Makieva, Sofia; Dubicke, Aurelija; Rinaldi, Sara F; Fransson, Emma; Ekman-Ordeberg, Gunvor; Norman, Jane E
Premature prelabor rupture of fetal membranes accounts for 30% of all premature births and is associated with detrimental long-term infant outcomes. Premature cervical remodeling, facilitated by matrix metalloproteinases, may trigger rupture at the zone of the fetal membranes overlying the cervix. The similarities and differences underlying cervical remodeling in premature prelabor rupture of fetal membranes and spontaneous preterm labor with intact membranes are unexplored. We aimed to perform the first transcriptomic assessment of the preterm human cervix to identify differences between premature prelabor rupture of fetal membranes and preterm labor with intact membranes and to compare the enzymatic activities of matrix metalloproteinases-2 and -9 between premature prelabor rupture of fetal membranes and preterm labor with intact membranes. Cervical biopsies were collected following preterm labor with intact membranes (n = 6) and premature prelabor rupture of fetal membranes (n = 5). Biopsies were also collected from reference groups at term labor (n = 12) or term not labor (n = 5). The Illumina HT-12 version 4.0 BeadChips microarray was utilized, and a novel network graph approach determined the specificity of changes between premature prelabor rupture of fetal membranes and preterm labor with intact membranes. Quantitative reverse transcription-polymerase chain reaction and Western blotting confirmed the microarray findings. Immunofluorescence was used for localization studies and gelatin zymography to assess matrix metalloproteinase activity. PML-RARA-regulated adapter molecule 1, FYVE-RhoGEF and PH domain-containing protein 3 and carcinoembryonic antigen-ralated cell adhesion molecule 3 were significantly higher, whereas N-myc downstream regulated gene 2 was lower in the premature prelabor rupture of fetal membranes cervix when compared with the cervix in preterm labor with intact membranes, term labor, and term not labor. PRAM1 and CEACAM3 were localized
The diagnosis of preterm labor (PTL) is challenging, especially in women whose cervical dilatation is 15 mm. Transvaginal ultrasound CL can also be performed in the presence of ruptured membranes and predicts latency. Although additional data are needed, the evidence so far suggests that the use of transvaginal ultrasound CL and fetal fibronectin can be used to better identify and manage women with PTL likely to have an imminent preterm delivery, and to avoid interventions in women who would not.
Quist-Nelson, Johanna; Parker, Pamela; Mokhtari, Neggin; Di Sarno, Rossana; Saccone, Gabriele; Berghella, Vincenzo
Preterm prelabor rupture of membranes occurs in 3% of all pregnancies. Neonatal benefit is seen in uninfected women who do not deliver immediately after preterm prelabor rupture of membranes. The purpose of this study was to evaluate whether the administration of progestogens in singleton pregnancies prolongs pregnancy after preterm prelabor rupture of membranes. Searches were performed in MEDLINE, OVID, Scopus, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials with the use of a combination of keywords and text words related to "progesterone," "progestogen," "prematurity," and "preterm premature rupture of membranes" from the inception of the databases until January 2018. We included all randomized controlled trials of singleton gestations after preterm prelabor rupture of membranes that were randomized to either progestogens or control (either placebo or no treatment). Exclusion criteria were trials that included women who had contraindications to expectant management after preterm prelabor rupture of membranes (ie, chorioamnionitis, severe preeclampsia, and nonreassuring fetal status) and trials on multiple gestations. We planned to include all progestogens, including but not limited to 17-α hydroxyprogesterone caproate, and natural progesterone. The primary outcome was latency from randomization to delivery. Metaanalysis was performed with the use of the random effects model of DerSimonian and Laird to produce relative risk with 95% confidence interval. Analysis was performed for each mode of progestogen administration separately. Six randomized controlled trials (n=545 participants) were included. Four of the included trials assessed the efficacy of 17-α hydroxyprogesterone caproate; 1 trial assessed rectal progestogen, and 1 trial had 3 arms that compared 17-α hydroxyprogesterone caproate, rectal progestogen, and placebo. The mean gestational age at time randomization was 26.9 weeks in the 17-α hydroxyprogesterone caproate
... gov/ency/patientinstructions/000512.htm Premature rupture of membranes To use the sharing features on this page, ... water that surrounds your baby in the womb. Membranes or layers of tissue hold in this fluid. ...
Full Text Available To characterize subgroups of preterm prelabor rupture of membranes (PPROM and short-term neonatal outcomes based on the presence and absence of intraamniotic inflammation (IAI and/or microbial invasion of the amniotic cavity (MIAC.One hundred and sixty-six Caucasian women with singleton pregnancies were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis (n=166 and were assayed for interleukin-6 levels by a lateral flow immunoassay. The presence of Ureaplasma species, Mycoplasma hominis, Chlamydia trachomatis, and 16S rRNA was evaluated in the amniotic fluid. IAI was defined as amniotic fluid IL-6 values, measured by a point of care test, higher than 745 pg/mL.Microbial-associated IAI (IAI with MIAC and sterile intraamniotic inflammation (IAI alone were found in 21% and 4%, respectively, of women with PPROM. Women with microbial-associated IAI had higher microbial loads of Ureaplasma species in the amniotic fluid than women with MIAC alone. No differences in the short-term neonatal morbidity with respect to the presence of microbial-associated IAI, sterile IAI and MIAC alone were found after adjusting for the gestational age at delivery in women with PPROM.Microbial-associated but not sterile intraamniotic inflammation is common in Caucasian women with PPROM. The gestational age at delivery but not the presence of inflammation affects the short-term neonatal morbidity of newborns from PPROM pregnancies.
Sperling, Lene; Schantz, A L; Wåhlin, A
OBJECTIVE: To compare the rate of obstetric interventions, length of labor, and maternal morbidity in pregnancies with prelabor rupture of membranes at term after either early or late induction of labor in both primiparous and pluriparous women. DESIGN: Prospective, randomized study. SUBJECTS: 362...... primiparous and pluriparous (p rupture of membranes to delivery increased...
In patients presenting with premature rupture of the membranes there are two factors which influence the foetal morbidity and mortality. These factors are prema- turity and intra-uterine infection. The purpose of this analysis was to elucidate which factor carried the greater risk to the foetus. Recently there has been a spate of.
Full Text Available Abstract Background Preterm prelabor rupture of membrane (PPROM causes maternal and neonatal complications. Prophylactic antiobiotics were used in the management of PPROM. The objectives of this retrospective study were to compare clinical course and outcome of PPROM managed expectantly with prophylactic antibiotics and antenatal corticosteroids with those without prophylactic antibiotics and antenatal corticosteroids. Results A total of 170 cases of singleton pregnant women with gestational age between 28–34 weeks suffering from PROM during January 1998 to December 2009 were included; 119 cases received prophylactic antibiotics and antenatal corticosteroids while 51 cases did not received prophylactic antibiotics and antenatal corticosteroids. Median latency period in the study group was significantly longer than in the control group (89.8 vs. 24.3 hours, P Conclusions Latency period of PPROM after using prophylactic antibiotics and antenatal corticosteroids increased while neonatal infectious morbidity was low. But maternal infectious morbidity was not increased. This retrospective study confirms the benefit of prophylactic antibiotics and antenatal corticosteroids in management of PPROM.
Musilova, Ivana; Pliskova, Lenka; Kutova, Radka; Jacobsson, Bo; Paterova, Pavla; Kacerovsky, Marian
The main aim of this study was to evaluate the presence of Streptococcus agalactiae (S. agalactiae) in the vagina and the amniotic fluid in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). The next aim was to evaluate the incidence of S. agalactiae early onset sepsis in newborns from PPROM pregnancies, with respect to the presence of S. agalactiae in the vagina and the amniotic fluid. Singleton gestations with PPROM between 24 + 0 and 36 + 6 were included. A vaginal swab was obtained, and amniocentesis was performed at admission. The presence of S. agalactiae in the vagina and in the amniotic fluid was assessed by culture and by real-time polymerase chain reaction, respectively. In total, 336 women were included. The presence of S. agalactiae in the vaginal and amniotic fluid was found in 9% (31/336) and 1% (3/336) of women. One woman had S. agalactiae in the amniotic fluid but was negative for the presence of S. agalactiae in the vaginal fluid. Early onset neonatal sepsis developed in one newborn from pregnancies complicated by the presence of S. agalactiae in the amniotic fluid. The presence of S. agalactiae in the vagina and amniotic fluid complicated approximately each 10th and each 100th PPROM pregnancy. Cultivation-negative findings of S. agalactiae in the vagina did not exclude the positivity of the amniotic fluid for S. agalactiae and the development of early onset sepsis in newborns.
Full Text Available BACKGROUND: Rupture of the fetal membranes is a common harbinger of imminent labor and delivery. Telomere shortening is a surrogate for oxidative stress (OS and senescence. Fetal leukocyte and placental membrane DNA telomere lengths were evaluated to determine their association with preterm prelabor rupture of the membranes (pPROM or spontaneous preterm births with intact membranes (PTB, compared to term birth. METHODS: Telomere lengths were quantified in cord blood leukocytes (n = 133 from three major groups: 1 pPROM (n = 28, 2 PTB (n = 69 and 3 uncomplicated full term births (controls, n = 35, using real-time quantitative PCR. Placental membrane specimens (n = 18 were used to correlate fetal leukocyte and placental telomere lengths. Telomere length differences among the groups were analyzed by ANOVA. Pearson correlation coefficients determined relationships between leukocyte and placental membrane telomere lengths. RESULTS: In pregnancies with intact membranes, fetal leukocyte telomere length was inversely proportional to gestational age. The mean telomere length decreased as gestation progressed, with the shortest at term. pPROM had telomere lengths (9962 ± 3124 bp that were significantly shorter than gestational age-matched PTB (11546 ± 4348 bp, p = 0.04, but comparable to term births (9011 ± 2497 bp, p = 0.31. Secondary analyses revealed no effects of race (African American vs. Caucasian or intraamniotic infection on telomere length. A strong Pearson's correlation was noted between fetal leukocyte and placental membrane telomere lengths (ρ = 0.77; p<0.01. CONCLUSIONS: Fetal leukocyte telomere length is reduced in pPROM compared to PTB but is similar to term births. pPROM represents a placental membrane disease likely mediated by OS-induced senescence.
van der Ham, David P.; van der Heyden, Jantien L.; Opmeer, Brent C.; Mulder, Antonius L. M.; Moonen, Rob M. J.; van Beek, J. (Hans) J.; Franssen, Maureen T. M.; Bloemenkamp, Kitty W. M.; Sikkema, J. (Marko) M.; de Groot, Christianne J. M.; Porath, Martina; Kwee, Anneke; Woiski, Mallory D.; Duvekot, J. (Hans) J.; Akerboom, Bettina M. C.; van Loon, Aren J.; de Leeuw, Jan W.; Willekes, Christine; Mol, Ben W. J.; Nijhuis, Jan G.
OBJECTIVE: The evidence for the management of near term prelabor rupture of membranes is poor. From January 2007 until September 2009, we performed the PPROM Expectant Management versus Induction of Labor (PPROMEXIL) trial. In this trial, we showed that in women with preterm prelabor rupture of
Vijgen, S.M.; Ham, D.P. van der; Bijlenga, D.; Beek, J.J. van; Bloemenkamp, K.W.; Kwee, A.; Groenewout, M.; Kars, M.M.; Kuppens, S.; Mantel, G.; Molkenboer, J.F.; Mulder, A.L.; Nijhuis, J.G.; Pernet, P.J.; Porath, M.; Woiski, M.D.; Weinans, M.J.; Wijngaarden, W.J. van; Wildschut, H.I.J.; Akerboom, B.; Sikkema, J.M.; Willekes, C.; Mol, B.W.; Opmeer, B.C.; et al.,
OBJECTIVE: To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). DESIGN: Economic analysis based on a randomized clinical trial. SETTING: Obstetric departments of eight academic and 52 non-academic hospitals in the
Vijgen, Sylvia M. C.; Van der Ham, David P.; Bijlenga, Denise; Van Beek, Johannes J.; Bloemenkamp, Kitty W. M.; Kwee, Anneke; Groenewout, Mariet; Kars, Michael M.; Kuppens, Simone; Mantel, Gerald; Molkenboer, Jan F. M.; Mulder, Antonius L. M.; Nijhuis, Jan G.; Pernet, Paula J. M.; Porath, Martina; Woiski, Mallory D.; Weinans, Martin J. N.; Van Wijngaarden, Wim J.; Wildschut, Hajo I. J.; Akerboom, Bertina; Sikkema, J. Marko; Willekes, Christine; Mol, Ben W. J.; Opmeer, Brent C.
ObjectiveTo compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). DesignEconomic analysis based on a randomized clinical trial. SettingObstetric departments of eight academic and 52 non-academic hospitals in the Netherlands.
Vijgen, Sylvia M. C.; van der Ham, David P.; Bijlenga, Denise; van Beek, Johannes J.; Bloemenkamp, Kitty W. M.; Kwee, Anneke; Groenewout, Mariët; Kars, Michael M.; Kuppens, Simone; Mantel, Gerald; Molkenboer, Jan F. M.; Mulder, Antonius L. M.; Nijhuis, Jan G.; Pernet, Paula J. M.; Porath, Martina; Woiski, Mallory D.; Weinans, Martin J. N.; van Wijngaarden, Wim J.; Wildschut, Hajo I. J.; Akerboom, Bertina; Sikkema, J. Marko; Willekes, Christine; Mol, Ben W. J.; Opmeer, Brent C.
To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). Economic analysis based on a randomized clinical trial. Obstetric departments of eight academic and 52 non-academic hospitals in the Netherlands. Women with PPROM near
Radochova, Vladimira; Kacerovska Musilova, Ivana; Stepan, Martin; Vescicik, Peter; Slezak, Radovan; Jacobsson, Bo; Kacerovsky, Marian
Periodontal disease is frequently suggested as a possible causal factor for preterm delivery. The link between periodontal disease and preterm delivery is a possible translocation of periopathogenic bacteria to the placenta and amniotic fluid as well as a systemic response to this chronic inflammatory disease. However, there is a lack of information on whether there is an association between clinical periodontal status in women with preterm prelabor rupture of membranes (PPROM) and the presence of microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation (IAI). Therefore, the main aim of this study was to evaluate the incidence and severity of periodontal disease in women with PPROM. The secondary aim was to characterize an association between periodontal status and the presence of intra-amniotic PPROM complications (MIAC and/or IAI). Seventy-eight women with PPROM at gestational ages between 24 + 0 and 36 + 6 weeks were included in this study. The samples of amniotic fluid were obtained at admission via transabdominal amniocentesis, and amniotic fluid interleukin (IL)-6 concentrations were determined using a point-of-care test. All women had a full-mouth recording to determine the periodontal and oral hygiene status. Probing pocket depth and clinical attachment loss were measured at four sites on each fully erupted tooth. In total, 45% (35/78) of women with PPROM had periodontal disease. Mild, moderate, and severe periodontal disease was present in 19% (15/78), 19% (15/78), and 6% (5/78) of women, respectively. The presence of MIAC and IAI was found in 28% (22/78) and 26% (20/78) of women, respectively. Periopathogenic bacteria (2 × Streptococcus intermedius and 1 × Fusobacterium nucleatum) was found in the amniotic fluid of 4% (3/78) of women. There were no differences in periodontal status between women with MIAC and/or IAI and women without these intra-amniotic complications. The presence of MIAC and IAI was not related
Menon, Ramkumar; Boldogh, Istvan; Hawkins, Hal K; Woodson, Michael; Polettini, Jossimara; Syed, Tariq Ali; Fortunato, Stephen J; Saade, George R; Papaconstantinou, John; Taylor, Robert N
Preterm prelabor rupture of the membranes (pPROM) may lead to preterm births (PTBs). We investigated premature senescence of fetal membranes in women with pPROM and spontaneous PTB with intact membranes (PTBs, and term births. Term fetal membranes were exposed to cigarette smoke extract to induce oxidative stress. Western blots documented p-p53 and p-p38 MAPK. Transmission electron microscopy assessed cellular morphologic features in clinical and cigarette smoke extract-treated membranes. A total of 80% of pPROM cells and >60% of term cells were positive for all three senescence phenotype markers, and concentrations were higher than in PTBs (P PTBs. Histologic and biochemical resemblance of pPROM and term membranes suggests premature senescence of the membranes is a mechanistic feature in pPROM, and this can be phenocopied in an in vitro model. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.
Maria URSACHI (BOLOTA
Full Text Available The membranes surrounding the amniotic cavity are composed from amnion and chorion, tightly adherent layers which are composed of several cell types, including epithelial cells, trophoblasts cells and mesenchyme cells, embedded in a collagenous matrix. They retain amniotic fluid, secret substances into the amniotic fluid, as well as to the uterus and protect the fetus against upward infections from urogenital tract. Normally, the membranes it breaks during labor. Premature rupture of the amniotic sac (PRAS is defined as rupture of membranes before the onset of labor. Premature rupture of the fetal membrane, which occurs before 37 weeks of gestation, usually, refers to preterm premature rupture of membranes. Despite advances in the care period, premature rupture of membranes and premature rupture of membranes preterm continue to be regarded as serious obstetric complications. On the term 8% - 10% of pregnant women have premature rupture of membranes; these women are at increased risk of intrauterine infections, where the interval between membrane rupture and expulsion is rolled-over. Premature rupture of membranes preterm occurs in approximately 1% of all pregnancies and is associated with 30% -40% of preterm births. Thus, it is important to identify the cause of pre-term birth (after less than 37 completed weeks of "gestation" and its complications, including respiratory distress syndrome, neonatal infection and intraventricular hemorrhage. Objectives: the development of the protocol of the clinical trial on patients with impending preterm birth, study clinical and statistical on the socio-demographic characteristics of patients with imminent preterm birth; clinical condition of patients and selection of cases that could benefit from the application of interventional therapy; preclinical investigation (biological and imaging of patients with imminent preterm birth; the modality therapy; clinical investigation of the effectiveness of short
Butt, K D; Bennett, K A; Crane, J M; Hutchens, D; Young, D C
To compare labor induction intervals between oral misoprostol and intravenous oxytocin in women who present at term with premature rupture of membranes. One hundred eight women were randomly assigned to misoprostol 50 microg orally every 4 hours as needed or intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Sample size was calculated using a two-tailed alpha of 0.05 and power of 80%. Baseline demographic data, including maternal age, gestation, parity, Bishop score, birth weight, and group B streptococcal status, were similar. The mean time +/-standard deviation to vaginal birth with oral misoprostol was 720+/-382 minutes compared with 501+/-389 minutes with oxytocin (P = .007). The durations of the first, second, and third stages of labor were similar. There were no differences in maternal secondary outcomes, including cesarean birth (eight and seven, respectively), infection, maternal satisfaction with labor, epidural use, perineal trauma, manual placental removal, or gastrointestinal side effects. Neonatal outcomes including cord pH, Apgar scores, infection, and admission to neonatal intensive care unit were not different. Although labor induction with oral misoprostol was effective, oxytocin resulted in a shorter induction-to-delivery interval. Active labor intervals and other maternal and neonatal outcomes were similar.
Maria URSACHI (BOLOTA); Emil ANTON; Sorana Caterina ANTON
The membranes surrounding the amniotic cavity are composed from amnion and chorion, tightly adherent layers which are composed of several cell types, including epithelial cells, trophoblasts cells and mesenchyme cells, embedded in a collagenous matrix. They retain amniotic fluid, secret substances into the amniotic fluid, as well as to the uterus and protect the fetus against upward infections from urogenital tract. Normally, the membranes it breaks during labor. Premature rupture of the amn...
Stefanoska, Ivana; Tadić, Jasmina; Vilotić, Aleksandra; Jovanović Krivokuća, Milica; Abu Rabi, Tamara; Vićovac, Ljiljana
Gal-3, which can regulate immune responses upon infection and inflammation, was not studied so far in intrauterine infection leading to preterm prelabor rupture of the membranes (PPROM), although gal-1 was reported to be implicated in the process. Gal-3 mRNA and protein expression in amnion and its changes during histological chorioamnionitis were studied here. Fetal membranes were obtained from women with PPROM with (n =15) and without histological chorioamnionitis (n =15) during second and third trimester. Immunohistochemical reactivity was evaluated semiquantitatively and analyzed using t-test. Galectin profile of amniotic epithelia was determined by polymerase chain reaction (PCR) and change assessed in gal-3 in PPROM with (n =5) or without histological chorioamnionitis (n =5) by real-time PCR. Human amniotic epithelium was found to express gal-1, gal-3, gal-7 and gal-8 mRNA. Gal-3 mRNA and protein is increased in fetal membranes and in the amniotic epithelium in patients with chorionamnionitis. Histological chorioamnionitis is associated with increased gal-3 expression and strong immunoreactivity of the amnion. Gal-3 may participate in the regulation of the inflammatory responses to chorioamniotic infection and/or direct interaction with pathogens.
Kacerovsky, Marian; Pliskova, Lenka; Menon, Ramkumar; Kutova, Radka; Musilova, Ivana; Maly, Jan; Andrys, Ctirad
To evaluate Ureaplasma species and M. hominis DNA in the umbilical cord blood and its correlation with its microbial load in the amniotic fluid, as a measure of microbial burden in fetal inflammatory response and neonatal outcome in pregnancies complicated by preterm prelabor rupture of membranes (pPROM). A retrospective study of 158 women with singleton pregnancies complicated by pPROM between 24(0/7) and 36(6/7) weeks was conducted. Amniotic fluid was obtained from all women by transabdominal amniocentesis, and umbilical cord blood was obtained by venipuncture from umbilical cords immediately after the delivery of the neonates. The Ureaplasma species and M. hominis DNA was quantitated using absolute quantification techniques. Ureaplasma species and M. hominis DNA was identified in 9% of the umbilical cord blood samples. No correlation between the amniotic fluid and umbilical cord blood microbial load was observed. The presence of Ureaplasma species and M. hominis DNA in the umbilical cord blood had no impact on short-term neonatal morbidity. A high microbial load of genital mycoplasma Ureaplasma species DNA in the umbilical cord in pregnancies complicated by pPROM is not associated with a high fetal inflammatory response and is therefore not associated with serious neonatal morbidity.
Musilova, Ivana; Pliskova, Lenka; Kutova, Radka; Hornychova, Helena; Jacobsson, Bo; Kacerovsky, Marian
To evaluate Ureaplasma species and Mycoplasma hominis DNA in the cervical fluid and their association with microbial invasion of the amniotic cavity (MIAC) and/or histological chorioamnionitis (HCA) in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). A prospective study of 68 women with singleton pregnancies complicated by PPROM between 24(0/7) and 36(6/7) weeks was conducted. Cervical fluid and amniotic fluid were collected from all women at the time of admission. The Ureaplasma species and Mycoplasma hominis DNA in the cervical fluid were identified using specific real-time PCR. Ureaplasma species and Mycoplasma hominis DNA were identified in 59% (40/69) of the cervical fluid samples. Women with the presence of Ureaplasma species DNA with and without Mycoplasma hominis DNA in the cervical fluid had a higher rate of MIAC alone [35% (14/40) versus 11% (3/28); p = 0.02] and a higher rate of the presence of both MIAC and HCA [30% (12/40) versus 4% (1/28); p = 0.01] than women without Ureaplasma species and Mycoplasma hominis DNA in the cervical fluid. The presence of Ureaplasma species DNA with and without Mycoplasma hominis DNA in the cervical fluid is associated with a higher risk of MIAC or MIAC and HCA together in pregnancies complicated by PPROM.
F. Nili AA. Shams Ansari
Full Text Available Premature rupture of membranes (PROM is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91% cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86% of neonates was less than 37 completed weeks. Thirty five infants (21.47% had respiratory distress syndrome and 33 (20.245% had clinical sepsis. Pneumonia in 6 (3.7% and skeletal deformity in 7 (4.294% were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6% of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11% of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane
Singh, Katherine; Mercer, Brian
Preterm premature rupture of the membranes remains a common cause of preterm deliveries and neonatal morbidities. The goal of this study is to review the evidence with regard to the antibiotic treatment after preterm premature rupture of the membranes, long-term outcomes related to antibiotic treatment, and possible complications with treatment. Future research goals are also discussed.
Full Text Available To evaluate maternal serum C-reactive protein (CRP concentrations in pregnancies complicated by preterm prelabor rupture of membranes (PPROM in relation to the presence of microbial invasion of the amniotic cavity (MIAC and/or intra-amniotic inflammation (IAI.Two hundred and eighty-seven women with singleton pregnancies complicated by PPROM between 2014 and 2016 were included in this study. Maternal blood and amniotic fluid samples were collected at the time of admission. Maternal serum CRP concentration was measured using a high-sensitivity immunoturbidimetric assay. Interleukin-6 (IL-6 concentration was measured using a point-of-care test. MIAC was diagnosed based on a positive polymerase chain reaction result for Ureaplasma species, Mycoplasma hominis, and/or Chlamydia trachomatis and for the 16S rRNA gene. IAI was characterized by an amniotic fluid IL-6 concentration of ≥ 745 pg/mL.Women with MIAC and IAI had higher maternal serum CRP concentrations than did women without (with MIAC: median 6.9 mg/L vs. without MIAC: median 4.9 mg/L; p = 0.02; with IAI: median 8.6 mg/L vs. without IAI: median 4.7 mg/L; p < 0.0001. When women were split into four subgroups based on the presence of MIAC and/or IAI, women with the presence of both MIAC and IAI had higher maternal serum CRP than did women with IAI alone, with MIAC alone, and women without MIAC and IAI (both MIAC and IAI: median: 13.1 mg/L; IAI alone: 6.0 mg/L; MIAC alone: 3.9 mg/L; and without MIAC and IAI: median 4.8 mg/L; p < 0.0001. The maternal serum CRP cutoff value of 17.5 mg/L was the best level to identify the presence of both MIAC and IAI, with sensitivity of 47%, specificity of 96%, positive predictive value of 42%, negative predictive value of 96%, and the positive likelihood ratio of 10.9.The presence of both MIAC and IAI was associated with the highest maternal serum CRP concentrations. Maternal serum CRP concentration in women with PPROM at the time of admission can rule out the
Elizebeth V. Issac; Sareena Gilvaz; Neetha B. George
BACKGROUND Preterm premature rupture of membrane (PPROM) is defined as premature rupture of membrane before 37 completed weeks. It is associated with 40% preterm deliveries and results in significant perinatal mortality and morbidity. Present study is an attempt to find the association between infection and PPROM. MATERIALS AND METHODS 100 pregnant women between 29 weeks and 34 weeks of gestation who were admitted in our labour room during a period from November 2012 to Nove...
Hofmeyr, G Justus; Essilfie-Appiah, George; Lawrie, Theresa A
Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). Randomised trials of amnioinfusion compared to no amnioinfusion in women with PPROM. Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. We included five trials but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26, 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for
Ha, Sandie; Liu, Danping; Zhu, Yeyi; Sherman, Seth; Mendola, Pauline
Extreme ambient temperatures have been linked to preterm birth. Preterm premature rupture of membranes is a common precursor to preterm birth but is rarely studied in relation to temperature. We linked 15,381 singleton pregnancies with premature rupture of membranes from a nationwide US obstetrics cohort (2002-2008) to local temperature. Case-crossover analyses compared daily temperature during the week preceding delivery and the day of delivery to 2 control periods, before and after the case period. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CIs) of preterm and term premature rupture of membranes for a 1°C increase in temperature during the warm (May-September) and cold (October-April) season separately after adjusting for humidity, barometric pressure, ozone, and particulate matter. During the warm season, 1°C increase during the week before delivery was associated with a 5% (95% CI, 3%, 6%) increased preterm premature rupture of membranes risk, and a 4% (95% CI, 3%, 5%) increased term premature rupture of membranes risk. During the cold season, 1°C increase was associated with a 2% decreased risk for both preterm (95% CI, 1%, 3%) and term premature rupture of membranes (95% CI, 1%, 3%). The day-specific associations for the week before delivery were similar, but somewhat stronger for days closer to delivery. Relatively small ambient temperature changes were associated with the risk of both preterm and term premature of membranes. Given the adverse consequences of premature rupture of membranes and concerns over global climate change, these findings merit further investigation. See video abstract at, http://links.lww.com/EDE/B312.
Puertas, Alberto; Tirado, Pilar; Pérez, Isabel; López, María S; Montoya, Francisco; Cañizares, José M; Miranda, José A
To investigate the effect of transcervical amnioinfusion on the management of labour and neonatal outcomes in preterm premature rupture of the membranes. This clinical trial included 86 patients with premature rupture of the membranes between weeks 27 and 35 of gestation. Patients were randomly assigned to receive amnioinfusion via a two-way catheter or to the control group. Clinical management was otherwise the same in both groups. Amnioinfusion decreased the frequency of variable decelerations in fetal heart rate (27.9% versus 53.5%, pamnioinfusion for preterm premature rupture of the membranes reduced the number of interventions needed because of nonreassuring fetal status, and improved neonatal gasometric values without increasing maternal or fetal morbidity.
Objective: To compare the maternal outcomes of immediate induction of labor with expectant management in women presenting with premature rupture of membranes (PROM) at term. Methods: One hundred and fifty two women with PROM at term were randomized into either immediate induction of labor with oxytocin or ...
Objective. To determine the optimal way to manage patients with premature rupture of the membranes after 34 weeks' gestation. Design. A prospective, randomised controlled trial comparing immediate induction and delayed induction after 24 • 48 hours. Setting. Tygerberg Hospital, Gape Town. Participants. Seventy ...
Should preterm labour and preterm premature rupture of membranes be treated with antibiotics? AP Macdonald. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/ogf.v19i2.43719 · AJOL African Journals Online. HOW TO ...
Verspyck, Eric; Bisson, Violene; Roman, Horace; Marret, Stéphane
To determine whether preterm premature rupture of membranes (PPROM) before 24 weeks is an independent risk factor for poor outcome in preterm neonates. A retrospective comparative cohort study was conducted, including viable premature infants born between 25 and 34-weeks gestation. Each preterm case with early PPROM was matched with two preterm controls of the same gestational age at birth, sex and birth date and who were born spontaneously with intact membranes. Logistic regression was performed to identify independent risk factors associated with composite respiratory and perinatal adverse outcomes for the overall population of preterm infants. Thirty-five PPROM cases were matched with 70 controls. Extreme prematurity (26-28 weeks) was an independent risk factor for composite perinatal adverse outcomes [odds ratio (OR) 43.9; p = 0.001]. Extreme prematurity (OR 42.9; p = 0.001), PPROM (OR 7.1; p = 0.01), male infant (OR 5.2; p = 0.02) and intrauterine growth restriction (IUGR, OR 4.8; p = 0.04) were factors for composite respiratory adverse outcomes. Preterm premature rupture of membranes before viability represents an independent risk factor for composite respiratory adverse outcomes in preterm neonates. Extreme prematurity may represent the main risk factor for both composite respiratory and perinatal adverse outcomes. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Full Text Available Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E . coli , S . aureus , C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.
Karat, C; Madhivanan, P; Krupp, K; Poornima, S; Jayanthi, N V; Suguna, J S; Mathai, E
Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E. coli, S. aureus, C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.
Trentacoste, Stephanie V; Jean-Pierre, Claudel; Baergen, Rebecca; Chasen, Stephen T
To describe outcomes in twin pregnancies with preterm premature rupture of membranes (PPROM). Dichorionic twin pregnancies complicated by PPROM at premature rupture of membranes (PROM), latency from PROM to delivery, and infection were examined. In 49 twin pregnancies, the median gestational age at PROM was 31 weeks with a median latency between PROM and delivery of 0 days (interquartile range 0-6). Latency intervals of >or=2 and >or=7 days were achieved by 40.8% and 22.4%, respectively. PPROM at or= 2 days (70.6% vs. 25.0%) and >or=7 days (47.1% vs. 9.4%). There was a significant relationship between latency and clinical and histologic signs of infection. After 30 weeks, most twin pregnancies with PPROM delivered within 2 days. Infection appears to be a consequence rather than a cause of PPROM in most cases.
Roberts, D; Vause, S; Martin, W; Green, P; Walkinshaw, S; Bricker, L; Beardsmore, C; Shaw, N; McKay, A; Skotny, G; Williamson, P; Alfirevic, Z
To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk (RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group (RR 9.0 (95% CI, 0.51-159.70)). This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy
Kusumam Vilangot Nhalil
Full Text Available BACKGROUND Preterm premature rupture of membrane is defined as rupture of foetal membrane before onset of labour at less than 37 completed weeks of gestation. Incidence of PPROM is around 3-10% of all deliveries. Primary complication for mother is infection and for foetus and neonate is prematurity, foetal distress, cord compression, deformation, pulmonary hypoplasia, necrotising enterocolitis and neurologic disorders. Most likely outcome is preterm delivery within 1 week. The aim of the study is to study the foetomaternal and neonatal outcome in PPROM patients and the common prevalent organism in PPROM. MATERIALS AND METHODS This is a cohort study of pregnant women from 24-37 weeks with PPROM admitted to IMCH for a period of 1 year, January 2016 to December 2016. 100 patients with PPROM were taken up for the study. The data was collected using the following inclusion and exclusion criteria. Inclusion criteria are gestational age 24-37 weeks confirmed by dates, clinical examination and ultrasound with lack of uterine contractions for at least 1 hour from PPROM; single live pregnancy in vertex presentation; PPROM confirmed by direct visualisation, neonates admitted in NICU soon after delivery. RESULTS 49% of patients with preterm premature rupture of membranes were from 18-24 years.68% of patients had a latency period of 3 weeks.15% of patients had maternal tachycardia, 4% had tenderness of uterus and 4% had leucocytosis and 14% had an elevated CRP. Thus, clinical chorioamnionitis was seen in 14% of patients, 38% of babies born had prematurity and 2% had sepsis and 19% had respiratory distress syndrome and hyperbilirubinaemia, 2% had perinatal asphyxia, 2% had anomalies, 1% had necrotising enterocolitis and 5% were NND. Common organisms were normal flora, E. coli, Streptococci and Enterococci. CONCLUSION PPROM increases the incidence of maternal morbidity with longer hospital stay due to chorioamnionitis. Neonatal morbidity is increased due to
Elizebeth V. Issac
Full Text Available BACKGROUND Preterm premature rupture of membrane (PPROM is defined as premature rupture of membrane before 37 completed weeks. It is associated with 40% preterm deliveries and results in significant perinatal mortality and morbidity. Present study is an attempt to find the association between infection and PPROM. MATERIALS AND METHODS 100 pregnant women between 29 weeks and 34 weeks of gestation who were admitted in our labour room during a period from November 2012 to November 2013 were included. Preterm Premature Rupture of Membrane (PPROM is confirmed by history, sterile per speculum examination demonstrating pooling of fluid in posterior vaginal fornix and vaginal pH. An ultrasound examination showing oligohydramnios also supports the diagnosis. RESULTS 62% of neonates had RDS; p value <0.001, strong significance. 16% had no morbidity. 10% had late sepsis. 6% had NHB; p value 0.090, moderate significance. 6% had PHTN. CONCLUSION Relation between infection and PPROM remains an association. So patients at risk for preterm delivery need to be watched more closely for infection as it is also associated with neonatal morbidity.
Vijgen, Sylvia M C; van der Ham, David P; Bijlenga, Denise; van Beek, Johannes J; Bloemenkamp, Kitty W M; Kwee, Anneke; Groenewout, Mariët; Kars, Michael M; Kuppens, Simone; Mantel, Gerald; Molkenboer, Jan F M; Mulder, Antonius L M; Nijhuis, Jan G; Pernet, Paula J M; Porath, Martina; Woiski, Mallory D; Weinans, Martin J N; van Wijngaarden, Wim J; Wildschut, Hajo I J; Akerboom, Bertina; Sikkema, J Marko; Willekes, Christine; Mol, Ben W J; Opmeer, Brent C
To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). Economic analysis based on a randomized clinical trial. Obstetric departments of eight academic and 52 non-academic hospitals in the Netherlands. Women with PPROM near term who were not in labor 24 h after PPROM. A cost-minimization analysis was done from a health care provider perspective, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs. Primary health outcome was the incidence of neonatal sepsis. Direct medical costs were estimated from start of randomization to hospital discharge of mother and child. Induction of labor did not significantly reduce the probability of neonatal sepsis [2.6% vs. 4.1%, relative risk 0.64 (95% confidence interval 0.25-1.6)]. Mean costs per woman were €8094 for induction and €7340 for expectant management (difference €754; 95% confidence interval -335 to 1802). This difference predominantly originated in the postpartum period, where the mean costs were €5669 for induction vs. €4801 for expectant management. Delivery costs were higher in women allocated to induction than in women allocated to expectant management (€1777 vs. €1153 per woman). Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. In women with pregnancies complicated by PPROM near term, induction of labor does not reduce neonatal sepsis, whereas costs associated with this strategy are probably higher. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.
To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes (PPROM). Study Design: Cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Material and Methods: Neonates of singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Results: Out of 164 babies, 84 (51.2%) were female and 80 (48.8%) were male. Mean maternal age was 23 years (range: 18-36 years). Mean gestational age was 33 weeks (range: 30-36 weeks). Sepsis was suspected in 41(25%) babies on clinical grounds. C-reactive protein was raised in 36 (22%) neonates. There was statistically insignificant difference between clinical versus serological diagnosis (p=0.515). Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane (p < 0.001). Conclusion: Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis. (author)
Full Text Available Data from literature, especially from the US, has provided data on prediction, prevention and treatment of premature membrane rupture (RPM. RPM is a significant cause of premature birth and can cause complications of a term task. Considerable research on RPM has led to a better understanding of the mechanism of spontaneous breakage of membranes, risk factors, and good results for newborns resulting from such obstetrical events. Spontaneous rupture of the membranes increases the risk of intrauterine infection and umbilical cord compression as well as the risk of premature detachment of placenta. Newborn babies resulting from RPM have an increased risk of morbidity compared to gestational age, and the risk of infection is increased compared with other premature babies due to ancillary causes. If RPM occurs in the second trimester, there is an additional risk of pulmonary hypoplasia and hip dysplasia. Pre-term conservative treatment prolongs latency to birth. Antibiotics reduce the risk of infection while corticosteroid treatment (dexamethasone reduces respiratory complications and interventricular haemorrhage without increasing the risk of infection. Birth is necessary or unavoidable in many cases by RPMs and because conservative treatment often results in no results; That is why studies are needed to identify all risk factors and the need to treat pregnant women at risk of RPM; 17-hydroxy-progesterone is a specific treatment for preventing recurrent membrane rupture. (http://www.ginecologultau.ro/ruptura-prematura-a-membranelor, 2013.
Full Text Available Background: Premature rupture of membrane (PROM is one of the common complications of pregnancy that has major impact on fetal and neonatal outcome. It is the commonest clinical event where a normal pregnancy becomes suddenly a high-risk one for mother and fetus or neonate. Objective: The study was undertaken to investigate whether raised fibronectin level in vaginal fluid may indicate premature rupture of membrane. Materials and Methods: This cross sectional study was conducted in the department of Obstetrics and Gynecology in Sir Salimullah Medical College & Mitford Hospital, Dhaka during the period of January 2006 to December 2007. A total of 114 pregnant women with gestational age 28th week up to 40th week were included. Sixty were PROM (Group I and 54 were non-PROM (Group II subjects. Fibronectin in vaginal fluid was measured by an immunochemical reaction by nephelometer. Statistical analysis was done by SPSS version 10.0. Results: The PROM patients had significantly higher concentration of fibronectin (225.77 ± 115.18 ng/mL compared to that in non-PROM subjects (8.04 ± 16.17 ng/mL (p < 0.001. Conclusion: It can be concluded that in cases of unequivocal rupture or intactness of the membranes, the result of the fibronectin test corresponds well with the clinical situation. So fibronectin is a sensitive test for detection of amniotic fluid in the vagina.
Yaqoob, U.; Mushtaq, R.; Mushtaq, M.
To compare the management outcome of induction of labor with expectant management in patients with term pre labor rupture of membranes (PROM). Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25th July 2010 to 25th January 2011. Methods: A total of 384 patients were selected for this study, which were divided into two groups by lottery method. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma. Results: The mean duration between PROM to onset of active labor in group A was significantly less (8.4 ± 2.3 hours) as compared to group B in which it was (9.6±2.1 hours) (p = 0.000). The mean duration between PROM to delivery in group A was significantly less in group A (17.4 ± 2.0) versus group B (22.2 ± 2.0 hours) (p = 0.000). The spontaneous vaginal delivery (SVD) rate was considerably higher (p=0.056) in group A in which 161 (83.8%) patients delivered by SVD and 31 (16.1%) patients by LSCS. In group B, 146 (76.0%) patients delivered by SVD and 46 (23.9%) patients by LSCS. In group A, 8 (4.1%) patients developed chorioamnionitis and 13 (6.7%) patients in group B (p = 0.262). In group A there were 178 (92.7%) neonates with APGAR score of > 5 at 1 minute in contrast to 173 (90.1%) in group B with (p = 0.363). Similarly in group A at 5 minutes, there were 178 (92.7%) neonates with APGAR score of > 7 and 173 (90.1%) in group B (p = 0.460). There were 9 (4.6%) cases of neonatal sepsis in group A, in comparison with 12 (6.2%) patients in group B (p = 0.501). Conclusion: The mean duration of labor in induced patients was less as compared to patients with expectant management. (author)
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm premature rupture of membranes (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
Hou, L; Wang, X; Zou, L Y; Ruan, Y; Chen, Y; Li, G H; Zhang, W Y
Comparative study of delivery mode and perinatal outcomes in women with premature rupture of membranes at term compared to those with intact membranes. A cross sectional survey of all deliveries in 39 hospitals in 3 geographic regions of mainland China from January 1 to December 31, 2011 was carried out to investigate the demographic data and delivery outcomes. In our analysis of 103 124 pregnancies, 14 073(13.6%) were complicated by premature rupture of membranes. Compared to those with intact membrane, the risks of postpartum hemorrhage, maternal complications and neonatal complications were increased significantly for women with premature rupture of membranes at term, especially the prevalence of neonatal respiratory distress syndrome(NRDS) and meconium aspiration syndrome. The risk of low Apgar (premature rupture of membranes at term. The adverse perinatal outcomes are slightly higher in women with term premature rupture of membranes than those with intact membrane.
Singla, Anshuja; Yadav, Poonam; Vaid, Neelam B; Suneja, Amita; Faridi, Mohammad M A
To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM). We conducted a prospective randomized controlled study of women with pPROM during singleton live pregnancy-between 26 and 33+6weeks-whose amniotic fluid index (AFI) was less than the 5th percentile. The study group underwent transabdominal amnioinfusion at admission and then weekly if their AFI fell below the 5th percentile again. The control group received expectant management. The difference in the mean interval from pPROM to delivery between the groups was not statistically significant. Neonatal and maternal outcomes were significantly improved in the study group compared with the control group (fetal distress [10% vs 37%]; early neonatal sepsis [17% vs 63%]; neonatal mortality [17% vs 63%]; spontaneous delivery [83% vs 53%]; and postpartum sepsis [7% vs 33%]). Transabdominal amnioinfusion reduced fetal distress, early neonatal sepsis, and neonatal mortality. In the study group, more participants delivered spontaneously and there were fewer cases of postpartum sepsis, although the pPROM-delivery interval was not increased.
Soni, Shelly; Moldenhauer, Julie S; Spinner, Susan S; Rendon, Norma; Khalek, Nahla; Martinez-Poyer, Juan; Johnson, Mark P; Adzick, N Scott
Since the results of the Management of Myelomeningocele Study were published, maternal-fetal surgery for the in utero treatment of spina bifida has become accepted as a standard of care alternative. Despite promise with fetal management of myelomeningocele repair, there are significant complications to consider. Chorioamniotic membrane separation and preterm premature rupture of membranes are known complications of invasive fetal procedures. Despite their relative frequency associated with fetal procedures, few data exist regarding risk factors that may be attributed to their occurrence or the natural history of pregnancies that are affected with chorionic membrane separation or preterm premature rupture of membranes related to the procedure. The objective of this study was to review chorioamniotic membrane separation and preterm premature rupture of membranes in a cohort of patients undergoing fetal management of myelomeningocele repair including identification of risk factors and outcomes. This was a retrospective review of patients undergoing fetal management of myelomeningocele repair and subsequent delivery from January 2011 through December 2013 at 1 institution. Patients were identified through the institutional fetal management of myelomeningocele repair database and chart review was performed. Perioperative factors and outcomes among patients with chorioamniotic membrane separation and preterm premature rupture of membranes were compared to those without. Risk factors associated with the development of chorioamniotic membrane separation and preterm premature rupture of membranes were determined. A total of 88 patients underwent fetal management of myelomeningocele repair and subsequently delivered during the study period. In all, 21 patients (23.9%) were diagnosed with chorioamniotic membrane separation by ultrasound and preterm premature rupture of membranes occurred in 27 (30.7%). Among the chorioamniotic membrane separation patients, 10 (47.6%) were
Hofmeyr, G Justus; Eke, Ahizechukwu C; Lawrie, Theresa A
Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013). Randomised trials of amnioinfusion compared with no amnioinfusion in women with PPROM. Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required
Neuhaus, W; Eibach, H W; Ahr, A; Bolte, A
The treatment of a premature rupture of the foetal membrane (prom) has up to now been a subject of controversy. Depending on the stage of gestation, the prompt birth ensuing as a result of prom, involves the risk of immaturity of the child. Conservative waiting by contrast, exposes mother and child to a potential risk of infection. The retrospective study presented, summarises the strategies for treating prom used at the Cologne University Department of Obstetrics and Gynaecology during the period from 1984 to 1989, and attempts to develop from these data proposals for the treatment of prom. With an increase in latency of over 24 hours between prom and delivery, the maternal and neonatal rate of infection also increased significantly. An effective result of a prophylaxis with antibiotics could only be shown in the reduction of incidence of infection in the mother. An effect on the neonatal rate of infection could not be seen. Inducing prepartually lung-maturity with glucocorticoides or ambroxol resulted in a significant decrease of the RDS-rate in new born children up to the 34th week of gestation. Beyond the 34th week of gestation, this effect could not be found. Whereas after completion of the 37th week of gestation, the preferred treatment used by doctors is allowing the shortest possible time of latency between prom and delivery, the expected pulmonary immaturity before the 34th week of gestation has to be treated by prolonging the pregnancy and inducing pulmonary maturity under antibiotic prophylaxis and at the same time controlling infection.(ABSTRACT TRUNCATED AT 250 WORDS)
Wallace, Maeve E; Grantz, Katherine L; Liu, Danping; Zhu, Yeyi; Kim, Sung Soo; Mendola, Pauline
Premature rupture of membranes (PROM) is a major factor that predisposes women to preterm delivery. Results from previous studies have suggested that there are associations between exposure to air pollution and preterm birth, but evidence of a relationship with PROM is sparse. Modified Community Multiscale Air Quality models were used to estimate mean exposures to particulate matter less than 10 µm or less than 2.5 µm in aerodynamic diameter, nitrogen oxides, carbon monoxide, sulfur dioxide, and ozone among 223,375 singleton deliveries in the Air Quality and Reproductive Health Study (2002-2008). We used log-linear models with generalized estimating equations to estimate adjusted relative risks and 95% confidence intervals for PROM per each interquartile-range increase in pollutants across the whole pregnancy, on the day of delivery, and 5 hours before delivery. Whole-pregnancy exposures to carbon monoxide and sulfur dioxide were associated with an increased risk of PROM (for carbon monoxide, relative risk (RR) = 1.09, 95% confidence interval (CI): 1.04, 1.14; for sulfur dioxide, RR = 1.15, 95% CI: 1.06, 1.25) but not preterm PROM. Ozone exposure increased the risk of PROM on the day of delivery (RR = 1.06, 95% CI: 1.02, 1.09) and 1 day prior (RR = 1.04, 95% CI: 1.01, 1.07). In the 5 hours preceding delivery, there were 3%-7% increases in risk associated with exposure to ozone and particulate matter less than 2.5 µm in aerodynamic diameter and inverse associations with exposure to carbon monoxide and nitrogen oxides. Acute and long-term air pollutant exposures merit further study in relation to PROM. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Rahmanian, M.; Jahed, F. S.; Yousefi, B.; Ghorbani, R.
Objective: To examine the correlation of zinc and copper serum concentration level, body mass index, age and parity with premature rupture of the membranes. Methods: The cross-sectional study was conducted between 2009 and 2010 at the fertility ward of Amiralmomenin Hospital of Semnan University of Medical Sciences, Iran. It comprised 100 full-term pregnant women with and without premature rupture of the membranes and 50 non-pregnant women as controls. The diagnosis of rupture of membranes was made on the basis of gross leakage of fluid within the vagina and a positive nitrazin test. A sample of 5mL blood was collected. The levels of zinc and copper were determined by an enzyme-linked immunosorbent assay method. Mean values among the three equal groups were compared using standard analysis of variance. Statistical significance was set at p<0.05. Results: Pregnant women with (p<0.027) and without (p<0.019) premature rupture of the membranes had significantly lower serum zinc concentration than non-pregnant women. Inversely, the maternal serum copper concentration level was higher in both groups of pregnant women than in the controls (p<0.001). However, the results suggest that the decreased plasma zinc concentration and increased copper concentration in pregnant women were not the cause of premature rupture of the membranes at term. Conclusion: Zinc and copper concentration levels in maternal serum had no effect on premature rupture of the membranes. (author)
Castillo Huerta, Eugenio; Garibay Valencia, Miguel; Mirabent-González, Felio
Vulvovaginitis is one of the main causes of premature membrane rupture. To evaluate effectiveness of a combination of ketoconazole (400 mg) and clindamycin (100 mg) in vaginal tablets, compared with clindamicyn alone (600 mg/daily) orally, for six days, to prevent premature membrane rupture in patients with vulvovaginitis. Longitudinal, prospective, comparative, randomized, double-blind, double-dummy study in patients older than 18 years, during them third trimester of normoevolutive pregnancy with symptomatic vulvovaginitis. Patients were monitored as out patient. Genital secretion culture and fresh studies were made. Signs and symptoms were evaluated in regular intervals: 4, 7 and 11 days. Pregnancy control was performed every three weeks, until childbirth or premature membrane rupture. 105 patients were included: 53 in the group of ketoconazole and clindamicyn (1), and 52 in the group of clindamycin alone (2). Symptoms were similar in both groups of treatment, without statistically significant differences. A case of group 2 has premature membrane rupture (p = 0.495). C. albicans was cultured in 35% of group 2 and in 11% of group 2. No adverse events with treatments were reported. The combination of ketoconazole and cindamycin was effective to prevent premature membrane rupture in patients with vulvovaginitis.
Brandão, Ana Maria Simões; Domingues, Ana Patrícia Rodrigues; Fonseca, Etelvina Morais Ferreira; Miranda, Teresa Maria Antunes; Belo, Adriana; Moura, José Paulo Achando Silva
Evaluation of maternal, obstetrics e neonatal features in both spontaneous preterm births (PTB) with or without preterm premature rupture of membranes (PPROM). Retrospective study of single fetus pregnancies with PTB between 2003 and 2012. PTB associated with ou without PPROM. Exclusion criterias: PTB by medical indication due to fetal/maternal disease and all non accessible or incomplete clinical files. Different characteristics were compared between two groups of PTB: spontaneous PTB without PPROM (sPTB) versusPPROM. Kolmogorov-Smirnov, Levene, χ2, t Student and Mann-Withney tests were used for statistical analysis. From 2,393 PTB of single fetus, 1,432 files were analysed, from which 596 were sPTB and 836 PPROM. The socioeconomic conditions were similar in both groups. Multiparity (50.7 versus 40.3%), personal history of previous PTB (20.8 versus10.2%), cervical length (18.2 versus27.2 mm), lower body index mass (23.4 versus 24.3 kg/m2) and higher infectious parameters (Protein C Reactive: 2.2 versus1.2 mg/L; Leukocytes: 13.3 versus 12.4 x109) were more frequent in PBTs (p<0,001). Neonatal outcomes, specially neurologic outcomes (4.7 versus2.8%, p<0,001), were worst in PBTs. PTB with or without PPROM has a complex etiology. From all evaluated features in our study, only maternal thinness, multiparity with a previous PTB, the cervical length and worst systemic infections parameters were significant in sPTB. This group also showed worst neonatal outcomes, specially on neurological outcomes.
Yudin, Mark H; van Schalkwyk, Julie; Eyk, Nancy Van
To review the evidence and provide recommendations on the use of antibiotics in preterm premature rupture of the membranes (PPROM). Outcomes evaluated include the effect of antibiotic treatment on maternal infection, chorioamnionitis, and neonatal morbidity and mortality. Published literature was retrieved through searches of Medline, EMBASE, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM, infection, and antibiotics). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and new material incorporated in the guideline to July 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Guideline implementation should assist the practitioner in developing an approach to the use of antibiotics in women with PPROM. Patients will benefit from appropriate management of this condition. This guideline has been reviewed and approved by the Infectious Diseases Committee and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive and Council of the SOGC. The Society of Obstetricians and Gynaecologists of Canada. 1. Following PPROM at 32 weeks' gestation, administration of antibiotics to prolong pregnancy is recommended if fetal lung maturity can not be proven and/or delivery is not planned. (I-A) 4
Buek, John D; McVearry, Ingrid; Lim, Elaine; Landy, Helain; Afriyie-Gray, Akua
After hospitalization subsequent to preterm premature rupture of membranes at 29 weeks, our patient was scheduled for induction of labor at 34 weeks. When the fetus was found to be breech with oligohydramnios, amnioinfusion was performed to facilitate external cephalic version, and this successful procedure enabled the patient to deliver vaginally.
Micili, Serap C; Valter, Markus; Oflaz, Hakan; Ozogul, Candan; Linder, Peter; Föckler, Nicole; Artmann, Gerhard M; Digel, Ilya; Artmann, Aysegul T
A fundamental question addressed in this study was the feasibility of preterm birth prediction based on a noncontact investigation of fetal membranes in situ. Although the phenomena of preterm birth and the premature rupture of the fetal membrane are well known, currently, there are no diagnostic tools for their prediction. The aim of this study was to assess whether optical coherence tomography could be used for clinical investigations of high-risk pregnancies. The thickness of fetal membranes was measured in parallel by optical coherence tomography and histological techniques for the following types of birth: normal births, preterm births without premature ruptures and births at full term with premature rupture of membrane. Our study revealed that the membrane thickness correlates with the birth type. Normal births membranes were statistically significantly thicker than those belonging to the other two groups. Thus, in spite of almost equal duration of gestation of the normal births and the births at full term with premature rupture, the corresponding membrane thicknesses differed. This difference is possibly related to previously reported water accumulation in the membranes. The optical coherence tomography results were encouraging, suggesting that this technology could be used in future to predict and distinguish between different kinds of births.
Popowski, T; Goffinet, F; Batteux, F; Maillard, F; Kayem, G
Premature rupture of membranes is a common situation in obstetrics that links the amniotic cavity and the bacterial cervicovaginal flora. The main risk in case of preterm premature rupture of membranes is the occurrence of an amniochorial infection, which increases neonatal morbidity and mortality. One main purpose in cases of preterm premature rupture of membranes is to identify infection early to adapt the clinical care. Among the marker used in practice, CRP has a sensitivity between 56% and 86% and specificity between 55% and 82% for predicting clinical chorioamnionitis. These values are respectively 21% to 56% and 76% to 95% for the prediction of early neonatal infection. The white blood cell count, also used in routine, has a poor predictive value of clinical chorioamnionitis although a high specificity when the threshold is of 16 giga/l. Among the pro-inflammatory cytokines, interleukin-6 has been the most studied. Its predictive value for chorioamnionitis or neonatal infection is higher but its clinical usefulness is limited by the various threshold used in the studies and the lack of routine measure. Procalcitonin appears to have low predictive values for detecting amniochorial infection but has finally been little studied. Ways to improve prediction of infection in cases of premature rupture of membranes are either looking for new markers or the analysis of local markers (vaginal secretions and amniotic fluid). Copyright © 2011. Published by Elsevier SAS.
