Misoprostol for labor induction in women with term premature rupture of membranes: a meta-analysis.

OBJECTIVE: To systematically review published data evaluating the comparative use of misoprostol with placebo/expectant management or oxytocin for labor induction in women with term (> or = 36 weeks of gestation) premature rupture of membranes. DATA SOURCES: PubMed (1966-2005), Ovid (1966-2005), CINAHL, The Cochrane Library, ACP Journal Club, OCLC, abstracts from scientific forums, and bibliographies of published articles were searched using the following keywords: premature rupture of membranes, misoprostol, labor induction, and cervical ripening. Primary authors were contacted directly if the data sought were unavailable or only published in abstract form. METHODS OF STUDY SELECTION: Only randomized controlled trials evaluating the efficacy and safety of misoprostol in comparison with placebo or expectant management (n = 6) and oxytocin (n = 9) published in either article or abstract form were analyzed and included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Studies were reviewed independently by all authors. Meta-analysis was performed, and the relative risks (RRs) were calculated and pooled for each study outcome. Misoprostol, compared with placebo, significantly increased vaginal delivery less than 12 hours (RR 2.71, 95% confidence interval [CI] 1.87-3.92, P < .001). Misoprostol was similar to oxytocin with respect to vaginal delivery less than 24 hours (RR 1.07, 95% CI 0.88-1.31, P = .50) and less than 12 hours (RR 0.98, 95% CI 0.71-1.35, P = .90). Misoprostol was not associated with an increased risk of tachysystole, hypertonus, or hyperstimulation syndrome when compared with oxytocin and had similar risks for adverse neonatal and maternal outcomes. CONCLUSION: Misoprostol is an effective and safe agent for induction of labor in women with term premature rupture of membranes. When compared with oxytocin, the risk of contraction abnormalities and the rate of maternal and neonatal complications were similar among the 2 groups.

[Early amnion rupture and fetal and newborn defects as an obstetrical and pathomorphological problem]. / Wczesne pekniecie owodni a wady plodów i noworodkow--problem polozniczy i patomorfologiczny.

OBJECTIVES: Early amnion rupture (EAR, EARS, EAROD) may be the cause of amniotic bands and sheets development, which may lead to different fetal defects--from minor finger amputation, chiloschisis or palatoschisis to major amputation, acranius, deep paroschisis or broad body covering cleavage. DESIGN: The aim of this report was to analyse cases of fetal malformation, which might have been caused by EARS. MATERIALS AND METHODS: A retrospective analysis of 3173 autopsies performed within a span of 14 years (1989-2003). RESULTS: Among 744 cases of malformations 14 cases of fetuses and newborns presented developmental anomalies, which probably were the consequences of EARS. CONCLUSIONS: The EARS is probably more frequent than it is generally presumed, but it is very often impossible to find remnants of bands and sheets. Nevertheless, the presence of at least two typical anomalies excludes a different cause than early amnion rupture and amniotic bands.

Gestational age at preterm premature rupture of membranes: a risk factor for neonatal white matter damage.

OBJECTIVE: Gestational age at delivery and spontaneous prematurity are independent risk factors for white matter damage (WMD). However, among infants delivered spontaneously after preterm premature rupture of membranes (PPROM), latency of PPROM has been inconsistently correlated with risk of WMD. We have explored whether gestational age at membrane rupture is independently associated with WMD. STUDY DESIGN: Using a cohort of 196 liveborn singleton nonanomalous neonates born at 24.0 to 33.6 weeks from January 1993 to December 2002 after pPROM and who survived 7 days, we compared the characteristics of those who developed WMD (n = 15) with those who did not (n = 181) using Fisher exact test, Student t test, and logistic regression analysis, with a 2-tailed P < .05 or odds ratio (OR) with 95% CI not inclusive of the unity considered significant. RESULTS: Stepwise logistic regression analysis demonstrated that gestational age at PPROM (P < .001, OR 0.79) was significantly associated with WMD. The association was independent of corticosteroid administration (P = .016), latency interval (P = .69), gestational age at delivery (P = .99), and birth weight (P = .62). CONCLUSION: Among premature infants born at <34 weeks after pPROM, gestational age at diagnosis is independently associated with WMD.

