The Efficacy and Safety of a Combination of Amino Acids, Vitamins and Probiotics in PROM and PPROM

The prevalence and severity of prelabor rupture of the membranes (PROM)/preterm PROM (PPROM) are a worldwide public health concern. PROM is the result of a cascade of events involving matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases 1 (TIMP1), cytokines and proapoptotic genes, which is initiated by several factors such as infection, genotoxic agents or some unknown etiology. In PROM, there is an increased expression and activation of MMP-2, MMP-3 and MMP-9 and a reduction of TIMP1. p53 and tumor necrosis factor (TNF)-? mediate the major apoptotic pathway of PROM. p53 can transactivate some MMP genes, resulting in the overexpression of MMPs. This leads to apoptosis. MMP-2 and MMP-9 degrades type-IV collagen, which is the major structural component of chorioamnion. Understanding the fundamental pathology at the molecular level, it appears necessary to adjust the biologically protective mechanism to prevent spontaneous preterm labor. Our findings show that the novel combination of arginine, ascorbic acid, folic acid, glutamine, glutathione, thiamine, lactic acid bacillus spores, vitamin E acetate and pyridoxine is safe and effectively prevents PROM and PPROM (97% patients) and prolongs pregnancy term.

Study of Effectiveness of Medical Method for Induction of Labor and its Outcome

Background: Modern obstetrics has a tremendous issue in inducing full-term labor in women with a viable fetus. When the hazards of prolonging pregnancy outweigh the advantages of birth, induction is undertaken. This study’s objective was to evaluate the efficacy of misoprostol 50µg administered sublingually, orally and vaginally in the process of inducing labor.Material & Methods:Between June 2021 and July 2022, 120 pregnant women admitted in Department of Gynecology and Obstetrics, ShaheedZiaur Rahman Medical College and Hospital, Bogura in Bangladesh were recruited randomly for a randomized control trial as per inclusion criteria. Misoprostol was administered either orally or sublingually to each patient. A maximum of three doses might be administered if necessary. A previous cesarean birth was an exclusion criterion. The number of women who had a vaginal birth during 24 hours of induction was our major metric for success. SPSS 26 was used to analyze the data.Results:The induction to delivery intervals were considerably shorter in the sublingual group (18 hours versus 25.5 hours; mean difference was 6.2 hours; 95 percent confidence interval, 1.5 to 14.6). In the sublingual group, there was just 2% occurrence of uterine hyperstimulation. The two groups did not vary significantly in terms of delivery method, fetal distress, or newborn outcomes. A total of 80% percent and 82.60 percent of patients were satisfied with the oral and sublingual groups, respectively, and only 10% percent believed the sublingual tablets didn’t entirely dissolve.Conclusion:Sublingual misoprostol seems to be a successful method of delivery, although further clinical studies are needed to demonstrate the safety and effectiveness of the sublingual mode.

Aetiological Factors and Foetomaternal Outcome in PROM.

Premature rupture of membrane (PROM) refers to the disruption of foetal membranes before the beginning of labour, resulting in spontaneous leakage of amniotic fluid.Homeyr, GJ et al in his study “Amnio infusion for third trimester preterm rupture of membranes”, march 2014 states that premature rupture of membranes (PROM), or pre-labour rupture of membranes, is a condition occurring in pregnancy and defined it as rupture of membranes (breakage of the amniotic sac), commonly called breaking of the mother's water (s), more than one hour before the onset of labour.METHODSThe present study was carried out in the Department of Obstetrics and Gynaecology of Rajendra Institute of Medical Sciences (RIMS), Ranchi, during from April 2017 to October 2018. A total 595 cases were studied. The cases were divided into two groups, Study Group-195 cases and Control Group- 400 cases.RESULTSVarious factors were studied and analysed. Incidence of PROM in the present study was 7.49%. Out of 195 cases 68% were term PROM and 32% were preterm PROM. Mean age in the study group was 23 yrs. Risk factors associated with PROM in most of the cases was unknown (52%). Other causes were anaemia 34%, cervicovaginal infections 16%, malpresentation 10%, multiple gestation 3.5%, prior cervical surgery 1%, history of fall 1% PROM following coitus was 1.5%. In the present study the correlation between CRP and clinical chorioamnionitis was significant. Caesarean section was done was done in 19% cases in study group. There were 3 % cases of chorioamnionitis in study group. Out of 10 patients in the study group, maximum patients had puerperal sepsis (4 patients- 40%) followed by UTI (30%), wound infection (20%) and breast engorgement (10%).CONCLUSIONSPremature infant puts immense burden on the economy and health care resources of the country. Therefore, management of PPROM requires accurate diagnosis and evaluation of the risks and benefits of continued pregnancy or expeditious delivery. Once PROM is diagnosed, it is important to weigh the risk of PROM and prematurity and make the right choice for conservative management or active interventions. Adequate antenatal care should be advocated so that appropriate risk assessment can be done, and intervention provided where applicable. Neonatal units should also be equipped to be able to render necessary care for these preterm neonates thereby reducing the morbidity and mortality associated with PPROM.

