Prophylactic antibiotics and tocolysis are two major factors associated with latency period ≥2 days in PPROM, where prophylactic antibiotics is the main factor associated with latency period ≥7 days in PPROM.

The aim of this study was to determine the predictive value of the combination of plasma-soluble fms-like tyrosine kinase 1 (sFlt-1) and uterine artery Doppler for the detection of preeclampsia in women of advanced age at 16-18 weeks of gestation and to identify associations between other pregnancy complications and abnormalities of these combined tests. The maternal plasma sFlt-1 level was measured, and uterine artery Doppler was performed at 16-18 weeks of gestation in 314 cases of elderly gravida. The main outcome was preeclampsia. Fourteen women (4.46%) developed preeclampsia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of uterine artery Doppler combined with plasma sFlt-1 for preeclampsia prediction were 28.6, 95.7, 23.5 and 96.6%, respectively. For the prediction of early-onset preeclampsia, the sensitivity, specificity, PPV and NPV were 80, 95.8, 23.5 and 99.7%, respectively. Patients with abnormal uterine artery Doppler findings and an abnormal plasma s Flt-1 level (greater than 1724.5 pg ml(-1)) had a higher risk of preterm delivery (relative risk (RR)=3.38, 95% confidence interval (CI) 1.47-7.59), neonatal respiratory distress syndrome (RR=52.06, 95% CI 5.71-474.45) and perinatal death (RR=17.35, 95% CI 1.13-265.64). Our findings indicate that the combination of uterine artery Doppler and sFlt-1 level at 16-18 weeks of gestation in cases of elderly gravida has a high predictive value for early-onset preeclampsia, but not for overall preeclampsia. This combination test may be a useful early second trimester screening test for the prediction of early-onset preeclampsia in cases of elderly gravida.

BackgroundPreterm prelabor rupture of membrane (PPROM) causes maternal and neonatal complications. Prophylactic antiobiotics were used in the management of PPROM. The objectives of this retrospective study were to compare clinical course and outcome of PPROM managed expectantly with prophylactic antibiotics and antenatal corticosteroids with those without prophylactic antibiotics and antenatal corticosteroids.ResultsA total of 170 cases of singleton pregnant women with gestational age between 28–34 weeks suffering from PROM during January 1998 to December 2009 were included; 119 cases received prophylactic antibiotics and antenatal corticosteroids while 51 cases did not received prophylactic antibiotics and antenatal corticosteroids. Median latency period in the study group was significantly longer than in the control group (89.8 vs. 24.3 hours, P < 0.001). The percentage of patients who did not deliver within 48 hours and within 7 days in the study group were also significantly higher than in control group (64.7 vs. 31.4%, P < 0.001 and 29.4 vs. 7.8%, P = 0.002, respectively). Maternal infectious morbidity was comparable between groups (17.6% vs. 13.7%, P = 0.52). Neonatal infectious morbidity was significantly lesser in study group than control group (21% vs. 35.3%, p = 0.04).ConclusionsLatency period of PPROM after using prophylactic antibiotics and antenatal corticosteroids increased while neonatal infectious morbidity was low. But maternal infectious morbidity was not increased. This retrospective study confirms the benefit of prophylactic antibiotics and antenatal corticosteroids in management of PPROM.

Aims: To assess whether terbutaline is able to prolong the latency period in women with preterm premature rupture of membranes (PPROM) and compare maternal and neonatal morbidity and mortality in the terbutaline and nontocolysis groups. Methods: This study retrospectively analyzed data from women with singleton pregnancies (gestational ages between 28 and 34 weeks) suffering from PPROM from January 1998 to December 2009. Results: A total of 163 cases of PPROM were analyzed; there were 61 cases (37.4%) in the terbutaline group and 102 cases (62.6%) in the nontocolysis group. The median latency period was comparable in the two groups (78 vs. 75 h, p = 0.44). The percentage of patients who did not deliver within 48 h was significantly higher in the terbutaline group compared with the nontocolysis group (78.7 vs. 62.7%, p = 0.03). There were no differences in maternal morbidity and mortality, and neonatal mortality between the two groups. Interestingly, neonatal infectious morbidity was significantly higher in the terbutaline group when compared with the nontocolysis group. Conclusions: Terbutaline cannot prolong the latency period in PPROM. There were no differences in maternal morbidity and mortality. However, neonatal infectious morbidity was higher in the terbutaline group.