Rupture Of Amniotic Membranes Research Articles

A prospective study of clinical profile of premature rupture of membranes and its effect on maternal and perinatal outcome at term gestation in primigravida

Premature rupture of membranes (PROM) is defined as the spontaneous rupture of amniotic membranes with a release of amniotic fluid, before the onset of labor. If it occurs after 37 weeks of gestation, it is called as term PROM. The incidence of PROM worldwide varies between 5-10%.Out of which 80% occurs at term. In India, the incidence of PROM was reported as 7-12% in all labours.This study was a prospective, observational hospital based study which include the cases admitted to labour ward, Department of Obstetrics, District hospital, Tumakuru, Karnataka with Premature rupture of membranes or prelabor rupture of membranes (PROM) after fulfilling the inclusion and exclusion criteria. Out of 220 participants, about 60% (132) of subjects delivered vaginally and40%(88)of subjects underwent caesarean section. Among the 88 subjects who underwent caesarean section, the indications were fetal distress(34.09%), CPD(23%), failed induction (15.9%), non-progress of labour (23.86%). Among the study population, 10(4.54%) babies were with APGAR score <7 and 210(95.45%) babies were with APGAR score ≥7. The Premature rupture of membranes at term still remains as one of the challenging situation to the practicing obstetrician. It is still an important cause of maternal and perinatal morbidity.

PP-026 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

PP-026 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

PP-027 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

PP-027 Obstetrical and neonatal outcome of premature rupture of amniotic membranes before 28 weeks of gestatio

Detailed mapping of Bifidobacterium strain transmission from mother to infant via a dual culture-based and metagenomic approach

A significant proportion of the infant gut microbiome is considered to be acquired from the mother during and after birth. Thus begins a lifelong and dynamic relationship with microbes that has an enduring impact on host health. Based on a cohort of 135 mother-infant (F = 72, M = 63) dyads (MicrobeMom: ISRCTN53023014), we investigated the phenomenon of microbial strain transfer, with a particular emphasis on the use of a combined metagenomic-culture-based approach to determine the frequency of strain transfer involving members of the genus Bifidobacterium, including species/strains present at low relative abundance. From the isolation and genome sequencing of over 449 bifidobacterial strains, we validate and augment metagenomics-based evidence to reveal strain transfer in almost 50% of dyads. Factors important in strain transfer include vaginal birth, spontaneous rupture of amniotic membranes, and avoidance of intrapartum antibiotics. Importantly, we reveal that several transfer events are uniquely detected employing either cultivation or metagenomic sequencing, highlighting the requirement for a dual approach to obtain an in-depth insight into this transfer process.

Clinical phenotype and genetic analysis of a child with 3p26.3p25.3 deletion

To explore the genetic basis for a child with facial dysmorphism and multiple malformations. The child, born at 34+6 weeks' gestation due to premature rupture of amniotic membrane, dichorionic diamniotic twinning and gestational diabetes, was subjected to chromosomal karyotyping analysis and copy number variations sequencing (CNV-seq). The child was found to have facial dysmorphism, hypospadia, cryptorchidism and hypotonia. He was found to have a 46,XY,del(3)(p26) karyotype in addition with a 9.80 Mb deletion (chr3: 60 000-9 860 000) encompassing 33 protein coding genes. The 3p26.3p25.3 deletion probably underlay the multiple malformations in this child. Continuous follow-up is required to improve his quality of life.