Perinatal outcomes in women with preterm rupture of membranes between 24 and 32 weeks of gestation and a history of vaginal bleeding.

OBJECTIVE: The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding. STUDY DESIGN: This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome. RESULTS: Outcome data were available for 581 patients (n=50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5%; P=.01), perinatal death (16% vs 4.9%; P=.006), intraventricular hemorrhage (14.3% vs 5.9%; P=.03), and respiratory distress syndrome (69.4% vs 40.4%; P<.0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60%; P=.002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P=.02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P=.04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P=.004). CONCLUSION: Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.

Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study.

OBJECTIVE: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal hemorrhage [IPH]). STUDY DESIGN: This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery. RESULTS: We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH. CONCLUSION: Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection.

Cervical incompetence and the role of emergency cerclage.

OBJECTIVE: To evaluate the role of emergency cerclage for women who present with a dilated external cervical os and bulging or "hour-glassing" membranes. We examined overall experiences at Kingston General Hospital (KGH) from 2000 to 2004 and conducted a literature review for the period January 1, 1995, to December 31, 2004. METHODS: A search for cerclages placed by operators in Kingston revealed 12 pregnancies in the period between 2000 and 2004. We reviewed the charts for these women and for their infants. We conducted a literature review, using the terms "cerclage," "cervical," "emergent or emergency cerclage," "rescue cerclage," and "incompetent cervix," using an OVID interface to access MEDLINE records. We excluded articles in which the diagnosis of cervical incompetence was made using ultrasound, because its predictive value has not been shown in randomized trials. The most recent review of this type was carried out in 1995; since then, an additional 24 articles have been published that met our inclusion and exclusion criteria. RESULTS: The average time between cerclage placement and delivery at KGH was 7 weeks, which allowed for 10 of 13 infants (one twin pregnancy) to be born at 28 weeks or later. Three infants were born weighing under 1 kg; the 10 remaining infants weighed over 1 kg. Histological data are available for 12 placentas of the 13 infants delivered; 7 infants had a histological diagnosis of chorioamnionitis; none of the blood cultures from any of the infants post-delivery revealed septicemia. The literature review identified 638 women. Where reported, the average prolongation of the pregnancy was 7 weeks plus 1 day. This allowed for 60% of infants (range 26% to 80%) to be born after 28 weeks, with an average neonatal survival of over 70% (range 47.2% to 96%). Preterm premature rupture of membranes complicated an average of 29% of pregnancies (range 1% to 58%), and chorioamnionitis was reported in 5% to 80% of pregnancies. CONCLUSIONS: The KGH data collected and the data available in the literature suggest that emergency cerclage, under ideal circumstances, can significantly prolong pregnancy and increase the chance of viable pregnancy outcome. However, in counselling women about the potential therapeutic benefit of emergency cerclage, the increased risk of chorioamnionitis and its associated risk of fetal inflammatory brain injury, as well as the risk of extending a pregnancy from pre-viability to severe prematurity, should be discussed. A longer-term follow-up than has been carried out here is required for better elucidation of the effect of chorioamnionitis on those infants in childhood and beyond.

Premature rupture of the membranes: a cause for neonatal osteomyelitis?

Osteomyelitis is rare in the neonatal period. Many etiologic factors for causing neonatal osteomyelitis have been discussed in the literature; however, premature rupture of the membranes has never been emphasized. We report on a neonate with osteomyelitis of the right humerus infected with an uncommon pathogen, Klebsiella pneumonia. In the absence of any perinatal disease, premature rupture of the membranes was suggested to be the cause of the illness. The infant was initially regarded as having Erb palsy because of the absence of systemic symptoms and lack of perinatal high-risk factors. Antibiotic administration was delayed for 3 weeks. Luckily, nearly complete recovery was noted after 2 months of follow up. We emphasize the importance of considering osteomyelitis in a newborn infant with limb palsy, particularly in the presence of premature rupture of the membranes of the mother. We also discuss the results of the microbial examination and significance of magnetic resonance imaging in neonatal osteomyelitis.

