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Intraamniotic Infection and Inflammation (Triple I)
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Victoria Adewale, Cecily May Barber, Elizabeth Liveright
In women with prelabor rupture of membranes (PROM), the reported incidence is higher. The Term PROM study showed a rate overall of 7% in women with rupture of membranes prior to active labor [11]. In women with PROM greater than 24 hours, the rates of infection may be as high as 40% [12].
Chlamydia
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Untreated maternal genital C. trachomatis has been associated to be an independent risk factor for the statistically significant increase in preterm premature rupture of membranes, preterm birth, low birth weight, endometritis, and decreased perinatal survival when compared to either treated women or controls without the infection [10, 11]. Successful treatment is therefore associated with prevention of premature rupture of membranes and small-for-gestational-age infants [12]. Treatment early in pregnancy with sustained eradication is associated with better outcomes compared to diagnosis and treatment later in pregnancy [13]. Neonatal infection acquired from an infected maternal genital tract at the time of delivery is associated with neonatal conjunctivitis and pneumonitis.
Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Premature rupture of membranes (PROM) is the leak of amniotic fluid prior to the onset of labour. Differential diagnoses include urinary incontinence and mucous plug. The risks associated with PROM include:Intrauterine infection: monitor closely for maternal pyrexia, fetal tachycardia, foul-smelling or purulent amniotic fluid. Do not give tocolytics if an infection is suspected.Cord ProlapsePreterm birth if PROM < 37 weeks gestation (PPROM)
Prediction model for labour dystocia occurring in the active phase
Published in Journal of Obstetrics and Gynaecology, 2023
Yanqing Liu, Qingquan Gong, Yuhong Yuan, Qi Shi
The premature rupture of membranes before labour is a common complication in obstetrics. The incidence rate is about 2.7%–17.0%. It could lead to premature delivery, foetal distress, infection and dystocia, even fatally threatening the health of the mother and foetus (American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics 2016). The premature rupture of membranes was often considered a warning sign of dystocia, most of which occurred in those who did not engage in the foetal head. It is caused by the gap between the foetal presentation and pelvis, communication between anterior and posterior amniotic fluid and uneven stress on the anterior amniotic sac. The premature rupture of membranes causes amniotic fluid loss. The uterine wall is close to the carcase and is prone to uncoordinated uterine contraction or blocked rotation of the foetal head, increasing the chance of dystocia (Waters and Mercer 2009).
Predicting previable preterm premature rupture of membranes (pPPROM) before 24 weeks: maternal and fetal/neonatal risk factors for survival
Published in Journal of Obstetrics and Gynaecology, 2022
Aylin Günes, Hüseyin Kiyak, Semra Yüksel, Gökhan Bolluk, Rabia Merve Erbiyik, Ali Gedikbasi
Management of previable premature rupture of membranes is controversial and there is no definite consensus on the approach. The physician and the family must work together, all risks should be discussed, and the family members should be offered consultation with maternal-foetal medicine and neonatology specialists. Maternal infection risk is increased with an increased latency period of PPROM. Although in our population we found maternal infections to occur frequently, we did not observe serious maternal complications. Treatment decisions, therefore, should focus on foetal outcome. Of pregnancies referred for previable PPROM, 54.16% resulted in neonatal survival. The factor that best predicts neonatal survival is the gestational age at birth (Deutsch et al. 2010). As the gestational age at birth increases, the survival rate increases and neonatal complication rates decrease. Other important determinants of neonatal survival and well-being are the presence of oligo-anhydramnios and latency period of previable PPROM to delivery. There were no major complications in 18.22% of infants who were followed for previable PPROM. In our tertiary centre, immediate life support after birth and complex perinatal interventions and treatment are possible and these contribute to high survival rates and low morbidity in neonates.
The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient
Published in Journal of Obstetrics and Gynaecology, 2022
Shadan S. Mehraban, Joanna C. Pessolano, Jane M. Ponterio, Katherine Williamson, Anastasiya Holubyeva, Michael Moretti, Nisha Lakhi
The rate of preterm delivery in our study was higher in the short stature cohort. Other studies have also demonstrated that pre-pregnancy obesity has been linked to spontaneous preterm delivery (Kramer et al. 1995; Hendler et al. 2005). Obesity is known to cause an upsurge in pro-inflammatory cytokines via an increased level of adipokines. Through stimulation of prostaglandins and matrix degrading metalloproteins, these proinflammatory cytokines are associated with cervical ripening and may also cause weakening of the membranes and preterm contractions of the myometrium. These factors can likewise lead to premature rupture of membranes (PROM). Cnattingius et al conducted a population-based cohort study in Sweden with live singleton births from 1992 to 2010 that characterised an association of body mass index to rates of preterm delivery (Cnattingius et al. 2013). This study also found that preterm delivery rates were increased among overweight and obese women along with short stature less than 155 cm (Cnattingius et al. 2013).