Objective(s): Description of mothers “ characteristics, obstetricians” practices, and PPROM-linked mortality in all 81 maternity hospitals in the Rhone-Alpes Region, over a period of 2 years. Study design: Prospecti...Objective(s): Description of mothers “ characteristics, obstetricians” practices, and PPROM-linked mortality in all 81 maternity hospitals in the Rhone-Alpes Region, over a period of 2 years. Study design: Prospective cohort study of 598 women with PPROM between 24 and 34 weeks’gestation, leading to 680 births. At time of PPROM, collection of mothers’ socioeconomic characteristics, medical and obstetric histories and PPROM circumstances. Collection of perinatal management, neonates’ medical status and postnatal referral. Results: The birth rate after PPROM between 24 and 34 weeks’ gestation was 0.47% (95% CI: 0.42- 0.48). Sixty percent of PPROM occurred before 32 weeks’ gestation and 98% of births before 37 weeks. The incidence of previous PPROM was 14.3% . Antibiotics, corticosteroids, and tocolytics were given to 82, 78, and 52% of women, respectively. The rate of antibiotics and antenatal corticosteroids varied with gestational age (lower rates for antibiotics just after the limit of viability (23- 24 weeks) and after 32 weeks, higher rates of corticosteroids between 26 and 30 weeks). The PPROM- birth interval became shorter as gestation advanced. The incidence of C- section was 58.7% (n = 270), C- section before labour being the most frequent mode of delivery. Sixty-seven percent of neonates were born in Level- 3 hospitals. The overall neonatal mortality rate at 28 days decreased with gestational age at PPROM, and was 17.2% (16/93), 3% (6/200), and 0.41% (1/241) at 24- 27, 28- 31 and 32- 33 weeks of PPROM, respectively. Conclusion(s): After PPROM, antibiotics and antenatal corticosteroids were widely used in our cohort, and C- section rates were elevated. With that up-to-date management, the perinatal mortality rate was less than 3% following PPROM after 28 weeks’ gestation.展开更多
OBJECTIVE: To examine whether preterm premature rupture of membranes (PROM), intrauterine infection, and oligohydramnios are risk factors for placental abruption. METHODS: Data for this retrospective cohort study were...OBJECTIVE: To examine whether preterm premature rupture of membranes (PROM), intrauterine infection, and oligohydramnios are risk factors for placental abruption. METHODS: Data for this retrospective cohort study were derived from the 1988 National Maternal and Infant Health Survey (N=11,777). Association between abruption and these clinical risk factors was expressed as relative risk (RR) and 95%confidence interval (CI), with multivariate adjustment for potential confounders. RESULTS: The overall incidence of abruption was 0.87%. The risk of abruption was 3.58-fold higher (95%CI 1.74-7.39)among women with preterm PROM (2.29%) compared with women with intact membranes (0.86%). The rates of abruption among women with and without intrauterine infection were 4.81%and 0.83%, respectively (RR 9.71, 95%CI 3.23-29.17). However, oligohydramnios was not associated with abruption (1.46%compared with 0.87%; RR 2.09, 95%CI 0.92-5.31). Compared with women with intact membranes, the RR for abruption among preterm PROM and whose membranes were ruptured for 24-47 hours and 48 hours or more before delivery, respectively, were 2.37 (95%CI 0.99-9.09), and 9.87 (95%CI 3.57-27.82). When preterm PROM was accompanied by intrauterine infections, the RR for abruption was 9.03 (95%CI 2.80-29.15) compared with women with intact membranes and no infections. Similarly, preterm PROM accompanied by oligohydramnios conferred over a 7.17-fold risk (95%CI 1.35-38.10) for abruption compared with women with neither of these 2 conditions. CONCLUSION: Women presenting with preterm PROM are at increased risk of developing abruption, with the risk being higher either in the presence of intrauterine infections or oligohydramnios. Physicians managing patients with preterm PROM should be aware that these patients are at increased risk of developing abruption after 24 hours following preterm PROM.展开更多
