Lamellar Bodies Count (LBC) as a Predictor of Fetal Lung Maturity in Preterm Premature Rupture of Membranes Compared to Neonatal Assessment

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 × 103/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

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, G6P1+4 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.

Maternal and fetal outcomes in term premature rupture of membrane

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.

The Study of Vaginal Fluid Urea, Creatinine, B-HCG and Placental Alpha-1 Microglobulin in Diagnosis of Premature Rupture of Membranes

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.

Premature Rupture of Membrane and Neonatal Infection

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.

Support Epidemiology and Prognosis of Premature Rupture of Membranes in Pikine National Hospital Center

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.

Foley Balloon Catheter versus Oral Misoprostol for Induction of Labour after Prelabour Rupture of Membranes: A Retrospective Data Analysis

Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening, but concerns about infection risk restrict its use in cases of prolonged prelabour rupture of membranes (PROM). This study aims to evaluate the efficacy and safety of the FC compared to oral misoprostol for cervical ripening after PROM. Study Design: A retrospective data-analysis of 128 pregnant women was conducted. Of these, 49 underwent cervical ripening with an FC and 79 with oral misoprostol. We included all women with a vital singleton pregnancy at 37 - 42 weeks of gestation who underwent cervical ripening after ≥ 24 hours of PROM in specific time frames in two Dutchsecondary care and teaching hospitals. The primary outcome was the incidence of intrapartum infection, a composite of maternal and neonatal infection. In addition, we evaluated the mode of delivery, duration of priming and priming-to-delivery interval. Secondary endpoints included uterine hyperstimulation, umbilical cord prolapse, birth weight, Apgar scores, length of admission to the neonatal low dependency unit, admission to the (neonatal) Intensive Care Unit (ICU) and mortality. Statistical analyses included bivariate and multivariate techniques. Results: Cervical ripening with FC, compared with oral misoprostol, showed a higher incidence of intrapartum infection, respectively 32.7% (n = 16) vs. 12.7% (n = 10) (p = 0.006). However, after adjusting for epidural anaesthesia and pregestational BMI, the association was no longer significant. No difference was found in mode of delivery and total priming-to-delivery interval (median 21.3 hours vs. 22.0, p = 0.897). Furthermore, FC, compared with oral misoprostol, showed a longer duration of cervical ripening and hence a shorter duration of active labour (p 0.001). Apart from the 1-min Apgar score, secondary maternal and neonatal outcomes did not differ between the groups. Conclusion: In women who require cervical ripening after prolonged PROM at term, the FC and oral misoprostol are similar in terms of efficacy and safety. Advantages associated with the FC are its safe application in women with a history of caesarean section, although we did not study these women, and an implied shorter duration of active labour. Our study adds to the limited available data on the use of the FC after the rupture of membranes and a large randomized controlled trial is needed to strengthen our findings.

Expectant Management of Preterm Ruptured Membranes before 34 Gestational Weeks at the University Hospital of Kinshasa, a Tertiary Referral Hospital in the Democratic Republic of Congo

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.

Changes of cytokines and matrix metalloproteinases in patients with premature rupture of chorioamnion and its clinical significance

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.

A Bayesian Stepwise Discriminant Model for Predicting Risk Factors of Preterm Premature Rupture of Membranes： A Case-control Study

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.

Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes

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.

1例未足月胎膜早破青霉素过敏患者抗菌药物应用的药学监护

1例29岁有青霉素过敏史的妊娠女性,因“停经31+周,阴道流液5 h”入院。患者诊断为胎膜早破,有预防性应用抗菌药物指征。临床药师了解患者过敏史后,考虑发生青霉素速发型过敏反应风险较低,建议试行青霉素皮试或使用头孢呋辛。患者拒绝青霉素皮试,头孢呋辛皮试阳性。调整为万古霉素(1 g,每8 h 1次,静脉滴注)联合阿奇霉素(首次500 mg口服,第2天250 mg 1次·d^(-1),口服,疗程4 d),行B族链球菌(GBS)筛查及宫腔细菌培养。GBS筛查阴性,建议停用万古霉素。宫腔细菌培养报大肠埃希菌,结合患者症状体征、检验指标考虑污染可能性大,继续使用阿奇霉素。患者羊水较少,予引产后分娩,母儿情况可。阿奇霉素使用5d后停用,患者出院。产后2周随访母儿情况良好。

