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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Gao YM, Wu SH, Shang HX, Yang YL, Zhou BH, Yang X. [Feasibility study of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester]. Zhonghua Fu Chan Ke Za Zhi 2024; 59:121-129. [PMID: 38389231 DOI: 10.3760/cma.j.cn112141-20230915-00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Objective: To investigate the feasibility of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester. Methods: A retrospective cohort study was conducted to collect 103 pregnant women who were diagnosed with premature rupture of membranes in the second trimester of pregnancy and insisted on continuing the pregnancy in Shanxi Bethune Hospital from July 2012 to July 2022. According to the degree of vaginal fluid, pregnant women were divided into rupture group (with typical vaginal fluid, 48 cases) and leakage group (without typical vaginal fluid, 55 cases). The rupture latency (the time from rupture of membranes to termination of pregnancy), gestational weeks of termination, indications and methods of termination of pregnancy, maternal infection related indicators and perinatal outcomes were compared between the two groups. Univariate regression model was used to analyze the correlation between different degrees of vaginal fluid in pregnant women with premature rupture of membranes and maternal and neonatal outcomes. Results: (1) Obstetric indicators: there was no significant difference in the gestational age of rupture of membranes between the two groups (P>0.05). However, the proportion of rupture latency >28 days in the leakage group was significantly higher than that in the rupture group [42% (23/55) vs 13% (6/48); χ2=33.673, P<0.001], and the incidence of pregnancy termination ≥28 weeks was significantly higher [47% (26/55) vs 19% (9/48); χ2=9.295, P=0.002]. (2) Indications and methods of termination: the incidence of progressive reduction of amniotic fluid as the indication for termination in the leakage group was significantly lower than that in the rupture group [22% (12/55) vs 42% (20/48); χ2=4.715, P=0.030], and the incidence of full-term termination in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 12% (6/48); χ2=5.008, P=0.025], while there were no significant differences in the indications of termination of pregnancy, including amniotic cavity infection, uterine contraction failure and fetal distress between the two groups (all P>0.05). The incidence of induced labor or spontaneous contraction in the leakage group was significantly lower than that in the rupture group [53% (29/55) vs 81% (39/48); χ2=9.295, P=0.002], while the cesarean section rate and vaginal delivery rate were similar between the two groups (both P>0.05). (3) Infection related indicators: the incidence of amniotic cavity infection in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 13% (6/48); χ2=4.003, P=0.045]. However, there were no significant differences in the elevation of inflammatory indicators, the positive rate of cervical secretion bacterial culture and the incidence of tissue chorioamnionitis between the two groups (all P>0.05). (4) Perinatal outcomes: the live birth rate in the leakage group was significantly higher than that in the rupture group [51% (28/55) vs 27% (13/48); χ2=5.119, P=0.024]. The proportion of live births with 1-minute Apgar score >7 in the leakage group was significantly higher than that in the rupture group [38% (21/55) vs 17% (8/48); χ2=4.850, P=0.028]. However, there were no significant differences in the birth weight of live births and the incidence of neonatal complications between the two groups (all P>0.05). (5) Univariate regression analysis showed that compared with the rupture group, the leakage group had a higher risk of pregnancy termination at ≥28 gestational weeks (RR=2.521, 95%CI: 1.314-4.838; P=0.002), amniotic infection (RR=2.473, 95%CI: 1.061-5.764; P=0.025), perinatal survival (RR=1.880, 95%CI: 1.104-3.199; P=0.014). Conclusion: Compared with pregnant women with typical vaginal fluid in the second trimester of premature rupture of membranes, expectant treatment for pregnant women with atypical vaginal fluid is more feasible, which could effectively prolong the gestational weeks and improve the perinatal live birth rate.
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Affiliation(s)
- Y M Gao
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, the Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - S H Wu
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, the Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - H X Shang
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, the Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - Y L Yang
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, the Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - B H Zhou
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, the Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - X Yang
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, the Third Hospital of Shanxi Medical University, Taiyuan 030032, China
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Baradwan S, AlSghan R, Sabban H, Khadawardi K, Abdelrahman Mohamed Ali Z, Felemban LHA, Khamis Galal S, Ragab Rashed A, Salah Elsayed T, Mohammed Ibrahim E, Abdelghaffar Moustafa A, Mohamed Abdelhakim A, Abdelaziz A, Abdelgawad Magdy H, ElHodiby ME. Vaginal probiotics as an adjunct to antibiotic prophylaxis in the management of preterm premature rupture of membranes: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2023; 291:112-119. [PMID: 37862929 DOI: 10.1016/j.ejogrb.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/23/2023] [Accepted: 10/08/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To investigate the efficacy of vaginal probiotics administration in combination with prophylactic antibiotics versus antibiotic prophylaxis only on perinatal outcomes in women with preterm premature rupture of membrane (PPROM). METHODS Four different databases were searched from inception till March 2023. We selected randomized controlled trials (RCTs) that compared vaginal probiotics along with antibiotics versus antibiotics only among pregnant women who were presented with PPROM between 24 and 34 weeks of gestation. We performed the meta-analysis using Revman software. Our primary outcomes were gestational age at birth and latency period duration. Our secondary outcomes were the rate of admission in the neonatal intensive care unit (NICU), infant birth weight, length of stay in the NICU, and neonatal complications. RESULTS Four RCTs, involving a total of 339 patients, were included in the meta-analysis. The gestational age at the time of delivery and latency period duration were significantly higher among probiotics + antibiotics group (p = 0.01 & p < 0.001). There was a significant reduction in the rate of NICU admission and length of NICU stay among the probiotics + antibiotics group compared to the antibiotics only group. A significant improvement in the infant birth weight after delivery was demonstrated among the probiotics + antibiotics group (p = 0.002). Although there was a decrease in the incidence of neonatal sepsis and respiratory distress syndrome within probiotics + antibiotics group versus antibiotics only group, these differences were not statistically significant (p > 0.05). CONCLUSIONS The combination of vaginal probiotics and antibiotic prophylaxis has been shown to effectively improve perinatal outcomes in women with PPROM. Further trials are needed to validate our findings.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia
| | - Hussein Sabban
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Samir Khamis Galal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Tamer Salah Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | | | | | - Hagar Abdelgawad Magdy
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mohamed E ElHodiby
- Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Tate B, Dussaux C, Mandelbrot L. Impact of extending criteria for home care management in Preterm Prelabor Rupture of Membranes. J Gynecol Obstet Hum Reprod 2023; 52:102638. [PMID: 37544361 DOI: 10.1016/j.jogoh.2023.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Preterm prelabor rupture of membranes (PPROM) is a frequent obstetrical condition with risks of maternal and neonatal morbidity and mortality. Home hospitalization (HH) management is an alternative to conventional hospitalization (CH) which remains controversial, and there has been little study of eligibility criteria. OBJECTIVE To study obstetrical and perinatal outcomes of PPROM between 24 and 34 gestational weeks in patients discharged to homecare after 4 days, based on a policy of expanded discharge criteria. STUDY DESIGN AND SETTING Retrospective before-and-after study over 10 years in a single French level III perinatal center. In period A (2009-2013), discharge criteria were restrictive and in period B (2015-2019), more extended discharge criteria were adopted. The primary outcome was the incidence of confirmed early-onset neonatal sepsis (EOS). RESULTS The proportion of patients discharged to home hospitalization increased from 28/170 (16.5) in period A to 39/114 (34.2) in period B (p < 0.01). Regarding the primary outcome, no statistically significant difference in EOS rates was observed between periods (11/153 (7.1) vs 5/110 (4.5), p = 0.37). The incidence of a composite outcome combining severe perinatal complications (intrauterine fetal demise, placental abruption and cord prolapse) did not significantly increase during period B (7/170 (4.1) vs 4/114 (2.7), p = 0.37). There was no significant difference between the periods for chorioamniotitis (9.41% in period A and 11.4% in period B, p = 0.58). CONCLUSION Severe maternal or neonatal complications rates did not increase when criteria for home hospitalization were expanded. Larger, prospective studies are needed to confirm the results of such a strategy.
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Affiliation(s)
- Bérangère Tate
- Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Assistance Publique des Hôpitaux de Paris, Colombes 92700, France; Fédération Hospitalo-Universitaire PREMA, Paris, France; Université Paris Cité, Paris, France
| | - Chloé Dussaux
- Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Assistance Publique des Hôpitaux de Paris, Colombes 92700, France; Fédération Hospitalo-Universitaire PREMA, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Assistance Publique des Hôpitaux de Paris, Colombes 92700, France; Fédération Hospitalo-Universitaire PREMA, Paris, France; Université Paris Cité, Paris, France; Inserm IAME, Paris 1137, France.
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Ubom AE, Vatish M, Barnea ER. FIGO good practice recommendations for preterm labor and preterm prelabor rupture of membranes: Prep-for-Labor triage to minimize risks and maximize favorable outcomes. Int J Gynaecol Obstet 2023; 163 Suppl 2:40-50. [PMID: 37807588 DOI: 10.1002/ijgo.15113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Preterm labor occurs in around 10% of pregnancies worldwide. Once diagnosed, significant efforts must be made to reduce the likelihood of morbidity and mortality associated with preterm birth. In high-resource settings, access to hospitals with a neonatal intensive care unit (NICU) is readily available, whereas access to NICU care is limited in low- and middle-income countries (LMICs) and many rural settings. Use of FIGO's Prep-for-Labor triage method rapidly identifies low- and high-risk patients with preterm labor to enable clinicians to decide whether the patient can be managed on site or if transfer to a level II-IV facility is needed. The management steps described in this paper aim to minimize the morbidity and mortality associated with preterm labor and in the setting of preterm labor with preterm premature rupture of membranes (PPROM). The methods for accurate diagnosis of PPROM and chorioamnionitis are described. When the risk of preterm birth is high, antenatal corticosteroids should be administered for lung maturation combined with limited tocolysis for 48 hours to permit the corticosteroid course to be completed. Magnesium sulfate is also administered for fetal neuroprotection. Implementation of FIGO's Prep-for-Labor triage method in an LMIC setting will help improve maternal and neonatal outcomes.
