Rate Of Preterm Premature Rupture Of Membranes Research Articles

Effect of Gestational Age at Fetoscopic Laser Photocoagulation on Perinatal Outcomes for Patients with Twin–Twin Transfusion Syndrome

The aim of this study was to evaluate the effect of gestational age (GA) at the time of fetoscopic laser photocoagulation (FLP) for severe twin-twin transfusion syndrome (TTTS) on perinatal outcomes in a single center in Taiwan. Severe TTTS was defined as a diagnosis of TTTS before a GA of 26 weeks. Consecutive cases of severe TTTS treated at our hospital with FLP between October 2005 and September 2022 were included. The evaluated perinatal outcomes were preterm premature rupture of membranes (PPROM) within 21 days of FLP, survival 28 days after delivery, GA at delivery, and neonatal brain sonographic imaging findings within 1 month of delivery. We included 197 severe TTTS cases; the mean GA at the time of FLP was 20.6 weeks. After the cases were divided into cases of FLP at early (below 20 weeks) and late GAs (more than 20 weeks), the early-GA group was discovered to be associated with a deeper maximum vertical pocket in the recipient twin, a higher rate of PPROM development within 21 days of FLP, and lower rates of survival of one or both twins. In the cases of stage I TTTS, the rate of PPROM within 21 days of FLP was higher in the group that underwent FLP at an early GA than in the group that underwent FLP at a late GA (50% (3/6) vs. 0% (0/24), respectively, p = 0.005). Logistic regression analysis revealed that the GA at the time of FLP and the cervical length before FLP is implemented are significantly associated with the survival of one twin and the incidence of PPROM development within 21 days of FLP. The GA at the time of FLP, the cervical length before FLP, and TTTS being stage III TTTS were associated with the survival of both twins after FLP. Neonatal brain image anomalies were associated with GA at delivery. FLP being performed at an earlier GA is a risk factor for lower fetal survival and PPROM development within 21 days of FLP in cases of severe TTTS. Delaying FLP for cases involving stage I TTTS diagnosed at an early GA without risk factors, such as maternal symptoms, cardiac overload in the recipient twin, or a short cervical length, may be considered, but whether delaying FLP would improve surgical outcomes and, if so, how long the delay should be may need further trials to answer.

Association between Preterm Premature Rupture of Membranes and Vitamin D Levels in Maternal Plasma and Umbilical Cord Blood of Newborns: A Prospective Study

Background: Preterm premature rupture of membranes (PPROM) is a major cause of preterm birth. There are few reports on vitamin D deficiency associated with PPROM. We aimed to investigate the association between PPROM and vitamin D levels in maternal plasma and the umbilical cord blood of newborns. Methods: This prospective study included 355 pregnant women who delivered live infants between March 2017 and December 2018 at a medical center. Vitamin D levels were measured in the maternal plasma at the first, second, third trimesters of pregnancy and just before delivery, and in the umbilical cord blood of newborns at birth. In addition, we evaluated the pregnancy and neonatal outcomes according to vitamin D status. Results: The rate of PPROM in the vitamin D deficiency group (25(OH)D <20 ng/mL) was higher than in the non-deficiency group (25(OH)D ≥20 ng/mL) (p = 0.003). Vitamin D levels were significantly lower in the PPROM group than non-PPROM group in maternal plasma [at the first (p = 0.020) and second trimesters (p = 0.029), just before delivery (p = 0.015)], and in the cord blood of newborns (p = 0.006). Multiple logistic regression analysis showed that the odds ratio of PPROM by the increase of 1ng/mL of vitamin D levels in the cord blood of newborns was 0.907 (95% confidence interval 0.836–0.983) after adjustment for other confounders (age, gravidity, parity, and body mass index). Conclusions: Vitamin D deficiency has a significant association with PPROM. Our study would aid in understanding the mechanism of prevention of PPROM associated with vitamin D deficiency as well as reduction in preterm births.

Recurrence of premature rupture of membranes among pregnancies admitted to a Tertiary Hospital: a retrospective cohort study.

