Risk factors associated with shortened latency before delivery in outpatients managed for preterm prelabor rupture of membranes.

INTRODUCTION: Preterm prelabor rupture of membranes (PPROM) occurs in 3% of pregnancies and is the main cause (~30%) of premature delivery. Home care seems to be a safe alternative for the management of patients with PPROM, who have a longer latency than those with PPROM managed with conventional hospitalization. We aimed to identify the risk factors associated with a shortened latency before delivery in women with PPROM managed as outpatients. MATERIAL AND METHODS: The design was a retrospective cohort study and the setting was a Monocentric Tertiary centre (Lille University Hospital, France) from 2009 to 2018. All consecutive patients in home care after PPROM at 24-36 weeks were included. For the main outcome measure we calculated the latency ratio for each patient as the ratio of the real latency period to the expected latency period, expressed as a percentage. The risk factors influencing this latency ratio were evaluated. RESULTS: A total of 234 patients were managed at home after PPROM. Mean latency was 35.5 ± 20.7 days, corresponding to an 80% latency ratio. In 196 (83.8%) patients the length of home care was more than 7 days. A lower latency ratio was significantly associated with oligohydramnios (p < 0.001), gestational age at PPROM (p = 0.006), leukocyte count at PPROM more than 12 × 109 /L (p = 0.025), and C-reactive protein concentration more than 5 mg/L at 7 days after PPROM (p = 0.046). Cervical length was not associated with a lower latency ratio. CONCLUSIONS: Women with PPROM managed with home care are stable. The main risk factor associated with a reduced latency is oligohydramnios. Outpatients with oligohydramnios should be informed of the probability of a shortened latency period.

Continuous amnioinfusion for treatment of mid-trimester preterm premature rupture of membranes with oligoamnios.

AIM: Given the scarcity of relevant reports, this study aimed to elucidate whether pregnancy can be prolonged by maintaining the amniotic fluid volume with continuous transabdominal amnioinfusion (TA) for patients with mid-trimester preterm premature rupture of membranes (PPROM) and oligoamnios. METHODS: We retrospectively examined patients who were managed during hospitalization at our department after developing PPROM between week 22 day 0 and week 25 day 6 of gestation and subsequent oligoamnios (amniotic fluid index [AFI] <5 cm) within 7 days after PPROM onset. Cases between 2006 and 2011 comprised the conventional management group (n = 14); cases administered continuous TA between 2012 and 2017 comprised the continuous TA group (n = 14). The primary outcome was the number of days between PPROM and delivery. The secondary outcomes were the proportion of normal amniotic fluid volume (AFI ≥ 5 cm) maintained between PPROM and delivery and the perinatal prognosis for the mother and infant. RESULTS: The continuous TA group had significantly more days between PPROM and delivery and a significantly higher proportion of days that a normal amniotic fluid volume was maintained during that period, regardless of antimicrobial agents administered. Although no significant differences in the perinatal prognosis of disease were found between groups, there was a decreasing trend of composite perinatal mortality and morbidity, and the incidence rates were reduced by half. CONCLUSION: Continuous TA for PPROM with oligoamnios may allow significant prolongation of the gestation period while maintaining the amniotic fluid volume and may lead to improved perinatal prognosis.

High risk of spontaneous preterm birth among infants with gastroschisis.

We examined the association between gastroschisis and preterm birth (PTB, <37 weeks) by subtype. The sample was drawn from singleton live births in California from 2007 to 2012 contained in a birth cohort file maintained by the California Office of Statewide Health Planning and Development (n = 2,891,965; 1,421 with gastroschisis). Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for PTB by gestational age (<34, 34-36, and any <37 weeks) and by type (spontaneous labor with intact membranes, preterm premature rupture of the membranes [PPROM], provider initiated) and were adjusted for maternal characteristics. Over 44.5% of infants with gastroschisis were born preterm because of spontaneous etiologies; notably, 8.4% of infants with gastroschisis were born <34 weeks because of spontaneous etiologies (adjusted RRs 9.1-12.2). Overall, 53.7% of infants with gastroschisis were born preterm compared with only 6.9% of infants without gastroschisis (adjusted RR 15.2, 95% CI 13.6-19.5) and are at particularly high risk of spontaneous PTB. Nearly 9% of infants with gastroschisis delivered <34 weeks, regardless of preterm etiology, indicating that these infants are at great risk for PTB morbidities in addition to the complications from gastroschisis.

