The diagnostic value of serum levels of pro calcitonin, β2 defensins, C-reactive protein and the positive rate of group B streptococci in preterm premature rupture of membranes with amniotic infection / 中国医师杂志

Objective:To explore the diagnostic value of serum levels of pro calcitonin (PCT), β2 defensins (HBD-2), C-reactive protein (CRP) and the positive rate of group B streptococci (GBS) in preterm premature rupture of membranes (PROM) with amniotic infection.Methods:This study was a retrospective study. 156 pregnant women with preterm PROM who were diagnosed by the Obstetrics Department of the Hospital of Southern University of Science and Technology from January 2017 to January 2022 were selected as the study subjects. According to whether there was amniotic infection, they were divided into 57 infected women and 99 non infected women. The levels of serum PCT, HBD-2 and CRP before delivery were compared between the two groups, and the positive rate of GBS in vaginal discharge was detected, and the receiver operating curve (ROC) was used to analyze the value of various indicators in diagnosing amniotic cavity infection in preterm PROM mothers.Results:The serum levels of PCT, HBD-2, CRP, and GBS positivity in the infected group were significantly higher than those in the non infected group, with statistically significant differences (all P<0.01); The area under the curve (AUC) value, sensitivity, and specificity of serum PCT for diagnosing preterm PROM with amniotic cavity infection were 0.894, 82.56%, and 80.74%, respectively; The AUC value of HBD-2 for diagnosing preterm PROM with amniotic cavity infection was 0.792, the sensitivity was 70.78%, and the specificity was 77.59%; The AUC value, sensitivity, and specificity of CRP in diagnosing preterm PROM with amniotic cavity infection were 0.756, 68.94%, and 72.78%, respectively; The positive rate of GBS in vaginal discharge was 0.733, the sensitivity was 64.91%, and the specificity was 81.82%. Conclusions:The serum levels of PCT, HBD-2, CRP and the positive rate of GBS in vaginal discharge of pregnant women with preterm PROM complicated with amniotic infection will increase significantly. All indicators have high practical value for the diagnosis of preterm PROM complicated with amniotic infection.

Riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria

La salud materna y perinatal es una de las prioridades actuales de la salud global. La enfermedad cardiovascular y el accidente cerebrovascular son las principales causas de mortalidad materna. La abrupción placentaria sigue siendo una preocupación crítica para la morbilidad materna debido a que se ha asociado a enfermedad vascular a largo plazo. Sin embargo, no existe mucha literatura disponible en español ni evidencia reciente que haya dilucidado algunas interrogantes sobre este tópico. Entonces, el objetivo de esta revisión consiste en sintetizar evidencia reciente sobre el riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria. Se encontró que, a través de mecanismos fisiopatológicos complejos, que involucran la estructura y funcionalidad de la red vascular placentaria con posterior extensión de lesión vascular y producción de factores proinflamatorios y procoagulantes que permanecen después del parto, se precipita la aparición de eventos cardiovasculares mayores a mediano y largo plazo. Evidencia de alta calidad ha revelado que el riesgo de sufrir de complicaciones maternas en aquellas mujeres con abrupción placentaria es de 2,14, que se eleva aún más para aquellas con desprendimiento severo. A mediano y largo plazo, el riesgo de mortalidad por cardiopatía coronaria es de 2,64, y de 1,70 para desorden cerebrovascular, con igual riesgo tanto para el tipo isquémico como hemorrágico. Entonces, se puede concluir que el riesgo cardiovascular y cerebrovascular es inminente en mujeres con antecedente de abrupción placentaria, dado por numerosos mecanismos fisiopatológicos vasculares. No obstante, este riesgo se eleva considerablemente al asociarse con factores modificables tradicionales y no tradicionales.

Maternal and perinatal health is one of today's global health priorities. Cardiovascular disease and stroke are the leading causes of maternal mortality. Placental abruption remains a critical concern for maternal morbidity because it has been associated with long-term vascular disease. However, there is neither much literature available in Spanish nor recent evidence elucidating some questions on this topic. Thus, this review aims to synthesize recent evidence on the long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption. It was found that, through complex pathophysiological mechanisms involving the structure and functionality of the placental vascular network with subsequent extension of vascular injury and production of proinflammatory and procoagulant factors which remain after delivery, major cardiovascular events are precipitated in the medium and long term. High-quality evidence has shown that the risk of maternal complications in women with placental abruption accounts for 2.14, rising even higher for those with severe placental abruption. In the medium and long term, the mortality risk caused by coronary heart diseases is 2.64 and by cerebrovascular disorders is 1.70, with equal risk for both ischemic and hemorrhagic strokes. It can therefore be concluded that cardiovascular and cerebrovascular risk is imminent in women with a history of placental abruption due to a number of vascular pathophysiological mechanisms. However, this risk is considerably increased when associated with traditional and non-traditional modifiable factors.

The expression of high mobility group protein 1 and interleukin-17 in peripheral blood and membrane tissues of pregnant women with premature rupture of membranes and its relationship with intrauterine infection / 中国医师进修杂志

