Length of Latency with Preterm Premature Rupture of Membranes before 32 Weeks' Gestation

Peaceman, Alan M.; Lai, Yinglei; Rouse, Dwight J.; Spong, Catherine Y.; Mercer, Brian M.; Varner, Michael W.; Thorp, John M.; Ramin, Susan M.; Malone, Fergal D.; OʼSullivan, Mary J.; Hankins, Gary D.V.

doi:10.1055/s-0034-1373846

Cited by 20 publications

(10 citation statements)

References 8 publications

(11 reference statements)

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“…In patients with PPROM before 28 weeks of gestation median latency time was 9 days and 11 days if delivery took place between 28 + 0 to 33 + 6, similar results were presented by A. Peaceman. In a group of 1377 patient's median latency time between 24-28 weeks was approximately 9 days, and between 30-31 weeks was 6 days [18].…”

Section: Discussionmentioning

confidence: 94%

Perinatal outcome in preterm premature rupture of membranes before 37 weeks of gestation

et al. 2019

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Objectives:The aim of this study was to assess the maternal and neonatal outcome in patients with preterm premature rupture of membranes between 22 to 37 weeks of gestation in comparison to preterm birth patients. Material and methods:Group of PPROM patients consisted of 127 women, the control group counted 141 women who delivered prematurely. The control group was formed by matching patient with the same gestational age at delivery and neonatal birth weight to every woman from study group. In both groups speculum and ultrasound examinations were performed, microbiological swabs were taken. In unclear cases of PPROM tests detecting amniotic proteins, such as PAMG-1 or IGFBP-1, were performed. According to gestational age at delivery, neonates were divided into subgroups: extremely premature infants (< 27 weeks 6 days), moderate premature infants (from 28 weeks 0 days to 33 weeks 6 days), late premature infants (from 34 weeks 0 days to 37 weeks 0 days). Results:In the study group, median gestational age of delivery was 34 weeks 1 day and the same in control group -34 weeks and 5 days (p > 0.05). Parameters of inflammatory status were more often reported in the PPROM group than in the preterm birth group, even if they weren't statistically significant (positive culture of cervical swab, increased leukocytosis, CRP above 5).The rate of neonate survival was similar in both groups (93.7% and 94.1%). Congenital infection was more often diagnosed in group of neonates from PPROM pregnancies than in neonates from control group; (36% and 21.2% respectively; p = 0.009). Conclusions:Our research appears to be consistent with theory of inflammatory etiology of PPROM. Optimal management of infection in PPROM patients seems to be the most important in efforts to prolong pregnancy.

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Section: Discussionmentioning

confidence: 94%

Perinatal outcome in preterm premature rupture of membranes before 37 weeks of gestation

et al. 2019

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“…It is hypothesised that colonisation of the vagina with pathogenic bacteria activate the local and upper (cervical and fetal membrane) innate immune system [ 3 , 6 ], driving an inflammatory cascade [ 7 – 10 ] that leads to remodelling and disruption of membrane architecture and premature rupture [ 11 ]. In 80% of cases, delivery occurs within 9 days of rupture [ 12 ], during which time the uterine cavity, placenta and fetus are exposed to ascending infection and increased risk of chorioamnionitis and funisitis, which are associated with poor maternal and neonatal outcomes [ 13 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

