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PubMed2004

Obstetric outcomes associated with increase in BMI category during pregnancy.

OBJECTIVE: The purpose of this study was to investigate effect of increase in body mass index (BMI) category on obstetric outcomes. STUDY DESIGN: A cohort study was conducted from 1999 to 2002. Women with singleton pregnancies were placed in standard BMI categories. Increase in BMI was calculated as difference between initial BMI and delivery BMI. ANOVA was used to compare continuous variables, and chi-square test for categorical variables. RESULTS: This study included 5131 women: 49.8% had no change in BMI category, 43.9% increased by 1 BMI category, and 6.3% by >1 category. Increase in BMI category was associated with higher rates of gestational diabetes (P = .005), failed induction (P < .001), lacerations (P < .001), cesarean deliveries (P < .001), and postpartum infection (P = .007) in normal weight women. Overweight women also had increased rates of preeclampsia (P = .002) and operative vaginal deliveries (P < .001). Obese women had higher rates of chorioamnionitis (P = .003), failed induction (P < .001), and cesarean deliveries (P = .016). CONCLUSION: Increase in BMI category is associated with increased risk of complications.

Adult↗

PubMed2004

Genome-wide expression profiling of fetal membranes reveals a deficient expression of proteinase inhibitor 3 in premature rupture of membranes.

OBJECTIVE: We used a genome-wide approach to identify differentially expressed genes in patients with preterm premature rupture of membranes to improve the understanding of underlying molecular mechanisms. STUDY DESIGN: RNA was isolated from the fetal membranes of patients with preterm labor with intact membranes and preterm premature rupture of membranes and was stratified according to the presence or absence of histologic chorioamnionitis. Microarray experiments were used to identify differentially expressed genes, and real-time quantitative reverse transcriptase-polymerase chain reaction and immunohistochemistry were used in follow-up experiments. RESULTS: Microarray experiments identified decreased expression of proteinase inhibitor 3 in the preterm premature rupture of membranes cases. Quantitative reverse transcriptase-polymerase chain reaction confirmed these results. Immunohistochemistry demonstrated decreased proteinase inhibitor 3 protein expression in preterm premature rupture of membranes. CONCLUSION: A genome-wide approach identified deficient expression of proteinase inhibitor 3 in preterm premature rupture of membranes, which demonstrated the usefulness of functional genomics for the dissection of mechanisms of disease and identification of differentially regulated genes that were not suspected previously to play a role in parturition.

Acute Disease↗

PubMed2005

Severe fetal placental vascular lesions in term infants with neurologic impairment.

OBJECTIVE: This study tests the hypothesis that placental disease can identify antepartum processes that either progress into the intrapartum period or predispose to intrapartum brain injury. STUDY DESIGN: Lesions that affect large fetal vessels were compared in the placentas of 125 neurologically impaired term infants who were the focus of clinical negligence litigation and 250 consecutive singleton deliveries of >/=36 weeks of gestation. RESULTS: One or more of 4 severe placental fetal vascular lesions (fetal thrombotic vasculopathy, chronic villitis with obliterative fetal vasculopathy, chorioamnionitis with severe fetal vasculitis, and meconium-associated fetal vascular necrosis) were found in 51% of index cases versus 10% of the comparison group ( P <.0001). Prevalence of these lesions in the 64 infants with cerebral palsy was 52% ( P <.0001). CONCLUSION: Severe fetal placental vascular lesions are correlated highly with neurologic impairment and cerebral palsy. Their nature, duration, and anatomic location make them strong candidates for the antepartum processes that place fetuses at risk for brain injury during the intrapartum period.

Adult↗

PubMed2005

Outcomes of second-trimester pregnancy terminations with misoprostol: comparing 2 regimens.

OBJECTIVE: The purpose of this study was compare outcomes of second-trimester pregnancy terminations with misoprostol between our previous low- (200 microg every 12 h) and present high-dose (400 microg every 6 h) regimens. STUDY DESIGN: This was an historic cohort study that was conducted from June 1996 to February 2004 on women undergoing medical termination of pregnancy at 13 to 27 weeks. Exclusion criteria were multiple gestation, placenta previa, and primary use of another medication. RESULTS: The cohort consisted of 147 women. For the low- (n = 100) and high-dose (n = 47) groups, respectively, median times to delivery were 22.5 vs 13.25 hours (P = .001). More patients in the high-dose group were delivered vaginally within 24 (81% vs 54%; P = .002) and 48 hours (98% vs 84%; P = .014). Fewer patients in the high-dose group required a second abortifacient (6% vs 27%; P = .004). Clinical chorioamnionitis was more common in the high-dose group (P = .03). One patient experienced a uterine rupture and is included in the analysis. Side effects were uncommon and did not differ between groups. CONCLUSION: Our present high-dose regimen for misoprostol terminations of pregnancy effects delivery more rapidly without an appreciable increase in side effects or complications.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Women with one elevated 3-hour glucose tolerance test value: are they at risk for adverse perinatal outcomes?

