Association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes. METHODS: This retrospective cohort included pregnant women with premature rupture of membranes (between 24 and 33+6 weeks) who used or did not use prophylactic antibiotics. Pearson's chi-square (χ²) test, Student's t-test, and binary logistic regression were used for statistical analysis. RESULTS: A significant effect was observed in patients with premature rupture of membranes using prophylactic antibiotics regarding amniotic fluid index (p=0.007), deepest vertical pocket (p=0.049), duration of antibiotic therapy (p≤0.001), C-reactive protein level upon admission (p≤0.001), leukocyte count upon admission (p=0.007), and length of stay in neonatal intensive care (p=0.047). A significant association was observed between the abovementioned patients and surfactant use during the neonatal period (p=0.04). A higher prevalence of surfactant use was noted in these patients (20.0 vs. 8.7%; p=0.04). CONCLUSION: No association was found between antibiotic prophylaxis and the presence of adverse perinatal outcomes in pregnant women with premature rupture of membranes between 24 and 33+6 weeks of gestation.

Study of Effectiveness of Medical Method for Induction of Labor and its Outcome

Background: Modern obstetrics has a tremendous issue in inducing full-term labor in women with a viable fetus. When the hazards of prolonging pregnancy outweigh the advantages of birth, induction is undertaken. This study’s objective was to evaluate the efficacy of misoprostol 50µg administered sublingually, orally and vaginally in the process of inducing labor.Material & Methods:Between June 2021 and July 2022, 120 pregnant women admitted in Department of Gynecology and Obstetrics, ShaheedZiaur Rahman Medical College and Hospital, Bogura in Bangladesh were recruited randomly for a randomized control trial as per inclusion criteria. Misoprostol was administered either orally or sublingually to each patient. A maximum of three doses might be administered if necessary. A previous cesarean birth was an exclusion criterion. The number of women who had a vaginal birth during 24 hours of induction was our major metric for success. SPSS 26 was used to analyze the data.Results:The induction to delivery intervals were considerably shorter in the sublingual group (18 hours versus 25.5 hours; mean difference was 6.2 hours; 95 percent confidence interval, 1.5 to 14.6). In the sublingual group, there was just 2% occurrence of uterine hyperstimulation. The two groups did not vary significantly in terms of delivery method, fetal distress, or newborn outcomes. A total of 80% percent and 82.60 percent of patients were satisfied with the oral and sublingual groups, respectively, and only 10% percent believed the sublingual tablets didn’t entirely dissolve.Conclusion:Sublingual misoprostol seems to be a successful method of delivery, although further clinical studies are needed to demonstrate the safety and effectiveness of the sublingual mode.

STUDY OF BACTERIAL VAGINOSIS IN PREGNANCY

AIM Ÿ To screen and diagnose bacterial vaginosis during first two trimesters of pregnancy. Ÿ To give early treatment for bacterial vaginosis during first two trimesters of pregnancy and prevent obstetric complications. METHODS – Pregnant women fitting in the inclusion criteria are recruited and explained about the procedure. Informed consent and ethics committee clearance is obtained. Vaginal smear is sent for microscopy. Vaginal pH is detected. Amine (fishy) odour in wet mount examination is identified. AMSELS score and NUGENTS criterion are applied. Positive specimens are sent for antibiotic culture and sensitivity and treatment is initiated accordingly. Afollow up is kept for all patients diagnosed as bacterial vaginosis to see the outcome of their pregnancy. CONCLUSION - Prevalence of Bacterial vaginosis in my study is 29.2%. BV in pregnancy is common among low socioeconomic status, multigravida, and less educated females. It is associated with significant risk of miscarriages, preterm labour and PROM. Universal screening of all pregnant women at booking visit may be recommended to initiate treatment with metronidazole / clindamycin in those women at risk for preterm delivery, symptomatic women and before surgical abortions.