Relationship between Experience of Antepartum Intervention and Posttraumatic Stress Symptoms Following Childbirth: A Prospective Study

Background: Childbirth is an important event in a woman’s life. Adverse childbirth experiences may lead to negative psychological reactions and disturb the mother’s mental health during the postpartum period. Objective: This prospective study aimed to assess the relationship between experiences of antepartum intervention and post-traumatic stress symptoms in mothers following childbirth. Methods: The study sample comprised 176 Iranian women, who were under assessment for 8 weeks postpartum. Current Post-Traumatic Stress Disorder symptoms (PTSD) were assessed through the Impact of Events Scale-Revised (IES-R) questionnaire. Data were analyzed using SPSS software (Version 19.0), and the adjusted odds ratios (ODs) were estimated by binary logistic regression. Results: Based on the obtained results, 38.3% (N = 62) of the women appeared to be at risk of developing PTSD symptoms. The mean ± SD score of PTSD symptoms was obtained at 22.51 ± 12.04 (0-65). The results showed that women in the PTSD group underwent more obstetric interventions (P = 0.002) and experienced more childbirth pain (P = 0.048), compared to women without PTSD, during childbirth. Insertion of sublingual or vaginal prostaglandin tablets, experiencing episiotomy incision, perineal/labial/vaginal sutures, and artificial rupture of amniotic membranes correlated significantly with PTSD symptoms (P < 0.05). The results of binary logistic regression analysis confirmed that the rate of obstetric interventions was the significant predictor of PTSD after childbirth (OD = 1.284; P = 0.008). Conclusion: The findings of the present study indicate that the enhanced understanding of healthcare providers of obstetric intervention consequences may prevent postpartum PTSD through the provision of physiological delivery and supportive care during labor.

Title: The effects of demographic transformation due to refugee migration in Turkey on maternal and neonatal outcomes Running Title: Syrian pregnancies and their adverse outcomes

Objective: This research analyzes the obstetric and neonatal outcomes of Syrian and Turkish pregnant women. Methods: This retrospective cross-sectional study included 1,823 pregnant Turkish and Syrian women aged 13 to 47 who gave birth at a tertiary care facility in the Mediterranean region of Turkey. Between September 2020 and August 2021, 940 Turkish and 883 Syrian refugees (SYR) pregnant women participated in the study. The groups were compared for demographic data, obstetric outcomes, and neonatal features. Results: The maternal age distribution for SYR includes younger ages (p<0,001). The literacy status among Syrians is lower than that of Turks (p<0,001). Syrian pregnant women have a lower prevalence of cesarean section (CS); they have a greater rate of first spontaneous vaginal delivery (fSVD) and spontaneous vaginal delivery (SVD) than Turkish pregnant women (p<0,001). Amniotic membrane rupture is more prevalent among pregnant Syrian women (p=0,007). APGAR scores differ by nationality (p=0.004). There is a significant difference in maternal hemoglobin median values (g/dL) according to nationality (p<0.001). There is a substantial difference between the birth weights of newborns with low birth weight (LBW) (1500 ≤ - <2500 grams) and those with 2500 grams or more in both groups (p<0.001). Conclusion: There is a strong correlation between education and prenatal care utilization. As women's education levels increase, the rates of prenatal care also increase. Antenatal care is the most valuable and effective method for preventing adverse pregnancy and neonatal outcomes.

The role of infection factor in premature rupture of amniotic membranes after laser coagulation of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome

The role of infection factor in premature rupture of amniotic membranes after laser coagulation of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome

Features of the clinical course of pregnancy, childbirth and the condition of newborns in women with HCV infection

