Impact of Maternal Obesity on Perinatal Outcomes in Preterm Prelabor Rupture of Membranes ≥34 Weeks

2019 ◽  
Vol 37 (05) ◽  
pp. 467-474 ◽  
Author(s):  
Tara A. Lynch ◽  
Amol Malshe ◽  
Sarah Colihan ◽  
Jeffrey Meyers ◽  
Dongmei Li ◽  
...  
Keyword(s):  
Maternal Obesity ◽  
Neonatal Outcome ◽  
Univariate Analysis ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Respiratory Support ◽  
Antibiotic Administration ◽  
Significant Difference ◽  
Prelabor Rupture Of Membranes

Abstract Objective This study aimed to compare pregnancy outcomes in obese and nonobese women with preterm prelabor rupture of membranes (PPROM) ≥34 weeks. Study Design The present study is a secondary analysis of a multicenter retrospective cohort of singletons with PPROM from 2011 to 2017. Women with a delivery body mass index (BMI) ≥30 kg/m2 (obese) were compared with women with a BMI < 30 kg/m2 (nonobese). Pregnancies were stratified based on delivery policies of expectant management until 35 weeks versus immediate delivery ≥34 weeks. The primary outcome was a composite neonatal outcome (neonatal sepsis, antibiotic administration for duration >72 hours after delivery or respiratory support). Univariate analysis and general estimating equations models including maternal age, delivery timing, mode of delivery, hospital, and gestational age were used with p < 0.05 level of significance. Results Among 259 pregnancies, 47% were obese. Pregnant women with obesity had increased composite neonatal outcome versus nonobese pregnancies (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (CI): 1.01–2.17]). Obesity was also associated with increased neonatal antibiotic administration for a duration >72 hours after delivery, respiratory support, ventilation, oxygen supplementation, and surfactant administration. When stratified by delivery policies there was no significant difference in perinatal outcomes based on obesity. Conclusion Obese women with PPROM ≥34 weeks have an increased odds of adverse neonatal respiratory and infectious outcomes compared with nonobese women.

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 Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention

2020 ◽  
Vol 10 (04) ◽  
pp. e395-e402
Author(s):  
Felicia LeMoine ◽  
Robert C. Moore ◽  
Andrew Chapple ◽  
Ferney A. Moore ◽  
Elizabeth Sutton
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Intensive Care Unit Discharge ◽  
Expectant Management ◽  
Antibiotic Administration ◽  
Tertiary Referral Center ◽  
Membrane Rupture ◽  
South Central ◽  
Prelabor Rupture Of Membranes ◽  
Latency Duration

Abstract Objective To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM). Study Design Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival. Results Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 180/7 to 226/7 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74). Conclusion Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.

scholarly journals Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261906
Author(s):  
Francesco D’Ambrosi ◽  
Nicola Cesano ◽  
Enrico Iurlaro ◽  
Alice Ronchi ◽  
Ilaria Giuditta Ramezzana ◽  
...  
Keyword(s):  
High Risk ◽  
Cesarean Section ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Low Risk ◽  
Clinical Protocol ◽  
Hemolytic Streptococcus ◽  
Beta Hemolytic Streptococcus ◽  
Prelabor Rupture Of Membranes

Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group. Results Of the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH < 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered. Conclusions A clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.

scholarly journals A Comparative Study on Feto-Maternal Outcome of GDM Treated by Either Insulin or Metformin

2020 ◽  
Vol 34 (1) ◽  
pp. 8-14
Author(s):  
Tania Noor ◽  
Tahmina Parvin ◽  
Sharmin Siddika ◽  
Farjana Begum ◽  
Selina Akter Banu ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Perinatal Outcomes ◽  
Perinatal Complications ◽  
Neonatal Hypoglycemia ◽  
Maternal Complications ◽  
Insulin Group ◽  
Metformin Group ◽  
Significant Difference

