Term Premature Rupture Of Membranes Research Articles

Oxytocin with calcium vs oxytocin for induction of labor in women with term premature rupture of membranes: a randomized controlled trial

BackgroundIntravenous calcium administration has shown promise in enhancing uterine contractions and reducing blood loss during cesarean section, but this regimen has not been compared in vaginal labor induction. ObjectiveTo determine the efficacy of oxytocin combined with calcium versus oxytocin alone for inducing labor among women with term premature rupture of membranes (PROM). Study designThis single-blind, randomized control trial was conducted between October 2022 and May 2023 in a tertiary university hospital. Patients diagnosed with PROM were randomly allocated into two groups. The intervention group received a bolus of 10 mL of calcium gluconate followed by a continuous infusion of oxytocin via a pump (n = 210), whereas the control group received only oxytocin infusion (n = 218). The primary outcome was successful vaginal deliveries within 24 hours of labor induction. Secondary outcomes included the interval from labor induction to delivery, vaginal delivery blood loss, and maternal and neonatal complications. ResultsBaseline characteristics, including maternal age, BMI, Bishop score before labor induction, were comparable between groups. The rate of vaginal delivery within 24 hours of labor induction was statistically higher in the intervention group (79.52% vs. 70.64%; P = 0.04). Participants in intervention group experienced a shortened interval between induction and delivery (10.48 h vs. 11.25h; P = 0.037), and demonstrated a higher success rate in induction of labor assessed by the onset of active phase (93.80% vs. 87.61%; P = 0.04) without increasing the cesarean rate. Reduced hemorrhage was presented in the intervention group (242.5ml vs. 255.0ml; P = 0.0015) while the maternal and neonatal outcomes were comparable between groups. ConclusionThe co-administration of calcium and oxytocin in labor induction among pregnancies with PROM was more efficient and safer than oxytocin alone. Our research suggests that the combination therapy of calcium and oxytocin may offer significant advantages during the process of labor induction and result in better outcomes.

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.

Vitamin C Levels in Pregnant Women and the Efficacy of Vitamin C Supplements in Preventing Premature Rupture of Membranes: A Systematic Review and Meta-Analysis

Premature rupture of membranes (PROM) is defined as the leakage of amniotic fluid before the onset of labor and delivery contractions. Some studies found that women who experienced PROM had significantly lower vitamin C blood levels than those who did not, while others found no significant differences. Previous systematic reviews and meta-analyses on the efficacy of vitamin C in the prevention of PROM had conflicting results. Conduct a systematic review and meta-analysis to determine if there was a significant difference in vitamin C blood levels in women who had PROM versus the control group who did not and to determine if vitamin C supplements could help prevent it. Systematic review and meta-analysis. We registered our protocol with PROSPERO (CRD42022371644). We searched PubMed/MEDLINE, Web of Science, and Scopus through February 15, 2024. Additionally, backward and forward citation searches were conducted. Studies were selected based on predetermined inclusion and exclusion criteria. Meta-Essentials: Workbooks for Meta-Analysis (version 1.5) was used for analysis. Twenty-five studies (26 reports) met all eligibility criteria, with 18 studies (18 reports) assessing vitamin C levels and seven studies (eight reports) evaluating efficacy. Women with PROM, whether preterm or term, had significantly lower vitamin C levels [Hedges’ g, -1.48; 95% confidence interval (CI): -2.82, -0.14; p = 0.020; I2 = 94.08%) and specifically preterm PROM after removing the outlying study [Hedges’ g, -1.29; 95% CI: -1.85, -0.73; p < 0.001; I2 = 87.35%). Vitamin C supplementation significantly reduced the risk of preterm or term PROM [risk ratio (RR), 0.57; 95% CI: 0.39, 0.81; p < 0.001; I2 = 12.17%), particularly for preterm PROM (RR, 0.67; 95% CI: 0.45, 0.99; p = 0.001; I2 = 0.00%). There were no significant differences in vitamin C levels between women with term PROM and controls, and there were no differences in the risk of developing term PROM between women taking vitamin C supplements and controls. Results were not robust in all sensitivity analyses. Women with PROM, particularly those who developed it preterm, appear to have significantly lower vitamin C levels, and vitamin C supplementation appears to be effective in reducing the risk of PROM, particularly preterm PROM. More high-quality studies with low risk of bias, more homogenous, and larger samples are needed to confirm these findings.

