Rupture Of Membranes Research Articles

MATERNITY NURSING CARE FOR MRS. H G1P1A0 H 1ST POSTPARTUM SECTIO CAESAREA INDICATIONS OF PREMATURE RUPTURE OF MEMBRANES FOCUS PAIN RELIEVING INTERVENTION WITH THERAPY FINGER HOLDINGAND WARM COMPRESSAT PERMATA BUNDA HOSPITAL

Background: Sectio Caesarea delivery is an artificial delivery by removing the fetus or baby through the abdominal wall by making an incision in the uterine wall provided that the uterus is intact and the fetus weighs more than 500 grams. Causes of cesarean section delivery There are problems on the part of the mother and baby (Sari & Absari, 2020). The Maternal Mortality Rate (MMR) is one of the targets that has not been completely addressed and is a priority in the Sustainable Development Goals (SDG). The goal is to reduce maternal mortality to below 70 per 100,000 live births by 2030. Based on data from the 2021 Indonesia Health Profile Book, the number of deaths from year to year is increasing. It can be seen from the number of maternal deaths in Indonesia in 2021, which is 7,389 compared to 2020, which is 4,627 deaths (Angka Kematian Ibu, 2022, p. Kementrian Kesehatan Republik Indonesia). Relaxation technique is a technique related to human behavior and is effective in overcoming acute pain, especially pain due to diagnostic and surgical procedures. One of the techniques used is the finger holding technique and warm compress.Methodology: This design uses a case study research design. This type of research used in quantitative research is to analyze the process of conclusion and dynamics of existing situational relationships and relationship processes that occur from a phenomenon. The subject in this study is Mrs. H, 32 years old, post-sectio caesarea, with premature rupture of membranes at Permata Bunda Hospital.Results: The researchers identified that after finger holding therapy and warm compresses for 3 consecutive days, it can reduce the degree of discomfort and reduce pain. Conclusion: There is a very significant influence, it can be concluded that giving finger holding therapy and warm compresses can reduce the degree of discomfort and reduce pain.

Genetic Causal Association Between 15 Micronutrients and 12 Obstetric-Related Diseases: A Mendelian Randomization Study.

Micronutrients, namely vitamins and minerals, are associated with pregnancy outcomes. However, the effects reported in previous observational studies and randomized controlled trials have been inconsistent. Using publicly available genetic data, we conducted a two-sample MR analysis to estimate the causal association between 15 micronutrient levels and 12 obstetric-related diseases. Sensitivity analysis was performed to assess the robustness of the results, detect heterogeneity, and examine the potential existence of horizontal pleiotropy. Iron was protective against gestational diabetes mellitus (GDM) (OR = 0.597, 95% CI 0.438-0.814, P = 0.001), while zinc increased the risk of pregnancy hypertension (OR = 1.064, 95% CI 1.004-1.128, P = 0.035). Vitamin B6 was associated with increased risk of spontaneous abortion (OR = 1.222, 95% CI 1.001-1.490, P = 0.047), and vitamin D was linked to poor fetal growth (OR = 1.612, 95% CI 1.018-2.552, P = 0.041). Conversely, vitamin B12 showed protective effects against preterm birth (OR = 0.686, 95% CI 0.482-0.976, P = 0.036). Selenium and vitamin E were protective against polyhydramnios (OR = 0.828, 95% CI 0.698-0.981, P = 0.030; OR = 0.441, 95% CI 0.213-0.910, P = 0.026), whereas selenium increased the risk of premature rupture of membranes (OR = 1.083, 95% CI 1.007-1.164, P = 0.030).However, no causal links were found between the other micronutrients analyzed and obstetric-related diseases. Sensitivity analyses revealed no significant heterogeneity or pleiotropy. Our research has clarified the causal link between micronutrients and obstetric-related diseases, assisting clinicians in offering personalized guidance on the appropriate intake of micronutrients for women preparing for pregnancy and those who are pregnant. These findings are essential for screening and preventing pregnancy complications, and they also provide new insights and evidence for improving pregnancy outcomes through nutritional interventions.