A cohort study found that white blood cell count and endocrine markers predicted preterm birth in symptomatic women.

OBJECTIVE: This cohort study investigated potential clinical and biochemical predictors of subsequent preterm birth in women presenting with threatened preterm labor. STUDY DESIGN AND SETTING: Subjects were 218 pregnant women admitted to hospital with a diagnosis of threatened preterm labor at 22-36 weeks gestation. Exclusion criteria were multiple pregnancy, fetal anomalies, diabetes mellitus, abruptio placenta, preeclampsia, intrauterine growth restriction, cervical dilatation > 4 cm, and clinical signs of infection. Analyses used logistic regression. RESULTS: The presence of ruptured membranes was the best predictor of birth within 48 hours. Other important predictors were maternal white blood cell count at 22-27 weeks gestation and maternal adrenocorticotropin and corticotropin-releasing hormone concentrations at 28-36 weeks gestation. CONCLUSION: Subclinical infection may be an important etiologic factor in preterm births of gestational age < 28 weeks. For those at > or = 28 weeks gestation, the findings support the etiologic role of activation of the fetal and/or maternal hypothalamic pituitary adrenal axis leading to preterm birth.

Pregnancy outcome following recurrent spontaneous abortions.

OBJECTIVE: The purpose of the present study was to examine the association between spontaneous consecutive recurrent abortions and pregnancy complications such as hypertensive disorders, abruptio placenta, intrauterine growth restriction and cesarean section (CS) in the subsequent pregnancy. METHODS: A population-based study comparing all singleton pregnancies in women with and without two or more consecutive recurrent abortions was conducted. Deliveries occurred during the years 1988-2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders. RESULTS: During the study period 154,294 singleton deliveries occurred, with 4.9% in patients with history of recurrent consecutive abortions. Using a multivariate analysis, with backward elimination, the following complications were significantly associated with recurrent abortions-advanced maternal age, cervical incompetence, previous CS, diabetes mellitus, hypertensive disorders, placenta previa and abruptio placenta, mal-presentations and PROM. A higher rate of CS was found among patients with previous spontaneous consecutive recurrent abortions (15.9% versus 10.9%; OR = 1.6; 95% CI, 1.5-1.7; P < 0.001). Another multivariate analysis was performed, with CS as the outcome variable, controlling for confounders such as placenta previa, abruptio placenta, diabetes mellitus, hypertensive disorders, previous CS, mal-presentations, fertility treatments and PROM. A history of recurrent abortion was found as an independent risk factor for CS (OR = 1.2; 95% CI, 1.1-1.3; P < 0.001). About 58 cases of inherited thrombophilia were found between the years 2000-2002. These cases were significantly more common in the recurrent abortion as compared to the comparison group (1.2% versus 0.1%; OR = 11.1; 95% CI, 6.5-18.9; P < 0.001). CONCLUSION: A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions. Careful surveillance is required in pregnancies following recurrent abortions, for early detection of possible complications.

Ruptura prematura de membranas / Premature rupture of the membranes

A ruptura prematura de membranas ovulares (ruprema) acomete, aproximadamente, 8 por cento das gestações. Associa-se a um elevado índice de complicações materno-fetais, especialmente as infecciosas, requerendo diagnóstico preciso, assim como adequada terapêutica. Os autores fazem uma revisão sobre ruprema, abordando os principais aspectos a este tema relacionados

[Analysis of pregnancy and labor course in patients after preterm premature rupture of membranes]. / Analiza przebiegu ciazy i porodu po przedwczesnym peknieciu pecherza plodowego w ciazy niedonoszonej.