Study of fetomaternal outcome in cases of premature rupture of membrane at tertiary care rural institute of Western Uttar Pradesh, India

Background: Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications.Methods: This was a prospective study carried out at the department of obstetrics and gynaecology, UPUMS, Saifai from April 2018 to September 2018 (6 months study). Patients with Spontaneous rupture of membranes any time beyond 28th week of pregnancy, but before the onset of labour. Patients with following conditions were excluded from the study- meconium stain liquor, cord prolapse, antepartum haemorrhage, active infection at other sites, active liver disease.Results: A total of 103 cases of premature rupture of membrane (PROM) were recorded from April 2018 to September 2019 among 1523 admitted pregnant patients. Most of the patients 56 (54.36%) were delivered by caesarean section (C/S). Previous C/S, oligohydramnios, fetal distress, chorioamnionitis were the common indications for doing C/S. Forty-seven (45.63%) patients were delivered vaginally.Conclusions: Most of the affected women belongs to 20-24 years of age (53.39%). Term PROM was more in comparison to PPROM and most of them were multigravidae. Cesarean section rate was high. Most common complication was of subclinical urogenital infection (51.02%).

Comparison of intravenous oxytocin infusion versus intracervical dinoprostone followed after 6 hours by intravenous oxytocin infusion for labor induction in prelabor rupture of membranes: A randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

Background@#A prolonged interval from prelabor rupture of membranes to delivery is associated with an increase in the incidence of maternal and neonatal morbidities and mortality. Various agents have been tested to improve the cervical Bishop score to expedite the delivery of the fetus and lessen the maternal and neonatal complications.@*Objective@#To compare two protocols for labor induction in pregnant women with prelabor rupture of membranes (PROM).@*Population@#Subjects were recruited from the University of Santo Tomas Hospital (Private Division and Clinical Division). Pregnant women with a live, term, singleton fetus, cephalic presentation, a reactive Non stress test, who presented with PROM and a Bishop score of ?5, with no previous Cesarean section, or other uterine surgery.@*Methodology@#This is a two-arm superiority, open label, randomized controlled trial. Pregnant women with a live, term, singleton fetus, cephalic presentation, a reactive Non stress test, who presented with PROM and a Bishop score of ?5, and with no previous Cesarean section or other uterine surgery were randomly assigned to receive either intravenous (IV) oxytocin infusion or intracervical dinoprostone 0.5 mg gel followed 6 hours later by IV oxytocin infusion.@*Results@#Vaginal delivery within 24 hours of labor induction increased significantly with intracervical dinoprostone gel followed by IV oxytocin infusion (87% versus 61%; RR: 1.43; 95% CI: 0.99 – 2.06; P<0.044). Comparable result was observed for nulliparous women included in the study population. The time interval from labor induction to active phase was significantly shorter in the dinoprostone-oxytocin group than in the oxytocin alone group (2.4 ± 2.1 versus 6.3 ± 1.4 hours; p<0.001). The time interval from labor induction to delivery was also significantly shorter in the dinoprostoneoxytocin group (6.3 ± 1.5 versus 10.4 ± 1.4 hours; p<0.000). Cesarean delivery rates were statistically similar in the dinoprostone-oxytocin and oxytocin alone groups (17% versus 40%; p=0.102). The neonatal outcomes were comparable in both groups, except for birth weight.@*Conclusion@#Intracervical dinoprostone 0.5 mg gel followed 6 hours later by an oxytocin infusion in term women presenting with PROM and an unfavorable cervix (Bishop Score of 5 or less) was associated with a higher rate of vaginal delivery within 24 hours, shorter time interval from labor induction to active phase of labor, and shorter time interval from labor induction to delivery, and no difference in maternal and neonatal complications was observed compared with oxytocin infusion alone.