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Affiliation(s)
- Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Manu Vatish
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Eytan R Barnea
- Society for the Investigation of Early Pregnancy (SIEP), New York, New York, USA
- Obstetrics Gynecology & Reproductive Sciences University of Miami Miller School of Medicine, Miami, Florida, USA
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Forde B, Lim FY, McKinney DN, Habli M, Markham KB, Hoffman M, Tabbah S, Oria M, Peiro JL. Association of amnioinfusion volume at the time of surgery for twin-twin transfusion syndrome and latency to delivery. Prenat Diagn 2023; 43:1239-1246. [PMID: 37553727 DOI: 10.1002/pd.6415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/24/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To evaluate the impact of amnioinfusion and other peri-operative factors on pregnancy outcomes in the setting of Twin-twin transfusion syndrome (TTTS) treated via fetoscopic laser photocoagulation (FLP). METHODS Retrospective study of TTTS treated via FLP from 2010 to 2019. Pregnancies were grouped by amnioinfusion volume during FLP (<1 L vs. ≥1 L). The primary outcome was latency from surgery to delivery. An amnioinfusion statistic (AIstat) was created for each surgery based on the volume of fluid infused and removed and the preoperative deepest vertical pocket. Regression analysis was planned to assess the association of AIstat with latency. RESULTS Patients with amnioinfusion of ≥1 L at the time of FLP had decreased latency from surgery to delivery (61 ± 29.4 vs. 73 ± 28.8 days with amnioinfusion <1 L, p < 0.001) and increased preterm prelabor rupture of membranes (PPROM) <34 weeks (44.7% vs. 33.5%, p = 0.042). Amnioinfusion ≥1 L was associated with an increased risk of delivery <32 weeks (aRR 2.6, 95% CI 1.5-4.5), 30 weeks (aRR 2.4, 95% CI 1.5-3.8), and 28 weeks (aRR 1.9, 95% CI 1.1-2.3). Cox-proportional regression revealed that AIstat was inversely associated with latency (HR 1.1, 95% CI 1.1-1.2). CONCLUSION Amnioinfusion ≥1 L during FLP was associated with decreased latency after surgery and increased PPROM <34 weeks.
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Affiliation(s)
- Braxton Forde
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Foong-Yen Lim
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of General and Thoracic Surgery, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David N McKinney
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mounira Habli
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, TriHealth Health System, Cincinnati, Ohio, USA
| | - Kara B Markham
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mallory Hoffman
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, TriHealth Health System, Cincinnati, Ohio, USA
| | - Sammy Tabbah
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, TriHealth Health System, Cincinnati, Ohio, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Cincinnati, Ohio, USA
| | - Marc Oria
- Division of General and Thoracic Surgery, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jose L Peiro
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of General and Thoracic Surgery, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Awkadigwe FI, Ezugwu FO, Eleje GU, Nweze SO, Odugu BU, Dinwoke VO, Olu EA, Ortuanya KE, Ezenwaeze MN, Eze OC, Onyekpa JI, Ofor IJ, Onah OO, Omeje CU, Ezike AU, Enyinna PK, Malachy DE, Okafor CG. Active versus expectant management for premature rupture of membranes at term: A randomized, controlled study. J Int Med Res 2023; 51:3000605231195451. [PMID: 37656970 PMCID: PMC10478565 DOI: 10.1177/03000605231195451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To compare the effects on feto-maternal outcomes of expectant versus active management for premature rupture of membranes (PROM) at term. METHODS This was a prospective randomized (1:1) controlled study involving 86 pregnant-women who received either expectant management (n = 43) or active management with misoprostol (n = 43) for PROM at term. Primary outcome was route of delivery. Secondary outcomes were: PROM to presentation interval; latency period; PROM to delivery interval; recruitment to delivery interval; labour and delivery complications. RESULTS Baseline-characteristics were similar between groups. There was no significant difference between active and expectant groups in mean PROM to presentation/admission, or PROM to delivery. However, mean latency period (11.1 ± 7.3 hours vs 8.8 ± 5.5 hours) and mean recruitment to delivery intervals after PROM (14.7 ± 5.2 hours vs 11.8 ± 5.0 hours) were significantly shorter for the active group compared with the expectant group. Although the rate of caesarean section was less in expectant management group (21%) compared with the active management group (30%), the difference was not statistically significant. There were no significant differences between groups in delivery or perinatal complications. CONCLUSION Active and expectant management for PROM at term gave comparable outcomes in terms of methods of delivery and complications. However, active management significantly shortened the latency period and induction to delivery intervals compared with expectant management.Trial-Registration: Pan-African-trial-registry-(PACTR)-approval-number PACTR202206797734088.
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Affiliation(s)
- Fredrick I. Awkadigwe
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Frank O. Ezugwu
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - George U. Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - Sylvester O. Nweze
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Boniface U. Odugu
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Victor O. Dinwoke
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Ephraim A. Olu
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Kelvin E. Ortuanya
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Malachy N. Ezenwaeze
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Obiechina C. Eze
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Johnson I. Onyekpa
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Ifeanyichukwu J. Ofor
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Osmond O. Onah
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chimdalu U. Omeje
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Andre U. Ezike
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Perpetua K. Enyinna
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu, Nigeria
| | - Divinefavour E. Malachy
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - Chigozie G. Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
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Melamed N, Berghella V, Ananth CV, Lipworth H, Yoon EW, Barrett J. Optimal timing of labor induction after prelabor rupture of membranes at term: a secondary analysis of the TERMPROM study. Am J Obstet Gynecol 2023; 228:326.e1-326.e13. [PMID: 36116523 DOI: 10.1016/j.ajog.2022.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In the case of prelabor rupture of membranes at term, the risk for neonatal and maternal infectious morbidity increases progressively with time from prelabor rupture of membranes. Although most studies identified a benefit associated with early induction within the first 24 hours following term prelabor rupture of membranes, there is currently no precise data regarding how early should induction be scheduled. OBJECTIVE This study aimed to identify the optimal timing of labor induction among women with term prelabor rupture of membranes by comparing the maternal and neonatal outcomes associated with labor induction with those of expectant management at any given 1-hour interval following prelabor rupture of membranes. STUDY DESIGN This was a secondary analysis of data from the TERMPROM trial, an international, multicenter, randomized clinical trial on immediate delivery vs expectant management of women with prelaor rupture of membranes at term (≥37+0/7 weeks' gestation). We considered all participants as a single cohort of women with term prelabor rupture of membranes, irrespective of the original randomized study group allocation. For each given 1-hour time interval within the first 36 hours following prelabor rupture of membranes, we compared the outcomes of subjects for whom labor induction was initiated during this interval with those of subjects managed expectantly at the same time interval. The primary neonatal outcome was a composite of neonatal infection and admission to the neonatal intensive care unit. The primary maternal outcomes included maternal infection (clinical chorioamnionitis or postpartum fever) and cesarean delivery. RESULTS Of the 4742 subjects who met the study criteria, 2622 underwent labor induction, and 2120 experienced a spontaneous onset of labor. The rates of the neonatal composite outcome, neonatal admission to intensive care unit, and maternal infection increased progressively with time after prelabor rupture of membranes. The risk for these outcomes was lower among women who underwent induction when compared with those managed expectantly within the first 15 to 20 hours after prelabor rupture of membranes without affecting the risk for cesarean delivery. In addition, women who underwent labor induction within the first 30 to 36 hours had a shorter prelabor rupture of membranes to delivery time and a shorter total maternal hospital stay when compared with those managed expectantly at the same time interval. Among women managed expectantly, less than two-thirds (64%; 1365/2120) experienced a spontaneous onset of labor within the first 24 hours following prelabor rupture of membranes. CONCLUSION These findings suggest that immediate labor induction seems to be the optimal management strategy to minimize neonatal and maternal morbidity in the setting of prelabor rupture of membranes at term gestations. In cases for which immediate induction is not feasible, labor induction remains the preferred option over expectant management if performed within the first 15 to 20 hours after prelabor rupture of membranes.
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Affiliation(s)
- Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cardiovascular Institute of New Jersey, New Brunswick, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Hayley Lipworth
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Eugene W Yoon
- Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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Powell JM, Frank ZC, Clark GV, Lo JO, Caughey AB. Expectant management of preterm premature rupture of membranes at 34 weeks: a cost effectiveness analysis. J Matern Fetal Neonatal Med 2022; 35:9136-9144. [PMID: 34915811 PMCID: PMC10148142 DOI: 10.1080/14767058.2021.2017874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the outcomes and cost effectiveness of expectant management versus immediate delivery of women who experience preterm premature rupture of membranes (PPROM) at 34 weeks. METHODS A cost-effectiveness model was built using TreeAge software to compare outcomes in a theoretical cohort of 37,455 women with PPROM at 34 weeks undergoing expectant management until 37 weeks versus immediate delivery. Outcomes included fetal death, neonatal sepsis, neonatal death, neonatal neurodevelopmental delay, healthy neonate, maternal sepsis, maternal death, cost, and quality-adjusted life years. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000 per quality-adjusted life year. RESULTS In our theoretical cohort of 37,455 women, expectant management yielded 58 fewer neonatal deaths and 164 fewer cases of neonatal neurodevelopmental delay. However, it resulted in 407 more cases of neonatal sepsis and 2.7 more cases of maternal sepsis. Expectant management resulted in 3,531 more quality-adjusted life years and a cost savings of $71.9 million per year, making it a dominant strategy. Univariate sensitivity analysis demonstrated expectant management was cost effective until the weekly cost of antepartum admission exceeded $17,536 (baseline estimate: $12,520) or the risk of maternal sepsis following intraamniotic infection exceeded 20%. CONCLUSION Our model demonstrated that expectant management of PPROM at 34 weeks yielded better outcomes on balance at a lower cost than immediate delivery. This analysis is important and timely in light of recent studies suggesting improved neonatal outcomes with expectant management. However, individual risks and preferences must be considered in making this clinical decision as expectant management may increase the risk of adverse perinatal outcomes when the risk of puerperal infection increases.
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Affiliation(s)
- Jacqueline M Powell
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Zoë C Frank
- Department of Obstetrics & Gynecology, Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA
| | - Grace V Clark
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Jamie O Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
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Ronzoni S, Boucoiran I, Yudin MH, Coolen J, Pylypjuk C, Melamed N, Holden AC, Smith G, Barrett J. Guideline No. 430: Diagnosis and management of preterm prelabour rupture of membranes. J Obstet Gynaecol Can 2022; 44:1193-1208.e1. [PMID: 36410937 DOI: 10.1016/j.jogc.2022.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide clear and concise guidelines for the diagnosis and management of preterm prelabour rupture of membranes (PPROM) TARGET POPULATION: All patients with PPROM <37 weeks gestation BENEFITS, HARMS, AND COSTS: This guideline aims to provide the first Canadian general guideline on the management of preterm membrane rupture. It includes a comprehensive and up-to-date review of the evidence on the diagnosis, management, timing and method of delivery. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane in 2021: preterm premature rupture of membranes, PPROM, chorioamnionitis, Nitrazine test, ferning, commercial tests, placental alpha microglobulin-1 (PAMG-1) test, insulin-like growth factor-binding protein-1 (IGFBP-1) test, ultrasonography, PPROM/antenatal corticosteroids, PPROM/Magnesium sulphate, PPROM/ antibiotic treatment, PPROM/tocolysis, PPROM/preterm labour, PPROM/Neonatal outcomes, PPROM/mortality, PPROM/outpatient/inpatient, PPROM/cerclage, previable PPROM. Articles included were randomized controlled trials, meta-analyses, systematic reviews, guidelines, and observational studies. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. 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 Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All prenatal and perinatal health care providers. SUMMARY STATEMENTS RECOMMENDATIONS.