Expression and role of anti-oxidative damage factors in the placenta of preterm infants with premature rupture of membranes / 中国当代儿科杂志

OBJECTIVES@#To study the association of the anti-oxidative damage factors nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and NAD(P)H:quinone oxidoreductase-1 (NQO1) with preterm premature rupture of membranes (PPROM).@*METHODS@#A prospective study was conducted. The neonates who were hospitalized in Yanbian Hospital from 2019 to 2020 were enrolled as subjects, among whom there were 30 infants with PPROM, 32 infants with term premature rupture of membranes (TPROM), and 35 full-term infants without premature rupture of membranes (PROM). Hematoxylin and eosin staining was used to observe the inflammatory changes of placental tissue. Immunohistochemical staining was used to measure the expression of Nrf2, HO-1, and NQO1 in placental tissue. Western blot was used to measure the protein expression levels of Nrf2, HO-1, and NQO1 in placental tissue.@*RESULTS@#Compared with the PPROM group, the TPROM group and the non-PROM full-term group had significantly higher positive expression rates and relative protein expression levels of Nrf2, HO-1, and NQO1 in placental tissue (P<0.05). There were no significant differences in the positive expression rates and relative protein expression levels of Nrf2, HO-1, and NQO1 in placental tissue between the TPROM and non-PROM full-term groups (P>0.05).@*CONCLUSIONS@#The low expression levels of Nrf2, HO-1, and NQO1 in placental tissue may be associated with PPROM, suggesting that anti-oxidative damage is one of the directions to prevent PPROM.

Repercusión de la corioamnionitis como factor de riesgo en la sepsis materna y neonatal temprana / Impact of Chorioamnionitis as a risk factor in early neonatal and maternal sepsis / Impacto da coioamnionite como fator de risco nasepse materna e neonatal precoce

RESUMEN Introducción: se realiza una revisión bibliográfica sobre la repercusión de la corioamnionitis como factor de riesgo en la sepsis neonatal temprana para la madre y el neonato en el Hospital provincial Universitario Docente "Carlos M. de Céspedes" en Bayamo, Granma en los cinco primeros meses del año 2019. Objetivo: profundizar el conocimiento de este factor de riesgo, suetiopatogenia, factores predisponentes, diagnóstico clínico y de laboratorio, riesgos para la madre y repercusión en el recién nacido, su prevención y tratamiento. Métodos: se utilizaron libros de texto específicos de Medicina y se realizó la recopilación de artículos de Internet a través de buscadores como el Servicio de la Editorial Elsevier, Secretaría de Ciencia y Técnica de la Nación, LILACS, MEDLINE con la asistencia del buscador específico PUBMED, IMBIOMED, La Biblioteca Cochrane, SciELO. Resultados: su incidencia en los partos pretérmino es mayor que en las gestaciones a término. Representa una de las tres principales causas de infección antes de término del embarazo con membranas íntegras y en caso de rotura prematura de membranas. Conclusiones: la repercusión en la madre incluye el parto pretérmino, si cesárea (atonía uterina o hemorragia postparto, absceso pélvico, tromboembolismo y endometritis, sepsis puerperal y la infección del torrente sanguíneo, mientras que en el neonato la leucomalacia periventricular con la consiguiente hemorragia periventricular, la broncodisplasia pulmonar, enterocolitis necrotizante, parálisis cerebral y el retraso mental.

ABSTRACT Introduction: a bibliographical review on the impact of Chorioamnionitis as a risk factor in early neonatal sepsis for the mother and the newborn in the provincial University Hospital "Carlos M. de Céspedes" is carried out in Bayamo, Granma in the first five months of the year 2019. Objective: to deepen the knowledge of this risk factor, its pathogenesis, predisposing factors, clinical and laboratory diagnosis, risks to the mother and repercussion in the newborn, its prevention and treatment. Methods: medicine-specific textbooks were used and the collection of Internet articles was made through search engines such as the service of the Editorial Elsevier, Secretariat of Science and Technology of the nation, LILACS, MEDLINE with the assistance of Specific search engine PUBMED, imbiomed, the Cochrane Library, SciELO. Results: its incidence in preterm births is greater than in term gestations. It represents one of the three main causes of infection before the end of pregnancy with intact membranes and in case of premature rupture of membranes. Conclusion: the impact on the mother includes preterm delivery, if caesarean section (uterine sluggishness or postpartum hemorrhage, pelvic abscess, thromboembolism and endometritis, puerperal sepsis and bloodstream infection, while in the neonate the Periventricular periventricular with consequent periventricular hemorrhage, pulmonary broncodisplasia, necrotizing enterocolitis, cerebral palsy and mental retardation.