Objective:To investigate the expression of high mobility group protein 1 (HMGB1) and interleukin-17 (IL-17) in peripheral blood and membrane tissues of pregnant women with premature rupture of membranes (PROM) and its relationship with intrauterine infection.Methods:Seventy-four pregnant women with PROM from January 2019 to June 2021 were selected as the study group, and 58 healthy pregnant women at the corresponding period were selected as the healthy control group. The levels of HMGB1 and IL-17 in peripheral blood and membrane tissues and serum CD 8+ were compared between the two groups. The pregnant women with PROM were divided into the chorioamnionitis group, subclinical chorioamnionitis group and normal group according to their intrauterine infection, the expression levels of HMGB1 and IL-17 in peripheral blood and membrane tissues of patients with different infection degrees were compared, and the correlation with the severity of intrauterine infection were analyzed. Results:The levels of peripheral blood HMGB1, membrane tissues HMGB1, peripheral blood IL-17, membrane tissues IL-17 and serum CD 8+ in the study group were higher than those in the control group: (28.34 ± 5.16) μg/L vs. (22.51 ± 4.09) μg/L, 0.79 ± 0.12 vs. 0.34 ± 0.05, (13.05 ± 2.57) ng/L vs. (8.16 ± 1.38) ng/L, 0.37 ± 0.06 vs. 0.12 ± 0.02, 0.386 ± 0.052 vs. 0.252 ± 0.044, there were statistical differences ( P<0.05). The levels of HMGB1 and IL-17 in peripheral blood and membrane tissues and serum CD 8+ were increased with the severity of severity of intrauterine infection ( P<0.05). The results of Spearman correlation analysis showed that the level of peripheral blood HMGB1, membrane tissues HMGB1 and IL-17 had positively correlated with the severity of intrauterine infection ( r = 0.336, 0.316, 0.311, P<0.05). The results of receiver operating characteristic curve analysis showed that combined detection of HMGB1 and IL-17 levels in peripheral blood and membrane tissues and serum CD 8+ levels in evaluating the severity of intrauterine infection had higher area under the curve than that of each index alone ( P<0.05). Conclusions:Pregnant women with PROM have abnormal HMGB1 and IL-17 levels in peripheral blood and membrane tissues, and HMGB1 levels in peripheral blood and mRNA expressions of HMGB1 and IL-17 in membrane tissues are positively correlated with the severity of intrauterine infection, which has evaluation value for the severity of the disease.

Establishment and validation of predictive model for histologic chorioamnionitis during expected treatment of preterm premature rupture of membrane before 34 weeks of gestation / 中华围产医学杂志

Objective:To establish and verify a model to predict histologic chorioamnionitis (HCA) for women during expected management of preterm premature rupture of membranes (PPROM) at 24-34 weeks of gestation.Methods:This retrospective study enrolled 493 pregnant women who were diagnosed with PPROM at 24-33 +6 weeks of gestation and delivered in Peking University Third Hospital from January 1, 2012, to December 31, 2020. They were randomly divided into the modeling set ( n=345) and validation set ( n=148) at a ratio of 7∶3. Basic information, risk factors, clinical treatment, and maternal and infant outcomes were compared between participants with and without HCA using Chi-square test, t test, or Mann-Whitney U test. Multivariate logistic regression analysis was performed to analyze the independent risk factors for HCA. The predictive values of different indexes for HCA were compared and the predictive model was then established and verified using the receiver operating characteristic (ROC) curve and area under curve (AUC). Results:There were no significant differences in the basic information, common risk factors for premature rupture of membranes (PROM), or the use of tocolytics, antibiotics or dexamethasone between women in the HCA and non-HCA groups (all P>0.05). Compared with the non-HCA group, the HCA group showed an earlier onset of PROM [31.3 (24.0-33.9) vs 32.3 (27.0-33.9) gestational weeks, U=4 103.00, P=0.017], longer expected treatment [66.5 (0.7-895.3) vs 18.0 (0.3-1 123.0) h, U=1 791.00, P<0.001] and higher incidence of neonatal asphyxia, sepsis, and intracranial hemorrhage [24.3% (58/239) vs 13.2% (14/106), χ 2=5.44; 9.6% (23/239) vs 2.8% (3/106), χ 2=4.86; 41.0% (98/239) vs 17.9% (19/106), χ 2=17.45; all P<0.05]. Moreover, the positive rate of bacterial culture, C-reactive protein (CRP) level, neutrophil/lymphocyte ratio (NLR), white blood cell (WBC) and neutrophil counts were significantly increased in the HCA group [37.2% (89/239) vs 22.6% (24/106), χ 2=7.10; 8.2 (0.0-273.0) vs 5.0 (0.0-218.9) ng/ml, U=2 419.00; 5.6 (1.2-58.6) vs 4.6 (1.7-18.7), U=2 357.50; 11.9 (4.5-30.0)×10 9/L vs 10.1 (5.8-21.8)×10 9/L, U=4 074.50; 9.5 (2.5-28.1)×10 9/L vs 7.6 (3.5-18.5)×10 9/L, U=4 021.50; all P<0.05], while the lymphocyte count was decreased [1.5 (0.5-3.7)×10 9/L vs 1.6 (0.7-3.9)×10 9/L, U=4 237.00, P=0.017]. CRP level, NLR, the gestational week at the onset of PROM and the duration of expected treatment were independent risk factors for HCA ( OR=1.069, 95% CI: 1.024-1.117; OR=1.192, 95% CI: 1.048-1.356; OR=0.906, 95% CI: 0.867-0.947; OR=1.017, 95% CI: 1.007-1.026). Based on the four risk factors, the predictive model was established and ROC curve was drawn. AUC for evaluating the performance of the predictive model was 0.880, which indicated a clinical significance. Conclusion:The model established based on the four risk factors, which were CRP level, NLR, the gestational week at onset of PROM and the duration of expected treatment, performs well in the prediction of HCA in women with PPROM during expected treatment and has good clinical practical value.

Preterm premature rupture of membranes: management between 28 and 34 weeks of pregnancy / Ruptura prematura de membranas pré-termo: conduta entre 28 e 34 semanas de gestação

INTRODUCTION: Premature rupture of membranes remains a challenge for professionals due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. OBJECTIVE: To analyze the scientific production about premature rupture of membranes in pregnancies above 28 weeks and below 34 weeks. METHODS: Integrative literature review carried out in the Lilacs, SciELO, Medline and Cochrane Library databases, between 2014 and 2018, in Portuguese, English and Spanish, including original articles, available in full online, with free access, that addressed the study theme, using the keywords "premature rupture of ovular membranes", "premature labor" and "pregnancy complications" combined using the Boolean operators "AND" and "OR". RESULTS: Fourteen studies were included. It was possible to highlight the main recommendations regarding preterm premature rupture of membranes, divided into six categories for discussion, namely: indications for expectant management and delivery induction, prophylactic antibiotic therapy, prenatal corticosteroids, use of tocolytics, recommendations regarding the use of magnesium sulfate and amniocentesis. CONCLUSION: It was identified that expectant management is the ideal approach, with constant monitoring of the pregnant woman and the fetus, in addition to the administration of prophylactic antibiotics and prenatal corticosteroids, in the face of premature rupture of membranes in pregnancies between 28 and 34 weeks in order to provide the best maternal and perinatal results, guiding health professionals to evidence-based practice.

