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Induction of labour versus expectant management in women with preterm prelabour rupture of membranes between 34 and 37 weeks (the PPROMEXIL-trial)
David P van der Ham, Jan G Nijhuis, Ben Mol, Johannes J van Beek, Brent C Opmeer, Denise Bijlenga, Mariette Groenewout, Birgit Arabin, Kitty WM Bloemenkamp, Wim J van Wijngaarden, Maurice GAJ Wouters, Paula JM Pernet, Martina M Porath, Jan FM Molkenboer, Jan B Derks, Michael M Kars, Hubertina CJ Scheepers, Martin JN Weinans, Mallory D Woiski, Hajo IJ Wildschut, Christine Willekes
BMC Pregnancy and Childbirth , 2007, DOI: 10.1186/1471-2393-7-11
Abstract: We aim to determine the effectiveness and cost-effectiveness of immediate delivery after PPROM in near term gestation compared to expectant management. Pregnant women with preterm prelabour rupture of the membranes at a gestational age from 34+0 weeks until 37+0 weeks will be included in a multicentre prospective randomised controlled trial. We will compare early delivery with expectant monitoring.The primary outcome of this study is neonatal sepsis. Secondary outcome measures are maternal morbidity (chorioamnionitis, puerperal sepsis) and neonatal disease, instrumental delivery rate, maternal quality of life, maternal preferences and costs. We anticipate that a reduction of neonatal infection from 7.5% to 2.5% after induction will outweigh an increase in RDS and additional costs due to admission of the child due to prematurity. Under these assumptions, we aim to randomly allocate 520 women to two groups of 260 women each. Analysis will be by intention to treat. Additionally a cost-effectiveness analysis will be performed to evaluate if the cost related to early delivery will outweigh those of expectant management. Long term outcomes will be evaluated using modelling.This trial will provide evidence as to whether induction of labour after preterm prelabour rupture of membranes is an effective and cost-effective strategy to reduce the risk of neonatal sepsis.ISRCTN29313500Preterm prelabour rupture of the membranes (PPROM) is an important clinical problem and a dilemma for the gynaecologist. On the one hand, awaiting spontaneous labour may lead to an increase in infectious disease for both mother and child, whereas on the other hand induction of labour leads to preterm birth with an increase in neonatal morbidity (e.g., respiratory distress syndrome (RDS)) and a possible rise in the number of instrumental deliveries.The estimated incidence of PPROM between 34 and 37 weeks of gestation is 1.5%, which equals about 3.000 cases per year in the Netherlands. The incidence o
Amenaza de parto prematuro: Rotura prematura de membranas. Corioamnionitis Preterm labour: Premature rupture of membranes. Chorioamnionitis
A. Ochoa,J. Pérez Dettoma
Anales del Sistema Sanitario de Navarra , 2009,
Abstract: Cuanto menor es la edad gestacional al nacer, mayor es el riesgo de morbimortalidad perinatal y de morbilidad materna (aumento del número de cesáreas, metritis postparto). Es importante diagnosticar a tiempo una amenaza de parto prematuro (APP) para comenzar con el tratamiento tocolítico y conseguir una maduración pulmonar fetal eficaz. También es necesario distinguir lo que es una verdadera de una falsa APP. Hay una alta incidencia de sobrediagnóstico y de sobretratamiento y es frecuente la hospitalización prolongada. Con las pruebas que informan sobre la modificación cervical y la dinámica uterina se puede establecer un diagnóstico certero que conlleve una conducta adecuada. La identificación temprana y la prevención primaria no están tan desarrolladas como la actitud terapeútica, pero es importante tener en cuenta mecanismos para identificar pacientes de alto riesgo. Entre ellos están los antecendentes de parto pretérmino, signos y síntomas, modificación cervical, etc. La rotura prematura de membranas y la corioamnionitis conllevan riesgo de parto pretérmino si se producen en edades gestaciones tempranas. The lower the gestational age at birth, the greater the risk of perinatal morbidity and mortality and maternal morbidity (increase in the number of caesareans, postnatal metritis). It is important for there to be a timely diagnosis of threatened preterm labour (TPL) in order to begin tocolytic treatment and to obtain efficient foetal pulmonary maturity. It is also necessary to distinguish between a true and a false TPL. There is a high tendency of overdiagnosis and overtreatment and prolonged hospitalisation is frequent. With cervical alteration and uterine dynamics tests it is possible to establish an accurate diagnosis that will result in suitable management. Early identification and primary prevention are not as developed as the therapeutic attitude, but it is important to bear in mind mechanisms for identifying high risk patients. They include antecedents of preterm labour, signs and symptoms, cervical alteration, etc. Premature rupture of membranes and chorioamnionitis involve the risk of preterm labour if they occur in early gestational ages.