The recurrence of PPROM (Preterm Premature Rupture of Membranes) has multifactorial etiology. The aim of this study is to discuss outcome measures of subsequent PPROMs after pregnancy with PPROM before 37weeks 'gestation. One hundred fifty-one patients were identified with PPROM between 20 + 0- 36 + 6weeks of gestation between 2012 and 2017 in Trakya University Hospital. The subsequent pregnancy (n = 68) outcomes were retrospectively analyzed. The rate of PPROMs among all deliveries was 4.7%. The recurrence rate of PPROM in the next pregnancies was 13.2%. No differences in smoking, comorbidity, latency, antibiotic use, levels of leucocytes and C-Reactive Protein were observed between women with PPROM and without PPROM in previous and subsequent pregnancies. The interpregnancy intervals in subsequent pregnancies with PPROM were significantly longer than those without PPROM (p = 0.015). The subsequent pregnancies without PPROM had longer gestational weeks of PPROM and birth according to previous pregnancies (p = 0.049; p = 0.014). The short interpregnancy interval may be considered in the planning of pregnancies of these women who had previous PPROM.

Pregnancy outcomes following early fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks’ gestation

To evaluate perinatal outcomes following fetoscopic laser placental photocoagulation (FLPC) performed for twin-to-twin transfusion syndrome (TTTS) at 16 weeks’ gestation (16.0 – 16.9 weeks), as compared to FLPC performed at 17 weeks’ gestation and beyond. This retrospective review included monochorionic twins complicated by TTTS necessitating FLPC at a single tertiary center from 2012 to 2021, with cohorts defined as cases undergoing FLPC at 16.0 to 16.9 weeks (early laser group) and cases with FLPC at 17 weeks or greater (standard laser group). Primary outcomes included rates of immediate chorioamniotic membrane separation (CAS), preterm premature rupture of membranes (PPROM), and chorioamnionitis. Primary outcomes were compared between cohorts, with a p-value of < 0.05 denoting statistical significance. Secondary outcomes included dual twin survival rates at birth and 30 days of life, adjusting for maternal age and Quintero stage at the time of FLPC. A total of 343 cases were included (35 early laser, 308 standard laser), with demographics summarized in Table 1. As seen in Table 2, the early laser group had significantly higher rates of CAS when compared to the standard laser group [34.3% vs 13.3% of cases (p < 0.001)]. The early laser group also demonstrated higher rates of PPROM [45.7% versus 25.0% (p=0.009)] and chorioamnionitis [11.4% vs 1.3% (p=0.005)]. Cessation of amniotic fluid leakage following PPROM occurred more frequently in the early laser group [37.5% vs 3.9% (p=0.001)]. Dual twin survival differed between the early and standard groups, although not significantly so. Early FLPC for TTTS performed at 16 weeks is associated with significantly higher rates of CAS, PPROM, and chorioamnionitis. However, amniotic fluid leakage tends to stop after PPROM following early FLPC, which we speculate may help to ameliorate some adverse fetal effects. Even after adjustment for higher Quintero staging in the early laser group, twin survival does not seem to be affected.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Cesarean section and pregnancy outcomes of preterm premature rupture of membranes under different fertility policies in China

BackgroundThe aim of the present study was to compare the outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) in China.MethodsThe present study was a single-center retrospective study of women admitted to Beijing Obstetrics and Gynecology Hospital in 2012, 2014, and 2017. Deliveries at <24 and >37 weeks, fatal deformities, stillbirths, and multiple pregnancies were excluded. Pregnancies were divided into 24–27+6, 28–33+6, and 34–36+6 weeks according to weeks of gestation in each year. In total, 1,178 pregnancies complicated by PPROM were analyzed in terms of incidence rate, risk factors, delivery mode, and neonatal outcomes.ResultsThe rate of PPROM was 3.11% in 2012, 2.35% in 2014, and 2.4% in 2017; the difference was significant (P<0.001). Age [odds ratio (OR): 1.046, P<0.001], intrauterine infection (OR: 2.087, P=0.007), and vaginitis (OR: 1.812, P=0.039) were risk factors for PPROM. In all 3 years, patients with PPROM tended to choose vaginal delivery rather than cesarean section (CS) delivery (68.9% in 2012, P<0.001; 76.5% in 2014, P<0.001; 69.3% in 2017, P<0.001), and the rate of vaginal deliveries in 2014 was higher than that in 2012 and 2017 (P=0.027). Indications for PPROM at 34–36+6 weeks varied significantly among the 3 years (P<0.001). No significant difference was found in body weight, body length, and Apgar score at 1, 5, and 10 min; however, there was a significant difference in Apgar score after 1 min at 28–33+6 weeks (P=0.012).ConclusionsThe incidence rate of PPROM at our single center varied between 2012, 2014, and 2017. Risk factors for pregnancies complicated by PPROM include age, intrauterine infection, and vaginitis. The rate of CS delivery varied, and breech/transverse presentation was the major indication for patients with PPROM at 34–36+6 weeks.

