Feasibility study of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester / 中华妇产科杂志

Objective:To investigate the feasibility of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester.Methods:A retrospective cohort study was conducted to collect 103 pregnant women who were diagnosed with premature rupture of membranes in the second trimester of pregnancy and insisted on continuing the pregnancy in Shanxi Bethune Hospital from July 2012 to July 2022. According to the degree of vaginal fluid, pregnant women were divided into rupture group (with typical vaginal fluid, 48 cases) and leakage group (without typical vaginal fluid, 55 cases). The rupture latency (the time from rupture of membranes to termination of pregnancy), gestational weeks of termination, indications and methods of termination of pregnancy, maternal infection related indicators and perinatal outcomes were compared between the two groups. Univariate regression model was used to analyze the correlation between different degrees of vaginal fluid in pregnant women with premature rupture of membranes and maternal and neonatal outcomes.Results:(1) Obstetric indicators: there was no significant difference in the gestational age of rupture of membranes between the two groups ( P>0.05). However, the proportion of rupture latency >28 days in the leakage group was significantly higher than that in the rupture group [42% (23/55) vs 13% (6/48); χ2=33.673, P<0.001], and the incidence of pregnancy termination ≥28 weeks was significantly higher [47% (26/55) vs 19% (9/48); χ2=9.295, P=0.002]. (2) Indications and methods of termination: the incidence of progressive reduction of amniotic fluid as the indication for termination in the leakage group was significantly lower than that in the rupture group [22% (12/55) vs 42% (20/48); χ2=4.715, P=0.030], and the incidence of full-term termination in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 12% (6/48); χ2=5.008, P=0.025], while there were no significant differences in the indications of termination of pregnancy, including amniotic cavity infection, uterine contraction failure and fetal distress between the two groups (all P>0.05). The incidence of induced labor or spontaneous contraction in the leakage group was significantly lower than that in the rupture group [53% (29/55) vs 81% (39/48); χ2=9.295, P=0.002], while the cesarean section rate and vaginal delivery rate were similar between the two groups (both P>0.05). (3) Infection related indicators: the incidence of amniotic cavity infection in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 13% (6/48); χ2=4.003, P=0.045]. However, there were no significant differences in the elevation of inflammatory indicators, the positive rate of cervical secretion bacterial culture and the incidence of tissue chorioamnionitis between the two groups (all P>0.05). (4) Perinatal outcomes: the live birth rate in the leakage group was significantly higher than that in the rupture group [51% (28/55) vs 27% (13/48); χ2=5.119, P=0.024]. The proportion of live births with 1-minute Apgar score >7 in the leakage group was significantly higher than that in the rupture group [38% (21/55) vs 17% (8/48); χ2=4.850, P=0.028]. However, there were no significant differences in the birth weight of live births and the incidence of neonatal complications between the two groups (all P>0.05). (5) Univariate regression analysis showed that compared with the rupture group, the leakage group had a higher risk of pregnancy termination at ≥28 gestational weeks ( RR=2.521, 95% CI: 1.314-4.838; P=0.002), amniotic infection ( RR=2.473, 95% CI: 1.061-5.764; P=0.025), perinatal survival ( RR=1.880, 95% CI: 1.104-3.199; P=0.014). Conclusion:Compared with pregnant women with typical vaginal fluid in the second trimester of premature rupture of membranes, expectant treatment for pregnant women with atypical vaginal fluid is more feasible, which could effectively prolong the gestational weeks and improve the perinatal live birth rate.

[Comment on article "Risk factors associated with preterm birth in a second level hospital"]. / Comentario al artículo "Factores de riesgo asociados a parto pretérmino en un hospital de segundo nivel".

Preterm birth is a worldwide problem with a high economic impact and morbimortality in children. Therefore, the literature has focused on finding modifiable factors associated with this entity, such as the study "Risk factors associated with preterm birth in a second level hospital," which concluded that "100% of risk factors associated with preterm birth are potentially preventable". Our team reanalyzed the results and found in the regression model that premature rupture of membranes was the only variable associated with preterm birth. This variable is not 100% preventable, so the results found are different from the authors' conclusions.

El parto pretérmino es un problema a nivel mundial que tiene un alto impacto económico y de morbimortalidad en los niños. Por lo tanto, la literatura se ha centrado en encontrar factores modificables asociados a esta entidad, como el estudio de "Factores de riesgo asociados a parto pretérmino en un hospital de segundo nivel de atención", el cual tiene como conclusión que "El 100% de los factores asociados a parto pretérmino son potencialmente prevenibles". Nuestro equipo volvió a analizar los resultados y encontró en el modelo de regresión que la ruptura prematura de membranas fue la única variable asociada a parto pretérmino. Esta variable no es 100% prevenible, por lo que los resultados encontrados son diferentes a las conclusiones de los autores.