OBJECTIVE OF THE STUDY: The aim of this study was to compare the pregnancy and labor course in patients hospitalized due to PROM in relation to patients with membrane rupture at term of labor. MATERIALS AND METHODS: The study group consisted of 70 gravidas hospitalized in the Department of Pathological Pregnancy. The control group consisted of 70 patients. Special attention was paid to: time of PROM, pregnancy outcome and mode of delivery, obstetrical history, the symptoms of intrauterine infection. CONCLUSIONS: 1. The ascending infection after PROM was the most common indication for pregnancy termination. 2. There is a significant difference in pathological obstetrical history between patients hospitalized due to PROM and control group. 3. There is no significant difference in mode of delivery between study and control group.

Antibiotics for preterm rupture of the membranes: a systematic review.

OBJECTIVE: We sought to evaluate the administration of antibiotics to pregnant women with preterm rupture of membranes (PROM). DATA SOURCES: We collected data by using the Cochrane Controlled Trials Register and MEDLINE. METHODS OF STUDY SELECTION: We included randomized controlled comparisons of antibiotic versus placebo (14 trials, 6,559 women). TABULATION, INTEGRATION, AND RESULTS: Antibiotics were associated with a statistically significant reduction in maternal infection and chorioamnionitis. There also was a reduction in the number of infants born within 48 hours and 7 days and with the following morbidities: neonatal infection (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52-0.85), positive blood culture (RR 0.75, 95% CI 0.60-0.93), use of surfactant (RR 0.83 95% CI 0.72-0.96), oxygen therapy (RR 0.88, 95% CI 0.81-0.96), and abnormal cerebral ultrasound scan before discharge from hospital (RR 0.82, 95% CI 0.68-0.99). Perinatal mortality was not significantly reduced (RR 0.91, 95% CI 0.75-1.11). A benefit was present both in trials where penicillins and erythromycin were used. Amoxicillin/clavulanate was associated with a highly significant increase in the risk of necrotizing enterocolitis (RR 4.60, 95% CI 1.98-10.72). CONCLUSION: The administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity. These data support the routine use of antibiotics for women with PROM. Penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust. Amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis. Antibiotic administration after PROM is beneficial for both women and neonates.

Risks in triplet pregnancy: advanced maternal age, premature rupture of membranes and risk estimates of mortality.

OBJECTIVE: To investigate the impact of older maternal age on the risk of mortality associated with premature rupture of membranes (PROM) among triplets. STUDY DESIGN: A retrospective, cohort study was performed on triplet deliveries in the United States that occurred in the period perinatal and 1995-1998. The study group comprised mothers aged > or =40 years (older mothers), who were compared to mothers aged 30-39 (mature mothers), 20-29 (younger mothers) and mothers <20 (teenagers). We computed risks of mortality associated with PROM within each maternal age category using generalized estimating equations to take into account both intracluster and intercluster sources of variation. RESULTS: The risk of stillbirth and of neonatal and perinatal mortality related to PROM was highest among teenagers. In all circumstances, the risk of both intrauterine and extrauterine death resulting from PROM diminished progressively with increasing maternal age until age 40 and beyond, at which point the risk rose once more and produced a U shape. PROM triplets of older mothers had apparently higher mortality indices than did those of younger and mature mothers, although the risk difference did not show statistical significance for any of the mortality indices. Similarly, the proportion of preventable deaths if PROM could be averted demonstrated a U-shape, consistent with that of risk estimates. CONCLUSION: Premature rupture of membranes was associated with an increase risk of perinatal and infant mortality among triplets. Although older mothers demonstrated higher risk levels for all mortality indices in comparison to younger and mature mothers, our findings did not reach statistical significance.

Maternal role transition experiences of women hospitalized with PROM: a phenomenological study.