Complication rates after chorionic villus sampling and midtrimester amniocentesis: A 7-year national registry study

To assess the complication rates following chorionic villus sampling (CVS) and midtrimester amniocentesis in Taiwan. This is a national registry-based cohort study from Taiwan. We included all women with singleton pregnancies who received either CVS (n=1409) or midtrimester amniocentesis (n=250,566) during 2006-2012. We assessed preterm premature rupture of membranes (PPROM), intrauterine fetal demise (IUFD), infection and spontaneous abortion (SA) that occurred within fourteen days after the procedures. We also assessed the risks of preterm delivery and miscarriage before 24 gestational weeks after amniocentesis. These complications were collected from the Genetic Disease Database of the Ministry of Health and Welfare, Taiwan National Birth Certificate Registry, and the Taiwan National Health Insurance Database. Pearson χ2 tests were used to compare the distributions between groups. For patients who underwent midtrimester amniocentesis, the rates of PPROM, IUFD, infection and SA within fourteen days were 0.24%, 0.11%, 0.05%, and 0.05%, respectively. Women with a normal fetal karyotype had a preterm birth rate (<37 gestational weeks) of 9.38%. The miscarriage rate (<24 gestational weeks) was 0.68%, which was 0.22% higher than those who did not receive the invasive procedures (p<0.0001). After CVS, the IUFD rate was 1.68%, and the SA rate within fourteen days was 0.77%. The use of our large cohort demonstrated that the procedure-related complication rates were comparable to recent review or meta-analysis. This dataset might facilitate counselling in women who consider invasive genetic diagnostic procedures.

Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases.

Preterm premature rupture of membranes (PPROM) is a leading complication following fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time. The secondary objective was to assess potential risk factors for PPROM. Single-centre retrospective observational study. 1092 consecutive cases of TTTS operated by FLC between 2000 and 2016, with a 6.8% rate of loss to follow up. The incidence of PPROM and potential risk factors were analysed using competing risks models. PPROM, neonatal survival and neurological damage at 28 days. PPROM <32 weeks increased from 15 to 40% between 2000 and 2016 along with an overall improvement of perinatal outcomes: dual survival rose from 42 to 66% whereas dual losses dropped two-fold, from 19 to 9%. Gestational age at surgery at <17 weeks was a significant risk-factor for PPROM, with an additional risk of 10% within the first week of surgery. Although early PPROM at <20 weeks carried a 56% risk of miscarriage, the occurrence of PPROM at >20 weeks did not affect survival, despite an increase in preterm birth at <32 weeks. With significant improvement in perinatal outcomes, possibly related to improvements in surgical technique, postoperative complications have shifted to non-lethal obstetric complications such as PPROM, with rather reassuring postnatal outcomes, despite an increase in preterm birth and, potentially, morbidity. Early surgeries (<17 weeks) are at higher risk of postoperative PPROM. Following laser/TTTS, rates of PPROM increased with perinatal survival; surgeries at <17 weeks are at highest risk.

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.

Does Intramuscular Progesterone Help Women With Prior Preterm Birth Screened for Ultrasound-Indicated Cerclage? [25K