The diagnostic value of serum levels of pro calcitonin, β2 defensins, C-reactive protein and the positive rate of group B streptococci in preterm premature rupture of membranes with amniotic infection / 中国医师杂志

Objective:To explore the diagnostic value of serum levels of pro calcitonin (PCT), β2 defensins (HBD-2), C-reactive protein (CRP) and the positive rate of group B streptococci (GBS) in preterm premature rupture of membranes (PROM) with amniotic infection.Methods:This study was a retrospective study. 156 pregnant women with preterm PROM who were diagnosed by the Obstetrics Department of the Hospital of Southern University of Science and Technology from January 2017 to January 2022 were selected as the study subjects. According to whether there was amniotic infection, they were divided into 57 infected women and 99 non infected women. The levels of serum PCT, HBD-2 and CRP before delivery were compared between the two groups, and the positive rate of GBS in vaginal discharge was detected, and the receiver operating curve (ROC) was used to analyze the value of various indicators in diagnosing amniotic cavity infection in preterm PROM mothers.Results:The serum levels of PCT, HBD-2, CRP, and GBS positivity in the infected group were significantly higher than those in the non infected group, with statistically significant differences (all P<0.01); The area under the curve (AUC) value, sensitivity, and specificity of serum PCT for diagnosing preterm PROM with amniotic cavity infection were 0.894, 82.56%, and 80.74%, respectively; The AUC value of HBD-2 for diagnosing preterm PROM with amniotic cavity infection was 0.792, the sensitivity was 70.78%, and the specificity was 77.59%; The AUC value, sensitivity, and specificity of CRP in diagnosing preterm PROM with amniotic cavity infection were 0.756, 68.94%, and 72.78%, respectively; The positive rate of GBS in vaginal discharge was 0.733, the sensitivity was 64.91%, and the specificity was 81.82%. Conclusions:The serum levels of PCT, HBD-2, CRP and the positive rate of GBS in vaginal discharge of pregnant women with preterm PROM complicated with amniotic infection will increase significantly. All indicators have high practical value for the diagnosis of preterm PROM complicated with amniotic infection.

Management of preterm premature rupture of membranes: controversies and challenges / 中华围产医学杂志

Preterm premature rupture of membranes (PPROM) is always an important issue in obstetric clinical studies for its high incidence and association with maternal and neonatal morbidity, such as preterm birth, infection, respiratory disease, etc. Although the management of PPROM has been updated and improved in recent years, some controversies and challenges still exist. Are PPROM women required for bed rest? Which is better for PPROM women, labor induction or expectant treatment? How to select various medications to achieve the best effect for PPROM women? Based on the newest evidence in recent years, this paper elaborates on the above issues in detail.

Diagnosis and management of premature rupture of membranes at term / 中华围产医学杂志

Premature rupture of membranes is a common complication in the third trimester and is often a clinical manifestation before the onset of labor. Clinical management strategy of term premature rupture of membranes is still controversial even after a hundred years of discussion. This article summarizes and discusses the occurrence, diagnosis, and clinical management strategy of term premature rupture of membranes.

Risk factors for preterm premature rupture of membranes after transvaginal cervical cerclage: a retrospective cohort study / 中华围产医学杂志

Objective:To investigate the incidence and risk factors associated with preterm premature rupture of membranes (PPROM) following transvaginal cervical cerclage.Methods:This retrospective cohort study involved 170 singleton pregnancies with cervical incompetence who underwent vaginal cervical cerclage at Fujian Maternity and Child Health Hospital from January 2021 to January 2022. Based on the onset of PPROM after cervical cerclage, the patients were divided into the PPROM group ( n=28) and the non-PPROM group ( n=142). Independent samples t-test, rank-sum test, Chi-square test, or Fisher's exact test were used to compare the general condition, pre- and postoperative data, pregnancy complications or comorbidities between the two groups, with a significance level at α=0.1. Multiple logistic regression analysis was conducted to identify the risk factors for PPROM after cerclage surgery. Results:The overall incidence of PPROM after vaginal cervical cerclage was 16.5% (28/170). Logistic regression analysis showed that a history of cervical conization ( OR=11.966, 95% CI:1.695-84.468), the use of Mersilene RS22 tape as the suture material ( OR=3.318, 95% CI:1.064-9.252), cervical length<2.5 cm after cerclage ( OR=3.486, 95% CI:1.116-10.888), and Mycoplasma genitalium- positive results for cervical secretion culture after surgery ( OR=4.856, 95% CI:1.487-15.861) were the independent risk factors for PPROM after cervical cerclage (all P<0.05). Conclusions:The incidence of PPROM following vaginal cervical cerclage is relatively high and can have unfavorable effects on pregnancy outcomes. Factors such as a history of cervical conization, the use of Mersilene RS22 tape for cerclage, cervical length<2.5 cm after cerclage, and Mycoplasma genitalium-positive results for cervical secretion culture after surgery may increase the risk of PPROM after cerclage.

Riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria

La salud materna y perinatal es una de las prioridades actuales de la salud global. La enfermedad cardiovascular y el accidente cerebrovascular son las principales causas de mortalidad materna. La abrupción placentaria sigue siendo una preocupación crítica para la morbilidad materna debido a que se ha asociado a enfermedad vascular a largo plazo. Sin embargo, no existe mucha literatura disponible en español ni evidencia reciente que haya dilucidado algunas interrogantes sobre este tópico. Entonces, el objetivo de esta revisión consiste en sintetizar evidencia reciente sobre el riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria. Se encontró que, a través de mecanismos fisiopatológicos complejos, que involucran la estructura y funcionalidad de la red vascular placentaria con posterior extensión de lesión vascular y producción de factores proinflamatorios y procoagulantes que permanecen después del parto, se precipita la aparición de eventos cardiovasculares mayores a mediano y largo plazo. Evidencia de alta calidad ha revelado que el riesgo de sufrir de complicaciones maternas en aquellas mujeres con abrupción placentaria es de 2,14, que se eleva aún más para aquellas con desprendimiento severo. A mediano y largo plazo, el riesgo de mortalidad por cardiopatía coronaria es de 2,64, y de 1,70 para desorden cerebrovascular, con igual riesgo tanto para el tipo isquémico como hemorrágico. Entonces, se puede concluir que el riesgo cardiovascular y cerebrovascular es inminente en mujeres con antecedente de abrupción placentaria, dado por numerosos mecanismos fisiopatológicos vasculares. No obstante, este riesgo se eleva considerablemente al asociarse con factores modificables tradicionales y no tradicionales.

Maternal and perinatal health is one of today's global health priorities. Cardiovascular disease and stroke are the leading causes of maternal mortality. Placental abruption remains a critical concern for maternal morbidity because it has been associated with long-term vascular disease. However, there is neither much literature available in Spanish nor recent evidence elucidating some questions on this topic. Thus, this review aims to synthesize recent evidence on the long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption. It was found that, through complex pathophysiological mechanisms involving the structure and functionality of the placental vascular network with subsequent extension of vascular injury and production of proinflammatory and procoagulant factors which remain after delivery, major cardiovascular events are precipitated in the medium and long term. High-quality evidence has shown that the risk of maternal complications in women with placental abruption accounts for 2.14, rising even higher for those with severe placental abruption. In the medium and long term, the mortality risk caused by coronary heart diseases is 2.64 and by cerebrovascular disorders is 1.70, with equal risk for both ischemic and hemorrhagic strokes. It can therefore be concluded that cardiovascular and cerebrovascular risk is imminent in women with a history of placental abruption due to a number of vascular pathophysiological mechanisms. However, this risk is considerably increased when associated with traditional and non-traditional modifiable factors.

The expression of high mobility group protein 1 and interleukin-17 in peripheral blood and membrane tissues of pregnant women with premature rupture of membranes and its relationship with intrauterine infection / 中国医师进修杂志

Objective:To investigate the expression of high mobility group protein 1 (HMGB1) and interleukin-17 (IL-17) in peripheral blood and membrane tissues of pregnant women with premature rupture of membranes (PROM) and its relationship with intrauterine infection.Methods:Seventy-four pregnant women with PROM from January 2019 to June 2021 were selected as the study group, and 58 healthy pregnant women at the corresponding period were selected as the healthy control group. The levels of HMGB1 and IL-17 in peripheral blood and membrane tissues and serum CD 8+ were compared between the two groups. The pregnant women with PROM were divided into the chorioamnionitis group, subclinical chorioamnionitis group and normal group according to their intrauterine infection, the expression levels of HMGB1 and IL-17 in peripheral blood and membrane tissues of patients with different infection degrees were compared, and the correlation with the severity of intrauterine infection were analyzed. Results:The levels of peripheral blood HMGB1, membrane tissues HMGB1, peripheral blood IL-17, membrane tissues IL-17 and serum CD 8+ in the study group were higher than those in the control group: (28.34 ± 5.16) μg/L vs. (22.51 ± 4.09) μg/L, 0.79 ± 0.12 vs. 0.34 ± 0.05, (13.05 ± 2.57) ng/L vs. (8.16 ± 1.38) ng/L, 0.37 ± 0.06 vs. 0.12 ± 0.02, 0.386 ± 0.052 vs. 0.252 ± 0.044, there were statistical differences ( P<0.05). The levels of HMGB1 and IL-17 in peripheral blood and membrane tissues and serum CD 8+ were increased with the severity of severity of intrauterine infection ( P<0.05). The results of Spearman correlation analysis showed that the level of peripheral blood HMGB1, membrane tissues HMGB1 and IL-17 had positively correlated with the severity of intrauterine infection ( r = 0.336, 0.316, 0.311, P<0.05). The results of receiver operating characteristic curve analysis showed that combined detection of HMGB1 and IL-17 levels in peripheral blood and membrane tissues and serum CD 8+ levels in evaluating the severity of intrauterine infection had higher area under the curve than that of each index alone ( P<0.05). Conclusions:Pregnant women with PROM have abnormal HMGB1 and IL-17 levels in peripheral blood and membrane tissues, and HMGB1 levels in peripheral blood and mRNA expressions of HMGB1 and IL-17 in membrane tissues are positively correlated with the severity of intrauterine infection, which has evaluation value for the severity of the disease.

