1
|
Trahan MJ, Ronzoni S, Roy-Lacroix ME, Baril S, Massé E, Morin C, Atallah A, Wou K, Lapointe A, Bizgu V, Abenhaim H, Beltempo M, Boucoiran I. Antibiotic Regimens for the Management of Preterm Prelabour Rupture of Membranes: A Multicenter Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2025:102922. [PMID: 40379253 DOI: 10.1016/j.jogc.2025.102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/19/2025] [Accepted: 02/21/2025] [Indexed: 05/19/2025]
Abstract
OBJECTIVE Evolving bacterial ecology and resistance warrant re-evaluation of traditional antibiotic regimens for prelabour premature rupture of membranes (PPROM). This study aimed to compare delivery within 7 days of PPROM and overall latency according to different antibiotic regimens. Secondary objectives were to compare adverse maternal and neonatal outcomes. METHODS This multicenter retrospective study utilized data from five Canadian hospitals from 2016-2022. Singleton pregnancies with PPROM at 18-34 weeks of gestation were included. Cases were divided into four groups based on antibiotic regimen administered, and outcomes were compared using logistic and linear regression analyses, controlling for gestational age at PPROM. RESULTS Of 669 PPROM cases, 50% received ampicillin/amoxicillin and macrolide, and the remainder received macrolide only (30%), macrolide and other (3%), and non-macrolide (17%) regimens. "Macrolide-only" was associated with a significantly shorter latency compared to "ampicillin/amoxicillin with macrolide" [adjusted odds ratio (aOR) for latency ≤7 days 1.9, 95% confidence interval (CI) (1.3, 2.8); and adjusted relative mean overall latency -6.7 days, 95% CI (-9.3, -4.1)]. Compared to other regimens, "macrolide-only" was associated with higher rates of maternal clinical and histological chorioamnionitis (37% vs. 14%-25%, P = 0.001, and 74% vs. 52%-61%, P < 0.001, respectively) and neonatal intraventricular hemorrhage (23% vs. 11%-13%, P = 0.009). Among cases of neonatal bacteremia, ampicillin resistance was frequent (11/19; 58%). CONCLUSION Macrolide alone is inferior to ampicillin/amoxicillin with a macrolide in prolonging pregnancy and preventing adverse outcomes; therefore, its use should be strongly reconsidered in women with penicillin allergy. Broader-spectrum regimens warrant further clinical investigation. OBJECTIF L'évolution de l'écologie bactérienne et de la résistance aux antibiotiques justifie la réévaluation des antibiothérapies traditionnelles pour la rupture prématurée des membranes avant terme (RPMAT). Cette étude visait à comparer l'accouchement dans les 7 jours suivant la RPMAT et la période de latence globale en fonction de différentes antibiothérapies. Les objectifs secondaires étaient de comparer les issues maternelles et néonatales défavorables. MéTHODES: Cette étude rétrospective multicentrique a utilisé les données de 5 hôpitaux canadiens pour la période de 2016 à 2022. Les grossesses monofœtales avec une RPMAT à un âge gestationnel entre 18 et 34 semaines ont été incluses. Les cas ont été divisés en quatre groupes en fonction de l'antibiothérapie administrée, puis les résultats ont été comparés à l'aide d'analyses de régression logistique et linéaire, en tenant compte de l'âge gestationnel au moment de la RPMAT. RéSULTATS: Sur 669 cas de RPMAT, 50 % des patientes ont reçu une combinaison d'ampicilline-amoxicilline et d'un macrolide et les autres ont reçu un macrolide seul (30 %), un macrolide combiné à un autre agent (3 %) ou une antibiothérapie sans macrolide (17 %). L'option « macrolide seul » a été associée à une période de latence significativement plus courte que l'option « combinaison d'ampicilline-amoxicilline et d'un macrolide » (rapport de cotes ajusté [RCa] pour une période de latence ≤ 7 jours : 1,9; intervalle de confiance [IC] à 95 % : 1,3-2,8; et durée de latence globale moyenne relative ajustée de -6,7 jours; IC à 95 % : -9,3 à -4,1). Par rapport aux autres antibiothérapies, l'option « macrolide seul » a été associée à des taux plus élevés de chorioamnionite clinique ou histologique maternelle (clinique : 37 % p/r à 14-25 %, p = 0,001; histologique : 74 % p/r à 52-61 %, p < 0,001) et d'hémorragie intraventriculaire néonatale (23 % p/r à 11-13 %, p = 0,009). Dans les cas de bactériémie néonatale, la résistance à l'ampicilline était fréquente (11/19; 58 %). CONCLUSION Le macrolide seul est inférieur à la combinaison d'ampicilline-amoxicilline et d'un macrolide pour ce qui est de la prolongation de la grossesse et de la prévention des issues défavorables; par conséquent, son utilisation doit être fortement reconsidérée chez les femmes allergiques à la pénicilline. Des analyses cliniques supplémentaires sur les antibiothérapies à large spectre seraient justifiées.
Collapse
Affiliation(s)
- Marie-Julie Trahan
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stefania Ronzoni
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marie-Eve Roy-Lacroix
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sherbooke, Quebec, Canada
| | - Sophie Baril
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada
| | - Edith Massé
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sherbooke, Sherbrooke, Quebec, Canada
| | - Caroline Morin
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Anthony Atallah
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada; Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Karen Wou
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anie Lapointe
- Department of Pediatrics, Université de Montréal, Montreal, Canada; Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Victoria Bizgu
- Department of Pediatrics, Division of Neonatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Haim Abenhaim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada; Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada; School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
| |
Collapse
|
2
|
Liao S, Xiong A, Xiong S, Zuo Y, Wang Y, Luo B. Associations between maternal body composition in the second trimester and premature rupture of membranes: a retrospective study using hospital information system data. BMC Pregnancy Childbirth 2025; 25:241. [PMID: 40050777 PMCID: PMC11883932 DOI: 10.1186/s12884-025-07334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 02/17/2025] [Indexed: 03/10/2025] Open
Abstract
BACKGROUND Maternal nutrition is associated with premature rupture of membranes (PROM), which affects 6.7-10.0% of term pregnancies and poses significant health challenges for both mothers and children. However, the relationship between body composition, a detailed reflection of maternal nutrition, and PROM remains under-explored. METHODS We conducted a retrospective correlational study using data from 38,610 obstetric cases (PROM = 9,857; non-PROM = 28,753) in the hospital information system of West China Second University Hospital. Multi-variable binary logistic regression was performed to investigate the relationships between key body composition indicators and PROM. RESULTS Advanced maternal age (OR:1.026, P < 0.001) and nulliparity (OR:1.402, P < 0.001) were associated with an increased risk of PROM, while longer gestational age (OR:0.864, P < 0.001) was linked to a lower risk. A higher waist-to-hip ratio was identified as a significant risk factor for PROM (OR:2.818, P < 0.001), whereas higher protein levels (OR:0.934, P < 0.001) and mineral content (OR:0.760, P = 0.045) were potential protective factors. CONCLUSION Key body composition indicators, including a higher waist-to-hip ratio, lower protein levels, and lower mineral content, are associated with an increased risk of PROM. Additionally, advanced maternal age, shorter gestational age, and nulliparity are linked to a higher incidence of PROM. These findings provide valuable insights for early PROM risk screening and contribute to maternal and child health promotion. Future prospective, longitudinal, and causal studies are necessary to validate and further support these findings.