RESUMO Introdução: uma revisão bibliográfica é realizada sobre o impacto da coioamnionite como fator de risco na sepse neonatal precoce para mãe e recém-nascidos no Hospital Escolar Provincial "Carlos M. de Céspedes" em Bayamo, Granma nos primeiros cinco meses de 2019. Objetivo: aprofundar o conhecimento desse fator de risco, sua etiopatogeneia, fatores predisponderantes, diagnóstico clínico e laboratorial, riscos para a mãe e impacto sobre o recém-nascido, sua prevenção e tratamento. Métodos: foram utilizados livros didáticos específicos de Medicina e o recolhimento de artigosna Internet foi realizado por meio de mecanismos de busca como o Serviço de Publicação Elsevier, Secretaria de Ciência e Técnica da Nação, LILACS, MEDLINE com o auxílio do mecanismo de busca específico PUBMED, IMBIOMED, The Cochrane Library, SciELO. Resultados: sua incidência em partos prematuros é maior do que nas gestações a termo. Representa uma das três principais causas de infecção antes do fim da gravidez com membranas completas e em caso de ruptura prematura de membranas. Conclusões: o impacto sobre a mãe inclui nascimento prematuro, se cesariana (atonia uterina ou hemorragia pós-parto, abscesso pélvico, tromboembolismo e endometrite, sepse pós-parto e infecção por corrente sanguínea, enquanto na leucomalacia periventricular neonate com hemorrhagem periventricular consequente, broncododisplasia pulmonar, enterocolite necrosante, paralisia cerebral e retardo mental.

A study of maternal outcome in first trimester bleeding

Background: The outcome of first trimester vaginal bleeding is a matter of debate. Vaginal bleeding is common and potentially alarming symptom in early pregnancy. First trimester bleeding is a common occurrence. It has been estimated to occur in 15-25% of all pregnant women. Objective of this study was to evaluate the various maternal outcomes in women with first trimester bleeding.Methods: This prospective observational study was conducted in the postgraduate department of obstetrics and gynecology, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir, India. The study included 200 pregnant women presented with first trimester bleeding. All the women were followed prospectively till delivery and early postpartum period for various outcomes such as preterm delivery, PROM, PPROM, anemia, oligohydramnios, placental abruption, placenta previa and postpartum hemorrhage.Results: Out of 200 patients studied, 19% patients aborted. Ectopic and molar pregnancy was seen in 5% and 1.5% patients respectively. Out of 74.5% patients who continued pregnancy, maternal complications included anemia (52%), PROM (14.09%), oligohydramnios (6.71%), placenta previa (5.37%), PPH (4.03%), PPROM (2.68%), preeclampsia (2.01%), gestational hypertension (1.34%), abruption and post-datism (0.67% each).Conclusions: From the results of this study, it can be concluded that first trimester bleeding can be a predicting factor in terms of mother and infant consequences of pregnancy and it is necessary to increase the knowledge of pregnant women in this regard for closer care.

