Duration Of Rupture Research Articles

Prolonged premature rupture of membranes with increased risk of infection is associated with gut accumulation of Pseudomonas from the environment

BackgroundPreterm premature rupture of membranes (PPROM) contributes to over one-third of preterm births, and PPROM infants are more susceptible to infections. However, the risk factors remain poorly understood. We here aim to investigate the association of duration of premature rupture of membranes (PROM) and environmental microbiota with the gut microbiota and infection in PPROM infants. MethodsForty-six premature infants were recruited from two hospitals, and infant fecal and environmental samples were collected. 16 s rRNA sequencing was performed to analyze the fecal and environmental microbiome. Human inflammatory cytokines in cord vein plasma were measured. ResultsThe gut microbiota composition of PPROM infants was different from that of non-PPROM infants, and the microbiome phenotypes were predicted to be associated with a higher risk of infection, further evidenced by the significantly increased levels of IL-6 and IL-8 in cord vein plasma of PPROM infants. The diversity of the gut microbiota in PPROM infants increased significantly as the duration of PROM excessed 12 h, and Pseudomonas contributed significantly to the dynamic changes. The Pseudomonas species in the gut of PPROM infants were highly homologous to those detected in the ward environment, suggesting that prolonged PROM is associated with horizontal transmission of environmental pathogens, leading to a higher risk of infection. ConclusionsThis study highlights that the duration of PROM is associated with the accumulation of environmental pathogens in the gut of PPROM infants, which is a risk factor for nosocomial infections. Improving environmental hygiene could be effective in optimizing the clinical care of PPROM infants.

Does Preterm Prolonged Rupture of Membranes Increase the Risk of Needing Invasive Respiratory Support? A Retrospective Single-Centre Study.

(1) Background: Preterm premature rupture of membranes (PPROM) has been associated with increased perinatal morbidity, but the effect of PPROM on respiratory disease has not been previously quantified. We hypothesised that PPROM would be associated with a higher incidence of invasive ventilation. (2) Methods: A retrospective cohort study at the Neonatal Unit at King's College Hospital NHS Foundation Trust, London, UK, was conducted on infants born before 37 weeks of gestation. PPROM was defined as the rupture of membranes for >48 h. (3) Results: We reviewed 1901 infants (434 with PPROM) with a median (IQR) gestational age of 32.4 (28.7-35.0) weeks. The median (IQR) duration of rupture of membranes in the infants with PPROM was 129 (78-293) h. The incidence of invasive ventilation was 56% in the infants with PPROM and 46% in the infants without PPROM (p < 0.001). Following regression analysis, PPROM was significantly related to a higher incidence of invasive ventilation (odds ratio: 1.48; 95% CI: 1.13-1.92, adjusted p = 0.004) after adjusting for birth weight [odds ratio = 0.34; 95% CI: 0.33-0.43, adjusted p < 0.001], Apgar score at 10 min [odds ratio =0.61; 95% CI: 0.56-0.66, adjusted p < 0.001] and antenatal corticosteroid use (adjusted p = 0.939). (4) Conclusions: PPROM was associated with a 1.48-fold higher risk of needing invasive ventilation.

Assessment of the Prevalence and Factors Associated with Post-Caesarean Surgical Site Infections among Patients in Fort Portal Regional Referral Hospital