Collapse
Affiliation(s)
- Shujuan Liao
- Department of Nursing, West China Second University Hospital, Sichuan University/ West ChinaSchool of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Anqi Xiong
- Department of Nursing, West China Second University Hospital, Sichuan University/ West ChinaSchool of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Siqi Xiong
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Yan Zuo
- Department of Nursing, West China Second University Hospital, Sichuan University/ West ChinaSchool of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yan Wang
- Department of Nursing, West China Second University Hospital, Sichuan University/ West ChinaSchool of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University/ West ChinaSchool of Nursing, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| |
Collapse
|
3
|
Giouleka S, Tsakiridis I, Chalkia-Prapa EM, Katzi F, Liberis A, Michos G, Kalogiannidis I, Mamopoulos A, Dagklis T. Antibiotic Prophylaxis in Obstetrics and Gynecology: A Comparative Review of Guidelines. Obstet Gynecol Surv 2025; 80:186-203. [PMID: 40080893 DOI: 10.1097/ogx.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
Importance The administration of prophylactic antibiotics in obstetrics and gynecology represents a pivotal intervention with a major contribution to the prevention of maternal and neonatal infectious morbidity. Objectives The aim of this study was to review and compare the most recently published guidelines on prophylactic antibiotic use in obstetric and gynecologic procedures. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on antibiotic prophylaxis was carried out. Results There is a consensus among the reviewed guidelines regarding the importance of antibiotic prophylaxis prior to cesarean delivery, hysterectomy, colporrhaphy and surgical-induced abortions, the optimal choice of antibiotics, and the timing of administration, as well as the indications for increased and additional doses. First-generation cephalosporins are unanimously recommended as first-line antibiotics. All the reviewed guidelines recommend antibiotic prophylaxis in case of preterm prelabor rupture of membranes, whereas they discourage routine antibiotic use in case of active preterm labor with intact membranes or cervical cerclage placement. There is also an overall agreement that antibiotic prophylaxis should not be given for hysteroscopic and laparoscopic procedures with no entry into the bowel or the vagina, endometrial biopsy, intrauterine device insertion, or cervical tissue excision surgeries. Moreover, all the guidelines agree that women undergoing hysterosalpingography should receive a course of antibiotics only when the fallopian tubes are abnormal or there is a history of pelvic inflammatory disease. In contrast, inconsistency was identified on the need of antibiotic prophylaxis in case of obstetric anal sphincter injuries, operative vaginal delivery, and early pregnancy loss. Finally, American College of Obstetricians and Gynecologists states that antibiotics should not be routinely offered for oocyte retrieval and embryo transfer. Conclusions Infectious complications following both obstetric and gynecological procedures are significant contributors of morbidity and mortality, rendering their prevention using antibiotic prophylaxis a crucial aspect of preoperative care. Nevertheless, antibiotic overuse should be avoided. Thus, it seems of paramount importance to develop consistent international practice protocols for the appropriate use of antibiotics in everyday practice to minimize their adverse effects and maximize their associated benefits.
Collapse
Affiliation(s)
- Sonia Giouleka
- Resident, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni-Markella Chalkia-Prapa
- Resident, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Florentia Katzi
- Resident, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Liberis
- Consultant, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michos
- Consultant, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Associate Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Associate Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
4
|
Aktemur G, Çakır BT, Karabay G, Ulusoy CO, Seyhanlı Z, Sucu ST, Tonyalı NV, İskender CT. The role of D-dimer changes in predicting delivery time in preterm premature rupture of membranes: a retrospective analysis. Arch Gynecol Obstet 2025; 311:323-331. [PMID: 39873767 PMCID: PMC11890246 DOI: 10.1007/s00404-025-07940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 01/07/2025] [Indexed: 01/30/2025]
Abstract
INTRODUCTION Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes. METHODS This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36 weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2 weeks. Patients were classified into two subgroups based on whether labor occurred within 7 days of PPROM diagnosis. Statistical analyses included the Mann-Whitney U test, Student's t test, Chi-square test, Friedman test, Durbin-Conover test, generalized estimating equations (GEE), and ROC analysis. RESULTS Gestational age at admission was significantly lower in patients who delivered later than 7 days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811). CONCLUSIONS Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.