OBJECTIVE: The purpose of this study was to examine whether women with one elevated value of the 3-hour glucose tolerance test are at increased risk for adverse perinatal outcomes. STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the use of the glucose loading test and with a glucose tolerance test for follow up, if screened values were positive. Perinatal outcomes in women with one elevated glucose tolerance test value were compared with the outcomes in women who screened negative by glucose loading test. The chi-square test was used to compare categorical outcomes, and multivariate logistic regression analysis was used to control for potential confounding factors; a P value of < .05 indicated statistical significance. RESULTS: Of 14,036 women who met the study criteria, women with one elevated glucose tolerance test value exhibited higher rates of cesarean delivery (in nulliparous women only), preeclampsia, chorioamnionitis, birth weight > 4000 g and > 4500 g, and neonatal admission to the intensive care nursery as compared with women who screened negative (P < .05 for all). CONCLUSION: Although women with one elevated glucose tolerance test value are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse perinatal outcomes.

Adult↗

PubMed2006

Placental inflammation and viral infection are implicated in second trimester pregnancy loss.

OBJECTIVE: Second trimester pregnancy loss continues to be a poorly understood adverse obstetric outcome. A case control study was performed to determine if: (1) similar to early spontaneous preterm birth, second trimester loss is associated with histologic chorioamnionitis (HCA); and (2) if HCA is present, which organisms may mediate this placental inflammation. STUDY DESIGN: Cases were patients with a spontaneous second trimester loss. Controls were patients who presented for induction of labor for fetal or maternal indications. Nested polymerase chain reaction (PCR) was performed on placental tissues to detect the presence of viruses and pathogenic and atypical bacteria. Chi-square and Fisher exact test were used to determine if HCA and/or the presence of virus or bacteria were significantly associated with second trimester loss. The associations of interest were adjusted for possible confounders using multivariable logistic regression. RESULTS: HCA was more prevalent in cases (67%) than controls (16%) (P < .001). Seventy-nine percent (66/84) of cases and 44% (7/16) of controls were positive for any virus (P = .01). The rate of bacterial infection was similar in both cases and controls (P = .35). In multivariable logistic regression models, HCA (odds ratio [OR] 14.58, 2.62-81.15) and the presence of any virus (OR 6.62, 1.56-28.07) were independently associated with second trimester loss. CONCLUSION: These studies demonstrate that spontaneous second trimester loss is strongly associated with HCA and viral infections.

Abortion, Spontaneous↗

PubMed2006

The Alabama preterm birth study: corticosteroids and neonatal outcomes in 23- to 32-week newborns with various markers of intrauterine infection.

OBJECTIVE: Intrauterine inflammation/infection is cited as a contraindication to the use of corticosteroids (CS). Our goal was to determine if CS given prenatally to enhance fetal maturity were harmful to infants with various indications of intrauterine infection. STUDY DESIGN: This was a retrospective analysis of data obtained from 457 consecutively enrolled infants delivered between 23 and 32 weeks. Cultures and a histologic examination of the placenta, and cord blood interleukin (IL)-6 levels were obtained. Neonatal outcomes included periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), chronic lung disease (CLD), necrotizing enterocolitis (NEC), systemic inflammatory response syndrome (SIRS), and infant death. RESULTS: Of the 457 pregnancies, 57.6% had a positive placental culture, 49.8% had histologic chorioamnionitis/funisitis, 28.8% had elevated cord IL-6 levels, and 12.5% had clinical chorioamnionitis. With intrauterine infection/inflammation, none of the neonatal outcomes were significantly worse if mothers were treated with CS. For those with histologic chorioamnionitis/funisitis, of the outcomes historically improved with CS, RDS (59.9 vs 72.2% P = .16), IVH (9.7 vs 14.7% P = .38), and neonatal death (9.9 vs 11.1% P = .82) all occurred less frequently with CS treatment, but differences were not significant. Similar results were seen for women with a positive placental culture. For women with an elevated IL-6, RDS was significantly reduced (59.4 vs 84.2 %, P = .045). Neonatal SIRS was significantly reduced with CS in women with histologic chorioamnionitis/funisitis (39.7 vs 65.7%, P = .005), positive placental cultures (32.7 vs 56.3%, P = .01), and elevated IL-6 levels (42.7 vs 73.7%, P = .02). CONCLUSION: In women with intrauterine infection/inflammation, CS use was not associated with significant worsening in any neonatal outcome, and was associated with significant reductions in RDS and SIRS. These data suggest that CS use may not be contraindicated in the presence of intrauterine inflammation/infection.

