared to healthy women. • SLE flares and pregnancy complications while receiving ART are equivalent to those in spontaneous conception and ART is relatively safe for SLE patients.

Perinatal outcomes of selective termination in dichorionic twin pregnancies: a retrospective study from a single center.

Selective termination (ST) is an appropriate procedure for managing discordant fetal anomalies in dichorionic diamniotic (DCDA) twin pregnancies. The aim of this study was to investigate the perinatal outcomes of ST at different gestational ages in DCDA twin pregnancies. This retrospective study was conducted on DCDA twin pregnancies with STs at West China Second University Hospital between January 2012 and December 2022. According to the gestational age at which ST was performed, the patients were assigned to four groups: Group 1 (13 to 17 + 6weeks), Group 2 (18 to 23 + 6weeks), Group 3 (24 to 27 + 6weeks), and Group 4 (≥ 28weeks). We identified 230 patients for this study. The overall rates of miscarriage, preterm delivery at < 32weeks, and term delivery were 1.3%, 10.5%, and 50%, respectively, while the rates of live birth and neonatal survival were 98.7% and 98.2%, respectively. The rate of term birth was highest (70.6%) and the birth weight was heaviest (2931 ± 535g) in Group 1 (p = 0.000). In the presence of a fetus subjected to feticide, the mean delivery age was earlier than that in the non-presenting group (p = 0.017); accordingly, the mean birth weight in the feticide group was lower (2366 ± 628g) than that in the non-presenting group (2590 ± 634g) (p = 0.011). When we examined the relative relationship between reduction weeks and delivery weeks of twins by correlation analysis, we observed that with regard to maternal prognosis, two pregnancies involved preterm premature rupture of membranes (PPROM) at 7days and 3days after the procedure. Intrauterine infection occurred in two patients in Group 4, but there were no maternal deaths or maternal coagulatory abnormalities. Optimal perinatal outcomes were obtained by ST of DCDA pregnancies before 18weeks, regardless of whether or not the reduced fetus was the presenting twin. However, if legally possible, late (i.e., after 28weeks) procedures can be a safe alternative for patients diagnosed after the 18th week of gestation. Overall, we herein noted a negative correlation between the procedure week and the delivery week in this study. Moreover, ST of the non-presenting twin was associated with a heavier birth weight and later gestational age at delivery.

Neonatal Survival and Outcomes following Periviable Rupture of Membranes.

To clarify survival for infants affected by periviable prolonged preterm premature rupture of membranes (PPROM) in the military health system (MHS). To add to current literature on outcomes following expectant management, including long-term neurodevelopment outcomes. Retrospective matched cohort review of six level 3 military neonatal intensive care units (NICUs; 2010-2020). Cases were matched 1:1 with control infants, matched by location, gender, gestational age (within 1 week), birth weight (within 300 g), and rupture of membranes (ROM) within 24 hours of delivery. Follow-up data were obtained for each infant through 48 months' corrected age or age of last documented health visit in a military treatment facility. Forty-nine infants met inclusion criteria. Mean ROM for cohort infants was 20.7 weeks, with mean latency period of 34.6 days and mean gestational age at delivery of 25.7 weeks. Cohort infants had a mean birth weight of 919 g. Cohort survival to NICU discharge was 75.5 versus 77.6% of controls (p = 0.81). Statistically significant short-term outcomes: oligohydramnios or anhydramnios at delivery (p < 0.0001), pulmonary hypertension (p = 0.0003), and high-frequency ventilation (p = 0.004) were higher in cohort infants. No differences were found regarding rates of early sepsis, intraventricular hemorrhage, surgical necrotizing enterocolitis, oxygen at 36 weeks or at discharge. No statistical difference in long-term outcomes at 18 to 48 months of age or incidence of autism, cerebral palsy, attention deficit hyperactivity disorder, or asthma. Cohort survival to discharge in the MHS was 75.5%, higher than previously reported and not different from matched controls. Infants born after periviable PPROM should deliver at centers with access to high-frequency ventilation and ability to manage pulmonary hypertension. There was no difference in long-term neurodevelopment between the groups. · Survival to NICU discharge is similar between infants exposed to periviable PPROM and controls.. · Cohort survival to discharge was 75.5%, higher than previously reported in recent literature.. · Infant with periviable PPROM should delivery at centers capable of managing pulmonary complications..