Collapse
Affiliation(s)
- Gizem Aktemur
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Betül Tokgöz Çakır
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Gülşan Karabay
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Can Ozan Ulusoy
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Zeynep Seyhanlı
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Serap Topkara Sucu
- Department of Obstetrics and Gynecology , Ankara Etlik City Hospital , Ankara, Turkey
| | - Nazan Vanlı Tonyalı
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Can Tekin İskender
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey
| |
Collapse
|
5
|
Bhullar H, Stritzke A, Makarchuk S, Tang S, Lodha A. Long-term neurodevelopmental outcomes at three years in preterm infants born before 29 Weeks gestation following Preterm Premature Rupture of Membranes (PPROM). J Perinatol 2025; 45:180-185. [PMID: 39349683 DOI: 10.1038/s41372-024-02134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/20/2024] [Accepted: 09/24/2024] [Indexed: 04/26/2025]
Abstract
OBJECTIVE To determine the association between preterm premature rupture of membranes (PPROM) and neurodevelopmental impairment (NDI) at 3 years corrected age (CA) in infants born before 29 weeks of gestational age (GA). DESIGN/METHODS Infants born before 29 weeks GA between 2005 and 2017 were included. The primary outcome was a composite of death or NDI (full-scale intelligence quotient<85, cerebral palsy, vision or hearing impairment) at 3 years of CA. Infants were stratified by maternal PPROM status. Associations were explored using multivariate models. RESULTS Of 1231 participants, 481 were in the PPROM group, and 750 were in the No PPROM group. After adjusting for factors, the odds ratio of death or NDI for PPROM vs. No PPROM was 1.22 (95% Confidence Interval 0.93-1.59). CONCLUSION Our study suggests that PPROM was not associated with an increased risk of a composite outcome of death or NDI at 3 years CA.
Collapse
Affiliation(s)
- Harkirat Bhullar
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Amelie Stritzke
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | | | | | - Abhay Lodha
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
6
|
Tokalioglu EO, Tanacan A, Agaoglu MO, Özbebek ÜG, Okutucu G, Kayaalp H, Uzuner P, Sahin D. Aggregate index of systemic inflammation: A novel systemic inflammatory index for prediction of neonatal outcomes and chorioamnionitis in women with preterm premature rupture of membranes. Int J Gynaecol Obstet 2025; 168:640-649. [PMID: 39157934 DOI: 10.1002/ijgo.15868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/01/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To determine the value of the Aggregate index of systemic inflammation (AISI) in predicting admission to neonatal intensive care unit (NICU) and chorioamnionitis. METHODS The present retrospective cohort study with pregnant women who were diagnosed with preterm premature rupture of membranes (PPROM) in the Department of Perinatology, Ministry of Health Ankara City Hospital between January 1, 2021, and June 1, 2023 (n = 357). The patients were categorized into subgroups: (1) cases with (n = 27) or without (n = 330) chorioamnionitis, (2) admission (n = 182) or no admission (n = 175) to NICU; (3) gestational age at birth <28 weeks or 28 weeks or longer; and (4) gestational age at birth <34 weeks or 34 weeks or longer. AISI values were compared between the subgroups, and cut-off values for AISI were determined to predict adverse outcomes. RESULTS AISI values were significantly higher in the admission to NICU group compared with the no admission to NICU group (707.0 vs 551.2) (P < 0.05). AISI values were also significantly higher in the chorioamnionitis group compared with those without chorioamnionitis (850.3 vs 609.4) (P < 0.05). AISI levels were significantly higher in cases delivered before 28 weeks of gestation compared with the cases delivered at 28 weeks of gestation or later (945.6 vs 604.9) (P < 0.05), and were also significantly higher in cases delivered before 34 weeks of gestation compared with the cases delivered at 34 weeks of gestation or later (715.5 vs 550.1) (P < 0.05). Optimal cut-off values of AISI were found to be 626.19 (74.1% sensitivity, 52.8% specificity), 506.09 (68.9% sensitivity and, 47.7% specificity), and 555.1 (69.8% sensitivity, 48.1% specificity) in predicting NICU admission, chorioamnionitis, and delivery before 28 weeks, respectively. CONCLUSION The novel inflammatory marker AISI may be used in the prediction of chorioamnionitis and NICU admission in PPROM cases. SYNOPSIS Aggregate index of systemic inflammation may be used as a novel marker in predicting high-risk for chorioamnionitis and neonatal intensive care unit admission in women with preterm premature rupture of membranes.
Collapse
Affiliation(s)
- Eda Ozden Tokalioglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Merve Ozturk Agaoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ülkü Gürbüz Özbebek
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Gülcan Okutucu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hüseyin Kayaalp
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Petek Uzuner
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
7
|
Sgayer I, Zidan M, Nakhleh Francis Y, Abu Shqara R, Glikman D, Lowenstein L, Frank Wolf M. Maternal Colonization of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Preterm Rupture of Membranes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2025; 47:102755. [PMID: 39734002 DOI: 10.1016/j.jogc.2024.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 12/03/2024] [Accepted: 12/11/2024] [Indexed: 12/31/2024]
Abstract
OBJECTIVES Maternal colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) has risen, and the antimicrobial resistance of ESBL-E is significant. We aimed to evaluate the rates of ESBL-E colonization among women with preterm premature rupture of membranes (PPROM) and of maternal-neonatal vertical transmission. We also aimed to compare obstetrical and neonatal complications among ESBL-E positive versus negative maternal colonization in pregnancies complicated by PPROM. METHODS This retrospective study included women with PPROM who were admitted from 2018 to 2022 for expectant management and were screened for ESBL-E recto-vaginal colonization on their admission. Obstetrical and neonatal outcomes were compared between positive and negative ESBL-E pregnancies. Neonatal outcomes were compared between positive and negative ESBL-E neonates. RESULTS Of 118 women with PPROM, 27 (23%) had positive ESBL-E cultures. ESBL-E isolates (cultures from the placenta, cord, amnion, or uterus) were more common in colonized versus non-colonized ESBL-E mothers (55.6% vs. 11.0%, P < 0.001). ESBL-E isolates were more common in neonates of mothers with positive versus negative ESBL-E cultures (33.3% vs. 4.2%, P = 0.017). A higher proportion of neonates of ESBL-E positive than ESBL-E negative mothers needed antibiotic treatment in the neonatal intensive care unit. Neonatal ESBL-E colonization at birth was a predictor of longer stays in the neonatal intensive care unit (P = 0.006). CONCLUSIONS In women with PPROM, maternal-ESBL-E colonization was a significant risk factor for neonatal colonization and was associated with neonatal morbidity. The high maternal colonization rate in PPROM raises the need for routine maternal ESBL screening. Future studies should establish the ideal empiric antibiotic regimen in the neonatal intensive care unit for neonates born to ESBL-E colonized mothers.
