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)

Correlação Inexistente entre o Ciclo Lunar no Trabalho de Parto e Ruptura Prematura de Membranas em uma Amostra de Parturientes do Sul de Santa Catarina / No Correlation between the Lunar Cycle in Labor and Premature Rupture of Membranes in a Sample of Parturients from Southern Santa Catarina

Introdução: De acordo com as culturas mais antigas, a luz da lua é responsável pela fertilidade da terra e concepção dos animais, estendendo esse entendimento ao organismo materno. Este trabalho teve como objetivo analisar a ocorrência de trabalho de parto e ruptura prematura de membranas ovulares nas diferentes fases da lua e em suas mudanças. Métodos: Amostra composta por gestantes admitidas em um hospital do sul de Santa Catarina por trabalho de parto ou ruptura prematura de membranas ovulares, no ano de 2018, baseado em informações obtidas pela análise de prontuários. Resultados: Houve discreto aumento do número de partos na lua nova (19,2%) e mudança para lua nova (11,7%), porém sem significância estatística. Motivo de internação, via de parto e paridade não estiveram associados à lua e suas mudanças de fase. Não se observou relação entre meses do ano e motivo de internação. Conclusão: Verificou-se que a lua e suas mudanças de fase não denotaram um maior número de admissões hospitalares por trabalho de parto ou ruptura prematura de membranas ovulares, contrariando a crença popular.

Introduction: According to ancient cultures, the moonlight is responsible for the fertility of the earth and the conception of animals, extending this understanding to the maternal organism. This study aimed to analyze the occurrence of labor and premature rupture of ovular membranes in different phases of the moon and its changes. Methods: The sample was composed of pregnant women admitted to a hospital in southern Santa Catarina for labor or premature rupture of ovular membranes in 2018, based on information obtained by analyzing medical records. Results: There was a slight increase in the number of deliveries during the new moon (19.2%) and a change to the new moon (11.7%) but without statistical significance. Reason for hospitalization, mode of delivery, and parity were not associated with the moon and its phase changes. No relationship was observed between the months of the year and the reason for hospitalization. Conclusion: It was verified that the moon and its phase changes did not denote a higher number of hospital admissions for labor or premature rupture of ovular membranes, contrary to popular belief.

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)

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.

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.

Factores maternos de riesgo asociados a ruptura prematura de membranas / Maternal risk factors associated with premature rupture of membranes

Introducción: La ruptura prematura de las membranas se define como la ruptura de las membranas fetales de 12 a 18 horas o más antes del inicio del parto. Objetivo: El objetivo principal de esta revisión bibliográfica es generar conocimiento sobre los factores maternos de riesgo asociados a la ruptura prematura de membranas. Materiales y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: Los factores de riesgo hallados tenemos a la edad menor de 20 y mayor de 35 años (OR: 2.2), procedencia rural (OR: 5.8), unión estable (OR: 2.600), gestante mal nutrida (OR: 4.200), obesidad con (OR: 3), antecedente de aborto (OR: 2,76), la gestación múltiple (OR: 4,5), primigesta (OR: 3.370), gran multípara (OR: 2,10), periodo intergenésico corto (OR: 4.128), RPM previo (OR: 4.265), uso DIU (OR: 3.151), acto sexual antes del RPM (OR: 3,182), Hb 9,9-7,1 grs/dl (OR: 2), metrorragia del 1er y2do trimestre (OR: 3.88), infección cérvico-vaginal (OR: 13), infección urinaria (OR: 2,56). Conclusión: Los principales factores maternos de riesgo que condicionan a la ruptura prematura de membranas, tenemos: Edad menor de 20 y mayor de 35 años, procedencia rural, unión estable, gestante mal nutrida, gestante con obesidad, antecedente de aborto, gestación múltiple, primigesta, gran multípara, periodo intergenésico corto, RPM previo, uso DIU, acto sexual antes del RPM, Hb 9,9-7,1 grs/dl, metrorragia del 1er y 2do trimestre, infección cérvico-vaginal, infección urinaria. (AU)

Introduction: Premature rupture of the membranes is defined as the rupture of the fetal membranes 12 to 18 hours or more before the onset of labor. Objective: The main objective of this literature review is to generate knowledge about the maternal risk factors associated with premature rupture of membranes. Materials and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: The risk factors found are at the age of less than 20 and older than 35 years (OR: 2.2), rural origin (OR: 5.8), stable union (OR: 2,600), pregnant woman poorly nourished (OR: 4,200), obesity with (OR: 3), history of abortion (OR: 2.76), multiple gestation (OR: 4.5), primitive (OR: 3.370), large multiparous (OR: 2.10), short intergenic period (OR : 4,128), previous RPM (OR: 4,265), IUD use (OR: 3,151), sexual act before RPM (OR: 3,182), Hb 9,9-7,1 grs / dl (OR: 2), metrorrhagia 1st and 2nd trimester (OR: 3.88), cervical-vaginal infection (OR: 13), urinary infection (OR: 2.56). Conclusions: The main maternal risk factors that condition premature rupture of membranes, we have: Age under 20 and over 35 years of age, rural origin, stable union, malnourished pregnant woman, pregnant woman with obesity, history of abortion, multiple pregnancy, primitive, large multiparous, short intergenic period, prior RPM, IUD use, sexual intercourse before RPM, Hb 9.9-7.1 grs / dl, 1st and 2nd trimester metrorrhagia, cervical-vaginal infection, urinary tract infection. (AU)

