Influence of premature rupture of membranes on the early prognosis of extremely premature infants / 中国当代儿科杂志

OBJECTIVE@#To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation.@*METHODS@#A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (@*RESULTS@#Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (@*CONCLUSIONS@#PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.

Maternal and fetal risk factors associated with late preterm infants / Fatores de risco materno-fetais associados à prematuridade tardia

ABSTRACT Objective: To determine maternal and fetal risk factors associated with the birth of late preterm infants in comparison to those born at term. Methods: A case-control study was carried out in a tertiary center for high-risk pregnancies. For the cases, the study enrolled post-partum mothers and their respective newborns with gestational ages equal or greater than 34 weeks and less than 37 weeks. As controls, the post-partum mothers and their newborns with gestational ages of 37 weeks or greater were selected. The sample was calculated with a ratio of two controls for each case, resulting in 423 patients. Association studies were performed using the chi-square test or Fisher's exact test and logistic regression analysis. Results: The variables associated with late prematurity were inadequate prenatal (Odds Ratio [OR] 1.23; confidence interval of 95% [95%CI] 1.12-1.34; p≤0.001), premature rupture of membranes (OR 4.98; 95%CI 2.66-9.31; p≤0.001), length of hospital stay ≥24 hours until birth (OR 0.18; 95%CI 0.06-0.52; p≤0.001), cesarean section (OR 2.74; 95%CI 1.69-4.44; p≤0.001) and small for gestational age newborn (OR 3.02; 95%CI 1.80-5.05; p≤0.001). Conclusions: Inadequate prenatal care and membranes' premature rupture were found as factors associated with the late preterm birth. It is important to identify the factors that allow intervention with adequate prenatal care in order to reduce poor outcomes due to late prematurity.

RESUMO Objetivo: Determinar fatores maternos e fetais associados ao nascimento de recém-nascidos prematuros tardios, quando comparados aos nascidos a termo. Métodos: Estudo caso-controle em um hospital terciário de referência para atendimento de gestações de alto risco. Foram considerados casos as puérperas e seus respectivos recém-nascidos com idade gestacional maior ou igual a 34 semanas e menor de 37 semanas. Para os controles foram selecionadas as puérperas e seus recém-nascidos com idade gestacional de 37 semanas completas ou mais. A amostra foi calculada com razão de dois controles para cada caso, resultando em um total de 423 pacientes. Estudos de associação foram efetuados utilizando-se o teste do qui-quadrado ou teste exato de Fisher e posterior regressão logística. Resultados: As variáveis associadas à prematuridade tardia foram a realização de pré-natal inadequado (Odds Ratio - OR 1,23; intervalo de confiança de 95% - IC95% 1,12-1,34; p≤0,001), a rotura prematura de membranas amnióticas (OR 4,98; IC95% 2,66-9,31; p≤0,001), o tempo de internação ≥24 horas até o nascimento (OR 0,18; IC95% 0,06-0,52; p≤0,001), o parto operatório (OR 2,74; IC95% 1,69-4,44; p≤0,001) e o recém-nascido pequeno para a idade gestacional (OR 3,02; IC95% 1,80-5,05; p≤0,001). Conclusões: Assistência pré-natal inadequada e rotura prematura de membranas destacaram-se como fatores associados ao nascimento de prematuros tardios. Ressalta-se a relevância da identificação de fatores passíveis de intervenção por meio de adequada assistência pré-natal, a fim de reduzir os desfechos desfavoráveis decorrentes da prematuridade tardia.

Enfermedad periodontal como factor de riesgo adicional asociado con nacimiento pretérmino en México: un estudio de casos y controles / Periodontal disease as an additional risk factor associated with preterm birth in Mexico: a case-control study

