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PubMed2004

The possible role of intrauterine infections in unexplained second trimester abortions and macerated stillbirths: a study from a single center.

OBJECTIVE: To investigate the role of intrauterine infections in unexplained second trimester abortions and stillbirths. STUDY DESIGN: Histopathologic and microbiologic evidence of intrauterine infection in the placentas, fetal membranes and fetal lung tissues of 18 unexplained second trimester abortions and macerated stillbirth cases as well as the placentas and fetal membranes of 10 healthy term neonates were investigated in a prospective study conducted in Ankara University School of Medicine, Turkey. RESULTS: Histopathologic chorioamnionitis and placental culture positivity rates in the study and control groups were 64.7 vs 0%. Bacteria were recovered from 90.9% of placentas and 36.4% of fetal lungs of the cases with histopathologic chorioamnionitis. Intrauterine infection was found in 66.7% of the whole study group, in 85.7% of the unexplained second trimester abortions, and in 54.5% of the macerated stillbirths. CONCLUSION: Intrauterine infection may be an important factor in unexplained stillbirths and second trimester abortions in centers where pregnancy follow-ups lack evaluation for asymptomatic infection.

Abortion, Spontaneous↗

PubMed2004

[Perinatal mortality after previous cesarean section].

BACKGROUND: Perinatal neonatal mortality is increased where there is a maternal history of cesarean section (0.45 vs. 0.31 % in deliveries after previous vaginal delivery). In this study we have analyzed the causes of the perinatal deaths. PATIENTS AND METHODS: The increased risk was found by analyzing the database of the Swiss Working Group of Obstetric and Gynecological Institutions with its 29 046 deliveries with a history of previous cesarean section between 1983 and 1996. In this time period 130 perinatal neonatal deaths in deliveries after previous cesarean were recorded. RESULTS: The cause of death could be established in 124 cases. In the 42 term deliveries the causes of death were the following: malformations 20, uterine rupture 5, placental abruption 5, respiratory distress syndrome 5, and other causes 7. In the 82 preterm deliveries: prematurity caused by premature contractions/rupture of membranes 38, malformations 12, chorioamnionitis 12, placental abruption 9, severe growth retardation 4, complications of placenta praevia 2, uterine rupture 1, other causes 4. DISCUSSION: Preterm deliveries are more frequent (in births) after a previous c/s (7.75 vs. 5.55 % in multiparous mothers without previous cesarean) - not because of a higher frequency of preterm labor or premature rupture of membranes, but because of placental abruption, chorioamnionitis, placental insufficiency and severe growth retardation. Although some of the neonatal deaths are linked to the previous cesarean delivery, perinatal death after previous cesarean is a very rare event. A recommendation to routinely perform a repeat cesarean instead of a trial of labor seems not appropriate.

Cause of Death↗

PubMed1998

Selective feticide in twin pregnancies with very early preterm premature rupture of membranes.

Nine consecutive multichorionic multiple gestations with early second-trimester (< or =20 weeks) preterm premature rupture of the membranes (PPROM) of the lower gestational sac were managed expectantly. Mean gestational age at PPROM was 17.5 weeks (13-20 weeks), and the mean PPROM delivery time interval was 6.2 weeks (0-11 weeks). A fetal loss of 63% (12 of 19), and a subsequent neonatal loss of 57% (4 of 7) were observed. Of the four pregnancies evolving beyond 25 weeks, three delivered before 30 weeks. The baby take-home rate was 16% (3 of 19). Histologic evidence of chorioamnionitis was present in 5 of 7 (71%) investigated pregnancies. Three other consecutive twin pregnancies were complicated by PPROM of the precervical gestational sac at 13 to 16 weeks of gestation (mean: 15 weeks). In the absence of clinical chorioamnionitis and amniotic fluid, selective feticide with potassium chloride was performed. Pregnancy was successfully prolonged beyond 33 weeks in two cases. The overall PPROM delivery time interval was 21 weeks (20-22 weeks). No neonatal losses were encountered. The baby take-home rate was 66% (2 of 3). Selective feticide of the fetus with early midtrimester PROM in the absence of maternal signs of infection may improve the former unfavorable pregnancy outcome.

Female↗

PubMed2000

Management of cervical cerclage and preterm premature rupture of the membranes: should the stitch be removed?

