Rates Of Preterm Premature Rupture Research Articles

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.

Trauma in pregnancy: An analysis of the adverse perinatal outcomes and the injury severity score.

Trauma during pregnancy is one of the most important causes of non-obstetric maternal and fetal mortality and morbidity. The aim of our study is to evaluate the adverse perinatal outcomes that may occur according to the type and severity of the trauma. In this retrospective cohort study, pregnant traumatized women aged 18-50 years and referred for consultation to the Prof. Dr. Cemil Tascıoglu City Hospital's emergency services of the departments of gynecology and obstetrics, between January 1, 2017, and December 31, 2022, were evaluated. Demographic characteristics, trauma findings, Injury Severity Scoring (ISS), and obstet-ric outcomes were recorded. A total of 1825 trauma patients, including 900 pregnants were referred to our emergency gynecology clinic for consulta-tion. One hundred and fifty three pregnant patients, whose birth information we reached, were selected as the study group. The mean age of the patients was 25.56±5.99 years and the mean gestational week at the time of trauma was 21.59±9.89 weeks, the patients had fallen (67.97%), had been exposed to violence (30.07%), and had a traffic accient (1.96%). The patient's delivery and hospitalization status on the day of trauma, fracture and ISS ≥9 were statistically significantly at a higher rate in the 3rd trimester. Rates of hospitaliza-tion and 3rd trimester traumas were found to be significantly higher in the ISS ≥9 group. (P=0.0001, P=0.028, respectively). Compared to the general population, the rates of preterm premature rupture of membranes-premature rupture of membranes, fetal death, fetal distress, cesarean delivery, placental abruption, and preterm delivery increased in traumatized pregnant women. Patients with low ISS scores should also be followed closely during pregnancy in terms of perinatal complications, as well as the severe trauma group.

Effectiveness of cervical pessary in women with arrested preterm labor compared to those with asymptomatic cervical shortening

Objective To determine whether the effectiveness of cervical pessary is different in women who experienced cervical shortening after a threatened preterm labor episode compared to those with asymptomatic short cervix. Methods Retrospective study on singleton pregnancies at risk for preterm delivery (PTD) due to cervical length <25 mm before 28 weeks, who were treated with Arabin cervical pessary. Two groups of patients were compared: those who had contractions causing shortening of the cervix, prior to pessary placement, and those who had asymptomatic cervical shortening. Patients carrying a multiple pregnancy and those who underwent iatrogenic PTD were excluded. The primary outcome was the incidence of PTD at different gestational ages. Secondary outcome was the rate of preterm premature rupture of membrane (pPROM). The groups were compared using univariate and multivariate analyses. Results 115 patients that met the inclusion criteria were identified. Of these, 91 (79%) had asymptomatic cervical shortening, while 24 (21%) had an episode of threatened preterm labor that resolved, and the pessary was placed after the contractions had stopped. The two groups were similar for maternal characteristics, obstetric history, mean gestational age and length of the cervix at the time of pessary insertion. The median gestational age at delivery was significantly lower (36.4 vs 38.0 weeks, p = .02), and the incidence of PTD significantly higher (58.3% vs 30.8%, OR 4.69, 95% CI 1.68–13.1, p < .01) among women who had arrested preterm labor before the pessary was placed compared to the asymptomatic group, after controlling for confounders. The incidence of PTD before 34 and before 32 weeks was also significantly higher in the symptomatic group (p = .02 and p = .005, respectively). Women with asymptomatic cervical shortening had a longer interval between the placement of the pessary and delivery (median 15 weeks). pPROM occurred with a similar incidence in both groups. Conclusions Arabin cervical pessary to prevent preterm delivery seems be less effective in women with a short cervix following an episode of threatened preterm labor than in those with asymptomatic cervical shortening in the second trimester. This finding may help physicians to select patients in which cervical pessary is more likely to be effective, and to improve patient’s counseling about this intervention.

