Degree of oligohydramnios and pregnancy outcome in patients with premature rupture of the membranes

Amniotic fluid volume was serially assessed by real-time ultrasound in 90 patients who presented with premature rupture of the membranes (PROM) and not in labor. The degree of oligohydramnios was correlated to the outcome of pregnancy, as reflected by pregnancy prolongation, intrapartum fetal heart rate patterns consistent with umbilical cord compression, cesarean section rate, fetal distress, infection, and perinatal mortality rate. These data suggest that in patients with PROM the degree of oligohydramnios is positively correlated with unfavorable pregnancy outcome.     

Evaluating the effects of copper supplement during pregnancy on premature rupture of membranes and pregnancy outcome

Objective: To evaluate the effects of copper (Cu) supplementation during pregnancy on the rupture of membranes and pregnancy outcomes.

Methods: Study was conducted as a triple-blind randomized clinical trial. In one group, Cu in a dose of 1000?mg per day, and in the other group, placebo was prescribed orally from 16th week of pregnancy.

Results: The women of the two groups did not have significant difference according to age, gestational age at recruitment, BMI, and socioeconomic conditions. There was no statistically significant difference between case and control group regarding the incidence of PPROM, PROM, preterm labor, vaginal bleeding during pregnancy, preeclampsia, and the incidence of placenta abruption. There was a 75% and 90% decrease in depressive symptoms in 2nd trimester and 3rd trimester in supplemented group, respectively. Also, there was a 45% and 80% decrease in anxiety symptoms in 2nd trimester and 3rd trimester in the supplemented group, respectively The rate of infection during pregnancy was significantly higher in control group (p?=?0.046). There was no difference between the two groups according to neonatal outcomes.

Conclusions: Cu supplementation during pregnancy could not influence positively on ROM; however, it could improve some mood status of the women.     

The use of fetal biophysical profile improves pregnancy outcome in premature rupture of the membranes

A protocol using daily fetal biophysical assessment was applied in 73 consecutive patients with premature rupture of the membranes and no clinical signs of infection or labor. A persistently low biophysical score (7 or less on two examinations 2 hours apart) in the presence of a nonreactive nonstress test and absence of fetal breathing was used as an indication for delivery. Measures of pregnancy outcome included the presence of amnionitis or neonatal infection. The outcome of pregnancy in this group of patients was compared with the outcomes of two historic groups: one managed conservatively (control group) and the other managed with amniocentesis on admission to the hospital (amniocentesis group). Infection outcome, maternal as well as neonatal, and low 5-minute Apgar scores were significantly less in the study than in the control group. The frequency of neonatal sepsis was significantly less in the study than in the amniocentesis group. These data suggest that management of premature rupture of the membranes with daily fetal biophysical profiles improves pregnancy outcome by reducing the incidence of maternal and neonatal infection.     

Antibiotic prophylaxis for premature rupture of membranes and perinatal outcome

Aim: To evaluate the perinatal outcomes of newborns after premature rupture of membranes (PROM) at the term according to the timing of initial antibiotic administration.

Material and methods: This is a retrospective, cohort study investigating perinatal outcomes of newborns in pregnant women with PROM at the term who were treated with ampicillin within or after 6?h from the PROM. Statistical analysis was performed using Student’s t-test for continuous variables test and chi-square or for categorical data.

Results: The study involved 144 pregnant women with PROM and their newborns, a lower number received antibiotics after birth were in the group who received antibiotics within 6?h of PROM (26.4% versus 73.6%), the mediane values of C-reactive protein were lower (3.0?±?2.9?mg/l versus 6.1?±?7.3?mg/l; p?p =0.023) and time between PROM and delivery was shorter (p?Conclusion: Timely usage of antibiotic prophylaxis and shorter time between PROM and delivery improve perinatal outcomes.     

