Treatment Of Preterm Premature Rupture Research Articles

Use of Antibiotics and Probiotic Lactobacilli in the Treatment of Preterm Premature Rupture of Membranes: a Review

ABSTRACT To review the current evidence of the potential use of antibiotics and probiotics Lactobacillus in preterm premature rupture of membranes cases and to see the effect on microorganism concentrations especially Streptococcus agalatiae and Lactobacillus. This review used several databases (Google Scholar, Pubmed, and Science Direct) and searched for English and Indonesian articles in the last ten years. Articles were received in the form of case reports, observational studies and clinical trials that discussed the use of antibiotics and probiotic Lactobacillus in premature rupture of membranes especially in preterm pregnancy. After searching the database and eliminating duplicates and articles unrelated to the topic, we included some articles in this review. Prophylactic antibiotics are also expected to prolong the latent phase, thereby reducing the risk of fetomaternal morbidity and mortality. Penicillin is often recommended in preterm PROM, because broad-spectrum antibiotics are better as infection prophylaxis. Providing alternative therapy with lactobacillus probiotics is believed to prevent preterm birth and has the benefit of being a safe and effective therapy in restoring normal vaginal microflora and preventing vaginal infections during pregnancy. However, further research is needed to see the effectiveness of lactobacillus probiotics and look at the concentration of microbes, especially Streptococcus agalctiae and Lactobacillus. Keywords: Preterm Premature Rupture of Membranes, Antibiotics, Probiotics Lactobacillus, Streptococcus Agalactiae

Frontiers in the Etiology and Treatment of Preterm Premature Rupture of Membrane: From Molecular Mechanisms to Innovative Therapeutic Strategies.

Preterm premature rupture of membranes (pPROM) poses a significant threat to fetal viability and increases the risk for newborn morbidities. The perinatal period of preterm infants affected by pPROM is often characterized by higher rates of mortality and morbidity, with associated risks of cerebral palsy, developmental delays, compromised immune function, respiratory diseases, and sensory impairments. pPROM is believed to result from a variety of causes, including but not limited to microbially induced infections, stretching of fetal membranes, oxidative stress, inflammatory responses, and age-related changes in the fetal-placental interface. Maternal stress, nutritional deficiencies, and medically induced procedures such as fetoscopy are also considered potential contributing factors to pPROM. This comprehensive review explores the potential etiologies leading to pPROM, delves into the intricate molecular mechanisms through which these etiologies cause membrane ruptures, and provides a concise overview of diagnostic and treatment approaches for pPROM. Based on available therapeutic options, this review proposes and explores the possibilities of utilizing a novel composite hydrogel composed of amniotic membrane particles for repairing ruptured fetal membranes, thereby holding promise for its clinical application.

Individualized treatment of preterm premature rupture of membranes to prolong the latency period, reduce the rate of preterm birth, and improve neonatal outcomes