Brown

Marchesi

Lee

et al. 2018

BMC Med

223

215

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BackgroundPreterm prelabour rupture of the fetal membranes (PPROM) precedes 30% of preterm births and is a risk factor for early onset neonatal sepsis. As PPROM is strongly associated with ascending vaginal infection, prophylactic antibiotics are widely used. The evolution of vaginal microbiota compositions associated with PPROM and the impact of antibiotics on bacterial compositions are unknown.MethodsWe prospectively assessed vaginal microbiota prior to and following PPROM using MiSeq-based sequencing of 16S rRNA gene amplicons and examined the impact of erythromycin prophylaxis on bacterial load and community structures.ResultsIn contrast to pregnancies delivering at term, vaginal dysbiosis characterised by Lactobacillus spp. depletion was present prior to the rupture of fetal membranes in approximately a third of cases (0% vs. 27%, P = 0.026) and persisted following membrane rupture (31%, P = 0.005). Vaginal dysbiosis was exacerbated by erythromycin treatment (47%, P = 0.00009) particularly in women initially colonised by Lactobacillus spp. Lactobacillus depletion and increased relative abundance of Sneathia spp. were associated with subsequent funisitis and early onset neonatal sepsis.ConclusionsOur data show that vaginal microbiota composition is a risk factor for subsequent PPROM and is associated with adverse short-term maternal and neonatal outcomes. This highlights vaginal microbiota as a potentially modifiable antenatal risk factor for PPROM and suggests that routine use of erythromycin for PPROM be re-examined.Electronic supplementary materialThe online version of this article 10.1186/s12916-017-0999-x) contains supplementary material, which is available to authorized users.

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“…Nevertheless, there was no consensus on length of latency to optimize the neonatal morbidity. Peaceman et al( 7 ) assessed the optimal length of latency in patients with PPROM before 32 weeks of gestation in a multicenter randomized study. The authors found that with expectant management, the optimal latency period was approximately 9 days before 28 weeks of gestation, but was significantly shorter in patients with 29-30 weeks of gestation ( 7 ) .…”

Section: Discussionmentioning

confidence: 99%

“…Peaceman et al( 7 ) assessed the optimal length of latency in patients with PPROM before 32 weeks of gestation in a multicenter randomized study. The authors found that with expectant management, the optimal latency period was approximately 9 days before 28 weeks of gestation, but was significantly shorter in patients with 29-30 weeks of gestation ( 7 ) . In another study for all gestational age groups between 24-34 weeks, the best outcomes were in patients with PPROM of 1 to 7 days, and survival was lowest in infants where PPROM was >28 days ( 8 ) .…”

Section: Discussionmentioning

confidence: 99%

What is the optimal strategy in the management of patients with preterm premature rupture of membranes before 32 weeks of gestation?

Demir

Aslan

Atalay

2016

tjod

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Objective:Our aim was to compare the outcomes of expectant management of pregnancy or immediate delivery in patients with preterm premature rupture of membranes (PPROM) between 24+0 and 32+0 weeks of pregnancy.Materials and Methods:This is a retrospective cohort study conducted at a tertiary medical center. Patients who were diagnosed as having PPROM between 24+0 and 32+0 weeks of gestation were selected from an electronic database. Thirty-one patients with expectant management and 22 patients with spontaneous immediate delivery were analyzed. Birth weight, Apgar score, duration of stay in the neonatal intensive care unit (NICU), composite adverse outcomes, and mortality rates of groups were compared. Binary logistic regression analysis with backward stepwise elimination was used to determine confounding factors for antenatal complications and neonatal composite adverse outcomes.Results:Gestational age at admission was smaller in the expectant management group. The median latency period was 6 days (range, 2-58 days). Although gestational age at delivery was similar, birth weights were smaller in expectant management group compared with the immediate delivery group (p=0.264 and p<0.05, respectively). Apgar scores, duration in the NICU, composite adverse outcomes, and neonatal mortality rates were similar in each group. Antenatal complication in the expectant management group was higher (p<0.05). Gestational age at delivery and serum C-reactive protein levels were two confounding factors for antenatal complication and gestational age at delivery was the only factor affecting composite adverse outcome.Conclusion:Expectant management in patients with PPROM at 24 to 32 gestational weeks might be considered as a good alternative.

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Length of Latency with Preterm Premature Rupture of Membranes before 32 Weeks' Gestation

Cited by 20 publications

References 8 publications

Perinatal outcome in preterm premature rupture of membranes before 37 weeks of gestation

Perinatal outcome in preterm premature rupture of membranes before 37 weeks of gestation

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

What is the optimal strategy in the management of patients with preterm premature rupture of membranes before 32 weeks of gestation?

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