Establishment and validation of predictive model for histologic chorioamnionitis during expected treatment of preterm premature rupture of membrane before 34 weeks of gestation / 中华围产医学杂志

Objective:To establish and verify a model to predict histologic chorioamnionitis (HCA) for women during expected management of preterm premature rupture of membranes (PPROM) at 24-34 weeks of gestation.Methods:This retrospective study enrolled 493 pregnant women who were diagnosed with PPROM at 24-33 +6 weeks of gestation and delivered in Peking University Third Hospital from January 1, 2012, to December 31, 2020. They were randomly divided into the modeling set ( n=345) and validation set ( n=148) at a ratio of 7∶3. Basic information, risk factors, clinical treatment, and maternal and infant outcomes were compared between participants with and without HCA using Chi-square test, t test, or Mann-Whitney U test. Multivariate logistic regression analysis was performed to analyze the independent risk factors for HCA. The predictive values of different indexes for HCA were compared and the predictive model was then established and verified using the receiver operating characteristic (ROC) curve and area under curve (AUC). Results:There were no significant differences in the basic information, common risk factors for premature rupture of membranes (PROM), or the use of tocolytics, antibiotics or dexamethasone between women in the HCA and non-HCA groups (all P>0.05). Compared with the non-HCA group, the HCA group showed an earlier onset of PROM [31.3 (24.0-33.9) vs 32.3 (27.0-33.9) gestational weeks, U=4 103.00, P=0.017], longer expected treatment [66.5 (0.7-895.3) vs 18.0 (0.3-1 123.0) h, U=1 791.00, P<0.001] and higher incidence of neonatal asphyxia, sepsis, and intracranial hemorrhage [24.3% (58/239) vs 13.2% (14/106), χ 2=5.44; 9.6% (23/239) vs 2.8% (3/106), χ 2=4.86; 41.0% (98/239) vs 17.9% (19/106), χ 2=17.45; all P<0.05]. Moreover, the positive rate of bacterial culture, C-reactive protein (CRP) level, neutrophil/lymphocyte ratio (NLR), white blood cell (WBC) and neutrophil counts were significantly increased in the HCA group [37.2% (89/239) vs 22.6% (24/106), χ 2=7.10; 8.2 (0.0-273.0) vs 5.0 (0.0-218.9) ng/ml, U=2 419.00; 5.6 (1.2-58.6) vs 4.6 (1.7-18.7), U=2 357.50; 11.9 (4.5-30.0)×10 9/L vs 10.1 (5.8-21.8)×10 9/L, U=4 074.50; 9.5 (2.5-28.1)×10 9/L vs 7.6 (3.5-18.5)×10 9/L, U=4 021.50; all P<0.05], while the lymphocyte count was decreased [1.5 (0.5-3.7)×10 9/L vs 1.6 (0.7-3.9)×10 9/L, U=4 237.00, P=0.017]. CRP level, NLR, the gestational week at the onset of PROM and the duration of expected treatment were independent risk factors for HCA ( OR=1.069, 95% CI: 1.024-1.117; OR=1.192, 95% CI: 1.048-1.356; OR=0.906, 95% CI: 0.867-0.947; OR=1.017, 95% CI: 1.007-1.026). Based on the four risk factors, the predictive model was established and ROC curve was drawn. AUC for evaluating the performance of the predictive model was 0.880, which indicated a clinical significance. Conclusion:The model established based on the four risk factors, which were CRP level, NLR, the gestational week at onset of PROM and the duration of expected treatment, performs well in the prediction of HCA in women with PPROM during expected treatment and has good clinical practical value.

Preterm premature rupture of membranes: management between 28 and 34 weeks of pregnancy / Ruptura prematura de membranas pré-termo: conduta entre 28 e 34 semanas de gestação

INTRODUCTION: Premature rupture of membranes remains a challenge for professionals due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. OBJECTIVE: To analyze the scientific production about premature rupture of membranes in pregnancies above 28 weeks and below 34 weeks. METHODS: Integrative literature review carried out in the Lilacs, SciELO, Medline and Cochrane Library databases, between 2014 and 2018, in Portuguese, English and Spanish, including original articles, available in full online, with free access, that addressed the study theme, using the keywords "premature rupture of ovular membranes", "premature labor" and "pregnancy complications" combined using the Boolean operators "AND" and "OR". RESULTS: Fourteen studies were included. It was possible to highlight the main recommendations regarding preterm premature rupture of membranes, divided into six categories for discussion, namely: indications for expectant management and delivery induction, prophylactic antibiotic therapy, prenatal corticosteroids, use of tocolytics, recommendations regarding the use of magnesium sulfate and amniocentesis. CONCLUSION: It was identified that expectant management is the ideal approach, with constant monitoring of the pregnant woman and the fetus, in addition to the administration of prophylactic antibiotics and prenatal corticosteroids, in the face of premature rupture of membranes in pregnancies between 28 and 34 weeks in order to provide the best maternal and perinatal results, guiding health professionals to evidence-based practice.

