Ruptura prematura de membranas ovulares / Premature rupture of ovular membranes

La ruptura prematura de las membranas ovulares se define como la pérdida de la integridad del amnios y corion antes del inicio del trabajo de parto, afecta el 3 % de los embarazos, causa un tercio de los partos pretérminos, los cuales ocupan el 10,49 % de los nacimientos y es el origen de altos índices de morbimortalidad perinatal. En la actualidad, el manejo de esta patología se orienta principalmente en evitar los factores de riesgo, hacer un diagnóstico adecuado, determinar la edad gestacional en que ocurre, realizar el monitoreo exhaustivo del bienestar materno-fetal y en decidir el momento idóneo de finalización de la gestación para minimizar sus complicaciones. Debido a la compleja y lábil estructura histológica de las membranas ovulares, se ha dejado a un lado el tratamiento directo de la entidad el cual sería sellar o reparar el defecto en sí. En los últimos años, numerosos estudios y protocolos clínicos de prestigiosos centros asistenciales han servido como guía para el manejo de esta entidad, pero en muy pocos se observa una terapia destinada a la reparación de dichas membranas o en sellar tal defecto. Las evidencias científicas demuestran que la regeneración y reparación de las membranas es lenta y compleja y los tratamientos propuestos para reparar o sellar su defecto no han gozado de la aceptación científica para su aprobación, sin embargo, el uso del parche hemático transvaginal endocervical autólogo luce como una alternativa terapéutica prometedora(AU)

The premature rupture of the ovular membranes is defined as the loss of the integrity of the amnion and chorion before the on set of labor, affects 3% of pregnancies, causes athird of preterm births which occupy 10,49% of births and is the origin of high rates of perinatal morbidity and mortality. At present, the management of this pathology is mainly oriented towards avoiding risk factors, making an adequate diagnosis, determining the gestational age in which it occurs, carrying out exhaustive monitoring of maternal-fetal well-being and deciding the ideal moment to end the treatment. Pregnancy to minimizeits complications. Due to the complex and labile histological structure of the ovular membranes, the direct treatment of the entity has been set a side, which would be to seal or repairthe defect it self. In recent years, numerous studies and clinicalprotocols from prestigious health care centers have served as aguide for the management of this entity, but very few have observed a therapy aimed at repairing said membranes or sealing such a defect. Scientific evidence shows that the regeneration and repair of the membranes is slow and complex and the treatment sproposed to repair or seal their defect have not enjoyed scientific acceptance for their approval, how ever, the use of the autologous endocervical transvaginal blood patch looks like a promising therapeutic alternative(AU)

Predictive value of serum inflammatory markers for histological chorioamnionitis among women with preterm premature rupture of membranes after undergoing cervical cerclage

ABSTRACT Purpose: To determine the predictive value of maternal White Blood Cells (WBC), neutrophils, and C-Reactive Protein (CRP) for diagnosing Histological Chorioamnionitis (HCA) among women with Preterm Premature Rupture of Membranes (PPROM) who underwent cervical cerclage. Methods: A retrospective cross-sectional study was conducted among women with singleton pregnancy and PPROM, who underwent cervical cerclage during 2018-2020. Results: A total of 55 eligible women were included in the final analysis, including 36 (61.02%) cases with HCA and 19 (38.98%) without HCA. Women with HCA had higher WBC count (12.31 ± 2.80) × 109/L and neutrophil count (9.67 ± 2.90)×109/L than those without HCA (10.35 ± 2.53) × 109/L and 7.82 ± 2.82 × 109/L, respectively) (both p < 0.05). The cut-off value of WBC count at 10.15×109/L was found to be the most effective in identifying HCA, with an Area Under Curve (AUC) of 0.707 (95% CI: 0.56-0.86; p = 0.012), sensitivity of 86.11%, specificity of 57.90%, Positive Predictive Value (PPV) of 79.49%, Negative Predictive Value (NPV) of 68.75%, and Youden index of 0.44. The combination of WBC + neutrophil had a slightly higher (AUC = 0.711, 95% CI: 0.57-0.86; p = 0.011), specificity (68.42%), and PPV (81.25%), but lower sensitivity (72.22%), than the WBC count alone. A cut-off value of neutrophil at 7.46 × 109/L was effective in identifying HCA, with an AUC of 0.689 (95% CI: 0.53-0.84; p = 0.022). Discussion: Combination use of WBC+neutrophil was found to be the most accurate predictor of HCA among women with PPROM after surgery of cervical cerclage.

