Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

Souza, Alex Sandro Rolland; Patriota, Adriane Farias; Guerra, Gláucia Virgínia de Queiroz Lins; Melo, Brena Carvalho Pinto de

doi:10.1590/1806-9282.62.03.269

Cited by 18 publications

(27 citation statements)

References 17 publications

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“…These findings are consistent with previous studies . Furthermore, the results from the present study revealed that oligohydramnios was a risk factor for neonatal mortality, which is consistent with two recent studies by Souza et al . and Mousavi et al .…”

Section: Discussionsupporting

confidence: 94%

“…In the current study, residual amniotic fluid after PPROM played a key role in neonatal outcomes, which were associated with an older delivery age, higher birth weight, and higher neonatal Apgar score. These findings are consistent with previous studies . Furthermore, the results from the present study revealed that oligohydramnios was a risk factor for neonatal mortality, which is consistent with two recent studies by Souza et al .…”

Section: Discussionsupporting

confidence: 94%

“…PPROM, defined as rupture of membranes before the onset of labor and before term, is strongly associated with maternal and perinatal morbidity and mortality due to infection and prematurity . Furthermore, oligohydramnios after PPROM has been reported to contribute to higher maternal and perinatal morbidity …”

Section: Introductionmentioning

confidence: 99%

“…2 Furthermore, oligohydramnios after PPROM has been reported to contribute to higher maternal and perinatal morbidity. 3 The decision to remove the cerclage after PPROM is controversial because it is difficult to compare the risk between potential infectious complications and preterm birth. [4][5][6][7][8] Moreover, it is also controversial whether a longer latency between PPROM and delivery is associated with a higher risk of neonatal infection.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with neonatal outcomes in preterm prelabor rupture of membranes after cervical cerclage

Chen

Sun

et al. 2019

Intl J Gynecology & Obste

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Objective To evaluate risk factors associated with neonatal morbidity and mortality in pregnant women with preterm prelabor rupture of membranes (PPROM) after cervical cerclage. Methods A retrospective cohort study of singleton pregnancies with cervical insufficiency was conducted at a tertiary referral center in Taiwan from May 1, 2000 to July 31, 2017. Patients with PPROM after cerclage and delivered between 20 0/7 days and 36 6/7 days were recruited. Logistic and linear regression analyses were performed to evaluate various risk factors. Results Overall, 109 women were included. Mothers with a higher white blood cell count, a higher C‐reactive protein (CRP) level, a lower amniotic fluid index, and chorioamnionitis were significantly associated with neonatal morbidity. Neonatal mortality was related to oligohydramnios (adjusted odds ratio [aOR] 2.98, 95% confidence interval [CI] 1.11–8.01) and chorioamnionitis (aOR 3.17, 95% CI 1.03–9.69). An elevated CRP level was associated with a shorter PPROM to delivery latency (adjusted B −16.64, 95% CI −29.88 to −3.41), but cerclage retention more than 12 hours after PPROM was associated with a prolonged latency (adjusted B 17.21, 95% CI 3.25–31.18). Conclusion Oligohydramnios and chorioamnionitis are associated with neonatal mortality.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors associated with neonatal outcomes in preterm prelabor rupture of membranes after cervical cerclage

Chen

Sun

et al. 2019

Intl J Gynecology & Obste

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“…We have encountered patients with positive PPROM tests who maintain a normal amount of the amniotic fluid on ultrasound examination. The prognosis of these patients is better [22]. These patients are similar to patients experiencing PPROM as a complication of fetoscopic surgery.…”

Section: Pathologic Anatomical Remodelingmentioning

confidence: 76%

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

186

153

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Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long-and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/anhydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane -either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intraamniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR) = 0.66), neonatal infections (RR = 0.67) and abnormal ultrasound scan of neonatal brain (RR = 0.67)]. The positive effect of continuo...

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Platelet and White Blood Cell (WBC) Counts in the First Trimester and Pregnancy Outcome: Prospective Controlled Study

Al-Husban

Al-Atrash

Alhayek

et al. 2019

Journal of Fetal Medicine

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In pregnancy, there is usually a degree of thrombocytopenia and leukocytosis. Our aim was to find out if raised platelet and white blood cell counts (WBC) in the first trimester above 300 ⅹ 10 9 /L and 10 ⅹ 10 3 /mm 3 , respectively are related to the pregnancy outcome. This is a prospective controlled trial at Jordan University hospital in the period between June 2017 to September 2018. Pregnant women were enrolled in the study any time less than 14 weeks with platelet count of 300 ⅹ 10 9 /L or more and white blood cell count of 10.0 ⅹ 10 3 /mm 3 or more (study group, 100 pregnant women). The control group (84 pregnant women) were recruited at the same time. There was a statistically significant increased risk of miscarriage in the study group, P value 0.018, and a statistically significant increased risk of preterm delivery, P value 0.001. There was also a higher risk of preterm premature rupture of membranes in the study group than the control, 11.2 versus 3.8%, odds ratio 3.169, but this difference wasn’t statistically significant. Pregnancies complicated by preterm premature rupture of membranes had statistically significant higher risk of preterm deliveries, lower birth weight, higher risk of neonatal intensive care unit admission than those without membrane rupture. Elevated platelet and WBC counts in the first trimester are associated with increased risk of miscarriage, increased risk of preterm delivery and relatively increased risk of PPROM. This can serve as an early warning for adverse pregnancy outcome.

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Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

Cited by 18 publications

References 17 publications

Factors associated with neonatal outcomes in preterm prelabor rupture of membranes after cervical cerclage

Factors associated with neonatal outcomes in preterm prelabor rupture of membranes after cervical cerclage

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Platelet and White Blood Cell (WBC) Counts in the First Trimester and Pregnancy Outcome: Prospective Controlled Study

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