Incidence Rate, Risk Factors and Outcome of Premature Rupture of Membranes (PROM) at Zagazig University Hospitals

Background: Premature rupture of membranes (PROM) is a common pregnancy complication and is associated with significant risks of fetal and neonatal morbidity and mortality. Objective: This study aimed to measure the incidence rate of preterm premature rupture of membranes (PPROM) among pregnant women attending Zagazig University Hospital, and to identify the risk factors associated with PROM and fetal/neonatal outcomes. Methods: This cross-sectional study was conducted at Zagazig University Hospitals. It included 69 women with PROM. The study was conducted from July 2019 to January 2020. All patients were subjected to detailed history taking, general examination and laboratory investigations. Results: There were 46 mother gave birth of healthy babies with good Apgar score (66.7%), 15 with babies needed O2 incubators (21.7%) and 8 with babies that were put on ventilators (11.6%). There were 68 mothers with no bad outcomes and 1 with chorioamnionitis. The risk factors of the cases showed that there were 15 with no risk factor (21.7%), 8 with previous PROM (11.6%), 6 with multi pregnancy (8.7%), 12 with antepartum (17.4%), 16 with infections (23.2%) and 12 with chronic diseases (17.4%). Conclusions: we concluded that younger, illiterate parturient women were found to be provoking factors to increased PPROM. Such hazards may affect both maternal and neonatal outcome such as infection, maternal distress, fetal distress, increase operative delivery, as well as need for neonatal intensive care unit care in more than 50% of the neonates.

S716 Clinical Predictors of Disease Flares in Pregnant People With Inflammatory Bowel Disease

Introduction: Pregnancy in people with inflammatory bowel disease (IBD) is associated with a higher risk of adverse outcomes compared to the general population. Identification of clinical factors which predict flares could be used to guide treatment decisions. Our aim was to identify clinical predictors of disease flares in pregnant people with IBD. Methods: A retrospective cohort study of all deliveries from 1/1/2011 to 1/1/2020 at an academic tertiary care medical center in a major metropolitan area in the United States. Pregnant people were identified using ICD-9 codes for IBD and CPT codes for deliveries. Charts were reviewed for baseline demographics, obstetric history, disease subtype (Crohn’s disease [CD] or ulcerative colitis [UC]), medication use, disease course and adverse outcomes during pregnancy. Results: 42,000 deliveries were identified of which 122 were in those with IBD of whom 33% (n = 40) flared during pregnancy. UC diagnosis was associated with higher risk of pregnancy flare compared to CD (55% vs 22.4% p=0.001). Elevated stool calprotectin was associated with higher risk of pregnancy flare (564.4 vs 37.6 p=0.007). Patients on thiopurines and combination therapy with a biologic had fewer flares than those on no medications, 5-ASAs, biologics alone or steroids (p< 0.05). Pregnant people in endoscopic or clinical remission prior to pregnancy had significantly fewer disease flares compared to those who did not (p=0.0001). Pregnant people who flared had significantly higher rates of preterm premature rupture of membranes (PPROM 10.5% vs 1.3% p=0.04) and small for gestational age offspring (12.8% vs 2.6% p=0.04) compared to those who did not experience a peripartum flare (Table 1). Rate of other adverse obstetric and neonatal outcomes did not differ between groups (Table 1). A logistic regression model utilizing clinical, endoscopic remission, and calprotectin resulted in 85.7% accuracy for prediction of flares. Conclusion: In our population of pregnant people with IBD, disease flares during pregnancy were associated with higher rates preterm premature rupture of membranes and small for gestational age offspring. Clinical and endoscopic remission along with calprotectin data may be sufficient to predict disease flares during pregnancy and assist in counseling and treating this group of patients to maximize optimal pregnancy outcomes.Table 1.: Patient Characteristics and Outcomes.

Clinical and biochemical markers of spontaneous preterm birth in singleton and multiple pregnancies

