Midtrimester preterm prelabour rupture of membranes (PPROM): expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL – III trial)

Teeffelen, Augustinus S.P. van; Ham, David P. van der; Willekes, Christine; Nasiry, S. Al; Nijhuis, Jan G.; Kuijk, Sander M. J. van; Schuyt, Ewoud; Mulder, Twan; Franssen, Maureen; Oepkes, Dick; Jansen, Frederik W.; Woiski, Mallory; Bekker, Mireille N.; Bax, Caroline J.; Porath, Martina; Laat, Monique W. M. de; Mol, Ben Willem; Pajkrt, Eva

doi:10.1186/1471-2393-14-128

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…Moreover, repetitive puncture in the AI method would increase the risk of separation of amniotic membrane from the uterus, abruption of the placenta, and injured umbilical cord causing a trauma to the fetus. A new trial with intraamniotic Ringers lactate instillation in PPROM patients with oligohydramnios has been started 2014 in the Netherlands (NTR3492 Dutch Trial Register [152]). …”

Section: Amnio-infusion Techniquesmentioning

confidence: 99%

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

188

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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Section: Amnio-infusion Techniquesmentioning

confidence: 99%

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

188

153

View full text Add to dashboard Cite

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“…Antibiotic administration has become the standard of care for patients with preterm PROM [1,35,36,78–88]. Antimicrobial agents are prescribed to eradicate existing subclinical intra-amniotic infection, or to prevent secondary ascending infection into the amniotic cavity [1,35,36,78–89].…”

Section: Introductionmentioning

confidence: 99%

A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM

Lee

Romero

Kim

et al. 2015

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective To determine if a new antibiotic regimen could reduce the frequency of intra-amniotic inflammation/infection in patients with preterm PROM. Study design This retrospective cohort study was conducted to evaluate the effect of antibiotics on the frequency of intra-amniotic inflammation/infection based on the results of follow-up transabdominal amniocenteses from 89 patients diagnosed with preterm PROM who underwent serial amniocenteses. From 1993–2003, ampicillin and/or cephalosporins or a combination was used (“regimen 1”). A new regimen (ceftriaxone, clarithromycin, and metronidazole) was used from 2003–2012 (“regimen 2”). Amniotic fluid was cultured and matrix metalloproteinase-8 (MMP-8) concentrations were measured. Results 1) The rates of intra-amniotic inflammation and intra-amniotic inflammation/infection in patients who received regimen 2 decreased during treatment from 68.8% to 52.1% and from 75% to 54.2%, respectively. In contrast, in patients who received regimen 1, the frequency of intra-amniotic inflammation and infection/inflammation increased during treatment (31.7% to 55% and 34.1% to 58.5%, respectively); and 2) intra-amniotic inflammation/infection was eradicated in 33.3% of patients who received regimen 2, but in none who received regimen 1. Conclusion The administration of ceftriaxone, clarithromycin, and metronidazole was associated with a more successful eradication of intra-amniotic inflammation/infection and prevented secondary intra-amniotic inflammation/infection more frequently than an antibiotic regimen which included ampicillin and/or cephalosporins in patients with preterm PROM.

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“…Based on clinical guidelines, PPROM with AIS should receive antibiotics and prompt to termination of pregnancy. PPROM without AIS is closely observed (expectant management) and treated with antibiotics [reviewed in 11].In particular, the treatment for PPROM in the gestational age of 22+0–23+6 weeks is an important aspect of interdisciplinary discussion and needs informed consent of families [ 8 – 11 ].There is currently no evidence on the beneficial use of transabdominal amnioinfusion in women with an (oligo)-hydramnios secondary to PPROM before 26 weeks [ 10 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Preterm Prelabor Rupture of Membranes and Outcome of Very-Low-Birth-Weight Infants in the German Neonatal Network

et al. 2015

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ObjectiveIt was the aim of our study to evaluate the independent effect of preterm prelabor rupture of membranes (PPROM) as a cause of preterm delivery on mortality during primary hospital stay and significant morbidities in very-low-birth-weight (VLBW) infants < 32 weeks of gestation.DesignObservational, epidemiological study design.SettingPopulation-based cohort, German Neonatal Network (GNN).Population6102 VLBW infants were enrolled in GNN from 2009-2012, n=4120 fulfilled criteria for primary analysis (< 32 gestational weeks, no pre-eclampsia, HELLP (highly elevated liver enzymes and low platelets syndrome) or placental abruption as cause of preterm birth).MethodsMultivariable logistic regression analyses included PPROM as potential risk factors for adverse outcomes and well established items such as gestational age in weeks, birth weight, antenatal steroids, center, inborn delivery, multiple birth, gender and being small-for-gestational-age.ResultsPPROM as cause of preterm delivery had no independent effect on the risk of early-onset sepsis, clinical sepsis and blood-culture proven sepsis, while gestational age proved to be the most important contributor to sepsis risk. The diagnosis of PPROM was associated with an increased risk for bronchopulmonary dysplasia (BPD; OR: 1.25, 95% CI: 1.02-1.55, p=0.03) but not with other major outcomes.ConclusionsThe diagnosis of PPROM per se is not associated with adverse outcome in VLBW infants < 32 weeks apart from a moderately increased risk for BPD. Randomized controlled trials with primary neonatal outcomes are needed to determine which subgroup of VLBW infants benefit from expectant or intentional management of PPROM.

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Midtrimester preterm prelabour rupture of membranes (PPROM): expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL – III trial)

Cited by 19 publications

References 18 publications

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

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

A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM

Preterm Prelabor Rupture of Membranes and Outcome of Very-Low-Birth-Weight Infants in the German Neonatal Network

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