Lorthe, Elsa; Goffinet, François; Marret, Stéphane; Vayssiere, Christophe; Flamant, Cyril; Quere, Mathilde; Benhammou, Valérie; Ancel, Pierre-Yves; Kayem, Gilles
There are conflicting results regarding tocolysis in cases of preterm premature rupture of membranes. Delaying delivery may reduce neonatal morbidity because of prematurity and allow for prenatal corticosteroids and, if necessary, in utero transfer. However, that may increase the risks of maternofetal infection and its adverse consequences. The objective of the study was to investigate whether tocolytic therapy in cases of preterm premature rupture of membranes is associated with improved neonatal or obstetric outcomes. Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national prospective, population-based cohort study of preterm births that occurred in 546 maternity units in 2011. Inclusion criteria in this analysis were women with preterm premature rupture of membranes at 24-32 weeks' gestation and singleton gestations. Outcomes were survival to discharge without severe morbidity, latency prolonged by ≥48 hours and histological chorioamnionitis. Uterine contractions at admission, individual and obstetric characteristics, and neonatal outcomes were compared by tocolytic treatment or not. Propensity scores and inverse probability of treatment weighting for each woman were used to minimize indication bias in estimating the association of tocolytic therapy with outcomes. The study population consisted of 803 women; 596 (73.4%) received tocolysis. Women with and without tocolysis did not differ in neonatal survival without severe morbidity (86.7% vs 83.9%, P = .39), latency prolonged by ≥48 hours (75.1% vs 77.4%, P = .59), or histological chorioamnionitis (50.0% vs 47.6%, P = .73). After applying propensity scores and assigning inverse probability of treatment weighting, tocolysis was not associated with improved survival without severe morbidity as compared with no tocolysis (odds ratio, 1.01 [95% confidence interval, 0.94-1.09], latency prolonged by ≥48 hours (1.03 [95% confidence interval, 0.95-1.11]), or histological chorioamnionitis
Faucett, Allison M; Metz, Torri D; DeWitt, Peter E; Gibbs, Ronald S
Maternal obesity is associated with increased systemic inflammation and an increased risk of preterm premature rupture of membranes. There is an established association between an inflammatory intrauterine environment and adverse neonatal outcomes that is independent of gestational age and mediated by the fetal inflammatory response. It is unknown whether the maternal systemic inflammation that is present in obese women influences the intrauterine environment and predisposes the fetus to adverse neonatal outcomes after preterm premature rupture of membranes. The purpose of this study was to determine whether maternal obesity is associated with adverse neonatal outcomes in pregnancies that are complicated by preterm premature rupture of membranes. This was a secondary analysis of the Maternal-Fetal Medicine Units Network Randomized Clinical Trial on the Beneficial Effects of Antenatal Magnesium Sulfate. Women with singleton pregnancies that were affected by preterm premature rupture of membranes who delivered live-born infants between 24 + 0 and 33 + 6 weeks of gestation were included. An adverse neonatal outcome was defined as a composite outcome of neonatal death, severe necrotizing enterocolitis, respiratory distress syndrome, sepsis, or severe intraventricular hemorrhage. The rates of the composite outcome were compared between obese (body mass index, ≥30 kg/m(2)) and nonobese women. Multivariable logistic regression was used to evaluate the independent effect of obesity on neonatal outcomes. Magnesium sulfate administration, steroid administration, maternal diabetes mellitus, gestational age at delivery, indomethacin exposure, birthweight, and chorioamnionitis were all considered as possible covariates in the multivariable regression models. Three hundred twenty-five of the 1288 women (25.2%) who were included were obese, and 202 of these women (62.2%) had neonates with adverse outcomes. In univariable analysis, maternal prepregnancy obesity was associated
Thiery, M; Parewijck, W; Martens, G
In term with premature rupture of the membranes (PROM) and an unripe cervix who have no contraindications for prostaglandin (PG) administration and vaginal delivery, intravenous (I.V.) infusion of titrated PGE2 is highly effective. In healthy gravidas with dito fetus this treatment appeared perinatally safe and was well tolerated by the mother. To enhance its safety margin and procedure must be conducted under toco-cardiographic control.
Çetin, Cihan; Büyükkurt, Selim; Cömert, Ercan; Özlü, Ferda; Bahar, Nilgün; Demir, Cansun
In this study, we aimed to evaluate some laboratory and clinical factors in the prediction of latency period for pregnant patients complicated with preterm premature rupture of the membranes. Sixty-five pregnant patients between 24 and 34 weeks of gestation, who were admitted to University of Çukurova School of Medicine Hospital with the diagnosis of preterm premature rupture of the membranes (PPROM) between January 01, 2013 and December 31, 2013, were included in this study. Serum CRP, procalcitonin, sedimentation rate, leukocyte count and cervical length (measured with transvaginal ultrasound) of patients were analyzed for the correlation with the latency period. None of the parameters were found to be correlated with the latency period. However, patients with cervical length of premature rupture of the membranes is thought to be either an infection-based disease or a disease increasing the risk of infectious complications, major infection markers are not found to be helpful criteria for the prediction of latency period. Patients with a cervical length of <25 mm can be expected to deliver earlier and, therefore, can be referred to a tertiary center earlier.
Horton, Amanda L
This study aims to evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes (PPROM) between 24 and 31(6\\/7) weeks\\' gestation.
Conclusion: Test of Lactate concentration in vaginal fluid test is a valid, quick and easy with high sensitivity and specificity for the diagnosis of premature rupture of membranes the fetus of pregnant women.
Moghaddam Banaem, Lida; Mohamadi, Bita; Asghari Jaafarabadi, Mohamad; Aliyan Moghadam, Narges
The aim of this study was to determine the relationship between maternal serum C-reactive protein (CRP) levels in the first 20 weeks of pregnancy and later occurrence of preterm premature rupture of membranes and preterm birth. A prospective cohort study that measured maternal serum CRP levels in 778 pregnant women in the first half of pregnancy was performed in the city of Noor (north Iran), and included follow-up of patients up to time of delivery. Preterm premature rupture of membranes and preterm birth were defined as the occurrence of membranes rupture and birth, respectively before 37 weeks of gestation. Of the 778 pregnancies studied, 19 (2.41%) preterm premature rupture of membranes and 58 (7.3%) preterm births were seen. Median CRP levels in preterm premature rupture of membranes and preterm birth cases were much higher than in term deliveries (7 and 6.8 respectively vs 2.4 mg/L; 66.67 and 64.76, respectively vs 24.38 nmol/L). CRP levels >4 mg/L had statistically significant relationships with preterm premature rupture of membranes (OR 5.91, 95% CI 2.07-16.89) and preterm birth (OR 8.95, 95% CI 4.60-17.43). With a cut-off level of 4 mg/L of CRP, sensitivity, specificity, and likelihood ratios (LR(+) and LR(-) ) for preterm birth were 81, 70, 2.70, 0.28%, respectively, and for preterm premature rupture of membranes they were 79, 67, 2.41 and 0.31%, respectively. It seems that the inflammatory marker, CRP, can be used in the early stages of pregnancy to identify women at risk of experiencing preterm premature rupture of membranes and preterm birth. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.
Full Text Available BACKGROUND Before onset of labour, rupture of membrane is known as Premature rupture of membrane (PROM. PROM is one of the most common complications of pregnancy that has major impact on foetal and maternal outcomes. The aim of the present study was to evaluate the foetomaternal outcome of the patient with premature rupture of membranes, in Department of Obstetrics and Gynaecology, Umaid Hospital, Dr. Sampuranand Medical College, Jodhpur, Rajasthan, India. MATERIALS AND METHODS Randomly 100 cases were studied out during six months of period from Jan. 2016 to June 2016. RESULTS Out of 100 cases it was observed that the mean age of PROM patients was 25 ± 2.59 years with higher incidence in unbooked cases of hospital. Gestational age from 24 weeks to 42 weeks of pregnancy were included in the study. The mode of delivery in 73 patients was vaginal and 27 delivered by LSCS. The implicated risk was found i.e. anaemia (22, UTI (14, lower genital tract infection (8, Cervical stitched (1, malpresentation (5, twin (2 and 48 cases were without any risk factor. CONCLUSION Evaluation of risks of PROM and timely diagnosis is essential to reduce maternal and perinatal morbidity and mortality. Women who experience PROM should be informed that they are at higher risk of a similar complication in a subsequent pregnancy and that early initiation of prenatal care in future pregnancies could reduce the risk of another preterm delivery.
Arnildo A. Hackenhaar
Full Text Available OBJECTIVE:tthis study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections.METHODS:this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight > 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression.RESULTS:of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94, with lower level of schooling (PR = 2.43, age > 29 years (PR = 2.49, and smokers (PR = 2.04. It was also associated with threatened miscarriage (PR = 1.68 and preterm labor, (PR = 3.40. There was no association with maternal urinary tract infection or presence of genital discharge.CONCLUSIONS:the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach.
Brumbaugh, Jane E; Colaizy, Tarah T; Nuangchamnong, Nina; O'Brien, Emily A; Fleener, Diedre K; Rijhsinghani, Asha; Klein, Jonathan M
To evaluate neonatal survival after prolonged preterm premature rupture of membranes (PROM) in the era of antenatal corticosteroids, surfactant, and inhaled nitric oxide. A single-center retrospective cohort study of neonates born from 2002-2011 after prolonged (1 week or more) preterm (less than 24 weeks of gestation) rupture of membranes was performed. The primary outcome was survival to discharge. Neonates whose membranes ruptured less than 24 hours before delivery (n=116) were matched (2:1) on gestational age at birth, sex, and antenatal corticosteroid exposure with neonates whose membranes ruptured 1 week or more before delivery (n=58). Analysis used conditional logistic regression for categorical data and Wilcoxon signed rank test for continuous data. The prolonged preterm PROM exposed and unexposed cohorts had survival rates of 90% and 95%, respectively, although underpowered to assess the statistical significance (P=.313). Exposed neonates were more likely have pulmonary hypoplasia (26/58 exposed, 1/114 unexposed, Prupture (20.4 weeks exposed, 22.3 weeks unexposed, P=.189), length of rupture (3.7 weeks exposed, 6.4 weeks unexposed, P=.717), and lowest maximal vertical pocket before 24 weeks of gestation (0 cm exposed, 1.4 cm unexposed, P=.114) did not discriminate between survivors and nonsurvivors after exposure to prolonged preterm PROM. With antenatal steroid exposure and aggressive pulmonary management, survival to discharge after prolonged preterm PROM was 90%. Pulmonary morbidities were common. Of note, the data were limited to women who remained pregnant 1 week or longer after rupture of membranes.
Lannon, Sophia M R; Vanderhoeven, Jeroen P; Eschenbach, David A; Gravett, Michael G; Adams Waldorf, Kristina M
Preterm premature rupture of membranes (PPROM) occurs in 1% to 2% of births. Impact of PPROM is greatest in low- and middle-income countries where prematurity-related deaths are most common. Recent investigations identify cytokine and matrix metalloproteinase activation, oxidative stress, and apoptosis as primary pathways to PPROM. These biological processes are initiated by heterogeneous etiologies including infection/inflammation, placental bleeding, uterine overdistention, and genetic polymorphisms. We hypothesize that pathways to PPROM overlap and act synergistically to weaken membranes. We focus our discussion on membrane composition and strength, pathways linking risk factors to membrane weakening, and future research directions to reduce the global burden of PPROM. © The Author(s) 2014.
Fortner, Kimberly B.; Grotegut, Chad A.; Ransom, Carla E.; Bentley, Rex C.; Feng, Liping; Lan, Lan; Heine, R. Phillips; Seed, Patrick C.; Murtha, Amy P.
Objective Bacterial colonization of the fetal membranes and its role in pathogenesis of membrane rupture is poorly understood. Prior retrospective work revealed chorion layer thinning in preterm premature rupture of membranes (PPROM) subjects. Our objective was to prospectively examine fetal membrane chorion thinning and to correlate to bacterial presence in PPROM, preterm, and term subjects. Study Design Paired membrane samples (membrane rupture and membrane distant) were prospectively collected from: PPROM = 14, preterm labor (PTL = 8), preterm no labor (PTNL = 8), term labor (TL = 10), and term no labor (TNL = 8), subjects. Sections were probed with cytokeratin to identify fetal trophoblast layer of the chorion using immunohistochemistry. Fluorescence in situ hybridization was performed using broad range 16 s ribosomal RNA probe. Images were evaluated, chorion and choriodecidua were measured, and bacterial fluorescence scored. Chorion thinning and bacterial presence were compared among and between groups using Student's t-test, linear mixed effect model, and Poisson regression model (SAS Cary, NC). Results In all groups, the fetal chorion cellular layer was thinner at rupture compared to distant site (147.2 vs. 253.7 µm, prupture site compared to distant sites. In PPROM fetal chorion, we demonstrated pronounced global thinning. Although cause or consequence is uncertain, bacterial presence is greatest and inversely correlated with chorion thinning among PPROM subjects. PMID:24421883
Vergani, Patrizia; Locatelli, Anna; Verderio, Maria; Assi, Francesca
We sought to evaluate whether serial amnioinfusions for persistent oligohydramnios can affect the perinatal and long-term outcomes in extreme cases of preterm premature rupture of membranes. All singleton pregnancies with preterm premature rupture of membranes at 4 days between January 1991 and December 2001 were included. Amniotic fluid volume was assessed as the maximum cord-free pocket with serial ultrasonographic examinations. Consenting women with persistent (>4 days) oligohydramnios (amniotic fluid=2 cm) received serial transabdominal amnioinfusions to maintain an amniotic fluid pocket >2 cm. The pregnancy, neonatal, and long-term neurologic outcomes of the cases that spontaneously maintained a median amniotic fluid pocket >2 cm were compared with those of women with oligohydramnios who underwent amnioinfusion but continued to have persistent oligohydramnios and with those of women in whom oligohydramnios was alleviated. Statistical analysis included the Wilcoxon rank-sum test and the Fisher exact test with a 2-tailed Pamnioinfusions, which successfully restored a median amniotic fluid pocket >2 cm for =48 hours in 11 (30%) patients. This successful amnioinfusion group was comparable with the persistent oligohydramnios group (n=25) in gestational age at first amnioinfusion (median, 20.2 weeks; range, 16-25.6 weeks; vs median, 20.3 weeks; range, 16.5-24.2 weeks; P=.4), number of amnioinfusions (median, 3; range, 1-9; vs median, 3; range, 1-5; P=.4), and interval between amnioinfusions (median, 6 days; range, 4-14 days; vs median, 8 days; range, 6-43 days; P=.1). However, patients in the persistent oligohydramnios group had a significantly shorter interval to delivery, lower neonatal survival (20%), and higher rates of pulmonary hypoplasia (62%) and abnormal neurologic outcomes (60%) than the patients in the groups in which amnioinfusion was not necessary or was successful (all P=.01). Logistic regression analysis demonstrated that after taking into
Locatelli, A; Vergani, P; Di Pirro, G; Doria, V; Biffi, A; Ghidini, A
We sought to evaluate whether serial amnioinfusions for persistent oligohydramnios can affect the perinatal and long-term outcomes in extreme cases of preterm premature rupture of membranes. All singleton pregnancies with preterm premature rupture of membranes at 4 days between January 1991 and June 1998 were included. Amniotic fluid volume was assessed as the maximum cord-free pocket with serial ultrasonographic examinations. Consenting women with persistent (>4 days) oligohydramnios (amniotic fluid amnioinfusions to maintain an amniotic fluid pocket >2 cm. The pregnancy, neonatal, and long-term neurologic outcomes of the cases that spontaneously maintained a median amniotic fluid pocket >2 cm (amnioinfusion-not-necessary group) were compared with those of women with oligohydramnios who underwent amnioinfusion but continued to have a median amniotic fluid pocket after preterm premature rupture of membranes amnioinfusion group). Statistical analysis included the Wilcoxon rank-sum test and the Fisher exact test, with a 2-tailed P amnioinfusions, which successfully restored a median amniotic fluid pocket >2 cm for >/=48 hours in 11 (30%) patients. This successful amnioinfusion group was comparable with the persistent oligohydramnios group (n = 25) in gestational age at first amnioinfusion (median, 20.2 weeks; range, 16-25.6 weeks; vs median, 20.3 weeks; range, 16.5-24.2 weeks; P =.4), number of amnioinfusions (median, 3; range, 1-9; vs median, 3; range, 1-5; P =.4), and interval between amnioinfusions (median, 6 days; range, 4-14 days; vs median, 8 days; range, 6-43 days; P =. 1). However, patients in the persistent oligohydramnios group had a significantly shorter interval to delivery, lower neonatal survival (20%), and higher rates of pulmonary hypoplasia (62%) and abnormal neurologic outcomes (60%) than the patients in the groups in which amnioinfusion was not necessary or was successful (all P amnioinfusions successfully alleviate oligohydramnios have a perinatal
Saccone, Gabriele; Berghella, Vincenzo
The objective of the study was to evaluate the efficacy of antibiotic prophylaxis in women with term or near-term premature rupture of membranes. Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE, ScienceDirect.com, MEDSCAPE, and the Cochrane Central Register of Controlled Trials with the use of a combination of key words and text words related to antibiotics, premature rupture of membranes, term, and trials from inception of each database to September 2014. We included all randomized trials of singleton gestations with premature rupture of membranes at 36 weeks or more, who were randomized to antibiotic prophylaxis or control (either placebo or no treatment). The primary outcomes included maternal chorioamnionitis and neonatal sepsis. A subgroup analysis on studies with latency more than 12 hours was planned. Before data extraction, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42014013928). The metaanalysis was performed following the Preferred Reporting Item for Systematic Reviews and Meta-analyses statement. Women who received antibiotics had the same rate of chorioamnionitis (2.7% vs 3.7%; relative risk [RR], 0.73, 95% confidence interval [CI], 0.48-1.12), endometritis (0.4% vs 0.9%; RR, 0.44, 95% CI, 0.18-1.10), maternal infection (3.1% vs 4.6%; RR, 0.48, 95% CI, 0.19-1.21), and neonatal sepsis (1.0% vs 1.4%; RR, 0.69, 95% CI, 0.34-1.39). In the planned subgroup analysis, women with latency longer than 12 hours, who received antibiotics, had a lower rate of chorioamnionitis (2.9% vs 6.1%; RR, 0.49, 95% CI, 0.27-0.91) and endometritis (0% vs 2.2%; RR, 0.12, 95% CI, 0.02-0.62) compared with the control group. Antibiotic prophylaxis for term or near-term premature rupture of membranes is not associated with any benefits in either maternal or neonatal outcomes. In women with latency longer
Ahmadi, M.; Rafaei, F.; Nazari, N.
Objectives:To determine the diagnostic value of the lactate concentration in vaginal secretions in determining the premature rupture of membranes. Subjects and Methods:One hundred 100 pregnant women with single pregnancy of gestational age 20--41 weeks were divided to two groups of 50 each. One group comprised of women with premature rupture of membranes, and the other (control group) of women with intact membranes. To verify the premature rupture of membranes in both groups, the speculum, fern, and nitrazine tests were done. Lactate Pro manual instrument was used to measure the lactate levels in vaginal fluid via enzymatic staining which was displayed on the instrument's liquid crystal display after 60 seconds. Descriptive analytic statistics and SPSS 17 software were used to analyze the data. Results The lactate concentration of 4.6 mM in the vaginal fluid was diagnostic for premature rupture of membranes. It had a sensitivity of 96%, specificity of 98.8%, accuracy of 97%, positive predictive value of 97.9%, and negative predictive value of 96%. Conclusions:Testing lactate levels in the vaginal fluid is an easy, rapid and reliable method for the diagnosis of premature rupture of membranes in pregnancy. (author)
Concurrent intraoperative uterine rupture and placenta accreta. Do preoperative chronic hypertension, preterm premature rupture of membranes, chorioamnionitis, and placental abruption provide warning to this rare occurrence?
Cometa, M Anthony; Wasilko, Scott M; Wendling, Adam L
Uterine and placental pathology can be a major cause of morbidity and mortality in the parturient and infant. When presenting alone, placental abruption, uterine rupture, or placenta accreta can result in significant peripartum hemorrhage, requiring aggressive surgical and anesthetic management; however, the presence of multiple concurrent uterine and placental pathologies can result in significant morbidity and mortality. We present the anesthetic management of a parturient who underwent an urgent cesarean delivery for non-reassuring fetal tracing in the setting of chronic hypertension, preterm premature rupture of membranes, and chorioamnionitis who was subsequently found to have placental abruption, uterine rupture, and placenta accreta.
Esteves, Juliana Silva; de Sá, Renato Augusto Moreira; de Carvalho, Paulo Roberto Nassar; Coca Velarde, Luis Guillermo
The aim of this study was to identify adverse neonatal outcomes and identifies the predictors of adverse neonatal outcomes in premature rupture of membranes before 26 weeks. Data were collected between January 2005 and December 2011 from all pregnant women who presented preterm premature rupture of membranes (PPROM) between 18 and 26 complete weeks of gestation and were admitted to one of three Brazilian institutes. The adverse outcomes included mortality or the development of a severe morbidity during the length of stay in the neonatal intensive care unit (NICU). The descriptive statistics of the population were reported. A multiple logistic regression was performed for each predictor of neonatal adverse outcomes. The area under the receiver operating characteristics curves for the birth weight was calculated. Composite adverse outcomes during the NICU stay occurred in 82.1% (n = 23) of the cases and included 33 (54%) neonatal deaths, 19 (67.8%) cases of retinopathy of prematurity (ROP), 13 (46.4%) cases of pulmonary hypoplasia (BPD), 8 (28.5%) cases of periventricular-intraventricular hemorrhage (PIH) and 3 (10.7%) cases of periventricular leukomalacia (PVL). Only 17.8% (n = 5) of the neonates survived without morbidity. The area under the curve for the birth weight was 0.90 (95% IC: 0.81-0.98) for the prediction of mortality. PPROM before 26 weeks has a high morbidity and mortality, and the significant predictors of neonatal mortality and adverse outcomes were antibiotic prophylaxis, latency period, GA at birth and birth weight. Nevertheless, the only independent significant predictor of survival rate was birth weight.
Hackenhaar, Arnildo A; Albernaz, Elaine P; da Fonseca, Tânia M V
this study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight ≥ 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR]=1.94), with lower level of schooling (PR=2.43), age > 29 years (PR=2.49), and smokers (PR=2.04). It was also associated with threatened miscarriage (PR=1.68) and preterm labor, (PR=3.40). There was no association with maternal urinary tract infection or presence of genital discharge. the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Ko, Hyun Sun; Cheon, Ju Young; Choi, Sae Kyung; Lee, Hye Won; Lee, Ahwon; Park, In Yang; Shin, Jong Chul
To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM). We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery. Mean gestational age at membrane rupture was 29.5 ± 3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p = 0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1 min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242-20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617-34.653). Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.
L. I. Dyatlova
Full Text Available The goal of present study was a search for pathogenetical reasoning of an opportunity for prolongation of pregnancy complicated by premature rupture of membranes at a gestational term of 22-34 weeks. The patients were subject to due observation and expectant treatable of pregnancy with prevention of possible infectious and inflammatory complications, as well as monitoring of systemic inflammatory response markers, immune state, and cytokine profile of blood in pregnant women with this disorder. We conducted a comprehensive clinical and laboratory examination of fifty pregnant women, whose pregnancy was complicated by premature membrane rupture at 22-34 weeks of gestation. A control group consisted of 40 women with normal pregnancy. For assessment of cellular composition of the blood, a BC3000+ hematological analyzer was used. Distinct subsets of peripheral blood lymphocytes were studied by flow cytometry using monoclonal antibodies («FACS Calibur» «Becton Dickinson», USA. Blood levels of cytokines (IL-2, IL-6, IL-8, TNFα, IL-4, IL-10 were determined by ELISA using test systems (ZAO “VectorBest”, Novosibirsk, Russia. Stereoultrastructural study of membranes was performed with a scanning electron microscope «Hitachi S-450”. The findings suggest that the failure of membranes emerging du to systemic metabolic disorders and changes in peripheral blood cells (leukocytosis, lymphopenia due to CD19+ B lymphocytes. Moreover, one could observe reduced counts of CD16+CD56+ T cells (natural killer cells that showed certain parallelism with increased levels of proinflammatory cytokines (IL-6, IL-8, TNFα in blood from pregnant PROM, as well as a decrease in IL-10 and IL-4 contents antagonized their proinflammatory effects to certain extent. An opportunity of incomplete pregnancy prolongation for patients with premature rupture of membranes was based on thorough assessment of their somatic and obstetric status and general condition of the fetus
Objective: To find out the effect of prenatal exposure to low lead from cosmetics on gestational age, premature rupture of the membrane and birth weight. Methods: The study was carried out in the mountainous Aseer region, Southwest of Saudi Arabia where the air is thought to be clean and free of lead pollution due to the absence of petroleum smelting and other heavy industries. The region is famous as a holiday resort for tourists from Arabia and the gulf countries. All 176 pregnant women included in the study were of singleton pregnancies of gestational age 27 weeks or more who attended the antenatal outpatient clinic of the main maternity hospital. On the day of delivery 4 milliliters of venous blood from each singleton parturient was placed in a heparinized non-silica containing tube and stored at -20 deg. C prior to analysis. Results: Ninety-four (70.1%) women out of 134 had maternal blood lead concentration 200 mu g/L. The mean difference in gestational age was 10.5 days, showing a non significant difference (P=0.152). Ninety-three women (72.7%) out of a total of 128 who had blood lead concentration 200 mu g/L gave birth to infants weighing an average of 2.99 kg. The mean difference was 0.12 kg which is non-significant (P=0.261). Regarding premature rupture of the membrane a total of 127 women with maternal blood lead levels above 200 mu g/L showed no significant differences (P=0.64). The Chi-square test of the relationship between the birth weight (kg) and the levels of blood lead below 150 mu g/L was not significant while the relationship between the birth weight (kg) and the levels of blood lead above 200 mu g/L resulted in very slight differences in the values of infants' birth weight. Conclusion: The detected low lead exposures from cosmetics does not produce statistically significant effects on the three pregnancy outcomes; gestational age, premature rupture of the membrane or birth weight. However, the importance of low lead exposure from the 100% lead
To find out the effect of prenatal exposure to low lead from cosmetics on gestational age, premature rupture of the membrane and birth weight. The study was carried out in the mountainous Aseer region, Southwest of Saudi Arabia where the air is thought to be clean and free of lead pollution due to the absence of petroleum smelting and other heavy industries. The region is famous as a holiday resort for tourists from Arabia and the gulf countries. All 176 pregnant women included in the study were of singleton pregnancies of gestational age 27 weeks or more who attended the antenatal outpatient clinic of the main maternity hospital. On the day of delivery 4 milliliters of venous blood from each singleton parturient was placed in a heparinized non-silica containing tube and stored at -20 degrees C prior to analysis. Ninety-four (70.1%) women out of 134 had maternal blood lead concentration 200 microg/L. The mean difference in gestational age was 10.5 days, showing a non significant difference (P=0.152). Ninety-three women (72.7%) out of a total of 128 who had blood lead concentration 200 microg/L gave birth to infants weighing an average of 2.99 kg. The mean difference was 0.12 kg which is non-significant (P=0.261). Regarding premature.rupture of the membrane a total of 127 women with maternal blood lead levels above 200 microg/L showed no significant differences (P=0.64). The Chi-square test of the relationship between the birth weight (kg) and the levels of blood lead below 150 microg/L was not significant while the relationship between the birth weight (kg) and the levels of blood lead above 200 microg/L resulted in very slight differences in the values of infants' birth weight. The detected low lead exposures from cosmetics does not produce statistically significant effects on the three pregnancy outcomes; gestational age, premature rupture of the membrane or birth weight. However, the importance of low lead exposure from the 100% lead sulfide eye cosmetic "kohl
Kasprian, G.; Zentrum fuer Anatomie und Zellbiologie der Medizinischen Universitaet Wien; Brugger, P.C.; Helmer, H.; Langer, M.; Balassy, C.; Prayer, D.
A well-organized interplay between many molecular factors as well as mechanical forces influence fetal lung development. At the end of this complex process a sufficiently sized and structurally mature organ should ensure the postnatal survival of the newborn. Besides prenatal ultrasonography, magnetic resonance imaging (MRI) can now be used to investigate normal and pathological human lung growth in utero. Oligohydramnios, due to premature rupture of membranes (PROM), is an important risk factor for compromised fetal lung growth. In these situations MR volumetry can be used to measure the size of the fetal lung quite accurately. Together with the evaluation of lung signal intensities on T2-weighted sequences, fetuses with pulmonary hypoplasia can be readily detected. (orig.) [de
Packard, Roger Everett; Mackeen, Awathif Dhanya
Preterm premature rupture of membranes (PPROM) affects up to one-third of all preterm births and confers serious maternal risks, including intra-amniotic infection, and an increased risk of neonatal complications, including respiratory distress and intraventricular hemorrhage. Management of PPROM is a highly individualized process that requires an accurate determination of gestational age and causal factors, as well as the balancing of maternal and fetal risks. In this review of the existing literature on induction of labor in PPROM, we examine the differences in appropriate management of patients with early (32 weeks 0 days to 33 weeks 6 days) and near term (34 weeks 0 days to 36 weeks 6 days) PPROM, and compare the safety and efficacy of available treatment options. This review of previous research findings provides general guidelines for clinical decision making and highlights the need for future research on management of PPROM. Copyright © 2015 Elsevier Inc. All rights reserved.
Mura, Thibault; Picaud, Jean-Charles; Larroque, Béatrice; Galtier, Florence; Marret, Stephane; Roze, Jean-Christophe; Truffert, Patrick; Kuhn, Pierre; Fresson, Jeanne; Thiriez, Gérard; Arnaud, Catherine; Mercier, Gregoire; Picot, Marie-Christine; Ancel, Pierre-Yves; Ledesert, Bernard
To evaluate the relationship between preterm premature rupture of membranes (PPROM) and cognitive impairment in 5-year-old children born very preterm. The Etude Epidémiologique sur les Petits Ages Gestationnels Study is a population-based cohort of children followed up from birth to age 5 years recruited in 9 French regions in 1997. We analyzed data from singletons born between 24 and 32 weeks gestation categorized into 4 groups according to etiology of prematurity: infants born after PPROM, after idiopathic preterm labor, in a vascular context (Vasc), and to women with other complications (Other). Cognitive development at age 5 years was assessed using the Mental Processing Composite score of the Kaufman-Assessment Battery for Children. Among the 1051 children followed up to age 5 years, the mean Mental Processing Composite score was 93.6 ± 19.7, and 13.3% of the children (140 of 1051) had cognitive impairment. After adjustment for potential confounders, the risk of cognitive impairment among infants in the PPROM group was not significantly different than that in the idiopathic preterm labor group (OR, 1.09; 95% CI, 0.62-1.92) and the Other group (OR, 1.36; 95% CI, 0.75-2.47), but was lower than that in the Vasc group (OR, 1.86; 95% CI, 1.16-2.97). In the PPROM group, the risk of cognitive impairment was greater when the latency period (ie, time from rupture to delivery) was <3 days (OR, 2.32; 95% CI, 1.07-5.02). Preterm infants born after PPROM are not at increased risk for cognitive impairment in childhood, but the time between PPROM and birth may influence that risk. Copyright © 2013 Mosby, Inc. All rights reserved.
Kimberly B Fortner
Full Text Available OBJECTIVE: Bacterial colonization of the fetal membranes and its role in pathogenesis of membrane rupture is poorly understood. Prior retrospective work revealed chorion layer thinning in preterm premature rupture of membranes (PPROM subjects. Our objective was to prospectively examine fetal membrane chorion thinning and to correlate to bacterial presence in PPROM, preterm, and term subjects. STUDY DESIGN: Paired membrane samples (membrane rupture and membrane distant were prospectively collected from: PPROM = 14, preterm labor (PTL = 8, preterm no labor (PTNL = 8, term labor (TL = 10, and term no labor (TNL = 8, subjects. Sections were probed with cytokeratin to identify fetal trophoblast layer of the chorion using immunohistochemistry. Fluorescence in situ hybridization was performed using broad range 16 s ribosomal RNA probe. Images were evaluated, chorion and choriodecidua were measured, and bacterial fluorescence scored. Chorion thinning and bacterial presence were compared among and between groups using Student's t-test, linear mixed effect model, and Poisson regression model (SAS Cary, NC. RESULTS: In all groups, the fetal chorion cellular layer was thinner at rupture compared to distant site (147.2 vs. 253.7 µm, p<0.0001. Further, chorion thinning was greatest among PPROM subjects compared to all other groups combined, regardless of site sampled [PPROM(114.9 vs. PTL(246.0 vs. PTNL(200.8 vs. TL(217.9 vs. TNL(246.5]. Bacteria counts were highest among PPROM subjects compared to all other groups regardless of site sampled or histologic infection [PPROM(31 vs. PTL(9 vs. PTNL(7 vs. TL(7 vs. TNL(6]. Among all subjects at both sites, bacterial counts were inversely correlated with chorion thinning, even excluding histologic chorioamnionitis (p<0.0001 and p = 0.05. CONCLUSIONS: Fetal chorion was uniformly thinner at rupture site compared to distant sites. In PPROM fetal chorion, we demonstrated pronounced global thinning
Kwak, Hye-Min; Choi, Hyun-Jin; Cha, Hyun-Hwa; Yu, Hee-Jun; Lee, Jee-Hun; Choi, Suk-Joo; Oh, Soo-Young; Roh, Cheong-Rae; Kim, Jong-Hwa
We reviewed women with previable spontaneous premature rupture of membranes (sPPROM) in whom an amniopatch was performed and compared their pregnancy outcomes with a conservative management group. Amniopatch, an amnioinfusion of autologous platelet concentrate followed by cryoprecipitate, was performed in 7 women with sPPROM diagnosed at 17-23 weeks' gestation, including one twin pregnancy. Three patients had incompetent cervices and the other 4 patients had sPPROM without incompetent cervices. Pregnancy outcomes of the cases were compared with the controls who were managed conservatively (n = 22). Amniopatch treatment was successful in 1 of 7 cases (14.3%), in which the ruptured membranes were completely sealed and the patient delivered a healthy baby at 39 weeks' gestation. No procedure-related complications were observed. Overall, neonatal outcome was similar in the amniopatch and conservatively managed groups, although the incidences of early neonatal sepsis and respiratory distress syndrome were lower in the amniopatch group. The overall success rate of amniopatch among our small number of cases was low. However, if successful, amniopatch may prolong a pregnancy with previable sPPROM to term. Copyright © 2012 S. Karger AG, Basel.
McKenzie, F; Tucker Edmonds, B
To describe obstetricians' induction counseling practices for 22-week preterm premature rupture of membranes (PPROM) and identify provider characteristics associated with offering induction. Surveyed 295 obstetricians on their likelihood (0-10) of offering induction for periviable PPROM across 10 vignettes. Twenty-two-week vignettes were analyzed, stratified by parental resuscitation preference. Bivariate analyses identified physician characteristics associated with reported likelihood ratings. Obstetricians (N=205) were not likely to offer induction. Median ratings by preference were as follows: resuscitation 1.0, uncertain 1.0 and comfort care 3.0. Only 41% of obstetricians were likely to offer induction to patients desiring comfort care. In addition, several provider-level factors, including practice region, parenting status and years in practice, were significantly associated with offering induction. Obstetricians do not readily offer induction when counseling patients with 22-week ruptured membranes, even when patients prefer palliation. This may place women at risk for infectious complications without accruing a neonatal benefit from prolonged latency.
In Germany almost 10 % of children are born before the end of 37th week of gestation. In at least one quarter of these cases, ascending infection of the vagina plays a causative role, particularly during the early weeks of gestation. If, in addition to the decidua, the amniotic membrane, amniotic fluid and the umbilical cord are also affected, infection not only triggers uterine contractions and premature rupture of membranes but also initiates a systemic inflammatory reaction on the part of the fetus, which can increase neonatal morbidity. Numerous studies and meta-analyses have found that antibiotic therapy prolongs pregnancy and reduces neonatal morbidity. No general benefit of antibiotic treatment was found for premature uterine contractions. But it is conceivable that a subgroup of pregnant women would benefit from antibiotic treatment. It is important to identify this subgroup of women and offer them targeted treatment. This overview summarizes the current body of evidence on antibiotic treatment for impending preterm birth and the effect on neonatal outcomes. PMID:24771902
Full Text Available BACKGROUND The incidence of PROM is about 10% of all pregnancies and 70% of them occur at term. Most of the Indian studies document an incidence of 7-12% for PROM of which 60-70% occurs at term. Rest of the 30-40% is contributed at preterm. The aim of the study is to study the usefulness of maternal CRP measurements in diagnosis of chorioamnionitis, puerperal endometritis, neonatal infectious morbidities and mortalities among patients with PROM ( both term and preterm. MATERIALS AND METHODS This is a hospital-based cross-sectional observational study where 100 premature rupture of membrane cases were diagnosed and observed for fetomaternal outcome by doing routine clinical, biochemical and serum CRP examinations. RESULTS Maximum number of chorioamnionitis (16% has developed when duration of rupture was for more than 36 hrs. PROM patients with latent period of ≥36 hrs had poorer neonatal outcome; i.e. 54.83% neonatal morbidity and 84.61% neonatal mortality were seen when duration of rupture was more than 36 hrs. 47.36% of CRP positive PROM women had developed chorioamnionitis during the course of delivery or postpartum. 49.12% of CRP positive PROM women had developed preterm delivery. CRP positive PROM women had poorer neonatal outcome; i.e. 82.35% neonatal morbidity and mortality has noted in babies delivered from CRP positive mother. CONCLUSION Careful antenatal monitoring, detection and prompt treatment of infection is necessary. Strict aseptic precautions, appropriate therapy, regular antenatal follow up are important features in the prevention and management of PROM. Evaluation of CRP in blood has helped to predict development of chorioamnionitis and preterm delivery following PROM and also perinatal morbidity and mortality.
Galyean, Anna; Garite, Thomas J; Maurel, Kimberly; Abril, Diana; Adair, Charles D; Browne, Paul; Combs, C Andrew; How, Helen; Iriye, Brian K; Kominiarek, Michelle; Lu, George; Luthy, David; Miller, Hugh; Nageotte, Michael; Ozcan, Tulin; Porto, Manuel; Ramirez, Mildred; Sawai, Shirley; Sorokin, Yoram
The decision of whether to retain or remove a previously placed cervical cerclage in women who subsequently rupture fetal membranes in a premature gestation is controversial and all studies to date are retrospective. We performed a multicenter randomized controlled trial of removal vs retention of cerclage in these patients to determine whether leaving the cerclage in place prolonged gestation and/or increased the risk of maternal or fetal infection. A prospective randomized multicenter trial of 27 hospitals was performed. Patients included were those with cerclage placement at ≤23 weeks 6 days in singleton or twin pregnancies, with subsequent spontaneous rupture of membranes between 22 weeks 0 days and 32 weeks 6 days. Patients were randomized to retention or removal of cerclage. Patients were then expectantly managed and delivered only for evidence of labor, chorioamnionitis, fetal distress, or other medical or obstetrical indications. Management after 34 weeks was at the clinician's discretion. The initial sample size calculation determined that a total of 142 patients should be included but after a second interim analysis, futility calculations determined that the conditional power for showing statistical significance after randomizing 142 patients for the primary outcome of prolonging pregnancy was 22.8%. Thus the study was terminated after a total of 56 subjects were randomized with complete data available for analysis, 32 to removal and 24 to retention of cerclage. There was no statistical significance in primary outcome of prolonging pregnancy by 1 week comparing the 2 groups (removal 18/32, 56.3%; retention 11/24, 45.8%) P = .59; or chorioamnionitis (removal 8/32, 25.0%; retention 10/24, 41.7%) P = .25, respectively. There was no statistical difference in composite neonatal outcomes (removal 16/33, 50%; retention 17/30, 56%), fetal/neonatal death (removal 4/33, 12%; retention 5/30, 16%); or gestational age at delivery (removal mean 200 days; retention
Full Text Available Objectives: Preterm premature rupture of membranes (PPROM is among the most important causes of perinatal morbidity and mortality. The aim of this study is to survey the pregnancy outcomes in preterm premature rupture of membranes with an amniotic fluid index of 5.Methods: This prospective cohort study was performed on 137 pregnant women complicated by preterm premature rupture of membranes (PPROM with a gestational age of 28-34 weeks during October 2006 to October 2008. The patients were divided in two groups according to their amniotic fluid index; AFI<5 (77cases, AFI≥5 (60cases. The Chi-squared test for qualitative variables and T-student test for quantitative variables were used to analyze the results.Results: The results showed that there was no significant difference in terms of the number of pregnancies, gestational age at rupture of membranes and birthweight between the two groups. However, the results demonstrated that the patients with AFI<5 exhibited a significantly shorter latency period (p=0.049, a higher rate of cesarean due to fetal distress (p=0.008, a lower neonatal Apgar score in the first minute (p=0.0127 and a higher rate of neonatal death during the first week (p=0.045.Conclusion: Overall, PPROM with oligohydroamnios is associated with shorter latency, higher rate of C/S, higher rate of early neonatal death and lower neonatal Apgar.
Nihal Al Riyami
Full Text Available Objectives: Preterm premature rupture of membranes (PPROM is defined as a rupture of the amniotic membranes occurring before 37 weeks of gestation and before the onset of labor. Extreme PPROM occurs prior to 26 weeks gestation and contributes to an increased risk of prematurity, leading to maternal and fetal complications. This study aims to estimate the risk factors associated with various maternal complications and to determine the worst outcomes in Omani females with extreme PPROM.Methods: A retrospective cohort study was conducted on 44 women with extreme PPROM, who delivered at Sultan Qaboos University Hospital (SQUH from January 2006 to December 2011. Women with incomplete information, multiple gestations, or a preterm delivery resulting from medical intervention, as well as women who delivered elsewhere were excluded from the study.Results: Forty-four women with extreme PPROM were included in our study. The results revealed the most important risk factor to be history of infection, which was noted in 24 study participants. The mean maternal age was 30 years. The mean gestational age at PPROM and at delivery were 20.7±3.2 (range: 16-26 weeks and 29.7±7.6 weeks (range: 17-40 weeks, respectively. The maternal complications observed in this study included; infection which was seen in 20 (45% patients, antepartum hemorrhage in 11 (25% patients, and cesarean section which was required in 12 (27% patients. There was no significant association between risk factors such as gestational age at delivery, parity, maternal age at PPROM, or maternal Body Mass Index (BMI and cesarean section rate. Infection played a major role, both as a risk factor and in causing extreme PPROM, which in turn increased in 12 patients (27%. In the multivariable model for predicting the need for cesarean section (gestational age at delivery, parity, maternal age at PPROM in years and maternal BMI, none of the factors were statistically significant.Conclusion: Overall
Akin, Mustafa Ali; Gunes, Tamer; Coban, Dilek; Ozgun, Mahmut Tuncay; Akgun, Hulya; Kurtoglu, Selim
Pentraxin 3 (PTX3) is an acute phase reactant which has been used to detect intra-amniotic infections (IAI) in pregnancy, but the prognostic value of PTX3 concentrations on neonates has not been studied. We aimed to investigate the relationship between maternal PTX3-neonatal PTX3 concentrations and early neonatal outcome. The mothers diagnosed with preterm prelabor rupture of membranes (PPROM) (n = 28) and their preterm infants (n = 28) were included in the study. PTX3 concentrations were studied in plasma in the maternal peripheral blood and umbilical/peripheral vein in the neonates. The relationship between the mPTX3-nPTX3 concentrations and neonatal outcome were investigated using non-parametric tests and binary logistic regression analysis. The mean mPTX3 concentration was 10.35 ± 7.82 μg/L. Ten (35.7%) of all mothers were within the normal range and 18 (64.3%) in high percentile (≥ 97.5 percentile). There was no relation between mPTX3 concentrations and clinical or histologic chorioamnionitis, latency of PPROM, and early neonatal outcome. Mean nPTX3 concentrations was 9.18 ± 7.83 μg/L and high nPTX3 concentrations were detected in five (17.8%) neonates. nPTX3 concentrations were inversely correlated with gestational age and correlated with rate of intraventricular hemorrhage (IVH) and mortality. Neonates with high nPTX3 concentrations also have lowered APGAR scores, increased rate of respiratory distress syndrome, clinical sepsis, IVH, necrotizing enterocolitis and prolonged NICU stay. High PTX3 concentrations of the newborns are associated with some worsened early neonatal outcome including lower gestational age at delivery, increased rate of IVH and mortality. Maternal PTX3 concentrations are not an adequate marker in defining clinical or histologic chorioamnionitis and early neonatal outcome.
Tranquilli, Andrea Luigi; Giannubilo, Stefano Raffaele; Bezzeccheri, Valeria; Scagnoli, Caterina
To evaluate the role of transabdominal amnioinfusion in improving the perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (pPROM). A randomised controlled trial. A teaching hospital in Italy, obstetric unit. Population Women with singleton pregnancies complicated by pPROM, between 24 + 0 and 32 + 6 weeks of gestation. Patients were randomised 24 hours after admission to our referral hospital, to expectant management with transabdominal amnioinfusion or expectant management only. The effects of transabdominal amnioinfusion on pPROM-delivery interval and on perinatal outcomes. Of the 65 women with pPROM 34 met the inclusion criteria. Seventeen women were assigned to amnioinfusion (the amnioinfusion group) and the other 17 to expectant management. Compared with the control group (median: 8 days; range: 3-14), the pPROM-delivery period was significantly longer in women who underwent amnioinfusion (median: 21 days; range: 15-29) (P amnioinfusion were less likely to deliver within seven days since pPROM (RR: 0.18; range: 0.04-0.69 95% CI) or within two weeks (RR: 0.46; range: 0.21-1.02 95% CI). In the amnioinfusion group the neonatal survival was significantly higher at each gestational age (P amnioinfusion after pPROM resulted in significant prolongation of pregnancy and better neonatal outcomes.
Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold; Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela; Helmer, Hanns; Brugger, Peter C.
Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)
Luque-Fernandez, Miguel Angel; Ananth, Cande V.; Sanchez, Sixto E.; Qiu, Chun-fang; Hernandez-Diaz, Sonia; Valdimarsdottir, Unnur; Gelaye, Bizu; Williams, Michelle A.
Purpose Data regarding circadian rhythm in the onset of spontaneous preterm premature rupture of membranes (PROM) and placental abruption (PA) cases are conflicting. We modeled the time of onset of preterm PROM and PA cases and examined if the circadian profiles varied based on the gestational age at delivery. Methods We used parametric and nonparametric methods, including trigonometric regression in the framework of generalized linear models, to test the presence of circadian rhythms in the time of onset of preterm PROM and PA cases, among 395 women who delivered a singleton between 2009 and 2010 in Lima, Peru. Results We found a diurnal circadian pattern, with a morning peak at 07h:32’ (95%CI:05h:46’ – 09h:18’) among moderate preterm PROM cases (P-value<0.001), and some evidence of a diurnal circadian periodicity among PA cases in term infants (P-value=0.067). However, we did not find evidence of circadian rhythms in the time of onset of extremely or very preterm PROM (P-value=0.259) and preterm PA (P-value=0.224). Conclusions The circadian rhythms of the time of onset of preterm PROM and PA cases varied based on gestational weeks at delivery. While circadian rhythms were presented among moderate preterm PROM and term PA cases, there was no evidence of circadian rhythms among preterm PA and very or extremely preterm PROM cases, underlying other mechanisms associated with the time of onset. PMID:25453346
Alex Sandro Rolland Souza
Full Text Available SUMMARY Objective: To determine the association between amniotic fluid index (AFI and perinatal outcomes in preterm premature rupture of membranes (PPROM. Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR and 95% confidence intervals (95CI. Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion: The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.
Yudin, Mark H; van Schalkwyk, Julie; Van Eyk, Nancy
To review the evidence and provide recommendations on the use of antibiotics in preterm premature rupture of the membranes (PPROM). Outcomes evaluated include the effect of antibiotic treatment on maternal infection, chorioamnionitis, and neonatal morbidity and mortality. Published literature was retrieved through searches of Medline, EMBASE, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM, infection, and antibiotics). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and new material incorporated in the guideline to July 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Guideline implementation should assist the practitioner in developing an approach to the use of antibiotics in women with PPROM. Patients will benefit from appropriate management of this condition. This guideline has been reviewed and approved by the Infectious Diseases Committee and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive and Council of the SOGC. The Society of Obstetricians and Gynaecologists of Canada. Copyright © 2017. Published by Elsevier Inc.
Full Text Available Objective: Preterm premature rupture of membranes (PPROM occurs in 2% of all pregnancies. The aim of this study was to compare positive cultures of GBS in two groups of pregnant women.Materials and methods: This case control research was conducted on 242 pregnant women: first group was consisted of 117 pregnant with PPROM and gestational ages between 26-37 weeks; second group was consisted of 125 term pregnant women with intact membranes and before onset of labor. Rectovaginal and urine samples were studied using specific culture medium of GBS, "Todd Hewitt Broth". The percentage of positive results was calculated using odds ratio and chi-square test.Results: GBS cultures were positive in 20 cases (17% in PPROM group and 5 cases in group of term pregnant (4% (Odds ratio=4.95 CI= 1.79-13.67, p=0.001. Past history of preterm labor and neonate hospitalization were more common in PPROM group but without any significant relationship to positive cultures.Conclusion: Our study showed significant difference of GBS colonization rate between two groups (p=0.001. According to CDC and ACOG guidelines routine screening and treatment of positive cases are indicated.
Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold [Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna (Austria); Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Helmer, Hanns [Medical University of Vienna, Department of Obstetrics and Maternal-Fetal Medicine, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria)
Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)
Thornburg, Loralei L; Queenan, Ruthanne; Brandt-Griffith, Brianne; Pressman, Eva K
To assess serum procalcitonin (PCT), a marker of monocyte activity, in predicting chorioamnionitis in preterm premature rupture of membranes (PPROM). Prospective cohort study in singleton gestation patients with PPROM between 2 2 + 0 to 3 3 + 6 weeks gestation. Two blood samples were taken - admission and delivery or diagnosis of clinical chorioamnionitis. Maternal serum PCT > 0.1 ng/mL was considered positive. Patients were divided into four groups: clinical evidence of chorioamnionitis confirmed by placental pathology (group C + P); pathological evidence of chorioamnionitis without clinical signs (group P); clinical signs only (group C); and patients without clinical or pathological findings (group N). Groups were compared to gestational age matched controls. Forty eight patients recruited, with 28 eligible for analysis: 10 in C + P group, 10 P group, 3 C group, and 5 N group. None of the control or PPROM patients had positive PCT on admission. At delivery, 3 of 10 group C + P and 4 of 10 group P had positive PCT. Maternal serum PCT sensitivity was 50% and specificity 55.6% for diagnosis of pathological chorioamnionitis. Maternal serum PCT is not detectable in PPROM patients at admission or in uncomplicated pregnant controls and is a poor predictor for clinical or pathological chorioamnionitis.
Park, Kyo Hoon; Lee, Sung Youn; Kim, Shi Nae; Jeong, Eun Ha; Oh, Kyung Joon; Ryu, Aeli
To develop a model based on non-invasive clinical parameters to predict the probability of imminent preterm delivery (delivery within 48 h) in women with preterm premature rupture of membranes (PPROM), and to determine if additional invasive test results improve the prediction of imminent delivery based on the non-invasive model. Transvaginal ultrasonographic assessment of cervical length was performed and maternal serum C-reactive protein (CRP) and white blood cell (WBC) count were determined immediately after amniocentesis in 102 consecutive women with PPROM at 23-33+6 weeks. Amniotic fluid (AF) obtained by amniocentesis was cultured and interleukin-6 (IL-6) levels and WBC counts were determined. Serum CRP, cervical length, and gestational age were chosen for the non-invasive model (model 1), which has an area under the curve (AUC) of 0.804. When adding AF IL-6 as an invasive marker to the non-invasive model, serum CRP was excluded from the final model (model 2) as not significant, whereas AF IL-6, cervical length, and gestational age remained in model 2. No significant difference in AUC was found between models 1 and 2. The non-invasive model based on cervical length, gestational age, and serum CRP is highly predictive of imminent delivery in women with PPROM. However, invasive test results did not add predictive information to the non-invasive model in this setting.
Cho, GeumJoon; Min, Kyung-Jin; Hong, Hye-Ri; Kim, SuhngWook; Hong, Jin-Hwa; Lee, Jae-Kwan; Oh, Min-Jeong; Kim, HaiJoong
Human papillomavirus (HPV) is known to be more prevalent in spontaneous abortions than in elective terminations of pregnancy. More recently, placental infection with HPV was shown to be associated with spontaneous preterm delivery. However, no study has evaluated the prevalence of HPV infection in pregnant Korean females and its association with adverse pregnancy outcomes. We conducted a cross-sectional study of 311 females who gave birth at Korea University Medical Center. Our sample included 45 preterm deliveries, 50 cases of premature rupture of the membranes (PROM), 21 preeclampsia cases, and 8 gestational diabetes mellitus (GDM) patients. We used the Hybrid Capture II system to detect high-risk (HR)-HPV infection at six weeks postpartum. The prevalence of HR-HPV infection was 14.1%. Women with HR-HPV infection had a higher incidence of PROM than those without HR-HPV. HR-HPV infection was associated with an increased risk of PROM (OR, 2.380; 95% CI, 1.103-5.134). The prevalence of preterm delivery, preeclampsia, or GDM was not different between the two groups. We observed a high prevalence of HR-HPV infection in pregnant women. Moreover, HR-HPV infection was associated with a risk of PROM at term. Further studies are needed to evaluate mechanisms by which HR-HPV infection induces PROM.
Zhou, Qiongjie; Zhang, Weiyuan; Xu, Huan; Liang, Huan; Ruan, Yan; Zhou, Shufeng; Li, Xiaotian
To investigate the prevalence of preterm premature rupture of membranes (PPROM) in urban areas in China and examine the associated risk factors. A population-based, prospective study was undertaken in 14 cities in China between January 1, 2011, and January 31, 2012. Women were recruited at their first prenatal-care visit, when maternal characteristics were recorded. Risk factors were analyzed by one-way analysis of variance. Of 112 439 women included in analyses, 3077 (2.7%) had PPROM. Univariate analysis showed an increased risk of PPROM before 28weeks of pregnancy in migrant women (odds ratio [OR] 2.25; 95% confidence interval [CI] 1.53-3.30; P<0.001), in those with a history of recurrent induced abortions (OR 2.75; 95% CI 1.66-4.56; P<0.001), and in those with a history of preterm birth (OR 3.90; 95% CI 0.77-19.61; P<0.001). The associations were maintained in multivariate analysis (P<0.001). Migration as a result of urbanization, high rates of induced abortion, and preterm birth are potential risk factors for PPROM in Chinese women. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Sayed Ahmed, Waleed Ali; Ahmed, Magdy Refaat; Mohamed, Mariam Lotfi; Hamdy, Mostafa Ahmed; Kamel, Zenab; Elnahas, Khaled Mohamed
To evaluate the clinical usefulness of maternal serum interleukin-6 for the detection of subclinical chorioamnionitis and in the prediction of the latency period in patients with preterm premature rupture of membrane (PPROM). The study group included 60 patients at 24-34 weeks of gestation complaining of PPROM. Laboratory investigations included serial measurements of IL-6, TLC and CRP. Conservative management was carried out till 36 weeks unless delivery was indicated beforehand. The main outcome measures were the latency period and the occurrence of subclinical chorioamnionitis. The mean gestational age at presentation was 30.9 weeks and 35.2 weeks at delivery. The mean IL-6 level at presentation was 4.7 pg/ml. There was no correlation between IL-6 at presentation and the latency period. In addition, those diagnosed as having subclinical chorioamnionitis by placental histopathology had significantly higher levels of IL-6 at delivery. Taking IL-6 level cutoff point of 8.5 pg/ml, histological chorioamnionitis, RDS and NICU admission were significantly higher above that level while neonatal birth weight, Apgar scores at one and five minutes were significantly lower. Maternal serum IL-6 at the time of PPROM has no correlation to the latency period while IL-6 levels at the time of delivery have significant correlation to the subclinical chorioamnionitis and neonatal outcome measures.