Proof of concept testing of a vascular closure device for use in fetal surgery

Objective Prior clinical findings have demonstrated that maternal laparotomy with trans-amniotic trans-uterine suturing of the fetoscopic port site during in utero myelomeningocele repair reduces the risk of membrane rupture. However, due to laparotomy-associated morbidity, we aimed to explore the feasibility of using a vascular closure device for percutaneous trans-amniotic trans-uterine suturing. Methods This IRB and IACUC-exempt study utilized 2 strategies for proof-of-concept testing of using the Abbott Perclose™ ProStyle™ Device for suture placement; 1. Ultrasound guided application on a high fidelity maternal abdominal uterus model used for fetal procedures and 2. Placement under direct visualization with sheep undergoing cesarean delivery for other research purposes. In the high-fidelity uterus model, the Abbott Perclose™ ProStyle™ device was used to place a transuterine/transamniotic stitch with accompanying video recording of the approach (https://go.screenpal.com/watch/cZfhoDVsYvW password: perclose). Regarding the second approach, at the time of a cesarean section, 12 French Checkflo® cannulas were inserted into the sheep amniotic space via different approaches: (1) Seldinger technique, (2) Seldinger technique insertion of Checkflo® cannula and subsequent use of the Abbott Perclose™ ProStyle™ device to suture the port site after check flow removal, (3) Abbott Perclose™ ProStyle™ device utilized in what is described as a “pre-close” technique, where prior to cannula placement, trans-uterine trans-amniotic stitches are placed followed by the insertion of a 12 French Checkflo® cannula over the same guidewire. Samples of the sutured uterine wall were sent to pathology and H&E staining was performed to assess uterine hole closure and amnion-to-uterus fixation. Results The high-fidelity model confirmed that the Perclose™ ProStyle™ Device was easily visualized by ultrasound and suture deployment was without complication. In the animal model, the Perclose™ ProStyle™ device effectively sutured the amnion to the uterus in both the pre- and post-close approach. The pre-close technique achieved better amnion-to-uterus approximation and more appropriate uterine hole closure. H&E staining revealed that without suturing, amnion separation from the chorion layer occurred, and the uterine hole persisted. The post-close technique showed partial connection between the amnion and chorion, but inadequate uterine hole closure with amnion shift into the defect. Optimal closure, with secure amnion-to-chorion fixation and uterine closure, was achieved through the pre-close technique. Conclusion The Abbott Perclose™ ProStyle™ Device seems to be a feasible device for use of uterine port closure in maternal-fetal surgery, larger animal studies with mid-pregnancy application are needed to further validate or refute these findings.

Antibacterial and anti-biofilm efficacy of 1,4-naphthoquinone against Chromobacterium violaceum: an in vitro and in silico investigation.

Antimicrobial resistance (AMR) is an urgent worldwide health concern, requiring the exploration for novel antimicrobial interventions. A Gram-negative bacterium, Chromobacterium violaceum, synthesizes quorum-sensing-regulated violacein pigment, develops resilient biofilms, and is often used for the screening of anti-infective drugs. The aim of this work is to assess the antibacterial and antibiofilm properties of three polyphenols: 1,4-naphthoquinone, caffeic acid, and piperine. The determination of antibacterial activity was conducted by the agar overlay and broth microdilution techniques. Analysis of membrane rupture was conducted by crystal violet uptake and β-galactosidase assay. Inhibition of biofilm was evaluated using a 96-well microtiter plate assay. Biofilm structures were visualized using light, scanning electron microscopy (SEM), and confocal laser scanning electron microscopy (CLSM). Among the phytochemicals, 1,4-naphthoquinone exhibited the highest antibacterial action (25mm zone of inhibition). The minimum inhibitory concentration of 1,4-naphthoquinone was determined to be 405µM. Outer and inner membrane permeability was enhanced by 52.01% and 1.28 absorbance, respectively. Violacein production was reduced by 74.85%, and biofilm formation was suppressed by 63.25% at sub-MIC levels (202.5µM). Microscopic analyses confirmed reduced adhesion on surfaces. Hemolytic activity of 1,4-naphthoquinone showed a concentration-dependent effect, with 32.16% haemolysis at 202.5µM. Molecular docking revealed significant interactions of 1,4-naphthoquinone with DNA gyrase followed by CviR. These findings highlight 1,4-naphthoquinone's potent antibacterial efficacy against C. violaceum, proposing its use as a surface coating agent to prevent biofilm formation on medical devices, thereby offering a promising strategy to combat bacterial infections.

Probiotics in the Prophylaxis of Premature Rupture of Membranes and Cervical Incompetence

Premature rupture of membranes (PROM) and cervical incompetence (CI) are major contributors to preterm birth, a leading cause of neonatal morbidity and mortality. Background/Objectives: Disorders of the vaginal microbiota, such as bacterial vaginosis, have been associated with an increased risk of PROM, CI, and subsequent preterm birth. Probiotics, particularly Lactobacillus strains, have been proposed as a preventive strategy to restore and maintain a healthy vaginal microbiome. This review aims to summarize the latest evidence on the role of probiotics in the prevention of PROM and CI. Methods: A comprehensive review was conducted to evaluate the effectiveness of probiotic interventions in the prevention of PROM and CI, yielding 1809 records from 2005 to 2024. Seven relevant studies were selected by searching medical databases and focusing on studies that investigated the restoration of healthy vaginal flora, the reduction of pathogenic bacteria colonization, and the modulation of immune responses by probiotics. Results: The studies analyzed suggest that probiotics may help restore healthy vaginal flora, reduce pathogenic bacterial colonization, and modulate immune responses, thereby reducing the risk of membrane rupture and cervical insufficiency. Evidence from randomized controlled trials and observational studies shows that the use of probiotics is associated with a lower incidence of PROM and preterm birth, especially in high-risk groups. Conclusions: Probiotics emerge as a potential non-invasive and cost-effective strategy to improve pregnancy outcomes in women at risk of preterm birth due to PROM. According to our research, probiotic prophylaxis of cervical insufficiency has not yet been sufficiently investigated. Despite the promising findings, further research is needed to determine standardized probiotic formulations, optimal timing, and routes of administration. Personalized probiotic therapies may represent the future of preterm birth prevention as they offer targeted interventions based on individual microbiome composition.