OBJECTIVE: Our aim was to determine whether retention of cerclage after preterm premature rupture of the membranes occurring before 34 completed weeks' gestation influences pregnancy outcome. STUDY DESIGN: Singleton pregnancies with cerclage and premature rupture of the membranes between 24.0 and 34.9 weeks were reviewed. Women were excluded if they were first seen in labor, had chorioamnionitis, or were delivered within 48 hours. Control subjects consisted of women with premature rupture of the membranes without cerclage. RESULTS: Eighty-one cases of cerclage with premature rupture of the membranes met criteria for inclusion: 30 women (37%) had their cerclage removed at presentation, and 51 (63%) retained the cerclage until delivery. Cases were similar in terms of gestational age at placement and gestational age at premature rupture of the membranes. There was no significant difference between the retained, removed, or control groups in terms of latency, gestational age at delivery, chorioamnionitis, or neonatal morbidity and mortality. CONCLUSIONS: Retention of cervical cerclage after premature rupture of the membranes occurring before 34 completed weeks' gestation is associated with comparable clinical outcomes with respect to latency and perinatal outcome, when compared with removal of the cerclage.

Adult↗

PubMed2000

The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis.

OBJECTIVE: The purpose of this study was to determine whether funisitis (inflammation of the umbilical cord detected by histologic examination of the placenta) is associated with changes in the umbilical cord plasma concentration of interleukin 6, microbial invasion of the amniotic cavity, and neonatal sepsis. STUDY DESIGN: The relationship among the presence of funisitis, interleukin 6 concentrations in umbilical cord plasma at birth, the results of amniotic fluid culture performed within 3 days of birth, and the occurrence of congenital neonatal sepsis was examined in 315 consecutive singleton preterm births (20-35 weeks' gestation). Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton jelly. The interleukin 6 concentration was measured with a specific immunoassay. Amniocentesis was performed in 106 patients within 3 days of birth. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. RESULTS: (1) Funisitis was present in 25% of patients (78/315). (2) Patients with funisitis had a significantly higher median cord plasma interleukin 6 and a lower gestational age at birth than did those without funisitis (cord interleukin 6: median, 52.4 pg/mL; range, 0.9-19,230 pg/mL; vs median, 4.6 pg/mL; range, 0-18,108 pg/mL; gestational age: median, 31.1 weeks' gestation; range, 21.0-35.0 weeks' gestation; vs median, 32.9 weeks' gestation; range, 21.4-35.0 weeks' gestation; P<.001 for each comparison). (3) A cord plasma interleukin 6 of > or =17.5 pg/mL had a sensitivity of 70% and a specificity of 78% in the identification of funisitis. (4) Microbial invasion of the amniotic cavity and clinical chorioamnionitis were more common among patients with funisitis than among those without funisitis (positive amniotic fluid culture: 53% [20/38]; vs. 12% [8/68]; clinical chorioamnionitis: 18% [14/78]; vs. 4% [9/237]; P<.001 for each comparison). (5) Neonates with funisitis had a significantly higher rate of congenital sepsis than did those without this lesion (12% [8/66] vs. 1% [3/216]; P<.001); this difference remained significant after adjustment for gestational age at birth (odds ratio, 7.2; 95% confidence interval, 1.8-29.0). CONCLUSION: (1) Umbilical cord plasma interleukin 6 concentrations were higher in neonates born with funisitis than in those without this lesion. (2) Funisitis is associated with amniotic fluid infection, congenital neonatal sepsis, and the fetal inflammatory response syndrome.

Adult↗

PubMed2001

Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help.