Beneficios maternos en el manejo conservador de ruptura prematura de membranas ovulares (R. P. M) en embarazadas entre las 34 y 37 semanas de gestación atendidas en el Hospital Bertha Calderón Roque, Managua, Nicaragua, Julio - noviembre 2019 / Maternal benefits in the conservative management of premature rupture of ovular membranes (R. P. M) in pregnant women between 34 and 37 weeks of gestation attended at Bertha Calderón Roque Hospital, Managua, Nicaragua, July - November 2019

Objetivo: Determinar los beneficios maternos fetales en el manejo conservador de ruptura prematura de membranas ovulares (R.P.M) en embarazadas entre las 34 y 37 semanas de gestación atendidas en el Hospital Bertha Calderón Roque, Managua, Nicaragua, julio - noviembre 2019. Diseño metodológico: Se realizó estudio descriptivo, retrospectivo, de corte transversal, con universo y muestra de 89 pacientes y sus 89 neonatos, con (R.P.M). La información fue tomada de los expedientes clínicos, basado en la construcción de 2 instrumentos que contenían preguntas relacionadas a datos sociodemográficos de las pacientes y antecedentes gineco obstétricos, los criterios para el manejo conservador de la RPM y los posibles elementos de los beneficios maternos y los beneficios fetales. La información fue procesada en sistema estadístico SPSS 21.0 para Windows, representada en tablas y gráficos. El análisis fue de frecuencia simple y porcentajes. Resultados: La edad gestacional de diagnóstico de la RPM fue de 24 a 29sg 66.3%, con 100% de bienestar fetal y sin malformaciones, sin criterios de Gibbs en un 98.9%, se encontró infecciones urinarias y vaginales, obesidad y diabetes en un 43.8%. En el 95.5% sin infección puerperal y la finalización del embarazo fue a las 37 semanas en 89.9% por vía vaginal 86.5%. El peso al nacer fue en 79.7% mayor a 2500 gramos, con recién nacidos sanos 96.6%, con apgar de 8 al minuto en 94.4% y 9 a los 5 minutos 97.8%, sin muerte perinatal en un 100%. Conclusión: Los beneficios maternos más evidentes con el manejo conservador fueron la reducción de incidencia de Cesáreas, prolongación del embarazo disminuyendo riesgo de hemorragia posparto, y disminución de infecciones puerperales lo que permitió mantener la prolongación del embarazo y de esta manera lograr los beneficios fetales, adecuado peso al nacer, con buen APGAR, sin complicaciones, infecciosas, metabólicas y respiratorias

A Comprehensive Integrative Review of the Factors Associated with Spontaneous Preterm Birth, Its Prevention and Prediction, Including Metabolomic Markers / Uma revisão integrativa abrangente dos fatores associados ao parto prematuro espontâneo, sua prevenção e predição, incluindo marcadores metabolômicos

Abstract Pretermbirth is amajormaternal complication that has a great impact on perinatal and neonatal health, with consequences suffered during childhood and adulthood. Little is known about its etiology and development, resulting in poor screening, prediction and preventive methods. The present integrative review discusses the current knowledge regarding some risk factors for preterm birth, the differences between screening and prediction methods, the limitations of some current preventive interventions, the importance of applying standardized concepts for exposures and outcomes, and why it is important to develop more accurate and reproducible methods to predict preterm birth. In addition, the authors introduce the concept of metabolomics and the technology involved in this technique, and discuss about how it has become a promising approach to identify biomarkers for spontaneous preterm birth.

Resumo Parto prematuro é uma complicação obstétrica de grande impacto para saúde perinatal e neonatal, tendo consequências tambémpara a infância e a vida adulta. Pouco se sabe sobre sua etiologia e fatores determinantes, o que limita osmétodos de rastreamento, predição e prevenção. Esta revisão integrativa traz a discussão sobre o conhecimento atual sobre fatores de risco para parto prematuro espontâneo, as diferenças entre métodos de rastreamento e predição, as limitações das atuais intervenções preventivas, a importância de se aplicar conceitos padronizados para exposição e desfecho na investigação de parto prematuro espontâneo, e porque é importante desenvolver métodos precisos e reprodutíveis para predizer o parto prematuro. Por fim, introduzimos o conceito demetabolômica e da tecnologia envolvida nessa técnica, e discutimos como ela tem se mostrado uma abordagem prosmissora para identificar biomarcadores associados ao parto prematuro espontâneo.