Collapse
Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Muhammad Zidan
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Yara Nakhleh Francis
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Daniel Glikman
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| |
Collapse
|
8
|
Liu D, Wu L, Zeng L, Li H, Zhan Y, Wang L, Zhang X, Li X, Ling Y, Zhang P, Su H, Peng B, Wu H, Qin L, Liu X, Teng Y, Li L, Xing A, Zhang L. No difference in outcomes with early vs late antibiotic prophylaxis for term premature rupture of membranes: a multicenter analysis. Am J Obstet Gynecol 2025:S0002-9378(25)00031-6. [PMID: 39848395 DOI: 10.1016/j.ajog.2025.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 01/11/2025] [Accepted: 01/15/2025] [Indexed: 01/25/2025]
Abstract
BACKGROUND Although guidelines suggest administering antibiotics 12 to 18 hours after the rupture of membranes in women with term premature rupture of membranes, in practice, clinicians tend to initiate prophylactic antibiotics as soon as possible to avoid risk of infection. OBJECTIVE This study aimed to assess whether early administration of prophylactic antibiotics for term premature rupture of membranes reduces the incidence of maternal and neonatal infections. STUDY DESIGN This multicenter prospective cohort study included women with term premature rupture of membranes. The participants were divided into early and late administration groups according to the duration between rupture of membranes and antibiotic use. The effectiveness outcomes included the incidence of puerperal infection, the incidence of total maternal infection, and the rate of neonatal sepsis, whereas the safety outcomes included the incidence of adverse reactions. Antibiotic use density was used to assess antibiotic consumption. The propensity score matching method was used to control for confounding factors. RESULTS A total of 1099 women with term premature rupture of membranes were enrolled: 459 in the early 6-hour group (antibiotic administration within 6 hours) and 640 in the late 6-hour group (antibiotic administration after 6 hours) and 707 in the early 12-hour group (antibiotic administration within 12 hours) and 392 in the late 12-hour group (antibiotics administration after 12 hours). After propensity score matching, there were 300 women in each 6-hour group and 230 women in each 12-hour group. The baseline characteristics showed no significant difference between the matched groups (P>.05). The early 6-hour and 12-hour groups had lower maternal C-reactive protein levels than the late 6-hour and 12-hour groups (P<.05). However, no significant difference was observed in other maternal and neonatal outcomes (P<.05). Adverse reactions showed no statistically significant difference between the early and late treatment groups (P=1.000). Antibiotic use density was higher in the early treatment groups by 10.1 defined daily doses (6-hour groups) and 11.7 defined daily doses (12-hour groups). CONCLUSION There was no substantial difference in the efficacy and safety of antibiotics administered within 6 to 12 hours after rupture of membranes compared with that administered after 6 to 12 hours in women with term premature rupture of membranes. Delayed antibiotic use substantially reduced antibiotic consumption.
Collapse
Affiliation(s)
- Dan Liu
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Children's Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lin Wu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China; Department of Gynecology and Obstetrics, Meishan Women and Children's Hospital, Meishan, China
| | - Linan Zeng
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Children's Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hailong Li
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Children's Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yangyang Zhan
- Chengdu Chenghua District Maternal and Child Health Care Hospital, Chengdu, China
| | - Lin Wang
- The First People's Hospital of Mianyang, Mianyang, China
| | - Xu Zhang
- Dechang People's Hospital, Liangshan, China
| | - Xuebin Li
- Dechang People's Hospital, Liangshan, China
| | - Ya Ling
- Dechang People's Hospital, Liangshan, China
| | - Peng Zhang
- Chengdu First People's Hospital, Chengdu, China
| | - Huaiyu Su
- Deyang City People's Hospital, Deyang, China
| | - Bing Peng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Honglin Wu
- Qingbaijiang Maternal and Child Health Care Hospital, Chengdu, China
| | - Lang Qin
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiumei Liu
- Department of Obstetrics and Gynecology, Ziyang Maternal and Child Health Care Hospital, Ziyang, China
| | - Yun Teng
- The People's Hospital of Yuechi County, Guangan, China
| | - Lin Li
- Nanchong Central Hospital, Nanchong, China
| | - Aiyun Xing
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Lingli Zhang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Children's Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
9
|
Suissa N, Badeghiesh A, Baghlaf H, Dahan MH. Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries. Arch Gynecol Obstet 2025; 311:67-77. [PMID: 39692870 DOI: 10.1007/s00404-024-07861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 11/26/2024] [Indexed: 12/19/2024]
Abstract
PURPOSE The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. METHODS We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications. RESULTS There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77-2.02), gestational hypertension (aOR = 1.84, CI = 1.65-2.05), preeclampsia (aOR = 1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44-2.87), and placenta previa (aOR = 0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06-1.34), chorioamnionitis (aOR = 1.24, CI = 1.03-1.51), caesarean deliveries (aOR = 1.28, CI = 1.18-1.38), wound complications (aOR = 1.65, CI = 1.31-2.08), and transfusions (aOR = 0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16-2.10). CONCLUSION Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.
Collapse
Affiliation(s)
- Naomi Suissa
- Obstetrics and Gynecology, McGill University Health Centre, Montreal, Canada.
| | - Ahmad Badeghiesh
- Obstetrics and Gynecology, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Haitham Baghlaf
- Obstetrics and Gynecology, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H Dahan
- Obstetrics and Gynecology, McGill University Health Centre, Montreal, Canada
| |
Collapse
|
10
|
Georges HM, Norwitz ER, Abrahams VM. Predictors of Inflammation-Mediated Preterm Birth. Physiology (Bethesda) 2025; 40:0. [PMID: 39106300 DOI: 10.1152/physiol.00022.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 08/09/2024] Open
Abstract
Preterm birth remains a worldwide health concern because of ongoing challenges in prediction and prevention. Current predictors are limited by poor performance, need for invasive sampling, and an inability to identify patients in a timely fashion to allow for effective intervention. The multiple etiologies of preterm birth often have an inflammatory component. Thus, a deeper understanding of the inflammatory mechanisms involved in preterm birth may provide opportunities to identify new predictors of preterm birth. This review discusses the multiple etiologies of preterm birth, their links to inflammation, current predictors available, and new directions for the field.