Characteristics of vaginal microbiota in pregnant women with premature rupture of membranes and establishment of prediction model / 中华微生物学和免疫学杂志

Objective:To study the characteristics of vaginal microbiota in pregnant women with premature rupture of membranes (PROM) and to establish prediction models for PROM.Methods:This study involved 35 women with preterm premature rupture of membranes (PPROM), 180 with term premature rupture of membranes (TPROM) and 255 term birth cases without premature rupture of membranes (TBWPROM, control group). The V3-V4 hypervariable region sequences in the vaginal samples collected at 16-28 weeks of gestation were detected by 16S rRNA gene next-generation sequencing. The differences in Alpha and Beta diversity, and the attributes and metabolic function prediction of each recognized species among the three groups were analyzed. Subsequently, a random forest model was used to establish the prediction models for PROM using vaginal microbiota species and environmental risk factors.Results:Compared with the control group, the Alpha diversity of the PPROM group was higher (Observed features, P=0.022; Faith_pd index, P=0.024) and Beta diversity was also significantly different (Unweighted UniFrac, P=0.010; Jaccard index, P=0.008). In PPROM cases, Megasphaera genomosp. typeⅠ was significantly increased ( P=0.017) and Lactobacillus mulieris was significantly decreased ( P=0.003). In the patients with TPROM, Megasphaera was significantly increased ( P=0.009) and Lactobacillus mulieris was significantly decreased ( P=0.002). In terms of functional pathways, sulfur oxidation ( P=0.021), methanogenesis from acetate ( P=0.036), L-histidine biosynthesis ( P=0.009), adenosylcobalamin biosynthesis ( P=0.041) and fucose degradation ( P=0.001) were significantly increased in patients with PPROM; L-histidine biosynthesis ( P<0.001) and fucose degradation ( P=0.030) were significantly increased in patients with TPROM. The prediction models were established using the random forest model with vaginal microbiota species and environmental risk factors and the prediction model for PPROM performed well [AUC: 0.739 (95%CI: 0.609-0.869), sensitivity: 0.928, specificity: 0.659, positive predictive value: 0.750, negative predictive value: 0.906], which had a certain reference value. Conclusions:Vaginal microbiota might be related to the development and progression of PROM. Studying the differences in vaginal microbiota might provide a new idea for the prevention and treatment of PROM. Functional prediction provided a direction for further research on the mechanism of PROM. The established prediction model could prevent the occurrence of PPROM and promote maternal and infant health.

Complicaciones materno-fetales en embarazadas añosas. Centro de salud san jacinto de buena fe, 2020 / Maternal-fetal complications in elderly pregnant women. San Jacinto de Buena Fe Health Center, 2020

El embarazo añoso representa una problemática de salud pública debido a sus repercusiones en el binomio madre-hijo. Objetivo. Determinar las complicaciones materno-fetales en embarazadas añosas atendidas en el Centro de Salud Tipo C San Jacinto de Buena Fe durante el periodo enero y diciembre del 2020. Materiales y métodos. El diseño de investigación observacional, cuantitativo, retrospectivo, descriptivo de corte transversal con una muestra de 80 gestantes mayores de 35 años, como instrumento se empleó un formulario de recolección de datos que constó de 12 ítems validados por un juicio de expertos. Resultados. Las caracteristicas sociodemográficas de interés en las pacientes del estudio fueron: grupo etario de 35-37 años con el 67,2 %, unión libre con 52,5 %, grado de instrucción primario con el 46,3 % y procedencia rural en el 95 %; entre las complicaciones maternas: ruptura prematura de membranas con el 25 %, trastornos hipertensivos en el 16,2 % y aborto espontáneo con el 13,7 %; las complicaciones fetales: prematuridad con el 17,5 %, bajo peso al nacer con el 17,5 % y síndrome de dificultad respiratoria con el 11,2%. Conclusión. Fue posible establecer las características sociodemográficas de interés en la muestra de estudio, identificar algunos factores de riesgo de complicaciones y determinar las complicaciones que comprometen a la madre y al hijo/a en embarazos de edad avanzada.

Elderly pregnancy represents a public health problem due to its repercussions on the mother-child binomial. Objective. To determine the maternal-fetal complications in elderly pregnant women treated at the San Jacinto de Buena Fe Type C Health Center during the period January and December 2020. Materials and methods. The observational, quantitative, retrospective, descriptive cross-sectional research design with a sample of 80 pregnant women over 35 years of age, as an instrument a data collection form that consisted of 12 items validated by an expert judgment was used. Results. The sociodemographic characteristics of interest in the study patients were age group 35-37 years with 67.2%, free union with 52.5%, grade of primary education with 46.3% and rural origin in 95 %; among maternal complications: premature rupture of membranes with 25%, hypertensive disorders in 16.2% and spontaneous abortion with 13.7%; fetal complications: prematurity with 17.5%, low birth weight with 17.5% and respiratory distress syndrome with 11.2%. Conclusion. It was possible to establish the sociodemographic characteristics of interest in the study sample, identify some risk factors for complications, and determine the complications that affect the mother and the child in older pregnancies(AU)

El prematuro tardío, ¿qué sabemos desde el punto de vista perinatal? / The late premature, what do we know from the perinatal point of view?