Resumen Introducción: Las sustancias relacionadas con los microorganismos involucrados en la enfermedad periodontal puedan llegar a la interfaz materno-fetal por vía hematógena y estimular la contractilidad uterina. Objetivo: Determinar la asociación entre enfermedad periodontal con nacimiento pretérmino. Método: Estudio de casos y controles de 343 embarazadas pretérmino y 686 de término. Se calculó la edad gestacional por fecha de último periodo menstrual y se confirmó con los métodos de Capurro y Ballard. La enfermedad periodontal se diagnosticó por la profundidad del espacio entre la raíz dental y la encía. La asociación fue medida con regresión logística. Resultados: La edad de las madres en los casos fue de 23.8 ± 6.7 años y en los controles de 23.2 ± 6.7 años. La enfermedad periodontal estuvo presente en 66.8 % de los casos y 40.5 % de los controles. Los factores asociados con nacimiento pretérmino fueron enfermedad periodontal (RM = 2.26), antecedente de nacimiento pretérmino (RM = 4.96), embarazo no planeado (RM = 2.15), control prenatal deficiente (RM = 2.53), infección de vías urinarias (RM = 2.22), preeclampsia (RM = 4.49), ruptura prematura de membranas amnióticas (RM = 2.59) y nacer por cesárea (RM = 9.15). Conclusión: La enfermedad periodontal en el embarazo constituyó un factor de riesgo independiente para nacimiento pretérmino.

Abstract Introduction: Substances related to microorganisms involved in periodontal disease can reach the maternal-fetal interface via the hematogenous route and stimulate uterine contractility. Objective: To determine the association between periodontal disease and preterm birth. Method: Case-control study in 343 preterm and 686 full-term pregnant women. Gestational age was calculated based on the date of the last menstrual period and confirmed with Capurro and Ballard methods. Periodontal disease was diagnosed according to the depth of the space between the tooth root and the gum. The association was measured with logistic regression. Results: Maternal age of the cases was 23.8 ± 6.7 years, and 23.2 ± 6.7 in the controls. Periodontal disease was present in 66.8% of cases and 40.5% of controls. The factors associated with preterm birth were periodontal disease (Odds ratio [OR] = 2.26), history of preterm birth (OR = 4.96), unplanned pregnancy (OR = 2.15) poor prenatal control (OR = 2.53), urinary tract infection (OR = 2.22), preeclampsia (OR = 4.49), premature rupture of membranes (OR = 2.59) and caesarean section delivery (OR = 9.15). Conclusion: Periodontal disease in pregnancy was an independent risk factor for preterm birth.

Epidemiological profile of patients with preterm premature rupture of membranes at a tertiary hospital in São Paulo, Brazil

OBJECTIVE: To perform a descriptive analysis of preterm premature rupture of membranes (PPROM) cases attended in a tertiary hospital. METHOD: Retrospective analysis of medical records and laboratory tests of patients admitted to a Brazilian tertiary hospital between 2006 and 2011, with a confirmed diagnosis of PPROM and gestational age (GA) at delivery <37 weeks. RESULTS: A total of 299 pregnant women were included in the study. Nine patients evolved to abortion, and 290 pregnant women remained for the final analysis. There was initial diagnostic doubt in 17.6% of the cases. The oligohydramnios rate [amniotic fluid index (AFI) <5] was 27.9% on admission. Chorioamnionitis was initially diagnosed in 10.8% of the patients and was retrospectively confirmed in 22.9% of the samples. The latency period had a mean of 9.1 days. The main reasons for interruption were premature labor (55.2%), GA ≥36 weeks (27.2%), and fetal distress (6.9%). The delivery method was cesarean section in 55% of cases. The mean birth weight was 2,124 grams, and 67% of the neonates had a low birth weight (<2500 g). The GA at delivery averaged 33.5 weeks. The stillbirth rate was 5.3%, and the early neonatal mortality rate was 5.6%. There were complications at delivery in 18% of mothers. CONCLUSION: In one of the few Brazilian reports on the epidemiological profile of PPROM, with GA until 37 weeks and intercurrences generally excluded from assessments (such as twinning and fetal malformations), there is a favorable evolution, with an acceptable rate of complications.

Sepsis en pacientes con rotura prematura de membranas pretérmino / Sepsis in patients with preterm premature rupture of membranes