The global incidence of cesarean section deliveries has significantly increased, resulting in a rise in post cesarean surgical site infections (SSIs). These infections pose a notable threat to maternal health, often leading to prolonged hospital stays, elevated costs, and direct health consequences, particularly in populations facing low socioeconomic status, limited resources, and conditions involving forced internal displacement due to conflict. Fort Portal Regional Referral Hospital lacked prior studies on SSIs, prompting the initiation of this research to ascertain the prevalence and specific factors linked to post-caesarean SSIs within the Maternity Ward at FPRRH. The study adopted a retrospective cross-sectional approach, utilizing a pretested checklist to gather information from 110 patient files admitted and operated in Maternity Ward during the six months preceding the investigation. The collected data underwent entry and analysis using IBM SPSS version 25, incorporating the chi-square test to establish relationships between SSIs and associated risk factors. Results were presented through tables and charts. The mean age of study participants was 27.67 years, with a standard deviation of 6 and an age range of 16 to 45 years. A majority (64.3%) were over 30 years old, over 50% hailed from rural areas, and the majority identified as Christians and were married. The overall prevalence of post-caesarean SSIs stood at 12.7%. Statistically significant factors influencing SSIs included gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH. In conclusion, this study revealed a 12.7% prevalence of post-caesarean SSIs, with gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH identified as significant contributing factors. Recognizing and addressing these factors early on could guide obstetricians in enhancing their daily practices, ultimately improving the outcomes of cesarean sections and diminishing the risk of post-caesarean SSIs. Keywords: Cesarean section, SSI, Patients, Post caesarean, FPRRH.

Duration of rupture of membranes and microbiome transmission to the newborn: A prospective study.

To assess whether labour variables (i.e. individuals characteristics, labour characteristics and medical interventions) impact maternal and newborn microbiomes. Prospective monocentric study. Saint-Joseph Hospital tertiary maternity unit, in Paris, France. All consecutive primiparous women with a physiological pregnancy and term labour from 15 April to 1 June 2017. 16S ribosomal RNA gene sequencing of the maternal vaginal, newborn skin and newborn oral microbiomes from 58 mother-baby dyads. Analysis of the effects of 19 labour variables on the composition and diversity of these microbiomes. The 19 labour variables explained a significant part of the variability in the vaginal, newborn oral and skin microbiomes (44%-67%). Strikingly, duration of rupture of membranes was the single factor that explained the greatest variability (adjusted R2: 7.7%-8.4%, p ≤ 0.002) and conditioned, by itself, the compositions of the three microbiomes under study. Long duration of rupture of membranes was specifically associated with a lower relative abundance of the Lactobacillus genus (1.7-fold to 68-fold reduction, p < 0.0001) as well as an increase in microbiome diversity, including genera implicated in nosocomial infections. The effects of duration of rupture of membranes were also present in newborns delivered by non-elective caesarean section. Maternal and newborn microbiomes were greatly affected by labour variables. Duration of rupture of membranes, even in non-elective caesarean sections, should be considered in epidemiological and microbiological studies, as well as in vaginal seeding practices.

Bacterial Etiology and Antibiotic Susceptibility Profile in Neonatal Sepsis

Background: Sepsis is a leading cause of morbidity and mortality in neonates. Objectives: This study aimed to investigate the bacterial profile and antibiotic sensitivity in infants with sepsis. Methods: This cross-sectional study was conducted on 90 neonates with sepsis admitted to the neonatal intensive care unit of Namazi Hospital, a tertiary-level hospital, in Shiraz, Iran, from 2020 to 2021. Demographic and clinical data including gestational age, previous diseases, maternal infectious, underlying diseases, history and duration of premature rupture of the membrane and delivery, clinical symptoms (fever, reduced breastfeeding, and lethargy), laboratory results (complete blood cell and C-reactive protein), and results of blood and urine cultures were recorded and analyzed. Results: Among 90 neonates with sepsis, the average age was 6.7 ± 7.6 days; 54 were male (60.0%), and 36 were female (40.0%). Fifty (55.5%) neonates had early sepsis. Gram-negative organisms were grown in 61% of positive blood cultures; the most common was Klebsiella. Among Gram-positive organisms, Staphylococcus epidermidis was the most common. Most organisms were sensitive to colistin, and most were resistant to cefotaxime. There was a significant relationship between the age of onset of sepsis symptoms and birth weight in infants with positive blood cultures (P = 0.004) (r = 0.3). Conclusions: Gram-negative bacteria are the most common causes of sepsis, mainly resistant to aminoglycosides and cefotaxime. Therefore, increasing awareness about the optimal use of antibiotics is necessary to curb the increase in resistance levels.

