Prolonged Premature Rupture Of Membranes Research Articles

Maternal and neonatal outcome associated with prolonged premature rupture of membranes below 26 weeks' gestation.

The outcomes of 41 patients with prolonged, premature rupture of membranes in the midtrimester (19.5 to 26 weeks) managed conservatively were retrospectively analyzed. The maternal obstetric history was notable for a high incidence of second trimester bleeding and a prior history of preterm delivery. The mean duration of ruptured membranes before delivery was 10.6 days and was unrelated to gestational age. Delivery occurred within 2 weeks in 75% of the cases. The major indication for delivery was chorioamnionitis in 71% of patients. The only major maternal morbidity was chorioamnionitis. The overall perinatal survival was 47%, but in infants exceeding 24 weeks' gestation or 500 gm weight, the survival increased to 75%. No significant limb abnormalities, facial anomalies, growth retardation, or pulmonary hypoplasia occurred in the study population. Long-term follow-up demonstrated that 28% of infants exhibited major neurologic or developmental deficits.

Can Prenatal Ultrasound Predict Pulmonary Hypoplasia?

Pulmonary hypoplasia is often associated with sonographically detectable conditions: oligohydramnios, prolonged premature rupture of membranes, and, not infrequently, fetal anomalies. In their efforts to improve prenatal sonographic diagnosis of this condition, investigators have used an array of different sonographic biometric measurements and fetal behavioral patterns. Definitions of these measurements and their respective successes in predicting pulmonary hypoplasia are presented. The sonographic parameters that have been of most value in the prediction of pulmonary hypoplasia are chest circumference, direct measurements of the lung, lung length, lung span to hemithorax diameter, and more complex formulas, such as lung area/heart area x 100/chest area. Although fetal measurements may help predict pulmonary hypoplasia, no single sonographic finding consistently leads to a prediction of the presence of pulmonary hypoplasia. Therefore, obstetric management (i.e., nonintervention) cannot currently be altered with the finding of abnormal biometric parameters unless a known lethal anomaly is observed.

Very early prolonged premature rupture of membranes and survival

Fetal survival is possible even with very premature rupture of membranes followed by persisting oligohydramnios, secondary Potter facies and limb deformities. A case history is given with continuous amniotic fluid loss starting at 11+4 weeks, without development of pulmonary hypoplasia.

Factors associated with neonatal deaths in very low birth weight infants.

The majority of neonatal deaths in normally formed newborns occur in V.L.B.W. infants. This study was performed to determine where efforts should be directed towards improving their management. The charts of 18 infants with birth weights 750–1,500 grams who died in the first month of life over a 2 year period at the Rotunda Hospital were reviewed. During this time there were 11,500 total births with 0.8% of births < 1.5 Kg. birth weight. Gestational age of the infants studied ranged from 24 to 30 weeks. Fifteen infants died less than 48 hours of age. Postmortems were performed on 16. Twelve infants were severely asphyxiated. Seven died from intraventricular haemorrhage; all who died after surviving greater than 44 hours developed I.V.H. Seven developed a pneumothorax, two of whom subsequently developed an I.V.H. Four infants died due to pneumonia. Six twins died, three due to twin to twin transfusion. Other important prenatal factors were antepartum haemorrhage (7), prolonged premature rupture of membranes (3), and mothers presenting “unbooked” (2).

Immunoglobulins in prolonged ruptured membranes

Concentrations of immunoglobulins G, M, and A were studied in maternal and cord serum of patients with prolonged premature rupture of membranes, as well as in properly matched control patients. None of the patients studied showed any evidence of clinical chorioamnionitis or other prenatal infections. Cases were divided into term premature rupture of membranes and term controls and preterm (<34 gestational weeks) premature rupture of membranes and preterm controls. In the term group, with 12 to 24 hours of premature rupture of membranes, maternal immunoglobulins M and A, and cord immunoglobulin A were significantly increased. With a duration of premature rupture of membranes of more than 24 hours, levels of immunoglobulins M and A in maternal serum and levels of immunoglobulins G and A in cord serum showed significant elevations. Levels of cord immunoglobulin M from both subgroups of patients with premature rupture of membranes showed a trend upward but were not significantly higher than those in control patients. In the preterm group, with 12 to 24 hours of premature rupture of membranes, only cord immunoglobulin A was significantly increased. With premature rupture of membranes of ≥72 hours, only maternal immunoglobulin G increased significantly and remained elevated; immunoglobulins M and A in cord serum were also significantly increased. The significant rise in immunoglobulins in patients with premature rupture of membranes may indicate subclinical maternal and fetal infection. This suggests the possibility that subclinical infections may play a role in the etiology of premature rupture of membranes.

984 THE INFLUENCE OF PROLONGED PREMATURE RUPTURE OF MEMBRANES (PPROM) ON THE FETUS

A conservative approach to non-delivery of women with prolonged premature rupture of membranes (PPROM) before 36 wks. was associated with congenital postural deformities and hypoplastic lungs but not with neonatal asphyxia or sepsis. PPROM> 24 hrs. occurred in 89 infants (15.8/1000 deliveries 1975-1977). Positional foot deformity (PFD), congenital dislocation of hips (CDH) and hypoplastic lungs (HL) were present only with PPROM at 28 wks. gestation or less. The incidence of PFD and CDH in this group was significantly higher than in all newborns (5.5% and 1.1% vs. 0.4% and 0.5% respectively). 3/89(3.3%) of the infants were stillborn; 8/89 (9.0%) died; 8/11 perinatal deaths were <1000 gm. There was no difference in the incidence of neonatal asphyxia in PPROM infants matched for gestational age and birth weights with non-PPROM controls. The one PPROM infant with infection survived Group B streptococcal septicemia.

A CONTROLLED STUDY OF THE INFLUENCE ON THE NEWBORN OF PROLONGED PREMATURE RUPTURE OF THE AMNIOTIC MEMBRANES AND/OR INFECTION IN THE MOTHER

A CONTROLLED STUDY OF THE INFLUENCE ON THE NEWBORN OF PROLONGED PREMATURE RUPTURE OF THE AMNIOTIC MEMBRANES AND/OR INFECTION IN THE MOTHER

Prolonged premature rupture of membranes

Prolonged premature rupture of membranes