Maternal and perinatal outcomes in midtrimester rupture of membranes.

OBJECTIVE: The aim of this study was to assess neonatal and maternal adverse outcomes following expectant management of preterm prelabor rupture of membranes (PPROM) between 18 and 26 weeks and to identify maternal morbidity and prognostic factors for neonatal outcomes. METHODS: Data were collected from all pregnant women who presented PPROM between 18+0 and 26+0 weeks admitted into two tertiary centers in Brazil from 2005 to 2016. The neonatal adverse outcomes (mortality or the development of a severe morbidity) and maternal adverse outcomes were analyzed and compared among four groups (180/7 to 200/7 weeks, 20+1 to 220/7 weeks, 22+1 to 240/7 weeks and 24+1 to 260/7 weeks). A multiple logistic regression was performed for each predictor of neonatal adverse outcomes, and the area under the receiver operating characteristics curves for birth weight and gestational age at birth were calculated. RESULTS: Of the 101 women with PPROM during the study period, 97 fulfilled the eligible criteria. Among these patients, 30 (30.9%) had a miscarriage or stillbirth. Overall there were 67/97 (69.1%) livebirths, 45/97 newborns survived to discharge (46.3%), and 53/97 (54.6%) experienced severe neonatal adverse outcome. The median latency period was seven days, with 36 (37.1%) patients ending the pregnancy in 2-14 days. Among 29 patients with PPROM at 24+1 to 260/7 weeks, only 13 (44.8%) delivered between 2 and 14 days. Multivariate analysis has demonstrated that the independent predictor for adverse neonatal outcome was birthweight. The maternal morbidity was high; however, the expectant management did not increase the rate of severe maternal morbidity. CONCLUSIONS: PPROM between 18+0 and 26+0 weeks has high morbidity and mortality, and the only significant independent predictor of severe adverse neonatal outcomes is birthweight. Maternal morbidity is high, however, the expectant management is not increased by expectant management.

Resultados adversos maternos e neonatais de gestações acometidas por ruptura prematura de membranas ovulares da viabilidade / Adverse maternal and neonatal outcomes of pregnancies affected by premature rupture of ovarian membranes from viability

Objetivo: avaliar os resultados adversos neonatais e maternos após a conduta expectante na ruptura prematura de membranas ovulares (RPMO) entre 18 e 26 semanas e identificar fatores prognósticos para os desfechos neonatais. Métodos: estudo retrospectivo que analisou todas as gestantes com diagnóstico de RPMO entre 180/7 e 260/7 semanas admitidas em dois centros terciários de 2005 a 2016. Os resultados adversos neonatais (mortalidade ou desenvolvimento de pelo menos uma morbidade grave) e maternos foram analisados e comparados entre 4 grupos conforme a idade gestacional em que a PROM ocorreu: (a) 180/7 e 200/7semanas, (b) 201/7 e 220/7semanas, (c) 221/7 e 240/7semanas e (d) 240/1 e 260/7semanas. Foi realizada uma análise multivariada para identificar os fatores preditores independentes para os desfechos adversos neonatais, e calculou-se a área sob as curvas ROC (receiver operating characteristics curves) para peso e idade gestacional ao nascer. Resultados: foram identificadas 101 mulheres com RPMO neste período, 4 foram excluídas, sendo 02 por diagnóstico de malformação fetal e 02 por apresentar gestação múltipla. Dentre as 97 pacientes recentes, 30 (30,9%) evoluíram para aborto espontâneo ou para natimorto, 67 (69,1%) deram à luz a recém-nascidos vivos (RN), 45 destes receberam alta hospitalar (46,3%). Desfechos adversos neonatais graves foram observados em 53 (54,6%) RN, sendo 22 óbitos (22,6%). A mediana dos períodos de latência foi de 7 dias, com 36 (37,1%) gestantes evoluindo para parto em 2 a 14 dias. Dentro das 29 pacientes com RPMO entre 241/7 ­ 260/7 semanas, apenas 13 (44,8%) tiveram o parto entre 2 e 14 dias. A análise multivariada demonstrou que o único preditor independente para desfecho neonatal adverso foi o peso ao nascer. As principais complicações maternas foram corioamnionite (38/97) e retenção placentária (26/97). Não houve diferença entre os 4 grupos para as complicações infecciosas e houve uma diminuição significativa na frequência de retenção placentária e necessidade de curetagem com a evolução do tempo gestacional. Conclusão: diagnóstico de RPMO entre 180/7 e 260/7 semanas foi associado a elevada morbidade materna e neonatal. A mortalidade neonatal também foi alta, e o único fator prognóstico identificado foi o peso ao nascimento.