Factors associated with the admission of moderate to late preterm and term neonates within 72 hours of birth at Dedza and Mangochi District Hospitals, Malawi: a matched case-control study

ObjectiveTo investigate the demographic characteristics, maternal, and perinatal factors associated with the hospitalization of moderate to late preterm and term neonates within 72 h of birth in the Dedza and Mangochi districts of Malawi.MethodsThis case-control study was conducted with one-to-one matching for age, location, and sex. Cases were sick neonates who were admitted in the Sick Intensive Neonatal Care Unit (SINCU) within 72 h of life, while controls were non-sick neonates delivered within two weeks of the birth dates of cases. Prenatal data were extracted from case files, while other maternal practices and demographic characteristics were obtained by interviewing primary care takers or legal guardians after obtaining consent. Descriptive analyses and logistic regression were used to identify factors associated with hospitalization of moderate to late preterm and term neonates within 72 h of birth.ResultsApplication of tetracycline eye ointment (AOR: 0.41, 95% CI: 0.20–0.82, p = 0.012) applying chlorhexidine to the umbilical cord stump (AOR: 0.30, 95% CI: 0.10–0.88, p = 0.027), and stimulation resuscitation (AOR: 0.20, 95% CI: 0.05–0.78, p = 0.020) were associated with a reduced odd of hospitalization. An increased odds of hospitalization was significantly associated with low birth weight (AOR: 10.48, 95% CI: 4.25–25.89, p = 0.001), Apgar score < 5 (AOR: 5.0, 95% CI: 2.14–11.63, p = 0.001), suctioning resuscitation (AOR: 2.82, 95% CI: 1.17–6.83, p = 0.021), and resuscitation using O2 (AOR: 4.23, 95% CI: 1.32–13.56, p = 0.015). Maternal factors associated with reduced odds of hospitalization included the mother testing positive and successfully treated for syphilis antenatally (AOR: 0.06, 95% CI: 0.02–0.18, p = 0.001) and the mother being married (AOR: 0.39, 95% CI: 0.16–0.93, p = 0.34). Maternal factors associated with an increased odds of hospitalization include premature rupture of membranes (AOR: 2.49, 95% CI: 1.12–5.52, p = 0.025) and presence of meconium stain during delivery (AOR: 3.14, 95% CI: 1.63–6.06, p = 0.001).ConclusionThe research findings indicate that several interventions significantly reduce infections in neonates within their initial 72 h of life. These include the application of ophthalmic ointment to all neonates, utilization of chlorhexidine on the umbilical cord stump, and provision of antenatal treatment for syphilis and HIV in infected mothers. Conversely, certain factors increase the likelihood of neonatal morbidity and potential hospitalization during this critical period. These risk factors include low birth weight, a low Apgar score, and conditions necessitating suctioning or oxygen resuscitation at birth. Furthermore, infants born to mothers who experienced premature rupture of membranes or meconium-stained amniotic fluid during parturition are more susceptible to infectious conditions, which may necessitate hospitalization within the first 72 h postpartum. We recommend that stimulation be used as the core procedure for resuscitation, whereas suctioning should be used with caution and only when it is essential. Infection prevention measures should always be adhered to during all procedures on neonates. We recommend intensifying HIV and syphilis testing and treating during the antenatal period to reduce neonatal infection.

Intrapartum maternal risks of group B streptococcus carriage in premature rupture of membranes