Progestogens in singleton gestations with preterm prelabor rupture of membranes: a systematic review and metaanalysis of randomized controlled trials.

OBJECTIVE DATA: 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. STUDY: 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. STUDY APPRAISAL AND SYNTHESIS METHODS: 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. RESULTS: 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 group and 27.3 weeks in the control group. 17-α Hydroxyprogesterone caproate administration was not found to prolong the latency period between randomization and delivery (mean difference, 0.11 days; 95% confidence interval, -3.30 to 3.53). There were no differences in mean gestational age at delivery, mode of delivery, or maternal or neonatal outcomes between the 2 groups. Similarly, there was no difference in latency for those women who received rectal progesterone (mean difference, 4.00 days; 95% confidence interval, -0.72 to 8.72). CONCLUSION: Progestogen administration does not prolong pregnancy in singleton gestations with preterm prelabor rupture of membranes.

Fetal Urine Production Rate in Preterm Premature Rupture of Membranes Is Associated with Adverse Neonatal Outcome: A Pilot Study.

AIM: In this study, we evaluate the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). METHODS: We conducted a prospective pilot cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later managed until spontaneous labor (after 48 h of admission), chorioamnionitis, or induction by protocol at 35 + 0 weeks. FUPR was evaluated by 2D sonography at admission (corrected for gestational age). The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate (<4 mL/kg/h), and early neonatal sepsis. Samples of maternal (at admission) and umbilical cord blood were analyzed for interleukin-6 (IL-6) level. RESULTS: The study included 38 women. Low FUPR was associated with clinical chorioamnionitis, longer NICU hospitalization (p = 0.01), higher rates of NEC or IVH (p = 0.008), and blood transfusion (p = 0.004). CONCLUSIONS: A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of adverse neonatal outcome.

The preterm cervix reveals a transcriptomic signature in the presence of premature prelabor rupture of membranes.

BACKGROUND: 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. OBJECTIVES: 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. STUDY DESIGN: 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. RESULTS: 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 to immune cells at the cervical stroma and NDRG2 and FGD3 were localized to cervical myofibroblasts. The activity of matrix metalloproteinase-9 was higher (1.22 ± 4.403-fold, P < .05) in the cervix in premature prelabor rupture of fetal membranes compared with preterm labor with intact membranes. CONCLUSION: We identified 4 novel proteins with a potential role in the regulation of cervical remodeling leading to premature prelabor rupture of fetal membranes. Our findings contribute to the studies dissecting the mechanisms underlying premature prelabor rupture of fetal membranes and inspire further investigations toward the development of premature prelabor rupture of fetal membranes therapeutics.

Intraamniotic Infection and the Term Neonate.

Intraamniotic infection (IAI) may occur when the amniotic membranes are ruptured >18 hours prior to birth. The term neonate is at risk for early onset sepsis. This article describes the pathophysiology of IAI and the role of the mother-baby nurse during the anticipated birth and the ongoing assessment of the neonate.

[Ultrasound diagnosis of fetal inflammatory response syndrome in women with preterm premature rupture of membrane]. / Ultrazvuková diagnostika syndromu fetální zánetlivé odpovedi u zen s predcasným odtokem plodové vody.