Aim The aim of this study was to compare the clinical characteristics of singleton and twin pregnancies that resulted in spontaneous preterm births (sPTB) and to evaluate the prognostic value of phosphorylated insulin-like growth factor binding protein-1 (phIGFB-1) and placental alpha macroglobulin-1(PAMG-1) for sPTB prediction in symptomatic women. Patients and methods The study included 420 women and included two parts. Firstly, we performed a retrospective cohort study comparing pregnancy and neonatal outcomes in 170 women with singleton pregnancies and spontaneous preterm birth before 37 weeks of gestation with 150 women with twin pregnancies who delivered at the same gestational age. In order to obtain the link between clinical and biochemical predictors of preterm labor we organized the second part of the research. The second part was a prospective observational study in 100 women with singleton and twin pregnancies between 24 and 33 + 6 weeks of gestation and symptoms of threatening preterm labor and intact membranes. We assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for phIGFBP-1 and PAMG-1 in terms of sPTB within 7 days and 14 days after testing. Results The rate of preterm premature rupture of membranes was higher in singleton pregnancies (67.1 versus 42.8%, p = 0.034). Cervical shortening in multiples was diagnosed at an earlier mean gestational age than in singleton pregnancies (30.1 ± 4.3 versus 35.9 ± 3.1 weeks, p = 0.013). In the singleton pregnancies group, the rate of microbial cervical colonization and the rate of bacterial vaginosis were significantly higher than in twin pregnancies (49.4 versus 15.3%, p < 0.001; 32.9 versus 12.0%, p = 0.007, respectively). Premature twins had a longer oxygen dependency period, while the singletons were more predisposed to infectious morbidity. The study showed low sensitivity of phIGFBP-1 for sPTB, while the sensitivity of the PAMG-1 test was higher (sensitivity 60% and 90% within 7 days after testing and 50 versus 75% within 14 days after testing). Both tests showed a high NPV for sPTB (93.3% for phIGFBP-1 versus 98.9% for PAMG-1). The NPV for preterm labor in twins was also high for both tests (93% for phIGFBP-1 and 96% for PAMG-1). Conclusion Cervical shortening is the main risk factor of sPTB in women with twin pregnancies; sPTB among singletons is associated with ascendent infection, involving fetal membranes. The PAMG-1 test showed high PPV and NPV for sPTB in symptomatic women and could be a reliable prognostic tool in clinical obstetrics. High NPV was observed for phIGFBP-1 and PAMG-1 in twin pregnancies.

Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin-twin transfusion syndrome.

We tested the hypothesis that increasing severity of chorioamnion membrane separation (CAS) after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) is associated with worse pregnancy outcomes. Prospective cohort of patients undergoing FLS for TTTS between 2011 and 2018. CAS was defined as separation of fetal membranes from the uterine wall on post-operative ultrasound. Patient groups were defined: Group 1: No CAS; Group 2: CAS lower than 50th centile; Group 3: CAS upper than 50th centile or complete CAS. Comparative analysis was performed. Of 387 patients meeting inclusion criteria, 29 (7.5%) had CAS (median 9.8 mm [4.9-30.8 mm]). Group 1 patients were more likely to undergo FLS at later gestational age, had increased recipient maximum vertical pocket, and higher amnioreduction volume than Group 3. Group 3 had higher rates of preterm premature rupture of membrane, delivered earlier and were more likely to terminate than Group 1. Group 2 had fewer neonatal survivors than Group 1. Survival analysis for gestational age at delivery and Cox proportional hazards model indicated increased risk for early delivery in Groups 2 and 3 compared with Group 1. Patients with CAS ≥9.8 mm or complete CAS after FLS for TTTS had worse obstetric and neonatal outcomes.

Vaginal colonization of extended-spectrum beta-lactamase-producing bacteria during pregnancy: An observational study

ObjectiveExtended-spectrum beta-lactamase (ESBL) is a rapidly evolving enzyme that cleaves beta-lactam-containing antibiotics, forming resistance to certain types of antibiotics, such as penicillin, cephalosporins and monobactams. Colonization with ESBL-producing bacteria during pregnancy is harmful, however this topic is currently underrepresented in the literature. Study designUsing a retrospective design, we analyzed data of all consecutive pregnant women who were identified with a vaginal colonization of ESBL-producing bacteria from 2011 to 2016 at the Medical University of Vienna, Department of Obstetrics and Gynecology. Swabs were taken during pregnancy and/or at delivery, as well as from neonates. Demographic and clinical data were obtained from the central in-house alert system and patients’ clinical records. ResultsOf the 14,279 deliveries performed in our department during the study period, we identified 13 women with vaginal colonization of ESBL-producing bacteria during pregnancy. Of these cases, 6 born neonates were tested ESBL positive. The maternal-to-neonatal transmission rate was 43 %, associated with a 70 % rate of preterm premature rupture of the membranes (pPROM) and a preterm birth rate of 83 %. Of the 6 neonates with ESBL colonization, 4 neonates (67 %) were born to mothers who were still tested positive at the time of delivery. ConclusionMaternal colonization of ESBL-producing bacteria is an important risk factor for transmission. The vaginal presence of ESBL-producing bacteria during pregnancy is associated with preterm birth and pPROM, which shows the need for clear diagnostic and therapeutic guidelines.

