Rupture Of Membranes In Pregnancies Research Articles

An Introduction to the Special Issue on Premature Rupture of Membranes in Pregnancy Including Its Etiology, Management, and Maternal and Neonatal Outcomes

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Ovarian Mature Cystic Teratoma is an Independent Risk Factor for the Premature Rupture of Membranes in Pregnancy: A Single-Center Retrospective Study.

BackgroundOvarian mature cystic teratomas (MCTs) are the most common tumors in pregnant women. The premature rupture of membranes (PROM) is a typical complication of pregnancy; however, the relationship between MCT and PROM is unknown. Therefore, we aimed to determine whether MCT is associated with the occurrence of PROM during pregnancy.MethodsThe data of patients with adnexal masses during pregnancy between January 2017 and August 2021 were retrospectively analyzed. Ovarian cystectomy was performed during cesarean delivery or after vaginal delivery. Univariate and multivariate logistic regression models were used for statistical analysis.ResultsA total of 234 patients with histopathological results were included. Among these patients, 21 occurred PROM during pregnancy, of which 11 were diagnosed with MCT. Compared with other subtypes, MCT (p=0.025) showed a stronger correlation with PROM and was an independent risk factor for PROM (odds ratio [OR], 2.811; 95% confidence interval [CI], 1.096–7.215; p=0.032). Furthermore, we found that MCT with a diameter >5 cm (p=0.0037) was more likely to promote the development of PROM than those that with a diameter <5 cm.ConclusionMCT was an independent risk factor for PROM during pregnancy. Positive actions and preventative clinical treatments should be fully taken into consideration by clinicians for pregnant women with MCTs, especially those ≥5 cm in diameter, to reduce the clinical complications related to MCT-associated PROM.

Preterm premature rupture of membranes: management between 28 and 34 weeks of pregnancy

Introduction: Premature rupture of membranes remains a challenge for professionals due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. Objective: To analyze the scientific production about premature rupture of membranes in pregnancies above 28 weeks and below 34 weeks. Methods: Integrative literature review carried out in the Lilacs, SciELO, Medline and Cochrane Library databases, between 2014 and 2018, in Portuguese, English and Spanish, including original articles, available in full online, with free access, that addressed the study theme, using the keywords "premature rupture of ovular membranes", "premature labor" and "pregnancy complications" combined using the Boolean operators "AND" and "OR". Results: Fourteen studies were included. It was possible to highlight the main recommendations regarding preterm premature rupture of membranes, divided into six categories for discussion, namely: indications for expectant management and delivery induction, prophylactic antibiotic therapy, prenatal corticosteroids, use of tocolytics, recommendations regarding the use of magnesium sulfate and amniocentesis. Conclusion: It was identified that expectant management is the ideal approach, with constant monitoring of the pregnant woman and the fetus, in addition to the administration of prophylactic antibiotics and prenatal corticosteroids, in the face of premature rupture of membranes in pregnancies between 28 and 34 weeks in order to provide the best maternal and perinatal results, guiding health professionals to evidence-based practice.

Study of Fetomaternal Outcome in Premature Rupture of Membranes in Pregnancy More Than 34 Weeks

Premature rupture of membranes (PROM) affects approximately 10% of pregnant women. PROM, when unattended or mismanaged may lead to severe maternal and neonatal complications. The present study aims to study the subsequent course of pregnancy and evaluate the maternal, and neonatal morbidity and mortality in PROM patients admitted in our hospital. To study the outcome of PROM and assess the maternal and perinatal morbidity and mortality. It was a prospective observational study. All the patients of PROM admitted in hospital and considered based on inclusion and exclusion criteria were included in the study. They were induced with either oxytocin or misoprostol depending on their Bishops score. In the group of patients, where PROM delivery interval &gt;18 hours were found to have more maternal complications like puerperal sepsis, chorioamnionitis, wound gape, paralytic ileus, and more neonatal complications like jaundice, sepsis. In our study, maternal morbidity was directly related to the PROM delivery interval. Thus, women diagnosed with PROM should be hospitalised early or referred early to tertiary hospital and actively managed and followed up till delivery. Timely referral and timely intervention can further improve perinatal outcome.