3. A comparative study of outcome of labour induction with vaginal misoprostol versus intravenous oxytocin in premature rupture of membranes beyond 36 weeks of gestation
Vidyadhar B. Bangal,Purushottam A. Giri,Bhaumik G. Shah
International Journal of Pharmaceutical and Biomedical Research (IJPBR) , 2011,
Abstract: Induction of labour is indicated, when it is agreed that the fetus or mother will benefit with a higher probability of a healthy outcome, than if birth is delayed. Oxytocin is being used for decades for the purpose of labor induction in premature rupture of membranes (PROM). misoprostol (PgE1), a newer prostaglandin has shown promising results for the same purpose. The efficacy and safety of vaginal misoprostol and intravenous oxytocin for labor induction, in premature rupture of membranes beyond 36 weeks of gestation was evaluated and compared. A prospective randomized study of two hundred women (100 each from vaginal misoprostol group and intravenous oxytocin group) with premature rupture of the membranes beyond 36 weeks' of gestation, was carried out for two years at Pravara Rural Hospital, Loni. Results were analysed using Statistical Package of Social Sciences (SPSS) v13.0. Induction to delivery interval was significantly longer (p<0.05) in oxytocin group (7.17±1.20h in primigravidas and 6.06±1.09h in multigravidas) as compared to misoprostol group (6.61±1.06 h in primigravidas and 5.27±1.11 h in multigravidas). Mean induction delivery interval with misoprostol was 8.5h and with oxytocin was 9.3h. Labor induction with oxytocin infusion in PROM cases, beyond 36 weeks of gestation, in an unfavorable cervix was associated with higher rate of failed induction, longer duration of labor and higher rate of cesarean section, in comparison to those with vaginal misoprostol.
F. Nili AA. Shams Ansari
Acta Medica Iranica , 2003,
Abstract: Premature rupture of membranes (PROM) is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91%) cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86%) of neonates was less than 37 completed weeks. Thirty five infants (21.47%) had respiratory distress syndrome and 33 (20.245%) had clinical sepsis. Pneumonia in 6 (3.7%) and skeletal deformity in 7 (4.294%) were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6%) of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours ) showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11%) of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane were higher than previous studies.
Spontaneous Pre-Labour Rupture of Membranes at Term: Immediate versus Delayed Induction of Labour
A Ohonsi, A Ashimi, S Adeleke
West African Journal of Medicine , 2009,
Abstract: BACKGROUND: Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery. OBJECTIVE: To compare the outcome of labour in women who had immediate induction of labour, with those who had delayed induction following SPROM at term. METHODS: A prospective case control study of 200 women who had either immediate induction of labour with intravaginal misoprostol tablets, or delayed induction with intravenous oxytocin infusion after an expectant period of 12 hours, at Aminu Kano Teaching Hospital, Kano, Nigeria. The outcome of labour was compared in the two groups using the Z test and Chi square test, while, p-value of less than 0.05 was taken as significant. The odds ratio (OR) and 95% confidence interval were also determined where appropriate RESULTS: Immediate induction of labour with intravaginal misoprotol resulted in lower rates of caesarean section and operative vaginal delivery, with a higher rate of spontaneous vaginal delivery. The duration of latent phase of labour and hospital stay before delivery was statistically significantly shorter in the immediate induction group. Neonatal and maternal morbidity were insignificant and comparable between the two groups. CONCLUSION: Immediate induction of labour with intravaginal misoprotol resulted in significantly lower rates of intervention without compromising fetomaternal outcome. We recommend the immediate induction of labour with proper use of intravaginal misoprotol in women with SPROM at term. WAJM 2009; 28(3): 156–160.
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.