INTRODUÇÃO: A ruptura prematura de membranas continua a ser um desafio para os profissionais devido às altas taxas de morbimortalidade materna e neonatal, relacionada principalmente às complicações decorrentes da prematuridade. OBJETIVO: Analisar a produção científica acerca das evidências frente a ruptura prematura de membranas em gestações acima de 28 semanas e abaixo de 34 semanas. MÉTODOS: Revisão integrativa da literatura realizada nas bases de dados Lilacs, SciELO, Medline e Cochrane Library, entre 2014-2018, em português, inglês e espanhol, incluídos artigos originais, disponíveis completos online, com acesso livre, que abordassem a temática do estudo, utilizando os descritores "ruptura prematura de membranas ovulares", "trabalho de parto prematuro" e "complicações na gravidez" combinados por meio dos operadores booleanos "AND" e "OR". RESULTADOS: Foram incluídos 14 estudos, nos quais foi possível evidenciar as principais recomendações frente a ruptura prematura de membranas fetais pré-termo, divididos em seis categorias para discussão, sendo elas: indicações para o manejo expectante e indução do parto, antibioticoterapia profilática, corticosteroides pré-natais, uso de tocolíticos, recomendações quanto ao uso de sulfato de magnésio e realização de amniocentese. CONCLUSÃO: O estudo possibilitou identificar que o manejo expectante é a conduta ideal, com monitorização constante da gestante e do feto, além da administração de antibióticos profiláticos e corticosteroides pré-natais, frente a ruptura prematura de membranas em gestações entre 28 e 34 semanas a fim de proporcionar os melhores resultados maternos e perinatais, guiando os profissionais da saúde para uma prática baseada em evidências.

The effect of CD 8+ CD 25+ FoxP3 + regulatory T cell expression levels on balance of helper T cells 1/ helper T cells 2 in peripheral blood of pregnant women with premature rupture of fetal membranes / 中国医师进修杂志

Objective:To investigate the effect of CD 8+ CD 25+ FoxP3 + regulatory T cell (Treg) expression levels in peripheral blood of pregnant women with premature rupture of fetal membranes(PROM) on immune function of helper T cells (Th) 1/Th2. Methods:Thirty cases of pregnant women with PROM (PROM group), 30 cases of normal pregnant women (normal pregnancy group) and 30 cases of normal non-pregnant women (non-pregnancy group) who treated in Binhai County People′s Hospital from September 2019 to May 2020 were collected. Peripheral blood of each group was collected and the proportion of CD 8+ CD 25+ FoxP3 + Treg was determined by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were extracted and FoxP3 mRNA was determined by polymerase chain reaction (PCR). The levels of Th1-related cytokines interferon-γ (IFN-γ), interleukin (IL)-2, and Th2-related cytokines IL-10 and IL-4 were measured by Luminex liquid phase microarray. The effects of CD 8+ CD 25+ FoxP3 + Tregexpression on Th1/Th2 balance were analyzed. Results:The proportion of CD 8+ CD 25+ FoxP3 + Tregand the expression of FoxP3 mRNA in PROM groupand normal pregnancy group were lower than those in non-pregnancy group: (0.15 ± 0.03) %, (0.35 ± 0.09) % vs. (0.47 ± 0.11) %; 0.89 ± 0.11, 3.15 ± 0.67 vs. 3.75 ± 0.23 , the proportion of CD 8+ CD 25+ FoxP3 + Treg and the expression of FoxP3 mRNA in PROM groupwere lower than those in the normal pregnancy group , and the differences were statistically significant ( P<0.05). The levels of Th1-related cytokines IFN-γ and IL-2 in PROM group and normal pregnancy group were higher than those in non-pregnancy group, the level of Th2-related cytokines IL-4 was lower than that in non-pregnancy group , the levels of IFN-γ and IL-2 in PROM group were higher than those in normal pregnancy group, the level of IL-4 was lower than that in normal pregnancy group , and the differences were statistically significant ( P<0.05). In PROM group, the proportion of CD 8+ CD 25+ FoxP3 + Treg and the expression of FoxP3 mRNA in peripheral blood were negatively correlated with Th1-related cytokines IFN-γ ( r = - 0.413, -0.451, P<0.05) and IL-22 ( r = -0.645, -0.535, P<0.05), and were positively correlated with Th2-related cytokines IL-4 ( r = 0.558, 0.469, P<0.05). Conclusions:The proportion of CD 8+ CD 25+ FoxP3 + Treg in peripheral blood of pregnant women with PROM is lower, and the expression level of related FoxP3 mRNA is lower, which all affecte the Th1/Th2 immune balance and cause Th1 immune drift, which may be the related immune mechanism of PROM.

