Preterm Birth Prevention: How Well Are We Really Doing? A Review of the Latest Literature

Avraham, Sarit; Azem, Fouad; Seidman, Daniel S.

doi:10.1007/s13224-014-0571-y

Cited by 3 publications

(4 citation statements)

References 72 publications

(60 reference statements)

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“…Preterm premature rupture of membranes (PPROM) is one of the most important causes of perinatal morbidity and mortality [ 13 ]. Prematurity predisposes to long-term morbidities like diabetes mellitus, hypertension, obesity, and stroke [ 5 ]. Ascending infection from the vagina results in dangerous chorioamnionitis, which threatens the life of the baby and mother.…”

Section: Discussionmentioning

confidence: 99%

“…Preterm premature rupture of membranes (PPROM) complicates 3-10 percent of pregnancies and leads to one-third of preterm deliveries [1][2][3][4]. Prematurity is the leading cause of neonatal mortality and morbidity and also predisposes to long-term morbidities like diabetes mellitus, hypertension, obesity, and stroke [5]. As many as 15 million preterm births occurred worldwide in the year 2010, as per the Lancet report [6].…”

Section: Introductionmentioning

confidence: 99%

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Vaginal Drain to Prevent Ascending Infection in Preterm Premature Rupture of Membranes: A Novel Method

Samartharam¹,

Ila²,

Vasudeva³

2023

Cureus

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Background: Not to delay delivery for more than 24 hours after rupture of the membrane is the thumb rule in obstetrics. Ascending infection from the vagina results in dangerous chorioamnionitis, which threatens the lives of the baby and mother. We developed a novel method to prevent ascending infection by using a vaginal drain, which helps to continue pregnancies if the leak stops and buys some time for antenatal steroids to act if the leak doesn't stop.Method: In this study, 20 uncomplicated singleton pregnant women with spontaneous preterm premature rupture of membranes at gestational ages <35 weeks were recruited. Under the speculum, vaginal epithelial debris and secretions were cleared by a saline wash. The tip of the Nelaton Catheter was kept in the posterior fornix and then strapped to the thigh. The outer end was connected to the collection bag system and allowed to hang down to the ground. The foot end of the cot was raised. Leaked amniotic fluid and amniotic fluid index (AFI) were measured daily. A daily AFOD estimation was done for leaked AF. Uterine activity was controlled with low-dose Isoxsuprine Hydrochloride rapid infusion tocolysis. Antenatal steroids (ANS) were given. The spread of infection was monitored by maternal pulse rate, fetal heart rate, TC, and CRP. Pregnancies were terminated when leaks didn't stop, AFI didn't raise, or mature AFOD was observed. The number of women in whom leaks stopped, the number of days pregnancies continued, neonatal respiratory distress (NRD), birth weights, and perinatal deaths were recorded.Results: Leaks stopped in eight (40%) women. Pregnancy continuation ranged from 7 to 74 days. In 12 women, the leak did not stop, but we could buy 2-5 days' time for ANS to act. All parameters of the infection were within normal limits. Thirteen babies developed mild NRD, and we lost one baby. Conclusion: By using a vaginal drain for P(P)ROM, ascending infection can be prevented, leaks can be stopped in 40% of women, and can buy time for ANS to act.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vaginal Drain to Prevent Ascending Infection in Preterm Premature Rupture of Membranes: A Novel Method

Samartharam¹,

Ila²,

Vasudeva³

2023

Cureus

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“…PTB is one of the major causes of neonatal mortality and long-term morbidity [ 1 ]. A majority of preterm births occur in low-resource settings with suboptimal facilities [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Premature birth (PTB) is a serious medical problem globally, and it is the leading cause of neonatal mortality and long-term morbidity [ 1 ]. As per a Lancet report published in 2012, as many as 15 million preterm births occurred worldwide in 2010.…”

Section: Introductionmentioning

confidence: 99%

The Role of Humidity in the Management of Premature Neonates in a Rural Incubator