A study of bacteriological profile and outcome of babies born to mother with Premature rupture of membrane and its correlation with blood and gastric culture

Background: PROM, a condition that occurs when fetal membranes are ruptured at least one hour before onset of labor. While PROM is observed in 10% of all pregnancies, 60-80% of PROM is observed in term and 20-40% in pregnancies less than 37th gestational week. PROM is the most significant reason for preterm labor. The three causes of neonatal death associated with PROM are prematurity, sepsis and pulmonary hypoplasia. Infants born with sepsis have a mortality rate four times higher than those without sepsis. Objective of the study was correlation of blood and gastric culture positive sepsis in PROM newborns. It helps to find out the incidence of PROM in our locality.Methods: This retrospective study enrolled 90 neonates born to healthy mothers with history of PROM more than 18 hours duration, admitted in SNCU/ward at a tertiary care hospital for six months duration from 1st January 2017 to 30 June 2017. Clinical profile of these Newborn with history of PROM was noted such as birth weight, gender, gestation, duration of membrane rupture, history of maternal fever. For all newborns with PROM, sepsis screen had been sent. The neonatal outcome was also recorded, and the data was collected and analyzed by using frequency and percentages.Results: Gram negative bacilli were the commonest cause of neonatal sepsis and male neonates were more prone to infection. PROM and low birth weight especially, ELBW and VLBW are the common high-risk factors for early onset sepsis. Most common organisms isolated in blood and gastric culture were Klebsiella and Staphylococcus aureus respectively.Conclusions: PROM is a high-risk obstetric condition. Active management is needed to enable delivery within 24 hours of PROM as it offers better neonatal outcome. Morbidity and mortality increase as the duration of PROM increases. This can be reduced by early diagnosis, specific treatment and strict infection control practices in neonatal units.

A study of survival of very low birth weight neonates in a tertiary care hospital

Background: Preterm birth is one of the major clinical problems in Obstetrics and Neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. Very low birth weight (VLBW) neonates comprise between 4-8% of live-births but about one-third of deaths during the neonatal period occur in this group of newborns. Data on the probability of survival of infant in high risk pregnancies can be of great value in guiding management. The objective is to study the survival at discharge of VLBW neonates admitted in a tertiary care hospital.Methods: Retrospective observational study of all VLBW infants admitted in Aditya Hospital NICU over 3 years between 1-7-2011 to 30-6-2014. Descriptive and inferential statistical analysis has been carried out in the present study.Results: In the present study maternal PROM was seen in 32.9% of cases, Preeclampsia in 31.7% of cases which constituted the most important antenatal risk factor for VLBW followed by multiple gestations in 25.2%. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Survival improved with increasing gestational age and weight.Conclusions: Birth weight and gestational age specifically predicts survival of preterm VLBW babies, facilitating decision making for obstetricians, neonatologists and parents. In the present study total survival rate was 86.6% with a mortality of 13.4%.

Maternal outcome in term premature rupture of membranes

Background: Rupture of Fetal membranes before the onset of labour is called PROM. Premature rupture of membrane (PROM) is associated with various complications. The present study is undertaken to study the maternal morbidity in term PROM.Methods: A prospective cross-sectional study was conducted at Vijaynagar institute of medical science Ballari for a period of one year by Department of Obstetrics and Gynecology from November 2016 to October 2017.  120 cases of spontaneous rupture of membranes with term gestation with confirmed PROM were selected.Results: PROM was common in age group of 20-29 years (80%), and common in primigravida. Study showed majority of them belongs to low socioeconomic status (80%) , 13.33% belonged  to middle socioeconomic status and 6.66% belonged to higher socioeconomic status. In present study, it is observed that 27.05% cases  went  into  spontaneous labour and delivered normally, 56.50% cases delivered by induction and  20% cases  were delivered by LSCS. The rate of maternal morbidity was 16.6%,  which includes febrile morbidity accounting to maximum with 9.6% followed by wound infection 3.33% and others were PPH(1.66%)and puerperal sepsis (each 1.66%).Conclusions: The rate of maternal morbidity was 16.6% and no maternal death observed. Hence an appropriate and accurate diagnosis of PROM is essential for favorable outcome in pregnancy and reduces the maternal morbidity.