胎膜早破孕妇阴道微生态和胎盘分离菌及耐药性分析

目的 比较胎膜早破和正常破裂孕妇孕晚期(孕35~37周)阴道微生态、胎盘拭子细菌分布和耐药性情况,为临床预防和治疗提供病原学依据。方法 收集甘肃省妇幼保健院产科2020年1月1日至2022年6月30日胎盘拭子培养结果,将培养阳性的孕妇分成胎膜早破组和正常破裂组,比较两组基本临床特征及孕晚期阴道微生态、胎盘分离菌和药敏结果。结果 两组孕周、年龄、细菌性阴道病和正常微生态情况差异有统计学意义(P<0.05);多因素Logistic回归分析显示孕周(β=-0.711,OR=0.491)和正常微生态(β=-1.412,OR=4.103)与胎膜早破发生呈负相关,年龄(β=0.076,OR=1.079)呈正相关,细菌性阴道病的差异无统计学意义(P>0.05)。两组胎盘主要分离菌为革兰阴性杆菌,差异无统计学意义(P>0.05),以大肠埃希菌为主,检出率差异有统计学意义(P<0.05),胎膜早破组产超广谱β-内酰胺酶比例较高,对氨苄西林、头孢类耐药性高,差异有统计学意义(P<0.05);其次是革兰阳性球菌(粪肠球菌和无乳链球菌为主),差异无统计学意义(P>0.05)。无乳链球菌对青霉素类、糖肽类等敏感,对喹诺酮类耐药率较高;粪肠球菌对青霉素类、糖肽类、恶唑烷酮类等敏感,对红霉素和克林霉素的耐药性较高。结论 胎膜早破组年龄偏大且孕周小,孕晚期易发生阴道微生态异常,其胎盘拭子大肠埃希菌检出率、对青霉素和头孢类抗生素耐药性较高。

孕妇阴道B族链球菌检测联合胎儿脐带血中性粒细胞CD64指数预测胎膜早破新生儿感染的价值

目的 探讨孕妇阴道B族链球菌(GBS)检测联合胎儿脐带血中性粒细胞CD64指数对胎膜早破(PROM)新生儿感染的预测价值,并分析其影响因素。方法 选取2022年3—12月湖南省妇幼保健院170例足月分娩PROM新生儿作为观察组,根据新生儿感染情况分为感染组(48例)和未感染组(122例)。比较新生儿一般资料,分析PROM新生儿感染与临床特征的关系。采用多因素Logistic回归分析评价PROM新生儿感染的影响因素;构建列线图模型,并进行验证。采用受试者工作特征(ROC)曲线评价GBS阳性、CD64指数判断新生儿感染的效能。结果 感染组和未感染组PROM到分娩时间、绒毛膜羊膜炎、GBS阳性、阴道指检次数、产前使用抗菌药物、5 min Apgar评分<7分、羊水污染、CD64指数差异均有统计学意义(P<0.05)。PROM到分娩时间、绒毛膜羊膜炎、GBS阳性、阴道指检次数、CD64指数是PROM新生儿感染的危险因素(P<0.05),这5项指标在列线图预测模型中的总分为294分,对应的感染风险为73.15%。交互作用分析结果显示,CD64指数、GBS阳性对感染组和未感染组具有正相加交互作用(P<0.001)。ROC曲线分析结果显示,CD64指数和GBS阳性单项检测和联合检测判断PROM新生儿感染的曲线下面积分别为0.763、0.807和0.847。结论 孕妇阴道GBS检测联合胎儿脐带血中性粒细胞CD64指数对PROM新生儿感染具有较高的预测价值。PROM到分娩时间、绒毛膜羊膜炎、阴道检查次数是导致PROM新生儿感染的危险因素,临床应重点关注,以降低感染风险。

GBS、衣原体联合解脲支原体检测对胎膜早破患者妊娠结局的预测作用

目的 研究B族链球菌(GBS)、衣原体联合解脲支原体(UU)检测对胎膜早破患者妊娠结局的预测作用。方法 选取上海交通大学医学院附属新华医院2021年2月至2023年1月收治的胎膜早破产妇168例为观察组,另选取同期进行孕检且结果正常的165名孕妇为对照组。对比两组GBS、衣原体、UU阳性率;分析GBS、衣原体、UU单一检测对观察组不良妊娠结局的预测结果;分析GBS、衣原体、UU三者联合对观察组孕妇不良妊娠结局的预测结果。结果 观察组GBS阳性率、衣原体阳性率、UU阳性率均比对照组高,差异均有统计学意义(P<0.05)。GBS阴性122例,GBS阳性46例,GBS阳性胎膜早破孕妇不良妊娠结局发生率比对照组高,差异有统计学意义(P<0.05)。衣原体阴性128例,衣原体阳性40例,衣原体阳性胎膜早破孕妇不良妊娠结局发生率比对照组高,差异有统计学意义(P<0.05)。UU阴性117例,UU阳性51例,UU阳性胎膜早破孕妇不良妊娠结局发生率比对照组高,差异有统计学意义(P<0.05)。168例胎膜早破孕妇中,GBS、衣原体和UU均为阴性117例,GBS、衣原体和UU为单一一个或两个为阳性11例,GBS、衣原体和UU均为阳性40例;GBS、衣原体和UU均为阳性胎膜早破孕妇不良妊娠结局发生率均比单一或两个感染及阴性胎膜早破孕妇高,差异有统计学意义(P<0.05)。结论 胎膜早破孕妇的GBS、衣原体和UU阳性率均高于正常妊娠孕妇,且GBS、衣原体和UU联合检测可更准确地预测母体和胎儿不良结局。