OBJECTIVE: The aim of this review is to analyze the existing possibilities of using ultrasound in the diagnosis of the fetal inflammatory response. DESIGN: Review. SETTINGS: Gynekologicko-porodnická klinika, Fakultní nemocnice Ostrava. METHODS: Preterm delivery is defined as a delivery before completed 37 weeks of gestation. Approximately one-thirdof these cases is associated with preterm premature rupture of membranes. About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity. Recent prenatal diagnosis of the fetal inflammatory response syndrome is based on the invasive methods (amniocentesis, cordocentesis), which are limited by several risk factors accompanying these procedures and technical difficulties. Therefore, there is an effort to replace them by non-invasive approach. The development of ultrasound, as a diagnostic method through the last decade, and knowledge of pathophysiological and morphological changes in fetal organs associated with the fetal inflammatory response may lead to more specific diagnosis in the future and improvement of neonatal outcome. CONCLUSION: Early identification of fetuses affected by FIRS in pregnancies with PPROM is necessary for right management of these pregnancy pathology. At this moment, ultrasonography examination of fetal lineal vein and fetal echocardiography, seems to be suitable for diagnosing FIRS.

Determination of antepartum and intrapartum risk factors associated with neonatal intensive care unit admission.

OBJECTIVE: To determine antepartum and intrapartum factors that are associated with admission to neonatal intensive care unit (NICU) among infants delivered between 36.0 and 42.0 weeks at our institution. METHODS: The retrospective cohort study included 73 consecutive NICU admissions and 375 consecutive non-NICU admissions. Data on demographic, antepartum, intrapartum and neonatal factors were collected. The primary endpoint defined was admission to NICU. Univariate analyses using the Student's t-test, Mann-Whitney U-test, χ2 Fisher's exact test was performed along with multivariate analysis of significant non-redundant variables. RESULTS: Those with a significantly higher risk of NICU admission underwent induction of labor with prostaglandin analogs (12.5% vs. 24.7%, P=0.007). Length of first stage ≥720 min (33.5% vs. 51.9%, P=0.011), length of second stage of labor ≥240 min (10.6% vs. 31.6%, P<0.001) and prolonged rupture of membranes ≥120 min (54.0% vs. 80.0%, P=0.001) were all associated with an increased chance of NICU admission. Intrapartum factors predictive of NICU admission included administration of meperidine (11.7% vs. 27.4%, P<0.001), presence of preeclampsia (5.5% vs. 0.8%, P=0.015), use of intrapartum IV antihypertensives (1.1% vs. 13.7%, P<0.001), maternal fever (5.3% vs. 31.5%, P<0.001), fetal tachycardia (1.9% vs. 12.3%, P<0.001), and presence of meconium (30% vs. 8%, P<0.001). CONCLUSION: Identification of modifiable risk factors may reduce neonatal morbidity and mortality. Results from this study can be used to develop and validate a risk model based on combined antepartum and intrapartum risk factors.

Perinatal outcome in women with prolonged premature rupture of membranes at term undergoing labor induction.

PURPOSE: We aimed to evaluate perinatal outcome in women with prolonged (>24 h) premature rupture of membranes (PROM) undergoing induction of labor (IoL). METHODS: We retrospectively assessed all women presenting with term (≥37 weeks) PROM and Bishop-score <7 in a tertiary hospital (2012-14). Women without spontaneous onset of labor <24 h from PROM underwent Prostaglandin E2 (PGE2) IoL and were compared to women with low Bishop-score who developed spontaneous onset of labor <24 h. Women with IoL at <24 h from PROM, women presenting in active labor at admission or women who did not attempt vaginal delivery were excluded. RESULTS: Among 15,563 deliveries 1,171 (8.2 %) admitted with term PROM. Of them, 625 (53 %) were eligible; 155 (24.8 %) in the induction group and 470 (75.2 %) served as comparison group. No significant difference was found between the groups regarding maternal age, parity and obstetrical complications. Women in the induction group were at increased risk for Cesarean section (CS) (OR 8.27, CI 1.30-52.36, p = 0.025) and especially CS due to labor dystocia (2.97, 1.20-7.36, p = 0.018). The rate of neonatal complications was comparable between the groups. CONCLUSION: Women undergoing IoL for prolonged term PROM were at increased risk for CS compared to those with spontaneous onset of labor. However, neonatal outcome was comparable between the groups.