OBJECTIVE: The purpose of this study was to identify the risk factors that are associated with increased neonatal morbidity in patients who were treated for sonographic evidence of internal os dilation and distal cervical shortening during the second trimester. STUDY DESIGN: From May 1998 to June 2000 patients between 16 and 24 weeks of gestation with the following sonographic criteria were randomly assigned to McDonald cerclage or no cerclage: internal os dilation and either membrane prolapse into the endocervical canal at least 25% of the total cervical length but not beyond the external os or a shortened distal cervix <2.5 cm. Before randomization, all patients were treated identically with an amniocentesis, multiple urogenital cultures, and therapy with indomethacin and clindamycin for 48 to 72 hours. Except for the cerclage, all patients were treated identically after randomization. Multiple variables of perinatal outcome were analyzed. A regression model with gestational age at delivery as the dependent variable was constructed and repeated with neonatal morbidity as the dependent variable. This model was applied to 3 populations: the cerclage group, the no cerclage group, and both groups combined. RESULTS: Of the 135 patients, 20 patients declined randomization, and 2 patients were diagnosed with acute chorioamnionitis. Of the 113 patients remaining, 55 patients were randomly assigned to the cerclage group, and 58 patients were randomly assigned to the no cerclage group. There were 8 rescue cerclage procedures (4 in each group). Regression analysis showed that readmission for preterm labor, chorioamnionitis, and abruption were consistently associated with early gestational age at delivery and increased morbidity. Cerclage did not affect perinatal outcome. CONCLUSION: The sonographic findings of second trimester internal os dilation, membrane prolapse, and distal cervical shortening likely represent a common pathway of several pathophysiologic processes. Use of cerclage does not alter any perinatal outcome variables. Increased neonatal morbidity in these patients appears to be associated with subclinical infection, preterm labor, and abruption.

Abruptio Placentae↗

PubMed2004

Outcomes with premature rupture of membranes at 32 or 33 weeks when management is based on evaluation of fetal lung maturity.

OBJECTIVE: To assess outcomes of patients with premature rupture of membranes (PROM) at 32 or 33 weeks gestation. METHODS: This historical cohort study included all immune competent patients managed at our institution from October 1, 1999 to March 31, 2003 with singleton gestations and PROM at 32 or 33 weeks, and without clinical chorioamnionitis at presentation or antenatal diagnosis of a fetal anomaly. If amniotic fluid studies revealed pulmonary maturity, patients were intentionally delivered. Otherwise, they were expectantly managed until intentional delivery at 34 weeks, or labor, chorioamnionitis, or non -reassuring testing led to delivery sooner. RESULTS: For the groups with mature (n = 29) and immature or unobtainable (n = 60) fluid, respectively, rates of neonatal ICU admission (83% vs. 77%; p = 0.51), respiratory distress (41% vs. 45%; p = 0.75), mechanical ventilation (10% vs. 17%; p = 0.53), and proven neonatal infection (4% vs. 2%; p = 0.60) were similar, as were rates of other neonatal and maternal complications. The mature group had shorter mean maternal hospital stays (3.6 +/- 0.6 vs. 6.4 +/- 2.9 d; p < 0.001) and latency periods (30.2 +/- 19.3 vs. 83.8 +/- 68.7 h; p < 0.001). CONCLUSION: Compared to those managed expectantly due to immature or unavailable fetal lung studies, intentional delivery of patients with PROM at 32 or 33 weeks with mature fetal lung studies did not increase neonatal morbidity in our small cohort.

Adult↗

PubMed2006

A systematic review of intentional delivery in women with preterm prelabor rupture of membranes.

OBJECTIVE: To evaluate the effect of intentional delivery versus expectant management in women with preterm prelabor rupture of membranes (PPROM). METHODS: We searched electronic databases and trials registries, contacted experts, and checked reference lists of relevant studies. Studies were included if they were randomized controlled trials comparing intentional delivery versus expectant management after PPROM, the gestational age of participants was between 30 and 36 weeks, and the study reported one of several pre-determined outcomes. RESULTS: Four studies were included in the meta-analysis. No difference was found between intentional delivery and expectant management in neonatal intensive care unit (NICU) length of stay (LOS) (weighted mean difference (WMD) -0.81 day, 95% confidence interval (CI) -1.66, 0.04), respiratory distress syndrome (risk difference (RD) -0.01, 95% CI -0.07, 0.06), and confirmed neonatal sepsis (RD -0.01, 95% CI -0.05, 0.04). One study found a significantly lower incidence of suspected neonatal sepsis among the intentional delivery group (RD -0.31, 95% CI -0.50, -0.12; number needed to treat (NNT) 3, 95% CI 2, 8). Maternal LOS was significantly shorter for the intentional delivery group (WMD -1.39 day, 95% CI -2.03, -0.75). There was a significant difference in the incidence of clinical chorioamnionitis favoring intentional delivery (RD -0.16, 95% CI -0.23, -0.10; NNT 6, 95% CI 5, 11). There was no significant difference in the incidence of other maternal outcomes, including cesarean section (RD 0.05, 95% CI -0.01, 0.11). CONCLUSIONS: Intentional delivery may be favorable to expectant management for some maternal outcomes (chorioamnionitis and LOS). There is insufficient evidence to suggest that either strategy is beneficial or harmful for the baby. Large multicenter trials with primary neonatal outcomes are required to assess whether intentional delivery is associated with less neonatal morbidity.