Resumen El parto prematuro es la principal causa de morbimortalidad neonatal en Chile. Los prematuros tardíos, definidos como nacimientos entre 34 semanas con 0 días (34+0) y 36 semanas con 6 días (36+6) de gestación, representan el 70-80% de los prematuros y se asocian a baja morbilidad y excepcional mortalidad si se comparan con partos bajo 34 semanas, pero significativamente mayor al compararlos con partos de término. Los prematuros tardíos son el resultado de diversas condiciones obstétricas, tales como síndromes hipertensivos del embarazo, rotura prematura de membranas, colestasia intrahepática del embarazo y comorbilidad médica. El propósito de esta revisión es actualizar la información asociada a los prematuros tardíos y dar una visión de las tendencias en el uso de corticoides y el manejo expectante de la rotura prematura de membranas con el objetivo de disminuir las complicaciones en este grupo de prematuros.

Abstract Preterm delivery is the most important cause of neonatal morbidity and mortality in Chile. Late preterm, defined as deliveries between 34 +0 and 36+6-weeks accounts for 70-80% of preterm and is associated with non-severe morbidity and extremely low mortality when compared with deliveries below 34 weeks but significantly high when compared with full term babies. Late preterm deliveries are a result of several obstetric conditions, such a hypertensive disorder, premature rupture of membranes, intrahepatic cholestasis, and maternal medical comorbidities. The purpose of this review is to update the information associated with the risks of late preterm and to guide in the new trends in the application of steroid and expectant management for premature rupture of membranes in order to reduce the frequency of late preterm.

Beneficios de los antibióticos en la rotura prematura de membranas de pretérmino y factores que intervienen en la eficacia del tratamiento: revisión narrativa / Benefits of antibiotics in preterm premature rupture of membranes and factors involved in the efficacy of the treatment: narrative review

Resumen El parto prematuro es la principal causa de morbilidad y de mortalidad perinatal, y hasta un tercio de los casos presentan rotura prematura de membranas. La infección intrauterina que asciende desde la vagina es su principal causa en un hospital público de Chile. Esta revisión narrativa mediante búsqueda en PubMed, Cochrane, Embase, Scielo, Science Direct y Wiley Online Library incluye estudios publicados sobre los diferentes factores infecciosos que intervienen en el resultado adverso perinatal y la eficacia de los antibióticos en la rotura prematura de membranas de pretérmino. Además, contiene recomendaciones de sociedades científicas sobre el uso de antibióticos en estos casos. Los ensayos concluyen que los antimicrobianos prolongan el embarazo, disminuyen la corioamnionitis clínica y reducen variadas morbilidades neonatales, pero no reducen la mortalidad perinatal ni las secuelas tardías en la infancia. Los resultados adversos obstétricos, especialmente los neonatales, y las secuelas dependen de la existencia de invasión microbiana de la cavidad amniótica o de infección cérvico-vaginal, de la virulencia de los microorganismos aislados, del compromiso inflamatorio/infeccioso de la placenta (corioamnionitis histológica, funisitis) y de la respuesta inflamatoria fetal. Para mejorar los resultados adversos obstétricos neonatales en la rotura prematura de membranas de pretérmino, los esquemas de antibióticos deben ser eficaces, cubriendo el amplio espectro microbiológico existente y actuando sobre los factores infecciosos implicados en la gravedad de la infección. Además, deben administrarse de manera intensiva y prolongada hasta el parto.

Abstract Preterm birth is the leading cause of perinatal morbidity and mortality, and up to a third of them have premature rupture of membranes. Intrauterine infection that rises from the vagina is its main cause in a public hospital in Chile. This narrative review by searching PubMed, Cochrane, Embase, Scielo, Science Direct and Wiley Online Library includes published studies of the different infectious factors involved in perinatal adverse outcome and of the efficacy of antibiotics in preterm premature rupture of membranes. It also contains recommendations from scientific societies on the use of antibiotics in these cases. These trials conclude that antimicrobials prolong pregnancy, decrease clinical chorioamnionitis, and reduce various neonatal morbidities, but do not reduce perinatal mortality or infant sequelae. Obstetric and especially neonatal adverse outcomes in these patients depend on the existence of microbial invasion of the amniotic cavity and/or cervicovaginal infection, of the virulence of the isolated microorganisms, of inflammatory/infectious involvement of the placenta (histological chorioamnionitis, funisitis) and fetal inflammatory response. To improve adverse neonatal obstetric outcomes in preterm premature rupture of membranes, antibiotic regimens must be effective, covering the wide existing microbiological spectrum and acting on infectious factors responsible for the severity of the infection. In addition, they must be administered aggressively and for a long time until delivery.