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de Ruigh AA, Simons NE, van der Windt LI, Breuking SH, van 't Hooft J, van Teeffelen AS, Alfirevic Z, Roberts D, Mol BW, Pajkrt E. Amnioinfusion versus usual care in women with prelabour rupture of membranes in midtrimester: a systematic review and meta-analysis of short and long-term outcomes. Fetal Diagn Ther 2022; 49:321-332. [PMID: 35835036 DOI: 10.1159/000526020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Midtrimester prelabour rupture of membranes (PROM) between 16 and 24 weeks' gestational age is a major obstetric complication with high rates of perinatal morbidity and mortality. Amnioinfusion has been proposed in women with midtrimester PROM to target oligohydramnios and subsequently enhance pulmonary development and perinatal outcomes. MATERIAL AND METHODS The purpose of this study was to perform a systematic review and meta-analysis including all randomized clinical trials investigating amnioinfusion versus no intervention in women with PROM between 16+0 and 24+0 weeks gestational age. Databases Central, Embase, Medline, ClinicalTrials.gov and references of identified articles were searched from inception of database to December 2021. The primary outcome was perinatal mortality. Secondary outcomes included neonatal, maternal and long-term developmental outcomes as defined in the core outcome set for preterm birth studies. Summary measures were reported as pooled relative risk (RR) or mean difference (MD) with corresponding 95% of confidence interval (CI). RESULTS Two studies (112 patients, 56 in the amnioinfusion group and 56 in the no intervention group) were included in this review. Pooled perinatal mortality was 66.1% (37/56) in the amnioinfusion group compared with 71.4% (40/56) in no intervention group (RR 0.92, 95% CI 0.72 - 1.19). Other neonatal and maternal core outcomes were similar in both groups although, due the relatively small number of events and wide confidence intervals, there is possibility that amnioinfusion can be associated with clinically important benefits and harms. Long-term healthy survival was seen in 35.7% (10/28) of children assessed for follow-up and treated with amnioinfusion versus 28.6% (8/28) after no intervention (RR 1.30, 95% CI 0.47 - 3.60, 'best case scenario'). CONCLUSIONS Based on these findings the benefits of amnioinfusion for midtrimester PROM <24 weeks gestational age are unproven and the potential harms remain undetermined.
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Affiliation(s)
- Annemijn A de Ruigh
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Noor E Simons
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Larissa I van der Windt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sofie H Breuking
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Augustinus S van Teeffelen
- Department of Obstetrics and Gynaecology, Grow, School for Oncology and Reproduction, Maastricht UMC+, Maastricht, The Netherlands
| | - Zarko Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Alfoldi M, Papcun P, Krizko M, Gabor M, Feriancova M, Gazdarica J, Ferianec V. Is amniopatch an effective treatment for spontaneous previable premature rupture of membranes? Analysis of perinatal outcome. BRATISL MED J 2022; 123:326-333. [PMID: 35420876 DOI: 10.4149/bll_2022_051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To characterize the perinatal outcomes of pregnancies complicated by spontaneous previable premature rupture of membranes with a therapeutic intervention in the form of amniopatch (AP) at the 2nd Department of Obstetrics and Gynecology (2008‒2019). MATERIALS AND METHODS The retrospective analysis of perinatal markers and early neonatal morbidity of pregnancies treated with amniopatch. Discussion comparison with the published papers of cases of spontaneous previable rupture of membranes managed expectantly. RESULTS Out of the total number of pregnancies, 53 met the exclusion criteria, of which 35 were terminated by delivering a live newborn, 3 newborns died during the hospitalization. The following incidence of early complications has been reported in live births: 1) Bronchopulmonary dysplasia (10/35-28.57 %), 2) Newborn respiratory distress syndrome (25/35-71.42 %), 3) Neonatal sepsis (15/35-42.85 %), 4) Intraventricular hemorrhage (14/35-40 %), 5) Periventricular leukomalacia (3/35-8.57 %), 6). Necrotizing enterocolitis (2/35-5.71 %), 7) Retinopathy of prematurity (7/35-20 %) and 8) Foetal compression syndrome (16/35-45.71 %). In a discussion comparison with available publications of expectantly managed pregnancies, we observed a statistically significantly lower incidence of respiratory distress syndrome, retinopathy, and chorioamnionitis in our cohort along with a higher incidence of foetal compression defects. CONCLUSION Amniopatch can be a therapeutic method for reducing the neonatal mortality associated with RDS, maternal infectious morbidity, and an alternative in patients, who require an active approach to such a compromised pregnancy (Tab. 12, Fig. 1, Ref. 50).
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14
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Sklar A, Sheeder J, Davis AR, Wilson C, Teal SB. Maternal morbidity after preterm premature rupture of membranes at <24 weeks' gestation. Am J Obstet Gynecol 2022; 226:558.e1-558.e11. [PMID: 34736914 DOI: 10.1016/j.ajog.2021.10.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND After preterm premature rupture of membranes at <24 weeks' gestation, pregnant women may choose continuation (expectant management) or termination of pregnancy, via either dilation and evacuation or labor induction. Neonatal outcomes after expectant management are well described. In contrast, limited research addresses maternal outcomes associated with expectant management compared to termination of pregnancy. OBJECTIVE This study aimed to compare maternal morbidity after preterm premature rupture of membranes at <24 weeks' gestation in women who choose either expectant management or termination of pregnancy. STUDY DESIGN This retrospective cohort study included women with preterm premature rupture of membranes between 14 0/7 and 23 6/7 weeks' gestation with singleton or twin pregnancies at 3 institutions from 2011 to 2018. We excluded pregnancies complicated by fetal anomalies, rupture of membranes immediately after obstetrical procedures (chorionic villus sampling, amniocentesis, cerclage placement, fetal reduction), spontaneous delivery <24 hours after membrane rupture, and contraindications to expectant management. Our primary outcome was the difference in composite maternal morbidity between women choosing expectant management and women choosing termination of pregnancy. We defined composite maternal morbidity as at least 1 of the following: chorioamnionitis, endometritis, sepsis, unplanned operative procedure after delivery (dilation and curettage, laparoscopy, or laparotomy), injury requiring repair, unplanned hysterectomy, unplanned hysterotomy (excluding cesarean delivery), uterine rupture, hemorrhage of >1000 mL, transfusion, admission to the maternal intensive care unit, acute renal insufficiency, venous thromboembolism, pulmonary embolism, and readmission to the hospital within 6 weeks. We compared the demographic and antenatal characteristics of women choosing expectant management with that of women choosing termination of pregnancy and used logistic regression to quantify the association between initial management decision and composite maternal morbidity. RESULTS We identified 350 women with pregnancies complicated by preterm premature rupture of membranes at <24 weeks' gestation, and 208 women were eligible for the study. Of the 208 women, 108 (51.9%) chose expectant management as initial management, and 100 (48.1%) chose termination of pregnancy as initial management. Among women selecting termination of pregnancy, 67.0% underwent labor induction, and 33.0% underwent dilation and evacuation. Compared to women who chose termination of pregnancy, women who chose expectant management had 4.1 times the odds of developing chorioamnionitis (38.0% vs 13.0%; 95% confidence interval, 2.03-8.26) and 2.44 times the odds of postpartum hemorrhage (23.1% vs 11.0%; 95% confidence interval, 1.13-5.26). Admissions to the intensive care unit and unplanned hysterectomy only occurred after expectant management (2.8% vs 0.0% and 0.9% vs 0.0%). Of women who chose expectant management, 36.2% delivered via cesarean delivery with 56.4% non-low transverse uterine incisions. Composite maternal morbidity rates were 60.2% in the expectant management group and 33.0% in the termination of pregnancy group. After adjusting for gestational age at rupture, site, race and ethnicity, gestational age at entry to prenatal care, preterm premature rupture of membranes in a previous pregnancy, twin pregnancy, smoking, cerclage, and cervical examination at the time of presentation, expectant management was associated with 3.47 times the odds of composite maternal morbidity (95% confidence interval, 1.52-7.93), corresponding to an adjusted relative risk of 1.91 (95% confidence interval, 1.35-2.73). Among women who chose expectant management, 15.7% avoided morbidity and had a neonate who survived to discharge. CONCLUSION Expectant management for preterm premature rupture of membranes at <24 weeks' gestation was associated with a significantly increased risk of maternal morbidity when compared to termination of pregnancy.
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Affiliation(s)
- Ariel Sklar
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Leandro, CA.
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anne R Davis
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Carrie Wilson
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Stephanie B Teal
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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de Ruigh AA, Simons NE, Van 't Hooft J, van Wassenaer-Leemhuis AG, Aarnoudse-Moens CSH, van Wely M, van Baaren GJ, Vlemmix F, van der Ham DP, van Teeffelen ASP, Mol BW, Roseboom TJ, Pajkrt E. Child outcomes after induction of labour or expectant management in women with preterm prelabour rupture of membranes between 34 and 37 weeks of gestation: study protocol of the PPROMEXIL Follow-up trial. A long-term follow-up study of the randomised controlled trials PPROMEXIL and PPROMEXIL-2. BMJ Open 2021; 11:e046046. [PMID: 34130959 PMCID: PMC8208011 DOI: 10.1136/bmjopen-2020-046046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Late preterm prelabour rupture of membranes (PROM between 34+0 and 36+6 weeks gestational age) is an important clinical dilemma. Previously, two large Dutch randomised controlled trials (RCTs) compared induction of labour (IoL) to expectant management (EM). Both trials showed that early delivery does not reduce the risk of neonatal sepsis as compared with EM, although prematurity-related risks might increase. An extensive, structured long-term follow-up of these children has never been performed. METHODS AND ANALYSIS The PPROMEXIL Follow-up trial (NL6623 (NTR6953)) aims to assess long-term childhood outcomes of the PPROMEXIL (ISRCTN29313500) and PPROMEXIL-2 trial (ISRCTN05689407), two multicentre RCTs using the same protocol, conducted between 2007 and 2010 evaluating IoL versus EM in women with late preterm PROM. The PPROMEXIL Follow-up will analyse children of mothers with a singleton pregnancy (PPROMEXIL trial n=520, PPROMEXIL-2 trial n=191, total IoL n=359; total EM n=352). At 10-12 years of age all surviving children will be invited for a neurodevelopmental assessment using the Wechsler Intelligence Scale for Children-V, Color-Word Interference Test and the Movement Assessment Battery for Children-2. Parents will be asked to fill out questionnaires assessing behaviour, motor function, sensory processing, respiratory problems, general health and need for healthcare services. Teachers will fill out the Teacher Report Form and answer questions regarding school attainment. For all tests means with SDs will be compared, as well as predefined cut-off scores for abnormal outcome. Sensitivity analyses consisting of different imputation techniques will be used to deal with lost to follow-up. ETHICS AND DISSEMINATION The study has been granted approval by the Medical Centre Amsterdam (MEC) of the AmsterdamUMC (MEC2016_217). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER NL6623 (NTR6953).