Nursing Care of Premature Rupture of Membranes in Pregnancy: Roy Adaptation Model

Premature rupture of membranes (PROM) is a condition associated with spontaneous rupture of the amniotic membranes before any signs of the active labour. It increases the risk of complications on maternal and foetal health. In preventing various complications that would arise due to PROM, nurses should apply an appropriate nursing theories or models in developing the nursing care plan. Nursing theories and conceptual models are the nursing knowledge that organize nursing activities, and guide nurses in research, practice, education, and management. However, in Indonesia, nursing models have rarely been used by nurse practitioners and researchers including in the perinatal periods. The aim of this article was to determine the application of Roy’s adaptation theory in the premature rupture of membranes cases. This study was a case study design. There were 5 pregnant women participate in this study. The results showed that the assessment based on the two adaptation model approaches applied in this study, six nursing diagnosis were identified, and all nursing care plan had implemented. The concept of adaptation was appropriate in helping patient with premature rupture of membranes. However, the social aspect related to the client's cultural practices were not describe clearly. Combining two or more theories in a nursing care plan would benefit to mothers and their babies’ health and welfare. Keywords: Nursing theories, Premature rupture of membranes, pregnancy, complications

PERBANDINGAN ANTARA KADAR VITAMIN C PLASMA DARAH HAMIL ATERM PADA KETUBAN PECAH DINI DENGAN HAMIL ATERM TANPA KETUBAN PECAH DINI

Premature rupture of membranes is the most common complication of pregnancy. The incidence of premature rupture of membranes in pregnancy ranged from 6% to 10%, and 20% of these cases occur before 37 weeks gestation. The incidence of premature rupture of membranes in Indonesia ranges from 4.5% to 7.6% of all pregnancies. This research was conducted to determine the cross-sectional differences in the blood plasma levels of vitamin C in term pregnancy premature rupture of membranes with blood plasma levels of vitamin C in term pregnancy without premature rupture of membranes in M. Jam- il Padang hospital, Achmad Muchtar Bukittinggi hospital, and Pariaman Hospital. There are significant differences in vitamin C blood plasma levels in term pregnancy with premature rupture of membranes and term pregnancy without premature rupture of membranes ( P &lt; 0.05). Mean levels of vitamin C in blood plasma at term pregnancy with premature rupture of membranes lower than in the blood plasma levels of vitamin C in term pregnancy without premature rupture of membranes.Keywords: Premature rupture of membrane in aterm, blood plasma levels of vitamin C

The value of urea, creatinine, prolactin, and beta sub-unit of human chorionic gonadotropin of vaginal fluid in the diagnosis of premature preterm rupture of membranes in pregnancy.

Objective:To evaluate the effectiveness of urea, creatinine, prolactin, and the beta sub-unit of human chorionic gonadotropin (β-hCG) of vaginal fluid in the diagnosis premature preterm rupture of membranes (PROM).Materials and Methods:In this observational study, 160 pregnant women with gestational age of 28 to 40 weeks were divided into two equal groups: investigation (documented PROM) and control (intact membrane) groups. Five cubic centimeters of normal saline was poured into the vagina of all participants and the liquid was extracted after a few minutes using a syringe. The liquid was sent to a laboratory for examination. Data were analyzed using a t-test.Results:The volume of urea, creatinine, prolactin, and β-hCG was significantly different in the two groups (p<0.001). Based on receiver operating characteristic curve and cut-off point, sensitivity, specificity, positive and negative predictive values of β-hCG for detecting PROM were 87.5%, 86%, 86.4%, and 87.3%, respectively. Also, the same factors for urea in detecting PROM were 79.7%, 82.5%, 81.8%, and 80.4%, respectively. Creatinine had 74.6% sensitivity, 85% specificity, and 83% and 77.2% positive and negative predictive values for detecting PROM. Finally, prolactin had 87.5% sensitivity, 90% specificity, and 90% positive and 88% negative predictive values for detecting PROM.Conclusion:Prolactin and β-hCG have more diagnostic value than urea and creatinine in detecting PROM, and can be used in suspected cases.

