Gestational age at preterm premature rupture of membranes: A risk factor for neonatal white matter damage

Inflammation is associated with preterm premature rupture of membranes (PPROM) and adverse neonatal outcomes. Subchorionic thrombi, with or without inflammation, may also be a significant pathological finding in PPROM. Patterns of inflammation and thrombosis may give insight into mechanisms of adverse neonatal outcomes associated with PPROM. To characterize histologic findings of placentas from pregnancies complicated by PPROM at altitude, 44 placentas were evaluated for gross and histological indicators of inflammation and thrombosis. Student's t-test (or Mann–Whitney U-test), χ2 analysis (or Fisher's exact test), mean square contingency and logistic regression were used when appropriate. The prevalence of histologic acute chorioamnionitis (HCA) was 59%. Fetal-derived inflammation (funisitis and chorionic plate vasculitis) was seen at lower frequency (30% and 45%, respectively) and not always in association with HCA. There was a trend for Hispanic women to have higher odds of funisitis (OR = 5.9; P = 0.05). Subchorionic thrombi were seen in 34% of all placentas. The odds of subchorionic thrombi without HCA was 6.3 times greater that the odds of subchorionic thrombi with HCA (P = 0.02). There was no difference in gestational age or rupture-to-delivery interval, with the presence or absence of inflammatory or thrombotic lesions. These findings suggest that PPROM is caused by or can result in fetal inflammation, placental malperfusion, or both, independent of gestational age or rupture-to-delivery interval; maternal ethnicity and altitude may contribute to these findings. Future studies focused on this constellation of PPROM placental findings, genetic polymorphisms and neonatal outcomes are needed.

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Acute Histologic Chorioamnionitis Is a Risk Factor for Adverse Neonatal Outcome in Late Preterm Birth after Preterm Premature Rupture of Membranes

PLoS ONE ◽

10.1371/journal.pone.0079941 ◽

2013 ◽

Vol 8 (12) ◽

pp. e79941 ◽

Cited By ~ 23

Author(s):

Seung Mi Lee ◽

Jeong Woo Park ◽

Byoung Jae Kim ◽

Chan-Wook Park ◽

Joong Shin Park ◽

...

Keyword(s):

Risk Factor ◽

Preterm Birth ◽

Neonatal Outcome ◽

Late Preterm ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Adverse Neonatal Outcome ◽

Preterm Premature Rupture ◽

Late Preterm Birth ◽

Histologic Chorioamnionitis

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Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34–36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1718954 ◽

2020 ◽

Vol 42 (11) ◽

pp. 717-725

Author(s):

Malú Flôres Ferraz ◽

Thaísa De Souza Lima ◽

Sarah Moura Cintra ◽

Edward Araujo Júnior ◽

Caetano Galvão Petrini ◽

...

Keyword(s):

Gestational Age ◽

Perinatal Outcomes ◽

Expectant Management ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Management Group ◽

Group I ◽

Adverse Perinatal Outcomes ◽

Group Ii

Abstract Objective To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. Methods In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Results Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). Conclusion There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

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