Maternal obesity and the risk of fetal acidosis at birth.

BACKGROUND: Maternal obesity is a risk factor for multiple obstetrics complications and adverse outcomes. The objective of the study was to investigate the association between obesity (IMC >30) and fetal acidosis at birth. METHODS AND FINDINGS: This hospital-based cohort study was based on 24,307 live-born infants in which maternal body mass index (BMI) information was available and delivered in the Granada north region during 2007-2018 from data of the Hospital Medical Birth Registry. Multivariate using logistic regression was performed to assess the association between fetal acidosis and BMI, crude, and adjusted odds ratio of fetal acidosis were calculated. p < .05 was considered statistically significant. We adjusted by maternal age, parity, hypertension, diabetes, and smoking habits. In the study population of 17,167 term live births, 518 infants (3.02%) had an umbilical cord blood pH < 7.10. The obesity rate in mothers with acidosis at delivery was 12.7%, but morbid obesity rate was 2.51% (adjusted OR 1.82). CONCLUSION: This study strengthens the evidence that demonstrates that morbid obesity is an independent risk factor for fetal acidosis at birth.

Resultados obstétricos en gestantes diagnosticadas de síndrome antifosfolípido / Obstetric outcomes in pregnant women diagnosed of antiphospholipid syndrome

INTRODUCCIÓN: El síndrome antifosfolípido (SAF) es una enfermedad autoinmune caracterizada por la aparición de trombosis, complicaciones obstétricas y la presencia de anticuerpos antifosfolípidos. El objetivo de este estudio fue evaluar los resultados obstétricos en gestantes diagnosticadas de síndrome antifosfolípido, así como evaluar las condiciones que podrían influir en estos resultados. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de gestantes con diagnóstico previo de SAF, que fueron atendidas en nuestro centro entre los años 2007 y 2017. RESULTADOS: En el período de estudio se recogieron 35 gestantes con SAF, con un total de 50 gestaciones. Se empleó heparina en el 100% de las gestaciones y ácido acetilsalicílico en el 96%. La aparición de alguna complicación obstétrica ocurrió en el 34% de las gestaciones estudiadas. El perfil de anticuerpos triple positivo se asoció a mayor porcentaje de partos prematuros. La presencia de anticoagulante lúpico de forma aislada no se asoció a peores resultados obstétricos. DISCUSIÓN: La gestación en la mujer con SAF supone un importante reto, que precisa de un manejo multidisciplinar por parte del obstetra y el reumatólogo. Por otro lado, el perfil de anticuerpos antifosfolípidos podría detectar a las pacientes con mayor riesgo con el fin de adecuar el tratamiento y mejorar los resultados obstétricos.

INTRODUCTION: The antiphospholipid syndrome (APS) is an autoinmune disease characterized by the occurence of thrombosis, obstetric morbidity and the presence of antiphospholipid antibodies. The aim of this study was to evaluate the obstetric outcomes in pregnant women diagnosed of antiphospholipid syndrome, as well as examine the conditions which may influence in those results. MATERIALS AND METHODS: A retrospective study was undertaken with pregnant women diagnosed of APS, who were attended in our hospital between 2007 and 2017. RESULTS: During the period of study 35 patients with APS and a sum of 50 pregnancies were gathered. Heparin was used in all pregnancies and acetylsalicylic acid in 96%. Any adverse obstetric outcome occurred in 34% of the pregnancies in the study. The triple positivity of antiphospholipid antibodies was associated to higher percentage of premature deliveries. The lupus anticoagulant alone was not related to worse obstetric outcomes. CONCLUSIONS: Pregnancy in APS patients means a challenge, requiring a multidisciplinary management by Obstetricians and Rheumathologists. On the other hand, the antiphospholipid antibodies profile could help to recognize those patients at risk, in order to adequate treatment and improve obstetric results.

CORRIGENDUM TO: "Preterm birth and/or low birth weight are associated with periodontal disease and the increased placental immunohistochemical expression of inflammatory markers".

This correct the article DOI: 10.14670/HH-11-671.

Correction to: Relationship between periodontal parameters and plasma cytokine profiles in pregnant woman with preterm birth or low birth weight.

The authors are correcting this article because they accidentally included some wrong data in the analysis.

An integrated model with classification criteria to predict vaginal delivery success after cesarean section.