Tsafrir, Z; Margolis, G; Cohen, Y; Cohen, A; Laskov, I; Levin, I; Mandel, D; Many, A
We aimed to investigate whether conservative management of preterm premature rupture of membranes (PPROM) at 32-34 weeks' gestation improves outcome. In this retrospective analysis of singleton pregnancies, the study group included patients with PPROM at 28-34 weeks' gestation and the control group included patients presented with spontaneous preterm delivery at 28-34 weeks' gestation. Both groups were subdivided according to gestational age - early (28-31 weeks' gestation) versus late (32-34 weeks' gestation). Adverse neonatal outcome included neonatal death, intraventricular haemorrhage grade 3/4, respiratory distress syndrome, periventricular leucomalacia and neonatal sepsis. The study and control groups included 94 and 86 women, respectively. The study group had a lower incidence of adverse neonatal outcome at the earlier weeks (28-31), compared with the control group at the same gestational age. In contrast, at 32-34 weeks' gestation no difference in the risk for adverse neonatal outcome was noticed. Additionally, within the study group, chorioamnionitis rate was significantly higher among those who delivered at 32-34 weeks' gestation (p < 0.01). No advantage for conservative management of PPROM was demonstrated beyond 31 weeks' gestation. Moreover, conservative management of PPROM at 32-34 weeks' gestation may expose both mother and neonate to infectious morbidity.
Andres, Robert L; Zhao, Yuan; Klebanoff, Mark A; Hauth, John C; Caritis, Steve N; Carey, J Christopher; Wapner, Ronald J; Iams, Jay D; Leveno, Kenneth J; Miodovnik, Menachem; Sibai, Baha; Van Dorsten, J Peter; Dombrowski, Mitchell P; O'Sullivan, Mary J; Langer, Oded
To determine if tobacco use increases the incidence of preterm premature rupture of the membranes (pPROM) or alters perinatal outcomes after pPROM. This is a secondary analysis of the databases of three completed Eunice Kennedy Shriver National Institute of Child Health and Human Development-supported Maternal Fetal Medicine Units Network studies. Self-reported tobacco exposure data was obtained. Its relationship with the incidence of pPROM and associated neonatal outcome measures were assessed. There was no difference in the incidence of pPROM when comparing nonsmokers to those using tobacco. Although a trend was seen between the incidence of pPROM and the amount smoked, this did not reach statistical significance. Among the patients with pPROM, the use of tobacco was not associated with an increase in perinatal morbidity. Our data do not support a significant relationship between tobacco use and pPROM. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Arnildo A. Hackenhaar
Full Text Available Objective: this study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. Methods: this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight ≥ 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. Results: of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94, with lower level of schooling (PR = 2.43, age > 29 years (PR = 2.49, and smokers (PR = 2.04. It was also associated with threatened miscarriage (PR = 1.68 and preterm labor, (PR = 3.40. There was no association with maternal urinary tract infection or presence of genital discharge. Conclusions: the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. Resumo: Objetivo: o objetivo deste estudo foi verificar a ocorrência da ruptura prematura das membranas fetais pré-termo em gestações únicas e sua associação com fatores sociodemográficos maternos e infecções geniturinárias autorreferidas. Métodos: estudo transversal de base populacional onde foram incluídas todas as mães dos recém-nascidos dos partos únicos ocorridos no ano de 2010, com peso ao nascer igual
Toprak, Erzat; Bozkurt, Murat; Dinçgez Çakmak, Burcu; Özçimen, Emel Ebru; Silahlı, Musa; Ender Yumru, Ayşe; Çalışkan, Eray
Objective: Preterm premature rupture of membranes (PPROM) is closely related with maternal and fetal complications. Therefore, early diagnosis is extremely important to provide maternal and fetal well-being. Many inflammatory markers have been evaluated for their ability to diagnose membrane rupture at early stages. We aimed to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and preterm premature membrane rupture. Material and Methods: In this study, 121 pregnant women with PPROM and 96 age-matched pregnant women with spontaneous preterm labor who were admitted to our hospital between January 2014 and December 2015 were enrolled. Demographic data, complete blood cell count results, and neonatal outcomes were recorded. Results: The neutrophil and platelet counts were higher in the PPROM group (9948.4±3393.2 vs. 7466.1±1698.5/mm3 and 244.5±60 vs. 210.6±64.8/mm3, respectively, ppremature rupture of membranes was evaluated using an ROC curve. The sensitivity and specificity of the PLR was 57.8% and 73.7%, respectively, at a threshold >117.14 (p<0.001). Conclusion: The PLR might be a cost effective, easy to use, and practical marker for the early diagnosis of PPROM, which can help to determine the appropriate waiting time for delivery and provide maternal and fetal well-being. PMID:28890425
Shree, Raj; Caughey, Aaron B; Chandrasekaran, Suchitra
Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy. A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤6 months. IPI >6 months was categorized into two groups: IPI 7-23 months and IPI ≥24 months. PPROM was defined as premature rupture of membranes between 16 0 and 36 6 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤24 0 , 24 1 -28 0 , 28 1 -32 0 , 32 1 -34 0 , and 34 1 -36 6 weeks). 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70-1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 28 1 and 32 0 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m 2 , BMI ≥30 kg/m 2 , use of social services, tobacco use, and
Feng, Liping; Allen, Terrence K; Marinello, William P; Murtha, Amy P
Preterm premature rupture of membranes (PPROM) is a leading contributor to maternal and neonatal morbidity and mortality. Epidemiologic and experimental studies have demonstrated that thrombin causes fetal membrane weakening and subsequently PPROM. Although blood is suspected as the likely source of thrombin in fetal membranes and amniotic fluid of patients with PPROM, this has not been proven. Ureaplasma Parvum (U. parvum) is emerging as a pathogen involved in prematurity, including PPROM, but until now, prothrombin production directly induced by bacteria in fetal membranes has not been described. This study was designed to investigate whether U. parvum exposure can induce prothrombin production in fetal membranes cells. Primary fetal membrane cells (amnion epithelial, chorion trophoblast, and decidua stromal) or full-thickness fetal membrane tissue explants from elective, term, uncomplicated cesarean deliveries were harvested. Cells or tissue explants were infected with live U. parvum (1 x 10 5 , 1 x 10 6 , or 1 x 10 7 colony forming units (cfu)/ml) or lipopolysaccharide (Escherichia coli J5, L-5014, Sigma, 100 ng/ml or 1000 ng/ml) for 24 hours. Tissue explants were fixed for immunohistochemistry staining of thrombin/prothrombin. Fetal membrane cells were fixed for confocal immunofluorescent staining of the biomarkers of fetal membrane cell types and thrombin/prothrombin. Protein and mRNA were harvested from the cells and tissue explants for Western blot or qRT-PCR to quantify thrombin/prothrombin protein or mRNA production, respectively. Data are presented as mean values ± standard errors of mean. Data were analyzed using one-way ANOVA with post hoc Dunnett's test. Prothrombin production and localization was confirmed by Western blot and immunostainings in all primary fetal membrane cells and tissue explants. Immunofluorescence observations revealed a perinuclear localization of prothrombin in amnion epithelial cells. Localization of prothrombin in chorion and
Gabriel, R; Morille, C; Drieux, L; Bige, V; Leymarie, F; Quereux, C
To assess the value of ultrasonographic measurement of cervical length for predicting the duration of the latency period from admission to delivery in women with preterm premature rupture of the membranes (PROM). Prospective study in 88 women with preterm PROM before 34 weeks of amenorrhea. The median gestational age at admission was of 30.1 weeks. The clinical management included: no digital examination of the uterine cervix, antenatal corticosteroids, antibiotics (amoxicillin & clavulanic acid) for 7 days, and hoding back until 34 weeks. Cervical length at admission was determined with transvaginal ultrasonography. The duration of the latency period was studied in relation with cervical length, serum C-reactive protein (CRP) level and white blood cell (WBC) count at admission. The median latency period was longer in women with a cervical length > or = 25 mm (10 vs 5 days; p = 0.04), but this was not associated with a significant increase in birth weight. The median latency period was also longer in women with CRP < 20 mg/l (10 vs 3 days; p < 0.001) and this was associated with a significant increase in birth weight (1716 +/- 549 vs 1201 +/- 485 g; p < 0.01). Moreover, increased CRP levels were more frequent in women with a cervical length < 25 mm, and cervical length was no more predictive of the duration of the latency period in the subgroup of women with CRP < 20 mg/l and WBC < 20,000 cells/mm3. In women with preterm PROM, the latency period from admission to delivery is shorter when cervical length is < 25 mm. However, the clinical value of transvaginal ultrasonography is limited in comparison with serum CRP.
Full Text Available Preterm premature rupture of membranes (PPROM is a condition leading to an increased risk of maternal and neonatal morbidity and mortality in pregnant women. To prevent this complication, some studies have proposed using prophylactic progesterone. However, due to lack of sufficient relevant data, there is still need for further studies in this regard. This study was performed to determine the effect of rectal progesterone on the latent phase and maternal and neonatal outcome variables in females with PPROM. During the present randomized clinical trial study (IRCT201512077676N4, a total of 120 patients with PPROM at pregnancy ages between 26 and 32 weeks were randomly assigned to 2 equal intervention and control groups. In the intervention group, progesterone suppositories (400 mg per night were administered until delivery or completion of the 34th gestational week and was compared with placebo effect in control group. The latent phase and maternal and neonatal outcome variables were compared between the two groups. The mean age of patients was 29.56±5.66 (19-42 and 29.88±5.57 (17-40 years in the intervention and control group, respectively. The two groups were almost identical in the confounding factors. The median latent phase was 8.5 days in the intervention group vs. 5 days in the control group in the 28th-30th weeks of gestation, which was significantly higher in the intervention group (P=0.001. Among maternal and neonatal outcome variables, only the mean birth-weight was significantly higher in the intervention group than that in the controls (1609.92±417.28 gr vs. 1452.03±342.35 gr, P=0.03. Administration of progesterone suppository in patients with PPROM at gestational ages of 28 to 30 weeks is effective in elongating the latent phase and increasing birth-weight with no significant complications.
Kibel, Mia; Barrett, Jon; Tward, Carly; Pittini, Alex; Kahn, Michael; Melamed, Nir
To compare the characteristics of preterm premature rupture of membranes (PPROM) between twin and singleton pregnancies. This was a retrospective study of all women with twin and singleton pregnancies admitted with PPROM between 24-34 weeks of gestation. Overall 698 women with PPROM were eligible for the study: 101 (14.5%) twins and 597 (85.5%) singletons. Twins presented with PPROM at a more advanced gestational age compared with singletons (29.1 ± 2.7 vs. 28.5 ± 2.8 weeks, p = 0.03). The latency period was shorter in twins compared with singletons, especially for women presenting after 28 weeks of gestation (5.0 ± 0.8 vs. 7.0 ± 0.4 days, p = 0.01). Women with twins were more likely to deliver within 48 h (OR: 2.7; 95%CI: 1.7-4.2) and were less likely to deliver within 2-7 days (OR: 0.5; 95%CI: 0.3-0.9) following PPROM. The rate of clinical chorioamnionitis or placental abruption following PPROM was lower in twins compared with singletons (15.8% vs. 26.0%, p = 0.03). PPROM in twin pregnancies tends to occur at a more advanced gestational age, is associated with a shorter latency period and is less likely to be complicated by chorioamnionitis or placental abruption compared with singletons. This information may be useful for counseling and management decisions in cases of PPROM in women with twins.
Rocha, Frederico G; Slavin, Thomas P; Li, Dongmei; Tiirikainen, Maarit I; Bryant-Greenwood, Gillian D
Relaxin H2 (RLN2) is a systemic hormone (sRLN) that is produced by the corpus luteum, whereas decidual RLN (dRLN) acts only locally. Elevated sRLN is associated with spontaneous preterm birth (sPTB) and elevated dRLN with preterm premature rupture of membranes (PPROM). Associations were sought between single nucleotide polymorphisms (SNPs) in the RLN2 promoter with levels of dRLN and sRLN in Filipino patients with sPTB, PPROM, or normal term delivery. Stringent selection of women with sPTB (n = 20) or PPROM (n = 20) and term control subjects (n = 20) was made from >8000 samples from Filipino patients who delivered at 34-36 weeks' gestation. Twelve SNPs were genotyped on maternal blood, with 9 excluded based on the high linkage disequilibrium or being the same as in the control population. Quantitative immunocytochemistry on parietal decidual tissue was performed (n = 60); sRLN was measured by enzyme-linked immunosorbent assay in a subset of patients (n = 21). SNP rs4742076 was associated significantly with PPROM (P < .001) and increased expression of dRLN (P < .001). The genotype TT had increased dRLN in PPROM (P < .05). SNP rs3758239 was associated significantly with both PPROM and sPTB (P < .01), and genotype AA had increased dRLN expression (P < .05). The sRLN showed a trend of higher levels in PPROM and sPTB, but was not significant. SNP rs4742076 in the RLN2 promoter was associated with increased dRLN expression and PPROM; SNP rs3758239 was associated with both PPROM and sPTB in these Filipino patients. Specific homozygous genotypes were identified for both SNPs and were shown to be associated with increased dRLN tissue expression. Copyright © 2013 Mosby, Inc. All rights reserved.
Kuć, Paweł; Laudański, Piotr; Kowalczuk, Oksana; Chyczewski, Lech; Laudański, Tadeusz
To analyse the expression of 15 genes encoding receptors and enzymes associated with the molecular mechanism of the tocolytic drugs atosiban (oxytocin receptor antagonist), nifedipine (calcium channel blocker) and celecoxib (selective cyclo-oxygenase-2 inhibitor) in preterm labor patients with premature rupture of fetal membranes in relation to symptoms of intrauterine infection and preterm labor risk factors. Experimental molecular study. Tertiary obstetric care center. Myometrial samples were obtained during cesarean sections from 35 patients who delivered preterm with unverified symptoms of intrauterine infection, 35 patients who delivered preterm without symptoms of intrauterine infection and 90 women who delivered at term. The Micro Fluidic Profiling Card analytic system was used to evaluate mRNA expression of the genes of interest. The relative quantification values for mRNA expression. The median oxytocin receptor and cyclo-oxygenase-2 mRNA expression in preterm patients with clinical symptoms of intrauterine infection was significantly higher than in preterm patients without symptoms. The median mRNA expression of β(1) , β(3) and β(4) subunits of the L-type calcium channel and prostaglandin E(2) receptor was significantly higher in preterm patients compared with term patients. The mRNA expression of hormones, enzymes and their receptors associated with tocolytic actions can differ in various clinical conditions. The expression of these genes is regulated at different levels and can be modified by inflammatory factors, which affect their functions. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
Linehan, Laura Aoife; Walsh, Jennifer; Morris, Aoife; Kenny, Louise; O'Donoghue, Keelin; Dempsey, Eugene; Russell, Noirin
Preterm premature rupture of membranes (PPROM) complicates 1% of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of this retrospective descriptive cohort study was to investigate the natural history of midtrimester PPROM in a jurisdiction where termination of pregnancy in the absence of maternal compromise is unavailable. Cases of midtrimester PPROM diagnosed between 14 and 23 + 6 weeks' gestation during April 2007 to June 2012 were identified following a manual search of all birth registers, pregnancy loss registers, annual reports, ultrasound reports, emergency room registers and neonatal death certificates at Cork University Maternity Hospital - a large (circa 8500 births per annum) tertiary referral maternity hospital in southwest Ireland. Cases where delivery occurred within 24 h of PPROM were excluded. The prevalence of midtrimester PPROM was 0.1% (42 cases/44,667 births). The mean gestation at PPROM was 18 weeks. The mean gestation at delivery was 20 + 5 weeks, with an average latency period of 13 days. Ten infants were born alive (23%; 10/42). The remainder (77%; 32/42) died in utero or intrapartum. Nine infants were resuscitated. Two infants survived to discharge. The overall mortality rate was 95% (40/42). Five women had clinical chorioamnionitis (12%; 5/42) but 69% demonstrated histological chorioamnionitis. One woman developed sepsis (2.4%; 1/42). Other maternal complications included requirement of intravenous antibiotic treatment (38%; 17/42), retained placenta (21%, 9/42) and post-partum haemorrhage (12%; 5/42). This study provides useful and contemporary data on midtrimester PPROM. Whilst fetal and neonatal mortality is high, long-term survival is not impossible. The increased risk of maternal morbidity necessitates close surveillance.
Moussa, Hind; Hosseini Nasab, Susan; Fournie, David; Ontiveros, Alejandra; Alkawas, Rim; Chauhan, Suneet; Blackwell, Sean; Sibai, Baha
Perinatal death, in particular intrapartum stillbirth and short-term neonatal death, as well as neonatal short term and long term morbidity have been associated with the time of day that the birth occurs. Indeed, evening and nighttime deliveries were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Impact of shift change, as well as time of day delivery have been extensively studied in the context of maternal and neonatal complications of cesarean delivery, however, no studies were previously performed on timing of delivery and its effect on the outcome of pregnancies complicated by preterm premature rupture of membranes. Our objective was to compare obstetric, neonatal as well as long-term outcomes between women delivered in the daytime versus nighttime, in singleton gestations whose pregnancies were complicated by preterm premature rupture of membranes. This was a secondary analysis of a trial of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network "A Randomized Clinical Trial of the Beneficial Effects of Antenatal Magnesium Sulfate for the Prevention of Cerebral Palsy". For this analysis, the time of delivery was divided into the daytime, from 07:01 to 19:00, and the nighttime, from 19:01 to 07:00. Epidemiological, obstetric characteristics as well as neonatal and long-term outcomes were compared between deliveries occurring during the daytime versus the nighttime periods. Inclusion criteria consisted of singleton gestations diagnosed with preterm premature rupture of membranes (PPROM). Multifetal gestations and pregnancies with preterm labor without preterm premature rupture of membranes were excluded. A total of 1752 patients met inclusion criteria, 881 delivering during the daytime, while 871 during the nighttime. There were no differences in demographic maternal variables. There were no differences in the number of patients
Full Text Available Introduction: Preterm premature rupture of the membranes (PPROM is one of the most important causes of perinatal morbidity and mortality. The aim of this study was to evaluate pregnancy outcome in preterm premature rupture of the membranes with amniotic fluid index less than 5 and more than 5. Methods: This prospective study was performed on 137 pregnant women with gestational age of 28-34 weeks with PPROM from Oct 2006 to Oct 2008. The patients were divided in two groups according to amniotic fluid index: AFI<5 (77 cases, AFI≥5 (60 cases. Chi-square test was used for qualitative variables, while T-student test was used for quantitative test. Results: Both groups were similar with respect to number of pregnancies, gestational age at rupture of the membranes and birth weight. In the group with AFI<5, applied latency was significantly shorter (PV=0.049, rate of cesarean section was higher due to fetal distress (PV=0.008, neonatal Apgar score in first minute was lower during the first week (PV=0.0127 and the rate of neonatal death was higher (PV=0.045 during the first week. Conclusion: An AFI<5 cm after PPROM is associated with earlier delivery, higher rate of cesarean due to fetal distress, higher rate of neonatal death, and lower neonatal Apgar score in first minute during the first week
Tan, L-K; Kumar, S; Jolly, M; Gleeson, C; Johnson, P; Fisk, N M
To evaluate whether a test amnioinfusion procedure is useful in selecting cases of midtrimester preterm premature rupture of membranes (PPROM) which may benefit from serial amnioinfusions if the initial fluid is retained. The Centre for Fetal Care database between 1992 and 2000 was reviewed for women with PPROM amnioinfusion. Amniotic fluid index (AFI) was assessed before and after a test amnioinfusion procedure. Those who retained fluid > or =48 h underwent serial AFI assessment with a view to serial amnioinfusion when oligohydramnios recurred. Eighty-five amnioinfusion procedures were performed in 60 women with oligohydramnios. Nineteen of these women presented with confirmed PPROM at a median gestation of 19 (range 15-22) weeks and severe olighohydramnios (median AFI 1, range 0-3 cm), in whom 20 test amnioinfusions were carried out. Two amnioinfusions were abandoned during the procedure because of fetal bradycardia and both mothers opted for termination of pregnancy. Only 4 women retained fluid during the test amnioinfusion, 1 of whom miscarried at 19 weeks before serial amnioinfusion could be started. The remaining 3 underwent a median of 4 (range 1-6) serial amnioinfusion procedures; none had evidence of pulmonary hypoplasia. Thirteen (68%) leaked fluid within 48 h; within this group there was 1 subsequent miscarriage and 9 pregnancy terminations. The remaining 3 pregnancies resulted in livebirths 2 of which had pulmonary hypoplasia with 1 early neonatal death. Overall survival was poor (4/19), largely attributed to the high incidence of terminations in the presence of persistent severe oligohydramnios. In continuing pregnancies reaching viability survival was 67% (4 of 6). Three quarters of women with mid-trimester PPROM lose fluid at test amnioinfusion and therefore would not be suitable candidates for serial amnioinfusion. However, if infused fluid is retained, this allows subsequent serial amnioinfusion and prolongation of pregnancy in about 75%, with an
Namba, Fumihiko; Ina, Shihomi; Kitajima, Hiroyuki; Yoshio, Hiroyuki; Mimura, Kazuya; Saito, Shigeru; Yanagihara, Itaru
The aim of this study was to determine whether amniotic fluid levels of annexin A2, a phospholipid-binding protein that is abundant in amnion and regulates fibrin homeostasis, are associated with histological chorioamnionitis, preterm premature rupture of the membranes, and subsequent preterm delivery. Amniotic fluid was obtained from 55 pregnant women with preterm labor and/or preterm premature rupture of the membranes before 32weeks of gestation, and amniotic fluid levels of annexin A2 were measured with a sandwich enzyme-linked immunosorbent assay. Amniotic fluid levels of annexin A2 in patients with histological chorioamnionitis was higher than that in the remainder (P=0.053), whereas amniotic fluid levels of annexin A2 in patients with preterm premature rupture of the membranes was significantly higher than that in the remainder (P=0.002). Amniotic levels of annexin A2 was a fair test (area under receiver-operator characteristic curve=0.679), and amniotic fluid levels of annexin A2>878.2ng/mL had a sensitivity of 68.8%, a specificity of 65.2%, a positive predictive value of 73.3%, and a negative predictive value of 60.0% for predicting delivery within 2weeks after amniotic fluid sampling. Furthermore, the combined use of amniotic fluid cut-off levels of 878.2ng/mL for annexin A2 and 13.3ng/mL for interleukin-8 improved the specificity (91.3%) and the positive predictive value (89.5%). We identified amniotic fluid levels of annexin A2, especially in combination with amniotic fluid levels of interleukin-8, as a novel predictive marker for preterm delivery. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.
Garzetti, G G; Ciavattini, A; De Cristofaro, F; La Marca, N; Arduini, D
This study was designed to: (i) evaluate the effect of amnioinfusion on the latency period in patients with oligohydramnios for preterm premature rupture of membranes, and (ii) to investigate the relationship between changes in the amniotic fluid index and fetal heart rate short-term variability by computerized Hewlett-Packard cardiotocography, longitudinally estimated before and after prophylactic amnioinfusion. All singleton pregnancies with prolonged premature rupture of membranes after 25 weeks of gestation and seen at the Institute of Obstetrics and Gynecology, University of Ancona (Italy), between January 1994 and June 1995 were included in the study. Transabdominal amnioinfusion with 150-350 ml warmed normal saline (25-50 ml/min) was performed at weekly intervals. Amniotic fluid volume was assessed ultrasonographically by means of the four-quadrant technique on a weekly basis before and after each amnioinfusion, as well as the short-term variability by a Hewlett-Packard computerized cardiotocographic system. 18 women were enrolled and underwent prophylactic transabdominal amnioinfusion at weekly intervals until delivery. Eighteen controls, who did not undergo prophylactic amnioinfusion, were recruited from our 1992-1993 series and included in the study. The median interval between premature rupture of membranes and delivery was 3.0 weeks (range 1-8 weeks), with an average delivery age of 33.0 weeks (range 27-36 weeks). The latency period was significantly longer in patients who underwent prophylactic amnioinfusion (mean +/- SD, 4.1 +/- 1.7 weeks) than in controls(1.7 +/- 1.0 weeks; p amnioinfusion. A direct relationship was observed between the amniotic fluid index and short-term variability (linear regression analysis r = 0.54, p = 0.04). The mean values of fetal movements recorded by computerized tomography during the 20 min of observation significantly increased after amnioinfusion in comparison with those before it (2.6 +/- 0.9 and 0.9 +/- 0
Gharebaghi, Manizheh M.; Peirovifar, A.; Gharebaghi, Parvin M.
Objective was to compare inflammatory mediators in the cord blood of premature newborn infants with premature rupture of membranes (PROM) and intact membranes. Eighty-nine premature neonates with gestational age of 27-34 weeks that delivered in Ghaem Hospital in Mashhad, Iran from June 2005 to March 2006 were enrolled in a prospective observational study and their umbilical cord plasma was collected at birth. They were allocated into 2 groups (45 patients with PROM and 44 neonates with intact membranes). Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were measured in cord plasma by the enzyme linked immunoassay (ELISA) method. Mean cord plasma IL-6 levels in preterm neonates with PROM was 205.71 pg/ml and in neonates with intact membranes was 33.3 pg/ml for IL-6 (p=0.000). The mean cord blood CRP level in newborns was 10.2 ug/ml, and in those with intact membranes was 1.6 ug/ml and in those with intact membranes was 1.6 ug/ml (p=0.41). Early onset sepsis was more frequent in infants with PROM than premature infants with intact membrane (38% versus 10%, p=0.001). In neonates with PROM, the mean cord blood IL-6 level was significantly higher in septic newborns (414.28 versus 40.44 pg/ml, p=0.000). The premature newborn infants with PROM had increased IL-6 levels in cord blood, which was significantly higher in neonates that developed early onset sepsis. (author)
Özalkaya, Elif; Karatekin, Güner; Topçuoğlu, Sevilay; Karatepe, Hande Özgün; Hafızoğlu, Taner; Baran, Pervin; Ovalı, Fahri
The aim of this study, to determine an index of oxidative stress index in preterm infants less than 34 weeks gestational age with premature preterm rupture of membrane (PPROM) and fetal inflammatory response syndrome (FIRS). This study was designed as a prospective study. Fifty-one premature infants less than 35 weeks of gestational age were included in the study. The umbilical cord blood concentrations of IL-6, TAC (total antioxidant capacity) and PON-1 (paraoxonase-1) levels and TOS (total oxidative stress) were studied. The oxidative stress index (OSI = TAC/TOS) was calculated in all of prematüre infants. PPROM was defined as rupture of membranes at least 24 hours before the onset of labor. FIRS was defined by an umbilical cord IL-6 level greater than 11 pg/mL. Premature infants included in the study were divided into 4 groups. Group 1 included preterm infants without FIRS and with PPROM (n = 16), while Group 2 included preterm infants without PPROM and with FIRS (n = 9), Group 3 consisted of premature infants with PPROM and FIRS (n = 21) and Group 4 included premature infants without PPROM or FIRS (n = 5). Umbilical cord TOS level was found to be higher in the preterm infants without FIRS and with PPROM (36.1 μmol H 2 O 2 Equiv./L) compared to the preterm infants without PPROM or FIRS (11.9 μmol H 2 O 2 Equiv./L) (p = 0.03). Umbilical cord PON-1 level was found to be lower in the preterms without FIRS and with PPROM (32 U/L), preterms without PPROM and with FIRS (30. 3 U/L) and the preterm infants with both PPROM and FIRS (48.6 U/L) compared to the preterm infants having no PPROM or FIRS (85.6 U/L) (p = 0.001). High pro-oxidant capacity was found in PPROM and low antioxidant capacity in PPROM and FIRS. Copyright © 2017. Published by Elsevier B.V.
López-Farfán, José Angel; Gámez-Guevara, Catalina
Premature rupture of membranes is a normal occurrence of labor and can occur before or after the onset of contractions. The clinical factors associated with premature rupture of membranes include: low socioeconomic status, low body mass index, prior preterm pregnancies, smoking, sexually transmitted infections and urinary tract, conization, cervical cerclage and amniocentesis. To evaluate whether prolonged release of the vaginal insert of PGE2 is superior to dinoprostone gel to achieve cervical ripening in patients with term pregnancy that occur with premature rupture of membranes. Randomized clinical trial in the surgical unit of play in a period of 6 months, with an estimated sample of 50 patients was randomized by block table. After assessment confirming rupture of membranes, Bishop Score and meeting inclusion criteria, group A was applied PGE2 intracervical gel 0.5 mg with a maximum of 3 doses, every 6 hours. Group B was administered at vaginal insert of PGE2 single dose for 24 hours, the patient was left to sleep 30 minutes cardio toco-monitoring chart for at least 2 hours after application. The average time to maturity was 310.59 minutes with a standard deviation of 198.7 and concluded that there was no significant difference between the onset of uterine activity and the onset of labor among the prolonged release dinoprostone and alternatives such as the gel cervical for cervical ripening. Either this is a good choice to ripen the cervix in patients with term pregnancy and premature rupture of membranes.
De Santis, Marco; Scavo, Maria; Noia, Giuseppe; Masini, Lucia; Piersigilli, Fiammetta; Romagnoli, Costantino; Caruso, Alessandro
To evaluate the efficacy of transabdominal amnioinfusion on feto-neonatal and maternal morbidity and feto-neonatal mortality. We studied 71 patients with preterm premature rupture of membranes (pPROM) at amnioinfusion with saline every 7 days in case of persistent oligohydramnios. Latency period pPROM delivery, week of delivery (26.0 vs. 22.4, pamnioinfusion-treated patients, we did not note a higher rate of complications from infection during both pregnancy and puerperium. In the amnioinfusion group, fluid loss within 6 h after infusion is the main variable in predicting pulmonary hypoplasia and neonatal survival. Our data suggest that amnioinfusion seems to be a low fetal and maternal risk technique that modifies the natural history of pPROM, improving fetal intrauterine stay and survival. Copyright 2003 S. Karger AG, Basel
Ferrell, Georgia; Lu, Minyan; Stoddard, Paul; Sammel, Mary D; Romero, Roberto; Strauss, Jerome F; Matthews, Catherine A
Pelvic organ prolapse and preterm premature rupture of membranes, the 2 conditions which have in common weakening of the tensile strength of tissues, are thought to be caused, in part, by abnormal extracellular matrix synthesis and/or catabolism. We identified a new single nucleotide polymorphism (NT_010194(LOXL1):g.45008784A>C) in the promoter of the LOXL1 gene, which is essential for elastin synthesis. Promoter studies showed that the minor "C'' allele had significantly greater activity than the major "A'' allele. Case-control studies examined the association of the alleles of this single nucleotide polymorphism with pelvic organ prolapse and preterm premature rupture of membranes. When comparing allele frequencies and genotypes in pelvic organ prolapse cases versus controls, no significant associations were found. A case-control study conducted in African American neonates also found no significant associations between the promoter alleles and preterm premature rupture of membranes. We conclude that a functional single nucleotide polymorphism exists in the promoter region of the LOXL1 gene. Association studies suggest that the promoter single nucleotide polymorphism does not contribute significantly to risk of pelvic organ prolapse or preterm premature rupture of membranes.
In the 'Overview of the role of antibiotics in curtailing labour and early delivery'(ORACLE I)-trial in women with premature rupture of membranes, the use of erythromycin was found to be associated with a decrease in the primary composite outcome (neonatal death, chronic lung disease or major
Full Text Available Background: Premature rupture of membranes (PROM is a common obstetric issue during pregnancy which might lead to serious fetal or maternal problems. Therefore, an appropriate diagnosis and management of PROM are of significant importance in patients. Objective: The aim of this study was to determine the accuracy of placental alpha microglobuline-1 (PAMG-1 test in PROM diagnosis and compare this diagnostic method with other standard tests in diagnosis of PROM. Materials and Methods: In this prospective diagnostic accuracy study, patients with symptoms of membrane rupture in 16-39 weeks of gestation were involved. Three tests including Fern, Nitrazine and PAMG-1 were performed at the same time. Results: PROM was confirmed in 86 patients out of 100. The sensitivity and specificity were respectively 81.3% and 100% for Fern test, 93% and 92.8% for Nitrazine test, 98.9% and 92.8% for PAMG-1 test. PAMG-1 test showed higher sensitivity (98.9% with p<0.001 and accuracy (98% compared with conventional tests. Although PAMG-1showed a lower positive predictive value (PPV compared to conventional tests such as Fern test (100%, it was shown to be more accurate. Conclusion: The accuracy of PAMG-1 test was superior to both Fern and Nitrazine test in PROM diagnosis.
Mendez-Figueroa, Hector; Dahlke, Joshua D; Viteri, Oscar A; Chauhan, Suneet P; Rouse, Dwight J; Sibai, Baha M; Blackwell, Sean C
To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age. This was a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Inclusion criteria were twin gestation with preterm PROM diagnosed between 24 0/7 and 31 6/7 weeks of gestation and planned expectant management. Latency (time from membrane rupture to delivery) and perinatal outcomes were evaluated by gestational age at membrane rupture. Long-term neonatal outcomes were also analyzed. Among 151 women who met inclusion criteria, the median gestational age at preterm PROM was 28.1 weeks (range 24.1-31.6 weeks). Approximately one-third of women achieved a latency of at least 1 week. Gestational age at preterm PROM (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.63-0.90 for each week after 24 weeks of gestation) and cervical dilation at admission (OR 0.66, 95% CI 0.49-0.90 for each centimeter of dilation) were inversely associated with a latency period of at least 1 week. There were no stillbirths (95% CI 0-1%), but the rate of neonatal mortality was 90 per 1,000 newborns (95% CI 57-112) with a 7.3% cerebral palsy rate among survivors (95% CI 4.4-10.3%). In twin pregnancies, preterm PROM from 24 to 31 weeks of gestation is associated with a neonatal mortality rate of 9.0% and an overall cerebral palsy rate of 7.3%. A longer latency period is associated with less advanced cervical dilation and later gestational age at PROM. LEVEL OF EVIEDENCE: II.
Gezer, Cenk; Ekin, Atalay; Golbasi, Ceren; Kocahakimoglu, Ceysu; Bozkurt, Umit; Dogan, Askin; Solmaz, Ulaş; Golbasi, Hakan; Taner, Cuneyt Eftal
To determine whether urea and creatinine measurements in vaginal fluid could be used to diagnose preterm premature rupture of membranes (PPROM) and predict delivery interval after PPROM. A prospective study conducted with 100 pregnant women with PPROM and 100 healthy pregnant women between 24 + 0 and 36 + 6 gestational weeks. All patients underwent sampling for urea and creatinine concentrations in vaginal fluid at the time of admission. Receiver operator curve analysis was used to determine the cutoff values for the presence of PPROM and delivery within 48 h after PPROM. In multivariate logistic regression analysis, vaginal fluid urea and creatinine levels were found to be significant predictors of PPROM (p 6.7 mg/dl for urea and >0.12 mg/dl for creatinine. The optimal cutoff values for the detection of delivery within 48 h were >19.4 mg/dl for urea and >0.23 mg/dl for creatinine. Measurement of urea and creatinine levels in vaginal fluid is a rapid and reliable test for diagnosing and also for predicting delivery interval after PPROM.
Full Text Available The aim of the study was to compare sRAGE and esRAGE plasma levels in pregnant women with (A threatened premature labor (n=41, (B preterm premature rupture of membranes (n=49, and (C preterm rupture of membranes at term (n=48. The relationship between these and classic intrauterine infection markers and the latent time from symptoms up to delivery depending on RAGE’s concentration were investigated. In groups A and B, a positive correlation was found between plasma sRAGE and latent time (r = 0,422; p = 0,001; r = 0,413, p = 0,004, resp.. High prognostic values were found in both groups for plasma sRAGE concentration and the latent time from symptoms up to delivery. Groups B and C presented higher levels of esRAGE than group A (526,315 ± 129,453 pg/mL and 576,212 ± 136,237 pg/mL versus 485,918 ± 133,127 pg/mL, p< 0,05. The conclusion is that sRAGE concentration can be a favorable prognostic factor in the presence of symptoms of threatened premature labor. Higher esRAGE plasma level in case of the rupture of membranes in mature and premature pregnancy suggests its participation in fetal membranes destruction.
Amnioinfusion in preterm premature rupture of membranes (AMIPROM): a randomised controlled trial of amnioinfusion versus expectant management in very early preterm premature rupture of membranes--a pilot study.
Roberts, Devender; Vause, Sarah; Martin, William; Green, Pauline; Walkinshaw, Stephen; Bricker, Leanne; Beardsmore, Caroline; Shaw, Ben N J; McKay, Andrew; Skotny, Gaynor; Williamson, Paula; Alfirevic, Zarko
Fetal survival is severely compromised when the amniotic membrane ruptures between 16 and 24 weeks of pregnancy. Reduced amniotic fluid levels are associated with poor lung development, whereas adequate levels lead to better perinatal outcomes. Restoring amniotic fluid by means of ultrasound-guided amnioinfusion (AI) may be of benefit in improving perinatal and long-term outcomes in children of pregnancies with this condition. The AI in preterm premature rupture of membranes (AMIPROM) pilot study was conducted to assess the feasibility of recruitment, the methods for conduct and the retention through to long-term follow-up of participants with very early rupture of amniotic membranes (between 16 and 24 weeks of pregnancy). It was also performed to assess outcomes and collect data to inform a larger, more definitive, clinical trial. A prospective, non-blinded randomised controlled trial. A computer-generated random sequence using a 1 : 1 ratio was used. Randomisation was stratified for pregnancies in which the amniotic membrane ruptured between 16(+0) and 19(+6) weeks' gestation and 20(+0) and 24(+0) weeks' gestation. The randomisation sequence was generated in blocks of four. Telephone randomisation and intention-to-treat analysis were used. Four UK hospital-based fetal medicine units - Liverpool Women's NHS Trust, St. Mary's Hospital, Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust. Women with confirmed preterm prelabour rupture of membranes between 16(+0) and 24(+0) weeks' gestation. Women with multiple pregnancies, resultant fetal abnormalities or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal AI or expectant management (Exp) until 37 weeks of pregnancy, if the deepest pool of amniotic fluid was < 2 cm. Short-term maternal, pregnancy and neonatal outcomes and long-term outcomes for the child were studied. Long-term respiratory
Dutta, Eryn H; Behnia, Faranak; Boldogh, Istvan; Saade, George R; Taylor, Brandie D; Kacerovský, Marian; Menon, Ramkumar
In women with preterm premature rupture of the membranes (PPROM), increased oxidative stress may accelerate premature cellular senescence, senescence-associated inflammation and proteolysis, which may predispose them to rupture. We demonstrate mechanistic differences between preterm birth (PTB) and PPROM by revealing differences in fetal membrane redox status, oxidative stress-induced damage, distinct signaling pathways and senescence activation. Oxidative stress-associated fetal membrane damage and cell cycle arrest determine adverse pregnancy outcomes, such as spontaneous PTB and PPROM. Fetal membranes and amniotic fluid samples were collected from women with PTB and PPROM. Molecular, biochemical and histologic markers were used to document differences in oxidative stress and antioxidant enzyme status, DNA damage, secondary signaling activation by Ras-GTPase and mitogen-activated protein kinases, and activation of senescence between membranes from the two groups. Oxidative stress was higher and antioxidant enzymes were lower in PPROM compared with PTB. PTB membranes had minimal DNA damage and showed activation of Ras-GTPase and ERK/JNK signaling pathway with minimal signs of senescence. PPROM had higher numbers of cells with DNA damage, prosenescence stress kinase (p38 MAPK) activation and signs of senescence. Samples were obtained retrospectively after delivery. The markers of senescence that we tested are specific but are not sufficient to confirm senescence as the pathology in PPROM. Oxidative stress-induced DNA damage and senescence are characteristics of fetal membranes from PPROM, compared with PTB with intact membranes. PTB and PPROM arise from distinct pathophysiologic pathways. Oxidative stress and oxidative stress-induced cellular damages are likely determinants of the mechanistic signaling pathways and phenotypic outcome. This study is supported by developmental funds to Dr R. Menon from the Department of Obstetrics and Gynecology at The University of
Jeong Woo Park
Full Text Available To evaluate the effect of histological chorioamnionitis (HCA with a negative amniotic fluid (AF culture on adverse pregnancy and neonatal outcomes and inflammatory status in the AF compartment in women with preterm labor or preterm premature rupture of membranes (PPROM.This is a retrospective cohort study of 153 women diagnosed as having a preterm labor or PPROM (20-34 weeks who delivered singleton gestations within 48 hours of amniocentesis. AF obtained through amniocentesis was cultured, and interleukin (IL-6, IL-8, and metalloproteinase-9 (MMP-9 levels were determined. The placentas were examined histologically.The prevalence of HCA with negative AF culture was 23.5% (36/153. The women with HCA but with a negative AF culture (group 2 and those with a positive AF culture (group 3 had a significantly lower mean gestational age at amniocentesis and delivery than those with a negative AF culture and without HCA (group 1. Women in group 3 had the highest levels of AF IL-6, IL-8, and MMP-9, followed by those in group 2, and those in group 1. Composite neonatal morbidity was significantly higher in groups 2 and 3 than in group 1, but this was no longer significant after adjusting for confounders caused mainly by the impact of gestational age.In the women who delivered preterm neonates, HCA with a negative AF culture was associated with increased risks of preterm birth, intense intra-amniotic inflammatory response, and prematurity-associated composite neonatal morbidity, and its risks are similar to the risk posed by positive AF culture.
Porat, Shay; Amsalem, Hagai; Shah, Prakesh S; Murphy, Kellie E
The purpose of this study was to review systematically the efficacy of transabdominal amnioinfusion (TA) in early preterm premature rupture of membranes (PPROM). We conducted a literature search of EMBASE, MEDLINE, and ClinicalTrials.gov databases and identified studies in which TA was used in cases of proven PPROM and oligohydramnios. Risk of bias was assessed for observational studies and randomized controlled trials. Primary outcomes were latency period and perinatal mortality rates. Four observational studies (n = 147) and 3 randomized controlled trials (n = 165) were eligible. Pooled latency period was 14.4 (range, 8.2-20.6) and 11.41 (range -3.4 to 26.2) days longer in the TA group in the observational and the randomized controlled trials, respectively. Perinatal mortality rates were reduced among the treatment groups in both the observational studies (odds ratio, 0.12; 95% confidence interval, 0.02-0.61) and the randomized controlled trials (odds ratio, 0.33; 95% confidence interval, 0.10-1.12). Serial TA for early PPROM may improve early PPROM-associated morbidity and mortality rates. Additional adequately powered randomized control trials are needed. Copyright © 2012 Mosby, Inc. All rights reserved.
Chmait, Ramen H; Chon, Andrew H; Korst, Lisa M; Llanes, Arlyn; Kontopoulos, Eftichia V; Quintero, Ruben A
The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB). In this study trocar location was documented in the operating room. Lower uterine segment (LUS) location was defined as any insertion location was defined as ≥5 cm horizontally from the midline. Patient characteristics were tested against three outcomes: PPROM ≤ 21 days postoperative, PTB location, controlling for potential risk factors. A total of 743 patients were studied. Patients with LUS location were twice as likely as those with a more superior location to have PPROM ≤ 21 days (OR = 2.33, 1.12-4.83, p = 0.0236). Patients with both a LUS and Lateral location were over six times more likely to have PPROM ≤ 21 days (OR = 6.66, 2.36-18.78, p = 0.0003). Trocar insertion site was not associated with PTB. We found that trocar insertion in the LUS, particularly the lateral LUS, was associated with an increased risk of PPROM. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
González-Mesa, Ernesto; Herrera, José A; Urgal, Amaya; Lazarraga, Cristina; Benítez, María J; Gómez, Cristina
This paper shows temporal trends of latency period and perinatal survival after preterm premature rupture of membranes at or before 28 weeks (very early PPROM). We have studied retrospectively medical records of all cases of very early PPROM attended in our Obstetric Department from January 1, 2000 to December 31, 2010. A total of 327 cases of very early PPROM were attended, representing 0.4 % of all deliveries, 3.68 % of all preterm births and 15 % of cases all of PPROM. The mean gestational age at delivery was 27 weeks (range 20-34). The mean duration of latency period for the total of 327 cases was 12.1 days (range 0-83, SD 13.3), with a clear trend to its increase from 2005 (p 2000-2010, perinatal deaths reached 30.6 % of all cases, with a clear trend to decrease as gestational age at diagnosis increased, and over the years of study. We have also found a high rate of obstetric complications and a high rate of cesarean deliveries. The upward trend in the duration of latency period in all groups over the years of study and the encouraging perinatal survival observed, even in previable PPROM, are incentives to follow expectant/conservative management in these cases.
Pakrashi, Tarita; Defranco, Emily A
To compare the relative contribution of premature rupture of membranes (PROM) to preterm births in singleton compared with multifetal gestations. A population-based retrospective cohort study of 291,782 nonanomalous live births in the state of Ohio from January 1, 2006, to December 31, 2007, identified through birth certificate data. Frequency of PROM was compared between singleton and multifetal gestations and then stratified by gestational age at birth. Multivariate regression analysis estimated the risk of PROM by plurality in each gestational age group, accounting for influential risk factors. The frequency of PROM increased with increasing plurality of gestation. The relative proportion of preterm birth < 37 weeks complicated by PROM increased with gestational plurality 13.2% singletons, 16.8% twins, 20.0% triplets, 19.6% quadruplets, and 100% for higher-order multiples (p < 0.001). The frequency of PROM increased with earlier gestational age at birth, regardless of plurality. The increased risk of PROM in multifetal gestation persisted even after adjustment for influential concomitant risk factors. The proportion of preterm birth attributable to PROM increases by plurality of gestation, with its most significant contribution in higher-order multiples and at earliest gestational ages when outcomes are the poorest. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
M. G. Nikolayeva
Full Text Available The retrospective study was designed to identify association of premature rupture of the fetal membranes (PROM with carrying polymorphisms in genes encoding folate metabolism and hemostasis in 717 women. More than one hundred potential predictors were analyzed including carriage of thrombogenic genes polymorphisms and genes encoding folate metabolism: FV[Arg506Gln], F II [20210 G/A], MTHFR [Ala222Val], (PAI-I[-675 5G/4G]. Study revealed that plasminogen activator ingibitor-1 gene polymorphism increases significantly the risk of premature rupture of the fetal membranes in term pregnancy (PROM: heterozygous plasminogen activator ingibitor-1 gene polymorphism is associated with 3.6-fold (95% CI 2.4–5.4; p < 0.001, homozygous plasminogen activator ingibitor-1 gene polymorphism – with 1.7-fold (95% CI 1.1–2.6; p = 0.01 risk rise of PROM.
Isnard, T; Vincent-Rohfritsch, A; Le Ray, C; Goffinet, F; Patkai, J; Sibiude, J
To describe survival rate after preterm premature rupture of membranes (PPROM) before 25 weeks of gestation and compare neonatal morbidity and mortality among those born alive with a control group of infants born at a similar gestational age without premature rupture of membranes. We conducted a retrospective single-centre study at Port-Royal maternity, from 2007 to 2015, comparing neonatal outcomes between liveborninfants exposed to PPROM prior to 25 weeks of gestation (WG) and a control group not exposed to premature rupture of the membranes. For each live-born child, the next child born after spontaneous labor without PPROM was matched for gestational age at birth, sex, and whether or not they received antenatal corticosteroid therapy. The primary endpoint was severe neonatal complications assessed by a composite endpoint including neonatal deaths, grade 3-4 HIV, bronchopulmonary dysplasia, leukomalacia and stade 3-4 retinopathies. Among 77 cases of very premature rupture of the membranes, 55 children were born alive. Among these, the average gestational age at birth was 28 WG and 1 day. The rate of severe neonatal complications did not differ between the two groups (43.6% in the PPROM group vs. 36.4%, P=0.44) and the survival rate at discharge was also similar in the two groups (85.5% vs. 83.6%, P=0.98). In our cohort and among livebirths after 24 WG, PPROM before 25 WG was not associated with an increased risk of morbidity and mortality compared to children born at the same gestational age after a spontaneous labor with intact membranes. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
Dołegowska, Barbara; Kwiatkowski, Sebastian; Sałata, Daria; Budkowska, Marta; Domański, Leszek; Mikołajek-Bedner, Wioletta; Torbé, Andrzej
The aim of the study was to compare sRAGE and esRAGE plasma levels in pregnant women with (A) threatened premature labor (n = 41), (B) preterm premature rupture of membranes (n = 49), and (C) preterm rupture of membranes at term (n = 48). The relationship between these and classic intrauterine infection markers and the latent time from symptoms up to delivery depending on RAGE's concentration were investigated. In groups A and B, a positive correlation was found between plasma sRAGE and latent time (r = 0,422; p = 0,001; r = 0,413, p = 0,004, resp.). High prognostic values were found in both groups for plasma sRAGE concentration and the latent time from symptoms up to delivery. Groups B and C presented higher levels of esRAGE than group A (526,315 ± 129,453 pg/mL and 576,212 ± 136,237 pg/mL versus 485,918 ± 133,127 pg/mL, ppremature labor. Higher esRAGE plasma level in case of the rupture of membranes in mature and premature pregnancy suggests its participation in fetal membranes destruction. PMID:26413536
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Full Text Available Introduction. Pre-term premature rupture of membranes (PPROM is one of the leading causes of perinatal morbidity and mortality. This complication is diagnosed in 3% of pregnant women in Kazakhstan, and it is the leading cause of pre-term deliveries. The aim of this study was to determine the outcomes of pregnancies complicated by PPROM in gestation periods between 24 to 32 weeks among three institutions in Kazakhstan.Methods. This is descriptive analysis of 154 cases with PPROM observed between 24 to 32 weeks of gestation at Perinatal Centers #2 and #3 and the National Research Center for Maternal and Child Health, Astana, Kazakhstan. Cases were selected on the basis of retrospective chart review where PPROM diagnosis occurred in 2013. Descriptive statistics were utilized for data analysis.Results. The most frequent complications associated with PPROM were threat of miscarriage (13.6% of cases and chronic placental insufficiency (7.8%. The mean time between PPROM and onset of spontaneous labor was 12.1 ± 2.3 days. Spontaneous labor within 3 days after PPROM started in patients with an amniotic fluid index of 3.0 ± 0.2 cm. Complications experienced by PPROM women during delivery and early postpartum period included: precipitous labor (6.4%, weakness of labor activity (16.2%, atonic hemorrhage (1.2%, and chorioamnionitis (3.2%. 37.6% of newborns in this study were admitted to the Intensive Care Unit. Their health complications included pneumonia (7.7%, conjunctivitis (1.3%, omphalitis and infectious-toxic shock (3.8%, intraventricular hemorrhage (7.8%, and respiratory distress (10.3% .Conclusion. Thus, preterm rupture of membranes is associated with preterm delivery and an increase of neonatal morbidity. Therefore, it is necessary to find ways to effectively manage PPROM, including developing new techniques to restore the amniotic fluid volume in women experiencing PPROM during 24 to 32 weeks of gestation.
Nakubulwa, Sarah; Kaye, Dan K; Bwanga, Freddie; Tumwesigye, Nazarius Mbona; Mirembe, Florence M
Inflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda. We conducted an unmatched case-control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on socio-demographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between genital infections and PROM. There was an association between PROM and abnormal vaginal discharge (OR = 2.02, 95% CI 1.10-3.70 and AOR = 2.30, 95% CI 1.18-4.47), presence of candidiasis (OR = 0.27, 95% CI 0.14-0.52 and AOR = 0.22, 95% CI 0.10-0.46) and T. vaginalis (OR = 2.98, 95% CI 1.18-7.56 and AOR = 4.22, 95% CI 1.51-11.80). However, there was no association between PROM and presence of C. trachomatis (OR = 2.05, 95% CI 0.37-11.49) and HSV-2 serostatus (OR = 1.15, 95% CI 0.63-2.09). Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM (AOR = 1.34, 95% CI 0.16-11.10). Co infection with T. vaginalis and C. trachomatis was associated with PROM (OR = 3.09, 95% CI 1.21-7.84 and AOR = 4.22, 95% CI 1
Amorosa, Jennifer M H; Stone, Joanne; Factor, Stephanie H; Booker, Whitney; Newland, Meredith; Bianco, Angela
In premature rupture of membranes (PROM), the risk of chorioamnionitis increases with increasing duration of membrane rupture. Decreasing the time from PROM to delivery is associated with lower rates of maternal infection. The American College of Obstetricians and Gynecologists suggests that all women with PROM who do not have a contraindication to vaginal delivery have their labor induced instead of being managed expectantly. Although the use of oxytocin for labor induction has been demonstrated to decrease the time to delivery compared with expectant management, no studies have evaluated the effectiveness of cervical ripening with a Foley bulb to additionally decrease the time to delivery. To determine whether simultaneous use of an intracervical Foley bulb and oxytocin decreases time from induction start to delivery in nulliparous patients with PROM compared with the use of oxytocin alone. A randomized trial was conducted from August 2014 to February 2016 that compared the use of concurrent Foley bulb/oxytocin vs oxytocin alone in nulliparous patients ≥34 weeks' gestational undergoing labor induction for PROM. Our primary outcome was time from induction to delivery. Secondary outcomes were mode of delivery, tachysystole, chorioamnionitis, postpartum hemorrhage, Apgar scores, and admission to the neonatal intensive care unit. A total of 128 women were randomized. Baseline characteristics were similar between groups. We found no difference in induction-to-delivery time between women induced with concurrent Foley bulb/oxytocin vs oxytocin alone (median time 13.0 hours [interquartile 10.7, 16.1] compared with 10.8 hours [interquartile range 7.8, 16.6], respectively, P = .09). There were no significant differences in mode of delivery, rates of postpartum hemorrhage, chorioamnionitis, or epidural use. Both groups had similar rates of tachysystole as well as total oxytocin dose. There were no differences in neonatal birth weight, Apgar scores, cord gases, or
Cohen, Aviad; Skornick-Rapaport, Avital; Cohen, Yoni; Mandel, Dror; Rimon, Eli
To compare the neonatal outcome in twin gestations complicated by prolonged preterm premature rupture of membranes (PPROM). Between the years 2000 and 2010 we identified 48 women with twin pregnancies who were diagnosed as having PPROM and a latency period to delivery >24h. We compared the neonatal morbidity and mortality between the presenting and non-presenting twins, assuming that the rupture occurred in the lower sac. Importantly, in 30 women we were able to identify the location of the ruptured sac by ultrasound examination demonstrating oligohydramnion. In these 30 cases, neonatal outcome of fetuses in the ruptured sac and those in the intact sac were compared. The median gestational age was 31 weeks (range 28-33) with a median latency period between PPROM and delivery of 9 days (range 1-18). Of the identified ruptures 90% (27/30) occurred in the lower sac (presenting twin). There was no significant difference between the presenting and non-presenting twin in terms of neonatal morbidity and mortality. Moreover, no difference was found when fetuses with ruptured sac were compared to those with intact membrane sac. Importantly, the outcomes were not affected by the length of the latency period. The current study results demonstrated that the outcome of fetuses exposed to prolonged preterm rupture of membranes is similar to that of fetuses with intact membranes. Our data suggest that rupture of membranes per se did not cause any deleterious clinical manifestations or lead to clinical discordant inflammation and poor neonatal outcome, supporting a conservative management of twin pregnancies with PPROM. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Kibel, Mia; Asztalos, Elizabeth; Barrett, Jon; Dunn, Michael S; Tward, Carly; Pittini, Alex; Melamed, Nir
To assess the natural history and contemporary outcomes in pregnancies complicated by previable preterm premature rupture of membranes (PROM). Retrospective study of all women with a singleton or twin pregnancy admitted to a single tertiary referral center who experienced preterm PROM between 20 and 23 6/7 weeks of gestation during 2004-2014 and underwent expectant management. Women electing termination of pregnancy and pregnancies complicated by major fetal anomalies were excluded. Severe neonatal morbidity was defined as a composite of bronchopulmonary dysplasia, severe neurologic injury, or severe retinopathy of prematurity. Long-term follow-up to a corrected age of 18-21 months was available for the majority of surviving neonates. Of the 140 neonates born to women with previable preterm PROM during the study period, 104 were eligible for the study. Overall 51 (49.0%, 95% confidence interval [CI] 39.4-58.6%) newborns survived to discharge, of whom 24 (47.1%, 95% CI 33.4-60.8%) experienced severe neonatal morbidity. The overall rate of long-term morbidity among surviving neonates was 23.3% (95% CI 11.7-34.9%) and was significantly higher among neonates who previously experienced severe neonatal morbidity compared with those who did not (39.1% compared with 10.0%, P=.04). The only two factors that were significantly associated with overall survival and survival without severe neonatal morbidity were gestational age at preterm PROM of 22 weeks or greater (adjusted odds ratio [OR] 12.2, 95% CI 3.3-44.8 and adjusted OR 4.8, 95% CI 1.2-19.3, respectively) and a latency period of greater than 7 days (adjusted OR 10.1, 95% CI 3.2-31.6, and adjusted OR 6.7, 95% CI 2.2-21.0, respectively). Expectant management was associated with maternal risks including placental abruption (17.3%, 95% CI 10.0-24.6%) and sepsis (4.8%, 95% CI 0.7-8.9%). Expectant management in pregnancies complicated by previable preterm PROM between 20 and 23 6/7 weeks of gestation is associated with an
Luo, Xiucui; Pan, Jing; Wang, Leilei; Wang, Peirong; Zhang, Meijiao; Liu, Meilin; Dong, Ziqing; Meng, Qian; Tao, Xuguang; Zhao, Xinliang; Zhong, Julia; Ju, Weina; Gu, Yang; Jenkins, Edmund C; Brown, W Ted; Shi, Qingxi; Zhong, Nanbert
Preterm premature rupture of membranes (PPROM) is responsible for one third of all preterm births (PTBs). We have recently demonstrated that long noncoding RNAs (lncRNAs) are differentially expressed in human placentas derived from PPROM, PTB, premature rupture of the membranes (PROM), and full-term birth (FTB), and determined the major biological pathways involved in PPROM. Here, we further investigated the relationship of lncRNAs, which are differentially expressed in spontaneous PTB (sPTB) and PPROM placentas and are found to overlap a coding locus, with the differential expression of transcribed mRNAs at the same locus. Ten lncRNAs (five up-regulated and five down-regulated) and the lncRNA-associated 10 mRNAs (six up- and four down-regulated), which were identified by microarray in comparing PPROM vs. sPTB, were then validated by real-time quantitative PCR. A total of 62 (38 up- and 24 down-regulated) and 1,923 (790 up- and 1,133 down-regulated) lncRNAs were identified from placentas of premature labor (sPTB + PPROM), as compared to those from full-term labor (FTB + PROM) and from premature rupture of membranes (PPROM + PROM), as compared to those from non-rupture of membranes (sPTB + FTB), respectively. We found that a correlation existed between differentially expressed lncRNAs and their associated mRNAs, which could be grouped into four categories based on the gene strand (sense or antisense) of lncRNA and its paired transcript. These findings suggest that lncRNA regulates mRNA transcription through differential mechanisms. Differential expression of the transcripts PPP2R5C, STAM, TACC2, EML4, PAM, PDE4B, STAM, PPP2R5C, PDE4B, and EGFR indicated a co-expression among these mRNAs, which are involved in the ubiquitine-proteasome system (UPS), in addition to signaling transduction and beta adrenergic signaling, suggesting that imbalanced regulation of UPS may present an additional mechanism underlying the premature rupture of membrane in PPROM
Huang, Sha; Xia, Wei; Li, Yuanyuan; Zhang, Bin; Zhou, Aifen; Zheng, Tongzhang; Qian, Zhengmin; Huang, Zheng; Lu, Shi; Chen, Zhong; Wang, Youjie; Pan, Xinyun; Huo, Wenqian; Jin, Shuna; Jiang, Yangqian; Xu, Shunqing
Chromium exposure from increasing industrial releases has become a threat for pregnant women due to the potential health effects on vulnerable embryos. Previous studies have suggested that maternal chromium exposure is associated with adverse birth outcomes, but no epidemiological research has been conducted to examine the relationship between chromium exposure and premature rupture of membranes (PROM). This study aimed at investigating the association of maternal urinary chromium exposure levels with PROM and was performed with 5408 pregnant women recruited from 2012 to 2014 in the city of Wuhan, China. Maternal urinary chromium collected before labor was adjusted with creatinine, and its association with PROM was evaluated using logistic regression. Each one unit increase in the natural logarithm transformed maternal urinary chromium concentration (μg/g creatinine), an odds ratio (OR) of 1.47 [95% confidence interval (CI): 1.36, 1.58] for PROM was observed. Compared to the lowest tertile of maternal urinary chromium, PROM was positively correlated with increased urinary levels of chromium (adjusted OR = 1.42; 95% CI: 1.09, 1.84 for the medium tertile; adjusted OR = 2.77; 95% CI: 2.18, 3.52 for the highest tertile). Additionally, the association of chromium with PROM appeared to be more significant among male infants (adjusted OR = 3.52; 95% CI: 2.51, 4.94 for the highest tertile) than female infants (adjusted OR = 2.16; 95% CI: 1.52, 3.06 for the highest tertile) (p for interaction = 0.05). Our large birth cohort showed an association between maternal urinary chromium levels and PROM, and the association may differ by infant gender. Further studies from different populations are needed to confirm the observed association. Copyright © 2017 Elsevier Ltd. All rights reserved.
