Three commonly used methods for confirming rupture of membranes (ROM) are obvious leakage of fluid from the cervix, positive nitrazine test, and ferning. Sonography may be used to confirm oligohydramnios, but is not confirmatory of ROM. Neither of these tests have been found to be 100% sensitive or specific. Despite the significant advances in technology, diagnosis of ROM still requires integration of symptomatology, physical examination, laboratory testing.
This prospective randomized control study was planned to assess the relation of chorioamnionitis with neonatal sepsis in women with preterm premature rupture of membranes between gestation 26 weeks to 34 weeks The two groups had comparable demographic profile. The mean age of the women in the group A was 26.32 ± 4.79years, while that in the group B was 26.14± 3.82 years which was not statistically significant. Demonstrable leakage on speculum examination was present in 85% women and overall 78% women had AFI<5 which were diagnostic criterion in my study. The mean AFI in group A was 3.654 and in group B was 2.085 with p=0.551 which was not clinically significant. The latency period was calculated from the time of membrane rupture till the time of delivery. The mean latency period in the group A was 1.32±2.29 days was less than that in the group B 3.38±6.26 days which was statistically significant (p=0 .001). The rate of vaginal delivery (73.5% vs.(82%) and rate of Caesarean section (26.5% vs. 18%) were
Prelabour rupture of membranes (PROM) is one of the most common clinical problem where a low risk pregnancy can turn into high risk pregnancy at term. Prelabour rupture of membranes is defined by the American college of Obstetrics and gynaecology as “Spontaneous rupture of membranes prior to the onset of regular uterine contractions.” 1 PROM occurs in 6-18% of
Premature rupture of membrane (PROM) is an obstetric problem related to the prevalence, prematurity, morbidity and mortality of perinatal. The etiology of PROM is multifactorial and the mechanism remains unclear. The weakening of amniotic membrane is suspected due to various biochemistry process that causing remodeling and apoptosis, and the stretch of the amniotic membrane. Apoptosis plays an integrated role in the pathogenesis of PROM. The mechanism of apoptosis is through caspase-dependent and caspase-independent pathway. Apoptosis protein such as Apoptosis Inducing Factor (AIF) as caspase independent are hypothesized to be involved as the risk factor of PROM. To determine the role of AIF as caspase independent in the mechanism of patogenesis of premature rupture of membranes. A case-control study with PROM as a case, and non-PROM as a control at 20-42 weeks gestation age. Amniotic tissue was taken after delivery of the placenta. Immunohistochemical examination of AIF was done at Integrated Lab.Biomedic Medical Faculty of Udayana University in Bali. The study was conducted on 37 cases of PROM and 46 cases non PROM. There was no characteristic difference between the case and control groups (p>0.05). The expression of positive AIF is a risk factor of PROM of 5.10 times (OR = 5.10; CI 95% = 1.86 to 13.96; p= 0.001). AIF expression was more in the group of PROM. AIF expression is a risk factor for premature rupture of membranes.
Neonatal sepsis can be divided into two main subtypes depending on whether the onset is during the first 72 hours of life or later. Early onset septicemia is caused by organisms prevalent in the genital tract or in the labor room. Early onset bacterial infections occur either due to ascending infection following rupture of membranes or during the passage of baby through infected birth canal. 5 PROM of duration more than 18 hours is the appropriate cut-off for increased risk of neonatal infection. 6 There are recommendations of antenatal antibiotic administration in pregnant women who had PROM ≥18 hours but the regimen to prevent postnatal neonatal infection still varies among institutions. 7
This study was a prospective study of Outcome of neonates born to mothers with premature rupture of membranes conducted in the department of Paediatrics of Konaseema Institute of Medical Sciences and Research Foundation from January 2016 to June 2017. The present study was carried out at Department of Pediatrics, Konaseema Institute of Medical Sciences and RF, Amalapuram, Andhra Pradesh, India. The sample size is 100 neonates who are born to mothers with premature rupture of membranes.
Premature rupture of membranes is a common complication of pregnancy which leads to increased maternal complications, operative procedures, maternal mortality and morbidity. The present study was conducted at Narayana General Hospital among 200 cases attending the emergency and Department of Obstetrics and Gynecology. In present study the commonest age group was 20-24 years (35%) which correlates with the findings in the study of Kodkany BS et al and Devi A et al. 8,9 Most of the studies demonstrate
remature Rupture of Membranes (PROM) is a condition that occurs in pregnancy when there is rupture of membrane of the amniotic sac and chorion more than one hour before the onset of labor. PROM is prolonged when it occurs more than 18 hours before labor. PROM is preterm (PPROM) when it occurs before 37 weeks gestation and after the viability of the fetus (1) .
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 in- fection, 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 con- ditions 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 compli- cation. Conclusions and Recommendations: Further large studies should be done for more elabo- ration 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.