Nulliparas at Term with Premature Rupture of Membranes and an Unfavorable Cervix: Labor Induction with Prostaglandin or Oxytocin? A Retrospective Matched Case Study

Background: Induction of labor (IOL) in nulliparas with premature rupture of membranes (PROM) and an unfavorable cervix at term poses challenges. Our study sought to investigate the impact of prostaglandin E2 (PGE2) compared to oxytocin on the duration of IOL in this specific group of parturients. Methods: This was retrospective matched-case study. All nulliparas with term PROM who underwent induction between January 2006 to April 2023 at Shaare Zedek Medical Center were identified. Cases induced by either PGE2 or oxytocin were matched by the following criteria: (1) time from PROM to IOL; (2) modified Bishop score prior to IOL ≤ 5; (3) newborn birthweight; and (4) vertex position. The primary outcome was time from IOL to delivery. Results: Ninety-five matched cases were identified. All had a modified Bishop score ≤ 5. Maternal age (26 ± 4.7 years old, p = 0.203) and gestational age at delivery (38.6 ± 0.6, p = 0.701) were similar between the groups. Matched factors including time from PROM to IOL (23.5 ± 19.2 versus 24.3 ± 21.4 p = 0.780), birth weight of the newborn (3111 g versus 3101 g, p = 0.842), and occiput anterior position (present on 98% in both groups p = 0.687) were similar. Time from IOL to delivery was significantly shorter by 3 h and 36 min in the group induced with oxytocin than in the group induced with PGE2 (p = 0.025). Within 24 h, 55 (58%) of those induced with PGE2 delivered, compared to 72 (76%) of those induced with oxytocin, (p = 0.033). The cesarean delivery rates [18 (19%) versus 17 (18%)], blood transfusion rates [2 (2%) versus 3 (3%)], and Apgar scores (8.8 versus 8.9) were similar between the groups (PGE2 versus oxytocin, respectively), p ≥ 0.387. Conclusions: Induction with oxytocin, among nulliparas with term PROM and an unfavorable cervix, was associated with a shorter time from IOL to delivery and a higher rate of vaginal delivery within 24 h, with no difference in short-term maternal or neonatal adverse outcomes.

Outcomes of Premature Rupture of Membrane Among Women Admitted in Teaching Hospital, Chitwan, Nepal

Background: Premature rupture of membranes is defined as rupture of membranes after 28th weeks of gestation before the onset of labor is called preterm PROM when it occurs after 37 completed weeks of gestation and before onset of labor, then it is term PROM. Spontaneous rupture of the membrane any time beyond 28th weeks of pregnancy but before the onset of labor is called Premature Rupture of Membrane (PROM). The management of maternal and fetal outcome in PROM is very important to decrease maternal as well as neonatal mortality and for better management and prevention of complications which has essential significance for the further fate pregnancy. Thus, the study aims to find out the factors and outcomes of PROM among the women who will be admitted in maternity ward at Chitwan Medical College. Methods: A descriptive cross-sectional study was conducted in a teaching hospital of Chitwan, Nepal during the study period of six months from 13th Feb 2023 to 14th August 2023 after getting ethical approval from Chitwan Medical College- institutional Review Committee (Reference number-CMC-IRC/079/080). Women were selected via convenience sampling technique. Face to face interview was conducted to gather socio-demographic and obstetric data by structured interview schedule whereas, data related to the feto maternal outcomes were obtained from patient charts and delivery record books. Statistical Package for Social Sciences version 20 was used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Result: The prevalence of premature rupture of membrane was found to be 15.3% out of 503 delivered mothers during six-month period. More than half (67.5%) of postnatal mother were between age of 35-45 years. More than half (57.1%) of mother were at 33-35weeks of gestation. Only 3.9 % of mother has Postpartum hemorrhage as maternal outcome. Only 2.6% of fetus have meconium aspiration syndrome as fetus outcome. Conclusion: The burden of premature rupture of membrane was found quite higher as compared to other similar studies done in Nepal. Hence, awareness, early screening, and treatment are necessary for the hospital attended pregnant women to minimize the risk of premature rupture of membrane. Keywords: Outcomes, premature and Rupture of membrane

Incidence and management of premature rupture of membranes in Victoria, Australia: A retrospective cohort study of 636 590 births between 2009 and 2017.