Background: Gestational Diabetes Mellitus (GDM) is linked with amplified risk of variety of maternal and perinatal complications. There have been a number of studies comparing metformin with insulin in the management of GDM. Methods: A clinical trial (Quasi experimental) was conducted on fifty women with GDM at their 24 – 34 weeks of gestation with the aim to compare maternal and perinatal outcomes treated by either insulin or metformin. The study population were recruited from obstetrics and gynaecology outpatient department of Medical College for Women and Hospital, Uttara, Dhaka, from July 2012 to December 2012.The patients were divided into two groups (nonrandomized), 25 patients in each, and were subjected to either injection insulin or oral metformin medication. Results: The patients were grouped as insulin or metformin group. They were compared in terms of age, parity and developing maternal complications like preeclampsia (p=0.24), UTI (p=0.40), polyhydramnios (p=0.70). However, the incidence of preterm birth was higher among metformin group in comparison to insulin group (P=0.007).There was no significant difference between insulin and metformin group as regard to mode of delivery. The proportion of neonatal hypoglycemia in insulin group was higher than metformin group (P=0.46) but statistically not significant. Other neonatal outcomes such as macrosomia, birth asphyxia and hyperbillirubinaemia did not differ significantly between two groups. Conclusion: In women with GDM, treatment with metformin is associated with higher proportion of preterm birth than with insulin. Proportion of neonatal hypoglycemia is higher with insulin use. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 8-14

Perinatal outcome associated with oligohydramnios in term pregnancies

2018 ◽  
Vol 1 (01) ◽  
pp. 25-30
Author(s):  
Deepa Chudal ◽  
Keshang Diki Bista ◽  
Neelam Pradhan
Keyword(s):  
Cesarean Section ◽  
Amniotic Fluid ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Fetal Outcome ◽  
University Teaching ◽  
Amniotic Fluid Index ◽  
Prelabor Rupture Of Membranes

Introduction: Amniotic fluid is a complex substance essential to fetal well-beingand dynamic milieu that changes as pregnancy progresses andsurrounds developing fetus providing an ideal environment for normal fetal growth and development. Amniotic fluid volume is fetal well being which varies with gestational age and depends on a dynamic interaction between placenta, fetus and maternal components. Methods: This was a hospital based descriptive study conducted at Tribhuvan University Teaching Hospital, from 14th April 2013 to 13th April 2014(2070) which consisted of singleton, term (37-42weeks) pregnancies admitted with ultrasonographicfinding of Amniotic Fluid Index≤ 5 with delivery within one week of ultrasonographicfinding. A prefixed questionnaire was used to fill maternal and fetal outcome parameters like age, parity, period of gestation, Amniotic Fluid Index, associated maternal conditions, mode of delivery, indication of Cesarean section, color of liquor and perinatal outcomes. Results: Total 115 cases of oligohydramnioswere noted accounting for an incidence of 2.4%. 92 women were term, giving incidence of term oligohydramnios to be 2%. Out of 92 cases, 77(83.6%) underwent emergency caesarean section and 15 (16.3%) were delivered vaginally. Low birth weight of < 2.5 kg was noted in 14 (15.2%) babies and meconium stained liquor was present in 12 (13%) of oligohydramnios cases. APGAR score of < 7 at 1 minute and 5 minute was seen in 13 (14.13%) and 3 (3.26%) cases respectively. . Among 92 cases, 44 (47.8%) were associated with Prelabor Rupture of Membranes followed by post dated pregnancies and Intrauterine Growth Retardation accounting for 12 (13.1%) cases in each group Conclusion: Prelabor Rupture of Membranes was  most common cause of term oligohydramnios resulting in high risk of caesarean delivery in oligohydramnios cases. Cesarean Section for oligohydramnios has been associated with good perinatal outcome.

scholarly journals A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population

2018 ◽  
Vol 7 (6) ◽  
pp. 2393 ◽  
Author(s):  
Rajani Rawat ◽  
Pragati Divedi ◽  
Sukla Debbarma ◽  
Soniya Vishwakarma ◽  
Nupur Mittal
Keyword(s):  
Caesarean Section ◽  
Neonatal Outcome ◽  
Latency Period ◽  
Expectant Management ◽  
Active Management ◽  
Labour Induction ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Management Group ◽  
Significant Difference