Introducción: la prematuridad es en la actualidad uno de los grandes desafíos de la medicina perinatal. Objetivo: caracterizar la sepsis perinatal en gestantes con rotura prematura de membranas y parto pretérmino entre las 28 y 36,6 semanas en el Hospital Ginecobstétrico Ramón González Coro. Métodos: se realizó un estudio observacional, retrospectivo y de corte transversal desde enero hasta diciembre de 2008. Se revisaron 33 historias clínicas. Se confeccionó una planilla para la recolección de datos como la edad materna, factores de riesgo, edad gestacional al ingreso, tipo de parto y tipos de sepsis según análisis del laboratorio. Resultados: del total de gestantes, 42,5 por ciento tenía entre 20 y 29 años; 36,4 por ciento ingresó entre 34 y 36 semanas. Presentó anemia 51,4 por ciento; el parto fue por cesárea en 69,7 por ciento. Presentaron sepsis 58,3 por ciento; con un 41,7 por ciento de positividad en el leucograma. Conclusiones: predominó la edad materna entre 20 a 29 años y la edad gestacional al ingreso entre 34 y 36 semanas. La anemia fue el factor de riesgo más frecuente. Prevaleció el parto por cesárea con incremento de sepsis. Mayor proporción de positividad del leucograma en la sepsis neonatal(AU)

Introduction: prematurity is one of the great challenges faced by perinatal medicine at present. Objective: characterize perinatal sepsis in pregnant women with premature rupture of membranes and preterm delivery between weeks 28 and 36.6 at Ramón González Coro Obstetrics and Gynecology Hospital. Methods: a cross-sectional observational retrospective study was conducted of 33 medical records from January to December 2008. A form was developed to collect data such as maternal age, risk factors, gestational age at admission, type of delivery and types of sepsis according to laboratory tests. Results: of the total pregnant women, 42,5 percent were in the 20-29 age group, 36,4 percent were admitted at 34-36 weeks of pregnancy, 51,4 percent had anemia, and 69,7 percent underwent cesarean section, 58,3 percent had sepsis, and 41,7 percent had positive leukocyte counts. Conclusions: the predominant maternal age was 20-29 years, whereas gestational age at admission was 34-36 weeks. Anemia was the most common risk factor. There was a predominance of cesarean delivery with increased sepsis, and there was a higher proportion of positive leukocyte counts in neonatal sepsis(AU)

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

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

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

Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections / Ruptura prematura das membranas fetais pré-termo: associação com fatores sociodemográficos e infecções geniturinárias maternas

OBJECTIVE: tthis study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. METHODS: this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight > 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. RESULTS: of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94), with lower level of schooling (PR = 2.43), age > 29 years (PR = 2.49), and smokers (PR = 2.04). It was also associated with threatened miscarriage (PR = 1.68) and preterm labor, (PR = 3.40). There was no association with maternal urinary tract infection or presence of genital discharge. CONCLUSIONS: the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. .

OBJETIVO: o objetivo deste estudo foi verificar a ocorrência da ruptura prematura das membranas fetais pré-termo em gestações únicas e sua associação com fatores sociodemográficos maternos e infecções geniturinárias autorreferidas. MÉTODOS: estudo transversal de base populacional onde foram incluídas todas as mães dos recém-nascidos dos partos únicos ocorridos no ano de 2010, com peso ao nascer igual ou superior a 500 gramas, residentes no município. As puérperas foram entrevistadas nas duas maternidades da cidade. Foram considerados casos as gestantes que perderam líquido amniótico antes da internação hospitalar e cujo tempo de gestação fosse inferior a 37 semanas. Foi realizada análise estatística por níveis, para controle de fatores de confusão por meio da regressão de Poisson. RESULTADOS: das 2.244 mulheres elegíveis para o estudo, 3,1% apresentaram ruptura prematura das membranas fetais pré-termo, a qual foi mais frequente, após ajuste, nas mulheres de menor nível econômico, razão de prevalência (RP) de 1,94, menor escolaridade, RP de 2,43, com idade superior a 29 anos, RP de 2,49 e tabagistas, RP de 2,04. Também esteve relacionada com ameaça de aborto, RP de 1,68, e de trabalho de parto pré-termo, RP de 3,40. Não houve associação com infecção urinária materna ou presença de corrimento genital. CONCLUSÕES: o desfecho foi mais frequente nas puérperas com menor escolaridade, mais pobres, mais velhas e tabagistas, assim como naquelas com histórico de ameaça de abortamento e trabalho de parto prematuro. Estes fatores devem ser considerados na sua abordagem preventiva, diagnóstica e terapêutica. .

