Ruptura prematura de membranas ovulares / Premature rupture of ovular membranes

La ruptura prematura de las membranas ovulares se define como la pérdida de la integridad del amnios y corion antes del inicio del trabajo de parto, afecta el 3 % de los embarazos, causa un tercio de los partos pretérminos, los cuales ocupan el 10,49 % de los nacimientos y es el origen de altos índices de morbimortalidad perinatal. En la actualidad, el manejo de esta patología se orienta principalmente en evitar los factores de riesgo, hacer un diagnóstico adecuado, determinar la edad gestacional en que ocurre, realizar el monitoreo exhaustivo del bienestar materno-fetal y en decidir el momento idóneo de finalización de la gestación para minimizar sus complicaciones. Debido a la compleja y lábil estructura histológica de las membranas ovulares, se ha dejado a un lado el tratamiento directo de la entidad el cual sería sellar o reparar el defecto en sí. En los últimos años, numerosos estudios y protocolos clínicos de prestigiosos centros asistenciales han servido como guía para el manejo de esta entidad, pero en muy pocos se observa una terapia destinada a la reparación de dichas membranas o en sellar tal defecto. Las evidencias científicas demuestran que la regeneración y reparación de las membranas es lenta y compleja y los tratamientos propuestos para reparar o sellar su defecto no han gozado de la aceptación científica para su aprobación, sin embargo, el uso del parche hemático transvaginal endocervical autólogo luce como una alternativa terapéutica prometedora(AU)

The premature rupture of the ovular membranes is defined as the loss of the integrity of the amnion and chorion before the on set of labor, affects 3% of pregnancies, causes athird of preterm births which occupy 10,49% of births and is the origin of high rates of perinatal morbidity and mortality. At present, the management of this pathology is mainly oriented towards avoiding risk factors, making an adequate diagnosis, determining the gestational age in which it occurs, carrying out exhaustive monitoring of maternal-fetal well-being and deciding the ideal moment to end the treatment. Pregnancy to minimizeits complications. Due to the complex and labile histological structure of the ovular membranes, the direct treatment of the entity has been set a side, which would be to seal or repairthe defect it self. In recent years, numerous studies and clinicalprotocols from prestigious health care centers have served as aguide for the management of this entity, but very few have observed a therapy aimed at repairing said membranes or sealing such a defect. Scientific evidence shows that the regeneration and repair of the membranes is slow and complex and the treatment sproposed to repair or seal their defect have not enjoyed scientific acceptance for their approval, how ever, the use of the autologous endocervical transvaginal blood patch looks like a promising therapeutic alternative(AU)

Exposición antenatal a contaminantes vehiculares y asociación con parto pretérmino en Colombia / Antenatal exposure to vehicular pollutants and association with preterm birth in Colombia

Objetivo: Determinar la asociación entre parto pretérmino y exposición prenatal de gestantes a emisiones vehiculares de material particulado menor de 10 micras y de monóxido de carbono, en una ciudad de Colombia, entre julio de 2014 y julio de 2015. Métodos: Estudio relacional, retrospectivo, de casos y controles, en el Hospital de Caldas de la ciudad de Manizales; en mujeres que asistieron para atención del parto. La exposición a emisiones vehiculares de material particulado menor de 10 micras y de monóxido de carbono, se determinó usando estimaciones previamente publicadas para la ciudad. El análisis estadístico se realizó en el aplicativo Jamovi ­ Stats Open Now. Se contó con el aval de los comités de ética de las instituciones implicadas. Resultados: Se analizaron 222 pacientes, 74 presentaron parto pretérmino (casos) y 148 parto a término (controles). No se encontró asociación estadísticamente significativa entre el desarrollo de parto pretérmino y los niveles de material particulado menor de 10 micras o de monóxido de carbono; no obstante, podría haber una asociación entre parto pretérmino y aseguramiento en salud, que no pudo establecerse por el tamaño de muestra pequeño. También se obtuvo el patrón espacial de los casos de parto pretérmino en la ciudad con base en la residencia habitual de las pacientes. Conclusión: Los contaminantes ambientales como el material particulado menor de 10 micras y el monóxido de carbono, pueden estar implicados en la presentación de parto pretérmino, sin embargo, se requieren más estudios que analicen esta asociación(AU)