The objective: to conduct a retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns in women with HCV infection.Materials and methods. A retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns was carried out according to the data of 351 birth histories of women with HCV infection based on the materials of the archive of the communal non-commercial enterprise “Kyiv Municipal Center of Reproductive and Perinatal Medicine” for the period from 2016 to 2021. The control group (CG) included 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 8.0”. Results. In women with HCV infection compared to the group of healthy pregnant women a significantly high frequency (p<0.001) of such pregnancy complications was found: threat of pregnancy interruption – 64 (18.2 %) patients versus 2 (4.0 %) persons, edema of pregnant women – 72 (20.5 %) and 4 (8.0 %), respectively; preeclampsia – 45 (12.8 %) versus 2 (4.0 %), gestational anemia – 131 (37.3 %) versus 6 (12.0 %), as well as placental insufficiency with fetal growth retardation syndrome (FGR) – 69 (19.6 %) versus 3 (6.0 %; p<0.05) and intrahepatic cholestasis of pregnant women – 42 (11.9 %) versus 1 (2.0 %; p<0.05). In 73 (20.8 %) pregnant women with HCV infection the childbirth was complicated by premature rupture of the membranes, of which almost half of the cases (42 (11.9 %) of the patients) finished with premature birth, while in CG only some women had such complications. Fetal distress during childbirth was reliably detected more often in pregnant women with HCV infection than in CG women (χ2=4.76; p=0.024). Caesarean section was performed in 86 (24.5 %) patients with HCV infection versus 2 (4.0 %) persons in CG (p<0.001).The newborns from mothers with HCV infection had lower indicators of physical development and decreased Apgar score assessment, increased frequency of conjugation jaundice.Conclusions. Pregnant women with HCV infection are characterized by a significant increase in the number of pregnancy complications, such as the threat of pregnancy interruption, the threat of premature birth, gestational anemia, placental dysfunction, fetal growth retardation syndrome, and preeclampsia; during childbirth – premature and antepartum rupture of amniotic membranes, premature birth, weakness of uterine activity in labor, increased blood loss. The condition of newborns from women with HCV infection is characterized by a significant increase in the frequency of asphyxia during childbirth, CNS hypoxic-ischemic damage, prematurity and conjugation jaundice.

NEONATAL SEPSIS AND PROLONGED RUPTURE OF M EMBRANES

Background: Prolonged rupture of membranes (PROM) is considered when the duration of rupture of amniotic membranes is more than 18 hours prior to delivery. PROM is one of the common risk factors for early-onset neonatal sepsis. Timely identication of sepsis is important.The aim of the study was to determine the outcome and requirement of prophylactic use of antibiotics in newborns born to PROM. Materials & methods: A retrospective study on neonates born to mothers with PROM was conducted from December 2019 to December 2020. Total of 54 neonates fullling the inclusion criteria were included and their case records were evaluated for clinical and laboratory records as well as diagnosis and outcomes. Results: Out of 54 neonates, 30(55%) were males and 24(45%) females. 28 (51%) were full term and 26(49%) were pre term. Mode of delivery was vaginal in 32 (59%), and LSCS in 22 (41%). Clinical features suggestive of sepsis were present in Twenty-eight neonates (52%). Fever was the most common symptom seen in 13(46%) neonates followed by poor feeding in 9 neonates and tachypnoea in two neonates. C- reactive protein was positive in 20 (37%) neonates with a mean CRP value being 30 mg/dl. from which 14 (70%) had clinical signs. Twelve (22%) neonates required NICU admission and culturepositive sepsis was seen in ve (9%) neonates. E. coli was isolated in three neonates while Acinetobacter baumanii in two. Only one neonate succumbed. Conclusion: Conrmed sepsis was seen in a very low proportion of neonates born to mothers with prolonged rupture of membranes. Hence early sepsis screening and follow-up of neonates with clinical features suggestive of sepsis might decrease the use of prophylactic antibiotics.

Outcomes following Placement and Removal of Transvaginal Cerclage in at Risk Pregnancies: A Single Center Experience.