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Affiliation(s)
- Annemijn A de Ruigh
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Noor E Simons
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Janneke Van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Floortje Vlemmix
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - D P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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Kole MB, Villavicencio J, Werner EF. Reproductive services for the patient at increased risk for morbidity and mortality during the second trimester. Semin Perinatol 2020; 44:151270. [PMID: 32624201 DOI: 10.1016/j.semperi.2020.151270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Some complications of pregnancy that occur in the second trimester, such as preeclampsia, bleeding placenta previa, and preterm premature rupture of membranes, require delivery to avoid maternal morbidity and mortality. When these situations occur before fetal viability, pregnancy termination, either by induction of labor or dilation and evacuation, can be lifesaving. To optimize maternal health in these situations, Maternal Fetal Medicine providers should be trained to provide all needed medical services, including termination. Currently, only the minority of Maternal Fetal Medicine providers are skilled in dilation and evacuation. Training programs should focus on ways to facilitate training in second trimester dilation and evacuation to improve care access and quality when these medically necessary procedures are needed for women in whom a healthy pregnancy is no longer an option.
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Affiliation(s)
- Martha B Kole
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02906, United States.
| | - Jennifer Villavicencio
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, United States
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02906, United States
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Guckert M, Clouqueur E, Drumez E, Petit C, Houfflin-Debarge V, Subtil D, Garabedian C. Is homecare management associated with longer latency in preterm premature rupture of membranes? Arch Gynecol Obstet 2019; 301:61-67. [PMID: 31760462 DOI: 10.1007/s00404-019-05363-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/25/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE According to national guidelines, conventional management of preterm premature rupture of membranes (PPROM) is hospitalization until induction. Outpatient management could be another option. Our objective was to compare latency period between patients managed in hospital versus outpatients. METHODS A retrospective before/after monocentric study that occured from 2002 to 2015. Were included all patients with PPROM prior to 35 weeks with homecare inclusion criteria. The primary outcome measure was to study length of latency period (delay between PPROM and delivery). Second outcome measures were maternal and perinatal morbidities and mortalities. RESULTS Among the 395 women included after PPROM, 191 were managed as outpatients and 204 in hospital. In the outpatient group, the length of latency period was longer than in the inpatient group [39 (IQR 20 to 66) versus 21 (IQR 13 to 42) days; p < 0.001]. Clinical chorioamnionitis was observed in 30 (15.7%) in outpatient group versus 49 (24.0%) in inpatient group (p = 0.039). Concerning neonatal outcome, there were less neonatal transfer (49.2% versus 77.2%, p < 0.001), less respiratory distress syndrome (29.4% versus 47.5%; p < 0.001), less neonatal sepsis (13.9% versus 22.1%; p = 0.037), less bronchodysplasia (2.7% versus 9.8%; p = 0.004), and less pulmonary arterial hypertension (4.8% versus 10.3%; p = 0.040) in the outpatient group than in the inpatient group. CONCLUSION Home management seems to be a safe option to hospitalization in selected patients with PPROM. However, a randomized study would be required to approve those results.
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Affiliation(s)
- M Guckert
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France.
| | - E Clouqueur
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France
| | - E Drumez
- Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Public Health Epidemiology and Healthcare Quality, 59000, Lille, France
| | - C Petit
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France
| | - V Houfflin-Debarge
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France
- University of Lille, EA 4489-Perinatal Environment and Health, 59000, Lille, France
| | - D Subtil
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France
| | - C Garabedian
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59000, Lille, France
- University of Lille, EA 4489-Perinatal Environment and Health, 59000, Lille, France
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How should you plan to deliver a preterm breech? BJOG 2019; 126:1076. [PMID: 30793495 DOI: 10.1111/1471-0528.15615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schmitz T, Kayem G, Senat MV, Sentilhes L. [Preterm Premature Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Method and Organization]. ACTA ACUST UNITED AC 2018; 46:996-997. [PMID: 30385353 DOI: 10.1016/j.gofs.2018.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Indexed: 11/19/2022]
Affiliation(s)
- T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France.
| | - G Kayem
- Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Abstract
OBJECTIVES To synthetize the available evidence regarding the incidence and risk factors of preterm premature rupture of membranes (PPROM). To describe the evolution of pregnancy, neonatal outcomes and the prognosis of infants born in a context of PPROM, according to the existence of an associated intrauterine infection and to the latency duration. METHOD Consultation of the Medline database, from 1980 to February 2018. RESULTS PPROM before 37 and before 34 weeks' gestation occur in 2-3% and <1% of pregnancies, respectively (LE2). Although many risk factors are identified, few are modifiable, and the vast majority of patients have no risk factors (LE2). Consequently, individual prediction of the risk of PPROM and primary prevention measures have not been shown to be effective and are not recommended in clinical practice (Grade B). Most women give birth within the week following PPROM (LE2). The main complications of PPROM are prematurity, intrauterine infection and obstetric and maternal complications (LE2). Latency duration and the frequency of complications decrease with increasing gestational age at PPROM (LE2). Neonatal prognosis is largely conditioned by gestational age at birth, with no apparent over-risk of poor outcomes linked to PPROM compared to other causes of preterm birth (LE2). In contrast, intrauterine infection is associated with an increased risk of in utero fetal death (LE3), necrotizing enterocolitis (LE1) and early-onset sepsis (LE2). The association of intrauterine infection with neurological morbidity remains controversial. Prolongation of latency, from gestational age at PPROM, is beneficial for the child (LE2). CONCLUSION PPROM is a major cause of prematurity and short- and long-term mortality and morbidity. Antenatal care is an important issue for obstetric and pediatric teams, aiming to reduce complications and adverse consequences for both mother and child.
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Affiliation(s)
- E Lorthe
- Inserm UMR 1153, obstetrical, perinatal and pediatric epidemiology research team (Épopé), Center for epidemiology and statistics Sorbonne Paris Cité, département hospitalo-universitaire risks in pregnancy, Paris Descartes university, 75000 Paris, France; EPI unit - institute of public health, university of Porto, rua das Taipas n(o) 135, 4050-600 Porto, Portugal.
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Roman S, Hillary C, Narice B, Bullock AJ, Anumba DO, MacNeil S. Visualisation of the insertion of a membrane for the treatment of preterm rupture of fetal membranes using a synthetic model of a pregnant uterus. J Biomater Appl 2018; 33:234-244. [PMID: 29996717 DOI: 10.1177/0885328218786038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preterm premature rupture of fetal membranes is a leading cause of preterm delivery. Preterm labour can compromise fetal survival, and even if a pregnancy affected by preterm premature rupture of fetal membrane continues, major complications associated with leakage of amniotic fluid and risk of infection can affect the normal development and survival of the baby. There are limited management options for preterm premature rupture of fetal membrane other than delivery of the baby if ascending infection (chorioamnionitis) is suspected. We have previously reported the development and characterisation of an implantable membrane with the aim of using it to occlude the internal os of the cervix, in order to prevent amniotic fluid loss, allow fluid reaccumulation and reduce the risk of chorioamnionitis. For this, an electrospun biocompatible and distensible bilayer membrane was designed with mechanical properties similar to the human amniotic membrane. In this study, we consider the effects of sterilization on the membrane, how to insert the membrane and visualise it using routine clinical methods. To do this, we used e-beam sterilisation and examined the ability of the membrane to adhere to ex vivo human cervical tissues. We also studied its insertion into a custom-synthesised model of a 20-week pregnant uterus and imaged the membrane using ultrasound. Sterilisation produced minor effects on physical and mechanical properties, but these did not affect the capacity of the membrane to be sutured or to provide a fluid barrier. We demonstrated that fibrin glue can successfully adhere the bilayer membrane to cervical tissues. Finally, we demonstrated that the membrane can be inserted through the cervix as well as visualized in place using ultrasound imaging and an endoscope. In summary, we suggest this membrane is a candidate for further development in an appropriate animal model, supported by appropriate imaging, to precede possible future human studies if judged to demonstrate satisfactory safety and efficacy profiles.
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Affiliation(s)
- Sabiniano Roman
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | | | - Brenda Narice
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | | | - Dilly Oc Anumba
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - Sheila MacNeil
- Kroto Research Institute, University of Sheffield, Sheffield, UK
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Daskalakis G, Fotinopoulos P, Pergialiotis V, Theodora M, Antsaklis P, Sindos M, Papantoniou N, Loutradis D. Delayed interval delivery of the second twin in a woman with altered markers of inflammation. BMC Pregnancy Childbirth 2018; 18:206. [PMID: 29866067 PMCID: PMC5987477 DOI: 10.1186/s12884-018-1848-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/23/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Delayed interval intertwin delivery rates are expected to rise during the next years as potent and targeted tocolytic agents are employed and antenatal surveillance methods become more sophisticated and specific in predicting the critical delivery timepoint of optimal perinatal outcome. CASE PRESENTATION We present a case of delayed intertwin delivery after delivery of the first twin due to premature prelabor rupture of the membranes. Maternal serum White Blood Cells and C-Reactive Protein levels remained high until delivery of the second twin (34 days after the first was delivered), although maternal temperature remained constant. The mother underwent close antenatal surveillance and she was hospitalized. She had an uncomplicated delivery of the second twin at 29+ 2 weeks by cesarean section due to an abnormal Non-Stress Test. CONCLUSION We strongly suggest future evaluation of maternal serum inflammatory markers among these rare cases as these could predict intraamniotic infection.