Preterm premature rupture of membranes complicates approximately 3% of pregnancies. Currently, in the absence of chorioamnionitis or placental abruption, expectant management, including antenatal steroids for lung maturation and prophylactic antibiotic treatment, is recommended. The benefits of individualized management have not been adequately explored. This study aimed to compare the impact of 2 different management strategies of preterm premature rupture of membranes in 2 tertiary obstetrical centers on latency of >7 days, latency to birth, chorioamnionitis, funisitis, and short-term adverse maternal and neonatal outcomes. This was a multicenter retrospective study of women with singleton pregnancies with preterm premature rupture of membranes from 23 0/7 to 33 6/7 weeks of gestation between 2014 and 2018 and undelivered within 24 hours after hospital admission managed at Sunnybrook Health Sciences Center, Toronto, Canada (standard management group), and BCNatal (Hospital Clínic of Barcelona and Hospital Sant Joan de Déu Barcelona), Barcelona, Spain (individualized management group), following local protocols. The standard management group received similar management for all patients, which included a standard antibiotic regimen and routine maternal and fetal surveillance, whereas the individualized management group received personalized management on the basis of amniocentesis at hospital admission (if possible), to rule out microbial invasion of the amniotic cavity and targeted treatment. The exclusion criteria were cervical dilatation >2 cm, active labor, contraindications to expectant management (acute chorioamnionitis, placental abruption, or abnormal fetal tracing), and major fetal anomalies. The primary outcome was latency of >7 days, and the secondary outcomes included latency to birth, chorioamnionitis, and short-term adverse maternal and neonatal outcomes. Statistical comparisons between groups were conducted with propensity score weighting. A total of 513 pregnancies with preterm premature rupture of membranes were included in this study: 324 patients received standard management, and 189 patients received individualized management, wherein amniocentesis was performed in 112 cases (59.3%). After propensity score weighting, patients receiving individualized management had a higher latency of >7 days (76.0% vs 41.6%; P<.001) and latency to birth (18.1±14.7 vs 9.7±9.7 days; P<.001). Although a higher rate of clinical chorioamnionitis was suspected in the individualized management group than the standard group (34.5% vs 22.0%; P<.01), there was no difference between the groups in terms of histologic chorioamnionitis (67.2% vs 73.4%; P=.16), funisitis (57.6% vs 58.1%; P=.92), or composite infectious maternal outcomes (9.1% vs 7.9%; P=.64). Prolonged latency in the individualized management group was associated with a significant reduction of preterm birth at <32 weeks of gestation (72.1% vs 90.5%; P<.001), neonatal intensive care unit admission (75.6% vs 83.0%; P=.046), and neonatal respiratory support at 28 days of life (16.1% vs 26.1%; P<.01) compared with that in the standard management group. Moreover, prolonged latency was not associated with neonatal severe morbidity at discharge (survival without severe morbidity, 80.4% vs 73.5%; P=.09). Individualized management of preterm premature rupture of membranes may prolong pregnancy and reduce preterm birth at <32 weeks of gestation, the need for neonatal support, and neonatal intensive care unit admissions, without an increase in histologic chorioamnionitis, funisitis, neonatal infection-related morbidity, and short-term adverse maternal and neonatal outcomes.

The role of latency period on the preterm premature rupture of membranes: implication for treatment

IntroductionConservative treatments with a latency period have been used for the treatment of preterm premature rupture of membranes (PPROM) in clinical practice. We aimed to evaluate the role and potential influencing factors of the latency period, to provide insights for the clinical treatment of PPROM.Material and methodsPPROM pregnant women treated in our hospital from January 1, 2015 to September 30, 2020 were included. PPROM patients were divided into a 48–168 h group and a &gt; 168 h latency group; the characteristics and prognosis of these two groups were compared and analyzed. Logistic regression analyses were conducted to analyze the relevant influencing factors of the latency period.ResultsA total of 131 PPROM patients were included. There were significant differences in the age, BMI, gestational age on admission, amniotic fluid volume before childbirth, and positive rate of cervical secretion culture between the two groups (all p &lt; 0.05). Logistic regression analyses indicated that the latency period was shorter in the PPROM patients with age ≥ 30 years (OR = 0.048, 95% CI: 0.121–0.863) and gestational age ≥ 32 weeks on admission (OR = 0.463, 95% CI: 0.069–0.811), and the latency period was prolonged in the PPROM patients with BMI ≥ 23 kg/m2 (OR = 1.591, 95% CI: 1.134–1.944) and amniotic fluid volume ≥ 6 cm (OR = 2.129, 95% CI: 1.093–3.042) (all p &lt; 0.05). There were significant differences in the incidence of low birth weight and neonatal respiratory distress syndrome (NRDS) between the 48–168 h group and &gt; 168 h group (all p &lt; 0.05).ConclusionsThe latency period plays an important role in PPROM, which is associated with the pregnant women’s age, BMI, gestational week of rupture and amniotic fluid index.