Factores asociados al desprendimiento prematuro de placenta en gestantes atendidas en el Hospital Docente Madre Niño San Bartolomé durante el periodo 2008-2012 / Factors associated with abruptio placentae in pregnant women attended at the Teaching Hospital Mother Child San Bartolome during the period 2008-2012

Determinar los factores asociados al Desprendimiento prematuro de placenta en gestantes atendidas en el Hospital Docente Madre Niño San Bartolomé durante el periodo 2008-2012. Metodología: Estudio de tipo observacional, analítico comparativo, retrospectivo y transversal. Se estudió a 39 pacientes gestantes con desprendimiento prematuro de placenta (DPP) y 21 gestantes como grupo comparativo que no tenían DPP. Para determinar las diferencias de medias de las variables cuantitativas se utilizó las pruebas t de student y para determinar la relación entre variables y los factores asociados se usó las pruebas de Chi-cuadrado y Odds ratio. Resultados: La edad promedio de las pacientes con sospecha de desprendimiento prematuro de placenta es de 23.1±5.3 años, teniendo en su mayoría entre 19 a 35 años (75 por ciento), la mayoría son sólo convivientes (71.7 por ciento) de educación secundaria (96.7 por ciento). El grupo etario de las pacientes no está relacionado significativamente con el diagnóstico de desprendimiento prematuro de placenta (p=0.562), de la misma forma el estado civil de las pacientes no está relacionado significativamente con el DPP (p=0.067), tampoco 10 está el grado de instrucción de las pacientes (p=0.291). De los factores médicos obstétricos se observó que existe diferencia entre los peso y talla promedios entre gestantes con y sin DPP (p<=0.001) y (p=0.038) respectivamente. No se ha encontrado asociación significativa de las gestantes con DPP con la paridad (p=0.49), control prenatal (p=0.075), tipo de gestación (0.495), índice de masa corporal (0.131). Con respecto a los factores maternos conductuales no se detectó ningún caso con hábitos nocivos. Referente a los otros factores estudiados sólo la ausencia de la desproporción céfalo pélvica tiene relación significativa (p=0.002) con la presencia del DPP. La prevalencia del desprendimiento prematuro de placenta en el periodo 2008 a 2012 es de 39 / 60 casos que cumplieron los criterios...

To determine the factors associated with abruptio placentae in pregnant women at the Mother Child Teaching National Hospital San Bartolome during the period 2008-2012. Methodology: Observational, comparative, retrospective, transversal study. The sample was 39 pregnant patients with diagnosis of abruptio placentae and 21 pregnant patients without that diagnosis. To determine the mean differences of quantitative variables, the T-student test was used, and to determine the relationship between variables and the factors associated the chi-square test and Odds ratio were used. Results: The average age of patients with suspected abruptio placentae was 23.1 years, the majority was between 19-35 years (75 per cent), most were just cohabiting (71.7 per cent), secondary education (96.7 per cent). The age group of patients was not significantly associated with the diagnosis of abruptio placentae (p=0.562), likewise the marital status of patients was not significantly related with DPP (P=0.067), Likewise the marital status of the patients was not significantly associated to the DPP (p = 0.067), nor the level of education (p=0.291). Of obstetric medical factors that were significantly associated with patients with or without a diagnosis of abruptio placentae were the weight (p<=0.001) and height (p=0.038), there was also no significant association with parity (p=0.49), prenatal care (p=0.075), type of pregnancy (0.495) and body mass index (0.131). Regarding maternal behavioral factors, no harmful habit was detected. As for the other factors studied, only the absence of cephalopelvic disproportion had significant relationship (p=0.002) with the presence of the DPP. The prevalence of abruptio placentae in the period 2008 to 2012 was 39 cases of the 60 cases that met the inclusion and exclusion criteria. Conclusions: The only factor related with the diagnosis of abruptio placentae showing a significant association (p=0.002) factor was cephalo pelvic disproportion...