倍他米松联合硫酸镁治疗未足月胎膜早破的疗效观察

目的:探讨未足月胎膜早破的有效治疗方案。方法:选取我院收治的120例未足月胎膜早破孕妇[入院孕周28~34(33.47±3.19)周],按治疗方案分为对照组和研究组各60例。对照组给予倍他米松治疗(肌肉注射12 mg),研究组给予倍他米松联合硫酸镁治疗,2 d后评估各项指标。比较两组孕妇炎症因子(IL-2、TNF-α)水平、持续治疗时间、孕周延长时间、宫缩抑制时间、产后出血量、焦虑情况、分娩结局[Apgar评分、新生儿出生体质量、产褥感染发生率及新生儿呼吸窘迫综合征(NRDS)发生率]、新生儿肺功能及不良反应发生率。结果:治疗后两组孕妇血清IL-2、TNF-α水平均降低,且研究组均低于对照组(P均<0.01);研究组持续治疗时间、宫缩抑制时间均短于对照组,孕周延长时间长于对照组(P均<0.05);研究组Apgar评分、新生儿出生体质量均高于对照组,NRDS、出生窒息发生率均低于对照组(P均<0.05);研究组新生儿出生第1天、第7天气道阻力低于对照组,功能残气量和肺顺应性高于对照组(P均<0.01)。结论:倍他米松联合硫酸镁治疗未足月胎膜早破,可有效降低炎症反应及NRDS发生率,缩短治疗时间,改善分娩结局及肺功能,且不增加不良反应发生率。

孕妇孕晚期生殖道GBS感染对胎膜早破、妊娠结局影响

目的:院内妊娠晚期孕妇生殖道B族链球菌(GBS)感染情况调查并探究对胎膜早破、妊娠结局的影响。方法:选取2021年6月-2023年7月于本院定期产前检查的妊娠晚期孕妇3970例GBS感染检测,根据感染情况分为感染组和非感染组,比较两组胎膜早破发生率及妊娠不良结局。结果:3970例孕妇中103例GBS感染,感染率2.6%,纳入感染组,非感染孕妇中随机选取103例纳入非感染组;感染组年龄≤30岁组感染率(68.0%)高于>30~35岁组及>35岁组,感染组胎膜早破发生率(18.5%)高于非感染组(4.9%),绒毛膜羊膜炎(6.8%)、新生儿肺炎(13.6%)、胎儿生长发育迟缓(8.7%)、新生儿感染(7.8%)、胎儿宫内窘迫(9.7%)发生率均高于非感染组(0、4.9%、1.0%、1.0%、1.9%)(均P<0.05);两组产妇分娩期发热、新生儿黄疸发生率未见差异(P>0.05)。结论:孕晚期孕妇发生GBS感染增加胎膜早破及不良妊娠结局发生风险,临床应及时采取措施治疗干预。

未足月胎膜早破患者血清和胎盘中可溶性髓系细胞触发受体-1与绒毛膜羊膜炎的相关性研究

目的探讨未足月胎膜早破(PPROM)患者血清和胎盘中可溶性髓系细胞触发受体-1(sTREM-1)及炎症介质TNF-α、IL-1β与绒毛膜羊膜炎(CA)的相关性,为疾病早期诊断提供敏感性标志物。方法收集2021年3月至2023年9月金华市中心医院收治的84例PPROM患者,平均孕周为(34.5±2.3)周。根据胎盘病理检查结果分为CA组40例和无CA组44例,并选择同期年龄和孕周匹配的正常妊娠者40例作为对照组。ELISA法检测产前孕妇血清sTREM-1、TNF-α和IL-1β水平,检查血液WBC、粒细胞百分比、CRP和降钙素原(PCT),Western blot法检测产后胎盘中sTREM-1、TNF-α和IL-1β蛋白相对表达量。分析血清和胎盘中各项检测指标的相关性。绘制ROC曲线,分析血清s TREM-1诊断PPROM和CA的效能。结果CA组血清sTREM-1、TNF-α、IL-1β、CRP和PCT水平均显著高于无CA组和对照组,无CA组sTREM-1、TNF-α和IL-1β水平均显著高于对照组(均P<0.05)。CA组胎盘sTREM-1、TNF-α和IL-1β蛋白相对表达量均显著高于无CA组(均P<0.05)。胎盘sTREM-1、TNF-α、IL-1β蛋白相对表达量与血清s TREM-1、TNF-α、IL-1β水平均两两呈正相关(均P<0.001)。血清sTREM-1、TNF-α和IL-1β诊断PPROM的AUC分别为0.916、0.785和0.815(均P<0.05);血清sTREM-1诊断CA的AUC为0.935(P<0.05)。结论PPROM患者血清s TREM-1升高可作为疾病诊断和CA评估的重要血清生化标志物。

