Vaginal Infection Causing Spontaneous Rupture of the Membranes and Premature Delivery

Summary: The incidence of vaginal infection in a group of patients in whom spontaneous rupture of the membranes and subsequent premature delivery occurred was compared with the incidence in a control group of patients. The incidence of vaginal moniliasis was essentially the same in both groups of patients. However, the incidence of vaginal trichomoniasis was 2.2 times higher in patients who had spontaneous rupture of the membranes and subsequent premature delivery than in the control group of patients (P < 0.01).     

Antibiotic Therapy in Preterm Premature Rupture of the Membranes

ObjectiveTo review the evidence and provide recommendations on the use of antibiotics in preterm premature rupture of the membranes (PPROM).OutcomesOutcomes evaluated include the effect of antibiotic treatment on maternal infection, chorioamnionitis, and neonatal morbidity and mortality.EvidencePublished literature was retrieved through searches of Medline, EMBASE, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM, infection, and antibiotics). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and new material incorporated in the guideline to July 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.ValuesThe evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.Benefits, Harms, and CostsGuideline implementation should assist the practitioner in developing an approach to the use of antibiotics in women with PPROM. Patients will benefit from appropriate management of this condition.ValidationThis guideline has been reviewed and approved by the Infectious Diseases Committee and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive and Council of the SOGC.SponsorThe Society of Obstetricians and Gynaecologists of Canada.Recommendations

• 1.Following PPROM at ≤ 32 weeks’ gestation, antibiotics should be administered to women who are not in labour in order to prolong pregnancy and to decrease maternal and neonatal morbidity. (I-A)
• 2.The use of antibiotics should be gestational-age dependent. The evidence for benefit is greater at earlier gestational ages (< 32 weeks). (I-A)
• 3.For women with PPROM at > 32 weeks’ gestation, administration of antibiotics to prolong pregnancy is recommended if fetal lung maturity can not be proven and/or delivery is not planned. (I-A)
• 4.Antibiotic regimens may consist of an initial parenteral phase followed by an oral phase, or may consist of only an oral phase. (I-A)
• 5.Antibiotics of choice are penicillins or macrolide antibiotics (erythromycin) in parenteral and/or oral forms. (I-A) In patients allergic to penicillin, macrolide antibiotics should be used alone. (III-B)
• 6.The following two regimens may be used (the two regimens were used in the largest PPROM randomized controlled trials that showed a decrease in both maternal and neonatal morbidity): (1) ampicillin 2 g IV every 6 hours and erythromycin 250 mg IV every 6 hours for 48 hours followed by amoxicillin 250 mg orally every 8 hours and erythromycin 333 mg orally every 8 hours for 5 days (I-A); (2) erythromycin 250 mg orally every 6 hours for 10 days (I-A)
• 7.Amoxicillin/clavulanic acid should not be used because of an increased risk of necrotizing enterocolitis in neonates exposed to this antibiotic. Amoxicillin without clavulanic acid is safe. (I-A)
• 8.Women presenting with PPROM should be screened for urinary tract infections, sexually transmitted infections, and group B streptococcus carriage, and treated with appropriate antibiotics if positive. (II-2B)

     

检测胎儿型纤维连接蛋白用于诊断胎膜早破

应用ＡＢＣ抗体凝集素夹心斑点免疫法，对３０例正常妇女血浆、５０例正常孕妇宫颈分泌物和８０例胎膜早破孕妇宫颈分泌物，进行纤维连接蛋白（Ｆｎ）岩藻糖化异质体检测。结果：胎膜早破孕妇宫颈分泌物中Ｆｎ岩藻糖化异质体检出阳性纺为９５．０％，正常孕妇为６．０％。提示：胎儿型Ｆｎ对诊断胎膜早破有较高的敏感性。为胎膜早破的诊断提供了一个新方法。     

胎膜早破发病机制的研究进展

胎膜早破（premature rupture of fetal membranes,PROM）是产科临床非常普遍且相当棘手的问题,是早产的常见原因,若不能合理处理,母儿的生命就会受到威胁。引起胎膜早破的原因众多,其发病机制也十分复杂。综述胎膜破口区域的组织学特征,包括传统病理学和新型光学研究观察结果;其次介绍新发现的胎膜存在微小裂隙并持续重塑的观点;另外部分早破胎膜破口有发生自发性愈合,总结胎膜破口自愈现象的机制,主要是以细胞迁移为基础的物理性封闭;PROM发生机制一直以来都是研究热点,介绍当下较新的理论如胎膜老化和胎膜氧化应激失衡研究进展,同时对胎膜细胞凋亡、胎膜蛋白酶系统/抗蛋白酶系统平衡失调等传统理论的新近研究加以综述,旨在为胎膜早破进一步研究提供理论思路。     

Factors That Predispose to Premature Rupture of the Fetal Membranes

Causes of premature rupture of the fetal membranes were explored in a study of 25,820 pregnancies. Fourteen risk factors were analyzed using multivariate analysis. The following maternal factors had a positive association with premature ruptures: advanced maternal age, non-white race, multiparity, instrumentation of the cervix prior to pregnancy, cigarette smoking, incompetent cervix, low pregnancy weight gain, and recent coitus.     