Comparaison des protocoles d’antibiothérapie en cas de rupture prématurée des membranes avant terme entre deux maternités de niveau III en termes de sélection de bacilles Gram négatifs résistants

The objective of this retrospective study is to compare two types of antimicrobial management used to treat premature rupture of membranes in pregnancy. This study evaluates both duration and the type of antibiotic therapy used for treatment. The antimicrobials used to treat premature rupture of membranes include a first generation cephalosporin in one group and amoxicillin in the other group. Cephalosporin was used over a 7-day period to treat 38 cases, whereas amoxicillin was used through delivery in 52 cases. Emergence of multidrug-resistant Gram negative bacteria (GNB) on maternal of neonatal sampling was the primary outcome. Emergence of antibiotic resistant GNB can be seen under both antibiotic regimens and appears to be linked to the duration of latency, and to duration of antibiotic treatment. Other outcomes (duration of latency period, gestational age at delivery, maternal and neonatal complications) were similar in both groups. Antibiotic treatment in PPROM favors a selection of GNB. This emergence is positively linked with the duration of latency between rupture of membranes and delivery and with the length of antibiotic administration. The extension of antibiotherapy does not alter other maternal or neonatal parameters.

Dermatosparaxis (Ehlers–Danlos Type VIIC): Prenatal Diagnosis Following a Previous Pregnancy With Unexpected Skull Fractures at Delivery

Dermatosparaxis Ehlers-Danlos syndrome (or EDS VIIC), a rare autosomal recessive connective tissue disorder, is characterized by extreme skin fragility, premature rupture of membranes in pregnancy, and spontaneous rupture of internal organs. Here we report a second patient with EDS VIIC presenting with congenital skull fractures and skin lacerations at birth, complications which may occur more frequently than previously thought in this condition. We also discuss the role of prenatal diagnosis in the management of a subsequent normal pregnancy.

Neonatal outcome in infants of patients with radical vaginal trachelectomy

Radical vaginal trachelectomy (RVT) as a fertility-preserving surgery in patients with early-stage cervical cancer is proven to be oncologically safe. After RVT, pregnancy rates vary between 40 % and 80 %. Outcome of infants is complicated by a preterm delivery rate of 30 – 50 %. We investigated pregnancy and neonatal outcome after RVT. A total of 154 patients with cervical cancer underwent RVT between March 1995 and February 2008. Desire to conceive, pregnancy data, and neonatal outcome were prospectively recorded. Infants’ data were pair-matched to data of a control group according to weeks of gestation. Bayley scales of infant development scores were recorded in the group of preterm-delivered infants. Fifty-five women who underwent RVT gave birth to 58 children. Twenty-five (43 %) pregnancies were complicated by preterm rupture of membranes. Thirty infants (52 %) were born preterm, of with 17 (29 %) were < 32 gestational weeks (GW) and seven (12 %) were < 28 GW. There were significantly more premature rupture of membranes in pregnancies after RVT. Despite a higher occurrence of postnatal infections in newborns of mothers who underwent RVT, long-term outcomes are not affected negatively. Regarding overall morbidity, a trend to fewer postnatal complications, compared with the control group, was found. Postnatal morbidity in infants of women who underwent RVT, based on trend, is decreased compared with controls. Intense medical observation and treatment during pregnancy, birth, and neonatal period may explain this finding. Neonates in the RVT group have a non-significantly elevated risk for postnatal infections. They do not show an additional risk due to the maternal operation. Their long-term postnatal outcome is not affected negatively.