Clinical associations of complement-activating collectins, collectin-10, collectin-11 and mannose-binding lectin in preterm neonates.

Premature and low-birthweight infants are at especially high risk of perinatal complications, including impaired thermoregulation, infections and respiratory distress. Such adverse effects and the need for invasive procedures are associated with high mortality among preterms. This study focused on the influence of the innate immune system and tested the levels of collectins, collectin-10 (CL-10), collectin-11 (CL-11) and mannose-binding lectin (MBL) in preterm neonates. Cord blood was collected from 535 preterms (born at gestational age ≤37 weeks). COLEC10 and COLEC11 polymorphisms were analyzed by real-time PCR and those of MBL2 by PCR/PCR-RFLP. The concentrations of collectins in sera from cord blood were determined with ELISA. Low concentrations of CL-10 in cord sera (<462 ng/ml corresponding to the 10th percentile) were significantly associated with births at GA ≤32 weeks. Median levels of both CL-10 and CL-11 were significantly lower in preterms with very low birthweight (<1500 g), low Apgar 1' score and those who needed prolonged hospitalisation. Lower median CL-10 was also observed in fetal growth restriction cases. An important finding was the decreased concentrations of CL-10, CL-11 and MBL in respiratory distress syndrome (RDS). For CL-10 and CL-11, that relationship was confined to infants born at GA ≥33 weeks and/or with body mass at birth ≥1500 g. Only CL-10 was found to influence susceptibility to early-onset infections. COLEC11 heterozygosity for the activity-decreasing polymorphism (rs7567833, +39618 A>G, His219Arg) was more common in preterm premature rupture of membranes (pPROM) cases, compared with corresponding reference groups. Furthermore, C/T or T/T genotypes at COLEC11 at rs3820897 (-9570 C>T) as well as MBL deficiency-associated MBL2 gene variants were more common in preterms diagnosed with RDS than among unaffected newborns. The complement-activating collectins investigated here could be important for maintaining homeostasis in preterm neonates. Despite similar structure and specificity, MBL, CL-10 and CL-11 manifest a different spectrum of clinical associations.

Escherichia coli induced matrix metalloproteinase-9 activity and type IV collagen degradation is regulated by progesterone in human maternal decidual

BackgroundEscherichia coli (E. coli) is one of the main bacteria associated with preterm premature rupture of membranes by increasing pro-matrix metalloproteinase 9 (proMMP-9) and degradation of type IV collagen in human feto-maternal interface (HFMi). proMMP-9 is regulated by progesterone (P4) but it is unclear whether P4 inhibits proMMP in human maternal decidual (MDec). This study aimed to determine a role of P4 on proMMP-2 and − 9 and type IV collagen induced by E. coli infection in MDec.MethodsNine HFMi were mounted in a Transwell system. MDec was stimulated with P4 or E. coli for 3-, 6-, or 24-hours. proMMP-2, -9 and type IV collagen were assessed.ResultsGelatin zymography revealed an increase in proMMP-9 after 3, 6, and 24 h of stimulating MDec with E. coli. Using immunofluorescence, it was confirmed the increase in the HFMi tissue and a reduction on the amount of type IV collagen leading to the separation of fetal amniochorion and MDEc. The degradative activity of proMMP-9 was reduced by 20% by coincubation with P4.ConclusionsP4 modulates the activity of proMMP-9 induced by E. coli stimulation but it was unable to completely reverse the degradation of type IV collagen in human MDec tissue.