Chorioamnionitis risk and neonatal outcome in preterm premature rupture of membranes

Objective The objective of this study was to compare the neonatal outcome in patients with preterm premature rupture of membranes with and without clinical chorioamnionitis.Study design This is a retrospective study that included 254 pregnant women with preterm rupture of membranes. The study group was divided according to the presence or absence of clinical chorioamnionitis defined as the presence of two or more of the following criteria: maternal temperature >38°C on two or more occasions 1 h apart, maternal tachycardia (120 beats/min), uterine tenderness, foul smelling amniotic fluid, maternal leukocytosis 20,000 mm^–3 with bands and positive C reactive protein. Also the study population was divided according to the use of tocolysis. Exclusion criteria included multiple pregnancy, fetal congenital anomalies, diabetes mellitus and severe preeclampsia. Amniotic fluid was collected from the cervix or from the transabdominal amniocentesis. Antibiotics and tocolysis were used according to the hospital protocols. Parametric and nonparametric statistics were used for comparisons.Results There were no significant differences in birth weight, Apgar scores at 1 and 5 min, rates of respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis between patients with and without clinical chorioamnionitis or between women who received tocolysis and the ones that did not receive tocolysis. In cases of clinical chorioamnionitis and when tocolysis was used the neonates stayed longer in the neonatal intensive care unit (NICU).Conclusion Patients with preterm premature rupture of membranes and clinical chorioamnionitis have similar neonatal outcomes than the ones without clinical chorioamnionitis.     

Management of premature rupture of membranes and unfavorable cervix in term pregnancy

One hundred thirty-four indigent patients at term who had premature rupture of membranes and a cervix unfavorable for induction of labor (80% effacement or less, 2 cm dilation or less) were randomized to compare expectant with intervention management. Women with any medical or obstetric condition warranting immediate intervention were excluded from the study. Patients treated expectantly were placed at bed rest and observed for labor or infection. Patients managed by intervention were given oxytocin if labor did not ensue within 12 hours of rupture of the membranes. Patients in the intervention protocol had longer labor (P less than .02) and a higher incidence of both cesarean delivery (P less than .05) and intraamniotic infection (P less than .05). There was only one case of proven neonatal sepsis, and this occurred in a patient managed by induction of labor. There was no statistically significant difference between groups in mean length of maternal hospitalization.     

Introduction to premature rupture of membranes.

PROM is associated with controversies in diagnosis, management, and prognosis. The lack of a gold standard to confirm PROM makes it difficult to determine which diagnostic tool is the best and most reliable. It appears that the older methods of confirming PROM, which depend on properties inherent to amniotic fluid, are the best tools available today: ferning and nitrazine combined with patient history.     

A systematic review of pregnancy outcome following preterm premature rupture of membranes at a previable gestational age

Our objective was to identify the maternal and fetal outcome following preterm premature rupture of membranes at a previable gestational age (less than 23 weeks). We conducted a systematic review to identify articles that assessed perinatal and maternal outcome of pregnancies complicated by preterm premature rupture of membranes in early weeks of gestation. Articles available in the electronic database (MEDLINE and EMBASE) from the year 1980 to 1999 were included in the review The subjects were patients with rupture of membranes less than 23 weeks of gestation. Two reviewers independently reviewed the abstracts and finally 11 articles were eligible. Data were extracted separately from available sources within the articles. Data on individual subjects were extracted in eight studies whereas in three studies it was only possible to extract the data on divided gestational age groups. We found a live birth rate of 67% (95% CI: 60-73) in these groups of patients. The perinatal survival was 18% (95 % CI: 11-28) and 17% (95% CI: 16-27) in less than 20 weeks and 20-23 weeks groups respectively. Very little information could be extracted regarding perinatal morbidity Respiratory distress syndrome was diagnosed to be the major morbidity among the surviving infants. The review illustrates how little good quality information is available for pregnancy outcome following PPROM at less than 23 weeks gestation. Although the survival prognosis of this group of patients is poor, the perinatal survival is approximately 21%.     