Active versus expectant management for preterm premature rupture of membranes at 34-36 weeks of gestation and the associated adverse perinatal outcomes / Manejo ativo versus expectante para ruptura prematura de membranas entre 34 e 36 semanas de gestação e os resultados perinatais adversos associados

Abstract Objective: To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. Methods: In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Results: Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). Conclusion: There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

Resumo Objetivo: Comparar o tipo de manejo (ativo versus expectante) para ruptura prematura de membranas (PPROM, na sigla em inglês) entre 34 e 36 semanas e 6 dias de gestação e os resultados perinatais adversos relacionados, em 2 hospitais terciários do sudeste brasileiro. Métodos: No presente estudo de coorte retrospectivo, os dados foram obtidos através da revisão dos prontuários de gestantes internadas em dois centros terciários com protocolos diferentes para o seguimento da PPROM. As gestantes foram divididas em dois grupos com base no manejo da PPROM: grupo I (ativo) e grupo II (expectante). Para análise estatística, foram utilizados o teste t de Student, qui-quadrado e regressão logística binária. Resultados: Das 118 gestantes incluídas, 78 foram submetidas a tratamento ativo (grupo I) e 40 a seguimento expectante (grupo II). Comparado ao grupo II, o grupo I apresentou índice de líquido amniótico médio significativamente menor (5,5 versus 11,3 cm, p = 0,002), reação em cadeia da polimerase na admissão (1,5 versus 5,2 mg/dl, p = 0,002), tempo de antibióticos profiláticos (5,4 versus 18,4 horas, p < 0,001), tempo de latência (20,9 versus 33,6 horas, p = 0,001) e idade gestacional no parto (36,5 versus 37,2 semanas, p = 0,025). Não houve associações significativas entre os grupos e a presença de resultados perinatais adversos. A idade gestacional no diagnóstico foi o único preditor significativo de desfecho composto adverso (x2 [1] = 3,1, p = 0,0001, R2 Nagelkerke = 0,138). Conclusão: Não houve associação entre manejo ativo e expectante em gestantes com PPROM entre 34 e 36 semanas e 6 dias de gestação e resultados perinatais adversos.

Clinical Study of the Incidence of Preterm Premature Rupture of Membranes and Maternal and Fetal Outcome

Preterm premature rupture of membranes is one of the important causes of premature birth that can result in high perinatal morbidity and mortality along with maternal morbidity. The definition of premature rupture of membranes is rupture of membranes before labour and before 37 weeks of gestation is referred as Preterm PROM. If the membrane rupture is after 37 weeks of gestation, it is Term PROM. The incidence of PPROM ranges from 3 - 10 % of all deliveries and it contributes to 30 - 40 % of all preterm births. METHODSA prospective observational study of clinical analysis of the PPROM in 100 cases of 28 - 37 weeks of gestation which were delivered by caesarean section was conducted from 2018 October to 2019 September in the Department of Obstetrics and Gynaecology of Chalmeda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar. RESULTSPrevalence of PPROM in the study is 7.8 %. Intra amniotic infection was seen in 32 %. The mean latency period from rupture of membranes to delivery is 3.78 + 2.74 days. 25 % neonates were delivered by caesarean section. There was a total of 12 % perinatal deaths, still births - 4 %, 10 % - early neonatal deaths. CONCLUSIONSIn the current study, the prevalence of PPROM was 7.8 %. Careful antenatal monitoring, detection and prompt treatment of infection is necessary. Strict septic precautions, appropriate therapy, regular antenatal follow up are important factors in the prevention of PPROM. Close antenatal monitoring, identification of risk factors like cervicovaginal infection and their management play an important role in the prevention of PPROM.

Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes

Background: Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes.Methods: The study was conducted on150 pregnant patients, 50 in each group. Confirmed PROM and unconfirmed PROM. Per speculum examination was done to look for pooling, pH tested using the Pehanon paper and vaginal wash fluid was collected. Vaginal wash fluid urea and creatinine levels were tested by a kit based on spectrophotometry.Results: The mean urea levels were 26.35 mg/dl in the study Group 1 and 3.12 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid urea was found to be 8.55 mg/dl. The vaginal wash fluid urea levels of >8.55 mg/dl detected PROM with a sensitivity, specificity, negative and positive predictive value of 100%. The mean creatinine levels were 0.62 mg/dl in study Group 1 and 0.20 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid creatinine was found to be 0.405 mg/dl. Vaginal wash fluid creatinine levels detected PROM with a sensitivity of 76% and specificity of 100%. The negative predictive value and positive predictive values were 80.4% and 100%.Conclusions: Urea can be used as a definite marker of PROM and creatinine can be used as a supportive marker.

