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PubMed1991

Doppler evaluation of the fetoplacental circulation in the latent phase of preterm premature rupture of membranes.

Blood velocity waveform analysis by pulsed Doppler ultrasonography in preterm premature rupture of membranes is described. Reduced amounts of amniotic fluid did not impair determination of the resistance indices from the umbilical artery. Good results were obtained from the internal carotid artery in 82% of cases. Failure in measurements at the internal carotid artery occurred when fetal head engagement prevented good study planes. Ninety-three percent of umbilical artery determinations fell within the normal limits for our control population as did 89.2% of those at the internal carotid artery. No differences in the resistance indices could be attributed to the length of the latent period in prematurely ruptured membranes or subclinical chorioamnionitis. Therefore, if a mother or fetus has an underlying condition that affects fetoplacental circulation, the resulting abnormal blood velocity waveform should reflect this condition rather than the effect of ruptured membranes.

Blood Flow Velocity↗
PubMed2000

Focused obstetrical clinic for active duty junior enlisted service women: model for improved outcomes.

OBJECTIVE: To evaluate the utility of an interdisciplinary clinic in improving perinatal outcomes for all pregnant patients of junior enlisted rank (E4 and below) in response to previous reports that this group is at higher risk for adverse outcomes. METHODS: The study population included all junior enlisted active duty patients (E4 and below) delivering between January 1, 1993, and June 30, 1996. Outcomes for patients receiving care in a focused active duty obstetrical clinic were compared with outcomes in similar cohorts of senior active duty patients (E5 and above) and non-active duty pregnant patients. Evaluation was based on perinatal outcomes, including chorioamnionitis, postpartum hemorrhage, intrauterine growth retardation, cesarean delivery, preterm delivery rates (< 37 weeks), postterm delivery rates (> 41 weeks), postpartum days, mean gestational age at delivery, mean delivery weights, Apgar scores at 1 and 5 minutes, preeclampsia, and premature labor. Variables with potential to confound perinatal outcomes were also studied. Confounding variables included tobacco use, gestational diabetes, chronic hypertension, thyroid disease, history of substance abuse, and alcohol use. Power analysis accomplished before initiation of the study showed adequate sample size (> 240 patients in each group) to demonstrate statistically different rates of preterm delivery. Statistical analysis was done using the chi 2 test for categorical variables and Student's t test for continuous variables. RESULTS: There were no statistical differences between junior active duty patients, senior active duty patients, and non-active duty patients in preterm delivery and other outcome variables. CONCLUSION: The focused obstetrical clinic, conducted for junior enlisted soldiers by a senior nurse practitioner, appears to provide an intervention that ensures perinatal outcomes equal to those of both the non-active duty and the senior active duty population.

Adult↗
PubMedDate not supplied

[Efferent methods in the therapy of puerperal and postoperative complications].

Ninety-six patients with chorioamnionitis in labor were treated. Clinical observations and laboratory findings demonstrated high efficiency of multiple-modality treatment including use of efferent methods: plasmapheresis, incubation of cell mass with antibiotics, and ultra-violet exposure of the blood.

Cesarean Section↗
PubMed2000

[Premature rupture of the membranes between 28 and 34 weeks of amenorrhea. Retrospective study apropos of 71 cases].

