scholarly journals An Analysis of Factors Affecting the Duration of Latency Period and Its Impact on Neonatal Outcome in Patients with PPROM

2012 ◽  
Vol 3 (3) ◽  
pp. 87-91 ◽  
Author(s):  
Manju Puri ◽  
Neha Gami ◽  
Seema Singhal
Keyword(s):  
Gestational Age ◽  
Neonatal Outcome ◽  
Latency Period ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Inverse Association ◽  
Prognostic Information ◽  
Factors Affecting ◽  
Time Of Presentation ◽  
Singleton Pregnancies

ABSTRACT Introduction Preterm premature rupture of membranes (PPROM) complicates approximately 3% of all births, but accounts for 30% of neonatal morbidity and mortality among premature gestations. Prediction of latency period for women with PPROM is imprecise and therefore consulting women with PPROM about their predicted latency period is a difficult task. The studies are limited, thus more information is required to support clinical decisions and to provide prognostic information in cases of expectant management following PPROM. Materials and methods We conducted a prospective observational study of women with singleton pregnancies presenting with rupture of membranes. A total of 120 women presenting with PPROM from 26 to 36 weeks with rupture of membrane were included in this study. Results Advanced maternal age >30 years was found to be associated with prolongation of latency period (p = 0.000). Nulliparity was found to be associated with shortening of latency period (p = 0.012). An inverse association between gestational age at the time of presentation and latency period was established. The average gain in duration of latency period by not doing a digital examination was found to be statistically significant (p = 0.000). Gestational age and duration of latency period were found to be the important predictors of neonatal outcome. Conclusion In the current study, several predictive factors were identified which affect the duration of the latency period in cases of PPROM. This information may assist clinician in risk stratification and in providing consultation regarding the natural course of expectant management for women presenting with PPROM. How to cite this article Singhal S, Puri M, Gami N. An Analysis of Factors Affecting the Duration of Latency Period and Its Impact on Neonatal Outcome in Patients with PPROM. Int J Infertility Fetal Med 2012;3(3):87-91.

scholarly journals Active versus expectant management of preterm premature rupture of membrane before 34 weeks and neonatal outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 501
Author(s):  
Gouda A. P. Kartikeswar ◽  
Dhyey I. Pandya ◽  
Siddharth Madabhushi ◽  
Vivek M. Joshi ◽  
Sandeep Kadam
Keyword(s):  
Gestational Age ◽  
Neonatal Outcome ◽  
Tertiary Care ◽  
Expectant Management ◽  
Active Management ◽  
Respiratory Support ◽  
Care Hospital ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference

Background: Preterm premature rupture of membranes (PPROM) predisposes the mother for chorioamnionitis, endometritis, bacteremia and neonate to preterm delivery related complication. There is often dilemma regarding the management of PPROM in mothers with gestational age (GA) <34 weeks.Methods: A retrospective cohort study conducted in a tertiary care hospital over two year period. Neonates delivered before 34 weeks were enrolled and categorized into active management (AM) and expectant management (EM) group. Associated risk factors, duration of PPROM and latency period, Neonatal outcomes like sepsis, morbidity, duration of respiratory support, duration of NICU stay compared between groups.Results: Out of total 197 cases, AM group had 91 babies. Active management resulted in earlier delivery [mean GA (SD): 30.88(1.8) VS 31(2.1) weeks], higher number of caesarian section (76.9% versus 53.8%), lesser birth weight {1233.6 (±282.9) versus 1453.39 (±380.6) gm} and more ELBW babies (23.1% versus 7.5%). EM resulted in significantly higher antenatal steroid cover (73.6% in AM versus 89.6% in EM) and lesser need of surfactant for RDS [42.9% versus 28.3%]. Significant difference was found for NICU stay days {mean (SD): 25.46 (16.8) versus 20.94 (17.5)}. No difference found between respiratory support days [median (IQR) 2 (0, 6) versus 2 (0, 7)]. No significant differences found in incidence of maternal chorioamnionitis, NEC, sepsis, BPD and ROP. Early delivery resulted in higher mortality though that was statistically not significant.Conclusions: Gestational age at delivery is more important predictor of neonatal outcome then PPROM in early preterm. 