BACKGROUND: Group B streptococcal infection remains the epicenter of attention for maternal and child health services around the world. Premature rupture of membranes requires adaptation of obstetric tactics and intrapartum antibiotic prophylaxis. AIM: The aim of this study was to identify maternal intrapartum risks of group B streptococcus colonization of the birth canal and the lack of antepartum screening for group B streptococcus in cases of premature rupture of membranes in full-term pregnancy. MATERIALS AND METHODS: This retrospective cohort study was conducted in the Perinatal Center of City Clinical Hospital No. 31 named after Academician G.M. Savelyeva (Moscow, Russia) in 2023–2024. We selected women with premature rupture of membranes at full-term pregnancy, whose birth canals were subsequently divided into those colonized by group B streptococcus and those not colonized and who underwent antenatal group B streptococcus screening at 35–37 weeks of pregnancy or not. In the absence of group B streptococcus screening upon admission to the hospital, vaginal discharge was collected and sent off for bacteriological testing. Two tactics for labor management were selected: expectant, and active. Intrapartum antibiotic prophylaxis was performed in case of group B streptococcus isolation during screening. RESULTS: With premature rupture of membranes in full-term pregnancy, only 57.14% of group B streptococcus carriers have prenatal group B streptococcus screening; therefore, in 42.86% of group B streptococcus carriers, intrapartum antibiotic prophylaxis was delayed by 18 hours. Group B streptococcus carriage is not associated with the gestational age of premature rupture of membranes, but has intrapartum features such as a trend of younger age (less than 30 years) and attendance at the hospital earlier than six hours after premature rupture of membranes with the opportunity for induction or effective pre-induction of labor with a single dose of an antigestagen (in more than 70% of women). These women had a blood leukocyte count of ≥12.5 × 109/l and higher C-reactive protein levels. They were most often delivered by cesarean section, with characteristic indications for chorioamnionitis and fetal distress. The absence of prenatal group B streptococcus screening distinguishes the age of women under 30 years old, the threshold C-reactive protein level being 19.5 g/l, with a tendency towards a less frequent spontaneous onset of labor and a higher frequency of its induction, hypotonic hemorrhage, and chorioamnionitis. CONCLUSIONS: There are intrapartum maternal risks of group B streptococcus carriage and the presence of group B streptococcus screening, which are conditionally controlled in the Moscow. Intrapartum antibiotic prophylaxis and the metropolis resource “equalize” the outcome of births in cases of group B streptococcus carriage and absence, with the presence and absence of group B streptococcus screening. Modern medicine allows for minimizing the risks of chorioamnionitis and hypotonic hemorrhage in group B streptococcus carriers after premature rupture of membranes, even in the absence of group B streptococcus screening in more than half of women or deferment of intrapartum antibiotic prophylaxis for 18 hours.

Microrheometric study of damage and rupture of capsules in simple shear flow

Capsules, which are potentially active fluid droplets enclosed in a thin elastic membrane, experience large deformations when placed in suspension. The induced fluid–structure interaction stresses can potentially lead to rupture of the capsule membrane. While numerous experimental studies have focused on the rheological behaviour of capsules until rupture, there remains a gap in understanding the evolution of their mechanical properties and the underlying mechanisms of damage and breakup under flow. We here investigate the damage and rupture of bioartificial microcapsules made of ovalbumin reticulated with terephthaloyl chloride and placed in simple shear flow. We characterize damage by identifying how the surface shear modulus of the capsule membrane changes over time. Rupture is then characterized by comparing the number and size distribution of capsules before and after exposure to shear, while varying the shear rates and time during which capsules are sheared. Our findings reveal how the percentage of ruptured capsules increases with their size, exposure time to shear, and the ratio of viscous to elastic forces at rupture.

Management of twin-reversed arterial perfusion (TRAP) sequence: a systematic review and meta-analysis.

Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic twin pregnancies characterized by placental anastomoses between a normally developed twin and an acardiac mass. Though several treatment modalities exist, the optimal management strategy is unclear. This study aims to compare the various treatment strategies for TRAP sequence. A systematic review of the literature was performed using PRISMA guidelines including PubMed, Scopus, Web of Science and the Cochrane Library. Studies were imported into Covidence, where they were independently screened by two authors. Studies included described interventions for TRAP sequence. Those excluded were unavailable in English and lacked differentiation between intervention strategies for TRAP and other monochorionic twin pregnancies. Fisher's exact test and random effects modeling were used for statistical analysis. 2340 abstracts were screened, of which 218 articles progressed to full review and 120 qualified for data extraction. 757 twin pregnancies were described. Most were treated with radiofrequency ablation (RFA) (n=363, 47.95%) and laser ablation (n=220, 29.06%). Statistically significant differences amongst the modalities were seen in technical success (p = 0.005), gestational age at presentation (p < 0.01), intervention (p = 0.01), and delivery (p = 0.01), respectively, and time between treatment and delivery (p < 0.01). Notably, pump twin survival did not differ based on treatment modality used (p = 0.196). Overall, complication rates were low with no differences in preterm premature rupture of membranes (PPROM) (p = 0.66), preterm labor (p = 0.58) or maternal hemorrhage between modalities (p = 0.28). Suture cord ligation, however, had a greater hemorrhage rate than RFA (p = 0.03). This embodies the first meta-analysis comparing treatment modalities for TRAP sequence with outcomes and complications. RFA is the most technically successful strategy. Prospective data is required to further understand the optimal modality and gestational age at treatment to ensure best overall outcomes. .

Influence of clinical risk factors for preterm premature rupture of membranes (PPROM) on the elastic strength of fetal membranes at term: A prospective study.