OBJECTIVE: The aim of our study is to compare the outcome of infants born after preterm premature rupture of the membranes (PPROM) between 28 and 34 weeks gestation. We compare two groups of infants: group A, infants born in hospitals without neonatal intensive care unit, after PPROM with long tocolysis, no maternal prophylactic antibiotic therapy and no systematic maternal steroid therapy. Group B with systematic maternal steroid therapy, maternal prophylactic antibiotic therapy, short tocolysis and born in an hospital with neonatal intensive care unit. The latency period (time from rupture of membranes to the onset of labor) authorized was 15 days in the group B and not limited in the group A. RESULTS: Death (13.8% vs 0%; p=0.022), neonatal infection (66.6% vs 28.6%; p=0.0013), and respiratory distress (63.8% vs 34.3%; p=0.0144) were less frequent in the group B. The group A infants passed more than ten days in intensive care unit (61.1% vs 37.1%; p=0.043). Neonatal infection was not higher in the corticosteroïd therapy group (41.2% vs 70.3%; p=0.0135). There is more neonatal infection in the group A with long latency period (61.7% vs 24.3%; p=0.0014) and more chorioamnionitis (70.6% vs 24.3%; p<0.0001). CONCLUSION: The association maternal steroid and antibiotic therapy, short latency period, and hospitalization of the pregnant woman close to a neonatal intensive care unit reduce significantly the neonatal morbidity after preterm premature rupture of the membranes.

Adrenal Cortex Hormones↗
PubMed2001

[Neonatal neurological impact of inflammation in the fetus].

With improvement of critical care of the newborn, perinatal mortality had decreased along the past decades. However, recent studies have shown that there is a slightly increase in the prevalence of cerebral palsy over the same period either for term or premature babies. Epidemiological data stress the multifactorial origins of cerebral palsy. Along with premature birth one of the predominant cause appears to be chorioamnionitis. Using data from a review of clinical and experimental studies the authors aim to clarify the link between infection, inflammation and fetal brain damage. The hypothesis that cytokines as mediators of inflammation can also mediate neurotoxicity is developed.

Cerebral Palsy↗
PubMed2000

[Meconium and its significance].

OBJECTIVE: A review of meconium patophysiology and its contribution to the incidence of perinatal infection. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic. METHOD: The reported incidence of meconium-stained amniotic fluid varies between 7 and 22%. The patophysiology of the presence of meconium in the amniotic fluid is not sufficiently explained. Meconium in fetal bowels is under hormonal and neurol control. The presence of the meconium-stained amniotic fluid was always considered to be a potential risk for the fetal and neonatal well-being. The review is further divided in to three chapters. (II. Meconium and meconium aspiration syndrome, III. Meconium and postnatal neurological handicap). RESULTS AND CONCLUSION: The first chapter on deals with meconium risk in the development of perinatal infection: intraamniotic infection/chorioamnionitis, postnatal endometritis, infection of the abdominal wound after Caesarean and neonatal infection. The incidence of clinical chorioamnionitis is 15% with the presence of meconium compared to 3% in controls. The incidence of puerperal endometritis is 10% in comparison to 3% under normal conditions. Two main mechanisms of development (or coincidence) of intraamniotic infection in the presence of meconium exist. 1) Infection may be a cause of meconium passage. 2A) Alteration of Zn/P ratio in the amniotic fluid can promote bacterial growth. 2B) Meconium attached to macrophages or absorbed by phagocytosis can impair cellular immune response. The antibiotic prophylaxis is discussed.

Amniotic Fluid↗
PubMed2001

Maternal serum tumor necrosis factor-alpha in patients with preterm labor.

OBJECTIVE: To evaluate maternal serum tumor necrosis factor-alpha (TNF alpha) levels in patients with preterm labor without clinical signs of chorioamnionitis and to compare these with levels in nonlaboring controls. STUDY DESIGN: The study group consisted of 44 patients with a singleton pregnancy admitted to our department with the diagnosis of preterm labor between 26 and 36 weeks' gestation. The control group consisted of 25 healthy consecutive patients with a singleton pregnancy without preterm contractions who were seen for routine antenatal visits. Maternal serum TNF alpha was measured using a solid-phase, two-site chemiluminescent enzyme immunometric assay method, and levels were compared in patients with preterm labor and nonlaboring controls. RESULTS: The median maternal serum TNF alpha level for patients with preterm labor was 29.4 pg/mL (range, 12.3-173) as compared with 23 pg/mL (range, 11.9-62.7) in the control group (P = .031). Among 44 patients with preterm labor, 14 (32%) delivered within one week of admission. The median maternal serum TNF alpha level was significantly higher in patients who delivered within one week than in those who delivered after one week and controls (71.3 pg/mL [range, 28-173]) versus 22 pg/mL (range, 12.3-86) versus 23 pg/mL (range, 11.9-62.7) (P < .0001). CONCLUSION: TNF alpha was elevated in patients with preterm labor, suggesting a role for maternal serum TNF alpha in its initiation.