Objective The objective of this study was to estimate the time between removal of cerclage and delivery, stratified by indication for cerclage placement (elective or non-elective). Additionally, delivery within 72 hours after cerclage removal was compared between elective and non-elective cerclage placement, as well as between ultrasound-indicated and physical examination-indicated cerclage placement. Design A single-center retrospective cohort study. Participants/Materials, Setting, and Methods. Clinical information of 72 pregnant women who underwent transvaginal cerclage over a 4-year period was obtained. Comparisons were made between elective (history-indicated) and non-elective (ultrasound or physical examination-indicated) cerclage placement. Comparisons were also made between physical examination-indicated and ultrasound-indicated cerclage. Results Compared to those who had a non-elective cerclage, women undergoing elective cerclage were more likely to have history of cervical treatment (44% vs. 15%, p = 0.02), and spontaneous preterm delivery (92% vs. 61%, p = 0.003). There was no difference in the rate of delivery ≤72 hours following cerclage removal between women who had elective cerclage and those who had non-elective cerclage (46% vs. 58%, p = 0.47). Women who had an elective cerclage were more likely to have elective cerclage removal ≥36 weeks (71.8% vs. 39.4%, p = 0.01), compared to those who had undergone non-elective cerclage. The rate of delivery ≤72 hours following removal of cerclage was greater in women who had a physical examination-indicated cerclage compared to women who had ultrasound-indicated cerclage (80% vs. 39%, p = 0.04). Among women who had an elective cerclage, there was no difference in the rate of delivery at ≤72 hours between those who had elective cerclage removal at 36 weeks compared to those electively removed at 37 weeks (31% vs. 58%, p = 0.30). No complications such as fetal demise, iatrogenic amniotic membrane rupture, hemorrhage, or cervical laceration were reported within this cohort. Conclusion Cerclage indication should be considered prior to scheduling elective cerclage removal. Women who had an elective cerclage are most likely to get it electively removed at 36 weeks compared to their counterparts who had a non-elective cerclage. Furthermore, women who had a physical examination-indicated cerclage are most likely to deliver within 72 hours of cerclage removal.

Клінічна ефективність застосування внутрішньовенного імуноглобуліну у вагітних з внутрішньоутробною інфекцією

Проблема внутрішньоутробної інфекції (ВУІ) і в наш час не втрачає своєї актуальності. Неефективність лікування цієї патології пов’язана з фізіологічним зниженням імунітету у таких пацієнток. Нами запропоновано додаткове використання внутрішньовенного імуноглобуліну для лікування вагітних з ВУІ. Обстежено 75 пацієнток із ВУІ, що була діагностована в них протягом ІІ триместру. І групу становили 40 осіб, які отримували загальноприйняте лікування, ІІ групу сформували 35 жінок, які додатково отримували внутрішньовенний імуноглобулін. На фоні ВУІ перебіг вагітності характеризувався підвищенням частоти загрози її переривання та передчасних пологів, гестозів і плацентарної дисфункції, у пологах були більш поширеними передчасний розрив плодових оболонок і дистрес плода. У таких пацієнток плаценти мали як ультразвукові, так і гістологічні ознаки інфікування. Серед новонароджених було істотне зростання частоти патології, пов’язаної з реалізацією внутрішньоутробного інфікування. Додаткове застосування препарату внутрішньовенного імуноглобуліну при лікуванні ВУІ протягом II триместру вагітності порівняно із загальноприйнятою терапією призводить до вірогідного зниження частоти як акушерських ускладнень, так і перинатальної патології.

Оптимизация метода родоразрешения женщин при развитии аномалий родовой деятельности

The aim of the research. To develop a means that would optimise the method of delivery for women with development of abnormalities of labour. Material and methods. Retrospective analysis of 186 cases of labour was carried out at the premises of the perinatal centre of the Regional Clinical Hospital in Chita in 2018-2021. The total sample was divided into 5 study groups: group 1 included 33 women with primary uterine inertia; group 2 included 16 women with secondary uterine inertia, group 3 included 32 women with discoordinated labour activity, group 4 included 55 women with excessive uterine activity, group 5 included 50 women with abnormal uterine contractile activity which arose against the background of the clinical narrow pelvis. All women on the eve of labour (1-2 days) underwent general and special obstetric examination. The groups were comparable in nationality, age, financial and social conditions of the women, their gestational age, frequency of genital and extragenital pathology as well as the main pathology of pregnancy. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 program. Results. Optimisation of the delivery method for patients with abnormal labour was implemented on the basis of multilayer perceptron, the percentage of incorrect predictions in the learning process of which was 2.4%. The structure of the trained neural network included 14 input neurons: gestational age, labour parity, the woman’s height, uterine fundus height, presence / absence of fetal growth retardation or macrosomia, oligohydramnios, prelabour rupture of amniotic membranes and the posterior view of the foetus’s occipital presentation. Conclusion. An integrated approach based on implementation of universally available methods of objective and instrumental research on the eve of labour makes it possible to choose the correct method of delivery for patients with abnormalities of labour with an accuracy of 96.2%.