Premature rupture of membranes (PROM) is a complication affecting 7-12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (ie <37 weeks gestation) precedes one-third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis. To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009 and 2017. This retrospective population-based cohort study included all singleton pregnancies from 2009 to 2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: (a) expectant management; (b) induction of labour (IOL); and (c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management. Of 636 590 singleton pregnancies, 52 669 (8.3%) births with PROM at term (42 439; 6.7%) or PPROM (10 230; 1.6%) were identified. Of these, the majority were managed expectantly (n = 22 726; 43.1%), or with IOL (25 931; 49.2%). While elCS represented only 7.6% of these cases (n = 4012), its use rose consistently from 2009 to 2017 for PROM at term and PPROM alike. For women with PPROM at 34-36 weeks the odds of elCS increased by 5% annually (adjusted odds ratio (aOR) 1.05; 95% CI 1.02-1.08) and 2% for IOL (aOR 1.02; 95% CI 1.00-1.05) vs expectant management. The use of elCS and IOL in PPROM is rising in Victoria, particularly between 34 and 36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase.

Premature rupture of membrane - Evaluation of incidence and risk factors in a tertiary Medical College Hospital

Background: Premature rupture of membrane (PROM) is defined as rupture of membrane before onset of true labour pain and one of the most common complications of pregnancy. It is associated with maternal morbidity and perinatal morbidity and mortality. Objective of this study is to determine the incidence and risk factors of pregnant woman with PROM admitted in a tertiary medical college in Bangladesh. Materials and methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at Khawaja Younus Ali medical college, Sirajgonj from 1st January 2021 to 31st December 2021. In this period total admitted antenatal patients were 8117. Among the pregnant patients with PROM were 665 and their weeks of gestation were &gt; 28 weeks. Data was collected by an interviewer with semi structured questionnaire &amp; check list. Results: Incidence of PROM was 9.3%. PROM was found to be frequent (39.1%) in younger age group between 21-25 years. Majority of the patients were housewife (71%). Maximum (61%) patient’s education level was up to secondary. PROM is extremely influenced by low socioeconomic status which was (49.1%) of cases in our study. It was also common in multigravida (67.2%) and term PROM was higher (56.4%) than preterm PROM (43.6%). Analysis of risk factors revealed etiology was unknown in 53 (48%) cases, anemia (16 %), lower genital tract infection (7.2%), UTI (19%), previous history of PROM (26.3%), malpresentation (15%) multiple pregnancy (6.7%) DM and GDM (10.5%) were commonly associated with PROM. Conclusions: Early identification of various risk factors causing PROM and their management can prevent premature deliveries and its complications to some extent as well as serious maternal complication like Chorioamnionitis. Bangladesh Crit Care J September 2023; 11 (2): 109-112

Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with premature rupture of membranes.

Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of chorioamnionitis with its attendant feto-maternal complications. The study was aimed to determine the association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM. Eligible participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb's criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the proportion of women with PROM and histological chorioamnionitis that were detected clinically. Of the 136 participants analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM. Clinical signs of chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.

A study on the level of NLRP3 inflammasome in patients with premature rupture of membranes.

In this study, we investigated the levels of interleukin-1β (IL-1β), IL-18, and the NOD-like receptor pyrin domain-containing 3 (NLRP3) inflammasome in patients with premature rupture of membranes (PROMs). We selected 60 pregnant women at the Fourth Hospital of Baotou between January 2019 and July 2021. These women were divided into three distinct groups: the preterm PROM group with 20 cases, term PROM (TPROM) group with 20 cases, and a control group with 20 cases consisting of normal full-term pregnancies without PROM. Peripheral blood was collected from all participants. Using enzyme-linked immunosorbent assay, the levels of IL-1 and IL-18 in the plasma were assessed. Additionally, the proportions of NLRP3, apoptosis-associated speck-like protein (ASC), and caspase-1-positive macrophages were also evaluated. The ratios of NLRP3, ASC, IL-1β, and IL-18 concentrations, along with the presence of caspase-1-positive macrophages, were notably greater in the PROM groups in comparison with the control group (p < .05). In the TPROM group and control group, the proportions of IL-1β and IL-18 levels were found to be lower than NLRP3, ASC, and caspase-1-positive macrophages levels (p < .05). The concentrations of IL-1β and IL-18, as well as the ratios of NLRP3, ASC, and caspase-1-positive macrophages, were elevated in patients with PROM compared to the control group. This suggests a potential correlation between the excessive activation of NLRP3 and the development of PROM.