Repercusiones materno neonatales de rotura prematura de membranas pretérmino en pacientes atendidas en el Hospital Regional de Pucallpa - 2011 / Effects maternal and neonatal of the premature rupture of membranes, preterm labor in patients treated in Regional Hospital Pucallpa - 2011

OBJETIVO: Este estudio estuvo dirigido a determinar las repercusiones maternas neonatales de la ruptura prematura de membranas pretérmino del Hospital Regional de Pucallpa, durante Enero-Diciembre del 2011. MATERIALES y METODOS: Estudio observacional, analítico de casos y controles. RESULTADOS: Se estudiaron 109 pacientes con RPM. La incidencia de RPM es de 4.65 por ciento. Terminación de parto: cesárea en 33.9 por ciento (37), p=0,018800 OR:1,61 (1,08-2,42), y un 11 por ciento (12) se encuentra < a las 28 semanas, (p=0,000001 OR: 12,99 (6,46-26,1)), Sin CPN p=0,000382, OR: 2,34 (1,45-3,80), control prenatal inadecuado (de 1-3 CPN) p=0,002611 OR: 1,87 (1,24-2,83), CPN adecuado >4 en 48.6 por ciento (53), p=0,000000 OR:0,33 (0,23-0,49), En el caso de la edad gestacional al nacer, 78 por ciento (89) era prematuros leves (34 a 37 semanas) (p=0,000003 OR: 52,40 (31,72-86,5)), 10 por ciento (9) eran de prematuridad moderada (30 a 34 semanas), p=0,000048 OR: 3,77 (1,90-7,49); Hallazgos obstétricos asociados: en 10.1 por ciento (11) tuvieron Oligohidramnios severo en 11 (10.1 por ciento), p=0,000001 OR: 7,82 (3,93-15,58), podálico en 6.4 por ciento (7), p=0,001579 OR: 3,40 (1,52-7,60), preeclampsia severa en 2.8 por ciento (3), Mortalidad en 12 prematuros (11 por ciento) p=0,000001 OR: 8,25 (4,24-16,05). CONCLUSION: Se encontró estadísticamente significativa con un valor de p<0.05, en el grupo de prematuridad leve, edad gestacional < de 28 semanas, Mortalidad en el recién nacido, Oligohidramnios, recién nacido en presentación podálico, prematuridad moderada, Madre sin control prenatal, control prenatal inadecuado < de 3 controles, Los casos de RPM en el Hospital de Pucallpa, son más del tipo de prematuridad leve, y la mortalidad se asocia a prematuros de bajo peso al nacer.

OBJECTIVE: This study was aimed to determine the effects of neonatal maternal premature rupture of membranes Pucallpa Regional Hospital during January to December 2011. MATERIALS AND METHODS: A retrospective descriptive study, correlational. RESULTS: We studied 109 patients with RPM. RPM incidence is 4.65 per cent. Termination of birth: caesarean section 33.9 per cent (37), P=0.018800 OR: 1.61 (1.08 to 2.42), and 11 per cent (12) is < at 28 weeks (p=0.000001 OR 12.99 (6.46 to 26.15)), No CPN p=0.000382, OR: 2.34 (1.45 to 3.80), inadequate prenatal care (from 1-3 CPN) p=0.002611 OR: 1.87 (1.24 to 2.83), appropriate CPN>4 in 48.6 per cent (53), P=0.000000 OR: 0.33 (0.23-0.49) in the case of gestational age at birth, 78 per cent (89) was mild preterm (34-37 weeks) (p=0.000003 OR: 52.40 (31.72 to 86.56)), 10 per cent (9) were of moderate prematurity (30-34 weeks), p=0.000048 OR: 3.77 (1.90 to 7.49) associated obstetric Findings: 10.1 per cent (11) had severe in 11 Oligohidramnios (10.1 per cent)., p=0.000001 OR: 7.82 (3.93 to 15.58), breech in 6.4 per cent (7), P=0.001579 OR: 3.40 (1.52 to 7, 60), severe preeclampsia in 2.8 per cent (3), mortality in 12 infants (11 per cent) p=0.000001 OR: 8.25 (4.24 to 16.05). CONCLUSION: We found statistically significant with a p-value <0.05, in the group of mild prematurity, gestational age <28 weeks, mortality in newborn, oligohydramnios, newborn baby in breech presentation, moderate prematurity, Mother without prenatal care, inadequate prenatal care <3 controls, RPM cases at the Hospital of Pucallpa, are mild prematurity rate, and mortality associated with premature low birth weight.

Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes [Mid-Trimester PROM]

Preterm premature rupture of membranes [PPROM] is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM. A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study. Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 [55%] survived, 7 [16%] died within 24 hours of birth, 9 [20%] were miscarried, and 4 [9%] were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 [46%], respiratory distress syndrome in 19 [79%], sepsis in 12 [50%], and low birth weight in 11 [46%]. The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes. Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counseling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals

Mantención de cerclaje luego de rotura prematura pretérmino de membranas antes de las 34 semanas se asocia a un aumento de corioamnionitis materna y mortalidad neonatal por sepsis / Retained cerclage after preterm premature rupture of membranes before 34 weeks is associated with increased maternal chorioamnionitis and neonatal sepsis mortality

El cerclaje es un factor de riesgo de rotura prematura pretérmino de membranas (RPPM). La RPPM ocurre en aproximadamente un 38-65 por ciento de los embarazos con cerclaje y no existe consenso aún sobre cuál es el manejo más adecuado: retirar o mantener el cerclaje. En esta revisión presentamos la evidencia disponible en relación al retiro versus mantención del cerclaje y su directa influencia sobre el resultado materno-perinatal, con el objetivo de proponer una pauta de manejo. La mantención del cerclaje se asoció a un aumento de la latencia al parto mayor a 48 horas, a un aumento en la incidencia de corioamnionitis clínica, y aumento en la incidencia de mortalidad neonatal por sepsis. Conclusión: en pacientes embarazadas con cerclaje que presentan RPPM antes de las 34 semanas proponemos como la conducta más adecuada la mantención del cerclaje sólo hasta completar la inducción de madurez pulmonar con corticoides, luego retirar el cerclaje y proceder al manejo habitual de un embarazo con RPPM antes de las 34 semanas.

Cervical cerclage is a risk factor for preterm premature rupture of membranes (PPROM). PPROM occurs in about 38-65 percent of pregnancies with cerclage. There is no consensus on whether to remove or retain the cerclage after PPROM. Here we review the evidence about clinical management of PPROM in women with cerclage and its influence on maternal and neonatal outcome. Retained cerclage was found to be associated to a prolongation of pregnancy by more than 48 hours, to a higher incidence of maternal chorioamnionitis and to a higher incidence of neonatal mortality from sepsis. In pregnancies with cerclage complicated with PPROM before 34 weeks we propose to retain the cerclage just enough time to complete fetal lung maturation with corticosteroid therapy, then remove the cerclage and manage pregnancy as any PPROM before 34 weeks.

Riesgo obstétrico y perinatal en embarazadas mayores de 35 años / Perinatal risk in pregnant women of 35 years and older

Antecedentes: El embarazo en edades tardías es una condición que ha aumentado en los últimos años. Objetivo: Evaluar el riesgo materno y perinatal en embarazadas mayores de 35 años. Método: Estudio de cohorte retrospectiva de todos los embarazos atendidos en el hospital Dr. Gustavo Fricke de Viña del Mar, entre enero de 2001 y diciembre de 2006. Se excluyeron menores de 20 años. Se analizaron variables maternas y perinatales. Resultados: En el período hubo 16.338 partos, 10,9 por ciento fueron en mujeres entre 35 y 39 años y 3,6 por ciento en embarazadas de 40 años o más. Un 27,2 por ciento de los embarazos fue en primigestas. La comparación entre embarazadas de 20-34 años y de 35-39 años mostró mayor frecuencia de hipertensión arterial crónica, hospitalización durante el embarazo, diabetes, preeclampsia, hemorragia del tercer trimestre, parto cesárea, hemorragia puerperal, menor peso del recién nacido, y defectos congénitos, entre otros. Hubo mayor frecuencia de rotura prematura de membranas al analizar las mayores de 40 años. Las primigestas tuvieron mayor frecuencia de obesidad, preeclampsia, diabetes, hospitalización del recién nacido, y hemorragia puerperal. Al realizar una regresión logística para determinar influencia de la edad, se apreció que el riesgo de comorbilidades y eventos adversos maternos y fetales aumentaba proporcionalmente con la edad. Conclusión: La edad materna se asoció significativamente en forma independiente con resultados maternos y perinatales adversos. Hubo mayor riesgo para la mayoría de las variables analizadas en embarazadas de 35 años o más.