The effects of a maternal nursing competency reinforcement program on nursing students' problem-solving ability, emotional intelligence, self-directed learning ability, and maternal nursing performance in Korea: a randomized controlled trial.

PurposeThe purpose of this study was to develop a maternal nursing competency reinforcement program for nursing students and assess the program’s effectiveness in Korea.MethodsThe maternal nursing competency reinforcement program was developed following the ADDIE model. This study employed an explanatory sequential mixed methods design that applied a non-blinded, randomized controlled trial with nursing students (28 experimental, 33 control) followed by open-ended interviews with a subset (n=7). Data were analyzed by both qualitative and quantitative analysis methods.ResultsRepeated measures analysis of variance showed that significant differences according to group and time in maternal nursing performance; assessment of and intervention in postpartum uterine involution and vaginal discharge (F=24.04, p<.001), assessment of and intervention in amniotic membrane rupture (F=36.39, p<.001), assessment of and intervention in delivery process through vaginal examination (F=32.42, p<.001), and nursing care of patients undergoing induced labor (F=48.03, p<.001). Group and time improvements were also noted for problem-solving ability (F=9.73, p<.001) and emotional intelligence (F=4.32, p=.016). There were significant differences between groups in self-directed learning ability (F=13.09 p=.001), but not over time. The three themes derived from content analysis include “learning with a colleague by simulation promotes self-reflection and learning,” “improvement in maternal nursing knowledge and performance by learning various countermeasures,” and “learning of emotionally supportive care, but being insufficient.”ConclusionThe maternal nursing competency reinforcement program can be effectively utilized to improve maternal nursing performance, problem-solving ability, and emotional intelligence for nursing students.

Исходы беременности при преждевременном излитии околоплодных вод в зависимости от длительности ее пролонгирования

Aim. Evaluation of pregnancy outcomes depending on the duration of its prolongation in preterm rupture of amniotic membranes at 22 to 34 weeks gestation period. Material and Methods. Outcomes of pregnancy were studied in 196 patients of the contingent of O. Gudushauri National Medical Center with prenatal rupture of amniotic membranes at gestational age of 22 to 34 weeks, who underwent treatment aimed at prolongation of pregnancy in 2016-2018. All the patients were divided into 2 groups. Group 1 included pregnant women in whom it was possible to prolong the pregnancy for 14 days or more; group 2 included women in whom pregnancy could not be prolonged or duration of prolongation was less than 14 days. The patients who were clinically stable, after examination and observation for 48 hours, were discharged from hospital and, subsequently, were observed and treated on an outpatient basis. In order to identify contraindications for prolongation of pregnancy on the part of the mother, a routine clinical and laboratory examination was carried out: complete blood count, biochemical blood test, coagulogram, general urine analysis, bacterioscopy of a vaginal smear, bacteriological examination of the vaginal secretion. Diagnostics of the fetal condition included ultrasound fetometry with daily assessment of the amniotic fluid index using Voluson e8 Expert ultrasound device, daily cardiotocography (CTG) using Sonicaid Team Cape device, as well as Doppler study of blood flow in the umbilical cord artery, fetal aorta, and uterine arteries. Results. In premature rupture of amniotic membranes, a significantly higher incidence of premature birth was revealed in pregnant women of group 2 with prolongation of pregnancy for less than 14 days: 76 (100%), compared with group 1 with prolongation for 14 days or more: 40 (33.33%) (p&lt;0.0001). The average gestational age at which childbirth took place was significantly greater in group 1 than in group 2: 35.92±3.65 weeks and 29.97±3.02 weeks, respectively (t=-12.38, p&lt;0.0001). The same can be said about the average weight of the fetus at birth: 2660.33±876.55 g in group 1 and 1488.68±61.94 g in group 2 (t=-10.17, p&lt;0.0001). In the group without prolongation, compared with patients in group 1, there was an increase in the comparative risk of such complications of the newborn as patent ductus arteriosus, RR=2.50 (95% CI: 1.84 to 3.39); chronic hypoxia, RR=5.00 (95% CI: 3.23to 7.72); retinopathy, RR=2.939 (95% CI: 2.108 to 4.097); hemolytic disease, RR=5.16 (95% CI: 2.80 to 9.50); infections, RR=6.54 (95% CI: 4.04 to 10.61); respiratory distress syndrome, RR = 2.88 (95% CI: 2.29 to 3.61); intraventricular hemorrhage, RR=7.14 (95% CI: 2.40 to 21.21). Due to the presence of complications, newborns from women of group 2 required antibiotic therapy, RR=3.14 (95% CI: 2.46 to 4.00); installation of surfactant, RR=4.76 (95% CI: 1.49 to 15.19). Conclusion. Prolongation of pregnancy for more than 14 days in case of preterm rupture of amniotic membranes in the period of 22-34 weeks, reduces the risk of unfavorable perinatal outcomes.

