This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 ± 4.2 and 28.4 ± 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.
RESUMOObjetivos: analisar a contagem dos corpos lamelares em comparação com o teste de Clements na avaliação da maturidade pulmonar fetal em gestantes diabéticas. Métodos: estudo prospectivo envolvendo 62 gestantes submetidas a amniocentese entre a 26ª e a 39ª semana. O líquido amniótico foi imediatamente submetido ao teste de Clements e à contagem de corpos lamelares. Os partos ocorreram até três dias após a amniocentese. A ocorrência de síndrome de angústia respiratória, indicativa de imaturidade pulmonar, foi confrontada com os resultados de imaturidade da amniocentese (ausência de anel completo no 3 o tubo e menos de 50.000 corpos lamelares). O teste do χ 2 foi utilizado para comparar o desempenho dos dois métodos e p<0,05 foi considerado signifi cante. Resultados: sete neonatos apresentaram síndrome de angustia respiratória (11,3%). A contagem de corpos lamelares e o teste de Clements tiveram desempenhos semelhantes quanto à sensibilidade (100 vs 71,4%, respectivamente) e valor preditivo negativo (100 vs 93,5%). A contagem de corpos lamelares teve melhor especifi cidade (87,3% vs 52,7; p<0,001), valor preditivo positivo (50 vs 16,1%; p=0,017) e acurácia (88,7% versus 54,8%; p<0,001) que o teste de Clements. Conclusões: a contagem de corpos lamelares revelou ser método simples e preciso na avaliação da maturidade pulmonar fetal. Comparado ao teste de Clements, tem a vantagem de não necessitar de manipulações e reagentes e de ter melhor desempenho quanto à especifi cidade, valor preditivo positivo e acurácia. Assim como o teste de Clements, a contagem de corpos lamelares tem alto valor preditivo negativo, assegurando que diante de um resultado maduro (50.000 ou mais), não ocorrerá síndrome de angustia respiratória. PALAVRAS-CHAVE:Líquido amniótico; Síndrome do desconforto respiratório do recém-nascido; Diabetes mellitus; Pregnancy in diabetics; Maturidade dos órgãos fetais; Pulmão/embriologia ABSTRACT Purpose: to assess the performance of lamellar body count compared to the shake (Clements) test in the prediction of fetal lung maturity in diabetics. Methods: prospective study of 62 patients who underwent amniocentesis between the 26th and 39th week of pregnancy. Immediately after collection, the amniotic fl uid sample was submitted to the shake test and lamellar body count. Deliveries occurred within three days of amniocentesis. Immature test results (absence of a complete bubble ring in the third tube for the shake test and less than 50,000 lamellar bodies) were confronted with the occurrence of pulmonary immaturity in the neonate (respiratory distress syndrome). The performance of both tests was compared using the χ 2 test and p<0.05 was considered to be signifi cant. Results: seven infants had respiratory distress syndrome (11.3%). The lamellar body count and shake test were similar regarding sensitivity (100 vs 71.4%, respectively) and negative predictive value (100 vs 93.5%). Lamellar body count was superior as regards specifi city (87.3 vs 52.7%, p=0.0001), positive predictive value (50 vs 16.1%, p=0.01...
Introduction: Prediction of pulmonary hypoplasia remains difficult. At autopsy, pathologists use the lung weight/body weight ratio to diagnose pulmonary hypoplasia. Estimating lung volumes in utero could aid management when pulmonary hypoplasia is suspected. We measured fetal lung volumes on post mortem MRI. By comparing these volumes to organ weights at autopsy, we estimated fetal lung densities. This may allow prenatal calculation of lung weights in future. Methods: 21 fetuses underwent postmortem MRI at 1.5T prior to conventional autopsy with parental consent. Fetal weights ranged from 113-3270 g, with gestational ages of 17-40 weeks. T2-weighted sequences were used. Conventional autopsies were performed to RCPath guidelines. Lung volumes were independently estimated by two researchers using the ANALYZE (BIR, Mayo Foundation) software package's stereology tool. Organ volumes for each observer were compared to autopsy organ weights, and the reciprocal of the gradients and R 2 values were calculated. Inter-observer agreement was assessed using BlandAltman analysis. Results: There was high linear correlation between estimated lung volume and actual lung weights (R 2 > 0.98 for both observers). The reciprocal of the gradient gave an average lung density of 1.15 g/cm 3 which corresponds closely to the density of non-aerated adult lung (1.04-1.09). Bland-Altman analysis demonstrated good interobserver agreement, which appeared to improve with increasing organ size. Conclusions: Ex utero fetal lung volume measurements are highly correlated to lung weight at autopsy, with a calculated density that corresponds well to published figures. The technique has low interobserver variability and provides non-invasive information about fetal lung development when conventional autopsy is declined. It may also prove of value in the prenatal assessment of lung development.
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