229: Use of tissue grafts for in-utero spina bifida closure of large skin defects

In-utero spina bifida closure of large defects is often challenging, requiring tissue graft (acellular dermal matrix or bovine collagen materials) for watertight skin closure. Using the fMMC Consortium registry sponsored by NAFTNet, we compared risk factors for tissue graft utilization and outcomes of primary skin closure vs. tissue graft closure. The fMMC Consortium registry is an international prospectively collected dataset including 296 patients from 15 centers during the period 2011-2018. Overall inclusion for in-utero spina bifida closure adhered to MOMS study criteria. The decision for the use of a tissue graft or the type of tissue graft was at the discretion of the pediatric neurosurgeon at the respective site. The perioperative management protocol was also institution dependent. Data collected included maternal demographics, fetal preoperative evaluation, operative outcomes, use of patch, and neonatal and childhood outcomes to age 3 years. The comparative statistics were performed with p-value of <0.05 considered significant. Overall 23% (67/296) of patients required fetal spina bifida closure using a tissue graft for skin closure. The comparison between the two groups is illustrated in Table 1. The risk factors for the use of tissue graft included higher lesion level and no covering sac. There were no differences in maternal age, gravidity, parity, ventricular size, or gestational age at procedure. The rate of preterm premature rupture of membranes and the gestational age at delivery were similar in the two groups. The development of syringomyelia was 5-fold higher with use of tissue graft. Shunt placement was 1.3-fold higher with tissue graft but did not reach statistical difference. There was a trend towards high risk of tethered cord in the tissue graft group. The higher level lesions or myeloschisis are more likely to need tissue grafts for the closure of skin during in utero spina bifida closure. These children are at higher risk of developing syringomyelia at the repair site. Further exploration of the mechanisms and optimal methods of wound closure are urgently needed.

History-indicated cerclage: the association between previous preterm history and cerclage outcome.

ObjectiveOur hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome.MethodsWe conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses.ResultsThe incidence of preterm delivery (<32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at <32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively.ConclusionComparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.

Outcome Comparison Between Obese and Nonobese Patients With Singleton Gestations Following Cerclage Placement [38F

INTRODUCTION: Cervical cerclage is an established treatment in preventing preterm birth, however, there are little data regarding the effect of obesity on cerclage efficacy. The primary purpose of this study was to identify the effect of obesity on preterm birth prevention in patients undergoing cerclage placement. METHODS: A retrospective cohort study was performed at a single teaching institute and included all singleton pregnancies that underwent McDonald cerclage placement between 2006 and 2014. The study group consisted of patients with a body mass index (BMI) greater than or equal to 30 kg/m2 and was stratified into obesity classes based on World Health Organization (WHO) criteria. The control group consisted of patients with a BMI less than 30 kg/m2. Additional variables included maternal demographics, progesterone use, cerclage indication, and maternal co-morbidities (hypertension, smoking, history of preterm birth and diabetes). RESULTS: 326 deliveries were included. There was a statistically significant latency between non-obese and class III obesity in reaching 30 weeks gestation (70% vs 55%, P = .0477). There was no difference in delivery less than 37 weeks and no difference in neonatal outcomes (Apgar scores, intubation, ICU admission, interventricular hemorrhage). There was a significant increase of chorioamnionitis in class III obesity (47% vs 14%, P &lt; .005). A non-significant increase in the rate of preterm premature rupture of membranes (PPROM) with increasing BMI class was observed. CONCLUSION: In patient’s undergoing cerclage placement, class III obesity appears to increase the risk of earlier preterm birth as well as antenatal maternal complications (PPROM and chorioamnionitis) however this had no impact on neonatal outcomes.