Outcomes of prolonged preterm premature rupture of the membrane: a report of six cases

Preterm premature rupture of the membranes (PROM) is associated with significant maternal morbidity and perinatal mortality. With an increasing era of infertility, the main interest of an assisted reproductive technology specialist is to increase the take-home baby rate. Here authors present report on the outcomes of prolonged preterm PROM cases facilitated with expectant management. Report is based on the medical records of six women with preterm PROM between 16-31 weeks of gestation who gave their consent to continue the pregnancy. These women were diagnosed with PROM by the litmus test and per speculum examination. Ultrasound scan and clinical investigation, which included complete blood count and C-reactive protein level, were performed in all cases. Prophylactic antibiotics were administered to prevent the infection and increase the latency period. All six babies (100%) were delivered successfully. There was no foetal mortality and maternal morbidity observed. Expectant management in preterm PROM cases can increase the survival rate and hence the take-home baby rate.

Maternal and neonatal effects of Acinetobacter colonisation in preterm premature rupture of membrane and term labour

@#Some anecdotal reports suggest that maternal colonisation with Acinetobacter baumannii during pregnancy is associated with adverse maternal and neonatal effects, including preterm premature rupture of membrane (PPROM). The objective of this study was to compare the maternal and neonatal effects of A. baumannii colonisation in cases with PPROM and those with spontaneous onset of labour at term.

Colonization of Acinetobacter baumannii, Streptococcus agalactiae (GBS) and Candida albicans in preterm premature rupture of membrane (PPROM) compared to normal labor at term

Aims@#Preterm premature rupture of membrane (PPROM) is usually associated with maternal vaginal colonization of Group B Streptococci (GBS). However, there are reports on isolation of Acinetobacter baumannii in PPROM cases. In order to ascertain A. baumannii’s role in PPROM, we determine the colonization of A. baumannii and other common vaginal tract flora, i.e. GBS and Candida albicans, in women with PPROM, and compared them to those with normal labor at term (NLT). The transmissibility of the organisms to their babies was also investigated. @*Methodology and results@#A total of 218 high vaginal swabs from 108 and 100 women with PPROM and NLT respectively were collected. The transmission of these organisms to their 215 babies was determined by swabbing the ears and axillae. These were cultured for isolation of A. baumannii, GBS and C. albicans. Results showed that mothers with PPROM were predominantly colonized with GBS (32.4%), followed by C. albicans (19.4%) and A. baumannii (7.4%), compared to 10.9%, 17.3% and 7.2% respectively, in women with NLT. Between 34 to 50% of the babies of mothers with PPROM acquired the organisms, with GBS being the most significantly (p=0.000) transferred compared to other organisms. Co-existence of A. baumannii with either GBS or C. albicans, or both, did not enhance the occurrence of PPROM. @*Conclusion, significance and impact of study@#Colonization of A. baumannii in vaginal tract of pregnant women does not increase the possibility of PPROM, as compared to GBS.

Clinical Analysis of Pregnancy Outcome in 95 Cases with Preterm Premature Rupture of Membrane / 实用妇产科杂志

Objective:To investigate the risk factors of preterm premature ruPture of membrane(PPROM) and their pregnancy outcomes.Methods:The clinical data of 95 cases of patients with PPROM admitted and treated in our hospital from October 2013 to July 2016 were collected,which were divided into two groups,observation group(gestational week 28-33 +6 weeks) and control group(gestational week 34-36 +6 weeks).The risk factors of PPROM,delivery method and pregnancy outcomes were analyzed.Results:Genital tract infection was the main risk factor of PPROM(33.68％).of the incidences of cesarean delivery,neonatal asphyxia,neonatal infections and neonatal death in observation group were significantly higher than those of control group,the differences were statistically significant(P ＜ 0.05).The intrauterine infection and puerperal infection rates of observation group of were higher than those of control group,but differences were not statistically significant (P ＞ 0.05).Conclusions:Reproductive tract infections is the most important risk factor of PPROM.The purpose of active treatment including tocolytic therapy and prevention of infection for the patients with PPROM less than 34 weeks is to prolong the gestational weeks,to reduce the rate of neonatal complication,and to improve the pregnancy outcome.