Samartharam¹,

Vasudeva²,

Ila³

2021

Cureus

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Background While growing inside the uterus, the human fetus floats in amniotic fluid, and the mother maintains a stable temperature of 37 °C and a humidity of 100%. In most neonatal incubators, a stable temperature is maintained but not the humidity. We hypothesised that maintaining a humidity of 70% and a temperature of 32 °C in incubator rooms might improve the outcomes related to low birth weight (LBW) neonates. Methods In this interventional study, 30 preterm LBW neonates delivered at different gestational ages were studied. Instead of an incubator box, we converted one entire room (14’/9’/10’) into an incubator. Three 200-watt bulbs were fixed to the wall at a height of 1 meter from babies. The room thermometer was mounted on the wall close to babies. The room temperature was maintained at 32 °C by turning the lights on or off as required. Wet cotton sheets (4’ × 6’) were spread on the opposite wall with the support of a stand. A hygrometer was fixed to the wall near to babies, and the humidity of the room was maintained at 70-80%. The hydration and nutrition needs of the babies were met with IV fluids/nasogastric (NG) tube feeding. Antenatal steroids were given to all mothers before the completion of 38 weeks. Babies were discharged when they were stable, and further care was given at home with similar arrangements of maintaining temperature and humidity. Birth weights, the number of babies that developed neonatal respiratory distress syndrome (NRDS), hypothermia, septicaemia, neonatal intensive care unit (NICU) admission days, home incubator days, and neonatal deaths were recorded and compared with the findings in the existing literature. Results Among the 30 neonates studied, birth weights ranged from 1.00 to 1.95 kg. Twenty-three babies developed NRDS, and four babies developed septicaemia; NICU days ranged from five to 28 days, and at-home incubator days ranged from 15 to 60 days. One baby succumbed to the illness. Conclusion Open nursing care of functionally premature neonates at room temperature of 32 °C and humidity of 70% is a cost-effective method that can lead to excellent outcomes.

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Role of Amniotic Fluid Optical Density (AFOD) and Low dose Isoxsuprine Hcl rapid infusion tocolysis for the management of PTL

H¹,

HS²,

S³

et al. 2014

IOSRJDMS

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Background:S.Ramet.al reported: Onset of spontaneous labor occurs at completion of fetal functional maturity at AFOD value of 0.98±0.27 (at 650nm). All these events together occurring at any time from 35+wks to 42+wks indicateindividual term for each fetus 1, 2 .Preterm labors with AFOD 0.98±0.27 are mature and cannot be stopped by any means, as labor cascades are already established. Babies born with AFOD <0.40 arefunctionally premature 1, 2 , and we expected thesepremature laborswouldrespond well for tocolysis and other methods for continuation of pregnancies as labor cascades are not fully established. Methods:In thiscase series study, 22 singleton pregnant women who were inpreterm labor (PTL),and who underwent CRL gestational age estimations, 5 of them PTL with membrane rupture and17 without membrane rupture were included. USG guided amniocentesis was performed as per the ACOG guidelines, and AFOD estimations were done for fresh uncentrifuzed samples. Antenatal corticosteroids, low dose Isoxsuprine Hcl rapid infusion tocolysis, and weekly 17-alphahydroxy progesterone caproate were given. After successful tocolysis and continuation of pregnancies, AFOD estimations were repeated when women presented with labor pains again before 37w+6days. Women were allowed to deliver if mature or near mature AFOD values were observed. AFOD estimations were also done at spontaneous labor or at caesarean sections after 38wks. Babies were observed for functional maturity in terms of color of skin, adherence of vernix, and development of RDS. Results were presented in two tables and analyzed. Results:In non-membrane rupture group (N=17), pregnancies could be continued for 1 to 7 wks. In membrane rupture group, in N=2/5 women leak could be stopped and pregnancies could be continued for 3 to 6 wks. Except one, in both groups all babies could attain mature or near mature AFOD values irrespective of GA and birth weight,noRDS was observed, and all babies survived. Conclusion:WithAFOD guided PTL management coupled with low dose Isoxsuprine Hcl rapid infusion tocolysis, pregnancies could be continued to completion of fetal functional maturity in 21/22 women with good neonatal outcome.

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Preterm Birth Prevention: How Well Are We Really Doing? A Review of the Latest Literature

Cited by 3 publications

References 72 publications

Vaginal Drain to Prevent Ascending Infection in Preterm Premature Rupture of Membranes: A Novel Method

Vaginal Drain to Prevent Ascending Infection in Preterm Premature Rupture of Membranes: A Novel Method

The Role of Humidity in the Management of Premature Neonates in a Rural Incubator

Role of Amniotic Fluid Optical Density (AFOD) and Low dose Isoxsuprine Hcl rapid infusion tocolysis for the management of PTL

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