Objective: This study was undertaken to investigate the association among plurality (number of fetuses per pregnancy), abruptio placenta, and perinatal mortality. Study design: A retrospective cohort study on 15,051,8...Objective: This study was undertaken to investigate the association among plurality (number of fetuses per pregnancy), abruptio placenta, and perinatal mortality. Study design: A retrospective cohort study on 15,051,872 singletons, 413,619 twins, and 22,585 triplets delivered in the United States between 1995 and 1998 was conducted. We compared the occurrence of perinatal death between pregnancies complicated by abruptio placenta and those without with the use of adjusted odds ratios. The generalized estimating equations framework was applied to adjust for intracluster correlations among multiples. Results: Placental abruption occurred among 93,968 singletons (6.2 per 1000), 5051 twin (12.2 per 1000), and 353 triplet (15.6 per 1000) gestations (P for trend < .0001). Placental abruption was associated with significant risk of mortality irrespective of the plurality subtype. Perinatal mortality was greatest among singletons (adjusted odds ratio 95% CI = 14.3 13.2-15.4 ), followed by twins (4.4 3.9-4.9 ) and least among triplets (3.0 2.0-4.6 ) (P for trend < .0001). Conclusion: As plurality increases from 1 to 3, the risk of placental abruption rises, whereas the risk of abruptio-associated perinatal mortality declines.展开更多
Objective: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age SGA , other) and cerebral damage (eg, cystic per...Objective: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age SGA , other) and cerebral damage (eg, cystic periventricular leukomalacia c-PVL , grade Ⅲ intraventricular hemorrhage Ⅳ H , and intra-parenchymal hemorrhage IPH ). Study design: This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery. Results: We found that the risk of c-PVL and grade Ⅲ Ⅳ H was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH. Conclusion: Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection.展开更多
OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricul ar leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm m...OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricul ar leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm membrane rupture, spont aneous preterm labor, or indicated preterm delivery at 24 to 33 weeks of gestati on from January 1, 1993, to December 31, 2002, we evaluated the obstetric and histopathologic pla cental variables in reference to the development of intraventricular hemorrhage (n = 44), periventricular leukomalacia (n = 19), or no ultrasonographic cerebral lesion (n = 589). Excluded were stillbirths and congenital anomalies. Statistic al analysis included Fisher exact test, Student t test, and stepwise logistic re gression analysis with a 2-tailed P < .05 consi-dered significant. RESULTS: Mu ltivariate analysis showed that occurrence of neonatal intraventricular hemorrha ge and periventricular leukomalacia were associated only with spontaneous premat urity (odds ratio = 1.9; 95%confidence interval 1.1-3.4) and gestational age a t delivery in weeks (odds ratio = 0.8; 95%confidence interval 0.7-0.9). Neonat es with intraventricular hemorrhage did not differ from those with periventricul ar leukomalacia in any obstetric or neonatal variable, but there was a higher ri sk of neurodevelopmental delay associated with periventricular leukomalacia. CON CLUSION: Among premature infants born at less than 34.0 weeks of gestation, intr aventricular hemorrhage and periventricular leukomalacia share common clinical c haracteristics, with spontaneous preterm delivery and gestational age at deliver y as the only independent antenatal predictors.展开更多
Objective This study was undertaken to evaluate whether aggressive to colysis i mproves pregnancy outcome after preterm premature rupture of the membranes (PPRO M). Study design Retrospective case-control study of pat...Objective This study was undertaken to evaluate whether aggressive to colysis i mproves pregnancy outcome after preterm premature rupture of the membranes (PPRO M). Study design Retrospective case-control study of patients with PPROM before 34 weeks of gestation, followed by a prospective cohort study with historical c ontrols. The retrospective phase covered 1995 through 1999 when we used tocolysi s aggressively. With the use of survival analysis, we compared latency in our ca ses with 4 published control series in which tocolysis was never used. On the ba sis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective eval uation of this new protocol. Results In the retrospective phase, tocolysis was u sed in 94%of 130 cases and maintained during 84%of 1162 total antenatal patien t-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospe ctive study, 43%of 63 patients received tocolytics, but these were used at lowe r doses and were given during only 7%of 770 patient-days. Latency with this ve ry limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive toc olysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. Conclusion Aggressive tocolysis after PPROM causes significant maternal morbidity, but does not incr ease latency or decrease neonatal morbidity compared with either very limited to colysis or no tocolysis at all.展开更多