Background: Pregnancy in elderly ages is a condition that has been rising in the last years. Objective: To evaluate the maternal and perinatal risk of pregnant over the 35 years-old. Methods: Retrospective cohort study of all pregnant women attended in Dr. Gustavo Fricke Hospital, Viña del Mar, from January 2001 to December 2006. Patients under 20 years were excluded. Maternal and perinatal variables were analyzed. Results: 16,338 childbirths were analyzed, 10.9 percent were in women between 35 and 39 years, and 3.6 percent in women of 40 years or more. A 27.2 percent of the pregnancy was the first gestation. A greater frequency of chronic hypertension, hospitalization during pregnancy, diabetes, preeclampsia, third trimester hemorrhage, cesarean section, postpartum hemorrhage, low birth weight, and congenital defects, among others, were found when comparing pregnant of 20-34 years-old with pregnant of 35-39 years-old. Elevated frequencies of premature rupture of fetal membranes were found in women over 40 years. First gestation women had higher frequency of obesity, preeclampsia, and hospitalization during pregnancy, diabetes and postpartum hemorrhage. Using logistic regression to determinate the influence of age, we determine that the risk of co morbidity and maternal and fetal adverse events, increase according to age. Conclusion: Maternal age was associated independently and significantly with adverse maternal and perinatal results. Major risk was observed for the majority of the variables analyzed in pregnant of 35 years or more.

[Vitamin C supplementation and PROM]

Premature rupture of membranes [PROM] affects 10-20% of all pregnancies, occuring in approximately 30% to 40% of preterm deliveries. Vitamin C has a role in collagen metabolism and increases resistance maintenance of the chorioamniotic membranes. The objective of this study was to evaluate the relationship between vitamin C supplementation with PROM and preterm delivery. This clinical-trial study carried out from Jan to Jul 2006 at Hafez and Shoushtari Hospitals of Shiraz University of Medical Sciences. This study was approved by the local committee of medical ethics. Pregnant women [n=117] with 20 weeks gestational age, randomly divided into two groups 57 in the case group and 60 in the control group and evaluated every 4 weeks, from 20 to 36 weeks of pregnancy. At each evaluation, a vaginal examination was performed, to rule out bacterial vaginosis infection. The case group received a chewing tablet of 100 mg vitamin C daily. PROM and preterm delivery was recorded for each group as indicator of the protective effect of vitamin C supplementation. PROM occurred in 5 [8.77%] and 22 [36.67%] pregnancies in the case and control group respectively [p<0.001]. Four patients [7.41%] in the case group and 18 pregnant women [32.08%] in the control group delivered at term with PROM [p=0.001]. One woman [33.30%] in the case group and 4 women [57.10%] in the control group delivered due to PROM at term [p> 0.5]. Supplementation of vitamin C after 20 weeks of gestation prevents PROM

Early onset neonatal sepsis.

OBJECTIVE: To study the maternal risk factors and clinico-bacteriological profile of early onset sepsis (EOS), in a tertiary care neonatal unit. METHODS: Relevant data of neonates born during the study period were obtained from their case records. A diagnosis of early onset sepsis was made if either clinical sepsis developed within 72 hours of life or if positive blood/CSF cultures were obtained in those with potential maternal risk factors. Statistical analysis was done using Odds Ratio or Chi-square and Fisher's exact t-test as applicable. RESULTS: Among 1743 live births, a total of 69 episodes of sepsis occurred in 65 neonates (43% culture proven) with an incidence of 37.2 per 1000 live births. The incidence of EOS was 20.7 per 1000 live births and it constituted 55.4% of overall sepsis. Among the perinatal risk factors assessed, a significant association of EOS with prolonged rupture of membranes, foul smelling liquor, dai (midwife) handling and maternal urinary tract infection was observed (p < 0.05). Among infants at risk of EOS, 20.6% developed sepsis compared to only 0.5% of those without these risk factors (p 0.001). Even among those at high risk such as low birth weight, preterm, and asphyxiated neonates, incidence of EOS was negligible in the absence of a maternal risk factor. Pneumonia (66.7%), shock (27.7%), metabolic acidosis (19.4%) and meningitis (8.3%) were the comorbidities seen among the cases. Culture proven EOS occurred in 41.6%, Pseudomonas being the commonest (60%) isolate. The case fatality rate was 19.4%. CONCLUSION: Screening for sepsis in an asymptomatic neonate is warranted only in the presence of a maternal risk factor even if the neonate is at high risk of developing sepsis due to associated problems of prematurity, low birth weight or asphyxia. Knowledge of likely causative organisms of EOS can aid in instituting prompt and appropriate therapy, in order to minimise morbidity and mortality.