PREDICTOR VARIABLES OF NEONATAL MORTALITY IN VERY-LOW-BIRTH-WEIGHT INFANTS

The aim of this study is to investigate the mortality profile in very-low-birth-weight infants, as well as model the association of some variables with neonatal mortality, in order to detect possible preventable causes of death. This retrospective cross-sectional study included a total of 109 Very-Low-Weight-Infants admitted to a Neonatal Intensive Care Unit in a municipality in Minas Gerais, Brazil, between January 2012 and December 2016. The neonates were divided into two groups: death and non-death. Frequency distributions were constructed for the variables maternal age, sex, birth weight, gestational age, type of delivery, asphyxia (Apgar at five minutes), administration of antenatal corticosteroids, hypothermia, twinning, and amniotic membrane rupture. The survival curve was plotted using the Kaplan-Meier non-parametric estimator, and theassociation between death and the observed explanatory variables was modeled via Logistic Regression. In the survivor group, most infants exhibited normothermia and weight ≥1,000g. As for the death group, weight below 1,000g and hypothermic infants were predominant. In both groups, maternal age between 18 and 35 years prevailed, as well as the male sex, gestational age of 224 days, cesarean delivery, and fifth minute Apgar scores ≥7. The survival rate, estimated using the Kaplan-Meier method, showed a decrease from 1.0 to 0.55 at the beginning of the observation period. The adjusted logistic regression model included fetal weight and the fifth minute Apgar score. No significant relationship was found between death and the variables type of delivery, hypothermia, and antenatal corticosteroid use.Logistic regression indicated a high probability of death associated with birth weight and the Apgar score at five minutes. The low association with the other variables may be related to the good quality of prenatal, intrapartum, and postpartum care provided in the region and the analyzed hospital.

Granulocyte-macrophage colony-stimulating factor initiates amniotic membrane rupture and preterm birth in a mouse model.