Asperity Size and Neighboring Segments Can Change the Frictional Response and Fault Slip Behavior: Insights From Laboratory Experiments and Numerical Simulations

AbstractAccurate assessment of the rate and state friction parameters of rocks is essential for producing realistic earthquake rupture scenarios and, in turn, for seismic hazard analysis. Those parameters can be directly measured on samples, or indirectly based on inversion of coseismic or postseismic slip evolution. However, both direct and indirect approaches require assumptions that might bias the results. Aiming to reduce the potential sources of bias, we take advantage of a downscaled analog model reproducing megathrust earthquakes. We couple the simulated annealing algorithm with quasi‐dynamic numerical models to retrieve rate and state parameters reproducing the recurrence time, rupture duration and slip of the analog model, in the ensemble. Then, we focus on how the asperity size and the neighboring segments' properties control the seismic cycle characteristics and the corresponding variability of rate and state parameters. We identify a tradeoff between (a–b) of the asperity and (a–b) of neighboring creeping segments, with multiple parameter combinations that allow mimicking the analog model behavior. Tuning of rate and state parameters is required to fit laboratory experiments with different asperity lengths. Poorly constrained frictional properties of neighboring segments are responsible for uncertainties of (a–b) of the asperity in the order of per mille. Roughly one order of magnitude larger uncertainties derive from asperity size. Those results provide a glimpse of the variability that rate and state friction estimates might have when used as a constraint to model fault slip behavior in nature.

Source Parameters of Strong Turkish Earthquakes on February 6, 2023 (&lt;i&gt;M&lt;sub&gt;w&lt;/sub&gt;&lt;/i&gt; = 7.8 and &lt;i&gt;M&lt;sub&gt;w&lt;/sub&gt;&lt;/i&gt; = 7.7) from Surface Wave Data

Abstract—Based on the amplitude spectra of surface waves, the source parameters of the strong Turkish earthquakes of February 6, 2023 (Mw = 7.8 and Mw = 7.7) were calculated in two approximations: an instantaneous point source and an elliptical shear dislocation. As a result, rupture planes were identified, data were obtained on the scalar seismic moment, moment magnitude, focal mechanism, and source depth of the considered seismic events, and the integral parameters characterizing the rupture geometry and its development in time were estimated. It is shown that the sources of the earthquakes under study were formed under the influence of the regional stress field and their focal mechanisms were left lateral faults with a strike direction close to the strike of the East Anatolian fault zone for the first event and close to the strike of the Sürgü-Çardak fault system for the second. For the first earthquake, our estimates of the rupture duration and its length (t = 52.5 s, L = 180 km) probably refer not to the entire rupture, but only to its main phase, confined to the northeastern segments of the East Anatolian fault and characterized by maximum displacements and values of the released seismic moment. The values of t = 30 s and L = 180 km that we obtained for the second earthquake fully characterize the entire rupture.

Study of the rupture processes of the 1989 (Mw 6.9) and 2021 (Mw 7.0) Guerrero earthquakes using teleseismic records: Sismotectonic implications

Slip models of the April 25, 1989 (Mw 6.9) earthquake and the Acapulco earthquake of September 8, 2021 (Mw 7.0) were determined to analyze its rupture zone and understand the relationship of interplate earthquakes in the Acapulco–San Marcos subduction zone. For both events, velocity P and SH waves recorded at teleseismic distances were modeled. For the 1989 San Marcos event, two slip zones were determined with a maximum slip of 121cm, a stress drop of 8bars and a rupture duration of approximately 13s. This event showed a complex rupture. For the 2021 Acapulco event, a zone of maximum slip of 267cm, a stress drop of 5bars, and a rupture duration of approximately 24s were determined. Analysis of rupture zones suggests that complex events occur in the Acapulco–San Marcos subduction zone. Therefore, these results have important implications in seismic potential studies since the source parameters are critical.