Mehra, Suwan; Amon, Erol; Hopkins, Sarah; Gavard, Jeffrey A; Shyken, Jaye
We sought to determine whether transvaginal cervical length (TVCL), amniotic fluid index (AFI), or a combination of both can predict delivery latency within 7 days in women presenting with preterm premature rupture of membranes (PPROM). This was a prospective observational study of TVCL measurements in 106 singleton pregnancies with PPROM between 23-33 weeks. Delivery latency was defined as the period (in days) from the initial TVCL after PPROM to delivery of the infant, with our primary outcome being delivery within 7 days of TVCL. The independent predictability of significant characteristics for delivery within 7 days was determined using multiple logistic regression. Sensitivity, specificity, and predictive values were used to examine whether the presence of a short TVCL, AFI, or a combination of both affected the risk of delivery within 7 days. Delivery within 7 days occurred in 51/106 (48%) of pregnancies. Median duration (interquartile range) from PPROM to delivery and TVCL to delivery was 8 days (4.0-16.0) and 8 days (3.0-15.0), respectively. Using multiple regression TVCL as a continuous variable (odds ratio, 0.65; 95% confidence interval, 0.44-0.97; P 7 days for TVCL >2 cm alone was 61%. This predictive value changed when analyzed in conjunction with an AFI ≤5 cm and >5 cm at 42% and 89%, respectively. A shorter TVCL and an AFI ≤5 cm independently predict delivery within 7 days in women presenting with PPROM. The combination of an AFI >5 cm and TVCL >2 cm greatly improved the potential to remain undelivered at 7 days following cervical length assessment. These findings may be helpful for counseling and optimizing maternal and neonatal care in women with PPROM. Copyright © 2015 Elsevier Inc. All rights reserved.
Barrett, Bridget M.
The purpose of this study was to examine the status of antioxidant vitamins in women with premature rupture of the fetal membranes. Specimens of blood and amniotic fluid were obtained from 80 pregnant subjects included both smokers and non-smokers during the third trimester. The concentrations of ascorbic acid (ASA), beta -carotene, retinol and alpha -tocopherol in serum and amniotic fluid were determined. The experimental group consisted of those subjects with PROM while the control subjects were those with normal pregnancy. No statistical differences were found between the PROM and control groups in retinol and vitamin E concentrations in amniotic fluid and serum. Serum ASA concentrations of PROM subjects were not different from controls, but the PROM subjects had significantly lower amniotic fluid ASA concentrations. However, in a study with fewer subjects a lower serum ASA concentration in the PROM subjects was observed. The ratio of amniotic fluid ASA concentration to ASA serum concentration was significantly lower in PROM patients than in controls in both studies. This suggests that low levels of ASA in the amniotic fluid, but not in serum is better associated with PROM. A low amniotic fluid concentration of ASA may reflect an inefficient transfer and/or increased fetal utilization. Alterations in ASA concentration in the amniotic fluid may affect the integrity of the chorioamnion leading to PROM. beta -Carotene was not found in the amniotic fluid. Serum beta-carotene levels were significantly lower in the PROM group compared to the control group. Low concentrations of beta-carotene in maternal serum in smokers not only associated with poor maternal outcome (PROM) but also compromised the fetal outcome (decreased birth weight). Maintenance of adequate serum beta-carotene concentration and amniotic fluid ASA in smokers may result in better maternal and fetal outcome. This study demonstrated that nutrition is an important factor in the prevention of PROM.
Recommendations about the management of premature rupture of membranes at term are based, in part, on a large, randomized controlled trial published in 1996: the TERMPROM trial. The original article contained an error in Table 1, in which "Interval from membrane rupture to delivery" was listed instead of "Interval from membrane rupture to study entry." While the authors and journal corrected this error, the mistake published in the original paper has made its way into subsequent publications and even in guidelines or practice bulletins issued by professional organizations, textbooks, and other publications around the world. The mistake, that half of women with premature rupture of membranes at term who were managed expectantly delivered within 5 hours and 95% delivered within 28 hours of membrane rupture, should be replaced with the actual fact that half of women with premature rupture of membranes at term who were managed expectantly delivered within 33 hours, and 95% delivered within 94-107 hours of membrane rupture. Correcting this error in contemporary health care information and publications is important to counsel patients accurately and to optimize the clinical care of women with premature rupture of membranes at term. Copyright © 2017 Elsevier Inc. All rights reserved.
Lu, Hong-Yan; Zhang, Qiang; Wang, Qiu-Xia; Lu, Jun-Ying
To determine the association of histologic chorioamnionitis (HCA) and fetal inflammatory response syndrome (FIRS) with brain injuries in infants born to mothers with preterm premature rupture of membranes. A total of 103 singleton infants born to mothers with preterm premature rupture of membranes were enrolled. The placental inflammation was confirmed by HCA, and FIRS was defined in fetuses with preterm labor and an elevation of the fetal plasma interleukin-6 concentration. Examination of brain images was conducted to confirm the existence of brain injuries. Based on placental HCA and umbilical cord blood interleukin-6 level, all patients were divided into three groups: HCA(-)FIRS(+), HCA(+)FIRS(-), and HCA(+)FIRS(+). Among all infants with preterm premature rupture of membranes, 53.40% were exposed to HCA, 20.38% experienced FIRS, and the overall incidence of brain injuries was 38.83%. The incidence of brain injury in HCA(-)FIRS(+), HCA(+)FIRS(-), and HCA(+)FIRS(+) groups were 20.83%, 41.18%, and 76.19%, respectively. HCA at the advanced grades and stages was associated with increased risk of brain injury. Umbilical cord blood levels of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α), and granulocyte-colony stimulating factor (G-CSF) in premature infants with brain injuries were significantly higher than in those without brain injuries. Infants diagnosed with both HCA and FIRS showed significantly higher levels of IL-8, TNF-α, and G-CSF than those with HCA alone. Preterm infants exposed to severe chorioamnionitis had an increased risk of brain injury. IL-6, IL-8, TNF-α, and G-CSF in cord blood were associated with brain injuries in preterm infants and may be used as extradiagnostic criteria. Copyright © 2016 Elsevier Inc. All rights reserved.
Kurek Eken, Meryem; Tüten, Abdülhamit; Özkaya, Enis; Karatekin, Güner; Karateke, Ateş
To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM). A population-based retrospective study including 331 singleton pregnant women with PPROM at 24-34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age, oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival. In linear regression analyses, birth weight, ROP, CCD, BPD, PDA, NEC and preeclampsia were significant confounders for length of stay in the NICU. Among them, birth weight was the most powerful confounder for prolongation of the NICU stay (t: -6.43; p Prematurity-related complications are the most important problems for which precautions should be taken. Therefore, premature deliveries should be avoided to prevent infection and to prolong the latent period in cases of PPROM in order to decrease prematurity-related outcomes.
Ilhan, N; Aygun, B K; Gungor, H
A major cause of perinatal morbidity and mortality has been reported to be preterm premature rupture of membranes (PPROM). Our objective was to evaluate oxidant-antioxidant balance, infection parameters, time interval between rupture of membranes and delivery (latency period), and the relationship among all these parameters. Seventy-five cases with PPROM between 24 and 34 gestational weeks were included in the study. A control group of 41 women who gave birth at term were considered as the control group. The relationship among maternal plasma total oxidative stress (TOS), malondialdehyde (MDA), total antioxidant status (TAS), leukocyte counts, CRP, vitamin C and E levels, gestational week, neonatal birthweight, and latency period was evaluated. In cases with PPROM, rupture occurred at an average of 29.4 gestational weeks and premature babies were born at an average of 31.6 gestational weeks. The mortality rate of babies born to PPROM women was 18.7% (14/75) died at or following birth. In the PPROM group, TOS, MDA, and leukocyte counts were found to be significantly higher compared to the control group (p < 0.001). Besides, a significant negative correlation was detected among the latency period, TOS, CRP, and leukocyte counts (p < 0.05). Appropriate treatment protocols that strengthen antioxidant defense systems and taking into consideration the signs of infection can decrease the incidence of PPROM and/or mortality rates of babies born to PPROM women.
Zhang, Li-Xia; Sun, Yang; Zhao, Hai; Zhu, Na; Sun, Xing-De; Jin, Xing; Zou, Ai-Min; Mi, Yang; Xu, Ji-Ru
Preterm premature rupture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory distress syndrome. Genital infection is a very important risk which closely related with PPROM. The preliminary study only made qualitative research on genital infection, but there was no deep and clear judgment about the effects of pathogenic bacteria. This study was to analyze the association of infections with PPROM in pregnant women in Shaanxi, China, and to establish Bayesian stepwise discriminant analysis to predict the incidence of PPROM. In training group, the 112 pregnant women with PPROM were enrolled in the case subgroup, and 108 normal pregnant women in the control subgroup using an unmatched case-control method. The sociodemographic characteristics of these participants were collected by face-to-face interviews. Vaginal excretions from each participant were sampled at 28-36+6 weeks of pregnancy using a sterile swab. DNA corresponding to Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Candida albicans, group B streptococci (GBS), herpes simplex virus-1 (HSV-1), and HSV-2 were detected in each participant by real-time polymerase chain reaction. A model of Bayesian discriminant analysis was established and then verified by a multicenter validation group that included 500 participants in the case subgroup and 500 participants in the control subgroup from five different hospitals in the Shaanxi province, respectively. The sociological characteristics were not significantly different between the case and control subgroups in both training and validation groups (all P > 0.05). In training group, the infection rates of UU (11.6% vs. 3.7%), CT (17.0% vs. 5.6%), and GBS (22.3% vs. 6.5%) showed statistically different between the case and control subgroups (all P case and control subgroups (P case and control subgroup were 84.1% and 86.8% in the training and validation groups, respectively
Lee, Sarah Y.; Buhimschi, Irina A.; Dulay, Antonette T.; Ali, Unzila A.; Zhao, Guomao; Abdel-Razeq, Sonya S.; Bahtiyar, Mert O.; Thung, Stephen F.; Funai, Edmund F.; Buhimschi, Catalin S.
Classic IL-6 signaling is conditioned by the transmembrane receptor (IL-6R) and homodimerization of gp130. During trans-signaling, IL-6 binds to soluble IL-6R (sIL-6R) enabling activation of cells expressing solely gp130. Soluble gp130 (sgp130) selectively inhibits IL-6 trans-signaling. To characterize amniotic fluid IL-6 trans-signaling molecules (IL-6, sIL-6R, sgp130) in normal gestations and pregnancies complicated by intra-amniotic inflammation (IAI) we studied 301 women during second trimester (n=39), third trimester (n=40) and preterm labor with intact (n=131, 85 IAI negative & 46 IAI positive) or preterm premature rupture of membranes (PPROM: n=91, 61 IAI negative & 30 IAI positive). ELISA, Western blotting and RT-PCR were used to investigate amniotic fluid, placenta and amniochorion for protein and mRNA expression of sIL-6R, sgp130, IL-6R and gp130. Tissues were immunostained for IL-6R, gp130, CD15+ (polymorphonuclear) and CD3+ (T-cell) inflammatory cells. The ability of sIL-6R and sgp130 to modulate basal and LPS-stimulated release of amniochorion matrix-metalloprotease-9 (MMP-9) was tested ex-vivo. We showed that in physiologic gestations amniotic fluid sgp130 decreases toward term. Amniotic fluid IL-6 and sIL-6R were elevated in IAI whereas sgp130 was decreased in PPROM. Our results suggested that fetal membranes are the probable source of amniotic fluid sIL-6R and sgp130. Immunohistochemistry and RT-PCR revealed increased IL-6R and decreased gp130 expression in amniochorion of women with IAI. Ex-vivo, sIL-6R and LPS augmented amniochorion MMP-9 release whereas sgp130 opposed this effect. We conclude that IL-6 trans-signaling molecules are physiologic constituents of the amniotic fluid regulated by gestational age and inflammation. PPROM likely involves functional loss of sgp130. PMID:21282511
Pavcnik-Arnol, Maja; Lucovnik, Miha; Kornhauser-Cerar, Lilijana; Premru-Srsen, Tanja; Hojker, Sergej; Derganc, Metka
Intra-amniotic inflammation with preterm premature rupture of membranes (PPROM) is a risk factor for fetal inflammatory response syndrome (FIRS) and adverse neonatal outcome. To evaluate the diagnostic accuracy of lipopolysaccharide-binding protein (LBP) for detecting FIRS in preterm neonates born after PPROM. This was a prospective study in the level III neonatal intensive care unit (42 neonates; 23 + 6 to 31 + 6 weeks' gestation) of mothers with PPROM. Umbilical cord blood concentrations of LBP, C-reactive protein (CRP), interleukin (IL)-6 and white blood cell count with differential were measured at delivery and 24 h after birth. Neonates were classified into FIRS (n = 22) and no FIRS (n = 20) groups according to clinical criteria and IL-6 level (≥17.5 pg/ml). Histological examination of the placenta and umbilical cord was performed. Neurological examination at 12 months' corrected age was performed. Umbilical cord blood concentration of LBP was significantly higher in the FIRS group than in the no FIRS group at delivery (median 21.6 mg/l vs. median 2.3 mg/l; p < 0.0001) and 24 h after birth (median 17.2 mg/l vs. median 20.0 mg/l; p < 0.001). The area under the ROC curve for FIRS at delivery was 0.98 (95% CI 0.88-1.0) for LBP, 0.92 (95% CI 0.80-0.99) for CRP and 0.82 (95% CI 0.64-0.94) for immature to total neutrophil ratio. Similar results were obtained if FIRS was defined by funisitis. Umbilical cord blood concentration of LBP at delivery was significantly higher in neonates with abnormal neurological exam at 12 months than in those with normal exam (median 19.5 mg/l vs. median 3.75 mg/l; p < 0.015). In preterm neonates born to asymptomatic women with PPROM, LBP in cord blood at delivery is an excellent diagnostic biomarker of FIRS/funisitis with prognostic potential. © 2013 S. Karger AG, Basel.
Lee, Sarah Y; Buhimschi, Irina A; Dulay, Antonette T; Ali, Unzila A; Zhao, Guomao; Abdel-Razeq, Sonya S; Bahtiyar, Mert O; Thung, Stephen F; Funai, Edmund F; Buhimschi, Catalin S
Classic IL-6 signaling is conditioned by the transmembrane receptor (IL-6R) and homodimerization of gp130. During trans-signaling, IL-6 binds to soluble IL-6R (sIL-6R), enabling activation of cells expressing solely gp130. Soluble gp130 (sgp130) selectively inhibits IL-6 trans-signaling. To characterize amniotic fluid (AF) IL-6 trans-signaling molecules (IL-6, sIL-6R, sgp130) in normal gestations and pregnancies complicated by intra-amniotic inflammation (IAI), we studied 301 women during second trimester (n = 39), third trimester (n = 40), and preterm labor with intact (n = 131, 85 negative IAI and 46 positive IAI) or preterm premature rupture of membranes (PPROM; n = 91, 61 negative IAI and 30 positive IAI). ELISA, Western blotting, and real-time RT-PCR were used to investigate AF, placenta, and amniochorion for protein and mRNA expression of sIL-6R, sgp130, IL-6R, and gp130. Tissues were immunostained for IL-6R, gp130, CD15(+) (polymorphonuclear), and CD3(+) (T cell) inflammatory cells. The ability of sIL-6R and sgp130 to modulate basal and LPS-stimulated release of amniochorion matrix metalloprotease-9 was tested ex vivo. We showed that in physiologic gestations, AF sgp130 decreases toward term. AF IL-6 and sIL-6R were increased in IAI, whereas sgp130 was decreased in PPROM. Our results suggested that fetal membranes are the probable source of AF sIL-6R and sgp130. Immunohistochemistry and RT-PCR revealed increased IL-6R and decreased gp130 expression in amniochorion of women with IAI. Ex vivo, sIL-6R and LPS augmented amniochorion matrix metalloprotease-9 release, whereas sgp130 opposed this effect. We conclude that IL-6 trans-signaling molecules are physiologic constituents of the AF regulated by gestational age and inflammation. PPROM likely involves functional loss of sgp130.
Polettini, J; Dutta, E H; Behnia, F; Saade, G R; Torloni, M R; Menon, R
Many adverse pregnancy outcomes (APOs), including spontaneous preterm birth (PTB), are associated with placental dysfunction. Recent clinical and experimental evidences suggest that premature aging of the placenta may be involved in these events. Although placental aging is a well-known concept, the mechanisms of aging during normal pregnancy and premature aging in APOs are still unclear. This review was conducted to assess the knowledge on placental aging related biochemical changes leading to placental dysfunction in PTB and/or preterm premature rupture of membranes (pPROM). We performed a systematic review of studies published over the last 50 years in two electronic databases (Pubmed and Embase) on placental aging and PTB or pPROM. The search yielded 554 citations, 30 relevant studies were selected for full-text review and three were included in the review. Only one study reported oxidative stress-related aging and degenerative changes in human placental membranes and telomere length reduction in fetal cells as part of PTB and/or pPROM mechanisms. Similarly, two animal studies reported findings of decidual senescence and referred to PTB mechanisms. Placental and fetal membrane oxidative damage and telomere reduction are linked to premature aging in PTB and pPROM but the risk factors and biomolecular pathways causing this phenomenon are not established in the literature. However, no biomarkers or clinical indicators of premature aging as a pathology of PTB and pPROM have been reported. We document major knowledge gaps and propose several areas for future research to improve our understanding of premature aging linked to placental dysfunction. Copyright © 2015 Elsevier Ltd. All rights reserved.
Gungorduk, Kemal; Asicioglu, Osman; Gungorduk, Ozgu Celikkol; Yildirim, Gokhan; Besimoğlu, Berhan; Ark, Cemal
To determine whether maternal vitamin C and vitamin E supplementation after the premature rupture of membranes is associated with an increase in the latency period before delivery. In the present prospective open randomized trial, 229 pregnant women with preterm premature rupture of membranes (PPROM) at ≥ 24.0 and vitamin C and 400 IU of vitamin E (n = 126) or a placebo (n = 123). The primary outcome was the latency period until delivery. Analysis was performed on an intention-to-treat basis. No significant differences in demographic or clinical characteristics were observed between the groups. Latency period until delivery was significantly higher in the group that received vitamins compared with the control group (11.2 ± 6.3 days versus 6.2 ± 4.0 days; p vitamin group compared with the control group (31.9 ± 2.6 weeks versus 31.0 ± 2.6 weeks; p = 0.01). No significant differences in adverse maternal outcome (i.e., chorioamnionitis or endometritis) or neonatal outcome (i.e., neonatal sepsis, neonatal death, necrotizing enterocolitis, or grade 3 to 4 intraventricular hemorrhage) were noted between groups. The findings of the present study suggest that the use of vitamins C and E in women with PPROM is associated with a longer latency period before delivery. Moreover, adverse neonatal and maternal outcomes, which are often associated with prolonged latency periods, were similar between the groups. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
José Mauro Madi
Full Text Available OBJETIVO: avaliar os resultados perinatais em casos de oligodramnia sem rotura de membranas amnióticas. MÉTODOS: foram estudados retrospectivamente 51 casos consecutivos de oligodramnia (índice de líquido amniótico (ILA menor que 5 cm em nascimentos ocorridos no período de março de 1998 a setembro de 2001. Compararam-se os dados obtidos aos de 61 casos com quantidade intermediária e normal de líquido amniótico (ILA >5 cm. Analisaram-se variáveis maternas e neonatais, bem como taxas de mortalidade fetal, neonatal precoce e perinatal. As avaliações estatísticas foram realizadas mediante a aplicação do teste não paramétrico do c² com a correção de Yates, e do teste t de Student. Adotou-se o nível de significância de 5%. RESULTADOS: não houve diferença significante entre os grupos estudados, ao se analisar a ocorrência de síndrome hipertensiva, presença de mecônio, índice de Apgar inferior a sete no primeiro e quinto minuto, internação na unidade de tratamento intensivo neonatal e prematuridade. A oligodramnia associou-se significantemente ao tipo de parto (pPURPOSE: to evaluate perinatal outcomes in cases of oligohydramnios without premature rupture of membranes. METHODS: a total of 51 consecutive cases of oligohydramnios (amniotic fluid index, AFI 5. Maternal and neonatal variables, as well as fetal mortality, early neonatal, and perinatal mortality rates were analyzed. For statistical analysis the c² test with Yates correction and Student's t test were used with level of signicance set at 5%. RESULTS: there were no significant differences between groups when the presence of gestational hypertensive syndromes, meconium-stained amniotic fluid, 1- and 5-minute Apgar score, need of neonatal intensive center unit, and preterm birth were analyzed. Oligohydramnios was associated with the way of delivery (p<0.0002; RR=0.3, fetal distress (p<0.0004; RR=2.2 and fetal malformations (p<0.01; RR=5.4. Fetal malformation rates
Rey, G; Skowronek, F; Alciaturi, J; Alonso, J; Bertoni, B; Sapiro, R
Preterm birth (PTB) is a worldwide health problem and remains the leading cause of perinatal morbidity and mortality. Systemic and local intrauterine infections have been implicated in the pathogenesis of preterm labor and delivery. Common pathways between PTB, premature rupture of ovular membranes (PROM) and altered molecular routes of inflammation have been proposed. There is evidence to support a genetic component in these conditions. Lipopolysaccharide (LPS), a component of the cell wall of Gram-negative bacteria, is thought to play a key role in eliciting an inflammatory response. LPS is recognized by proteins of the innate immune system, including Toll-like receptor 4 (TLR4). Individuals from some European countries carrying the variant alleles resulting in an amino acid substitution (Asp299Gly) are at increased risk of Gram-negative infections and premature birth. The objective of this study was to determine if preterm newborns have different allele frequency of the Asp299Gly TLR4 variant from healthy term neonates in Uruguay. The impact of PROM was also examined. There was an increase in the risk for fetuses carrying the Asp299Gly substitution in TLR4 of being severely premature (<33 weeks) and to present PROM at the same time.
Okeke, T C; Enwereji, J O; Adiri, C O; Onwuka, C I; Iferikigwe, E S
Preterm premature rupture of membranes (PPROM) is a challenging complication of pregnancies and an important cause of perinatal morbidity and mortality. Management of morbidities associated with PPROM is fraught with controversy. However, women should be informed of these complications. This article aimed to review the morbidities, concordance, and predictors of PPROM over a 10-year period. This was a retrospective review of morbidities, concordance, and predictors of PPROM among pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria between January 1, 1999, and December 31, 2008. The morbidities, concordance, and predictors of PPROM were expressed by regression analysis output for PPROM. Primigravidae had the highest occurrence of PPROM. Increasing parity does not significantly influence the incidence of PPROM. The concordance and predictors of PPROM are maternal age (P women should be informed of these complications.
Luo, Xiucui; Shi, Qingxi; Gu, Yang; Pan, Jing; Hua, Maofang; Liu, Meilin; Dong, Ziqing; Zhang, Meijiao; Wang, Leilei; Gu, Ying; Zhong, Julia; Zhao, Xinliang; Jenkins, Edmund C; Brown, W Ted; Zhong, Nanbert
Preterm birth (PTB) is a live birth delivered before 37 weeks of gestation (GW). About one-third of PTBs result from the preterm premature rupture of membranes (PPROM). Up to the present, the pathogenic mechanisms underlying PPROM are not clearly understood. Here, we investigated the differential expression of long chain non-coding RNAs (lncRNAs) in placentas of PTBs with PPROM, and their possible involvement in the pathogenic pathways leading to PPROM. A total number of 1954, 776, and 1050 lncRNAs were identified with a microarray from placentas of PPROM (group A), which were compared to full-term birth (FTB) (group B), PTB (group C), and premature rupture of membrane (PROM) (group D) at full-term, respectively. Instead of investigating the individual pathogenic role of each lncRNA involved in the molecular mechanism underlying PPROM, we have focused on investigating the metabolic pathways and their functions to explore what is the likely association and how they are possibly involved in the development of PPROM. Six groups, including up-regulation and down-regulation in the comparisons of A vs. B, A vs. C, and A vs. D, of pathways were analyzed. Our results showed that 22 pathways were characterized as up-regulated 7 down-regulated in A vs. C, 18 up-regulated and 15 down-regulated in A vs. D, and 33 up-regulated and 7 down-regulated in A vs. B. Functional analysis showed pathways of infection and inflammatory response, ECM-receptor interactions, apoptosis, actin cytoskeleton, and smooth muscle contraction are the major pathogenic mechanisms involved in the development of PPROM. Characterization of these pathways through identification of lncRNAs opened new avenues for further investigating the epigenomic mechanisms of lncRNAs in PPROM as well as PTB.
Full Text Available Preterm birth (PTB is a live birth delivered before 37 weeks of gestation (GW. About one-third of PTBs result from the preterm premature rupture of membranes (PPROM. Up to the present, the pathogenic mechanisms underlying PPROM are not clearly understood. Here, we investigated the differential expression of long chain non-coding RNAs (lncRNAs in placentas of PTBs with PPROM, and their possible involvement in the pathogenic pathways leading to PPROM. A total number of 1954, 776, and 1050 lncRNAs were identified with a microarray from placentas of PPROM (group A, which were compared to full-term birth (FTB (group B, PTB (group C, and premature rupture of membrane (PROM (group D at full-term, respectively. Instead of investigating the individual pathogenic role of each lncRNA involved in the molecular mechanism underlying PPROM, we have focused on investigating the metabolic pathways and their functions to explore what is the likely association and how they are possibly involved in the development of PPROM. Six groups, including up-regulation and down-regulation in the comparisons of A vs. B, A vs. C, and A vs. D, of pathways were analyzed. Our results showed that 22 pathways were characterized as up-regulated 7 down-regulated in A vs. C, 18 up-regulated and 15 down-regulated in A vs. D, and 33 up-regulated and 7 down-regulated in A vs. B. Functional analysis showed pathways of infection and inflammatory response, ECM-receptor interactions, apoptosis, actin cytoskeleton, and smooth muscle contraction are the major pathogenic mechanisms involved in the development of PPROM. Characterization of these pathways through identification of lncRNAs opened new avenues for further investigating the epigenomic mechanisms of lncRNAs in PPROM as well as PTB.
Full Text Available Background. Worldwide, the incidence of preterm premature rupture of membranes (PPROM is between 1% and 4% of all pregnancies.Objectives. The primary objectives of this study were to describe and compare the perinatal outcomes of HIV-positive and HIV-negative women presenting with PPROM to a regional hospital in KwaZulu-Natal.Methods. This was a retrospective analytical cross-sectional study which reviewed files of pregnant women presenting with premature rupture of membranes at gestation between 28 and 36 completed weeks. These were identified from the labour ward birth register and from the neonatal ward admission book. Categorical and numerical variables pertaining to the method of confirmation of diagnoses, clinical profiles, modes of delivery, maternal outcomes and neonatal outcomes were considered.Results. A total of 87 files were analysed. Forty-six women (53% were HIV-negative and 41 (47% were HIV-positive. Fifty-two percent were in the gestational age <34 weeks. Fifty-nine percent (n=51 of women delivered vaginally and 31% (n=27 delivered by caesarean delivery (CD. There was also no statistical significance between the Apgar scores of the HIV-exposed and HIV-unexposed neonates, birth weights and modes of delivery. There was no statistical significance in sepsis rates, the need for ventilation and the duration of hospital stay between the two groups. The odds of developing neonatal jaundice (NNJ in the HIV-positive group was 0.14(95% confidence interval (CI 0 - 0.93, which was statistically significant. There was no reported maternal or neonatal mortality and no maternal morbidity associated with PPROM in either groups.Conclusion. This study suggests that there are no immediate significant differences in neonatal and maternal outcomes in pregnancies complicated by PPROM between HIV-negative and HIV-positive women on ART except that of NNJ.
Clausen, Tine Dalsgaard; Bergholt, Thomas; Eriksson, Frank
BACKGROUND: Unfavorable conditions associated with cesarean section may influence the risk of type 1 diabetes in offspring, but results from studies are conflicting. We aimed to evaluate the association between prelabor cesarean section and risk of childhood type 1 diabetes. METHODS: A Danish...... nationwide cohort study followed all singletons born during 1982-2010. Five national registers provided information on mode of delivery, outcome, and confounders. The risk of childhood type 1 diabetes with onset before the age of 15 years was assessed by Cox regression. A total of 1,760,336 singletons...... contributed 20,436,684 person-years, during which 4,400 were diagnosed with childhood type 1 diabetes. RESULTS: The hazard ratio for childhood type 1 diabetes was increased in children delivered by prelabor cesarean section compared with vaginal delivery when adjusted for year of birth, parity, sex, parental...
Rare mutations and potentially damaging missense variants in genes encoding fibrillar collagens and proteins involved in their production are candidates for risk for preterm premature rupture of membranes.
Modi, Bhavi P; Teves, Maria E; Pearson, Laurel N; Parikh, Hardik I; Chaemsaithong, Piya; Sheth, Nihar U; York, Timothy P; Romero, Roberto; Strauss, Jerome F
Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of preterm birth with ~ 40% of preterm births being associated with PPROM and occurs in 1% - 2% of all pregnancies. We hypothesized that multiple rare variants in fetal genes involved in extracellular matrix synthesis would associate with PPROM, based on the assumption that impaired elaboration of matrix proteins would reduce fetal membrane tensile strength, predisposing to unscheduled rupture. We performed whole exome sequencing (WES) on neonatal DNA derived from pregnancies complicated by PPROM (49 cases) and healthy term deliveries (20 controls) to identify candidate mutations/variants. Genotyping for selected variants from the WES study was carried out on an additional 188 PPROM cases and 175 controls. All mothers were self-reported African Americans, and a panel of ancestry informative markers was used to control for genetic ancestry in all genetic association tests. In support of the primary hypothesis, a statistically significant genetic burden (all samples combined, SKAT-O p-value = 0.0225) of damaging/potentially damaging rare variants was identified in the genes of interest-fibrillar collagen genes, which contribute to fetal membrane strength and integrity. These findings suggest that the fetal contribution to PPROM is polygenic, and driven by an increased burden of rare variants that may also contribute to the disparities in rates of preterm birth among African Americans.
Nalat Sompagdee, M.D.
Full Text Available Objective: To present outcomes of expectant management (EM in HIV-infected pregnancy with preterm premature rupture of membranes (PPROM at less than 34-week gestation. Case presentation: During January 2008-December 2015, there were 513 HIV-infected pregnant women giving birth at Siriraj Hospital, Thailand. Ten of them presented with PPROM at GA <34 weeks and six women received EM. The deliveries took place at GA 28 2/7 - 33 5/7 weeks. The longest interval of ROM was 15 days and the highest on-admission viral load was 633,000 copies/mL. Three of them had antepartum highly active antiretroviral therapy (HAART for at least four weeks prior to the delivery. Mode of delivery included 3 vaginal deliveries and 3 caesarean sections. All infants’ HIV molecular tests were negative at birth. The longest follow-up interval was 12 months and HIV vertical transmission remained negative. Conclusion: Expectant management in HIV-infected women with PPROM at GA <34 weeks may be sensible because complications of prematurity outweigh the risk of vertical HIV transmission.
Serdar Kutuk, Mehmet; Bastug, Osman; Ozdemir, Ahmet; Adnan Ozturk, Mehmet; Tuncay Ozgun, Mahmut; Basbug, Mustafa; Gunes, Tamer; Kurtoglu, Selim
This historical cohort study aimed to assess the relationship between antenatal maternal C-reactive protein (CRP) level and neonatal outcome preterm premature rupture of membranes (PPROM). We reviewed the records of 70 singleton pregnancies with PPROM between 24 and 34 weeks. Maternal CRP levels of neonates with respiratory distress syndrome, neonatal sepsis, grade 3-4 intraventricular haemorrhage and stage 2-3 necrotizing enterocolitis, perinatal mortality were compared with those without these complications. Administration of corticosteroid, tocolysis for two days and prophylactic antibiotics (intravenous ampicillin/sulbactam, and oral azithromycin) were the standard management protocol. The mean age at PPROM was 29 weeks 2 days (±3 weeks), the mean age at birth was 30 weeks 5 days (±20 days). CRP levels were not different between groups. Uni/multivariate analysis showed that maternal CRP levels were not related with neonatal outcomes. Neonatal complications in PPROM are related with the degree of prematurity and maternal WBC counts.
Wu, Ming-Yih; Chen, Shee-Uan; Lee, Chien-Nan; Ho, Hong-Nerng; Yang, Yu-Shih
Pregnancies with extremely preterm premature rupture of membranes (EPPROM), especially before 20 weeks of gestation, are usually considered to be a termination of pregnancy. By improvement of obstetric and neonatal care, we can prolong the pregnancy across the threshold of survival by aggressive tocolysis. Using intrauterine insemination, a 32-year-old woman became pregnant with twins (first pregnancy). Threatened abortion occured since 9 weeks of gestation and EPPROM of the upper twin was noted at 18 weeks. Massive vaginal bleeding and vigorous uterine contractions occurred at 22 weeks. Poor control of preterm labor occurred using ritodrine and MgSO(4). Atosiban was applied to calm uterine activities. After discontinuation of atosiban at 30 weeks, the uterine contractions became severe again and an emergency cesarean section was performed to deliver two live, premature babies weighing 1,518 g and 830 g, respectively. Twin A was healthy, weighing 2,030 g at 35 days after birth and subsequently discharged. The smaller twin B was dependent on continuous positive airway pressure and died of pulmonary infection 120 days after birth. Comparing to other tocolytic agents, Atosiban has few side effects and assisted in prolonging a pregnancy involving twins that experienced EPPROM. Copyright Â© 2010 Taiwan Association of Obstetric & Gynecology. Published by Elsevier B.V. All rights reserved.
Awara, A M; Marei, S K; Elghorab, N M; Elnewahy, M A; Aboulenin, A A
Physicians compared clinical history, examination, and laboratory data on 10 pregnant women at various gestational ages with intact membranes till labor began (controls) with data on 25 pregnant women also at various gestational ages who experienced premature rupture of membranes (PROM) (cases) to determine the value of C-reactive protein (CRP) in maternal and cord blood as a predictor of chorioamnionitis in women with PROM. 32% of cases had clinical chorioamnionitis and 44% histopathological chorioamnionitis. The maternal serum level of CRP in cases with and without chorioamnionitis at delivery was statistically higher than that of the controls (45.82 CRP mg/L and 9.71 CRP mg/L vs. 6.6 CRP mg/l; P.05). Further the CRP level in cord blood of cases with chorioamnionitis also stood much higher than that of the controls (p.001). In addition, the total leukocytic count (TLC) for cases with chorioamnionitis at delivery was much higher than it was for the control group at delivery (12,510 TLC/cubic mm vs. 18,231 TLC/cubic mm; p.05). A significant difference also existed between the temperature of the cases with chorioamnionitis and that of the controls (37.11 degrees Celsius vs. 63.97 degrees Celsius; p.05). Sensitivity and specificity tests showed that CRP 24 mg/L was the most reliable predictor of chorioamnionitis (100% and 93.3% respectively) followed by TLC (77.8% and 92.8% respectively) then temperature (55.6% and 78.6% respectively). Thus CRP can be used to predict premature delivery and simultaneously reduces unnecessary premature delivery of many PROM cases which occur due to fear of developing infections in both the mother and the fetus.
Hackney, David N; Kuo, Kelly; Petersen, Rebecca J; Lappen, Justin R
Patients with PPROM are at risk for a variety of outcomes, including chorioamnionitis (CA), placental abruption (PA), or preterm labor (PTL). Competing risk regression can analyze a cohort's risk of individual outcomes while accounting for ongoing deliveries secondary to competing events. A secondary analysis of the subjects from MFMU BEAM study of neuroprotection after preterm birth (BEAM) with conservative PPROM management. Deliveries were categorized as: PA, CA, PTL, "elective" or "indicated". The association between outcomes of PA, CA or PTL and clinical predictors of twins, ethnicity, parity, gestational age at rupture, bleeding, contractions, cervical dilation, preterm birth history, weight, and genitourinary infections were evaluated via competing risk regression. 1970 subjects were included. The significance and directionality of predictors varied according to specific outcomes. Patients with twins had an increased PTL hazard (1.85) though reductions in CA- (0.66) or PA-specific (0.56) hazards. Decreased latency in African-Americans was almost entirely due to an increased CA hazard (1.44) without a significant association with PTL. Increasing gestational age at membrane rupture was associated with a decreasing hazard of CA although increasing hazard of PTL. For patients with PPROM, the hazards associated with different clinical predictors vary according to exact outcomes.
Sentilhes, L; Sénat, M-V; Ancel, P-Y; Azria, E; Benoist, G; Blanc, J; Brabant, G; Bretelle, F; Brun, S; Doret, M; Ducroux-Schouwey, C; Evrard, A; Kayem, G; Maisonneuve, E; Marcellin, L; Marret, S; Mottet, N; Paysant, S; Riethmuller, D; Rozenberg, P; Schmitz, T; Torchin, H; Langer, B
To determine the measures to prevent spontaneous preterm birth (excluding preterm premature rupture of membranes)and its consequences. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. In France, premature birth concerns 60,000 neonates every year (7.4 %), half of them are delivered after spontaneous onset of labor. Among preventable risk factors of spontaneous prematurity, only cessation of smoking is associated to a decrease of prematurity (level of evidence [LE] 1). This is therefore recommended (grade A). Routine screening and treatment of vaginal bacteriosis in general population is not recommended (grade A). Asymptomatic women with single pregnancy without history of preterm delivery and a short cervix between 16 and 24 weeks is the only population in which vaginal progesterone is recommended (grade B). A history-indicated cerclage is not recommended in case of only past history of conisation (grade C), uterine malformation (Professional consensus), isolated history of pretem delivery (grade B) or twin pregnancies in primary (grade B) or secondary (grade C) prevention of preterm birth. A history-indicated cerclage is recommended for single pregnancy with a history of at least 3 late miscarriages or preterm deliveries (grade A).). In case of past history of a single pregnancy delivery before 34 weeks gestation (WG), ultrasound cervical length screening is recommended between 16 and 22 WG in order to propose a cerclage in case of lengthpremature rupture of membranes. Maintenance tocolysis is not recomended (grade B). Antenatal corticosteroid administration is recommended to every woman at risk of preterm delivery before 34 weeks of gestation (grade A). After 34 weeks, evidences are not consistent enough to recommend systematic antenatal corticosteroid treatment (grade B), however, a course might be indicated in the clinical situations associated with the
Lu, Hongyan; Wang, Qiuxia; Lu, Junyin; Zhang, Qiang; Kumar, Pravesh
The objective of this study is to identify possible perinatal risk factors related to intraventricular hemorrhage (IVH) in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes (pPROM). A total of 292 preterm infants born at 34 weeks of gestation or less following pPROM were enrolled in the study, while 155 newborns with incomplete data, especially those that lack histological examination of the placenta, maternal details, and neonatal characteristics, have been further excluded. Finally, data of 137 preterm infants were included in the analysis. All infants underwent ultrasonographic screening for IVH. Thirty-three infants with IVH were considered as cases and 104 infants without IVH were considered as controls. The association between risk factors and IVH was evaluated by univariate and multivariate logistic regression analyses. The incidence of IVH in preterm infants born at 34 weeks of gestation or less following pPROM was 24.1%, while the incidence of maternal chorioamnionitis was 43.8%. By univariate analysis, gestational age, birth weight, asphyxia resuscitation, maternal chorioamnionitis, fetal distress, amniotic fluid index, and latency of the rupture of membranes to birth were found to be significantly different between the 2 groups. By logistic regression analysis, lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis were found to be independent risk factors for IVH. Lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis are independent risk factors for IVH in preterm infants born at 34 weeks of gestation or less following pPROM. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Erenberg, Miriam; Yagel, Yael; Press, Fernanda; Weintraub, Adi Y
The incidence of chorioamnionitis varies widely. The highest incidence is reported in preterm deliveries. Among preterm deliveries, chorioamnionitis usually occurs after preterm premature rupture of membranes (PPROM). To date, only five cases of chorioamnionitis due to Serratia marcescens were reported. Here we present a case of a pregnant woman with chorioamnionitis due to Serratia marcescens who delivered a premature neonate at 28 weeks and four days of gestation. We also conducted a review of the literature in order to identify and characterize the clinical presentation and outcomes of this rare infection. A 36 year old female (gravida 9, para 6) was admitted with cervical effacement of 16mm and intact membranes at gestational age of 25 weeks and five days. One week following her admission PPROM was noticed. Treatment with the standard antibiotic regimen for PPROM was initiated. Thirteen days after the diagnosis of PPROM (28 weeks and four days) she developed chills, abdominal pain, sub febrile fever, tachycardia, leukocytosis and fetal tachycardia, and a clinical diagnosis of chorioamnionitis was made. An urgent CS was performed. In the first post-operative day the patient developed surgical sight infection. Cultures obtained from the purulent discharge of the wound, as well as cultures from the placenta and uterine cavity that were obtained during surgery grew Serratia marcescens. The patient was treated with Meropenem for six days, with a good clinical response. We present a rare case of nosocomialy acquired Serratia marcescens chorioamnionitis in a patient with PPROM. This case emphasizes the need for good infection control measures. Our favorable outcome together with the scares reports in the literature, add insight into this type of rare infection. Copyright © 2017 Elsevier B.V. All rights reserved.
Miño, M; Puertas, A; Herruzo, A J; Miranda, J A
To analyze the utility of prophylactic amnioinfusion in term pregnancies with PROM and a low amniotic fluid index during labor induction. Forty-two women with amnioinfusion and 42 in a control group with amniotic fluid index (AFI) below 10 cm when admitted to labor induction were studied. All patients had electronic fetal heart rate and intrauterine pressure continuous monitoring. Amnioinfusion of normal saline (37 degrees C) was realized in the study group, using a continuous perfusion pump at 600 ml/h for 1 h, after which the AFI was again recorded; if this was amnioinfusion. Both groups were similar in age, primiparity, gestational age, initial AFI, interval from rupture of membranes until delivery and length of labor. The amnioinfusion of 600 ml in 1 h significantly increased the AFI (an increase of 7.2 +/- 3.9 vs. a decrease of 1.1 +/- 1.6, P amnioinfusion group, there was a significantly lower rate of cesarean deliveries (0 vs. 6, P amnioinfusion improves neonatal metabolic state when used in labor induction of term pregnancies with PROM and a low amniotic fluid index.
Ilhan, Nevin; Celik, Ebru; Kumbak, Banu
Preterm premature rupture of membranes (PPROM) is associated with significant maternal and perinatal morbidity. This study examined maternal oxidative stress in PPROM. This was a prospective cross-sectional study conducted in a university hospital. A total of 72 pregnant women were recruited into two groups, those with PPROM (38 cases) and those without PPROM (34 controls) matched for gestational age. Plasma interleukin-6, C-reactive protein, vitamins C, E and A, 8-isoprostane, total oxidant status (TOS) and antioxidant status (TAS) were determined for all study participants and the data were compared between the PPROM and control groups. Both case and control groups were comparably matched in age, parity, gestational age and smoking status. There was a significant association between low 8-isoprostane, low vitamin C and high total oxidant status and the occurrence of PPROM (p vitamin C and 8-isoprostane levels were lower and TOS higher in women with PPROM. Further research is needed to identify robust biological markers for the prevention and also prognosis of PPROM.
Pavlová, Tereza; Zlámal, Filip; Šplíchal, Zbyněk; Tomandl, Josef; Hodická, Zuzana; Ventruba, Pavel; Bienertová-Vašků, Julie
The aim of the study is to investigate differences in visfatin concentrations between mothers with term and preterm birth (PTB) and between mothers who delivered within seven days and after more than seven days following admission for PTB/preterm premature rupture of membranes (PPROMs). Maternal peripheral blood and cord blood were collected from 56 mothers with PTB (31 with PPROM) and 71 mothers with term delivery (three with PPROM). Maternal visfatin concentration was significantly higher for given gestational age in PTBs compared to term deliveries (p = .021) and also in mothers who delivered within seven days after admission for PTB or PPROM, compared to those who delivered after more than seven days (p = .027; p = .039). Cord blood visfatin concentration was found to be decreased in preterm compared to term infants (p = .007). Visfatin in both maternal and fetal circulation may play an important role in the pathogenesis of PTB/PPROM and could be used to distinguish between women who will deliver in a short period of time after clinical presentation of PTB/PPROM and those who deliver later. Nevertheless, additional research is necessary in order to identify its direct involvement in PTB/PPROM.
Marcelo Luís Nomura
Full Text Available The objective of this study was to identify group B streptococcus (GBS colonization rates and compare detection efficiency of selective versus non-selective culture media and anorectal versus vaginal cultures in women with preterm labor and preterm-premature rupture of membranes (PROM. A prospective cohort study of 203 women was performed. Two vaginal and two anorectal samples from each woman were collected using sterile swabs. Two swabs (one anorectal and one vaginal were placed separately in Stuart transport media and cultured in blood-agar plates for 48 hours; the other two swabs were inoculated separately in Todd-Hewitt selective media for 24 hours and then subcultured in blood-agar plates. Final GBS identification was made by the CAMP test. A hundred thrity-two cultures out of 812 were positive. The maternal colonization rate was 27.6%. Colonization rates were 30% for preterm PROM and 25.2% for preterm labor. Todd-Hewitt selective medium detected 87.5% and non-selective medium 60.7% GBS-positive women. Vaginal samples and anorectal samples had the same detection rate of 80.3%. Anorectal selective cultures detected 75% of carriers; 39% of GBS-positive women were detected only in selective medium. A combined vaginal-anorectal selective culture is appropriate for GBS screening in this population, minimizing laboratory costs.
Fetal lung development on MRI. Normal course and impairment due to premature rupture of membranes; Fetale Lungenentwicklung in der MRT. Normaler Verlauf und Beeintraechtigung durch vorzeitigen Blasensprung
Kasprian, G. [Medizinische Universitaet Wien (Austria). Klinik fuer Radiodiagnostik; Zentrum fuer Anatomie und Zellbiologie der Medizinischen Universitaet Wien (Austria). Arbeitsgruppe Integrative Morphologie; Brugger, P.C. [Zentrum fuer Anatomie und Zellbiologie der Medizinischen Universitaet Wien (Austria). Arbeitsgruppe Integrative Morphologie; Helmer, H.; Langer, M. [Medizinische Universitaet Wien (Austria). Klinik fuer Frauenheilkunde; Balassy, C.; Prayer, D. [Medizinische Universitaet Wien (Austria). Klinik fuer Radiodiagnostik
A well-organized interplay between many molecular factors as well as mechanical forces influence fetal lung development. At the end of this complex process a sufficiently sized and structurally mature organ should ensure the postnatal survival of the newborn. Besides prenatal ultrasonography, magnetic resonance imaging (MRI) can now be used to investigate normal and pathological human lung growth in utero. Oligohydramnios, due to premature rupture of membranes (PROM), is an important risk factor for compromised fetal lung growth. In these situations MR volumetry can be used to measure the size of the fetal lung quite accurately. Together with the evaluation of lung signal intensities on T2-weighted sequences, fetuses with pulmonary hypoplasia can be readily detected. (orig.) [German] Die fetale Lungenentwicklung wird einerseits durch eine Vielzahl molekularer Faktoren und andererseits durch mechanisch-physiologische Kraefte beeinflusst. Ein geordnetes Zusammenspiel dieser Mechanismen fuehrt zu einem ausreichend grossen und strukturell reifen Organ, das sofort nach der Geburt das Ueberleben des Neugeborenen sicherstellt. Neben der praenatalen Ultraschalluntersuchung bietet nun auch die Magnetresonanztomographie (MRT) die Moeglichkeit, die normale und pathologische fetale Lungenentwicklung zu untersuchen. Ein wesentlicher Risikofaktor fuer eine Beeintraechtigung der Lungenentwicklung ist die verminderte Fruchtwassermenge nach vorzeitigem Blasensprung. In diesen Faellen kann die MR-Volumetrie dazu eingesetzt werden, die Groesse der fetalen Lungen relativ genau zu bestimmen. Gemeinsam mit der Beurteilung der MR-Signalintensitaeten des Lungengewebes auf T2-gewichteten Sequenzen koennen Feten mit hypoplastischen Lungen mit zunehmender Sicherheit bereits praenatal identifiziert werden. (orig.)
Eleje, George U; Adinma, Joseph I; Ghasi, Samuel; Ikechebelu, Joseph I; Igwegbe, Anthony O; Okonkwo, John E; Okafor, Charles I; Ezeama, Chukwuemeka O; Ezebialu, Ifeanyichukwu U; Ogbuagu, Chukwuanugo N
To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource-limited settings. A prospective cross-sectional study was undertaken involving women with (n=105) and without (n=105) a confirmed diagnosis of PPROM admitted to Nnamdi Azikiwe University Teaching Hospital, southeast Nigeria, between January 1, 2011, and April 30, 2013. Endocervical swabs were collected from all participants and examined microbiologically. Antibiotic sensitivity testing was performed using Kirby-Bauer disk diffusion. Streptococcus spp., Staphylococcus aureus, and Escherichia coli were significantly more prevalent among women with PPROM than among those without PPROM (P<0.01). Among the antibiotics considered safe to use during pregnancy, the bacteria were most sensitive to ampicillin-sulbactam, cefixime, cefuroxime, and erythromycin. For the first 48hours, women with PPROM should receive an intravenous dose combining ampicillin-sulbactam, cefixime, cefuroxime, or erythromycin with metronidazole followed by oral administration of the chosen antibiotic combination to complete a 7-day course. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
To investigate the clinical significance and value in the prediction of preterm delivery of combined amniotic fluid IL-8 and Annexin A2 levels in preterm premature rupture of membranes (PPROM) and preterm labor (PTL). Sixty pregnant women at < 32 gestational weeks who developed PTL were divided into a PPROM group and a non-PPROM group. Ten normal pregnant women served as a control group. IL-8 and Annexin A2 levels were measured in amniotic fluid samples from each patient. Amniotic fluid IL-8 and Annexin-A2 levels in PTL (PPROM and non-PPROM groups) were significantly higher than those of the controls (p < 0.05). The PPROM group displayed higher amniotic fluid Annexin-A2 levels than did the non-PPROM group, with a statistically significant difference (p < 0.05). The PPROM group showed higher amniotic fluid IL-8 levels than did the non-PPROM group; however, this was statistically insignificant (p = 0.56). Combined detection of amniotic fluid IL-8 and Annexin-A2 in the prediction of preterm delivery within 2 weeks of measurement showed sensitivity of 81.25%, specificity of 88.89% and PPV of 92.86%. Amniotic fluid IL-8 and Annexin-A2 levels are associated with the occurrence of PPROM and PTL. Combined detection of IL-8 and Annexin-A2 levels in identifying preterm delivery within 2 weeks in PTL and PPROM is of possible clinical and predictive value.
Gulati, Shilpa; Agrawal, Swati; Raghunandan, Chitra; Bhattacharya, Jayashree; Saili, Arvind; Agarwal, Shilpi; Sharma, Deepika
To analyze the association of maternal serum interleukin-6 (IL-6) with fetomaternal outcome in preterm premature rupture of membranes (PPROM). Serial serum IL-6 levels were measured in 45 women with PPROM at gestation 24-34 weeks. The women were followed till pueperium and fetomaternal outcome as well as the histopathology of the placenta and the umbilical cord was studied. The data were analyzed using t test and χ(2) test. IL-6 levels ≥ 8 pg/ml were significantly associated with puerperal sepsis and neonatal sepsis. Histological chorioamnionitis and funisitis were demonstrated in 48.8% and 13.3% women respectively and significantly correlated with elevated serum IL-6 levels and fetomaternal infection. A cut-off value of IL-6 of 8 pg/ml was found to correctly diagnose 19 out of 23 patients with infectious morbidity and showed the best sensitivity (82.6%) and specificity (86.3%) as compared to the total leucocycte count (TLC) and C-reactive protein (CRP) in diagnosing infection in PPROM. Maternal serum IL-6 can be used as a biomarker to predict preclinical asymptomatic infection in PPROM with good sensitivity and specificity.