Premature Rupture of Membranes Characteristics, Determinants, and Outcomes of in Benghazi, Libya  [PDF]
Milad M. M. Gahwagi, Musa O. Busarira, Mona Atia
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.59072
Abstract: Premature rupture of membranes (PROM) is a frequent phenomenon that occurs in about 4% - 7%. However, the associated sequent problems are proportionally high. Almost two thirds of PROM are spontaneous, common risk factor young mother, multiple pregnancy, genital tract infection, previous preterm delivery. The complications range from induction of labour, caesarean section, fetal pulmonary morbidity and even mortality. Objectives of the Study: To identify and quantify the risk factors and complications of premature rupture of membrane in pregnant women in Benghazi, Libya, 2012. Material and Methods: 100 pregnant women diagnosed as PROM were examined for the physical signs. Detailed gynaecological and obstetric history was reported. Laboratory investigations included cervical swabs and posterior fornix swabs under aseptic conditions Drugs including types of antibiotics, Dexamethasone and tocolytics were also included. Results: The mean age of 100 patients was 28.9 years. Most of them, 66.1% of patients received antibiotis mostly Erythromycin. Dexamethasone was given for 32.1%. FTND accounted for 62% and PTND for 10% and Caesarean section was performed for 28%. The main indications for C/S were failed induction, in 50%, 11.8% were equally distributed between; macrosomia, previous scars, drained liquor, previous C/S, breech presentation. Only 1% of new born babies had complication. Conclusions and Recommendations: Further large studies should be done for more elaboration and analytical studies to quantify the strength of each risk factor. Strategy for management of PROM should be adopted for proper timing of induction, emergency caesarean intervention with ultimate goals of minimizing and or preventing maternal and fetal complications of disease.
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.
The experience of women in hospital rest with preterm premature rupture of de amniotic membranes  [cached]
Aránzazu Domínguez Luna,María del Mar Fernández Míguez,Mónica Rojo López
NURE Investigación , 2012,
Abstract: Hospital bed rest in a preterm premature rupture of the amniotic membranes involves a crisis situation for women with very high emotional effects.To understand the needs felt of the gestantes with pregnancies of high risk on the part of the professionals, it will improve the quality of the attention and it can help to diminish the stress levels at this vulnerable period and to confronting the maternity.Aim: Investigate women′s experience when they are resting in hospital in cases de preterm premature rupture of membranes.Methodology: Phenomenological study, It has taken as a population of study to women hospitalized in the plant of obstetrics of high risk from Gregorio Mara ón Hospital, with preterm premature rupture of membranes between 24 and 31 weeks of gestation.Data collection: Was be carried out by means of the individual interviews in hospitable environment; observation and withdrawal of notes during the accomplishment of this one.
Preterm Premature Rupture of Membranes in Human Immunodeficiency Virus-Infected Women: A Novel Case Series  [PDF]
Kjersti M. Aagaard-Tillery,Monique G. Lin,Virginia Lupo,Alan Buchbinder,Patrick S. Ramsey
Infectious Diseases in Obstetrics and Gynecology , 2006, DOI: 10.1155/idog/2006/53234
Abstract: Objective. To evaluate the management and outcomes of a series of human immunodeficiency virus-(HIV-) infected women whose pregnancies were complicated by preterm premature rupture of membranes (PPROM). Study design. We conducted a retrospective chart review of all women with confirmed HIV infection who had a pregnancy complicated by PPROM remote from term. PPROM remote from term was defined as rupture of membranes prior to 32-week gestation. Collective cases from two centers (Hennepin County Medical Center and The University of Alabama at Birmingham) were reviewed and data on management and outcomes were abstracted. Results. Of the HIV-positive women, we identified 291 pregnancies having occurred in the study interval from two institutions. Of these pregnancies, 7 (2.4%) developed PPROM remote from term with subsequent delivery from 25- to 32-week gestation. Vertical HIV transmission was noted in 2 of 6 children whose long-term followup status was confirmed (33%) of these cases. However, both of these cases occurred in women with either no antepartum/intrapartum antiviral therapy or where only zidovudine monotherapy was used. Importantly, in spite of expectant management, no cases of vertical HIV transmission occurred in women who were receiving either multidrug or highly active antiviral therapy (HAART) at the time of PPROM and who had a cesarean delivery in cases where the predelivery viral load > 1000 copies/mL. Conclusion. Our limited observations raise the question as to whether in the current era of multidrug therapy immediate delivery should be undertaken in HIV
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