Adult↗
PubMed2001

[Clinical investigation of cefpirome for perinatal infection and infection prevention].

Effectiveness and safety of cefpirome (CPR) were studied in perinatal infection and prevention of postoperative infections. 1. Enrolled in the study of perinatal infections were the total 62 cases comprising 47 of chorioamnionitis, 10 of puerperal intrauterine infections, 1 of infectious abortion and 4 of others. The effective rate of CPR 2 g/day given in drip infusion was 61/62 (98.4%). In bacteriological studies, the bacterial elimination rate was 57/61 (93.4%). Unchanged and remained were 3 strains of Gram-positive bacteria and 1 strain of Bacteroides spp. 2. Enrolled in the study of prevention of postoperative infections during perinatal period were the total 88 cases comprising 74 who underwent cesarean section and 14 others. The effective rate of CPR 2 g/day given in drip infusion was 87/88 (98.9%). 3. With respect to subjective and objective adverse affects due to the agent, drug eruption was observed in 1/150 (0.7%). No abnormal result of clinical laboratory tests was found. The above results suggested the usefulness of CPR for treatment of perinatal infections and prevention of postoperative infections.

Adult↗
PubMed2001

Infection in pregnancy and cerebral palsy.

Infections in pregnancy, including the most common congenital infections (TORCH: toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus), are known causes of long-term neurodevelopmental disabilities, although the proportion of children with specific disabilities attributable to TORCH infections appears to be 5% to 10% or less. Intrauterine infection, especially subclinical infection of the kind associated with preterm birth, is under investigation as a cause of neurodevelopmental disability. These studies have focused almost exclusively on cerebral palsy. Summary estimates from a published meta-analysis suggest that chorioamnionitis is associated with a twofold increased risk of cerebral palsy in preterm and a fivefold increased risk in term children. In some studies, cytokine levels in amniotic fluid or newborn blood have also been found to be significantly elevated in preterm and term children with cerebral palsy compared to controls. These data suggest that factors related to the fetal inflammatory response, including cytokines, may be causal agents in brain damage and neurodevelopmental disability associated with intrauterine infection. We need to greatly improve both our understanding of and our ability to measure the relevant exposures related to infection and inflammation, to further understand differences in the association between intrauterine infection and cerebral palsy relative to gestational age, and to investigate a broad range of neurodevelopmental outcomes as potential adverse effects of intrauterine infection.

Cerebral Palsy↗
PubMed2002

Short-term maternal outcomes that are associated with the EXIT procedure, as compared with cesarean delivery.

OBJECTIVE: The ex utero intrapartum treatment procedure was developed to treat iatrogenic tracheal obstruction that resulted from in utero fetal therapy for congenital diaphragmatic hernia. The ex utero intrapartum treatment procedure allows for controlled intubation while the neonate is maintained on placental circulation, prolonging operative time. This study evaluates whether there is increased maternal morbidity associated with this procedure compared with routine cesarean deliveries. STUDY DESIGN: Maternal outcomes on 34 patients who underwent the ex utero intrapartum treatment procedure were evaluated. Infection rate, estimated blood loss, need for transfusion, and length of postoperative hospital stay were compared to maternal outcomes from 52 non-laboring patients who underwent non-emergent primary cesarean delivery of singleton fetuses during the same time interval. RESULTS: The rate of chorioamnionitis was similar between groups (26% vs 21%; P =.57). Postpartum wound complications were more common in patients who underwent ex utero intrapartum treatment (15% vs 2%; P =.03), although the rate of endometritis was similar (15% vs 10%; P =.50). Estimated blood loss was higher in the patients who underwent ex utero intrapartum treatment (1104 mL vs 883 mL; P <.001), but there was no difference between groups in hematocrit level change or postpartum hospital stay. CONCLUSION: Women who undergo the ex utero intrapartum treatment procedure experience more wound complications but no difference in postoperative hematocrit level change or postpartum length of stay.

