Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth

BACKGROUND: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).METHODS: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.RESULTS: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.CONCLUSION: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.

A systematic review of amniopatch

The objective of this review is to evaluate the safety and effectiveness of the amniopatch procedure for the treatment ofpreterm premature rupture of the membranes. The searches were conducted via electronic databases including Ovid-MEDLINE, Ovid-Embase, the Cochrane Library, and eight Korean databases. In the study design, in addition to randomized controlled trials, case report studies in which patients underwent the amniopatch procedure were included. Two reviewers independently selected data in standardized form and assessed the methodological quality. Quality evaluation was performed by the SIGN (Scottish Intercollegiate Guideline Network) method. A total of 11 studies (2 cohort studies, 1 case series, and 8 case reports) were included. There were no serious maternal or fetal complications. It was reported that there were lower rates of maternal chorioamnionitis after the amniopatch relative to conservative treatment (control). The mean gestational age at delivery was 27.7 weeks (a total of 70 cases in 10 studies; spontaneous group, 27.6 weeks; iatrogenic group, 27.8 weeks). The amniopatch was successful in 46.6% of cases (33/71 cases in 11 studies). The overall neonatal survival rate was 55.3% (52/94 cases in 11 studies). Neonatal morbidity was 23.4% (11/47 cases in 7 studies). Although this systematic review, did not find clear evidence of the safety and effectiveness, the amniopatch procedure is a viable treatment option to prolong a pregnancy with previable premature rupture of membranes.

A live birth after spontaneous complete chorioamniotic membrane separation associated with uterine scar

Spontaneous complete chorioamniotic membrane separation (CMS) without invasive fetal procedure is extremely rare and associated with adverse perinatal outcomes. A woman with complete CMS which was detected at the 21 weeks' gestation. She did not take any fetal invasive procedures before the diagnosis. At 27 weeks' gestation, an emergency Caesarean section was performed because of fetal distress. The defect of the uterine muscle was detected on the fundus. The baby has grown well without any morbidity. This is the first reported case of complete CMS relative to uterine scar. And we suggest that the pregnancy can be maintained successfully if there is no fetal abnormality when complete CMS is detected on ultrasound.

Antepartum Use of Antibiotics / 대한주산의학회잡지

Antibiotics are among the most commonly prescribed medicines during pregnancies for various reasons. The antepartum use of antibiotics requires the consideration of maternal physiologic change, its effects to fetuses and drug-resistance. Usually, antibiotics are prescribed to pregnant women complicated with preterm labor, preterm premature ruptures of the membranes, urinary tract infection or sexually transmitted diseases. In this article, we reviewed the antepartum use of antibiotics in obstetrical management.

The diagnostic and prognostic value of amniotic fluid white blood cell count in patients with preterm premature rupture of the membranes / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was 1) to determine the diagnostic performance of amniotic fluid white blood cell (WBC) count for the antenatal detection of intrauterine infection and 2) to identify the value in prediction of preterm birth and significant neonatal morbidity in patients with preterm premature rupture of membranes. METHODS: Transabdominal amniocentesis was done in 255 singleton pregnancies with preterm premature rupture of membranes before 36 weeks of gestational age. Amniotic fluid was cultured for aerobic and anaerobic bacteria and mycoplasmas. Receiver-operator characteristic curve, survival analysis and logistic regression were used for statistical analysis. RESULTS: 1) Prevalence of positive amniotic fluid culture was 19.6% (50/255). Amniotic fluid WBC count was higher in the patients with positive amniotic fluid culture than those with negative amniotic fluid culture (median 269 [0-19764] cells/mm3 vs median 2 [0-7956] cells/mm3, p or = 20 cells/mm3) had sensitivity of 74%, specificity of 74%, positive predictive value of 41% and negative predictive value of 92% for the positive result of amniotic fluid culture. 3) An increased amiotic fluid WBC was strongly associated with shorter amniocentesis-to-delivery interval even after adjustment of gestational age at amniocentesis(hazard ratio 3.2736, p<0.0001). 4) Amniotic fluid WBC count was higher in patients with significant neonatal morbidity or congenital neonatal infectious morbidity than those without these (p<0.001 and p<0.005 respectively). 5) Patients with increased amniotic fluid WBC count had higher incidence of significant neonatal morbidity and congenital neonatal infectious morbidity than those with low amniotic fluid WBC count and the association between amniotic fluid WBC and significant neonatal morbidity was statistically significant after adjustment of gestational age at amniocentesis (OR 3.3649, p<0.0001). CONCLUSION: Amniotic fluid WBC count is of value in antenatal diagnosis of intrauterine infection and prediction of maternal and neonatal outcomes in patients with preterm premature rupture of membranes.

Study of the predictive value for the early intrauterine infection in patients with PPROM / 中国综合临床

s Objective To investigate the predictive value of maternal serum C reactive protein,IL 6 and glucose concentration for the early intrauterine infection in patients with preterm premature rupture of the membranes(PPROM).Methods Amniotic fluid(AF) was collected from patients with PPROM,IL 6,glucose concentration,anti Chlamycdia trachomatis, anti lytomegalovirus IgM and ureaplasma urealytiaum were detected and cultured.Results The most sensitive test was AF IL 6 determination(P

The Significance of Amniotic Fluid Index at Admission as a Predictor of Latency Period in the Patients with Preterm Premature Rupture of the Membranes / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study was to determine the clinical significance of residual amniotic fluid volume, as measured by the amniotic fluid index(AFI), on the prediction of latency period and perinatal outcomes in patients with preterm premature rupture of the membranes(PPROM). METHODS: Study population consisted of 103 singleton pregnancies with PPROM between 24 and 34 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. Latency period was defined as time interval in hours between admission and delivery. All medical records of mothers and neonates were reviewed. Spearman's rho rank correlation, receiver-operator characteristic(ROC) curve analysis, survival analysis and Cox's proportional hazard model were used for statistical analysis. RESULTS: There was a statistically significant correlation between latency period and AFI at admission. ROC curve analysis showed that AFI at admission had a significant predictive value in the prediction of latency period 5.0 but the incidence of chorioamnionitis was not significantly different between two groups. Comparing the perinatal mortality and neonatal morbidity including infectious morbidity between the neonates born to mothers with AFI 5.0, there was no significance after adjustment of gestational age at birth. CONCLUSION: AFI at admission has a significant correlation with latency period and predictive value in prediction of latency period in the patients with PPROM. AFI <5.0 is a independent predictor for the shorter latency period.