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Affiliation(s)
- George Daskalakis
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Panagiotis Fotinopoulos
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Vasilios Pergialiotis
- 3rd Department of Obstetrics and Gynecology, Athens Medical School, Attikon General Hospital, Athens, Greece
| | - Mariana Theodora
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Michail Sindos
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Nikolaos Papantoniou
- 3rd Department of Obstetrics and Gynecology, Athens Medical School, Attikon General Hospital, Athens, Greece
| | - Dimitrios Loutradis
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
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Lorthe E, Goffinet F, Marret S, Vayssiere C, Flamant C, Quere M, Benhammou V, Ancel PY, Kayem G. Tocolysis after preterm premature rupture of membranes and neonatal outcome: a propensity-score analysis. Am J Obstet Gynecol 2017; 217:212.e1-212.e12. [PMID: 28412086 DOI: 10.1016/j.ajog.2017.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are conflicting results regarding tocolysis in cases of preterm premature rupture of membranes. Delaying delivery may reduce neonatal morbidity because of prematurity and allow for prenatal corticosteroids and, if necessary, in utero transfer. However, that may increase the risks of maternofetal infection and its adverse consequences. OBJECTIVE The objective of the study was to investigate whether tocolytic therapy in cases of preterm premature rupture of membranes is associated with improved neonatal or obstetric outcomes. STUDY DESIGN Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national prospective, population-based cohort study of preterm births that occurred in 546 maternity units in 2011. Inclusion criteria in this analysis were women with preterm premature rupture of membranes at 24-32 weeks' gestation and singleton gestations. Outcomes were survival to discharge without severe morbidity, latency prolonged by ≥48 hours and histological chorioamnionitis. Uterine contractions at admission, individual and obstetric characteristics, and neonatal outcomes were compared by tocolytic treatment or not. Propensity scores and inverse probability of treatment weighting for each woman were used to minimize indication bias in estimating the association of tocolytic therapy with outcomes. RESULTS The study population consisted of 803 women; 596 (73.4%) received tocolysis. Women with and without tocolysis did not differ in neonatal survival without severe morbidity (86.7% vs 83.9%, P = .39), latency prolonged by ≥48 hours (75.1% vs 77.4%, P = .59), or histological chorioamnionitis (50.0% vs 47.6%, P = .73). After applying propensity scores and assigning inverse probability of treatment weighting, tocolysis was not associated with improved survival without severe morbidity as compared with no tocolysis (odds ratio, 1.01 [95% confidence interval, 0.94-1.09], latency prolonged by ≥48 hours (1.03 [95% confidence interval, 0.95-1.11]), or histological chorioamnionitis (1.03 [95% confidence interval, 0.92-1.17]). There was no association between the initial tocolytic drug used (oxytocin receptor antagonists or calcium-channel blockers vs no tocolysis) and the 3 outcomes. Sensitivity analyses of women with preterm premature rupture of membranes at 26-31 weeks' gestation, women who delivered at least 12 hours after rupture of membranes, women with direct admission after the rupture of membranes and the presence or absence of contractions gave similar results. CONCLUSION Tocolysis in cases of preterm premature rupture of membranes is not associated with improved obstetric or neonatal outcomes; its clinical benefit remains unproven.
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Affiliation(s)
- Elsa Lorthe
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie, Institut de Formation Doctorale, Paris, France.
| | - François Goffinet
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Rouen University Hospital and Région-Institut National de la Santé et de la Recherche Médicale (ERI 28), Normandy University, Rouen, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, University Hospital, Toulouse, France; Research Unit on Perinatal Epidemiology, Childhood Disabilities, and Adolescent Health, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1027, Paul Sabatier University, Toulouse, France
| | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Mathilde Quere
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Valérie Benhammou
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Unité de Recherche Clinique-Centre d'Investigations Cliniques P1419, Département Hospitalo-Universitaire Risks in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Kayem
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie, Institut de Formation Doctorale, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Bergeson K, Prasad S. PURLs: Deliver or wait with late preterm membrane rupture? J Fam Pract 2016; 65:820-822. [PMID: 28087870 PMCID: PMC5117834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While ACOG recommends delivery for all women with ruptured membranes after 34 weeks' gestation, a new study finds expectant management may be the way to go.
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Affiliation(s)
- Keri Bergeson
- University of Minnesota North Memorial Family Medicine Residency, Minneapolis, MN, USA
| | - Shailendra Prasad
- University of Minnesota North Memorial Family Medicine Residency, Minneapolis, MN, USA
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Abstract
BACKGROUND Preterm prelabour rupture of the membranes (PPROM) complicates approximately 2% of pregnancies and can be either spontaneous or iatrogenic in nature. Complications of PPROM include prematurity, chorioamnionitis, neonatal sepsis, limb position defects, respiratory distress syndrome, pulmonary hypoplasia chronic lung disease, periventricular leukomalacia and intraventricular haemorrhage.A number of different sealing techniques have been employed which aim to restore a physical barrier against infection and encourage the re-accumulation of amniotic fluid. Routine use of sealants is currently not recommended due to a lack of sufficient evidence to support the safety and effectiveness of such interventions. OBJECTIVES To assess the effects of sealing techniques following PPROM against each other, or versus standard care (including no sealant), on maternal and neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing different techniques for sealing preterm prelabour ruptured membranes. Cluster-randomised trials and trials using a cross-over design were not eligible for inclusion in this review. We planned to include abstracts when sufficient information was provided. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. MAIN RESULTS We included two studies (involving 141 women - with data from 124 women). We considered both studies as being at high risk of bias. Meta-analysis was not possible because the included studies examined different interventions (both in comparison with standard care) and reported on few, but different, outcomes. One study compared cervical adapter (mechanical sealing), and the other study examined an immunological membrane sealant. Neither of the included studies reported on this review's primary outcome of interest - perinatal mortality. Similarly, data were not reported for the majority of this review's secondary infant and maternal outcomes. Cervical adapter (mechanical sealing) versus standard care (one study, data from 35 participants)No data were reported for this review's primary outcome - perinatal mortality. Data were reported for few of this review's infant or maternal secondary outcomes.There was no clear difference between the mechanical sealing group and the standard care control in relation to the incidence of neonatal sepsis (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.28 to 5.09 (very low-quality evidence)) or chorioamnionitis (RR 1.19, 95% CI 0.28 to 5.09 (very low-quality evidence)). Oral immunological membrane sealant versus standard care (one study, data from 94 participants)No data were available for perinatal mortality (this review's primary outcome) or for the majority of this review's infant and maternal secondary outcomes. Compared to standard care, the immunological membrane sealant was associated with a reduction in preterm birth less than 37 weeks (RR 0.48, 95% CI 0.34 to 0.68 (very low-quality evidence)) and a reduction in neonatal death (RR 0.38, 95% CI 0.19 to 0.75 (very low-quality evidence)). However, there was no clear difference between groups in terms of neonatal sepsis (RR 0.64, 95% CI 0.28 to 1.46 (very low-quality evidence)) or respiratory distress syndrome (RR 0.64, 95% CI 0.28 to 1.46 (very low-quality evidence)). AUTHORS' CONCLUSIONS There is insufficient evidence to evaluate sealing procedures for PPROM. There were no data relating to this review's primary outcome (perinatal mortality) and the majority of our infant and maternal secondary outcomes were not reported in the two included studies.There was limited evidence to suggest that an immunological membrane sealant was associated with a reduction in preterm birth at less than 37 weeks and neonatal death, but these results should be interpreted with caution as this is based on one small study, with a high risk of bias, and the intervention has not been tested in other studies.Although midtrimester PPROM is not a rare occurrence, there are only a small amount of published data addressing the benefits and risks of sealing procedures. Most of these studies are retrospective and cohort based and could therefore not be included in our data-analysis.This review highlights the paucity of prospective randomised trials in this area. Current evidence provides limited information both on effectiveness and safety for the interventions described. Given the paucity of high-quality data, we recommend that future research efforts focus on the conduct of randomised trials assessing the effect of promising interventions that have been only evaluated to date in cohort studies (e.g. amniopatch). Future trials should address outcomes including perinatal mortality, preterm birth, neonatal death, respiratory distress syndrome, neonatal sepsis and developmental delay. They should also evaluate maternal outcomes including sepsis, mode of delivery, length of hospital stay and emotional well-being.
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Affiliation(s)
- Adele E Crowley
- The Women's and Children's HospitalDepartment of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Rosalie M Grivell
- The University of Adelaide, Women's and Children's HospitalDiscipline of Obstetrics and Gynaecology, Robinson Research Institute72 King William RoadAdelaideSouth AustraliaAustraliaSA 5006
| | - Jodie M Dodd
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
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Ruptured Membranes: When the Bag of Water Breaks. J Midwifery Womens Health 2016; 61:545-6. [PMID: 27305653 DOI: 10.1111/jmwh.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
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Morris JM, Roberts CL, Algert CS, Thornton JG. Expectant management in pregnancies with ruptured membranes - Authors' reply. Lancet 2016; 387:1996-7. [PMID: 27203768 DOI: 10.1016/s0140-6736(16)30367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan M Morris
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW 2065, Australia.
| | - Christine L Roberts
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW 2065, Australia
| | - Charles S Algert
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW 2065, Australia
| | - Jim G Thornton
- School of Clinical Sciences, Division of Obstetrics and Gynaecology, City Hospital, University of Nottingham, Nottingham, UK
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Milosevic I, Hartley P, Dale A, Drysdale H, Goldacre B. Expectant management in pregnancies with ruptured membranes. Lancet 2016; 387:1996. [PMID: 27203769 DOI: 10.1016/s0140-6736(16)30462-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ioan Milosevic
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford, OX2 6GG, UK.
| | - Philip Hartley
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford, OX2 6GG, UK
| | - Aaron Dale
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford, OX2 6GG, UK
| | - Henry Drysdale
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Services, Oxford, OX2 6GG, UK
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Lorain P, Laas E, Girard G. [Premature rupture of membranes between 34 et 36+6weeks: How to manage?]. Gynecol Obstet Fertil 2016; 44:248-249. [PMID: 27053040 DOI: 10.1016/j.gyobfe.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 06/05/2023]
Affiliation(s)
- P Lorain
- Service de gynécologie obstétrique, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - E Laas
- Service de gynécologie obstétrique, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - G Girard
- Service de gynécologie obstétrique, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Sahibzadi Hingoro SA, Rizwan N, Qazi RA. Maternal outcome of early intervention in women with prom at term (37 weeks or more). J PAK MED ASSOC 2016; 66:334-336. [PMID: 26968288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pre-labour rupture of membranes (PROM) is associated with complications as increase in the rate of induction of labour, foetal distress, foetal and maternal infection, and caesarean section. The objective of this case series was to determine the maternal outcome of early intervention with prostaglandin E2 in women with PROM at term in a Tertiary Care Hospital. The study period was six months from 2nd July 2014 to 1st January 2015. A total of 183 women with spontaneous PROM were selected. Detailed history was taken and clinical examination was performed. Prostaglandins 3mg tablet was kept in the posterior fornix of the vagina, which was repeated 6 hours later. The average age of the patients was 27.68±1.19 years. Chorioamniotis was observed in 2.19% (4/183) women and caesarean section in 8.2% (15/183) cases. It was concluded that Vaginal PGE2 tablet was very effective for labour induction in patients with PROM at term.
