Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage f...Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage form of pulmonary surfactant within Type II pneumocytes, secretion of which increases with advancing gestational age, thus enabling prediction of the degree of FLM. Preterm premature rupture of membranes (PPROM) complicates approximately 1/3 of all preterm births. Birth within 1 week is the most likely outcome for any patient with PPROM in the absence of adjunctive treatments. Respiratory distress has been reported to be the most common complication of preterm birth. Sepsis, intraventricular haemorrhage, and necrotizing enterocolitis also are associated with prematurity, but these are less common near to term. Objective: To assess the efficacy of the amniotic fluid lamellar body counting from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Methods: This study was conducted at Ain Shams University Maternity Hospital in the emergency ward from January 2019 to September 2019. It included 106 women with singleton pregnancies, gestational age from 28 - 36 weeks with preterm premature rupture of membranes. This study is designed to assess the efficacy of the amniotic fluid lamellar body counting (LBC) from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Results: The current study revealed a highly significant increase in the lamellar body count in cases giving birth to neonates without RDS compared to that cases giving birth to neonates with RDS. Also, no statistically significant difference between LBC and age, parity and number of previous miscarriages in the mother was found. Gestational age at delivery was significantly lower among cases with respiratory distress. Steroid administration was significantly less frequent among cases with respiratory distress. However, lamellar bodies had high diagnostic performance in the prediction of respiratory distress. Conclusion: Lamellar body count (LBC) is an effective, safe, easy, and cost-effective method to assess fetal lung maturity (FLM). It does not need a highly equipped laboratory or specially trained personnel, it just needs the conventional blood count analyzer. Measurement of LBC is now replacing the conventional Lecithin/Sphyngomyelin L/S ratio. LBC cut-off value of ≤42.5 × 10<sup>3</sup>/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.展开更多
Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first tw...Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G<sub>6</sub>P<sub>1</sub><sup>+4</sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.展开更多
BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is ver...BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia.METHODS: A retrospective cross sectional study was conducted using data available at MizanAman General Hospital during a period of 3 years(January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically signifi cant.RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours(AOR=5.6, 95%CI 1.3–24.1) latency >24 hours(AOR=2.8, 95%CI 1.7–11.8), residing in rural areas(AOR=4.2, 95%CI 3.96–29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes.CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.展开更多
Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) ...Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 - 42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and <0.0001 respectively). Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Furthermore they were more accurate than β-HCG. Conclusion: Detection of PAMG-1 in cervico vaginal discharge is promising in diagnosis of PROM & especially in those cases of suspected PROM and it should be done as a worse trial in every case of suspected PROM. Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Also they were more accurate than β-HCG and they can be used if PAMG-1 is not available for detection of doubtful PROM cases.展开更多
Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to estab...Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.展开更多
Objective: To investigate changes of cytokines and matrix metalloproteinases in patients with premature rupture of membranes (PROM) with chorioamnionitis (HCA) and its clinical significance. Methods: A total of 80 pre...Objective: To investigate changes of cytokines and matrix metalloproteinases in patients with premature rupture of membranes (PROM) with chorioamnionitis (HCA) and its clinical significance. Methods: A total of 80 pregnant women with premature rupture of membranes were selected as PROM group and 80 normal pregnant women as control group. The PROM group was subgrouped into HCA group (n=45) and non HCA group (n=35) according to the presence or absence of HCA. Matrix metalloproteinases (MMP-8, MMP-9) and cytokines (IL-8, IL-10, TNF-α) in pregnant women were compared. Results: The level of IL-8, TNF-αwere (420.45±110.26) ng/L, (413.53±125.19) ng/L in the PROM group, which were significantly higher than those in the control group;the levels of IL-10 were(332.07±48.12) ng/L in the PROM groups, which were significantly lower than the control group. The levels of IL-8 and TNF-α in PROM combined with HCA group were significantly higher than those in non-HCA group, the levels of IL-10 were significantly lower than those in non-HCA group. The level of MMP-8, MMP-9 were (11.02±2.48) ng/mL, (648.42±73.35) ng/L in the PROM group, which were significantly higher than the control group. The levels of MMP-8, MMP-9 in PROM combined with HCA were significantly higher than those in non-HCA group with the difference was statistically significant. Conclusion: When premature rupture of membranes and chorioamniositis occurring, pregnant women were accompanied by the level changes of cytokines and matrix metalloproteinases, so timely monitoring of these indicators can offer basis for the early diagnosis the premature rupture of membranes and chorioamnionitis, which will help to reduce morbidity and mortality of the perinatal pregnant women and newborns with important clinical value.展开更多