Background: Cesarean delivery (CD) is the most frequently performed surgical procedure worldwide. Trial of labor after cesarean (TOLAC) is associated with an increase in perinatal complications related to uterine rupture. However, in general, vaginal birth after cesarean (VBAC) is considered safe and women have less morbidity than those who undergo an elective repeat CD.Objective: To develop an integrated model with the best performance criteria for predicting vaginal delivery success after CD.Study design: Retrospective observational study including 2367 women who underwent a TOLAC. A predictive model using classification and regression tree modeling was constructed to predict vaginal delivery using maternal demographic, medical history, and labor predictors.Results: Vaginal delivery was best predicted by spontaneous onset of labor, estimated fetal weight <3775 g, maternal body mass index <25, previous CD as an elective or for fetal distress reasons, and interdelivery interval <2290 days. The algorithm showed a sensitivity of 75%, a specificity of 53%, and the area under the curve was 0.69.Conclusions: The classification and regression tree algorithm can be used to develop a predictive model for the success of TOLAC.

Maternal obesity and the risk of group B streptococcal colonisation in pregnant women.

The aim of the study was to test if maternal obesity and being overweight are independent risk factors for rectovaginal Group B Streptococcus (GBS) colonisation in pregnancy and for early onset GBS disease in the neonate. A case-control study of 9877 deliveries was conducted. The obese gravidas were significantly more likely to be colonised by GBS when compared with non-obese gravidas (22.7% versus 17.5%, P < .001). Obese gravidas were still 33% more likely than non-obese women to test positive for GBS after adjusting for the perinatal factors (adjusted OR 1.33 [95% CI 1.12-1.56]). The risk of early onset GBS disease was not calculated due to its very low incidence. The conclusion is that maternal obesity is a significant risk factor for GBS colonisation at term. Impact statement What is already known on this subject? Group B Streptococcus (GBS) is as an important cause of perinatal mortality and morbidity if prophylaxis is not performed. Intrapartum antibiotics are given if the carrier status is positive or unknown, provided that the risk factors are present. What do the results of this study add? Maternal obesity is a significant and independent risk factor for GBS colonisation at term. What are the implications of these findings for clinical practice and/or further research? Maternal obesity may be considered as a risk factor that should be taken into account in strategies for reducing GBS disease in neonates.

Cardiotocography alone vs. cardiotocography with ST segment analysis for intrapartum fetal monitoring in women with late-term pregnancy. A randomized controlled trial.

OBJECTIVES: Randomized studies have obtained conflicting results regarding the usefulness of fetal electrocardiographic (ECG) ST-segment analysis, possibly because these studies included non-homogeneous populations. We designed a study to determine whether this monitoring technique is potentially useful for populations at risk for fetal heart rate alterations during labor, i.e. groups of women who share late-term pregnancy as a risk factor. STUDY DESIGN: This randomized clinical trial recruited women whose pregnancy had lasted more than 290 days. The participants were randomly assigned to continuous fetal cardiotocographic monitoring alone (CTG group) or with fetal ECG ST-segment analysis (ECG-F group). In the CTG group fetal heart rate was interpreted according to guidelines from the National Institute of Child Health and Human Development, whereas in the ECG-F group the tracings were interpreted according the original International Federation of Gynecology and Obstetrics (FIGO) guidelines. The primary outcome measure was neonatal outcome, evaluated as arterial blood pH in neonates after abdominal or vaginal operative delivery indicated because of nonreassuring fetal status. RESULTS: A total of 237 women were randomized, of whom 200 were included in the final analysis (100 in each group). The rate of cesarean delivery was the same in both groups (26%), and the rate of operative delivery due to nonreassuring fetal status did not differ significantly (38% in the CTG group vs. 39% in the ECG-F group). Regarding neonatal outcomes, there was no significant difference between groups in neonatal pH (7.27 [7.23-7.29] and 7.25 [7.21-7.27]). CONCLUSIONS: In a population comprising only late-term pregnancies, fetal ECG monitoring had no benefits for the mother or fetus. Additional studies are needed of protocols for using ST waveform analysis in selected population groups.

Detection of bacterial pathogens in sterile fluids with the FilmArray Meningitis/Encephalitis identification system / Detección de patógenos bacterianos en líquidos estériles con el sistema de identificación FilmArray Meningitis/Encefalitis

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Association of periodontitis with preterm birth and low birth weight: a comprehensive review.