Correlation between Clinical, Placental Histology and Microbiological Findings in Spontaneous Preterm Births

2015 ◽  
Vol 40 (2) ◽  
pp. 141-149 ◽  
Author(s):  
Gali Garmi ◽  
Marina Okopnik ◽  
Yoram Keness ◽  
Noah Zafran ◽  
Elad Berkowitz ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Outcome ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Spontaneous Preterm Birth ◽  
Retrospective Case ◽  
Delivery Methods ◽  
Main Determinant ◽  
Gestational Age At Delivery ◽  
The Impact

Aims: To examine the occurrence of chorioamnionitis and abruption among women who had a spontaneous preterm birth (SPTB), the correlation between clinical and placental findings, and the impact of these complications on neonatal outcome after delivery. Methods: This was a retrospective case-control study conducted between 2008 and 2012 at a single teaching hospital. The study group included all women who had an SPTB (23-36 weeks). Placentas were cultured and underwent histological examination. Results: A total of 478 women were included. The mean gestational age at delivery was 32.6 ± 3.1 weeks. Overall, 260 (54.4%) women had either clinical and/or histological abruption or chorioamnionitis. Clinical chorioamnionitis was diagnosed before birth in 14 (2.9%) women, while histological chorioamnionitis (HCA) in 84 (17.4%). Overall, 38 neonates had infection. Placental cultures were negative in 65.8% (25/38) of these neonates, and in 77.1% (27/38), HCA was ruled out. Logistic regression analysis revealed that neonatal morbidity and mortality were correlated with gestational age at delivery (p = 0.02), not with placental pathology (p = 0.08). Conclusions: Half of the women with PTB had clinical or histological abruption, chorioamnionitis or both. A partial correlation was found between clinical and placental findings. The main determinant of neonatal outcome was gestational age at delivery and not placental findings.

scholarly journals Elective induction of labour at 39 weeks versus expectant management up to 41 weeks in a tertiary care centre

2020 ◽  
Vol 9 (2) ◽  
pp. 794
Author(s):  
Yogindra M. Kabadi ◽  
Sanjana Kumar
Keyword(s):  
Cesarean Section ◽  
Gestational Age ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Perinatal Deaths ◽  
Elective Induction ◽  
Singleton Pregnancies

Background: The timing of delivery and effective management of labour at term makes a huge difference in the obstetric and perinatal outcome. There have always been controversies between choosing the elective induction of labour at 39 weeks versus expectant management up to 41/42 weeks which can result in placental ageing, reduced liquor, non-assuring fetal heart tracings, meconium stained amniotic fluid and fetal macrosomia.  our objective was to perform a comparative effectiveness analysis of elective induction of labor at 39 weeks gestational age among nulliparous women with uncomplicated singleton pregnancies as compared to expectant management up to 41 weeks.Methods: 120 primigravidae with singleton pregnancies with fetus in cephalic presentation were recruited into the study and divided into 2 groups of 60 each A: Patients were induced electively using dinoprostone gel (maximum 3 doses 8 hours apart) B: They were managed expectantly up to 41 weeks allowing for spontaneous onset of labour, induction or cesarean section was done for obstetric indications between 39 and 41 weeks and pregnancy was  terminated by induction for those who continued up to 41 weeks. Their obstetric and perinatal outcome were noted.Results: The cesarean section rates were higher in the expectantly managed group (21%) when compared to the electively induced group (16%). The same was with instrumental delivery rates (15% versus 10%). The perinatal outcome was poorer for the expectantly managed group with 20% NICU admissions and 5% perinatal deaths compared to the electively induced group which had 12% NICU admissions and 3.3% perinatal deaths. The expectantly managed group also resulted in respiratory distress in a larger number of fetuses and resulted in problems due to reduced liquor.Conclusions: Elective induction at 39 weeks gestational age was found to be a better option compared to expectant management up to 41 weeks in terms of obstetric and perinatal outcomes.

