Wearable sensors for prediction of intraamniotic infection in women with preterm premature rupture of membranes: a prospective proof of principle study (Preprint)

BACKGROUND Preterm premature rupture of membranes (PPROM), defined as rupture of the membranes occurring before 37 weeks of gestation, is the leading cause of intraamniotic infection and consequent preterm delivery with known consequences for the physical and mental health of the child. Prediction of which women will develop intraamniotic infection, requiring premature delivery after PPROM remains one of the major unsolved obstetric problems. Wearable sensors using photoplethysmographic technology are increasingly used for continuous monitoring of physiological parameters in medicine. Previous studies suggest that patterns of physiological activity may be used for early detection of infection and systemic inflammation in the general population, which might also be helpful in pregnant women. OBJECTIVE To evaluate the use of wearable sensors for prediction of intraamniotic infection in pregnant women with PPROM. METHODS In a prospective proof of principle study, we included 50 patients diagnosed with PPROM at the University Hospital Zurich between November 2017 and May 2020. Patients were instructed to wear a bracelet during the night, which measures physiological parameters including wrist skin temperature, heart rate, heart rate variability and breathing rate. A two-way repeated measures ANOVA was performed to evaluate the difference over time of both the wearable device measured parameters and standard clinical monitoring values, such as body temperature, pulse, leucocytes, and C-reactive protein, between women with and without intraamniotic infection. RESULTS The median gestational age (GA) at PPROM was 30.7 weeks of gestation (223 days, interquartile range [IQR] 197 to 234); the median GA at delivery was 32.9 weeks of gestation (236 days, IQR 220 to 247). Altogether, 23 patients (46%) were diagnosed with intraamniotic infection. Regarding the physiological parameters measured with the bracelet, we observed a significant difference in breathing rate (19 vs 16 per minute, p<.01) and heart rate (72 vs 67 beats per minute, p=.03) in women with intraamniotic infection compared to those without during the three days prior to birth. In parallel to these changes standard clinical monitoring values were significantly different in the intraamniotic infection group compared to women without infection in the three days preceding birth. CONCLUSIONS Our results suggest that wearable sensors are a promising, noninvasive, patient friendly approach to support the early detection of intraamniotic infection in women with PPROM. However, confirmation of our findings in larger studies is required before implementing this technique in standard clinical management.

INFLUENCE OF MATERNAL CHORIOAMNIONITIS ON NEWBORNS MORBIDITY

In recent decades, the problem of chorioamnionitis (CA) (or intra-amniotic infection) takes a leading place in modern obstetrics and perinatology. It is known that CA is one of the main risk factors for preterm birth and increases neonatal morbidity. Intraamniotic infection is a polyetiology condition. It is characterised by the variety of clinical manifestations absence of clearly association between the infection`s clinical signs in mother and infants injury. In present review we defined current data about chorioamnionitis, based on the last evidence of international scientific literature.