Adrenal Cortex Hormones↗

PubMed2006

Preterm labor is induced by intraamniotic infusions of interleukin-1beta and tumor necrosis factor-alpha but not by interleukin-6 or interleukin-8 in a nonhuman primate model.

OBJECTIVES: The purpose of this study was to determine the relative contributions of individual proinflammatory cytokines and chemokines to the triggering of preterm labor. STUDY DESIGN: Eighteen chronically instrumented pregnant rhesus monkeys at 135 +/- 3 days gestation (term = 167 days) received 1 of 5 intraamniotic infusions: (1) interleukin-1beta (IL-1beta) (10 microg; n = 5), (2) tumor necrosis factor-alpha (TNF-alpha) (10-100 microg; n = 5), (3) IL-6 (20 microg twice a day; n = 2), (4) IL-8 (20 microg twice a day; n = 2), and (5) saline control (n = 4). Primary study outcomes were the mean uterine hourly contraction area (mm Hg x s/h) in 24 hours during peak response to cytokine infusion (all groups) and the interval from cytokine infusion until labor onset (IL-1beta, IL-6, and IL-8 groups). Secondary outcomes were quantities of amniotic fluid cytokines and chemokines (IL-1beta, TNF-alpha, IL-6, and IL-8), prostaglandins E2 and F2alpha, leukocytes, and matrix metalloproteinase-9 (MMP-9). Histopathology of fetal lungs and placental membranes was assessed. RESULTS: IL-1beta stimulated the most intense contraction patterns, resulting in preterm labor in all cases. TNF-alpha induced a variable degree of uterine activity among individual animals stimulating either preterm labor (n = 2) or a uterine contraction pattern of moderate intensity (n = 3). Despite prolonged elevations in amniotic fluid levels, neither IL-6 nor IL-8 induced preterm labor or an increase in uterine activity until near term. The mean interval from the initiation of IL-6 and IL-8 infusion to the onset of labor was significantly longer than after IL-1beta (21.9 vs 1.1 days; P < .01), and did not differ from the saline control group (27.6 days; P = NS). Intraamniotic infusion of IL-1beta or TNF-alpha was associated with significant elevations in all tested amniotic fluid cytokines, IL-8, prostaglandins, MMP-9 and leukocytes compared with gestational age-matched saline controls. IL-6 and IL-8 infusions were not associated with increases in IL-1beta or TNF-alpha and only produced a moderate increase in amniotic fluid prostaglandins. All cytokine infusions induced histologic chorioamnionitis and an accumulation of neutrophils in fetal lungs. CONCLUSION: Preterm labor was induced by intraamniotic infusions of IL-1beta and TNF-alpha, but not by IL-6 or IL-8 although inflammatory changes in fetal membranes and lungs were uniformly present. Our results indicate a primary role for IL-1beta and TNF-alpha in the triggering of preterm labor associated with inflammation or infection.

Amniotic Fluid↗

PubMed2006

The Alabama Preterm Birth study: polymorphonuclear and mononuclear cell placental infiltrations, other markers of inflammation, and outcomes in 23- to 32-week preterm newborn infants.