INTRODUCTION: Weekly intramuscular 17α-hydroxyprogesterone caproate (17P) is endorsed by the American College of Obstetricians and Gynecologists for recurrent preterm birth (PTB) prevention. Cerclage is indicated in patients with prior PTB and a midtrimester cervical length (CL) less than 25 mm. We aimed to assess if these two preventive strategies, when combined, confer additive benefit in prolonging gestation. METHODS: Retrospective cohort of all singletons delivered at a single center that underwent CL screening from 2011 to 2016 for prior PTB. Exposure was any 17P use. Primary outcome was gestational age (GA) at delivery. Secondary outcomes included cerclage, preterm labor (PTL) admission, and preterm premature rupture of membranes (PPROM). ANCOVA was used to assess the relationship between 17P and delivery GA, controlling for cerclage, initial CL, number of prior PTB, and GA of earliest prior PTB. RESULTS: Of 409 patients who underwent CL screening, 293 received 17P (group 17P), and 116 did not. Groups did not differ by age, race, BMI, payer, number of prior PTB, or initial CL. GA of earliest prior PTB was lower in group 17P (27.4 vs 29.9 weeks; P &lt; .001). Delivery GA occurred earlier in group 17P (35.7 vs 37.2 weeks; P=.002). Group 17P also had higher rates of PPROM (22.2% vs 11.2%; P=.011), PTL admission (42% vs 25%; P=.001), and cerclage (18.1% vs 5.2%; P &lt; .001). After controlling for confounders, delivery GA remained significantly lower in group 17P (34.9 vs 35.9 weeks; P=.027). CONCLUSION: In a population with prior PTB followed with CL screening and ultrasound-indicated cerclage, 17P did not prolong gestation.

Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation

Introduction: This study aimed to investigate the risk factors, incidence, and influence on the perinatal outcome of chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP). Material and Methods: This retrospective study included 312 women who underwent FLP for twin-to-twin transfusion syndrome (TTTS). Clinical records were used to review obstetrical examinations, complications, operative data, ultrasonographic findings, and perinatal and neonatal follow-up data in all patients. Results: A total of 260 cases of TTTS were analyzed. The incidence of CMS was 12.7% (33 cases). The only independent risk factor of CMS was performing FLP before 20 weeks of gestational age (GA) (odds ratio = 3.38 [1.44-7.93], p = 0.005). Concerning perinatal outcome, CMS was only related with increased risk of premature rupture of membranes (PROM) before 32 weeks (33.3 vs. 13.9%, p = 0.005), with no differences in GA at delivery and survival rate. Discussion: In our cohort, the incidence of CMS after FLP was approximately 13%, with surgery before 20 weeks being the only risk factor identified. Although in our population CMS did not worsen perinatal outcome in terms of preterm delivery or survival, the preterm PROM rate was increased and this should be considered for the patients' management.

Clinical follow-up of pregnancy in myasthenia gravis patients

This study aimed to analyze the outcome and impact of pregnancy in women with myasthenia gravis (MG). Obstetric and clinical data were retrospectively analyzed before, during and after pregnancy. Predictors of outcome were studied. We included 35 pregnancies from 21 MG patients. In the course of MG symptoms in 30 pregnancies with live births, 50% deteriorated (mainly during the second trimester, p = 0.028), 30% improved, and 20% remained unchanged. The deterioration group had more frequent abnormal repetitive nerve stimulation (RNS) (p = 0.028) and lower myasthenia gravis composite (MGC) scores (p = 0.045) before pregnancy. The improvement group was associated with higher MGC scores (p = 0.012) before pregnancy. The no-change group was associated with longer duration of MG (p = 0.026) and normal RNS (p = 0.008) before pregnancy. The course of MG in the second pregnancy was different from that in the previous pregnancy in 65.3% of cases. Obstetric complications were reported in 20 pregnancies; the most common was preterm premature rupture of membranes (PPROM) (25.8%), and the most severe were abortion (11.4%) and fetal death (2.9%). Most of the patients delivered via caesarean section (66.7%). Spinal anesthesia was performed in 73.3%. Transient neonatal myasthenia gravis occurred in 12.9% of live-born infants, and no predictors were found. In conclusion, severity and duration of MG, RNS and treatment influence MG and pregnancy. Pregnant MG patients have greater rates of PPROM and caesarean delivery. Our data suggest that duration of MG, MGC and RNS before pregnancy may be useful in helping to predict the course of MG during pregnancy.