Factores de riesgo asociados con la ruptura prematura de membranas pretérmino en pacientes de un hospital del Callao, Perú / Risk factors associated with the preterm premature rupture of membranes in pregnant women of a hospital in Callao, Peru

Resumen OBJETIVO: Determinar los factores de riesgo asociados con ruptura prematura de membranas pretérmino. MATERIALES Y MÉTODOS: Estudio observacional, analítico, de casos y controles, retrospectivo y transversal, efectuado en pacientes embarazadas atendidas en 2017 en el Hospital San José del Callao, Perú. Se estudiaron factores sociodemográficos y obstétricos. Para el análisis estadístico bivariado se aplicó χ2, razón de momios con intervalo de confianza; y para el análisis multivariado la prueba de regresión logística binaria. RESULTADOS: Se estudiaron 32 pacientes embarazadas, con ruptura prematura de membranas pretérmino (casos) y 64 embarazadas sin enfermedad (controles). Entre los factores estudiados, los sociodemográficos no demostraron asociación significativa; mientras que los factores obstétricos: infecciones cervicovaginales (ORa: 6.9; IC95%: 1.6-29.2), infección de vías urinarias (ORa: 5.1; IC95%: 1.5-17.2) y anemia (odds ratio ajustado (ORa). 6.9) 4.8; IC95%: 1.6-14.2) demostraron incrementar, significativamente, el riesgo de ruptura prematura de membranas pretérmino cuando una embarazada está expuesta a esos riesgos. CONCLUSIONES: Las infecciones cervicovaginales, urinarias y la anemia fueron factores de riesgo que se asociaron con la ruptura prematura de membranas pretérmino.

Abstract OBJECTIVE: Determine the risk factors associated with preterm premature rupture of membranes. MATERIALS AND METHODS: An observational, analytical study design of cases and controls, retrospective and transversal, carried out in pregnant women treated in 2017 at the San José Hospital, Callao, Peru. Sociodemographic and obstetric factors were studied. For the bivariate statistical analysis, the chi-square test was applied χ2, the Odds ratio with its confidence intervals; and for multivariate analysis, the binary logistic regression test. RESULTS: The sample was 32 pregnant women with Preterm Premature Rupture of Membranes (cases) and 64 pregnant women without pathologies (controls). Among the factors studied, the sociodemographic ones showed no significant association; while obstetric factors such as vaginal cervical infections (ORa: 6.9; CI 95%: 1.6-29.2), urinary tract infection (ORa: 5.1; CI 95%: 1.5-17.2) and anemia (ORa: 4.8; CI 95%: 1.6-14.2) showed a significant increase in the risk of preterm premature rupture of membranes when a pregnant woman is exposed to them. CONCLUSIONS: Vaginal cervical infections, urinary tract infection and anemia were risk factors associated with Preterm Premature Rupture of Membranes in the study group.

Características maternas de riesgo para ruptura prematura de membranas fetales / Maternal risk characteristics for premature rupture of fetal membranes

Objetivo: Determinar los factores de riesgo para ruptura prematura de membranas fetales (RPM) en el Hospital Augusto Hernández Mendoza de Ica. Material y Métodos: Se realizó un estudio caso-control en 32 pacientes con diagnóstico de RPM (casos) y 64 pacientes con gestación normal (controles) a través de una encuesta. Se usó el programa SPSS v19.0 para el análisis de riesgo. Resultados: Los factores de riesgo para RPM con significancia estadística (p<0,05), con OR>1 e IC95%?1, fueron: unión conyugal estable (OR: 2,600; IC95%: 1,085-6,233), gestante mal nutrida (OR: 4,200; IC95%: 1,706-10,339), primigesta (OR: 3,370; IC95%: 1,318-8,620), periodo intergenésico corto (OR: 4,128; IC95%: 1,022-5.804), RPM previo (OR: 4,265; IC95%: 1,461-12,455), antecedente de uso de DIU (OR: 4,200; IC95%: 1,129-15,630), control prenatal inadecuado (OR: 3,151: IC95%:1,265-7,851), acto sexual antes del RPM (OR: 3,182; IC95%: 1,111-9,114). Conclusiones: Los factores de riesgo para RPM con significancia estadística en orden de importancia para nuestra serie fueron: RPM previo, gestante mal nutrida, antecedente de uso de DIU, primigesta, acto sexual antes del RPM, control prenatal inadecuado, unión estable con la pareja y periodo intergenésico corto.