Associations between the size and duration of asymptomatic subchorionic hematoma and pregnancy outcomes in women with singleton pregnancies

BackgroundThe purpose of this study was to investigate the relationship between the size and duration of asymptomatic subchorionic hematoma and pregnancy outcomes in women with singleton pregnancies.MethodsThis was a retrospective study that enrolled 701 singleton pregnant women who were diagnosed with asymptomatic subchorionic hematoma by ultrasound at 5–10 gestational weeks. The control group recruited 640 normal pregnant women without subchorionic hematoma who were matched with subchorionic hematoma group on baseline characteristics. The pregnancy outcomes were compared between the two groups, and the associations of the size and duration of subchorionic hematoma with pregnancy outcomes were analyzed by logistic regression model.ResultsCompared with the normal pregnancy group, the incidence of, gestational diabetes mellitus, gestational thrombocytopenia, placenta adhesion, fetal growth restriction, macrosomia in subchorionic hematoma group were higher (all P < 0.05). After adjusting for confounding factors, the hematoma size was positively associated with the occurrence of gestational hypothyroidism (adjusted OR[95%CI]: 1.029[1.004–1.054]), intrahepatic cholestasis of pregnancy (adjusted OR[95%CI]: 1.095[1.047–1.146]), term premature rupture of membranes (adjusted OR[95%CI]: 1.044[1.005–1.085]), hypertensive disorders of pregnancy (adjusted OR[95%CI]: 1.030[1.0004-1.060]), gestational thrombocytopenia (adjusted OR[95%CI]: 1.078 [1.045–1.113]), placenta adhesion (adjusted OR[95%CI]: 1.054 [1.027–1.082]), and the duration of hematoma was positively associated with the incidence of term premature rupture of membranes (adjusted OR[95%CI]: 1.070[1.027–1.115]), gestational diabetes mellitus (adjusted OR[95%CI]: 1.938 [1.886–1.993]) and fetal growth restriction (adjusted OR[95%CI]: 1.194 [1.124–1.268]).ConclusionsThe presence, size and duration of a first-trimester asymptomatic subchorionic hematoma may be associated with adverse pregnancy outcomes at later gestations such as term premature rupture of membranes and fetal growth restriction.

ASSESSMENT OF FACTORS INCREASING THE RISK OF PRELABOUR RUPTURE OF MEMBRANES AND ITS EFFECT ON FETOMATERNAL OUTCOME

Background: Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. Patient with PROM presents with leakage of fluid, vaginal discharge and pelvic pressure, but they are not having contraction. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate. Methods: - This present observational study was conducted at Obstetrics &amp; Gynecology, Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria will be studied from 1st April 2021 to 30th September 2022 (18 months). After were Institutional ethical committee. among the patients diagnosed as premature rupture of membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission detailed history was taken. General and Systemic examination were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of this method. Continuous monitoring of maternal and fetal condition done, antibiotics was given intra/ post natal period. P/ V exam were done when necessary. Investigations done and maternal and fetal outcome were noted. Results: The prevalence of premature rupture of membranes (PROM) was found to be 4.1%, with a corresponding perinatal mortality rate of 0.18 per 1000 deliveries. Approximately 33% of the cases involved pre-term premature rupture of membranes (PROM), while the remaining 67% were term PROM. Among the cases with preterm PROM, 10% of the perinatal deaths occurred. The average age of the female participants was 36.9 years, with a standard deviation of 2.1 years. The median number of children per participant was 1, with a range of 1 to 5 children. A notable correlation was observed between the gestational age at which premature rupture of membranes (PROM) occurred in women and the latency period (p&lt; 0.001). There was a significant association between the gestational age at which premature rupture of membranes (PROM) occurred and foetal birth weight, APGAR score, and Neonatal Intensive Care Unit (NICU) admission (p&lt;0.05). A statistically significant distinction was observed between the implemented intervention and the method of delivery (p=0.009). Conclusion: The incidence of PROM at term was high and conservative/ expectant management was effective. The latency period and fetal outcomes such as birth weight, apgar score and NICU admission were determined by the gestational age at which PROM occurred.