INTRODUÇÃO: A ruptura prematura de membranas continua a ser um desafio para os profissionais devido às altas taxas de morbimortalidade materna e neonatal, relacionada principalmente às complicações decorrentes da prematuridade. OBJETIVO: Analisar a produção científica acerca das evidências frente a ruptura prematura de membranas em gestações acima de 28 semanas e abaixo de 34 semanas. MÉTODOS: Revisão integrativa da literatura realizada nas bases de dados Lilacs, SciELO, Medline e Cochrane Library, entre 2014-2018, em português, inglês e espanhol, incluídos artigos originais, disponíveis completos online, com acesso livre, que abordassem a temática do estudo, utilizando os descritores "ruptura prematura de membranas ovulares", "trabalho de parto prematuro" e "complicações na gravidez" combinados por meio dos operadores booleanos "AND" e "OR". RESULTADOS: Foram incluídos 14 estudos, nos quais foi possível evidenciar as principais recomendações frente a ruptura prematura de membranas fetais pré-termo, divididos em seis categorias para discussão, sendo elas: indicações para o manejo expectante e indução do parto, antibioticoterapia profilática, corticosteroides pré-natais, uso de tocolíticos, recomendações quanto ao uso de sulfato de magnésio e realização de amniocentese. CONCLUSÃO: O estudo possibilitou identificar que o manejo expectante é a conduta ideal, com monitorização constante da gestante e do feto, além da administração de antibióticos profiláticos e corticosteroides pré-natais, frente a ruptura prematura de membranas em gestações entre 28 e 34 semanas a fim de proporcionar os melhores resultados maternos e perinatais, guiando os profissionais da saúde para uma prática baseada em evidências.

Relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes / 中国医师杂志

Objective:To explore the relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes (PPROM).Methods:The clinical data of each 68 PPROM patients with normal amniotic fluid (group A), less amniotic fluid (group B) and oligohydramnios (group C) were retrospectively analyzed. The delivery modes, perinatal complications, survival of perinatal infants and Apgar score at 1 min and 5 min after birth of live-born neonates were compared among the three groups. Pearson correlation analysis was used to evaluate the correlation between Apgar score of surviving neonates and residual amniotic fluid.Results:There was no significant difference in the incidence of vaginal midwifery and placental abruption among the three groups ( P>0.05). There were significant differences in natural delivery rate, cesarean section rate, incidence of some perinatal complications (amniotic cavity infection, chorioamnionitis, amniotic fluid fecal staining) and perinatal survival rate among the three groups ( P<0.05); There was no significant difference in natural delivery rate and cesarean section rate between group B and group C ( P>0.05); The natural delivery rate in group A was significantly higher than that in group B and C ( P<0.05), and the cesarean section rate was lower than that in group B and C ( P<0.05); There was no significant difference in the incidence of perinatal complications and perinatal survival between group A and group B ( P>0.05); The above perinatal complications in group C were significantly higher than those in group A and group B ( P<0.05), and the perinatal survival rate was lower than that in group A and group B. Using amniotic fluid volume as the independent variable (normal=0, less=1, too little=2) and the above perinatal complications as the dependent variable, logistic regression analysis showed that there was no significant correlation between amniotic fluid volume and the above perinatal complications ( OR=1.029, 1.117, 1.004, 1.045, P>0.05). There were significant differences in Apgar scores at 1 min and 5 min after birth among the three groups ( P<0.05), and the change trend was group A>group B>group C ( P<0.05). Pearson correlation analysis showed that there was a significant positive correlation between Apgar score at 1 min and 5 min after birth and the residual amniotic fluid of pregnant mothers ( r=0.402, 0.371, P<0.05). Conclusions:Residual amniotic fluid volume in PPROM patients is closely related to the degree of neonatal hypoxia, and the reduction of residual amniotic fluid can also increase the cesarean section rate, and oligohydramnios can also affect maternal-infant outcomes, thus it is necessary to pay attention to clinical practice.

Effect of modified vaginal cervical cerclage in the treatment of cervical insufficiency during pregnancy / 中国基层医药

Objective:To investigate the efficacy of modified vaginal cervical cerclage in the treatment of cervical insufficiency during pregnancy.Methods:The clinical data of 18 women with cervical insufficiency during pregnancy who received treatment in Changzhi Maternal and Child Health Hospital from January 2018 to January 2020 (including nine cases receiving modified Shirodkar operation and nine cases receiving modified McDonald operation) were retrospectively analyzed.Results:The operation process was successful in all 18 women, and there were no postoperative complications. After modified Shirodkar operation, the average gestational weeks were prolonged by 14.7 weeks. Six cases had a smooth vaginal delivery [full-term delivery in five cases and preterm premature rupture of membranes (35 weeks + 1 day) in one case]. Three women had a cesarean delivery [cesarean delivery at full-term in two cases, including twin pregnancy in one case and previous cesarean delivery in one case; preterm premature rupture of membranes because of chorioamnionitis (32 weeks + 1 day) with poor prognosis in one case]. The rate of holding babies home was 88.9%. After modified McDonald operation, the average gestational weeks were prolonged by 11.5 weeks. Five cases had a smooth vaginal delivery [full-term delivery in three cases, preterm premature rupture of membranes in one case (35 weeks + 3 days) and in one case (31 weeks)]. Three women had a cesarean delivery at full-term [secondary cesarean delivery in one case, twin pregnancy in one case, and preterm premature rupture of membrane because of preeclampsia in one case]. One case had infectious abortion, and the rate of holding the baby home was 88.9%.Conclusion:Selection of different modified operations according to the length of cervical canal can prolong gestational weeks and increase the survival rate of newborns. The modified vaginal cervical cerclage is simple and easy to operate with minimal damage to pregnant women, which is suitable for clinical promotion.