Impact of Minority Races on Clinical Trials on Latency Antibiotics [12C

INTRODUCTION: Racial variations in response to therapy exist in many areas of medicine, as it must in obstetric practice. The objective of this study was to determine if the study populations in published literature on latency antibiotics (LA) in the treatment of preterm premature rupture of membrane (PPROM) were diverse enough to demonstrate a benefit for minority races. METHODS: This was a meta-analysis of literature published between 1995 and 2018 by searching PubMed using the keywords: antibiotics, preterm and ruptured membranes. Included studies were randomized clinical trials that identified the racial composition and delivery within 48 hours as an outcome of interest. Population level modeling was performed on the pooled result by recalculating the rate of outcome for each study if the rate of outcome of a particular race was the same between intervention and placebo arms. Pooled results that remain statistically significant after race specific adjustments suggest minimal influence from that particular race. RESULTS: There were 495 studies identified, 64 of which were clinical trials. Three studies reported racial composition of the study population and were included in the analysis. LA decreased risk of delivery within 24hrs (RR 0.80, 95% CI [0.67–0.94]). Race adjusted pooled result remained significant for white (RR 0.82, 95% CI [0.70–0.97]), black (RR 0.80, 95% CI [0.67–0.94]), Hispanic (RR 0.81, 95% CI [0.69–0.96]) and Asian (RR 0.79, 95% CI [0.67–0.93]). CONCLUSION: In studies on latency antibiotic use in PPROM, no individual race had a major influence on the pooled result based on studies that published population racial composition.

539: Comparison of antibiotic regimens in the treatment of preterm premature rupture of membranes

539: Comparison of antibiotic regimens in the treatment of preterm premature rupture of membranes

Amniopatch treatment for preterm premature rupture of membranes before 23 weeks' gestation and factors associated with its success

ObjectiveThe purpose of this study is to investigate the factors associated with successful amniopatch treatment in patients with iatrogenic preterm premature rupture of membranes (iPPROM) or spontaneous PPROM (sPPROM) before 23 weeks' gestation. Materials and methodsThis cohort study included 28 women who received amniopatch treatment due to iPPROM or sPPROM at 15–23 weeks' gestation. Patients' clinical characteristics before performing the amniopatch, factors associated with the procedure, pregnancy and neonatal outcomes were compared between the iPPROM and sPPROM groups, and also between the successful and failed groups. ResultsThe amniopatch was successful in 6 of 28 patients (21.4%) with a success rate of 36.4% (4/11) and 11.8% (2/17) in the iPPROM group and sPPROM group (P = 0.174), respectively. The success group had a longer PPROM-to-delivery interval, fewer cases of clinical chorioamnionitis, larger birth weight, and lower neonatal intensive care unit admission rate than the failed group. The success rate of amniopatch procedure was proportional to maximal vertical pocket prior to procedure, which showed statistically significant association (adjusted odds ratio: 3.62, 95% confidence interval: 1.16–11.31, P = 0.027). ConclusionThe amniopatch treatment success rate was higher in the iPPROM group than the sPPROM group, but was not statistically significant. The neonatal outcome was more favorable when the amniopatch was successful. However, the only predictive factor associated with successful amniopatch was a larger amniotic fluid volume before the procedure.

Сучасна діагностика та лікування передчасного розриву плодових оболонок (огляд літератури)

Сучасна діагностика та лікування передчасного розриву плодових оболонок (огляд літератури)

A systematic review of amniopatch

The objective of this review is to evaluate the safety and effectiveness of the amniopatch procedure for the treatment ofpreterm premature rupture of the membranes. The searches were conducted via electronic databases including Ovid-MEDLINE, Ovid-Embase, the Cochrane Library, and eight Korean databases. In the study design, in addition to randomized controlled trials, case report studies in which patients underwent the amniopatch procedure were included. Two reviewers independently selected data in standardized form and assessed the methodological quality. Quality evaluation was performed by the SIGN (Scottish Intercollegiate Guideline Network) method. A total of 11 studies (2 cohort studies, 1 case series, and 8 case reports) were included. There were no serious maternal or fetal complications. It was reported that there were lower rates of maternal chorioamnionitis after the amniopatch relative to conservative treatment (control). The mean gestational age at delivery was 27.7 weeks (a total of 70 cases in 10 studies; spontaneous group, 27.6 weeks; iatrogenic group, 27.8 weeks). The amniopatch was successful in 46.6% of cases (33/71 cases in 11 studies). The overall neonatal survival rate was 55.3% (52/94 cases in 11 studies). Neonatal morbidity was 23.4% (11/47 cases in 7 studies). Although this systematic review, did not find clear evidence of the safety and effectiveness, the amniopatch procedure is a viable treatment option to prolong a pregnancy with previable premature rupture of membranes.