Successful pregnancy outcome after preterm premature rupture of membranes at < 20 weeks. A report of three cases

BACKGROUND: Spontaneous preterm premature rupture of the membranes occurring before 20 weeks' gestation carries a perinatal mortality of approximately 82% and potential for considerable morbidity for mother and fetus. This is in contrast to amniotic fluid leakage after second-trimester amniocentesis, when the prognosis is usually good. CASES: We report three cases of spontaneous rupture of the membranes before 20 weeks' gestation, all associated with reaccumulation of amniotic fluid and satisfactory neonatal outcomes. CONCLUSION: Our cases may represent a subgroup with a relatively good prognosis. The existence of such subgroups would better be determined in a prospective, cohort study, and it might need to be a multicenter one. It requires well-defined entry criteria, management protocols and neonatal follow-up as well as information about pregnancies where termination, rather than continuation, is chosen.     

Fetal growth and infant neurodevelopmental outcome after preterm premature rupture of membranes

OBJECTIVE: To evaluate the prognostic values of fetal size before birth and fetal growth during the latency period in patients with preterm premature rupture of the membranes (PROM). METHODS: A prospective cohort study of 69 singleton pregnancies complicated by prolonged (14 days or more) PROM (24 to 31 weeks of gestation). Measures of fetal size and growth were compared with corresponding expected values from our reference curves. The correlations between deviations from expected measures of fetal size and growth, short-term neonatal complications, and infant neurodevelopmental outcome at 2 years were studied by univariate methods and logistic regression. RESULTS: The mean gestational ages and standard deviations at membrane rupture and at birth were 27.9 +/- 2.4 and 31.5 +/- 2.1 weeks. At a corrected age of 2 years, of the 65 (94.2%) survivors, 3 infants (4.6%) had cerebral palsy, 13 (20%) had minor neurodevelopmental impairment, and 49 (75.4%) were judged to have had normal development. Compared with surviving infants without a major handicap, the group of infants who died and those with cerebral palsy had lower proportions of expected birth weight (0.766 +/- 0.1 as compared with 0.859 +/- 0.13, P =.029), head (0.869 +/- 0.07 as compared with 0.950 +/- 0.07, P =.05), and abdominal (0.793 +/- 0.04 as compared with 0.888 +/- 0.1, P =.001) circumference growth during latency period. In logistic regression analysis, lower-than-expected ultrasound measures of fetal abdominal circumference before birth (odds ratio 1.09; 95% confidence interval 1.01, 1.18) or of abdominal circumference growth during the latency period (odds ratio 1.1; 95% confidence interval 1.01, 1.2) were significantly associated with an increased likelihood of an infant neurodevelopmental abnormality at 2-year follow-up. CONCLUSION: In pregnancies complicated by preterm PROM, lower-than-expected measures of fetal size and fetal growth were associated with an increased rate of infant neurodevelopmental outcome at 2-year follow-up. LEVEL OF EVIDENCE: II-2     

Cocaine use and preterm premature rupture of membranes: improvement in neonatal outcome

OBJECTIVE: Our aim was to determine whether cocaine use increases neonatal morbidity in patients with preterm premature rupture of membranes. STUDY DESIGN: We reviewed records of pregnancies that were complicated with preterm premature rupture of membranes between 24 weeks to 34 weeks of gestation. Clinical characteristics and neonatal outcomes of patients who had positive results for cocaine in the urine were compared with patients with negative test results. RESULTS: During the study period, 16.1% (85/528 patients) had a positive result in a urine screen for cocaine use. Patients who used cocaine were older and of higher gravidity and parity. When major neonatal morbidities were compared, there was improvement in morbidities that were linked to neonatal infection in patients with positive test results for cocaine, including pneumonia (3.5% vs 11.7%; P =.012) and sepsis (5.9% vs 14.7%; P =.016). Jointly, neonatal outcomes were significantly worse in the negative cocaine group (chi(2) = 5.143; P =.023). CONCLUSION: The association of preterm premature rupture of membranes with major neonatal morbidity was unexpectedly and significantly weaker in pregnancies complicated by cocaine use.     