A clinical, radiological and etiological study of neonatal pneumonia

Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children's Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children's Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.

A Comparitive Study On Induction Of Labour Versus Expectant Management In Term Premature Rupture Of Membranes In Tertiary Care Hospital,Visakhapatnam.

Premature rupture of membranes (PROM), also called Prelabour Rupture Of Membranes, is classically dened as rupture of membranes before labour and accounts for 0.8-0.9% of all pregnancies at term. this study was conducted over a period of 14 months ( from March 2018 to May 2019) in a tertiary care medical college . A total of 100 term PROM patients were recruited in our study – and divided into two groups randomly--50 (Group A) patients were managed conservatively and 50 (Group- B) patients underwent induction of labour. Both these patient groups were studied to compare the feto-maternal outcome. Group-A (conservative management group) patients were observed to await the spontaneous onset of labour pains for at least 24 hours. Patients in group B were induced with either - PGE1 tab (misoprostol) 25 μgm 4 hourly orally or iv oxytocin infusion. the PROM-delivery interval was < 12 hours in 72 % of induced groups (Group B) and 10% (5) in group- A (conservative or expectant group). LSCS rate was 10 % in group-A (expectant group) & 15 % in group –B (induced group). Sepsis rate, maternal and fetal, hospital stay, NICU admission & duration of NICU stay were notably higher in group – A (expectant management group). therefore, from our study we concluded that immediate induction of labour in term PROM cases shortens the PROM- delivery interval, hospital stay, NICU stay and reduction in both maternal & neonatal sepsis.

Reducción embrionaria en embarazo gemelar / Embryo reduction in twin pregnancy

La reducción embrionaria es la interrupción selectiva del desarrollo de uno o varios fetos en el primer trimestre del embarazo. El embarazo gemelar se presenta aproximadamente en uno de cada 100 nacimientos y se considera como una entidad con alto riesgo materno y fetal. Los embarazos múltiples tienen un impacto mayor en los sistemas de salud, debido a la mayor frecuencia de complicaciones. La rotura prematura de membranas causa aproximadamente el 40 por ciento de los partos pretérmino y, como consecuencia, aportan un 10 por ciento de la mortalidad perinatal según la Sociedad Española de Ginecología y Obstetricia. En este caso clínico se observó que una actitud expectante con los pertinentes controles ecográficos (índice del líquido amniótico), analíticos (recuento leucocitario y reacción en cadena de la polimerasa) y clínicos (frecuencia cardiaca y temperatura) pueden llevar a una buena evolución posnatal que justificó al menos en esta ocasión, una actitud conservadora(AU)

Embryonic reduction is the selective interruption of the development of one or several fetuses in the first trimester of pregnancy. Twin pregnancy occurs in approximately one in every 100 births. It is considered an entity with high maternal and fetal risk. Multiple pregnancies have greater impact on health systems due to the higher frequency of complications. Premature rupture of membranes causes approximately 40 percent of preterm births and, consequently, it contributes 10 percent of perinatal mortality according to the Spanish Society of Gynecology and Obstetrics. In this clinical case it was observed that an expectant attitude with the relevant ultrasound (index of amniotic fluid), analytical (leukocyte count and polymerase chain reaction) and clinical (heart rate and temperature) controls can lead to good postnatal evolution, justified at least on this occasion, a conservative attitude(AU)

A study of survival of very low birth weight neonates in a tertiary care hospital