Emergency cerclage: Neonatal outcomes and evaluation of prognostic scores − A decade of experience at a tertiary center

ObjectivesEmergency cervical cerclage is a high-risk surgical procedure associated with maternal and fetal risks, including preterm birth. Authors have developed scores to try to predict the probability of success following emergency cerclage, but these tools have yet to be externally validated.Our main objective was to assess the preterm birth rate before 32 weeks following emergency cerclage. Secondary objectives included assessing perinatal outcomes and the predictive validity of two published scores in our setting. We hypothesized that predictive scores, such as Fuchs and Kokia scores, may not perform optimally in our population due to variability in clinical and biological characteristics that influence eligibility for cerclage across different settings. Study designWe conducted a retrospective, monocentric study in a tertiary maternity hospital. All patients who underwent emergency cerclage between January 1st, 2010, and December 31st, 2021, were included. The main outcome was preterm birth rate before 32 weeks. Secondary outcomes were need for maternal hospitalization after initial hospitalization for cerclage, preterm premature rupture of membrane, and perinatal death. The rate of preterm birth before 32 weeks and adverse perinatal outcomes were estimated. To assess the predictive validity of Fuchs’ score in our population, we performed a multivariable logistic regression model including the score’s variables and constructed receiver operating characteristic (ROC) curve. To assess the validity of Kokia’s score in our population, we studied the correlation between the initial score and gestational age at delivery using Pearson’s correlation coefficient. ResultsOur population was composed of 64 women who underwent an emergency cerclage. The median gestational age at delivery was 30.6 weeks (IQR (24.2; 37.6)). The preterm birth rate before 32 weeks was 54.7 %. The rate of perinatal death was 30.7 %. There were no statistical differences between the patients delivered before and after 32 weeks. The multivariable logistic regression model showed that none of the variables of Fuchs’s score were significantly associated with preterm birth risk in our population. The AUC of the ROC curve using Fuchs’ score was 0.63. There was a minor yet significant correlation between Kokia’s score and gestational age at delivery (r = 0.26 – p = 0.04). ConclusionsOur study underscores the persistent risks associated with cervical insufficiency, including very preterm birth. It highlights the variability in performance of predictive scores across different populations, underscoring the need for external validation in diverse clinical settings.

Long-term neurodevelopmental outcomes at three years in preterm infants born before 29 Weeks gestation following Preterm Premature Rupture of Membranes (PPROM).

To determine the association between preterm premature rupture of membranes (PPROM) and neurodevelopmental impairment (NDI) at 3 years corrected age (CA) in infants born before 29 weeks of gestational age (GA). Infants born before 29 weeks GA between 2005 and 2017 were included. The primary outcome was a composite of death or NDI (full-scale intelligence quotient<85, cerebral palsy, vision or hearing impairment) at 3 years of CA. Infants were stratified by maternal PPROM status. Associations were explored using multivariate models. Of 1231 participants, 481 were in the PPROM group, and 750 were in the No PPROM group. After adjusting for factors, the odds ratio of death or NDI for PPROM vs. No PPROM was 1.22 (95% Confidence Interval 0.93-1.59). Our study suggests that PPROM was not associated with an increased risk of a composite outcome of death or NDI at 3 years CA.

Impact of Early Dressing Removal After Cesarean Section on Wound Healing and Complications: A Systematic Review.

The global increase in cesarean section (C-section) births has heightened concerns about surgical site infections (SSIs), a significant risk associated with this common obstetric procedure. This literature review evaluates the impact of early dressing removal after C-sections, drawing from randomized controlled trials and clinical studies to assess potential benefits and risks. The review found no definitive evidence favoring a specific timing for dressing removal to reduce SSIs. However, earlier removal before hospital discharge generally enhances patient comfort. Factors such as high BMI, urgent C-sections, preterm premature rupture of membranes (PPROM), and chorioamnionitis are linked to higher wound healing complications, irrespective of when the dressing is removed. Removing staples before discharge is advised for convenience, with close monitoring recommended for high-risk patients. The findings emphasize the need for further research to optimize wound healing protocols, particularly for high-risk groups, to improve patient outcomes and minimize complications. A personalized approach to postoperative care, tailored to individual risk factors, may offer the best strategy for reducing SSIs and enhancing recovery after C-sections.