Risk Factors for Intraventricular Hemorrhage in Preterm Infants Born at 34 Weeks of Gestation or Less Following Preterm Premature Rupture of Membranes.

OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Related factors and adverse neonatal outcomes in women with preterm premature rupture of membranes complicated by histologic chorioamnionitis.

BACKGROUND: The aim of this study was to identify factors predicting histologic chorioamnionitis (HCA) in women with preterm premature rupture of membranes (PPROM). MATERIAL AND METHODS: We retrospectively enrolled 371 women diagnosed with PPROM at less than 34 weeks of gestation at the Second Affiliated Hospital of Wenzhou Medical University between January 2008 and December 2012. HCA was diagnosed by placental histopathology in 70% of participants. Binary logistic regression was used to identify factors associated with HCA and neonatal outcomes. RESULTS: Patient age, rate of parity, tocolysis, cesarean section, serum C reactive protein (CRP) level at admission, white blood cell count, and latency duration did not significantly differ between the 2 groups. Binary logistic regression revealed that oligohydramnios at admission, gestational age at PPROM, and serum CRP >8 mg/L before delivery were significantly associated with HCA. Gestational age at delivery and birth weight were significantly lower in HCA patients than control patients. The rate of 1-min Apgar score <7, abnormal neonatal intracranial ultrasound findings, neonatal pneumonia, bronchopulmonary dysplasia, early-onset neonatal sepsis, and mortality were higher in HCA patients, but no significant difference was observed in the incidence of neonatal respiratory distress syndrome, necrotizing enterocolitis, hyperbilirubinemia, or hypoglycemia. CONCLUSIONS: Younger gestational age at time of PPROM, higher CRP level before delivery, and oligohydramnios at admission in women with PPROM are associated with HCA, and HCA is associated with some adverse neonatal outcomes.

Complex and irregular heart rate dynamics in fetuses compromised by maternal anemia as a high-risk pregnancy.

AIM: To examine how complex and irregular fetal heart rate (FHR) dynamics differ between fetuses of normal pregnancies and those of pregnancies complicated by maternal anemia (MA), and to place this in the context of high-risk pregnancies. METHODS: Our study population consisted of 97 pregnant women affected by MA, 118 affected by pregnancy-induced hypertension (PIH), 88 affected by gestational diabetes mellitus (GDM), 53 with preterm premature rupture of membranes (pPROM), and 356 normal pregnancies as controls. We calculated approximate entropy (ApEn), sample entropy (SampEn), and correlation dimension (CD) to quantify irregularity and the chaotic dynamics of each FHR time series. RESULTS: The ApEn in the fetuses of the MA and PIH groups was significantly lower than that of the normal controls (P<0.05). The SampEn was significantly lower in the high-risk groups, except for the pPROM group, than in the normal controls (P<0.05). The CD in the PIH and severe MA groups was significantly lower than that of the normal controls (P<0.05, respectively). In the MA group, the dynamic indices showed a highly significant positive correlation with hemoglobin (Hb) levels (P<0.0001). CONCLUSION: The decreased complexity and/or irregularity in the FHR from pregnancies with MA may reflect abnormalities in the complex, integrated cardiovascular control. The irregularity and complexity of the FHR increased together with Hb levels in pregnancies with MA. Our data suggest that the integrity of the nervous system in the fetuses compromised by severe MA might result directly in adverse outcomes.

False vs True rupture of membranes.

New medical nomenclature: False rupture of membranes or False ROM and Double rupture of membranes or Double ROM are being introduced into the English language. A single caregiver found about 1% of term births and 10% of term PROM involved False ROM, in which the chorion breaks while the amnion remains intact. Diagnostically, if meconium or vernix is observed, then both the chorionic and amniotic sacs have broken. In the absence of detection of vernix or meconium, an immediate accurate diagnostic test for False ROM is lacking and differentiating between True ROM from False ROM is possible only after leaking stops, which takes hours to days. The obvious benefit of differentiating between 'True' and 'False' ROM, is that in the case of False ROM, the amnion is intact and ascending infections are likely not at increased risk, although research is lacking as to whether False ROM is associated with an increased rate of ascending infection. Three cases of False ROM are presented and avenues for future research are enumerated.

