Periodontal disease and intra-amniotic complications in women with preterm prelabor rupture of membranes

Objective: Periodontal disease is frequently suggested as a possible causal factor for preterm delivery. The link between periodontal disease and preterm delivery is a possible translocation of periopathogenic bacteria to the placenta and amniotic fluid as well as a systemic response to this chronic inflammatory disease. However, there is a lack of information on whether there is an association between clinical periodontal status in women with preterm prelabor rupture of membranes (PPROM) and the presence of microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation (IAI). Therefore, the main aim of this study was to evaluate the incidence and severity of periodontal disease in women with PPROM. The secondary aim was to characterize an association between periodontal status and the presence of intra-amniotic PPROM complications (MIAC and/or IAI).

Materials and methods: Seventy-eight women with PPROM at gestational ages between 24?+?0 and 36?+?6 weeks were included in this study. The samples of amniotic fluid were obtained at admission via transabdominal amniocentesis, and amniotic fluid interleukin (IL)-6 concentrations were determined using a point-of-care test. All women had a full-mouth recording to determine the periodontal and oral hygiene status. Probing pocket depth and clinical attachment loss were measured at four sites on each fully erupted tooth.

Results: In total, 45% (35/78) of women with PPROM had periodontal disease. Mild, moderate, and severe periodontal disease was present in 19% (15/78), 19% (15/78), and 6% (5/78) of women, respectively. The presence of MIAC and IAI was found in 28% (22/78) and 26% (20/78) of women, respectively. Periopathogenic bacteria (2?×?Streptococcus intermedius and 1?×?Fusobacterium nucleatum) was found in the amniotic fluid of 4% (3/78) of women. There were no differences in periodontal status between women with MIAC and/or IAI and women without these intra-amniotic complications.

Conclusions: The presence of MIAC and IAI was not related to the periodontal status of women with PPROM.     

Amniotic fluid prostaglandin E2 in pregnancies complicated by preterm prelabor rupture of the membranes

Objective: To determine amniotic fluid prostaglandin E2 concentrations in women preterm prelabor rupture of the membranes (PPROM) with respect to microbial invasion of the amniotic cavity (MIAC), intraamniotic inflammation (IAI), microbial-associated IAI, histological chorioamnionitis, and short-term neonatal morbidity.

Methods: One hundred forty-five women with singleton pregnancies were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis and were assayed for prostaglandin E2 concentrations by ELISA. IAI was defined as amniotic fluid interleukin-6 >745?pg/mL. Microbial-associated IAI was defined as the presence of both MIAC and IAI.

Result: No differences in prostaglandin E2 concentrations were found between women with and without MIAC (p?=?0.27). Women with IAI (p?=?0.0008) and microbial-associated IAI (p?=?0.01) had higher prostaglandin E2 concentrations than women without these complications. Women with histological chorioamnionitis had higher prostaglandin E2 concentrations only in crude analysis (p?=?0.02), but not after adjustment for gestational age at sampling (p?=?0.10). No associations between amniotic fluid prostaglandin E2 concentrations and the selected conditions of severe neonatal morbidity were found.

Conclusions: The intraamniotic inflammatory response either to infectious or to non-infectious stimulus, but not MIAC per se, seems to be a main factor associated with the elevation of the amniotic fluid PGE2 concentrations in women with PPROM.     

The fetal inflammatory response in subgroups of women with preterm prelabor rupture of the membranes

Abstract

Objective: To evaluate the influence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) on the intensity of the fetal inflammatory response and the occurrence of fetal inflammatory response syndrome (FIRS) in preterm prelabor rupture of membranes (PPROM).

Methods: One hundred and forty-nine women with singleton pregnancies complicated by PPROM between the gestational ages 24?+?0 and 36?+?6 weeks were included in the study. Blood samples were obtained by venipuncture from the umbilical cord after the delivery of the newborn. The umbilical cord blood interleukin (IL)-6 levels were evaluated using ELISA kits. The fetal inflammatory response was determined by IL-6 levels, and FIRS was defined as an umbilical cord blood IL-6 >11?pg/mL.