scholarly journals Sonographic Estimated Fetal Weight among Diabetics at ≥ 34 Weeks and Composite Neonatal Morbidity

2018 ◽  
Vol 08 (02) ◽  
pp. e121-e127
Author(s):  
Leen Al-Hafez ◽  
Michael Pirics ◽  
Suneet Chauhan
Keyword(s):  
Retrospective Study ◽  
Confidence Intervals ◽  
Gestational Age ◽  
Neonatal Morbidity ◽  
Fetal Weight ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
Estimated Fetal Weight ◽  
Singleton Pregnancies

Objectives The objective was to assess the composite neonatal morbidity (CNM) among diabetic women with sonographic estimated fetal weight (SEFW) at 10 to 90th versus >90th percentile for gestational age (GA). Study Design The inclusion criteria for this retrospective study were singleton pregnancies at 34 to 41 weeks, complicated by diabetes, and that had SEFW within 4 weeks of delivery. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Results Among the 140 cohorts that met the inclusion criteria, 72% had SEFW at 10th to 90th percentile for GA, and 28% at >90th percentile. Compared with women with diabetes with last SEFW at 10th to 90th percentile, those with estimate > 90th percentile for GA had a significantly higher rate of CNM (13 vs. 28%; OR, 2.65; 95% CI, 1.07–6.59). Among 109 diabetic women who labored, the rate of shoulder dystocia was significantly higher with SEFW at >90th percentile for GA than those at 10th to 90th percentile (25 vs. 2%; p = 0.002); the corresponding rate of CNM was 29 versus 10% (p = 0.02). Conclusion Among diabetic women with SEFW > 90th percentile for GA, CNM was significantly higher than in women with estimate at 10 to 90th percentile. Despite the increased risk of CNM, these newborns did not have long-term morbid sequela.

scholarly journals A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population

2018 ◽  
Vol 7 (6) ◽  
pp. 2393 ◽  
Author(s):  
Rajani Rawat ◽  
Pragati Divedi ◽  
Sukla Debbarma ◽  
Soniya Vishwakarma ◽  
Nupur Mittal
Keyword(s):  
Caesarean Section ◽  
Neonatal Outcome ◽  
Latency Period ◽  
Expectant Management ◽  
Active Management ◽  
Labour Induction ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Management Group ◽  
Significant Difference

Background: Premature rupture of membranes at term (PROM) is defined as a spontaneous rupture of membranes after 37 completed weeks of gestation and before the onset of regular painful uterine contractions. PROM occurs in 5-10% of all pregnancies of which approximately 80% occur at term. The study aimed to compare the maternal and neonatal outcome in patients with term PROM receiving active induction versus expectant management.Methods: The present study was a prospective randomised controlled trial, conducted on 100 term antenatal women with PROM in the Department of Obstetrics and Gynaecology, UPUMS, Saifai from January 2016 to June 2017. 50 antenatal women received immediate induction with oral misoprostol while another 50 antenatal women were expectantly managed for 24 hours. The latency period, PROM delivery interval, maternal and neonatal outcome were compared and subjected to statistical analysis.Results: 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant (p value = 0.005). There was no statistically significant difference in the rate of caesarean section, maternal and neonatal morbidity in both the groups.Conclusions: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group.

Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13–20 Weeks: Is Selective Termination an Appropriate Management Option?

2020 ◽  
Vol 41 (04) ◽  
pp. e17-e22
Author(s):  
Michal Zajicek ◽  
Simcha Yagel ◽  
Dan Valsky ◽  
Moshe Ben-Ami ◽  
Yoav Yinon ◽  
...  
Keyword(s):  
Survival Rate ◽  
Gestational Age ◽  
Neonatal Outcome ◽  
Clinical Signs ◽  
Expectant Management ◽  
Inclusion Criteria ◽  
Fetal Demise ◽  
Management Group ◽  
Gestational Age At Delivery ◽  
Twin Pregnancies

Abstract Objective To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13–20 weeks of gestation and were managed by expectant management or by selective termination. Methods A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13–20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included. Results 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups. Conclusion Selective termination in twin pregnancies complicated by rupture of membranes at 13–20 weeks has a favorable outcome and should be offered.