TLR4/NF-κB signal pathway mediate HBD-2 in patients with preterm premature rupture of membrane associated with histologic chorioamnionitis / 中国综合临床

Objective To observe the effect of human β-defensins-2(HBD-2) for chorioamnionitis(HCA) pregnant women before term premature rupture of fetal membrane(PROM) process,and explore toll-like receptor 4 / nuclear factor-κ B (TLR4 / NF-κB) predominate role in the process of signal transduction pathway in the mechanism.Methods Fifty five women with PROM were enrolled in the study.According to the Results of pathological diagnosis of membranes,pregnant women with PROM divided into histological chorioamnionitis,HCA and non-HCA.The same sample without PROM pregnancies matching the same gestational ages were recruited as control group.We examined the messenger RNA(mRNA) of TLR4,NF-κB p65 and HBD-2 in placenta and fetal membrane real-time reverse transcription polymerase chain reactions by dsDNA-binding dyes of SYBR Green.Results (1)In the placenta,the level of TLR-4(17.15±4.52),NF-κB p65(47.11±14.23),HBD-2mRNA(27.35±2.67) in PROM group were significantly higher than the level of TLR-4(7.21±3.25),NF-κB p65(30.51±13.05),HBD-2mRNA(13.55±0.8) in control group(t=-1.966,-1.474,-1.754,P0.05).Conclusion Linear positive correlation of TLR4,NF-κB and HBD2 indicated that TLR4/NF-κB/HBD2 signal transduction pathway may be involved in the development of preterm premature rupture of membrane associated with histologic chorioamnionitis.

Relationship between early-onset neonatal sepsis and the level of interleukin-6, C-reactive protein in umbilical cord serum of the newborns with premature rupture of membrane / 中国新生儿科杂志

Objective To study the levels of interleukin-6 (IL-6) and C-reactive protein(CRP) in umbilical cord serum of the newborns with premature rupture of membrane(PROM)and to explore the value of IL-6 and CRP in the diagnosis of early onset neonatal sepsis (EONS).Method A total of 187 term newborns with PROM ＞ 12 h who were born normal vaginally in our Hospital from April 2015 to December 2015 were enrolled in this study as the PROM group and another 50 term infants without PROM and infection as the control group.The levels of IL-6 and CRP in umbilical cord serum were quantified by ELISA,the results of which were compared between groups.Receiver operating characteristics (ROC) curves were drawn to find out the cut-off value of IL-6 and CRP for the diagnosis of EONS.Result The levels of IL-6 and CRP in umbilical cord serum in the PROM group were significantly higher than those in the control group [IL-6 20.3 (9.5,35.8) pg/ml vs.9.3 (6.9,27.5) pg/ml,CRP 0.42 (0.25,0.78) mg/L vs.0.33 (0.18,0.45) mg/L,P ＜ 0.05].The levels of IL-6 and CRP in the newborns whose mother had chorioamnionitis were significantly higher than those in the newborns whose mother was without chorioamnionitis [IL-6 62.5 (35.2,92.7) pg/ml vs.10.8 (9.3,33.4) pg/ml,CRP 0.86 (0.44,1.95) mg/L vs.0.35 (0.20,0.62) mg/L,P ＜0.05].The levels of IL-6 and CRP in the infants with PROM≥18 h was significantly higher than those in the infants with PROM ＜ 18 h [IL-6 32.1 (9.9,42.2) pg/ml vs.10.7 (9.2,32.6) pg/ml,CRP 0.44(0.29,0.86) mg/L vs.0.35 (0.23,0.61) mg/L,P ＜ 0.05].The levels of IL-6 and CRP in the neonates with EONS was significantly higher than those in the neonates without EONS [IL-6 92.0 (58.3,161.0) pg/ml vs.20.0(9.4,35.2)pg/ml,CRP 1.94(0.47,2.73) mg/L vs.0.38(0.24,0.67) mg/L,P ＜ 0.05].ROC curve analysis showed that the cut-off value of IL-6 and CRP for the diagnosis of EONS were 81.lpg/ml (sensitivity 76.5％,specificity 90.6％) and 1.88mg/L (sensitivity 64.7％,specificity 89.4％).With the combination of IL-6 and CRP levels,the sensitivity was 88.2％ and the specificity was 84.1％ for the diagnosis of EONS.Conclusion To measure the IL-6 and CRP levels in umbilical cord serum is helpful for the early diagnosis of EONS,and the combined detection of the 2 items may improve the sensitivity of diagnosis.