Objective: To determine the association between preterm delivery and prenatal exposure of pregnant women to vehicular emissions of particulate matter smaller than 10 microns and carbon monoxide, in a city in Colombia, between July 2014 and July 2015. Methods: Relational, retrospective, case-control study at the Caldas Hospital in the city of Manizales; in women who attended delivery care. Exposure to vehicular emissions of particulate matter smaller than 10 microns and carbon monoxide was determined using previously published estimates for the city. The statistical analysis was carried out in the Jamovi ­ Stats Open Now application. It had the endorsement of the ethics committees of the institutions involved. Results: A total of 222 patients were analyzed, 74 presented preterm delivery (cases) and 148 term delivery (controls). No statistically significant association was found between the development of preterm labor and levels of particulate matter less than 10 microns or carbon monoxide; however, there could be an association between preterm delivery and health insurance, which could not be established due to the small sample size. The spatial pattern of cases of preterm delivery in the city was also obtained based on the habitual residence of the patients. Conclusion: Environmental pollutants such as particulate matter smaller than 10 microns and carbon monoxide may be involved in the presentation of preterm labor, however, more studies are required to analyze this association(AU)

Incidence, associated risk factors, and the ideal mode of delivery following preterm labour between 24 to 28 weeks of gestation in a low resource setting.

BACKGROUND: Preterm labour, between 24 to 28 weeks of gestation, remains prevalent in low resource settings. There is evidence of improved survival after 24 weeks though the ideal mode of delivery remains unclear. There are no clear management protocols to guide patient management. We sought to determine the incidence of preterm labour occurring between 24 to 28 weeks, its associated risk factors and the preferred mode of delivery in a low resource setting with the aim of streamlining patient care. METHODS: Between February 2020 and September 2020, we prospectively followed 392 women with preterm labour between 24 to 28 weeks of gestation and their newborns from admission to discharge at Kawempe National Referral hospital in Kampala, Uganda. The primary outcome was perinatal mortality associated with the different modes of delivery. Secondary outcomes included neonatal and maternal infections, admission to the Neonatal Special Care Unit (SCU), need for neonatal resuscitation, preterm birth and maternal death. Chi-square test was used to assess the association between perinatal mortality and categorical variables such as parity, mode of delivery, employment status, age, antepartum hemorrhage, digital vaginal examination, and admission to Special Care unit. Multivariate logistic regression was used to assess the association between comparative outcomes of the different modes of delivery and maternal and neonatal risk factors. RESULTS: The incidence of preterm labour among women who delivered preterm babies between 24 to 28 weeks was 68.9% 95% CI 64.2-73.4). Preterm deliveries between 24 to 28 weeks contributed 20% of the all preterm deliveries and 2.5% of the total hospital deliveries. Preterm labour was independently associated with gravidity (p-value = 0.038), whether labour was medically induced (p-value <0.001), number of digital examinations (p-value <0.001), history of vaginal bleeding prior to onset of labour (p-value < 0.001), whether tocolytics were given (p-value < 0.001), whether an obstetric ultrasound scan was done (p-value <0.001 and number of babies carried (p-value < 0.001). At multivariate analysis; multiple pregnancy OR 15.45 (2.00-119.53), p-value < 0.001, presence of fever prior to admission OR 4.03 (95% CI .23-13.23), p-value = 0.002 and duration of drainage of liquor OR 0.16 (0.03-0.87), p-value = 0.034 were independently associated with preterm labour. The perinatal mortality rate in our study was 778 per 1000 live births. Of the 392 participants, 359 (91.5%), had vaginal delivery, 29 (7.3%) underwent Caesarean delivery and 4 (1%) had assisted vaginal delivery. Caesarean delivery was protective against perinatal mortality compared to vaginal delivery OR = 0.36, 95% CI 0.14-0.82, p-value = 0.017). The other protective factors included receiving antenatal corticosteroids OR = 0.57, 95% CI 0.33-0.98, p-value = 0.040, Doing 3-4 digital exams per day, OR = 0.41, 95% 0.18-0.91, p-value = 0.028) and hospital stay of > 7 days, p value = 0.001. Vaginal delivery was associated with maternal infections, postpartum hemorrhage, and admission to the Special Care Unit. CONCLUSION: Caesarean delivery is the preferred mode of delivery for preterm deliveries between 24 to 28 weeks of gestation especially when labour is not established in low resource settings. It is associated with lesser adverse pregnancy outcomes when compared to vaginal delivery for remote gestation ages.