The effect of CD 8+ CD 25+ FoxP3 + regulatory T cell expression levels on balance of helper T cells 1/ helper T cells 2 in peripheral blood of pregnant women with premature rupture of fetal membranes / 中国医师进修杂志

Objective:To investigate the effect of CD 8+ CD 25+ FoxP3 + regulatory T cell (Treg) expression levels in peripheral blood of pregnant women with premature rupture of fetal membranes(PROM) on immune function of helper T cells (Th) 1/Th2. Methods:Thirty cases of pregnant women with PROM (PROM group), 30 cases of normal pregnant women (normal pregnancy group) and 30 cases of normal non-pregnant women (non-pregnancy group) who treated in Binhai County People′s Hospital from September 2019 to May 2020 were collected. Peripheral blood of each group was collected and the proportion of CD 8+ CD 25+ FoxP3 + Treg was determined by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were extracted and FoxP3 mRNA was determined by polymerase chain reaction (PCR). The levels of Th1-related cytokines interferon-γ (IFN-γ), interleukin (IL)-2, and Th2-related cytokines IL-10 and IL-4 were measured by Luminex liquid phase microarray. The effects of CD 8+ CD 25+ FoxP3 + Tregexpression on Th1/Th2 balance were analyzed. Results:The proportion of CD 8+ CD 25+ FoxP3 + Tregand the expression of FoxP3 mRNA in PROM groupand normal pregnancy group were lower than those in non-pregnancy group: (0.15 ± 0.03) %, (0.35 ± 0.09) % vs. (0.47 ± 0.11) %; 0.89 ± 0.11, 3.15 ± 0.67 vs. 3.75 ± 0.23 , the proportion of CD 8+ CD 25+ FoxP3 + Treg and the expression of FoxP3 mRNA in PROM groupwere lower than those in the normal pregnancy group , and the differences were statistically significant ( P<0.05). The levels of Th1-related cytokines IFN-γ and IL-2 in PROM group and normal pregnancy group were higher than those in non-pregnancy group, the level of Th2-related cytokines IL-4 was lower than that in non-pregnancy group , the levels of IFN-γ and IL-2 in PROM group were higher than those in normal pregnancy group, the level of IL-4 was lower than that in normal pregnancy group , and the differences were statistically significant ( P<0.05). In PROM group, the proportion of CD 8+ CD 25+ FoxP3 + Treg and the expression of FoxP3 mRNA in peripheral blood were negatively correlated with Th1-related cytokines IFN-γ ( r = - 0.413, -0.451, P<0.05) and IL-22 ( r = -0.645, -0.535, P<0.05), and were positively correlated with Th2-related cytokines IL-4 ( r = 0.558, 0.469, P<0.05). Conclusions:The proportion of CD 8+ CD 25+ FoxP3 + Treg in peripheral blood of pregnant women with PROM is lower, and the expression level of related FoxP3 mRNA is lower, which all affecte the Th1/Th2 immune balance and cause Th1 immune drift, which may be the related immune mechanism of PROM.

Comparison of Clinical Factors and Neurodevelopmental Outcomes between Early- and Late-Onset Periventricular Leukomalacia in Very Low Birth Weight Infants

PURPOSE: To analyze and compare the clinical factors and neurodevelopmental outcomes compare early- and late-onset periventricular leukomalacia (PVL) in very low birth weight infants (VLBWI). METHODS: We performed a retrospective study involving 199 newborn infants weighing < 1,500 g admitted to the neonatal intensive care unit between March 2009 and December 2015. VLBWI with PVL were categorized into early- and late-onset PVL groups based on the time of diagnosis based on 28 days of age. We analyzed the clinical factors and neurodevelopmental outcomes between the groups. RESULTS: The incidence rate of PVL was 10.1% (16/158). The Apgar score at 1 minute and the mean duration of tocolytic therapy were associated with the development of PVL. The incidence rate of premature rupture of membranes (PROM) was significantly higher in the early-onset PVL group (P=0.041). No significant differences were observed in neurodevelopmental outcomes between the early- and late-onset PVL groups. CONCLUSION: Results suggest that a higher incidence of PROM was associated with clinical characteristics in the early-onset PVL group. No significant intergroup differences were observed in neurodevelopmental outcomes; however, the Bayley Scales of Infant Development-III scores were lower in the early-onset PVL group.

Comparative study of misoprostol and oxytocin in induction of labor in full-term pregnancy complicated with premature rupture of membranes / 中国基层医药

Objective To investigate effect of the application of misoprostol and oxytocin in full-term pregnancy induced labor with premature rupture of membranes.Methods From March 2016 to June 2017,95 pregnant women in term pregnancy induced labor with premature rupture of membranes in General Hospital of Taiyuan Iron&Steel (Group) CO.LTD were selected as the research objects,and they were randomly divided into study group and control group,the control group was given oxytocin,the study group was given misoprostol for induction of labor,then the effect,the total production process,delivery time,labor time,maternal and infant outcomes,the occurrence of adverse reactions of the two groups were observed.Results The total effective rate of pregnant women of the study group and the control group were 95.83％,78.72％,respectively,the difference was statistically significant (x2=7.136,P ＜ 0.05);The total production process,delivery time and labor time in the study group were (5.76 ±1.38)h,(9.39 ±3.44)h,(5.53 ± 1.51) h,respectively,which in the control group were (7.89 ± 1.67)h,(12.83 ±3.76)h,(7.56 ± 1.9 2)h,respectively,the research group's total stage of labor,delivery time,delivery time were shortened significantly compared with those of the control group (t =5.829,7.331,4.276,all P ＜ 0.05);The cesarean delivery,fetal distress and amniotic fluid contamination rates of the study group were 6.25％,8.33％,8.33％,respectively,which of the control group were 21.28％,31.91％,27.65％,respectively,the study group's cesarean section rate,fetal distress and amniotic fluid were significantly lower compared with those of the control group (x2 =6.936,10.185,7.429,all P ＜ 0.05).The incidence of abnormal uterine contraction,gastrointestinal reaction and tachycardia had not statistically significantly difference between the two groups (P ＞ 0.05).Conclusion Compared with oxytocin,misoprostol for full-term pregnancy with fetal membranes induction effect is more significant,which can shorten the birth process,improve maternal and child outcomes.So it is worthy of clinical promotion.