Adult↗
PubMed2002

Indications for and questions about antenatal steroids.

Antenatal glucocorticoid treatment of women at risk of preterm delivery between 24 and 34 weeks' gestation has been the standard of care since 1994. Recent information supports its use with preterm prolonged rupture of membranes, in very early gestations in which neonatal survival will be attempted, and in women with preeclampsia. Many women who deliver before 30 weeks' gestation have chronic silent chorioamnionitis, which does not seem to be a contraindication to antenatal glucocorticoid therapy. The preferred antenatal treatment is a short- and long-acting betamethasone combination given as 12-mg maternal injections at the identification of preterm labor and 24 hours later. Repeated courses of antenatal glucocorticoids given at 7- to 10-day intervals if preterm delivery does not occur are not indicated. Antenatal glucocorticoid therapy is very effective, and no adverse effects of a single treatment course have been identified.

Chorioamnionitis↗
PubMed1992

Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes.

OBJECTIVE: To compare the clinical outcome in patients with preterm premature rupture of membranes (PROM) who had a sterile speculum examination with those having a digital vaginal examination. METHODS: We studied 271 singleton pregnancies complicated by preterm PROM from the Memorial Medical Center of Long Beach Perinatal Outreach program that met the criteria for expectant treatment from January 1986 to April 1990. Patients were not included in the study if they had multiple gestations, cerclage, advanced labor, or any indication for delivery on admission (eg, mature lung profile, chorioamnionitis). All subjects were maternal transports to our tertiary care facility and were managed similarly by our perinatal group. The women were questioned as to whether a digital vaginal examination had been performed before transport. Latency period and other obstetric characteristics were then compared. The latency period, defined as days from rupture of membranes until active intervention was initiated or labor began spontaneously, was also stratified by gestational age. RESULTS: One hundred twenty-seven subjects had a digital vaginal examination and 144 had a sterile speculum examination. A significantly (P less than .0001) shorter mean latency period (2.1 +/- 4.0 versus 11.3 +/- 13.4 days) was found in those who had a digital vaginal examination. In addition, a shorter latency period was noted for each gestational age. No difference in uterine activity or cervical dilatation and effacement was noted between the groups on admission. CONCLUSION: Digital vaginal examinations performed on patients whose pregnancies are complicated by preterm PROM appear to shorten significantly the latency period.

Chorioamnionitis↗
PubMed1992

[Clinical studies on imipenem/cilastatin sodium in the early therapy of preterm premature rupture of the membrane or threatened abortion and premature delivery].

The efficacy and safety of early therapy with imipenem/cilastatin sodium (IPM/CS) were studied in patients who had chorioamnionitis with preterm PROM or threatened abortion and premature delivery. The following results were obtained. 1. The clinical efficacy of IPM/CS administered by intravenous drip infusion at daily dosages of 1 to 2 g as concurrent treatment with antiuteronics (ritodrine hydrochloride or terbutaline sulfate) was studied in patients with threatened abortion and premature delivery in the 11th to 34th week of pregnancy (n = 9), or premature PROM in the 23rd to 36th week (n = 9). 2. Response to IPM/CS were good in all of the patients with threatened abortion and premature delivery. Latent periods were prolonged for more than 7 days in 44.4% (4/9) of the patients with preterm PROM. 3. Changes in elastase appeared to be significant as those in CRP for inflammatory markers. 4. These findings combined with our previous results indicate that treatment of preterm PROM before the 32nd of pregnancy prolongs the latent period.

Abortion, Threatened↗
PubMed2003

[New clinical entity in perinatology: fetal inflammatory response syndrome].

