Association of histological chorioamnionitis and magnesium sulfate treatment in singleton and dichorionic twin pregnancies with preterm premature rupture of membranes: preliminary observations

Abstract

Objective To evaluate the possible association between antenatal magnesium sulfate treatment with histological chorioamnionitis in patients with singleton or dichorionic twins that had preterm premature rupture of the membranes. Methods This was an observational study performed in patients admitted to the hospital with rupture of membranes before 34 weeks' gestation. The primary outcome was histological chorioamnionitis and the primary predictor was antenatal magnesium sulfate treatment. A logistic regression model was used without consideration of other antenatal medical treatments. Results Among 107 patients with preterm deliveries, 57 were admitted to the hospital before 34 weeks' gestation with preterm premature rupture of membranes. Fifty-cases were excluded from the analysis because they were admitted after 34 weeks' gestation, delivered before 24 weeks' gestation or had intrauterine fetal demise or monochorionic twins. The logistic regression analysis adjusting for maternal age, gravidity, parity, multiple gestation, gestational age at delivery, and birthweight, indicated that patients with singleton pregnancies and histological chorioamnionitis had received magnesium sulfate antenatally more frequently (χ2=6.46; P=0.01). The association between histological chorioamnionitis and magnesium sulfate treatment was not found among patients with dichorionic twin pregnancies with one intact gestational sac. Conclusions In this cohort of patients with preterm premature rupture of membranes admitted to the hospital before 34 week's gestation, those with singleton pregnancies treated antenatally with magnesium sulfate for neonatal neuroprotection had a greater rate of histological chorioamnionitis.

The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes

“…An imbalance in the pro-inflammatory and anti-inflammatory cytokine production may activate various cellular and humoral immunologic pathways that can drive membrane weakening by several processes, including increasing the production of prostaglandins and cytokines and the activation of matrix-degrading proteases that lyse the collagens [8]. Histological chorioamnionitis (HCA) is demonstrated in approximately 40-60 % of patients with PPROM [13,14]. Early and correct diagnosis of HCA is important; however, the event restricts that placental pathology can be evaluated only after delivery.…”

Significance of highly phosphorylated insulin-like growth factor binding protein-1 and cervical length for prediction of preterm delivery in twin pregnancies

“…Twin delivery increases the risk of preterm birth due to the raised fetuses, amniotic fluid, and intrauterine pressure. According to the latest statistics[ 2 ], approximately 15 million premature babies are born every year, accounting for more than 10% of newborns. Moreover, 965000 premature babies die in their neonatal period and about 12000 die within 5 years.…”