Collapse
Affiliation(s)
- Hanah M Georges
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Errol R Norwitz
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| |
Collapse
|
11
|
Geremew H, Ali MA, Simegn MB, Golla EB, Abate A, Wondie SG, Kumbi H, Taderegew MM, Tilahun WM. Determinants of preterm prelabor rupture of fetal membrane among pregnant women in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0311151. [PMID: 39514514 PMCID: PMC11548779 DOI: 10.1371/journal.pone.0311151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 09/13/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION Ethiopia is one of the countries where persistently high neonatal and maternal mortalities are reported. Preterm prelabor rupture of membrane (PPROM) plays an important contribution to these high mortalities. However, there is a paucity of comprehensive evidence about the epidemiology of PPROM in Ethiopia. Therefore, this systematic review was conducted to assess the pooled prevalence and determinants of PPROM among pregnant women in Ethiopia. METHODS A systematic review and meta-analysis were conducted following the PRISMA guideline. Relevant literatures were searched on African Journals Online (AJOL), PubMed, Scopus, Epistemonikos, CINAHL, Cochrane Library and gray literature. All statistical analyses were performed using STATA 17 software. The random effect meta-analysis model was employed to summarize the pooled estimates. Heterogeneity between included studies was evaluated using I2 statistic. Egger's regression test and Begg's correlation test were employed to assess publication bias, in conjunction with funnel plot. Besides, the non-parametric trim-and-fill analysis, sensitivity analysis, subgroup analysis and meta-regression were also performed. RESULTS A total of 13 original studies with 24,386 participants were considered in this systematic review. The pooled prevalence of PPROM was 6.58% (95% CI: 5.36, 7.79). Urinary tract infection (OR: 3.44; 95% CI: 1.81, 6.53), abnormal vaginal discharge (OR: 4.78; 95% CI: 2.85, 8.01), vaginal bleeding (OR: 2.04; 95% CI: 1.03, 4.06), history of PROM (OR: 4.64; 95% CI: 2.71, 7.95), history of abortion (OR: 3.06; 95% CI: 1.71, 5.46), malnutrition (OR: 5.24; 95% CI: 2.63, 10.44), anemia (OR: 3.97; 95% CI: 2.01, 7.85) and gestational diabetes (OR: 5.08; 95% CI: 1.93, 13.36) were significantly associated with PPROM. CONCLUSION This meta-analysis found a high prevalence of PPROM in Ethiopia. Urinary tract infection, abnormal vaginal discharge, vaginal bleeding, history of PROM, history of abortion, malnutrition, anemia and gestational diabetes were risk factors for PPROM. Prevention and control of antenatal infections and malnutrition are highly recommended to reduce the magnitude of PPROM in Ethiopia. Additionally, healthcare providers should emphasize the identified risk factors. PROTOCOL REGISTRATION NUMBER CRD42024536647.
Collapse
Affiliation(s)
- Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mohammed Ahmed Ali
- Department of Midwifery, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mulat Belay Simegn
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Alegntaw Abate
- Department of Medical Laboratory Science, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Smegnew Gichew Wondie
- Department of Human Nutrition, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Hawi Kumbi
- Department of Laboratory, Adama Hospital Medical College, Adama, Ethiopia
| | - Mitku Mammo Taderegew
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
12
|
Williamson M, Dong S, D'Souza R, Brignardello‐Petersen R, Ronzoni S. Outpatient vs inpatient management of preterm prelabor rupture of membranes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024; 103:2147-2162. [PMID: 38946314 PMCID: PMC11502410 DOI: 10.1111/aogs.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION To compare neonatal, obstetrical, and maternal outcomes associated with outpatient vs inpatient management of pregnancies with preterm prelabor rupture of membranes (PPROM). MATERIAL AND METHODS A search of MEDLINE, EMBASE, the Cochrane Database and Central Register from January 1, 1990 to July 31, 2023 identified randomized controlled trials (RCTs) and cohort studies comparing outpatient with inpatient management for pregnant persons diagnosed with PPROM before 37 weeks' gestation. No language restriction was applied. We applied a random effects model for meta-analysis. Trustworthiness was assessed using recently published guidance and Risk of bias using the RoB 2.0 tool for RCTs and ROBINS-I tool for cohort studies. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the certainty of evidence (COE). Outcomes of interest included perinatal mortality, neonatal morbidities, latency and gestational age at delivery, and maternal morbidities. RCTs and cohort studies were analyzed separately. This study was registered in the International Prospective Register of Systematic Reviewsr: CRD42022295275. RESULTS From 2825 records, two RCTs and 10 cohort studies involving 1876 patients were included in the review and meta-analysis. Outpatient management protocols varied but generally included brief initial hospitalization, strict eligibility criteria, and surveillance with laboratory and ultrasound investigations. Outpatient management showed lower rates of neonatal respiratory distress syndrome (cohort: RR 0.63 [0.52-0.77, very low COE]), longer latency to delivery (RCT: MD 7.43 days [1.14-13.72 days, moderate COE], cohort: MD 8.78 days [2.29-15.26 days, low COE]), higher gestational age at birth (cohort: MD 7.70 days [2.02-13.38 days, low COE]), lower rates of Apgar scores <7 at 5 min of life (cohort: RR 0.66 [0.50-0.89, very low COE]), and lower rates of histological chorioamnionitis (cohort: RR 0.74 [0.62-0.89, low COE]) without increased risks of adverse neonatal, obstetrical, or maternal outcomes. CONCLUSIONS Meta-analysis of data from RCTs and cohort studies with very low-to-moderate certainty of evidence indicates that further high-quality research is needed to evaluate the safety and potential benefits of outpatient management for selected PPROM cases, given the moderate-to-high risk of bias in the included studies.