Rosenberg, Victor A; Buhimschi, Irina A; Dulay, Antonette T; Abdel-Razeq, Sonya S; Oliver, Emily A; Duzyj, Christina M; Lipkind, Heather; Pettker, Christian M; Buhimschi, Catalin S
Activins and inhibins are important modulators of inflammatory processes. We explored activation of amniotic fluid (AF) activin-A and inhibin-A system in women with intra-amniotic infection and preterm premature rupture of the membranes (PPROM). We analyzed 78 AF samples: '2nd trimester-control' (n=12), '3rd trimester-control' (n=14), preterm labor with intact membranes [positive-AF-cultures (n=13), negative-AF-cultures (n=13)], and PPROM [positive-AF-cultures (n=13), negative-AF-cultures (n=13)]. Activin-A levels were evaluated ex-vivo following incubation of amniochorion and placental villous explants with Gram-negative lipopolysaccharide (LPS) or Gram-positive (Pam3Cys) bacterial mimics. Ability of recombinant activin-A and inhibin-A to modulate inflammatory reactions in fetal membranes was explored through explants' IL-8 release. Activin-A and inhibin-A were present in human AF and were gestational age-regulated. Activin-A was significantly upregulated by infection. Lower inhibin-A levels were seen in PPROM. LPS elicited release of activin-A from amniochorion, but not from villous explants. Recombinant activin-A stimulated IL-8 release from amniochorion, an effect that was not reversed by inhibin-A. Human AF activin-A and inhibin-A are involved in biological processes linked to intra-amniotic infection/inflammation-induced preterm birth. © 2011 John Wiley & Sons A/S.
Torricelli, Michela; Voltolini, Chiara; Novembri, Romina; Bocchi, Caterina; Di Tommaso, Mariarosaria; Severi, Filiberto M; Petraglia, Felice
LABELED PROBLEM: To investigate regulation of activin A and related molecules in placenta/fetal membranes from preterm premature rupture of membranes (pPROM) associated with acute chorioamnionitis (ACA). Tissues were obtained from women with spontaneous preterm deliveries (PTD), pPROM without ACA, pPROM with ACA. Activin A, follistatin, and nodal and cripto mRNA were measured by RT-PCR. Activin A mRNA was up-regulated in tissues from pPROM, in presence or absence of HCA, respect to PTD and in pPROM with ACA respect to pPROM without ACA. Follistatin mRNA expression did not differ between the groups. In placenta, nodal mRNA showed the same trend of activin A, while cripto was down-regulated in pPROM with ACA than other groups. Nodal and cripto were not expressed by fetal membranes. The study shows the involvement of activin A pathway in pPROM with ACA. Further studies will focus on its role in placental immune functions. © 2012 John Wiley & Sons A/S.
Yang, Xiao; Zhang, Xiao-Ai; Wu, Zhi-Hao; Peng, Wei; Zhu, Li-Na; Wang, Yan
To investigate the association between the genetic polymorphism of 2',5'-oligoadenylate synthetase 1 (OAS1) and susceptibility to spontaneous preterm birth (SPTB) and preterm premature rupture of membranes (PPROM). The case-control study consisted of 599 preterm infants including 171 cases of PPROM, and 673 full-term infants without maternal histories of SPTB and PPROM as controls. The single nucleotide polymorphism (SNP) at OAS1 intron 5, rs10774671, was analyzed by polymerase chain reaction-restriction fragment length polymorphism. No significant differences were observed between the case and control groups in the frequencies of genotypes (AA, GA, and GG) and alleles (A and G) of OAS1 rs10774671. When the case group was divided into two subgroups with or without PPROM, no significant differences in the genotype and allele frequencies were found between each subgroup and the control group. When the case group was divided into three subgroups with different gestational ages at SPTB, no significant differences in the genotype and allele frequencies were detected between each subgroup and the control group. No association is identified between OAS1 SNP and susceptibility to SPTB and PPROM.
Consonni, Sara; Mainini, Veronica; Pizzardi, Agnese; Gianazza, Erica; Chinello, Clizia; Locatelli, Anna; Magni, Fulvio
Preterm delivery is one of the main causes of perinatal morbidity and mortality and it accounts for 75 % of perinatal mortality and more than half of the long-term morbidity. We applied a proteomic approach based on mass spectrometry (MS) for biomarkers discovery of preterm premature rupture of membranes (pPROM) by investigating amniotic fluid (AF) invasively and non-invasively collected. Amniotic fluid was obtained from vagina of women with pPROM (group 1), PROM at term (group 2) and by genetic amniocentesis (group 3). Pre-fractionated AF proteome was analyzed through matrix assisted laser desorption ionization-time of flight (MALDI-TOF) MS. The characterization of proteins/peptides of interest was obtained by high performance liquid chromatography-electrospray tandem MS. Three peptides overexpressed in pPROM and able to discriminate the groups 1 and 2 were detected. One peptide was identified as the fragment Gly452LAVPDGPLGLPPKPro466 of the protein KIAA1522, expressed by fetal brain and liver. This peptide was overexpressed in a patient of the group 3, completely asymptomatic at the time of the amniocentesis, who later developed pPROM. Amniotic fluid invasively and non-invasively collected can be analyzed by MALDI-TOF MS to obtain proteomic profiles. Proteomic analysis identified a peptide with promising diagnostic capability for pPROM.
Kwak, Dong-Wook; Hwang, Han-Sung; Kwon, Ja-Young; Park, Yong-Won; Kim, Young-Han
The purpose of this study was to determine the prevalence of Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) in patients with preterm labor or preterm premature rupture of membranes (PPROM) and to determine the effect of these organisms on pregnancy outcomes based on the density of colonization. The study group consisted of 184 women with preterm labor or PPROM. Vaginal cultures for UU and MH were performed for all patients at admission, and the placentas were histologically evaluated after delivery. The prevalence of positive vaginal fluid cultures for genital mycoplasma was 62.5% (112/179). This group included 99 patients carrying only UU and 13 carrying both organisms. No patients were found to carry only MH. Compared to patients only positive for UU, patients with both organisms showed significantly decreased gestational age at birth and birth weight, and significant increases in the incidences of preterm birth, NICU admissions and histologic chorioamnionitis. Vaginal MH tends to be detected with UU, and patients carrying both organisms simultaneously had more severe adverse pregnancy outcomes compared to patients in preterm labor or PPROM who were only positive for UU.
Modi, Bhavi P; Teves, Maria E; Pearson, Laurel N; Parikh, Hardik I; Haymond-Thornburg, Hannah; Tucker, John L; Chaemsaithong, Piya; Gomez-Lopez, Nardhy; York, Timothy P; Romero, Roberto; Strauss, Jerome F
Twin studies have revealed a significant contribution of the fetal genome to risk of preterm birth. Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of preterm delivery. Infection and inflammation of the fetal membranes is commonly found associated with PPROM. We carried out whole exome sequencing (WES) of genomic DNA from neonates born of African-American mothers whose pregnancies were complicated by PPROM (76) or were normal term pregnancies (N = 43) to identify mutations in 35 candidate genes involved in innate immunity and host defenses against microbes. Targeted genotyping of mutations in the candidates discovered by WES was conducted on an additional 188 PPROM cases and 175 controls. We identified rare heterozygous nonsense and frameshift mutations in several of the candidate genes, including CARD6, CARD8, DEFB1, FUT2, MBL2, NLP10, NLRP12, and NOD2. We discovered that some mutations (CARD6, DEFB1, FUT2, MBL2, NLRP10, NOD2) were present only in PPROM cases. We conclude that rare damaging mutations in innate immunity and host defense genes, the majority being heterozygous, are more frequent in neonates born of pregnancies complicated by PPROM. These findings suggest that the risk of preterm birth in African-Americans may be conferred by mutations in multiple genes encoding proteins involved in dampening the innate immune response or protecting the host against microbial infection and microbial products. © 2017 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.
Hsu, Te-Yao; Hsu, Jenn-Jeih; Fu, Hung-Chun; Ou, Chia-Yu; Tsai, Chih-Chang; Cheng, Bi-Hua; Fang, Fu-Min; Kao, Hui-Fen; Yang, Chun-Yuh; Tsai, Wen Lin; Sung, Chuen Chu; Tsai, Men-Yi
To investigate the changes in Doppler indices of the fetal ductus venosus (DV) and umbilical artery (UMA) after amnioinfusion in pregnant women with preterm premature rupture of membranes (pPROM). Pregnancies with pPROM and severe oligohydramnios cause sequelae in newborns and mothers. This cross-sectional study included a group of 25 patients with pPROM before 26 weeks' gestation. Color Doppler imaging was used to measure the impedance index and quantitative blood flow in the DV and systolic/diastolic ratio (S/D) of the UMA before and 30 minutes after the end of amnioinfusion. The following velocity parameters were measured: (1) DV peak systolic velocity; (2) DV time-averaged velocity; (3) DV maximum forward velocity during atrial contraction; (4) DV S/D; (5) DV pulsatility index (PI); (6) DV Pourcelots resistance index (RI); (7) fetal heart rate; and (8) UMA S/D. Twenty-one of the 25 patients underwent a total of 27 amnioinfusions. The mean PI and RI of the DV, and S/D of the DV and UMA decreased significantly after amnioinfusion (PI, 0.75 +/- 0.24 vs. 0.60 +/- 0.18, p = 0.009; RI, 0.60 +/- 0.15 vs. 0.50 +/- 0.13; DV S/D, 3.07 +/- 1.81 vs. 2.13 +/- 0.66, p = 0.008; UMA S/D, 3.58 +/- 0.87 vs. 2.88 +/- 0.62, p = 0.001). Amnioinfusion increases the space for the fetuses and reduces the impedance of the fetoplacental circulation. Improvements in DV and UMA flow may benefit fetuses suffering severe oligohydramnios in mid-pregnancy.
Full Text Available Background: Vitamin C is a water-soluble antioxidant that not only stimulates and protects collagen synthesis but also plays an important role in maintaining cellular integrity in a normal pregnancy. This study surveyed the effects of ascorbic acid on the serum level of unconjugated estriol and the relationship between unconjugated estriol and preterm premature rupture of membrane (PPROM. Methods: This double-blind, randomized clinical trial recruited 60 patients with predisposing factors to PPROM. The women were randomly divided into two groups of intervention and control and received vitamin C and placebo, respectively. The intervention group received 250 mg vitamin C twice a day and the controls received the placebo only. Unconjugated estriol was measured using the ELISA. All data were extracted and recorded in a checklist and compared using descriptive statistics as well as the x2, Fisher exact, and t tests. Results: The demographic data showed no difference between the two groups. The mean level of serum unconjugated estriol was significantly lower in the intervention group than in the control group (P=0.044. Also, the frequency of PPROM was lower in the intervention group, but the difference was not significant (P>0.05. Unconjugated estriol levels were not significantly different between the healthy women and the PPROM patients. Conclusion: This study demonstrated that vitamin C administration decreased unconjugated estriol levels in the patients with PPROM. The findings of this study also indicated that administration of ascorbic acid was a safe and effective method to reduce the incidence of PPROM. Alteration in unconjugated estriol is an active mediator for this effect. Trial Registration Number: IRCT201012083580N3
Kayem, Gilles; Batteux, Frederic; Girard, Noémie; Schmitz, Thomas; Willaime, Marion; Maillard, Francoise; Jarreau, Pierre Henri; Goffinet, Francois
Examine the predictive value for maternal-fetal infection of routine bedside tests detecting the proinflammatory cytokines, TNFα and IL-6, in the vaginal secretions of women with premature rupture of the membranes (PROM). This prospective two-center cohort study included all women hospitalized for PROM over a 2-year period. A bedside test assessed IL-6 and TNFα in vaginal secretions. Both centers routinely tested CRP and leukocytes, assaying both in maternal serum, and analyzed vaginal bacterial flora; all samples were repeated twice weekly until delivery. The study included 689 women. In cases of preterm PROM (PPROM) before 37 weeks (n=184), a vaginal sample positive for one or more bacteria was the only marker associated with early neonatal infection (OR 5.6, 95%CI; 2.0-15.7). Its sensitivity was 82% (95%CI; 62-94) and its specificity 56% (95%CI; 47-65). All positive markers of infection were associated with the occurrence of chorioamnionitis. In cases of PROM from 37 weeks onward (n=505), only CRP >5mg/dL was associated with early neonatal infection (OR=8.3, 95%CI; 1.1-65.4) or clinical chorioamnionitis (OR=6.8, 95%CI; 1.5-30.0). The sensitivity of CRP >5mg/dL was 91% (95%CI; 59-100) and its specificity 45% (95%CI; 40-51) for predicting early neonatal infection, and 89% (95%CI; 65-99) and 46% (95%CI; 41-51), respectively, for predicting clinical chorioamnionitis. The association of vaginal cytokines with maternal-fetal infection is weak and thus prevents their use as a good predictor of maternal-fetal infection. CRP and vaginal samples may be useful for identifying a group of women at low risk of infection. Copyright © 2017 Elsevier B.V. All rights reserved.
Plunkett, Jevon; Borecki, Ingrid; Morgan, Thomas; Stamilio, David; Muglia, Louis J
Adverse pregnancy outcomes, such as preterm birth, preeclampsia and placental abruption, are common, with acute and long-term complications for both the mother and infant. Etiologies underlying such adverse outcomes are not well understood. As maternal and fetal genetic factors may influence these outcomes, we estimated the magnitude of familial aggregation as one index of possible heritable contributions. Using the Missouri Department of Health's maternally-linked birth certificate database, we performed a retrospective population-based cohort study of births (1989-1997), designating an individual born from an affected pregnancy as the proband for each outcome studied. We estimated the increased risk to siblings compared to the population risk, using the sibling risk ratio, lambdas, and sibling-sibling odds ratio (sib-sib OR), for the adverse pregnancy outcomes of preterm birth, preterm premature rupture of membranes (PPROM), placental abruption, and pre-eclampsia. Risk to siblings of an affected individual was elevated above the population prevalence of a given disorder, as indicated by lambdaS (lambdaS (95% CI): 4.3 (4.0-4.6), 8.2 (6.5-9.9), 4.0 (2.6-5.3), and 4.5 (4.4-4.8), for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively). Risk to siblings of an affected individual was similarly elevated above that of siblings of unaffected individuals, as indicated by the sib-sib OR (sib-sib OR adjusted for known risk factors (95% CI): 4.2 (3.9-4.5), 9.6 (7.6-12.2), 3.8 (2.6-5.5), 8.1 (7.5-8.8) for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively). These results suggest that the adverse pregnancy outcomes of preterm birth, PPROM, placental abruption, and pre-eclampsia aggregate in families, which may be explained in part by genetics.
Yu, Haiyan; Wang, Xiaodong; Gao, Haocheng; You, Yong; Xing, Aiyun
Preterm premature rupture of the membranes (PPROM) remains the leading cause of preterm deliveries and neonatal mortality and morbidity. The current cohort study sought to retrospectively examine perinatal outcomes in cases of PPROM < 34 weeks' gestation that were managed conservatively from 2010 to 2012 and to identify risk factors for short-term neonatal outcomes. Subjects were 510 pregnancies consisting of 114 twin and 396 singleton pregnancies. Clinical chorioamnionitis occurred in 17.8% of the pregnancies. Neonatal mortality was 7.4%, the rate of major neonatal conditions was 40%, and the rate of NICU admission was 72.9%. The latency period exceeded 48 h in 62.5% of the pregnancies and 7 days in 24.3% of the pregnancies. Twin pregnancies had a shorter latency period than singleton pregnancies (median of 2 days versus 4 days, p < 0.001). Pregnancies complicated with early vaginal bleeding had a higher neonatal mortality (13.95% vs. 6.36%, p = 0.013) and morbidity (51.16% vs. 38.32%, p = 0.024), fewer weeks of gestation at PPROM (p = 0.029). Multivariate logistic regression analysis revealed that weeks of gestation at PPROM (OR: 0.953, 95% CI: 0.939-0.966, p < 0.001) and a latency period (OR: 0.948, 95%CI: 0.926-0.970, p < 0.001) were associated with neonatal mortality or morbidity. A twin pregnancy (OR: 0.319, 95% CI: 0.17-0.6, p < 0.001) and weeks of gestation at PPROM (OR: 0.737, 95% CI: 0.66-0.822, p < 0.001) were associated with the latency period. Gestational age at PPROM, a twin pregnancy, and the latency period are associated with neonatal mortality and morbidity.
Kucukaydin, Zehra; Kurdoglu, Mertihan; Kurdoglu, Zehra; Demir, Halit; Yoruk, Ibrahim H
To compare maternal, fetal and placental trace element (magnesium, zinc and copper) and heavy metal (cadmium and lead) and maternal vitamin (retinol, α [alpha]-tocopherol, vitamin D 3 , 25-hydroxyvitamin D 3 and 1,25-dihydroxyvitamin D 3 ) levels in preterm deliveries with and without preterm premature rupture of membranes (PPROM). Sixty-eight patients giving birth preterm were grouped into preterm deliveries with PPROM (n = 35) and without PPROM (n = 33). Following delivery, maternal and umbilical cord blood sera and placental tissue samples were obtained. While magnesium, zinc, copper, cadmium and lead levels were measured in all samples, the levels of retinol, α-tocopherol, vitamin D 3 , 25-hydroxyvitamin D 3 and 1,25-dihydroxyvitamin D 3 were measured only in maternal serum. While magnesium level in maternal serum and zinc levels in both maternal and umbilical cord sera were lower, placental magnesium level was higher in preterm deliveries with PPROM (P 0.05). In preterm deliveries with PPROM, 25-hydroxyvitamin D 3 and retinol levels were higher, while vitamin D 3 and 1,25-dihydroxyvitamin D 3 levels were lower in maternal serum (P < 0.05). Maternal serum α-tocopherol levels were similar between the groups. Compared to spontaneous preterm births, PPROM is associated with low maternal serum together with high placental tissue magnesium and low maternal and umbilical cord sera zinc levels. Higher retinol and 25-hydroxyvitamin D 3 and lower vitamin D 3 and 1,25-dihydroxyvitamin D 3 maternal serum levels are also evident in these patients. © 2018 Japan Society of Obstetrics and Gynecology.
Zou, Li-ying; Fan, Ling; Duan, Tao; Wang, Zi-lian; Ma, Run-mei
To investigate safety and efficacy of dinoprostone suppositories (0.8 mm) used in cervical ripening and labor induction in women with term premature rupture of the membranes. One hundred women of term monocyesis with premature rupture of the membranes, head presentation, bishop score less than 6 (test group) and 180 women with intact fetal membranes (control group) were enrolled into this multicenter, prospective clinical study. The vaginal delivery system was inserted into the posterior fornix, and the patients were recumbent for 2 hours after insertion. The interval time from using dinoprostone suppositories to uterine contraction, to labor and delivery were recorded. The following index were also recorded and compared, including the mean inserted time of dinoprostone suppositories, fetal heart beat, meconium stained amniotic fluid, hyperstimulation of uterus and the other complications, mode of delivery, stage of labor, postpartum hemorrhage, status of neonates. Three cases in test group and 23 cases in control group weren't in labor within 24 hours. The rate of labor within 24 hours in test group was significant higher than that in control group (97.0% vs. 87.2%, P 0.05). It had no significant difference in the interval time from using dinoprostone suppositories to labor starting and the mean inserted time and the total labor time between two groups (P > 0.05). The incidence of uterine tachysystole was 11.3% (11/97) in test group and 19.1% (30/157) in control group (P > 0.05), which did not reach statistical difference (P > 0.05). There wasn't neonatal asphyxia in both groups. It was safe and efficient to use dinoprostone suppositories for cervical ripening and induction of term pregnancy with premature rupture of the membranes, however, monitoring should be intensified.
José Elias Soares da Rocha
avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM, and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients received ampicillin and the control group (60 patients received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index, and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes, bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Repercussões maternas e perinatais da ruptura prematura das membranas até a 26ª semana gestacional Maternal and perinatal outcomes of premature rupture of the membranes up to the 26th week of gestation
Alessandra Maria Mont'Alverne Pierre
Full Text Available OBJETIVO: avaliar o prognóstico materno e perinatal em casos com amniorrexe prematura ocorridas até a 26ª semana de gravidez. MÉTODOS: análise retrospectiva dos casos de ruptura prematura das membranas ocorridas até a 26ª semana gestacional, sem sinais de trabalho de parto, sem qualquer tratamento para esta condição antes da admissão, acompanhados no período de janeiro de 1994 a dezembro de 1999. Os casos com idade gestacional menor que 22 semanas e peso ao nascimento inferior a 500 gramas foram excluídos. A amniorrexe foi confirmada pelo exame especular. Em caso de dúvida realizaram-se o teste da cristalização e a determinação do pH. Todas as grávidas foram submetidas a exame ultra-sonográfico para determinação da idade gestacional e índice de líquido amniótico. Os dados referentes ao resultado final da gravidez e as conseqüências para mãe, feto e neonato foram tabulados. RESULTADOS: preencheram os critérios de inclusão 29 casos de amniorrexe prematura. A ruptura ocorreu entre a 17ª e a 26ª semana, com média de 23,6 semanas. A duração média do período de latência foi de 21,7 dias. Ocorreram 22 partos vaginais espontâneos e três induzidos, além de quatro cesarianas. Houve sinais de infecção antes do parto em seis casos. Em 37,9% dos casos foram administrados antibióticos e em 6,9%, corticóides. Nenhuma paciente foi submetida a tocólise. Ocorreram três óbitos fetais e 25 neonatais. Apenas um recém-nascido sobreviveu, tendo permanecido na unidade de neonatologia por 19 dias devido a infecção e síndrome do desconforto respiratório. Não ocorreram óbitos maternos. CONCLUSÃO: a amniorrexe prematura até a 26ª semana gestacional tem sido doença com prognóstico extremamente sombrio para fetos e neonatos em nossa instituição.PURPOSE: to evaluate maternal and perinatal outcomes of premature rupture of membranes up to the 26th week of gestation. METHODS: retrospective analysis of the cases of
Eleje, George Uchenna; Ezugwu, Euzebus Chinonye; Ogunyemi, Dotun; Eleje, Lydia Ijeoma; Ikechebelu, Joseph Ifeanyichukwu; Igwegbe, Anthony Osita; Okonkwo, John E; Ikpeze, Okechukwu Christian; Udigwe, Gerald Okanandu; Onah, Hyacinth Eze; Nwosu, Betrand Obi; Ezeama, Chukwuemeka Okwudili; Ezenkwele, Eziamaka Pauline
To determine accuracy and costs of placental α-microglobulin-1 (PAMG-1) test compared to standard clinical assessment (SCA) for diagnosing rupture of membranes (ROM). A multicenter double-blind study of consecutive women with symptoms and signs of ROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, both in south-east Nigeria using SCA for ROM and the PAMG-1 test was done. ROM was diagnosed if two out of three methods from SCA (pooling, positive nitrazine test or ferning) were present and confirmed post-delivery based on presence of any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes overtly ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. A cost-analysis was also done. The outcome measures included sensitivity, specificity, accuracy and costs for the two tests. Accuracy, sensitivity and specificity for the PAMG-1 test were 97.2%, 97.4% and 96.7%, higher than for SCA which were 83.7%, 87.9% and 70.5%, respectively (P < 0.001). Accuracy of SCA was higher at less than 34 weeks than 34 weeks or more (88.3% vs 81.4%) while the PAMG-1 test performed equally at both gestational age categories (96.1% vs 97.7%). In women without pooling, accuracy of the PAMG-1 test was 96.7%, while it was 40.0% with SCA. Analysis showed that the overall cost of SCA was 45% higher than the PAMG-1 test. This study confirms that the PAMG-1 test has a consistently high diagnostic accuracy at all gestational ages and with equivocal cases of ROM. The PAMG-1 test appears less costly than SCA. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.
Lorthe, Elsa; Ancel, Pierre-Yves; Torchin, Héloïse; Kaminski, Monique; Langer, Bruno; Subtil, Damien; Sentilhes, Loïc; Arnaud, Catherine; Carbonne, Bruno; Debillon, Thierry; Delorme, Pierre; D'Ercole, Claude; Dreyfus, Michel; Lebeaux, Cécile; Galimard, Jacques-Emmanuel; Vayssiere, Christophe; Winer, Norbert; L'Helias, Laurence Foix; Goffinet, François; Kayem, Gilles
To assess the impact of latency duration on survival, survival without severe morbidity, and early-onset sepsis in infants born after preterm premature rupture of membranes (PPROM) at 24-32 weeks' gestation. This study was based on the prospective national population-based Etude Épidémiologique sur les Petits Ȃges Gestationnels 2 cohort of preterm births and included 702 singletons delivered in France after PPROM at 24-32 weeks' gestation. Latency duration was defined as the time from spontaneous rupture of membranes to delivery, divided into 4 periods (12 hours to 2 days [reference], 3-7 days, 8-14 days, and >14 days). Multivariable logistic regression was used to assess the relationship between latency duration and survival, survival without severe morbidity at discharge, or early-onset sepsis. Latency duration ranged from 12 hours to 2 days (18%), 3-7 days (38%), 8-14 days (24%), and >14 days (20%). Rates of survival, survival without severe morbidity, and early-onset sepsis were 93.5% (95% CI 91.8-94.8), 85.4% (82.4-87.9), and 3.4% (2.0-5.7), respectively. A crude association found between prolonged latency duration and improved survival disappeared on adjusting for gestational age at birth (aOR 1.0 [reference], 1.6 [95% CI 0.8-3.2], 1.2 [0.5-2.9], and 1.0 [0.3-3.2] for latency durations from 12 hours to 2 days, 3-7 days, 8-14 days, and >14 days, respectively). Prolonged latency duration was not associated with survival without severe morbidity or early-onset sepsis. For a given gestational age at birth, prolonged latency duration after PPROM does not worsen neonatal prognosis. Copyright © 2016 Elsevier Inc. All rights reserved.
Treatment of Preterm Premature Rupture of Membranes with Oligo-/Anhydramnion Colonized by Multiresistant Bacteria with Continuous Amnioinfusion and Antibiotic Administrations through a Subcutaneously Implanted Intrauterine Port System: A Case Report.
Tchirikov, Michael; Zhumadilov, Zhaxybay; Winarno, Andreas Suhartoyo; Haase, Roland; Buchmann, Jörg
Bacterial infection is one of the main causes of preterm premature rupture of membranes (PPROM) leading to preterm delivery, pulmonary hypoplasia, sepsis and joint deformities. Expectant management, broad-spectrum antibiotics and antenatal corticosteroids are routinely used in this condition with very limited success to prevent bacteremia, chorioamnionitis, funisitis and intra-amniotic infection syndrome. Here, we report a case in which we attempted to treat PPROM at 26+3 weeks of gestation with anhydramnion colonized by multiresistant Klebsiella. A perinatal port system was implanted subcutaneously at 28+0 weeks of gestation, enabling long-term continuous lavage of the amniotic cavity with a hypotonic aqueous composition similar to human amniotic fluid combined with intra-amniotic antibiotic application. The patient gave birth to a preterm female infant at 31+1 weeks without any signs of infection. The girl was discharged with a weight of 2,730 g in very good condition. In the follow-up examinations at 5 months and 1 year of age, there was no apparent neurological disturbance, developmental delay or Klebsiella colonization. © 2015 The Author(s) Published by S. Karger AG, Basel.
Eleje, George Uchenna; Edokwe, Emeka Stephen; Ikechebelu, Joseph Ifeanyichukwu; Onubogu, Chinyere Ukamaka; Ugochukwu, Ebele Francesca; Okam, Princeston Chukwuemeka; Ibekwe, Adaobi Maryann
To determine mother-to-child transmission (MTCT) rate and associated risk factors of human immune-deficiency virus (HIV) among HIV-infected pregnant women with term premature rupture of membranes (PROM) in comparison with those without PROM at term. All optimally managed HIV-positive pregnant women of Nnamdi Azikiwe University Teaching Hospital, on highly active anti-retroviral therapy (HAART) who had PROM at term were enrolled. Maternal HIV-1 viral load was not assessed. Follow up was for a minimum of 18 months for evidence of HIV infection. Of the 121 women with PROM at term, 46 (38.0%) were HIV sero-positive, 22/46 (47.8%) of which had their babies followed up till 18 months. The mean latency period was 10.5 ± 5.3 h in PROM group. Apart from duration of PROM (OR = 0.01; 95%CI = 0.00-0.13; p 0.05). Of the 22 (47.8%) babies followed-up in the PROM group and 13 in non-PROM group, none tested positive to HIV, given an MTCT rate of 0%. MTCT rate was 0% following term PROM and in women without PROM. Since maternal HIV-1 viral load was not assessed, we need to be critical while interpreting the findings.
Preterm labor and preterm premature rupture of membranes have a different pattern in the involved compartments of acute histologoic chorioamnionitis and/or funisitis: Patho-physiologic implication related to different clinical manifestations.
Park, Chan-Wook; Park, Joong Shin; Moon, Kyung Chul; Jun, Jong Kwan; Yoon, Bo Hyun
It is unknown whether histo-topographic findings about the involved compartments (i.e., choriodecidua, amnion, chorionic-plate) of acute-histologic chorioamnionitis (acute-HCA) and/or funisitis according to the presence or absence of intra-amniotic inflammation (IAI) and/or fetal inflammatory response syndrome (FIRS) are different between preterm labor and intact membranes (PTL) and preterm premature rupture of membranes (preterm-PROM). The involved compartments of acute-HCA and/or funisitis were examined in 161 singleton preterm-births ( 0.1). However, IAI(+)/FIRS(+) group had a significantly higher rate of inflammation in each compartment than IAI(+)/FIRS(-) group in both PTL and preterm-PROM (each-for P < 0.05). We first demonstrated that PTL and preterm-PROM had a different pattern in the involved compartments of acute-HCA and/or funisitis in the IAI(-)/FIRS(--) group and in the change of involved compartments from IAI(-)/FIRS(-) to IAI(+)/FIRS(-). © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.
Usefulness of maternal serum C-reactive protein with vaginal Ureaplasma urealyticum as a marker for prediction of imminent preterm delivery and chorioamnionitis in patients with preterm labor or preterm premature rupture of membranes.
Kwak, Dong-Wook; Cho, Hee-Young; Kwon, Ja-Young; Park, Yong-Won; Kim, Young-Han
To assess whether maternal serum C-reactive protein (CRP) and genital mycoplasmas measured can help predict imminent preterm delivery or chorioamnionitis in patients with preterm labor (PL) or preterm premature rupture of membranes (PPROM). The study group consisted of 165 women with PL or PPROM. Vaginal cultures for genital mycoplasmas and maternal blood for CRP were obtained when they were admitted for the management of PL or PPROM. An elevated level of serum CRP was defined as ≥0.8 mg/dL. Histologic evaluation of the placenta was performed after delivery. The prevalence of positive vaginal fluid cultures for Ureaplasma urealyticum (UU) was 63.0%, and elevated maternal serum CRP was 32.7%. No outcome variables were associated with vaginal UU infection in patients with lower CRP levels. However, among women with elevated CRP, the mean gestational age at birth was significantly reduced, and low Apgar score, neonatal intensive care unit admission, histologic chorioamnionitis, and delivery within 7 days of admission were significantly more common in patients with vaginal UU. Although vaginal UU in PL or PPROM cannot act as the sole predictor of imminent preterm delivery or chorioamnionitis, it can provide predictive information in patients with elevated maternal serum CRP levels.
Okeke, Tc; Anyaehie, Ub; Ezenyeaku, Cc
Premature menopause affects 1% of women under the age of 40 years. The women are at risk of premature death, neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease and infertility. There is need to use simplified protocols and improved techniques in oocyte donation to achieve pregnancy and mother a baby in those women at risk. Review of the pertinent literature on premature menopause, selected references, internet services using the PubMed and Medline databases were included in this review. In the past, pregnancy in women with premature menopause was rare but with recent advancement in oocyte donation, women with premature menopause now have hoped to mother a child. Hormone replacement therapy is beneficial to adverse consequences of premature menopause. Women with premature menopause are at risk of premature death, neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease and infertility. Public enlightenment and education is important tool to save those at risk.
Park, Chan-Wook; Park, Joong Shin; Norwitz, Errol R; Moon, Kyung Chul; Jun, Jong Kwan; Yoon, Bo Hyun
Histologic chorio-deciduitis and chorio-deciduo-amnionitis (amnionitis) in extra-placental membranes are known to represent the early and advanced stages of ascending intra-uterine infection. However, there are no data in humans about the time required for chorio-deciduitis to develop and for chorio-deciduitis without amnionitis to progress to chorio-deciduitis with amnionitis, and the effect of prolongation of pregnancy on the development of chorio-deciduitis and amnionitis in patients with preterm labor and intact membranes (PTL) and preterm premature rupture of membranes (preterm-PROM). We examined these issues in this study. The study population consisted of 289 women who delivered preterm (133 cases with PTL, and 156 cases with preterm-PROM) and who had sterile amniotic fluid (AF) defined as a negative AF culture and the absence of inflammation as evidenced by a matrix metalloproteinase-8 (MMP-8) level membranes (i.e., inflammation-free extra-placental membranes, choroi-deciduitis only, and chorio-deciduitis with amnionitis) in patients with PTL and preterm-PROM. Amniocentesis-to-delivery interval was longer in cases of chorio-deciduitis with amnionitis than in cases of chorio-deciduitis only in both PTL (median [interquartile-range (IQR)]; 645.4 [319.5] vs. 113.9 [526.9] hours; P = 0.005) and preterm-PROM (131.3 [135.4] vs. 95.2 [140.5] hours; Pmembranes. Moreover, prolongation of pregnancy is an independent predictor of the development of both chorio-deciduitis and amnionitis in cases of PTL with sterile AF.
... eardrum ruptures. After the rupture, you may have: Drainage from the ear (drainage may be clear, pus, or bloody) Ear noise/ ... doctor to see the eardrum. Audiology testing can measure how much hearing has been lost. Treatment You ...
ini merupakan penelitian analitik dengan rancangan penelitian kasus kontrol. Sampel terdiri dari 114 orang kasus ibu yang mengalami KPD dan kontrol sebanyak 228 ibu bersalin yang tidak mengalami KPD. Hasil penelitian menunjukkan faktor risiko terhadap kejadian KPD yaitu usia, paritas, pendidikan. Berdasarkan analisis multivariat, didapatkan faktor yang paling dominan berisiko terhadap kejadian KPD yaitu pendidikan.
Full Text Available Placental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns.To determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival.This prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birthn = 34. Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics.Twenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI or maternal under perfusion (MUP (P < 0.05. Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05. Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0
Valores séricos de imunoglobulinas e dos componentes do complemento em gestantes com ruptura prematura de membranas Immunoglobulin serum values and complement components in pregnant women with premature rupture of the membranes
imunoglobulinas e complementos.PURPOSE: the premature rupture of membranes (PROM has been a reason for many investigations, amongst which the involved immune mechanisms. Ahead of the scarcity of studies related to the subject, this work had as objective to evaluate the serum values of IgA, IgG, IgM, C3 and C4 in pregnant women with pre-term PROM. METHODS: in this transversal study, 36 pregnant women had been enclosed, with gestational age between 23 and 37 weeks. Of this total, 15 women had had laboratorial and clinical diagnosis of PROM. Patients with beginning of the childbirth work, clinical signals of infection, clinical dysfunction with systemic repercussion had been excluded. Serum concentrations of immunoglobulin (IgA, immunoglobulin M (IgM and immunoglobulin G (IgG, C3 and C4 had been evaluated in the patients with (study group and without PROM (control group. Correlation among dosages; number of childbirths and time of rupture was determined by Spearman coefficient correlation (r value. RESULTS: serum levels of IgA (average±SD had been significantly higher in the patients of the control group (271.0±107.0 versus 202.9±66.1; respectively, control and study group; p=0.024. There was no statistical difference when the levels of IgM, IgG, C3 and C4 had been compared between two groups. Significant association was not noticed between the number of childbirths and the IgA, IgM, IgG, C3 and C4 dosages (Spearman; r between -0,009 and 0,027; p>0,05. The average time of rupture of study group patients was of 19.1 hours (one - 72 hours, without association with the evaluated serum dosages. CONCLUSIONS: pregnant women with PROM show levels of IgA significantly lower than normal pregnant patients. The variable "number of childbirths" does not act as a factor of confusion in the comparative analysis of the dosages obtained in patients with or without PROM, as well as also it did not have association between the time of rupture and the immunoglobulin and complements serum dosages.
Miguel Lugones Botell
Full Text Available Se realizó una revisión sobre aspectos de la rotura prematura de las membranas ovulares, la cual resulta de gran importancia por constituir un tema de mucho interés y tener una morbimortalidad importante en el desarrollo normal del embarazo en cualquiera de sus etapas, sobre todo, antes del término de este. Se destacan aspectos sobre la constitución de las membranas, la clasificación, así como los fundamentos fisiopatológicos y su etiología, enfatizando en la importancia que tienen las infecciones cervicovaginales, y, consecuentemente, en la necesidad de una prevención adecuada en ese sentido, sin prescindir de otros aspectos que también tienen su influencia, como son, las relaciones sexuales y otras complicaciones propias del embarazo (gemelaridad, sangrados de la gestación, presentaciones viciosas, polihidramnios, tabaquismo, etc.. Se resaltan también las complicaciones que pueden ocurrir para el feto y para la madre; y se enfatiza en la necesidad de una adecuada prevención, la cual puede lograrse, fundamentalmente, con el correcto seguimiento de la gestante en el nivel primario de salud.A review on the features related to premature rupture ovular membranes was carried out, which is essential because it is a interesting subject and with a high mortality and morbidity rate in the development of a normal pregnancy in any of its stages, mainly before its term. There are significant features on the membrane's composition, its classification, as well as the physiopathologic basis and its etiology, emphasizing on the significance of cervicovaginal infections and thus in the need of a appropriate prevention in that sense, without disregard of other features that also have its influence including the intercourses and other complications own of pregnancy (twinning, pregnancy bleeding, defective presentations, polyhydramnios, smoking, etc. Also are emphasized the complications that may to occur for fetus and for the mother as well as the
... matter Infection or neonatal sepsis Low blood sugar (hypoglycemia) Neonatal respiratory distress syndrome, extra air in the tissue ... Outlook (Prognosis) Prematurity used to be a major cause of infant deaths. Improved medical and nursing techniques ...
Devlieger, R.; Millar, L. K.; Bryant-Greenwood, G.; Lewi, L.; Deprest, J. A.
In view of the important protective role of the fetal membranes, wound sealing, tissue regeneration, or wound healing could be life saving in cases of preterm premature rupture of the membranes. Although many investigators are studying the causes of preterm premature rupture of membranes, the emphasis has not been on the wound healing capacity of the fetal membranes. In this review, the relevant literature on the pathophysiologic condition that leads to preterm premature rupture of membranes ...
The intermediate heat transport system for a sodium-cooled fast breeder reactor includes a device for rapidly draining the sodium therefrom should a sodium-water reaction occur within the system. This device includes a rupturable member in a drain line in the system and means for cutting a large opening therein and for positively removing the sheared-out portion from the opening cut in the rupturable member. According to the preferred embodiment of the invention the rupturable member includes a solid head seated in the end of the drain line having a rim extending peripherally therearound, the rim being clamped against the end of the drain line by a clamp ring having an interior shearing edge, the bottom of the rupturable member being convex and extending into the drain line. Means are provided to draw the rupturable member away from the drain line against the shearing edge to clear the drain line for outflow of sodium therethrough
Full Text Available History of present illness: A 46-year-old male presented to the emergency department (ED with severe left eye pain and decreased vision after tripping and striking the left side of his head on the corner of his wooden nightstand. The patient arrived as an inter-facility transfer for a suspected globe rupture with a protective eye covering in place; thus, further physical examination of the eye was not performed by the emergency physician in order to avoid further leakage of aqueous humor. Significant findings: The patient’s computed tomography (CT head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow, consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies. Discussion: A globe rupture is a full-thickness defect in the cornea, sclera, or both.1 It is an ophthalmologic emergency. Globe ruptures are almost always secondary to direct perforation via a penetrating mechanism; however, it can occur due to blunt injury if the force generated creates sufficient intraocular pressure to tear the sclera.2 Globes most commonly rupture at the insertions of the intraocular muscles or at the limbus. They are associated with a high rate of concomitant orbital floor fractures.2,3 Possible physical examination findings include a shallow anterior chamber on slit-lamp exam, hyphema, and an irregular “teardrop” pupil. Additionally, a positive Seidel sign, which is performed by instilling fluorescein in the eye and then examining for a dark stream of aqueous humor, is indicative of a globe rupture.4 CT is often used to assess for globe rupture; finds of a foreign body, intraocular air, abnormal contour or volume of the globe, or disruption of the sclera suggest globe rupture.2 The sensitivity of CT scan for diagnosis of globe rupture is only 75%; thus, high clinical
... be caused by various underlying problems, such as mononucleosis and other infections, liver disease, and blood cancers. ... cause a ruptured spleen. For instance, people with mononucleosis — a viral infection that can cause an enlarged ...
... include the following: Anxiety about performance Guilty feelings Depression Stress Relationship problems Men who have a low amount of a special ... on your favorite sports team. Psychological assistance Anxiety, depression ... may help men who have premature ejaculation. Some antidepressants seem to ...
Dec 5, 2015 ... Background: Preterm premature rupture of membranes (PPROM) is a challenging complication of ... PROM (P < 0.000), latency period (P < 0.000), and birth weight (P < 0.001). ..... J Obstet Gynecol 2000;183:271‑6. 25. Mercer ...
Bernardita Donoso Bernales
Full Text Available Preterm delivery is the single most important cause of perinatal morbidity and mortality. In Chile, preterm births have increased in the past decade, although neonatal morbidity and mortality attributable to it shows a downward trend, thanks to improvements in neonatal care of premature babies, rather than the success of obstetric preventive and therapeutic strategies. This article describes clinical entities, disease processes and conditions that constitute predisposing factors of preterm birth, as well as an outline for the prevention and clinical management of women at risk of preterm birth.
The hypothesis that radiation may accelerate aging phenomenon has been studied extensively, using the population of A-bomb survivors. In this paper, non-specific radiation-induced premature aging is discussed with a review of the literature. Cardiac lipofuscin, papillary fibrosis, aortic extensibility, hexamine/collagen ratio in the skin and aorta, testicular changes, giant hepatic cell nucleus, and neurofibril changes have so far been studied pathologically in the context of A-bomb radiation. Only testicular sclerosis has been found to correlate with distance from the hypocenter. Suggestive correlation was found to exist between the hexamine/collagen ratio in the skin and aorta and A-bomb radiation. Grip strength and hearing ability were decreased in the group of 100 rad and the group of 50-99 rad, respectively. The other physiological data did not definitely correlate with A-bomb radiation. Laboratory data, including erythrocyte sedimentation rate, α and β globulin levels, phytohemagglutinin reaction, T cell counts, erythrocyte glycophorin-A, the incidence of cerebral stroke, ischemic heart disease, and cataract were age-dependent and correlated with A-bomb radiation. These findings indicated that the occurrence of arteriosclerosis-related diseases, changes in immunological competence, and some pathological and physiological findings altered with advancing age, suggesting the correlation with A-bomb radiation. In general, it cannot be concluded that there is a positive correlation between A-bomb radiation and the premature aging. (N.K.) 51 refs
Context: Pre‑labour rupture of membranes (PROM) is a common obstetric complication which presents a diagnostic challenge, especially in equivocal ... problematic with the need to balance the risk of prematurity with that of prolonged ... array of rapid, minimally invasive tests based on biochemical markers in amniotic fluid ...
Ruptura prematura das membranas amnióticas no pré-termo: fatores associados à displasia broncopulmonar Preterm premature rupture of the fetal membranes: factors associated with bronchopulmonary dysplasia
Danieli Dias Gonçalves
Full Text Available OBJETIVO: identificar os fatores obstétricos e neonatais associados ao desfecho de displasia broncopulmonar em pacientes com amniorrexe prematura no pré-termo. MÉTODOS: foram analisados 213 prontuários do Instituto Fernandes Figueira, entre 1998 e 2002, cujas pacientes evoluíram com quadro de amniorrexe prematura 10 dias (OR: 54,00 [11,55-278,25] p=0,000; idade gestacional 10 dias (p=0,001 e "uso de surfactante" (p=0,040 permaneceram independentemente associadas ao desfecho. CONCLUSÕES: observou-se que os fatores associados à displasia broncopulmonar são de natureza neonatal, sendo que a ventilação mecânica duradoura e o uso de surfactante neonatal influenciaram no desenvolvimento dessa doença.PURPOSE: to analyze obstetric and neonatal factors associated with bronchopulmonary dysplasia outcome in patients with preterm premature amniorrhexis. METHODS: we analyzed 213 medical records of patients of Fernandes Figueira Institute who suffered premature amniorrhexis (10 days (p=0.001 and "use of a surfactant" (p=0.040 remained independently associated with bronchopulmonary dysplasia. CONCLUSIONS: the factors associated with bronchopulmonary dysplasia are related to neonatal features, asprolonged mechanical ventilation and the use of a surfactant influencethe development of thedisease.
... volunteer leader Partner Spotlight Become a partner World Prematurity Day What's happening in your area Find out ... 3 weeks after a premature birth. Retinopathy of prematurity (ROP) . This is an abnormal growth of blood ...
... email updates Enter email Submit Early or premature menopause Menopause that happens before age 40 is called ... What is the difference between early and premature menopause? Early or premature menopause happens when ovaries stop ...
Chris G McMahon
Full Text Available Premature ejaculation (PE is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects.
McMahon, Chris G
Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects.
Uso de misoprostol retal para indução do parto em gestantes com amniorrexe prematura: ensaio clínico fase II Use of rectal misoprostol for induction of labor in patients with premature rupture of membranes: a phase II clinical trial
Francisco Carlos Nogueira Arcanjo
Full Text Available OBJETIVO: avaliar se o misoprostol por via retal constitui método efetivo para indução do parto em gestantes com amniorrexe prematura a termo. MÉTODOS: realizou-se estudo piloto, incluindo 32 gestantes com amniorrexe prematura entre 36 e 41 semanas, feto vivo e único, em apresentação cefálica, escore de Bishop 18 horas receberam antibiótico (penicilina cristalina para profilaxia de infecção estreptocócica. Analisaram-se desfechos diversos como intervalo entre indução e início do trabalho de parto, entre indução e parto, incidência de taquissistolia, tipo de parto, incidência de corioamnionite e resultados neonatais. A análise estatística foi realizada no programa de domínio público Epi-Info 2002, calculando-se médias com os respectivos desvios-padrão, além de distribuições de freqüência. Realizou-se análise de sobrevivência para determinação do percentual de partos em função do tempo transcorrido (em horas desde a administração do primeiro comprimido. RESULTADOS: os intervalos (média ± desvio padrão entre indução e início das contrações e entre indução e parto foram de, respectivamente, 299,8±199,9 e 681±340,5 minutos. Observou-se freqüência de 9,4% de taquissistolia. Cerca de 72% das pacientes evoluíram para parto vaginal. Diagnosticou-se corioamnionite em 12,5% dos casos. As medianas dos escores de Apgar foram de 8 e 9 no primeiro e quinto minuto, respectivamente. Não houve nenhum caso de Apgar PURPOSE: to investigate whether rectally administered misoprostol is an effective method for induction of labor in patients with premature ruptured membranes at term. METHODS: a pilot trial was conducted, enrolling 32 women with alive, singleton, cephalic fetus and ruptured membranes between 36 and 41 weeks of pregnancy, with Bishop score 18 h received antibiotics (crystalline penicillin for prophylaxis of streptococcal infeccion. Outcomes included time from induction to labor and induction to
... medlineplus.gov/ency/article/007227.htm Apnea of prematurity To use the sharing features on this page, ... down or stops from any cause. Apnea of prematurity refers to short episodes of stopped breathing in ...
Waldinger, Marcel D
PURPOSE OF REVIEW: As there are various drugs and different treatment strategies to delay ejaculation, a review of the current drug treatments for premature ejaculation is relevant for daily clinical practice. RECENT FINDINGS: There are four premature ejaculation subtypes: lifelong premature
Steinweg, Sue Byrd; Griffin, Harold C.; Griffin, Linda W.; Gingras, Happy
The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant's eye. Retinopathy of prematurity develops when abnormal blood vessels grow and spread throughout the retina, which is the nerve tissue at the…
The use of dexamethasone in women with preterm premature rupture of membranes - A multicentre, double-blind, placebocontrolled, randomised trial. R.C. Pattinson, J.D. Makin, M. Funk, S.D. Delport, A.P. Macdonald, K. Norman, G. Kirsten, C. Stewart, D. Woods, G. Moller, E. Coetzee, P. Smith, J. Anthony, M. Schoon, ...
and the incidence of sepsis in the women did not differ significantly. Eleven infants in each group developed sepsis. Conclusion. This is the first randomised trial in women with. PPROM to compare the effects of the use of corticosteroids with placebo, where all women received prophylactic antibiotics concomitantly with the ...
Full Text Available Uterine rupture is a deadly obstetrical emergency endangering the life of both mother and fetus. In Bangladesh, majority of deliveries arc attended by unskilled traditional birth attendant and maternal mortality is still quite high. It is rare Ln developed country but unfortunately it is common in a developing country like Bangladesh. We report a case history of a patient age 32yrs from Daudkandi, Comilla admitted with H/0 previous two rupture uterus and repair with no living issue. We did caesarean section at her 31+ weeks of pregnancy when she developed Jabour pain. A baby of 1.4 kg was delivered. During cesarean section, focal rupture was noted in previous scar of rupture. Unfortunately the baby expired in neonatal ICU after 36 hours.
Zero to Three (J), 2003
In this article, seven families describe their experiences giving birth to and raising a premature baby. Their perspectives vary, one from another, and shift over time, depending on each family's circumstances and the baby's developmental course. Experiences discussed include premature labor, medical interventions and the NICU, bringing the baby…
Premature ovarian failure is characterized by secondary amenorrhea affecting a woman before the age of 40, leading to hypoestrogenism, infertility, and consequences of premature menopause, such as osteoporosis, cardiovascular disease, neurovegetative alterations, and others. Follicular exhaustion is due to either follicles shortage or oocytes accelerated destruction. Main causes are genetic, autoimmune and iatrogenic. Among genetic causes Xq and Xp deletions, translocations, numeric aberratio...
Polettini, Jossimara; Vieira, Eliane Passarelli; Santos, Mariana Perlati dos; Peraçoli, José Carlos; Witkin, Steven S; da Silva, Márcia Guimarães
To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis. A case control study that included 42 pregnant women not in labor in the following groups: PPROM (n=28) and controls with intact membranes submitted to selective cesarean section at term (n=14). Expression of IL-18 mRNA in chorioamniotic membranes was determined by real-time polymerase chain reaction, and IL-18 protein expression was measured by western blot. Histopathological analyses and immunolocalization of IL-18 by immunohistochemistry were also performed. Analyses were performed using the Mann-Whitney or Fisher's exact tests and the group effect was considered significant if the adjusted p-values were <0.05 and the magnitude of change was greater than 2-fold for mRNA expression. IL-18 mRNA was present in 100% of samples and no difference in expression was observed between term vs. PPROM membranes (fold-change 0.12; p=0.88). In the PPROM group, no difference was observed in IL-18 mRNA regarding gestational age (fold-change 0.11; p=0.42) or the presence of histological chorioamnionitis (fold-change 0.26; p=0.15). ProIL-18 was present in all samples. IL-18 was immunolocalized to amnion, chorion and decidua cells, with intense immunohistochemical staining at the choriodecidual junction. Chorioamniotic membranes are sources of IL-18 mRNA and proIL-18, and their expression is unrelated to PPROM or histological chorioamnionitis. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Winer-Muram, H.T.; Muram, D.; Salazar, J.; Massie, J.D.
The diagnosis of hepatic rupture in patients with pregnancy-induced hypertension (preeclampsia and eclampsia) is rarely made preoperatively. Diagnostic imaging can be utilized in some patients to confirm the preoperative diagnosis. Since hematoma formation precedes hepatic rupture, then, when diagnostic modalities such as sonography and computed tomography identify patients with hematomas, these patients are at risk of rupture, and should be hospitalized until the hematomas resolve
Many therapists regard alliance ruptures as one of the greatest challenges therapists face in the therapy room. Alliance ruptures has been previously defined as breakdowns in the process of negotiation of treatment tasks and goals and a deterioration in the affective bond between patient and therapist. Alliance ruptures have been found to predict premature termination of treatment and poor treatment outcomes. But ruptures can also present important opportunities for gaining insight and awareness and for facilitating therapeutic change. A process of rupture resolution may lead to beneficial outcomes and serve as a corrective emotional experience. The article describes unique processes of alliance rupture resolution inherent in animal-assisted psychotherapy (AAP). Building on Safran and Muran's model and on clinical examples, the article describes strategies for identifying ruptures in AAP and techniques for repairing them to facilitate a corrective experience in treatment. Implications for clinical practice and future research are discussed.
... developing severe ROP, especially those in underserved or remote areas. Currently in the U.S., evaluation of premature ... files require the free Adobe® Reader® software for viewing. This website is maintained by the NEI Office ...
Lynch, Anne M; Wagner, Brandie D; Hodges, Jennifer K; Thevarajah, Tamara S; McCourt, Emily A; Cerda, Ashlee M; Mandava, Naresh; Gibbs, Ronald S; Palestine, Alan G
Retinopathy of prematurity is an adverse outcome of preterm birth and is a leading cause of childhood blindness. The relationship between the subtypes of preterm birth with retinopathy of prematurity is understudied. To investigate whether there is a difference in the incidence of type 1 or type 2 retinopathy of prematurity in infants with preterm birth resulting from spontaneous preterm labor, a medical indication of preterm birth, or preterm premature rupture of the membranes. A retrospective cohort study was conducted of 827 infants screened for retinopathy of prematurity who were delivered at a single tertiary care center in Colorado. All infants fulfilled the American Academy of Pediatrics 2013 screening criteria for retinopathy of prematurity defined as "infants with a birth weight of ≤1500 g or gestational age of 30 weeks or less (as defined by the attending neonatologist) and selected infants with a birth weight between 1500 and 2000 g or gestational age of >30 weeks with an unstable clinical course, including those requiring cardiorespiratory support and who are believed by their attending pediatrician or neonatologist to be at high risk for retinopathy of prematurity." Two independent reviewers masked to retinopathy of prematurity outcomes determined whether preterm birth resulted from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes. Discrepancies were resolved by a third reviewer. Data were analyzed with univariate and multivariable logistic regression. In our cohort, the frequency of preterm birth resulting from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes was 34%, 40%, and 26%, respectively. The mean gestational age (weeks, days) ± SD (range) in the cohort and across the preterm birth subtypes was as follows: entire cohort, 28 weeks, 6 days ± 2 weeks, 3 days (23 weeks, 3 days - 36 weeks, 4 days); spontaneous preterm labor
The classical triad of presentation of delayed menses, irregular vaginal bleeding and abdominal pain may not be encountered at all! Overwhelming features of abdominal pain, amenorrhea, pallor, abdominal tenderness, shifting dullness with positive pregnancy test gave a clinical diagnosis of ruptured ectopic pregnancy.
Full Text Available Premature ovarian failure (POF, also termed as primary ovarian insufficiency (POI, is a highly heterogenous condition affecting 0.5-3.0% of women in childbearing age. These young women comprise quite a formidable group with unique physical and psychological needs that require special attention. Premature ovarian senescence (POS in all of its forms evolves insidiously as a basically asymptomatic process, leading to complete loss of ovarian function, and POI/POF diagnoses are currently made at relatively late stages. Well-known and well-documented risk factors exist, and the presence or suspicion of autoimmune disorder should be regarded as an important one. Premature ovarian failure is to some degree predictable in its occurrence and should be considered while encountering young women with loss of menstrual regularity, especially when there is a concomitant dysfunction in the immune system.
Dam, Mie S.; Juhl, Sandra M.; Sangild, Per T.
