P08.09: Risk factors for the development of histologic chorioamnionitis after preterm premature rupture of membranes: sonographic cervical length, intra-amniotic infection at presentation and prolonged latency

Abstract

Results: Mean gestational age at birth was 33.0 ± 1.4 weeks (range 30.3-35) and mean birth weight was 2003 ± 335 gm (range 1262-2880). Fourteen of them were given dexamethasone. The mean velocity of pulmonary artery was 67 cm/sec. The mean acceleration/ejection time ratio of right and left pulmonary arteries were 0.16 ± 0.05 and 0.15 ± 0.05 respectively. After birth, 7 of them needed mechanical ventilation, and 3 needed surfactants. However, we found no significant correlation between prenatal pulmonary blood flow findings and postnatal pulmonary functions. Conclusion: Doppler blood flow of the pulmonary artery in preterm births has no relationship with the postnatal pulmonary functions. P08.09Risk factors for the development of histologic chorioamnionitis after preterm premature rupture of membranes: sonographic cervical length, intra-amniotic infection at presentation and prolonged latency K. Park, S. Kim, H. Jung, J. S. HongDepartment of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea Aims: To determine whether decreased cervical length, intraamniotic infection at presentation and prolonged latency are associated with an increased risk of the development of histologic chorioamnionitis after preterm premature rupture of membranes (PPROM). Methods: Transvaginal ultrasonographic assessment of cervical length was performed and antibiotic therapy was initiated immediately after amniocentesis in 81 consecutive women with PPROM at 23.4 to 35.0 weeks of gestation. Amniotic fluid obtained by amniocentesis was cultured for aerobic and anaerobic bacteria and for Mycoplasmas, and WBC count was determined. PPROM was defined as gross rupture and histologic chorioamnionitis was diagnosed in the presence of neutrophil infiltration into any tissues samples (amnion, chorion-decidua, umbilical cord, or chorionic plate). Results: The prevalence of acute histologic chorioamnionitis in patients after PPROM was 41% (33/81) and that of positive amniotic fluid cultures was 22% (18/81). Logistic regression indicated that decreased cervical length, a positive amniotic fluid culture, and gestational age at amniocentesis, but not prolonged latency, bear a significant relationship with the development of histologic chorioamnionitis after PPROM. Similarly, in terms of the development of the funisitis as the outcome variable, logistic regression demonstrated that only gestational age at amniocentesis was significantly and independently associated with an increased risk of development of funisitis after PPROM. Conclusions: We demonstrated the shorter the cervix in patients with PPROM, the greater the risk of ascending transcervical infection after PPROM documented by the increasing odds ratios of placental inflammation. Methods: 60 women admitted in labour who are nulliparous, gestational age from 37 to 40 weeks, singleton pregnancy, cephalic presentation and delivered vaginally will be randomized into three groups for management of the third stage; 20 women will be managed with full packag...