Collapse
Affiliation(s)
- Monica Williamson
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Susan Dong
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Rohan D'Souza
- Department of Obstetrics & GynecologyMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | | | - Stefania Ronzoni
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences CenterUniversity of TorontoTorontoOntarioCanada
- Fetal Medicine Unit, Ontario Fetal Center, Department of Obstetrics & Gynecology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
13
|
Gu J, Li T, Ding Y, Chang C, Yin S, Wang Y. Effects of Pregnancy-Onset Asthma on Perinatal Outcomes: A Retrospective Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2408-2414.e2. [PMID: 38880304 DOI: 10.1016/j.jaip.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND It is unknown whether women with pregnancy-onset asthma are predisposed to worse pregnancy outcomes compared with women with pre-pregnancy asthma. OBJECTIVE To explore whether pregnancy-onset asthma leads to worse perinatal outcomes compared with pre-pregnancy asthma. METHODS Women who were discharged with a diagnosis of asthma and gave birth to a live singleton were included in this retrospective cohort analysis. Women were separated into groups based on whether the asthma was diagnosed during or before pregnancy. We compared clinical characteristics, perinatal outcomes, and asthma exacerbations (AEs) between groups. RESULTS A total of 335 women were included in this study, 39 of whom (11.6%) had pregnancy-onset asthma and 296 had pre-pregnancy asthma. All pregnant women in the pregnancy-onset group experienced AEs during pregnancy. The proportion of chronic hypertension, chronic hypertension with superimposed preeclampsia, and spontaneous preterm births in the pregnancy-onset group was significantly higher than that in the pre-pregnancy asthma group. After adjusting for age, body mass index, onset of asthma during pregnancy, and severity of AEs through multivariate analysis, pregnancy-onset asthma was an independent risk factor for spontaneous preterm birth (adjusted odds ratio = 7.71; 95% CI, 1.30-46.12) and severe AE was an independent risk factor for gestational hypertension and preeclampsia (adjusted odds ratio = 3.58; 95% CI, 1.30-9.87). CONCLUSIONS During pregnancy, pregnancy-onset asthma in women is associated with an exacerbation of the condition. Obstetricians should be vigilant for signs of asthma onset during pregnancy. Other health care providers should watch for symptoms of gestational hypertension and preeclampsia in pregnant women with preexisting or new-onset asthma.
Collapse
Affiliation(s)
- Jinyu Gu
- Center for Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center on Obstetrics and Gynecology Disease, Beijing, China; Department of Obstetrics and Gynecology, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, China
| | - Tongxin Li
- Department of General Practice, Peking University Third Hospital, Beijing, China
| | - Yishan Ding
- Peking University School of Basic Medical Sciences, Beijing, China
| | - Chun Chang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Siyuan Yin
- Peking University School of Basic Medical Sciences, Beijing, China
| | - Yan Wang
- Center for Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center on Obstetrics and Gynecology Disease, Beijing, China.
| |
Collapse
|
14
|
Fan X, Li X, Yu T, Jiao R, Song W, Su A, Li M, Guo Q. Evaluation of alanine aminotransferase/aspartate aminotransferase ratio and high-density lipoprotein for predicting neonatal adverse outcomes associated with intrahepatic cholestasis of pregnancy. PeerJ 2024; 12:e17613. [PMID: 38938614 PMCID: PMC11210484 DOI: 10.7717/peerj.17613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
Background To determine the association between lipid metabolism and intrahepatic cholestasis of pregnancy (ICP), and explore the value of maternal alanine aminotransferase/aspartate aminotransferase (ALT/AST) and high-density lipoprotein (HDL) in predicting adverse neonatal outcomes in women with ICP. Methods A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis. Results Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p < 0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p < 0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p < 0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p = 0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p = 0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p = 0.014; AOR = 0.134 (0.039-0.461), p = 0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively. Conclusions The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.
Collapse
Affiliation(s)
- Xizhenzi Fan
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xia Li
- Department of Scientific Research and Education, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Tianxiao Yu
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Ruifen Jiao
- Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Wenhui Song
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Achou Su
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Mingwei Li
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Qing Guo
- Department of Obstetrics, Hebei Key Laboratory of Maternal and Fetal Medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Shijiazhuang, China
| |
Collapse
|
15
|
Xu L, Yang T, Wen M, Wen D, Jin C, An M, Wang L, Liu Y, Fan J. Frontiers in the Etiology and Treatment of Preterm Premature Rupture of Membrane: From Molecular Mechanisms to Innovative Therapeutic Strategies. Reprod Sci 2024; 31:917-931. [PMID: 37989803 DOI: 10.1007/s43032-023-01411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ludan Xu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Tiantian Yang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Meiling Wen
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
- Research Center for Nanobiomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Dawei Wen
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Chaoyang Jin
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Meiwen An
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Li Wang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Yang Liu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China.
- Research Center for Nanobiomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, Shanxi, China.
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Junmei Fan
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China.
| |
Collapse
|
16
|
Kunze M, Maul H, Kyvernitakis I, Stelzl P, Rath W, Berger R. Statement of the Obstetrics and Prenatal Medicine Working Group (AGG - Preterm Birth Section) on "Outpatient Management for Pregnant Women with Preterm Premature Rupture of Membranes (PPROM)". Geburtshilfe Frauenheilkd 2024; 84:43-47. [PMID: 38178898 PMCID: PMC10764122 DOI: 10.1055/a-2205-1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/05/2023] [Indexed: 01/06/2024] Open
Abstract
Preterm premature rupture of membranes (PPROM) is one of the leading causes of perinatal morbidity and mortality. After a PPROM, more than 50% of pregnant women are delivered within 7 days. Fetal and maternal risks are primarily due to infection and inflammation, placental abruption, umbilical cord complications and preterm birth. Standard care usually consists of an expectant approach. Management includes the administration of antenatal steroids and antibiotic therapy. Patients with PPROM require close monitoring. The management of pregnant women with PPROM (inpatient vs. outpatient) is still the subject of controversial debate. The international guidelines also do not offer a clear stance. The statement presented here discusses the current state of knowledge.
