scholarly journals Changes in Umbilical and Cerebral Blood Flow in Pregnancies Diagnosed with Clinical Chorioamnionitis. Is Chorioamnionitis Predictable?

2019 ◽  
pp. 1
Author(s):  
Berfin Okmen Ozkan ◽  
Emre Ekmekci
Keyword(s):  
Umbilical Artery ◽  
Demographic Data ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference ◽  
Umbilical Artery Doppler ◽  
Doppler Evaluation ◽  
Umbilical Arteries

<p><strong>Objective:</strong> To evaluate the predictability of clinical chorioamnionitis by Doppler changes in fetal middle cerebral and umbilical arteries, at hospitalized patients due to preterm premature rupture of membranes.</p><p><strong>Study Design:</strong> Patients who were admitted and hospitalized due to preterm premature rupture of membranes between 24 weeks and 33 weeks and 6 days pregnancies are included in the study. Demographic data of patients, gestational age at referring to hospitalization, fetal presentation at admission, delivery time, delivery indications and total follow-up time until delivery of each case were recorded.</p><p><strong>Results:</strong> A total of 108 patients were evaluated retrospectively. The rate of clinical chorioamnionitis was 5.55% (6/108). There was no significant difference between pregnancies terminated with the diagnosis of clinical chorioamnionitis and pregnancies terminated with other indications in terms of the maximum systolic velocity at middle cerebral artery and umbilical artery pulsatility indices.</p><p><strong>Conclusion:</strong> Clinical chorioamnionitis is a serious complication and is more common in patients being followed up after preterm premature rupture of membranes. Although it is crucial to be predicted due to neonatal worse prognosis, it cannot be predicted by middle cerebral and umbilical artery Doppler evaluation.</p>

A case of severe SARS-CoV-2 infection with negative nasopharyngeal PCR in pregnancy

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Anna Fuchs ◽  
Lauren Harris ◽  
Ashley Huber ◽  
Mia Heiligenstein ◽  
Cassandra Heiselman ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
Igg Antibodies ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Case Presentation ◽  
Preterm Premature Rupture ◽  
High Clinical Suspicion ◽  
Maternal Status

Abstract Objectives SARS-CoV-2 remains a pressing issue for our obstetric community during the current pandemic. We present a case of a 22-year-old nulliparous woman 31 weeks pregnant, with significant clinical SARS-CoV-2 disease, in the setting of negative nasopharyngeal PCR testing but positive IgG antibodies. Case presentation This was a 22-year-old patient 31 weeks pregnant who presented with fever, tachycardia, and subsequently preterm premature rupture of membranes (PPROM) and pulmonary emboli with multifocal pneumonia. The patient underwent three negative SARS-CoV-2 tests via nasopharyngeal PCR testing during her hospital stay as well as a negative workup for fever. After a cesarean section for worsening maternal status after 7 days of hospitalization, the patient was admitted for worsening clinical status to the SICU. At the time of SICU admission patient was found to have serum IgG positive antibodies and was managed with intubation, antibiotics, and anticoagulation. Patient eventually left hospital against medical advice on hospital day 16 on oral antibiotics but was found to be recovering well at later outpatient follow up. Conclusions Diagnosis of SARS-CoV-2 remains a complicated picture in the setting of testing limitations. This case highlights an antepartum clinical presentation of severe SARS-CoV-2 and recommends a high clinical suspicion for diagnosis of SARS-CoV-2 and initiation of treatment in the pregnant population, even in the presence of negative nasopharyngeal PCR testing.

scholarly journals Antenatal Screening for Group B Streptococcus in the Setting of Preterm Premature Rupture of Membranes: Empiric versus Culture-based Prophylaxis

2020 ◽  
Vol 10 (01) ◽  
pp. e26-e31
Author(s):  
Leena B. Mithal ◽  
Nirali Shah ◽  
Anna Romanova ◽  
Emily S. Miller
Keyword(s):  
Multivariable Analysis ◽  
Group B Streptococcus ◽  
Preterm Neonates ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference ◽  
Culture Sensitivity ◽  
Intrapartum Antibiotic ◽  
Group B