Factores de riesgo que inciden en la mortalidad neonatal en el Hospital Dr. León Becerra Camacho Del Cantón Milagro 2014-2017 / Risk factors that affect neonatal mortality in the Dr. León Becerra Hospital Camacho Del Cantón Milagro 2014-2017

Según la OMS, la mortalidad neonatal está asociada a factores que son de necesaria identificación para reducir la incidencia. El objetivo del trabajo es identificar los factores de riesgo que inciden en el evento. Se utilizó un diseño transversal, retrospectivo, descriptivo, cuantitativo, con una población de 74 neonatos que fallecieron en los servicios de neonatología del Hospital Dr. León Becerra Camacho 2014-2017. Los resultados arrojan que de los neonatos fallecidos, el mayor porcentaje es el sexo masculino, de madres con edades entre 21 y 35 años, donde la mayoría pertenecen a zonas urbanas con instrucción secundaria incompleta y dedicada a las labores del hogar. Como características maternas encontramos que la mayoría, fueron secundigestas, el 60.81% con controles mínimos, el 56,7% con parto vaginal. Las características Obstétricos encontradas revelan que el 67.5% tuvieron menos de 1-2 años de periodo intergenésico, el 100% presentaron Infecciones de vías Urinarias, 44.5% tuvieron Ruptura Prematura de Membrana, y desproporción cefálica con traumas obstétricas en un 33,7%. Como factores neonatales y fetales tenemos que el 51.3% fueron neonatos a Término con peso adecuado para edad gestacional, y el 51.3% tuvieron depresión severa y 44,5% con sufrimiento fetal, siendo la patología más frecuente la Asfixia en un 51,3% seguido del 33,7% de Membrana Hialina, y las comorbilidades más comunes son la acidosis metabólica en un 87.8%, seguidos de 48.6% con prematurez. Se propone fortalecer los protocolos para el manejo de la embarazada, que permitan mejorar la calidad de la atención, favoreciendo al binomio madre hijo(AU)

According to OMS, neonatal mortality is associated with factors that are necessary to identify the incidence. The objective of the work is to identify the risk factors that affect the event. It is a cross-sectional, retrospective, descriptive, quantitative design, with a population of 74 neonates who have fallen into the neonatology services of the Hospital Dr. León Becerra Camacho 2014-2017. The majority of people in urban areas with incomplete secondary education and dedicated to household chores. The maternal characteristics of the majority were secundigestas, 60.81% with minimal controls, 56.7% with vaginal delivery. The Obstetric characteristics revealed in 67.5% occurred during 1-2 years of the intergenesic period, 100% were published in Urinary Tract Infections, 44.5% were performed Premature Membrane Rupture, and the cephalic disproportion with obstetric traumas in 33.7%. As neonatal and fetal factors we have that 51.3% were Term neonates with adequate weight for gestational age, and 51.3% had a severe severity and 44.5% with fetal, the most frequent pathology being Asphyxia in 51.3% Following 33.7% of the Hyaline Membrane, and the most common Comorbidities in metabolic acidosis in 87.8%, followed by 48.6% with prematurity. It was proposed to strengthen protocols for the management of the pregnant woman, to improve the quality of care, favoring the child(AU)

Care Practices, Morbidity and Mortality of Preterm Neonates in China, 2013-2014: a Retrospective study.

