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.

Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks

2018 ◽  
Vol 36 (07) ◽  
pp. 659-668
Author(s):  
Tara A. Lynch ◽  
Courtney Olson-Chen ◽  
Sarah Colihan ◽  
Jeffrey Meyers ◽  
Conisha Holloman ◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Estimating Equation ◽  
Antibiotic Administration ◽  
Fetal Demise ◽  
Maternal Sepsis ◽  
Nicu Admission ◽  
Prelabor Rupture Of Membranes

Objective To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. Study Design This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant. Results A total of 280 mother–infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis. Conclusion There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

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.

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 Preterm and term rupture of the amniotic sac in the third trimester: outcomes for mother and child

2021 ◽  
Vol 12 (4) ◽  
pp. 12-19
Author(s):  
E. V. Enkova ◽  
A. S. Fomina ◽  
V. V. Enkova ◽  
O. V. Khoperskaya
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Neonatal Intensive Care ◽  
Latency Period ◽  
Breech Presentation ◽  
Maternity Hospital ◽  
Third Trimester ◽  
The Third ◽  
Prelabor Rupture Of Membranes

Objective: To evaluate the characteristics of women in labor and pregnancy outcomes at different gestational periods with preterm prelabor rupture of membranes (PPROM) and preterm rupture of membranes (PROM) in the third trimester of pregnancy.Materials and Methods: The study included pregnant women in the third trimester, at the gestation period of 28-41.6 weeks of pregnancy, divided into groups of PROM and PPROM: 173 (80.8%) and 41 (19.2%) pregnant women, respectively.Results: It was found that PPROM is associated with a significantly lower gestational age, higher levels of C-reactive protein, and higher body temperature upon admission to the maternity hospital (P <0.05). Breech presentation and history of cesarean section were significantly associated with PPROM (P < 0.05), rather than PROM. The PPROM group had a significantly longer latency period compared to the PROM group, in which the latency period increased with a lower gestational age (28–31.6 weeks). A significantly higher rate of admission to the neonatal intensive care unit (NICU) was observed in the PPROM group compared to the PROM group. Also, at the gestational age of 28-31.6 weeks, a significantly higher rate of admission to the NICU was revealed compared to the gestational age of 32-36. 6 weeks (P < 0.05).Conclusions: The purpose of this retrospective study was to evaluate the characteristics of women in labor and pregnancy outcomes at different gestational periods with PPROM and PROM in the third trimester of pregnancy.

scholarly journals Expectant Management of Severe Pre-eclampsia remote from term: Maternal and Perinatal outcome

2020 ◽  
Vol 32 (2) ◽  
pp. 73-78
Author(s):  
Kamrun Nahar ◽  
Hosna Akter ◽  
Summyia Nazmeen ◽  
Saria Tasnim
Keyword(s):  
Gestational Age ◽  
Early Onset ◽  
Perinatal Outcome ◽  
Stress Test ◽  
Case Series ◽  
Fetal Loss ◽  
Expectant Management ◽  
Pressure Control ◽  
Severe Preeclampsia ◽  
Tertiary Referral Center

Background: Management of severe pre eclampsia remote from term remains one of the most difficult challenges in obstetric practice. Expectant management of early onset severe pre eclampsia improves neonatal outcome. Methods: A prospective case series extending over five years peiod were recorded to evaluate the maternal and perinatal outcome of expectant management of severe preeclampsia presenting between 24-34 weeks of gestation in a tertiary referral center. All women (n=160) presenting with early onset (24-34 weeks of gestation) severe preeclampsia , where both the mother and the fetus were otherwise stable. Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Foetal surveillance included six hourly foetal heart rate monitoring, bi weekly non stress test and weekly USG evaluation. Results: Mean number of days of prolongation of gestation was 6 days ( range 1-24days). The largest prolongation of pregnancy was recorded in patients with the lowest gestational age. Conservative management was associated with a 1.63% ( 17/160) intrauterine fetal loss rate. The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at <30 weeks. Increasing gestational age correlated with a reduction of RDS ( respiratory distress syndrome). Maternal morbidities were significantly higher among those managed at < 32 weeks. But there was no maternal mortality. Conclusion: Good perinatal outcome and less risk to mother can be achieved at 30-34 weeks gestation. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 73-78

scholarly journals Expectant Management of PPROM Improves Neonatal Outcome—A Retrospective Study of 562 Patients

2021 ◽  
Vol 11 (1) ◽  
pp. 214
Author(s):  
Roxana Elena Bohilțea ◽  
Ana Maria Cioca ◽  
Vlad Dima ◽  
Ioniță Ducu ◽  
Corina Grigoriu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Age Groups ◽  
Latency Period ◽  
Expectant Management ◽  
Short Term ◽  
Group 3

Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period.

scholarly journals Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5865
Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Incidence Rates ◽  
Large For Gestational Age ◽  
Mortality And Morbidity ◽  
Early Term ◽  
Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

scholarly journals Regional variation in cost of neonatal intensive care for extremely preterm infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asaph Rolnitsky ◽  
David Urbach ◽  
Sharon Unger ◽  
Chaim M. Bell
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Preterm Infants ◽  
Gestational Age ◽  
Regional Variation ◽  
Neonatal Intensive Care ◽  
Cost Optimization ◽  
Program Cost ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving. Methods An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23–28-week preterm infants in 2011–2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay. Results We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920–$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500–$188,757). Median daily cost for all infants was $1940 (IQR: $1518–$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R2 = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634–$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period. Conclusion Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.

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