Chorioamniotic membrane separation and preterm premature rupture of membranes complicating in utero myelomeningocele repair

Since the results of the Management of Myelomeningocele Study were published, maternal-fetal surgery for the in utero treatment of spina bifida has become accepted as a standard of care alternative. Despite promise with fetal management of myelomeningocele repair, there are significant complications to consider. Chorioamniotic membrane separation and preterm premature rupture of membranes are known complications of invasive fetal procedures. Despite their relative frequency associated with fetal procedures, few data exist regarding risk factors that may be attributed to their occurrence or the natural history of pregnancies that are affected with chorionic membrane separation or preterm premature rupture of membranes related to the procedure. The objective of this study was to review chorioamniotic membrane separation and preterm premature rupture of membranes in a cohort of patients undergoing fetal management of myelomeningocele repair including identification of risk factors and outcomes. This was a retrospective review of patients undergoing fetal management of myelomeningocele repair and subsequent delivery from January 2011 through December 2013 at 1 institution. Patients were identified through the institutional fetal management of myelomeningocele repair database and chart review was performed. Perioperative factors and outcomes among patients with chorioamniotic membrane separation and preterm premature rupture of membranes were compared to those without. Risk factors associated with the development of chorioamniotic membrane separation and preterm premature rupture of membranes were determined. A total of 88 patients underwent fetal management of myelomeningocele repair and subsequently delivered during the study period. In all, 21 patients (23.9%) were diagnosed with chorioamniotic membrane separation by ultrasound and preterm premature rupture of membranes occurred in 27 (30.7%). Among the chorioamniotic membrane separation patients, 10 (47.6%) were diagnosed with global chorioamniotic membrane separation and 11 (52.4%) with local chorioamniotic membrane separation. Earlier gestational age at the time of fetal surgery was a significant risk factor for the development of chorioamniotic membrane separation (P= .01) and preterm premature rupture of membranes (P < 0.0001). Chorioamniotic membrane separation was significantly associated with preterm premature rupture of membranes (59.1% vs 21.2%, P= .008) and earlier gestational age at delivery (32.1 ± 4.2 vs 34.4 ± 3.5 weeks, P= .01). The average number of days from chorioamniotic membrane separation to preterm premature rupture of membranes was 11.0 ± 10.1 and from chorioamniotic membrane separation to delivery was 31.0 ± 22.5. The mean time interval between fetal management of myelomeningocele repair and preterm premature rupture of membranes was 47.9 days. Mean latency period from preterm premature rupture of membranes to delivery was 25 days. Gestational age at delivery was significantly lower in patients with preterm premature rupture of membranes (31.6 ± 3.4 vs 34.9 ± 3.5 weeks, P= .0001). Using logistic regression analysis, nulliparity, gestational age at fetal management of myelomeningocele repair, and membrane separation remained significant risk factors for preterm premature rupture of membranes. Chorioamniotic membrane separation after fetal management of myelomeningocele repair is a significant risk factor forsubsequent development of preterm premature rupture of membranes and preterm delivery. Fetal management of myelomeningocele repair <23 weeks is associated with higher rates of preterm premature rupture of membranes and chorioamniotic membrane separation. Therefore fetal management of myelomeningocele repair should be deferred until ≥23 weeks to mitigate these complications. Nulliparity also appears to increase the risk for preterm premature rupture of membranes.

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Objective: The aim of this study is to evaluate the interest in the in utero treatment of twin anemia-polycythemia sequence (TAPS). Methods: The obstetrical and neonatal data on all cases of TAPS followed up in our institution between 2006 and 2013 were reviewed. Statistical analyses were conducted using Bayesian methods. Results: Twenty cases of TAPS were included. Laser therapy or intrauterine transfusion (IUT) was performed on the donor twin in 9 cases. Eleven cases were included in the ‘nontreated' group (managed expectantly or diagnosed at birth). The gestational age at diagnosis was lower in the group with treated TAPS [difference (diff) = -22.20 days (-57.13, 14.28), probability (Pr) (diff >0) = 10.6%]. The rate of preterm premature rupture of membranes was higher in the group with treated TAPS [diff = 22.5% (-14, 57), Pr (diff >0) = 89%], but overall mortality was similar. The interval between diagnosis and delivery was longer [diff = 44.37 days (9.41, 77.90), Pr (diff >0) = 99.2%], the TAPS resolution rate was higher [diff = 49.9% (12, 81), Pr (diff >0) = 99.4%], and the neonatal transfusion rate was lower [diff = -30.5% (-60, 0), Pr (diff >0) = 2.6%] in the treated group. Conclusion: In utero treatment for TAPS is associated with a higher resolution rate of TAPS and a longer time between diagnosis and birth, but overall mortality is the same as with expectant management.