In spite of the adequate therapy serious inflammatory complications affect the majority of preterm neonates. Recently, the role of fetal inflammatory response syndrome has been emerged as a possible mechanism. This new clinical entity is characterised by the generalised activation of fetal immune system which is often the result of chorioamnionitis. The level of inflammatory cytokines (interleukin-6) often elevates in fetuses affected by this syndrome. Elevated cytokine levels induce the infiltration of inflammatory cells into the amnion and activate matrix metalloproteases in the fetus. As a result, preterm birth occurs. The high levels of inflammatory cytokines in the fetus are associated with the development of bronchopulmonary dysplasia and periventricular leukomalacia in the newborn. Except the elevation of fetal interleukin-6 levels there is still no specific clinical or laboratory sign of the fetal inflammatory response syndrome. Further investigation is needed to understand the importance of this syndrome in the development of perinatal complications and to develop specific laboratory tests for the early recognition.

Bronchopulmonary Dysplasia↗
PubMed2004

Sepsis and multisystem organ failure in a woman attempting interval delivery in a triplet pregnancy: a case report.

BACKGROUND: Interval delivery of the fetuses in multiple gestations has been shown to increase perinatal survival. CASE: A woman attempting interval delivery of triplets at 21 weeks developed chorioamnionitis, acute respiratory distress syndrome and tubular necrosis 7 days after delivery of the first fetus. CONCLUSION: When counseling women about the typically favorable outcomes of delayed interval deliveries, physicians should also warn of the potential risk of complications.

Adult↗
PubMed2004

[Frequency, diagnostic criteria and consequences of bacterial vaginosis in pregnant women].

Vaginal discharge based on changes in a vaginal ecosystem (decreasing number of Lactobacillus and increasing number of Mobiluncus spp., Gardnerella vaginalis, Prevotella spp., Mycoplasma hominis, Peptostreptococcus spp) appears to be a major cause of bacterial vaginosis. Bacterial vaginosis is associated with: preterm delivery, premature rupture of membranes, chorioamnionitis, amniotic fluid infection, endometritis, low-weight neonates. The role of natural microflora of vagina, the most important diagnostic criteria, epidemiology and immunological changes in pregnant women with bacterial vaginosis are discussed in the light of the recent publications.

Chorioamnionitis↗
PubMed2005

Incidence of neonatal infection in newborn infants with a maternal history of premature rupture of membranes (PROM) for 18 hours or longer by using Phramongkutklao Hospital Clinical Practice Guideline (CPG).

BACKGROUND: Phramongkutklao CPG was developed for detecting infants with maternal PROM > or = 18 hours who had a high risk of infection. OBJECTIVE: To determine efficacy of the CPG, and risk factors of infection. STUDY DESIGN: Prospective cohort study. MATERIAL AND METHOD: Eligible infants were categorized into group I (symptomatic), group II (chorioamnionitis) or group III (asymptomatic). Infants in group I, II and those in group III who had scores > or = 3 were treated with antibiotics. Infants were followed-up until 28 days of age. RESULTS: 104 infants were recruited into the present study. 29 of 104 (27.88%) infants had infection. Risk factors were Apgar scores < or = 5, PROM > 72 hours, gestational age < 34 weeks, and low birth weight. The success rate of using CPG was 98.08% and antibiotic use was reduced by 53.08%. CONCLUSION: Phramongkutklao CPG on PROM is safe and cost saving. All risk factors should be included in the guideline.

Adult↗
PubMed1992

Management of premature rupture of membranes at term.

Although prelabor rupture of membranes at term is common, in most cases, the spontaneous onset of labor relieves the obstetrician of the need for making management decisions. The standard practice in the United States has been to induce labor with intravenous oxytocin in that minority of patients who fail to labor spontaneously. Controlled trials suggest that this practice is associated with higher rates of both chorioamnionitis and the need for cesarean delivery than is expectancy. Expectancy, however, has not been demonstrated to be safer for the perinate.

Chorioamnionitis↗