A STUDY ON MATERNAL AND FETAL OUTCOME IN OLIGOHYDRAMNIOS

Background: Amniotic fluid provides a protected milieu for growing fetus, cushioning the fetus against mechanical and biological injury. It also supplies nutrients and facilitates growth and movement.Oligohydramnios is defined as Amniotic fluid index (AFI) less than 5 cm, or deep vertical pocket &lt; 21. It occurs in 1–5% pregnancies at term, with the incidence increasing in postdate pregnancies to 11%.2 Maternal conditions associated with decreased AFV ( amniotic fluid volume)include post-dated pregnancy, preterm premature rupture of membranes (PPROM), hypertension, autoimmune disorders and maternal medication like prostaglandin synthetase inhibitors. Fetal factors: Which influence AFV are essentially related to fetal growth (intrauterine growth restriction) and fetal anomalies, particularly of the renal tract. The most commonly associated renal anomalies with oligohydramnios include bilateral renal agenesis, multicystic dysplastic kidneys, bladder outlet obstruction and infantile polycystic kidney disease.The aim of this study is to evaluate the etiological risk factors of oligohydramnios and to know the clinical significance and mode of delivery and maternal and perinatal outcome. Methods: This was a retrospective study conducted on 100 cases in Basaveshwar Medical and Teaching Hospital attached to MahadevappaRampure Medical college, Kalaburagi from 1-8-2023 to 1-6-2024.All cases coming to Basaveshwar medical and teaching hospital with oligohydramnios were included in the study after fulfilling inclusion and exclusion criteria Results: Of the 100 cases in the present study,40 cases were in 25-30 years accounting for 40% of cases with maximum number of cases in this age group.56 cases were primigravida accounting for 56% of cases with majority of cases being primigravida and 44 cases were multigravida accounting for 44% of cases.The number of cases with preterm rupture of membranes were 21 ( 21%), cases with Intra uterine growth restriction were 15 (15%). 6 cases (6%) had congenital anamolies. The number of cases withpost dated pregnancy were 22 (22%), Pregnancy induced hypertension cases were 28 (28%). Cases with autoimmune diseases were 1 (1%) and 7 cases (7%) were idiopathic.The most important cause for oligohydramnios was pregnancy induced hypertension and post-dated pregnancy. 13 of the cases had spontaneous onset of labouri.e 13% cases, 28 cases (28%) were induced and 59 cases underwent cesarean section accounting for 59% of all cases.In the present study, total of 19 cases underwent cesarean section because of fetal distress accounting for 19% of cases with the most common indication for cesarean section.11 cases (11%) underwent LSCS due to IUGR, ,4 cases (4%) underwent cesarean section because of non-progression of labour, 2 cases(2%) underwent LSCS because of malpresentation/malposition, 9 cases (9%) had cephalopelvic disproportion, 2 cases (2%) refused for induction of labour and 12 cases (12%) were previous LSCS.Among the 100 cases studied ,there were 8 cases (8%) with meconium aspiration syndrome, 5 cases (5%) had respiratory distress, 6 cases (6%) had low birth weight, 6 cases (6%) with congenital anomalies, 21 cases (21%)had NICU admissions, 4 cases (4%) were still born and 2 cases(2%) had intrauterine fetal death Conclusion: Oligohydramnios is associated with fetal distress, meconium aspiration syndrome ,respiratory distress syndrome ,increased NICU admissions, low birth weight, perinatal mortality, morbidity and increased maternal morbidity due to increased cesarean section rates.Oligohydramnios requires intense fetal monitoring with proper antenatal and intrapartum care.Hence, AFI can be used as a primary tool in fetal surveillance in antenatal and intrapartum period and can help in categorization of fetus into high risk and low risk .One can have favourable outcome with good antenatal and intrapartum care