Premature rupture of membranes (PROM) before 37 weeks of gestation is a common obstetrical event, whose pathophysiology is still poorly understood. Our objective was to study the mechanical strength of fetal membranes in women with a clinical risk factor for preterm premature rupture of membranes (PPROM). We included, in a prospective, descriptive, single-center study, patients scheduled for cesarean section at term (≥ 37 weeks of gestation). For each patient, we performed uniaxial tensile tests on fetal membranes with a universal testing machine equipped with a force sensor (EZ20®, Lloyds), allowing the recording of an applied force/time curve. We collected maximum force (Fmax), maximum stress (σMax), and Young's modulus of elasticity. The thickness of each membrane sample was also measured. We compared the values obtained according to certain clinical risk factors for PPROM such as age, body mass index, gravidity, parity, a history of PPROM or preterm birth, smoking, gestational diabetes, geographic origin, and socioeconomic level. We analyzed 31 patients and found no association between the studied risk factors and σMax. Fmax was lower in primiparous patients (p = 0.02) but increased with patient parity (p = 0.005). Gestational diabetes was associated with a higher Fmax (p = 0.033) and sub-Saharan geographical origin with a greater thickness (p = 0.0043). As membrane thickness increased, σMax (p = 0.009) and Young's modulus decreased (p = 0.037). Primiparous patients have lower membrane mechanical strength than patients who have had one or more deliveries. Mechanically, the thicker membranes are less rigid and less resistant.

Routine 36-week scan: diagnosis and outcome of abnormal fetal presentation.

First, to report the incidence of non-cephalic presentation at a routine 36-week ultrasound scan, the uptake and success of external cephalic version (ECV) and the incidence of spontaneous rotation from non-cephalic to cephalic presentation. Second, to determine the maternal and pregnancy characteristics that provide a significant contribution to the prediction of non-cephalic presentation at the 36-week scan, successful ECV from non-cephalic to cephalic presentation and spontaneous rotation from non-cephalic to cephalic presentation. This was a retrospective analysis of prospectively collected data from 107 875 women with a singleton pregnancy who had undergone a routine ultrasound scan at 35 + 0 to 36 + 6 weeks' gestation. Patients with breech or transverse/oblique presentation were divided into two groups: those scheduled for elective Cesarean section for a fetal or maternal indication other than abnormal presentation, and those that would potentially require ECV. The latter group was reassessed after 1-2 weeks and, if the abnormal presentation persisted, the parents were offered ECV or elective Cesarean section at 38-40 weeks' gestation. Multivariable logistic regression analysis was carried out to determine which maternal and pregnancy characteristics provided a significant contribution in the prediction of non-cephalic presentation at the 36-week scan, successful ECV from non-cephalic to cephalic presentation and spontaneous rotation from non-cephalic to cephalic presentation. At the 36-week scan, fetal presentation was cephalic in 101 664 (94.2%) pregnancies and either breech, transverse or oblique in 6211 (5.8%). In 0.3% of cases with cephalic presentation at the 36-week scan, there was subsequent spontaneous rotation to non-cephalic presentation, and in half of these, the diagnosis was made during labor or at birth. ECV was attempted in 1584/6211 (25.5%) pregnancies with non-cephalic presentation at the 36-week scan and was successful in only 44.1% of cases. In the remaining 74.5% of cases, ECV was not attempted because of any of the following reasons: ECV was declined; Cesarean section was planned for a reason other than abnormal presentation; ECV was planned for the subsequent 1-2 weeks but, in the meantime, there was spontaneous rotation to cephalic presentation; or there was spontaneous onset of labor or rupture of membranes before planned ECV. In 5513/6211 (88.8%) pregnancies with non-cephalic presentation at the 36-week scan, ECV was not attempted or was unsuccessful, and in 37.7% of these, there was subsequent spontaneous rotation to cephalic presentation. Among the 6211 pregnancies with non-cephalic presentation at the 36-week scan, the presentation at birth was cephalic in 43.8%; in 74.8%, this was due to spontaneous rotation, and in 25.2%, it was due to successful ECV. Multivariable analysis demonstrated that the likelihood of non-cephalic presentation at the 36-week scan, that of successful ECV and that of spontaneous rotation from non-cephalic to cephalic presentation was affected by several maternal and pregnancy characteristics, but the predictive performance for these events was poor, with the area under the receiver-operating-characteristics curve ranging from 0.608 to 0.717 and the detection rate at a 10% false-positive rate ranging from 19.0% to 33.7%. Routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation could improve pregnancy outcome by substantially reducing the risk of unexpected abnormal presentation in labor. However, an additional ultrasound scan for fetal presentation should be considered in all women when they present in labor. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasound evaluation of the size of the umbilical cord vessels and Wharton’s jelly and correlation with intrapartum CTG findings