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Affiliation(s)
| | - Naushaba Rizwan
- Department of Gynaecology & Obstetrics, Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan
| | - Roshan Ara Qazi
- Department of Gynaecology & Obstetrics, Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan
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Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, Thornton JG, Crowther CA. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet 2016; 387:444-52. [PMID: 26564381 DOI: 10.1016/s0140-6736(15)00724-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection, but immediate delivery is associated with risks of prematurity. The balance of risks is unclear. We aimed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity. METHODS The PPROMT trial was a multicentre randomised controlled trial done at 65 centres across 11 countries. Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included. Women were randomly assigned (1:1) by a computer-generated randomisation schedule with variable block sizes, stratified by centre, to immediate delivery or expectant management. The primary outcome was the incidence of neonatal sepsis. Secondary infant outcomes included a composite neonatal morbidity and mortality indicator (ie, sepsis, mechanical ventilation ≥24 h, stillbirth, or neonatal death); respiratory distress syndrome; any mechanical ventilation; and duration of stay in a neonatal intensive or special care unit. Secondary maternal outcomes included antepartum or intrapartum haemorrhage, intrapartum fever, postpartum treatment with antibiotics, and mode of delivery. Women and caregivers could not be masked, but those adjudicating on the primary outcome were masked to group allocation. Analyses were by intention to treat. This trial is registered with the International Clinical Trials Registry, number ISRCTN44485060. FINDINGS Between May 28, 2004, and June 30, 2013, 1839 women were recruited and randomly assigned: 924 to the immediate birth group and 915 to the expectant management group. One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses. Neonatal sepsis occurred in 23 (2%) of 923 neonates whose mothers were assigned to immediate birth and 29 (3%) of 912 neonates of mothers assigned to expectant management (relative risk [RR] 0·8, 95% CI 0·5-1·3; p=0·37). The composite secondary outcome of neonatal morbidity and mortality occurred in 73 (8%) of 923 neonates of mothers assigned to immediate delivery and 61 (7%) of 911 neonates of mothers assigned to expectant management (RR 1·2, 95% CI 0·9-1·6; p=0·32). However, neonates born to mothers in the immediate delivery group had increased rates of respiratory distress (76 [8%] of 919 vs 47 [5%] of 910, RR 1·6, 95% CI 1·1-2·30; p=0·008) and any mechanical ventilation (114 [12%] of 923 vs 83 [9%] of 912, RR 1·4, 95% CI 1·0-1·8; p=0·02) and spent more time in intensive care (median 4·0 days [IQR 0·0-10·0] vs 2·0 days [0·0-7·0]; p<0·0001) compared with neonates born to mothers in the expectant management group. Compared with women assigned to the immediate delivery group, those assigned to the expectant management group had higher risks of antepartum or intrapartum haemorrhage (RR 0·6, 95% CI 0·4-0·9), intrapartum fever (0·4, 0·2-0·9), and use of postpartum antibiotics (0·8, 0·7-1·0), and longer hospital stay (p<0·0001), but a lower risk of caesarean delivery (RR 1·4, 95% CI 1·2-1·7). INTERPRETATION In the absence of overt signs of infection or fetal compromise, a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term. FUNDING Australian National Health and Medical Research Council, the Women's and Children's Hospital Foundation, and The University of Sydney.
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Affiliation(s)
- Jonathan M Morris
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia.
| | - Christine L Roberts
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Jennifer R Bowen
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia; Department of Neonatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Diana M Bond
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Charles S Algert
- Perinatal Research, Kolling Institute, Northern Sydney Local Health District, and Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Jim G Thornton
- School of Clinical Sciences, Division of Obstetrics and Gynaecology, City Hospital, University of Nottingham, Nottingham, UK
| | - Caroline A Crowther
- The Robinson Institute, Women's and Children's Hospital, Adelaide, SA, Australia; Liggins Institute, The University of Auckland, Grafton, Auckland, New Zealand
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Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
| | - David Churchill
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Dumitrescu B, Axelsson O, Strand R. [Bed rest when the water breaks early--in accordance with the evidence or old habit?]. Lakartidningen 2015; 112:DHZM. [PMID: 26241811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bed rest is often prescribed as part of the treatment plan for women with preterm premature rupture of membranes in the hope of avoid-ing premature birth. The purpose of this study was to determine the routine care of these patients in Swedish hospitals.A survey was sent to all hospitals in Sweden with an obstetrics department (n=45). Out of these, 31 answered our survey (69 %). The women were separated into three groups depending on gestation length (22+0-26+6, 27+0-32+6 and 33+0-36+6).Most hospitals chose to admit the women and to recommend total or partial bed rest. The earlier in the pregnancy the rupture occurred, the more likely the patient was to be confined to total bed rest.The study shows that this topic is controversial. Most hospitals use bed rest even though there is no evidence to support that it is of benefit for the patient. More studies in this area are required in order to find an optimal treatment for this patient group.
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Affiliation(s)
- Bogdan Dumitrescu
- Mälarsjukhuset - Eskilstuna, Sweden Mälarsjukhuset - Obstetrics & Gynecology Eskilstuna, Sweden
| | | | - Roland Strand
- Mälarsjukhuset - Eskilstuna, Sweden Mälarsjukhuset - Eskilstuna, Sweden
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McKenzie F, Tucker Edmonds B. Offering induction of labor for 22-week premature rupture of membranes: a survey of obstetricians. J Perinatol 2015; 35:553-7. [PMID: 25927269 PMCID: PMC4754108 DOI: 10.1038/jp.2015.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/16/2015] [Accepted: 03/13/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To describe obstetricians' induction counseling practices for 22-week preterm premature rupture of membranes (PPROM) and identify provider characteristics associated with offering induction. METHODS Surveyed 295 obstetricians on their likelihood (0-10) of offering induction for periviable PPROM across 10 vignettes. Twenty-two-week vignettes were analyzed, stratified by parental resuscitation preference. Bivariate analyses identified physician characteristics associated with reported likelihood ratings. RESULTS Obstetricians (N=205) were not likely to offer induction. Median ratings by preference were as follows: resuscitation 1.0, uncertain 1.0 and comfort care 3.0. Only 41% of obstetricians were likely to offer induction to patients desiring comfort care. In addition, several provider-level factors, including practice region, parenting status and years in practice, were significantly associated with offering induction. CONCLUSIONS Obstetricians do not readily offer induction when counseling patients with 22-week ruptured membranes, even when patients prefer palliation. This may place women at risk for infectious complications without accruing a neonatal benefit from prolonged latency.
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Affiliation(s)
- F McKenzie
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
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Wong LF, Holmgren CM, Silver RM, Varner MW, Manuck TA. Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks. Am J Obstet Gynecol 2015; 212:215.e1-9. [PMID: 25218125 DOI: 10.1016/j.ajog.2014.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/22/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks. STUDY DESIGN This was a retrospective cohort of all multifetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single maternal-fetal medicine practice between July 4, 2002, and Sept. 1, 2013. Neonatal and maternal outcomes were assessed and comparisons made between the fetus with ruptured membranes and the first fetus to deliver with intact membranes. RESULTS Twenty-three pregnancies (46 fetuses) were analyzed with a median gestational age at PPROM of 22.9 weeks; 74% experienced PPROM at less than 24 weeks' gestation. A median latency of 11 days was achieved with expectant management. Of the 46 neonates, 20 (43%) survived to hospital discharge. Of these, 12 (60%) experienced severe neonatal morbidity defined as defined as grade III or IV intraventricular hemorrhage, bronchopulmonary dysplasia, pulmonary hypoplasia, necrotizing enterocolitis requiring surgical intervention, and/or grade 3 or 4 retinopathy of prematurity. Eight neonates survived to hospital discharge without severe neonatal morbidity. The multiple with ruptured membranes was more likely to experience intrauterine demise but otherwise had similar outcomes as the multiple with intact membranes. Maternal morbidity was considerable, with 7 of 23 pregnancies (30%) complicated by clinical chorioamnionitis, 12 of 23 (52%) delivering by cesarean, of which 3 of 12 (25%) were classical cesarean deliveries. CONCLUSION Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multifetal gestation complicated by very early PPROM.
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MESH Headings
- Abnormalities, Multiple
- Adult
- Bronchopulmonary Dysplasia
- Cerebral Hemorrhage
- Cesarean Section
- Chorioamnionitis
- Disease Management
- Enterocolitis, Necrotizing
- Female
- Fetal Membranes, Premature Rupture/therapy
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases
- Lung/abnormalities
- Lung Diseases
- Pregnancy
- Pregnancy Outcome
- Pregnancy Trimester, Second
- Pregnancy, Quadruplet
- Pregnancy, Twin
- Retinopathy of Prematurity
- Retrospective Studies
- Watchful Waiting
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Affiliation(s)
- Luchin F Wong
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.
| | - Calla M Holmgren
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Tracy A Manuck
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT
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Ulkumen BA, Pala HG, Baytur YB, Koyuncu FM. Outcomes and management strategies in pregnancies with early onset oligohydramnios. CLIN EXP OBSTET GYN 2015; 42:355-357. [PMID: 26152010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the outcomes and management options in pregnancies with early onset oligohydramnios. MATERIALS AND METHODS The file datas of all pregnancies diagnosed as oligohydramnios or anhydramnios before 27 gestational weeks between January 2006 and September 2013 were evaluated retrospectively. The underlying pathology and associated anomalies, karyotype analysis, the outcome of the pregnancy (either termination or labour), and gestational week at the time of diagnosis were analyzed. RESULTS A total of 54 pregnancies were evaluated; mean gestational week at the time of the diagnosis was 19.8 ± 4.6. Mean maternal age was 27.28 ± 6.03. Thirty-seven pregnancies were anhydramniotic, 13 fetuses had associated anomalies, five of them had multicyctic dysplastic kidney, five had bilateral renal agenesis, one had hypoplastic right heart syndrome, one had clubfoot, and one had ventricular septal defect and cleft palate. Karyotyping was normal regarding the fetuses with structural anomalies. Nineteen patients had premature preterm rupture of membranes and 39 patients had termination of pregnancy. CONCLUSION The prognosis of early onset oligohydramnios is poor. Main determinant is gestational week at the time of the diagnosis.