Objetive: To determine the risk factors for premature rupture of fetal membranes (PROM) in Augusto Mendoza Hernández Hospital from Ica. Material and Methods: Acase-control study in 32 patients diagnosed with PROM (cases)and 64 patients with normal pregnancy (controls) through a structured interview was conducted. Risk analysis was done through SPSS v19.0 program. Results: Risk factors for PROM, with statistical significance (p<0.05), OR>1 and CI 95%≠1, were: stable union (OR: 2.600; 95% CI: 1085-6233), pregnant with bad nutrition (OR: 4.200; 95% CI: 1.706-10.339),first pregnancy (OR: 3.370; 95% CI: 1.318-8.620),short inter pregnancy period (OR: 4.128; 95% CI : 1.022-5.804), PROM in previous pregnancy (OR: 4.265; 95% CI: 1.461-12,455), previous IUD use (OR: 4.200; 95% CI: 1.129-15.630), inadequate prenatal care (OR: 3.151; 95% CI: 1.265-7.851), sexual intercourse before the PROM (OR: 3.182; 95% CI: 1.111-9.114). Conclusions: Risk factors for PROM with statistical significance in order of importance to our study were: previous PROM, malnourished pregnant, previous IUD use, first pregnancy, sex before PROM, inadequate prenatal care, stable union with the couple and period short interpregnancy

Does the use of probiotics in pregnant women with premature rupture of membranes improve the maternal and perinatal outcome? A systematic review / O uso de probióticos em gestantes com rotura prematura de membranas ovulares melhora o desfecho materno e perinatal? Uma revisão sistemática

Introduction: Premature rupture of membranes (PROM) is a condition that affects 8­10% of all pregnancies, and contributes with 20­40% of preterm deliveries. Evidence shows that changes in the vaginal microbiota may also have a favorable impact on the decrease in the prevalence of PROM, and that expectant treatment may be an appropriate approach to reduce morbidity in these cases. Objective: To investigate whether the use of probiotics in pregnant women with premature rupture of ovary membranes improves the maternal and perinatal outcome. Methods: This is a systematic review, developed from articles published between January 2001 and August 2018, which justify the use of probiotics in pregnant women with PROMto improve maternal and perinatal outcome. Results: Some studies have shown a potential role of probiotics in modulating vaginal bacterial communities, reducing rates of cesarean section and PROM, and increasing the latency and weight of newborns in pregnant women with PROM. However, in other studies, there was no confirmation of changes in the vaginal microbiota from the use of oral probiotics. Conclusion: There are benefits in the administration of probiotics to the mother-fetus binomial. However, there are still doubts about routes of administration, choice of strains and period of use. More studies are necessary to settle them.

Introdução: A rotura prematura de membranas ovulares é uma condição que afeta 8­10% de todas as gestações e contribui com 20­40% dos partos prematuros. Evidências mostram que mudanças na microbiota vaginal podem ter impacto favorável na diminuição de sua prevalência, e o tratamento expectante pode ser uma abordagem adequada para reduzir a morbidade nesses casos. Objetivo: Investigar se o uso de probióticos em gestantes com rotura prematura de membranas ovulares melhora o desfecho materno e perinatal. Métodos: Trata-se de uma revisão sistemática desenvolvida com base em artigos publicados no período de janeiro de 2001 a agosto de 2018, que justificam o uso de probióticos em gestantes com rotura prematura de membranas ovulares para melhorar o desfecho materno e perinatal. Resultados: Alguns estudos mostraram potencial atuação dos probióticos em modular comunidades bacterianas vaginais, em reduzir taxas de cesarianas e rotura prematura de membranas ovulares, além de aumentar o período de latência e peso do recém-nascido de gestantes com esse quadro. Porém, em outros trabalhos, não houve confirmação de mudanças na microbiota vaginal pelo uso de probióticos orais. Conclusão: Há benefícios na administração dos probióticos sobre o binômio mãe-feto, contudo ainda há dúvidas sobre vias de administração, sobre escolha das cepas e sobre tempo de uso. Mais estudos precisam ser realizados para dirimi-las.

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.

Rotura prematura de membrana: abordagem clínica / Premature membranes rupture: a clinical approach

A rotura prematura de membranas (RPM) é conceituada como corioamniorrexe espontânea que ocorre antes do início do trabalho de parto, independentemente da idade gestacional. Ocorre, aproximadamente, em 10% das gestações. A maioria dos casos incide em pacientes de termo e 2-3% dos casos em gestações pré-termo. Seu diagnóstico, em 90% das vezes, é clínico. Em relação às condutas, a intenção é reduzir ao máximo os prejuízos para o binômio materno-fetal, mas essa é uma tarefa complicada e que ainda suscita muitas discussões. Prioriza-se a interrupção da gestação na presença de corioamnionite ou sofrimento fetal. Na ausência destes, as condutas devem ser individualizadas de acordo com a idade gestacional, levando em conta o uso de corticoterapia e neuroprofilaxia com sulfato de magnésio.(AU)

Premature membranes rupture (PMR) is conceptualized as spontaneous chorioamniorrex that occurs before labor begins, regardless of gestational age. It occurs in approximately 10% of pregnancies. The majority of cases are in term pregnancies patients and 2-3% of cases in preterm pregnancies. The diagnosis is predominantly clinical (about 90%). In relation to the management, the intention is to reduce to the maximum the losses to the maternal-fetal binomial, but this is a complicated task and that still raises many discussions. Discontinuation of gestation is prioritized in the presence of chorioamnionitis or fetal distress. In the absence of these, the management should be individualized according to gestational age, taking into account the use of corticosteroids and neuroprophylaxis with magnesium sulfat.(AU)