ObjectiveTo compare the sonographic measurement of the umbilical cord between women with or without repetitive decelerations during the first stage of labor. Study designProspective study including a non-consecutive cohort of women at term gestation carrying a normal sized fetus at term in cephalic presentation. The cross-sectional area of the umbilical cord, of its vessels and the amount of the Wharton’s jelly were assessed at 2D ultrasound upon labor admission. The CTG traces recorded in labor were retrospectively evaluated and the biometric parameters of the umbilical cord were compared between women with or without repetitive decelerations during the first stage and their correlation with the total deceleration area/total length (stage I TDA/t) of the first stage of labor (overall and following the rupture of membrane) was assessed. ResultsOverall, 113 women were included, of whom 21 (18.6 %) presented repetitive decelerations during the first stage of labor. In this latter group, the umbilical cord showed a significantly smaller total arterial area (24.4 ± 10.7 vs. 19.6 ± 9.0 mm2; p = 0.02), vein area (46.8 ± 13.6 vs. 34.1 ± 13.3 mm2; p < 0.001) as well Wharton’s Jelly (WJ) area (122.7 ± 32.1 vs. 79.3 ± 11.1 mm2; p < 0.001) compared with fetuses with a normal CTG. At logistic regression analysis the WJ area was associated with the occurrence of repetitive decelerations during the first stage of labor (p < 0.001). The I stage TDA/t overall and after the rupture of membranes was found to be negatively correlated with the WJA (Spearman’s coefficient −0.40; p < 0.001 and −0.45; p < 0.001 respectively). ConclusionIn normal sized infants a reduced umbilical cord thickness is associated with an increased occurrence of repetitive decelerations during the first stage of labor. The severity of these decelerations is negatively correlated to the amount of WJ.

Changes in short-term variation of antenatal cardiotocography to identify intraamniotic infection: a historical cohort study

Introduction Intraamniotic infection (IAI) is one of the main possible complications of preterm prelabor rupture of membranes (PPROM) and can lead to severe consequences for the neonate, such as early onset neonatal sepsis (EONS). Available diagnostic tools for IAI have poor diagnostic performance, which may result in both over- and underdiagnoses of IAI. In a search for better diagnostic tools, we have examined short-term variation (STV) in fetal heart rate. We have previously shown that in IAI exposed pregnancies, the STV was more than 20% lower in the last cardiotocography trace before the start of labor, as compared to those not exposed to IAI. The association between IAI and STV needs further evaluation and we therefore continued by examining the longitudinal change in STV in association with IAI. Material and methods We performed a historical cohort study on 628 singleton pregnancies with PPROM, delivering between 24 + 0 to 33 + 6 gestational weeks. The main exposure of the study was IAI, using EONS as a proxy as no easily available method exists for confirming IAI antepartum, and IAI and EONS are strongly associated. The main outcome was STV in fetal heart rate. At least two available cardiotocography traces per fetus were required as a minimum, from PPROM or from seven days before birth, whichever came later, until the start of labor or planned cesarean birth. A total of 9 690 cardiotocography traces were analyzed. Results Fetuses exposed to IAI had a 26.5% steeper decline in their STV during the last 24 h before the start of labor when compared to fetuses not exposed (95% CI −32.9% to −19.4%; p < 0.001). After adjustment for antenatal corticosteroids, the decline remained significant. The decline became less prominent but the significance remained when also adjusting for the baseline frequency (−12.7% [95% CI −19.3% to −5.5%], p < 0.001). In the IAI-exposed group, the baseline frequency increased by 11.1 bpm during the last 12 h before the start of labor, beyond those who were not exposed (95% CI 8.3 bpm to 13.8 bpm; p < 0.001). Conclusions In pregnancies affected by IAI the STV declines steeper in the last 24 h before the start of labor as compared to pregnancies not affected by IAI, even after adjustment for increasing baseline frequency. The association of STV in relation to IAI needs to be further studied in order to evaluate and establish STVs usefulness in monitoring patients for IAI.

Ferroptosis: mechanisms and therapeutic targets.

Ferroptosis is a nonapoptotic form of cell death characterized by iron-dependent lipid peroxidation in membrane phospholipids. Since its identification in 2012, extensive research has unveiled its involvement in the pathophysiology of numerous diseases, including cancers, neurodegenerative disorders, organ injuries, infectious diseases, autoimmune conditions, metabolic disorders, and skin diseases. Oxidizable lipids, overload iron, and compromised antioxidant systems are known as critical prerequisites for driving overwhelming lipid peroxidation, ultimately leading to plasma membrane rupture and ferroptotic cell death. However, the precise regulatory networks governing ferroptosis and ferroptosis-targeted therapy in these diseases remain largely undefined, hindering the development of pharmacological agonists and antagonists. In this review, we first elucidate core mechanisms of ferroptosis and summarize its epigenetic modifications (e.g., histone modifications, DNA methylation, noncoding RNAs, and N6-methyladenosine modification) and nonepigenetic modifications (e.g., genetic mutations, transcriptional regulation, and posttranslational modifications). We then discuss the association between ferroptosis and disease pathogenesis and explore therapeutic approaches for targeting ferroptosis. We also introduce potential clinical monitoring strategies for ferroptosis. Finally, we put forward several unresolved issues in which progress is needed to better understand ferroptosis. We hope this review will offer promise for the clinical application of ferroptosis-targeted therapies in the context of human health and disease.

Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved?

