Preterm premature rupture of membranes

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A study on active versus expectant management and perinatal outcome of preterm premature rupture of membranes between 32-37 weeks of pregnancy

A study on active versus expectant management and perinatal outcome of preterm premature rupture of membranes between 32-37 weeks of pregnancy

I solemnly declare that this dissertation entitled “A STUDY ON ACTIVE VERSUS EXPECTANT MANAGEMENT AND PERINATAL OUTCOME OF PRETERM PREMATURE RUPTURE OF MEMBRANES BETWEEN 32-37 WEEKS OF PREGNANCY” was done by me at The Institute Of Social Obstetrics, Govt Kasturba Gandhi Hospital, Madras Medical College during 2011-2014 under the guidance and supervision of, Prof. Dr. S. BABY VASUMATHI MD. DGO. This dissertation is submitted to the TamilNadu Dr. M.G.R. Medical University towards the partial fulfillment of requirements for the award of M.S. Degree in Obstetrics and Gynaecology.
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A study of perinatal outcome in preterm premature rupture of membranes

A study of perinatal outcome in preterm premature rupture of membranes

I solemnly declare that this dissertation “A STUDY OF PERINATAL OUTCOME IN PRETERM PREMATURE RUPTURE OF MEMBRANES” was prepared by me under the guidance and supervision of Dr.Arasi Srivathsan, MD, OG., Professor, Institute of Social Obstetrics and Gynaecology, Kasturba Gandhi Hospital, Madras Medical College, Triplicane, Chennai.

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Active Versus Expectant Management in women with preterm premature rupture of membranes between 34 and 37 weeks of gestation

Active Versus Expectant Management in women with preterm premature rupture of membranes between 34 and 37 weeks of gestation

expression is not known, but bacterial products and/or the pro inflammatory cytokines, IL-1 β and TNF- α , as paracrine or autocrine signals may trigger these processes in pregnancies complicated with intra amniotic infections (VallidoOrtego et al). In 2003, Romero et al described MMP-3 as a physiological constituent of amniotic fluid that may play a role in the mechanism of human parturition and in the regulation of host response to intrauterine infection. Microbial invasion of amniotic cavity in preterm gestation has also been associated with a significant increase in amniotic fluid concentration of MMP-7, playing a role in host defense mechanism. (Maymon E, Romero R, Pacona P et al). Marked elevations of mid trimester amniotic fluid MMP-8 have also been found to be associated with subsequent preterm premature rupture of membranes, suggesting that pathophysiological processes that contribute to preterm premature rupture of membranes may begin early in pregnancy (Biggio Jr JR et al).
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Relationship of chorioamnionitis with neonatal sepsis in preterm premature rupture of membranes- A Study

Relationship of chorioamnionitis with neonatal sepsis in preterm premature rupture of membranes- A Study

Preterm premature rupture of membranes (pPROM) is an important cause of premature delivery. Although exact etiology of pPROM is unknown butvarious risk factors associated are: Black race, 1 low socioeconomic status, smoking, history of sexually transmitted infections, preterm delivery and uterine distension (e.g., polyhydramnios, multifetal pregnancy). 2 Preterm premature rupture of membranes (pPROM) is one of the significant contributor for prematurity. It complicates only 2% pregnancies but is associated with 40%of preterm deliveries 1 .pPROM is strongly associated with maternal infectious morbidity like chorioamnionitis, endometritis and bacteraemia. It increases the risk of prematurity and can lead to significant perinatal morbidity, including respiratory distress syndrome (RDS),
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Lamellar body count as a predictor of neonatal respiratory distress syndrome in preterm premature rupture of membranes

Lamellar body count as a predictor of neonatal respiratory distress syndrome in preterm premature rupture of membranes

Background: Lamellar bodies are present in amniotic fluid and their quantity increases with increased gestational age. Preterm premature rupture of the membranes (P-PROM) is one of the most common complications of pregnancy and is a major cause of preterm deliveries and thus the important cause of RDS. Fetal pulmonary maturity can be assessed by direct or indirect measurement of surfactant phospholipids secreted by the fetal lungs into amniotic fluid. Lamellar body count (LBC) has been introduced as an alternative to other methods.
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AZITHROMYCIN VERSUS ERYTHROMYCIN IN PRETERM PREMATURE RUPTURE OF MEMBRANES

AZITHROMYCIN VERSUS ERYTHROMYCIN IN PRETERM PREMATURE RUPTURE OF MEMBRANES

6- Mercer BM, Miodovnik M and Thurnau GR .(1997): Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal- Fetal Medicine Units Network. JAMA. Sep 24 1997;278(12):989-95.