A study of maternal outcome in term premature rupture of membranes in a tertiary care hospital

Background: Premature rupture of membranes (PROM) remains a subject of great clinical relevance. The present study was conducted to study maternal morbidity and its relationship with PROM-delivery interval in patients with term PROM as compared to patients without PROM.Methods: A prospective case control study was conducted in the department of obstetrics and gynecology, Kasturba Hospital, New Delhi. 100 pregnant patients presenting to the labor room with features of PROM at term (POG>37 weeks) were taken as cases and 100 term pregnant women (age and parity matched) with intact membranes were taken as controls and compared in terms of maternal outcome.Results: This study reported maternal morbidity rate of 21% in term PROM cases which was significantly higher than in control group (5%). The major cause was febrile morbidity which occurred in 16% of cases indicating ascending infection. Other complications were abdominal and episiotomy wound infection (4%), chorioamnionitis (2%), postpartum hemorrhage (2%) and puerperal sepsis (1%). There was an increased rate of operative delivery in the case group (33%) as compared to 18% in patients without PROM. Duration of PROM-delivery interval had a significant direct proportional impact on the maternal morbidity. The duration of combined hospital stay of mother and neonate was also increased.Conclusions: Patients with term PROM have significant maternal morbidity which was mainly due to infection. The duration of the hospital stay was also significantly increased.

Retinopathy of prematurity in preterm babies in a local medical college and hospital

Background: Retinopathy of prematurity is a multifactorial vasoproliferative retinal disease that increases in incidence with decreasing gestational age and is one of the leading causes of preventable childhood blindness in India. Advances in neonatology have led to dramatic increase in survival of preterm neonates and in turn, to the risk of developing ROP. Since most of the risk factors associated with ROP mentioned above arise in the neonatal intensive care unit (NICU) itself and most of them are avoidable, cautious monitoring of the risk factors, early screening, follow up and surgical intervention have been shown to reduce the incidence and improve the outcome of ROP.Methods: This was a prospective observational study conducted for a period of 2 years. A total of 151 infants admitted in NICU /SNCU who satisfied the inclusion criteria were enrolled in this study. Initial and follow up screening was conducted in three phases the results were documented in proforma after ethical clearance.Results: Comparison of risk factors between eyes with and without ROP was done using Chi-square test. A p-value of<0.05 was considered to be statistically significant. Incidence of ROP in centre is found to be 33.8%. Among maternal risk factors, multiple gestation and PROM/PPROM is found to be significant in the development of ROP from this study. However, mode of delivery and gestational hypertension, were found to be not significant in ROP. Among neonatal risk factors, low birth weight, lower gestational age, prolonged oxygen exposure, blood transfusion, mechanical ventilation, sepsis, phototherapy was found to be significant in this study.Conclusions: ROP, being an emerging cause for potentially blinding visual disability, needs to be diagnosed early. Due to the advancements in neonatology and better survival of preterm babies, timely screening, regular follow up, early detection and intervention is mandatory. A multidisciplinary approach is required in diagnosis and treatment of the disease. Proper counselling and motivation for parents of preterm and low birth weight babies for regular follow up is also essential.

Effect of premature rupture of membranes on the maternal and fetal prognosis during childbirth at the gynecology-obstetrics department of the Matam Communal Medical Center, Conakry, Guinea

Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections.

Study on fetomaternal outcome in short interpregnancy interval: case control study

Background: This study was carried out at a tertiary health centre with the aim of studying the effect of short interpregnancy interval on fetomaternal outcome. The maternal complications and fetal complications of short interpregnancy interval were analysed in comparison to normal interpregnancy interval.Methods: This is a case control study. 125 women with short interpregnancy interval seeking healthcare at tertiary health care centre were matched with 125 women with normal interpregnancy interval on the basis of demographic characteristics like age, height, weight and socio-economic status. These were included in the case control study.Results: Short interpregnancy interval is associated with increased risk of anemia, premature rupture of membranes (PROM), scar dehiscence and low birth weight whereas normal interpregnancy interval is associated with increased risk of PIH as compared to short interpregnancy interval.Conclusions: Short interpregnancy interval is associated with increased risk of anemia, PROM, scar dehiscence and low birth weight whereas normal interpregnancy interval is associated with increased risk of PIH.