Background: Preterm premature rapture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory distress syndrome. Genital infecti...Background: Preterm premature rapture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory distress syndrome. Genital infection is a very important risk which closely related with PPROM. The preliminary study only made qualitative research on genital infection, but there was no deep and clear judgment about the effects of pathogenic bacteria. This study was to analyze the association of in fections with PPROM in pregnant women in Shaanxi, China, and to establish Bayesian stepwise discriminant analysis to predict the incidence of PPROM. Methods: In training group, the 112 pregnant women with PPROM were enrolled in the case subgroup, and 108 normal pregnant women in the control subgroup using an unmatched case-control method. The sociodemographic characteristics of these participants were collected by face-to-face interviews. Vaginal excretions fiom each participant were sampled at 28 36-6 weeks of pregnancy using a sterile swab. DNA corresponding to Chlamrdia trachomalix (CT), Ureaplasma urealyticwn (UU), Candida albicans, group B streptococci (GBS), herpes simplex virus- 1 (HSV-1), and HSV-2 were detected in each participant by real-time polymerase chain reaction. A model of Bayesian discriminant analysis was established and then verified by a mull)center validation group that included 500 participants in the case subgroup and 5(10 participants in the control subgroup from five different hospitals in the Shaanxi province, respectively. Results: The sociological characteristics were not significantly different between the case and control subgroups in both training and validation groups (all P 〉 0.05). In training group, the infection rates of UU (11.6% vs. 3.7%), CT (17.0% vs. 5.6%), and GBS (22.3% vs. 6.5%) showed statistically different between the case and control subgroups (all P 〈 0.05), Iog-transfomacd quantification of UU, CE GBS, and HSV-2 showed statistically different between the case and control subgroups (P 〈 0.05). All etiological agents were introduced into the Bayesian stepwise discriminant model showed that UU, CT, and GBS infections were the main contributors to PPROM, with coe|'ficients of 0.441,3.347, and 4.126, respectively. The accuracy rates of the Bayesian stepwise discriminant analysis between the case and control subgroup were 84.1% and 86.8% in the training and validation groups, respectively. Conclusions: This study established a Bayesian stepwise discriminant model to predict the incidence of PPROM. The UU, CT, and GBS infections were discriminant factors for PPROM according to a Bayesian stepwise discriminant analysis. This model could provide a new method for the early predicting of PPROM in pregnant women.展开更多
Background:Preterm premature rupture of membranes(PPROM)is associated with high neonatal morbidity and mortality.However,the influences of cesarean section(CS)on neonatal outcomes in preterm pregnancies complicated wi...Background:Preterm premature rupture of membranes(PPROM)is associated with high neonatal morbidity and mortality.However,the influences of cesarean section(CS)on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated.The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.Methods:A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st,2011 to December 31st,2011.A total of 2756 singleton pregnancies complicated with PPROM were included.Adverse neonatal outcomes including early neonatal death,birth asphyxia,respiratory distress syndrome(RDS),pneumonia,infection,birth trauma,and 5-min/10-min Apgar scores were obtained from the hospital records.Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression.Numerical variables were compared by multiple linear regressions.Results:In total,2756 newborns were involved in the analysis.Among them,1166 newborns(42.31%)were delivered by CS and 1590 newborns belonged to vaginal delivery(VD)group.The CS proportion of PPROM obviously increased with the increase of gestational age(x2=5.014,P=0.025).Compared with CS group,VD was associated with a higher risk of total newborns mortality(odds ratio[OR],2.38;95%confidence interval[Cl],1.102-5.118;P=0.027),and a lower level of pneumonia(OR,0.32;95%Cl,0.126-0.811;P=0.016).However,after multivariable adjustment and stratification for gestational age,only pneumonia was significantly related with CS in 28 to 34 weeks group(OR,0.34;95%Cl,0.120-0.940;P=0.038).There were no differences regarding to other adverse outcomes in the two groups,including neonatal mortality,birth asphyxia,Apgar scores,RDS,pneumonia,and sepsis.Conclusions:The proportion of CS of pregnant women with PPROM was very high in China.The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.展开更多
Premature rupture of membrane (PROM) is obstetric dilemma that carries risk of neonatal and maternal complications. PROM has controversy in management although many factors affect the outcome of PROM.
Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 we...Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.展开更多
文摘Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage form of pulmonary surfactant within Type II pneumocytes, secretion of which increases with advancing gestational age, thus enabling prediction of the degree of FLM. Preterm premature rupture of membranes (PPROM) complicates approximately 1/3 of all preterm births. Birth within 1 week is the most likely outcome for any patient with PPROM in the absence of adjunctive treatments. Respiratory distress has been reported to be the most common complication of preterm birth. Sepsis, intraventricular haemorrhage, and necrotizing enterocolitis also are associated with prematurity, but these are less common near to term. Objective: To assess the efficacy of the amniotic fluid lamellar body counting from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Methods: This study was conducted at Ain Shams University Maternity Hospital in the emergency ward from January 2019 to September 2019. It included 106 women with singleton pregnancies, gestational age from 28 - 36 weeks with preterm premature rupture of membranes. This study is designed to assess the efficacy of the amniotic fluid lamellar body counting (LBC) from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Results: The current study revealed a highly significant increase in the lamellar body count in cases giving birth to neonates without RDS compared to that cases giving birth to neonates with RDS. Also, no statistically significant difference between LBC and age, parity and number of previous miscarriages in the mother was found. Gestational age at delivery was significantly lower among cases with respiratory distress. Steroid administration was significantly less frequent among cases with respiratory distress. However, lamellar bodies had high diagnostic performance in the prediction of respiratory distress. Conclusion: Lamellar body count (LBC) is an effective, safe, easy, and cost-effective method to assess fetal lung maturity (FLM). It does not need a highly equipped laboratory or specially trained personnel, it just needs the conventional blood count analyzer. Measurement of LBC is now replacing the conventional Lecithin/Sphyngomyelin L/S ratio. LBC cut-off value of ≤42.5 × 10<sup>3</sup>/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.
文摘Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G<sub>6</sub>P<sub>1</sub><sup>+4</sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.
文摘BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia.METHODS: A retrospective cross sectional study was conducted using data available at MizanAman General Hospital during a period of 3 years(January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically signifi cant.RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours(AOR=5.6, 95%CI 1.3–24.1) latency >24 hours(AOR=2.8, 95%CI 1.7–11.8), residing in rural areas(AOR=4.2, 95%CI 3.96–29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes.CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.
文摘Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 - 42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and <0.0001 respectively). Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Furthermore they were more accurate than β-HCG. Conclusion: Detection of PAMG-1 in cervico vaginal discharge is promising in diagnosis of PROM & especially in those cases of suspected PROM and it should be done as a worse trial in every case of suspected PROM. Urea and Creatinine is the second option in diagnosis of PROM with high sensitivity, and specificity after PAMG-1 with a privilege of low cost than PAMG-1. Also they were more accurate than β-HCG and they can be used if PAMG-1 is not available for detection of doubtful PROM cases.
文摘Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.
文摘Objective: To investigate changes of cytokines and matrix metalloproteinases in patients with premature rupture of membranes (PROM) with chorioamnionitis (HCA) and its clinical significance. Methods: A total of 80 pregnant women with premature rupture of membranes were selected as PROM group and 80 normal pregnant women as control group. The PROM group was subgrouped into HCA group (n=45) and non HCA group (n=35) according to the presence or absence of HCA. Matrix metalloproteinases (MMP-8, MMP-9) and cytokines (IL-8, IL-10, TNF-α) in pregnant women were compared. Results: The level of IL-8, TNF-αwere (420.45±110.26) ng/L, (413.53±125.19) ng/L in the PROM group, which were significantly higher than those in the control group;the levels of IL-10 were(332.07±48.12) ng/L in the PROM groups, which were significantly lower than the control group. The levels of IL-8 and TNF-α in PROM combined with HCA group were significantly higher than those in non-HCA group, the levels of IL-10 were significantly lower than those in non-HCA group. The level of MMP-8, MMP-9 were (11.02±2.48) ng/mL, (648.42±73.35) ng/L in the PROM group, which were significantly higher than the control group. The levels of MMP-8, MMP-9 in PROM combined with HCA were significantly higher than those in non-HCA group with the difference was statistically significant. Conclusion: When premature rupture of membranes and chorioamniositis occurring, pregnant women were accompanied by the level changes of cytokines and matrix metalloproteinases, so timely monitoring of these indicators can offer basis for the early diagnosis the premature rupture of membranes and chorioamnionitis, which will help to reduce morbidity and mortality of the perinatal pregnant women and newborns with important clinical value.