Background: Preterm birth is one of the major clinical problems in Obstetrics and Neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. Very low birth weight (VLBW) neonates comprise between 4-8% of live-births but about one-third of deaths during the neonatal period occur in this group of newborns. Data on the probability of survival of infant in high risk pregnancies can be of great value in guiding management. The objective is to study the survival at discharge of VLBW neonates admitted in a tertiary care hospital.Methods: Retrospective observational study of all VLBW infants admitted in Aditya Hospital NICU over 3 years between 1-7-2011 to 30-6-2014. Descriptive and inferential statistical analysis has been carried out in the present study.Results: In the present study maternal PROM was seen in 32.9% of cases, Preeclampsia in 31.7% of cases which constituted the most important antenatal risk factor for VLBW followed by multiple gestations in 25.2%. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Survival improved with increasing gestational age and weight.Conclusions: Birth weight and gestational age specifically predicts survival of preterm VLBW babies, facilitating decision making for obstetricians, neonatologists and parents. In the present study total survival rate was 86.6% with a mortality of 13.4%.

To Assess the Safety and Efficacy of Misoprostol Administered Sublingually For Induction of Labour in Patient with PROM with Poor Bishop’s Score

Background: The management of PROM has often been adilemma in obstetrics. Different regimens are followed indifferent centres all over the world for management of PROM.This study is aimed to compare the safety and efficacy ofsublingually equivalent dose regimen administered vaginally forinduction of labour in patient with PROM with poor Bishop’sScore.Material & Methods: A prospective randomised controlled trialdone on 60 Patients of PROM admitted in labour room ofGovernment Medical College, Dungarpur, as per inclusion andexclusion criteria. Group 1- Received 25µg misoprostol,intravaginally 4 hourly up to maximum of 3 doses, placed inposterior fornix. Group 2- Received 25 µg misoprostol,sublingually 4 hourly up to maximum of 3 doses. Foetal heartand labour progress monitoring was done. Before every dose apervaginum examination was performed to assess the Bishopscore.Results: Our study showed that the foetal distress (foetal heartrate (FHR) abnormalities; FB<120bpm, FT >160bpm) wasmost common intrapartum complication in both groups(13.33% each). Mean induction delivery interval in sublingualgroup was 8.13±4.29 hours and in intravaginal group was7.31±4.11hours. Majority of women in both groups deliveredvaginally; 25 patients (83.33%) in intravaginal and 26 patients(86.66%) in sublingual group. 2 patients in intravaginal and 1patient in sublingual group had atonic PPH. However nopatient required blood transfusion. None had retained placenta.There was no maternal mortality.Conclusion: We concluded that both sublingual andintravaginal route of administration of 25µg misoprostol areequally effective in achieving favourable Bishop’s score,vaginal delivery rates, with comparable induction to deliveryintervals without increasing the caesarean rates and thepostpartum complications.

To Assess the Safety and Efficacy of Misoprostol Administered Vaginally For Induction of Labour in Patient with PROM with Poor Bishop’s Score

Background: The management of PROM has often been adilemma in obstetrics. This study is aimed to assess the safetyand efficacy of misoprostol administered vaginally for inductionof labour in patient with PROM with poor Bishop’s Score.Materials & Methods: A randomised observational study doneon 90 Patients of PROM admitted in labour room of MahilaChikitsalaya, SMS Medical College, Jaipur as per inclusion andexclusion criteria. Augmentation with oxytocin was done inpatients with favourable bishop score (>5) with mild uterinecontraction or patients with poor bishops score (<5) even after3 doses of misoprostol. If leaking of more than 24 hours andunfavourable cervix (bishop <5) or any evidence of foetaldistress then further management was at the discretion ofattending obstetrician.Results: Our study showed that the mean induction deliveryinterval was 7.67±4.86hours & 78 patients (86.7%) deliveredwithin 12 hours after induction in patient of PROM. Apgar scoreof new born babies at 1 min in majority was 8 – 10 min.(81.1%) and at 5 min in majority was 8-10 (98.9%).Conclusion: Misoprostol maximum of 75µg is an effectivemethod of improving the inducibility score and induction oflabour in properly selected cases. Misoprostol in above dosesis without any untoward effect on maternal and foetal outcomeand hence, safe.