Late Prematurity in Twins: A Polish Multicenter Study

2014 ◽  
Vol 17 (5) ◽  
pp. 369-375 ◽  
Author(s):  
Katarzyna Kosinska-Kaczynska ◽  
Iwona Szymusik ◽  
Dorota Bomba-Opon ◽  
Anna Madej ◽  
Jan Oleszczuk ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Outcome ◽  
Neonatal Morbidity ◽  
Morbidity Rate ◽  
Complication Rates ◽  
Respiratory Disorders ◽  
Neonatal Deaths ◽  
Neonatal Birth Weight ◽  
The Impact

The study aimed at investigating the impact of late prematurity (LPT) on neonatal outcome in twins and neonatal morbidity and mortality within LPT with regard to the completed weeks of gestation. The study was conducted in six tertiary obstetric departments from different provinces of Poland (Warsaw, Lublin, Poznan, Wroclaw, Bytom). It included 465 twin deliveries in the above centers in 2012. A comparative analysis of maternal factors, the course of pregnancy and delivery and neonatal outcome between LPT (34 + 0–36 + 6 weeks of gestation) and term groups (completed 37 weeks) was performed. The neonatal outcome included short-term morbidities. The analysis of neonatal complication rates according to completed gestational weeks was carried out. Out of 465 twin deliveries 213 (44.8%) were LPT and 156 (33.55%) were term. There were no neonatal deaths among LPT and term twins. One-third of LPT newborns suffered from respiratory disorders or required antibiotics, 40% had jaundice requiring phototherapy, and 30% were admitted to NICU. The analysis of neonatal morbidity with regard to each gestational week at delivery showed that most analyzed complications occurred less frequently with the advancing gestational age, especially respiratory disorders and NICU admissions. The only two factors with significant influence on neonatal morbidity rate were neonatal birth weight (OR = 0.43, 95% CI = 0.2–0.9, p = .02) and gestational age at delivery (OR = 0.62, 95% CI = 0.5–0.8, p < .01). LPT have a higher risk of neonatal morbidity than term twins. Gestational age and neonatal birth weight seem to play a crucial role in neonatal outcome in twins.

scholarly journals Measurement of the uterocervical angle for the prediction of preterm birth in symptomatic women

2021 ◽  
Author(s):  
Philipp Wagner ◽  
Jana Schlechtendahl ◽  
Markus Hoopmann ◽  
Natalia Prodan ◽  
Harald Abele ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Cervical Length ◽  
University Hospital ◽  
Second Line ◽  
Uterine Contractions ◽  
Gestational Age At Delivery ◽  
The University ◽  
Time Of Presentation ◽  
Singleton Pregnancies

Abstract Purpose To examine if the uterocervical angle (UCA) can be used to predict preterm delivery in women with painful and regular uterine contractions and a cervical length of 25 mm or less. Methods Retrospective study at the perinatal unit of the University Hospital of Tuebingen, Germany. Women with singleton gestation and preterm contractions between 24 + 0 and 33 + 6 weeks’ gestation were included. For the UCA measurement, a line is placed from the internal os to the external os irrespective of whether the cervix is straight or curved. A second line is drawn to delineate the lower uterine segment. The angle between the two lines is the UCA measurement. The measurements were taken on stored images from our database. Results The study consisted of 213 singleton pregnancies. At the time of UCA measurement, median maternal and gestational age was 31.4 years and 29.7 weeks’ gestation. Median gestational age at delivery was 35.3 weeks and the corresponding birth weight 2480 g, respectively. The UCA measurement in women who delivered within 2 days, between 3–7 days and after 7 days was not helpful to distinguish between these three groups [median UCA measurements: 108.5°, 108.0° and 107.3° (Kruskal–Wallis test p = 0.576)]. Uni- and multivariate logistic multiple regression analysis demonstrated that the delivery within 2 days was only dependent on the gestational age and the cervical length at the time of presentation. Conclusion The measurement of UCA is not useful in predicting preterm birth in the subsequent 7 days after an episode of preterm contractions.