Earthquake source parameters in Zagros region (Iran) from the time-evolutive P-wave displacement

The rupture process of the recent moderate-to-large earthquakes in the Zagros area along the Iran plateau is investigated by analysing the strong motion data provided by the Iranian Building and Housing Research Centre (BHRC). The selected dataset includes the largest and deadliest 2017 Mw 7.3, Iran-Iraq (Ezgeleh) earthquake. The earthquake source parameters (moment magnitude, rupture duration and length, average slip, and static stress drop) are determined using a time-domain, parametric modelling technique based on the time evolution of the P-wave displacement signals. The earthquake source parameters are calculated from simulated triangular moment-rate functions assuming the circular source models for a constant rupture velocity. The anelastic attenuation effect is modelled through the independent frequency-Q parameter ranging from 50 to 200 and accounted for by a post-processing procedure that retrieves the attenuation-corrected, moment-rate triangular shape. Results show that the average static stress-drop with different {Q}_{P}, varies between <Δσ> = 0.9 (0.7–1.2) MPa and <Δσ> = 1.6 (1.2–2.0) MPa. Overall, in this research, the rupture radius/length empirically scales with the seismic moment with a self-similar, near-constant stress drop of about 1 MPa. Assuming a circular rupture model for the Ezgeleh earthquake, we estimate a moment magnitude of 6.9, rupture duration of 7 s, source radius of 16 km, average slip of about 2 m and static stress drop of 3.4 MPa.

Imaging the Sources of the March 2021 Seismic Sequence in Thessaly Basin (Central Greece) from Kinematic Slip Inversion and Backprojection of Waveform Envelopes

ABSTRACT In March 2021, a series of three moderate events with moment magnitudes Mw 6.3, 6.0, and 5.5 occurred within a span of 10 days in northern Thessaly, Greece, resulting in a stop–start pattern. The moment tensors (MTs) obtained from the events suggested normal faulting along distinct yet adjacent southeast–northwest-trending faults, indicating a sequential triggering process. We applied two methods to investigate the spatial and temporal characteristics of the source process of the triplet. This approach includes linear slip inversion of regional seismic waveforms and static Global Positioning System offsets, along with backprojection of regional waveforms using the Source-Scanning Algorithm technique. The detailed modeling suggests that three adjacent, subparallel (∼300°), and low-angle, detachment-type structures were responsible for the earthquakes. The stress axes orientation was determined by inverting a dataset of recomputed MTs combined with published solutions of the sequence. The results indicated a clockwise rotation of the local extensional axis by ∼25° compared to the regional ∼north–south extension. This rotation is consistent with the orientation of the modeled seismogenic structures. Inversions for both nodal planes and grid-searching fault geometry and orientation showed that for the first-two strongest events, the activated fault planes dipped to the northeast, whereas an antithetic (southwest dipping) fault was activated during the last weaker event. For the Mw 6.3 event, both the independent analyses indicated an overall rupture duration of ∼10 s, energy bursts above and near the hypocenter, up-dip (toward the southwest) rupture propagation in the early stages of the source process, and a bilateral rupture at later stages.

What makes low-frequency earthquakes low frequency.

Low-frequency earthquakes, atypical seismic events distinct from regular earthquakes, occur downdip of the seismogenic megathrust where an aseismic rheology dominates the subduction plate boundary. Well situated to provide clues on the slip regime of this unique faulting environment, their distinctive waveforms reflect either an unusual rupture process or unusually strong attenuation in their source zone. We take advantage of the unique geometry of seismicity in the Nankai Trough to isolate the spectral signature of low-frequency earthquakes after correcting for empirically derived attenuation. We observe that low-frequency earthquake spectra are consistent with the classical earthquake model, yet their rupture duration and stress drop are orders of magnitude different from ordinary earthquakes. We conclude their low-frequency nature primarily results from an atypical seismic rupture process rather than near-source attenuation.

