402: Elevated adiponectin in mid trimester amniotic fluid predicts premature rupture of membranes, respiratory distress syndrome and fetal growth restriction

Objective The aim of the present study was to evaluate the impact of residual anhydramnios following preterm premature rupture of membranes (PPROM) on respiratory distress syndrome (RDS) after the pregnancy was expectantly managed. Methods This study was retrospectively conducted at Erciyes University Medical School, Turkey. It assessed women with singleton pregnancies admitted to the hospital between 2010 and 2020 for expectant management of PPROM between 24th and 28th gestational weeks. The patients were divided into three groups as follows: (1) anhydramnios, (2) oligohydramnios, (3) normal amniotic fluid volume (AFV). Main outcome measure was as follows: The first evaluation was AFV at admission and the primary outcome was a neonatal RDS. Adjusted odds ratios (aOR) and 95% confidence interval (CI) for RDS were calculated for each AFV-at-presentation adjusting for gestational age (GA) at PPROM, GA at delivery, latency period, birth-weight percentile, cesarean birth, and chorioamnionitis. Results Of the 440 women with PPROM, 261 fulfilled the inclusion criteria. There were 125 (47.8%) with normal AFV, 71 (27.3%) with oligohydramnios, and 65 (24.9%) with anhydramnios at admission. The maternal demographic characteristics were similar among the groups. Birth weight was significantly different among the groups. RDS was highest in the anhydramnios group (64.6%). Decreased AFV was not associated with RDS in either oligohydramnios or anhydramnios at presentation. A GA at PPROM, latency period >30 days, and cesarean delivery were co-factors in the outcome. Conclusion Our results indicated that oligohydramnios and anhydramnios were not associated with RDS risk, but GA at PPROM and delivery, latency period, and cesarean delivery were independently associated with the RDS risk.

Download Full-text

Latency duration of preterm premature rupture of membranes and neonatal outcome: a retrospective single-center experience

European Journal of Pediatrics ◽

10.1007/s00431-021-04245-2 ◽

2021 ◽

Author(s):

Hanna Müller ◽

Ann-Christin Stähling ◽

Nora Bruns ◽

Christel Weiss ◽

Maria Ai ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Distress Syndrome ◽

Neonatal Outcome ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Latency Duration

AbstractIn preterm premature rupture of membranes (PPROM), a decision between early delivery with prematurity complications and pregnancy prolongation bearing the risk of chorioamnionitis has to be made. To define disadvantages of delayed prolongation, latency duration of PPROM in expectantly managed pregnancies was investigated. We included those PPROMs > 48 h leading to preterm birth prior 37 weeks’ gestation and retrospectively analyzed 84 preterm infants fulfilling these criteria. The association between latency duration/appearance of PPROM and respiratory outcome (primary outcomes) and neurological outcome (secondary outcomes) was investigated. The study showed that latency duration of PPROM is not associated with clinical or histological chorioamnionitis (p = 0.275; p = 0.332). As the numerous clinical parameters show multicollinearity between each other, we performed a multiple regression analysis to consider this fact. Respiratory distress syndrome is significantly associated with gestational age at PPROM (p < 0.001), and surfactant application is significantly associated with PPROM duration (p = 0.014). The other respiratory parameters including steroids and diuretics therapy, bronchopulmonary dysplasia, and the neurological parameters (intraventricular hemorrhage, Bayley II testing at a corrected age of 24 months) were not significantly associated with PPROM duration or gestational age at PPROM diagnosis.Conclusion: Latency duration of PPROM was not associated with adverse neonatal outcome in expectantly and carefully managed pregnancies, but respiratory distress syndrome was pronounced. The observed effect of pronounced respiratory distress syndrome can be treated with surfactant preparations and was not followed by increased rate of bronchopulmonary dysplasia. What is Known:• In case of preterm premature rupture of membranes, a decision between pregnancy prolongation with the risk of chorioamnionitis and early delivery with prematurity complications has to be made.• Chorioamnionitis is a dangerous situation for the pregnant woman and the fetus.• Impaired neurodevelopmental outcome is strongly correlated with pronounced prematurity due to the increased rate of serious complications. What is New:• Respiratory distress syndrome is significantly associated with gestational age at PPROM, and surfactant application is significantly associated with PPROM duration.• Latency duration of PPROM is not associated with adverse respiratory neonatal outcome (therapy with continuous positive airway pressure, therapy with diuretics and/or steroids, bronchopulmonary dysplasia) in expectantly and carefully managed pregnancies.• Intraventricular hemorrhage and Bayley II testing at a corrected age of 24 months are not associated with latency duration of PPROM when pregnancies are carefully observed.