Preterm premature rupture of membranes is associated with 30% of all preterm births. The weakening of amniotic membranes is associated with an increase in matrix metallopeptidases (MMPs) along with a decrease in their inhibitors, tissue inhibitor metallopeptidases (TIMPs). Additionally, granulocyte-macrophage colony-stimulating factor (GM-CSF) has been shown to weaken fetal membranes in-vitro. We hypothesize pregnant mice treated with GM-CSF lead to increased MMPs:TIMPs resulting in membrane rupture and preterm birth. Pregnant CD-1 mice on gestational day 17 received either an intrauterine injection of GM-CSF or vehicle control. A second series of mice were administered an intrauterine injection of Lipopolysaccharide along with either anti-mouse GM-CSF or control antibody. Mice were evaluated for rupture of membranes and/or preterm birth and the uterus, amniotic fluid, and serum were collected for analysis. 87.5% of GM-CSF mice exhibited evidence of membrane rupture or preterm birth, compared with 0% in control mice (p<.001). Treatment with GM-CSF decreased the expression of TNFα (p<.05) while increasing the ratio of MMP2:TIMP1 (p<.05), MMP2:TIMP2 (p<.05), MMP2:TIMP3 (p<.001), MMP9:TIMP1 (p<.01), MMP9:TIMP2 (p<.05), MMP9:TIMP3 (p<.001), and MMP10:TIMP1 (p<.05). Mice treated with LPS and the GM-CSF antibody resulted in a decrease in the ratio of MMP2:TIMP1 (p<.0001) compared with controls. These studies demonstrate GM-CSF will result in membrane rupture and preterm birth by increasing the ratio MMPs:TIMPs in our animal model. By increasing our understanding of the molecular pathways associated with GM-CSF, we may be able to develop future therapies to prevent preterm birth and reduce neonatal morbidity.

Funisitis as a Risk Factor for Adverse Neonatal Outcomes in Twin Neonates with Spontaneous Preterm Birth: A Retrospective Cohort Study.

PurposeFunisitis, inflammation of the umbilical cord, is considered a strong risk factor for adverse neonatal outcomes; however, a clinical definition of funisitis has not been established. In this study, we aimed to determine the clinical significance of funisitis in twin neonates with spontaneous preterm birth.Materials and MethodsThe study included preterm twin neonates (<35 weeks) delivered after spontaneous preterm labor and/or preterm premature rupture of amniotic membranes. The presence of funisitis was examined in the umbilical cord of each twin. We analyzed the risk of adverse neonatal outcomes according to the presence and absence of funisitis. Adverse neonatal outcomes were defined as the occurrence of neonatal mortality, significant morbidity, or both.ResultsAmong 474 preterm neonates (237 twin pairs) included in this study, the frequency of funisitis was 6.5% (31 cases). Funisitis was significantly associated with neonatal mortality and adverse neonatal outcomes after adjustment for confounding variables [neonatal mortality, odds ratio (OR) 9.043, 95% confidence interval (CI) 2.620–31.204; adverse neonatal outcome, OR 2.445, 95% CI 1.017–5.875]. The concordance rate of funisitis between the twins was 10.7%, and in the absence of funisitis in one twin, the risk of neonatal mortality or adverse neonatal outcome was not influenced by the presence of funisitis in the other twin.ConclusionThe presence of funisitis appears to be associated with an increased risk for adverse neonatal outcomes in twin neonates with spontaneous preterm birth.

Огляд теорій патогенезу гастрошизису

Gastroschisis and omphalocele are the most common congenital malformations of the abdominal wall that required surgical correction. Despite of the long history of the gastroschisis’ study, there is no generally accepted theory of the pathogenesis of this malformation. There are numerous theories of the pathogenesis of gastroschisis discussed in the modern literature: disorders of differentiation of embrionic mesenchyme as the result of teratogenic influence on the early stages of the embryonic development; rupture of amniotic membrane at the base of the umbilical cord; vascular disorders during of the embryonic development; disorders of the yolk-sac escape. Each of existing theories has its supporters and opponents. It is no generally accepted theory of the pathogenesis of gastroschisis. Most likely is the rupture of physiological hernia along the umbilical cord in its pars flaccid, with the subsequent elongation of the midgut out of the abdominal cavity with the vascular compression, especially of venous and lymphatic vessels. Narrow mesenteric root and narrow-sized defect may contribute to various complications that jeopardize the ultimate prognosis. Further studies are needed to finalize the pathogenesis of gastroschisis. No conflict of interest was declared by the author. Key words: gastroschisis, pathogenesis, vascular disorders, embryonic disorders.

Dubin-Johnson Syndrome in Pregnancy: Case Report and Literature Review

Dubin-Johnson Syndrome in Pregnancy: Case Report and Literature Review