Determinants of term premature rupture of membrane: case-control study in Saint Paul’s Millennium Medical College Hospital, Addis Ababa, Ethiopia

BackgroundThe term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications.ObjectivesThis study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia.MethodsThis institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul’s hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value < 0.05.ResultsFactors like a history of vaginal discharge (AOR 3.508;95% CI:1.595.7.716), place of Antenatal care follow-up (health center and Mercy Ethiopia) (AOR 5.174;95% CI:2.165,12.362), the previous history of rupture of membrane (AOR 9.955;95% CI:3.265,20.35), and gestational age (AOR 3.018;95% CI:1.338,6.811) were associated with term premature rupture of membrane. There were more maternal and neonatal complications, including puerperal sepsis, wound infection, anemia/PPH, a hospital stays of more than seven days, clinical amnionitis, neonatal hypoglycemia, early onset neonatal sepsis, and respiratory distress encountered by women who presented with premature rupture of membrane.ConclusionProper screening, close monitoring, and early interventions in those mothers with identified risk factors would help to reduce its negative consequences. Moreover, the provision of continuous professional skill development and improving the quality of ANC service is needed.

Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study.

The aim of this study was to evaluate the effect of maternal age and body mass index (BMI) on induction of labor with oral misoprostol for premature rupture of membrane (PROM) at term. We have conducted retrospective cross-sectional study, including only term (37 weeks or more of gestation) PROM in healthy nulliparous women with a negative vaginal-rectal swab for group B streptococcus, a single cephalic fetus with normal birthweight, and uneventful pregnancy that were induced after 24 h from PROM. Ninety-one patients were included. According to the multivariate logistic regression, age and BMI odds ratio (OR) for induction success were 0.795 and 0.857, respectively. The study population was divided into two groups based on age (<35 and ≥35 years) and obesity (BMI <30 and ≥30). Older women reported a higher induction failure rate (p < 0.001); longer time to cervical dilation of 6 cm (p = 0.03) and delivery (p < 0.001). Obese women reported a higher induction failure rate (p = 0.01); number of misoprostol doses (p = 0.03), longer time of induction (p = 0.03) to cervical dilatation of 6 cm (p < 0.001), and delivery (p < 0.001); and higher cesarean section (p = 0.012) and episiotomy rate (p = 0.007). In conclusion, maternal age and BMI are two of the main factors that influence oral misoprostol efficacy and affect the failure of induction rate in term PROM.

The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort

BackgroundSignificant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM. MethodsWe conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5 and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined. ResultsIn total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9–14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5 during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts. ConclusionUsing a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.

Immediate Versus Delayed Induction with PGE2 Gel in Term Premature Rupture of Membranes: Comparative Study of Maternal Outcome

Immediate Versus Delayed Induction with PGE2 Gel in Term Premature Rupture of Membranes: Comparative Study of Maternal Outcome

Outcome of Early and Late Induction of Labour in Premature Rupture of Membranes

Objective: To determine the frequency of early and late labour induction in premature rupture of membranes and compare their outcome.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Combined Military Hospital, Rawalpindi Pakistan,from Jan-Dec 2021.&#x0D; Methodology: One hundred and sixty-four pregnant women aged 18-35 years, with uncomplicated pregnancies at gestational age ≥37 weeks to ≤40 weeks with premature rupture of membranes, were included. All primigravida and multiparous with previous normal vaginal deliveries were selected. Patients were selected with reactive CTG, adequate pelvis, clear liquor and vertex presentation. Induction of labour achieved with cervical Prostaglandin E2. Labour was monitored accordingly.&#x0D; Results: Seventy-four women (45%) presented (and got induction of labour) within 12 hours of premature rupture of membranes (early induction of labour), while 90(55%) fell under late induction of labour. 35(21%) were delivered by instrumental vaginal delivery, while 31(19%) were delivered by caesarian section. The most common indication of the caesarian section was fetal distress (36%), followed by poor progress of labour (32%). Patients with early induction of labour witnessed less chorioamnionitis (7% vs 18%) and post-partum haemorrhage (8% vs 13%). Likewise, with early induction of labour incidence of neonatal sepsis was less (3% vs 10%) with limited poor APGARs at birth (3% vs 12%). No early neonatal death was observed in 164 cases.&#x0D; Conclusion: For women with term premature rupture of membranes, earlier induction of labour results in lower maternal and fetal morbidity.

Labor induction with misoprostol 25 ug versus misoprostol 50 ug in patients with term premature rupture of membranes

Labor induction with misoprostol 25 ug versus misoprostol 50 ug in patients with term premature rupture of membranes

A nationwide study of obstetric management and outcomes in premature rupture of membrane at term: Report from the Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2017-2018.

