Use of urea and creatinine levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes and delivery interval after membrane rupture

2016 ◽  
Vol 30 (7) ◽  
pp. 772-778 ◽  
Author(s):  
Cenk Gezer ◽  
Atalay Ekin ◽  
Ceren Golbasi ◽  
Ceysu Kocahakimoglu ◽  
Umit Bozkurt ◽  
...  
Keyword(s):  
Vaginal Fluid ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Membrane Rupture ◽  
Preterm Premature Rupture

Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation

2018 ◽  
Vol 46 (5) ◽  
pp. 555-565 ◽  
Author(s):  
Verena Kiver ◽  
Vinzenz Boos ◽  
Anke Thomas ◽  
Wolfgang Henrich ◽  
Alexander Weichert
Keyword(s):  
Survival Rate ◽  
Pregnancy Termination ◽  
Treatment Options ◽  
Latency Period ◽  
Perinatal Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Mortality And Morbidity ◽  
Membrane Rupture ◽  
Preterm Premature Rupture

Abstract Objective: A current descriptive assessment of perinatal outcomes in pregnancies complicated by previable preterm premature rupture of membranes (pPPROM) at <24 weeks of gestation, after expectant treatment. Study design: Maternal and short-term neonatal data were collected for patients with pPPROM. Results: Seventy-three patients with 93 fetuses were hospitalized with pPPROM at 15–24 weeks’ gestation. Among these patients, 27.4% (n=20) chose pregnancy termination, 27.4% (n=20) miscarried and 45.2% (n=33) proceeded to live births. After a median latency period of 38 days, ranging from 1 to 126 days, 24 singletons and 20 multiples were live-born, of whom 79.5% (n=35) survived the perinatal period. The main neonatal sequelae were pulmonary hypoplasia (29.5%; n=13), connatal infection (56.8%; n=25), intraventricular hemorrhage (25%; n=11; resulting in five neonatal deaths) and Potter’s syndrome (15.9%; n=7). Nine newborns died, within an average of 2.8 days (range, 1–10 days). The overall neonatal survival rate was 51.5% – including miscarriages but not elective terminations. The intact survival rate was 45.5% of all live-born neonates. Conclusions: Even with limited treatment options, overall neonatal survival is increasing. However, neonatal mortality and morbidity rates remain high. The gestational age at membrane rupture does not predict neonatal outcome.

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

2015 ◽  
Vol 21 (4) ◽  
pp. 161-170
Author(s):  
Ieva Daunoravičienė ◽  
Rūta Lenkutienė ◽  
Audrė Musteikytė ◽  
Diana Ramašauskaitė
Keyword(s):  
Congenital Infection ◽  
Intrauterine Infection ◽  
Maternal Blood ◽  
Maternal Serum ◽  
Prognostic Indicators ◽  
Youden Index ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Membrane Rupture ◽  
Preterm Premature Rupture

Background. The study investigates the influence of the length of membrane rupture period among pregnant women with preterm premature rupture of membranes (PPROM) between the 32nd and 34th weeks of gestation on the development of chorioamnionitis and the congenital infection of a newborn. It seeks to ascertain the values of indicators in mother’s blood that enable to predict chorioamnionitis and funisitis for mothers, and congenital infection for newborns. Materials and methods. A retrospective study of case records of women with PPROM at 32 (32 w. + 0 d)–34 (33 w. + 6 d) weeks of gestation and their newborns was performed. Two comparative groups were made: 1) of women who had funisitis and / or chorioamnionitis with or without deciduitis and 2) of women having no proved inflammation (according to the results of histological examination of placentae). Analogically, comparative groups were made of their newborns: those who had diagnosis of congenital infection and those who had no infection. The duration of membrane rupture period and the blood markers were investigated in all the groups. Results. The study included 135 women. Duration of the membrane rupture period lasted 85.17 ± 84.72 hrs in the group of women who had histological inflammation, and 40.06 ± 56.57 hrs in the group with no inflammation, P = 0.01, AUC = 0.735; the critical membrane rupture period value for developing intrauterine infection by the Youden index was 43.7 hrs. The corresponding maternal CRP values (mg/l) were 25.85 ± 40.27 vs. 5.23 ± 7.88 (P = 0.01, AUC = 0.6), the Youden index 4.6 mg/l. For the mothers of the newborns diagnosed with infection, the duration of the membrane rupture period was 55.95 ± 65.04 hrs, for the mothers of the newborns without congenital infection it was 40.25 ± 73.71 hours. Respectively, CRP values for the mothers of newborns averaged 12.25  ±  22.14  mg/l vs. 4.8 ± 4.82 mg/l (P = 0.005). Conclusions. Longer membrane rupture period and higher maternal CRP are correlated with inflammatory changes in the placenta and umbilical cord, thus they can be used as the prognostic indicators of intrauterine infection. When the duration of the membrane rupture period lasts ≥44 hrs, the risk of chorioamnionitis and funisitis increases five times; when the maternal serum CRP is higher than 5 mg/l, funisitis / chorioamnionitis is twice more frequent than at lower than 5 mg/l CRP values.