483: The relation between duration of rupture of membranes and perinatal outcome in patients with preterm delivery

and perinatal outcome in patients with preterm delivery Jantien van der Heyden, Stijn van Teeffelen, David van der Ham, Jelle Schaaf, Anita Ravelli, Christine Willekes, Jan Nijhuis, Ben Mol VieCuri Medical Center, Department of Obstetrics and Gynaecology, Venlo, Netherlands, Maastricht University Medical Center, Obstetrics and Gynecology, Maastricht, Netherlands, Maastricht University Medical Center, Obstetrics & Gynecology, GROW School for Oncology and Developmental Biology, Maastricht, Netherlands, Academic Medical Center, Obstetrics and Gynecology, Amsterdam, Netherlands, Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands OBJECTIVE: To assess the association between duration of rupture of membranes on perinatal outcome in patients with preterm delivery. STUDY DESIGN: We used data from the nationwide perinatal registry (PRN) from 1999 to 2007. We selected singleton pregnancies with preterm delivery between 26 0/7 and 36 6/7 weeks. We studied the association between duration of rupture of membranes (ROM) and perinatal outcome for different gestational ages. Perinatal outcome was defined as perinatal mortality, neonatal sepsis, Apgar score 7 after 5 minutes and composite morbidity (respiratory distress syndrome, necrotizing enterocolitis and intraventricular hemorrhage). RESULTS: During the study period, 166,118 births were complicated by preterm delivery between 26 0/7 and 36 6/7 weeks. The perinatal mortality rate in this group was 2.5%. For a gestational age between 26-30 weeks, the mortality rates for women delivering before and after 24 hours of ROM were 30% and 3.9% respectively (OR .34 (.22 to .55)). For gestational age groups at 30-33, 34, 35 and 36 weeks, these rates were 6.9% versus 0.9%, 2.6% versus 0.5%, 1.5% versus 0.4%, and 0.8% versus 0.4%, respectively (OR .21, .33, .32 and .36, all P .05). Sepsis rates were comparable with short and prolonged PPROM when PPROM occurred before 34 weeks (OR 1.1), but higher after prolonged PPROM when PPROM occurred after 34 weeks (OR 1.6, 1.9 and 2.6 for 34, 35 and 36 weeks, all P .05). The patterns of low Apgar score and composite morbidity resembled that of perinatal mortality. CONCLUSION: In women with a preterm delivery, prolonged duration of ROM is not associated with an increased risk of perinatal mortality, morbidity or low Apgar score at any gestational age. The risk of neonatal sepsis increases with longer duration of ROM in pregnancies over 34 weeks. These data do not support a policy of induction of labor in case of PPROM. 484 Ethnic disparities in spontaneouspreterm-birth-related perinatal mortality Jelle M. Schaaf, Ben Mol, Ameen Abu Hanna, Anita C.J. Ravelli Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands OBJECTIVE: Although preterm birth has been defined as delivery before 37 weeks of gestation, ethnic disparities both in the risk of preterm birth as well as in the risk of perinatal mortality after preterm birth have been identified. We hypothesize that the definition of preterm birth should incorporate ethnicity, as normality could be different between women of different ethnic origins. To test this hypothesis, we studied ethnic disparities in spontaneous preterm birth and its subsequent mortality. STUDY DESIGN: We used data of the nationwide perinatal registry (PRN) of The Netherlands. For this study all singleton births between 1 January 1999 and 31 December 2007 were selected. We defined preterm birth as birth before 37 weeks. First, we studied the risk of preterm birth for Caucasians, Mediterraneans, Black women, SouthAsians and other Asian women. We then analysed mortality, defined as intrapartum or neonatal mortality within 28 days, in case of preterm birth in these ethnic groups. We chose 26 weeks as lower limit as there were active management differences between hospitals below this gestational age during the study period. We used multivariate logistic regression methods. RESULTS: We analyzed data of 969,491 women. Risk of delivery before 37 weeks was 5.3% in Caucasians, 4.7% in Mediterranean, 7.5% in Black women, 8.5% in South-Asians and 5.8% in other Asian women (Table 1). For the 50,823 women who experienced preterm birth between 26 and 37 weeks, the risks of perinatal mortality were 73, 65, 67, 67 and 67 respectively. The risk of mortality after preterm birth seems to be lower for all ethnic groups (when compared to Caucasians) and was significantly lower for Mediterranean women (odds 0.67). CONCLUSION: When preterm birth was defined as delivery before 37 weeks, both Black and South-Asian women had a significantly increased risk to deliver preterm. Since the subsequent risk of perinatal mortality after delivery before 37 weeks seems to be decreased in all ethnic groups as compared to Caucasian women, we plead for ethnic specific definitions for preterm delivery. Poster Session III Doppler Assessment, Fetus, Prematurity www.AJOG.org