This retrospective cohort study aimed to investigate the prevalence, morbidity, mortality and the maternal/neonatal care of preterm neonates and the perinatal risk factors for mortality. We included data on 13,701 preterm neonates born in 15 hospitals for the period 2013-2014 in China. Results showed a prevalence of preterm neonates of 9.9%. Most infants at 24-27 weeks who survived more than 12 hours were mechanically ventilated (56.1%). Few infants born before 28 weeks received CPAP without first receiving mechanical ventilation (8.1%). Few preterm neonates received antenatal steroid(35.8% at 24-27 weeks, 57.9% at 28-31 weeks, 57.0% at 32-33 weeks and 32.7% at 34-36 weeks). Overall mortality was 1.9%. Most of the deaths at 24-27 weeks of gestation occurred within 12 hours after birth, accounting for 68.1%(32/47), and within 12-72 hours after birth at 28-36 weeks of gestation, accounting for 47.4%(99/209). Rates of survival to discharge increased from 68.2% at 24-27 weeks, 93.3% at 28-31 weeks, 99.2% at 32-33 weeks to 99.4% at 34-36 weeks. The smaller of the GA, there was a greater risk of morbidities due to prematurity. Preterm birth weight (OR = 0.407, 95% CI 0.346-0.478), antenatal steroid (OR = 0.680, 95% CI 0.493-0.938), and neonatal asphyxia (OR = 3.215, 95% CI 2.180-4.741) proved to significantly influence the odds of preterm neonatal death. Overall, our results support that most of the preterm neonates at 28-36 weeks of gestation survived without major morbidity. Rate of survival of GAs less than 28 weeks was still low. Maternal and infant care practices need to be improved in the very preterm births.

Antenatal corticosteroids for low and middle income countries.

Antenatal corticosteroids (ACS) are sporadically used in low and middle income countries (LMIC), although their use is considered by the World Health Organization (WHO) as essential for decreasing infant mortality. Presently the WHO recommends the use of ACS only when gestational age is known, delivery is imminent, and the delivery will be in a facility that can provide care for the mother and the infant. We review uncertainties about ACS in high income countries that are underappreciated for anticipating their effectiveness in LMIC. We discuss the implications of a large RCT that evaluated the use of ACS in LMIC and found no benefit for presumed preterm infants and increased mortality in larger infants. The treatment schedules for ACS have not been optimized and more is now known about how to improve treatment strategies to hopefully decrease risks such as neonatal hypoglycemia in LMIC. The benefits from ACS may depend on the patient populations and health care environment in which the therapy is used. Further trials are needed to evaluate the safety and efficacy of ACS in LMIC.

Knot positioning during McDonald cervical cerclage, does it make a difference? A cohort study.

Objective: To study the effect of McDonald cerclage knot position on the different maternal and neonatal outcomes. Methods: This historical cohort study included women with singleton pregnancy who had a prophylactic McDonald cervical cerclage between 1 May 2010 and 31 September 2017. Maternal and neonatal outcome parameters were compared between the anterior and posterior knot cerclage procedures. The primary outcome measure was the rate of term birth. Results: 550 Women had a prophylactic McDonald cervical cerclage, 306 with anterior knot (Group A) and 244 with posterior knot (Group B). There were no statistically significant differences regarding gestational age (GA) at delivery (36.3 ± 4.2 versus 35.8 ± 5.3 for groups A and B respectively), term birth rate, post-cerclage cervical length, symptomatic vaginitis, urinary tract infection, difficult cerclage removal and cervical lacerations. Similarly, there were no statistically significant differences as regards the studied neonatal outcomes including take home babies, neonatal intensive care admission, respiratory distress syndrome and neonatal sepsis. Survival analysis on GA at delivery demonstrated no statistically significant difference as regards the proportion of term deliveries in the anterior and posterior knot cerclage groups (log-rank test p-value = .478). Conclusions: Knot positioning during McDonald cervical cerclage, anteriorly or posteriorly, didn't significantly impact the studied maternal and neonatal outcomes.