OBJECTIVE: The purpose of this study was to better understand the relationship between placental polymorphonuclear and mononuclear cell infiltrations with bacterial cultures, markers of inflammation, and preterm outcomes. STUDY DESIGN: This was a prospective study in 446 women who were delivered of a singleton infant at <32 weeks of gestational age. Five placental sites were categorized as having polymorphonuclear or mononuclear infiltrations. Results were compared with placental and cord cultures, umbilical cord interleukin-6 levels, and neonatal outcomes. RESULTS: Polymorphonuclear, but not mononuclear, cell infiltrations were more common at the earliest gestational ages and in black women (56.0% vs 39.3%; P < .01). Polymorphonuclear infiltration was associated with spontaneous preterm birth (73.9% vs 8.0%; P < .0001), but not with preeclampsia (9.9% vs 34%; P < .0001). Women with positive cultures, high interleukin-6 levels, and clinical chorioamnionitis all had significantly more polymorphonuclear infiltrations than did women without those conditions (all probability values, <.0001). In all sites, polymorphonuclear infiltration was associated with neonatal systemic inflammatory response syndrome (P < .0001) and in the cord with necrotizing enterocolitis (22.4% vs 13.5%; P = .02). Intraventricular hemorrhage and neonatal death were not associated with polymorphonuclear infiltration. Polymorphonuclear infiltration at all sites was associated with less respiratory distress syndrome (P < .01). Mononuclear cell infiltration, when present in the decidua basalis, was associated with an increase in neonatal intraventricular hemorrhage (23.8% vs 7.4%; P < .0004). Plasmacytic infiltrates were associated with increased intraventricular hemorrhage (29.4% vs 8.3%; P = .01) and neonatal death (27.8% vs 9.2%; P = .02). CONCLUSION: Polymorphonuclear infiltrations of the free membranes, chorionic plate, and umbilical cord were associated with positive intrauterine cultures and elevated cord blood interleukin-6. There was also an association with systemic inflammatory response syndrome and necrotizing enterocolitis, but not with intraventricular hemorrhage or death, and with decreased respiratory distress syndrome. Decidual mononuclear cell infiltration was associated with an increased risk of intraventricular hemorrhage and decidual plasma cell infiltration with increased intraventricular hemorrhage and neonatal death.

Black or African American↗

PubMed2004

Is maternal alcohol use a risk factor for early-onset sepsis in premature newborns?

Because chronic alcohol abuse alters immune defenses and increases infection in adults, we tested the hypothesis that maternal alcohol use during pregnancy would increase the risk of sepsis in very low birth weight (VLBW) premature newborns. We performed a case-controlled analysis of VLBW newborns born at Grady Memorial Hospital (Atlanta, GA). Alcohol exposure, as the predictive variable, was assessed by maternal self-report. The outcome variables were early-onset and multiple late-onset sepsis. Univariate analysis with Fisher exact test and multivariate analysis with the use of binary logistic regression were performed. Early-onset sepsis was 15-fold higher in the alcohol-exposed group (n=20) compared with findings for the matched control group (n=168) [alcohol-exposed group, 10%, vs. control group, 0.6%: odds ratio (OR) 6.8 (95% confidence interval [CI], 2.7-17.1), P < or = .05]. Early-onset sepsis in the alcohol+cocaine-exposed group (n=64) did not differ from findings for the control group. The prevalence of multiple late-onset sepsis did not differ among the exposure groups. Logistic regression analysis, controlling for chorioamnionitis and premature prolonged rupture of membranes, demonstrated an independent, increased risk of early-onset sepsis with alcohol exposure [OR 16 (95% CI, 1.2-210), P < or = .05]. We conclude that alcohol exposure significantly increased the risk of early-onset sepsis in this group of VLBW newborns. The effects of maternal alcohol abuse during pregnancy on the risk of infection in the VLBW newborn require further analysis.

Adult↗

PubMed2004

[Morganella morganii and early-onset neonatal infection].

UNLABELLED: Morganella morganii is an opportunistic gram-negative bacterium, resistant to ampicillin, and scarcely involved in early-onset neonatal sepsis. CASE REPORT: After a premature rupture of the membranes, a pregnant patient received prophylactic amoxicillin per os. She developed chorioamnionitis. Her infant was diagnosed with early-onset sepsis. Maternal and baby's blood cultures grew M. morganii. Both the mother and the infant were successfully treated with a third-generation cephalosporin and an aminoglycoside. DISCUSSION: The influence of a prior antibiotherapy on the emergence of M. morganii vertical infections is discussed.

Administration, Oral↗

PubMed2005

Possible antenatal and perinatal related factors in development of cystic periventricular leukomalacia.