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Preterm premature rupture of membranes: maternal and perinatal outcome

Preterm premature rupture of membranes: maternal and perinatal outcome

Methods: The present study is a prospective observational study of perinatal and maternal outcome in 100 cases of preterm premature rupture of membranes in between 2837 weeks gestation with singleton pregnancy, from 1st March 2013 to 28th February 2014. Patients with medical complications like anemia, preexisting hypertension, diabetes, vascular or renal disease, multiple gestations, uterine or fetal anomalies etc. are excluded from the study. Detailed history, physical examinations were carried out and appropriate management instituted as per individual patients need.
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A study of perinatal outcome in preterm premature rupture of membranes

A study of perinatal outcome in preterm premature rupture of membranes

The gestational age was calculated from LMP, if there is discrepancy of more than seven days between LMP and early weeks USG and consecutive two coincide then USG EDD taken in to account. Per speculum examination done to confirm the diagnosis of preterm premature rupture of membranes. Digital examination only be done only when the patient is in the active labour. The above-mentioned patients were closely monitored throughout labour. Immediately after delivery paediatrician was called over and look sign of infection and Respiratory distress syndrome.
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Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study

Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study

Midtrimester preterm premature rupture of membranes (PPROM) is an uncommon complication, occurring in less than 1 % of pregnancies [1]. PPROM is an important contributor to perinatal mortality and morbidity; in pregnancies that continue following PPROM at early gestations, morbidity is high among surviving neonates with problems including respiratory distress syndrome, pulmonary hypoplasia, intraventricular haemorrhage and limb contractures [2]. Pregnancies complicated by PPROM early in pregnancy, when the risk of pulmonary hypoplasia is highest, present a counselling and manage- ment dilemma. It is difficult to predict the eventual out- come as many factors impact on this – the development of sepsis, the eventual gestational age at delivery and the degree of oligohydramnios. There is a wide variety in chorioamnionitis rates and survival rates quoted in the literature. Chorioamnionitis ranged from 28 to 42 % [3, 4], whilst survival rates quoted range from 6.25 [3] to 100 % [5], dependant on gestation. Advances in neonatal care, particularly intensive care to those at the threshold of via- bility, have dramatically enhanced survival rates. These changes, which reflect a multimodal approach to care, include advances in newborn stabilisation, surfactant administration, optimising respiratory support, the use of nitric oxide and reduction in associated morbidities such as infection and intraventricular haemorrhage and the use of probiotics to reduce necrotising enterocolitis (NEC) [6]. There is a paucity of contemporary evidence about the natural history of these pregnancies as therapeutic ter- mination of pregnancy is routinely offered as standard care in many countries. Termination of pregnancy was not available in Ireland during the time period of this study. However, the publication of the Protection of Life during Pregnancy Act in 2013, provided clarification that termination of pregnancy may be performed if there is a “real and substantial risk of loss of the woman’s life from a physical illness” [7]. There remains an absence of clear guidance if there is no imminent threat to maternal life or health, even in the case of fatal fetal abnormality or where prognosis for the fetus is poor.
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Role of amniotic fluid index on maternal and neonatal outcomes among obstetric women with preterm premature rupture of membranes

Role of amniotic fluid index on maternal and neonatal outcomes among obstetric women with preterm premature rupture of membranes

13. Hargar JH, Hsing AW, Tuomala RE, Gibbs RS, Mead PB, Eschenbach DA, Knox GE, Polk BF, Risk Factors for preterm premature rupture of fetal membranes: a multicentric case control study. Am J Obstet Gynecol.1990:163(1):130-7.