Effect of modified vaginal cervical cerclage in the treatment of cervical insufficiency during pregnancy / 中国基层医药

Objective:To investigate the efficacy of modified vaginal cervical cerclage in the treatment of cervical insufficiency during pregnancy.Methods:The clinical data of 18 women with cervical insufficiency during pregnancy who received treatment in Changzhi Maternal and Child Health Hospital from January 2018 to January 2020 (including nine cases receiving modified Shirodkar operation and nine cases receiving modified McDonald operation) were retrospectively analyzed.Results:The operation process was successful in all 18 women, and there were no postoperative complications. After modified Shirodkar operation, the average gestational weeks were prolonged by 14.7 weeks. Six cases had a smooth vaginal delivery [full-term delivery in five cases and preterm premature rupture of membranes (35 weeks + 1 day) in one case]. Three women had a cesarean delivery [cesarean delivery at full-term in two cases, including twin pregnancy in one case and previous cesarean delivery in one case; preterm premature rupture of membranes because of chorioamnionitis (32 weeks + 1 day) with poor prognosis in one case]. The rate of holding babies home was 88.9%. After modified McDonald operation, the average gestational weeks were prolonged by 11.5 weeks. Five cases had a smooth vaginal delivery [full-term delivery in three cases, preterm premature rupture of membranes in one case (35 weeks + 3 days) and in one case (31 weeks)]. Three women had a cesarean delivery at full-term [secondary cesarean delivery in one case, twin pregnancy in one case, and preterm premature rupture of membrane because of preeclampsia in one case]. One case had infectious abortion, and the rate of holding the baby home was 88.9%.Conclusion:Selection of different modified operations according to the length of cervical canal can prolong gestational weeks and increase the survival rate of newborns. The modified vaginal cervical cerclage is simple and easy to operate with minimal damage to pregnant women, which is suitable for clinical promotion.

Relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes / 中国医师杂志

Objective:To explore the relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes (PPROM).Methods:The clinical data of each 68 PPROM patients with normal amniotic fluid (group A), less amniotic fluid (group B) and oligohydramnios (group C) were retrospectively analyzed. The delivery modes, perinatal complications, survival of perinatal infants and Apgar score at 1 min and 5 min after birth of live-born neonates were compared among the three groups. Pearson correlation analysis was used to evaluate the correlation between Apgar score of surviving neonates and residual amniotic fluid.Results:There was no significant difference in the incidence of vaginal midwifery and placental abruption among the three groups ( P>0.05). There were significant differences in natural delivery rate, cesarean section rate, incidence of some perinatal complications (amniotic cavity infection, chorioamnionitis, amniotic fluid fecal staining) and perinatal survival rate among the three groups ( P<0.05); There was no significant difference in natural delivery rate and cesarean section rate between group B and group C ( P>0.05); The natural delivery rate in group A was significantly higher than that in group B and C ( P<0.05), and the cesarean section rate was lower than that in group B and C ( P<0.05); There was no significant difference in the incidence of perinatal complications and perinatal survival between group A and group B ( P>0.05); The above perinatal complications in group C were significantly higher than those in group A and group B ( P<0.05), and the perinatal survival rate was lower than that in group A and group B. Using amniotic fluid volume as the independent variable (normal=0, less=1, too little=2) and the above perinatal complications as the dependent variable, logistic regression analysis showed that there was no significant correlation between amniotic fluid volume and the above perinatal complications ( OR=1.029, 1.117, 1.004, 1.045, P>0.05). There were significant differences in Apgar scores at 1 min and 5 min after birth among the three groups ( P<0.05), and the change trend was group A>group B>group C ( P<0.05). Pearson correlation analysis showed that there was a significant positive correlation between Apgar score at 1 min and 5 min after birth and the residual amniotic fluid of pregnant mothers ( r=0.402, 0.371, P<0.05). Conclusions:Residual amniotic fluid volume in PPROM patients is closely related to the degree of neonatal hypoxia, and the reduction of residual amniotic fluid can also increase the cesarean section rate, and oligohydramnios can also affect maternal-infant outcomes, thus it is necessary to pay attention to clinical practice.

Questionnaire survey on the management of pregnant women with preterm premature rupture of membranes.