88: Nifedipine versus placebo in the treatment of preterm premature rupture of membranes. Assessment of perinatal outcome by use of tocolysis in early labor - APOSTEL IV study

36th Annual Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting 01 February 2016 - 06 February 2016

Development of an implantable synthetic membrane for the treatment of preterm premature rupture of fetal membranes.

Preterm premature rupture of fetal membranes is a very common condition leading to premature labour of a non viable fetus. Significant morbidities may occur when preterm premature rupture of fetal membranes management is attempted to prolong the pregnancy for fetal maturation. Reducing the rate of loss of amniotic fluid and providing a barrier to bacterial entry may allow the pregnancy to continue to term, avoiding complications. Our aim is to develop a synthetic biocompatible membrane to form a distensible barrier for cervical closure which acts to reduce fluid loss and provide a surface for epithelial ingrowth to help repair the damaged membranes. Therefore, a bilayer membrane was developed using an electrospinning technique of combining two FDA-approved polymers, poly-L-lactic acid (PLA) and polyurethane (Z3) polymer. This was compared to a plain electrospun Z3 membrane. The physical and mechanical properties were assessed using scanning electron microscope images and a BOSE tensiometer, respectively, and compared to native fetal membranes. The performance of the membranes in preventing fluid loss was assessed by measuring their ability to support a column of water. Finally the ability of the membranes to support cell ingrowth was assessed by culturing adipose-derived stem cells on the membranes for two weeks and assessing metabolic activity after 7 and 14 days. The physical properties of the bilayer were similar to that of the native fetal membranes and it was resistant to fluid penetration. This bilayer membrane presented mechanical properties close to those for fetal membranes and showed elastic distention, which may be crucial for progress of the pregnancy. The membrane was also able to retain surgical sutures. In addition, it also supported the attachment and growth of adipose-derived stem cells for two weeks. In conclusion, this membrane may prove a useful approach in the treatment of preterm premature rupture of fetal membranes and now merits further investigation.

Placental transfer of clarithromycin in human pregnancies with preterm premature rupture of membranes

The aim of this study was to evaluate the transplacental transfer of clarithromycin, which was used in the treatment of preterm premature rupture of membranes (PPROM) in human pregnancies, by comparing umbilical cord and maternal serum clarithromycin concentrations. Singleton pregnant women with PPROM (<34 weeks) were prospectively enrolled between April 2009 and January 2011. The diagnosis of PPROM was made with vaginal pooling, leakage, nitrazine, and Amnisure tests. The women were managed expectantly with bed rest, corticosteroids, and a triple antibiotic combination including ceftriaxone, clindamycin, and clarithromycin. Amniocentesis was offered, and culture for aerobe/anaerobe and mycoplasma was performed. After delivery, blood was drawn from the mother's antecubital and umbilical cord veins. Clarithromycin concentrations were measured using liquid chromatography-tandem mass spectrometry. The percentage and correlation between cord and maternal serum clarithromycin concentrations were calculated. Logistic regression analysis was performed to investigate the factors related to the cord and maternal serum clarithromycin concentration percentage. A total of 34 cord-maternal serum pairs were included in the final analysis. The mean cord-maternal serum clarithromycin concentration percentage was 7.93±0.9%. There was a good correlation between cord serum and maternal serum clarithromycin concentration (r=0.795, P<0.001). The cord-maternal serum clarithromycin concentration percentage significantly increased according to advancing gestation (P<0.001). Our data showed that the mean placental transfer of clarithromycin is approximately 8% and dependent on gestational age.