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Effect of antibiotics on inflammatory marker (IL 6) and perinatal outcomes in women with preterm premature rupture of membranes

Effect of antibiotics on inflammatory marker (IL 6) and perinatal outcomes in women with preterm premature rupture of membranes

30. Romero R, Yoon BH, Mazor M, Gomez R, Gonzalez R, Diamond MP, et al. A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and Gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes. Am J Obstet Gynecol 1993;169(4):839–51.

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Pregnancy outcome of preterm premature rupture of membranes

Pregnancy outcome of preterm premature rupture of membranes

Preterm premature rupture of membranes (PPROM) is a common complication of pregnancy and a major cause of both maternal and neonatal morbidity and mortality. Around 3% of pregnancies are complicated by PPROM and is associated with approximately one third of all preterm births (Dinsmoor et al., 2014; Kilpatrick et al., 2006; Mercer, 2005). In the USA, approximately 1% of pregnancies from 16 to 26 completed weeks of gestation are being complicated by PPROM and associated with significant risk of neonatal morbidity and mortality (Nourse and Steer, 1997). In our study, the mean latent period was established to be 8 days, and similar duration was shown in Yang et al where the mean latent period was 8.6 days (Lee et al., 2004), but this was not the case in previously conducted studies which showed much longer latency period of 18.6 days (Nourse and Steer, 1997; Moretti and Sibai, 1988; Vintzileos et al., 1985; Vermillion et al., 2000). Perhaps the reason for this shorter latency period could be consistent with the fact that a large number of patients were presented much later in their gestational age in this retrospective study, as was seen in Patil et al study. More the gestational age of the patients, shorter the latency period would be (Shweta Patil1 et al., 2004). Much emphasis was placed on the rates of caesarean section in our study. 49% of the patients underwent caesarean section in this study which is comparable with the study conducted by Charles et al where the incidence of C- Section was found to be 58.7% (Charles et al., 2005). However, the percentage of caesarean delivery in our study population was shown to be significantly higher than that reported in previous studies (Shehla Noor et al., 2010; Tahir et al., 2002). Probably such higher rates of caesarean section may be attributed
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Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

The most common cause of PPROM before the 37th week of gestation is intrauterine infection (5). Infection occurs in 40–70% of premature deliver- ies. Recent evidence indicates that intrauterine in- fection is one of the main risk factors in newborn’s inflammatory response syndrome, white matter lesions, cerebral palsy, chronic pulmonary illness- es and sepsis (5–9). Therefore accurate prediction of infection, including maternal chorioamnio- nitis and early-onset neonatal infection, remains a critical challenge for obstetrician management in these cases. Late diagnosis and delayed treatment enhance probability of poor long-term outcomes and handicap.
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Non Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

Non Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

The present study was conducted as a retrospective cohort study, including consecutive women diagnosed with PPROM at Seoul National University Bundang Hospital (Seongnam, Korea) between June 2004 and August 2013. The inclusion cri- teria were 1) singleton gestation, 2) a live fetus with a gesta- tional age between 20+0 and 33+6 weeks, 3) transabdominal amniocentesis performed to assess the microbiologic and in- flammatory status of the amniotic cavity and/or fetal lung ma- turity, 4) maternal blood drawn to measure WBC counts and CRP levels at the time of amniocentesis, 5) cervical length mea- sured at the time of amniocentesis, 6) absence of active labor, defined by the presence of cervical dilatation >3 cm by sterile speculum examination, 7) no history of prior or subsequent cervical cerclage, and 8) absence of a major congenital anom- aly. PPROM was defined as spontaneous rupture of the fetal membranes before the onset of uterine contractions, as diag- nosed by a sterile speculum examination to confirm both AF pooling in the vagina and a positive nitrazine test. Digital ex- aminations were not performed until the onset of labor (de- fined by the presence of regular and painful uterine contrac- tions). Non-invasive clinical data collected at the time of enro- llment included demographic variables (maternal age, parity, and number of previous preterm deliveries), gestational age at the time of assessment, CRP level, maternal WBC counts,
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Epigenetic regulation of lncRNA connects ubiquitin proteasome system with infection inflammation in preterm births and preterm premature rupture of membranes