It is estimated that six million perinatal deaths occur every year worldwide, with premature birth being the main cause. Scientific evidence has shown that there is an association between periodontal health during pregnancy and adverse outcomes of labor, although interventional studies based on the treatment of periodontitis have failed to document an impact on reducing the incidence of preterm birth (PB) or low birth weight (LBW). Two pathogenic mechanisms have been proposed to explain this association. The direct pathway is based on the presence of gram-negative anaerobic bacteremia originating in the gingival biofilm, whereas the indirect pathway involves the production of pro-inflammatory markers which enter the bloodstream from the gingival submucosa. The result is the same: the development of an immune inflammatory response and/or the local suppression of growth factors in the fetal-placental unit, which in turn triggers labor. In the present review, we describe current concepts pertinent to PB and LBW, chronic and aggressive periodontitis, and the most frequent aspects of periodontal pathology during pregnancy. We evaluate the scientific evidence available to date, and offer a detailed description of the two pathways proposed to explain the association of maternal periodontitis with preterm and LBW delivery.

Risk of recurrence of small-for-gestational-age foetus after first pregnancy.

The aim of this study was to assess the incidence of and to analyse factors related to the recurrence of small-for-gestational-age (SGA) neonates in the second pregnancy. A prospective observational study was conducted at a tertiary university hospital in Granada, Spain. A total of 7896 women who delivered their first and second singleton pregnancies at the hospital from 2003-2013 were included and evaluated all birth weights. Women whose first pregnancy was complicated by a SGA birth had a fivefold increased risk of recurrence (23.6% vs. 5.7%, p < .001). Multivariate analyses revealed that only SGA at first birth retained a statistically significant relationship, revealing that the other variables (maternal age, gestational age, interdelivery interval, maternal pre-pregnancy body mass index, occupation of the mother, smoking, hypertension, and diabetes mellitus) were confounders. Prevention of SGA in subsequent pregnancies by modification of established risk factors could be of limited utility based on the present results, supporting a genetic contribution to SGA recurrence. Impact statement The results support a genetic contribution on recurrence of SGA.

Relationship between periodontal parameters and plasma cytokine profiles in pregnant woman with preterm birth or low birth weight.

OBJECTIVES: The aim was to determine whether clinical periodontal parameters are associated with plasma anti- and/or pro-inflammatory cytokines in pregnant woman with preterm birth (PB) or low birth weight (LBW) neonates. MATERIALS AND METHODS: An observational case-control study was performed in 131 puerperal women: mothers of PB/LBW neonates (cases, n = 67) and mothers of full-term normal-weight neonates (controls, n = 64). Sociodemographic and periodontal data was gathered from all participants, and interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-17, IL-23, and tumor necrosis factor alpha (TNF-α) were determined in plasma. RESULTS: In multiple linear regression models, clinical attachment loss was associated with TNF-α (0.28 ± 0.14; 95% confidence interval (CI) [0.006, 0.553]) and IL-1ß (0.43 ± 0.21; 95%CI [0.018, 0.842]), independent of group membership. IL-1ß (-1.67 ± 0.27, 95%CI [-2.199, -1.141]), IL-6 (-0.86 ± 0.27; 95%CI [-1.389, -0.331]), and IL-8 (-3.84 ± 0.50, 95%CI [-4.820, -2.860]) were lower, and IL-10 (0.86 ± 0.26; 95%CI [0.350, 1.370]) was higher in cases versus controls after adjusting for potential confounders. CONCLUSIONS: Clinical attachment loss was associated with plasma TNF-α and IL-1ß levels. No plasma cytokine profiles suggestive of systemic inflammatory response were observed in the pregnant women with PB/LBW neonates. CLINICAL RELEVANCE: Clinical attachment loss, as the main periodontal measure, is associated with TNF-α and IL-1ß plasma levels in pregnant women. No relationship was found between PB/LBW and the markers of systemic inflammatory response assessed in this study.

Preterm birth and/or low birth weight are associated with periodontal disease and the increased placental immunohistochemical expression of inflammatory markers.