Premature Rupture of the Membranes, Oligohydramnios and Pulmonary Hypoplasia

Summary: The clinical and pathological features of oligohydramnios associated with severe pulmonary hypoplasia are described in 10 infants without renal anomalies. In 8 patients the condition was associated with prolonged premature rupture of the membranes at 16 to 36 weeks of gestation in a study of 244 patients (3.3%). Seven of the infants died of respiratory failure within 24 hours of delivery; the other infant survived. In the remaining 2 patients with severe oligohydramnios at term, but unassociated with premature rupture of the membranes, both infants succumbed.
Problems with resuscitation should be anticipated in pregnancies complicated by prolonged leakage of amniotic fluid or oligohydramnios, and pulmonary hypoplasia should be recognized as a cause of respiratory distress. Apart from the ultrasonic predelivery confirmation of normal kidneys to exclude Potter's syndrome it is recommended that ultrasonic assessment of thoracic cage volume should be made before delivery.     

Amniocentesis in the Management of Preterm Premature Rupture of the Membranes

A retrospective analysis has been performed of perinatal outcome in 81 pregnancies in which preterm premature rupture of membranes (PPROM) was managed using amniocentesis to diagnose intrauterine infection and lung maturity. Ten patients (13%) had a positive Gram stain on microscopy whilst 29 (37%) had a positive culture. Forty-one patients (58%) had a mature lecithin:sphingomyelin ratio. There was evidence of sepsis in 13 neonates (16%), with a further 16 (20%) being colonized. Both Gram stain and amniotic fluid culture were relatively poor predictors of neonatal sepsis. For Gram stain the sensitivity was low at only 15%. Although the sensitivity for culture was higher (69%), the specificity (71%) was too low to be clinically useful. It is recommended that a randomized controlled trial of amniocentesis in PPROM is needed to define the role of this diagnostic test.     

间隙连接蛋白43与胎膜早破的相关性

胎膜早破(premature rupture of membranes,PROM)是产科最常见的早产原因之一,可诱发新生儿呼吸窘迫综合征、绒毛膜羊膜炎、胎盘早剥、败血症等不良结局.间隙连接通讯是细胞间最常见的信息交互及物质交换途径,其功能主要由间隙连接蛋白实现,间隙连接蛋白43(Connexin43,Cx43)是间隙连...     

Ascorbic Acid Concentration and Preterm Premature Rupture of Membranes

Introduction

Preterm premature rupture of membranes (PPROM) complicates 1–5 % of all pregnancies and is the major contributory factor for perinatal morbidity and mortality. Micronutrient deficiency (vitamin C) is associated with increased risk of PPROM. This study was conducted to establish the association between maternal plasma vitamin C concentration in women with PPROM and women without PPROM and to study the difference in maternal morbidity, neonatal morbidity, and mortality.

Methods

A prospective study was conducted where 40 women (20 in each study and control group) with singleton pregnancies between 28 and 37 weeks gestation were recruited. Women with anemia, diabetes, UTI, RTI, vaginal infection, bleeding, h/o PPROM in previous pregnancy, polyhydramnios, and smoker were excluded from the study. Maternal plasma vitamin C levels were measured.

Results

Ascorbic acid levels were low in women with PPROM 0.41 ± 0.08 versus 0.84 ± 0.19 mg/dl. There is a linear decline in plasma vitamin C levels as the pregnancy advances. Inverse relationship was observed between duration of rupture of membranes and vitamin C levels. There was a significant difference in maternal morbidity, neonatal morbidity, and mortality.

Conclusion

Ascorbic acid concentration was low in women with PPROM. Thus, vitamin C supplementation should be made mandatory along with iron and calcium to antenatal women to avoid the complications of PPROM.     

Warm Tub Bath After Spontaneous Rupture of the Membranes

ABSTRACT: Increasing numbers of pregnant women take a warm bath during labor. Yet few evaluations have addressed benefits claimed and possible risks of this practice. Using retrospective data from a continuing trial at a birth center in Stockholm, we compared 89 women who took a warm bath after spontaneous rupture of the membranes at term with 89 women who had the same interval from spontaneous membrane rupture to delivery and who did not bathe. No statistical difference was observed between the groups with respect to infections, asphyxia or respiratory problems in the newborn infant, or maternal signs of amnionitis. However, a tendency toward more complications was observed in the bathing group. Babies born more than 24 hours after rupture of membranes had significantly lower Apgar scores at 5 minutes in the bathing group than in the control group. As a result of our review of the sparse literature on this practice and the data from this study, we have modified the bathing policy at the birth center from a rather enthusiastic to a more cautious approach. Recommendations about the use of a warm bath in labor will require further investigation, such as randomized trials with large numbers of subjects. (BIRTH 19:2 June, 1992)     

胎膜早破162例临床分析

目的探讨胎膜早破与难产及母儿并发症的关系.方法对829例无妊娠合并症及并发症的产妇资料进行回顾性分析,其中胎膜早破病例162例,胎膜未破病例682例作为对照组.结果胎膜早破组的剖宫产率、早产率、新生儿窒息及肺炎发病率均较对照组显著升高,母亲产褥病率两组间无差异.破膜距妊娠结束时间及早产与新生儿窒息及肺炎关系密切.结论胎膜早破与难产互为因果关系.对不同孕周胎膜早破患者应采取不同治疗方案,以尽可能减少母儿并发症.