Preterm premature rupture of membranes and neonatal outcome prior to 34 weeks of gestation.

OBJECTIVES: To investigate the impact of preterm premature rupture of membranes on neonatal outcome. METHODS: A retrospective study was conducted among singleton pregnancies with or without intact amniochorional membranes. The impact of maternal age, gestational age at birth, 1- and 5-min Apgar scores, birthweight, presence of meconium, use of tocolytics, corticosteroids and antibiotics, mode of delivery, umbilical artery pH, histologic presence of chorioamnionitis, and state of the membranes were analyzed in relation to neonatal outcome. Neonatal outcomes were categorized into: none, presence of respiratory distress syndrome, early neonatal sepsis, neonatal death, and days at neonatal intensive care unit. RESULTS: A total of 180 preterm deliveries with ruptured (n=80) and intact membranes (n=100) constituted the study group (group 1) and the control group (group 2), respectively. Compared with group 2, there were more cases in group 1 of maternal antibiotic use (P<0.001), short-term tocolysis (P=0.03), and histologic chorioamnionitis (P<0.001). Multiple logistic regression analysis showed that gestational age at delivery (P=0.009), 1-min Apgar score (P=0.013), and umbilical artery pH (P=0.05) were the independent factors affecting neonatal outcome. CONCLUSIONS: Neonatal outcome was mainly affected by prematurity rather than by preterm premature rupture of membranes.     

Preterm premature rupture of membranes complicating twin pregnancy: management considerations

Preterm premature rupture of membranes (PPROM) is more prevalent in twin gestations and is major contributor to preterm birth. The management of PPROM in twin pregnancies does not differ significantly from that of singletons. In general, antenatal steroids, latency antibiotics, magnesium sulpfate for neuroprotection, and tocolysis are all potential interventions to consider when PPROM complicates a twin gestation. Certain circumstances, such as PPROM following an invasive procedure, at a previable gestational age, or in a monochorionic gestation, warrant special attention as the implications of PPROM and subsequent recommendations for these twin pregnancies may differ. In general, the approach to PPROM in twins should be individualized based on gestational age, and the maternal and neonatal risks of delaying delivery to prolong the pregnancy.     

Meteorological factors in hypertensive disorders, vaginal bleeding and premature rupture of membranes during pregnancy.

In order to determine whether there is a correlation between meteorological factors and the occurrence of hypertensive disorders, vaginal bleeding during pregnancy and premature rupture of the fetal membranes, we stratified all the patients hospitalized with such complications between the years 1984 and 1988 by the months of occurrence, weather, humidity and heat. During this period, there were 276 women hospitalized with exacerbation of hypertension and toxemia, 349 because of vaginal bleeding during pregnancy and 35 women following premature rupture of the fetal membrane between 30 and 33 weeks of gestation. The occurrence of pre-eclampsia and exacerbation of pregnancy-induced hypertension was significantly increased in the winter months (p less than 0.001).     

Acute and chronic respiratory diseases in pregnancy: associations with spontaneous premature rupture of membranes.

OBJECTIVE: To examine whether acute and chronic respiratory diseases are associated with an increased risk of spontaneous premature rupture of the membranes (PROM). METHODS: We used the 1993-2004 National Hospital Discharge Survey data of singleton deliveries in the USA (N = 41 250 539). The International Classification of Diseases Ninth Revision was utilized to identify acute (acute upper respiratory diseases, viral/bacterial pneumonia, and acute bronchitis/bronchiolitis) and chronic (chronic bronchitis and asthma) respiratory conditions and spontaneous PROM. All analyses were adjusted for potential confounders. RESULTS: The incidence of PROM was 5%, and rates of acute and chronic respiratory conditions were 2.1 and 9.5 per 1000 pregnancies, respectively. Chronic bronchitis was associated with a reduced risk of PROM (RR 0.39, 95% CI 0.31, 0.48). Asthma was significantly associated with PROM at preterm (RR 1.15, 95% CI 1.14, 1.17) and term (RR 1.27, 95% CI 1.23, 1.30). Stratification by race showed that acute upper respiratory disease was associated with preterm PROM in whites (RR 1.90, 95% CI 1.71, 2.11) and blacks (RR 6.76, 95% CI 5.67, 8.07). Viral/bacterial pneumonia was associated with preterm PROM in blacks and term PROM in both races. Asthma was associated with term PROM in blacks but not whites. CONCLUSIONS: Acute respiratory diseases and asthma during pregnancy are associated with spontaneous PROM, with substantially stronger association among blacks than whites. We speculate that timely diagnosis and treatment, coupled with closely mentoring of pregnant women may help reduce the rate of PROM and associated complications.     