Background: Premature rupture of membranes at term (PROM) is defined as a spontaneous rupture of membranes after 37 completed weeks of gestation and before the onset of regular painful uterine contractions. PROM occurs in 5-10% of all pregnancies of which approximately 80% occur at term. The study aimed to compare the maternal and neonatal outcome in patients with term PROM receiving active induction versus expectant management.Methods: The present study was a prospective randomised controlled trial, conducted on 100 term antenatal women with PROM in the Department of Obstetrics and Gynaecology, UPUMS, Saifai from January 2016 to June 2017. 50 antenatal women received immediate induction with oral misoprostol while another 50 antenatal women were expectantly managed for 24 hours. The latency period, PROM delivery interval, maternal and neonatal outcome were compared and subjected to statistical analysis.Results: 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant (p value = 0.005). There was no statistically significant difference in the rate of caesarean section, maternal and neonatal morbidity in both the groups.Conclusions: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group.

scholarly journals Maternal and fetal outcome of prelabor rupture of membranes at term expectant management

2016 ◽  
Vol 10 (2) ◽  
Author(s):  
Tayyiba Wasim ◽  
Shazia Najibullah
Keyword(s):  
Wound Infection ◽  
Conservative Management ◽  
Apgar Score ◽  
Neonatal Outcome ◽  
Expectant Management ◽  
Neonatal Infection ◽  
Descriptive Study ◽  
Fetal Outcome ◽  
Prelabor Rupture Of Membranes

This descriptive study was carried out to analyze the maternal and fetal outcome of 24 hours expectant management`: in patients of PROM at term. 100 women presenting with prelabor rupture of membranes at term were included. All the patients were managed conservatively for 24 hours, followed by induction if labor did not start spontaneously, or if signs of chorioamnionitis developed at any stage. Magnitude of PROM during the year 2002 was` 7.008%. Spontaneous labor rate with in 24 hours was 84%. 2% patients developed signs of chorioamnionitis in less than 24 hours and 14% patient did not enter into spontaneous labor after 24 hours of PROM. 94% patients with PROM delivered vaginally while 6 caesarian sections were carried out. Postnatal complications were observed in 17% of patients. These included chorioamnionitis 2%, PPH 7%, puerperal pyrexia 4%, wound infection 3%, and DVT in 1% patient. Mean Apgar score of babies was 5.90, 1 min after birth and 8.7, 5 min after birth. Maximum babies had APGAR score of 9 at 5 min after birth, 8 babies were admitted to ICU and only 1 baby developed proven neonatal infection. This study shows that conservative management is safe with excellent maternal and neonatal outcome.

scholarly journals Comparative study of early neonatal outcome in low birth weight babies in hypertensive disorders complicating pregnancies with the mode of delivery

2021 ◽  
Vol 8 (3) ◽  
pp. 339-345
Author(s):  
Sivajyothi Pilli ◽  
Kavitha Bakshi
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Low Birth Weight ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Survival Advantage ◽  
Hypertensive Disorders ◽  
Significant Difference

Pregnancy induced Hypertension (PIH) is strongly associated with intrauterine fetal growth restriction (IUGR), low birth weight (LBW) and admission to NICU. PIH is not by itself an indication for caesarean delivery. However, the incidence of caesarean is high because of the development of complications in mother and the need to deliver prematurely. To compare the immediate morbidity and survival advantage of LBW vertex presenting babies with the mode of delivery in hypertensive disorders complicating pregnancies. This was a comparative cross-sectional study done on women admitted to the labour ward during the study period with PIH delivering a baby through either a vaginal delivery or a caesarean section with a birthweight of &#60;2.5kgs. A detailed history taking and clinical examination was done. Babies were followed up for one week following delivery to note down the early neonatal outcome. In this study, over all there was no statistically significant difference in neonatal outcome in both vaginal delivery and caesarean section groups. However, there was slight increased incidence of prematurity (68% vs 64%), Birth Asphyxia (14% vs 8%), Sepsis (8% vs 6%), IVH (6% vs 2%) and Hyperbilirubinemia (16% vs 14%) in vaginal delivery group. While, RDS (20% vs 14%) and NEC (4% vs 2%) had higher incidence in caesarean delivery group. Overall, prematurity and IUGR resulting in LBW, contributed to these neonatal complications. Caesarean delivery offers no short-term survival advantage compared with vaginal delivery for LBW vertex presenting foetuses in PIH patients. Neonatal outcomes are not worsened by spontaneous or induced vaginal delivery in women with hypertension with good control and also decreases morbidity due to caesarean section to the mother.

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