scholarly journals Identification of causative pathogen and its antibiotic sensitivity in cases of preterm premature rupture of membranes

2019 ◽  
Vol 8 (11) ◽  
pp. 4250
Author(s):  
Sai Prasanna Kandukuri ◽  
Ramamani Chadalawada ◽  
Bhavishya Gollapalli
Keyword(s):  
Gardnerella Vaginalis ◽  
Diffusion Method ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Group B Streptococci ◽  
Disk Diffusion Method ◽  
Membrane Rupture ◽  
Preterm Premature Rupture ◽  
Vaginal Swabs ◽  
Group B

Background: Pre-labor rupture of membranes is defined as amniotic membrane rupture before the onset of labor contractions, and if it happens before 37 weeks, it is called preterm premature rupture of membranes (PPROM). Several organisms commonly present in the vaginal tract are E.coli, Group-B streptococci, staphylococcus aureus, chlamydia trachomatis, Gardnerella vaginalis and Enterococcus faecalis which secrete proteases that degrade collagen thereby weakening  the fetal membranes leading to PPROM. Appropriate antibiotic therapy has a significant role in the prevention and treatment of maternal and neonatal complications.Methods: This was a prospective observational study done in the department of obstetrics and gynaecology, Narayana medical college, Nellore. Selectively 100 patients with complaint of PPROM admitted to labor room were included in the study. Diagnosis of membrane rupture was established by speculum examination, and high vaginal swabs are taken and sent to laboratory for identifying bacteria using gram staining and cultured in aerobic and anaerobic methods. Antimicrobial susceptibility testing of the organisms was performed by disk diffusion method by Kirby and Bauer.Results: Out of 100, high vaginal swabs had growth in 82 patients, and 18 were sterile. The repeatedly isolated organism in patients with PPROM is E.coli amounting 32%, followed by candidal species 20%. Staphylococci are scoring 11% and enterococci 8%. However, organisms like gardenella vaginalis and Group B streptococcus are least common with a score of 6% and 5% respectively. In this study, E.coli is highly sensitive to tigecycline, colistin 100% each and highly resistant to gentamycin and amikacin.Conclusions: In this study, E.coli is related to the maximum number of cases with preterm premature rupture of membranes. Appropriate use of antibiotics significantly lowers maternal morbidity and neonatal mortality.

Daily monitoring of vaginal interleukin 6 as a predictor of intraamniotic inflammation after preterm premature rupture of membranes – a new method of sampling studied in a prospective multicenter trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Gregor Seliger ◽  
Michael Bergner ◽  
Roland Haase ◽  
Holger Stepan ◽  
Ekkehard Schleußner ◽  
...  
Keyword(s):  
Synthetic Fiber ◽  
New Technique ◽  
Vaginal Fluid ◽  
Daily Routine ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Daily Monitoring ◽  
Preterm Premature Rupture ◽  
A New Technique ◽  
Fluid Sampling

