Term prelabor rupture of membranes: management and outcome

To review the management of term prelabour rupture of membranes and its outcome. Interventional and descriptive. Military Hospital Rawalpindi from 10th June 2002 to 9th March 2003. 110 patients including both primigravidas and multigravidas with singleton pregnancy having term prelabour rupture of membranes were recruited by convenience sampling. They did not have any other complicating factor. They were managed according to their Bishop's score either expectantly or actively by inducing them. 64.54% of patients went into spontaneous labour within 24 hours and only 35.45% required active intervention. Deliveries by the vaginal route were 89.2% with 61% normal and 28.20% instrumental. Cesarean section rate was 10.90%, higher in those induced and primigravidas as compared to the expectantly managed and multigravidas. Chorioamnionitis was seen in 5.45% cases, 3.6% developed postpartum fever, 1.8% wound infection with no case of endometritis or neonatal mortality. 43.64% neonates were put on antibiotics but significant infection was seen in 5[4.54]% cases. Both active and expectant management are equally effective with a significant percentage delivering vaginally. However the cesarean rate was higher among the actively managed

The role of maternal serum C-reactive protein and white blood cell count in the prediction of chorioamnionitis in women with premature rupture of membranes.

This study was performed to evaluate the diagnostic performance of maternal serum C-reactive protein, maternal white blood cell (WBC), and neutrophil counts in the detection of histologic chorioamnionitis. One hundred and twenty six pregnant women after at least 28 weeks of gestation with premature rupture of membranes (PROM) were studied. Blood samples for C-reactive protein, WBC and neutrophil counts were taken at delivery. Placental histology was evaluated for histologic chorioamnionitis. Maternal and neonatal complications were observed. Among women with and without histologic chorioamnionitis, the maternal WBC and neutrophil counts were different (P<0.05) but the maternal serum C-reactive protein was not. Cutoff values for C-reactive protein, WBC, and neutrophil counts were 0.5 mg/dL, 15,000 cell/mm3, and 80 per cent, respectively. Sensitivity and specificity were 56 per cent and 58 per cent for C-reactive protein, 60 per cent and 63 per cent for WBC count, and 62 per cent and 54 per cent for neutrophil count, respectively. In conclusion, the maternal serum C-reactive protein, WBC, and neutrophil counts have poor diagnostic performance for histologic chorioamnionitis.

Vaginosis bacteriana / Bacterial vaginosis

La flora vaginal normal es una de las barreras fisiológicas más importantes para impedir la colonización por flora patógena. Siendo el tracto genital femenino una de las zonas del organismo normalmente colonizadas, el conocimiento de su composición y mecanismo de regulación nos permite comprender la fisiopatología de la mayoría de las infecciones. Existe concenso que salvo las infecciones por enfermedades de transmisión sexual por agentes exógenos, el resto son producidas por un desequilibrio en la flora endógena, jugando el estado hormonal un papel determinante en este proceso. La Vaginosis Bacteriana (VB) es un síndrome clínico polimicrobiano que se caracteriza por presentar una secreción vaginal anormal y disturbios en el ecosistema vaginal con desplazamiento del lactobacilo por microorganismos anaerobios. Eschenbach y col. encuentran que los signos y síntomas aparecen cuando se halla asociada a bacterias anaerobias. Otros agentes que actúan como copatógenos serían: Mycoplasmahominis y vaginalis, Ureaplasma urealyticum, Mobiluncus curtisü y mulieris. Por lo tanto, la etiología se atribuye al denominado complejo GAMM. Para definir la VB deben estar presentes 3 de los 4 criterios clínicos establecidos: leucorrea, ph mayor de 4,5, test de aminas positivo y presencia de clue cells. Desde hace varios años se está estudiando la relación existente entre VB y mujeres embarazadas, específicamente en casos de trabajo de parto prematuro, rotura prematura de membranas y sus consecuencias: corioamnionitis, endometritis posparto y poscesárea. Aproximadamente entre un 15-20 por ciento de mujeres embarazadas presentan una VB lo cual constituiría un alto porcentaje de embarazadas con infección. El tratamiento posee cierta complejidad. Se debe tener en cuenta que el 50 por ciento de las mujeres portadoras de Gardnerellas vaginalis son asintomáticas...