Earlyvslate intervention in twin reversed arterial perfusion sequence

To compare two different management approaches in prenatally diagnosed twin reversed arterial perfusion (TRAP) sequence. Retrospective analysis of all cases with TRAP sequence diagnosed in one center over a period of 10 years. Prior to 2010, all cases were managed expectantly until 19 weeks' gestation; thereafter, patients could choose either radiofrequency ablation (RFA) or expectant management (Group A). From 2010 onward all patients were offered interstitial laser at the time of diagnosis (12 weeks at the earliest) or expectant management (Group B). Forty cases were included in the study. In Group A, 23 cases were diagnosed at a mean gestational age of 19.9 ± 6.3 weeks. Sixteen patients were managed expectantly (13 survivors, 81%), while six underwent RFA at the time of diagnosis and one later in pregnancy (six survivors, 86%). In Group B, 17 cases were diagnosed at a mean gestational age of 16.4 ± 4.7 weeks. Six patients chose expectant management (five survivors, 83%) and 11 had interstitial laser therapy at the time of diagnosis (eight survivors, 73%). The loss rate of the pump twin was not significantly different between Group A and Group B (three of 23 vs four of 17; P = 0.3). In Group B the rates of preterm premature rupture of membranes (PPROM) and delivery < 34 weeks were significantly lower, and gestational age at birth as well as birth weight were significantly higher than in Group A. Despite the limitations resulting from its retrospective design, our study on management of TRAP sequence adds some evidence in favor of prophylactic intervention by intrafetal laser from 12 weeks onward.

Effect of Maternal Cystic Fibrosis Genotype on Diabetes in Pregnancy

To evaluate the association between the cystic fibrosis (CF) genotype and the rate of diabetes complicating pregnancy. We conducted a retrospective cohort analysis of all pregnant patients with CF from 1972-2011 at a single institution. Patients who were homozygous for the ΔF508 mutation were compared with patients who were heterozygous for the ΔF508 mutation. Primary outcomes measured were incidence of CF-related diabetes and gestational diabetes mellitus (GDM) stratified by CF genotype. Secondary outcomes measured included pancreatic insufficiency, preterm premature rupture of membranes, preterm delivery, mode of delivery, gestational age at delivery, and maternal mortality. We identified 54 pregnancies among 36 women who met inclusion criteria. Of these pregnancies, 28 (51.9%) were carried by women who were homozygous for the ΔF508 mutation. Homozygous women had a significantly greater incidence of pancreatic insufficiency (89.3% compared with 61.5%, P=.03) and diabetes complicating pregnancy (60.7% compared with 23.1%, P<.01) compared with heterozygous women. In addition, there was some evidence of an increased incidence of GDM specifically among homozygous women (35.7% compared with 15.4%, P=.12). Regarding neonatal outcome, there was a lower mean birthweight (2,881 g compared with 3,203 g, P=.04) among the women who were homozygous for the ΔF508 mutation. There was no statistical difference in preterm deliveries, mode of delivery, gestational age at delivery, rate of preterm premature rupture of membranes, or incidence of maternal mortality between the two groups. Women with CF who are homozygous for the ΔF508 mutation have an increased risk of having a pregnancy complicated by diabetes.

Proportion of Parents Agreeing to Delay Fetal Karyotyping until the Third Trimester of Pregnancy in Cases with an Indication

Objective: To assess the extent to which couples who could benefit from fetal karyotyping during the first or second trimester would agree to delay the examination until the third trimester. Methods: In this prospective monocentric study, the same physician suggested to some couples to delay fetal karyotyping until the third trimester. Results: 458 couples participated in this study. 230 couples (230/458 = 50.2%) refused to delay the examination until the third trimester of pregnancy (group 1). For these patients, four chromosomal abnormalities led to the termination of pregnancy. Fifty-six couples (56/458 = 12.2%) who initially agreed to delay the fetal karyotyping later changed their minds (group 2). 104 couples (104/458 = 22.7%) agreed to delay the examination (group 3). For these patients, one trisomy 21 was diagnosed and led to the subsequent termination of the pregnancy at 33 weeks of amenorrhea. Sixty-eight couples (68/458 = 14.8%) refused any form of invasive prenatal diagnosis (group 4). There was no difference in the rate of preterm premature rupture of membranes, pregnancy term, premature birth rate and birth weight between the four groups. Conclusions: Our study reports that about a quarter of couples did indeed agree to delay fetal karyotype assessment until the third trimester of pregnancy.