Background: Maternal placental syndromes, including the hypertensive disorders of pregnancy and abruption or infarction of the placenta, probably originate from diseased placental vessels. The syndromes arise most oft...Background: Maternal placental syndromes, including the hypertensive disorders of pregnancy and abruption or infarction of the placenta, probably originate from diseased placental vessels. The syndromes arise most often in women who have metabolic risk factors for cardiovascular disease, including obesity, pre-pregnancy hypertension, diabetes mellitus, and dyslipidaemia. Our aim was to assess the risk of premature vascular disease in women who had had a pregnancy affected by maternal placental syndromes. Methods: We did a population-based retrospective cohort study in Ontario, Canada, of 1.03 million women who were free from cardiovascular disease before their first documented delivery. We defined the following as maternal placental syndromes: pre-eclampsia, gestational hypertension, placental abruption, and placental infarction. Our primary endpoint was a composite of cardiovascular disease, defined as hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral artery disease at least 90 days after the delivery discharge date. Findings: The mean (SD) age of participants was 28.2 (5.5) years at the index delivery, and 75 380 (7%) women were diagnosed with a maternal placental syndrome. The incidence of cardiovascular disease was 500 per million person-years in women who had had a maternal placental syndrome compared with 200 per million in women who had not (adjusted hazard ratio HR 2.0, 95 CI 1.7-2.2). This risk was higher in the combined presence of a maternal placental syndrome and poor fetal growth (3.1, 2.2-4.5) or a maternal placental syndrome and intrauterine fetal death (4.4, 2.4-7.9), relative to neither. Interpretation: The risk of premature cardiovascular disease is higher after a maternal placental syndrome, especially in the presence of fetal compromise. Affected women should have their blood pressure and weight assessed about 6 months postpartum, and a healthy lifestyle should be emphasised.展开更多
文摘Objective(s): Description of mothers “ characteristics, obstetricians” practices, and PPROM-linked mortality in all 81 maternity hospitals in the Rhone-Alpes Region, over a period of 2 years. Study design: Prospective cohort study of 598 women with PPROM between 24 and 34 weeks’gestation, leading to 680 births. At time of PPROM, collection of mothers’ socioeconomic characteristics, medical and obstetric histories and PPROM circumstances. Collection of perinatal management, neonates’ medical status and postnatal referral. Results: The birth rate after PPROM between 24 and 34 weeks’ gestation was 0.47% (95% CI: 0.42- 0.48). Sixty percent of PPROM occurred before 32 weeks’ gestation and 98% of births before 37 weeks. The incidence of previous PPROM was 14.3% . Antibiotics, corticosteroids, and tocolytics were given to 82, 78, and 52% of women, respectively. The rate of antibiotics and antenatal corticosteroids varied with gestational age (lower rates for antibiotics just after the limit of viability (23- 24 weeks) and after 32 weeks, higher rates of corticosteroids between 26 and 30 weeks). The PPROM- birth interval became shorter as gestation advanced. The incidence of C- section was 58.7% (n = 270), C- section before labour being the most frequent mode of delivery. Sixty-seven percent of neonates were born in Level- 3 hospitals. The overall neonatal mortality rate at 28 days decreased with gestational age at PPROM, and was 17.2% (16/93), 3% (6/200), and 0.41% (1/241) at 24- 27, 28- 31 and 32- 33 weeks of PPROM, respectively. Conclusion(s): After PPROM, antibiotics and antenatal corticosteroids were widely used in our cohort, and C- section rates were elevated. With that up-to-date management, the perinatal mortality rate was less than 3% following PPROM after 28 weeks’ gestation.