Abstract Objectives (A) To introduce a new technique for vaginal fluid sampling (biocompatible synthetic fiber sponge) and (B) evaluate the collected vaginal fluid interleukine-6 (IL-6vag)-concentration as a new diagnostic tool for daily monitoring of intrauterine inflammation after preterm premature rupture of membranes (PPROM). Secondary objectives were to compare the potential to predict an intrauterine inflammation with established inflammation parameters (e.g., maternal white blood cell count). Methods This prospective clinical case-control diagnostic accuracy multicenter study was performed with women after PPROM (gestational age 24.0/7 – 34.0/7 weeks). Sampling of vaginal fluid was performed once daily. IL-6vag was determined by electrochemiluminescence-immunoassay-kit. Neonatal outcome and placental histology results were used to retrospectively allocate the cohort into two subgroups: 1) inflammation and 2) no inflammation (controls). Results A total of 37 cases were included in the final analysis. (A): Measurement of IL-6 was successful in 86% of 172 vaginal fluid samples. (B): Median concentration of IL-6vag in the last vaginal fluid sample before delivery was significantly higher within the inflammation group (17,085 pg/mL) compared to the controls (1,888 pg/mL; p=0.01). By Youden’s index an optimal cut-off for prediction an intrauterine inflammation was: 6,417 pg/mL. Two days before delivery, in contrast to all other parameters IL-6vag remained the only parameter with a sufficient AUC of 0.877, p<0.001, 95%CI [0.670–1.000]. Conclusions This study established a new technique for vaginal fluid sampling, which permits assessment of IL-6vag concentration noninvasively in clinical daily routine monitoring.

scholarly journals Neonatal Outcomes In Women With Preterm Premature Rupture of Membranes At Periviable Gestational Age

2022 ◽  
Author(s):  
Jacky Herzlich ◽  
Laurence Mangel ◽  
Ariel Halperin ◽  
Daniel Lubin ◽  
Ronella Marom
Keyword(s):  
Survival Rate ◽  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Outcomes ◽  
High Survival ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Membrane Rupture ◽  
Preterm Premature Rupture ◽  
Gestational Week

Abstract Purpose: To examine the outcomes of preterm infants born to women with preterm premature rupture of membranes at periviable gestational age.Methods: This is a retrospective study analyzing data on singleton deliveries complicated by prolonged premature rupture of membranes occurring before 24 weeks of gestation. Neonatal outcomes including birth weight, Apgar score, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, hearing impairment and mortality were evaluated.Results: Ninety four preterm infants who were born after a prolonged premature rupture of membranes of at least 7 days were included in the study.Median gestational week at onset of membrane rupture was 27.1 ± 4.2 weeks (range 17 - 33) and median latency period in days was 16 ± 21.8 (range 7 - 105). We found that the survival rate to discharge within neonates born after prolonged rupture of membrane at gestational week less than 24 weeks is 79.2%. These neonates did not show an increased rate of major morbidities compared to neonates born following membrane rupture at gestational week 24 to 27. Conclusion: We described a high survival rate without major morbidities following prolonged preterm membrane rupture before viability.

Antibiotics for Preterm Premature Rupture of Membranes

2021 ◽  
pp. 43-47
Author(s):  
Katherine S. Kohari ◽  
Christian M. Pettker
Keyword(s):  
Risk Reduction ◽  
Broad Spectrum ◽  
Premature Birth ◽  
Neonatal Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Membrane Rupture ◽  
Preterm Premature Rupture ◽  
Prelabor Rupture Of Membranes ◽  
Prolonged Latency

Antibiotics for preterm prelabor rupture of membranes (PPROM) have been shown to prolong the length of pregnancy as well as improve neonatal outcomes as demonstrated by the landmark article by Mercer et al. PPROM complicates 3% of all pregnancies, and approximately one-half of patients will deliver within 1 week of membrane rupture. Infection is thought to play a role in both the etiology of PPROM and subsequent maternal and neonatal complications. Premature birth further complicates neonatal outcomes, therefore prolongation of pregnancy after PPROM is essential for risk reduction. Administration of broad spectrum antibiotics have been associated with prolonged latency in women with PPROM at less than 32 weeks and 0 days of gestation as well as improved neonatal outcomes.

C-reactive protein in vaginal fluid of patients with preterm premature rupture of membranes

2003 ◽  
Vol 82 (12) ◽  
pp. 1072-1079 ◽  
Author(s):  
Edoardo Di Naro ◽  
Fabio Ghezzi ◽  
Luigi Raio ◽  
Francesco Romano ◽  
Michel D. Mueller ◽  
...  
Keyword(s):  
Vaginal Fluid ◽  
C Reactive Protein ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Reactive Protein ◽  
Preterm Premature Rupture
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