Impact of premature rupture of membranes on fetal lung development / 中华全科医师杂志

Premature rupture of membranes ( PROM) is a common complication of pregnancy , seriously affecting the growth and development of fetus and newborns , even leading to death .PROM may disturb lung maturation and cause a variety of serious lung disease due to the infection and inflammation factors, which is one of the causes of poor prognosis or death in fetus and newborns .The awareness and knowledge of the impact of PROM on the fetal lung development may be of value for clinicians to improve neonatal survival rate .

Analysis of the change of vaginal microenvironment in pregnant women with preterm premature rupture of ;the membranes / 中国基层医药

Objective To study the vaginal microenvironment in pregnant women with preterm premature rupture of the membranes,and to explore the change of vaginal microenvironment in pregnant women with preterm premature rupture of the membranes.Methods 1 16 women with preterm premature rupture of the membranes were selected as preterm premature rupture of the membranes group,1 16 women with normal pregnancy outcomes were selected as control group.The vaginal pH value,vaginal lactobacilli,vaginal sialidase and HD5,IgE and SIgA levels were observed.Results At 28 weeks of pregnancy,the vaginal PH value,sialidase detection rate and HD5,IgE,SIgA levels of preterm premature rupture of the membranes group were higher than those of the control group,but there were no significant differences between the two groups(t=1.037,χ2 =1.052,t=1.282,1.051,1.861,all P>0.05).At pregnant 36 weeks,the vaginal pH value,sialidase detection rate and HD5,IgE,SIgA levels of preterm premature rupture of the membranes group[(4.13 ±0.22),71.4%,(12.53 ±1.55)pg/mL,(338.84 ±1.67)ng/mL, (53.44 ±1.57)μg/mL]were higher than those of the control group[(3.79 ±0.25),13.8%,(8.77 ±3.17)pg/mL, (167.43 ±3.66)ng/mL,(37.59 ±1.85)μg/mL],the differences were statistically significant(t=12.331,χ2 =24.816,t=5.258,9.469,7.357,all P0.05).At 36 weeks gestation,the vaginal lactobacilli detection rate of preterm premature rupture of the membranes group was lower than that of the control group,the difference was statistically significant (χ2 =19.545,P<0.05).Conclusion Preterm premature rupture of the membranes pregnant vaginal pH value increases,the detection rate of vaginal lactobacilli decreases,vaginal sialidase detection rate increases,vaginal immune factors HD5,IgE,SIgA level increases.

Parto pré-termo com e sem rotura prematura de membranas: características maternas, obstétricas e neonatais / Premature labour with or without preterm premature rupture of membranes: maternal, obstetric and neonatal features

OBJETIVO: Avaliação das caraterísticas maternas, obstétricas e neonatais nos partos pré-termo (PPT) associados ou não à rotura prematura de membranas pré-termo.MÉTODOS: Estudo retrospetivo de gestações de feto único, com um parto pré-termo, entre 2003 e 2012. Critérios de inclusão: a ocorrência de parto associado ou não à rotura prematura de membranas pré-termo. Critérios de exclusão: partos motivados por comorbidades fetal e/ou maternas (iatrogênicos); e processos não disponíveis ou incompletos para consulta. Foram comparadas caraterísticas entre os dois grupos de PPT: PPT espontâneo (PPTe)versusrotura prematura de membranas pré-termo (RPM-PT), tendo sido utilizados na análise estatística os testes Kolmogorov-Smirnov, Levene, χ2, t de Student e Mann-Withney.RESULTADOS: Dos 2.393 partos pré-termo de feto único, foram analisados 1.432, dos quais 596 foram espontâneos (PPTe) e 836 foram associados à RPM-PT. Das variáveis analisadas, os fatores socioeconômicos foram sobreponíveis em ambos os grupos. Foram mais frequentes no grupo PPTe (p<0,001) a multiparidade (50,7 versus40,3%), os antecedentes obstétricos de PPT (20,8 versus10,2%), o comprimento cervical (18,2 versus27,2 mm), o baixo índice de massa corpórea (IMC) (23,4 versus24,3 kg/m2) e a elevação dos marcadores infecciosos como a Proteína C reativa (2,2 versus1,2 mg/L) e os leucócitos (13,3 versus12,4x109). O desfecho neonatal, em termos de comorbilidade, foi mais adverso no grupo PPTe, sobretudo à custa de piores resultados neurológicos (4,7 versus2,8%, p<0,001).CONCLUSÕES: Os mecanismos etiológicos do PPT, com ou sem RPM-PT, são bastante complexos. Das várias caraterísticas analisadas no nosso estudo, apenas o baixo IMC, a multiparidade com PPT anterior, o comprimento cervical foram os piores parâmetros infeciosos que foram predominantes no grupo PPTe. Esse último grupo mostrou ainda piores resultados perinatais sobretudo neurologicamente.