[PECULIARITIES OF THE COURSE OF PREGNANCY, THE IMPLICATIONS OF DELIVERY IN WOMEN WITH PREECLAMPSIA IN THE CONDITIONS OF NATURAL IODINE DEFICIENCY].

The level of preeclampsia in 2.2 times higher in mountain regions as compared with lowland. In the presence of concomitant pathology of the thyroid gland on a background of natural iodine deficiency in pregnancy complicated with recurrent pregnancy loss in 2.8 times more primary placental insufficiency in 3.6 times, oligohydramnios 1.5 times, premature rupture of the amniotic fluid in 1.9 times, anemia, preeclampsia develops at earlier periods of gestation and more difficult to correct medication, in most cases becomes more severe.

Uterine artery pseudoaneurysm manifesting as delayed postpartum hemorrhage after precipitous delivery: three case reports.

Precipitous delivery may lead to serious maternal and neonatal complications. Uterine artery pseudoaneurysm (UAP) is one of the causes of delayed postpartum hemorrhage. Here we describe 3 cases of UAP manifesting as delayed postpartum hemorrhage after precipitous delivery. The duration of the second stage of labor in cases 1, 2, and 3 was 15, 15, and 60 min, respectively. Excessive vaginal bleeding occurred 10, 9, and 31 days after delivery, respectively. Ultrasonogram and pelvic angiography revealed the UAP in each case and uterine artery embolization was performed. UAP may be a complication of precipitous delivery.

Significance of cervical ripening in pre-induction treatment for premature rupture of membranes at term.

AIM: This study aimed to determine whether mechanical cervical dilatation with a laminaria tent in women with premature rupture of membranes (PROM) at term may influence the maternal/neonatal outcomes. METHODS: We reviewed the medical records and histopathologic results of the placenta in 782 women with PROM at term. Of the 486 women seen prior to 2010 (group 1), 85 had Bishop scores of 5 or less and underwent insertion of laminaria tents (group A). In the 296 women admitted after 2010 (group 2), 27 had Bishop scores of 5 or less and underwent labor management without insertion of laminaria tents (group B). The patient characteristics, delivery course and neonatal outcomes were compared between the groups. RESULTS: There were no significant differences in the maternal age, percentage of nulliparas, body mass index, gestational age at delivery or Bishop score between the groups. The Bishop score improved from 2.5 to 6.1 after laminaria tent insertion in group A. However, there were no significant intergroup differences in the frequency of use of labor-inducing agents or the time interval from PROM to delivery. The incidence of clinical/pathological chorioamnionitis was not higher in group A than in group B. No significant differences were found in the Apgar scores, umbilical artery pH or frequency of asphyxia neonatorum between the groups. Mechanical cervical dilatation by laminaria tent insertion neither increased the incidence of infection nor contributed to improvement of the perinatal prognosis. CONCLUSION: Mechanical cervical dilatation does not provide any benefit for women with PROM at term.

Coitus to expedite the onset of labour: a randomised trial.

OBJECTIVE: To evaluate the effect of suggesting coitus as a safe and effective means to expedite labour on pregnancy duration and requirement for labour induction. DESIGN: A randomised trial. SETTING: Antenatal clinic in a university hospital in Malaysia. POPULATION: Women from 35 weeks of gestation with an uncomplicated singleton pregnancy. METHODS: The advise-coitus arm was counselled that coitus at term is a safe, natural and effective means to initiate labour and to avoid labour induction. The control arm was told coitus was safe. Both arms were asked to record coital activity. MAIN OUTCOME MEASURES: Pregnancy duration and labour induction. RESULTS: The intervention to delivery interval (mean ± SD) was 3.2 ± 1.4 versus 3.3 ± 1.3 weeks (P = 0.417), with a gestational age at delivery of 39.4 ± 1.2 versus 39.5 ± 1.2 weeks (P = 0.112), and with labour induction rates of 126/574 (22.0%) versus 120/576 (20.8%) (P = 0.666) for the advise-coitus and control arms, respectively, with no statistical difference between the groups. Coitus prior to delivery was more often reported in the advise-coitus arm compared with the control arm: 481/574 (85.3%) versus 458/576 (79.9%) (RR 1.5, 95% CI 1.1-2.0, P = 0.019). Also, the median (interquartile range) reported number of coital acts of 3 (2-5) versus 2 (1-4) (P = 0.006) was higher for the advise-coitus arm. Other pregnancy and neonatal outcomes did not differ between the groups. CONCLUSIONS: Labour onset and labour induction did not differ in the advise-coitus arm.

