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Neonatal Complications Related with Prolonged Rupture of Membranes  [PDF]
Hassan Boskabadi,Gholamali Maamouri,Shahin Mafinejad
Macedonian Journal of Medical Sciences , 2011,
Abstract: Background. Prolonged rupture of membranes (PROM) is a common and significant cause of preterm labor and has a major impact on neonatal morbidity and mortality. The aim of this study was to determine maternal risk factors and the prevalence rate of neonatal complications following PROM . This study also detected the role of maternal antimicrobial treatment on neonatal complications.Methods: This cross-sectional study was performed at Ghaem hospital, Mashhad, Iran; from March 2008 to April 2010 to evaluate newborns’ outcome that were born from mothers with prolonged premature rupture of membranes (PROM> 18 hours). Maternal risk factors, antibiotic administration and its influences on neonatal complications were evaluated. Eligible infants were categorized into group I (symptomatic infants), II (mother with chorioamnionitis) and III (asymptomatic infants).Results. 150 infants were included in the study. 12 (7.7%) infants had definitive infections (meningitis, sepsis, pneumonia), 101(67%) infants were premature and 88(58.6%) infants had mothers with a history of antibiotic intake. Maternal risk factors were reported in the following order: previous PROM (10%), addiction (8%), high urinary tract infection (5/3%), diabetes (4.7%), placenta abruption (4.7%), preeclampsia (3/3%) and cercelage (2%). Neonatal complications related with PROM were prematurity (67.3%), respiratory distress syndrome (22.6%), asphyxia (8.6%), meningitis (5.2%), sepsis (4%), pneumonia (1.3%) and death (4.6%). History of antibiotic administration to mothers with PROM was negative in four babies with sepsis and one with meningitis.Conclusion. The most common complication of PROM was prematurity and its side effects, but infection is the most important modifiable complication. Although antimicrobial treatment of women with a history of PROM improves neonatal outcome through reducing neonatal sepsis and respiratory distress syndrome (RDS), but the incidence rate of meningitis and pneumonia may be increased.
Neonatal morbidity and mortality results in preterm premature rupture of membranes  [PDF]
Altay,Ezcan,Onur,Veli
Turk Pediatri Ar?ivi , 2011,
Abstract: Aim: To investigate the neonatal morbidity and mortality results in preterm premature rupture of membranes.Material and Method: A review of 228 PPROM singleton pregnancies followed-up in our clinic between 1996 and 2005 was performed.Results: The most common neonatal morbidities in PPROM cases are respiratory distress syndrome, sepsis and intraventricular hemorrhage. The route of delivery does not affect NICU requirement, perinatal asphyxia, sepsis and IVH rates in PPROM cases. NICU and PPV requirement, RDS, sepsis and IVH rates increase if APGAR score is <5. Neonatal morbidity and mortality rates increase as latent period lenghtens. CRP on admission, final CRP, birthweight and the 5th minute APGAR score were found to be associated with NICU requirement; only the 5th minute APGAR score was found to be associated with RDS; final leukocyte count and maternal hemotacrit was found to be associated with sepsis and pneumonia, independently.Conclusions: In PPROM cases, CRP on admission, last CRP, birthweight, the 5th minute APGAR score, final leukocyte count and maternal hematocrit must be considered to predict neonatal outcomes.(Turk Arch Ped 2011; 46: 296-301)
INDUCTION OF LABOUR VERSUS EXPECTANT MANAGEMENT FOR PREMATURE RUPTURE OF MEMBRANES AT TERM  [cached]
Vidyadhar B Bangal,Pujil Gulati,Kunnal K Shinde,Sai K Borawake
International Journal of Biomedical Research , 2013, DOI: 10.7439/ijbr.v3i3.328
Abstract: Background :Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 wks of the gestations and before the onset of the regular painful uterine contractions .It occurs in ten percent of cases These cases are either managed conservatively or by immediate induction of labour. Material and Methods :A prospective, randomized controlled study was carried out for a period of two years from November 2008 to October 2010 at Rural Medical College, Loni. One hundred pregnant women with term PROM were assigned randomly, each in induction and expectant group. Results :.The mean interval from induction to delivery was significantly shorter in the induction group as compared with expectant group . Incidence of maternal morbidity was comparable in both the groups Neonatal morbidity was higher in expectant group . Incidence of hyper stimulation were more with induction group as compared to expectant group. There was no maternal or perinatal mortality in any group. Intrapartum complications and mode of delivery were similar in both groups Conclusion: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval but increased rate of operative intervention. Maternal morbidity was comparable with induction and expectant line of management. However, neonatal morbidity was higher in expectant group