The role of caspase-3, apoptosis-inducing factor, and B-cell lymphoma-2 expressions in term premature rupture of membrane

Abstract Objective To determine the role of caspase-3, apoptosis-inducing factor (AIF), and Bcell lymphoma-2 (Bcl-2) expressions in term premature rupture of membrane (PROM). Methods An analytic observational study with case-control design was conducted, involving 52 subjects (37-42 weeks of gestation) who were divided into 2 groups: 26 cases of term delivery with PROM, and 26 controls of term delivery without PROM. The expressions of caspase-3, AIF, and Bcl-2 in the amniotic membrane were determined by immunohistochemistry. Data were analyzed using the chi-squared test. The risk of PROM was expressed by odds ratio (OR). Results There were no significant differences in age, parity and body mass index between the two groups (p > 0.05). High caspase-3 and AIF expressions increased the risk of PROM 17.64 times (OR = 17.64; 95% CI = 4.44-70.07; p = 0.001) and 9.45 times (OR = 9.45; 95% CI= 2.62-34.07; p = 0.001), respectively, while low Bcl-2 expression increased 10.39 times (OR = 10.39; 95% CI = 2.73-39.56; p = 0.001)the risk of PROM . Conclusion High caspase-3 and AIF expressions and low Bcl-2 expression were risk factors for term PROM. Caspase-dependent and independent pathways of apoptosis were involved in the mechanism of PROM in term pregnancy.

Vaginal fluid creatinine for the detection of pre-labor rupture of membranes / Philippine Journal of Obstetrics and Gynecology

Introduction@#Prelabor rupture of membranes (PROM) occurs in 8% of all pregnancies and is a major cause of preterm birth and perinatal morbidity and mortality. In 47% of cases, clinicians are uncertain regarding the diagnosis of PROM based on examination and history alone. A misdiagnosis often leads to unnecessary interventions that may be detrimental to mother and fetus. There is currently no ideal noninvasive diagnostic test that can diagnose prelabor rupture of membranes with certainty. @*Objective@#This study aims to determine if a quantitative assay of vaginal fluid creatinine can correctly diagnose prelabor rupture of membranes in women with singleton pregnancies at 28-42 weeks age of gestation@*Methodology@#A prospective study was performed at a tertiary hospital from December 2015 to August 2017 with a computed sample size of 180 patients (60 per group). If a history of watery discharge was confirmed by egress of fluid, then the patient was included in the Ruptured membranes group. If despite a history of watery discharge, no egress is noted, then she was included in the Unsure membrane status group. 60 women with normal pregnancies were randomly chosen for the control group. Vaginal fluid was collected for Litmus Paper, Fern, and Vaginal Fluid Creatinine Tests.@*Results and Conclusion@#Vaginal fluid creatinine at 1.00 mg/dL has higher sensitivity, specificity, positive and negative predictive values, and a higher positive likelihood ratio than the litmus paper or ferning tests. High accuracy values, with a low false negative rate of 0, and a large AUC make vaginal fluid creatinine an excellent test for the detection of PROM, in accordance with previous studies.

Identification of the PROM1 Mutation p.R373C in a Korean Patient With Autosomal Dominant Stargardt-like Macular Dystrophy

Stargardt-like macular dystrophy 4 (STGD4) is a rare macular dystrophy characterized by bull's eye atrophy of the macula and the underlying retinal pigment epithelium. Patients with STGD4 show decreased central vision, which often progresses to severe vision loss. The PROM1 gene encodes prominin-1, which is a 5-transmembrane glycoprotein also known as CD133 and is involved in photoreceptor disk morphogenesis. PROM1 mutations have been identified as genetic causes for STGD4 and other retinal degenerations such as retinitis pigmentosa. We report a case of STGD4 with a PROM1 p.R373C mutation in a Korean patient. Ophthalmic examinations of a 38-yr old man complaining of decreased visual acuity revealed bilateral atrophic macular lesions consistent with STGD4. Targeted exome sequencing of known inherited retinal degeneration genes revealed a heterozygous missense mutation c.1117C>T (p.R373C) of PROM1, which was confirmed by Sanger sequencing. To the best of our knowledge, this is the first case of a PROM1 mutation causing STGD4 in Koreans.

Insulin-like Growth Factor Binding Protein-1/ alpha-fetoprotein versus Placental alpha microglobulin-1 for diagnosis of premature fetal membranes rupture.