Preterm prelabour rupture of membranes: effect of latency on neonatal and maternal outcomes.

OBJECTIVES: To compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM). METHODS: 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 (< 24 hours, 24 hours to < 48 hours, 48 hours to < 7 days, and ≥ 7 days) and maternal and neonatal outcomes. Separate analyses were conducted for gestational age groups 24+0 to 33+6 weeks and 34+0 to 36+6 weeks. RESULTS: There were 4329 women included in the cohort. The composite variables representing serious maternal or neonatal infectious morbidity were not significantly associated with latency for either gestational age group. For PPROM occurring at gestational ages of 24+0 to 33+6 weeks, the odds of neonatal prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with < 24 hours latency. For PPROM at 34+0 to 36+6 weeks of gestation, the odds of prematurity-related morbidity at 48 hours to < 7 days latency was decreased compared with latencies < 24 hours (OR 0.4; 95% CI 0.2 to 0.8). CONCLUSION: Postponing delivery following PPROM may contribute to less 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.

Objectifs : Comparer les risques d'infection et les issues associées à la prématurité en fonction des périodes de latence chez les femmes qui présentent une rupture prématurée des membranes préterme (RPMP). Méthodes : Les femmes qui ont présenté une RPMP se manifestant entre 24+0 et 36+6 semaines de gestation ont été identifiées au sein d'une base de données périnatale en population générale provinciale, en Nouvelle-Écosse. Parmi les critères d'évaluation primaires, on trouvait des variables composites représentant la morbidité infectieuse maternelle et néonatale grave, et la morbidité néonatale liée à la prématurité. Une régression logistique a été utilisée pour quantifier la relation entre la période de latence (< 24 heures, de 24 heures à < 48 heures, de 48 heures à < 7 jours et ≥ 7 jours) et les issues maternelles et néonatales. Des analyses distinctes ont été menées pour ce qui est des groupes d'âge gestationnel allant de 24+0 à 33+6 semaines et de 34+0 à 36+6 semaines. Résultats : La cohorte comptait 4 329 femmes. Les variables composites représentant la morbidité infectieuse maternelle ou néonatale grave n'ont pas été associées de façon significative à la latence dans l'un ou l'autre des groupes d'âge gestationnel. Pour ce qui est de la RPMP se manifestant aux âges gestationnels situés entre 24+0 et 33+6 semaines de gestation, la probabilité d'une morbidité néonatale liée à la prématurité était considérablement amoindrie en présence de périodes de latence de 48 heures ou plus, par comparaison avec la latence < 24 heures. Pour ce qui est de la RPMP se manifestant aux âges gestationnels situés entre 34+0 et 36+6 semaines de gestation, la probabilité d'une morbidité liée à la prématurité en présence d'une période de latence se situant entre 48 heures et < 7 jours était amoindrie, par comparaison avec les latences < 24 heures (RC, 0,4; IC à 95 %, 0,2 - 0,8). Conclusion : Le report de l'accouchement à la suite d'une RPMP pourrait contribuer à amoindrir la morbidité liée à la prématurité, même près du terme, sans exposer la mère ou le nouveau-né à un risque substantiel de morbidité infectieuse grave. La généralisation de ces constatations à d'autres populations obstétricales devrait tenir compte du risque sous-jacent d'infection.