This study is a prospective randomized case-control study which was done to determine the role of quantitative level of β-hCG in vaginal fluid in diagnosis of premature rupture of membranes. This study was designed on pregnant women attending El-Hussien University and Sohag Teaching Hospitals in gestational age between 20 and 40 weeks. A total of 150 pregnant women were included in this study and were divided into three groups. Group І: PROM group (n=50), group ІІ: suspected PROM group (n=50) and group ІІI: pregnant women with no history of rupture of membranes as control group (n = 50).
Introduction: Rupturing of fetal membranes before week 37 is called preterm premature rupture of membranes (PPROMs). The pathogenesis of PPROM is not definite but it seems that many mechanical and physiological etiologies are involved. As the most important risk factors, having a late history of the same disease, genital infection, prepartum bleeding and smoking can be named. Premature rupture of the membranes is usually seen in preterm births and it accounts for about 1/3 of them.
Background: Premature rupture of membranes is defined as spontaneous rupture of fetal membranes beyond 28weeks of pregnancy but before the onset of uterine contractions. It occurs in approximately 10% of all pregnancies and in 70% it occurs at term. If PROM occurs before 37 completed weeks, it is referred as preterm premature rupture of membranes(PPROM). PROM is associated with adverse outcomes in both, hence its management becomes crucial. It complicates 8% of pregnancies. Objective of present study was to investigate the labour, maternal and perinatal outcomes.
Prelabor or premature rupture of membranes is defined as rupture of membranes before onset of labor . Pre- term prelabor rupture of membrane (PPROM) is prela- bor rupture of membranes that occurs before 37 weeks gestation. PPROM usually results in preterm birth and causes 1/3 of preterm birth. PPROM causes complica- tions not only in the neonate but also in the mother . These complications are more common in PPROM of less than 34 weeks gestation .
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.
The mechanical stress is induced by friction and adhesive forces that inhibit movement of chorion against the amnion or deciduas and prevent dissipation of locally applied forces arising from Foetal movements. Amniotic fluid proteins such an albumin and globulin are good adhesive and might predispose to this situation. On the contrary, surface active phospholipids (surfactants), present in the amniotic fluid can adhere to the membranes making them hydrophobic, and decreasing their surface energy, thus improving their release and boundary lubricating properties. The data indicate that the surface energy of the chorion and amnion in cases of premature rupture of membranes is significantly higher than the membranes that do not rupture prematurely. These membranes do not possess the properties necessary to avoid the buildup of local mechanical stress and protect them from tear. 20
A BSTRACT : Introduction: Premature rupture of membranes represents a major infectious risk for the mother and the fetus; it constitutes a risk factor for chorioamniotitis, puerperal and neonatal sepsis. Reactive protein C is a biological marker widely used in the detection of maternal and fetal infections, in particular in the early diagnosis of chorioamniotitis. The aim of this study is to assess the role of CRP in the diagnosis of chorioamniotitis, and to correlate it with the prediction of neonatal infection and thus review the arguments concerning its usefulness. Materials and methods: This is a retrospective study of patients collected from the Kangaroo unit at the Souissi maternity hospital in Rabat between March 2018 and October 2018, including all parturients having delivered vaginally to an asymptomatic newborn in a premature rupture of membranes context. Clinical and biological monitoring, in particular with reactive protein C in mothers and newborns, was carried out. Results: 238 patients were admitted to the kangaroo service for delivery in premature rupture of the membranes context. In the positive maternal CRP group, 8 women had clinical chorioamiotitis, while no case of clinical chorioamniotitis was recorded in the negative CRP group. In the positive neonatal CRP group, all mothers had a positive CRP while in the neonatal negative CRP group 37.6% of the women had a positive CRP with a P <0.001. Conclusion: Our study suggests that a high rate of maternal CRP before childbirth is a good predictor of chorioamniotitis and neonatal infection.
• Medical disorder complicating pregnancy (chronic hypertension, chronic renal disease and SLE). This was prospective observational study which was carried out those pregnant women admitted with preterm premature rupture of membranes between 28-36 weeks of gestation. Sample size was 200.
Digital examination is generally avoided, but visual inspection of the cervix can accurately estimate cervical dilatation. Digital examination of the cervix with PPROM has been shown to shorten latency and increase risk of infections without providing any additional useful clinical information (Simhan Although the management of PPROM has developed through various cycles of obstetric activity from being neglect to immediate intervention, the key factor in the foetal and maternal outcome is that the diagnosis of prelabour rupture of membranes must be established promptly. Management of PPROM is based on multiple factors: gestational age, foetal viability at the onset of PPROM and -being at the time of rupture of membranes and thereafter. PPROM is either managed ctively. Active management involves delivery 48 hours of rupture of membrane, as the risk of infection is considerably high. Gestational (1962) demonstrated that after 36 weeks of gestation, 80% of the mothers progressed into labour within 24 hours, whereas 70% went in labour within 48 hours. accepted timing for planned delivery for women whose pregnancies are complicated with PPROM is Newton, 2005). Gun et al., (1970) d an increased perinatal mortality rate after 48 hours of PPROM and advocated an early delivery. While, on the other , 1972) recommends expectant management unless there are signs of sepsis, since neonatal INTERNATIONAL JOURNAL