Identification of causative pathogen and its antibiotic sensitivity in cases of preterm premature rupture of membranes

Background: Pre-labor rupture of membranes is defined as amniotic membrane rupture before the onset of labor contractions, and if it happens before 37 weeks, it is called preterm premature rupture of membranes (PPROM). Several organisms commonly present in the vaginal tract are E.coli, Group-B streptococci, staphylococcus aureus, chlamydia trachomatis, Gardnerella vaginalis and Enterococcus faecalis which secrete proteases that degrade collagen thereby weakening  the fetal membranes leading to PPROM. Appropriate antibiotic therapy has a significant role in the prevention and treatment of maternal and neonatal complications.Methods: This was a prospective observational study done in the department of obstetrics and gynaecology, Narayana medical college, Nellore. Selectively 100 patients with complaint of PPROM admitted to labor room were included in the study. Diagnosis of membrane rupture was established by speculum examination, and high vaginal swabs are taken and sent to laboratory for identifying bacteria using gram staining and cultured in aerobic and anaerobic methods. Antimicrobial susceptibility testing of the organisms was performed by disk diffusion method by Kirby and Bauer.Results: Out of 100, high vaginal swabs had growth in 82 patients, and 18 were sterile. The repeatedly isolated organism in patients with PPROM is E.coli amounting 32%, followed by candidal species 20%. Staphylococci are scoring 11% and enterococci 8%. However, organisms like gardenella vaginalis and Group B streptococcus are least common with a score of 6% and 5% respectively. In this study, E.coli is highly sensitive to tigecycline, colistin 100% each and highly resistant to gentamycin and amikacin.Conclusions: In this study, E.coli is related to the maximum number of cases with preterm premature rupture of membranes. Appropriate use of antibiotics significantly lowers maternal morbidity and neonatal mortality.

Duration of Preterm Premature Rupture of Membranes as Predictor of Histologic Chorioamnionitis and Early Onset Neonatal Sepsis: A cohort study

Background@#Preterm premature rupture of membranes (PPROM) has been associated with chorioamnionitis but studies are inconsistent on the relationship between PPROM latency and the risk of chorioamnionitis and early onset sepsis.@*Objective@#To define the association of PPROM latency and the risk of histologic chorioamnionitis (HCA) and early onset neonatal sepsis (EONS). @*Methodology@#A prospective cohort study was done at a public tertiary hospital on 569 mothers with spontaneous rupture of membranes and with fetuses EONS was defined using test of association and Receiver Operating Characteristics (ROC) curve analysis. The association of HCA with maternal and neonatal characteristics as well as adverse neonatal outcomes were also determined. @*Results@#A total of 569 mothers with PPROM were included. Incidence of HCA and EONS were 13% and 24% respectively. PPROM latency was significantly associated with HCA and is a fair predictor of HCA (AUC = 0.7013; 76% accuracy at 31.5-hour cut-off) but failed as a predictor of EONS (AUC = 0.4799). PPROM, platelet count, CRP, and neutrophil count were ndependent predictors of HCA. HCA was associated with EONS and mortality. Mortality was higher in the presence of both HCA and EONS. @*Conclusion@#Longer PPROM is associated with HCA and is a fair predictor of HCA at a cut-off of 31.5 hours. PPROM fails as a predictor of EONS.

Epidemiological analysis of complications in preterm infants / 中国基层医药

Objective To explore the epidemiological analysis of complications in premature infants.Methods From January 2017 to March 2018,1800 premature babies in Ningbo Women and Children Hospital were selected in the study.The clinical data of pregnant women,premature infants and premature complications,and so on were investigated,and summarized epidemiology of premature infant complications.Results The probability of premature birth was 9.09％.The differences between different gestational age(x2 =2 481.34) and different body weight (x2 =3 088.21) were statistically significant (all P ＜ 0.05).Premature rupture of membranes occurred as the main one of the common factors lead to premature birth,the fetal distress was also more common factors,so in different gestational age,the difference was not statistically significant (P ＞ 0.05).However,compared with other factors,the difference of premature infants at different gestational weeks was statistically significant (P ＜ 0.05).Conclusion Epidemiological study of preterm infants,can promote their perinatal management level and quality,and then pointed to strengthen perinatal health education and health care,for the effective prevention and treatment of common diseases of perinatal,key management and monitoring work earnestly strengthen the high-risk pregnancy,attaches great importance to the establishment of collaborative relationship between made in pediatric claims intrauterine transhipment,making pregnant women can be produced in the hospital for treatment for premature babies,and reduce the mortality and morbidity rates of premature and low birth weight,can reduce the risk of intellectual disability,eventually making the birth population overall quality improved.