PURPOSE: Evaluation of maternal, obstetrics e neonatal features in both spontaneous preterm births (PTB) with or without preterm premature rupture of membranes (PPROM).METHODS: Retrospective study of single fetus pregnancies with PTB between 2003 and 2012. Inclusion criteria: PTB associated with ou without PPROM. Exclusion criterias: PTB by medical indication due to fetal/maternal disease and all non accessible or incomplete clinical files. Different characteristics were compared between two groups of PTB: spontaneous PTB without PPROM (sPTB) versusPPROM. Kolmogorov-Smirnov, Levene, χ2, t Student and Mann-Withney tests were used for statistical analysis.RESULTS: From 2,393 PTB of single fetus, 1,432 files were analysed, from which 596 were sPTB and 836 PPROM. The socioeconomic conditions were similar in both groups. Multiparity (50.7versus40.3%), personal history of previous PTB (20.8 versus10.2%), cervical length (18.2 versus27.2 mm), lower body index mass (23.4 versus24.3 kg/m2) and higher infectious parameters (Protein C Reactive: 2.2 versus1.2 mg/L; Leukocytes: 13.3 versus12.4x109) were more frequent in PBTs (p<0,001). Neonatal outcomes, specially neurologic outcomes (4.7 versus2.8%, p<0,001), were worst in PBTs.CONCLUSION: PTB with or without PPROM has a complex etiology. From all evaluated features in our study, only maternal thinness, multiparity with a previous PTB, the cervical length and worst systemic infections parameters were significant in sPTB. This group also showed worst neonatal outcomes, specially on neurological outcomes.

Incidence and pregnancy outcomes of premature rupture of membranes in pregnant women in Beijing region / 中华全科医师杂志

Objective To investigate the incidence and pregnancy outcomes of premature rupture of membranes (PROM) in pregnant women in Beijing.Methods A retrospective multicenter study of 18 534 cases delivered in Beijing Obstetrics and Gynecology Hospital,Beijing Friendship Hospital,Daxing MCH Hospital and Tongzhou MCH Hospital from January 2011 to December 2011,was conducted.Results Among 18 534 cases,PROM occurred in 4 504 cases (24.30％),including 3 910 cases of in term PROM (21.10％) and 594 cases of preterm PROM (3.20％).The incidence of premature delivery was 6.17％ (1 144/18 534),and among 1 144 cases of premature delivery 547 cases were PROM (47.81％);the incidence of PROM was 22.75％ (3 957/17 390) in term delivery.The overall cesarean section (CS) rate was 48.50％ (8 989/18 534) and that in pregnant women with PROM was 35.55％ (1 601/4 504),but the CS rate in pregnant women without PROM was 52.66％ (7 388/14 030).The rate of postpartum hemorrhage was 13.12％ (210/1 601)in CS cases and 4.17％ (121/2 903) in vaginal delivery cases (x2 =121.361,P=0.000).The mean hospital stay for PROM was (5.3±2.9) d in CS cases and (4.3±2.3) d in vaginal delivery cases (t =-12.136,P =0.000).Conclusions Without severe maternal or fetal complications,the incidence of PROM is relatively high in Beijing region and PROM may not increase the maternal or fetal complications.Vaginal delivery is the main mode of delivery for PROM.Cesarean section may not cause less neonatal complications,but may lead to more postpartum hemorrhage and longer hospital stay.

Correlation between the myometrial thickness in the second trimester and preterm delivery in a prospective study / 中华妇产科杂志

Objective To investigate the relationship between preterm delivery and anterior myometrial (MA) thickness measured by ultrasound in the second trimester. Methods The general information and pregnancy outcome of singleton pregnant women who had antenatal visit in the Hunan Provincial People′s Hospital between Oct 2010 and Sep 2013 were collected prospectively. The MA thickness was measured at 20-27+6 gestational weeks. The cases were divided into preterm delivery group and term delivery group. Results (1)A total of 1 031 pregnant women were recruited in this study. 147 pregnant women were in the preterm delivery group(14.26%,147/1 031) and 884 women were in the term delivery group(85.74%,884/1 031). The gestation age at delivery of the preterm delivery group was significantly earlier than the term delivery group [(34.57 ± 2.39) vs (39.23 ± 0.92) weeks,P0.05). The incidence of premature rupture of membrane(PROM) in the preterm delivery group and in the term delivery group were 49.0%(72/147) and 15.8%(140/884),respectively, with statistically significant diffrence(P0.05). The mean value of MA thickness in the spontaneous preterm delivery group was(5.15±0.75) mm, and was (5.61±1.38 ) mm in the term delivery group, with statistically significant difference(P0.05). No correlation was found among PROM and MA thickness(r=0.058,P>0.05). However, in the preterm delivery group, the mean value of MA in PPROM was significantly thicker than the spontaneous preterm delivery cases(P<0.01). There was a positive correlation between the MA thickness and PPROM (r=0.457,P<0.01). Conclusion The MA thickness had some correlation with spontaneous preterm delivery and PPROM, while the MA thickness should not be considered as an independent factor of preterm delivery.

Histological chorioamnionitis in placenta and preterm birth / 中华围产医学杂志

Objective To investigate the causes and mechanism of preterm birth through analysis of the relationship between histological chorioamnionitis (HCA) in placental tissue and preterm birth.Methods Totally,327 preterm birth cases with report of placental pathologic examination were retrospectively collected from those women who delivered from December 1,2009 to December 1,2012 in Peking University First Hospital.According to the etiology of preterm birth,three groups were assigned:iatrogenic group (n=106),spontaneous contraction group (n=56) and premature rupture of membranes (PROM) group (n=165).According to the gestational age at delivery,three subgroups were further divided:early-preterm group (≥ 28-＜ 32 weeks),mid-preterm group(≥ 32-＜ 34 weeks) and late-preterm group (≥ 34-＜ 37 weeks).HCA was confirmed when ≥ 5 neutrophil infiltration identified on the chorionic plate and amniotic membrane under high power light microscope after HE staining.The relationship between HCA and the different types of preterm birth and the different delivery gestational age were analyzed.Besides,the consistency between clinical chorioamnionitis and HCA was also analyzed.Chi-square test was applied for statistics.Results The incidence of HCA in the spontaneous contraction group was significantly higher than in the iatrogenic group and PROM group [66.1％ (37/56) vs 25.5％ (27/106) and 33.3％ (55/165),x2=25.27 and 18.44,both P ＜ 0.01],but no significant difference was found between the latter two groups (P ＞ 0.05).Among the three subgroups,the early-,midand late-preterm subgroup,the incidence of HCA in the iatrogenic group was 24.0％ (6/25),33.3％ (8/24) and 22.8％ (13/57) (P ＞ 0.05),and 13/17,5/7 and 59.4％ (19/32) in the spontaneous contraction group (P ＞ 0.05).However,significantly higher incidence of HCA was shown in the early-preterm subgroup than in the mid-and late-preterm subgroup [70.0％ (20/29) vs 41.2％ (14/34) and 20.6％ (21/102),X2=4.87 and 24.58,both P ＜ 0.05] in the PROM group.Among the subjects in PROM group,those with the latency ≥ 72 h after the rupture of membranes had a higher incidence of HCA than those with the latency less than 72 h [68.6％ (24/35) vs 23.8％ (31/130),x2=24.82,P ＜ 0.01].For all 327 cases in this study,the incidence of clinical chorioamnionitis was 15.9％ (52/327),among which 31 cases [59.6％ (31/52)] were diagnosed as HCA.Conclusions The occurrence of HCA is closely associated with spontaneous contraction preterm.Some iatrogenic preterm birth might cause HCA.The earlier the preterm birth and the longer the latency after PROM,the higher the incidence of HCA.Differential diagnosis is necessary as the inconsistency between clinical chorioamnionitis and HCA.

