Current and Emerging Strategies for Prediction and Diagnosis of Prelabour Rupture of the Membranes: A Narrative Review

Prelabour rupture of membranes (PROM) refers to the disruption of foetal membranes before the onset of labour, resulting in the leakage of amniotic fluid. PROM complicates 3% and 8% of preterm and term pregnancies, respectively. Accurate and timely diagnosis is crucial for effective management to prevent adverse maternal- and foetal-outcomes. The diagnosis of equivocal PROM cases with traditional methods often becomes challenging in current obstetrics practice; therefore, various novel biochemical markers have emerged as promising diagnostic tools. This narrative review is sought to review the published data to understand the current and emerging trends in diagnostic modalities in term and preterm pregnancies complicated with PROM and the potential role of various markers for predicting preterm PROM (pPROM) and chorioamnionitis in women with pPROM.

A STUDY OF THE MORPHOLOGY OF PLACENTA IN TERTIARY CARE HOSPITAL OF CENTRAL KARNATAKA, INDIA

Introduction: Placenta is a temporary structure, developed during Pregnancy and discarded at Parturition. Human Placenta is of Discoid and Haemo-Chorial type. It connects the foetus with the mother's womb. It is formed by the contribution of two Individuals - both Mother and Baby. At 1 term four- fth of Placenta is of foetal origin and one- fth is of maternal. Along with Amnion, Chorion, Allantois and Yolk sac, Placenta can also be considered as one of the foetal membranes, which acts as Nutritive and Protective to the developing Embryo. Method: - The present study was done on morphology and morphometry of 150 placentae carried at the Department of Anatomy, Basaveshwara Medical College & Hospital (BMCH), Chitradurga. The placentae were collected with prior ethical clearance and proper consent. Soon after the delivery the placental surface was washed thoroughly under running tap water which were then weighed, tagged and brought to the department of Anatomy, BMCH. The parameters like size, shape and attachment of umbilical cord were noted down. Gross examination was carried out according to the proforma. Result: - The maximum number of placentae belong to the range of 501-600 gms (38.7%). Least placental weight is recorded as 205 gms, showing dispersal pattern. The maximum recorded weight is 835 gms and the average being 491.4 gms. The majority of the placentae are discoid (63.3%). The minimum length recorded is 8.9 cms, maximum as 23.80 cms and the average being 18.3 cms. Conclusion: - Careful examination of Placenta can help in explaining adverse outcomes, their management in subsequent pregnancies and assessment of new born risk.

Caesarean Section in a Tertiary Hospital in South-South, Nigeria: A 3-year Review

Background: Caesarean section is the delivery of the foetus, placenta, and foetal membranes through an incision on the abdominal and uterine walls after the age of foetal viability. It is a life-saving surgical procedure, which has helped reduce maternal and perinatal morbidity and mortality over the years. Objective: To determine the rates, indications, outcomes, and complications of Caesarean section at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. Materials and Methods: This research was carried out at the Department of Obstetrics and Gynaecology, Federal Medical Centre (FMC), Yenagoa, Bayelsa State, South-South, Nigeria between 1st January 2018 and 31st December 2020. It was a retrospective study. Data was retrieved from the labour ward records, delivery register, theatre records, and patients’ folders during the period under review, and entered into a pre-designed proforma. Data were analysed with IBM SPSS version 23.0. Results were presented in frequencies and percentages for categorical variables and mean and standard deviation for continuous variables. Results: About 959 women had Caesarean section (CS) out of 2,263 deliveries, giving a Caesarean section rate of 42.4%. The commonest indication for emergency Caesarean section was cephalopelvic disproportion (36.0%), while that for elective Caesarean section was repeat Caesarean section (19.6%). Conclusion: The Caesarean section rate in our Centre is extremely high, almost three times the acceptable upper limit set by the WHO. Encouraging vaginal birth after Caesarean section as a means to reduce this high rate is recommended as it was noted that previous Caesarean section was a leading indication for surgeries.