Kinship, understood as biogenetic proximity, between a chosen animal model and a human patient counterpart, is considered essential to the process of ‘translating’ research from the experimental animal laboratory to the human clinic. In the Danish research centre, NEOMUNE, premature piglets are fed...... a novel milk diet (bovine colostrum) to model the effects of this new diet in premature infants. Our ethnographic fieldwork in an experimental pig laboratory and a neonatal intensive care unit (NICU) in 2013–2014 shows that regardless of biogenetics, daily practices of feeding, housing, and clinical care...... the researchers refer to as the ‘translatability’ of the results. In the NICU, parents of premature infants likewise imagine a kind of interspecies kinship when presented with the option to supplement mother's own milk with bovine colostrum for the first weeks after birth. However, in this setting the NICU...
Full Text Available Submitral aneurysm is a rare entity, with around few hundred cases reported till date. Presentation can be varied. We describe here a case of submitral aneurysm in a young male with rupture into the left atrium cavity.
... is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially. If your Achilles ...
Full Text Available Abstract Premature ovarian failure (POF is a primary ovarian defect characterized by absent menarche (primary amenorrhea or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea. It is a heterogeneous disorder affecting approximately 1% of women e.g. Turner syndrome represent the major cause of primary amenorrhea associated with ovarian dysgenesis. Despite the description of several candidate genes, the cause of POF remains undetermined in the vast majority of the cases. Management includes substitution of the hormone defect by estrogen/progestin preparations. The only solution presently available for the fertility defect in women with absent follicular reserve is ovum donation.
Hussain, M.; Yasmeen, H.; Noorani, K.
A case of ruptured cornual pregnancy is presented here. The patient presented with history of 30 weeks gestational amenorrhoea and pain in the lower abdomen and epigastrium for the last seven days. Ultrasound revealed a 29 weeks abdominal pregnancy with blood in the pelvic cavity. On laparotomy; there was a ruptured right cornual pregnancy, treated cornual resection and uterine repair. An alive male baby of one kg weight was delivered from the resected cornua of the uterus. (author)
... volunteer leader Partner Spotlight Become a partner World Prematurity Day What's happening in your area Find out ... to remove damaged parts of intestine. Retinopathy of prematurity (also called ROP) . ROP affects blood vessels in ...
... they leave the hospital for home. Retinopathy of Prematurity (ROP) What It Is: ROP is an eye ... sometimes seen in preterm babies include anemia of prematurity (a low red blood cell count) and heart ...
Nissenkorn, I; Yassur, Y; Mashkowski, D; Sherf, I; Ben-Sira, I
One hundred and fifty-five premature infants weighing 600-2000 g were followed up during 1974-80 for the presence of retinopathy of prematurity (ROP) and for the existence of myopia. 50% of the premature infants who had ROP were myopic, while only 16% myopic premature infants were found among those who did not have ROP. There was a positive correlation between the degree of myopia and the severity of cicatricial ROP. No difference existed in the frequency and degree of myopia between prematur...
Benavides Vargas, Ana Maria
Retinopathy of prematurity has been the leading cause of childhood blindness. Early and effective screening has helped to diagnose the visual target of an infant by the difference between growing up with a disability or not. A joint effort between ophthalmologists and neonatologists is proposed to control this disease, ensuring success. An appropriate, early, effective and timely treatment has been the laser and cryotherapy like good choices for the neonate to prevent disease progression. Evaluation of screening program, to determine the incidence, compare statistics variables have been measures as other medical pathologies should be encouraged as research topics. A decrease in the incidence of retinopathy of prematurity is expected, controlling the risk factors during the child's stay in intrahospital neonatal unit [es
Maria E. Linnaus
Full Text Available Perinatal omphalocele rupture is a rare occurrence. We present a case of a baby delivered at 35 weeks with a known giant omphalocele, transverse lie, and the omphalocele downward in the birth canal who suffered rupture of the omphalocele and liver injury around the time of delivery. The pregnancy was complicated by one day of preterm labor, preterm premature rupture of the membranes, and the omphalocele was the presenting part. Despite pulmonary hypertension, rupture of the omphalocele, and a significant liver injury, individualized management with decompression of the liver hematoma allowed successful early closure with mesh followed by delayed reconstruction.
A solution of the well response to a prematurely terminated slug test (PTST) is presented. The advantages of a PTST over conventional slug tests are discussed. A systematized procedure of a PTST is proposed, where a slug test is terminated in the midpoint of the flow point, and the subsequent shut-in data is recorded and analyzed. This method requires a downhole shut-in device and a pressure transducer, which is no more than the conventional deep-well slug testing. As opposed to slug tests, which are ineffective when a skin is present, more accurate estimate of formation permeability can be made using a PTST. Premature termination also shortens the test duration considerably. Because in most cases no more information is gained by completing a slug test to the end, the author recommends that conventional slug tests be replaced by the premature termination technique. This study is part of an investigation of the feasibility of geologic isolation of nuclear wastes being carried out by the US Department of Energy and the National Cooperative for the Storage of Radioactive Waste of Switzerland
Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but "extraordinary" phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable.
Beligere, Nagamani; Perumalswamy, Vijayalaksmi; Tandon, Manish; Mittal, Amit; Floora, Jayasheele; Vijayakumar, B; Miller, Marilyn T
Prematurity is a major global health issue leading to high mortality and morbidity among the survivors. Neurodevelopmental disability (NDD) and retinopathy of prematurity (ROP) are the most common complications of prematurity. In fact, ROP is the second leading cause of childhood blindness in the world. Although there is much information regarding the occurrence of ROP and of NDD in premature infants, there have been few studies on ROP and its association with NDD. The objectives of this article are to review the current literature on the subject and to publish our own findings concerning the association between ROP and NDD in premature infants. The review suggests that although NDDs are related to degree of prematurity, NDD could also be the result of visual impairments resulting from ROP. Our own study shows a close association between NDD and zonal involvement of ROP: higher NDD if zone 1 is involved and less if zone 3 is involved. Copyright © 2015 Elsevier Ltd. All rights reserved.
Frenette, Priscilla; Dodds, Linda; Armson, B Anthony; Jangaard, Krista
To compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM). Women with PPROM occurring between 24+0 and 36+6 weeks of gestation were identified from a provincial population-based perinatal database in Nova Scotia. The primary outcomes included composite variables for serious maternal and neonatal infectious morbidity and neonatal prematurity-related morbidity. Logistic regression was used to quantify the relationship between latency period (prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with prematurity-related morbidity at 48 hours to prematurity-related morbidity, even close to term, without putting mother or neonate at substantial risk for serious infectious morbidity. Generalization of these findings to other obstetric populations should be informed by the underlying risk of infection.
Kuhlman, J.E.; Fishman, E.K.; Zerhouni, E.A.; Knowles, M.
The CT scans of 55 patients with acquired immunodeficiency syndrome (AIDS) were reviewed for evidence of pulmonary emphysema. While the average age of patients in this series was 38 years, 25 of the 55 patients, or 45%, demonstrated CT evidence of emphysema. CT findings suggestive of emphysema included areas of low-attenuation, blebs and/or vascular disruption. The authors conclude there is an increased incidence of CT-detectable pulmonary emphysema that is premature for age in patients with AIDS. Destruction of pulmonary parenchyma may represent the response of the lung to repeated pulmonary infections or may be a direct result of the human immunodeficiency virus
Result of these observations, comparisons and evaluations can be summarized in the following list of concerns regarding the use of double rupture discs coupled to the liquid space of a steam generator that is subjected to a large leak sodium water reaction event. Single rupture disc show delayed collapse characteristics in LLTR Series I and double disc assemblies are presumed to be more complex with additional delay before opening to give pressure relief. Delayed failure increases pressures in the IHTS and must be adequately covered by design requirements. With CRBR design, the first disc may fail only partially reducing the loading on the second disc with the result that relief performance may not meet requirements
Piediferro, Guido; Colpi, Elisabetta M; Castiglioni, Fabrizio; Scroppo, Fabrizio I
Serotonergic drugs (SSRIs) are the most commonly used, but they are characterized by relapse some time after medication interruption as well as by sexual side effects. The efficacy of phosphodiesterase-5 inhibitors seems excellent, but the risk of tachyphylaxis has been reported. The former (fluoxetine, paroxetine, sertraline, clomipramine) should be used in young patients with hyper-orgasmic forms, while the latter (sildenafil, tadalafil, vardenafil) should be used in hypo-orgasmic forms, in old age or when PE is associated with erectile dysfunction. Topical anesthetics provide satisfactory results in premature ejaculation due to hypersensitivity of the glans, and physiotherapy of the pelvic floor muscles proves successful in cases associated with pelvic floor dysfunction. Therapeutic associations and psycho-sexual therapy techniques may improve results, particularly in the long term.
Promelle, V; Milazzo, S
Retinopathy of prematurity is a retinal vasoproliferative disease affecting extremely preterm infants exposed to high concentrations of oxygen therapy. Infants born before 32 post-menstrual weeks or with a birth weight of less than 1500g should systematically have a dilated fundus examination. The time of screening and schedule for follow-up are guided by the various risk factors. This disease results from immaturity of the peripheral retinal vessels at the time of premature birth. The classification of ROP depends on the anteroposterior extent of involvement (from center to periphery: zone I, II and III), its extension in 30° sectors (clock hours) and its stage (stage 1 to 5). "Plus" disease is defined as dilation and tortuosity of the retinal blood vessels in the posterior pole of the eye and represents a major risk factor for rapid unfavorable progression. A majority of patients will spontaneously recover, but patients with a high risk of progression will require treatment to prevent retinal detachment and blindness. The indications for treatment are threshold disease and type 1 pre-threshold disease. The current treatment of choice is peripheral retinal ablation with transpupillary laser, but ab externo cryotherapy may be used instead. Intravitreal injection of vascular endothelial growth factor inhibitors may be an attractive therapeutic option and is currently under investigation. After laser treatment, unfavorable outcomes occur in only 9 to 14 % of eyes, but at the price of peripheral retinal destruction. For all patients, whether treated or not, a regular fundus examination should be insured until complete retinal vascularization has occurred. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Thermann, H; Hüfner, T; Tscherne, H
The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques.
Sinai, Yohai Bar; Brener, Efim A.; Bouchbinder, Eran
The failure of frictional interfaces and the spatiotemporal structures that accompany it are central to a wide range of geophysical, physical and engineering systems. Recent geophysical and laboratory observations indicated that interfacial failure can be mediated by slow slip rupture phenomena which are distinct from ordinary, earthquake-like, fast rupture. These discoveries have influenced the way we think about frictional motion, yet the nature and properties of slow rupture are not comple...
Bar Sinai, Yohai; Brener, Efim A.; Bouchbinder, Eran
The failure of frictional interfaces and the spatiotemporal structures that accompany it are central to a wide range of geophysical, physical and engineering systems. Recent geophysical and laboratory observations indicated that interfacial failure can be mediated by slow slip rupture phenomena which are distinct from ordinary, earthquake-like, fast rupture. These discoveries have influenced the way we think about frictional motion, yet the nature and properties of slow rupture are not completely understood. We show that slow rupture is an intrinsic and robust property of simple non-monotonic rate-and-state friction laws. It is associated with a new velocity scale cmin, determined by the friction law, below which steady state rupture cannot propagate. We further show that rupture can occur in a continuum of states, spanning a wide range of velocities from cmin to elastic wave-speeds, and predict different properties for slow rupture and ordinary fast rupture. Our results are qualitatively consistent with recent high-resolution laboratory experiments and may provide a theoretical framework for understanding slow rupture phenomena along frictional interfaces.
Watkinson Sally J
Full Text Available Abstract Introduction If left untreated, severe combined immunodeficiency can lead to an acute susceptibility to infection. The intrauterine environment is sterile until the amniotic membranes rupture. The vaginal flora then ascends into the genital tract, thus increasing the risk of chorioamnionitis. An extremely premature and prolonged membrane rupture is associated with a dismal prognosis for an immunocompetent preterm fetus. There are no case reports to date that detail the outcome of an immunocompromised preterm baby following prolonged rupture of membranes. Case presentation We present the case of a 32-year-old Indian woman who delivered a 31-week gestational baby who had a severe combined immunodeficiency following premature prelabour prolonged rupture of the membranes at the 14th week of gestation. Conclusion Extreme preterm prelabour spontaneous rupture of membranes in an underlying condition of severe combined immunodeficiency does not necessarily lead to an unfavourable outcome.
Full Text Available AIM: To investigate the incidence and risk factors of retinopathy of prematurity(ROPin preterm infants. METHODS: The wide-field digital pediatric Retinal imaging system was used to screen 2 203 preterm infants with gestational age RESULTS: Totally 367 infants(621 eyeswere diagnosed as retinopathy among 2 203 premature infants and the incidence of ROP was 16.66%; 236 cases(399 eyesof ROP(26.61%were detected in 887 cases of premature infants in accord with screening standard of the Chinese Premature Retinopathy Screening Guidelines(2014, and 131 cases(222 eyesof ROP(9.95%was detected in 1 316 cases of premature infants outside the screening standard. In our research, the incidence of ROP was related with gestational age, birth weight, oxygen duration and mechanical ventilation. However, the relationship had not been found with artificial insemination, caesarean birth, gender, polyembryony, acute respiratory distress syndrome(ARDS, hypertensive disorders in pregnancy, gestational diabetes mellitus, intrauterine infection, intrauterine distress, premature rupture of membrane. The incidence of ROP was statistically significant between different gestational age groups, different birth weight groups and different oxygen groups(PCONCLUSION: The incidence of ROP is 16.66% in this study, and there is still a certain proportion outside the screening standard of the Chinese Premature Retinopathy Screening Guidelines(2014. Gestational age, birth weight, oxygen duration and mechanical ventilation are high risk factors for ROP.
Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten
Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether untre...
... mature enough to allow nonstop breathing. This causes large bursts of breath followed by periods of shallow breathing or stopped breathing. Apnea of prematurity usually ends on its own after a few ...
Full Text Available Premature ovarian failure (POF is the occurrence of hypergonadotropic hypoestrogenic amenorrhea in women under the age of forty years. It is idiopathic in 74-90% patients. Known cases can be divided into primary and secondary POF. In primary POF genetic aberrations can involve the X chromosome (monosomy, trisomy, translocations, deletions or autosomes. Genetic mechanisms include reduced gene dosage and non-specific chromosome effects impairing meiosis, decreasing the pool of primordial follicles and increasing atresia due to apoptosis or failure of follicle maturation. Autoimmune ovarian damage is caused by alteration of T-cell subsets and T-cell mediated injury, increase of autoantibody producing B-cells, a low number of effector/cytotoxic lymphocyte, which decreases the number and activity of natural killer cells. Bilateral oophorectomy, chemotherapy, radiotherapy and infections cause the secondary POF. Symptoms of POF include irritability, nervousness, loss of libido, depression, lack of concentration, hot flushes, weight gaining, dry skin, vaginal dryness, frequent infections etc. The diagnosis is confirmed by the level of FSH of over 40 IU/L and estradiol below 50 pmol/L in women aged below 40 years. Biochemical and other hormonal analysis (free thyroxin, TSH, prolactin, testosterone, karyotype (<30 years of age, ultrasound of the breasts and pelvis are advisable. Optimal therapy is combined estrogen progestagen therapy given in a sequential rhythm, after excluding absolute contraindications. Testosterone can be added to adnexectomized women and those with a low libido. Sequential estrogen progestagen replacement therapy is the first line therapy for ovulation induction in those looking for pregnancy and after that oocyte donation will be advised. Appropriate estro-progestagen therapy improves the quality of life and prevents complications such as cardiovascular diseases, osteoporosis, stroke etc.
Antonio Carlos Nogueira
Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.
Backes, Manouk; Zwaveling-Soonawala, Nitash; Kamp, Gerdine A.
Premature pubarche is defined as growth of pubic hair before the age of 8 years in girls and 9 years in boys. In most cases, it is caused by premature adrenarche, which is a premature increased synthesis of androgens in the adrenal gland and is considered to be relatively harmless. Premature
Medsker, Brock; Forno, Erick; Simhan, Hyagriv; Celedón, Juan C.
Asthma is the most common chronic disease of childhood, affecting millions of children in the U.S. and worldwide. Prematurity is a risk factor for asthma, and certain ethnic or racial minorities such as Puerto Ricans and non-Hispanic Blacks are disproportionately affected by both prematurity and asthma. In this review, we examine current evidence to support maternal psychosocial stress as a putative link between prematurity and asthma, while also focusing on disruption of the hypothalamic-pituitary-adrenal (HPA) axis and immune responses as potential underlying mechanisms for stress-induced “premature asthma”. Prenatal stress may not only cause abnormalities in the HPA axis but also epigenetic changes in the fetal glucocorticoid receptor gene (NR3C1), leading to impaired glucocorticoid metabolism. Moreover, maternal stress can alter fetal cytokine balance, favoring Th2 (allergic) immune responses characteristic of atopic asthma: IL-6, which has been associated with premature labor, can promote Th2 responses by stimulating production of IL-4 and IL-13. Given a link among stress, prematurity, and asthma, future research should include birth cohorts aimed at confirming and better characterizing “premature asthma”. If confirmed, clinical trials of prenatal maternal stress reduction would be warranted to reduce the burden of these common co-morbidities. While awaiting the results of such studies, sound policies to prevent domestic and community violence (e.g. from firearms) are justified, not only by public safety but also by growing evidence of detrimental effects of violence-induced stress on psychiatric and somatic health. PMID:26676148
Ferrari, Francesca; Facchinetti, Fabio; Saade, George; Menon, Ramkumar
The objective of this study is to investigate placental telomere shortening in unexplained stillbirths (SBs) as an indication of premature senescence. Placentas were collected from 42 unexplained SB (>22 weeks), 43 term and 15 preterm live births, at the Policlinico Hospital of Modena (Italy). DNA extracted from placentae was studied for telomere length by real time PCR. Standard curves were generated for telomere lengths from single copy gene amplifications using a reference DNA. The telomere length for each sample was derived based on the ratio of telomere length between the sample and single copy gene standard (T/S ratio). The mean ratio of placental telomere in term live births was 5.181 ± 3.841. A twofold decrease in telomere length was seen in SBs (over all 2.455 ± 1.239; p PTBs) (6.382 ± 5.525; p < 0.01), whereas SBs telomere length were similar to those of preterm premature rupture of membranes (pPROM) (3.296 ± 3.599; p = ns). Substantial reduction in telomere length in SBs is indicative of placental senescence. These data provide mechanistic insights that premature aging may lead to placental dysfunction as an initiator of fetal demise in unexplained SBs.
Casteels, Ingele; Cassiman, Catherine; Van Calster, Joachim; Allegaert, Karel
Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the premature infant with an incompletely vascularized retina. The spectrum of ophthalmological findings in ROP exists from minimal sequelae, which do not affect vision, to bilateral retinal detachment and total blindness. With the increased survival of very small infants, retinopathy of prematurity has become one of the leading causes of childhood blindness. Over the past two decades, major advances have been made in understanding the pathogenesis of ROP, to a large extent as a result of changes in clinical risk factors (oxygen and non-oxygen related) and characteristics observed in ROP cases. This article provides a literature review on the evolution in clinical characteristics, classification and treatment modalities and indications of ROP. Special attention is hereby paid to the neonatal factors influencing the development of ROP and to the necessity for everyone caring for premature babies to have a well-defined screening and treatment protocol for ROP. Such screening protocol needs to be based on a unit-specific ROP risk profile and, consequently, may vary between different European regions. Retinopathy of prematurity is an important cause of ocular morbidity and blindness in children. With better understanding of the pathogenesis, screening and treatment guidelines have changed over time and are unit specific.
Moura, Diogo Lino; Marques, Jos? Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira
Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a s...
Hölmich, Lisbet R; Vejborg, Ilse; Conrad, Carsten
participated in either one or two study MRI examinations, aiming at determining the prevalence and incidence of silent implant rupture, respectively, and who subsequently underwent explantation. Implant rupture status was determined by four independent readers and a consensus diagnosis of either rupture...... were in fact ruptured at surgery. Thirty-four of the 43 intact implants were described as intact at surgery. When categorising possible ruptures as ruptures, there were one false positive and nine false negative rupture diagnoses at MRI yielding an accuracy of 92%, a sensitivity of 89...
Full Text Available History of present illness: A 21-year-old female presented with sudden onset suprapubic abdominal pain associated with dysuria. The patient also experienced near syncope during bowel movements three times three days ago without falling or losing consciousness. She denied fever, nausea, and vomiting. She stated that she was five weeks pregnant by last menstrual period. She had an ultrasound a few weeks before that showed no intrauterine pregnancy, but she had not followed up for additional testing. Significant findings: The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00. A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10. Discussion: Ectopic pregnancies are a leading cause of maternal morbidity and mortality, as well as decreased fertility.1,2 Differentiating between an ectopic pregnancy and a normal early pregnancy may be difficult, since ultrasound and quantitative beta-hCG may show inconclusive results.3,4 Patients who have used fertility treatment may further complicate the picture because they are at risk for heterotypic pregnancies.5 Ectopic pregnancies most commonly implant in the fallopian tube, but may alternatively implant in the ovary, cervix, abdomen, or uterine cornua.4 Ultrasonography may show an empty uterus, adnexal mass, pelvic free fluid, or an extra-uterine gestational sac, yolk sac, and/or embryo.6 Treatment options for ectopic pregnancy include surgery or methotrexate.2,4 Some patients may be candidates for close outpatient surveillance if the diagnosis is unclear or in very limited cases for early, non-ruptured ectopic pregnancies.2,4
Kalmar, Magda; And Others
This study examined Hungarian mothers' recollections, 8 years after the birth of their premature baby, of their stress at the time of the baby's birth. Interviews were conducted with 30 mothers whose babies had been born between 30 and 37 weeks gestational age. At the time of the follow-up, all children had normal IQs and were attending normal…
Flanagan, Keri Ann
The use of noninvasive ventilation is a constantly evolving treatment option for respiratory disease in the premature infant. The goals of these noninvasive ventilation techniques are to improve gas exchange in the premature infant's lungs and to minimize the need for intubation and invasive mechanical ventilation. The goals of this article are to consider various uses of nasal interfaces, discuss skin care and developmental positioning concerns faced by the bedside nurse, and discuss the medical management aimed to reduce morbidity and mortality. This article explores the nursing role, the advances in medical strategies for noninvasive ventilation, and the team approach to noninvasive ventilation use in this population. Search strategy included a literature review on medical databases, such as EBSCOhost, CINAHL, PubMed, and NeoReviews. Innovative products, nursing research on developmental positioning and skin care, and advanced medical management have led to better and safer outcomes for premature infants requiring noninvasive ventilation. The medical focus of avoiding long-term mechanical ventilation would not be possible without the technology to provide noninvasive ventilation to these premature infants and the watchful eye of the nurse in terms of careful positioning, preventing skin breakdown and facial scarring, and a proper seal to maximize ventilation accuracy. This article encourages nursing-based research to quantify some of the knowledge about skin care and positioning as well as research into most appropriate uses for noninvasive ventilation devices.
Over 20 years of research and clinical practice in music therapy with premature infants has been compiled into this text designed for Board Certified Music Therapists specializing in Neonatal Intensive Care clinical services, for NICU medical staff incorporating research-based music therapy into developmental care plans, and for parents of…
Chandrasekharan, Praveen; Rawat, Munmun; Lakshminrusimha, Satyan
Infographics or information graphics are easy-to-understand visual representation of knowledge. An infographic outlining the course of an extremely preterm infant and various potential complications encountered during a neonatal intensive care unit (NICU) stay was developed. This infographic can be used to discuss outcomes of prematurity during prenatal counseling and while the infant is in the NICU. PMID:29138522
Xu, Shiqing; Fukuyama, Eiichi; Sagy, Amir; Doan, Mai-Linh
A comprehensive understanding of earthquake rupture propagation requires the study of not only the sudden release of elastic strain energy during co-seismic slip, but also of other processes that operate at a variety of spatiotemporal scales. For example, the accumulation of the elastic strain energy usually takes decades to hundreds of years, and rupture propagation and termination modify the bulk properties of the surrounding medium that can influence the behavior of future earthquakes. To share recent findings in the multiscale investigation of earthquake rupture propagation, we held a session entitled "Physics of Earthquake Rupture Propagation" during the 2016 American Geophysical Union (AGU) Fall Meeting in San Francisco. The session included 46 poster and 32 oral presentations, reporting observations of natural earthquakes, numerical and experimental simulations of earthquake ruptures, and studies of earthquake fault friction. These presentations and discussions during and after the session suggested a need to document more formally the research findings, particularly new observations and views different from conventional ones, complexities in fault zone properties and loading conditions, the diversity of fault slip modes and their interactions, the evaluation of observational and model uncertainties, and comparison between empirical and physics-based models. Therefore, we organize this Special Issue (SI) of Tectonophysics under the same title as our AGU session, hoping to inspire future investigations. Eighteen articles (marked with "this issue") are included in this SI and grouped into the following six categories.
Turgut, Abdulkadir; Katar, Selahattin; Sak, Muhammet Erdal; Turgut, Fethiye Gülden; Sahin, Alparslan; Başaranoğlu, Serdar; Yalınkaya, Ahmet
Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability.
Full Text Available A premature male infant was born at 30 weeks’ gestation with a birth weight of 1,700 g in a rural hospital. He was diagnosed with respiratory distress syndrome and received continuous positive airway pressure treatment for 26 days. At 26 days after birth, the patient was transferred to our hospital for further evaluation and management. A comprehensive eye examination revealed a stage 3 retinopathy of prematurity (ROP involving zone 2 in both eyes. The patient was recommended to a provincial-level eye hospital for emergency laser therapy. Five months after birth, the feedback from the eye hospital showed that the patient had a high risk of blindness in both eyes. Our case report shows that delaying first screening examination increases the possibility of developing aggressive posterior ROP in infants with ROP. Doctors in rural hospitals should be aware of this possibility and trained for early screening and treatment in high-risk infants.
Glass, Hannah C.; Costarino, Andrew T.; Stayer, Stephen A.; Brett, Claire; Cladis, Franklyn; Davis, Peter J.
Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (CPAP, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and
Moura, Diogo Lino; Marques, José Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira
Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.
Diogo Lino Moura
Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.
Svendsen, J H; Galatius, H; Hansen, P K
Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....
Li, W.; Haneman, D.
Fibers of cotton and wool, and samples of paper, have been ruptured in tension in vacuum and in air, and give detectable luminescence in the visible range. All have a common emission peak at around 2.0 eV, which is ascribed to the deexcitation of states excited by the rupture of organic chain molecule bonds. Rubber bands give stronger emission in air, but no emission in vacuum, suggesting the material breaks only at weak interchain bonds. Mohair, cat, and horse hair also give emission in air. The phenomena reveal effects that would occur widely in nature.
Tark, Kwan Chul; Jeong, Hii Sun; Roh, Tae Suk; Choi, Jong Woo
Breast implants used for augmentation mammoplasty or breast reconstruction could rupture from various causes such as trauma or spontaneous failure. The objectives of this study were to investigate the relationships between the causes of implant rupture and the degree of capsular contracture, and then to evaluate the relative efficacies of specific signs on magnetic resonance imaging (MRI) known to be beneficial for diagnosing the rupture. A retrospective review identified patients with prosthetic implant rupture or impending rupture treated by the senior author. The 30 cases of implant rupture available for review were classified into two groups: intracapsular and extracapsular ruptures. The 30 cases of breast implant ruptures were analyzed with respect to the clinical symptoms and signs, the causes of rupture, the degree of capsular contracture, and therapeutic plans. Among the 30 cases, 14 patients who had undergone MRI during the diagnostic period were analyzed with respect to the relationships between MRI readings and operative findings. Spontaneous rupture of membranes was most common (80%), followed by failure because of trauma (7%) and valve or implant base (4%). The symptoms during implant rupture were contour deformity, palpated mass-like lesions, pain, and focal inflammation. According to the analysis of specific MRI signs, the sensitivity and specificity of the linguine sign were 87% and 100%, respectively, for intracapsular rupture. For extracapsular rupture, the sensitivity and specificity of the linguine sign were, respectively, 67% and 75%. The sensitivity and specificity of the rat-tail sign and tear drop sign were 14% and 50%, respectively. Breast implant rupture was correlated with the degree of capsular contracture in our study. Among the various specific MRI signs used in diagnosing the rupture, the linguine sign was reliable and had a high sensitivity and specificity, especially in cases of intracapsular rupture. On the other hand, the rat
Kim, Nam Hyeon; Ki, Won Woo; Yoon, Kwon Ha; Kim, Song Mun; Shin, Myeong Jin; Kwon, Soon Tae
To differentiate a complete rupture of Achilles tendon from an incomplete one which is important because its treatment is quite different. And it is necessary to know the exact site of the rupture preoperatively. Fifteen cases of fourteen patients which were diagnosed as Achilles tendon rupture by ultrasonography and surgery were reviewed. We compared sonographic rupture site with surgical findings. Ultrasonographic criteria for differentiation of complete and incomplete rupture was defined as follows : the discreteness, which means the proximal intervening hypoechogenicity to the interface echogenicity of distal margin of ruptured tendon : the slant sign, which represents the interface of ruptured distal margin which was seen over the 3/4 of the thickness of the tendon without intervening low echogeneicity : the invagination sign, which means the echogenic invagination from Kager triangle into posterior aspect of Achilles tendon over the half thickness of the tendon. The sites of complete tendon rupture were exactly corresponded to surgical finding in four cases of ten complete ruptures. And the discrepancy between sonographic and surgical findings in the site of complete rupture was 1.2 ± 0.4 cm in six cases. Three of ten complete ruptures showed the discreteness sign, all of ten showed the slant sign and two of ten showed the invagination sign. It is helpful to differentiate a complete from incomplete rupture of the Achilles tendon and to localize the site of the complete rupture with the ultrasonographic evaluation
Kenyon, Sara; Boulvain, Michel; Neilson, James P
Premature birth carries substantial neonatal morbidity and mortality. Subclinical infection is associated with preterm rupture of membranes (PROM). Prophylactic maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection. To evaluate the immediate and long-term effects of administering antibiotics to women with PROM before 37 weeks, on maternal infectious morbidity, neonatal morbidity and mortality, and longer-term childhood development. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013). Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included as were trials of different antibiotics. Trials in which no placebo was used were included for the outcome of perinatal death alone. We extracted data from each report without blinding of either the results or the treatments that women received. We sought unpublished data from a number of authors. We included 22 trials, involving 6872 women and babies.The use of antibiotics following PROM is associated with statistically significant reductions in chorioamnionitis (average risk ratio (RR) 0.66, 95% confidence interval (CI) 0.46 to 0.96, and a reduction in the numbers of babies born within 48 hours (average RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (average RR 0.79, 95% CI 0.71 to 0.89). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.67, 95% CI 0.52 to 0.85), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.81, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.72, 95% CI 1.57 to 14.23).One study evaluated the children's health at seven years of age (ORACLE Children Study) and found
rupture of an aneurysm of a lateral branch of the right thyrocervical trunk in a patient suffering from diffuse neurofibromatosis. The operative findings are reported. s. Air. Med. ... system demonstrated decreased power in all muscles of the right shoulder girdle and arm, without sensory change. The cranial nerves were normal.
Full Text Available Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.
Triponez, Frédéric; Alifano, Marco; Bobbio, Antonio; Regnard, Jean-François
Non-traumatic, spontaneous diaphragmatic rupture is a rare event whose pathophysiology is not known. We report the case of endometriosis-related spontaneous rupture of the right diaphragm with intrathoracic herniation of the liver, gallbladder and colon. We hypothesize that the invasiveness of endometriotic tissue caused diaphragm fragility, which finally lead to its complete rupture without traumatic event. The treatment consisted of a classical management of diaphragmatic rupture, with excision of the endometriotic nodule followed by medical ovarian suppression for six months.
Lindsay A. Palmer
Full Text Available Objective: To educate others on unique Anterior Cruciate Ligament tears and percentage of usage of the ACL in normal daily function. Background: Patient is an eighteen year old male participating in wrestling and football at the time of the injury. Patient now only participates in wrestling. No previous knee or chronic injuries were reported prior to this injury. Patient was playing football during the time of injury. The patient stated that he planted his foot down and was tackled at the same time when the injury occurred. The patient felt his knee twist and buckle. Patient complained of clicking inside the knee and had minimal swelling. He also complained of it being difficult to bear weight at the time. The patient did not seek further treatment until two months after the injury occurred when he received an MRI. His MRI showed a positive finding for an Anterior Cruciate Ligament rupture. His previous Athletic Trainer could not find a positive diagnosis for the patient prior to the MRI. Differential Diagnosis: Possible meniscal or ACL injury. Treatment: Doctors officially diagnosed the injury as a complete rupture of the ACL. The patient did not receive surgery immediately. Doctors have stated that he only uses about 50% of his ACL on a daily basis compared to a normal person who uses about 95% of their ACL daily. Because of this, the patient played on his rupture for seven months before receiving surgery. He played a whole season of high school football and a whole season of wrestling his senior year with the ACL ruptured. The patient only used a brace for better comfort during the seven months. The patient then received reconstructive surgery to repair the rupture. A hamstring tendon graft was used to repair the ruptured ACL. Because a tendon was taken from the hamstring, patient experienced a tight ACL and hamstring of the left leg post-surgery. The patient participated in Physical Therapy for five months to strengthen and stretch the new
Woo Yeol Baek
Full Text Available BackgroundRupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants.MethodsWe performed a retrospective review of 72 implants that were removed for implant rupture between 2005 and 2014 at a single institution. The following data were collected: type of implants (saline or silicone, duration of implantation, type of implant shell, degree of capsular contracture, associated symptoms, cause of rupture, diagnostic tools, and management.ResultsForty-five Saline implants and 27 silicone implants were used. Rupture was diagnosed at a mean of 5.6 and 12 years after insertion of saline and silicone implants, respectively. There was no association between shell type and risk of rupture. Spontaneous was the most common reason for the rupture. Rupture management was implant change (39 case, microfat graft (2 case, removal only (14 case, and follow-up loss (17 case.ConclusionsSaline implants have a shorter average duration of rupture, but diagnosis is easier and safer, leading to fewer complications. Previous-generation silicone implants required frequent follow-up observation, and it is recommended that they be changed to a cohesive gel implant before hidden rupture occurs.
Full Text Available Yasser F Ali,1 Salah El-Morshedy,1 Abdulbasit Abdulhalim Imam,2 Nasser Ismai A Abdelrahman,1 Riad M Elsayed,3 Usama M Alkholy,1 Nermin Abdalmonem,1 Mohammed M Shehab1 1Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, 2Department of Pediatrics, Al-Azhar Faculty of Medicine-Girls, Cairo, 3Pediatric Neurology Unit, Pediatric Department, Mansoura University, Mansoura, Egypt Objective: To evaluate the role of serum apelin as a diagnostic tool in retinopathy of prematurity (ROP disease.Patients and methods: Thirty-eight preterm infants (60% male with gestational age ranging from 30 to 36 weeks admitted to the neonatal intensive care unit, KJO Hospital, Saudi Arabia with proven diagnosis of ROP were included in the study. In addition, 27 preterm infants without ROP served as controls. All newborn infants in the study were subjected to adequate history taking, full clinical examination, and fundus examination by indirect ophthalmoscope (at 4–6 weeks as well as determination of serum apelin at birth and at 4–6 weeks of age.Results: The study revealed that oxygen therapy longer than 7 days’ duration, cesarean section (as a mode of delivery, sepsis, mechanical ventilation, blood transfusion, premature rupture of membranes, pneumothorax, perinatal asphyxia, cardiac problems, and neonatal jaundice were considered as risk factors related to development of ROP. Serum apelin levels were significantly lower in patients than controls (P<0.001 at time of diagnosis of the disease (4–6 weeks while no significant differences were observed in levels at birth.Conclusion: Serum apelin was found to be of significant diagnostic value in the occurrence of ROP. Keywords: retinopathy of prematurity, preterm infants, serum apelin
The US appearances in seven pathologically and/or surgically proved cases of renal allograft rupture are presented. These include a triangular or amorphous echogenic area in the cortex and medulla in a polar location, an echogenic band or wavy, branching anechoic lines in the hyperechoic region, a subcapsular hematoma, and an extrarenal hematoma in direct continuity with the echogenic area. Duplex Doppler examination in renal allograft rupture shows marked reduction of absence of the diastolic component of the velocity waveform in the arcuate and interlobar arteries, with reduction in amplitude of the systolic wave form. Correlation of the US appearances with gross and microscopic pathologic findings indicates that the echogenic area is due to an intrarenal hematoma, while the echogenic band represents the cortical laceration with adherent blood clots. The US-duplex Doppler examination should be the primary diagnostic modality in this life-threatening condition
Ümeyye Taka Aydın; Hatip Aydın; Osman Çekiç
Oxidative stress plays an important role in the etiology of retinopathy of prematurity. Insufficient antioxidant system and increased oxidative stress in premature infants lead to the development of the disease. Understanding the mechanism of oxidative stress and antioxidant system and the related signaling pathways contribute to the development of novel options for diagnosis and treatment of retinopathy of prematurity. The current review aimed to evaluate the relationship between ox...
Kaalund, S; Lass, P; Høgsaa, B; Nøhr, M
The typical badminton player with an Achilles tendon rupture is 36 years old and, despite limbering up, is injured at the rear line in a sudden forward movement. He resumes work within three months and has a slight lack of dorsiflexion in the ankle as the main complication. Most patients resume badminton within one year, but some finish their sports career, mainly due to fear of a new injury. The investigation discusses predisposing factors and prophylactic measures. PMID:2605439
Quist-Nelson, Johanna; Landers, Kathryn; McCurdy, Rebekah; Berghella, Vincenzo
External cephalic version (ECV) increases the likelihood of a vaginal delivery in patients with breech presentation. Our objective was to determine the rate of cephalic vaginal delivery in women undergoing ECV after PROM. We performed a systematic review of all case reports, case series and clinical trials of patients undergoing an ECV after PROM ≥ 24 weeks. Maternal demographics and outcome data were obtained. The primary outcome was rate of cephalic vaginal delivery. Statistical analysis was performed for continuous outcomes by calculating mean and standard deviations for appropriate variables. The systematic review yielded six papers with 13 case reports and no clinical trials of ECV after PROM. The rate of success to cephalic presentation was 46.1% (six of 13 cases), with a subsequent vaginal delivery rate of 23.1% (three of 13 cases). The rate of umbilical cord prolapse was 33.3% (two of six cases). ECV after PROM has been reported in 13 cases in the literature. For the cases reported, 46.1% of ECV were successful in turning to cephalic position, but only 23.1% resulted in a vaginal delivery. There was a 33.3% incidence of umbilical cord prolapse. Given the high rate of umbilical cord prolapse, it would be imperative to offer an ECV in the setting of PROM only at an institution that has the ability to perform the indicated emergent cesarean delivery and only after appropriate counseling.
Full Text Available The aim of this study was to determine whether there is any different in hCG levels of vaginal fluids from normal pregnant women, women with confirmed PROM and with suspected PROM. After irrigating the posterior vaginal fornix with 3 ml of sterile saline and procuring vaginal washing , we measured hCG levels. Samples were analyzed from 38 normal pregnant women , 31 women with confirmed PROM , 28 women with suspected PROM. The mean of vaginal fluid hCG levels of normal pregnant women were 11.2 (0.00-98.6 mIu/ml. That of women with PROM was 140.2 (0.5 , 390.1 and that of women with suspected PROM was 21.5 (0.0 , 143.9. Sensivity was 80%, specility 83% , positive predictive value 73.7% , negative predictive value 88.1% , using a cut-value 20. It was concluded that the hCG level in vaginal fluid is a marker of PROM during third trimester.
Expression of MMP-9 and TNF-α was higher in the amniotic membrane of preterm delivery subjects with PROM than in preterm delivery subjects without PROM and can thus be used as predictor to avoid PPROM.
Sadeh-Mestechkin, Dana; Samara, Nivin; Wiser, Amir; Markovitch, Ofer; Shechter-Maor, Gil; Biron-Shental, Tal
To compare maternal and neonatal outcomes in induced vs. expectant management of term PROM. This retrospective study included patients with term PROM. A total of 325 were enrolled: 213 managed expectantly and 112 induced at admission and matched according to gestational age. Expectant management group patients were allowed to defer labour induction up to 48 h. Primary outcome measures were maternal or foetal signs of infection (chorioamnionitis, early neonatal sepsis or postpartum endometritis) and prolonged maternal hospitalization. Secondary outcome was caesarean delivery rate. All group characteristics were comparable except that expectant management included more nulliparous women. Women managed expectantly had a higher rate of prolonged hospitalization [15 (7 %) vs. 2 (1.8 %); P = 0.043] as an indication of maternal complications, compared to induction management. They also had a higher rate of caesarean delivery [34 (16.4 %) vs. 8 (7.1 %), respectively; P = 0.024]. Adjustment for parity did not change the results. Early neonatal outcomes were similar between groups. Expectant management increases the likelihood of caesarean delivery and prolonged maternal hospitalization. This should be considered when advising patients with term PROM regarding labour induction.
Maka, Erika; Imre, László; Somogyvári, Zsolt; Németh, János
Retinopathy of prematurity is a leading cause of childhood blindness around the world. The Department of Ophthalmology at the Semmelweis University and the Peter Cerny Neonatal Emergency and Ambulance Service started an innovative Premature Eye Rescue Program to reduce the non-essential transport of premature babies suffering from retinopathy of prematurity. During the first 5 years 186 eyes of 93 premature babies were treated at the bedside with stage 3 retinopathy of prematurity in the primary hospitals. In this first 5-years period the authors reduced the number of transports of premature babies for laser treatment; 93 children avoided the unnecessary transport, saving altogether a distance of 21,930 kilometers for children, as well as the ambulance service. The Premature Eye Rescue Program offers a good and effective alternative for treatment of retinopathy in the primary hospitals. The authors propose the national extension of this program.
After the economic failure of the 70's and not having been able to solve for decades its multiple problems, the nuclear industry was suffering a slow but inescapable agony. However, the need to reduce CO 2 emissions and the likely arrival of the worldwide peak of oil production have infused new life to the nuclear option, and it has again become one of the main topics of discussion in the worldwide energy debate. But in this debate we tend to forget that the causes of the abrupt end of the first nuclear era have not disappeared, and that for this reason it may well be that we are lead to a repetition of the events that induced its first demise. The much talked nuclear renaissance is thus likely to end up as a premature miscarriage. (Author)
Diaz, Sílvia O; Pinto, Joana; Barros, António S; Morais, Elisabete; Duarte, Daniela; Negrão, Fátima; Pita, Cristina; Almeida, Maria do Céu; Carreira, Isabel M; Spraul, Manfred; Gil, Ana M
This work assesses the urinary metabolite signature of prematurity in newborns by nuclear magnetic resonance (NMR) spectroscopy, while establishing the role of possible confounders and signature specificity, through comparison to other disorders. Gender and delivery mode are shown to impact importantly on newborn urine composition, their analysis pointing out at specific metabolite variations requiring consideration in unmatched subject groups. Premature newborns are, however, characterized by a stronger signature of varying metabolites, suggestive of disturbances in nucleotide metabolism, lung surfactants biosynthesis and renal function, along with enhancement of tricarboxylic acid (TCA) cycle activity, fatty acids oxidation, and oxidative stress. Comparison with other abnormal conditions (respiratory depression episode, large for gestational age, malformations, jaundice and premature rupture of membranes) reveals that such signature seems to be largely specific of preterm newborns, showing that NMR metabolomics can retrieve particular disorder effects, as well as general stress effects. These results provide valuable novel information on the metabolic impact of prematurity, contributing to the better understanding of its effects on the newborn's state of health.
Mehmet Ali Şekeroğlu
Full Text Available Objectives: To investigate the incidence, severity and risk factors of retinopathy of prematurity (ROP in triplets. Materials and Methods: The medical records of consecutive premature triplets who had been screened for ROP in a single maternity hospital were analyzed and presence and severity of ROP; birth weight, gender, gestational age of the infant; route of delivery and the mode of conception were recorded. Results: A total of 54 triplets (40 males, 14 females who were screened for ROP between March 2010 and February 2013 were recruited for the study. All triplets were delivered by Caesarean section and 36 (66.7% were born following an assisted conception. During follow-up, seven (13% of the infants developed ROP of any stage and two (3.7% required laser photocoagulation. The mean gestational age of triplets with ROP was 27.6±1.5 (27-31 weeks whereas it was 32.0±1.5 (30-34 weeks in those without ROP (p=0.002. The mean birth weights of triplets with and without ROP were 1290.0±295.2 (970-1600 g and 1667.5±222.2 (1130-1960 g, respectively (p<0.001. The presence of ROP was not associated with gender (p=0.358 or mode of conception (p=0.674. Conclusion: ROP in triplets seems to be mainly related to low gestational age and low birth weight. Further prospective randomized studies are necessary to demonstrate risk factors of ROP in triplets and to determine if and how gemelarity plays a role in the development of ROP.
Freezing breast milk may be protective for the preterm infant until the titer of CMV antibody increases. However clinical importance of CMV infection in premature infants by breast-feeding is still unclear. This minireview focuses on recent advances in the study of CMV infection in premature infants by breastfeeding.
... 7 Agriculture 2 2010-01-01 2010-01-01 false Prematurity. 29.1050 Section 29.1050 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... Type 92) § 29.1050 Prematurity. A condition of growth and development characteristic of the lower...
Full Text Available Objective: to define the risk factors adversely influencing prenatal development at premature birth at use of methods of assisted reproductive technology (ART; to estimate premature' infants health from multiple induced pregnancy according to Perinatal Center of Saratov for last 3 years. Material and Methods. Under supervision there were 139 pregnant women with application ART. 202 children (51 twins were born and 5 triplet babies, from them 83 premature infants born from multiple induced pregnancy have been analyzed. Results. The newborns examined by method ART, were distributed as follows: 22-28 weeks — 19 children; 29-32 weeks — 23; 33-36 weeks — 41. Asphyxia at birth was marked at all premature infants. Respiratory insufficiency at birth is revealed in 87,3% of cases. The most frequent pathologies in premature infants are revealed: neurologic infringements and bronchopulmonary pathology occured at all children, developmental anomaly — 33, 8%, retinopathies in premature infants — 26,5%. The mortality causes include: extreme immaturity, cerebral leukomalacia, IVN 3 degrees. Conclusion. The risk factors, premature birth at application of methods ART are revealed: aged primiparas, pharmacological influence, absence of physiological conditions of prenatal development; multifetation. The high percent of birth of children with ELBW and ULBW is revealed. RDCN with further BPD development, retinopathies in premature infants and CNS defeat is more often occured.
Underwood, Mark A.
Synopsis Premature infants are a heterogeneous group with widely differing needs for nutrition and immune protection with risk of growth failure, developmental delays, necrotizing enterocolitis, and late-onset sepsis increasing with decreasing gestational age and birth weight. Human milk from women delivering prematurely has more protein and higher levels of many bioactive molecules compared to milk from women delivering at term. Human milk must be fortified for small premature infants to achieve adequate growth. Mother’s own milk improves growth and neurodevelopment and decreases the risk of necrotizing enterocolitis and late-onset sepsis and should therefore be the primary enteral diet of premature infants. Donor milk is a valuable resource for premature infants whose mothers are unable to provide an adequate supply of milk, but presents significant challenges including the need for pasteurization, nutritional and biochemical deficiencies and a limited supply. PMID:23178065
Kurniadi, Rizal; Perkasa, Yudha S.; Waris, Abdul
The Neck Rupture Model is a model that explains the scission process which has smallest radius in liquid drop at certain position. Old fashion of rupture position is determined randomly so that has been called as Random Neck Rupture Model (RNRM). The neck curve polynomials have been employed in the Neck Rupture Model for calculation the fission yield of neutron induced fission reaction of 280 X 90 with changing of order of polynomials as well as temperature. The neck curve polynomials approximation shows the important effects in shaping of fission yield curve.
Alejandro Ordas Bayon
Full Text Available Pectoralis major (PM ruptures are uncommon injuries, although they are becoming more frequent. We report a case of a PM rupture in a young male who presented with axillar pain and absence of the anterior axillary fold after he perceived a snap while lifting 200 kg in the bench press. Diagnosis of PM rupture was suspected clinically and confirmed with imaging studies. The patient was treated surgically, reinserting the tendon to the humerus with suture anchors. One-year follow-up showed excellent results. The patient was recording his training on video, so we can observe in detail the most common mechanism of injury of PM rupture.
Raksha Ramlakhan, BMedSc, MBBCh
Full Text Available Intracranial dermoid cysts are congenital tumors of ectodermal origin. Rupture of these cysts can occur spontaneously, but rupture in association with trauma is reported infrequently. The diagnosis of rupture is made by the presence of lipid (cholesterol droplets in the subarachnoid spaces and ventricles. Nonenhanced CT of the head demonstrates multiple foci of low attenuation that correspond with hyperintense signal on T1-weighted MRI. We present a case of an adult patient with rupture of an intracranial dermoid cyst, precipitated by minor trauma.
Sacknoff, R.; Novelline, R.A.; Wittenberg, J.; Waltman, A.C.; De Luca, S.A.; Rhea, J.T.; Lawrason, J.N.
Ruptured abdominal aortic aneurysm (AAA) is a life-threatening condition requiring immediate diagnosis and surgery. In a series of 23 consecutive patients scanned by CT for suspected ruptured AAA, CT proved 100% accurate. In seven patients with surgically or pathologically proved ruptured AAA, CT demonstrated a similar distribution of hemorrhage into the perirenal space and to a lesser degree into the anterior and posterior pararenal spaces. The 16 true-negative examinations included ten in patients with unruptured AAA and six in patients with other diseases. The authors conclude that patients in stable condition with suspected ruptured AAA should be examined by CT
Kenyon, Sara; Boulvain, Michel; Neilson, James P
Premature birth carries substantial neonatal morbidity and mortality. Subclinical infection is associated with preterm rupture of membranes (PROM). Prophylactic maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection. To evaluate the immediate and long-term effects of administering antibiotics to women with PROM before 37 weeks, on maternal infectious morbidity, neonatal morbidity and mortality, and longer-term childhood development. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 April 2010). Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included as were trials of different antibiotics. Trials in which no placebo was used were included for the outcome of perinatal death alone. We extracted data from each report without blinding of either the results or the treatments that women received. We sought unpublished data from a number of authors. We included 22 trials, involving 6800 women and babies.The use of antibiotics following PROM is associated with statistically significant reductions in chorioamnionitis (average risk ratio (RR) 0.66, 95% confidence interval (CI) 0.46 to 0.96, and a reduction in the numbers of babies born within 48 hours (average RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (average RR 0.79, 95% CI 0.71 to 0.89). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.67, 95% CI 0.52 to 0.85), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.81, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.72, 95% CI 1.57 to 14.23).One study evaluated the children's health at seven years of age (ORACLE Children Study) and found
Khalil, E.O.; Alzoye, K.S.; Elwaer, A.M.
A ruptured A 42 medium carbon steel tube was collected by the engineering department in one of our steam power stations. Inspection of ruptured tube revealed a thin - lip fracture with brownish thin layer of oxide film on inner tube surfaces. There was no evidence of pitting, the outer surfaces of the tube exhibited a general oxidized conditions. A micro section taken near the fracture surface consists of ferrite and martensite, the amount of martensite decreased as we away from the fracture surface. Presence of martensite phase in the microstructure indicates that the tube material has been overheated. An erosion corrosion mechanism in conjunction with overheated. An erosion corrosion mechanism in conjunction with overheating resulted in strength deterioration with consequent premature failure. 4 fig., 1 tab
Full Text Available BACKGROUND: Premature ejaculation (PE is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up. OBJECTIVE: To assess the efficacy of psychosocial interventions for PE. CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW: Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010; PsycINFO (1974 to 2010; EMBASE (1980 to 2010; LILACS (1982 to 2010; the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010; and by checking bibliographies, and contacting manufacturers and researchers. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE. DATA COLLECTION AND ANALYSIS: Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation. The secondary outcome was change in validated PE questionnaires. MAIN RESULTS: In one study behavioral therapy (BT was significantly better than waiting list for duration of intercourse (MD (mean difference 407.90 seconds, 95% CI 302.42 to 513.38, and couples' sexual satisfaction (MD -26.10, CI -50.48 to -1.72. BT was also significantly better for a new functional-sexological treatment (FS (MD 412.00 seconds, 95% CI 305.88 to 518.12, change over time in subjective perception of duration of intercourse (Women: MD 2
Full Text Available Purtscher's retinopathy is usually associated with trauma, acute pancreatitis, vasculitis, lupus, and bone fractures. It was rarely described postpartum in patients with preeclampsia as well as associated with HELLP syndrome. We present a case of a multiparous patient aged 44 with severe preeclampsia and postpartum HELLP syndrome complicated with Purtscher-like retinopathy and large ruptured subcapsular liver hematoma that required emergency abdominal surgery after premature delivery of a dead fetus. Postsurgical outcome was favorable regarding both liver function and visual acuity.
Holmstroem, Stefan; Auerkari, Pertti
To extend creep life modelling from classical rupture modelling, a robust and effective parametric strain model has been developed. The model can reproduce with good accuracy all parts of the creep curve, economically utilising the available rupture models. The resulting combined model can also be used to predict rupture from the available strain data, and to further improve the rupture models. The methodology can utilise unfailed specimen data for life assessment at lower stress levels than what is possible from rupture data alone. Master curves for creep strain and rupture have been produced for oxygen-free phosphorus-doped (OFP) copper with a maximum testing time of 51,000 h. Values of time to specific strain at given stress (40-165 MPa) and temperature (125-350 deg. C) were fitted to the models in the strain range of 0.1-38%. With typical inhomogeneous multi-batch creep data, the combined strain and rupture modelling involves the steps of investigation of the data quality, extraction of elastic and creep strain response, rupture modelling, data set balancing and creep strain modelling. Finally, the master curves for strain and rupture are tested and validated for overall fitting efficiency. With the Wilshire equation as the basis for the rupture model, the strain model applies classical parametric principles with an Arrhenius type of thermal activation and a power law type of stress dependence for the strain rate. The strain model also assumes that the processes of primary and secondary creep can be reasonably correlated. The rupture model represents a clear improvement over previous models in the range of the test data. The creep strain information from interrupted and running tests were assessed together with the rupture data investigating the possibility of rupture model improvement towards lower stress levels by inverse utilisation of the combined rupture based strain model. The developed creep strain model together with the improved rupture model is
Beluffi, Giampiero; Alberici, Elisa
A case of acute appendicitis in a premature baby in whom diagnosis was suggested on plain films of the abdomen is presented. In this baby air in a hollow viscus suspected of being an enlarged appendix was the clue to diagnosis. The diagnostic dilemma of this rare and life-threatening condition in premature babies and newborns is underlined. The relevance of different imaging modalities and of different findings in this age group is discussed. Awareness of this rare condition and possible differential diagnosis in newborns and premature babies is stressed. (orig.)
Full Text Available Prematurity is still an actual medical problem. Significant increase in the survival rate of premature babies is observed due to the progress in perinatal care .Usually, parents are not prepared for a premature birth, for the majority of them the hospitalization of a child in neonatal intensive care unit is a source of fear, moreover parents often blame themselves for the situation. Appearing emotions and questions require a compatible response from the therapeutic team. The most important activity in the practice of the team is emotional, informative, evaluative support.
Saitz, Theodore Robert; Serefoglu, Ege Can
Vast advances have occurred over the past decade with regards to understanding the epidemiology, pathophysiology and management of premature ejaculation (PE); however, we still have much to learn about this common sexual problem. As a standardized evidence-based definition of PE has only recently been established, the reported prevalence rates of PE prior to this definition have been difficult to interpret. As a result, a large range of conflicting prevalence rates have been reported. In addition to the lack of a standardized definition and operational criteria, the method of recruitment for study participation and method of data collection have obviously contributed to the broad range of reported prevalence rates. The new criteria and classification of PE will allow for continued research into the diverse phenomenology, etiology and pathogenesis of the disease to be conducted. While the absolute pathophysiology and true prevalence of PE remains unclear, developing a better understanding of the true prevalence of the disease will allow for the completion of more accurate analysis and treatment of the disease.