文摘OBJECTIVE: To examine whether preterm premature rupture of membranes (PROM), intrauterine infection, and oligohydramnios are risk factors for placental abruption. METHODS: Data for this retrospective cohort study were derived from the 1988 National Maternal and Infant Health Survey (N=11,777). Association between abruption and these clinical risk factors was expressed as relative risk (RR) and 95%confidence interval (CI), with multivariate adjustment for potential confounders. RESULTS: The overall incidence of abruption was 0.87%. The risk of abruption was 3.58-fold higher (95%CI 1.74-7.39)among women with preterm PROM (2.29%) compared with women with intact membranes (0.86%). The rates of abruption among women with and without intrauterine infection were 4.81%and 0.83%, respectively (RR 9.71, 95%CI 3.23-29.17). However, oligohydramnios was not associated with abruption (1.46%compared with 0.87%; RR 2.09, 95%CI 0.92-5.31). Compared with women with intact membranes, the RR for abruption among preterm PROM and whose membranes were ruptured for 24-47 hours and 48 hours or more before delivery, respectively, were 2.37 (95%CI 0.99-9.09), and 9.87 (95%CI 3.57-27.82). When preterm PROM was accompanied by intrauterine infections, the RR for abruption was 9.03 (95%CI 2.80-29.15) compared with women with intact membranes and no infections. Similarly, preterm PROM accompanied by oligohydramnios conferred over a 7.17-fold risk (95%CI 1.35-38.10) for abruption compared with women with neither of these 2 conditions. CONCLUSION: Women presenting with preterm PROM are at increased risk of developing abruption, with the risk being higher either in the presence of intrauterine infections or oligohydramnios. Physicians managing patients with preterm PROM should be aware that these patients are at increased risk of developing abruption after 24 hours following preterm PROM.
文摘Objective: This study was undertaken to investigate the association among plurality (number of fetuses per pregnancy), abruptio placenta, and perinatal mortality. Study design: A retrospective cohort study on 15,051,872 singletons, 413,619 twins, and 22,585 triplets delivered in the United States between 1995 and 1998 was conducted. We compared the occurrence of perinatal death between pregnancies complicated by abruptio placenta and those without with the use of adjusted odds ratios. The generalized estimating equations framework was applied to adjust for intracluster correlations among multiples. Results: Placental abruption occurred among 93,968 singletons (6.2 per 1000), 5051 twin (12.2 per 1000), and 353 triplet (15.6 per 1000) gestations (P for trend < .0001). Placental abruption was associated with significant risk of mortality irrespective of the plurality subtype. Perinatal mortality was greatest among singletons (adjusted odds ratio 95% CI = 14.3 13.2-15.4 ), followed by twins (4.4 3.9-4.9 ) and least among triplets (3.0 2.0-4.6 ) (P for trend < .0001). Conclusion: As plurality increases from 1 to 3, the risk of placental abruption rises, whereas the risk of abruptio-associated perinatal mortality declines.
文摘Objective: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age SGA , other) and cerebral damage (eg, cystic periventricular leukomalacia c-PVL , grade Ⅲ intraventricular hemorrhage Ⅳ H , and intra-parenchymal hemorrhage IPH ). Study design: This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery. Results: We found that the risk of c-PVL and grade Ⅲ Ⅳ H was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH. Conclusion: Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection.