OBJECTIVE: The aim of this survey was to study the status of the actual practice in the management of preterm premature rupture of membranes (PPROM) between 34.0 and 36.6 weeks of gestation. METHODS: This survey was designed for obstetricians who work in secondary or tertiary medical institutions and attended the Korean Society of Maternal Fetal Medicine conference held on July 1, 2017, in Korea, using a structured questionnaire consisting of 5 questions. RESULTS: The most commonly used antibiotic was cephalosporin monotherapy (34.5%). Antenatal corticosteroids were applied up to 34.0 weeks of gestation in half of the respondents. The frequency of expectant management was higher than that of immediate delivery in women with PPROM between 34.0 and 36.6 weeks of gestation (57.4%). The most important factor in determining immediate delivery was the symptoms of chorioamnionitis. CONCLUSION: The present survey showed a considerable variation in the actual management of PPROM in women, especially the optimal timing of delivery. More evidenced-based studies with statistical power are required to decrease the heterogeneity of clinical practice.

Oral Misoprostol for Induction of Labour in Term PROM: A Systematic Review.

OBJECTIVE: To assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes following the administration of oral misoprostol. DATA SOURCES: A systematic literature search was performed using Ovid Medline, Embase, PubMed, and the Cochrane Database of Systematic Reviews. STUDY SELECTION: Eligible studies were quasi-experimental trials or randomized controlled trials involving the use of oral misoprostol in singleton cephalic term pregnancies with confirmed rupture of membranes and no spontaneous labour at the time of membranes rupture, in mothers with no contraindications to vaginal delivery. Studies were excluded if they utilized vaginal misoprostol, excluded primigravid participants, or if the full text of the article was not accessible in English. DATA EXTRACTION: Data were extracted by two reviewers using a standardized data extraction form. Study quality was assessed using the modified Jadad score. DATA SYNTHESIS: Twelve randomized controlled trials that included 1489 singleton pregnancies were included. Doses of oral misoprostol ranged from 20 to 200 µg. The incidence of vaginal birth ranged from 73.0%-95.0% in the oral misoprostol group compared with 52.4%-94% in the control group. Hyperstimulation was infrequent, ranging from 0% to 13.8% in the oral misoprostol group compared with 0%-24% in the control group. Two trials, involving a total of 144 women that compared 50 µg of oral misoprostol every 4 hours versus expectant management followed by PGE2 gel showed a higher incidence of vaginal birth with misoprostol (pooled risk ratio 1.33, 95% confidence interval 1.10-1.61). CONCLUSION: Oral misoprostol appears to be a safe and effective for IOL in TPROM. However, the varying administration, dose, and frequency reported in the literature highlights the need to develop a standardized protocol for use in Canadian obstetrical practice.

Preterm Premature Rupture of Membranes in Twins: Comparison of Rupture in the Presenting Versus Non-presenting Sac.

OBJECTIVE: This study sought to compare the latency from membrane rupture to delivery and subsequent neonatal outcomes in twin gestations complicated by preterm premature rupture of membranes (PPROM) of the presenting versus non-presenting sac. METHODS: This was a retrospective study of twin pregnancies over a 7-year period diagnosed with PPROM between 12 and 37 weeks gestation with a latency period to delivery of >24 hours. The ruptured sac was identified by ultrasound scan. The study compared the latency period from PPROM to delivery and subsequent neonatal morbidity and mortality resulting from rupture of the presenting versus non-presenting sac. Obstetric and neonatal outcomes were evaluated using a matched-cohort subset analysis (Canadian Task Force Classification II-2). RESULTS: During the study period, 77 twin pregnancies diagnosed with PPROM satisfied the inclusion criteria. The mean latency periods from PPROM to delivery were 10.1 days (n = 7) when the presenting sac ruptured and 41.3 days (n = 10) when the non-presenting sac ruptured (P < 0.05). Neonatal death was higher with PPROM of the presenting than the non-presenting sac (21.4% vs. 0%, respectively; P = 0.05). Neonates were more likely to be affected by retinopathy of prematurity (57% vs. 19%; P < 0.05) but less likely to have persistent pulmonary hypertension of the newborn (0% vs. 25%; P < 0.05) when the rupture occurred in the presenting sac. The rates of other neonatal adverse outcomes were similar between the two groups. CONCLUSIONS: In twin gestations there is a longer latency from PPROM to delivery and fewer neonatal complications when rupture occurs in the non-presenting rather than the presenting sac.

Pathogens in preterm prelabour rupture of membranes and erythromycin for antibiotic prophylaxis: a retrospective analysis.