Epigenetic regulation of lncRNA connects ubiquitin proteasome system with infection inflammation in preterm births and preterm premature rupture of membranes

proteases, cysteine proteases, and ADAMTS family mem- bers, can also break down amniochorion ECM substrates [74]. The up-regulated mRNA expression of ADAMTS15 in the PPROM group might indicate that ADAMTS15 probably functioned as MMPs participating in the regula- tion of collagenolysis and ECM degradation in PPROM [5]. Another interesting gene, STAM, encodes a member of the signal-transducing adaptor molecule family, which mediates downstream signaling of the cytokine-cytokine receptor interaction pathway [73]. Host inflammatory re- sponses induced by different pro-inflammatory cytokines (including IL-1β, IL-6, and TNF-α) were closely associated with PPROM [5,75]. The up-regulated expression of STAM mRNA might imply that STAM was probably in- volved in PPROM through regulation of pro-inflammatory cytokine-cytokine receptor interaction. To gain further understanding of the regulation mechanism of STAM in PPROM, KEGG analysis of this gene was processed. The results revealed that STAM was involved in the JAK-STAT signaling pathway (data not shown but available upon request), which could be activated by IL-6 and cytokine re- ceptor interaction. Moreover, depending on the connec- tion with the MAPK or PI3K-Akt signaling pathways, STAM could participate in the regulation of apoptosis. Apoptosis has been demonstrated to play an integral role in PPROM, and IL-6 also has been proved to promote MMP activation or apoptosis of fetal membranes in PPROM. Therefore, STAM might regulate apoptosis of fetal membranes in PPROM by mediating downstream signaling of the IL-6 and cytokine receptor interaction pathway. The last gene in this category was EML4, which encodes a novel microtubule-associated protein belonging to the conserved family of EMAP-like proteins. EML4 has been demonstrated to be essential for microtubule forma- tion [76]. Up-regulated expression of EML4 mRNA might imply that microtubule formation of the cytoskeleton in fetal membranes possibly was abnormal in PPROM. Be- cause lncRNAs and mRNAs of ADAMTS15, STAM, and EML4 were located in opposite strands, lncRNAs in the third category could be complementary to their associated mRNAs. Although no evidence to date has demonstrated that lncRNAs can directly down-regulate their complemen- tary mRNA through the RNAi-like pathway as miRNAs, the opposite expression pattern of antisense lncRNAs and sense mRNAs in this category could be explained by another new finding that lncRNAs could be the host genes for small RNAs [77]. For example, lncRNA H19 is host to miR-675 [78], and the imprinted Gtl2, anti-Rtl1, and Mirg RNAs are hosts to almost 50 miRNAs and 40 snoRNAs [79]. These lncRNAs could yield Dicer- dependent small RNAs and repress their complemen- tary mRNAs through an RNAi-related pathway [77], which might be the mechanism whereby lncRNAs regu- late mRNAs in this category.
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Ancestry informative markers and selected single nucleotide polymorphisms in immunoregulatory genes on preterm labor and preterm premature rupture of membranes: a case control study

Ancestry informative markers and selected single nucleotide polymorphisms in immunoregulatory genes on preterm labor and preterm premature rupture of membranes: a case control study

Regarding PPROM, the presence of IL10-1082G and TLR2A increased the risk for this outcome. Interleukin 10 (IL-10) is a potent regulator of inflammatory re- sponse and altered levels of this mediator are involved in the pathophysiology of PTL and PPROM. Nevertheless, there are contradictory findings regarding the influence of polymorphisms located in its promoter region in the IL-10 expression. Annells et al. associated the low pro- ducing haplotype IL10-1082A-819 T-592A to the inflam- matory events of delivery before 29 weeks of gestation [57] and risk of chorioamnionitis [41] while other au- thors did not find association between these SNPs and adverse pregnancy outcomes [31, 43]. On the other hand, the high producing IL10-819C and IL10-1082G al- leles have also been implicated in the etiology of compli- cations with an inflammatory signature such as preeclampsia [58], and even delivery before 29 weeks of pregnancy [59], and there are reports that correlate the IL10-1082A-819 T-592A haplotype with a reduced risk for small-for-gestational age [60]. In the present we report the association between maternal IL10-1082G and PPROM and between presence of IL10-592C and IL10-819C in babies and PTL. The presence of these alleles may disrupt the balance between pro- and anti- inflammatory cytokines, increasing the risk for PPROM and PTL. It is also worth considering that some of the associations found between SNPs and diseases in genetic studies may be spurious as, as mentioned before, they may reflect differences in the distribution of SNPs in dis- tinct populations and as such are risk markers rather than risk factors. For instance, the allele IL10-592C re- ported here to be more frequent among children born preterm is more common in European populations [47], Table 8 Logistic regression model comparing the PTL and control groups
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Three Year Outcome of Very Low Birth Weight Infants in Conservatively Managed Premature Rupture of Membranes