Cystic periventricular leukomalacia (cPVL), the principal ischemic brain injury in premature infants, is characterized by necrosis of the white matter in the periventricular region and the major neuropathology for spastic motor deficits in cerebral palsy or epilepsy. Recent reports strongly suggest that the brain injury associated with cPVL may have already occurred in utero. In this study we searched retrospectively for possible clinical situations related to cPVL to facilitate assessment of optimal management. A total of 201 babies born at gestational ages from 24 to 33 weeks were entered into the study (1992-1997) and examined for involvement of 18 factors in cPVL retrospectively. And psychomotor development was examined at least until 18 months of corrected age. Among 201 premature babies 35 cases were diagnosed as cPVL later developed spastic diplegia. There are 23 cases of preeclampsia, no infant suffering from cPVL. In the univariate analysis, exposure to antenatal indomethacin, cord length > or =40 cm, and a low Apgar score were significantly associated with a 2-3 risk increased of cPVL occurrence, while antenatal magnesium sulfate reduced the risk. Chorioamnionitis was positively correlated with the risk, but did not reach statistical significance. In the multivariate analysis we found the statistical significance in exposure to antenatal indomethacin, a low Apgar score, and antenatal magnesium sulfate. Our results suggested that preeclampsia and antenatal exposure of magnesium sulfate reduced the risk while antenatal exposure of indomethacin and low Apgar score associated with the occurrence of cPVL. These findings support a growing consensus that cPVL is often the result of maternal and fetal factors as well as antenatal treatment.

Apgar Score↗

PubMed2004

Thickening of the amnion basement membrane and its relationship to placental inflammatory lesions and fetal and maternal disorders.

OBJECTIVE: The aim of this study is the morphological and morphometric analysis of the basement membrane amniotic epithelium of the chorionic plate to establish possible correlation between the basement membrane amniotic epithelium thickening and maternal and fetal disorders. STUDY DESIGN: Ninety-one placentas of infants delivered in Medical Hospital School were studied with hematoxylin-eosin (H&E) and Periodic Acid Schiff (PAS) methods, morphometric and ultrastructural analysis. RESULTS: Of the 91 placentas analyzed, 17 (18.6%) were normal with regard to placental morphology, fetal and maternal history. Basement membrane amniotic epithelium thickening was significantly greater in the cases associated with chorioamnionitis (P=0.013), villitis (P=0.040), maternal hypertension syndromes during pregnancy (P=0.027) and stillborn (P=0.040) babies. The electron microscopic examination of the basement membrane amniotic epithelium identified a structural alteration and edema of the dense lamina. CONCLUSION: Thickening of the basement membrane amniotic epithelium was associated with morphologic placental abnormalities and/or fetal or maternal disorders. Thickening of the basement membrane amniotic epithelium was identified away from the site of placental inflammation, possibly being a consequence of cytokines, supporting more than a local effect. This could be a new insight into the pathogenesis of fetal and maternal complications associated with inflammatory placental lesions.

Adult↗

PubMed2005

Detection of interleukin 6 mRNA by RT-PCR in vaginal secretions: association with preterm delivery and neonatal infection in women with preterm labour and intact membranes.

OBJECTIVE: To find a biological marker associated with preterm delivery or neonatal infection in pregnant women with preterm labour and intact membranes. STUDY DESIGN: Cervical secretions were collected from 286 women hospitalized for preterm labour with intact membranes at 24-34 weeks' gestation. The outcomes studied were delivery before 33 and 35 weeks' gestation, chorioamnionitis, and neonatal infection, and their association with the presence of IL-6 mRNA in cervical secretions as detected by RT-PCR. The other infectious markers tested were: bacterial vaginosis and fetal fibronectin in cervical secretions; serum CRP and white blood cell count. RESULTS: The vaginal secretions of 13 of 286 women (4.7%) contained IL-6 mRNA. The only other marker tested significantly associated with IL-6 mRNA+ was the presence of streptococcus in vaginal secretions (30.8% versus 9.4% in the IL-6+ and-groups, p = 0.03). Although the difference did not reach statistical significance (p<0.06 and 0.08, respectively), in women with IL-6 mRNA in cervical secretions we observed a tendency to give birth before 33 and 35 weeks more often than the population as a whole. This group was at higher risk of neonatal infection (38.5% versus 15.1%; p = 0.04). After adjustment for infectious risk factors, IL-6 remained significantly associated with neonatal infection (OR = 4.6, 95% CI [1.1-18.9]). The sensitivity of IL-6 mRNA for neonatal infection was 11.1%. The specificity was 96.7%. CONCLUSION: The detection of IL-6 mRNA by RT-PCR in vaginal secretions allows identification of a small group of women at high risk of neonatal infection, independently of other markers of infection.