Download Full-text

Respiratory Distress Syndrome in Infants Delivered via Cesarean from Mothers with Preterm Premature Rupture of Membranes: A Propensity Score Analysis

Journal of Pregnancy ◽

10.1155/2020/5658327 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mariko Nakahara ◽

Shunji Goto ◽

Eiji Kato ◽

Atsuo Itakura ◽

Satoru Takeda

Keyword(s):

Mechanical Ventilation ◽

Propensity Score ◽

Cesarean Section ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Cesarean Deliveries

Objective. This study aimed to clarify the effects of cesarean delivery on neonatal respiratory morbidity when women had preterm premature rupture of membranes. Methods. This retrospective study included women with preterm premature rupture of membranes who delivered from 23 weeks to 33 weeks of gestation between January 2009 and December 2014. Neonatal outcomes were compared between infants delivered by cesarean section and those delivered vaginally. The primary outcome was respiratory distress syndrome (RDS). Neonatal intubation and mechanical ventilation periods were secondary outcomes. Propensity score matching was used to compare outcomes between cesarean and vaginal delivery cases. Results. There were 101 cesarean deliveries and 89 vaginal deliveries. A comparison of the presence or absence of neonatal complications based on the delivery type indicated a higher occurrence of RDS with cesarean deliveries (P=0.025). The intubation and mechanical ventilation periods were not significantly longer in neonates delivered via cesarean section. Conclusions. Cesarean delivery is a risk factor for neonatal RDS in women with preterm premature rupture of membranes. Trials identifying long-term neonatal prognoses are needed to further develop optimal management strategies in such cases.

Download Full-text

Docosahexaenoic Acid Supplementation Early in Pregnancy May Prevent Deep Placentation Disorders

BioMed Research International ◽

10.1155/2014/526895 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Jorge A. Carvajal

Keyword(s):

Preterm Birth ◽

Docosahexaenoic Acid ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Preterm Labor ◽

Growth Restriction ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

In Pregnancy

Uteroplacental ischemia may cause preterm birth, either due to preterm labor, preterm premature rupture of membranes, or medical indication (in the presence of preeclampsia or fetal growth restriction). Uteroplacental ischemia is the product of defective deep placentation, a failure of invasion, and transformation of the spiral arteries by the trophoblast. The failure of normal placentation generates a series of clinical abnormalities nowadays called “deep placentation disorders”; they include preeclampsia, fetal growth restriction, preterm labor, preterm premature rupture of membranes, in utero fetal death, and placental abruption. Early reports suggested that a LC-PUFAs (long chain polyunsaturated fatty acids) rich diet reduces the incidence of deep placentation disorders. Recent randomized controlled trials are inconsistent to show the benefit of docosahexaenoic acid (DHA) supplementation during pregnancy to prevent deep placentation disorders, but most of them showed that DHA supplementation was associated with lower risk of early preterm birth. We postulate that DHA supplementation, early in pregnancy, may reduce the incidence of deep placentation disorders. If our hypothesis is correct, DHA supplementation, early in pregnancy, will become a safe and effective strategy for primary prevention of highly relevant pregnancy diseases, such as preterm birth, preeclampsia, and fetal growth restriction.

Download Full-text