Maternal and fetal outcomes in term premature rupture of membrane / 世界急诊医学杂志（英文）

@#BACKGROUND: Premature rupture of membrane (PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia. METHODS: A retrospective cross sectional study was conducted using data available at Mizan-Aman General Hospital during a period of 3 years (January 2011 to December 2013). We examined records of 4525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95％CI and P value less than 0.05 were considered statistically significant. RESULTS: Of the 4525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2％ of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5％ of neonates experienced unfavorable outcomes. The duration of PROM >12 hours (AOR=5.6, 95％CI 1.3–24.1) latency >24 hours (AOR=2.8, 95％CI 1.7–11.8), residing in rural areas (AOR=4.2, 95％CI 3.96–29.4) and birth weight less than 2500 g were associated with unfavorable outcomes. CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.

Uterus Didelphys presenting with ruptured uterus in third pregnancy: A rare case report

Uterus Didelphys “double uterus” is a congenital malformation that results from complete failure of fusion of the ipislateral paramesonephric ducts during embryonic development. Ideally, diagnosis should be made before pregnancy and labor to prevent adverse outcomes. Here we report a case of uterus didelphys in 30 year old female Gravida4 Para3 Living2 at 31st week of pregnancy admitted with prolonged rupture of membrane, hypovolemic shock and intrauterine fetal death. Postoperative recovery of the mother was uneventful. Clinicians should have high index of suspicion of uterine anomaly when assessing cases of dysfunctional labor to avoid delayed diagnosis and the associated adverse outcome

Distribution and Drug Resistance of Genital Tract Pathogenic Bacteria in Pregnant Women with Premature Rupture of Membrane / 现代检验医学杂志

Objective To investigate the distribution and drug resistance of genital tract pathogens in pregnant women with premature rupture of membranes (PROM),and provide guidance for clinical rational use of antibiotics.Methods From 2011 to 2013,3 162 cases of patients with premature rupture of membranes were cultured for bacteria,Mycoplasma and Chlamydia.Identification and drug sensitive test of the bacteria were detected by VITEK II system;all of the data were ana-lyzed by WHONET5.6 software.Results The rate of infection was 33.30%,in which the positive rate of bacteria,Fung, Mycoplasma culture and Chlamydia trachomatis antigen detection were 13.19%,4.87%,24.89% and 2.72% respectively. The ratio of Escherichia coli producing extended spectrum beta lactamases (ESBLS)were 13.76%.The ratio of Methicillin resistant Staphylococcus aureus (MRSA)and Methicillin resistant coagulase negative Staphylococcus (MRCNS)were 27.27%and 66.25% respectively.Mycoplasma was most sensitive to minocycline,doxycycline.Conclusion Mycoplasma in-fection was the first,followed by bacteria.clinical should strengthen the surveillance of pathogen infection,and rational use of antibiotics according to the results of drug sensitive test.

RETROSPECTIVE STUDY OF 2014 PRENATAL MORTALITY DATA OF THE FIRST MATERNITY HOSPITAL OF ULAANBAATAR CITY / Шинэ санаа Шинэ нээлт

In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks.Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6%/795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.

RETROSPECTIVE STUDY OF 2014 PRENATAL MORTALITY DATA OF THE FIRST MATERNITY HOSPITAL OF ULAANBAATAR CITY / Шинэ санаа Шинэ нээлт

In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks. Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6% /795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.