Placenta previa total acreta complicada con ruptura prematura de membranas pretérmino: reporte de un caso / Total placenta praevia accreta complicated with preterm premature rupture of membranes: A case report

Resumen ANTECEDENTES La incidencia de acretismo placentario se ha elevado en países industrializados debido al incremento en la tasa de cesáreas. La ruptura prematura de membranas pretérmino se asocia con complicaciones en 3% de todos los embarazos. En la actualidad no existen publicaciones que documenten la atención médica de ambas alteraciones en conjunto. CASO CLÍNICO Paciente de 31 años, en curso del segundo embarazo (30.2 semanas de gestación), que acudió al servicio médico por salida de líquido transvaginal. Se confirmó la ruptura prematura de membranas pretérmino por cristalografía y determinación de microglobulina alfa 1 placentaria por tira reactiva Amnisure®. La valoración de los médicos del servicio de Medicina Materno-Fetal fue: placenta previa total, con lagunas placentarias y flujo turbulento, grosor miometrial menor de 1 mm y pérdida de la interfase deciduomiometrial. Después de comprobar el bienestar fetal se inició el tratamiento conservador de la ruptura prematura de membranas pretérmino. Se decidió finalizar el embarazo a las 31 semanas, debido a que se confirmó el inicio del trabajo de parto y actividad uterina normal; se efectuó cesárea-histerectomía sin complicaciones maternas. CONCLUSIÓN La placenta previa total con datos de acretismo, concomitante con ruptura prematura de membranas pretérmino, es una complicación poco común. Estas pacientes deben recibir tratamiento conservador y adecuada vigilancia materno-fetal. A pesar de los buenos resultados obtenidos en este caso, se requiere mayor evidencia para indicar el tratamiento conservador en estas pacientes.

Abstract BACKGROUND The incidence of placental accreta has increased in industrialized countries, due to the increase in the rate of cesarean sections. On the other hand, the premature rupture of membranes (PPROM), complicate approximately 3% of all pregnancies and is associated mainly with neonatal complications related to prematurity. At present, there is no documented evidence in the medical literature of the approach of both pathologies together. CLINICAL CASE 31-year-old woman at 30.2 weeks' gestation in her second pregnancy is admitted to the hospital with vaginal discharge. PROM is confirmed by fern-type crystallization and quantification of placental alpha macroglobulin-1 (PAMG-1) microglobulin by Amnisure® test strip. Medical assessment is performed by the maternal-fetal specialists, finding complete placenta praevia with the presence of vascular lacunae with turbulent lacunar flow, myometrium thickness < 1mm and loss of the clear space. Fetal well-being is confirmed and conservative management of PPROM is initiated. Obstetric delivery is conducted at 31 weeks of gestation with Caesarean section - Hysterectomy without complications. CONCLUSIONS The premature rupture of membranes in presence of placenta accreta is a rare complication. In this patients, conservative management is a suitable alternative, with an appropriate maternal and fetal surveillance. More evidence is required to indicate the conservative treatment in these patients.

Tratamiento de la ruptura prematura de membranas pretérmino (24-33.6 semanas): evidencia científica reciente / Management of premature preterm rupture of membranes (24-33.6 weeks): Recent scientific evidence

Resumen OBJETIVO Ofrecer al clínico la evidencia científica más reciente en lo relativo a algunos aspectos de la atención de pacientes con ruptura prematura pretérmino de membranas que han generado debate, controversia y, en algunos momentos, opiniones divergentes que condicionan la toma de decisiones basadas en criterios con un débil rigor científico que se reflejan en morbilidad perinatal significativa. MÉTODO Búsqueda en PubMed, The Cochrane Library, OVID, Science Direct, Practice Guidelines Internacional Networks de artículos publicados en inglés entre los años 2014 a 2016 con las siguientes palabras clave (Mesh): Preterm premature rupture of membranes; diagnostic tests in premature rupture of preterm membranes; pulmonary maturity scheme; antibiotic therapy in premature rupture of preterm membranes; pulmonary maturity tests; fetal inflammatory response syndrome; fetal well-being tests; chorioamnionitis. Criterios de inclusión: revisiones sistemáticas, metanálisis y ensayos clínicos controlados con metodología de medicina basada en evidencias, con consistencia y claridad en las recomendaciones seleccionadas. RESULTADOS Se seleccionaron 70 artículos, entre estos 5 guías internacionales de práctica clínica y 45 artículos. Al final se excluyeron 20 artículos porque el diseño era de casos y controles, ensayos clínicos no controlados y sus recomendaciones no eran concluyentes porque su nivel de evidencia era bajo. CONCLUSIONES El uso racional de los diversos instrumentos de diagnóstico permite ser más eficaces y eficientes en la utilización de los recursos, y la identificación de fetos que podrían beneficiarse de una conducta expectante versus resolutiva y, viceversa. La comprensión y aplicación de lo aquí expuesto puede contribuir a disminuir la incidencia de desenlaces neonatales adversos asociados con procesos infecciosos directamente relacionados con la morbilidad y secuelas neurológicas a corto y mediano plazo. Se planteó el tratamiento de la ruptura prematura pretérmino de membranas en algoritmos aplicables en la práctica clínica.