Objectives: To compare insulin-like growth factor binding protein-1/alpha-fetoprotein (IGFBP-1/AFP) to placental alpha microglobulin-1 (PAMG-1) for diagnosis of premature fetal membranes rupture (PROM). Methods: 220 pregnant women ≥ 37 and < 39 weeks` gestation studied and classified into two groups; study group (PROM) and control group (no PROM). Examination of the studied women followed by abdominal ultrasound (TAS) and sterile vaginal speculum examination to visualize amniotic fluid leaking and for collection of samples for fern, nitrazine, AmniSure® and AmnioQuick® Duo+ tests on admission. Results: The sensitivity and specificity of AmnioQuick® Duo+ test to detect PROM was 93.6% and 86.4%; respectively compared to 95.5% and 89.1%; respectively for AmniSure® test, 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. PPV, NPV and accuracy of AmnioQuick® Duo+ test to detect PROM were 87.3%, 93.1% and 90%; respectively compared to 89.7, 95.1% and 92.3%; respectively for AmniSure® test, 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ and AmniSure® tests had higher sensitivity, specificity, predictive values and accuracy to detect PROM compared to conventional diagnostic tests. Conclusion: AmnioQuick® Duo+ test for detection of IGFBP-1/AFP was rapid, accurate bedside test better than the individual conventional diagnostic tests and has same accuracy and performance like AmniSure® test.

Outcome of Prelabor Rupture of Membranes in a Tertiary Care Center in West Bengal.

The etiology is unknown in majority of cases though bacterial infection, cervical incompetence, hypertensive disease, recent coitus, malpresentation, antepartum hemorrhage (APH), malnutrition are recognized causes of prelabor rupture of membranes (PROM). A study was conducted in our institution in 2011, where 478 cases out of a total obstetric admission of 9,637 presented with PROM. Spontaneous rupture of membranes after 28 weeks of gestation before the onset of labor is called PROM. When it occurs before 37 completed weeks of gestation it is called preterm PROM (pPROM). The term PROM cases were induced after waiting for 24 hours for a spontaneous onset of labor. The preterm population were divided in three groups and were given treatment as; Group A: with beta-mimetic, antibiotic, steroid, iron and folic acid (IFA); Group B: With steroid, antibiotic, natural progesterone and IFA; Group C: With only antibiotic and IFA. Observed neonatal mortality in the very preterm group (<34 weeks) was 10% as compared to 5.8% in preterm (34-37 weeks) and nearly 3% among term pregnancies. Treatment of pPROM cases with steroid and antibiotic compared with addition of natural progesterone with or without beta-mimetic did not show any significant difference in terms of Apgar score, need for resuscitation in absence of maternal infection. Elective lower segment cesarean section (LSCS) showed a zero neonatal mortality, better Apgar score and significantly lesser requirement of neonatal resuscitation compared to emergency LSCS. It was concluded that gestational age at the time of delivery is the main determinant of neonatal body weight as well as survival among PROM cases. Beta-mimetics and progesterone showed no role to prolong pregnancy in PROM cases.

Interventions and Neonatal Outcomes in Patients with Premature Rupture of Fetal Membranes at and Beyond 34 Weeks Gestational Age at a Tertiary Health Facility in Nigeria.

Aims: To compare the neonatal outcome in patients with PROM at and beyond 34 weeks, who had expectant management and progressed to spontaneous labour and those who had induction of labour. Study Design: Retrospective study of patients presenting with PROM at and beyond 34 weeks gestation over a 3 year period. Place and Duration of Study: Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, between July 2007 and June 2010. Methodology: Case files of 92 patients with PROM and live, singleton fetuses, at and beyond 34 weeks gestation, in the study period, were retrieved from the hospital Health Records Department, collated and analyzed. Data collected included parity, estimated gestational age (EGA) at PROM, latency period (time interval from PROM to onset of labour), intervention following PROM, eventual mode of delivery and neonatal outcome. Results: A total of 2340 deliveries were recorded in the study period and 92 cases of PROM were on record for the period. However, only 74 PROM cases were included in the study, due to incomplete information. Incidence of PROM was therefore 3.9%. Length of latency period had a direct influence on the number of patients that went into spontaneous labour (P = 0.012) and subsequent vaginal delivery (P = 0.021). Induction of labour did not increase rate of caesarean section (P = 0.449) and had no effect on neonatal outcome (P = 0.239). Conclusion: Acceptable approach for the management of PROM at and beyond 34 weeks would be expectant management for the 1st 24 hours and induction of labor afterwards in patients who have not progressed into spontaneous labour. Expectant management in the extended latency period in the late preterm PROM group is associated with increased NICU admission (OR 7.33, 95% C.I 2.45 – 21.98); however, this did not affect duration of NICU stay or neonatal mortality.