Impact of Vaginal Microbiota on Gestation and Labour

Background. Imbalances of vagina microbiota in pregnant women entail the development of bacterial vaginosis and candidal vulvovaginitis. Lactobacterial strains modulate pro-inflammatory epithelium responses to enhance resistance, which renders lactobacteria promising agents in pregnant women with elevated pH.Objectives. Assessment of the lactobacterial impact on vaginal microbiota and the course of gestation and labour.Methods. A total of 261 pregnant women were examined and separated by cohorts according to pH of vaginal fluid: ≥4.5 in cohort 1 (n = 147), <4.5 in cohort 2 (n = 114). Cohort 1 had age 29.9 (4.6) years, cohort 2 — 29.0 (4.6) years, p = 0.55. Screening: at weeks 11–14, 18–21, 30–34 and 36–41 of gestation we performed vaginal pH-metry, cervicometry, determined opportunistic pathogens and lactobacteria with mass spectrometry. Cohort 1 received lactobacteria. Statistical analyses were performed with Statistica 10.Results. In cohort 1 receiving lactobacteria, the number of women devoid of opportunistic flora increased from 31.29 to 43.53%. In cohort 2 not receiving lactobacteria, this number decreased from 53.51 to 35.09%. In cohort 1, L. jensenii (correlates with bacterial vaginosis rate) was primarily isolated in 9.52% women, and in 14.91% — in cohort 2. The rate of L. jensenii increased to 14.96% in cohort 1 (receiving lactobacteria) and decreased to 3.51% in cohort 2 (not receiving lactobacteria). A higher L. jensenii rate correlated with absent growth of opportunistic pathogens. Increasing the rate of L. crispatus (suppresses opportunistic pathogens) to 14.96% in cohort 1 lead to a 1.9-fold diminishing of active opportunistic flora. An increase of L. crispatus from 7.02 to 30.7% in cohort 2 supressed active opportunistic growth 3.9-fold at a normal baseline pH. Cervicometry values were invariant between the cohorts. Pregnancy complications were not observed under abundant lactobacterial growth. The risk of gestation loss occurred in 1.4% of women in cohort 1 and in 10.5% — in cohort 2. Abnormal labour and premature rupture of foetal membranes were more frequent in cohort 2.Conclusion. With a less favourable premorbid condition in cohort 1, vaginal changes with background lactobacterial therapy facilitate gestational health in pregnancy. Many “sterile” niches, especially the maternal generative passages, represent active low biomass environments inhabited by unique typical maternal microflora. Most remarkable is the correlation between health of vaginal microbiota and abnormal labour.

Anti-inflammatory effects of gallic acid in human gestational tissues in vitro

Spontaneous preterm birth is the leading cause of neonatal mortality and morbidity globally. Activation of the maternal immune system leads to a downstream cascade of proinflammatory events that culminate in the activation of spontaneous uterine contractions and the rupture of the foetal membranes. Anti-inflammatory agents may be a novel therapeutic approach to prevent inflammation-induced myometrial contractions and premature rupture of foetal membranes. The polyphenol gallic acid has been previously shown to exert potent anti-inflammatory effects. Thus, this study aimed to determine the effect of gallic acid on proinflammatory and pro-labour mediators in cytokine-stimulated gestational tissues in vitro. In primary human cells isolated from myometrium and foetal membranes (decidua, and amnion mesenchymal and epithelial cells), gallic acid treatment suppressed inflammation-induced expression of proinflammatory cytokines and chemokines and extracellular matrix-degrading and matrix-remodelling enzymes. Gallic acid also significantly inhibited inflammation-induced myometrial activation as evidenced by decreased expression of contraction-associated proteins, the uterotonic PGF2α and collagen cell contractility. Using a global proteomic approach, gallic acid may differentially regulate proteins associated with collagen synthesis, cell contractility and protein synthesis in primary myometrial and decidual cells. In summary, gallic acid inhibited inflammation-induced mediators involved in active labour in primary cells isolated from myometrium and foetal membranes. These in vitro studies suggest that the polyphenol gallic acid may be able to suppress the production of proinflammatory and pro-labour mediators involved in myometrial contractions and rupture of foetal membranes. Future preclinical studies may elucidate the efficacy of gallic acid in preventing inflammation-driven preterm birth.