Abstract OBJECTIVE To provide the clinician the most recent scientific evidence regarding some aspects of the management of patients with preterm premature rupture ofmembranes. Those aspects have generated debate, controversy and sometimes divergent opinions leading to medical decisions based on weak criteria and as consequence significant perinatal morbidity. METHOD We searched databases in PubMed, The Cochrane Library, OVID, Science Direct, Practice Guidelines International Networks from 2014 to 2016 with the following keywords: preterm premature rupture of membranes, diagnostic tests for preterm premature rupture of membranes, antenatal corticosteroids, antibiotic therapy in preterm premature rupture of membranes, fetal pulmonary maturity tests, fetal inflammatory response syndrome, fetal well-being tests, chorioamnionitis. RESULTS We extracted 70 studies, information was collected with emphasis on several controversial themes. Inclusion criteria were systematic reviews, meta-analysis and clinical controlled trials from 2014 to 2016, languages spanish or english, articles with evidence-based medicine methodology with strong recommendations. The final selection includes 5 international clinical practice guidelines and. 45 articles from 2014-2016. Articles which methodology consisted in case-control design, uncontrolled or unrandomized clinical trials or with level of evidence D were excluded. CONCLUSIONS The appropriate use of diagnostic tools will allow us to become more efficient in the use of resources, also allowing the identification of fetuses that would benefit from an expectant versus resolute management and vice versa. The review aims, among other things, to reduce the incidence of adverse neonatal outcomes associated with infectious processes, which are directly related to morbidity and neurological sequelae in short and mid-term. The management of PPROM is proposed in algorithms applicable in clinical practice.

Caracterización epidemiológica de pacientes con Sepsis Neonatal en un hospital de la ciudad de Cali (Colombia), 2014 / Epidemiological characterization of patients with Neonatal Sepsis in a Hospital of Cali city (Colombia), 2014

Objetivo: la infección neonatal se encuentra como la principal causa de fallecimientos neonatales en Colombia. El objetivo de este estudio fue establecer las características epidemiológicas de pacientes con sepsis neonatal reportados en un hospital de la ciudad de Cali. Materiales y métodos: estudio de corte transversal analítico a partir de la revisión de 215 historias clínicas de neonatos diagnosticados con sepsis durante el 2014. Los factores de riesgo y su asociación con el desarrollo del tipo de sepsis se establecieron mediante la prueba de χ2 y el Odds Ratio empleando el paquete estadístico IBM SPSS Vs 22,0. Resultados: el 67,9% de los pacientes presentaron sepsis temprana y el 32,1% tardía. El bajo peso al nacer y la prematuridad se encontró en el 12,1% y 15,8%, respectivamente. La ruptura prematura de membrana fue el antecedente materno más prevalente (25,1%) con 2,970 veces más posibilidad para el desarrollo de la sepsis temprana en el 83,3% de los casos. La PCR fue positiva en el 80,5% de los casos, y en el 69,9% de los neonatos con sepsis temprana. Conclusión: la ruptura prematura de membrana fue el factor que más riesgo representó para el desarrollo de la sepsis emprana. La PCR fue positiva principalmente en los neonatos con sepsis temprana, confirmando su utilidad como predictor positivo de este tipo de sepsis. El control prenatal y seguimiento de las madres embarazadas que eviten la infección o colonización bacteriana son necesarios para disminuir la enfermedad..(AU)

Objective: neonatal infection is an important cause of mortality of newborns in Colombia. The objective of this study was to establish the epidemiological characteristics of patients with neonatal sepsis reported in a hospital in Cali. Materials and methods: we conducted a analytical, cross-sectional study from 215 clinical medical charts of patients diagnosed with neonatal sepsis during 2014. Risk factors and their association with the development of sepsis type were established using the chi-square test and Odds Ratio (OR) with the IBM, SPSS statistical package Vs 22.0. Results: 67.9% of the patients were diagnosed with early-onset neonatal sepsis and 32.1% with late-onset sepsis. Low-birth-weigh and preterm infants were found in 12.1% and 15.8%, respectively. Premature rupture of membrane was the most prevalent maternal antecedent (25.1%) with 2,970 times more likely to develop early sepsis in 83.3% of cases. CRP was positive in 80.5% of cases, and in 69,9% of infants with early sepsis. Conclusion: premature rupture of membrane was the factor determined for the development of early sepsis. CRP was positive mainly in neonates with early-onset neonatal sepsis, confirming its usefulness as a positive predictor. Prenatal control and monitoring of pregnant mothers to prevent infection or bacterial colonization are needed to reduce disease..(AU)

Qualitative Determination of Human Chorionic Gonadotropin in Vaginal Washings for the Early Diagnosis of Premature Rupture of Fetal Membranes / Determinação qualitativa de gonadotrofina coriônica humana no lavado vaginal para o diagnóstico precoce de ruptura prematura de membranas fetais