Effect of antepartum meconium staining on perinatal and neonatal outcomes among pregnancies with gastroschisis

Objective: To investigate the association between meconium staining and perinatal and neonatal outcomes in pregnancies with gastroschisis. Methods: Retrospective analysis of infants with prenatally diagnosed gastroschisis born in two academic medical centers between 2008 and 2013. Neonatal outcomes of deliveries with and without meconium staining were compared. Primary outcome was defined as any of the following: neonatal sepsis, prolonged mechanical ventilation, bowel atresia or death. Secondary outcomes were preterm delivery, preterm-premature rupture of membranes (PPROM) and prolonged hospital length of stay. Results: One hundred and eight infants with gastroschisis were included of which 56 (52%) had meconium staining at delivery. Infants with meconium staining had a lower gestational age at delivery (36.3 (±1.4) versus 37.0 (±1.2) weeks, p = 0.007), and a higher rate of PPROM (25% versus 8%, p = 0.03) than infants without meconium. Meconium staining was not significantly associated with the primary composite outcome or with any of its components. After adjustments, meconium staining remained significantly associated with preterm delivery at <36 weeks [odds ratio OR = 4.0, 95% confidence intervals (CI): 1.5–11.4] and PPROM (OR = 3.8, 95%CI: 1.2–14.5). Conclusions: Among infants with gastroschisis, meconium staining was associated with prematurity and PPROM. No significant increase in other adverse neonatal outcomes was seen among infants with meconium staining, suggesting a limited prognostic value of this finding.

Chorioamniotic membrane separation over the cervical os ("moon sign") in twin-twin transfusion syndrome.

To determine whether chorioamniotic membrane separation from the internal cervical os, the "moon sign," is associated with preterm premature rupture of membranes (PPROM) in twin-twin transfusion syndrome (TTTS). A retrospective study of patients with TTTS treated with laser surgery was performed. Membrane separation before and after surgery was tested against any PPROM, PPROM within 7 days, and PPROM within 21 days. Because intrauterine fetal demise (IUFD) was weakly associated with PPROM, these cases were studied separately. Among 304 consecutive patients, 247 patients (81.3%) had no IUFD, and preoperative and postoperative membrane separation rates were 13.4% and 13.0%, respectively. In 7 cases (2.8%), preoperative membrane separation disappeared postoperatively, and in 6 cases (2.4%), membrane separation appeared postoperatively; 26 cases (10.5%) had membrane separation at both times. Rates of PPROM did not differ between those who did and did not have preoperative membrane separation (30.3% versus 28.0%; P= .9511). Among those with and without postoperative membrane separation, the rates of any PPROM were 34.4% and 27.4%, respectively (P = .5473), and the rates of PPROM within 21 days were 15.6% and 5.6% (P = .0524). Those with postoperative membrane separation were 3 times more likely to have PPROM within 21 days (odds ratio, 3.13; 95% confidence interval, 1.02-9.58; P= .0453). Preterm premature rupture of membranes was not associated with preoperative or postoperative membrane separation in patients with IUFD. The preoperative moon sign does not appear to be associated with PPROM in TTTS. Postoperatively, membrane separation may be weakly associated with PPROM at 21 days, but further research is required to confirm this association.

Cord occlusion followed by laser cord transection in monochorionic monoamniotic discordant twins

To compare the outcomes of a consecutive case series of monochorionic (MC) monoamniotic (MA) discordant twins treated with umbilical cord occlusion and transection, with those of a cohort of MC diamniotic (DA) twins treated with conventional cord occlusion. This study included 17 MCMA twins (12 true MA and five iatrogenic) treated with cord occlusion and transection and a control group of 72 MCDA discordant twins treated during the same period with cord occlusion in a single center. Duration of surgery, rates of preterm delivery (PTD) or preterm premature rupture of membranes (PPROM) < 32 weeks and intrauterine fetal demise (IUFD), perinatal outcome and neonatal survival were prospectively recorded in both groups. Median durations of surgery were 28.5 (range, 14.0-74.0) min and 24.0 (3.0-60.0) min in the cord transection and control groups, respectively (P = 0.24). There were no significant differences between cord transection and control groups in the rates of PPROM (35.3% vs. 20.8%, P = 0.22), PTD (41.2% vs. 28.2%, P = 0.29), IUFD (0% vs. 2.8%, P = 1.0) and neonatal survival (76.5% vs. 80.6%, P = 1.0). Gestational age at delivery (median 35.0 (24.5-39.0) vs. 37.1 (26.2-41.0) weeks, P = 0.21) and fetal birth weight (2215 (800-3200) g vs. 2605 (588-3830) g, P = 0.51) were similar between study groups. Cord occlusion and transection in MCMA discordant twins resulted in similar perinatal outcomes to those of MCDA discordant twins treated with cord occlusion.