Cesarean Section↗

PubMed2005

Surgical-site infections following cesarean section in an Estonian university hospital: postdischarge surveillance and analysis of risk factors.

OBJECTIVES: To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section. DESIGN: Cross-sectional survey. SETTING: Academic tertiary-care obstetric and gynecology center with 54 beds. PATIENTS: All women who delivered by cesarean section in Tartu University Women's Clinic during 2002. METHODS: Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System. RESULTS: The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P = .02). CONCLUSIONS: The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible.

Adult↗

PubMed1984

Fulminant neonatal septicemia due to Hemophilus parainfluenzae.

A woman with premature rupture of membranes and chorioamnionitis gave birth to a 0.73-kg infant at 28 weeks' gestation. The infant died of fulminant septicemia caused by Hemophilus parainfluenzae. This organism should be recognized as a potential cause of chorioamnionitis and neonatal septicemia.

Female↗

PubMed2001

Maternal glucose concentration influences fetal growth, gestation, and pregnancy complications.

Using 1990-1995 data, the authors examined the influence of post-challenge maternal glucose concentration on pregnancy outcome in 1,157 nondiabetic US gravidas. After control for potential confounding variables and comparing gravidas with lower glucose concentrations (<99 mg/dl) with the others, they found that mean birth weight increased by 50 g and 200 g with glucose concentrations of 99-130 mg/dl and >130 mg/dl, respectively. Increased maternal glucose concentration also was associated with an increased risk of large-for-gestation fetuses (p for trend < 0.001) and a decreased risk of fetal growth restriction (p for trend < 0.05). The association between glucose and gestation was inverse and significantly shortened when glucose concentrations were higher. Maternal complications increased twofold or more with high glucose concentrations and included cesarean section and clinical chorioamnionitis. Chorioamnionitis in combination with high maternal glucose concentration increased the risk of very preterm delivery almost 12-fold. These observations extend Pedersen's hypothesis-that high concentrations of maternal glucose give rise to increased nutrient transfer to the fetus and increase fetal growth, beyond the model of maternal diabetes (Acta Endocrinol 1954;16:330-42). They raise the question of whether higher, but seemingly normal maternal glucose concentration predisposes to or is a marker for placental inflammation and infection.

Adolescent↗

PubMed1991

Pathology and human immunodeficiency virus expression in placentas of seropositive women.

The pathology of term placentas from seropositive human immunodeficiency virus (HIV)-infected and seronegative women was investigated by routine histologic, immunocytochemical, and in situ hybridization techniques. Placentas were evaluated for evidence of villitis, chorioamnionitis, and funisitis. Membranes, trophoblast, and decidua were also examined by immunohistochemistry using monoclonal HIV p24 antibody. Twenty placentas were evaluated by combined immunochemical and in situ hybridization techniques, using a 35S-labeled RNA probe complementary to the 3' long terminal repeat and envelope region of HIV-1. HIV-seropositive placentas did not show significant villitis; however, the incidence of chorioamnionitis increased (P less than .01). HIV antigens and nucleic acids were identified in the trophoblast of 10% of the placentas that also showed chorionitis. Term HIV-positive placentas may show histologic changes that may or may not be directly related to the virus. Analysis of tissues from earlier gestational placentas may prove more informative in clarifying the mechanism of maternal-fetal HIV transmission.

Chorion↗

PubMed1999

Human placental cells show enhanced production of interleukin (IL)-8 in response to lipopolysaccharide (LPS), IL-1 and tumour necrosis factor (TNF)-alpha, but not to IL-6.