文摘OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricul ar leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm membrane rupture, spont aneous preterm labor, or indicated preterm delivery at 24 to 33 weeks of gestati on from January 1, 1993, to December 31, 2002, we evaluated the obstetric and histopathologic pla cental variables in reference to the development of intraventricular hemorrhage (n = 44), periventricular leukomalacia (n = 19), or no ultrasonographic cerebral lesion (n = 589). Excluded were stillbirths and congenital anomalies. Statistic al analysis included Fisher exact test, Student t test, and stepwise logistic re gression analysis with a 2-tailed P < .05 consi-dered significant. RESULTS: Mu ltivariate analysis showed that occurrence of neonatal intraventricular hemorrha ge and periventricular leukomalacia were associated only with spontaneous premat urity (odds ratio = 1.9; 95%confidence interval 1.1-3.4) and gestational age a t delivery in weeks (odds ratio = 0.8; 95%confidence interval 0.7-0.9). Neonat es with intraventricular hemorrhage did not differ from those with periventricul ar leukomalacia in any obstetric or neonatal variable, but there was a higher ri sk of neurodevelopmental delay associated with periventricular leukomalacia. CON CLUSION: Among premature infants born at less than 34.0 weeks of gestation, intr aventricular hemorrhage and periventricular leukomalacia share common clinical c haracteristics, with spontaneous preterm delivery and gestational age at deliver y as the only independent antenatal predictors.
文摘Objective This study was undertaken to evaluate whether aggressive to colysis i mproves pregnancy outcome after preterm premature rupture of the membranes (PPRO M). Study design Retrospective case-control study of patients with PPROM before 34 weeks of gestation, followed by a prospective cohort study with historical c ontrols. The retrospective phase covered 1995 through 1999 when we used tocolysi s aggressively. With the use of survival analysis, we compared latency in our ca ses with 4 published control series in which tocolysis was never used. On the ba sis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective eval uation of this new protocol. Results In the retrospective phase, tocolysis was u sed in 94%of 130 cases and maintained during 84%of 1162 total antenatal patien t-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospe ctive study, 43%of 63 patients received tocolytics, but these were used at lowe r doses and were given during only 7%of 770 patient-days. Latency with this ve ry limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive toc olysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. Conclusion Aggressive tocolysis after PPROM causes significant maternal morbidity, but does not incr ease latency or decrease neonatal morbidity compared with either very limited to colysis or no tocolysis at all.
文摘Background: Maternal placental syndromes, including the hypertensive disorders of pregnancy and abruption or infarction of the placenta, probably originate from diseased placental vessels. The syndromes arise most often in women who have metabolic risk factors for cardiovascular disease, including obesity, pre-pregnancy hypertension, diabetes mellitus, and dyslipidaemia. Our aim was to assess the risk of premature vascular disease in women who had had a pregnancy affected by maternal placental syndromes. Methods: We did a population-based retrospective cohort study in Ontario, Canada, of 1.03 million women who were free from cardiovascular disease before their first documented delivery. We defined the following as maternal placental syndromes: pre-eclampsia, gestational hypertension, placental abruption, and placental infarction. Our primary endpoint was a composite of cardiovascular disease, defined as hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral artery disease at least 90 days after the delivery discharge date. Findings: The mean (SD) age of participants was 28.2 (5.5) years at the index delivery, and 75 380 (7%) women were diagnosed with a maternal placental syndrome. The incidence of cardiovascular disease was 500 per million person-years in women who had had a maternal placental syndrome compared with 200 per million in women who had not (adjusted hazard ratio HR 2.0, 95 CI 1.7-2.2). This risk was higher in the combined presence of a maternal placental syndrome and poor fetal growth (3.1, 2.2-4.5) or a maternal placental syndrome and intrauterine fetal death (4.4, 2.4-7.9), relative to neither. Interpretation: The risk of premature cardiovascular disease is higher after a maternal placental syndrome, especially in the presence of fetal compromise. Affected women should have their blood pressure and weight assessed about 6 months postpartum, and a healthy lifestyle should be emphasised.