Three Year Outcome of Very Low Birth Weight Infants in Conservatively Managed Premature Rupture of Membranes

Preterm premature rupture of membranes (PPROM) in the second trimester is one of the main causes of subse- quent early preterm birth [1] [2]. Consequently, it is the cause of considerable neonatal mortality and morbidity, mainly due to prematurity. Moreover, in very low birthweight (VLBW) preterm infants (weighing less than 1500 g) both gestational age at birth and birth weight are related to neurodevelopmentally intact survival [3]. Although optimal management to improve long-term outcome remains undetermined in VLBW infants born af- ter PPROM, conservative management is generally recommended with careful observation of maternal and fetal condition [4] [5]. However, particularly in second trimester PPROM, there can be a conflict between the benefit of prolonging gestational age in the anticipation of fetal growth and the increased chance of intrauterine infec- tion and inflammation [6], which are closely related to PPROM and may also increase infant morbidity [4] [5].
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Risk of spontaneous preterm birth in relation to maternal experience of serious life events during pregnancy

Risk of spontaneous preterm birth in relation to maternal experience of serious life events during pregnancy

Methods: This case-control study included 479 PTB cases and 480 term controls. In-person interviews asked information regarding sociodemographics, medical and reproductive histories, and serious life events experienced during pregnancy. Multivariate logistic regression procedures were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Compared with women who did not experience a serious life event during pregnancy, those who experienced the following life events had a more than two-fold increased odds of PTB: death of first-degree relative (adjusted OR 2.10; 95% CI 1.38–3.20), divorce or separation (adjusted OR 2.09; 95% CI 1.10–4.00), financial troubles (adjusted OR 2.70; 95% CI 1.85–3.94), or serious fight with partner (adjusted OR 2.40; 95% CI 1.78–3.17). Women who experienced any serious life events during pregnancy had higher odds (adjusted OR 2.29; 95% CI 1.65–3.18) of suffering spontaneous preterm labor and preterm premature rupture of membranes (adjusted OR 2.19; 95% CI 1.56–3.08), compared with women who did not experience any such events. Associations of similar directions and extent were observed for severity of PTB (ie, very, moderate, or late PTB). The magnitude of the associations increased as increased frequency of serious life events (P trend ,0.001).
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PERINATAL OUTCOME OF THE INCIDENCES OF PROM AND PPROM – A RETROSPECTIVE STUDY

PERINATAL OUTCOME OF THE INCIDENCES OF PROM AND PPROM – A RETROSPECTIVE STUDY

3. Mercer BM, Goldenberg RL, Meis PJ, et al. The NICHD Maternal-Fetal Medicine Units Network, authors. The Preterm Prediction Study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. Am J Obstet Gynecol, 2000; 183: 738–745. [PubMed]

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A study on management of premature rupture of membranes

A study on management of premature rupture of membranes

Premature rupture of membranes (PROM) is a challenging problem to the obstetricians. During the last three decades it has taken a new dimension because of identification of clinical risk factors and improved fetomaternal outcome due to better management (use of antenatal corticosteroids, improved tocolysis, availability of safer antibacterial agents, safer modes of delivery and improved neonatal care). When membranes rupture before the onset of labor, it is known as premature rupture of membranes (PROM). When PROM occurs before 37 completed weeks of gestation it is termed as preterm premature rupture of membranes (p PROM). 1 In
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