Collapse
Affiliation(s)
- Mirjam Kunze
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Holger Maul
- Frauenkliniken, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | - Ioannis Kyvernitakis
- Frauenkliniken, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | - Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Richard Berger
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Klinikum St. Elisabeth, Neuwied, Germany
| |
Collapse
|
17
|
Phillips A, Pagan M, Smith A, Whitham M, Magann EF. Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review. Obstet Gynecol Surv 2023; 78:682-689. [PMID: 38134338 DOI: 10.1097/ogx.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Periviable and previable premature rupture of membranes (pPPROM) occurs in <1% of pregnancies but can have devastating consequences for the mother and the fetus. Understanding risk factors, possible interventions, and both maternal and neonatal outcomes will improve the counseling and care provided for these patients. Objective The aim of this review is to describe the etiology, risk factors, management strategies, neonatal and maternal outcomes, and recurrence risk for patients experiencing pPPROM. Evidence Acquisition A PubMed, Web of Science, and CINAHL search was undertaken with unlimited years searched. The search terms used included "previable" OR "periviable" AND "fetal membranes" OR "premature rupture" OR "PROM" OR "PPROM." The search was limited to English language. Results There were 181 articles identified, with 41 being the basis of review. Multiple risk factors for pPPROM have been identified, but their predictive value remains low. Interventions that are typically used once the fetus reaches 23 to 24 weeks of gestation have not been shown to improve outcomes when used in the previable and periviable stage. Neonatal outcomes have improved over time, but survival without severe morbidity remains low. Later gestational age at the time of pPPROM and longer latency period have been shown to be associated with improved outcomes. Conclusions and Relevance Periviable and previable premature rupture of membranes are uncommon pregnancy events, but neonatal outcomes remain poor, and routine interventions for PPROM >24 weeks of gestation have not proven beneficial. The 2 most reliable prognostic indicators are gestational age at time of pPPROM and length of the latency period.
Collapse
Affiliation(s)
- Amy Phillips
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Pagan
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Alex Smith
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Whitham
- Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR; Virginia Tech Carilion School of Medicine, Roanoke, VA
| |
Collapse
|
18
|
Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy Lacroix ME, Sharma S, Waterman E. Guideline No. 441: Antenatal Fetal Health Surveillance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:665-677.e3. [PMID: 37661122 DOI: 10.1016/j.jogc.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
19
|
Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy-Lacroix MÈ, Sharma S, Waterman E. Directive clinique n o 441 : Surveillance prénatale du bien-être fœtal. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:678-693.e3. [PMID: 37661123 DOI: 10.1016/j.jogc.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIF Résumer les données probantes actuelles et formuler des recommandations pour la surveillance prénatale du bien-être fœtal afin de détecter les facteurs de risque périnatal et toute potentielle décompensation fœtale et de permettre une intervention rapide en prévention de la morbidité et la mortalité périnatales. POPULATION CIBLE Personnes enceintes avec ou sans facteurs maternels, fœtaux ou gravidiques associés à des risques périnataux et à la décompensation fœtale. OPTIONS Utiliser des examens prénataux par technologie de base et/ou avancée en fonction des facteurs de risque de décompensation fœtale. RéSULTATS: La reconnaissance précoce de toute décompensation fœtale potentielle permet d'intervenir de façon à favoriser l'adaptation fœtale pour maintenir le bien-être ou à accélérer l'accouchement. BéNéFICES, RISQUES ET COûTS: Chez les personnes enceintes ayant des facteurs de risque périnatal confirmés, la surveillance du bien-être fœtal contribue à réduire le risque d'issue défavorable. Compte tenu du taux élevé de faux positifs, la surveillance du bien-être fœtal peut augmenter le risque d'interventions inutiles, ce qui peut avoir des effets nuisibles, dont l'anxiété parentale, l'accouchement prématuré ou assisté et l'utilisation accrue des ressources de soins de santé. L'optimisation des protocoles de surveillance d'après des pratiques fondées sur des données probantes peut améliorer les issues périnatales et réduire les effets nuisibles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed, Embase et Cochrane Library, de leur création jusqu'à janvier 2022, à partir de termes MeSH et de mots clés liés à la grossesse, à la surveillance fœtale, aux mouvements fœtaux, à la mortinaissance, aux complications de grossesse et à l'échographie fœtale. Le présent document est un résumé des données probantes et non pas une revue méthodologique. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les membres de l'équipe de soins qui prodiguent des soins ou donnent de l'information aux patientes en obstétrique, notamment les spécialistes en médecine fœto-maternelle, les obstétriciens, les médecins de famille, les sages-femmes, les infirmières, les infirmières praticiennes et les radiologistes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
Collapse
|
20
|
Chen X, Shi Y. Determinants of microbial colonization in the premature gut. Mol Med 2023; 29:90. [PMID: 37407941 DOI: 10.1186/s10020-023-00689-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Abnormal microbial colonization in the gut at an early stage of life affects growth, development, and health, resulting in short- and long-term adverse effects. Microbial colonization patterns of preterm infants differ from those of full-term infants in that preterm babies and their mothers have more complicated prenatal and postnatal medical conditions. Maternal complications, antibiotic exposure, delivery mode, feeding type, and the use of probiotics may significantly shape the gut microbiota of preterm infants at an early stage of life; however, these influences subside with age. Although some factors and processes are difficult to intervene in or avoid, understanding the potential factors and determinants will help in developing timely strategies for a healthy gut microbiota in preterm infants. This review discusses potential determinants of gut microbial colonization in preterm infants and their underlying mechanisms.
Collapse
Affiliation(s)
- Xiaoyu Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Yongyan Shi
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China.
| |
Collapse
|
21
|
Lin LL, Hung JN, Shiu SI, Su YH, Chen WC, Tseng JJ. Efficacy of prophylactic antibiotics for preterm premature rupture of membranes: a systematic review and network meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100978. [PMID: 37094635 DOI: 10.1016/j.ajogmf.2023.100978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE Various prophylactic antibiotic regimens are used in the management of preterm premature rupture of membranes. We investigated the efficacy and safety of these regimens in terms of maternal and neonatal outcomes. DATA SOURCES We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 20, 2021. STUDY ELIGIBILITY CRITERIA We included randomized controlled trials involving pregnant women with preterm premature rupture of membranes before 37 weeks of gestation and a comparison of ≥2 of the following 10 antibiotic regimens: control/placebo, erythromycin, clindamycin, clindamycin plus gentamicin, penicillins, cephalosporins, co-amoxiclav, co-amoxiclav plus erythromycin, aminopenicillins plus macrolides, and cephalosporins plus macrolides. METHODS Two investigators independently extracted published data and assessed the risk of bias with a standard procedure following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis was conducted using the random-effects model. RESULTS A total of 23 studies that recruited a total of 7671 pregnant women were included. Only penicillins (odds ratio, 0.46; 95% confidence interval, 0.27-0.77) had significantly superior effectiveness for maternal chorioamnionitis. Clindamycin plus gentamicin reduced the risk of clinical chorioamnionitis, with borderline significance (odds ratio, 0.16; 95% confidence interval, 0.03-1.00). By contrast, clindamycin alone increased the risk of maternal infection. For cesarean delivery, no significant differences were noted among these regimens. CONCLUSION Penicillins remain the recommended antibiotic regimen for reducing maternal clinical chorioamnionitis. The alternative regimen includes clindamycin plus gentamicin. Clindamycin should not be used alone.