Safety of the Seasonal Influenza Vaccine in 2 Successive Pregnancies

ImportanceAlthough influenza vaccination has been found to be safe in pregnancy, few studies have assessed repeated influenza vaccination over successive pregnancies, including 2 vaccinations in a year, in terms of adverse perinatal outcomes.ObjectiveTo examine the association of seasonal influenza vaccination across successive pregnancies with adverse perinatal outcomes and whether the association varies by interpregnancy interval (IPI) and vaccine type (quadrivalent or trivalent).Design, Setting, and ParticipantsThis retrospective cohort study included individuals with at least 2 successive singleton live-birth pregnancies between January 1, 2004, and December 31, 2018. Data were collected from the Vaccine Safety Datalink, a collaboration between the Centers for Disease Control and Prevention and integrated health care organizations. Data analysis was performed between January 8, 2021, and July 17, 2024.ExposuresInfluenza vaccination was identified using vaccine administration codes. The vaccinated cohort consisted of people who received influenza vaccines during the influenza season (August 1 through April 30) in 2 successive pregnancies. The comparator cohort consisted of people identified as unvaccinated during both pregnancies.Main Outcomes and MeasuresMain outcomes were risk of preeclampsia or eclampsia, placental abruption, fever, preterm birth, preterm premature rupture of membranes, chorioamnionitis, and small for gestational age among individuals with and without vaccination in both pregnancies. Adjusted relative risks (RRs) from Poisson regression were used to assess the magnitude of associations. The associations with adverse outcomes by IPI and vaccine type were evaluated.ResultsOf 82 055 people with 2 singleton pregnancies between 2004 and 2018, 44 879 (54.7%) had influenza vaccination in successive pregnancies. Mean (SD) age at the start of the second pregnancy was 32.2 (4.6) years for vaccinated individuals and 31.2 (5.0) years for unvaccinated individuals. Compared with individuals not vaccinated in both pregnancies, vaccination in successive pregnancies was not associated with increased risk of preeclampsia or eclampsia (adjusted RR, 1.10; 95% CI, 0.99-1.21), placental abruption (adjusted RR, 1.01; 95% CI, 0.84-1.21), fever (adjusted RR, 0.87; 95% CI, 0.47-1.59), preterm birth (adjusted RR, 0.83; 95% CI, 0.78-0.89), preterm premature rupture of membranes (RR, 1.00; 95% CI, 0.94-1.06), chorioamnionitis (adjusted RR, 1.03; 95% CI, 0.90-1.18), or small for gestational age birth (adjusted RR, 0.99; 95% CI, 0.93-1.05). IPI and vaccine type did not modify the observed associations.Conclusions and RelevanceIn this large cohort study of successive pregnancies, influenza vaccination was not associated with increased risk of adverse perinatal outcomes, irrespective of IPI and vaccine type. Findings support recommendations to vaccinate pregnant people or those who might be pregnant during the influenza season.

Placental lesions in patients with antiphospholipid antibody syndrome: experience of a single tertiary-care Italian reference center