Premature infants born after preterm premature rupture of membranes with 24–34 weeks of gestation: a study of factors influencing length of neonatal intensive care unit stay

Objectives. To determine the factors influencing length of neonatal intensive care unit (NICU) stay among premature infants born after preterm premature rupture of membranes (PPROM) with 24–34 weeks of gestation.Methods. Characteristic parameters of the pregnant women with PPROM and their premature infants were analyzed retrospectively using univariate and multivariate analysis.Results. The overall rate of PPROM was 1.3% (323/24,173), of which 19.2% (62/323) were premature infants with sepsis. Overall, the median NICU stay of the premature infants was 11 days. Multiple factor regression analysis identified factors influencing length of stay in premature infants: gestational age (β = −0.172, P = 0.000), parturition modes (β = −0.115, P = 0.000), infant’s birth weight (β = −0.728, P = 0.000), infant’s discharge weight (β = 0.443, P = 0.000), bacterial culture of cord blood (β = −0.100, P = 0.011) and sepsis (β = 0.192, P = 0.000). Additionally, latency period of sepsis diagnosis in neonatal sepsis between negative and positive cord blood culture was significantly discrepant, and 98.1% specificity and 84.4% positive predictive value for cord blood culture.Conclusion. We have identified several predictive factors for length of stay in cases of premature infants after PPROM, of which cord blood culture can be used as an additional diagnostic test to detect newborns at risk of infections, and be valuable in clinical application and generalization among neonate sepsis.

Chorioamnion plugging and the risk of preterm premature rupture of membranes after laser surgery in twin–twin transfusion syndrome

To examine the incidence of preterm premature rupture of membranes (PPROM) in pregnancies affected by twin-twin transfusion syndrome (TTTS) treated with laser photocoagulation where an absorbable gelatin sponge was used as a chorioamnion sealant of the fetoscopic access port. A retrospective review was undertaken of consecutive cases undergoing fetoscopic directed laser surgery for TTTS between October 2006 and November 2008 at Texas Children's Fetal Center, in which an absorbable gelatin sponge, used as a chorioamnion 'plug', was placed at the conclusion of the intervention as a possible prophylactic measure to prevent PPROM. We excluded cases that had a failure of plug placement and those in which it was not attempted. PPROM was defined as rupture of membranes before 34 weeks' gestation. A comparison was performed between the PPROM group and a no-PPROM group to determine risk factors and outcomes. Successful plug placement occurred in 79 of 84 cases (94%) in which it was attempted after laser surgery, with a rate of PPROM of 34% in these patients. PPROM occurred at an average gestational age of 26.5 +/- 3.6 weeks, with an average procedure-to-PPROM interval of 5.2 +/- 3.5 weeks. There were no statistically significant differences between the PPROM group and the no-PPROM group in maternal demographics or preoperative parameters including: amniotic fluid volumes in the recipient twin's gestational sac, volume of amnioreduction, and location of the placenta. The procedure-to-delivery interval for the total cohort (n = 79) was 9.2 +/- 4.7 weeks, without a significant difference between the two groups (P = 0.08). However, after exclusion of one PPROM outlier, the PPROM group had an average procedure-to-delivery time 2 weeks shorter than the group with no PPROM (P = 0.03). The live birth rates were similar in the PPROM and no-PPROM groups, at 77 and 73%, respectively. However, the average recipient's weight in the PPROM group was significantly lower than in the no-PPROM group (1321 +/- 493 vs. 1705 +/- 576 g; P = 0.02). The rate of PPROM and the mean gestational age at delivery in pregnancies in which an absorbable gelatin sponge was used as a sealant of the fetoscopic port following laser photocoagulation for TTTS were comparable to those that have been reported by other laser centers where membrane sealants were not used. A randomized controlled trial should be considered to evaluate the effect of chorioamnion plugging.