Delayed second twin delivery: benefits and risks.

BACKGROUND: An increasing number of reports describe the delayed second twin delivery for days, or weeks with good results in the majority of the cases, and different survival rate between centers, without reported randomized controlled trials (RCTs). OBJECTIVES: This study was designed to evaluate the suggested management of the delayed second twin delivery in the Sabah Maternity Hospital regarding its outcome, possible risks, and benefits. PATIENTS AND METHODS: Forty-seven twin pregnancies with preterm labor (PTL) of the first fetus between 20-30 weeks, and delayed delivery of the second twin were included in this study. Studied women signed informed consent about the possible risks of keeping the live fetus in the hostile intrauterine environment, and benefits of the prolonged gestation for the second twin. Throughout the conservative treatment of the second twin, the studied women were hospitalized with regular follow up for infections, consumptive coagulopathy parameters, and wellbeing of the second twin. RESULTS: There was significant difference in the gestational age at delivery between the first and second twin (22.6 ± 3.4 versus 34.3 ± 2.5 weeks; respectively, p = .01). There was significant difference in the birth weight between the first and second twin (435 ± 91.2 versus 1472 ± 61.5 g; respectively, p = .004). The rate of the cesarean delivery was significantly high during delivery of the second twin compared with the first twin (23.4% (11/47) versus 0% (0/47); respectively, p = .0001) with high survival rate for the second twin (85.1% (40/47)) after the delayed second twin delivery. CONCLUSIONS: The birth weight, the gestational age, and the survival rate of the studied second twin significantly increased after the suggested management of the delayed second twin delivery.

Resultados maternos y perinatales del manejo conservador de la rotura prematura de membranas en gestantes de 24 a 33 semanas / Maternal and perinatal outcomes of conservative management of premature rupture of membranes in pregnancies of 24-33 weeks

Introducción. El parto prematuro es la causa principal de morbilidad y mortalidad neonatales. Objetivo. Determinar los resultados maternos y perinatales del manejo conservador de la ruptura prematura de membranas pretérmino en gestantes de 24 a 33 semanas, en el período 2010-2011, en el Instituto Nacional Materno Perinatal (INMP). Material y método. Estudio no experimental, observacional, retrospectivo, transversal, descriptivo desarrollado en el INMP. La población estuvo compuesta por gestantes pretérmino con ruptura prematura de membranas. Se recolectó datos registrados en las historias clínicas. Resultados. Fueron 142 casos los que culminaron el parto por cesárea (71,8 %), con edad de 26,36 ± 7,418 años. Las nulíparas fueron más frecuentes (45,8 %). La edad gestacional promedio fue 29,06 ± 2,590 semanas; el control prenatal promedio, 2,35 ± 2,101; el período de latencia promedio, 10,68 ± 12,305 días. Hubo resultados maternos en 34,5 % (49 casos), donde la coriamnionitis fue el más frecuente (23,9 %). Hubo resultados perinatales en 32,4 % (46 casos), donde el síndrome de dificultad respiratoria fue el más frecuente (21,8 %). El peso promedio al nacer fue de 1 653,14 g ± 460,219 g. La mayoría de los recién nacidos pretérminos al nacer tuvieron buen Apgar. El promedio de días de internamiento de la madre fue de 15,30 días ± 12,912. Conclusiones. La coriamnionitis y el síndrome de dificultad respiratoria fueron los resultados maternos y perinatales más frecuentes.