Collapse
Affiliation(s)
- Li-Ling Lin
- Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan (Drs Lin, Hung, Chen, and Tseng); Genetic Counseling Program, Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei, Taiwan (Dr Lin)
| | - Jo-Ni Hung
- Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan (Drs Lin, Hung, Chen, and Tseng)
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan (Dr Shiu); Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan (Dr Shiu); Evidence-Based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan (Drs Shiu and Su)
| | - Yu-Hui Su
- Evidence-Based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan (Drs Shiu and Su)
| | - Wei-Chih Chen
- Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan (Drs Lin, Hung, Chen, and Tseng)
| | - Jenn-Jhy Tseng
- Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan (Drs Lin, Hung, Chen, and Tseng).
| |
Collapse
|
22
|
Blossia S, Tirkey RS, Kingsbury B, Yenuberi H, Mahasampath G, Jude J, Benjamin S, Mathews JE, Rathore S. C- reactive protein levels in women with prelabour rupture of membrane and women with normal labour. J Family Med Prim Care 2023; 12:953-957. [PMID: 37448938 PMCID: PMC10336935 DOI: 10.4103/jfmpc.jfmpc_1588_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background There is a very little information known about CRP in term pregnancies. It is a marker that is easily tested and is inexpensive. Although CRP has been used very effectively in diagnosing infection in the neonate, its clinical use and values have not been studied in term pregnancies. The level of CRP that is truly normal or clinically innocuous is not known. Objectives This is a cross-sectional study to compare the CRP levels in antenatal women with PROM and women with normal labor and assess its utility to predict sepsis. Methods This is a prospective study done over a period of one year and approved by the insititutional ethical committee (IRB. Min. No 11102[OBSERVE] dated 10.01.2018). Sample for CRP was collected from 112 antenatal women with prelabor rupture of membranes within 12 hours of admission (Group A) and from 112 antenatal women in spontaneous labor without rupture of membrane (Group B). CRP samples are processed by nephelometry method. Results The median CRP value in Group A is 9.15 and Group B is 7.26, with no statistical difference. Chorioamnionitis, neonatal sepsis, and endometritis were similar in both the groups. Conclusion CRP cannot be used as predictor for chorioamnionitis, endometritis, and neonatal sepsis. There was no significant difference in CRP levels between the two groups.
Collapse
Affiliation(s)
- Susan Blossia
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Richa Sasmita Tirkey
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Beena Kingsbury
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Hilda Yenuberi
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Gowri Mahasampath
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - John Jude
- Department of Microbiology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Santosh Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Jiji Elizabeth Mathews
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| | - Swati Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Tamil Nadu, India
| |
Collapse
|
23
|
Fan X, Wang L, Jiao R, Song W, Liu Y, Yu T. Correlation between high serum ferritin levels and adverse pregnancy outcomes in women with gestational diabetes mellitus. Heliyon 2023; 9:e14285. [PMID: 36942253 PMCID: PMC10023919 DOI: 10.1016/j.heliyon.2023.e14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Aims To explore the association between higher serum ferritin (SF) levels in mid-pregnancy and adverse pregnancy outcomes in gestational diabetes mellitus (GDM) pregnancies, then develop a predictive cut-off value that might effectively predict the risk of adverse pregnancy outcomes in future clinical. Methods The study involved 201 pregnant women with GDM. 201 gestational age and parity matched normoglycemic pregnant women were taken as control group. The differences in clinical data were compared by the Mann-Whitney U test and Chi-square tests. Multivariate logistic regression was used to determine the relationship between SF and GDM-relate adverse pregnancy outcomes. The predicted value of SF level was determined through receiver operating characteristic (ROC) curve analysis. Results SF level was significantly higher in women with GDM [16.10 (27.30-9.50) (ng/mL) vs. 12.04 (18.11-7.06) (ng/mL), (p < 0.001)]. Meanwhile, higher levels of SF were also discovered in GDM women with preeclampsia and neonatal hypoglycemia and respiratory distress (all p < 0.05). In the adjusted model, a positive association was shown between SF and preeclampsia [adjusted odds ratio (AOR) = 1.032, 95%CI = 1.004-1.060, p = 0.024], neonatal hypoglycemia [adjusted odds ratio (AOR) = 1.047, 95%CI = 1.022-1.072, p < 0.001] and respiratory distress outcomes (AOR = 1.034, 95%CI = 1.011-1.058, p = 0.004) respectively. The area under ROC curve (AUC) for prediction of preeclampsia by SF combined with serum calcium, age, pre-pregnancy BMI and gestational weight gain (GWG) was 0.658 (95% CI = 50.8-80.8%, p = 0.028) with the cut-off value of 24.45 ng/mL, and the sensitivity and specificity were 58.8.0% and 64.3%, respectively. To predict neonatal hypoglycemia, the clinical point value of SF was 27.43 ng/mL with AUC was 0.800, sensitivity and specificity was 90.5% and 68.0% respectively. Predicting neonatal respiratory distress, the AUC value of the SF level was 0.730, with a cut-off value of 27.37 ng/mL and the sensitivity and specificity were 52.0% and 86.5%, respectively. Conclusions Higher level of SF in mid-pregnancy was significantly associated with the risk of GDM and GDM-relate adverse pregnancy outcomes. Moreover, SF levels have moderate clinical value in predicting the adverse outcomes of maternal preeclampsia, neonatal hypoglycemia and respiratory distress.
Collapse
Affiliation(s)
- Xizhenzi Fan
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, 050000, China
| | - Lingli Wang
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, 050000, China
- School of Public Health, Hebei Medical University, Shijiazhuang, 050000, China
| | - Ruifen Jiao
- Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Wenhui Song
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, 050000, China
| | - Yumeng Liu
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, 050000, China
- School of Public Health, Hebei Medical University, Shijiazhuang, 050000, China
| | - Tianxiao Yu
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, 050000, China
- Corresponding author.
| |
Collapse
|