Result: IL-6 levels and the occurrence of FIRS were higher in women complicated with both MIAC and HCA (median IL-6 35.5?pg/mL, FIRS in 68%) than in women with HCA alone (median IL-6 5.8?pg/mL, FIRS in 36%), MIAC alone (median IL-6 2.8?pg/mL, FIRS in 17%) or women without MIAC or HCA (median IL-6 4.3?pg/mL, FIRS in 29%). There were no differences in IL-6 levels or rates of FIRS among women with MIAC alone or HCA alone and women without both MIAC and HCA.

Conclusion: A higher fetal inflammatory response mediated by umbilical cord blood IL-6 was identified when both MIAC and HCA were detected in pregnancies complicated by PPROM.     

Scavenger receptor for hemoglobin in preterm prelabor rupture of membranes pregnancies complicated by histological chorioamnionitis

Objective: We sought to evaluate the distribution of scavenger receptor for hemoglobin positive (CD163⁺) cells in the placenta and fetal membranes from pregnancies complicated by preterm prelabor rupture of membranes with respect to the presence and absence of histological chorioamnionitis. Methods: Sixty-two women with singleton pregnancies with a gestational age between 24+0 and 36+6 weeks were included in a prospective cohort study. CD163 was evaluated by immunohistochemistry in the placenta and fetal membranes. The number of CD163⁺ cells and neutrophils was counted in the following locations: fetal membranes’ amnion, chorion, and decidua, as well as the placenta’s amnion, chorionic plate, subchorionic fibrin, stem villi, terminal villi, and decidua. Results: CD163⁺ cells were found in all compartments of the placenta and the fetal membranes regardless of the inflammatory status. A positive correlation between the number of CD163⁺ cells and neutrophils in the subchorionic fibrin and the chorionic plate was found. The number of CD163⁺ cells was higher in the placental subchorionic fibrin and chorionic plate when histological chorioamnionitis was present. Conclusion: The presence of histological chorioamnionitis affected the number of CD163⁺ cells in the placental chorionic plate and in the subchorionic fibrin but not in the fetal membranes.     

A prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes: analyses of multiple proteins in the amniotic fluid

Objective: To determine the best prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes (PPROM) using selected candidate proteins in the amniotic fluid (AF). Material and methods: Prospective cohort study. Twenty-six AF proteins were assayed by a multiple immunoassay from 107 women with membranes rupture from 23+0 to 36+6 weeks. The Czech Republic policy is active management, and the majority of women were delivered within 72 h after the rupture of membranes, except for women with PPROM <28+0 weeks who were managed conservatively. The best predictive models to diagnose histological chorioamnionitis and funisitis were calculated by logistic regression depending on the gestational age (GA) at membrane rupture. Results: Both IL-6 and a combination of IL-10, and migration inhibiting factor (MIF) were the best predictive models of histological chorioamnionitis and funisitis, respectively, with sensitivity, specificity, positive and negative predictive values and positive likelihood ratio (LR+) of 62, 83, 37, 93 and 3.6 and of 63, 91, 53, 94 and 7.0, respectively. Depending on whether GA at membrane rupture was <32 or ≥ 32 weeks, IL-10, alone or in combination with MIF and triggering receptor expressed on myeloid cells-1, was the strongest inflammatory biomarker for funisitis (LR+10.6 and 36.6, respectively). Conclusion: Regardless of the GA at membrane rupture, IL-6 from the AF was the best predictor of histological chorioamnionitis. Amniotic fluid IL-10 was notably accurate in the prediction of funisitis.     

Microbial invasion and histological chorioamnionitis upregulate neutrophil-gelatinase associated lipocalin in preterm prelabor rupture of membranes

Our recent exploratory proteomic study suggested increased levels of neutrophil-gelatinase associated lipocalin (P80188, NGAL_HUMAN) due to microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) in women with preterm prelabor rupture of the membranes. In this study, we verified the proteomics findings by assessing the amniotic fluid NGAL by ELISA in the original exploratory cohort. The NGAL level was significantly higher in women positive for both MIAC and HCA compared to women with both conditions ruled out (median 75.1?ng/ml versus 27.9?ng/ml; p?<?0.0001). For independent validation and to assess NGALs potential to stratify women positive for both MIAC and HCA from women in whom at least one of these conditions was absent, we subsequently designed a retrospective replication cohort. Significantly higher NGAL levels were found in women positive for both MIAC and HCA (median 65.9?ng/ml versus 34.2?ng/ml; p?=?0.0061). Significantly higher levels of NGAL were confirmed only in strata below 32 weeks of gestation. Based on the observed likelihood ratio, the best predictive cutoff level (47.1?ng/ml) was evaluated in both cohorts. Data from the verification cohort implied that NGAL is a valuable clinical marker for revealing MIAC leading to HCA; however, this potential was not replicated in the replication cohort.     