Risk factors for bacterial vaginosis in women attending a hospital in Kerman, Islamic Republic of Iran

Bacterial vaginosis [BV] is the most prevalent form of vaginal disturbances in women of child-bearing age. This study examined the prevalence and risk factors of BV of 130 non-pregnant women attending a hospital of Kerman University of Medical Sciences. Prevalence was 37.7%. Patients with BV had significantly lower educational and socioeconomic levels. They were also more likely to be smokers. The prevalence of BV was higher in patients with a history of abortion but this was not statistically significant. Women using oral contraceptive pills were at a decreased risk of BV; this was statistically significant. There were significant positive associations between BV and a history of vaginal infection, preterm delivery and premature rupture of the membranes. As BV appears quite prevalent in our patients, and considering the various complications associated with it, screening and treatment of high-risk women is suggested

El test de Apgar una visión de la acción obstétrica: experiencia de 7 años / Apgar score a view point of the obstetric action: experience of 7 years

Se revisaron 382 fichas clínicas con Apgar bajo 7 ptos., a los 5 minutos de vida, de nuestra maternidad desde 1993 hasta 1999. Se investigó: incidencia, patologías asociadas y relación con variables no tradicionales. La incidencia de Apgar bajo 7 fue menor al 1 por ciento, excepto en 1999 (1,21 por ciento). El grupo de pacientes predominantes fue de 17-35 años (88,48 por ciento), siendo un 50,26 por ciento multípara. El 56,54 por ciento de RN eran pretérminos con peso inferior a 2.500 gramos (58,38 por ciento). La vida de parto principal fue vaginal (47,65 por ciento). La RPM representó la principal patología asociada (12,3 por ciento). Los diagnóstico pre y postnatal predominante fueron el trabajo de parto (54,45 por ciento) y la prematuridad (46,34 por ciento) respectivamente. Se encontró una relación directa con edad gestacional peso del RN. Esta investigación resalta la importancia del control prenatal para el diagnóstico precoz de patologías matemofetales, tomando conductas adecuadas para obtener un RN sano

Pre-labour rupture of membrane: the histological study of membrane and bacteriological profile.

One hundred two (102) cases of pre-labour rupture of membrane (PROM) were studied and special attention was given to the histological study of the amniotic membrane as well as to the bacteriological study of high vaginal flora, cervical flora and flora of amniotic fluid, in search of probable causes or factors leading to PROM. The incidence was found to be 3.16% in the age group of 20-25 years without any relation to parity; and the duration of gestation was 38 to 40 weeks in most of the cases. The histological study revealed: (a) Focally denuded amniotic epithelium, focally separated amniotic epithelium from chorion layer, lesser density of focal squamoid change of the epithelium and thicker chorion layer probably indicating focal immaturity of the chorio-amnion, (b) lesser thickness of collagen layer, focal hydropic degeneration and mild cellular infiltrate, (c) presence of focal hyaline degeneration and focal calcification of chorio-amnion. Microbial culture revealed: (a) Higher rate of positive culture in high vaginal swab, cervical swab and amniotic fluid showing presence predominantly of Esch coli, Strept haemolyticus, klebseilla species, Staph aureus, Strept non-haemolyticus, proteus species and pseudomonas species against that of positive cultures in the control cases, (b) no anaerobic bacteria from high vaginal swab, cervical swab or from amniotic fluid. It was presumed that focal immaturity of chorio-amnion or focal irregularity in the chorio-amnion at the microscopical level, focal degeneration of collagen superadded with bacterial infection, however mild, could be the factors leading to weakness in the tensile strength of chorio-amnion, again leading to PROM, in the face of stress factors of foetal origin.

uso de esteroides en la ruptura prematura de membranas pretérmino

Se hace un corto recuento sobre la forma como se descubrió el surfactante, el desarrollo morfológico del pulmón fetal y la composición del surfactante. Se pasa luego a enunciar lo que se conoce sobre la acción de los esteroides en la maduración pulmonar y los posibles efectos adversos a éstos sobre el feto y el neonato. Con el objeto de tener elementos de juicio que permitan concluir sobre el efecto benéfico o no de los esteroides sobre la maduración pulmomar en pacientes con R.P.M. pretérmino, se hace un resumen de los principales trabajos que se han efectuado en los últimos años sobre este aspecto