Association of delivery risk phenotype with early-onset sepsis in preterm infants.

To determine delivery risk phenotype-specific incidence of early-onset sepsis (EOS) among preterm infants. Retrospective cohort study of infants born <35 weeks' gestation at four perinatal centers during 2017-2021. Infants were classified into one of six delivery risk phenotypes incorporating delivery mode, presence of labor, and duration of rupture of membranes (ROM). The primary outcome was EOS incidence within the overall cohort and each risk phenotype. Among 2937 preterm infants, 21 had EOS (0.7%, or 7.1 cases/1000 preterm infants). The majority of EOS cases (13/21, 62%) occurred in the setting of prolonged ROM ≥ 18 h, with a phenotype incidence of 23.8 cases/1000 preterm infants. There were no EOS cases among infants born by cesarean section without ROM (with or without labor), nor via cesarean section with ROM < 18 h without labor. Delivery risk phenotyping may inform EOS risk stratification in preterm infants.

Umbilical Cord Blood IgA Levels and Bacterial Profile in Preterm Neonates Born with Maternal Risk Factors for Early-Onset Neonatal Sepsis.

To investigate the IgA levels and bacterial profile in umbilical cord blood (UCB) samples of mothers with risk factors compared to those without risk factors; and to understand the link between UCB culture positivity and neonatal outcomes [early-onset sepsis (EOS) or death within 7 d of life]. This is a pilot prospective case-control study. Mothers with preterm deliveries (gestational age <34 wk) were enrolled in two groups- Cases: Those with antenatal risk factors (prolonged duration of rupture of membranes of ≥24h or chorioamnionitis) and controls: Those without these two risk factors. Serum IgA levels was assayed and microbiological culture was tested in UCB samples. 16S sequencing to determine the UCB microbiome was performed in a subset of samples (n = 15). Neonates were followed-up for the occurrence of EOS or death until 7 d of life. Forty-nine mothers as cases and 50 mothers as controls were consecutively enrolled. No significant difference was observed in the IgA levels (60.5 vs. 58.1mg/L; p = 0.71), neonatal blood culture positivity (4.1% vs. 8.0%; p = 0.41) and UCB culture positivity (30.6% vs. 26.0%; p = 0.61) in the two groups.No difference was observed between the groups in occurrence of EOS or death within 7 d of life. Proteobacteria, Firmicutes and Actinobacteria were the most abundant phyla. Serratia, Bifidobacterium, Collinsella, Meganomas and Blautia being the most common genera. Cord blood IgA concentration could not differentiate the neonates at-risk of infection due to its presence in both the groups.

Prolonged second stage of labor: Predictors of adverse maternal and perinatal outcomes in a sub-Saharan setting.

To determine the predictors of adverse maternal and perinatal outcomes among parturients with prolonged second stage of labor. This study isa cross-sectional study of women with prolonged second stage of labor from January 1 to June 30, 2021, in four tertiary hospitals in Ethiopia. Data were collected prospectively using a structured questionnaire. Descriptive statistics were used to analyze baseline characteristics. Bivariate and multivariate logistic regression analyses were applied to determine predictors of adverse maternal and perinatal outcomes. A total of 406 women were included in the study. More than half (25/46, 54%) of the women with a prolonged second stage of 4 h or longer had vaginal delivery, which was lower than the 73% (140/190) of women who had a second stage of 2-3 h and the 63.4% (64/101) of women with a second stage duration of 3-4 h. Duration of second stage of labor was not a predictor of composite adverse maternal outcomes nor was it a predictor of adverse perinatal outcome. Operative vaginal delivery (adjusted odds ratio [aOR] 6.0, 95% confidence interval [CI] 2.41-14.9) and nulliparity (aOR 4.1, 95% CI 1.58-10.41) were predictors of adverse maternal outcome, but nulliparity (aOR 1.8, 95% CI 1.05-3.04) and duration of rupture of membranes greater than 18 h (aOR 2.4, 95% CI 1.21-4.93) were predictors of adverse perinatal outcomes. Under strict fetal and maternal well-being monitoring, women with a prolonged second stage of labor can labor for an additional 2 h (up to a total of 4 h) without increasing adverse maternal and neonatal outcomes.