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Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association, Obstetrics Subgroup Chinese Society of Obstetrics and Gynecology Chinese Medical Association. [Diagnosis and treatment of premature rupture of membrane]. Zhonghua Fu Chan Ke Za Zhi 2015; 50:3-8. [PMID: 25877416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Torricelli M, Vannuccini S, Moncini I, Cannoni A, Voltolini C, Conti N, Di Tommaso M, Severi FM, Petraglia F. Anterior placental location influences onset and progress of labor and postpartum outcome. Placenta 2014; 36:463-6. [PMID: 25573094 DOI: 10.1016/j.placenta.2014.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study is to evaluate whether placental location at term is associated with delivery outcome. METHODS A prospective study including 2354 patients with singleton pregnancy at term admitted for vaginal delivery was conducted. Placental position was determined before delivery by ultrasonographic examination performed transabdominally with women in the supine position. Maternal characteristics and delivery outcome such as premature rupture of membranes, induction of labor, mode and gestational age at delivery, indication for cesarean section, duration of the third stage, postpartum hemorrhage (PPH) and manual removal of placenta were correlated with anterior, posterior or fundal placental locations. RESULTS Among women enrolled: i) 1164 had an anterior placenta, ii) 1087 a posterior placenta, iii) 103 a fundal placenta. Women with anterior placenta showed: i) a higher incidence of induction of labor (p = 0.0001), especially for postdate pregnancies and prolonged prelabor rupture of membranes (p < 0.0001), ii) a higher rate of cesarean section rate for failure to progress in labor (p = 0.02), iii) a prolonged third stage (p = 0.01), iv) a higher incidence of manual removal of placenta (p = 0.003) and a higher rate of PPH in vaginal deliveries (p = 0.02). DISCUSSION The present study showed the influence of anterior placental location on the course of labor, with a later onset of labor, a higher rate of induction and cesarean section and postpartum complications. The reason for this influence on labor and delivery complications remains to be elucidated.
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MESH Headings
- Adult
- Cesarean Section/adverse effects
- Female
- Fetal Membranes, Premature Rupture/epidemiology
- Fetal Membranes, Premature Rupture/etiology
- Fetal Membranes, Premature Rupture/therapy
- Gestational Age
- Hospitals, University
- Humans
- Incidence
- Italy/epidemiology
- Labor, Induced/adverse effects
- Obstetric Labor Complications/epidemiology
- Obstetric Labor Complications/etiology
- Obstetric Labor Complications/therapy
- Placenta/diagnostic imaging
- Postpartum Hemorrhage/epidemiology
- Postpartum Hemorrhage/etiology
- Postpartum Hemorrhage/therapy
- Pregnancy
- Pregnancy Outcome
- Pregnancy, Angular/diagnostic imaging
- Pregnancy, Angular/physiopathology
- Pregnancy, Angular/therapy
- Pregnancy, Prolonged/epidemiology
- Pregnancy, Prolonged/etiology
- Pregnancy, Prolonged/therapy
- Prospective Studies
- Ultrasonography, Prenatal
- Young Adult
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Affiliation(s)
- M Torricelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - S Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - I Moncini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - A Cannoni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - C Voltolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - N Conti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M Di Tommaso
- Department of Health Sciences, University of Florence, Florence, Italy
| | - F M Severi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Petraglia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Galyean A, Garite TJ, Maurel K, Abril D, Adair CD, Browne P, Combs CA, How H, Iriye BK, Kominiarek M, Lu G, Luthy D, Miller H, Nageotte M, Ozcan T, Porto M, Ramirez M, Sawai S, Sorokin Y. Removal versus retention of cerclage in preterm premature rupture of membranes: a randomized controlled trial. Am J Obstet Gynecol 2014; 211:399.e1-7. [PMID: 24726507 DOI: 10.1016/j.ajog.2014.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/18/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The decision of whether to retain or remove a previously placed cervical cerclage in women who subsequently rupture fetal membranes in a premature gestation is controversial and all studies to date are retrospective. We performed a multicenter randomized controlled trial of removal vs retention of cerclage in these patients to determine whether leaving the cerclage in place prolonged gestation and/or increased the risk of maternal or fetal infection. STUDY DESIGN A prospective randomized multicenter trial of 27 hospitals was performed. Patients included were those with cerclage placement at ≤23 weeks 6 days in singleton or twin pregnancies, with subsequent spontaneous rupture of membranes between 22 weeks 0 days and 32 weeks 6 days. Patients were randomized to retention or removal of cerclage. Patients were then expectantly managed and delivered only for evidence of labor, chorioamnionitis, fetal distress, or other medical or obstetrical indications. Management after 34 weeks was at the clinician's discretion. RESULTS The initial sample size calculation determined that a total of 142 patients should be included but after a second interim analysis, futility calculations determined that the conditional power for showing statistical significance after randomizing 142 patients for the primary outcome of prolonging pregnancy was 22.8%. Thus the study was terminated after a total of 56 subjects were randomized with complete data available for analysis, 32 to removal and 24 to retention of cerclage. There was no statistical significance in primary outcome of prolonging pregnancy by 1 week comparing the 2 groups (removal 18/32, 56.3%; retention 11/24, 45.8%) P = .59; or chorioamnionitis (removal 8/32, 25.0%; retention 10/24, 41.7%) P = .25, respectively. There was no statistical difference in composite neonatal outcomes (removal 16/33, 50%; retention 17/30, 56%), fetal/neonatal death (removal 4/33, 12%; retention 5/30, 16%); or gestational age at delivery (removal mean 200 days; retention mean 198 days). CONCLUSION Statistically significant differences were not seen in prolongation of latency, infection, or composite neonatal outcomes. However, there was a numerical trend in the direction of less infectious morbidity, with immediate removal of cerclage. These findings may not have met statistical significance if the original sample size of 142 was obtained, however they provide valuable data suggesting that there may be no advantage to retaining a cerclage after preterm premature rupture of membranes and a possibility of increased infection with cerclage retention.
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Affiliation(s)
- Anna Galyean
- Long Beach Memorial Medical Center, Long Beach, and Kaiser Permanente, Anaheim, CA
| | - Thomas J Garite
- University of California Irvine, Orange, CA; Obstetrix/Pediatrix Medical Group, Sunrise, FL
| | | | - Diana Abril
- Obstetrix/Pediatrix Medical Group, Sunrise, FL
| | - Charles D Adair
- Regional Obstetrical Consultants and University of Tennessee, Chattanooga, TN
| | - Paul Browne
- Obstetrix Medical Group of Georgia, Decatur, GA
| | | | - Helen How
- University of Cincinnati, Cincinnati, OH, and Norton Healthcare, Kosair Maternal-Fetal Medicine, Louisville, KY
| | | | | | - George Lu
- Obstetrix Medical Group, Kansas City, MO
| | | | | | - Michael Nageotte
- Long Beach Memorial Medical Center, Long Beach, and Kaiser Permanente, Anaheim, CA
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Sirak B, Mesfin E. MATERNAL AND PERINATAL OUTCOME OF PREGNANCIES WITH PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) AT TIKUR ANBESSA SPECIALIZED TEACHING HOSPITAL, ADDIS ABABA, ETHIOPIA. Ethiop Med J 2014; 52:165-172. [PMID: 26410989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Preterm premature rupture of membranes is a common complication of pregnancy associated with significant maternal, fetal and neonatal risks. An understanding of its magnitude and consequences is critical in providing appropriate intervention to prevent poor pregnancy outcomes. OBJECTIVE To describe maternal and perinatal outcomes of preterm premature rupture of membranes at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. METHODOLOGY A Retrospective cross-sectional descriptive study done at Tikur Anbessa Hospital from June, 2010 G.C. to June, 2013 G.C. RESULTS The prevalence ofpreterm premature rupture of membranes in this study was 1.4%. Intra-amniotic infection, seen in 31.5% (35/111), was the commonest maternal complication. The mean latency period from rupture of membranes to delivery was 6.6 days. Twenty-six (23.2%) neonates were delivered by cesarean section. There were a total of 12 perinatal deaths, 4 (3.6%) stillbirths (2 antepartum and 2 itrapartum) and 8 (7.1%) early neonatal deaths, making the gross perinatal mortality rate to be 107 per 1000 live births. Prematurity was the commonest cause of neonatal death. CONCLUSION AND RECOMMENDATIONS Although the prevalence of preterm premature rupture of membranes in this study appears lower than many prior reports, the level of maternal and perinatal morbidity is high compared to many prior reports from similar setups. Especially the proportion of mothers presenting with established chorioamnionitis is high. Therefore, it is important that women be well informed regarding maternal, fetal and neonatal complications ofpremature rupture of membranes so that proper and timely management is provided.
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Fujiwara A, Fukushima K, Inoue H, Takashima T, Nakahara H, Satoh S, Ochiai M, Hara T, Shimokawa M, Kato K. Perinatal management of preterm premature ruptured membranes affects neonatal prognosis. J Perinat Med 2014; 42:499-505. [PMID: 24413214 DOI: 10.1515/jpm-2013-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/13/2013] [Indexed: 11/15/2022]
Abstract
AIM To determine the factors affecting neonatal prognosis in preterm premature rupture of membranes (PPROM). METHOD We conducted a case-control study involving 92 women between the years 2000 and 2010 diagnosed with PPROM between 25 and 31 weeks' gestation, who received antenatal steroids, and delivered between 26 and 31 weeks' gestation; a retrospective cohort study was conducted based on the results. We used data from four tertiary centers and compared the frequencies of neonatal neurologic deficits and neonatal deaths. RESULTS There was a difference between the two groups; specifically, the ND group (n=18) consisted of patients whose infants had neurologic deficits and/or neonatal deaths and the neurologically normal (NN) group (n=74) included NN neonates amongst the patients who had expectant management (94% vs. 73%, respectively). Multivariable analysis revealed that expectant management was independently associated with an increased risk for neonatal neurologic deficits and neonatal deaths (odds ratio, 16.14). All neonates with poor prognosis in the expectant-management group delivered within 14 days after PPROM. CONCLUSIONS Expectant management within 14 days after PPROM is associated with poor neonatal outcomes. Decisions regarding an expectant strategy should be made carefully. An immediate, planned delivery after steroid administration should be considered to improve neonatal prognosis in patients who have PPROM after 26 weeks' gestation.
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Roberts D, Vause S, Martin W, Green P, Walkinshaw S, Bricker L, Beardsmore C, Shaw N, McKay A, Skotny G, Williamson P, Alfirevic Z. Amnioinfusion in very early preterm prelabor rupture of membranes (AMIPROM): pregnancy, neonatal and maternal outcomes in a randomized controlled pilot study. Ultrasound Obstet Gynecol 2014; 43:490-499. [PMID: 24265189 DOI: 10.1002/uog.13258] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/03/2013] [Accepted: 11/07/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. METHODS This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was < 2 cm or expectant management until 37 weeks' gestation. Short-term maternal, pregnancy and neonatal and long-term outcomes for the child were studied. Long-term respiratory morbidity was assessed using validated respiratory questionnaires at 6, 12 and 18 months of age and infant lung function test at around 12 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant Development, second edition (BSID-II) at corrected age of 2 years. RESULTS Fifty-eight women were randomized to the study. Two babies were excluded from the analysis because of termination of pregnancy for lethal anomaly, leaving 56 participants (28 assigned to serial amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk (RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group (RR 9.0 (95% CI, 0.51-159.70)). CONCLUSIONS This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy survival is needed. The pilot suggests that, with appropriate funding, such a study is feasible.