Targeted delivery at 34 versus 35 weeks in women with preterm prelabor rupture of membranes

Objective: To compare planned delivery at 34 versus 35 weeks for women with preterm prelabor rupture of membranes (PPROM).

Materials and methods: We performed a retrospective cohort study of singleton pregnancies with PPROM after 24 weeks delivered from 2006 to 2014. In 2009, an institutional practice change established 35 weeks as the target gestational age before induction of labor was initiated after PPROM. Demographic and outcome measures were compared for two cohorts: women delivered 2006–2008 – target 34 weeks (T34) and women delivered 2009–2014 – target 35 weeks (T35). The primary outcome was neonatal intensive care unit (NICU) admission.

Results: Of the 382 women with PPROM, 153 (40%) comprized the T34 cohort and 229 (60%) comprized the T35 cohort. Demographic characteristics were similar between groups. There were no differences between groups in gestational age at PPROM (31.0?±?3.3 weeks versus 31.2?±?3.1 weeks; p?=?.50) or maternal complications. The mean gestational age at delivery was earlier in the T34 group (31.8?±?3.2 weeks versus 32.4?±?2.7 weeks; p?=?.04). The median predelivery maternal length of stay (LOS) was 1?day longer in the T35 group (p?=?.03); the total and postpartum LOS were similar between groups (p?>?.05). There were no differences in the rate of NICU admission (T34 89.5% versus T35 92.1%; p?=?.38) or median neonatal LOS (T34 14 days versus T35 17 days; p?=?.15). In those patients who reached their target gestational age, both maternal predelivery LOS and total LOS were longer in the T35 group (p?>?.05). The frequency of NICU admission in those reaching their target gestational age was similar between groups (T34 83.37% versus T35 76.19%; p?=?.46).

Conclusions: A 35-week target for delivery timing for women with PPROM does not decrease NICU admissions or neonatal LOS. This institutional change increased maternal predelivery LOS, but did not increase maternal or neonatal complications.     

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.     

Amniotic fluid CD200 levels in pregnancies complicated by preterm prelabor rupture of the membranes

Abstract

Objective: To determine the amniotic fluid CD200 levels in uncomplicated pregnancies and in preterm prelabor rupture of the membranes (PPROM) according to microbial invasion of the amniotic cavity and histological chorioamnionitis and its association with neonatal outcomes.

Methods: One hundred and fifty-nine women with singleton pregnancies were included in this study. Amniotic fluid was collected, and CD200 levels were determined using ELISA.

Results: No difference was found in CD200 levels between women in the second trimester and women at term without labor. Women at term with labor had higher CD200 levels than women in the second trimester and women at term without labor. The presence of funisitis in PPROM pregnancies was associated with higher CD200 levels independent of gestational age (with funisitis: median 197.5?pg/mL versus without funisitis: median 61.0?pg/mL; p?=?0.003). The need for tracheal intubation and the development of bronchopulmonary dysplasia were associated with higher CD200 levels.

Conclusions: Amniotic fluid CD200 levels remained stable in advanced pregnancy and they were increased during parturition. Elevated CD200 levels in the presence of funisitis suggest the involvement of negative regulatory mechanisms of innate immunity. CD200 may play a role in the development of pulmonary aspects of neonatal morbidity.     

Cervical IL-6 and pIGFBP-1 and the prediction of neonatal outcome in symptomatic preterm labour

Abstract

Objective: To evaluate the use of cervical Interleukin 6 (IL-6) and phosphorylated Insulin Growth Binding Protein 1 (pIGFBP1) in the prediction of adverse neonatal outcome.