Treatment outcome of neonatal sepsis and associated factors among neonates admitted to neonatal intensive care unit in public hospitals, Addis Ababa, Ethiopia, 2021. Multi-center cross-sectional study.

Globally, neonatal sepsis is the leading cause of neonatal mortality and morbidity, particularly in developing countries. Despite studies that revealed the prevalence of neonatal sepsis in developing countries, the outcome of the diseases, barriers for poor outcomes were inconclusive. The aim of this study was to assess the treatment outcome of neonatal sepsis and its associated factors among neonates admitted to neonatal intensive care unit in public hospitals, Addis Ababa, Ethiopia, 2021. A cross-sectional study was carried out from February 15 to May 10, 2021 on 308 neonates admitted to neonatal intensive care units of Addis Ababa city public hospitals. Hospitals and study participants were selected by lottery and systematic random sampling techniques, respectively. Data were collected through face-to-face interviews with a structured, pretested questionnaire and by reviewing both the maternal and newborn profile cards. Epi-data version 4.6 was used to enter the collected data, which was then exported to SPSS version 26 for analysis. The 95% CI odds ratio is used to determine the direction and strength of the association between the dependent and independent variables. Among the total study 308 neonates, 75(24.4%) were died. Regarding the poor treatment outcome of neonatal sepsis, neonates whose mothers <37 weeks of gestational age (AOR = 4.87, 95% CI: 1.23-19.22), Grunting (AOR 6.94: 1.48-32.54), Meconium amniotic stained (AOR = 3.03, 95% CI: 1.02-9.01), Duration of rupture of membrane >18hours (AOR = 3.66, 95% CI: (1.20-11.15), Hypertensive PIH/ Eclampsia (AOR = 3.54, 95% CI: 1.24-10.09), Meropenum (AOR = 4.16, 95% CI: 1.22-14.21) and CRP positive result (AOR = 5.87, 95% CI: 1.53-22.56) were significantly associated with poor treatment outcome of neonatal sepsis. The treatment outcomes of neonates were 75.6% recovered and 24.4% died. In this setting, empirical treatment was the cornerstone for managing neonatal sepsis. Professionals who are working in labor and delivery ward screened for mothers preeclampsia and duration of rupture of membrane >18hrs /PROM/ treated with antihypertensive drug and antibiotics for the prevention of neonatal sepsis.

Analysis of factors increasing the risk of prelabour rupture of membranes and its effect on fetomaternal outcome

Perinatal morbidity and mortality due to prelabour rupture of membranesPROM) is 18-20% and 21.4% respectively. Multiple risk factors are associated with the development of PROM. Limited data is available on the risk factors of term PROM and relation of its duration with adverse maternal and fetal outcomes from India. To assessfactors increasing the risk of PROM and effect of duration of rupture of membranes on fetomaternal outcome. Five hundred and ten patients presented with term PROM in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh (M.P.) from December 2018 to February 2019 were studied. After the detailed history, sociodemographic details, risk factors for PROM and neonatal outcomes were recorded. PROM was more common in women with age 21-25years (73.3%), who were housewife (92.5%), were underweight (21.37%), were from the rural area (58.4%), belong to lower SES (62.8%) and were primigravida (59.2%). Majority were leaking for 13-24 hours (70.2%). Majority (85.64%) of patients had spontaneous onset of labour in less than 24 hours of PROM and 28(14.35%) went into spontaneous labour after 24 hours of PROM. Most common risk factor was malpresentation (46.52%) followed by history of PROM (30.04%), Polyhydramnios (13.19%), multiple pregnancy (10.99%) and febrile illness (6.96%). Out of 312 women who had vaginal delivery, labour was induced in 87.82% women. The most common indication for Caesarean section was previous 1 LSCS (13.1%), followed by fetal distress (8.6%), breech presentation (7.3%) and cephalopelvic disproportion (2.9%). Most of the women presenting with PROM were delivered vaginally (61.2%), while 38.8% women underwent caesarean section. Out of 529 babies, 6.24% were admitted in NICU. Majority of the neonates were admitted for 3 days (39.39%). PROM is associated with poor fetomaternal outcome and timely diagnosis and prompt management is required for better outcome.