INTRODUCTION: Many authoritative guidelines recommend prescribing erythromycin as antibiotic prophylaxis in patients with preterm prelabour rupture of membranes (PPROM). This study evaluated the spectrum of pathogens in PPROM and assessed the effectiveness of erythromycin prophylaxis. METHODS: This retrospective study enrolled pregnant patients who were diagnosed with PPROM and who delivered at ≥24 weeks of gestation in an obstetric unit from 2013 to 2017. Pathogens isolated from maternal, placental, and neonatal specimens were analysed; their sensitivity profiles to various antibiotics were recorded. Neonatal outcomes were also evaluated. RESULTS: The overall incidence of PPROM was 2.63%. Gram-positive bacteria were cultured in 18.4% of PPROM patients (most frequent: Group B Streptococcus [GBS; 14.6%]); Gram-negative bacteria were cultured in 12.8% of PPROM patients (most frequent: Escherichia coli [8.0%]). Both Gram-positive and Gram-negative bacteria were significantly associated with early-onset neonatal sepsis (P=0.036 and P=0.001). In analyses stratified by bacterial species, E coli was significantly associated with early-onset neonatal sepsis (P=0.004), whereas GBS was not (P=0.39). Gram-positive bacteria had high rates of resistance to common antibiotics: 42.2% of GBS and 50.0% of Enterococcus and other Streptococcus bacteria were resistant to erythromycin. Escherichia coli had high rates of resistance to ampicillin (70.3%) and gentamicin (33.3%); rates of resistance to co-amoxiclav (3.6%) and intravenous cefuroxime (14.0%) were low. CONCLUSION: Gram-positive and Gram-negative bacteria were found in 29.1% of PPROM patients. Administration of erythromycin alone was insufficient to control these bacteria in 67.7% of patients with positive cultures.

Comparison of Clinical Factors and Neurodevelopmental Outcomes between Early- and Late-Onset Periventricular Leukomalacia in Very Low Birth Weight Infants

PURPOSE: To analyze and compare the clinical factors and neurodevelopmental outcomes compare early- and late-onset periventricular leukomalacia (PVL) in very low birth weight infants (VLBWI). METHODS: We performed a retrospective study involving 199 newborn infants weighing < 1,500 g admitted to the neonatal intensive care unit between March 2009 and December 2015. VLBWI with PVL were categorized into early- and late-onset PVL groups based on the time of diagnosis based on 28 days of age. We analyzed the clinical factors and neurodevelopmental outcomes between the groups. RESULTS: The incidence rate of PVL was 10.1% (16/158). The Apgar score at 1 minute and the mean duration of tocolytic therapy were associated with the development of PVL. The incidence rate of premature rupture of membranes (PROM) was significantly higher in the early-onset PVL group (P=0.041). No significant differences were observed in neurodevelopmental outcomes between the early- and late-onset PVL groups. CONCLUSION: Results suggest that a higher incidence of PROM was associated with clinical characteristics in the early-onset PVL group. No significant intergroup differences were observed in neurodevelopmental outcomes; however, the Bayley Scales of Infant Development-III scores were lower in the early-onset PVL group.

Comparative study of misoprostol and oxytocin in induction of labor in full-term pregnancy complicated with premature rupture of membranes / 中国基层医药

Objective To investigate effect of the application of misoprostol and oxytocin in full-term pregnancy induced labor with premature rupture of membranes.Methods From March 2016 to June 2017,95 pregnant women in term pregnancy induced labor with premature rupture of membranes in General Hospital of Taiyuan Iron&Steel (Group) CO.LTD were selected as the research objects,and they were randomly divided into study group and control group,the control group was given oxytocin,the study group was given misoprostol for induction of labor,then the effect,the total production process,delivery time,labor time,maternal and infant outcomes,the occurrence of adverse reactions of the two groups were observed.Results The total effective rate of pregnant women of the study group and the control group were 95.83％,78.72％,respectively,the difference was statistically significant (x2=7.136,P ＜ 0.05);The total production process,delivery time and labor time in the study group were (5.76 ±1.38)h,(9.39 ±3.44)h,(5.53 ± 1.51) h,respectively,which in the control group were (7.89 ± 1.67)h,(12.83 ±3.76)h,(7.56 ± 1.9 2)h,respectively,the research group's total stage of labor,delivery time,delivery time were shortened significantly compared with those of the control group (t =5.829,7.331,4.276,all P ＜ 0.05);The cesarean delivery,fetal distress and amniotic fluid contamination rates of the study group were 6.25％,8.33％,8.33％,respectively,which of the control group were 21.28％,31.91％,27.65％,respectively,the study group's cesarean section rate,fetal distress and amniotic fluid were significantly lower compared with those of the control group (x2 =6.936,10.185,7.429,all P ＜ 0.05).The incidence of abnormal uterine contraction,gastrointestinal reaction and tachycardia had not statistically significantly difference between the two groups (P ＞ 0.05).Conclusion Compared with oxytocin,misoprostol for full-term pregnancy with fetal membranes induction effect is more significant,which can shorten the birth process,improve maternal and child outcomes.So it is worthy of clinical promotion.

Impact of premature rupture of membranes on fetal lung development / 中华全科医师杂志

Premature rupture of membranes ( PROM) is a common complication of pregnancy , seriously affecting the growth and development of fetus and newborns , even leading to death .PROM may disturb lung maturation and cause a variety of serious lung disease due to the infection and inflammation factors, which is one of the causes of poor prognosis or death in fetus and newborns .The awareness and knowledge of the impact of PROM on the fetal lung development may be of value for clinicians to improve neonatal survival rate .