Granboulan, V; Danan, C; Dassieu, G; Janaud, J C; Durand, B
The ongoing progress in neonatal intensive care is modifying the psychic context of prematurity for all the partners, infants as well as parents and physicians. Comfort and prognosis of preterm infants have much improved. Since newborns under 24 weeks of gestational age are now surviving, they spend approximately half the duration of pregnancy out of the maternal uterus. All the psychological issues of such an early separation have to be considered, including the developmental outcome of a sensorial environment which is quite different from the intra-uterine one. Research has been developing in this field. The cooperation between neonatalogists and psychologists has been profitable to parents. Problems linked to the separation, such as difficulty in representing the infant, are no more frequent owing to the attention paid to the mother-child bond and subsequent early contacts. What is forward now is the impact of an hyper technical world of intensive care on the parents, and of the strange aspect of the tiny baby surrounded by engines and tubes. Such an overpresence of reality often results in a reaction of traumatic daziness among parents. The cooperation of the whole staff is necessary for the resumption of an imaginary process of psychic functioning. Finally, the survival of very-low-birth-weight infants confronts the neonatalogists with some delicate ethical questions. Psychiatrists and psychologists might have an important part to play in aiding the profession in its sorting out of these ethical issues.
Ahmed, M.Z.; Ling, L.; Ettles, D.F.
The rapid imaging evaluation and diagnosis of rupture and impending rupture of an abdominal aortic aneurysm (AAA) is imperative. This article describes the imaging findings of rupture, impending rupture, and other abdominal aortic abnormalities. It is important not to overlook AAA as the consequences can be life threatening. All patients who had open or endovascular repair of AAA rupture over 6 years (2008–2012) were identified from our departmental database. The computed tomography (CT) images of 99 patients were reviewed for relevant findings. The mean age of the patients was 65 years and 85% were male
Flickinger, F.W.; Jackson, G.L.
An initial liver/spleen scan performed on a patient with blunt abdominal trauma was negative 3 days following the accident. A follow-up scan 7 days later showed definite evidence of splenic rupture, proved surgically. The authors conclude that, in such cases, spleen scans may be negative initially because of delayed splenic ruptures
Wu, Jie; Tan, Yuyong; Huo, Jirong
Currently, beverages containing compressed air such as cola and champagne are widely used in our daily life. Improper ways to unscrew the bottle, usually by teeth, could lead to an injury, even a rupture of the esophagus. This letter to editor describes a case of esophageal rupture caused by compressed air.
Menovsky, T.; Rooij, W.J.J. van; Sluzewski, M.; Wijnalda, D.
OBJECTIVE: To assess the technical feasibility of treating ruptured pericallosal artery aneurysms with detachable coils and to evaluate the anatomic and clinical results. METHODS: Over a period of 27 months, 12 patients with a ruptured pericallosal artery aneurysm were treated with detachable
Sep 3, 2016 ... and such ruptures also lead to a pseudo-paralysis.[1,2]. Pain during daily ... 2) repairable rotator cuff rupture, as determined on MRI and during arthroscopy ..... functioning and lead to cosmetic deformities.. Arthroplasty is a ...
Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone
to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION: Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour...
Shin, Ho Seob; Nam, Kyung Jin; Lee, Jin Hwa; Kim, Chan Sung; Choi, Jong Cheol; Oh, Jong Young
Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued
May 26, 2015 ... Kaohsiung Medical University, Kaohsiung, Taiwan. Abstract. Isolated traumatic gallbladder rupture subsequent to blunt abdominal injury is rare. Most literatures on the subjects consist of case reports. We reported a rare case of isolated gallbladder rupture and discussed the possible predisposing factors to ...
Spontaneous Achilles tendon ruptures are uncommon. We present a 46-year-old man with spontaneous Achilles tendon rupture due to ochronosis. To our knowledge, this has not been previously reported in Sudan literature. The tendon of the reported patient healed well after debridement and primary repairs.
Shin, Ho Seob; Nam, Kyung Jin; Lee, Jin Hwa; Kim, Chan Sung; Choi, Jong Cheol; Oh, Jong Young [Dong-a University College of Medicine, Pusan (Korea, Republic of)
Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.
Lim, Chae Hun; Kim, Hyun Jin; Park, Soo Youn; Hwang, Seong Su; Choi, Hyun Joo [St. Vincent Hospital, Suwon (Korea, Republic of)
Rupture of adrenal tumor from various primary origins is a rather rare event. We report here on a ruptured adrenal metastasis from hepatocellular carcinoma, and this ruptured metastasis was observed at the time of the initial diagnosis.
Saxena, Amol; Hofer, Deann
We present a case report with 1-year follow-up data of a 57-year-old male soccer referee who had sustained an acute triple Achilles tendon rupture injury during a game. His triple Achilles tendon rupture consisted of a rupture of the proximal watershed region, a rupture of the main body (mid-watershed area), and an avulsion-type rupture of insertional calcific tendinosis. The patient was treated surgically with primary repair of the tendon, including tenodesis with anchors. Postoperative treatment included non-weightbearing for 4 weeks and protected weightbearing until 10 weeks postoperative, followed by formal physical therapy, which incorporated an "antigravity" treadmill. The patient was able to return to full activity after 26 weeks, including running and refereeing, without limitations. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Gallo, Robert A.; DeMeo, Patrick J.; Kolman, Brett H.; Daffner, Richard H.; Sciulli, Robert L.; Roberts, Catherine C.
Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58-67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of the tendon, and excess fluid in the tendon sheath. One patient demonstrated a partial tear showing an attenuated tendon with increased surrounding fluid. Although rupture of the tibialis anterior tendon is a rarely reported entity, MRI is a useful modality in the definitive detection and characterization of tibialis anterior tendon ruptures. (orig.)
Ahmad S. Ashrafi
Full Text Available Introduction: Gastroepiploic artery aneurysms are extremely rare, with few reported cases in the literature. The risk of rupture however, is high and thus warrants attention. Presentation of case: Here we present a rare case of a women who presented to the emergency department in shock and was found to have a ruptured gastroepiploic artery aneurysm during surgical exploration. Suture ligation of the aneurysm was completed. Discussion: Although rare, gastroepiploic artery aneurysms have up to a 90% rate of rupture and therefore require intervention. A laparoscopic approach has been described however, in cases where rupture has occurred, urgent laparotomy and control of hemorrhage is needed. Conclusion: We describe a rare case of a ruptured gastroepiploic aneurysm that was successfully managed with urgent laparotomy and aneurysmal resection. Keywords: Gastroepiploic, Aneurysm, Hemorrhage, Case report
T. V. Losseva
Full Text Available A physical model of earthquake lights is proposed. It is suggested that the magnetic diffusion from the electric and magnetic fields source region is a dominant process, explaining rather high localization of the light flashes. A 3D numerical code allowing to take into account the arbitrary distribution of currents caused by ground motion, conductivity in the ground and at its surface, including the existence of sea water above the epicenter or (and near the ruptured segments of the fault have been developed. Simulations for the 1995 Kobe earthquake were conducted taking into account the existence of sea water with realistic geometry of shores. The results do not contradict the eyewitness reports and scarce measurements of the electric and magnetic fields at large distances from the epicenter.
Dorfman, G.S.; Paolella, L.P.; Haas, R.A.; Lambiase, R.E.; Cronan, J.J.
To evaluate the acceptability of digital subtraction angiography (DSA) in the evaluation of traumatic rupture of the aorta (TRA), the authors obtained 56 thoracic aortograms in 55 consecutive trauma patients, using both DSA and cut-film angiography (CFA). Both studies were ranked blindly and assigned scores for quality and diagnosis. Interobserver variance for DSA and CFA quality rankings was insignificant. CFA achieved significantly higher ranking for quality. In the 56 examinations, CFA demonstrated seven abnormalities that demanded intervention for follow-up angiography. DSA demonstrated only five of these and found no additional abnormalities. While this evaluation applies only to the particular digital system that the authors tested, they found that DSA, as compared with CFA, failed to demonstrate significant aortic injury. The confidence of diagnosis was significantly greater with CFA. Similar double-blind evaluation is mandatory at any trauma center prior to converting from CFA to DSA in the diagnosis of this life-threatening condition
Full Text Available Abstract The meniscofibular ligament is an anatomically defined ligament of the knee in humans. However, there are no data regarding the prognosis following injury to this ligament. Our case was a 42-year-old man who presented at our clinic with pain of the lateral side of his left knee. MRI of his left knee revealed the rupture of the meniscofibular ligament. The mechanism of injury was consistent with anatomical and mechanical studies of the meniscofibular ligament. The patient was treated conservatively for 1 year, but his pain did not resolve completely. A case series of patients with the same injury is required to establish an effective treatment for this rare injury.
Maria Carolina Correia dos Santos
Full Text Available Objective: to identify mothers' perceptions about the pain in their premature babies in the Neonatal Intensive Care Unit. Methods: evaluative, quantitative study with investigative nature conducted with 19 mothers of hospitalized premature newborns. Data were obtained from closed questions, answered by mothers. Results: from the participants, two (10.5% reported that newborns are unable to feel pain. From the 17 mothers who said that premature babies can feel pain, the majority (94.1% identified crying as a characteristic of pain sensation. Eleven (64.7% stated that uneasiness is a sign of pain in newborns. Conclusion: for the proper management of neonatal pain it is essential that mothers know the signs of pain in premature newborns, and that health professionals instruct this recognition, through the enhancement of the maternal presence and practice of effective communication between professionals and newborns’ families.
Solans Pérez de Larraya, Ana M; Ortega Molina, José M; Fernández, José Uberos; Escudero Gómez, Júlia; Salgado Miranda, Andrés D; Chaves Samaniego, Maria J; García Serrano, José L
To analyse the speed of temporal retinal vascularisation in preterm infants included in the screening programme for retinopathy of prematurity. A total of 185 premature infants were studied retrospectively between 2000 and 2017 in San Cecilio University Hospital of Granada, Spain. The method of binocular indirect ophthalmoscopy with indentation was used for the examination. The horizontal disc diameter was used as a unit of length. Speed of temporal retinal vascularisation (disc diameter/week) was calculated as the ratio between the extent of temporal retinal vascularisation (disc diameter) and the time in weeks. The weekly temporal retinal vascularisation (0-1.25 disc diameter/week, confidence interval) was significantly higher in no retinopathy of prematurity (0.73 ± 0.22 disc diameter/week) than in stage 1 retinopathy of prematurity (0.58 ± 0.22 disc diameter/week). It was also higher in stage 1 than in stages 2 (0.46 ± 0.14 disc diameter/week) and 3 of retinopathy of prematurity (0.36 ± 0.18 disc diameter/week). The rate of temporal retinal vascularisation (disc diameter/week) decreases when retinopathy of prematurity stage increases. The area under the receiver operating characteristic curve was 0.85 (95% confidence interval: 0.79-0.91) for retinopathy of prematurity requiring treatment versus not requiring treatment. The best discriminative cut-off point was a speed of retinal vascularisation prematurity may be required. However, before becoming a new standard of care for treatment, it requires careful documentation, with agreement between several ophthalmologists.
McNamara, C M
This case report reviews the variability of dental eruption and the possible sequelae. Dental eruption of the permanent teeth in cleft palate children may be variable, with delayed eruption the most common phenomenon. A case of premature dental eruption of a maxillary left first premolar is demonstrated, however, in a five-year-old male. This localized premature dental eruption anomaly was attributed to early extraction of the primary dentition, due to caries.
Full Text Available Introduction: Preterm delivery is the delivery before 37 weeks of gestation are completed. The incidence of preterm birth ranges from 5 to 15%. Aims of the study were to determine the average body weight, Apgar score after one and five minutes, and the frequency of the most common complications in preterminfants.Methods: The study involved a total of 631 newborns, of whom 331 were born prematurely Aims of this study were to (24th-37th gestational weeks-experimental group, while 300 infants were born in time (37-42 weeks of gestation-control group.Results: Average body weight of prematurely born infants was 2382 grams, while the average Apgar score in this group after the fi rst minute was 7.32 and 7.79 after the fifth minute. The incidence of respiratory distress syndrome was 50%, intracranial hemorrhage, 28.1% and 4.8% of sepsis. Respiratory distresssyndrome was more common in infants born before 32 weeks of gestation. Mortality of premature infants is present in 9.1% and is higher than that of infants born at term.Conclusions: Birth body weight and Apgar scores was lower in preterm infants. Respiratory distress syndrome is the most common fetal complication of prematurity. Intracranial hemorrhage is the second most common complication of prematurity. Mortality of premature infants is higher than the mortality of infants born at term birth.
Barall, Michael; Harris, Ruth A.
Earthquakes are complex events that involve a myriad of interactions among multiple geologic features and processes. One of the tools that is available to assist with their study is computer simulation, particularly dynamic rupture simulation. A dynamic rupture simulation is a numerical model of the physical processes that occur during an earthquake. Starting with the fault geometry, friction constitutive law, initial stress conditions, and assumptions about the condition and response of the near‐fault rocks, a dynamic earthquake rupture simulation calculates the evolution of fault slip and stress over time as part of the elastodynamic numerical solution (Ⓔ see the simulation description in the electronic supplement to this article). The complexity of the computations in a dynamic rupture simulation make it challenging to verify that the computer code is operating as intended, because there are no exact analytic solutions against which these codes’ results can be directly compared. One approach for checking if dynamic rupture computer codes are working satisfactorily is to compare each code’s results with the results of other dynamic rupture codes running the same earthquake simulation benchmark. To perform such a comparison consistently, it is necessary to have quantitative metrics. In this paper, we present a new method for quantitatively comparing the results of dynamic earthquake rupture computer simulation codes.
Full Text Available The etiology of hepatic rupture is usually secondary to trauma, and hepatic rupture induced by spontaneous intrahepatic hematoma is clinically rare. We describe here a 61-year-old female patient who was transferred to our hospital with hepatic rupture induced by spontaneous intrahepatic hematoma. The patient had no history of trauma and had a history of systemic lupus erythematosus for five years, taking a daily dose of 5 mg prednisone for treatment. The patients experienced durative blunt acute right upper abdominal pain one day after satiation, which aggravated in two hours, accompanied by dizziness and sweating. Preoperative diagnosis was rupture of the liver mass. Laparotomy revealed 2500 mL fluid consisting of a mixture of blood and clot in the peritoneal cavity. A 3.5 cm × 2.5 cm rupture was discovered on the hepatic caudate lobe near the vena cava with active arterial bleeding, and a 5 × 6 cm hematoma was reached on the right posterior lobe of the liver. Abdominal computed tomography (CT and laparotomy revealed spontaneous rupture of intrahepatic hematoma with hemorrhagic shock. The patient was successfully managed by suturing the rupture of the hepatic caudate lobe and clearing part of the hematoma. The postoperative course was uneventful, and the patient was discharged after two weeks of hospitalization.
Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila
Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690
Creep rupture is a long term failure mode in structural materials that occurs at high temperatures and moderate stress levels. The deterioration of the material preceding rupture, termed creep damage, manifests itself in the formation of small cavities on grain boundaries. To measure creep damage, sometimes uniaxial tests are performed, sometimes density measurements are made, and sometimes the grain boundary cavities are measured by microscopy techniques. The purpose of the present research is to explore a new method of measuring creep rupture, which involves measuring the curvature of eccentric pressurized tubes. Theoretical investigations as well as the design, construction, and operation of an experimental apparatus are included in this research
Gitto, Salvatore; Draghi, Ferdinando
Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a 48-year-old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections. © 2017 Wiley Periodicals, Inc.
Cats, Bernard P.; Tan, Karel E. W. P.
Reporting long-term ophthalmologic sequelae among ex-prematures at 6 to 10 years of age, this study compares 42 ex-premature infants who had had regressed forms of retinopathy of prematurity (ROP) during the neonatal period with 42 matched non-ROP ex-premature controls at 6 to 10 years of age. Subjects were subdivided into four groups: (1) ROP…
Large earthquakes with long rupture durations emit P wave energy throughout the rupture period. Incorporating late-onset P waves into earthquake early warning (EEW) algorithms could contribute to robust predictions of strong ground motion. Here I describe a technique to detect in real time P waves from growing ruptures to improve the timeliness of an EEW algorithm based on seismic wavefield estimation. The proposed P wave detector, which employs a simple polarization analysis, successfully detected P waves from strong motion generation areas of the 2011 Mw 9.0 Tohoku-oki earthquake rupture. An analysis using 23 large (M ≥ 7) events from Japan confirmed that seismic intensity predictions based on the P wave detector significantly increased lead times without appreciably decreasing the prediction accuracy. P waves from growing ruptures, being one of the fastest carriers of information on ongoing rupture development, have the potential to improve the performance of EEW systems.
Salvadori, Priscila Silveira; Atzingen, Augusto Castelli von; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Bomfim, Lucas Novais [Universidade Tiradentes (UNIT), Maceio, AL, (Brazil)
Epithelial ovarian tumors are the most common malignant ovarian neoplasms and, in most cases, eventual rupture of such tumors is associated with a surgical procedure. The authors report the case of a 54-year-old woman who presented with spontaneous rupture of ovarian cystadenocarcinoma documented by computed tomography, both before and after the event. In such cases, a post-rupture staging tends to be less favorable, compromising the prognosis. (author)
Chounet, Agnès; Vallée, Martin; Causse, Mathieu; Courboulex, Françoise
Application of the SCARDEC method provides the apparent source time functions together with seismic moment, depth, and focal mechanism, for most of the recent earthquakes with magnitude larger than 5.6-6. Using this large dataset, we have developed a method to systematically invert for the rupture direction and average rupture velocity Vr, when unilateral rupture propagation dominates. The approach is applied to all the shallow (z earthquakes of the catalog over the 1992-2015 time period. After a careful validation process, rupture properties for a catalog of 96 earthquakes are obtained. The subsequent analysis of this catalog provides several insights about the seismic rupture process. We first report that up-dip ruptures are more abundant than down-dip ruptures for shallow subduction interface earthquakes, which can be understood as a consequence of the material contrast between the slab and the overriding crust. Rupture velocities, which are searched without any a-priori up to the maximal P wave velocity (6000-8000 m/s), are found between 1200 m/s and 4500 m/s. This observation indicates that no earthquakes propagate over long distances with rupture velocity approaching the P wave velocity. Among the 23 ruptures faster than 3100 m/s, we observe both documented supershear ruptures (e.g. the 2001 Kunlun earthquake), and undocumented ruptures that very likely include a supershear phase. We also find that the correlation of Vr with the source duration scaled to the seismic moment (Ts) is very weak. This directly implies that both Ts and Vr are anticorrelated with the stress drop Δσ. This result has implications for the assessment of the peak ground acceleration (PGA) variability. As shown by Causse and Song (2015), an anticorrelation between Δσ and Vr significantly reduces the predicted PGA variability, and brings it closer to the observed variability.
Chatziioannou, A.; Mourikis, D.; Katsimilis, J.; Skiadas, V.; Koutoulidis, V.; Katsenis, K.; Vlahos, L.
The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results
A new projection, oblique axial, is recommended for the arthrography of the acute sprained ankle for the correct diagnosis of a ruptured calcaneofibular ligament. Its value is experimentally confirmed. (Auth.)
Full Text Available We present a case of spontaneous rupture of the diaphragm, characterized by nonspecific symptoms. The rapid diagnosis and appropriate surgical approach led to a positive resolution of the pathology.
Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu
Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188
Full Text Available Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy.
Chetal, S.C.; Raju, C.; Anandkumar, V.; Seetharaman, V.; Rajan, K.K.
Rupture discs are required as a safety device for protecting the secondary sodium circuit and its components against high pressure surges due to accidental water steam leaks in sodium heated steam generator and the consequent sodium water reaction. For identical reasons, rupture discs are also required on the vessels used for decontamination of sodium components. Reverse buckling knife blade concept with austenitic stainless steel disc has been developed for the rupture disc assemblies required for Fast Breeder Test Reactor (FBTR). Hydroforming process without any die has been used for disc fabrication. One rupture disc assembly required for steam generator is undergoing sodium endurance test and has accumulated 4,500 hours. The present status of development work as demonstrated by room temperature experimental results as well as the scope for future work are discussed. (author)
Yurevich, Andrey V
As there seems to be a recurrent feeling of crisis in psychology, its present state is analyzed in this article. The author believes that in addition to the traditional manifestations that have dogged psychology since it emerged as an independent science some new features of the crisis have emerged. Three fundamental "ruptures" are identified: the "horizontal" rupture between various schools and trends, the "vertical" rupture between natural science and humanitarian psychology, and the "diagonal" rupture between academic research and applied practice of psychology. These manifestations of the crisis of psychology have recently been compounded by the crisis of its rationalistic foundations. This situation is described in terms of the cognitive systems in psychology which include meta-theories, paradigms, sociodigms and metadigms.
Full Text Available Introduction: Premature ejaculation is the most common male sexual dysfunction leading to distress in many couples. Master and Johnson emphasized the concept of early learned experiences and Kaplan emphasized lack of sensory awareness. For treatment sex therapists mainly utilize start-stop and squeeze techniques as homework. Couples enter sex therapy with some cognitive distortions and beliefs about sex and sexuality. These beliefs are also named sexual myths. For some couples using techniques to challenge cognitive distortions and maladaptive beliefs about sex and sexuality can be used. In this paper by presenting a case we discussed how cognitive techniques can be used along with behaviour techniques with couples. Case: Presenting clients are five years married couple who are thirty and twenty nine years old respectively. They attended to the outpatient clinic with the request of the female client. Their main complaint was premature ejaculation. They were diagnosed premature ejaculation using clinical interview. In treatment besides start and stop technique, cognitive techniques were utilized to address dysfunctional beliefs about sexuality. Discussion: Premature ejaculation is a male sexual dysfunction that causes distress and intimacy problems between couples. Stop start and squeeze techniques were accepted as the choice of treatment but their effectiveness is questioned recently. Also cognitive distortions and maladaptive beliefs may hamper therapy progress. Besides that, behavioral techniques utilizing cognitive techniques to lessen the degree of dysfunctional beliefs about sex and sexuality may help the couple to overcome premature ejaculation and enhance sexual satisfaction and intimacy.
Arajärvi, E; Santavirta, S; Tolonen, J
Several investigations have indicated that rupture of the thoracic aorta is one of the leading causes of immediate death in victims of road traffic accidents. In Finland in 1983, 92% of front-seat passengers were seat belt wearers on highways and 82% in build-up areas. The mechanisms of rupture of the aorta have been intensively investigated, but the relationship between seat belt wearing and injury mechanisms leading to aortic rupture is still largely unknown. This study comprises 4169 fatally injured victims investigated by the Boards of Traffic Accident Investigation of Insurance Companies during the period 1972 to 1985. Chest injuries were recorded as the main cause of death in 1121 (26.9%) victims, 207 (5.0%) of those victims having worn a seat belt. Aortic ruptures were found at autopsy in 98 victims and the exact information of the location of the aortic tears was available in 68. For a control group, we analyzed 72 randomly chosen unbelted victims who had a fatal aortic rupture in similar accidents. The location of the aortic rupture in unbelted victims was more often in the ascending aorta, especially in drivers, whereas in seat belt wearers the distal descending aorta was statistically more often ruptured, especially in right-front passengers (p less than 0.05). The steering wheel predominated statistically as the part of the car estimated to have caused the injury in unbelted victims (37/72), and some interior part of the car was the most common cause of fatal thoracic impacts in seat belt wearers (48/68) (p less than 0.001). The mechanism of rupture of the aorta in the classic site just distal to the subclavian artery seems to be rapid deceleration, although complex body movements are also responsible in side impact collisions. The main mechanism leading to rupture of the ascending aorta seems to be severe blow to the bony thorax. This also often causes associated thoracic injuries, such as heart rupture and sternal fracture. Injuries in the ascending
Background: Uterine rupture is an infrequent but life threatening obstetric emergency. Rupture of previously scarred uterus is often encountered especially in multiparous women, but the traumatic rupture of an unscarred primigravid uterus as presented here is a relatively rare event. We report a case of rupture of an ...
Seybold, C. A.; Harms, D. S.; Grossman, R. B.
Rupture resistance is a measure of the strength of a soil to withstand an applied stress or resist deformation. In soil survey, during routine soil descriptions, rupture resistance is described for each horizon or layer in the soil profile. The lower portion of the rupture resistance classes are assigned based on rupture between thumb and…
Hansen, Philip; Kovanen, Vuokko; Hölmich, Per
The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive.......The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive....
Rupture of the uterus is still a major obstetric problem in developing countries. The urinary bladder is often affected especially when a lower segment Caesarean scar ruptures. We present a case of bladder rupture associated with uterine rupture in a patient who was attempting vaginal delivery after two previous Caesarean ...
Polzer, Stanislav; Gasser, T Christian
A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach. © 2015 The Author(s).
Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.
Rupture is the most serious and lethal complication of the abdominal aortic aneurysm. Despite all improvements during the past 50 years, ruptured abdominal aortic aneurysms are still associated with very high mortality. Namely, including patients who die before reaching the hospital, the mortality rate due to abdominal aortic aneurysm rupture is 90%. On the other hand, during the last twenty years, the number of abdominal aortic aneurysms significantly increased. One of the reasons is the fact that in majority of countries the general population is older nowadays. Due to this, the number of degenerative AAA is increasing. This is also the case for patients with abdominal aortic aneurysm rupture. Age must not be the reason of a treatment refusal. Optimal therapeutic option ought to be found. The following article is based on literature analysis including current guidelines but also on my Clinics significant experience. Furthermore, this article show cases options for vascular medicine in undeveloped countries that can not apply endovascular procedures at a sufficient level and to a sufficient extent. At this moment the following is evident. Thirty-day-mortality after repair of ruptured abdominal aortic aneurysms is significantly lower in high-volume hospitals. Due to different reasons all ruptured abdominal aortic aneurysms are not suitable for EVAR. Open repair of ruptured abdominal aortic aneurysm should be performed by experienced open vascular surgeons. This could also be said for the treatment of endovascular complications that require open surgical conversion. There is no ideal procedure for the treatment of AAA. Each has its own advantages and disadvantages, its own limits and complications, as well as indications and contraindications. Future reductions in mortality of ruptured abdominal aortic aneurysms will depend on implementation of population-based screening; on strategies to prevent postoperative organ injury and also on new medical technology
Bjerring, Ole Steen
Splenic artery aneurysms (SAA) are traditionally treated surgically, but endovascular techniques are becoming increasingly popular. A 64 year-old male with chest pain and low blood pressure was admitted under suspicion of AMI. A CT scan showed a 56 mm SAA with signs of rupture. The patient...... was treated with endovascular embolisation of the SAA with coils. Blood pressure and haemoglobin levels were stabilized and the patient was discharged. In the case of rupture the treatment of choice seems to be endovascular....
Khan, H.R.; Low, S.; Selinger, M.; Nelson, N.
Rupture of a splenic artery aneurysm, commonly associated with pregnancy is a rare and catastrophic event. We report here a case of a patient in her second pregnancy who presented with a short history of left hypochondriac and epigastric pain, followed by collapse at 32 weeks gestation. Sudden fetal distress lead to emergency caesarean delivery when splenic artery aneurysm rupture was diagnosed. With timely involvement of multidisciplinary personnel both mother and baby survived and had an uneventful recovery. (author)
Servey, Jessica T; Jonas, Christopher
Plantar fascia rupture in the absence of previous diagnosis of plantar fasciitis, corticosteroid injection, or injury is a rare occurrence with only 7 case reports in the literature since 1978. This is a case of spontaneous plantar fascia rupture in a 38-year-old active-duty US military member with current considerations in musculoskeletal ultrasound, other radiologic imaging, treatment, and followup of this diagnosis. © Copyright 2018 by the American Board of Family Medicine.
Objective: To evaluate the MRI findings of achilles tendon rupture. Methods: The MRI data of 7 patients with achilles tendon rupture were retrospectively analysed. All 7 patients were male with the age ranging from 34 to 71 years. Routine MR scanning was performed in axial and sagittal planes, including T 1 WI, T 2 WI and a fat suppression MRI (SPIR). Results: Among 7 patients, complete achilles tendon rupture was seen in 6 cases, partial achilles tendon rupture 1 case. The site of tendon disruption were 2.6-11.0 cm( mean 5.4 cm) proximal to the insertion in the calcaneus. The MRI findings of a partial or complete rupture of the achilles tendon included enlarged and thickened achilles tendon (7 cases), wavy lax achilles tendon (2 cases), discontinuity of some or all of its fibers and intratendinous regions of increased signal intensity (7 cases). In the cases of complete tendon rupture, the size of the tendinous gap varied from 3.0-8.0 mm, which was filled with blood and appeared as edema of increase signal intensity on T 2 WI and SPIR. In all 7 patients, MR scanning showed medium signal intensity (7 cases) on T 1 WI, or medium signal intensity (1 cases), medium-high signal intensity (3 cases ), high signal intensity (3 cases) on T 2 WI, and medium-high signal intensity (2 cases), high signal intensity (5 cases) on fat suppression MRI. The preachilles fat pad showed obscure in 6 cases of complete achilles tendon rupture. Conclusion: MRI is an excellent method for revealing achilles tendon rupture and confirming the diagnosis. (authors)
Machi, Paolo; Lobotesis, Kyriakos; Vendrell, Jean Francoise; Riquelme, Carlos; Eker, Omer; Costalat, Vincent; Bonafe, Alain
The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues
Madsen, Berit L.; Giudice, Linda; Donaldson, Sarah S.
Purpose: To disprove the common view that women who have undergone irradiation to fields excluding the pelvis are at risk for radiation-induced premature menopause, we reviewed menstrual function and fertility among women treated with subtotal lymphoid irradiation for Hodgkin's Disease. Methods and Materials: Treatment and follow-up records of all women less than age 50 at the time of diagnosis of Stage I or II supradiaphragmatic Hodgkin's Disease, treated with subtotal lymphoid irradiation alone and enrolled in radiotherapy trials from 1967 to 1985, were reviewed. In addition, patients were surveyed regarding their menstrual status and fertility history. Results: Thirty-six women, aged 10 to 40 years, with normal menstrual function at the time of Hodgkin's diagnosis, were identified. Mean follow-up was 14 years, with a range of 1.25-22.75 years. The average radiation dose to mantle and paraaortic fields was 40-44 Gy; the calculated scatter radiation dose to the pelvis at the ovaries was 3.2 Gy. There were 38 pregnancies in 18 women; all offspring are normal. One of 36 women (2.7%) experienced premature menopause. The reported rate of premature menopause in women who have not undergone irradiation is 1-3%; not significantly different than the rate in our study. There is a syndrome whereby antibodies to several endocrine organs occur (including the ovary), which is associated with premature ovarian failure. This syndrome may be associated with prior radiation to the thyroid, such as that given by mantle-irradiation for Hodgkin's Disease. We report such a case. Conclusion: There is little risk of premature menopause in women treated with radiation fields that exclude the pelvis. Women with presumed radiation-induced premature menopause warrant an evaluation to exclude other causes of ovarian failure, such as autoimmune disorders
Discussion: Premature ejaculation is a male sexual dysfunction that causes distress and intimacy problems between couples. Stop start and squeeze techniques were accepted as the choice of treatment but their effectiveness is questioned recently. Also cognitive distortions and maladaptive beliefs may hamper therapy progress. Besides that, behavioral techniques utilizing cognitive techniques to lessen the degree of dysfunctional beliefs about sex and sexuality may help the couple to overcome premature ejaculation and enhance sexual satisfaction and intimacy. [JCBPR 2013; 2(1.000: 47-52
Larsen, Bjørn Strøier; Kumarathurai, Preman; Nielsen, Olav W
AIMS: The aim of the study was to assess a possible circadian variation of premature atrial contractions (PACs) in a community-based population and to determine if the daily variation could be used to assess a more vulnerable period of PACs in predicting later incidence of atrial fibrillation (AF...... variation in heart rate. After adjusting for relevant risk factors, the risk of AF was equal in all time intervals throughout the day. CONCLUSION: Premature atrial contractions showed a circadian variation in subjects with frequent PACs. No specific time interval of the day was more predictive of AF than...
Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)
To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.
Seouk, Kang Hyo; Keun, Rho Yong
To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture
Gratz, S.; Behr, T.; Becker, W.; Koester, G.; Vosshenrich, R.; Grabbe, E.
Aim: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n=20), contrast arthrography (n=20) and arthroscopy (n=10) of the shoulder joint. Methods: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 μCi/5 ml). The application was performed either in direct combination with contrast arthrography (n=10) or ultrasound conducted mixed with a local anesthetic (n=10). Findings at arthroscopical surgery (n=10) were used as the gold standard. Results: In case of complete rotator cuff rupture (n=5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistant. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. Conclusion: Arthroscinitgraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures. (orig.) [de
Robinson, R; O'Keefe, M
The ocular complications in population of 131 premature infants, with and without retinopathy of prematurity (ROP) are reported. An increased incidence of strabismus (20% with ROP and 25% without ROP) and myopia (27.5% with ROP and 8.8% without ROP) was shown. Significant visual loss occurred in 10.7% overall, increasing to 35% with stage 3 disease and 100% with stage 4. With the increased survival rate of premature infants, the relevance to future management of this expanding group of young ...
Jeong, Ji Hwan; Kweon, Young Chul
A multiple steam generator tube rupture (MSGTR) event has never occurred in the commercial operation of nuclear reactors while single steam generator tube rupture (SGTR) events are reported to occur every 2 years. As there has been no occurrence of a MSGTR event, the understanding of transients and consequences of this event is very limited. In this study, a postulated MSGTR event in an advanced power reactor 1400 (APR 1400) is analyzed using the thermal-hydraulic system code, MARS1.4. The APR 1400 is a two-loop, 3893 MWt, PWR proposed to be built in 2010. The present study aims to understand the effects of rupture location in heat transfer tubes following a MSGTR event. The effects of five tube rupture locations are compared with each other. The comparison shows that the response of APR1400 allows the shortest time for operator action following a tube rupture in the vicinity of the hot-leg side tube sheet and allows the longest time following a tube rupture at the tube top. The MSSV lift time for rupture at the tube-top is evaluated as 24.5% larger than that for rupture at the hot-leg side tube sheet
Kim, Jong Keon; Park, Heung Il; Kwun, Chung Sik [Chun Nam University College of Medicine, Kwangju (Korea, Republic of)
This is a report of a case of spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine for the purpose of suicide in a 27 year old Korean male whose chief complaints were dyspnea, epigastric pain, swallowing disturbance, and hoarseness for 3 days prior to admission. A review of literature is submitted.
Full Text Available Implantation, trophoblast development and placentation are crucial processes in the establishment and development of normal pregnancy. Abnormalities of these processes can lead to pregnancy complications known as the great obstetrical syndromes: preeclampsia, intrauterine growth restriction, fetal demise, premature prelabor rupture of membranes, preterm labor, and recurrent pregnancy loss. There is mounting evidence regarding the physiological and therapeutic role of heparins in the establishment of normal gestation and as a modality for treatment and prevention of pregnancy complications. In this review, we will summarize the properties and the physiological contributions of heparins to the success of implantation, placentation and normal pregnancy.
Full Text Available Idiopathic rupture of the urinary bladder is an uncommon condition and represents less than 1% of all bladder rupture cases. In most of the cases the main etiological factor was heavy alcohol ingestion. A combined injury of the spleen and bladder is a very rare condition that is almost often associated with trauma and foreign bodies. In this paper we present the extremely rare clinical course of acute abdomen caused by a combined spontaneous intraperitoneal injury; spontaneous rupture of the urinary bladder and spleen. According to our opinion, spontaneous bladder rupture caused by bladder distension due to alcohol ingestion led to urinary ascites and abdominal distension. Finally, repeated minor abdominal blunt trauma during everyday life, to a moderately distended abdomen caused a spontaneous splenic rupture in the patient with abnormal coagulation studies.
J.A. Schoemaker (Joop); H.A. Drexhage (Hemmo); A. Hoek (Annemieke)
textabstractPremature ovarian failure (POF) is defined as a syndrome characterized by menopause before the age of 40 yr. The patients suffer from anovulation and hypoestrogenism. Approximately 1% of women will experience menopause before the age of 40 yr. POF is a
Full Text Available There is a delicate balance between too little and too much supplemental oxygen exposure in premature infants. Since underuse and overuse of supplemental oxygen can harm premature infants, oxygen saturation levels must be monitored and kept at less than 95% to prevent reactive oxygen species-related diseases, such as retinopathy of prematurity and bronchopulmonary dysplasia. At the same time, desaturation below 80 to 85% must be avoided to prevent adverse consequences, such as cerebral palsy. It is still unclear what range of oxygen saturation is appropriate for premature infants; however, until the results of further studies are available, a reasonable target for pulse oxygen saturation (SpO2 is 90 to 93% with an intermittent review of the correlation between SpO2 and the partial pressure of arterial oxygen tension (PaO2. Because optimal oxygenation depends on individuals at the bedside making ongoing adjustments, each unit must define an optimal target range and set alarm limits according to their own equipment or conditions. All staff must be aware of these values and adjust the concentration of supplemental oxygen frequently.
Osteopenia is defined as postnatal bone mineralization that is inadequate to fully mineralize bones. Osteopenia occurs commonly in very low birth weight (VLBW) infants. Prior to the use of high-mineral containing diets for premature infants, which is the current practice, significant radiographic ch...
Rubin, Rosalyn A.; And Others
Psychological and educational correlates of prematurity in children during four periods, the last at 7 years of age, were assessed as part of a prospective longitudinal study of 241 infants classified by birth weight, gestational age, and sex to determine later functioning in school. (Author/MC)
Lunding, Stine Aa; Aksglæde, Lise; Anderson, Richard A
CONTEXT: The majority of Turner syndrome (TS) patients suffer from accelerated loss of primordial follicles. Low circulating levels of anti-Müllerian hormone (AMH) may predict the lack of spontaneous puberty in prepubertal girls and imminent premature ovarian insufficiency (POI) in TS women...
Lee, Hee Jung; Kim, Jung Sik; Lee, Sung Moon; Kim, Hong; Woo, Seong Ku; Yeun, Seong Do; Lee, Doo Ryong
To evaluate the usefulness of ultrasonography in the differentiation of the unruptured ones, we performed prospective ultrasonographic study in 56 patients with tubal pregnancy and subsequently correlated with the surgical (45 cases) and laparoscopic (11 cases) findings. The criterion for unruptured tubal pregnancy was the visualization of extra uterine gestational sac or a mass that was separated from the ipsilateral ovary. All cases were confirmed surgically or laparoscopically within 48 hours after sonographic examination. Forty five (80%)cases were proved as unruptured, tubal pregnancy, while 11 (20%) as ruptured one. Extra uterine gestational sac was seen in 31/45 (69%) in unruptured group and 2/11 (18%) in ruptured group. A mass separated from the ipsilateral ovary was seen in 7 unruptured tubal pregnancies and 2 ruptured pregnancies. A mass that was not separated from the ipsilateral ovary was seen in 13 cases. Seven of these were ruptured pregnancies, while 6 were unrupture dones. Using our criteria, the unruptured tubal pregnancy was diagnosed with a sensitivity of 84%, a specificity of 64%, an accuracy of 80%, a positive predictive value of 90% and a negative predictive value of 50%. We conclude that ultrasonography is useful in the differentiation of the unruptured tubal pregnancy from the ruptured one
Ahumada-Barrios, Margarita E.; Alvarado, German F.
Abstract Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital, with 298 pregnant women in the case group (who gave birth prematurely
Full Text Available Rupture of the extraembryonic membranes that form the gestational sac in humans is a typical feature of human parturition. However, preterm premature rupture of membranes (PPROM occurs in approximately 1% of pregnancies, and is a leading cause of preterm birth. Conversely, retention of an intact gestational sac during parturition in the form of a caul is a rare occurrence. Understanding the molecular and evolutionary underpinnings of these disparate phenotypes can provide insight into both normal pregnancy and PPROM. Using phylogenetic techniques we reconstructed the evolution of the gestational sac phenotype at parturition in 55 mammal species representing all major viviparous mammal groups. We infer the ancestral state in therians, eutherians, and primates, as in humans, is a ruptured gestational sac at parturition. We present evidence that intact membranes at parturition have evolved convergently in diverse mammals including horses, elephants, and bats. In order to gain insight into the molecular underpinnings of the evolution of enhanced membrane integrity we also used comparative genomics techniques to reconstruct the evolution of a subset of genes implicated in PPROM, and find that four genes (ADAMTS2, COL1A1, COL5A1, LEPRE1 show significant evidence of increased nonsynonymous rates of substitution on lineages with intact membranes as compared to those with ruptured membranes. Among these genes, we also discovered that 17 human SNPs are associated with or near amino acid replacement sites in those mammals with intact membranes. These SNPs are candidate functional variants within humans, which may play roles in both PPROM and/or the retention of the gestational sac at birth.
Khater, H.A.; Hadaller, G.I.; Stern, F.
A study has been prepared on the feasibility of conducting pressure tube/calandria tube rupture tests in a closed tank, simulating a scaled-down calandria vessel. The study includes: i) a review of previous work, ii) an analytical investigation of the scaling problem of the calandria vessel and relevant in-core structures, iii) selection of a method for initiating pressure tube/calandria tube rupture, iv) a set of specifications for the test assembly, v) general arrangement drawings, vi) a proposal for a test matrix, vii) a survey and evaluation of existing facilities which could provide the required high pressure, temperature and fluid inventory, and viii) a cost estimate for the detailed design and construction, instrumentation, data acquisition and reduction, testing and reporting. The study concludes that it is both technically and practically feasible to conduct pressure tube rupture tests in a closed tank
Dueñas-García, Omar Felipe; Rico, Hugo; Gorbea-Sanchez, Viridiana; Herrerias-Canedo, Tomas
Postpartum bladder rupture is an uncommon surgical emergency and a diagnostic challenge. A primigravida delivered a healthy newborn without complications at 39.4 weeks of gestation. The patient was admitted 80 hours postpartum with abdominal pain, oliguria, hematuria, and pain that worsened during the previous 4 hours. An inserted Foley catheter drained only a small amount of urine, and serum creatinine was elevated (3.5 mg/dL). A laparotomy was performed and revealed a 10-cm hole in the urinary bladder. The bladder was repaired and the patient was discharged 15 days after surgery. The follow-up cystoscopy revealed adequate healing of the bladder. Urinary retention can lead to serious complications, including bladder rupture. Postpartum bladder rupture due to urinary retention should be ruled out if there is a history of abdominal pain, oliguria, and elevated of serum creatinine.
Eide, S.A.; Khericha, S.T.; Calley, M.B.; Johnson, D.A.; Marteeny, M.L.
In order to perform detailed internal flooding risk analyses of nuclear power plants, external leakage and rupture frequencies are needed for various types of components - piping, valves, pumps, flanges, and others. However, there appears to be no up-to-date, comprehensive source for such frequency estimates. This report attempts to fill that void. Based on a comprehensive search of Licensee Event Reports (LERs) contained in Nuclear Power Experience (NPE), and estimates of component populations and exposure times, component external leakage and rupture frequencies were generated. The remainder of this report covers the specifies of the NPE search for external leakage and rupture events, analysis of the data, a comparison with frequency estimates from other sources, and a discussion of the results
Full Text Available Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.
El Damaty, Ahmed; Langner, Soenke; Schroeder, Henry W S
We report a case of ruptured massa intermedia (MI) as a sequela of hydrocephalus. A single case report is presented describing the sequelae of tumor bed hematoma after a posterior fossa hemangioblastoma resection in which the patient bled 3 days after surgery, resulting in secondary hydrocephalus and subsequently dilatation of the third ventricle, which resulted in rupture of the MI. The patient was managed on emergency basis with an external ventricular drain then endoscopically with a third ventriculostomy and clot extraction. Absent MI is not uncommon in hydrocephalic patients, and it is assumed to be the result of rupture from acute dilatation of the third ventricle. Our case report proves this assumption and documents the presence and absence of the MI before and after developing hydrocephalus. Copyright © 2016 Elsevier Inc. All rights reserved.
Yeow, Y. T.
A 'material modeling' methodology for predicting the creep rupture behavior of unidirectional advanced composites is proposed. In this approach the parameters (obtained from short-term tests) required to make the predictions are the three principal creep compliance master curves and their corresponding quasi-static strengths tested at room temperature (22 C). Using these parameters in conjunction with a failure criterion, creep rupture envelopes can be generated for any combination of in-plane loading conditions and ambient temperature. The analysis was validated experimentally for one composite system, the T300/934 graphite-epoxy system. This was done by performing short-term creep tests (to generate the principal creep compliance master curves with the time-temperature superposition principle) and relatively long-term creep rupture tensile tests of off-axis specimens at 180 C. Good to reasonable agreement between experimental and analytical results is observed.
Duryea, Dennis; Petscavage-Thomas, Jonelle; Frauenhoffer, Elizabeth E; Walker, Eric A
Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition.
Duryea, Dennis; Petscavage-Thomas, Jonelle; Frauenhoffer, Elizabeth E.; Walker, Eric A.
Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition. (orig.)
Duryea, Dennis; Petscavage-Thomas, Jonelle [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Frauenhoffer, Elizabeth E. [Milton S. Hershey Medical Center, Department of Pathology, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Walker, Eric A. [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Nuclear Medicine, Bethesda, MD, 20814 (United States)
Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition. (orig.)
The presence of premature graying of hair was associated with 3.24 times the risk of CAD on multiple logistic regression analysis. CONCLUSION: The presence of premature graying of hair was associated with an increased risk of CAD in young smokers. Premature graying of hair can be used as preliminary evidence by ...
Wei Yee Leong
Full Text Available Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. Conclusion: The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient. Keywords: Quadriceps tendon rupture; Achilles tendon rupture; Bilateral.
Tyler L. Holliday
Full Text Available Blunt scrotal injury represents a diagnostic dilemma for emergency physicians (EP. Consequently, point-of-care ultrasound (POCUS has emerged as a tool for early investigation of the acute scrotum in the emergency department. We describe a case where an EP used scrotal POCUS to immediately visualize the loss of testicular contour and underlying heterogeneous parenchyma to rapidly make the diagnosis of testicular rupture in a young male presenting with scrotal trauma. The use of POCUS in this case expedited therapy, likely improving the patient’s outcome. To our knowledge, this is the first detailed description of testicular rupture diagnosed with POCUS by an EP
Omar A. Alajoulin
Full Text Available Alkaptonuria (AKU is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA. Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis, early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations.
Alajoulin, Omar A; Alsbou, Mohammed S; Ja'afreh, Somayya O; Kalbouneh, Heba M
Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations.
Author: Karolína Čížková Institution: Rehab clinic LF UK in Hradec Králové Topic of bachelor's thesis: Physiotherapy in patiens with rupture of ACL Supervisor: Mgr. Zuzana Hamarová Number of pages: 108 Number of annex: 11 Year of vindication 2012 Key words: ACL, knee, rupture of ACL, rehabilitation In general part of this bachelor's thesis is described anatomy, kinesiology and biomechanics of the knee joint, mostly anterior cruciate ligament. It contents causes of injury of anterior cruciate ...
Startzman, Ashley N; Fowler, Oliver; Carreira, Dominic
Proximal hamstring tendinosis and partial hamstring origin ruptures are painful conditions of the proximal thigh and hip that may occur in the acute, chronic, or acute on chronic setting. Few publications exist related to their diagnosis and management. This systematic review discusses the incidence, treatment, and prognosis of proximal hamstring tendinosis and partial hamstring ruptures. Conservative treatment measures include nonsteroidal anti-inflammatory drugs, physical therapy, rest, and ice. If these measures fail, platelet-rich plasma or shockwave therapy may be considered. When refractory to conservative management, these injuries may be treated with surgical debridement and hamstring reattachment. [Orthopedics. 2017; 40(4):e574-e582.]. Copyright 2017, SLACK Incorporated.
Suckert, K; Benedetto, K P; Vogel, A
This is an analysis of decline of rupture of the Achilles tendon in skiing while there is a steady increase of skiing injuries. Three groups, equipped with three different types of ski boots were observed once on a plane slope on the other hand on a bump track. The simultaneous size of angle of knee and ankle was measured by telemetry. The high plastic ski boot, which obstructs the ankle forward and lateral is apart from the rise of heel in the boot, the safety binding and the new skiing style the main reason for decline of rupture of the Achilles tendon in skiing.
Afulani, Patience A; Altman, Molly; Musana, Joseph; Sudhinaraset, May
Globally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity. The key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors. There is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving
Mark Christopher Sykes
Conclusion: Atraumatic splenic rupture should be considered as an important differential in those presenting with abdominal pain and peritonism without a history of preceding trauma. Haematological and infectious diagnoses should be sought to identify causation for the splenic rupture.
Schoemaker, Joop; Drexhage, Hemmo; Hoek, Annemieke
textabstractPremature ovarian failure (POF) is defined as a syndrome characterized by menopause before the age of 40 yr. The patients suffer from anovulation and hypoestrogenism. Approximately 1% of women will experience menopause before the age of 40 yr. POF is a heterogeneous disorder with a multicausal pathogenesis involving chromosomal, genetic, enzymatic, infectious, and iatrogenic causes. There remains, however, a group of POF patients without a known etiology, the so-called "idiopathic...
Hofmeyr, G J
Preterm rupture of membranes places a fetus at risk of cord compression and amnionitis. Amnioinfusion aims to prevent or relieve umbilical cord compression by infusing a solution into the uterine cavity. The objective of this review was to assess the effects of amnioinfusion for preterm rupture of membranes on maternal and perinatal outcomes. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Randomised trials of amnioinfusion compared to no amnioinfusion in women with preterm rupture of membranes. Eligibility and trial quality were assessed by the reviewer. One trial of 66 women was included. It had some methodological flaws. No significant differences between amnioinfusion and no amnioinfusion were detected for caesarean section (relative risk 0.32, 95% confidence interval 0.07 to 1.40); low Apgar scores (relative risk 0.28, 95% confidence interval 0.03 to 2.33) or neonatal death (relative risk 0.55, 95% confidence interval 0.05 to 5.77). In the amnioinfusion group, the number of severe fetal heart rate decelerations per hour during the first stage of labour were reduced (weighted mean difference -1.20, 95% confidence interval -1.83 to -0.57). These outcomes are consistent with those found in the Cochrane review on amnioinfusion for cord compression. There is not enough evidence concerning the use of amnioinfusion for preterm rupture of membranes.
This report defines the role of cartridge rupture detection in the reactor Phenix. It gives the possible methods, their probable performances, their advantages and disadvantages. The final form of the installation will be determined mainly by the degree of safety required, by the technical possibilities of the reactor design and by the operational flexibility wanted. (author) [fr
Cho, Sung Tae; Kim, Sung Jin; Cha, Sang Hoon; Park, Kil Sun; Kim, Jin Hee; Yim, Se Hwan
The aim of this study was to assess the clinical utility of the known CT signs of the traumatic rupture of the diaphragm. CT scans and chest radiographs were retrospectively reviewed in 13 patients who had diaphragmatic rupture confirmed by surgery. On chest radiographs the elevation of the diaphragm was evaluated. On CT, 1) discontinuity of the diaphragm, 2) lack of depiction of the diaphragm surrounding the herniated intraabdominal organs (absent diaphragm sign), and 3) fat seen lateral to the diaphragm (fat sign) were evaluated. Chest radiographs showed the elevation of the diaphragm in 11 patients (85%). CT scan showed absent diaphragm sign in 11 patients (85%), discontinuity of the diaphragm in 8 (62%), and fat sign in 7 (54%). All of 12 patients who had the left diaphragmatic rupture had one or more of the above findings. Discontinuity of the diaphragm, absent diaphragm sign, and fat sign may be helpful CT findings in the diagnosis of the traumatic rupture of the left diaphragm
Schild, H.; Schwarzkopf, W.
Ruptures of the tuberosity of the tibia occur particularly in male adolescents, although on the whole they represent a rare type of injury. The article discusses classification into different types according to Watson-Jones as well as exemplary models, traumatology, clinic and therapy. (orig.) [de
A case is presented of spontaneous rupture of an aneurysm of a lateral branch of the right thyrocervical trunk in a patient suffering from diffuse neurofibromatosis. The operative findings are reported. S. Afr. Med. J., 48, 945 (1974). Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT ...
The rupture test rig for primary coolant pipes is constructed in the Japan Atomic Energy Research Institute to verify the reliability of the primary coolant pipes for both PWRs and BWRs. The planned test items consisted of reaction force test, restraint test, whip test, jet test and continuous release test. A pressure vessel of about 4 m 3 volume, a circulating pump, a pressurizer, a heater, an air cooler and the related instrumentation and control system are included in this test rig. The coolant test condition is 160 kg/cm 2 g, 325 deg C for PWR test, and 70 kg/cm 2 g, saturated water and steam for BWR test, 100 ton of test load for the ruptured pipe bore of 8B Schedule 160, and 20 lit/min. discharge during 20 h for continuous release of coolant. The maximum pit internal pressure was estimated for various pipe diameters and time under the PWR and BWR conditions. The spark rupturing device was adopted for the rupture mechanics in this test rig. The computer PANAFACOM U-300 is used for the data processing. This test rig is expected to operate in 1978 effectively for the improvement of reliability of LWR primary coolant pipes. (Nakai, Y.)
van Veldhuisen, DJ; van den Berg, MP
We:report the case of a previously healthy 20-year-old man who had a traumatic rupture of the right atrium. On admission an electrocardiogram (ECG) was recorded which is highly remarkable and, retrospectively, suggestive for the diagnosis. The patient died soon after the EGG, and the diagnosis was
Fazal, Muhammad Ali; Moonot, Pradeep; Haddad, Fares
The purpose of our study was to assess soft tissue features of acute patellar tendon rupture on lateral knee radiograph that would facilitate early diagnosis. The participants were divided into two groups of 35 patients each. There were 28 men and seven women with a mean age of 46 years in the control group and 26 men and nine women with a mean age of 47 years in the rupture group. The lateral knee radiograph of each patient was evaluated for Insall-Salvati ratio for patella alta, increased density of the infrapatellar fat pad, appearance of the soft tissue margin of the patellar tendon and bony avulsions. In the rupture group there were three consistent soft tissue radiographic features in addition to patellar alta. These were increased density of infrapatellar fat pad; loss of sharp, well-defined linear margins of the patellar tendon and angulated wavy margin of the patellar tendon while in the control group these features were not observed. The soft tissue radiographic features described in the rupture group are consistent and reliable. When coupled with careful clinical assessment, these will aid in early diagnosis and further imaging will be seldom required. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.
Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.
Davies, K.T.R.; Managan, R.A.; Nix, J.R.; Sierk, A.J.
We introduce a degree of freedom to describe the rupture of the neck in nuclear fission and calculate the point at which the neck ruptures as the nucleus descends dynamically from its fission saddle point. This is done by mentally slicing the system into two portions at its minimum neck radius and calculating the force required to separate the two portions while keeping their shapes fixed. This force is obtained by differentiating with respect to separation the sum of the Coulomb and nuclear interaction energies between the two portions. For nuclei throughout the Periodic Table we calculate this force along dynamical paths leading from the fission saddle point. The force is initially attractive but becomes repulsive when the neck reaches a critical size. For actinide nuclei the neck radius at which rupture occurs is about 2 fm. This increases the calculated translational kinetic energy of the fission fragments at infinity relative to that calculated for scission occurring at zero neck radius. With the effect of neck rupture taken into account, we calculate and compare with experimental results fission-fragment kinetic energies for two types of nuclear dissipation: ordinary two-body viscosity and one-body dissipation
Marcelo Augusto Fontenelle Ribeiro Junior
Full Text Available AIMS: Spontaneous ruptured hepatocellular adenoma (SRHA is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS: We reviewed medical records and radiology files of 28 patients (from 1989 to 2006 with a proven diagnosis of hepatocellular adenoma (HA. Three (10.7% of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS: The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation, as well as intraperitoneal abscess (re-operation and pleural effusion. CONCLUSION: Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.