INDUCTION OF LABOUR VERSUS EXPECTANT MANAGEMENT FOR PREMATURE RUPTURE OF MEMBRANES AT TERM  [cached]
Vidyadhar B Bangal,Pujil Gulati,Kunnal K Shinde,Sai K Borawake
International Journal of Biomedical Research , 2012, DOI: 10.7439/ijbr.v3i3.328
Abstract: Background :Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 wks of the gestations and before the onset of the regular painful uterine contractions .It occurs in ten percent of cases These cases are either managed conservatively or by immediate induction of labour. Material and Methods :A prospective, randomized controlled study was carried out for a period of two years from November 2008 to October 2010 at Rural Medical College, Loni. One hundred pregnant women with term PROM were assigned randomly, each in induction and expectant group. Results :.The mean interval from induction to delivery was significantly shorter in the induction group as compared with expectant group . Incidence of maternal morbidity was comparable in both the groups Neonatal morbidity was higher in expectant group . Incidence of hyper stimulation were more with induction group as compared to expectant group. There was no maternal or perinatal mortality in any group. Intrapartum complications and mode of delivery were similar in both groups Conclusion: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval but increased rate of operative intervention. Maternal morbidity was comparable with induction and expectant line of management. However, neonatal morbidity was higher in expectant group
Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study
Thomas Popowski, Fran?ois Goffinet, Fran?oise Maillard, Thomas Schmitz, Sandrine Leroy, Gilles Kayem
BMC Pregnancy and Childbirth , 2011, DOI: 10.1186/1471-2393-11-26
Abstract: We conducted a two-center prospective study of all women admitted for premature rupture of membranes at or after 34 weeks of gestation. The association of C-reactive protein, white blood cell count, vaginal sample bacteriological results, and a prediction model at admission, for early-onset neonatal infection and maternal chorioamnionitis were analyzed by comparing areas under the receiver operating characteristic curves and specificity.The study included 399 women. In all, 4.3% of the newborns had an early-onset neonatal infection and 5.3% of the women had clinical chorioamnionitis. Histological chorioamnionitis was detected on 10.8% of 297 placentas tested. White blood cell counts and C-reactive protein concentrations were significantly associated with early-onset neonatal infection and included in a prediction model. The area under the receiver operating characteristic curve of this model was 0.82 (95% CI [0.72, 0.92]) and of C-reactive protein, 0.80 (95% CI [0.68, 0.92]) (p = 1.0). Specificity was significantly higher for C-reactive protein than for the prediction model (48% and 43% respectively, p < 0.05). C-reactive protein was associated with clinical and histological chorioamnionitis, with areas under the receiver operating characteristic curve of 0.61 (95% CI [0.48, 0.74]) and 0.62 (95% CI [0.47, 0.74]), respectively.The concentration of C-reactive protein at admission for premature rupture of membranes is the most accurate infectious marker for prediction of early-onset neonatal infection in routine use with a sensitivity > 90%. A useful next step would be a randomized prospective study of management strategy comparing CRP at admission with active management to assess whether this more individualized care is a safe alternative strategy in women with premature rupture of membranes at or after 34 weeks.Premature rupture of membranes (PROM) occurs in 8% of pregnancies, 3% before and 5% after 37 weeks of gestation [1]. Accurate prediction of infection, includi
'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5)
Sedigheh Borna, Hajieh Borna, Soghra khazardoost, Sedigheh Hantoushzadeh
BMC Pregnancy and Childbirth , 2004, DOI: 10.1186/1471-2393-4-15
Abstract: We performed a prospective cohort study of 95 singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 26 and 34 weeks gestation.Patients were categorized in two groups on the basis of amniotic fluid index<5, (AFI<5 cm)(n = 26) or AFI ≥ 5 cm (n = 69). Categorical data were tested for significance with the χ2 and Fisher exact tests. Continuous data were evaluated for normal distribution and tested for significance with the student t test.All 2-sided p values < 0.05 were considered significant.Both groups were similar with respect to selected demographics, gestational age at rupture of the membranes, gestational age at the delivery, birth weight. Both groups were similar with respect to selected variable, latency until delivery, early onset neonatal sepsis, RDS and neonatal death. Patients with AFI<5 cm demonstrated greater frequency of C/S delivery for non reassuring fetal tests (23%vs 2.8%) (p = 0.001). Our study demonstrated that patients in group I had a significant increase in the