Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Abstract

Background. The study investigates the influence of the length of membrane rupture period among pregnant women with preterm premature rupture of membranes (PPROM) between the 32nd and 34th weeks of gestation on the development of chorioamnionitis and the congenital infection of a newborn. It seeks to ascertain the values of indicators in mother's blood that enable to predict chorioamnionitis and funisitis for mothers, and congenital infection for newborns.Materials and methods. A retrospective study of case records of women with PPROM at 32 (32 w. + 0 d)-34 (33 w. + 6 d) weeks of gestation and their newborns was performed. Two comparative groups were made: 1) of women who had funisitis and / or chorioamnionitis with or without deciduitis and 2) of women having no proved inflammation (according to the results of histological examination of placentae). Analogically, comparative groups were made of their newborns: those who had diagnosis of congenital infection and those who had no infection. The duration of membrane rupture period and the blood markers were investigated in all the groups.Results. The study included 135 women. Duration of the membrane rupture period lasted 85.17 ± 84.72 hrs in the group of women who had histological inflammation, and 40.06 ± 56.57 hrs in the group with no inflammation, P = 0.01, AUC = 0.735; the critical membrane rupture period value for developing intrauterine infection by the Youden index was 43.7 hrs. The corresponding maternal CRP values (mg/l) were 25.85 ± 40.27 vs. 5.23 ± 7.88 (P = 0.01, AUC = 0.6), the Youden index 4.6 mg/l. For the mothers of the newborns diagnosed with infection, the duration of the membrane rupture period was 55.95 ± 65.04 hrs, for the mothers of the newborns without congenital infection it was 40.25 ± 73.71 hours. Respectively, CRP values for the mothers of newborns averaged 12.25 ± 22.14 mg/l vs. 4.8 ± 4.82 mg/l (P = 0.005).Conclusions. Longer membrane rupture period and higher maternal CRP are correlated with inflammatory changes in the placenta and umbilical cord, thus they can be used as the prognostic indicators of intrauterine infection. When the duration of the membrane rupture period lasts ≥44 hrs, the risk of chorioamnionitis and funisitis increases five times; when the maternal serum CRP is higher than 5 mg/l, funisitis / chorioamnionitis is twice more frequent than at lower than 5 mg/l CRP values.

Evaluation of maternal and neonatal outcomes in the case of preterm premature rupture of membranes and their relationship to prenatal maternal indicators: Across -sectional descriptive study

“…In contrast, other studies did not prove any significant predictive value of the WBC count. [31,32] The current study showed the same results. In contrast, some studies have shown different results.…”

“…As the more extended leaking period of the membrane rupture is correlated with histological chorioamnionitis, funisitis and congenital infection. [32] Other studies reported that the prolonged duration of the membrane rupture period had a significant factor for chorioamnionitis. [36,37] It is clear that the current study has the same result as the previous studies.…”

Duration of Preterm Premature Rupture of Membranes as Predictor of Histologic Chorioamnionitis and Early Onset Neonatal Sepsis: A Cohort Study

“…Sample Size: To compute for the sample size, we calculated for the minimum sample required for both HCA and for EONS and the higher sample size was followed in this study. The values used for this sample size computation was based on a study by Daunoravičienė et al in 2014 12 . The calculations are presented below.…”

“…This value gives 80% power to detect an effect size of 15.7 at 0.05 α-level of significance. The values used for this sample size computation were based on a study by Daunoravičienė et al 2014 12 .…”

Revista de la Universidad del Zulia, Volumen 12, Número 33

“…El contaje de leucocitos mayor de 15.000 por milímetro cúbico, se ha asociado con la presencia de infección corioamniótica; sin embargo, este hallazgo puede resultar poco confiable, puesto que, puede existir leucocitosis en casos de administración antenatal de corticosteroides y en presencia de trabajo de parto lo que complica más aún el diagnóstico (Daunoraviciene, 2014).…”