BackgroundSuspected preterm labour (PTL) and prelabour rupture of membranes (PPROM) are common indications for aeromedical retrieval in the Top End, Northern Territory, Australia, where many women reside remotely and preterm birth (< 37 completed weeks of gestation) is common. The primary objective of this study was to determine rate of delivery during the index admission following aeromedical transfers from remote clinics to Royal Darwin Hospital for suspected PTL/PPROM.MethodsA retrospective cohort study of aeromedical transfers for suspected PTL/PPROM from 1 January 2020 to 31 July 2022 was undertaken. Transfers were identified through CareFlight, the regional air ambulance service, and complemented with data from hospital records. Clinical and sociodemographic characteristics were compared by delivery status during the index (post-retrieval) admission using parametric and non-parametric tests and multivariable linear regression analysis.Results238 women with singleton pregnancies were retrieved for suspected PPROM (n = 77, 32.4%) or PTL (n = 161, 67.6%), together accounting for 49.2% of all obstetric transfers (n = 483). Of 77 patients transferred for suspected PPROM, 47 (61.0%) had ruptured membranes confirmed on arrival, and 45 (95.7%) of them delivered during the index admission. None of the 30 women transferred for suspected PPROM with intact membranes on arrival delivered during the index admission. Of 161 patients transferred for suspected PTL, 13 (8.1%) had ruptured membranes confirmed on arrival, and 12 (92.3%) of them delivered during the index admission. Amongst women transferred for suspected PTL with intact membranes confirmed on arrival, 14.9% (22/149) delivered during the index admission. Prior to arrival, 120 women (50.4%) had a documented speculum examination, and 15 (6.3%) and 9 (3.8%) had cervicovaginal swab tests to assess their risks of a PPROM and PTL, respectively. Half of women who did not deliver during the index admission had received antenatal corticosteroids (n = 76).ConclusionsMany aeromedical retrievals for suspected PTL/PPROM did not result in delivery during the index admission. Women retrieved for suspected PPROM with intact membranes on arrival were less likely to deliver. Upskilling remote clinic staff and better point-of-care testing may reduce retrievals and unnecessary interventions. Prospective cohort studies designed to enable accurate prediction of which cases can be safely not retrieved are required.Trial registrationNot applicable.

Impacts of COVID-19 on Pregnancy Outcomes: A Retrospective Study

Background: This study compared outcomes of pregnant females with and without COVID-19 and their fetuses/newborns. Methods: This is a retrospective study from 2020 to 2023 utilizing the United States Collaborative Network of the TriNetX Database. We compared the outcomes of pregnant females with COVID-19 and pregnant females without COVID-19. Maternal outcomes evaluated were death, intubation, intensive care unit (ICU) admission, and premature rupture of membranes (PROM) within 9 months of the diagnosis of pregnancy. Fetal outcomes included preterm birth and intrauterine death (IUD). A subgroup analysis of outcomes was performed based on the mother’s vaccine status. Results: The risks of maternal death (RR = 1.97), maternal intubation (RR = 3.33), and maternal (ICU) admission (RR = 1.76) were significantly higher in pregnant females with COVID-19. For the neonate, there was a higher risk of preterm birth (RR = 1.12). When the confounders were eliminated with propensity matching, there was still an increase in maternal intubation (RR = 3.24) and maternal ICU admission (RR = 1.60). For the neonate/fetus, there was a decreased risk of PROM (RR = 0.83) and IUD (RR = 0.74) for the fetuses of the mothers with COVID-19. For the subgroup analysis, the mother was at an increased risk of ICU admission (RR = 0.04) when unvaccinated. Conclusions: There is an increased risk of poor outcomes for pregnant women infected with COVID-19; however, fetal outcomes are generally favorable. When unvaccinated, there was an increased risk of ICU admission for the mother.

Determinants of premature membrane rupture among mothers receiving labor care at public hospitals in Northeast Ethiopia: an unmatched case-control study

Premature rupture of membranes is responsible for increased perinatal mortality and neonatal morbidity. Therefore, identifying the determining factors is essential for minimizing its adverse impact. Despite the existence of this problem in the study area, there is a gap in identifying the factors affecting its occurrence. We investigate the determinants of premature membrane rupture among mothers receiving labor care at three public hospitals public hospitals in the Northeast Ethiopia, from December 1, 2022, to March 30, 2023. Unmatched case‒control study was conducted and a total of 353 participants (118 cases and 235 controls) receiving labor care were recruited. The data were collected using a face to face interview and card review, entered into EpiData 4.6 and analyzed using STATA version 17. As a result; previous caesarian section (AOR: 2.11; 95% CI: 1.05–4.23), history of abortion (AOR: 3.68; 95% CI: 1.70–7.94), history of premature membrane rupture (AOR: 3.89; 95% CI: 1.73–8.71), chronic cough (AOR: 4.23; 95% CI: 1.47–12.18), mid-upper arm circumference < 23 cm (AOR: 3.47; 95% CI: 1.53–7.84), suspected sepsis (AOR: 2.99; 95% CI: 1.25–1.99), and presence of urinary tract infection (AOR: 3.14; 95% CI: 1.50–6.60) were determinants of premature membrane rupture. These findings underscore previous history of C/S, abortion, PROM, presence of different infections and malnutrition are associated with the case. This highlighting the need for comprehensive prenatal care.

