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

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.

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The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0399 ◽

2020 ◽

Vol 48 (4) ◽

pp. 317-321

Author(s):

Rodney McLaren ◽

Bharati Kalgi ◽

Chima Ndubizu ◽

Peter Homel ◽

Shoshana Haberman ◽

...

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Repeated Measures ◽

Adverse Outcome ◽

Perinatal Outcomes ◽

Low Risk ◽

Doppler Velocity ◽

Chronic Hypertension ◽

Adverse Perinatal Outcomes

AbstractObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.

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Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention

American Journal of Perinatology Reports ◽

10.1055/s-0040-1721421 ◽

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.

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Vaginal colonization with Group B beta-hemolytic streptococcus as a risk factor for post-cesarean section febrile morbidity

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(82)90781-5 ◽

1982 ◽

Vol 142 (8) ◽

pp. 992-995 ◽

Cited By ~ 36

Author(s):

Howard L. Minkoff ◽

Marcelino F. Sierra ◽

George F. Pringle ◽

Richard H. Schwarz

Keyword(s):

Risk Factor ◽

Cesarean Section ◽

Hemolytic Streptococcus ◽

Vaginal Colonization ◽

Beta Hemolytic Streptococcus ◽

Group B ◽

Febrile Morbidity

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Perinatal outcome associated with oligohydramnios in term pregnancies

Nepal Medical Journal ◽

10.37080/nmj.10 ◽

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.

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Induction of Labor Versus Expectant Management for Prelabor Rupture of Membranes

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0014 ◽

2021 ◽

pp. 74-80

Author(s):

Adina Kern-Goldberger ◽

Dena Goffman

Keyword(s):

Cesarean Section ◽

Lower Risk ◽

Expectant Management ◽

Neonatal Infection ◽

Induction Of Labor ◽

Prostaglandin E ◽

Maternal Infection ◽

Prelabor Rupture Of Membranes

The article highlights a landmark paper from 1992 addressing the management of women with prelabor rupture of membranes at term. The article reviews the paper in detail, highlights similar and relevant subsequent studies, and addresses up-to-date guidelines. The study compared the outcomes of 5041 with prelabor rupture of membranes at term. Women were either induced with oxytocin or vaginal prostaglandin or expectant management with subsequent induction as indicated. In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E2 and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.

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444: Perinatal outcomes in low risk and high risk congenital pulmonary airway malformations (CPAMs) as indicated by CPAM volume ratio (CVR)

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2010.10.463 ◽

2011 ◽

Vol 204 (1) ◽

pp. S179

Author(s):

Zaria Murrell ◽

Foong-Yen Lim ◽

Sundeep Keswani ◽

Mounira Habli ◽

David Lewis ◽

...

Keyword(s):

High Risk ◽

Perinatal Outcomes ◽

Volume Ratio ◽

Low Risk ◽

Pulmonary Airway

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

American Journal of Perinatology ◽

10.1055/s-0039-1698833 ◽

2019 ◽

Vol 37 (05) ◽

pp. 467-474 ◽

Cited By ~ 2

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.

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Cesarean section rates and perinatal outcomes in resident and midwife attended low risk deliveries

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/0301-2115(95)02142-t ◽

1995 ◽

Vol 62 (1) ◽

pp. 3-5

Author(s):

Cem Turan ◽

Baran Kutlay

Keyword(s):

Cesarean Section ◽

Perinatal Outcomes ◽

Low Risk

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Fetal malposition and malpresentation: Mode of delivery and perinatal outcomes at Maternity Teaching Hospital in Erbil city

Zanco Journal of Medical Sciences ◽

10.15218/zjms.2020.044 ◽

2020 ◽

Vol 24 (3) ◽

pp. 367-375

Author(s):

Shahen Kak Hussein ◽

Shahla Alalaf

Keyword(s):

Cesarean Section ◽

Teaching Hospital ◽

Neonatal Intensive Care ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Breech Presentation ◽

Neonatal Morbidity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Neonatal Deaths

Background and objective: Delivering a malpositioned and malpresenting fetus remains uncertainty, despite advances in obstetric practice. This study aimed to determine the mode of delivery and neonatal outcome in cases of fetal malposition and malpresentation. Methods: A cross-sectional study of women delivering malpositioned and malpresenting fetuses was conducted at Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from the 1st of June, to the 30th of November, 2018. Three hundred women and their newborns were followed for seven days of life. Results: The total rate of malposition and malpresentation was 4.8%. Most women (87.3%) delivered by cesarean section, 25% of the neonates were admitted to the neonatal intensive care unit, where 69.3% of these infants stayed for seven days. There were three early neonatal deaths (1.0%), all of them were in occipito-posterior, or occipito-transverse position and were delivered abdominally. Among occipito-posterior and occipito-transverse deliveries, 2.2% ended with the death of the fetus (P = 0.360). An Apgar score of 7 was recorded after 5 minutes for 97.7% of the infants. Around 11% of the women had postpartum hemorrhage. Conclusion: Fetal malpresentation and malposition are not uncommon during labor, and most cases are delivered by cesarean section. Neonatal morbidity and mortality are dependent on the type of presentation and the mode of delivery. Keywords: Malposition; Malpresentation; Perinatal outcome; Breech presentation.

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