Introduction. Preterm birth is the leading cause of neonatal morbidity and mortality. Objectives. Determine maternal and perinatal outcomes of conservative management of preterm premature rupture of membranes in pregnancies of 24-33 weeks in the period 2010-2011. Material and method. Non-experimental, observational, retrospective, cross-sectional, descriptive from National Institute Maternal Perinatal. Pregnancies with preterm premature rupture of membranes. I collect it of data from medical records. Results. There were 142 cases, the culmination of the delivery via was the cesarean (71,8 %), the mean age was 26,36 + 7,418 years. The nulliparous were more frequent 45,8 %. The mean gestational age was 29,06 + 2,590 weeks. The mean birth control was 2,35 + 2,101. The mean latency period was 10,68 + 12,305 days. Maternal outcomes were 34,5 % (49 cases) where the chorioamnionitis was most frequent 23,9 %. Perinatal outcome was 32,4 % (46 cases) where respiratory distress syndrome was the most frequent 21,8 %. The mean birth weight was 1 653,14 g + 460,219. Most preterm infants had good Apgar scores at birth. The mean days of hospitalization of the mother were of 15,30 days + 12,912. Conclusions. The chorioamnionitis and respiratory distress syndrome were the maternal and perinatal outcomes more frequent.

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

OBJECTIVE: To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. DESIGN: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. SETTING: A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. SAMPLE: A total of 314 623 pregnant women admitted to the participating facilities. METHODS: We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. MAIN OUTCOME MEASURES: Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. RESULTS: Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1). CONCLUSIONS: Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes.

Predição e prevenção do parto pré-termo espontâneo / Prediction and prevention of spontaneous preterm birth

A incidência de parto pré-termo varia de 7-12% de todas as gestações e o nascimento prematuro é das principais causas de morbimortalidade neonatal, responsável por mais de três quartos das mortes neonatais, quando malformações congênitas são excluídas. Várias estratégias são adotadas com o objetivo de reduzir as taxas de partos prematuros, incluindo a identificação de fatores de risco e o uso profilático de progesterona. Destacam-se, entre as principais ações da progesterona, o efeito relaxante sobre a musculatura uterina, a capacidade de bloquear os efeitos da ocitocina, o efeito anti-inflamatório e imunossupressor. O uso de progesterona exógena reduz as taxas de prematuridade em pacientes com risco de parto prematuro, tal como história prévia de parto prematuro, e colo uterino curto demonstrado pela ultrassonografia transvaginal no segundo trimestre de gestação. Esta revisão objetiva, inicialmente, evidenciar aspectos importantes a serem abordados na assistência ambulatorial e, posteriormente descrever as principais ações preditivas e preventivas do nascimento prematuro disponíveis na assistência obstétrica.

Incidence of preterm delivery ranges from 7-12% of all gestations and premature birth is one of the main causes for newborn morbimortality. It is responsible for over three quarters of neonatal deaths, minus congenital malformations. Several strategies can be adopted to reduce premature delivery rates, including risk factor identification and prophylactic use of progesterone. Among the main actions of progesterone is its relaxingeffect upon uterine muscles, the ability to block the effects of cytokin, and its antiinflammatory and immunosuppresive effects. The use of exogenous progesterone reduces the rates of prematurity for patients under risk of premature delivery, such as those with a history of premature deliveries, and short cervix as revealed by transvaginal ultrasound in the second quarter of pregnancy. This review aims to highlight important aspects tobe considered in the outpatient clinic and describe the main predictive and preventive actions of premature birth available in obstetric care.

Histological chorioamnionitis: effects on premature delivery and neonatal prognosis.