Morbidade e mortalidade perinatal em gestações que cursaram com amniorrexe prematura em maternidade pública do Norte do Brasil / Perinatal morbidity and mortality in pregnancies that progressed with ruptured membranes at a public hospital in Northern Brazil

OBJETIVO: Identificar os fatores obstétricos e perinatais associados à morbimortalidade perinatal em gestações que cursaram com amniorrexe prematura. MÉTODOS: Estudo transversal de base hospitalar, com dados secundários de prontuários de pacientes (n=87) que evoluíram com quadro de amniorrexe prematura com idade gestacional entre 24 e 42 semanas, definida pela ultrassonografia, e internadas no período de janeiro a abril de 2013 em uma maternidade pública no estado do Acre, região Norte do Brasil. Os dados foram submetidos à análise bivariada para seleção de variáveis que compuseram o modelo múltiplo utilizando a técnica de regressão logística de Poisson. RESULTADOS: A prevalência de morbimortalidade perinatal foi de 51,4%. Nesse total estão computados 2,3% de óbitos fetais (2 casos) e 9,2% de óbitos neonatais (8 casos). As variáveis que apresentaram associação no modelo múltiplo final com morbimortalidade foram: número de consultas de pré-natal ≥6, com razão de prevalência (RP) 0,5 e intervalo de confiança de 95% (IC95%) 0,3-0,9, idade gestacional ≥30 semanas (RP=0,6; IC95% 0,4-0,8), baixo peso ao nascer (RP=2,9; IC95% 1,5-5,4) e necessidade de ventilação mecânica (RP=3,8; IC95% 2,0-7,2). CONCLUSÃO: Observou-se elevada morbimortalidade perinatal entre casos que cursaram com amniorrexe prematura. A morbimortalidade esteve associada a fatores como menor número de consultas de pré-natal, extrema prematuridade e o baixo peso. .

PURPOSE: To identify obstetric and perinatal factors associated with perinatal morbidity and mortality in pregnancies that progressed with ruptured membranes. METHODS: A cross-sectional hospital-based study with secondary data from records of patients (n=87) that evolved with the premature rupture of membranes between 24 and 42 weeks of gestation, admitted from January to April 2013 to a public hospital in Acre State, North of Brazil. Data were subjected to bivariate analysis for selection of variables to be used in a multiple regression model according to Poisson logistic regression with robust error. RESULTS: The prevalence of perinatal morbidity-mortality was 51.4%, including a 2.3% death rate (2 cases) and a 9.2% fetal neonatal death rate (8 cases). The variables associated with mortality in the final multiple model were: number of prenatal consultations ≥6, with a prevalence ratio (PR) of 0.5 and a 95% confidence interval (95%CI) of 0.3-0.9, gestational age ≥30 weeks (PR=0.6; 95%CI 0.4-0.8), low birth weight (PR=2.9; 95%CI 1.5-5.4), and mechanical ventilation (PR=3.8; 95%CI 2.0-7.2). CONCLUSION: Perinatal morbidity and mortality were high among cases of ruptured membranes. Morbidity and mortality were associated with factors such as fewer prenatal visits, extreme prematurity and low birth weight in this group. .

Volume de líquido amniótico e os desfechos maternos em gestantes com ruptura prematura das membranas pré-termo / Amniotic fluid volume and maternal outcomes in women with preterm premature rupture of membranes

OBJETIVO: Analisar entre pacientes com ruptura prematura de membranas pré-termo a associação do volume do líquido amniótico e os desfechos maternos. MÉTODOS: Estudo observacional do tipo coorte retrospectivo, realizado entre janeiro de 2008 e dezembro de 2012. Foram incluídas 86 gestantes com diagnóstico de ruptura prematura das membranas e idade gestacional entre a 24ªe a 35ª semanas, submetidas à mensuração do índice de líquido amniótico (ILA). Foram comparadas gestantes em dois pontos de cortes: com ILA <5,0 e ≥5,0 cm e ILA <3,0 e ≥3,0 cm. Foram excluídas mulheres com síndromes hipertensivas, diabetes mellitus, malformações fetais e com diagnóstico de infecção na admissão. Para análise estatística, foi utilizado o teste do χ2 ou exato de Fisher, quando pertinentes, e análise de regressão linear simples, adotando-se um nível de significância de 5%. Foi calculada a Razão de Risco (RR) e seu intervalo de confiança de 95% (IC95%). RESULTADOS: Quando avaliados os desfechos maternos em relação ao ILA ≥5,0 versus <5,0 cm, não foram encontradas diferenças estatisticamente significativas. Entretanto, em relação ao ILA <3,0 e ≥3,0 cm, foi verificado aumento do risco de corioamnionite (36,7 versus 10,7%; RR: 3,4; IC95% 1,4 -8,3; p=0,004), não sendo observadas diferenças significativas para as outras variáveis estudadas. Houve ainda correlação positiva estatisticamente significativa entre o ILA e idade gestacional do parto (R2=0,78; p<0,0001). CONCLUSÕES: O ILA <3,0 cm aumenta em três vezes o risco para corioamnionite, e quanto maior o ILA, maior a idade gestacional do parto. .