frequency of clinical chorioamnionitis (P < 0/001). Post partum infections were not seen in 2 groups.An AFI<5 cm after PPROM between 26 and 34 weeks gestation is associated with an increased risk of maternal infections and frequency of C/S.Preterm premature rupture of the membranes (PPROM) is one of the most common complications of the pregnancy.Preterm PROM is an important cause of perinatal morbidity and mortality, particularly because it is associated with brief latency from membrane rupture to deliver, perinatal infection, and umbilical cord compression due to oligohydramnios. PPROM is multifactor in nature. In any given patient, one or more path physiologic processes may be evident. Choriodecidual infection or inflammation appears to play an important role in etiology of preterm PROM, especially at early gestational ages.It has also been proposed that amniotic fluid posse's certain bacteriostatic properties that protect against p
A comparative study of maternal & neonatal outcome and patient satisfaction with intravaginal misoprostol versus intravenous oxytocin in patients with premature rupture of membranes beyond 36 weeks gestation  [cached]
Bhaumik Shah,Noopur Nagar,Shashwat S. Nagar
International Journal of Basic & Clinical Pharmacology , 2013, DOI: 10.5455/2319-2003.ijbcp20130616
Abstract: Background: Premature rupture of membranes (PROM) occurs in about 10% of patients beyond 36 weeks of gestation. In this situation, labor induction with prostaglandins, has been proved to be beneficial and results in decreased chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. Many techniques for induction of labor are available. This prospective randomized comparative study was thus taken up to compare the outcomes of misoprostol versus oxytocin with respect to the maternal and neonatal outcomes and patient satisfaction. Methods: A prospective randomized study was carried out where 200 women admitted to department of obstetrics & gynecology, Pravara Rural Hospital, PMT, Loni with PROM beyond 36 weeks of gestation were included where 100 each were included in two groups- vaginal misoprostol group & oxytocin infusion group. Results: Nearly 58% of the cases of PROM were in the age group 21-25 yrs. Vaginal deliveries were 42% in misoprostol group, where as 44% in oxytocin group; whereas LSCS were 7% in misoprostol group and 5% in oxytocin group. Maximum number of cases had APGAR score between 7-10 in both the groups. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction. Conclusions: Labor induction with oxytocin infusion for PROM beyond 36 weeks in an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with transvaginal misoprostol. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction. [Int J Basic Clin Pharmacol 2013; 2(3.000): 315-319]
Acute Histologic Chorioamnionitis Is a Risk Factor for Adverse Neonatal Outcome in Late Preterm Birth after Preterm Premature Rupture of Membranes  [PDF]
Seung Mi Lee, Jeong Woo Park, Byoung Jae Kim, Chan-Wook Park, Joong Shin Park, Jong Kwan Jun, Bo Hyun Yoon
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079941
Abstract: Background The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM. Methodology/Principal Findings The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005) than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids. Conclusions/Significance The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.
The clinical and microbiological correlates of premature rupture of membranes  [cached]
Karat C,Madhivanan P,Krupp K,Poornima S
Indian Journal of Medical Microbiology , 2006,
Abstract: Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E . coli , S . aureus , C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.
Preterm and premature rupture of membranes in pregnancies after in vitro fertilization  [PDF]
Tabs Dunja,Vejnovi? Tihomir,Radunovi? Neboj?a
Medicinski Pregled , 2005, DOI: 10.2298/mpns0508375t
Abstract: Women conceiving by assisted reproduction are at higher risk for preterm and premature rupture of membranes. The aim of our study was to estimate and compare incidence of preterm premature rupture of membranes in singleton pregnancies of women who conceived by intrauterine insemination and in vitro fertilization, from 1999 to 2003. We investigated 87 women from the intrauterine insemination, and 102 from the in vitro fertilization program. There were no statistically significant differences in regard to preterm and premature rupture of membranes: p>0.75 in two groups. The incidence of premature rupture of membranes was 2.30% (after intrauterine insemination) and 2.94% (after in vitro fertilization). There was no statistically significant differences in regard to preterm and premature rupture of membranes in women who conceived by insemination and in vitro fertilization. Estimated incidence of preterm and premature rupture of membranes was similar to the literature data and also similar to incidence after natural conception.
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