BACKGROUND: Chorioamnionitis is closely related to premature birth and has negative effects on neonatal morbidity and mortality. METHODS: In this prospective study, 43 mothers who delivered earlier than 35 gestational weeks and their 57 infants were evaluated clinically and with laboratory findings. Placentas and umbilical cords were investigated histopathologically for chorioamnionitis and funisitis. RESULTS: The overall frequency of clinical and histological chorioamnionitis (HCA) was 8.3% and 23.2%, respectively. The frequency of HCA was 47.3% and 83.3% in mothers delivered <32 weeks and <30 weeks, respectively. Maternal demographic and clinical findings and also leukocyte and C-reactive protein values were not indicative of HCA. Infants of mothers with HCA had significantly lower Apgar scores together with higher SNAP-PE-II and CRIB scores. These infants had increased mechanical ventilator and surfactant requirements, higher incidences of patent ductus arteriosus, early sepsis, and bronchopulmonary dysplasia, and higher mortality rates. The effect of HCA on neonatal morbidity and mortality was more prominent than the effect of low birthweight and lower gestational age. CONCLUSION: Chorioamnionitis not only causes premature deliveries, but is also associated with neonatal complications and increased mortality. Clinical findings and infectious markers in mother or infant do not predict the diagnosis of histological chorioamnionitis. Therefore, placental histopathology may have a role in predicting neonatal outcome in premature deliveries, especially those below 30 weeks.

The prevention, diagnosis and treatment of premature labor.

BACKGROUND: The percentage of preterm births in Germany is high at 9%, but stable. 77% of cases of perinatal death are in prematurely born infants. Intensive research efforts are being directed toward the development of new means of primary and secondary prevention, diagnostic assessment, and pharmacotherapy of premature labor. METHODS: We review pertinent publications that were retrieved by a selective search of the literature from 1966 to 2012, including current meta-analyses from the Cochrane database and the guidelines of German and foreign obstetric societies. RESULTS: Preterm labor is a multifactorial problem. The current treatment options are symptomatic, rather than causally directed. Preventive treatment with progesterone can lower the rate of preterm birth in high-risk groups by more than 30%. Transporting the pregnant women to an appropriately qualified perinatal care center and induction of fetal lung maturation lowers perinatal mortality. A variety of tocolytic drugs with different mechanisms of action (betamimetics, oxytocin antagonists, calcium-channel blockers, NO donors, and inhibitors of prostaglandin synthesis) can be used for individualized tocolytic treatment. Premature rupture of the membranes is an indication for antibiotics. CONCLUSION: The goal of all attempts to prevent and treat preterm labor is to improve preterm infants' chances of surviving with as few complications as possible. The methods discussed here can be used to prolong pregnancies at risk for preterm labor and so to reduce perinatal morbidity and mortality.

Complications in premature labor between severe preeclampsia and normal pregnancies.

Severe Preeclampsia may lead to liver and renal failure, Disseminated Intravascular Coagulopathy (DIC) and Central Nervous System (CNS) abnormalities. This study aimed at comparing of infant complication in premature labor between severe preeclampsia and normal pregnancies. In this analytical-descriptive study, one hundred pregnant with severe preeclampsia and premature delivery due to severity of preeclampsia were compared with one hundred cases of premature delivery without preeclampsia to study neonatal fate. The understudy subjects were divided into five age groups of 27-28, 29-30, 31-32, 33-34, 35-36 weeks considering type of delivery, neonate features and neonatal complications related to premature delivery. Mean age of mothers of normal delivery group was 27.28 +/- 5.42 mean age of mothers of the second group was 30.56 +/- 5.86. There was statistically meaningful difference between two groups of delivery regarding patients' systolic blood pressure (p < 0.001). The study made it clear that there was not statistically meaningful difference between two groups of delivery regarding fetus age (in weeks) at the time of delivery (p = 0.456). According to findings of this study, neonatal complications and mortality is high in preeclampsia due to stressful conditions created for the fetus.