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Affiliation(s)
- D Roberts
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
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Makrydimas G. Re: Amnioinfusion in very early preterm prelabor rupture of membranes (AMIPROM): pregnancy, neonatal and maternal outcomes in a randomized controlled pilot study. D. Roberts, S. Vause, W. Martin, P. Green, S. Walkinshaw, L. Bricker, C. Beardsmore, N. Shaw, A. McKay, G. Skotny, P. Williamson and Z. Alfirevic. Ultrasound Obstet Gynecol 2014; 43: 490-499. Ultrasound Obstet Gynecol 2014; 43:488. [PMID: 24789305 DOI: 10.1002/uog.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- G Makrydimas
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina, Greece.
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Abstract
BACKGROUND Preterm prelabour rupture of membranes (PPROM) is associated with increased risk of maternal and neonatal morbidity and mortality. Women with PPROM have been predominantly managed in hospital. It is possible that selected women could be managed at home after a period of observation. The safety, cost and women's views about home management have not been established. OBJECTIVES To assess the safety, cost and women's views about planned home versus hospital care for women with PPROM. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013) and the reference lists of all the identified articles. SELECTION CRITERIA Randomised and quasi-randomised trials comparing planned home versus hospital management for women with PPROM before 37 weeks' gestation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed clinical trials for eligibility for inclusion, risk of bias, and carried out data extraction. MAIN RESULTS We included two trials (116 women) comparing planned home versus hospital management for PPROM. Overall, the number of included women in each trial was too small to allow adequate assessment of pre-specified outcomes. Investigators used strict inclusion criteria and in both studies relatively few of the women presenting with PPROM were eligible for inclusion. Women were monitored for 48 to 72 hours before randomisation. Perinatal mortality was reported in one trial and there was insufficient evidence to determine whether it differed between the two groups (risk ratio (RR) 1.93, 95% confidence interval (CI) 0.19 to 20.05). There was no evidence of differences between groups for serious neonatal morbidity, chorioamnionitis, gestational age at delivery, birthweight and admission to neonatal intensive care.There was no information on serious maternal morbidity or mortality. There was some evidence that women managed in hospital were more likely to be delivered by caesarean section (RR (random-effects) 0.28, 95% CI 0.07 to 1.15). However, results should be interpreted cautiously as there is moderate heterogeneity for this outcome (I² = 35%). Mothers randomised to care at home spent approximately 10 fewer days as inpatients (mean difference -9.60, 95% CI -14.59 to -4.61) and were more satisfied with their care. Furthermore, home care was associated with reduced costs. AUTHORS' CONCLUSIONS The review included two relatively small studies that did not have sufficient statistical power to detect meaningful differences between groups. Future large and adequately powered randomised controlled trials are required to measure differences between groups for relevant pre-specified outcomes. Special attention should be given to the assessment of maternal satisfaction with care and cost analysis as they will have social and economic implications in both developed and developing countries.
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Affiliation(s)
- Ghada Abou El Senoun
- Queen's Medical Centre, Nottingham University HospitalDepartment of Obstetrics and GynaecologyDerby RoadNottinghamNottinghamshireUKNG7 2UH
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Hatem A Mousa
- Leicester Royal InfirmaryUniversity Department of Obstetrics and Gynaecology, Fetal and Maternal Medicine UnitInfirmary SquareLeicesterUKLE1 5WW
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Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. OBJECTIVES The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013). SELECTION CRITERIA Randomised trials of amnioinfusion compared with no amnioinfusion in women with PPROM. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. AUTHORS' CONCLUSIONS These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.
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Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of HealthDepartment of Obstetrics and Gynaecology, East London Hospital ComplexFrere and Cecilia Makiwane HospitalsPrivate Bag X 9047East LondonEastern CapeSouth Africa5200
| | - Ahizechukwu C Eke
- Michigan State University School of Medicine/Sparrow HospitalDepartment of Obstetrics and Gynecology1322 East Michigan AvenueSuite 220LansingMichiganUSA48912
| | - Theresa A Lawrie
- Royal United HospitalCochrane Gynaecological Cancer GroupEducation CentreBathUKBA13NG
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Kamper CH, Hvidman L, Helmig RB. [Implementation of new guidelines for management of prelabour rupture of membranes did not have the desired effect]. Ugeskr Laeger 2014; 176:250-253. [PMID: 24629755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many resources are used in developing guidelines for the treatment and handling of different diseases and clinical situations. It is important to evaluate the effect of these guidelines; are they being followed and do they have the desired impact on patient care? This report describes a quality control evaluation of whether the implementation of a new PROM (prelabour rupture of membranes) management guideline at Department Y at the Aarhus University Hospital had the wanted effect on the length of labour, use of prophylactic antibiotics, frequency of neonatal admission and neonatal infection.
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Affiliation(s)
- Christina Hjørnet Kamper
- Gynækologisk-obstetrisk Afdeling Y, Aarhus Universitetshospital, Brendstrupgårdsvej 100, 8200 Aarhus N.
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Engels AC, Van Calster B, Richter J, DeKoninck P, Lewi L, De Catte L, Devlieger R, Deprest JA. Collagen plug sealing of iatrogenic fetal membrane defects after fetoscopic surgery for congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2014; 43:54-59. [PMID: 23801588 DOI: 10.1002/uog.12547] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To investigate the efficacy of collagen plugs at reducing the risk of preterm premature rupture of membranes (PPROM) after fetoscopic surgery for congenital diaphragmatic hernia (CDH). METHODS This was a single-center cohort study on all consecutive cases undergoing fetoscopic endoluminal tracheal occlusion (FETO) for severe or moderate CDH, between April 2002 and May 2011 (n = 141). Cases either received a collagen plug for sealing the fetal membrane defect after FETO or did not, depending on the operating surgeon. The principal outcome measure was the time from fetal surgery to PPROM, further referred to as 'latency'. A multivariable Cox regression model was used to investigate the association between collagen plug and latency while adjusting for risk factors for PPROM. RESULTS Of the 141 cases, 54 (38%) received a collagen plug and 87 (62%) did not. Sixty cases experienced PPROM, 26 among cases with and 34 among cases without a plug (48 vs 39%). The hazard ratio of plug use was 1.29 (95% CI, 0.76-2.19), which does not exclude a potentially increased risk for PPROM when a collagen plug is used. For cases with a plug, 24% had PPROM before balloon removal and 24% had PPROM after elective balloon removal. For cases without a plug, these rates were 30 and 9%, respectively. Perinatal outcomes were similar in both groups. CONCLUSIONS No evidence was found that collagen plugs reduce the risk of PPROM after FETO for CDH.
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Affiliation(s)
- A C Engels
- KU Leuven, Centre for Surgical Technologies, Leuven, Belgium
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Matsumoto N, Osada M, Matsumoto C, Gomi Y, Era S, Udagawa H, Suzuki N, Takahashi S. Labor induction using modified metreurynters plus oxytocin at an institution in Japan: a retrospective study. CLIN EXP OBSTET GYN 2014; 41:10-16. [PMID: 24707674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The authors evaluated the effectiveness and safety of "neo-metoro" or 'mini-metoro" metreurynters plus oxytocin for labor induction and assessed differences in parturition outcomes, according to the metreurynter used at induction initiation. MATERIALS AND METHODS The authors retrospectively reviewed 146 consecutive women with live singleton pregnancies, and who underwent induction. Parturition outcomes were vaginal delivery achieved within the planned schedule (VDPS), vaginal delivery finally achieved (VDF), and induction-to-delivery interval (IDI). Women were divided into neo-metoro, mini-metoro, and without metreurynter groups based on metreurynter use at induction initiation. The authors examined the relationships of metreurynter groups with factors, parturition outcomes, and adverse events. In 113 women who underwent two-day induction, the authors calculated IDI and adjusted odds ratio (AOR) for achieving delivery per unit time. RESULTS VDPS rates were 65% in nulliparous and 81% in multiparous women. VDF rates were 78% in nulliparous and 96% in multiparous women. AORs for VDPS were 0.30 in nulliparous women and 0.18 in Bishop score (BS) 1-3 class. AORs for VDF were 0.04 in BS1-3 class and 0.14 in BS4-5 class. In 113 women undergoing two-day induction, AORs for achieving delivery per unit time were 0.45 in nulliparous women, 0.46 in obese women, and 0.48 in BS1-3 class. Neo-metoro use at induction initiation tended to reduce IDI. CONCLUSIONS Labor induction using these metreurynters plus oxytocin is safe and effective. The advantages of neo-metoro over mini-metoro use at induction initiation remain unclear; neo-metoro use at induction initiation may reduce IDI.
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Kurasawa K, Yamamoto M, Usami Y, Mochimaru A, Mochizuki A, Aoki S, Okuda M, Takahashi T, Hirahara F. Significance of cervical ripening in pre-induction treatment for premature rupture of membranes at term. J Obstet Gynaecol Res 2014; 40:32-9. [PMID: 23944943 DOI: 10.1111/jog.12116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to determine whether mechanical cervical dilatation with a laminaria tent in women with premature rupture of membranes (PROM) at term may influence the maternal/neonatal outcomes. METHODS We reviewed the medical records and histopathologic results of the placenta in 782 women with PROM at term. Of the 486 women seen prior to 2010 (group 1), 85 had Bishop scores of 5 or less and underwent insertion of laminaria tents (group A). In the 296 women admitted after 2010 (group 2), 27 had Bishop scores of 5 or less and underwent labor management without insertion of laminaria tents (group B). The patient characteristics, delivery course and neonatal outcomes were compared between the groups. RESULTS There were no significant differences in the maternal age, percentage of nulliparas, body mass index, gestational age at delivery or Bishop score between the groups. The Bishop score improved from 2.5 to 6.1 after laminaria tent insertion in group A. However, there were no significant intergroup differences in the frequency of use of labor-inducing agents or the time interval from PROM to delivery. The incidence of clinical/pathological chorioamnionitis was not higher in group A than in group B. No significant differences were found in the Apgar scores, umbilical artery pH or frequency of asphyxia neonatorum between the groups. Mechanical cervical dilatation by laminaria tent insertion neither increased the incidence of infection nor contributed to improvement of the perinatal prognosis. CONCLUSION Mechanical cervical dilatation does not provide any benefit for women with PROM at term.
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Affiliation(s)
- Kentaro Kurasawa
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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