Adult↗

PubMed2005

Preterm prelabour rupture of the membranes before 28 weeks: better than feared outcome of expectant management in Africa.

OBJECTIVE: To document the prognosis after conservative management of patients with membrane rupture at gestations less than 28 weeks. STUDY DESIGN: Prospective observational study of 78 women with confirmed membrane rupture at less than 28 weeks gestation, managed conservatively. Antibiotics were given from the time of membrane rupture till delivery. Patients were delivered if clinical infection supervened, there was fetal compromise, spontaneous labour ensued or if the pregnancy continued to 34 completed weeks gestation. RESULTS: The mean gestational age at membrane rupture was 23.3+/-3.17 weeks (16.5-27.8) and the median 24 weeks. Mean latency period was 24.1+/-29.1 days (1.5-154) with a median of 12.5 days. Eight women (10%) delivered between 24 and 48 h, 25 (32%) within 7 days and 55 (70%) within 1 month. Of note is that 23 patients (30%) had latency periods of greater than 1 month. The mean gestational age at delivery was 26.7+/-3.92 weeks. Overall of the 78 women there were 81 fetuses delivered, of which 35 (43%) survived. Survival was related to latency period, birth weight and gestational age at delivery. Sixteen women (20%) developed chorioamnionitis. There was no increase in the incidence of clinical infection with increasing latency period. Compression limb abnormalities occurred in 17% of neonates and lung hypoplasia in 18%. CONCLUSION: Conservative management of patients with very preterm prelabour membrane rupture offers a survival rate of at least 40% with no serious complications in a study of 78 women.

Adolescent↗

PubMed2004

Risk factors and obstetric complications associated with macrosomia.

OBJECTIVE: Macrosomia is associated with adverse maternal outcomes. The objective of this study was to characterize the epidemiology of macrosomia and related maternal complications. METHOD: Live births (146,526) were identified between 1995 and 1999 in the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR) database. Bivariate and multivariate analyses were performed for risk factors and complications associated with macrosomia (birth weight >4500 g). RESULT: Male infant sex, multiparity, maternal age 30-40, white race, diabetes, and gestational age >41 weeks were associated with macrosomia (p<0.001). In bivariate and multivariate analyses, macrosomia was associated with higher rates of cesarean birth, chorioamnionitis, shoulder dystocia, fourth-degree perineal lacerations, postpartum hemorrhage, and prolonged hospital stay (p<0.01). CONCLUSION: Macrosomia was associated with adverse maternal outcomes in this cohort. More research is needed to determine how to prevent complications related to excessive birth weight.

Adult↗

PubMed2005

Vitamins C and E in the latency period in women with preterm premature rupture of membranes.

OBJECTIVE: To determine whether supplementation with vitamins C and E after preterm premature rupture of membranes (PPROM) is associated with an increased latency period. METHODS: In this double-blind, randomized, controlled trial, 60 women with singleton pregnancies of 26 to 34 weeks' duration and PPROM were randomly assigned to vitamin C (500 mg/day) and vitamin E (400 IU/day) or placebo until delivery. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis. RESULTS: Important demographic, as well as clinical characteristics such as number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome, were similar in the 2 groups. A statically significant difference in the mean+/-S.D. number of days of latency was found between the groups (10.5+/-5.2 days vs. 3.5+/-4.0 days (P = 0.03). CONCLUSION: Vitamins C and E supplementation of after PPROM is associated with a longer latency before delivery.

Adult↗

PubMed2004

Fetal vasculitis in preterm newborns: interrelationships, modifiers, and antecedents.

Histologic expressions of the fetal inflammatory response predict preterm delivery and neonatal disorders. We examined 1146 placentas in the Developmental Epidemiology Network data set for histologic evidence of membrane inflammation (subchorionitis, chorionitis, and chorioamnionitis) and fetal vasculitis (acute umbilical vasculitis or chorionic vasculitis). Our main findings are that (1) in the presence of membrane inflammation, fetal vasculitis is common, (2) duration of membrane rupture and gestational age appear to modify the risk of fetal vasculitis, (3) this risk modification differs for the different components of fetal vasculitis, i.e. umbilical and chorionic vasculitis, and (4) antecedents can be identified that appear to increase or decrease the risk of fetal vasculitis among births with membrane inflammation. We conclude that fetal vasculitis, the morphologic component of the fetal inflammatory response, might not be a homogeneous entity and deserves further study.

Adult↗