Factors affecting the duration of the latency period in preterm premature rupture of membranes

Objective. To investigate the natural course of preterm premature rupture of membranes (PPROM) at <34 + 0 weeks and to identify factors that affect the duration of the latency period.Design. A retrospective cohort study of all women diagnosed with PPROM prior to 34 + 0 weeks during 1998–2006. Latency period was defined as the time between onset of PPROM to either spontaneous delivery, labor induction at 34 + 0 weeks, or indicated delivery prior to 34 + 0 weeks because of suspected chorioamnionitis or nonreassuring fetal heart rate.Results. The overall rate of PPROM was 1.4% (905/66,775), of which 46% (417/905) occurred at <34 + 0 weeks. Overall, the latency period exceeded 48 h in about 73.4% of cases (306/471). Women with short latency periods (<48 h) were characterised by higher degree of cervical dilatation and higher gestational age at admission and were more likely to be nulliparous. The duration of the latency period ranged between 0 and 59 days and was inversely related to gestational age at admission (r = −0.63, P < 0.001). Using Cox proportional hazards model, gestational age at admission (HR = 1.29, 95% CI = 1.22–1.37), oligohydroamnios (HR = 1.49, 95% CI = 1.18–1.87), cervical dilatation >1 cm (HR = 0.65, 95% CI = 0.52–0.83), fetal growth restriction (HR = 2.94, 95% CI = 1.24–6.94) and nulliparity (HR = 1.28, 95% CI = 1.12–1.63) were significantly associated with shorter duration of the latency period.Conclusion. In this study, we have identified several predictive factors for the duration of the latency period in cases of PPROM. This information may assist clinicians in risk stratification and in providing consultation for women presenting with PPROM prior to 34 weeks of gestation.

A single nucleotide A>G polymorphism at position −670 in the Fas gene promoter: Relationship to preterm premature rupture of fetal membranes in multifetal pregnancies

The relationship between a polymorphism at position -670 in the Fas gene (TNFRSF6) and preterm premature rupture of membranes (PPROM) in multifetal pregnancies was examined. Buccal swabs from 119 mother-infant sets were analyzed for an adenine (A) to guanine (G) substitution at position -670 in the TNFRSF6 promoter. Pregnancy outcome data were subsequently obtained. Analysis was by Fisher exact test. Maternal allele G homozygosity (TNFRSF6*G) was observed in 42.4% of 33 PPROM pregnancies as opposed to 19.5% of 77 with no spontaneous preterm birth (P = .01). Similarly, TNFRSF6*G homozygosity was present in 37.5% of 32 first-born neonates from PPROM pregnancies as opposed to 18.7% of 75 uncomplicated pregnancies (P = .04). PPROM occurred in 8 of 14 (57.1%) pregnancies in which mother and all neonates were TNFRSF6*G homozygotes as opposed to 25 of 105 (23.8%) cases in which uniform TNFRSF6*G homozygosity was not observed (P = .02). A genetic variant in the Fas gene is associated with an increased rate of PPROM in multifetal pregnancies.

Association of a maternal CD14 gene polymorphism with preterm premature rupture of membranes (PPROM) in multifetal pregnancies and its potentiation by interleukin-1 receptor antagonist (IL-1ra) and 70kDa heat shock protein (hsp70) gene polymorphisms

CD14 is involved in induction of pro-inflammatory immunity. IL-1ra and hsp70 inhibit pro-inflammatory cytokine expression. We hypothesized that specific combinations of these polymorphic genes may differentially influence the rate of PPROM.

Paternal care in social contexts without the mother: Associations with father-infant interaction at one year

The relationship between a polymorphism at position −670 in the Fas gene (TNFRSF6) and preterm premature rupture of membranes (PPROM) in multifetal pregnancies was examined.Buccal swabs from 119 mother-infant sets were analyzed for an adenine (A) to guanine (G) substitution at position −670 in the TNFRSF6 promoter. Pregnancy outcome data were subsequently obtained. Analysis was by Fisher exact test.Maternal allele G homozygosity (TNFRSF6∗G) was observed in 42.4% of 33 PPROM pregnancies as opposed to 19.5% of 77 with no spontaneous preterm birth (P = .01). Similarly, TNFRSF6∗G homozygosity was present in 37.5% of 32 first-born neonates from PPROM pregnancies as opposed to 18.7% of 75 uncomplicated pregnancies (P = .04). PPROM occurred in 8 of 14 (57.1%) pregnancies in which mother and all neonates were TNFRSF6∗G homozygotes as opposed to 25 of 105 (23.8%) cases in which uniform TNFRSF6∗G homozygosity was not observed (P = .02).A genetic variant in the Fas gene is associated with an increased rate of PPROM in multifetal pregnancies.