This study investigated the subjective experiences of the maternal role transition during the first two weeks of hospitalization for premature rupture of the amniotic membranes (PROM). Thirteen pregnant couples participated in the study by completing interviews. Average gestation of the expectant mothers was 27 weeks and the women were already experiencing fetal movement during the first two weeks of hospitalization for PROM. Lincoln and Cuba's trustworthiness criteria were employed to evaluate methodological rigor. Colaizzi's phenomenological approach was used to analyze the structure of the experience. Four themes emerged: pending loss, concern about the safety of the fetus, identification of maternal roles, and the process of maternal role-making. The results provide a scientific basis for empowering nurses to assist with maternal role transition in high-risk pregnancies in a more sensitive and effective manner.

To induce or not to induce labor: a macrosomic dilemma.

We assessed the effect of labor induction among parturients carrying macrosomic fetuses on the risk of a cesarean section (CS). The study population consisted of consecutive women with singleton fetuses weighing >/=4,000 g, delivered between 1988 and 1999. A comparison was made between parturients who delivered after labor induction and those who delivered without labor induction. The Mantel-Haenszel procedure was used to obtain the weighted odds ratios while controlling for confounding variables. During the study period, 4,755 women delivered macrosomic newborns in our institution. In 20% of the women (n = 951) labor was induced, while 80% of them (n = 3,804) delivered without labor induction. The women who delivered after labor induction were more likely to be nulliparous (18.0 vs. 10.0%; p < 0.001). In addition, these women had significantly higher rates of gestational diabetes (23.3 vs. 10.7%; p < 0.001), hypertensive disorders (10.1 vs. 5.3%; p < 0.001), hydramnios (17.4 vs. 9.9%; p < 0.001), and oligohydramnios (2.1 vs. 0.2%; p < 0.001). The CS rate was significantly higher among the patients who delivered after labor induction as compared with those in whom labor was not induced (17.8 vs. 11.9%; odds ratio 1.6, 95% confidence interval 1.3-1.9, p < 0.001). Stratified analysis using the Mantel-Haenszel technique was performed to control for confounders such as gestational diabetes, hypertensive disorders, previous CS, hydramnios, oligohydramnios, and nulliparity. None of these variables changed the significant association between induction of labor and CS. The induction of labor among women carrying macrosomic fetuses was found to be an independent risk factor for a CS.

Fetal vasculitis in preterm newborns: interrelationships, modifiers, and antecedents.

Histologic expressions of the fetal inflammatory response predict preterm delivery and neonatal disorders. We examined 1146 placentas in the Developmental Epidemiology Network data set for histologic evidence of membrane inflammation (subchorionitis, chorionitis, and chorioamnionitis) and fetal vasculitis (acute umbilical vasculitis or chorionic vasculitis). Our main findings are that (1) in the presence of membrane inflammation, fetal vasculitis is common, (2) duration of membrane rupture and gestational age appear to modify the risk of fetal vasculitis, (3) this risk modification differs for the different components of fetal vasculitis, i.e. umbilical and chorionic vasculitis, and (4) antecedents can be identified that appear to increase or decrease the risk of fetal vasculitis among births with membrane inflammation. We conclude that fetal vasculitis, the morphologic component of the fetal inflammatory response, might not be a homogeneous entity and deserves further study.

Coexistence of a prolapsed, pedunculated cervical myoma and pregnancy complications: a case report.