Risk factors and biomarkers of infection after Caesarean section / Монголын Анагаах Ухаан

Background@#The WHO recommends the ideal rate for cesarean section to be 15% of the total birth, but researchers are still attracting attention to the fact that in recent years this rate has been steadily increasing, and risk is not decreasing worldwide. Incidence of postcesarean section inflammation and infection are 8-10 times higher than vaginal birth. The determination of lactate levels in early diagnosis of sepsis is clinically significant and the higher the lactate level increases the risk of mortality. @*Objective@#The aim of the study is to improve early detection of inflammation and infection and prevention of serious complications by using risk factors of postcesarean section inflammation and infection, and detecting procalcitonin and lactate in maternal blood.@*Materials and Methods@#This research is conducted between 2015-2017 based at the “Urguu” Maternity Hospital, Obstetric Clinic of National Center for Maternal and Child Health of Mongolia. Factors affecting postcesarean section inflammation and infection are calculated based on multifactorial regression analysis. Procalcitonin was determined by enzyme binding assay while lactate, C-reactive protein, and lactate dehydrogenase were determined by “E-311” the fully automated analyzer.@*Results@#According to the results of the study, the probability of inflammatory and infectious complication is 2.4% when the duration of labor increases by one unit, 34.8% when the risk of amniotic fluid increases, 14.6% when the pregnancy process become more complicated. Whereas, excessive fetal weight statistically increases the risk of infection, but its impact is low. The result of the study shows that the procalcitonin sensitivity was 65%, and the specificity was 96%. Lactate resulted in sensitivity of 56%, but with only 67% specificity. C-reactive protein had a sensitivity of 65% and a specificity of 96%. Lactate dehydrogenase resulted in sensitivity of 95%, and specificity of 82% in the diagnosis of sepsis. @*Conclusion@#Postterm pregnancy, premature rupture of membranes, multifetal pregnancy, prolonged labor, placenta previa, pyelonephritis, chronic hepatitis, chronic hypertensive disorder, anemia, emergency cesarean section, preeclampsia are risk factors and it is statistically significant at (P<0.0001). The biomarkers have a direct correlation to all stages of inflammation and infections, which are important for the diagnosis.

Manejo actual de la rotura prematura de membranas en embarazos pretérmino

The obstetrician and gynecologist must frequently face complicated situations in the practice of obstetrics, one of them is the rupture of the membranes in a preterm pregnancy. While the medical conduct is to preserve both maternal and fetal health, many times the decision may affect fetal health in order to preserve the maternal health. This occurs when the presence of an infection makes it impossible to maintain the normal course of pregnancy and complete gestational age. In many cases the complications that cause prematurity of the newborn will put mother's life at risk and we must therefore be prepared to minimize the consequences of our decision. In this article we review evidence-based management that the obstetriciangynecologist should consider when this situation occurs.

Frecuentemente, el ginecólogo obstetra debe enfrentar situaciones complicadas en la práctica de la obstetricia; una de ellas es la rotura de membranas en un embarazo pretérmino. Si bien la conducta médica que debe tomar está encaminada a preservar la salud tanto materna como fetal, muchas veces, la decisión puede afectar la salud fetal en aras de preservar la salud materna. Esto ocurre cuando la presencia de una infección hace imposible mantener el curso normal de la gestación y la edad gestacional no es de término. En muchos casos, las complicaciones que ocasionará la prematuridad del recién nacido pondrán en riesgo su vida y por lo tanto debemos estar preparados para minimizar las consecuencias de nuestra decisión. En el presente artículo revisamos el manejo basado en evidencias, que el ginecólogo obstetra debería considerar cuando ocurre esta situación.

Factores de riesgos de ruptura prematura de membranas. Hospital Provincial General Docente Riobamba. Noviembre 2017-febrero 2018 / Factors of risk of premature rupture of membranes. General Hospital of Riobamba. November 2017-February 2018