Breast Implant Rupture: Causes, Diagnosis and Treatment

Breast implant rupture is a rare event that can occur at any time after breast augmentation surgery. The most common causes of rupture are natural aging of the implant, traumatic injury, and failure of the implant material. Symptoms of breast implant rupture can range from mild discomfort to total loss of breast shape and size. Diagnosing a ruptured breast implant can be challenging, as the condition can be asymptomatic in some cases. However, imaging tests such as MRI and ultrasound can help detect the presence of ruptured implants. Treatment options for ruptured breast implants vary depending on the type of implant, the duration of rupture and the presence of symptoms. In general, treatment involves surgical removal of the ruptured implant and replacement with a new one or complete removal of the implant and surrounding silicone material. Regular checkups with a board-certified plastic surgeon and being aware of any changes in the shape or feel of the breasts are crucial for early detection and treatment of breast implant rupture. Women considering breast augmentation surgery should carefully weigh the potential risks and benefits of the procedure before undergoing surgery. Breast implant rupture is a rare but important complication that requires prompt diagnosis and treatment to avoid potential complications. Understanding the causes, symptoms, diagnosis and treatment options for breast implant rupture can help women make informed decisions about breast augmentation surgery and maintain the health of their breasts.

Modern features of the delivery complicated premature rupture of membrane at term

Premature rupture of membranes (PROM) is diagnosed in 6–26.5% of full-term pregnancies. An analysis of the characteristics of labor and the frequency of complications in tPROM could allow us to identify «weak» points and optimize the managing this category of patients.The aim of the study was to assess the characteristics of labor during full-term pregnancy (at 37.0–41.0 weeks), complicated by premature rupture of the membranes.Materials and methods. A prospective analysis of the course of labor and the postpartum period was carried out in 425 patients with singleton pregnancy in cephalic presentation, 37,0–41,0 weeks of gestation, women of low and moderate risk groups, without contraindications to vaginal delivery.. As a complication of the pregnancy, 310 of them had PPROM (main group) and 115 women in labor went into labor with intact fetal membrane (comparison group). The features of the delivery and postpartum complications were analyzed.Results: The features of delivery patients with PROM was the longer duration of rupture – 4.7 times higher than in the comparison group (p&lt;0.001), the second stage of labor – in the main group more an average of 7 minutes (p=0.008). The frequency of abnomally labor activity in the main group, such as abnormally slow or protracted labor (primary and secondary), was 2 times higher than it was in the comparison group. The diagnosis of «cervical dystocia» was observed in 27 cases (8.7%) only in the group with PROM. In the main group, oxytocin was used in 165 patients (53.2%), which is more than 2 times higher than in the comparison group – 25 (21.7%, p&lt;0.001), respectively, the total dose of oxytocin used was higher at vaginal delivery: 8 .06 (0.44) U and 1.06 (0.46) U (p&lt;0.001). The differences in this parameter at patents of both group with C-section were not signifcant. Medical analgesia in the main group was required 2 times more often than in the comparison group (83.5 and 43.5%; &lt;0.001).The problem of tPROM is a higher percentage of operative delivery and obstetric trauma. Thus, in our study, the incidence of C-section was 54 cases (17.4%) compared with the another group – 2 cases (1.7%), vaginal operative delivery – 20 cases (6.5%) and 3 (2.6%)%) respectively (Xi=21.88; Df=2; p&lt;0.001), cervical ruptures: 11.3% (p=0.002), episiotomies: 8.3% (p=0.099). The frequency of postpartum septic complications was comparable in groups, but high level of leukocyts and antibiotic therapy were more often in patients with PROM.Conclusion: the management of labor in patients with PROM is associated with a high percentage of the use of oxytocin, antibacterial therapy, various methods of medical analgesia, and operative delivery.

