The Use of Somatex Shunt for Fetal Pleural Effusion: A Cohort of 8 Procedures

2021 ◽  
pp. 1-8
Author(s):  
Man Yan Chung ◽  
Wing Cheong Leung ◽  
Wing Ting Tse ◽  
Yuen Ha Ting ◽  
Kwok Ming Law ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Gestational Age ◽  
Single Case ◽  
Perinatal Outcomes ◽  
In Utero ◽  
Good Survival ◽  
Pleural Effusions ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Live Births

<b><i>Introduction:</i></b> Fetal pleural effusion may require in utero shunting which is associated with procedure-related complications. <b><i>Objective:</i></b> To evaluate the efficacy and complications of the newly designed Somatex shunt in treating fetal pleural effusion. <b><i>Methods:</i></b> Consecutive cases with primary fetal pleural effusion who were treated with the Somatex shunt between 2018 and 2019 were evaluated. Perinatal outcomes and complications were retrospectively analyzed. <b><i>Results:</i></b> There were 6 cases of unilateral and 1 case of bilateral pleural effusion, and hence a total of 8 pleuroamniotic shunting procedures were performed. The median gestational age at diagnosis and shunting was 20.7 and 22.6 weeks, respectively. All 8 procedures were successful, achieving complete in utero drainage. All but one were live births (85.7%) with a median gestational age of 38 weeks. The single case of in utero death occurred 4.7 weeks after successful shunting, and no cause could be identified after autopsy. The rates of preterm birth and premature rupture of membranes were 33.3% (2/6) and 16.7% (1/6), respectively. Four of the 8 procedures (50%) had minor shunt-related complications such as dislodgement and entrapment, occurring at a median of 7.7 weeks after shunting. None of the shunts became blocked. <b><i>Conclusions:</i></b> The Somatex shunt is effective in relieving fetal pleural effusions with good survival rate. Overall, it was a safe instrument, though minor shunt complications occurred.

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.

scholarly journals Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

2016 ◽  
Vol 62 (3) ◽  
pp. 269-275 ◽  
Author(s):  
Alex Sandro Rolland Souza ◽  
Adriane Farias Patriota ◽  
Gláucia Virgínia de Queiroz Lins Guerra ◽  
Brena Carvalho Pinto de Melo
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Perinatal Complications ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Amniotic Fluid Index ◽  
Apgar Scores ◽  
Preterm Premature Rupture

SUMMARY Objective: To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM). Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion: The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.

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.

scholarly journals Perinatal Outcomes of Twin Pregnancies With Preterm Premature Rupture of the Membranes at 24–34 Weeks’ Gestation

2021 ◽  
Author(s):  
Shuwei Zhou ◽  
Yajun Yang ◽  
XiaoYan Zhang ◽  
Xiaoling Mu ◽  
Quan Quan ◽  
...  
Keyword(s):  
Neonatal Death ◽  
Latency Period ◽  
Perinatal Outcomes ◽  
Neonatal Morbidity ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Factors Associated ◽  
Preterm Premature Rupture ◽  
Adverse Perinatal Outcomes ◽  
Twin Pregnancies

Abstract Objective: To describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity.Methods: This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks’ gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis.Results: Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score < 7 increased severe neonatal morbidity.Conclusion: As GA at PPROM increased, the risk of adverse perinatal outcomes decreased. GA at PPROM and latency period were significantly associated with discharge without severe or moderate-severe neonatal morbidity.

scholarly journals Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

2019 ◽  
Vol 4 (2) ◽  
pp. 83
Author(s):  
Isam Bsisu ◽  
Alaa Aldalaeen ◽  
Rawan Elrajabi ◽  
Ala AlZaatreh ◽  
Rama Jadallah ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Births ◽  
University Hospital ◽  
High Rate ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Gestational Week ◽  
The Mean

<p><strong><em>Background:</em></strong><em> Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. </em></p><p><strong><em>Materials and methods:</em></strong><em> This retrospective study included 65 patients who were born to mothers with Prolonged PPROM &lt;34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. </em></p><p><strong><em>Results: </em></strong><em>The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P &lt; 0.05). </em></p><p><strong><em>Conclusion:</em></strong><em> Prolonged PPROM before the 34<sup>th</sup> gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.</em></p>

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 A study on management of premature rupture of membranes

2018 ◽  
Vol 7 (3) ◽  
pp. 855
Author(s):  
Arnab Mondal ◽  
Sanhita Kanoongo
Keyword(s):  
Latent Period ◽  
Gestational Age ◽  
Labor Pain ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Chi Square ◽  
Definition Of ◽  
Individualized Management ◽  
Optimum Management ◽  
First Stage Of Labor

Background: Premature rupture of membranes (PROM) is a common obstetric complication. Knowledge of etiopathogenesis, diagnosis, complications and management of PROM has significantly increased due to extensive research in the recent past. Yet, there is no unanimous opinion regarding optimum management of PROM. The aim of the study was to observe the patients during labor and compare the latent period, duration of first stage of labor, modes of deliveries and the use of oxytocin and its outcome in PROM cases with controls. The study has been conducted with the belief that these data will help in better management of PROM cases in future.Methods: In this study, the definition of PROM adopted is rupture of fetal membranes before the onset of true labor pain. The minimum gestational age was taken to be 28 weeks. Diagnosis of PROM was mainly clinical. Patients were monitored during the latent period and during labor. Induction of labor was done where necessary. Collected data were analysed using Chi Square Test.Results: It was observed that onset of labor was more rapid with increasing gestational age. Use of oxytocin for induction and augmentation of labor and operative deliveries were higher in PROM cases. These results mostly corroborated with the findings of other researchers.Conclusions: The conclusion drawn at the end of the study was that individualized management of PROM cases depending on the gestational age and risk of complications is the best way to achieve a good fetomaternal outcome.

scholarly journals Effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes

2018 ◽  
Vol 7 (10) ◽  
pp. 4068
Author(s):  
Ashima Arora ◽  
Ratna Biswas ◽  
Bhawna Dubey ◽  
Binita Goswami ◽  
Sonal Saxena
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Inflammatory Marker ◽  
Perinatal Outcomes ◽  
Admission Rate ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Adverse Perinatal Outcomes ◽  
High Level

Background: The aim is to study the effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes (PPROM).Methods: 60 women with PPROM at 28–34 weeks of gestation were enrolled in the study. All the women were given antibiotics as per hospital protocol and were subjected to blood sampling for Interleukin -6(IL-6) at admission, delivery and umbilical cord blood. IL-6 levels were assessed for associations with adverse perinatal outcomes and the effect of antibiotic treatment on IL-6 and perinatal outcomes were studied. The data were analyzed using t test and χ2 test.Results: Increased level of IL-6 was associated with chorioamnionitis and neonatal sepsis (p<0.001). High level of IL-6 led to early delivery and complete course of antibiotics suppressed IL-6 (p<0.001) and clinical chorioamnionitis in women with PROM. Full course of antibiotics also decreased the admission rate of babies to neonatal intensive care unit and suppressed respiratory distress syndrome, neonatal sepsis.Conclusions: Increased level of IL-6 is seen in women with chorioamnionitis and neonatal sepsis. Antibiotics suppress the IL-6 levels, chorioamnionitis and neonatal sepsis.

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