Correlation between myometrial thickness and the latency interval in preterm premature rupture of membranes

In order to predict the time of labor in patients with preterm premature rupture of membrane [PPROM], different factors have been studied resulting in different detection rates. Recently, sonographic measurement of myometrial thickness [MT] has been introduced and studied as an applicable and noninvasive method in predicting the length of latency interval [LI] of labor [the period from PPROM to start of labor]. The objective of our study was to determine the correlation between MT and LI in pregnant women with PPROM led to oligohydramnios. This was a cross-sectional study on 24 cases with PPROM. The sonographic measurement of myometrial thickness and the latency interval of patients with PPROM without labor pain were recorded. Gestational age was between 26-34 weeks and amniotic fluid index [AFI] was less than 5 percentile. The data were analyzed using SPSS software. The mean +/- SD maternal age was 29.2 +/- 1.2 years. The AFI in all women was less than 5% percentile of normal fluid for that gestational age. The mean +/- SD of gestational age was 29.1 +/- 2.2 weeks. The mean +/- SD of MT was 6.5 +/- 1.5 mm interiorly, 7.9 +/- 4.2 mm fundal, 6.6 +/- 1.7 mm in the lower segment and 7.8 +/- 2.2 mm laterally. The mean LT was 545 +/- 4.7 hours. Our study showed that there is no significant correlation between MT and LI in pregnant women with PPROM and reduced AFI

effect of metronidazole, erythromycin and indomethacin on the process of idiopathic preterm labor

Approximately 39%-61%of cases with idiopathic preterm labor [IPL] fail to respond to toecolytic therapy; to increase this response many different antibiotics have tried but mostly the effect on suppression of IPL has been minimal. This study was conducted to investigate whether addition of antiprostaglandins to the antibiotic regimen could suppress IPL. A double blind randomized clinical trial was performed. Forty-nine women with IPL at 24-34 weeks of pregnancy were selected and divided into two groups of 25 cases and 24 controls by random allocation. Experimental cases received indomethacin with antibiotics while the controls were given similar antibiotics with placebo. Outcome variables were delay in delivery for 24 hours, carrying the pregnancy up to 37 weeks, comparison of birth weight and need for NICU admission. Statistical analysis was done by Chi square, T test and Fisher exact tests. Delay in delivery for 24 hour was 84%, [n=2l], in cases and 79%, [n=19], in controls, [p=0.1]. 32%, [n=8] of cases vs. 20.8% of controls carried the pregnancy up to 37 weeks, [p0.8]. Mean birth weight in cases and controls were 2273.3 +/- 863 vs. 20113 +/- 529gr, [p=0.9]. Need for NICU admission was 4 days in cases vs. 8days in controls. In each group 2 neonates died. In this study, the combination of antiprostaglandins, [indomethacin], and antibiotics, [metronidazole-erythromycin], did not have a significant effect on suppression of IPL

Meconium-stained amniotic fluid and puerperal infection

Puerperal infection describes any bacterial infection of the genital tract after delivery. It is the cause of 13% of pregnancy related deaths and the fifth leading cause of death. Some studies have addressed the role of meconium-stained amniotic fluid in puerperal infection. The aim of this study was to evaluate the association between meconium-stained amniotic fluid and puerperal infection. In this cohort study 300 pregnant women with gestational age >/= 37 weeks were divided in two groups. In case group amniotic fluid was meconium-stained and in control group amniotic fluid was clear. All patients were delivered by cesarean section and received prophylactic preoperative antibiotics. Patients were checked for puerperal infection within 40 days. All data was analyzed with SPSS. Among 150 patients in case group 2 women [1.3%] developed a fever but none in the control group showed any signs of infection. There was no significant statistical difference between case and control groups [P>0.05]. Although this study, revealed no relation between meconium-stained amniotic fluid and puerperal infection, but, since both groups had received antibiotics, further comprehensive studies are needed to elucidate the role of meconium-staining of the amniotic fluid in the occurrence of post-partum sepsis

Adnexal masses in the third trimester of pregnancy in Mahdieh Hospital, Tehran, between 2002 and 2006

The prevalence of adnexal tumour has been reported to vary between one in eight thousands to 2.3% of pregnancies according to investigational techniques administered. Broader use of ultrasonography in pregnancy and the increasing rate of caesarean section [c-section] could be expected to lead to the diagnosis of more adnexal tumours compared to previous studies. Aim and objectives: To identify the histological types, clinical manifestations, prevalence of malignant forms, and to assess the risk of two selected treatment approaches i.e. surgical [invasive] vs. conservative.This retrospective descriptive study was conducted on patients admitted to Mahdieh Hospital, Tehran, between 2002-2006 with confirmed adnexal tumours in the third trimester of pregnancy. Patients' medical records were reviewed for age, gestational age, parity, the reason for admission, diagnostic approach for adnexal tumour, ultrasound characteristics [where available], surgical and histopathological findings. In all, 45 patients were recognised. Mean age was 27.8 [4.8] and mean gravity was 2.1 [1.2]. Incidence rate for surgically confirmed adnexal malignancy in the third trimester was one in 570 live births and one in every 184 caesarean section. In forty three patients, diagnosis and tumour resection occurred during caesarean section of whom the reason for c-section was the adnexal mass in five cases, 33 were accidentally found during c-section due to obstetrics indications and the remainder [5 cases] was due to both causes. One case underwent tumour resection after post-partum tuboligation and one after vaginal delivery followed by laparatomy. No complication due to malignancy was found. Diagnostic procedure was ultrasonography only in 10 patients [23%]. of whom, half were in the third trimester and half were detected in the first trimester with the adnexal mass being 5-10 cm in diameter. All were benign in line with histological features. In 35 patients, no mass was reported despite ultrasonography. All had benign features in histopathology and the most frequent diagnosis was paratubal cyst followed by serous-cyst adenoma. Adnexal tumour complications in the third trimester are not frequent and the risk of malignancy is low. Therefore, if diagnosed, it is not a definite indication for an urgent surgical intervention provided that ultrasonographic feature of the mass is benign