Twin vs. singleton pregnancy. Clinical characteristics and latency periods in preterm premature rupture of membranes.

OBJECTIVE: To compare the clinical characteristics and latency periods (latencies) of preterm premature rupture of the membranes (PPROM) in twin vs. singleton pregnancy. STUDY DESIGN: Between January 1986 and December 1996, data on all women with singleton and twin gestations complicated by PPROM were reviewed. Perinatal morbidity, mortality and latencies between singleton and twin pregnancies were compared. A further division according to PPROM at < 30 and > or = 30 weeks' gestation was made in both groups. Their latencies were compared. RESULTS: A total of 131 singleton and 48 twin pregnancies with PPROM between 20 and 36 weeks' gestation were included in this series. Regardless of the gestational age at PPROM, the mean latencies of singleton and twin pregnancies were statistically similar (4.4 +/- 3.3 vs. 3.4 +/- 2.9 days, nonsignificant). When PPROM occurred at > or = 30 weeks, the latency of twin pregnancies was shorter than that of singleton pregnancies (2.5 +/- 1.9 vs. 3.7 +/- 2.6 days, P < .05). In both groups, the latencies of PPROM at < 30 weeks were longer than that at > or = 30 weeks (singleton, 5.6 +/- 4.0 vs. 3.7 +/- 2.6 days, P < .005; twin, 4.8 +/- 3.5 vs. 2.5 +/- 1.9 days, P < .05). We also observed a higher percentage of deliveries within the initial 48 hours in twin pregnancies: 50% of women delivered within 48 hours after PPROM and 91.7% within 7 days. In contrast, 26.7% and 85.5% of singleton pregnancies with PPROM were delivered within 48 hours and 7 days, respectively. Perinatal and neonatal outcomes in both groups were similar. CONCLUSION: This investigation provides the basis for patient counseling and management in twin pregnancies with PPROM. In general, singleton and twin pregnancies with PPROM had similar latencies. Latency in PPROM at < 30 was longer than that of PPROM at > or = 30 weeks' gestation in both singleton and twin pregnancies. When PPROM occurred at < 30 weeks' gestation, both groups appeared to have similar latencies. In pregnancies with PPROM at > or = 30 weeks' gestation, latency in twins was shorter than in singleton pregnancies. In twin pregnancies with PPROM after 30 weeks' gestation, prompt steroid administration for fetal lung maturity should be considered.     

Detection of premature rupture of the membranes.

One of the most common problems an obstetrician faces is evaluation of a patient for PROM. Proper assessment of the patient requires a careful integration of history, physical examination, and clinical testing. The most commonly used tests are analysis of vaginal pH with nitrazine paper and evaluation of vaginal secretions with the arborization test. When history, nitrazine, and arborization testing are used in combination, 90% of cases will be diagnosed correctly. When the diagnosis is questionable, other modalities, including ultrasound evaluation and intraamniotic dye injection, should be used as indicated.     

Etiology of preterm premature rupture of membranes.

Numerous factors have been indicted as playing a role in causing preterm premature rupture of membranes (PPROM). After discussing the development of the amnion and chorion, this article focuses primarily on the effects that infection, nutrition, smoking, and cervical incompetence have on the fetal membrane and the subsequent advent of PPROM. However, evidence continues to support a multifactorial etiology for this entity, with numerous factors acting in concert.