Expectant management of preterm premature rupture of membranes: is it all about gestational age?

2011 ◽  
Vol 204 (1) ◽  
pp. 48.e1-48.e8 ◽  
Author(s):  
Nir Melamed ◽  
Avi Ben-Haroush ◽  
Joseph Pardo ◽  
Rony Chen ◽  
Eran Hadar ◽  
...  
Keyword(s):  
Gestational Age ◽  
Expectant Management ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture

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

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.

Preterm Premature Rupture of Membranes

2021 ◽  
Author(s):  
Daniel Castro ◽  
Errol R. Norwitz
Keyword(s):  
Broad Spectrum ◽  
Gestational Age ◽  
Inpatient Care ◽  
Expectant Management ◽  
Intrauterine Infection ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Broad Spectrum Antibiotics ◽  
Twin Pregnancies

Preterm premature rupture of membranes (PPROM) refers to rupture of the fetal membranes prior to 37-0/7 weeks’ gestation and prior to the onset of labor. PPROM complicates 2-4% of singleton pregnancies and 7-20% of twin pregnancies, and has been implicated in 30-40% of preterm births. Antepartum management involves confirming the diagnosis, excluding contraindications to expectant management (such as stillbirth, nonreassuring fetal testing, and intrauterine infection), and continued inpatient care with perinatology/NICU consultation, antenatal corticosteroids, broad-spectrum antibiotics (to prolong latency), and serial fetal surveillance. Delivery is indicated in the setting of nonreassuring fetal testing, intrauterine infection, excessive vaginal bleeding, preterm labor, and/or a gestational age of 34 weeks or beyond. Latency (time from rupture of membranes to delivery) depends on gestational age, severity of oligohydramnios, number of fetuses (shorter in twins), pregnancy complications (placental abruption, infection), fetal wellbeing, and use of broad-spectrum antibiotics. PPROM cannot be accurately predicted or prevented. Appropriate evidence-based management is essential to optimize outcome for both the mother and fetus in the setting of PPROM. This review contains 1 table, 2 figures and 57 references. Key words: chorioamnionitis, preterm birth, perinatal morbidity, twin pregnancies, preterm premature rupture of membranes (PPROM), fetal complications, maternal complications, labor and delivery, inpatient care, antepartum management

scholarly journals Active versus expectant management of preterm premature rupture of membrane before 34 weeks and neonatal outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 501
Author(s):  
Gouda A. P. Kartikeswar ◽  
Dhyey I. Pandya ◽  
Siddharth Madabhushi ◽  
Vivek M. Joshi ◽  
Sandeep Kadam
Keyword(s):  
Gestational Age ◽  
Neonatal Outcome ◽  
Tertiary Care ◽  
Expectant Management ◽  
Active Management ◽  
Respiratory Support ◽  
Care Hospital ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference

Background: Preterm premature rupture of membranes (PPROM) predisposes the mother for chorioamnionitis, endometritis, bacteremia and neonate to preterm delivery related complication. There is often dilemma regarding the management of PPROM in mothers with gestational age (GA) <34 weeks.Methods: A retrospective cohort study conducted in a tertiary care hospital over two year period. Neonates delivered before 34 weeks were enrolled and categorized into active management (AM) and expectant management (EM) group. Associated risk factors, duration of PPROM and latency period, Neonatal outcomes like sepsis, morbidity, duration of respiratory support, duration of NICU stay compared between groups.Results: Out of total 197 cases, AM group had 91 babies. Active management resulted in earlier delivery [mean GA (SD): 30.88(1.8) VS 31(2.1) weeks], higher number of caesarian section (76.9% versus 53.8%), lesser birth weight {1233.6 (±282.9) versus 1453.39 (±380.6) gm} and more ELBW babies (23.1% versus 7.5%). EM resulted in significantly higher antenatal steroid cover (73.6% in AM versus 89.6% in EM) and lesser need of surfactant for RDS [42.9% versus 28.3%]. Significant difference was found for NICU stay days {mean (SD): 25.46 (16.8) versus 20.94 (17.5)}. No difference found between respiratory support days [median (IQR) 2 (0, 6) versus 2 (0, 7)]. No significant differences found in incidence of maternal chorioamnionitis, NEC, sepsis, BPD and ROP. Early delivery resulted in higher mortality though that was statistically not significant.Conclusions: Gestational age at delivery is more important predictor of neonatal outcome then PPROM in early preterm. 

scholarly journals Patterns of placental pathology in preterm premature rupture of membranes

2013 ◽  
Vol 4 (3) ◽  
pp. 249-255 ◽  
Author(s):  
J. Armstrong-Wells ◽  
M. D. Post ◽  
M. Donnelly ◽  
M. J. Manco-Johnson ◽  
B. M. Fisher ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pathological Finding ◽  
Neonatal Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Exact Test ◽  
Preterm Premature Rupture ◽  
Chorionic Plate ◽  
Adverse Neonatal Outcomes ◽  
Insight Into

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.

scholarly journals Treatment of Preterm Premature Rupture of Membranes with Oligo-/Anhydramnion Colonized by Multiresistant Bacteria with Continuous Amnioinfusion and Antibiotic Administrations through a Subcutaneously Implanted Intrauterine Port System: A Case Report

2015 ◽  
Vol 42 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Michael Tchirikov ◽  
Zhaxybay Zhumadilov ◽  
Andreas Suhartoyo Winarno ◽  
Roland Haase ◽  
Jörg Buchmann
Keyword(s):  
Good Condition ◽  
Expectant Management ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Antenatal Corticosteroids ◽  
Amniotic Cavity ◽  
Preterm Premature Rupture ◽  
System A ◽  
Multiresistant Bacteria ◽  
Port System

Bacterial infection is one of the main causes of preterm premature rupture of membranes (PPROM) leading to preterm delivery, pulmonary hypoplasia, sepsis and joint deformities. Expectant management, broad-spectrum antibiotics and antenatal corticosteroids are routinely used in this condition with very limited success to prevent bacteremia, chorioamnionitis, funisitis and intra-amniotic infection syndrome. Here, we report a case in which we attempted to treat PPROM at 26+3 weeks of gestation with anhydramnion colonized by multiresistant Klebsiella. A perinatal port system was implanted subcutaneously at 28+0 weeks of gestation, enabling long-term continuous lavage of the amniotic cavity with a hypotonic aqueous composition similar to human amniotic fluid combined with intra-amniotic antibiotic application. The patient gave birth to a preterm female infant at 31+1 weeks without any signs of infection. The girl was discharged with a weight of 2,730 g in very good condition. In the follow-up examinations at 5 months and 1 year of age, there was no apparent neurological disturbance, developmental delay or Klebsiella colonization.

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