IntroductionAbnormal placentation contributes to obstetric morbidity in antiphospholipid antibodies syndrome (APS). The placenta is the main target of antiphospholipid antibodies (aPL) in obstetric APS and is the site of dysfunctional inflammatory responses and thrombosis. Standard treatment for APS during pregnancy includes low-dose aspirin (LDA) plus low molecular weight heparin (LMWH) and, in refractory cases, hydroxychloroquine (HCQ). Recently, a systematic review of the literature identified five main pathological placental lesions in APS patients: placental infarction, decidual vasculopathy, decidual inflammation, increase of syncytial knots due to syncytiotrophoblast death, and decrease in vasculosyncytial membranes. The aims of this study were to investigate whether placental lesions associate with obstetrical outcomes in a cohort of APS patients.Methods130 pregnant APS patients evaluated between 2009 and 2023 at the High-Risk Obstetrics Outpatient Clinic of San Raffaele Hospital, Milan, were enrolled. Placental samples from 25 spontaneously conceived pregnancies in APS patients were collected from January 2017 to May 2023 and analyzed.ResultsAll (n = 130) patients were on LDA and 110/130 (85%) on both LDA and LMWH. Twenty-six patients (20%) also received HCQ. In these patients, signs of placental inflammation (preterm birth and preterm premature rupture of membranes) were less frequently observed. Of the 25 placental samples analyzed, 19 (76%) patients had primary APS, while 6 patients had APS secondary to SLE. All patients were treated with LDA and LMWH. In patients with concomitant systemic lupus erythematosus (SLE) or in refractory APS, HCQ was added. Histological analysis of placental tissue revealed increased syncytial knots in 17/25 (68%) placentas, decreased vasculosyncytial membranes in 11/25 (44%), infarction in 8/25 (32%), presence of macrophages and decidual inflammation in 2/25 (8%), and atherosis or reduction of spiral artery remodeling in 3/25 (12%). We also observed at least two coexisting placental lesions in 12/25 (48%) placentas. In the placenta of patients treated with HCQ we did not observe any decidual inflammation at histology.ConclusionPlacental anomalies have occurred in patients with APS despite close and optimal obstetric monitoring. It is thus tempting to speculate that HCQ may have beneficial effects on pregnancy by decreasing the risk of deciduitis in patients with APS.

Predictors of preterm birth following emergency and ultrasound-indicated cervical cerclage: A retrospective study on 136 singleton pregnancies

ObjectiveWe aimed to retrospectively evaluate obstetric and neonatal outcomes in patients who underwent ultrasound-indicated and rescue cervical cerclage and to identify predictors for cerclage failure and consequent preterm birth (PTB). Materials and methodsWe conducted a retrospective analysis on singleton pregnancies between 16 and 27 weeks of gestation who presented with a transvaginal sonographic cervical length (TVS-CL) <25 mm and a previous PTB/second-trimester miscarriage or prolapsed amniotic membranes and/or a TVS-CL <15 mm and underwent cervical cerclage at Mangiagalli Center, Milan, between September 2011 and December 2021. Univariate and multivariate logistic regression analyses were used to identify possible predictive factors of cerclage failure. ResultsDuring the study period, a total of 136 singletons met the inclusion criteria. Overall, 3 % of pregnancies did not reach fetal viability, mostly due to post-cerclage preterm premature rupture of membranes and/or chorioamnionitis. The mean gestational age at delivery was 35.9 ± 4.5 weeks. Neonates were delivered beyond 37 weeks in 63.2 % of cases, between 28 and 37 weeks in 26.5 %, and less than 28 gestational weeks in 10.3 %. At the multivariate analysis, independent risk factors for miscarriage or PTB were cervical length <10 mm (odds ratio, OR 3.44), advanced cervical dilatation (OR 4.76), and in vitro fertilization (OR 4.66). A history of previous miscarriage, premature delivery, and uterine malformations did not increase the risk of post-cerclage delivery before 37 weeks. In the preterm delivery group, 14 % of patients experienced preterm premature rupture of membranes (pPROM) and 10 % had chorioamnionitis, while no case was registered in the term delivery group. A positive vaginal swab at the time of cervical cerclage was not significantly associated with PTB at the multivariate analysis but it emerged as a significant risk factor for both chorioamnionitis (OR 11.03) and pPROM (OR 5.28). ConclusionsUltrasound-indicated and rescue cervical cerclage were effective in prolonging pregnancy, even when placed beyond 24 weeks of gestation. Preoperative cervical length of less than 10 mm, advanced dilatation, and in vitro fertilization are associated with an increased risk of cerclage failure. A positive vaginal swab before cerclage is associated with increased rates of intrauterine infectious-inflammatory processes.

