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.

scholarly journals Pregnancy outcome in preterm premature rupture of membranes between 24 to 34 weeks of gestation

2020 ◽  
Vol 9 (12) ◽  
pp. 5043
Author(s):  
Sujatha Venkatraman ◽  
Latha Chaturvedula ◽  
Subhash Chandra Parija
Keyword(s):  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Latency Period ◽  
Primary Objective ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Group B Streptococci ◽  
Preterm Premature Rupture ◽  
Nicu Admission ◽  
Group B

Background: Preterm premature rupture of membranes (PPROM) is spontaneous rupture of the fetal membranes before 37 completed weeks and before onset of labour which complicates 3-5% of all pregnancies. Studies regarding PPROM in very early gestation are lacking. The primary objective was to assess the maternal and perinatal outcome in preterm premature rupture of membranes and secondary objective was to assess the colonization of group B Streptococci (GBS) and Listeria monocytogenes in patients with PPROM.Methods: This prospective study was performed on 175 antenatal women with PPROM between 24 to 34 weeks of gestation.Results: Majority of women (54.2%) were between 32 to 34 weeks of gestation, 37% were between 28 to 32 weeks of gestation and 7.8% were between 24 to 28 weeks of gestation. About 22 % of women had cervicovaginal infections. The prevalence of group B Streptococci in the study group was 1.2% and no isolates of Listeria. The most common maternal morbidity was puerperal fever (11.4 %). Among newborn babies 87 (55 %) required neonatal intensive care unit (NICU) admission mainly for respiratory distress and prematurity. With each week of increase in gestational age, there is decrease in latency period by 22 hours and duration of NICU stay nearly by one day.Conclusions: From the present study it may be concluded that PPROM is associated with genitourinary infection, puerperal pyrexia and respiratory distress syndrome among neonates. The prevalence of group B Streptococci in antenatal women with PPROM is very low and no Listeria were isolated.

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 Opportunities to Reduce Overuse of Antibiotics for Perinatal Group B Streptococcal Disease Prevention and Management of Preterm Premature Rupture of Membranes

2005 ◽  
Vol 13 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Nina E. Glass ◽  
Jay Schulkin ◽  
Shadi Chamany ◽  
Laura E. Riley ◽  
Anne Schuchat ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Streptococcal Disease ◽  
Preterm Premature Rupture ◽  
Negative Results ◽  
Group B Streptococcal Disease ◽  
Group B

Objective:To identify opportunities to reduce overuse of antibiotics for prevention of perinatal group B streptococcal (GBS) disease and management of preterm premature rupture of membranes (pPROM).Methods:An anonymous written questionnaire was sent to each of 1031 Fellows of the American College of Obstetricians and Gynecologists, and the responses were subjected to statistical analysis.Results:Among those of the 404 respondents who saw obstetric patients in 2001, most (84%) screened for GBS colonization, and 22% of these prescribed prenatal antibiotics to try to eradicate GBS colonization. Of the 382 respondents (95%) who prescribed antibiotics for pPROM, 36% continued antibiotics for more than 7 days despite negative results from GBS cultures collected before initiation of treatment. Having more years of clinical experience (adjusted odds ratio (OR) 3.0, 95% confidence interval (CI) 1.5 to 6.2), working in a non-academic setting (adjusted OR 2.7, 95% CI 1.0 to 6.9), and prescribing antibiotics prenatally for GBS colonization (adjusted OR 2.0, 95% CI 1.1 to 3.4) were associated with prescribing prolonged antibiotics for pPROM.Conclusion:Prenatal antibiotic treatment for GBS colonization and prolonged antibiotic treatment for pPROM contribute to overuse of antibiotics in obstetrics.

scholarly journals Antenatal Screening for Group B Streptococcus in the Setting of Preterm Premature Rupture of Membranes: Empiric versus Culture-based Prophylaxis

2020 ◽  
Vol 10 (01) ◽  
pp. e26-e31
Author(s):  
Leena B. Mithal ◽  
Nirali Shah ◽  
Anna Romanova ◽  
Emily S. Miller
Keyword(s):  
Multivariable Analysis ◽  
Group B Streptococcus ◽  
Preterm Neonates ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference ◽  
Culture Sensitivity ◽  
Intrapartum Antibiotic ◽  
Group B

Abstract Objective Imperfect culture sensitivity and increase of early onset neonatal sepsis (EONS) risk in preterm neonates raise concern that culture-based intrapartum antibiotic prophylaxis (IAP) may be insufficient after preterm premature rupture of membranes (PPROM). Our objective was to compare rates of EONS after empiric versus culture-based IAP in PPROM. Study Design This retrospective cohort study included women with a singleton gestation and PPROM between 23 and 33 weeks. Outcomes after culture-based IAP were compared with empiric IAP. The primary outcome was EONS. Secondary outcomes included group B streptococcus (GBS) bacteremia, bacteremia, and neonatal GBS infection. Bivariable and multivariable logistic analyses were performed. Results Of the 270 women who met inclusion criteria, 136 (50%) had culture-based IAP of whom 36 (26.5%) were GBS positive. There was no significant difference in bacteremia (2.2 vs. 4.5%, p = 0.30), GBS infection (0.8 vs. 0.7%, p = 1.00), or EONS (11.8 vs. 12.7%, p = 0.82) in infants of women with culture-based IAP compared with empiric IAP. Multivariable analysis confirmed a lack of advantage to empiric versus culture-based IAP in EONS risk (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI]: 0.44–1.93). Conclusion In pregnancies complicated by PPROM, infants of women who received culture-based IAP had no significant difference in EONS or GBS infection compared with infants of women with empiric IAP.

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.

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