Neonatal outcomes and four‐year follow‐up after spontaneous or iatrogenic preterm prelabor rupture of membranes before 24 weeks

Chauleur, Céline; Rochigneux, Stéphanie; Seffert, P.; Chêne, Geneviève; Billiemaz, K; Collet, François

doi:10.1080/00016340902971433

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…Conservative management could be selected, but fetal prognosis remains poor in such cases. 5 Epidemiological, microbiological and clinical evidence suggests an association between infection and preterm birth. 4 Strategies for cases of preterm labor in which the presence of subclinical (silent) intrauterine infection, rather than overt intrauterine infection, is suspected may need to use not only tocolytic agents but also anti-inflammatory agents.…”

Section: Discussionmentioning

confidence: 99%

Initial experience using Sivelestat to manage preterm labor with a bulging fetal membrane in pregnant women

Nakajima

Masaoka

2012

J Perinatol

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Intrauterine infection and inflammation are recognized as major contributors to the onset of preterm labor. We describe two cases of severe preterm labor with bulging membrane that were treated by intravenous injection of Sivelestat, a neutrophil elastase inhibitor. Ritodrine hydrochloride and magnesium sulfate were intravenously administered for tocolysis, and ampicillin was provided as an antibiotic. Urinary trypsin inhibitor (UTI) was administered transvaginally. Sivelestat was infused intravenously at 4.8 mg kg À1 day À1 through the maternal vein. No side effects were observed. Levels of interleukin (IL)-6 and IL-8 in amniotic fluid decreased, and gestations were prolonged without complications for >1 week. Two healthy infants were delivered. Our experience suggests that multidrug therapy with Sivelestat offers a new therapeutic strategy for preterm labor, but further investigations of the indications, administration period and dosage are required.

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Section: Discussionmentioning

confidence: 99%

Initial experience using Sivelestat to manage preterm labor with a bulging fetal membrane in pregnant women

Nakajima

Masaoka

2012

J Perinatol

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“…Normal vaginal pH varies between 4.4 and 6.0, whereas pH of amniotic fluid is 8.0 [18]. A manual vaginal examination should be contraindicated in the presence of PPROM because of its association with an increased risk of chorioamnionitis by ascending infection and reduction of the latency period by 9 days on average [21,73].…”

Section: Diagnosis Of Pprom Routine Diagnostic Proceduresmentioning

confidence: 99%

“…Monitoring of initial signs of infection is necessary (maternal and fetal heart rate, maternal body temperature and laboratory findings), when procedure-related leakage occurs, but in general, leakage of amniotic fluid after a sterile invasive procedure is less likely to result in an obstetrical problem compared to spontaneous PPROM. Prolongation of pregnancy beyond completion 34 weeks of pregnancy to reduce the risk of neonatal complication and demise has been reported following procedure-related PPROM [73,95,98,99], whereas labor induction is recommended following spontaneous PPROM after 34 weeks' gestation.…”

Section: Antibiotics and Probioticsmentioning

confidence: 99%

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

194

153

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Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long-and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/anhydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane -either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intraamniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR) = 0.66), neonatal infections (RR = 0.67) and abnormal ultrasound scan of neonatal brain (RR = 0.67)]. The positive effect of continuo...

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“…8 Despite advances in neonatal care and apparent improved neonatal outcomes, longer-term outcomes of children delivered following early PPROM are largely unknown. One small study 9 examined early childhood outcomes among 13 neonates who were expectantly managed following spontaneous PPROM at less than 24 weeks; 3 (23%) died in the hospital, and only 2 (15%) survived without obvious long-term morbidity at age 4 years. In another small study, Pristauz et al 10 reported that half of 12 infants surviving PPROM between 14.0 and 24.9 weeks had normal neurological and developmental outcomes at age 2 years.…”

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confidence: 99%

Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes

Manuck

Varner

2014

American Journal of Obstetrics and Gynecology

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OBJECTIVE Data regarding long-term outcomes of neonates reaching viability following early preterm premature rupture of membranes (PPROM; <25.0 weeks at rupture) are limited. We hypothesized that babies delivered after early PPROM would have increased rates of major childhood morbidity compared with those with later PPROM (≥25.0 weeks at rupture). STUDY DESIGN This was a secondary analysis of a multicenter randomized controlled trial of magnesium sulfate vs placebo for cerebral palsy prevention. Women with singletons and PPROM of 15-32 weeks were included. All women delivered at 24.0 weeks or longer. Those with PPROM less than 25.0 weeks (cases) were compared with women with PPROM at 25.0-31.9 weeks (controls). Composite severe neonatal morbidity (sepsis, severe intraventricular hemorrhage, periventricular leukomalacia, severe necrotizing enterocolitis, bronchopulmonary dysplasia, and/or death) and composite severe childhood morbidity at age 2 years (moderate or severe cerebral palsy and/or Bayley II Infant and Toddler Development scores greater than 2 SD below the mean) were compared. RESULTS A total of 1531 women (275 early PPROM cases) were included. Demographics were similar between the groups. Cases delivered earlier (26.6 vs 30.1 weeks, P < .001) and had a longer rupture-to-delivery interval (20.0 vs 10.4 days, P < .001). Case neonates had high rates of severe composite neonatal morbidity (75.6% vs 21.8%, P < .001). Children with early PPROM had higher composite severe childhood morbidity (51.6% vs 22.5%, P < .001). Early PPROM remained associated with composite severe childhood morbidity in multivariable models, even when controlling for delivery gestational age and other confounders. CONCLUSION Early PPROM is associated with high rates of neonatal morbidity. Early childhood outcomes at age 2 years remain poor compared with those delivered after later PPROM.

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Neonatal outcomes and four‐year follow‐up after spontaneous or iatrogenic preterm prelabor rupture of membranes before 24 weeks

Cited by 25 publications

References 19 publications

Initial experience using Sivelestat to manage preterm labor with a bulging fetal membrane in pregnant women

Initial experience using Sivelestat to manage preterm labor with a bulging fetal membrane in pregnant women

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes

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