Liegl, Raffael; Hellström, Ann; Smith, Lois EH
More than 450,000 babies are born prematurely in the USA every year. The improved survival of even the most vulnerable low body weight preterm infants has, despite improving health outcomes, led to the resurgence in preterm complications including one of the major causes for blindness in children, retinopathy of prematurity (ROP). The current mainstay in ROP therapy is laser photocoagulation and the injection of vascular endothelial growth factor (VEGF) antibodies in the late stages of the disease after the onset of neovascularization. Both are proven options for ophthalmologists to treat the severe forms of late ROP. However, laser photocoagulation destroys major parts of the retina, and the injection of VEGF antibodies, although rather simple to administer, may cause a systemic suppression of normal vascularization, which has not been studied in sufficient depth. However, the use of neither VEGF antibody nor laser treatment prevents ROP, which should be the long-term goal. It should be possible to prevent ROP by more closely mimicking the intrauterine environment after preterm birth. Such preventive measures include preventing the toxic postbirth influences (eg, oxygen excess) as well as providing the missing intrauterine factors (eg, insulin growth factor 1) and are likely to also reduce other complications of premature birth as well as ROP. This review is meant to summarize the current knowledge on the prevention of ROP with a particular emphasize on the use of insulin growth factor 1 supplementation. PMID:28539804
Mezu-Ndubuisi, Olachi J.; Agarwal, Ghanshyam; Raghavan, Aarti; Pham, Jennifer T.; Ohler, Kirsten H.; Maheshwari, Akhil
Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a hemodynamically-significant patent ductus arteriosus (PDA) can cause cardiovascular instability, exacerbate respiratory distress syndrome, prolong the need for assisted ventilation, and increase the risk of bronchopulmonary dysplasia, intraventricular hemorrhage, renal dysfunction, intraventricular hemorrhage, cerebral palsy, and mortality. In this article, we review the pathophysiology, clinical features, and assessment of hemodynamic significance, and provide a rigorous appraisal of the quality of evidence to support current medical and surgical management of PDA of prematurity. Cyclo-oxygenase inhibitors such as indomethacin and ibuprofen remain the mainstay of medical therapy for PDA, and can be used both for prophylaxis as well as rescue therapy to achieve PDA closure. Surgical ligation is also effective and is used in infants who do not respond to medical management. Although both medical and surgical treatment have proven efficacy in closing the ductus, both modalities are associated with significant adverse effects. Because the ductus does undergo spontaneous closure in some premature infants, improved and early identification of infants most likely to develop a symptomatic PDA could help in directing treatment to the at-risk infants and allow others to receive expectant management. PMID:22564132
Harila, V; Heikkinen, T; Grön, M; Alvesalo, L
The aims of this study were to: examine the expression of open bite in prematurely born children and discuss the etiological factors that may lead to bite it. The subjects were 328 prematurely born (cross-sectional study of the Collaborative Perinatal Project in the 1960s and 1970s. Dental documents, including casts and photographs, were taken once at the age of 6-12 years in the mixed dentition. The occlusion was recorded by examining and measuring the hard stone casts. Vertical open bite was recorded only for full erupted teeth. The statistical method used was chi-square analysis. Significant differences in the incidence of anterior open bite (from left to right canine) was found between the preterm and control groups and between gender and ethnic groups. The prevalence of anterior open bite was nearly 9% in the preterm group and almost 7% in the control group. African Americans (9%) had a significantly greater incidence of open bite than Caucasians (3%; Pbite than boys (8% vs 6%; Pbite was increased--especially in preterm African American boys compared to controls (11% vs 8%). The results show differences in the development of anterior open bite between ethnic and gender groups. Premature birth may also influence dental occlusal development. Of importance are the patient's: general health condition; respiratory infections; inadequate nasal- and mouth-breathing; oral habits; and other medical problems. Preterm children may be relatively more predisposed to etiological factors for the development of anterior open bite.
Verkhoturov, A.D.; Kovalenko, V.S.; Dyatel, V.P.
Studied is the effect of the nature of the treated material treatment regimes on their unit rupture work at laser treatment in the regime of quasistationary evaporation. It is shown that the unit rupture work changes its values depending on the treatment regimes, coincidences between experimental and calculation values of unit rupture work are not being observed, especially for refractory metals of the 6th group and for solid alloys. Established are optimum regimes for determination of stable values of unit rupture work
Costanzo, Caitlyn M; Vinocur, Charles; Berman, Loren
Term infants with hypertrophic pyloric stenosis (HPS) typically present between 4 and 6 weeks. There is limited consensus, however, regarding age of presentation of premature infants. We aim to determine if there is an association between the degree of prematurity and chronological age of presentation of HPS. A total of 2988 infants who had undergone a pyloromyotomy for HPS were identified from the 2012 and 2013 NSQIP-P Participant Use Files. Two hundred seventeen infants (7.3%) were born prematurely. A greater degree of prematurity was associated with an older chronological age of presentation ( P Prematurity was significantly associated with an increase in overall postoperative morbidity, reintubation, readmission, and postoperative length of stay. When clinicians evaluate an infant with nonbilious emesis with a history of prematurity, they should consider pyloric stenosis if the calculated postconceptional age is between 44 and 50 weeks. When counseling families of premature infants, surgeons should discuss the increased incidence of postpyloromyotomy morbidity.
Ruiz Paredes, J.A.
In order to make the broadband kinematic rupture modeling more realistic with respect to dynamic modeling, physical constraints are added to the rupture parameters. To improve the slip velocity function (SVF) modeling, an evolution of the k -2 source model is proposed, which consists to decompose the slip as a sum of sub-events by band of k. This model yields to SVF close to the solution proposed by Kostrov for a crack, while preserving the spectral characteristics of the radiated wave field, i.e. a w 2 model with spectral amplitudes at high frequency scaled to the coefficient of directivity C d . To better control the directivity effects, a composite source description is combined with a scaling law defining the extent of the nucleation area for each sub-event. The resulting model allows to reduce the apparent coefficient of directivity to a fraction of C d , as well as to reproduce the standard deviation of the new empirical attenuation relationships proposed for Japan. To make source models more realistic, a variable rupture velocity in agreement with the physics of the rupture must be considered. The followed approach that is based on an analytical relation between the fracture energy, the slip and the rupture velocity, leads to higher values of the peak ground acceleration in the vicinity of the fault. Finally, to better account for the interaction of the wave field with the geological medium, a semi-empirical methodology is developed combining a composite source model with empirical Green functions, and is applied to the Yamaguchi, M w 5.9 earthquake. The modeled synthetics reproduce satisfactorily well the observed main characteristics of ground motions. (author)
Full Text Available Background: Liver abscess (pyogenic and amebic is frequently encountered clinical condition; however, it can result in lethal outcome if there is a delay in diagnosis and treatment. Despite modalities to diagnose the condition early, still ruptured liver abscess presents with a common cause of acute abdomen in surgical emergency. In developing countries, ruptured liver abscess is a common cause of mortality. For contained abscess, nonsurgical options are considered; however, for ruptured liver abscess, surgical intervention is considered necessary. Materials and Methods: This was a retrospective study carried in Safdarjung hospital, New Delhi, between 2015 and 2016. All patients with ruptured liver abscess (clear signs of peritonitis were included in this study, and those patients having other causes of peritonitis were excluded. A preformed protocol for management was followed for all the patients, and various parameters contributing to the illness and its prognosis were evaluated and assessed. Results: Out of the fifty patients assessed, male patients were mainly affected (86%. The most affected age group was 31–40 years (64% followed by 41–50 years (22%. Right hypochondrium pain was the most common presenting complaint. Nine patients (18% had presented with signs of toxemia. Only right lobe of the liver was affected the most in 44 patients (88%. Escherichia coli was the most common organism isolated in our study in 19 patients (38%. A total of 19 patients (38% had diabetes in our study and total of 13 patients had mortality in our study. Conclusion: Ruptured liver abscess most commonly involves the right lobe of the liver. Males are affected far higher than the females; probable cause believed to be higher alcohol consumption. Most common affected age group falls between 30 and 60 years of age. If prompt treatment is started in time, mortality involved with it is evitable.
This is a comparative prospective study of the risk factors for ruptured uterus in Aminu Kano Teaching Hospital, Kano, Nigeria, between 1st January 2000 and 31st December 2005. Forty six women with ruptured uterus (cases) were compared with two hundred and thirty women who delivered without ruptured uterus ...
Context: Ruptured uterus is an obstetric catastrophe associated with high maternal and perinatal mortality. Objectives: To determine the incidence, causes, management and fetomaternal outcomes of ruptured uterus in Afikpo, Southeast Nigeria. Methods: Delivery records, theatre registers and case notes of all ruptured ...
Vezina, W.C.; Nicholson, R.L.; Cohen, P.; Chamberlain, M.J.
Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems
An unusual case of ruptured uterus characterized by spontaneous delivery of the placenta while the foetus is retained in the abdomen is presented. The management and prevention of ruptured uterus in Sub- Saharan Africa is discussed. Key Words: Delivery of placenta, ruptured uterus. Annals of African Medicine Vol.3(3) ...
Full Text Available Rectal duplication (RD accounts for 5% of alimentary tract duplication. A varied presentation and associated anomalies have been described in the literature. Antenatal rupture of the RD is very rare. We present an unusual case of a ruptured RD associated with urogenital abnormalities in newborn male. We are discussing diagnosis, embryology, management and literature review of ruptured RD.
Solanki, Shailesh; Babu, M Narendra; Jadhav, Vinay; Shankar, Gowri; Santhanakrishnan, Ramesh
Rectal duplication (RD) accounts for 5% of alimentary tract duplication. A varied presentation and associated anomalies have been described in the literature. Antenatal rupture of the RD is very rare. We present an unusual case of a ruptured RD associated with urogenital abnormalities in newborn male. We are discussing diagnosis, embryology, management and literature review of ruptured RD.
O'Sullivan, S T
Spontaneous tendon rupture is an unusual condition usually associated with underlying disease processes such as rheumatoid arthritis, chronic renal failure or bony abnormalities of the hand. We report a case of spontaneous, non-concurrent bilateral rupture of flexor profundus tendons in an otherwise healthy individual. Treatment was successful and consisted of a two-stage reconstruction of the ruptured tendon.
Aortic rupture is quite rare in Warmblood horses and is best known as an acute and fatal rupture of the aortic root in older breeding stallions. It has now become clear that aortic rupture, which is diagnosed around an age of 4 years, is more frequent in the Friesian breed than in others. The high
Park, Hae-Ryung; Harris, Sean M; Boldenow, Erica; McEachin, Richard C; Sartor, Maureen; Chames, Mark; Loch-Caruso, Rita
Streptococcus agalactiae (group B streptococcus [GBS]) infection in pregnant women is the leading cause of infectious neonatal morbidity and mortality in the United States. Although inflammation during infection has been associated with preterm birth, the contribution of GBS to preterm birth is less certain. Moreover, the early mechanisms by which GBS interacts with the gestational tissue to affect adverse pregnancy outcomes are poorly understood. We hypothesized that short-term GBS inoculation activates pathways related to inflammation and premature birth in human extraplacental membranes. We tested this hypothesis using GBS-inoculated human extraplacental membranes in vitro. In agreement with our hypothesis, a microarray-based transcriptomics analysis of gene expression changes in GBS-inoculated membranes revealed that GBS activated pathways related to inflammation and preterm birth with significant gene expression changes occurring as early as 4 h postinoculation. In addition, pathways related to DNA replication and repair were downregulated with GBS treatment. Conclusions based on our transcriptomics data were further supported by responses of prostaglandin E2 (PGE2), and matrix metalloproteinases 1 (MMP1) and 3 (MMP3), all of which are known to be involved in parturition and premature rupture of membranes. These results support our initial hypothesis and provide new information on molecular targets of GBS infection in human extraplacental membranes.
Lee, Duk Su; Chang, Woo Hyun; Lee, Nam Young; A. C. D. Wright
This safety design guide for pipe rupture protection identifies high-energy systems in which pipe ruptures must be postulated to occur, as well as systems that must be protected from the dynamic effects of such ruptures. Dynamic effects considered in this SDG consist of pipe whip (including missiles generated by pipe ruptures, if any) and jet impingement, Requirements for protection against the dynamic effects of a postulated pipe rupture and method of protection of essential structures, systems and components are specified for these effects. The change status for the regulatory requirements, code and standards should be traced and this safety design guide shall be updated accordingly. 2 tabs., 5 refs. (Author) .new
Full Text Available ABSTRACT Purpose Premature ejaculation is considered the most common type of male sexual dysfunction. Hormonal controls of ejaculation have not been exactly elucidated. The aim of our study is to investigate the role of hormonal factors in patients with premature ejaculation. Materials and Methods Sixty-three participants who consulted our outpatient clinics with complaints of premature ejaculation and 39 healthy men as a control group selected from volunteers were included in the study. A total of 102 sexual active men aged between 21 and 76 years were included. Premature ejaculation diagnostic tool questionnaires were used to assessment of premature ejaculation. Serum levels of follicle stimulating hormone, luteinizing hormone, prolactin, total and free testosterone, thyroid-stimulating hormone, free triiodothyronine and thyroxine were measured. Results Thyroid-stimulating hormone, luteinizing hormone, and prolactin levels were significantly lower in men with premature ejaculation according to premature ejaculation diagnostic tool (p=0.017, 0.007 and 0.007, respectively. Luteinizing hormone level (OR, 1.293; p=0.014 was found to be an independent risk factor for premature ejaculation. Conclusions Luteinizing hormone, prolactin, and thyroid-stimulating hormone levels are associated with premature ejaculation which was diagnosed by premature ejaculation diagnostic tool questionnaires. The relationship between these findings have to be determined by more extensive studies.
Moore, Tiffany A; Berger, Ann M; Wilson, Margaret E
The morbidity and mortality of preterm infants are impacted by their ability to maintain physiologic homeostasis using metabolic, endocrine, and immunologic mechanisms independent of the mother's placenta. Exploring McEwen's allostatic load model in preterm infants provides a new way to understand the altered physiologic processes associated with frequently occurring complications of prematurity such as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. The purpose of this article is to present a new model to enhance understanding of the altered physiologic processes associated with complications of prematurity. The model of allostatic load and complications of prematurity was derived to explore the relationship between general stress of prematurity and complications of prematurity. The proposed model uses the concepts of general stress of prematurity, allostasis, physiologic response patterns (adaptive-maladaptive), allostatic load, and complications of prematurity. These concepts are defined and theoretical relationships in the proposed model are interpreted using the four maladaptive response patterns of repeated hits, lack of adaptation, prolonged response, and inadequate response. Empirical evidence for cortisol, inflammation, and oxidative stress responses are used to support the theoretical relationships. The proposed model provides a new way of thinking about physiologic dysregulation in preterm infants. The ability to describe and understand complex physiologic mechanisms involved in complications of prematurity is essential for research. Advancing the knowledge of complications of prematurity will advance clinical practice and research and lead to testing of interventions to reduce negative outcomes in preterm infants.
Thisted, Dorthe L A; Mortensen, Laust Hvas; Hvidman, Lone
OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine the vali......OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine...... uterine ruptures, the sensitivity and specificity of the codes for uterine rupture were 83.8% and 99.1%, respectively. CONCLUSION: During the study period the monitoring of uterine rupture in the MBR was inadequate....
For many decades it has been thought that lifelong premature ejaculation (PE) is only characterized by persistent early ejaculations. Despite enormous progress of in vivo animal research, and neurobiological, genetic and pharmacological research in men with lifelong PE, our current understanding of the mechanisms behind early ejaculations is far from complete. The new classification of PE into four PE subtypes has shown that the symptomatology of lifelong PE strongly differs from acquired PE, subjective PE and variable PE. The phenotype of lifelong PE and therefore also the pathophysiology of lifelong PE is much more complex. A substantial number of men with lifelong PE not only have PE, but also premature erection and premature penile detumescence as part of an acute hypertonic or hypererotic state when engaged in an erotic situation or when making love. As both erectio praecox, ejaculatio praecox, detumescentia praecox, and the hypererotic state are part of the phenotype lifelong PE, it is argued that lifelong PE is not only a disturbance of the timing of ejaculation but also a disturbance of the timing of erection, detumescence and arousal. Since 1998, the pathophysiology of lifelong PE was thought to be mainly mediated by the central serotonergic system in line with genetic polymorphisms of specific serotonergic genes. However, by accepting that lifelong PE is characterized by the reversible hypertonic state the hypothesis of mainly serotonergic dysfunction is no longer tenable. Instead, it has been postulated that the pathophysiology of lifelong PE is mediated by a very complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic and probably also epigenetic factors. Progress in research of lifelong PE can only be accomplished when a stopwatch is used to measure the IELT and the cut-off point of 1 minute for the definition of lifelong PE is maintained. Current use of validated questionnaires, neglect of
Park, Claire; Overton, Caroline
Premature menopause affects 1% of women under the age of 40, the usual age of the menopause is 51. Most women will present with irregular periods or no periods at all with or without climacteric symptoms. Around 10% of women present with primary amenorrhoea. A careful history and examination are required. It is important to ask specifically about previous chemotherapy or radiotherapy and to look for signs of androgen excess e.g. polycystic ovarian syndrome, adrenal problems e.g. galactorrhoea and thyroid goitres. Once pregnancy has been excluded, a progestagen challenge test can be performed in primary care. Norethisterone 5 mg tds po for ten days or alternatively medroxyprogesterone acetate 10 mg daily for ten days is prescribed. A withdrawal bleed within a few days of stopping the norethisterone indicates the presence of oestrogen and bleeding more than a few drops is considered a positive withdrawal bleed. The absence of a bleed indicates low levels of oestrogen, putting the woman at risk of CVD and osteoporosis. FSH levels above 30 IU/l are an indicator that the ovaries are failing and the menopause is approaching or has occurred. It should be remembered that FSH levels fluctuate during the month and from one month to the next, so a minimum of two measurements should be made at least four to six weeks apart. The presence of a bleed should not exclude premature menopause as part of the differential diagnosis as there can be varying and unpredictable ovarian function remaining. The progestagen challenge test should not be used alone, but in conjunction with FSH, LH and oestradiol. There is no treatment for premature menopause. Women desiring pregnancy should be referred to a fertility clinic and discussion of egg donation. Women not wishing to become pregnant should be prescribed HRT until the age of 50 to control symptoms of oestrogen deficiency and reduce the risks of osteoporosis and CVD.
The premature closure of the Trojan Nuclear Plant is discussed in outline form. The topics discussed include: an overview of Trojan; events leading to shutdown decision; Trojan's lifetime O ampersand M performance; Trojan's Regulatory performance; historical Trojan regulatory versus economic performance; applicable Oregon law; least-cost planning process; 1992 least cost plan; 1993 LCP update; LCP limitations; comparative performance analysis; management assessments; Trojan O ampersand M analysis; steam generator issues; quantification of deficiencies; quantification of impact of steam generator degradation; 'net benefits' test; conclusions from net benefits analysis; total disallowances; and conclusions and ramifications
Following years of research there have been some significant developments in the understanding and subsequent support being offered to Neonatal Intensive Care Unit (NICU) families. In addition, ground breaking advances in the treatment of premature infants, with specific interest in the role of human milk, are now available. New information was presented by leading international researcher, Professor Meier, at an international symposium earlier this year. This article seeks to share this insightful information and provide support to those working in or around the NICU.
Johnston, Karissa M; Gooch, Katherine; Korol, Ellen; Vo, Pamela; Eyawo, Oghenowede; Bradt, Pamela; Levy, Adrian
Preterm birth is a major risk factor for morbidity and mortality among infants worldwide, and imposes considerable burden on health, education and social services, as well as on families and caregivers. Morbidity and mortality resulting from preterm birth is highest among early (prematurity due to the larger number of late preterm infants relative to early and moderate preterm infants. The aim in this study was to characterize the burden of premature birth in Canada for early, moderate, and late premature infants, including resource utilization, direct medical costs, parental out-of-pocket costs, education costs, and mortality, using a validated and published decision model from the UK, and adapting it to a Canadian setting based on analysis of administrative, population-based data from Québec. Two-year survival was estimated at 56.0% for early preterm infants, 92.8% for moderate preterm infants, and 98.4% for late preterm infants. Per infant resource utilization consistently decreased with age. For moderately preterm infants, hospital days ranged from 1.6 at age two to 0.09 at age ten. Cost per infant over the first ten years of life was estimated to be $67,467 for early preterm infants, $52,796 for moderate preterm infants, and $10,010 for late preterm infants. Based on population sizes this corresponds to total national costs of $123.3 million for early preterm infants, $255.6 million for moderate preterm infants, $208.2 million for late preterm infants, and $587.1 million for all infants. Premature birth results in significant infant morbidity, mortality, healthcare utilization and costs in Canada. A comprehensive decision-model based on analysis of a Canadian population-based administrative data source suggested that the greatest national-level burden is associated with moderate preterm infants due to both a large cost per infant and population size while the highest individual-level burden is in early preterm infants and the largest total population size is
Ochoa, Theresa J; Sizonenko, Stéphane V
Lactoferrin (Lf) is the major whey protein in milk, with multiple beneficial health effects including direct antimicrobial activities, anti-inflammatory effects, and iron homeostasis. Oral Lf supplementation in human preterm infants has been shown to reduce the incidence of sepsis and necrotizing enterocolitis. In preclinical models of antenatal stress and perinatal brain injury, bovine Lf protected the developing brain from neuronal loss, improved connectivity, increased neurotrophic factors, and decreased inflammation. It also supported brain development and cognition. Further, Lf can prevent preterm delivery by reducing proinflammatory factors and inhibiting premature cervix maturation. We review here the latest research on Lf in the field of neonatology.
Champougny, Lorène; Miguet, Jonas; Henaff, Robin; Restagno, Frédéric; Boulogne, François; Rio, Emmanuelle
Although soap films are prone to evaporate due to their large surface to volume ratio, the effect of evaporation on macroscopic film features has often been disregarded in the literature. In this work, we experimentally investigate the influence of environmental humidity on soap film stability. An original experiment allows to measure both the maximum length of a film pulled at constant velocity and its thinning dynamics in a controlled atmosphere for various values of the relative humidity [Formula: see text]. At first order, the environmental humidity seems to have almost no impact on most of the film thinning dynamics. However, we find that the film length at rupture increases continuously with [Formula: see text]. To rationalize our observations, we propose that film bursting occurs when the thinning due to evaporation becomes comparable to the thinning due to liquid drainage. This rupture criterion turns out to be in reasonable agreement with an estimation of the evaporation rate in our experiment.
Wang Zhengdong; Wu Dongdi
Continuum Damage Mechanics studies the effect of distributed defects, whereas the failure of engineering structures is usually caused by local damage. In this paper, an analysis of localized damage in creep rupture is carried out. The material tested is a 2 1/4Cr-1Mo pressure vessel steel and the material constants necessary for damage analysis are evaluated. Notched specimens are used to reflect localized damage in creep rupture and the amount of damage is measured using DCPD method. Through FEM computation, stress components and effective stress in the region of notch root are evaluated and it is found that the von Mises effective stress can represent the damage effective stress in the analysis of localized creep damage. It is possible to develop a method for the assessment of safety of pressure vessels under creep through localized creep damage analysis. (orig.)
Harun, Mohd [Industrial Technology Division, Malaysian Nuclear Agency, Ministry of Science, Technology and Innovation Malaysia, Bangi, Kajang, Selangor (Malaysia); Shamsudin, Shaiful Rizam; Kamardin, A. [Univ. Malaysia Perlis, Jejawi, Arau (Malaysia). School of Materials Engineering
The failure took place on a welded elbow pipe which exhibited a catastrophic transverse rupture. The failure was located on the welding HAZ region, parallel to the welding path. Branching cracks were detected at the edge of the rupture area. Deposits of corrosion products were also spotted. The optical microscope analysis showed the presence of transgranular failures which were related to the stress corrosion cracking (SCC) and were predominantly caused by the welding residual stress. The significant difference in hardness between the welded area and the pipe confirmed the findings. Moreover, the failure was also caused by the low Mo content in the stainless steel pipe which was detected by means of spark emission spectrometer. (orig.)
Fajardo, L.F.; Lee, A.
Rupture of irradiated large vessels is an uncommon complication which tends to occur in carotid, aorta, and femoral arteries, in decreasing order of incidence. It particularly affects men subjected to surgery and radiotherapy for epidermoid carcinomas in oropharynx, esophagus, or genitalia. Contrary to some opinion, radiation is not the most significant cause; this spontaneous arterial rupture can occur without radiation. The perforation is not associated with tumor invasion of arterial wall, as has been claimed. Surgical complications, especially necrosis of skin flaps, infection, and fistulas are most important etiologically. Only 2 of the 11 instances that we describe appear to have been caused mainly by radiation. The perforation is usually fatal, but several patients, including 3 of our series (2 carotid, 1 femoral), have been saved by hospital personnel aware of this complication. To prevent it, prolonged exposure or infection of arteries, whether irradiated or not, should be avoided. (auth)
Ren, Weiju; Holcomb, David E.; Muralidharan, Govindarajan; Wilson, Dane F.
Disclosed herein are systems, devices and methods for stress-rupture testing selected materials within a high-temperature liquid salt environment. Exemplary testing systems include a load train for holding a test specimen within a heated inert gas vessel. A thermal break included in the load train can thermally insulate a load cell positioned along the load train within the inert gas vessel. The test specimen can include a cylindrical gage portion having an internal void filled with a molten salt during stress-rupture testing. The gage portion can have an inner surface area to volume ratio of greater than 20 to maximize the corrosive effect of the molten salt on the specimen material during testing. Also disclosed are methods of making a salt ingot for placement within the test specimen.
Titran, R. H.; Scheuerman, C. M.; Stephens, J. R.
The automotive Stirling engine, being investigated jointly by the Department of Energy and NASA Lewis as an alternate to the internal combustion engine, uses high-pressure hydrogen as the working fluid. The long-term effects of hydrogen on the high temperature strength properties of materials is relatively unknown. This is especially true for the newly developed low-cost iron base alloy NASAUT 4G-A1. This iron-base alloy when tested in air has creep-rupture strengths in the directionally solidified condition comparable to the cobalt base alloy HS-31. The equiaxed (investment cast) NASAUT 4G-A1 has superior creep-rupture to the equiaxed iron-base alloy XF-818 both in air and 15 MPa hydrogen.
Pascual Samaniego, M; Bravo Fernández, I; Ruiz Serrano, M; Ramos Martín, J A; Lázaro Méndez, J; García González, A
One-third to one-half of all patients with horseshoe kidney are asymptomatic and the condition is found incidentally. This congenital renal anomaly has shown as a predisponent condition for renal injury in blunt abdominal trauma, but often the degree of injury has a nonoperative therapy. Horseshoe kidney rupture is an exceptional pathology that require a complete diagnostic study to make an adequate management when surgical therapy is indicated. We present a fifteen-year-old male with previously unsuspected horseshoe kidney that suffered an atypical right upper-pole and mesorrenal kidney rupture after low-velocity-impact blunt abdominal trauma. A correct presurgical diagnose let a deferred surgical approach with right lower pole and horseshoe renal isthmus preservation. The trauma conditions, an excesive clinic manifestation, a clinical investigation about known congenital simultaneous anomallies and typical radiological signs, can suggest this infrequent patology. Computed tomography provides the best radiological information.
Auvinen, A.; Jokiniemi, J.K.; Laehde, A.; Routamo, T.; Lundstroem, P.; Tuomisto, H.; Dienstbier, J.; Guentay, S.; Suckow, D.; Dehbi, A.; Slootman, M.; Herranz, L.; Peyres, V.; Polo, J.
The steam generator tube rupture (SGTR) scenarios project was carried out in the EU 5th framework programme in the field of nuclear safety during years 2000-2002. The first objective of the project was to generate a comprehensive database on fission product retention in a steam generator. The second objective was to verify and develop predictive models to support accident management interventions in steam generator tube rupture sequences, which either directly lead to severe accident conditions or are induced by other sequences leading to severe accidents. The models developed for fission product retention were to be included in severe accident codes. In addition, it was shown that existing models for turbulent deposition, which is the dominating deposition mechanism in dry conditions and at high flow rates, contain large uncertainties. The results of the project are applicable to various pressurised water reactors, including vertical steam generators (western PWR) and horizontal steam generators (VVER)
The European Directive on Pressure Equipment requests risk studies and in particular to assure no risk of fatigue and rupture in operation. The answers to these questions are different in the different existing design codes (EN Standards, ASME III and VIII or RCC-M or CODAP-CODETI codes) and corresponding in operation codes (ASME or RSE-M). Design safety factors, material properties, fabrication, refinement in the analysis methods, monitoring in operation, hydro-proof test level... Around these Codes, different rules are under development. A16 in France, R6 in UK or FITNET at the EC level. This paper is concerned by a comparison between 2 different Codes to analyze the risk of fatigue or rupture of pressure equipments and mainly a comparison between RCC-M Code and EN 13445 standard for pressure vessel. Recommendations for future work will be proposed. (authors)
Suzuki, Michiyasu; Ogawa, Akira; Sakurai, Yoshiharu; Komatsu, Shinro; Suzuki, Jiro.
The differences between initial bleeding and rebleeding due to ruptured intracranial aneurysm was investigated by CT. The study included 120 cases of ruptured cerebral aneurysm; 71 cases had only one bleeding and 49 cases had rebleeding. All the cases underwent CT examinations within 2 weeks following bleeding. Subarachnoid hemorrhages were classified into three groups according to the CT findings: Diffuse high type-high density areas in the entire basal cistern; Localized high type-high density area in a restricted part of the basal cistern; and Iso or Low type-no high density areas in the basal cistern. CT scans done within 24 hours following initial bleeding showed Diffuse high type in 96% of the cases and Localized high type in 4%. On the other hand, in rebleeding cases, Diffuse high type was 50%, Localized high type 25% and Iso or Low type 25%. In rebleeding cases within three days following initial bleeding, Diffuse high type was 90% and Iso or Low type 10%. However, between day 4 and day 14, Diffuse high type was 14%, Localized high type 42% and Iso or Low type 42%. After day 15, Diffuse high type was 36%, Localized type 36% and Iso or Low type 28%. Intracerebral hematoma and/or ventricular hemorrhage secondary to ruptured aneurysms were also investigated. Following initial bleeding, 18% of cases showed intracerebral and/or ventricular hemorrhage, however, the incidence increased up to 59% in rebleeding cases. These observations indicate that the subarachnoid hemorrhage due to re-ruptured aneurysm tends to be more localized than in initial bleeding cases and that intracerebral and/or ventricular hemorrhage seems more frequent in rebleeding cases. (author)
Full Text Available Spontaneous bladder rupture is a rare condition that can be followed by an acute alcohol intoxication and can be associated with significant morbidity and mortality. We report a case diagnosed in a alcoholic young male who was admitted to our emergency room for epigastric pain. The case demonstrates the difficulties with diagnosis and the need for physicians who work in an emergency room to be aware of this condition.
Full Text Available HPI: A 26-year old male presented to the emergency department after experiencing the acute onset of left ankle pain while playing basketball. Upon jumping, he felt a “pop” in his left posterior ankle, followed by pain and difficulty ambulating. His exam was notable for a defect at the left Achilles tendon on palpation. The practitioner performed a Thompson test, which was positive (abnormal on the left. Significant Findings: The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing the right (unaffected calf, the ankle spontaneously plantar flexed, indicating a negative (normal Thompson test. Upon squeeze of the left (affected calf, the ankle did not plantar flex, signifying a positive (abnormal Thompson test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later. Discussion: The Achilles tendon (also: calcaneal tendon or heel cord is derived from the medial and lateral heads of the gastrocnemius muscle, as well as the soleus muscle. Rupture of the Achilles tendon most commonly occurs in the distal tendon, approximately 2-6 cm from its attachment to the calcaneal tuberosity, in an area of hypovascularity known as the “watershed” or “critical” zone.1-3 The Thompson test (also: Simmonds-Thompson test, described by Simmonds in 1957 and Thompson in 1962, is done while the patient is in the prone position, with feet hanging over the end of a table/gurney, or with the patient kneeling on a stool or chair.4-5 Squeezing the calf of an unaffected limb will cause the ankle to plantar flex, but squeezing the calf of a limb with an Achilles tendon rupture will cause no motion. The sensitivity of the Thompson’s test for the diagnosis of a complete Achilles tendon rupture is 96-100% and the specificity is 93-100%, but data is limited.6-8
Fields, S J; Livshits, G; Sirotta, L; Merlob, P
The present study tested whether various sociodemographic, anthropometric, behavioral, and medical/physiological factors act in a direct or indirect manner on the risk of prematurity using path analysis on a sample of Israeli births. The path model shows that medical complications, primarily toxemia, chorioammionitis, and a previous low birth weight delivery directly and significantly act on the risk of prematurity as do low maternal pregnancy weight gain and ethnicity. Other medical complications, including chronic hypertension, preclampsia, and placental abruption, although significantly correlated with prematurity, act indirectly on prematurity through toxemia. The model further shows that the commonly accepted sociodemographic, anthropometric, and behavioral risk factors act by modifying the development of medical complications that lead to prematurity as opposed to having a direct effect on premature delivery. © 1996 Wiley-Liss, Inc. Copyright © 1996 Wiley-Liss, Inc.
Shiroyama, Y; Saiki, M; Ueda, H; Katayama, S; Mitani, T
Intracranial fat-containing congenital tumors are characterized by negative absorption values on CT. We hereby report a case of an epidermoid cyst with subarachnoid free fats diagnosed preoperatively by CT. A 21-year-old female was admitted to our hospital because of continuous mild headache and nausea. At the time of admission, the results of her physical and neurological examinations were normal. CT, however, demonstrated multiple subarachnoid low-density spots and a suprasellar low-density area with high-density spots. In addition, there were negative absorption values (-12 -- -77), suggesting free fats. A spontaneously ruptured epidermoid or dermoid cyst was diagnosed on the basis of these findings. At surgery, a suprasellar tumor containing a yellowish, cheese-like material was confirmed. The patient made an uneventful recovery and was discharged 14 days after surgery. There have been several published reports of CT appearances of intracranial fat-containing tumors. However, spontaneously ruptured cases diagnosed by CT are rare. CT was found to be useful for the diagnosis of spontaneously ruptured cases of fat-containing tumors.
Lee, Yul; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)
We obtained the following results by reviewing the radiographic findings of 15 cases of Sinus valsalva rupture who were diagnosed surgically at Seoul National University Hospital since 1979. 1. Among distribution was from 15 years to 40 years with the mean age of 24 years. Among the 15 cases, 9 cases were male and 7 were female. 2. Ruptured sinus is right coronary sinus projecting to right ventricle in all 15 cases. Combined diseases are ventricular septal defect in 12 cases, Aortic Valvular heart disease in 4 cases, and narrowing of right ventricular outflow tract in 2 cases, and aneurysmal dilatation of right pulmonary artery in 1 cases. 3. Chest X-ray findings were that of left to right shunt, i.e, cardiomegaly, increased pulmonary vascularity but were normal in 3 cases. 4. Aortography showed sequential leakage of dye from right coronary sinus to right ventricle and finally to pulmonary artery in 9 cases, and in 9 cases of them the leakage is directly to right ventricular outflow tract without filling of sinus portion of the ventricle., i.e., type I. 5. The leakage was well shown in left ventricular diastolic phase and not shown in systolic phase. 6. Ventricular septal defects were not detected definitely in spite of taking left ventriculography. 7. Cine angiography is essential for detecting accurate site, degree and direction of sinus valsalva rupture and other associated cardiac abnormality.
Lee, Yul; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung
We obtained the following results by reviewing the radiographic findings of 15 cases of Sinus valsalva rupture who were diagnosed surgically at Seoul National University Hospital since 1979. 1. Among distribution was from 15 years to 40 years with the mean age of 24 years. Among the 15 cases, 9 cases were male and 7 were female. 2. Ruptured sinus is right coronary sinus projecting to right ventricle in all 15 cases. Combined diseases are ventricular septal defect in 12 cases, Aortic Valvular heart disease in 4 cases, and narrowing of right ventricular outflow tract in 2 cases, and aneurysmal dilatation of right pulmonary artery in 1 cases. 3. Chest X-ray findings were that of left to right shunt, i.e, cardiomegaly, increased pulmonary vascularity but were normal in 3 cases. 4. Aortography showed sequential leakage of dye from right coronary sinus to right ventricle and finally to pulmonary artery in 9 cases, and in 9 cases of them the leakage is directly to right ventricular outflow tract without filling of sinus portion of the ventricle., i.e., type I. 5. The leakage was well shown in left ventricular diastolic phase and not shown in systolic phase. 6. Ventricular septal defects were not detected definitely in spite of taking left ventriculography. 7. Cine angiography is essential for detecting accurate site, degree and direction of sinus valsalva rupture and other associated cardiac abnormality
Michalak, Maciej; Żurada, Anna; Biernacki, Maciej; Zygmunt, Kozielec
The rupture of ectopic pregnancy (EP) still remains the primary and direct cause of death in the first trimester of pregnancy. Ultrasonography is known to be a modality of choice in EP diagnostics. We found a severe discrepancy between the frequency of ectopic pregnancies (EP) and the number of available computed tomography (CT) examinations. A 29-year-old woman was admitted to the emergency department with a history of abdominal pain, nausea, vomiting and collapse. Sonographic findings of a suspected EP were unclear. Moreover, not all features of intrauterine pregnancy were present. Due to the patient’s life-threatening condition, an emergency multi-slice CT with MPR and VRT reconstructions was performed, revealing symptoms of a ruptured EP. In the right adnexal area, a well-vascularized, solid-cystic abnormal mass lesion was found. Intraperitoneal hemorrhage was confirmed intraoperatively, and the right fallopian tube with a tubal EP was resected. In the surgery in situ, as well as in the pathological examination of the tumor mass, a human embryo of approximately 1.5 cm in length (beginning of the 8 th week of gestation) was found. Although ultrasonography still remains the first-line imaging examination in EP diagnostics, sometimes the findings of suspected EPs are unclear and not sufficient. The rupture of EP, with serious bleeding and symptoms of shock, may require an emergent pelvic and abdominal CT inspection. A clear correlation was found between the macroscopic CT images and the intraoperatively sampled material
Arıbaş, Bilgin Kadri; Dingil, Gürbüz; Köroğlu, Mert; Üngül, Ümit; Zaralı, Aliye Ceylan
The aim of this case study is to present effectiveness of percutaneous drainage as a treatment option of ruptured lung and liver hydatid cysts. A 65-year-old male patient was admitted with complicated liver and lung hydatid cysts. A liver hydatid cyst had ruptured transdiaphragmatically, and a lung hydatid cyst had ruptured both into bronchi and pleural space. The patient could not undergo surgery because of decreased respiratory function. Both cysts were drained percutaneously using oral albendazole. Povidone–iodine was used to treat the liver cyst after closure of the diaphragmatic rupture. The drainage was considered successful, and the patient had no recurrence of signs and symptoms. Clinical, laboratory, and radiologic recovery was observed during 2.5 months of catheterization. The patient was asymptomatic after catheter drainage. No recurrence was detected during 86 months of follow-up. For inoperable patients with ruptured liver and lung hydatid cysts, percutaneous drainage with oral albendazole is an alternative treatment option to surgery. The percutaneous approach can be life-saving in such cases.
Bygum, Anette; Westermark, Per; Brandrup, Flemming
Ichthyosis prematurity syndrome is a rare syndrome characterized by the clinical triad of premature birth, thick caseous desquamating epidermis, and neonatal asphyxia. We describe two siblings with ichthyosis prematurity syndrome. The index patient was born at gestational week 34. Immediately aft...... in the stratum corneum and stratum granulosum. Diagnosing this syndrome is important to reassure parents, obstetricians, and pediatricians about its benign course after complications in the perinatal period....
Nissenkorn, I; Kremer, I; Gilad, E; Cohen, S; Ben-Sira, I
Three premature infants observed to develop severe stage III retinopathy of prematurity (ROP) at 3 to 5 weeks of age received immediate treatment by cryoablation and photocoagulation, with good results. The critical importance of the ophthalmic examination of premature babies from the age of 2 weeks, so as not to overlook such cases of 'rush' type ROP is stressed and the difficulty involved in treating such small neonates is discussed.
Domínguez Salgado, C R; Gorostieta García, A; Vázquez Bretón, S
It was accomplished a random comparative study to evaluate the effects of dinoprostone in the Hospital de Gineco Obstetricia No. 60 of the Mexican Institute of the Social Security, from June of 1997 to December of the same year, in relationship to the inducement cervical repening and vaginal delivery in patients with score less than or equal Bishop to 4. They were studied a total of 156 patients split into two groups: 78 patients who were administered by intracervical gel of Dinoprostone and to the remainders 78 were administered oxitocin with the same purpose, being this last the control group. We found that the duration time of induction with dinoprostone is 2 hours in average less than the inducement with oxitocin (p > 0.05). The were achieved 67 deliveries with dinoprostone and 65 deliveries with oxitocina, being not significantly. (p 0.05). We can conclude that the dinoprostone intracervical application reduce the induction and expulsion time, with better conditions of the new born, and less percent of infectious complications, in relationship to the Oxitocin control group.
Conclusion: The amniopatch treatment success rate was higher in the iPPROM group than the sPPROM group, but was not statistically significant. The neonatal outcome was more favorable when the amniopatch was successful. However, the only predictive factor associated with successful amniopatch was a larger amniotic fluid volume before the procedure.
J A Osaikhuwuomwan
Conclusion: The finding of a significant shorter latent period, requirement for less oxytocin dose and overall shorter duration of stimulated labour cases with PROM compared to induction of labour for those with intact membranes suggest that PROM may be a means of labour initiation by some parturients and thus implies that these two groups of paturients are different obstetric entities and should therefore be treated as such in their labour management and research consideration.
Korukcu, Oznur; Kukulu, Kamile
The purpose of the researchers is to determine the effect of a mindfulness program on readiness for motherhood, the level of maternal attachment, and on postpartum self-evaluation. We used a quasiexperimental design. Researchers applied the mindfulness-based Transition to Motherhood program to the treatment group for 7 days. Data were collected between December 2012 and June 2014 in Turkey. At the end of the study, the treatment group showed improvement in measures of acceptance of pregnancy, level of readiness to give birth, level of maternal attachment, and level of competence in the role of motherhood.
Preeti Patil Chhablani
Full Text Available Increasing rates of preterm births coupled with better survival of these infants have resulted in higher prevalence of systemic and ocular complications associated with prematurity. In addition to retinopathy of prematurity, infants who are born preterm may suffer from severe visual impairment as a result of hypoxic ischemic encephalopathy, hypoglycemia, and other metabolic imbalances. The effect of these processes on the anterior visual pathway may result in optic atrophy, optic nerve hypoplasia or optic disc cupping and affection of the posterior visual pathway leads to cortical visual impairment (CVI. Other ocular associations include strabismus, nystagmus, and ocular motor abnormalities such as tonic down gaze and defective saccades and pursuits. Cortical and subcortical involvement also manifests as defects in functional vision and these have not yet been completely understood. Children with CVI may have visual field defects, photophobia, defective visual processing, and deficient color vision. Since most of these children also suffer from additional systemic disabilities, evaluation, and management remains a challenge. However, early diagnosis and initiation of rehabilitation therapy can prove to be of significant benefit in these children.
Anna J Fenton
Full Text Available The term premature ovarian insufficiency (POI describes a continuum of declining ovarian function in a young woman, resulting in an earlier than average menopause. It is a term that reflects the variable nature of the condition and is substantially less emotive than the formerly used "premature ovarian failure" which signaled a single event in time. Contrary to the decline in the age of menarche seen over the last 3-4 decades there has been no similar change in the age of menopause. In developed nations, the average age for cessation of menstrual cycles is 50-52 years. The age is younger among women from developing nations. Much has been written about POI despite a lack of good data on the incidence of this condition. It is believed that 1% of women under the age of 40 years and 0.1% under the age of 30 years will develop POI. Research is increasingly providing information about the pathogenesis and treatments are being developed to better preserve ovarian function during cancer treatment and to improve fertility options. This narrative review summarizes the current literature to provide an approach to best practice management of POI.
Full Text Available This report deals with our experience in the management of threshold retinopathy of prematurity (ROP. A total of 45 eyes of 23 infants were subjected to treatment of threshold ROP. 26.1% of these infants had a birth weight of >l,500 gm. The preferred modality of treatment was laser indirect photocoagulation, which was facilitated by scleral depression. Cryopexy was done in cases with nondilating pupils or medial haze and was always under general anaesthesia. Retreatment with either modality was needed in 42.2% eyes; in this the skip areas were covered. Total regression of diseases was achieved in 91.1% eyes with no sequelae. All the 4 eyes that progressed to stage 5 despite treatment had zone 1 disease. Major treatment-induced complications did not occur in this series. This study underscores the importance of routine screening of infants upto 2,000 gm birth weight for ROP and the excellent response that is achieved with laser photocoagulation in inducing regression of threshold ROP. Laser is the preferred method of treatment in view of the absence of treatment-related morbidity to the premature infants.
Hansen, Ronald M.; Moskowitz, Anne; Akula, James D.; Fulton, Anne B.
Retinopathy of prematurity (ROP) is a neurovascular disease that affects prematurely born infants and is known to have significant long term effects on vision. We conducted the studies described herein not only to learn more about vision but also about the pathogenesis of ROP. The coincidence of ROP onset and rapid developmental elongation of the rod photoreceptor outer segments motivated us to consider the role of the rods in this disease. We used noninvasive electroretinographic (ERG), psychophysical, and retinal imaging procedures to study the function and structure of the neurosensory retina. Rod photoreceptor and post-receptor responses are significantly altered years after the preterm days during which ROP is an active disease. The alterations include persistent rod dysfunction, and evidence of compensatory remodeling of the post-receptor retina is found in ERG responses to full-field stimuli and in psychophysical thresholds that probe small retinal regions. In the central retina, both Mild and Severe ROP delay maturation of parafoveal scotopic thresholds and are associated with attenuation of cone mediated multifocal ERG responses, significant thickening of post-receptor retinal laminae, and dysmorphic cone photoreceptors. These results have implications for vision and control of eye growth and refractive development and suggest future research directions. These results also lead to a proposal for noninvasive management using light that may add to the currently invasive therapeutic armamentarium against ROP. PMID:27671171
Tan, K K; Yan, Z Y; Vijayan, A; Chiu, M T
Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. We reviewed our institution's management of patients with diaphragmatic rupture after blunt trauma. All patients in this study were treated at Tan Tock Seng Hospital, Singapore, from March 2002 to October 2008. Patients with penetrating injuries were excluded. The parameters included age, mechanism of injury, haemodynamic status at admission, Glasgow coma scale (GCS) score, injury severity score (ISS), imaging studies, location of diaphragmatic injuries, associated injuries and outcome. 14 patients with a median age of 38 years formed the study group. Vehicular-related incidents accounted for 71.4 percent of the injuries. The median GCS score on admission was 14 (range 3-15), while the median systolic blood pressure and heart rate were 94 (range 50-164) mmHg and 110 (range 76-140) beats per minute, respectively. The median ISS was 41 (range 14-66). All had chest radiographs performed in the emergency department, six (42.9 percent) had computed tomography performed before surgery, while the remaining eight (57.1 percent) were sent straight to the operating theatre from the emergency department. There were five (35.7 percent) right-sided and nine (64.3 percent) left-sided diaphragmatic ruptures. The mortality rate was 35.7 percent. Some of the associated injuries included eight (57.1 percent) splenic lacerations, five (35.7 percent) haemothorax and lung injuries, four (28.6 percent) bone fractures and three (21.4 percent) liver lacerations. 12 (85.7 percent) patients underwent repair of the diaphragmatic rupture using interrupted polypropylene suture, while the remaining two (14.3 percent) were too haemodynamically unstable to undergo definitive treatment. Advanced age, haemodynamic instability and raised ISS were associated with mortality. An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult, and a thorough examination of both the
Ohno, Tsutomu; Mizobe, Naoki; Takehiro, Hideo
Evaluation of the extracerebral space on CT resulted as follows: The existence of the etracerebral space in the parieto-occipital region (PO-ECS) was physiological findings characteristic to premature infants. Its incidence was higher and the width of the space was greater, in those of premature infants. Generally PO-ECS disappeared around 40 weeks of gestation, while it tended to remaine beyond 40 weeks in premature infants born after less than 30 weeks of pregnancy. The appearance and disappearance of the PO-ECS may present some approach to learning the development of the brain in premature infants. (Ueda, J.)
Fonseca, Luciana Teixeira; Senna, Denise C; Eckert, Gabriela Unchalo; Silveira, Rita de Cássia; Procianoy, Renato Soibelmann
To evaluate the possible protective effect of breast milk against retinopathy of prematurity by comparing the amount of breast milk received by patients who developed retinopathy of prematurity and those who did not and to determine both the required minimum amount of breast milk and the time of life during which neonates need to receive breast milk for this effect to be significant. Cohort study of newborns with a birth weight of prematurity of any degree was 31% (100 of 323 patients) and that of severe retinopathy of prematurity was of 9% (29 of 323 patients). The median amounts of breast milk received daily by patients with and without retinopathy of prematurity were 4.9 mL/kg (interquartile range, 0.3-15.4) and 10.2 mL/kg (1.5-25.5), respectively. The amount of breast milk received in the first 6 weeks of life was inversely associated with the incidence of both retinopathy of prematurity of any degree and severe retinopathy of prematurity in the univariate analyses. However, the statistical significance was maintained only during the sixth week of life in a per-period multivariate analysis controlling for confounding factors. Small amounts of breast milk are inadequate to prevent retinopathy of prematurity in premature newborns at risk for the disease.
Ouyang, Li-Juan; Yin, Zheng-Qin; Ke, Ning; Chen, Xin-Ke; Liu, Qin; Fang, Jing; Chen, Lin; Chen, Xiu-Rong; Shi, Hui; Tang, Ling; Pi, Lian-Hong
To investigate the refractive status and optical components of premature babies with or without retinopathy of prematurity (ROP) at 3-4 years old, and to explore the influence of prematurity and ROP on the refractive status and optical components. Premature babies receiving fundus examination were recruited into ROP group and non-ROP group, with age-matched full-term babies as controls. The incidence of myopia was the highest in ROP (3/59, 5.08%). The incidence of astigmatism was significantly different between ROP (37.29%, 22/59) and controls (17.86%, 15/84). The corneal refractive power in ROP and non-ROP was more potent compared with controls (PPremature babies with or without ROP are susceptible to myopia and astigmatism. ROP, prematurity and low birth-weight synergistically influence the development of refractive status and optical components, of which the prematurity and low birth-weight are more important.
Rosas-Salazar, Christian; Ramratnam, Sima K; Brehm, John M; Han, Yueh-Ying; Boutaoui, Nadia; Forno, Erick; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Canino, Glorisa; Celedón, Juan C
Puerto Rican children share a disproportionate burden of prematurity and asthma in the United States. Little is known about prematurity and childhood asthma in Puerto Rican subjects. We sought to examine whether prematurity is associated with asthma in Puerto Rican children. We performed a case-control study of 678 children aged 6 to 14 years with (n = 351) and without (n = 327) asthma living in San Juan, Puerto Rico. Prematurity was defined by parental report for our primary analysis. In a secondary analysis, we only included children whose parents reported prematurity that required admission to the neonatal intensive care unit. Asthma was defined as physician-diagnosed asthma and wheeze in the prior year. We used logistic regression for analysis. All multivariate models were adjusted for age, sex, household income, atopy (≥1 positive IgE level to common allergens), maternal history of asthma, and early-life exposure to environmental tobacco smoke. In a multivariate analysis there was a significant interaction between prematurity and atopy on asthma (P = .006). In an analysis stratified by atopy, prematurity was associated with a nearly 5-fold increased odds of asthma in atopic children (adjusted odds ratio, 4.7; 95% CI, 1.5-14.3; P = .007). In contrast, there was no significant association between prematurity and asthma in nonatopic children. Similar results were obtained in our analysis of prematurity requiring admission to the neonatal intensive care unit and asthma. Our results suggest that atopy modifies the estimated effect of prematurity on asthma in Puerto Rican children. Prematurity might explain, in part, the high prevalence of atopic asthma in this ethnic group. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
Injection-induced earthquakes pose a serious seismic hazard but also offer an opportunity to gain insight into earthquake physics. Currently used models relating the maximum magnitude of injection-induced earthquakes to injection parameters do not incorporate rupture physics. We develop theoretical estimates, validated by simulations, of the size of ruptures induced by localized pore-pressure perturbations and propagating on prestressed faults. Our model accounts for ruptures growing beyond the perturbed area and distinguishes self-arrested from runaway ruptures. We develop a theoretical scaling relation between the largest magnitude of self-arrested earthquakes and the injected volume and find it consistent with observed maximum magnitudes of injection-induced earthquakes over a broad range of injected volumes, suggesting that, although runaway ruptures are possible, most injection-induced events so far have been self-arrested ruptures.
Warenik-Szymankiewicz, Alina; Słopień, Radosław
Among the causes of premature ovarian failure (POF) two groups of factors are reported: factors which lead to decrease of follicular number and factors which stimulate follicular atresia. In the first group genetic factors are the most important whereas in the second: enzymatic autoimmunological, iatrogenic, toxins and infections are reported. In 1986 familiar POF on the background of long arm of chromosome X deletion was reported. Other chromosomes which are important for normal ovarian function are: chromosome 21 (AIRE gene), chromosome 11 (gene of beta FSH, ATM gene), chromosome 3 (gene responsible for BEPS syndrome) and chromosome 2 (genes of FSH and LH receptors). In this review the role of these genes and results of several epidemiological studies are reported.
Rodrigues, Ana Clara Tude; Afonso, José E; Cordovil, Adriana; Monaco, Claudia; Piveta, Rafael; Cordovil, Rodrigo; Fischer, Claudio H; Vieira, Marcelo; Lira-Filho, Edgar; Morhy, Samira S
Rupture of tricuspid valve is unusual, occurring mainly in the setting of blunt trauma or endomyocardial biopsy. Spontaneous tricuspid valve chordal rupture is particularly rare. We report herein a case of a patient with severe pulmonary hypertension, on the lung transplantation waiting list, who presented with spontaneous chordal rupture, exacerbation of tricuspid insufficiency and worsening of clinical status. Diagnosis and treatment, along with possible mechanisms for this complication, are discussed. © 2015, Wiley Periodicals, Inc.
Lică, I; Venter, M D; Mehic, R; Marian, R; Ionescu, G
The authors present a case of delayed rupture of the spleen in a polytraumatised patient. This entity was defined as a late occurrence of signs and symptoms attributed to splenic injury not detected by diagnostic computed tomographic scanning during the initial examination. The mechanisms in which the delayed rupture of the spleen occurs are discussed and the conclusion is that the delayed rupture of the spleen represent a real clinical entity.
Kim, Dong Hun; Oh, Hyung Woo; Kim, Dong Hyun; Byun, Joo Nam
We report here on a case of popliteal aneurysm and rupture that occurred over a 10-day period and this was all secondary to salmonella infection. Computed tomography (CT) angiography of the extremity that was performed before and after aneurysmal rupture showed the aneurysm's rapid evolution to rupture over a short period of time. We also review the pathogenesis, clinical presentation, diagnostic approach and management of salmonella aneurysms
Wernheden, Erika; Brenøe, Anne Sofie; Shahidi, Saeid
Splenic artery aneurysms (SAAs) are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm) SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured...... 15-cm giant SAA in an 84-year-old woman treated successfully with emergency endovascular coiling. To our knowledge, this is one of the few reports of emergency endovascular treatment for ruptured giant SAA....
Christian Linus Hastrup Sant
Full Text Available Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.
Sant, Christian Linus Hastrup; Andersen, Poul Erik
Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination...... and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability....
Khurana, Shruti; Wadhwa, Vibhor; Chhabra, Avneesh; Amirlak, Bardia
Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture. (orig.)
Pochini, Alberto De Castro; Andreoli, Carlos Vicente; Ejnisman, Benno; Maffulli, Nicola
Muscle rupture is rarely treated surgically. Few reports of good outcomes after muscular suture have been published. Usually, muscular lesions or partial ruptures heal with few side effects or result in total recovery. We report a case of an athlete who was treated surgically to repair a total muscular rupture in the pectoralis major muscle. After 6 months, the athlete returned to competitive practice. After a 2-year follow-up, the athlete still competes in skateboard championships. PMID:25716033
Khurana, Shruti [Lady Hardinge Medical College, New Delhi (India); Wadhwa, Vibhor [University of Arkansas for Medical Sciences, Little Rock, AR (United States); Chhabra, Avneesh [UT Southwestern Medical Center, Dallas, TX (United States); Johns Hopkins University, Baltimore, MD (United States); Amirlak, Bardia [UT Southwestern Medical Center, Dallas, TX (United States)
Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture. (orig.)
Vrijlandt, EJLE; Gerritsen, J; Boezen, HM; Grevink, RG; Duiverman, EJ
Rationale: Limited information is available about the long-term outcome of lung function and exercise capacity in young adults born prematurely. Objective: To determine long-term effects of prematurity on lung function (volumes, diffusing capacity) and exercise capacity in expreterms compared with