BACKGROUND: Different types of fibroids may affect reproductive outcome to a different extent, causing infertility and pregnancy wastage. Rectosigmoid compression, prolapse of a pedunculated submucous tumor through the cervix, venous stasis, polycythemia and ascites are infrequently associated with leiomyomas. Uterine leiomyomas arefound in approximately 2% of pregnant women; 1 in 10 causes complications during pregnancy. CASE: A 37-year-old woman, gravida 3, para 2, abortion 0, at 18 weeks of pregnancy, arrived at our outpatient clinic with a complaint of leaking vaginal fluid. On examination, a prolapsed, pedunculated myoma, measuring 5 x 6 x 7 cm, and pooling of amniotic fluid in the vaginal fornix were detected. Antibiotics were started, but the amniotic fluid leak continued, and the fetal heart beat became undetectable after 12 hours of hospitalization. We tried to excise the myoma from the vagina but because it was very large, we could not reach the proximal point it originatedfrom. We dissected the posterior cervical channel, removed the myoma and performed a total abdominal hysterectomy. CONCLUSION: Vaginal myomectomy is recommended as the initial treatment of choicefor a prolapsed, pedunculated submucous myoma except when other indications necessitate an abdominal approach. Use of Laminaria and hysteroscopic resection has been mentioned as other treatment choices. In our case a prolapsed, pedunculated cervical myoma was detected along with pregnancy complications, preterm premature rupture of membranes and fetal death. The cause-and-effect relationship between the prolapsed myoma and membrane rupture is unknown. We were unable to perform a vaginal or abdominal myomectomy because the myoma originated in the posterior cervical region, so we had to perform an abdominal hysterectomy.

Respiratory characteristics of infants with pulmonary hypoplasia syndrome following preterm rupture of membranes: a preliminary study for establishing clinical diagnostic criteria.

BACKGROUND: At present, the diagnosis of pulmonary hypoplasia is based on postmortem findings, and there are no clear clinical diagnostic criteria to facilitate its identification and management. AIM: To characterise the respiratory status of pulmonary hypoplasia syndrome (PHS) following preterm rupture of membranes so as to establish its clinical diagnostic criteria. STUDY DESIGN: Retrospective comparison of respiratory characteristics of six typical PHS infants with six wet lung syndrome (WLS) infants who served as controls. SUBJECTS: The PHS and WLS infants were selected from 1094 patients admitted to a tertiary care neonatal unit over a 6-year period, with criteria based on perinatal history, respiratory signs, X-ray and laboratory findings, and ventilator settings. OUTCOME MEASURES: The compared variables were lung volume index (LVI) calculated from lung dimensions on chest X-ray, ventilatory index (VI), ventilatory efficiency index (VEI), response to artificial surfactant treatment, and ventilation days. RESULTS: In PHS compared to WLS infants, LVI was lower (4.5 +/- 0.5 vs. 9.5 +/- 1.5; p < 0.01), VI was higher (0.108 +/- 0.030 vs. 0.022 +/- 0.005; p < 0.05), and VEI was lower (0.083 +/- 0.012 vs. 0.258 +/- 0.052; p < 0.01) (mean +/- S.E.). Artificial surfactant was given to four PHS infants, but none of them showed respiratory improvement. Ventilation days were 11-79 in three surviving PHS infants and 2-14 in WLS infants. CONCLUSIONS: In this preliminary study, low LVI (< 6.5) and VEI (< 0.15) were the most useful indicators of PHS.

Altered IGF-I receptor expression in chorioamniotic cells in premature rupture of fetal membranes.

OBJECTIVE: To investigate the presence and distribution of type I insulinlike growth factor receptor (IGF-IR) in the cells of the chorioamniotic membrane and to search for any alterations occurring in IGF-IR expression in premature rupture of membranes (PROM) patients. STUDY DESIGN: Fetal membranes collected at delivery from 42 pregnancies between 36 and 40 gestational weeks were included in the study. Seventeen of 42 cases had premature rupture of membranes, and 25 cases had intact membranes prior to delivery. Paraffin sections of thefetal membranes were stained with IGF-IR antibody by the streptavidin-biotin-immunoperoxidase method. The staining was scored and compared statistically between PROM and control cases. RESULTS: The fetal membranes of PROM cases had significantly reduced IGF-IR expression in chorionic trophoblastic cells when compared with the control group (P = .006, X2). CONCLUSION: Our immunohistochemical findings revealed that chanlges in IGF-IR levels in choriolzic amniotic cells may play a pathogenetic role in PROM cases, but the mechanism is speculative and needs further investigation.