文摘Background: Preterm premature rapture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory distress syndrome. Genital infection is a very important risk which closely related with PPROM. The preliminary study only made qualitative research on genital infection, but there was no deep and clear judgment about the effects of pathogenic bacteria. This study was to analyze the association of in fections with PPROM in pregnant women in Shaanxi, China, and to establish Bayesian stepwise discriminant analysis to predict the incidence of PPROM. Methods: In training group, the 112 pregnant women with PPROM were enrolled in the case subgroup, and 108 normal pregnant women in the control subgroup using an unmatched case-control method. The sociodemographic characteristics of these participants were collected by face-to-face interviews. Vaginal excretions fiom each participant were sampled at 28 36-6 weeks of pregnancy using a sterile swab. DNA corresponding to Chlamrdia trachomalix (CT), Ureaplasma urealyticwn (UU), Candida albicans, group B streptococci (GBS), herpes simplex virus- 1 (HSV-1), and HSV-2 were detected in each participant by real-time polymerase chain reaction. A model of Bayesian discriminant analysis was established and then verified by a mull)center validation group that included 500 participants in the case subgroup and 5(10 participants in the control subgroup from five different hospitals in the Shaanxi province, respectively. Results: The sociological characteristics were not significantly different between the case and control subgroups in both training and validation groups (all P 〉 0.05). In training group, the infection rates of UU (11.6% vs. 3.7%), CT (17.0% vs. 5.6%), and GBS (22.3% vs. 6.5%) showed statistically different between the case and control subgroups (all P 〈 0.05), Iog-transfomacd quantification of UU, CE GBS, and HSV-2 showed statistically different between the case and control subgroups (P 〈 0.05). All etiological agents were introduced into the Bayesian stepwise discriminant model showed that UU, CT, and GBS infections were the main contributors to PPROM, with coe|'ficients of 0.441,3.347, and 4.126, respectively. The accuracy rates of the Bayesian stepwise discriminant analysis between the case and control subgroup were 84.1% and 86.8% in the training and validation groups, respectively. Conclusions: This study established a Bayesian stepwise discriminant model to predict the incidence of PPROM. The UU, CT, and GBS infections were discriminant factors for PPROM according to a Bayesian stepwise discriminant analysis. This model could provide a new method for the early predicting of PPROM in pregnant women.
文摘Background:Preterm premature rupture of membranes(PPROM)is associated with high neonatal morbidity and mortality.However,the influences of cesarean section(CS)on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated.The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.Methods:A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st,2011 to December 31st,2011.A total of 2756 singleton pregnancies complicated with PPROM were included.Adverse neonatal outcomes including early neonatal death,birth asphyxia,respiratory distress syndrome(RDS),pneumonia,infection,birth trauma,and 5-min/10-min Apgar scores were obtained from the hospital records.Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression.Numerical variables were compared by multiple linear regressions.Results:In total,2756 newborns were involved in the analysis.Among them,1166 newborns(42.31%)were delivered by CS and 1590 newborns belonged to vaginal delivery(VD)group.The CS proportion of PPROM obviously increased with the increase of gestational age(x2=5.014,P=0.025).Compared with CS group,VD was associated with a higher risk of total newborns mortality(odds ratio[OR],2.38;95%confidence interval[Cl],1.102-5.118;P=0.027),and a lower level of pneumonia(OR,0.32;95%Cl,0.126-0.811;P=0.016).However,after multivariable adjustment and stratification for gestational age,only pneumonia was significantly related with CS in 28 to 34 weeks group(OR,0.34;95%Cl,0.120-0.940;P=0.038).There were no differences regarding to other adverse outcomes in the two groups,including neonatal mortality,birth asphyxia,Apgar scores,RDS,pneumonia,and sepsis.Conclusions:The proportion of CS of pregnant women with PPROM was very high in China.The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.
文摘Premature rupture of membrane (PROM) is obstetric dilemma that carries risk of neonatal and maternal complications. PROM has controversy in management although many factors affect the outcome of PROM.
文摘Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.