Abstract Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25). Results The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

Resumo Objetivo Este estudo objetivou validar o exame qualitativo da subunidade β da gonadotrofina coriônica humana (β-hCG) em lavado vaginal de gestantes com ruptura prematura de membranas (RPM) fetais. Métodos Estudo transversal de gestantes com 24 a 39 semanas atendidas em um hospital de Maringá divididas em 2 grupos: grupo A (clinicamente diagnosticadas com RPM) e grupo B (gestantes sem perda de liquido amniótico). As pacientes foram submetidas a lavado vaginal com 3 mL de soro fisiológico, que logo em seguida foi aspirado de volta na mesma seringa e imediatamente enviado ao laboratório para a realização do exame de β-hCG vaginal com pontos de corte de 10 mIU/mL (β-hCG-10) e/ ou 25 mIU/mL (β-hCG-25). Resultados O teste de β-hCG-10 na secreção vaginal foi realizado em 128 casos, e o teste do qui-quadrado com correção de Yates mostrou diferença significante entre os dois grupos (p = 0,0225). Os parâmetros de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram respectivamente 77,1%; 43,6%; 52,3%; 70,4%; e 58,6%. O teste de β-hCG-25 na secreção vaginal foi realizado em 49 casos, e a análise pelo teste exato de Fisher mostrou diferença significativa entre os grupos (p = 0,0175). Os parâmetros de sensibilidade, especificidade, VPP, VPN e acurácia foram respectivamente 44,4%; 87,1%; 66,6%; 72,9%; e 71,4%. Conclusões O β-hCG-25 apresentou melhor acurácia para o diagnóstico de RPM, e pode corroborar o diagnóstico precoce de RPM por se tratar de um exame simples e rápido.

Inducción del parto versus manejo expectante en ruptura prematura de membranas pretérmino: revisión sistemática y metanálisis / Induction of labor versus expectant management in patients with preterm premature rupture of membranes: a systematic review and meta-analysis

RESUMEN Introducción: La ruptura prematura de membranas pretérmino (PPROM) es una patología obstétrica que genera un alto riesgo de morbilidad fetal. Pese a esto, actualmente prevalece la incertidumbre ante el manejo adecuado para ésta entidad. Objetivo: Comparar los desenlaces materno-fetales de la inducción del parto (IL) y manejo expectante (EM) Metodología: Revisión sistemática y metanálisis Fuentes de datos: Se buscó en las bases de datos MEDLINE, EMBASE, SCIELO y Google Académico. Criterios de elección, pacientes e intervenciones: Se incluyeron ensayos clínicos aleatorizados controlados y estudios de cohortes que compararan el EM e IL en pacientes con PPROM entre la semana 24 a 36 6/7, y que adicionalmente tuvieran en cuenta como desenlaces analizados: sepsis neonatal (NS), síndrome de distrés respiratorio (SDR), muerte neonatal y corioamionitis. Recolección de datos y análisis: La extracción y registro de datos se ejecutó por dos revisores de forma independiente. La evaluación de calidad se realizó con CONSORT y STROBE, según corresponda. Metanálisis: Para cada desenlance, se realizó la estimación del Riesgo Relativo (RR) consolidado, usando modelos de efectos aleatorios. Resultados: Un total de 3378 mujeres con PPROM fueron incluidas en los 9 estudios (8 ensayos clínicos). En el meta-análisis no se encontraron diferencias significativas en la ocurrencia de SDR (RR= 1,08; IC 95%: 0,89-1,31), ni de sepsis neonatal (RR= 0,92; IC 95%: 0,61-1,39), en los tratados con IL comparados con el EM. Tampoco se encontraron diferencias significativas en la ocurrencia de muertes neonatales (RR= 1,34; IC 95%: 0,93-1,93) ni corioamnionitis (RR= 0,88; IC 95%: 0,58-1,35). Conclusiones: Los resultados sugieren que no existe evidencia de diferencias estadísticamente significativas en la ocurrencia de los principales desenlaces cuando se compara EM con IL. Más estudios y con mayores tamaños de muestras son necesarios.