This nationwide study aimed to investigate the practical management of term premature rupture of membrane (PROM) and its relationship with maternal and neonatal outcomes. We conducted a questionnaire survey of 415 facilities participating in the Japan Perinatal Registry Network of the Japan Society of Obstetrics and Gynecology in 2016. The patients were women expecting vaginal birth after PROM at term without clinical chorioamnionitis. We classified the facilities into three groups based on duration of the expectant management after PROM (within 24, 24, and 48 h). Furthermore, we analyzed the association between perinatal outcomes and management protocol using the Japan Perinatal Registry Network Database 2016. Of 415 facilities, 346 (83.4%) completed and returned the survey. Among 231 facilities with management protocols, an interval of 3 days from PROM to delivery was acceptable in 167 facilities (72.3%). One hundred forty-nine facilities (64.5%) responded that they did not perform mechanical cervical dilation, and 90 (39.0%) used oxytocin as a uterotonic irrespective of cervical maturation. The number of hospitals that had a policy to administer antibiotics to Group B streptococcus-positive patients was 211 (91.3%). Neonatal outcomes at birth and the frequency of cesarean section and postpartum fever did not differ among the three groups. Most facilities in the Japan Perinatal Registry Network managed women at term to delivery within 3 days after PROM with attention to bacterial infection. Expectant management up to 48 h after PROM did not increase the risk of postpartum fever, compared to labor induction immediately after PROM.

Prevalence of the pattern of Pre-labor premature rupture of membranes among pregnant women at Al-Sadaqa Teaching Hospital, Aden, Yemen

Pre-labor rupture of membranes (PROM) is the rupture of membranes before the onset of labor. It is a common obstetric problem (3 -4%) in developed and developing countries. The aim of this study to describe the pattern of PROM in pregnancies at Al-Sadaqa Teaching Hospital, Aden, Yemen from January to February 2020. This is a descriptive hospital based study of the patients diagnosed as PROMs managed in the Obstetrics and Gynecology Department. In this study 151 pregnant women with PROM comprising 11.1% of 1360 total deliveries. Only 9 (0.7%) patients presented with preterm premature rupture of membranes (PPROM) and 142 (10.4%) with term premature rupture of membranes (TPROM). The mean maternal age with PROM was 26.12 ± 6.67 years. With increasing parity, there was a decrease in the PROM; 6.0% in multipara to 4.6% in grand-multipara. The time interval from membrane rupture to delivery was &gt;24 hours in 47% of them. Anemia was the main predisposing factor causing PROMs (47.0%) followed by history of abortion and urinary tract infection (UTI) (29.1%, and 19.9% respectively). About 81.5% of them delivered vaginally while 18.5% by lower segment cesarean section. Conclusions: The prevalence of PROM in this study was comparably higher than the international average. A higher proportion of them delivered vaginally. The major contributing factors were anemia, history of abortion and UTI and increasing risk with prolonged rupture of membrane &gt; 24hrs. It is of paramount importance to screen for UTI with timely treatment initiation and those with recurrent abortion require close monitoring on risk of PROM during subsequent pregnancies.

Twenty-four versus 48 hours of expectant management in the setting of premature rupture of membranes at term among women with a prior cesarean delivery.

Compare two approaches of expectant management in the setting of term premature rupture of membranes (PROM) among women with prior cesarean delivery. A retrospective study conducted in a tertiary care center during 2006 to 2017, including primiparous women with singleton pregnancy and a prior low-transverse cesarean delivery who presented with term PROM and requested trial of labor after cesarean (TOLAC). Outcomes were compared between the two campuses at our center: campus A enabled expectant management up to 48 hours following PROM and campus B enabled up to 24 hours after PROM. A total of 158 women met the inclusion criteria and were divided into two groups. Maternal characteristics of the two groups were similar. In campus B, the rate of oxytocin administration was significantly higher as compared with campus A (46.6% versus 26.0%, P= 0.01). The rate of successful TOLAC was similar between the groups (84.0% versus 84.5%, P= 0.96). Rates of chorioamnionitis, uterine rupture, postpartum hemorrhage, recurrent hospitalization, and Apg scores did not differ between the groups. Expectant management up to 48 hours in women with TOLAC presenting with term PROM was associated with a lower rate of induction of labor and similar maternal and neonatal outcomes.