Methods: Prospective observational study including women between 24 and 34 weeks of gestation. One hundred and twelve cervical samples for IL-6 and pIFBP1 were taken. Neonatal outcome variables were birth weight, Apgar scores at 1st/5th minute, gestational age at delivery, admission to neonatal unit (NNU) and to neonatal intensive care unit (NICU), composite neonatal morbidity (NCM) and neonatal mortality.

Results: Cervical IL-6 concentrations (pg/ml) were higher in neonates admitted to NNU and NICU versus non-admission, and women developing chorioamnionitis versus non-chorioamnionitis (mean?±?standard deviation: 168.1?±?205.2 versus 62.3?±?72.4, p?<?0.01; 262.1?±?298 versus 92?±?127.6, p?<?0.01, and 564?±?213 versus 93.4?±?126.4, p?<?0.05, respectively). In the NCM group, the IL-6 concentrations were higher compared to the non-NCM (181.7?±?224 versus 84.1?±?117.7, p?<?0.05). In the preterm births <37 weeks, no differences were found for NCM, admission to NICU/NNU. The logistic regression analysis, showed cervical IL-6 and examination-to-delivery interval as predictors of NCM in the univariate analysis. However, the only independent marker of adverse neonatal outcome was the examination-to-delivery interval.

Conclusions: Adverse neonatal outcome is associated with increased cervical IL-6 concentrations.     

Pulsation of the fetal splenic vein - a potential ultrasound marker of histological chorioamnionitis and funisitis in women with preterm prelabor rupture of membranes

The fetal spleen is involved in the response to intrauterine infection and inflammation. The flow pattern of its vein is not pulsatile in normal conditions. The aim of the study was to determine whether the presence of histological chorioamnionitis and funisitis is associated with a continuous or pulsatile flow pattern in the fetal splenic vein. We performed a prospective study including 79 women with preterm prelabor rupture of membranes. We found a relation between pulsation in the splenic vein and histological chorioamnionitis (likelihood ratio 13.2), as well as funisitis (likelihood ratio 5.7). Ultrasound evaluation of the splenic vein could be a non-invasive tool for the prediction of these inflammatory complications.     

Neonatal outcomes in subgroups of women with preterm prelabor rupture of membranes before 34 weeks

Objective: To evaluate the influence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) on short-term neonatal outcome in women with preterm prelabor rupture of membranes before 34 weeks of gestation.

Methods: A prospective observational cohort study including 122 pregnant women with PPROM between 24+0 and 34+0. MIAC was defined as a positive PCR result for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive PCR result for the 16S rRNA gene in the amniotic fluid. HCA was defined according to the Salafia classification. Maternal and short-term neonatal outcomes were evaluated according to the presence or absence of MIAC and/or HCA.

Results: The presence of both MIAC and HCA was observed in 36% (45/122) of women, HCA alone in 34% (41/122) and MIAC in 5% (6/122). A significantly higher incidence of early onset sepsis was observed in newborns born from women with both MIAC and HCA [33% (15/45)] compared with women with HCA alone [12% (5/41)] or MIAC alone [0% (0/6)] or women without MIAC or HCA detected [0% (0/30); p?=?0.001].

Conclusions: The presence of both MIAC and HCA increases the risk of early onset sepsis in pregnancies complicated by preterm prelabor rupture of membranes before 34 weeks of gestation.     

Umbilical cord blood levels of cortisol and dehydroepiandrosterone sulfate in preterm prelabor rupture of membrane pregnancies complicated by the presence of histological chorioamnionitis