Interleukin-8 (IL-8) is a chemotactic and activating factor for neutrophils which play important roles in host defence mechanisms. The human placenta constitutively produces IL-8 during pregnancy and enhances its production in chorioamnionitis. The present study was designed to investigate in vitro the regulatory mechanism for IL-8 production in the placentas in normal and inflammatory states. Placental cells produced IL-8 in a dose-dependent fashion when stimulated with lipopolysaccharide (LPS). The purified trophoblasts showed significantly higher IL-8 production than untreated placental cells. The expression of IL-8 gene in the trophoblasts in the third trimester was observed by reverse transcription-polymerase chain reaction (RT-PCR). The placental cells also release IL-8 in a dose-dependent manner, in response to r-(recombinant) IL-1alpha and tumour necrosis factor (TNF)-alpha, but not rIL-6. Moreover, LPS-activated placental cells spontaneously produced a much larger amount of IL-8 and showed increased responses to rIL-1alpha and TNF-alpha. It may, therefore, be proposed that placental cells with multiple endocrine functions exert immunological functions by constitutive production of IL-1 and TNF-alpha, which stimulate placental IL-8 release. This cytokine cascade in the placenta may be augmented by LPS in chorioamnionitis, thereby potentiating the feto-maternal defence mechanisms against infection.

Cells, Cultured↗

PubMed1988

A randomized study of antibiotic therapy in idiopathic preterm labor.

A randomized study was undertaken to test the effects of antibiotics as an adjunct to established methods of tocolysis. One hundred fifty patients with cervical dilation of 1 cm or more and no clinically identifiable cause for preterm labor qualified for the study. Fifty-three (35%) received 500 mg ampicillin orally every 6 hours, 50 (33%) received 500 mg erythromycin orally every 6 hours, and 47 served as controls. Antibiotics were prescribed for 10 days, and the treatment was not altered by the results of cervical cultures. Of these 150 patients, 16 (11%) had positive amniotic fluid cultures. The pregnancies with positive amniotic fluid culture were characterized by significantly less time gained after admission (2.6 versus 28.7 days) and lower birth weight (1262 versus 2470 g) than in those with negative cultures. Histologic studies of the placenta revealed chorioamnionitis in 22 (16%) of 134 patients with negative amniotic fluid cultures; these pregnancies were associated with less time gained after admission (12.5 versus 31.9 days) and lower birth weight (1680 versus 2618 g) compared with pregnancies without histologic chorioamnionitis. In patients with similar gestational age and cervical dilation, the adjunctive use of antibiotic therapy resulted in a statistically significant delay from admission to delivery (30 versus 17 days). In cases of negative amniotic fluid cultures, cervical colonization with group B streptococcus and/or Gardnerella vaginalis increased the risk of prematurity, which improved significantly when ampicillin was given.

Adolescent↗

PubMed2004

Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes.

OBJECTIVE: This study was performed to evaluate the efficacy of weekly courses of antenatal corticosteroids compared with a single course in women with preterm premature rupture of membranes (PROM). METHODS: A planned secondary analysis of women with preterm PROM who participated in a multicenter, randomized trial of weekly courses of antenatal corticosteroids versus single-course therapy was performed. After their first course of standard antenatal steroid therapy, administered between 24 to 32-6/7 weeks of gestation, consenting women were randomly assigned to receive betamethasone versus placebo injections weekly until 34-0/7 weeks of gestation. Maternal and neonatal morbidities were compared between the 2 groups. RESULTS: Of the 161 women with preterm PROM, 81 women were assigned to receive weekly courses of steroids and 80 to the single-course group. There were no significant differences in composite morbidity between the groups (27 [34.2%] of 81 patients versus 33 [41.8%] of 80 patients, P =.41). Chorioamnionitis was higher in patients who received weekly courses of antenatal steroids (39 [49.4%] of 81 patients versus 25 [31.7%] of 80 patients, P =.04). CONCLUSION: Weekly courses of antenatal steroids in women with preterm PROM did not improve neonatal outcomes beyond that achieved with single-course therapy and was associated with an increased risk of chorioamnionitis. Antenatal steroid therapy should not be routinely repeated in patients with preterm PROM. LEVEL OF EVIDENCE: I

Adult↗

PubMed2004

Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth.