Defining standards of care in maternal-fetal medicine

The purpose of this study was to describe current practice patterns for 7 controversial topics in Maternal-Fetal Medicine. An interactive survey of obstetric treatment was performed as part of a postgraduate course at the 2004 Annual Meeting of the Society for Maternal-Fetal Medicine. Seven controversial topics were addressed, which included tocolytic therapy, progesterone supplementation for the prevention of preterm birth, screening for inherited thrombophilia, cervical cerclage for a shortened cervix, treatment of preterm premature rupture of membranes, magnesium sulfate seizure prophylaxis, and dexamethasone therapy for HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. A total of 298 obstetric care providers attended the postgraduate course. By report, most attendees were maternal-fetal medicine specialists (60.7% of respondents) who were >10 years out from specialty training (56.3% of respondents) and who were practicing in a university-based setting (52.9% of respondents). An average of 233 practitioners (range, 157-298 practitioners) answered each question. An analysis of the responses allowed for the determination of current practice patterns in the 7 controversial areas addressed. Contemporary practice patterns for 7 controversial topics in obstetric medicine are described. Such surveys may be useful in defining standards of care in maternal-fetal medicine.

Concomitant use of glucocorticoids: A comparison of two metaanalyses on antibiotic treatment in preterm premature rupture of membranes

OBJECTIVE: This study was performed to investigate whether the demonstrated beneficial effects of antibiotics on maternal and neonatal morbidity are altered when glucocorticoids are part of the treatment of preterm premature rupture of membranes. STUDY DESIGN: We performed a metaanalysis of five published, randomized trials of antibiotic treatment in preterm premature rupture of membranes in which glucocorticoids were used as additional treatments and compared the results with those of a previously published metaanalysis of antibiotic treatment in preterm premature rupture of membranes, which excluded studies with concomitant glucocorticoids. Primary outcomes included chorioamnionitis, postpartum endometritis, neonatal sepsis, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality. A logistic regression analysis was performed to test whether glucocorticoids significantly influenced the effect of antibiotic treatment. RESULTS: Among the 509 patients from five trials on antibiotic and glucocorticoid treatment published between 1986 and 1993 antibiotic therapy did not show any significant effect on any of the outcomes analyzed. In contrast, antibiotic therapy without concomitant use of glucocorticoids significantly reduced the odds of chorioamnionitis, postpartum endometritis, neonatal sepsis, and intraventricular hemorrhage by 62%, 50%, 68%, and 50%, respectively. The logistic regression analysis showed that glucocorticoids significantly diminished the effect of antibiotic treatment on chorioamnionitis and neonatal sepsis. CONCLUSION: Glucocorticoids appear to diminish the beneficial effects of antibiotics in the treatment of preterm premature rupture of membranes. A careful selection of patients who are likely to benefit from both therapies is therefore recommended. (Am J Obstet Gynecol 1998;178:899-908.)

In vitro studies of the interactions between platelets and amniotic membranes: A potential treatment for preterm premature rupture of the membranes

Thus far there is no satisfactory treatment for preterm premature rupture of the amniotic membranes. To evaluate the use of platelets to seal the membranes, we investigated in vitro interactions between platelets and the membranes. Platelet aggregation in the presence of amnion, chorion, and amniotic fluid was quantified. Platelet adhesion to the fetal membranes was investigated by electron microscopy. In addition, a model system was designed to evaluate the capacity of platelets to seal a standardized puncture in the membranes. Platelets aggregated in response to amnion but not to chorion or amniotic fluid. Adhesion and activation occurred on connective tissues underlying amnion and chorion but not on the amniotic epithelium. Platelets sealed a puncture in fetal membranes, and the platelet plug was visualized by electron microscopy. Exposed connective tissue of amniotic membranes was demonstrated to trigger platelet adhesion, aggregation, and activation, and platelets were shown to seal a standardized puncture in fetal membranes. Our results indicate that platelets might be useful for treatment of ruptured membranes after needle puncture.