Research on creep characteristics of loading and unloading of hard Flint limestone

The hard Flint limestone of Shuibuya hydropower station underground construction cavern is utilized as a research object to investigate the creep problem caused by excavation of rock masses such as caverns. In order to perform a triaxial compression grade-unloading creep test, the actual adjustment path of stress during excavation of underground cavern surrounding rock is used. Limestone under different confistiff pressures is then evaluated. Based on the Nishihara model, the elastic damage element considering time-dependent damage is introduced, and the unloading creep constitutive model of stiff Flint limestone is established and verified by experiments. The results show: 1) Deformation and creep strain appear at all stress levels. 2) As the unloading amount increased from 2 to 4 MPa, the quasi-destructive stresses of the samples were smaller from 83 to 79 MPa, indicating that the unloading amount affected the final creep damage strength of the rock samples. In other words, the higher the unloading amount, the lower the ultimate creep failure strength. 3) When entering the accelerated creep stage, the axial and lateral creep strains of the sample increase non-linearly, and the rupture duration of the sample is very short. Therefore, the creep deformation and creep rate characteristics of this stage should be paid attention to in practical engineering. 4) Different from the loading stress path, the failure mode of the Flint limestone rock sample is different. When the unloading amount is 2 and 4 MPa, the creep failure mode of the Flint limestone rock sample is shear failure, showing a significant oblique section crack. 5) The non-linear creep model curve of aging damage and the fitting effect of the unloading creep test curve are acceptable. The rationality of the established non-linear creep model is illustrated.

Diagnostic Accuracy of Histological Chorioamnionitis and Funisitis in Neonatal Sepsis

Background Histological chorioamnionitis (HCA) is present not only in women with clinical chorioamnionitis (CCA) but also in a large subset with silent chorioamnionitis which has a risk of developing complications of preterm labor, fetal, and maternal infection. Objectives To assess HCA and funisitis, and their correlation with the early neonatal outcome. Methods Of 778 preterm babies born over a period of 1 year at ≤34 weeks gestation, 100 placentae were analyzed as per the inclusion criteria in this prospective study. Sections from the placenta, membranes, and umbilical cord were examined for histopathology. Clinical parameters in mother and neonate were recorded and correlation with HCA was estimated. Results The incidence of HCA, funisitis, CCA was 35%, 7%, and 24%, respectively. Sixteen of 24 (66.7%) CCA had HCA and 19/35 (54%) of HCA had no CCA. History of preterm premature rupture of membranes was there in 73/100 cases, of which 41 had HCA. HCA cases having duration of rupture of membranes (DROM) &lt;24 h were 22/41 (53.6%), 77.2% of which developed early onset neonatal sepsis (EONS). Odds of EONS with DROM &lt;12 and 24 h was 1.3 and 2.9, respectively. EONS was suspected in 28/35 (80%) of HCA versus 13/24 (54%) of CCA. Culture positive sepsis was seen in (9/28) 32% cases with HCA and funisitis. In the absence of HCA, EONS was suspected in 30.7% cases. Conclusion HCA has a better diagnostic ability to detect EONS. Sepsis screen on the basis of CCA alone can miss about 50% of cases.