Comparative analysis of insulin-like growth factor binding protein-1 (IGFBP-1), placental alpha-microglobulin-1 (PAMG-1) and nitrazine test to diagnose premature rupture of membranes in pregnancy

to compare insulin-like growth factor binding protein-1 (IGFBP-1) (non-phosphorylated), placental alpha-microglobulin-1 (PAMG-1) and nitrazine test to diagnose premature rupture of membrane to allow gestation-specific management. we recruited 100 women with signs or symptoms of premature rupture of membranes (PROM), between 17 and 37 weeks at a tertiary referral center. in 100 women in whom PAMG-1 was performed, sensitivity was 92.7%, specificity was 100%, positive predictive value (PPV) was 100% and negative predictive value (NPV) was 95.2%. IGFBP-1 was performed in 94 women, the sensitivity was 87.5%, specificity was 94.4%, PPV was 92.1% and NPV was 91.1%. In 98 women in whom nitrazine test was performed, the sensitivity was 85%, specificity was 39.7%, PPV was 49.3% and NPV was 79.3%. PAMG-1 was the most accurate test in diagnosing rupture of membranes and had the highest sensitivity, specificity, PPVs and NPVs.

Preterm premature rupture of membranes in pregnancies complicated by human immunodeficiency virus infection: A single center's five-year experience

Objective. The objective of this study was to describe one center's five-year experience of the management of human immunodeficiency virus (HIV) positive gravidas with preterm premature rupture of the membranes (PPROM) not in labor at ≤34 weeks of gestation.Methods. This is a retrospective chart review of all HIV positive gravidas with PPROM at ≤34 weeks of gestation, who delivered between December 1, 2000 and December 31, 2005.Results. We identified 228 HIV positive gravidas of whom 19 had PPROM at ≤34 weeks of gestation. Mother-to-child transmission occurred in two of 18 surviving neonates as confirmed by a follow-up visit at six months of age. No mother-to-child transmission occurred in the 10 neonates of mothers who received antenatal highly active antiretroviral therapy and intrapartum zidovudine. Eleven neonates were delivered between 30 and 33 weeks of gestation. In this group, five of 11 gravidas received antenatal corticosteroids. The mean neonatal hospital stay was 31 days with or without prophylactic treatment of the mothers with antenatal corticosteroids.Conclusions. In this study of HIV positive patients with PPROM, the mother-to-child transmission rate of HIV did not seem to be related to the duration of rupture of membranes prior to delivery.

Preterm and premature rupture of membranes in pregnancies after in vitro fertilization

Women conceiving by assisted reproduction are at higher risk for preterm and premature rupture of membranes. The aim of our study was to estimate and compare incidence of preterm premature rupture of membranes in singleton pregnancies of women who conceived by intrauterine insemination and in vitro fertilization, from 1999 to 2003. We investigated 87 women from the intrauterine insemination, and 102 from the in vitro fertilization program. There were no statistically significant differences in regard to preterm and premature rupture of membranes: p > 0.75 in two groups. The incidence of premature rupture of membranes was 2.30% (after intrauterine insemination) and 2.94% (after in vitro fertilization). There was no statistically significant differences in regard to preterm and premature rupture of membranes in women who conceived by insemination and in vitro fertilization. Estimated incidence of preterm and premature rupture of membranes was similar to the literature data and also similar to incidence after natural conception.