早产及未足月胎膜早破与妊娠期生殖道感染的关系研究

目的明确早产及未足月胎膜早破(PPROM)与妊娠期生殖道感染(RTI)的相关性。方法选择2021年1月至2022年12月在北京市通州区妇幼保健院规律产前检查及分娩的早产或PPROM孕妇416例作为研究对象进行回顾性分析。根据分娩期间(分娩当次入院)检查有无明确的RTI病原学证据分为观察组(171例,有证据)和对照组(245例,无证据)。对孕妇相关资料进行分析,比较2组孕早期患阴道炎症情况、PPROM发生率、分娩孕周、分娩方式、胎儿宫内窘迫发生情况及不同年龄孕妇妊娠结局、相同孕周分娩新生儿出生体重。结果观察组171例孕妇阴道分泌物常规检查前3位病原菌为解脲支原体感染14例(8.2%)、细菌性阴道病13例(7.6%)、霉菌性阴道炎10例(5.8%);细菌学培养RTI的常见病原体为无乳链球菌9例(5.3%)、白色念珠菌8例(4.7%)、大肠埃希菌6例(3.5%)。观察组孕早期患阴道炎症比例高于对照组[18.7%(32/171)比11.4%(28/245)],差异有统计学意义(P=0.042)。观察组与对照组PPROM发生率、分娩孕周、分娩方式、胎儿宫内窘迫发生率比较差异均有统计学意义(均P<0.05)。不同年龄组孕妇PPROM、RTI、胎儿宫内窘迫发生率差异均无统计学意义(均P>0.05)。观察组和对照组相同孕周分娩新生儿出生体重比较差异均无统计学意义(均P>0.05)。结论解脲支原体、无乳链球菌、白色念珠菌是RTI的主要致病菌;妊娠期RTI有增加早产或PPROM发病风险的可能,同时妊娠期RTI增加妊娠期母儿的不良结局。

早发型子痫前期并发未足月胎膜早破孕妇的阴道菌群分布及其对妊娠结局的影响

目的探讨早发型子痫前期(PE)并发未足月胎膜早破(PPROM)孕妇的阴道菌群分布情况及不同阴道菌群分布对妊娠结局的影响。方法选取2019年1月至2022年1月该院收治的早发型PE孕妇120例为研究对象,将其中67例并发PPROM的孕妇作为观察组,53例未并发PPROM的孕妇作为对照组。比较两组孕妇的阴道菌群分布情况,并分析不同阴道菌群分布的早发型PE并发PPROM孕妇的妊娠结局。结果优势菌方面,观察组的乳杆菌占比低于对照组,革兰阳性杆菌、革兰阴性杆菌、革兰阳性球菌占比高于对照组,差异均有统计学意义(P<0.05)。致病菌方面,观察组的溶血葡萄糖球菌、阴沟肠杆菌占比高于对照组,差异均有统计学意义(P<0.05)。阴道菌群密集度方面,观察组的Ⅱ、Ⅲ级占比低于对照组,差异有统计学意义(P<0.05)。阴道菌群多样性方面,观察组的Ⅱ、Ⅲ级占比低于对照组,差异有统计学意义(P<0.05)。观察组的阴道微生态系统失调率为80.60%,高于对照组的45.28%,差异有统计学意义(χ^(2)=81.340,P<0.001)。与对照组比较,观察组治疗后血压偏高、24 h尿量偏低、24 h尿蛋白偏高、血小板偏高、凝血酶原时间和活化部分凝血活酶时间延长(均P<0.05)。观察组胎儿生长受限10例、胎儿宫内窘迫8例、新生儿窒息4例,对照组胎儿生长受限3例、胎儿宫内窘迫1例、新生儿窒息0例,观察组围生儿并发症发生率为32.84%,明显高于对照组的7.55%(P<0.05)。在67例早发型PE并发PPROM孕妇中,有54例菌群失调(菌群失调组),13例菌群正常(菌群正常组)。菌群失调组不良妊娠结局发生率为81.48%,高于菌群正常组的46.15%(χ^(2)=5.089,P=0.024)。与菌群正常组比较,菌群失调组新生儿出生体重明显降低(t=2.196,P=0.032),住院时间明显延长(t=7.463,P<0.001)。结论早发型PE并发PPROM孕妇的阴道菌群分布失调,容易导致不良妊娠结局。在临床中,需重视阴道菌群的变化并及时干预,以降低不良妊娠结局的风险。