Objective: The main aim of this study was to determine the levels of cortisol and dehydroepiandrosterone sulfate (DHEA-S) and the cortisol/DHEA-S ratio in the umbilical cord blood according to the presence of histological chorioamnionitis and fetal inflammatory response in pregnancies complicated by prelabor rupture of membranes at fewer than 34 gestational weeks. Methods: Seventy-two women with singleton pregnancies complicated by preterm prelabor rupture of membranes between gestational ages 24+0 and 33+6 weeks were included in the study. The sample of blood was obtained from the umbilical cord after delivery of the newborn. The umbilical cord blood cortisol and DHEA-S levels were evaluated using commercial immunoassay kits. A cortisol/DHEA-S ratio was calculated. Results: The presence of histological chorioamnionitis was not associated with higher median levels of cortisol (32.1 nmol/L vs. 33.0 nmol/L; p = 0.53), DHEA-S (2.6 μmol/L vs. 2.5 μmol/L; p = 0.83), or cortisol/DHEA-S ratio (19.5 vs. 18.7;p = 0.90). Higher median levels of DHEA-S (3.1 μmol/L vs. 2.3 μmol/L; p = 0.03) but not cortisol (91.0 nmol/L vs. 32.0 nmol/L; p = 0.06) or cortisol/DHEA-S ratio (24.5 vs. 18.7; p = 0.46) were observed when fetal inflammatory response was present. Conclusions: The presence of fetal inflammatory response but not the presence of histological chorioamnionitis per se was associated with increased DHEA-S levels in the umbilical cord blood.     

Amniotic fluid calreticulin in pregnancies complicated by the preterm prelabor rupture of membranes

Objective: This study aimed to determine the amniotic fluid calreticulin concentrations in women with the preterm prelabor rupture of membranes (PPROM) based on the microbial invasion of the amniotic cavity (MIAC), intraamniotic inflammation (IAI) and microbial-associated IAI.

Methods: One hundred sixty-eight women with singleton pregnancies were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis and were assayed for calreticulin concentrations by ELISA. IAI was defined as an amniotic fluid interleukin-6 concentration?>?745?pg/ml. Microbial-associated IAI was defined as the presence of both MIAC and IAI.

Result: Women with MIAC (with MIAC: median 54.4?ng/ml, versus without MIAC: median 32.6?ng/ml; p?<?0.0001), IAI (with IAI: median 66.8?ng/ml, versus without IAI: median 33.0?ng/ml; p?<?0.0001) and microbial-associated IAI (with microbial-associated IAI: median 82.5?ng/ml, versus without microbial-associated IAI: median 33.7?ng/ml; p?<?0.0001) had higher concentrations of calreticulin than women without these complications. An amniotic fluid calreticulin concentration of 81.4?ng/ml was found to be the best cutoff point for identifying women with microbial-associated IAI.

Conclusions: The presence of microbial-associated IAI is associated with increased amniotic fluid calreticulin concentrations. Calreticulin seems to be a promising marker for the early identification of PPROM complicated by microbial-associated IAI.     

Histological chorioamnionitis in preterm prelabor rupture of the membranes is associated with increased expression of galectin-3 by amniotic epithelium

Purpose: Gal-3, which can regulate immune responses upon infection and inflammation, was not studied so far in intrauterine infection leading to preterm prelabor rupture of the membranes (PPROM), although gal-1 was reported to be implicated in the process. Gal-3 mRNA and protein expression in amnion and its changes during histological chorioamnionitis were studied here.

Materials and methods: Fetal membranes were obtained from women with PPROM with (n?=15) and without histological chorioamnionitis (n?=15) during second and third trimester. Immunohistochemical reactivity was evaluated semiquantitatively and analyzed using t-test. Galectin profile of amniotic epithelia was determined by polymerase chain reaction (PCR) and change assessed in gal-3 in PPROM with (n?=5) or without histological chorioamnionitis (n?=5) by real-time PCR.

Results: Human amniotic epithelium was found to express gal-1, gal-3, gal-7 and gal-8 mRNA. Gal-3 mRNA and protein is increased in fetal membranes and in the amniotic epithelium in patients with chorionamnionitis.

Conclusion: Histological chorioamnionitis is associated with increased gal-3 expression and strong immunoreactivity of the amnion. Gal-3 may participate in the regulation of the inflammatory responses to chorioamniotic infection and/or direct interaction with pathogens.     