OBJECTIVE: To estimate the relationship between maternal periodontal disease and both early spontaneous preterm birth and selected markers of upper genital tract inflammation. METHODS: In this case-control study, periodontal assessment was performed in 59 women who experienced an early spontaneous preterm birth at less than 32 weeks of gestation, in a control population of 36 women who experienced an early indicated preterm birth at less than 32 weeks of gestation, and in 44 women with an uncomplicated birth at term (>or = 37 weeks). Periodontal disease was defined by the degree of attachment loss. Cultures of the placenta and umbilical cord blood, cord interleukin-6 levels, and histopathologic examination of the placenta were performed for all women. RESULTS: Severe periodontal disease was more common in the spontaneous preterm birth group (49%) than in the indicated preterm (25%, P =.02) and term control groups (30%, P =.045). Multivariable analyses, controlling for possible confounders, supported the association between severe periodontal disease and spontaneous preterm birth (odds ratio 3.4, 95% confidence interval 1.5-7.7). Neither histologic chorioamnionitis, a positive placental culture, nor an elevated cord plasma interleukin-6 level was significantly associated with periodontal disease (80% power to detect a 50% difference in rate of histological chorioamnionitis, alpha = 0.05). CONCLUSION: Women with early spontaneous preterm birth were more likely to have severe periodontal disease than women with indicated preterm birth or term birth. Periodontal disease was not associated with selected markers of upper genital tract inflammation. LEVEL OF EVIDENCE: II-2

Adult↗

PubMed2006

Induction of labor using a foley balloon, with and without extra-amniotic saline infusion.

OBJECTIVE: To compare transcervical Foley bulb with and without extra-amniotic saline infusion for induction of labor in patients with an unfavorable cervix. METHODS: Women who presented for induction of labor with Bishop score less than 5 were randomly assigned to receive Foley alone or Foley with extra-amniotic saline infusion for induction of labor. Primary outcome was time from start of induction to vaginal delivery. Secondary outcomes were cesarean delivery rates, incidence of chorioamnionitis, Apgar scores at 1 and 5 minutes, and adverse events. RESULTS: One hundred forty women completed the study. Time from induction to vaginal delivery was 16.58 (+/- 7.55) hours in the extra-amniotic saline infusion group compared with 21.47 (+/- 9.95) hours in the Foley group (P < .01). Chorioamnionitis occurred in 4 of 66 (6.1%) women in the extra-amniotic saline infusion group compared with 12 of 74 (16.2%) women in the Foley group (P = .067). Cesarean delivery rate was 21.2% versus 20.1% in the extra-amniotic saline infusion and Foley groups, respectively (P = 1.0). Median 1-minute and 5-minute Apgar scores were 9 in both groups. Adverse events were rare and unrelated to method of induction. CONCLUSION: Induction of labor by using Foley with extra-amniotic saline infusion results in shorter induction-to-vaginal-delivery time than Foley alone, without affecting cesarean delivery rates. LEVEL OF EVIDENCE: II-I

Adult↗

PubMed1997

Perinatal outcome following conservative management of mid-trimester pre-labour rupture of the membranes.

OBJECTIVE: To assess perinatal outcome and the effect of antenatal steroid use following conservative management of 86 consecutive singleton pregnancies complicated by pre-labour rupture of membranes (ROM) in the mid-trimester (13-26 weeks; mean 22.8 weeks). METHODOLOGY: Review of obstetric and neonatal case notes between 1 January 1990 and 31 December 1993. RESULTS: The duration of ruptured membranes (latent period) ranged from 1.25 to 105 days (mean 23.8 days; median 14 days) and was inversely related to gestational age at ROM. There was clinical evidence of chorioamnionitis in 39.5% with placental histological changes consistent with chorioamnionitis in 76.6%. All infants were delivered before 33 weeks gestation (mean 26 weeks). Overall, the mortality rate was 43.0% but 62.5% in infants with ROM before 24 completed weeks gestation. Adverse outcome (defined as death, severe intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL)) occurred in 46.5% and was significantly related to both gestation at delivery and gestation at ROM. In the group (n = 40) with ROM before 24 weeks gestation, adverse outcome occurred in 65% and was inversely related to gestation at ROM independent of gestation at delivery. Antenatal steroid administration resulted in less adverse outcome independent of gestation at delivery (OR 0.31; 95% CI (0.09-0.98; P = 0.046)). CONCLUSION: From the neonatal perspective conservative management is justified for pregnancies with ROM at or after 24 weeks gestation; in this group the use of antenatal steroids prior to delivery may improve perinatal outcome. A poor outcome is associated with ROM that occurs before 24 weeks gestation.

Adolescent↗