Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia

Abstract

Objective. To identify the risk factors for cystic periventricular leukomalacia (cPVL) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes (pPROM). Methods. The following risk factors were compared between cPVL infants and 6440 controls: chorioamnionitis, sex, gestational age (GA), birth weight, pPROM, and pPROM-delivery interval. Factor impact on cPVL risk and clinical decision-making was determined by multivariate logistic regression. Results. Overall cPVL prevalence (n = 32) was 0.99/1000 births. All cPVL infants but one were born <34 weeks of gestation and were <2500 g; 56% had histological chorioamnionitis versus 1.1% of controls (OR 35.9; 95%-CI 12.6–102.7). Because chorioamnionitis is a postnatal diagnosis, logistic regression was performed with prenatally available factors: pPROM-delivery interval >48 hours (OR 9.0; 95%-CI 4.1–20.0), male gender (OR 3.2; 95%-CI 1.4–7.3). GA was not a risk factor if birth weight was included. Risk decreased with increasing fetal weight despite a prolonged pPROM-delivery interval. Conclusion. pPROM-delivery interval is the single most important prenatally available risk factor for the development of cPVL. Immediate delivery favors babies with chorioamnionitis but disfavors those with non infectious pPROM. In the absence of clinical chorioamnionitis fetal weight gain may offset the inflammatory risk of cPVL caused by a prolonged pPROM-delivery interval.

Soluble and Endogenous Secretory Receptors for Advanced Glycation End Products in Threatened Preterm Labor and Preterm Premature Rupture of Fetal Membranes

“…The diagnosis of overt intrauterine infection is an adverse prognostic factor for premature newborns. From the other point of view, extension of pregnancy duration after preterm rupture of membranes, especially those occurring before 30 weeks of gestation, may increase the chance of proper psychomotor development in preterm infants [ 47 ]. There is a requirement of a marker of intrauterine infection onset, indicative of the immediate need for parturition.…”

Spontaneous hypocarbia without mechanical ventilation in preterm infants with cystic periventricular leukomalacia

“…Most pregnant women who gave birth to an infant with cPVL of this cohort had received tocolytics and antibiotics, with or without preterm premature rupture of the membranes (PPROM). Chorioamnionitis and PPROM have consistently emerged as features of cPVL in previous reports 17,25‐27 suggesting that an inflammatory intrauterine environment increases the risk of cPVL. Tocolytics and antibiotics used to treat intrauterine infection may mask smouldering chorioamnionitis.…”

“…19 Of note, birth weight is not helpful for indicating cPVL risk, as approximately 50% of cPVL infants weigh more than 1500 g at birth. [25][26][27] suggesting that an inflammatory intrauterine environment increases the risk of cPVL. Tocolytics and antibiotics used to treat intrauterine infection may mask smouldering chorioamnionitis.…”

Development of an implantable synthetic membrane for the treatment of preterm premature rupture of fetal membranes

“…The increase in fetal expression of cytokines, even when the presence of bacteria is subclinical and undetected by conventional routine techniques, is now known to contribute to neonatal brain injury. 5 Furthermore, persistent oligohydramnios (severely reduced amniotic fluid volume) prevents adequate lung development resulting in pulmonary hypoplasia and can also lead to umbilical cord compression. 6 Management of PPROM is controversial and normally depends on the gestation at which it occurred, as well as the presence or absence of complications.…”