Se realizó un estudio observacional, de tipo descriptivo y corte transversal con enfoque mixto; cuyo objetivo de determinar los factores de riesgo de ruptura prematura de membra-nas en las pacientes ingresadas con ese diagnóstico en el Hospital Provincial General Docen-te Riobamba durante el período noviembre 2017-febrero 2018. Se trabajó con la totalidad de la población, la que estuvo integrada por 17 embarazadas en el contexto de investigación. Se aplicó una guía de entrevista estructurada la misma que fue sometida a valoración por espe-cialistas integrado por siete docentes vinculadas a las tutorías de prácticas preprofesionales en el área del Proceso de Atención de Enfermería en Salud Sexual y Reproductiva de la Universidad Nacional de Chimborazo; el 85,71 % de las consultadas consideraron el instru-mento como muy adecuado. El 52,94 % de las mujeres estudiadas fue mayor de 26 años, tenía estado civil casadas y nivel de instrucción de secundaria. El factor clínico más relevante fue infecciones de vías urinarias y cérvico-vaginales durante el embarazo; sin embargo, entre los obstétricos fueron los controles obstétricos escasos y el oligoamnios. Los datos arrojaron la ausencia de aquellos relativos a ser víctima de violencia familiar, consumo de sustancias tóxicas, auto medicación, relaciones sexuales durante los últimos 15 días del embarazo, tacto vaginal y/o amniocentesis en las horas previas a la presentación de la entidad en cuestión, embarazo múltiple, antecedentes personales de RPM, incompetencia del cérvix y polihi-dramnios.

An observational, descriptive and cross-sectional study with a mixed approach was carried out. This research aimed to determine the risk factors for premature rupture of membranes in patients admitted with this diagnosis in the General Hospital of Riobamba during the period November 2017-February 2018. The entire population was integrated by 17 pregnant women in the research context. A structured interview guide was applied, which was assessed by seven specialists who worked at pre-professional practice tutoring in the area of the Nursing Care Process in Sexual and Reproductive Health of Universidad Nacional de Chimborazo; the instrument was considered as very adequate by 85.71% of interviewed ones. 52.94% of the women studied were over 26 years of age, married, and high school education level. The most relevant clinical factor was urinary tract and cervico-vaginal infections during pregnan-cy. However, the obstetric factors were the controls in this field and oligohydramnios. The data showed the absence of those ones related to being a victim of family violence, consump-tion of toxic substances, self-medication, sexual intercourse during the last 15 days of preg-nancy, vaginal touch and / or amniocentesis in the hours prior to the presentation of the entity in question , multiple pregnancy, personal history of RPM, incompetence of the cervix and polyhydramnios.

Utilidad de la proteína de unión al factor de crecimiento similar a la insulina tipo 1 en la ruptura prematura de membrana / Utility of insulin-like growth factor-binding protein type 1 in premature membrane rupture

Introducción: Fercuentemente no disponemos de una clara evidencia de la pérdida de líquido amniótico observado por examen con espéculo, por lo que el diagnóstico de rotura prematura de membranas puede ser con frecuencia incierto, por lo que se necesitan pruebas de diagnóstico apropiadas y complementarias para la toma de decisiones. Objetivo: conocer la precisión diagnóstica de la proteína-1 de unión al factor de crecimiento similar a la insulina (IGFBP-1) en la rotura prematura de membranas al compararla con la medición del bolsilla mayor por ecografía y el Test de de Ferning. Material y métodos: 102 gestantes de 24 a 37 semanas con signos y/o síntomas de rotura de membranas fueron elegibles, fueron evaluadas con las pruebas IGFBP-1, ecografía y Test de Ferning. Resultados: Para el IGFBP-1 se obtuvo 95% de sensibilidad (S), 95% de especificidad (E), 95% de valor predictivo positivo (VPP) y 96% de valor predictivo negativo (VPN). Par el Test de Fernig se obtuvieron valores de 85%, 25%, 25% y 83% respectivamente. En tanto que para la ecografía los hallazgos fueron de 81%, 29%, 56% y 58% respectivamente. Conclusión: el ensayo IGFBP-1 fue el método más preciso para diagnosticar la ruptura prematura de membranas con la mayor sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo.

Introduction: We do not have clear evidence of the loss of amniotic fluid observed by speculum examination, so the diagnosis of premature rupture of membranes can often be uncertain and appropriate and complementary diagnostic tests are needed for decision making. Objective: to know the diagnostic accuracy of insulin-like growth factor-binding protein-1 (IGFBP-1) in the premature rupture of membranes when compared with the measurement of the greater pocket by ultrasound and the Ferning test. Material and methods: 102 pregnant women from 24 to 37 weeks with signs and / or symptoms of rupture of membranes were eligible, which were evaluated with the IGFBP-1, ultrasound and Ferning Test. Results: For IGFBP-1 95% sensitivity (S), 95% specificity (E), 95% positive predictive value (PPV) and 96% negative predictive value (NPV) were obtained. For the Ferning Test values of 85%, 25%, 25% and 83% respectively were obtained. While for ultrasound the findings were 81%, 29%, 56% and 58% respectively. Conclusion: the IGFBP-1 assay was the most accurate method to diagnose the premature rupture of membranes with the highest sensitivity, specificity, positive predictive value and negative predictive value.