Comparison of the Fetomaternal Outcome in Women With Preterm Premature Rupture of Membranes on Expectant Management Versus Delivery at 34 Weeks.

This study aimed to study feto-maternal outcomes in women with preterm prelabor rupture of membranes (PTPROM) on expectant management versus delivery at 34 weeks of gestation and correlate the period of latency and inflammatory markers with delivery outcomes. We have chosen this research topic as there is a paucity of specific guidelines regarding the optimal period of gestation for delivering women with PTPROM. The study correlated the feto-maternal outcomes in women with PTPROM on expectant management till 37 weeks versus delivery at 34 weeks with a period of latency and maternal inflammatory markers. This was a prospective observational study conducted on 262 women with PTPROM from 28-33+6 weeks of gestation. Women were monitored till 37 weeks with biweekly total leukocyte count and weekly C-reactive protein, urine routine microscopy, urine culture, high vaginal culturesensitivity, and ultrasound. Women were monitored expectantly till 37 weeks. However, intervention was done at any time during the feto-maternal compromise. There were 52 women who delivered <34 weeks and 210 women who delivered ≥34 weeks. Feto-maternal outcomes were documented. Group A was assigned to women who delivered before 34 weeks and Group B was assigned to women who delivered after 34 weeks. Statistical analysis was done using SPSS software.A p-value <0.05 was considered significant. Amongthe study group, 238 (90.8%) women were managed expectantly while 24(9.1%) required intervention. A latency of 3-4 weeks was observed in 131(50%) women.Chorioamnionitis developed in 7 women (4.4%) in group A and 13 women (4.9%) in group B. Neonates developed sepsis in 5.7% in group A and 5.8 % in group B and were comparable in both the groups (p=1.000). Early neonatal death (END) occurred in 10 (3.8%) amongwhich seven died because of low birth weight (LBW), two due to sepsis, and one due to respiratory distress. LBW was significantly associated with END (p<0.001) Conclusion: Expectant management beyond 34 weeks with close monitoring can improve neonatal outcomes without increasing maternal morbidity in women with PTPROM.

Perinatal outcomes with a copper intrauterine device in situ after 28 gestational weeks: A retrospective study of sole center in southeast China.

The purpose of this study was to investigate the pregnancy outcomes with a copper intrauterine device (IUD) in situ after 28 gestational weeks and the association between pregnancy with copper IUDs and neonatal congenital malformations. This retrospective study had compared the singleton pregnancies with the copper IUDs in situ and without after 28 gestational weeks in 1 delivery center of southeast China. The main exposure was a copper IUD in uterine cavity with pregnancy. The pregnant outcomes as preterm birth, premature rupture of membranes, infections were observed and compared. We had also compared neonatal congenital malformations in 2 groups. The statistical analysis was carried out using R (version 4.0.4; R Development Core Team) statistical software. Association between IUD use or duration of IUD use and adverse pregnancy outcomes were estimated using logistic model. Two-tailed P value < .05 was deemed statistically significant. A total of 148 pregnant women were included in our study, 74 with copper IUDs in situ were categorized into case group and 74 without IUDs during pregnancy into control group. No significant difference of maternal age, BMI, birth weight and gender were observed between 2 groups. In case group, the rates of preterm premature rupture of membranes (37.8%) and spontaneous preterm birth (23.0%) were significantly high compared to control group. Odds ratios of premature rupture of membranes and spontaneous preterm birth were 2.86 and 5.22 respectively. Women of elder age (≥35 years) in case group were more likely to experience premature rupture of membranes. The rates of neonatal congenital malformation were 10.8% (8/74) in case group and 1.4% (1/74) in control group respectively. We had found that pregnancy with copper IUD in situ increased the risk of premature rupture of membranes and spontaneous preterm birth after 28 gestation weeks, the risk of spontaneous preterm birth increased 5.22 times. Pregnancy with IUD in situ may be at increased risk of infection and neonatal malformation.