Incidence of neonatal sepsis in tertiary care hospital: An overview.

Background: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. Aims & Objective: To determine the bacteriological profile of neonatal septicaemia, their antibacterial susceptibility pattern (AST) and production of extended spectrun β-lactamase (ESBL) by gram negative bacteria. Material and Methods: Blood culture specimens were collected from 238 neonates. Identification of organisms, their AST, methicillin resistant Staphylococcus aureus (MRSA) and ESBL detection was done. Results: Gram negative bacteria were more frequently isolated than gram positive bacteria. The gram positive bacteria were highly resistant to penicillin. Vancomycin and amoxyclav exhibited good activity against both Staphylococcus aureus and coagulase negative Staphylococcus. Gram negative bacteria also exhibited high resistance to the commonly prescribed group of drugs such as penicillins, cephalosporins and aminoglycosides. Out of the total 16 isolates of S. aureus, 31.25% were MRSA. ESBL production was seen in 52.9% of Escherichia coli and 50% of Klebsiella pneumoniae. Conclusion: E. coli and S. aureus were the most common bacteria associated with neonatal sepsis. Gram negative bacteria were isolated predominantly and many of them were resistant to several groups of drugs. Also high resistance was seen to third generation cephalosporins in case of E. coli and K. pneumoniae due to ESBL production.

Effects of Wrist Hand Orthoses on Cerebral Palsy Children with Adduction of Thumb / 中国康复理论与实践

@#ObjectiveTo observe the effects of wrist hand orthoses on cerebral palsy children with adduction of thumb. MethodsChildren with spastic hemiplegia were divided into experimental group （14 cases) and control group （15 cases）. Children in the both groups received routine rehabilitation for 3 months. Children in experimental group wore wrist hand orthoses 4～8 h/d in addition. ResultsThe passive range of motion (PROM) and scores of Fine Motor Function Measure Scale (FMFM) significantly increased in both groups after treatment. The PROM and FMFM scores in experimental groups increased more than those in the control group after treatment （P＜0.05).ConclusionWrist hand orthoses can improve the passive adduction angle of carpometacarpal joints of thumb and the fine motor function in spastic hemiplegia children after cerebral palsy.

Management of delivery with prelabor rupture of membranes (prom) in term labour / Монголын Анагаах Ухаан

Introduction:Prelabor rupture of membranes is defined as spontaneous rupture of membranes with no contractions and it is increased for serious maternal and fetal risk, as a inter and postpartum infections, dysfunctional labor, and the need for operative delivery. Prelabor rupture of membranes occurs in approximately 10 % of pregnancies, of these, approximately 90% in term parturiuents.Goal: To evaluate management of delivery with PROM in term labour.Materials and Мethods:The retrospective and prospective evaluation of 672 and 144 case series of women with PROM was done in First Maternity Hospital and DTC in Dornod Province. All medical records were reviewed by prestructured questionnaire consisting of 12 groups and analysed by descriptive and logistic regression.Results: The mean age of study subjects was 27.81 (SD 5.563) and the incidence of PROM was 11.3% and from them 69,1% were delivered vaginally and 31,9% by C-section. Induced labor the vaginally delivery was 87.8% and of them 33% use epidural anaesthesia and 50.3% of cases were women with unfavourable cervix. Conclusions: In women with PROM at term delivery to induct the labor with mizoprostol was more effective when use the regime by the guideline ‘’Management complication pregnancy and child birth’’. The positivie correlation was observed between induction of labor and cervical ripining scores (P<0.01).