Relationship Between Clinical and Laboratory Parameters at Admission and Pregnancy Outcomes in Cases of Preterm Premature Rupture of Membranes

Abstract Background: Preterm premature rupture of membranes (PPROM) is a significant complication in pregnancy, often associated with adverse maternal and fetal outcomes. Understanding the relationship between clinical and laboratory parameters at admission and pregnancy outcomes in PPROM cases is essential for effective management and intervention. Methods The study was conducted retrospectively to examine the relationship between clinical and laboratory parameters at the time of admission and the latent period in pregnant women with PPROM. Records of pregnant women diagnosed with PPROM between 2015-2017 in the obstetrics department of a university hospital were reviewed. The patients were grouped according to gestational weeks, clinical parameters at admission were recorded, and their relationships with the latent period were analyzed. Results When the data obtained in the study were analyzed, it was shown that cervical length (p = 0.008) and the gestational week at the time of admission had an effect on the latent period (p

Use of the WHO partograph and Zhang’s guideline for labor and delivery in China: implications for clinical practice

BackgroundThere is an unmet need for a large comprehensive population-based dataset documenting national birthing trends in China and a partograph specifically tailored to Chinese women. This study assessed the impact of using the World Health Organization (WHO) partograph or Zhang’s guideline to manage labor and delivery in China and inform the development of a partograph that specifically aligns with the progression of labor in Chinese women.MethodsThis retrospective analysis included low-risk nulliparous women with a singleton, full-term fetus in cephalic presentation entering spontaneous labor at a specialized obstetric hospital in China between January 2010 and June 2022. Pregnant women were managed according to the WHO partograph (January 2010-August 2014, n = 31,286) or Zhang’s guideline (September 2014-June 2022, n = 49,821).ResultsRates of assisted reproduction (4.57% vs. 1.05%; p < 0.0001) and hypertension (7.44% vs. 6.71%; p < 0.0001) were significantly higher for pregnant women managed according to Zhang’s guideline compared to the WHO partograph. Rates of labor intervention (35.31% vs. 13.95%; p < 0.0001), including induction of labor by oxytocin, artificial rupture of membranes, lateral episiotomy and conversion to cesarean section (all, p < 0.0001), were significantly higher for pregnant women managed according to the WHO partograph. Rates of forceps assisted vaginal deliveries (12.67% vs. 6.42%; p < 0.0001) and postpartum hemorrhage (10.9% vs. 6.2%; p < 0.0001) were significantly higher, and birth asphyxia (0.15% vs. 0.09%; p = 0.02) was significantly lower, for pregnant women managed according to Zhang’s guideline.ConclusionsThis study provides valuable insights into the utilization of the WHO partograph and Zhang’s guideline in managing labor and delivery among Chinese women. Findings indicate that women managed according to Zhang’s guideline had higher rates of assisted reproduction and hypertension, suggesting a potentially different demographic profile or underlying health conditions compared to women managed according to the WHO partograph. Notably, the use of the WHO partograph was linked to a significant increase in labor interventions, while Zhang’s guideline resulted in higher rates of forceps-assisted vaginal deliveries and postpartum hemorrhage, yet interestingly, a lower incidence of birth asphyxia. These contrasting outcomes underscore the importance of aligning labor management tools with the specific needs and progression of labor in Chinese women. The results advocate for a tailored partograph that could better reflect the unique characteristics of Chinese women and optimize decision making and maternal and neonatal outcomes.

The rising tide: Trends in induction of labor at term over a 5-year period at a single centre.

Induction of labor (IOL) is a controversial topic in contemporary obstetric practice, with some suggesting that the increase in elective induction (eIOL) as a potential contributor to increasing cesarean delivery (CD) rates. The objectives of this single-center study were to examine the rates of IOL, trends in indications for IOL, and the contribution of IOL to the overall CD rate at one of Europe's largest obstetric hospitals. This retrospective observational cohort study evaluated the outcomes of patients who were delivered following IOL from 2018 to 2022 inclusive at the largest obstetric hospital in Ireland. A total of 36 938 women (16 155 nulliparous and 20 783 multiparous) were delivered during the 5-year study period, of whom 8072 nulliparous and 6343 multiparous women underwent IOL. There was a significant increase in rates of induction, increasing from 42% to 57% (P <0.001) in nulliparous women, and from 27% to 33% (P < 0.001) in multiparous women. The highest contributions to the hospital CD rate were from those being induced for 'fetal' (5%), spontaneous rupture of membranes ('SROM') (4%), and 'maternal' (4%) reasons, with the lowest CD rates in the eIOL category (<1%) in both groups. Our data confirm that the rate of IOL is increasing. The contribution of maternal and fetal reasons for IOL to the overall CD rate may reflect increasing numbers of higher-risk pregnancies. Despite current controversy regarding the role of eIOL, our data do not confirm a significant contribution to either the overall IOL or CD rates in this center.