ABSTRACT Introduction: Preterm premature rupture of membranes (PPROM), is an obstetric pathology that causes a high-risk of morbidities and higher rate of hospital readmission in the first month of life. However, the management of this patology is still uncertain. Objetive: To compare maternal-fetal outcomes of induction of labor (IL) and expectant management (EM) in order to determine the actions to follow. Methodology: Systematic review and meta-analysis Data collection: We searched MEDLINE, EMBASE, SCIELO and Google Scholar. Selection Criteria, patients and interventions: Controlled randomized clinical trial and cohort studies were included. These studies compared the EM and IL in patients with PPROM within 24 to 36 6/7 weeks and take into account outcomes such as neonatal sepsis (NS), respiratory distress syndrome (RDS), neonatal death or chorioamnionitis. Analysis and data collection: Two authors independently executed the extraction and recording of data. Quality assessment was performed with the CONSORT or STROBE score, accordingly. Meta-analysis: For each outcome, a pooled Relative Risk was estimated using random effects models. Results 3378 women with PPROM were included in 9 studies (8 clinical trials). In the meta-analysis, we did not find a statistically significant differences in the occurrence of RDS (RR =1.08; 95% CI: 0.89-1.31 or NS (RR= 0.92; IC 95%: 0.61-1.39), in the IL group in comparison with EM. We did not find either differences in the occurrence of neonatal deaths (RR= 1.34; IC 95%: 0.93-1.93) or chorioamnionitis ( RR= 0.88; IC 95%: 0.58-1.35). Conclusions: The results suggest that there is no evidence of statistically significant differences in the occurrence of major outcomes when comparing MS with IL. Further studies and larger sample sizes will be necesary.

Relación entre el índice de masa corporal bajo previo al embarazo y el riesgo de parto prematuro / Relationship between low body mass index before pregnancy and the risk of preterm birth

Resumen OBJETIVOS: identificar si existe relación entre el índice de masa corporal bajo previo a la concepción y el riesgo de parto pretérmino y de ruptura prematura de membranas pretérmino. MATERIALES Y MÉTODOS: estudio transversal, analítico, de una muestra al azar de pacientes atendidas entre enero de 2015 y enero de 2016. Variables de estudio: edad, índice de masa corporal, ganancia ponderal durante el embarazo, antecedentes de infección de vías urinarias, cervicovaginitis, amenaza de aborto y ruptura prematura de membranas. El análisis se efectuó con un modelo de regresión lineal generalizada para identificar la influencia del índice de masa corporal y del resto de las variables estudiadas en el riesgo de parto prematuro. RESULTADOS: se analizaron los datos de 120 pacientes y la regresión lineal generalizada mostró una relación estadísticamente significativa entre el índice de masa corporal previo al embarazo y el riesgo de parto pretérmino (r2 = 0.016, p = < 0.001). CONCLUSIONES: el IMC bajo, previo al embarazo, se relaciona con aumento poco importante del riesgo de parto pretérmino; el riesgo de ruptura prematura de membranas se incrementa discretamente en pacientes con antecedente de amenaza de aborto y ruptura prematura de membranas pretérmino.

Abstract OBJECTIVE: To identify if there is a relationship between the low pre-conceptional body mass index and the risk of preterm delivery and / or PROM. MATERIALS AND METHODS: Analytical cross-sectional study was conducted with a random sample of 120 patients treated between January 2015 to January 2016. Patients were analyzed for age, body mass index, and weight gain during pregnancy, history of urinary tract infection, vaginal infections, threat of abortion and premature rupture of membranes. The analysis was performed using a generalized linear regression model to identify the influence of body mass index and the rest of the variables studied on the risk of preterm delivery. RESULTS: The generalized linear regression showed a statistically significant relationship between the pre gestational body mass index and the risk of preterm delivery. (R2 = 0.016, p = <0.001) CONCLUSION: Body mass index influenced the risk of preterm delivery but not premature rupture of preterm membranes.

Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes / Avaliação dos resultados perinatais em gestantes com rotura prematura das membranas pré-termo

SUMMARY Objective: To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM). Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion: The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.

RESUMO Objetivo: determinar a associação do índice de líquido amniótico (ILA) com os resultados perinatais na rotura prematura das membranas pré-termo (RPMPT). Método: realizou-se um estudo de coorte retrospectivo, de 2008 a 2012. Foram incluídas 86 gestantes, com diagnóstico de RPMPT e idade gestacional entre a 24ª e 35ª semanas. Foram excluídas gestantes que apresentavam síndromes hipertensivas, diabetes, fetos com malformações fetais e infecção na admissão. Para determinar a associação entre ILA e desfechos perinatais, foram utilizados os testes qui-quadrado e exato de Fisher, quando pertinentes, além da razão de risco (RR) e seu intervalo de confiança a 95% (IC95%). A correlação entre ILA e desfechos perinatais foi determinada por regressão linear simples, e a evolução do ILA durante a gestação foi analisada pelo teste Z. Resultados: quando comparados os recém-nascidos que apresentavam ultrassonografia com ILA<5 cm e ILA>5 cm, observou-se maior frequência de mortalidade perinatal nos casos de ILA<5 cm. Quando o oligo-hidrâmnio, porém, era diagnosticado como grave (ILA<3 cm), observava-se maior frequência de escore de Apgar <7 no 1º minuto, sepse neonatal e mortalidade neonatal precoce em relação aos que apresentavam ILA>3 cm. Observou-se uma correlação positiva entre ILA e idade gestacional no parto, peso ao nascer e escore de Apgar no 1º e 5º minutos, além de diminuição do volume do líquido amniótico com o avançar da idade gestacional. Conclusão: a presença de oligo-hidrâmnio grave após a RPMPT contribuiu para uma maior frequência de complicações e mortalidade perinatal.