UNLABELLED: The objective of this study was to determine whether gynecological and periodontal clinical parameters and the immunohistochemical expression in placental chorionic villi of the markers cyclooxygenase-2 (COX-2), interleukin (IL)-1ß, vascular endothelial growth factor receptor 1 (VEGFR1), podoplanin, and Heat Shock Protein 70 (HSP70) are associated with preterm birth (PB) and/or low birth weight (LBW) neonates. MATERIAL AND METHODS: An observational case-control study was performed in 130 puerperal women: mothers of PB/LBW neonates (cases, n=65) and mothers of full-term normal-weight neonates (controls, n=65). Data were gathered from all participants on socio-demographic, gynecological, and periodontal variables and on placental immunohistochemical COX-2, IL-1ß, VEGFR1, podoplanin, and HSP70 expression. RESULTS: Among the 42 women with mild/moderate periodontitis or gingivitis, the studied periodontal variables were significantly worse and the placental COX-2 (p=0.043), HSP70 (p=0.001), IL-1ß (p=0.001), VEGFR1 (p=0.032), and podoplanin (p=0.058) expressions were significantly higher in the cases than in the controls. In comparison to the mothers without periodontitis, only COX-2 (p=0.026) and VEGFR1 (p=0.005) expressions were significantly increased in those with the disease. Increased COX-2 values were detected in the women with a history of genitourinary infection (p=0.036), premature rupture of membrane (p=0.012), or drug treatment (p=0.050). CONCLUSIONS: The etiology of preterm birth and/or low birth weight is multifactorial and involves consumption habits, social-health factors, and infectious episodes. These adverse pregnancy outcomes were associated with periodontitis and the increased placental expression of IL-1ß, COX-2, VEGFR1, and HSP70.

Bakri balloon for the management of postpartum hemorrhage.

The aim of this study was to evaluate the effectiveness of the Bakri balloon in treating postpartum hemorrhage refractory to medical treatment. This retrospective study included 24 women with postpartum hemorrhage treated with a Bakri balloon as a conservative therapeutic option. The Bakri balloon was successful in controlling hemorrhage in 87.5% of the women. It was effective in all women with vaginal delivery (five of five) and in all women with uterine atony who did not respond to medical uterotonic treatment (eight of eight). Its ease of use and high effectiveness make the Bakri balloon a useful approach for the conservative management of acute postpartum hemorrhage. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures.

Are periodontal bacterial profiles and placental inflammatory infiltrate in pregnancy related to birth outcomes?

BACKGROUND: The aim of this study is to determine whether periodontal clinical parameters, periodontal bacterial profiles, and inflammatory infiltrate in placental chorionic villi are associated with adverse pregnancy results. METHODS: The authors designed an observational case-control study in 244 postpartum females: mothers with preterm/low-birth weight newborns (n = 91 cases) and mothers with full-term, normal-weight infants (n = 153 controls). Sociodemographic, gynecologic, and periodontal variables were gathered for all participants. Data on placental inflammatory infiltrate in biopsies from 68 cases and 65 controls and the gingival bacterial profile in mothers with periodontitis were gathered, detecting associations with bivariate analyses and constructing a multiple logistic regression model with the number of positive inflammatory cells as the dependent variable. RESULTS: Periodontal values were significantly worse in cases versus controls. Numbers of leukocyte subsets per square millimeters in maternal and fetal vascular spaces were similar between cases and controls. CD45 in maternal placental space was related to the presence of periodontitis (P = 0.029) but not to case or control group (P = 0.264). The anaerobic and commensal bacterial profile in mothers with periodontitis was similar between the groups. CONCLUSIONS: Periodontal disease was more severe and a periodontitis diagnosis more frequent in mothers with preterm or low-birth weight versus normal delivery. No differences in anaerobic or commensal bacterial profile were found between mothers with periodontitis in the two groups. Local placental factors, such as the nature of the inflammatory infiltrate and slightly higher expression of cyclooxygenase-2 in the females with these adverse pregnancy outcomes, may be related to a subclinical proinflammatory status that could contribute to triggering premature labor.

Fetal sex and perinatal outcomes.

