[Factors and neonatal outcomes associated with histologic chorioamnionitis after premature rupture of membranes in the preterms].

OBJECTIVE: To investigate factors and neonatal outcomes associated with histologic chorioamnionitis (HCA) in preterm premature rupture of membranes (PPROM). METHODS: From Jan. 2008 to Jun. 2011, 230 women with PPROM at 28 - 33(+6) weeks of gestation undergoing deliveries in the Second Affiliated Hospital of Wenzhou Medical College were studied retrospectively. According to placental histopathologic findings, those patients were categorized into two groups, including 138 cases in histologic chorioamnionitis (HCA group) and 65 cases in non-chorioamnionitis (control) group. Age, parity, gestational age of PPROM and delivery, latency period, oligohydramnios, white blood cell (WBC) count and serum C-reactive protein (CRP) level at admission and before delivery, the incidence of neonatal respiratory distress syndrome (NRDS), neonatal pneumonia, bronchopulmonary dysplasia, necrotizing enterocolitis, early-onset neonatal sepsis, abnormal brain sonography findings and mortality were compared between two groups. RESULTS: (1) The incidence of HCA was 68.0% (138/203) in all 203 cases with PPROM. (2) The occurring ruptured membrane gestation in HCA group was (31.1 ± 1.5) weeks, which were significantly earlier than (32.0 ± 1.3) weeks in control group (P < 0.05). The level of CRP of (8.2 ± 14.9) mg/L before delivery in HCA group was significantly higher than (5.5 ± 7.2) mg/L in control group (P < 0.05). The rate of oligohydramnios and cesearean sections were 55.1% (76/138) and 45.7% (63/138) in HCA group, which were significantly higher than 30.8% (20/65) and 29.2% (19/65) in control group (P < 0.05). There were no significant difference in patient's age, parity, WBC count and CRP at admission between two groups (P > 0.05). The latency period did not show significant difference between (140 ± 116) hours in HCA group and (129 ± 125) hours in control group (P > 0.05). (3) Using multivariable logistic regression models, oligohydramnios (OR = 2.937), gestational age of PPROM < 32 weeks (OR = 2.352), serum CRP level > 8 mg/L before delivery (OR = 4.923) and latency period > 48 - 168 hours (OR = 4.439) were significantly associated with HCA (P < 0.05). (4) The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group [(32.0 ± 1.5) weeks vs. (32.7 ± 1.5) weeks, (1680 ± 379) g vs. (2017 ± 333) g, respectively, P < 0.05]. The incidence of Apgar < 7, abnormal brain sonograhy findings, neonatal pneumonia, bronchopulmonary dysplasia, early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group [20.3% (28/138) vs. 7.7% (5/65), 14.5% (20/138) vs. 4.6% (3/65), 12.3% (17/138) vs. 3.1% (2/65), 5.8% (8/138) vs. 0, 6.5% (9/138) vs. 0, 12.3% (17/138) vs. 3.1% (2/65), respectively, P < 0.05]. The incidence of necrotizing enterocolitis (1.5%, 2/138) in HCA group was higher than that of control group (0) and the incidence of NRDS (18.8%, 26/138) in HCA group did not show statistical difference with 21.4% (14/65) in control group (P > 0.05). CONCLUSIONS: It was found that HCA was significantly correlated with lower gestational age of PPROM, higher serum CRP level before delivery, prolonged latency period and oligohydramnios in PPROM. HCA could increase the neonatal morbidity and mortality.

Maternal-fetal fluid balance and aquaporins: from molecule to physiology.

Maternal-fetal fluid balance is critical during pregnancy, and amniotic fluid is essential for fetal growth and development. The placenta plays a key role in a successful pregnancy as the interface between the mother and her fetus. Aquaporins (AQPs) form specific water channels that allow the rapid transcellular movement of water in response to osmotic/hydrostatic pressure gradients. AQPs expression in the placenta and fetal membranes may play important roles in the maternal-fetal fluid balance.

[Clinical outcomes and characteristics of concurrent eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome].

OBJECTIVE: the purpose was to describe the outcomes and characteristics of the obstetric patients with concurrent eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP) syndrome. METHODS: we retrospectively collected the materials between December 1999 and December 2008 in Obstetric Critical Care Center of Guangzhou. There were 76 patients in rolled then they were divided into two groups according to with or without HELLP syndrome. All the patients were injected Magnesium Sulfate to control seizure and to prevent the recurring of seizure. We analyzed the characteristics (such as age, gestational weeks, blood pressure after seizure), complications, biochemistry markers, the rate for intensive care unit (ICU) admittion, the need for mechanical ventilation, the Glasgow coma score (GCS) when admitted into ICU, computed tomography scan (CT) or magnetic resonance imaging (MRI), death rate of maternal and others, then compared between the two groups. RESULTS: (1) general data: There were 17 patients admitted with both eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of eclampsia with HELLP syndrome was 22% (17/76). In eclampsia with HELLP syndrome group, the systolic blood pressure was higher and the rate of preterm also was higher [(182 ± 20) mm Hg (1 mm Hg = 0.133 kPa) vs. (159 ± 21) mm Hg, P < 0.05]. But in regard to the age, gestational weeks, the rate of regular prenatal care and diastolic blood pressure, there were no differences between the two groups. (2) Biochemistry markers: the aspartate transaminase (AST), lanine transaminase (ALT), blood urea nitrogen and creatinine were significantly increased in eclampsia with HELLP syndrome group than eclampsia without HELLP syndrome group [(879 ± 337) U/L vs. (90 ± 27) U/L, (344 ± 83) U/L vs. (43 ± 11)U/L, (2245 ± 294) U/L vs. (485 ± 61) U/L, (14 ± 9) mmol/L vs. (7 ± 3) mmol/L, (140 ± 92) µmol/L vs. (83 ± 28) µmol/L, P < 0.01, P < 0.05], and the platelet was lower in eclampsia with HELLP syndrome group [(38 ± 13) × 10(9)/L vs (172 ± 46) × 10(9)/L, P < 0.01]. (3) Clinical outcomes: The maternal death rate was 35% (6/17) in eclampsia with HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (3%, 2/59) (P < 0.05). There were more patients admitted to ICU and more patients who need mechanical ventilation in eclampsia with HELLP syndrome (13/17 vs. 34%, 9/17 vs. 24/, P < 0.05), also more patients with GCS ≤ 8 in eclampsia with HELLP syndrome when admitted to ICU (8/17 vs. 7/59, P < 0.05), compared to the eclampsia without HELLP syndrome group. There were more patients complicated with cerebral venous thrombosis and cerebral hemorrhage in eclampsia with HELLP syndrome group than other group (8/17 vs. 7%, P < 0.05). Five of six patients died of cerebral hemorrhage in eclampsia with HELLP syndrome group, while other two missing cases in eclampsia without HELLP syndrome group all died of cerebral hemorrhage. The all missing cases were performed CT or MRI and seven (7/8) of them showed cerebral hemorrhage. CONCLUSION: the incidence of concurrent eclampsia and HELLP syndrome was not rare, it happened seriously and with more mortalities, such as cerebral hemorrhage, and also the maternal mortality rate was significantly higher. It should be warning that the obstetrician should take great attention for these women, and consider life support treatment for them.