Abstract Objective Imperfect culture sensitivity and increase of early onset neonatal sepsis (EONS) risk in preterm neonates raise concern that culture-based intrapartum antibiotic prophylaxis (IAP) may be insufficient after preterm premature rupture of membranes (PPROM). Our objective was to compare rates of EONS after empiric versus culture-based IAP in PPROM. Study Design This retrospective cohort study included women with a singleton gestation and PPROM between 23 and 33 weeks. Outcomes after culture-based IAP were compared with empiric IAP. The primary outcome was EONS. Secondary outcomes included group B streptococcus (GBS) bacteremia, bacteremia, and neonatal GBS infection. Bivariable and multivariable logistic analyses were performed. Results Of the 270 women who met inclusion criteria, 136 (50%) had culture-based IAP of whom 36 (26.5%) were GBS positive. There was no significant difference in bacteremia (2.2 vs. 4.5%, p = 0.30), GBS infection (0.8 vs. 0.7%, p = 1.00), or EONS (11.8 vs. 12.7%, p = 0.82) in infants of women with culture-based IAP compared with empiric IAP. Multivariable analysis confirmed a lack of advantage to empiric versus culture-based IAP in EONS risk (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI]: 0.44–1.93). Conclusion In pregnancies complicated by PPROM, infants of women who received culture-based IAP had no significant difference in EONS or GBS infection compared with infants of women with empiric IAP.

scholarly journals Perinatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes during the late preterm period

2021 ◽  
Author(s):  
Hayan Kwon ◽  
Suk Ho Kang ◽  
Hyun Sun Ko ◽  
Ja Young Kwon ◽  
Han-sung Kwon ◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Death ◽  
Expectant Management ◽  
Neonatal Outcomes ◽  
Late Preterm ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference ◽  
Maternal Sepsis

Abstract The aim of this study is to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34+ 0–36+ 6 weeks of pregnancy. We conducted a retrospective study on singleton pregnancies with PPROM during the late preterm period using medical records at twelve tertiary medical centres in Korea from January 2007 to December 2016. Data on demographic characteristics and outcome measures were collected. The primary outcomes were maternal sepsis for maternal outcome and neonatal sepsis and neonatal death for neonatal outcomes. Of the 1,072 women, 782 cases (72.9%) were assigned to the immediate delivery group, and 290 cases (27.1%) were categorized into the expectant management group. There was a significant difference in the rate of clinical neonatal sepsis (immediate delivery, 3.8% vs expectant management, 15.8%; p < 0.0001), however, no differences in maternal sepsis (p = 0.5424), culture-proven neonatal sepsis (p = 0.2108), or neonatal death (p = 0.3899) were observed. In conclusion, expectant management in women with PPROM during the late preterm period does not increase the risk of severe maternal and neonatal morbidities and mortality; however, careful monitoring for chorioamnionitis or fetal compromise should be considered during expectant management.

scholarly journals Risk of recurrence of preterm Premature Rupture of Membranes in subsequent pregnancies

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Aysha Malik
Keyword(s):  
Demographic Data ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Risk Of Recurrence ◽  
Preterm Premature Rupture

The study was designed to estimate the risk of recurrence of preterm premature rupture of membranes in subsequent pregnancies. 121 patients with idiopathic PROM were followed up over two or more subsequent pregnancies and the problem recurred in 39 patients, for a rate of 32.2%. Various demographic data and characteristics of the index pregnancies were compared to identify a sub-group of patients at higher risk of recurrence in an attempt to prevent problem of prematurity.

scholarly journals Neutrophil–lymphocyte ratio for the prediction of histological chorioamnionitis in cases of preterm premature rupture of membranes: a case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Greta Balciuniene ◽  
Greta Kvederaite-Budre ◽  
Violeta Gulbiniene ◽  
Irena Dumalakiene ◽  
Rita Viliene ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
P Value ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Preterm Premature Rupture ◽  
Significant Difference ◽  
Control Study

Abstract Background The neutrophil-lymphocyte ratio (NLR) is easily calculated blood test parameter, which can be used as marker to predict many inflammatory disorders. The aim of this study was to assess and compare the NLR in maternal blood with the white blood cell (WBC) count and C-reactive protein (CRP) concentration for the prediction of histological chorioamnionitis. Methods This was a case-control study of 137 woman with preterm premature rupture of membranes (PPROM) at a gestational age between 22+ 0 and 34+ 6 weeks. Blood samples, collected less than 48 h before delivery and at least 48 h after the administration of corticosteroids, were selected for the analysis. The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Chorioamnionitis was diagnosed by the histopathological evaluation of placental membranes and chorionic plate. Results Patients with diagnosed histological chorioamnionitis (HCA) had significantly higher levels of WBC, CRP and NLR (p-value < 0.001). Levels of WBC, CRP and NLR predicted HCA with an area under the curve (AUC) of 0.81, 0.81 and 0.89, respectively. NLR had statistically significantly higher AUC than WBC, but no significant difference was found between AUCs of NLR and CRP. The cut-off level of NLR was found to be 5,97, which had a sensitivity of 77 % and a specificity of 95 %. Conclusion NLR has a good predictive value for HCA and could be used as an additional diagnostic marker for predicting histological chorioamnionitis in cases with preterm premature rupture of membranes before 34 weeks of gestation.

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