scholarly journals A study of feto-maternal outcome in cases of pre-labour rupture of membranes

2017 ◽  
Vol 6 (10) ◽  
pp. 4473
Author(s):  
Koothan U. T. ◽  
Nina V. Kate ◽  
Anuradha V.
Keyword(s):  
Prospective Study ◽  
Pregnant Women ◽  
Gestational Age ◽  
Maternal Morbidity ◽  
Latency Period ◽  
Neonatal Morbidity ◽  
Management Issue ◽  
Inclusion Criteria ◽  
Membrane Rupture ◽  
Study Participants

Background: Prelabour rupture of membranes is a common obstetric problem and the assessment of women with possible membrane rupture is a management issue faced in every day practice. The diagnosis and treatment of Prelabour rupture of membranes depends upon the facilities available. Unrecognized and inadequately treated conditions can lead to various maternal and neonatal complications.Methods: The present prospective study was conducted on 200 pregnant women satisfying the inclusion criteria after getting consent for participation. Pregnant women between the gestational age of 28 – 40 weeks who presented with Prelabour rupture of membranes to casualty were enrolled into the study.Results: 76.5% of the study participants were between 37-40 weeks of gestation and the remaining 23.5% belonged to the preterm population. Maternal morbidity was found to be 68% among the study participants with latency period more than 24 hrs. 37.5% of the neonates developed morbidity and the neonatal mortality was 2%.Conclusions: Prelabour rupture of membranes contributes significantly to maternal morbidity, neonatal morbidity and perinatal mortality.

scholarly journals Two-year comparative study on immediate versus delayed induction in term premature rupture of membranes

2017 ◽  
Vol 7 (1) ◽  
pp. 94
Author(s):  
John Mary Betty Agnes ◽  
Sowmyanarayanan Lavanya
Keyword(s):  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Induction Of Labour ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Maternal Complications ◽  
Safe Delivery ◽  
Pg E2

Background: Premature rupture of membranes (PROM) has an incidence of about 10% of all pregnancies and is a significant event as it can cause maternal complications, neonatal morbidity and mortality. Some believe that the expectant management of PROM at term does not increase the perinatal and maternal morbidity, and immediate induction of labour leads to an increased caesarean section rate. There are some authors who report a significant increase in the rates of neonatal, maternal infection and foetal distress if delivery occurs over 24 hours after PROM. Thus, a data is required to manage the cases of PROM to effect safe delivery for both mother and baby. The objective of the study was to compare the neonatal and maternal outcomes between immediate and delayed induction with PG E2 gel in term PROM.Methods: A hospital based study in women admitted to Obstetrics and Gynaecology Department at R.S.R.M Hospital with a sample of 400 patients in age group between 19- 35 years with gestational age between 37 and 41 weeks were selected for the study. All the 400 cases who presented with term PROM were admitted in labour room and history was elicited regarding age, menstrual and obstetric history with enquiry regarding the time of rupture of membranes, duration and amount of leaking with general, systemic and detailed obstetric examination.Results: The number of PG E2 gel needed for induction varied between the two groups. Around 45 patients in group 2 needed second dose of gel whereas only 32 patients required the second dose in the late induction group and 72 cases got into active labour. There was no difference in maternal and neonatal infectious morbidity between the two groups. This may be due to the use of prophylactic antibiotics. Neonatal outcome was equally good in both the groups.Conclusions: Delayed induction of labour in PROM after a waiting period of 12 hours stands as a reasonable option as it reduces the number of operative deliveries without compromising the maternal and neonatal outcome.

Sign in / Sign up

Export Citation Format

Share Document