OBJECTIVE: To evaluate the relationship of fetal sex with obstetric risk factors and perinatal outcomes. MATERIAL AND METHODS: Retrospective study of deliveries during 2003-2009 at a tertiary hospital based on the analysis of obstetric and neonatal risk variables according to neonatal sex. RESULTS: Of the 29,530 deliveries studied, the neonate was a boy in 15,038 (50.92%) and a girl in 14,492 (49.08%). The rates of gestational diabetes, prematurity, true umbilical cord knot and nuchal cord were higher for male newborns, whereas the rate of echographic diagnosis of intrauterine fetal growth retardation was higher for female newborns. Mothers of male fetuses had higher rates of cesarean delivery and instrumental vaginal delivery. The indication for ending labor due to the non-reassuring fetal heart rate was also more frequent among male newborns. This group had higher rates of acidemia, although there were no significant differences between sexes in other short-term neonatal outcomes. In all subgroups analyzed here, fetal weight was higher in male newborns. CONCLUSIONS: Male sex is an independent risk factor for unfavorable outcomes of pregnancy and delivery.

Effectiveness of pulse oximetry versus fetal electrocardiography for the intrapartum evaluation of nonreassuring fetal heart rate.

OBJECTIVES: To compare the effectiveness of pulse oximetry and fetal electrocardiography in the management of labor with nonreassuring fetal heart rate (NRFHR). STUDY DESIGN: This randomized experimental study consisted of two arms. In group 1 we used pulse oximetry and in group 2 we used STAN® technology. The participants in each group were 90 pregnant women with a full-term singleton fetus in cephalic presentation and cardiotocographic tracings compatible with NRFHR. We compared the following variables: rate of cesarean delivery, indications for operative delivery due to NRFHR, and repercussions on the newborn's acid-base status. RESULTS: The two groups differed significantly in the mode of delivery, with a cesarean delivery rate of 47.6% in group 1 vs. 30% in group 2 (p=0.032). The groups did not differ in the indications for ending labor due to NRFHR (62% vs. 61%, NS). In terms of neonatal outcomes, the 1-min Apgar score was 6 or lower in 17.8% of the group 1 neonates vs. 4.44% of the group 2 neonates (p<0.001). The groups also differed significantly in umbilical cord vein pH (7.23 vs. 7.27) and pCO2 (57.27 vs. 46.86) at birth. CONCLUSIONS: Fetal electrocardiography with the STAN® 21 system was more effective in detecting good fetal status and thus in identifying cases in which labor could proceed safely. Intrapartum surveillance with the STAN® 21 system reduced the rate of emergency cesarean delivery.

Marcadores serológicos en gestantes inmigrantes y autóctonas en Granada / Serological markers in immigrant and Spanish pregnant women in Granada

Introducción La inmigración femenina a España desde países menos desarrollados se ha incrementado en los últimos años, lo que podría provocar cambios en la prevalencia de los agentes incluidos en el cribado serológico programado de la embarazada. Material y métodos Desde abril de 2007 a mayo de 2008 se llevó a cabo un estudio de prevalencia de anticuerpos frente a Treponema pallidum, Toxoplasma gondii, virus de la rubéola, virus de la inmunodeficiencia humana (VIH) y virus de la hepatitis B (VHB) en 4.171 sueros de embarazadas inmigrantes y nativas de Granada. Resultados La seroprevalencia de toxoplasmosis en inmigrantes embarazadas ha sido mayor que en nativas españolas (el 44 frente al 14,4%). Por área geográfica, todos los grupos mostraron mayores seroprevalencias. Para el virus de la rubéola la seroprevalencia global fue del 97,3%. Las mujeres subsaharianas y norteafricanas presentaron las menores prevalencias (el 88 y el 89%). En la determinación de AgHBs para VHB la prevalencia ha sido mayor en inmigrantes que en autóctonas (el 2,6 frente al 0,4%), y especialmente alta entre las embarazadas del este de Europa (6,9%) y de Asia (8,1%). La seroprevalencia frente al VIH (el 0,9 frente al 0,1%) y sífilis (TPHA) (el 3,5 frente al 0,07%), ha sido mayor en inmigrantes. La seroprevalencia frente a T. pallidum ha resultado mayor en mujeres del este europeo (11,5%) y latinoamericanas (3,5%) mientras que las subsaharianas (11,8%) y norteafricanas (1%) mostraron la mayor seroprevalencia frente al VIH. Conclusión Anti-VIH, hepatitis B, sífilis y anticuerpos anti-T. gondii son más frecuentes en las embarazadas inmigrantes que en las nativas españolas, mientras que la tasa de protección frente a rubéola es mayor en gestantes autóctonas que en extranjeras (AU)