Lack of relationship between histologic chorioamnionitis and duration of the latency period in preterm rupture of membranes

It is often believed that the frequency of clinical chorioamnionitis in preterm premature rupture of membranes (PROM) increases with the duration of the interval between membrane rupture and delivery. We tested the hypothesis that the prevalence of histologic evidence of intrauterine infection increases proportionally to the duration of the latency period. A total of 191 consecutive placentas of singleton, nonanomalous, liveborn infants delivered at > 32 weeks' gestation with PROM were examined prospectively. Demographic, obstetric, histopathologic, and neonatal information was obtained. Histopathologic evidence of acute inflammation in choriodecidua, amnion, umbilical cord, and chorionic plate was recorded and scored. The prevalence and severity of pathological evidence of intrauterine infection was correlated with the interval between membrane rupture and delivery. Maternal and neonatal outcomes were assessed in six groups defined by different intervals between membrane rupture and delivery. Statistical analysis utilized regression, Fisher's exact test, Chi-square, and one-way analysis of variance after log transformation where applicable. P > 0.05 was considered significant. No correlation was observed between total score of placental acute inflammation and the interval membrane rupture-to-delivery (r = 0.068, 95% confidence interval –0.075, 0.211; P = 0.35). There was no evidence that the rate of maternal (P = 0.4) or neonatal (P = 0.15) infectious morbidity, or the total score of acute placental inflammation (P = 0.13), acute amnionitis (P = 0.35), choriodeciduitis (P = 0.46), chorionic plate inflammation (P = 0.38), or umbilical and chorionic vasculitis (P = 0.06) increase with the prolongation of the PROM-to-delivery interval. This study had an 85% power to detect the lack of association that was actually observed. The rate of histologic evidence of chorioamnionitis in preterm PROM does not increase with the duration of the PROM-to-delivery interval.     

Amniotic fluid markers of oxidative stress in pregnancies complicated by preterm prelabor rupture of membranes

Objective: To determine amniotic fluid total antioxidant capacity (TAC), ferric-reducing antioxidant power (FRAP) and thiobarbituric acid-reacting substances (TBARS), markers of oxidative stress, in pregnancies complicated by preterm prelabor rupture of membranes (pPROM) and their correlation to microbial invasion of the amniotic cavity (MIAC) and/or histological chorioamnionitis (HCA).

Methods: One-hundred thirty-eight women with singleton pregnancies complicated by pPROM were included in this study. Amniotic fluid was collected by transabdominal amniocentesis at the time of admission and amniotic fluid concentrations of TAC, FRAP and TBARS were measured.

Result: The presence of MIAC and/or HCA did not show any significant differences in the amniotic fluid TAC, FRAP and TBARS concentrations. Positive correlations between gestational age at sampling and amniotic fluid TAC and FRAP concentrations were found (TAC: rho?=?0.32; p?=?0.0002; FRAP: rho?=?0.36; p?<?0.0001). A negative correlation between gestation age at sampling and amniotic fluid TBARS concentrations was identified (rho?=?–0.25; p?=?0.004).

Conclusions: Oxidative stress is associated with pPROM as indicated by the presence of markers tested in the amniotic fluid; however, oxidative stress markers tested are not influenced by the presence of MIAC or HCA.     

Predictive factors for neonatal survival in women with periviable preterm rupture of the membranes

Abstract

Objective: To identify clinical, hematological or instrumental factors available at the time of the diagnosis that may predict neonatal survival in periviable preterm premature rupture of the membranes (PROM).

Methods: We report on a cohort (n?=?85) of women with periviable PROM (14–23.6 weeks’ gestation) occurring over a 10-year period in a single institution. The main outcome chosen was the survival rate beyond the neonatal period. Variables considered were those available at 24?h after admission.

Results: The overall survival rate was 49%. In the multivariate analysis, significant contributions for the prediction of neonatal survival were provided by four variables: genetic amniocentesis-related cause of PROM (p?<?0.001), gestational age at PROM (p?=?0.019), CRP >?1?mg/dl within 24?h after admission (p?=?0.042) and oligohydramnios (largest vertical pocket ≤2?cm) (p?=?0.041). The corresponding adjusted odds ratio (OR)s were 73.9 (95% CI: 7.9–694.7), 1.5 (95% CI: 1.1–2.0) per week, 0.26 (95% CI: 0.07–0.95) and 0.20 (95% CI: 0.04–0.93), respectively.

Conclusions: Genetic amniocentesis-related cause of PROM, gestational age at PROM, C-reactive protein >1?mg/dl and oligohydramnios are significantly associated with survival in women with periviable PROM. The evaluation of these few and easily available variables may help physicians and patients in the decision-making process of this demanding condition.