Anomalies de fermeture de la paroi abdominale: Prise en charge post-opératoire néonatale et devenir à court terme

Since the results of the Management of Myelomeningocele Study were published, maternal-fetal surgery for the in utero treatment of spina bifida has become accepted as a standard of care alternative. Despite promise with fetal management of myelomeningocele repair, there are significant complications to consider. Chorioamniotic membrane separation and preterm premature rupture of membranes are known complications of invasive fetal procedures. Despite their relative frequency associated with fetal procedures, few data exist regarding risk factors that may be attributed to their occurrence or the natural history of pregnancies that are affected with chorionic membrane separation or preterm premature rupture of membranes related to the procedure.The objective of this study was to review chorioamniotic membrane separation and preterm premature rupture of membranes in a cohort of patients undergoing fetal management of myelomeningocele repair including identification of risk factors and outcomes.This was a retrospective review of patients undergoing fetal management of myelomeningocele repair and subsequent delivery from January 2011 through December 2013 at 1 institution. Patients were identified through the institutional fetal management of myelomeningocele repair database and chart review was performed. Perioperative factors and outcomes among patients with chorioamniotic membrane separation and preterm premature rupture of membranes were compared to those without. Risk factors associated with the development of chorioamniotic membrane separation and preterm premature rupture of membranes were determined.A total of 88 patients underwent fetal management of myelomeningocele repair and subsequently delivered during the study period. In all, 21 patients (23.9%) were diagnosed with chorioamniotic membrane separation by ultrasound and preterm premature rupture of membranes occurred in 27 (30.7%). Among the chorioamniotic membrane separation patients, 10 (47.6%) were diagnosed with global chorioamniotic membrane separation and 11 (52.4%) with local chorioamniotic membrane separation. Earlier gestational age at the time of fetal surgery was a significant risk factor for the development of chorioamniotic membrane separation (P = .01) and preterm premature rupture of membranes (P < 0.0001). Chorioamniotic membrane separation was significantly associated with preterm premature rupture of membranes (59.1% vs 21.2%, P = .008) and earlier gestational age at delivery (32.1 ± 4.2 vs 34.4 ± 3.5 weeks, P = .01). The average number of days from chorioamniotic membrane separation to preterm premature rupture of membranes was 11.0 ± 10.1 and from chorioamniotic membrane separation to delivery was 31.0 ± 22.5. The mean time interval between fetal management of myelomeningocele repair and preterm premature rupture of membranes was 47.9 days. Mean latency period from preterm premature rupture of membranes to delivery was 25 days. Gestational age at delivery was significantly lower in patients with preterm premature rupture of membranes (31.6 ± 3.4 vs 34.9 ± 3.5 weeks, P = .0001). Using logistic regression analysis, nulliparity, gestational age at fetal management of myelomeningocele repair, and membrane separation remained significant risk factors for preterm premature rupture of membranes.Chorioamniotic membrane separation after fetal management of myelomeningocele repair is a significant risk factor for subsequent development of preterm premature rupture of membranes and preterm delivery. Fetal management of myelomeningocele repair <23 weeks is associated with higher rates of preterm premature rupture of membranes and chorioamniotic membrane separation. Therefore fetal management of myelomeningocele repair should be deferred until ≥23 weeks to mitigate these complications. Nulliparity also appears to increase the risk for preterm premature rupture of membranes.