Perfil epidemiológico y factores de riesgo en recien nacidos prematuros, Hospital Regional, Gracias, Lempira / Epidemiology and risk factors in preterm newborns, Regional Hospital, Gracias, Lempira

Antecedentes: El parto prematuro está dentro de las principales causas de muerte neonatal a nivel mundial siendo, los prematuros vulnerables a la sepsis y sus complicaciones, generando un gran impacto a la salud, economía y la educación del país. Por lo que se planteó realizar este estudio con el objetivo de conocer la caracterización epidemiológica y factores de riesgo en recién nacidos prematuros atendidos en el Hospital Dr. Juan Manuel Gálvez, Gracias, Lempira, Honduras, 2011. Materiales y método: Estudio analítico retrospectivo de casos y controles; se realizó búsqueda de expedientes en el departamento de estadística del Hospital Juan Manuel Gálvez de enero a junio de 2011, por cada caso se tomaron dos controles de manera aleatoria; se utilizó el programa Epi Info 3.5.3 en donde analizamos medidas de frecuencia absoluta, tendencia central, razones, proporciones para las características epidemiológicas y, Odds Ratio e intervalo de confianza al 95%, para los factores de riesgo, tablas y gráficos se utilizó el programa Microsoft Excel 2010. Resultados: se incluyeron 29 casos de prematurez y 58 controles, encontrándose significancia estadística, sólo en las siguientes variables maternas: edad menor de 18 años OR 4,71(IC95% 1.40 -16.2), periodo intergenésico menor o igual a 2 años OR 5,8 (IC95% 1,03-35,07); madre con 4 o menos controles prenatales OR4,05 (IC95% 1,22-13.91), infección del tracto urinario OR 4,77 (IC95% 1,25-18.99), patología materna durante el embarazo, OR 3,99 (IC95%1,35-12,00) y anemia OR 17,5 (IC95% 3,08-129,90). Discusión: La determinación de los factores de riesgo de prematuridad constituye el primer paso para su prevención en una población determinada, a través de los resultados de este estudio se puede concluir que los factores fetales como el sexo masculino, presencia de malformaciones congénitas o productos de embarazo múltiple están relacionados al riesgo de prematurez y que los factores maternos como el embarazo...

Factores asociados al parto prematuro en el departamento de Lempira, Honduras / Associated risk factors with preterm delivery at Lempira, Honduras

Antecedentes: Mundialmente, entre 8 y 10% de partos son prematuros. La Organización Mundial de la Salud estimó para Honduras en 2010 que el 12% de los partos serían prematuros. En el Departamento de Lempira, durante el 2009 el 41% de muertes neonatales fueron atribuidas a la prematurez. Objetivo: Identificar factores asociados al parto prematuro. Pacientes y métodos: Estudio de cohorte prospectivo, realizado en el departamento de Lempira, occidente de Honduras, la muestra fue de 367 mujeres embarazadas seleccionadas de un universo de 8,148 reportadas por 87 centros de salud. Se seleccionaron embarazadas con fecha de última menstruación conocida y con fecha de parto en 2010. Definiendo parto prematuro al ocurrido entre las 22 y 36 semanas gestacionales; parto a término al ocurrido a las 37 o mas semanas gestacionales. Se obtuvo datos de la historia clínica y entrevista a las mujeres. Se calculó medidas de tendencia central y de asociación (riesgo relativo RR) con intervalos de confianza al 95% (IC95%), usando Epi info version 3.5.3. Resultados:De 367 embarazadas seleccionadas, se conoció el descenlace en 358 (98%). Ocurrieron partos prematuros en 27/358 (7.5%) rango 0-20 en los municipios. 284/358 (80%) fueron partos institucionales, 22/284 (8%) de ellos prematuros. El tener bacteriuria (RR=3.21; 95%CI 1.00- 10.28), < 3 atenciones prenatales (RR=2.59; IC95%=1.20-5.60, p <0.02) y > 4 hijos (RR=2.38; IC95%=1.14-4.97, p <0,02) fue asociado con parto prematuro. Conclusiones: El parto prematuro en el Departamento de Lempira esta asociaciado con bacteriuria, pocas atenciones prenatales y multiparidad, observando variaciones entre municipios. Para reducir partos prematuros, se ha monitorizado la cantidad y calidad de atenciones prenatales y focalizando la oferta de métodos de planificación familiar en multíparas. Se Recomienda realizar estudios en municipios con altas tasas de parto prematuro...