Objective: to assess neonatal and maternal adverse outcomes following expectant management of preterm prelabor rupture of membranes (PPROM) between 18 and 26 weeks and to identify maternal morbidity and prognostic factors for neonatal outcomes. Methods: restrospective data were collected from all pregnant womem who presented PPROM between 18+0 ­ 26+0 weeks admitted into two tertiary center in Brazil from 2005­2016. The neonatal adverse outcomes (mortality or the development of a severe morbidity) and maternal adverse outcome were analyzed and compared among 4 groups (180/7-200/7 weeks, 20+1­ 220/7 weeks, 22+1­ 240/7 weeks and 24+1­ 260/7 weeks). A multiple logistic regression was performed for each predictor of neonatal adverse outcomes, and the area under the receiver operating characteristics curves for birth weight and gestacional age at birth were calculated. Results: We identified 101 pregnant women with PPROM during the study period, 4 were excluded, 02 for fetal anomaly and 02 for twin pregnancy. Among 97 eligible women, 30 (30.9%) evolved to miscarriage or stillbirth, 67 (69.1%) to livebirth, and 45 newborns survived to discharge (46,3%). Severe adverse neonatal outcome occured in 53 cases (54,6%), 22 (22.6%) deaths. The median of latency period was 7 days, with 36 (37.1%) patients ended the pregnancy up 2 to 14 days. Among 29 patients with PPROM at 24+1­ 260/7 weeks, only 13 (44.8%) had the delivery between 2 and 14 days. Multivariate analysis demonstrated that the only independent predictor for severe adverse neonatal outcome was birthweight. The main maternal morbidities were chorioamnionitis (38/97) and placental retention (26/97). There was no difference between the 4 groups for infectious complications and there was a significant decrease in the frequency of placental retention and the need for winter curettage with the evolution of pregnancy. Conclusion: PPROM between 18+0 and 26+0 weeks was associated with high maternal and neonatal morbidity. The neonatal mortality was also high, and the only significant independent predictor of severe adverse neonatal outcomes founded was birthweight.

Zika Virus Infection Associated With Congenital Birth Defects in a HIV-infected Pregnant Woman.

We describe a case of Zika virus infection acquired during the first trimester in a HIV-infected pregnant woman that led to multiple fetal malformations and fetal demise in Rio de Janeiro, Brazil.

Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks.

OBJECTIVE: The aim of this study was to identify adverse neonatal outcomes and identifies the predictors of adverse neonatal outcomes in premature rupture of membranes before 26 weeks. METHODS: Data were collected between January 2005 and December 2011 from all pregnant women who presented preterm premature rupture of membranes (PPROM) between 18 and 26 complete weeks of gestation and were admitted to one of three Brazilian institutes. The adverse outcomes included mortality or the development of a severe morbidity during the length of stay in the neonatal intensive care unit (NICU). The descriptive statistics of the population were reported. A multiple logistic regression was performed for each predictor of neonatal adverse outcomes. The area under the receiver operating characteristics curves for the birth weight was calculated. RESULTS: Composite adverse outcomes during the NICU stay occurred in 82.1% (n = 23) of the cases and included 33 (54%) neonatal deaths, 19 (67.8%) cases of retinopathy of prematurity (ROP), 13 (46.4%) cases of pulmonary hypoplasia (BPD), 8 (28.5%) cases of periventricular-intraventricular hemorrhage (PIH) and 3 (10.7%) cases of periventricular leukomalacia (PVL). Only 17.8% (n = 5) of the neonates survived without morbidity. The area under the curve for the birth weight was 0.90 (95% IC: 0.81-0.98) for the prediction of mortality. CONCLUSIONS: PPROM before 26 weeks has a high morbidity and mortality, and the significant predictors of neonatal mortality and adverse outcomes were antibiotic prophylaxis, latency period, GA at birth and birth weight. Nevertheless, the only independent significant predictor of survival rate was birth weight.