PURPOSE: To describe the potential influence of amniotic fluid on the maternal outcome of preterm premature rupture of membranes (PROM). METHODS: An observational, retrospective cohort study was conducted between December 2012 and January 2008 on 86 pregnant women with preterm PROM and a gestational age (GA) of 24 to 35 weeks. The amniotic fluid index (AFI) was used to measure aminiotic fluid volume. Pregnant women were compared at two cut-off points: those with AFI <5.0 and ≥5.0 cm and AFI <3.0 and ≥3.0 cm. We excluded women with hypertensive disorders, diabetes mellitus, fetal malformations and a diagnosis of infections at admission. For statistical analysis, we used the χ2 test or Fisher's exact test, when appropriate, and simple linear regression analysis, with the level of significance set at 5%. We calculated the Risk Ratio (RR) and its 95% confidence interval (95%CI). RESULTS: When maternal outcomes were assessed by comparing ILA ≥5.0 versus <5.0 cm, no significant differences were detected. However, when considering ILA <3.0 and ≥3.0 cm, there was an increased risk of chorioamnionitis (36.7 versus10.7%, RR: 3.4, 95%CI 1.4 -8.3, p=0.004), with no significant differences for the other variables. There was also a statistically significant positive correlation between AFI and gestational age at delivery (R2=0.78, p<0.0001). CONCLUSIONS: AFI <3.0 cm causes a three-fold increase in the risk for chorioamnionitis; also, the higher the ILA, the higher the gestational age at delivery. .

Success rate and influencing factors of external cephalic version for breech presentation / 中华围产医学杂志

Objective To discuss the success rate of external cephalic version (ECV) for breech presentation in singleton pregnancies and the factors influencing ECV,and complications induced by ECV.Methods A prospective study was conducted which included 204 pregnant women who underwent regular prenatal examinations and delivered in Nanjing Drum Tower Hospital between March 1,2011 and February 29,2012.The 204 cases were single pregnancy with breech presentation identified by ultrasound during 32-37+6 weeks of gestation,and without other indications for cesarean section (CS).According to willingness of the participants,204 cases were divided into two groups.The 101 pregnant women who refused EVC (control group) were asked to practice knee-chest position twice a day; and 103 pregnant women volunteered to undergo EVC (ECV group) during 32-37+6 weeks of gestation.The proportion of cephalic presentation at delivery,CS rate and the incidence of PROM,premature delivery and cord around the neck were compared between the two groups.Factors influencing the success rate of ECV were analyzed.Chi-square or adjusted Chi-square test were used for statistical analysis.Results The proportion of cephalic presentation at delivery in the ECV group was higher than that in the control group [68.9％ (71/103) vs 29.7％ (30/101),x2=31.39]; the CS rate in the ECV group was lower than that in the control group [49.5％ (51/103) vs 78.2％ (79/101),x2=18.18],as was the rate of CS due to breech presentation [62.7％ (32/51) vs 89.9％ (71/79),x2=13.86],all P＜0.05.The success rates in frank breech presentation,complete breech presentation and incomplete breech presentation were 77.1％ (37/48),72.7％ (24/33) and 45.5％ (10/22),respectively (x2=7.37,P＜0.05),and the success rate in frank breech presentation was higher than that in incomplete breech presentation (x2=6.84,P＜0.017).No significant differences were observed in the success rates between primiparas and multiparas [67.7％ (63/93) vs 8/10,x2=0.19],placenta attached at front wall of uterus and other attachment sites [61.0％ (25/41) vs 74.2％ (46/62),x2=2.01],and EVC performed at 32-35+6weeks of gestation and 36-37+6 weeks [70.5％ (62/88) vs 9/15,x2=0.65],allP＞0.05.No significant differences were observed for the incidence of PROM [7.8％ (8/103) vs 6.9％ (7/101)],premature delivery [2.9％ (3/103) vs 2.0％ (2/101)] and cord around the neck [17.5％ (18/103) vs 21.8％ (22/101)] between the ECV and control group (x2=0.05,0.19 and 0.60,all P＞0.05).Conclusions ECV for breech presentation in singleton pregnancies can effectively correct the fetal position and reduce the CS rate.ECV performed after 32 weeks of gestation does not increase the risk of PROM and premature delivery.

The analysis of risk factors and neonatal outcomes associated with histologic chorioamnionitis after preterm premature rupture of membranes / 中国医师进修杂志

Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis(HCA) after preterm premature rupture of membranes (PPROM).Methods From January 2008 to January 2013,103 women with PPROM at 28-33+6 weeks of gestation undergoing deliveries were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 68 cases in histologic chorioamnionitis (HCA group) and 35 cases in non-chorioamnionitis (control group).Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C reactive protein (CRP) level at admission and before delivery,and the neonatal outcomes were compared between two groups.The risk factors were analyzed by multivariable Logistic regression analysis.Results The incidence of HCA was 66.0％ (68/103) in all cases with PPROM.The occurring ruptured membrane gestation in HCA group was (28.2 ± 1.2) weeks,which were significantly earlier than (32.3 ± 1.4) weeks in control group (P ＜ 0.05).The level of CRP of (8.3 ± 4.7) mg/L before dehvery in HCA group was significantly higher than (5.4 ± 3.2) mg/L in control group (P ＜ 0.05).The rates of oligohydramnios and cesarean sections were significantly higher than those in control group (P ＜0.01 or ＜0.05).Using multivariable Logistic regression analysis,oligohydramnios,gestational age of PPROM ＜ 32 weeks,serum CRP level ＞ 8 mg/L before delivery and latency period 48-168 h were significantly associated with HCA (P ＜ 0.01 or ＜ 0.05).The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group (P ＜ 0.05).The incidence of Apgar ＜ 7 scores,abnormal brain ultrasonography findings,neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group (P ＜ 0.05).Conclusions HCA has significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.