Laparoscopy‐assisted fetoscopy for laser surgery in twin–twin transfusion syndrome with anterior placentation

To compare a laparoscopy-assisted fetoscopic approach with an ultrasound-directed percutaneous approach for laser photocoagulation of placental anastomoses in cases of twin-twin transfusion syndrome (TTTS) with anterior placentation. We performed a retrospective review of all cases that underwent laser ablation of placental anastomoses for TTTS with an anterior placenta at Texas Children's Fetal Center from November 2006 to November 2008. The two cohorts were identified by chart review based on the type of approach: laparoscopy-assisted vs. ultrasound-guided percutaneous uterine entry for fetoscopy. Operative and outcome data were extracted and the groups were compared using statistical methods, taking P < 0.05 as statistically significant. In the 100 cases of TTTS studied, 48 had an anterior placenta. Fifteen (31%) of these underwent laparoscopy-assisted fetoscopy (LAF) while a percutaneous approach was used in the remaining 33 (69%) cases. The total procedure time was longer in the LAF group than in the percutaneous group (96.1 +/- 25 vs. 67.9 +/- 28 min; P < 0.01). There was no difference in the rate of preterm premature rupture of membranes up to 2 weeks and 4 weeks after surgery (7 vs. 15% and 13 vs. 21%, for the LAF group vs. the percutaneous group, respectively; P = 0.7). The gestational ages at delivery were similar: 30.3 +/- 4.5 weeks in the LAF group and 29.2 +/- 4.6 weeks in the percutaneous group (P = 0.32). The overall survival rate at birth was tending towards better survival in the laparoscopic group than in the percutaneous group (80 vs. 61%, respectively; P = 0.06). The neonatal survival rate was better with the LAF approach than with the percutaneous approach (80 vs. 59%, respectively; P = 0.045). Laparoscopy-assisted entry of the uterus is associated with improved neonatal survival for laser photocoagulation in cases of TTTS with a complete anterior placentation.

Antibiotic Prophylaxis before second‐trimester Genetic Amniocentesis (APGA): a single‐centre open randomised controlled trial

To compare procedure-related pregnancy loss after second-trimester genetic amniocentesis in women given an antibiotic prophylaxis and controls. Prospective, open randomised controlled single-centre study between January 1999 and December 2005 at Artemisia Fetal Maternal Medical Centre. A follow-up within 4 weeks after the procedure was done.Of 36,347 eligible women, 1424 refused to participate and 34,923 were enrolled and randomised with unequal chance of selection, 21,991 were assigned to treatment group and 12,932 were assigned to the control group, and did not receive any placebo. Oral azithromycin, 500 mg per day, was administered 3 days before amniocentesis. The primary endpoint was the procedure-related pregnancy loss. The secondary endpoint was the rate of preterm premature rupture of membranes. The rate of abortion related to the amniocentesis was 7/21 219 women (0.03%, 95% CI 0.009-0.057) in the intervention group, and 36/12 529 (0.28%, 0.28-0.30) in controls (p = 0.0019). The rate of preterm premature rupture of membranes was 14/21 219 (0.06%, 0.031-0.101) in the intervention group, and 140/12 529 (1.12%, 0.94-1.30) in the control group (p = 0.001). Antibiotic prophylaxis before second-trimester amniocentesis reduced the risk of abortion and of rupture of the membranes.

Differential expression of immune system–related components in midtrimester amniotic fluid from singleton and twin pregnancies

We investigated differences between singleton and twin gestations in immune mediators in midtrimester amniotic fluid. Amniotic fluid from 252 singleton and 46 twin gestations were tested by enzyme-linked immunosorbent assay for interleukin-1beta, interleukin-1 receptor antagonist, interleukin-4, tumor necrosis factor-alpha, nitric oxide, Clara cell protein 16, leptin, and the 70-kDa heat shock protein. A subset of amniotic fluid was also tested for leukemia inhibitory factor, angiogenin, and migration inhibitory factor-related protein 8 and migration inhibitory factor-related protein 14. Data were analyzed by the Mann-Whitney U test and Spearman rank correlation. Median concentrations of interleukin-1beta, tumor necrosis factor-alpha, interleukin-4, Clara cell protein 16, leptin, and angiogenin were increased in amniotic fluid from twins; median levels of the 70-kDa heat shock protein, leukemia inhibitory factor, migration inhibitory factor-related protein 8, and migration inhibitory factor-related protein 14 were highest in amniotic fluid from singletons (P < .001). Elevated levels of immune activators may contribute to the increased rate of preterm premature rupture of membranes and spontaneous preterm birth in twin populations.