Introduction Female immigration from less developed countries into Spain has grown in number over the years, and could contribute to changing the prevalence of routine serological markers in pregnant women. Material and methods From April 2007 until May 2008 we studied the prevalence of serum antibodies against Treponema pallidum, Toxoplasma gondii, rubella virus, human immunodeficiency virus (HIV 1/2), and hepatitis B virus (HBV) in samples from 4,171 immigrant and Spanish pregnant women in Granada. Results The seroprevalence of toxoplasmosis in pregnant immigrants was higher than in non-immigrants (44% vs. 14.4%). The overall prevalence against rubella was 97.3%. Sub-Saharan and North African women showed the lowest prevalence (88% and 89%). The prevalence of HBsAg was higher in immigrants than in Spanish women (2.6% vs. 0.4%), and especially high among the Eastern European (6.9%) and Asian (8.1%) pregnant women. The seroprevalences of HIV (0.9% vs. 0.1%) and syphilis (TPHA) (3.5% vs. 0.07%), were higher in immigrants. Seroprevalence against T. pallidum was higher among Eastern European (11.5%) and Latin-American (3.5%) women, whereas sub-Saharan (11.8%) and North African (1%) women showed the highest anti-HIV prevalence. Conclusion Hepatitis B, anti-HIV, syphilis, and antibodies against T. gondii are found more frequently in immigrants than in Spanish pregnant women, whereas rubella protection in Spanish women is higher than immigrant pregnant women (AU)

[Serological markers in immigrant and Spanish pregnant women in Granada]. / Marcadores serológicos en gestantes inmigrantes y autóctonas en Granada.

INTRODUCTION: Female immigration from less developed countries into Spain has grown in number over the years, and could contribute to changing the prevalence of routine serological markers in pregnant women. MATERIAL AND METHODS: From April 2007 until May 2008 we studied the prevalence of serum antibodies against Treponema pallidum, Toxoplasma gondii, rubella virus, human immunodeficiency virus (HIV 1/2), and hepatitis B virus (HBV) in samples from 4,171 immigrant and Spanish pregnant women in Granada. RESULTS: The seroprevalence of toxoplasmosis in pregnant immigrants was higher than in non-immigrants (44% vs. 14.4%). The overall prevalence against rubella was 97.3%. Sub-Saharan and North African women showed the lowest prevalence (88% and 89%). The prevalence of HBsAg was higher in immigrants than in Spanish women (2.6% vs. 0.4%), and especially high among the Eastern European (6.9%) and Asian (8.1%) pregnant women. The seroprevalences of HIV (0.9% vs. 0.1%) and syphilis (TPHA) (3.5% vs. 0.07%), were higher in immigrants. Seroprevalence against T. pallidum was higher among Eastern European (11.5%) and Latin-American (3.5%) women, whereas sub-Saharan (11.8%) and North African (1%) women showed the highest anti-HIV prevalence. CONCLUSION: Hepatitis B, anti-HIV, syphilis, and antibodies against T. gondii are found more frequently in immigrants than in Spanish pregnant women, whereas rubella protection in Spanish women is higher than immigrant pregnant women.

Transcervical intrapartum amnioinfusion for preterm premature rupture of the membranes.

OBJECTIVES: To investigate the effect of transcervical amnioinfusion on the management of labour and neonatal outcomes in preterm premature rupture of the membranes. STUDY DESIGN: This clinical trial included 86 patients with premature rupture of the membranes between weeks 27 and 35 of gestation. Patients were randomly assigned to receive amnioinfusion via a two-way catheter or to the control group. Clinical management was otherwise the same in both groups. RESULTS: Amnioinfusion decreased the frequency of variable decelerations in fetal heart rate (27.9% versus 53.5%, p<0.05) and the rate of obstetric interventions motivated by nonreassuring fetal status (13.6% versus 52.4%, p<0.05). At delivery, pH values were significantly higher in the treatment group than in the conventionally managed control group (median 7.29 versus 7.27). CONCLUSIONS: Intrapartum transcervical amnioinfusion for preterm premature rupture of the membranes reduced the number of interventions needed because of nonreassuring fetal status, and improved neonatal gasometric values without increasing maternal or fetal morbidity.