Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino / Amnioinfusion in premature rupture of membranes in preterm pregnancies

Objetivo: Valorar la posibilidad de la amnioinfusión en la rotura prematura de membranas en gestaciones pretérmino como medida terapéutica. Material y métodos: Se practicaron amnioinfusiones vía transabdominal seriadas en 2 pacientes con una rotura prematura de membranas pretérmino. La solución de Ringer lactato se administró por punción abdominal. Resultados: Se realizaron amnioinfusiones seriadas hasta aproximadamente la semana 23.a. A partir de ese momento, ambos casos mantuvieron un líquido amniótico normal durante el resto de la gestación. Conclusión: La amnioinfusión transabdominal es una opción terapéutica en la rotura prematura de membranas en gestaciones pretérmino

Objective: To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies. Material and methods: We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture. Results: We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid. Conclusions: Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy

Influencia de la analgesia epidural en la saturación arterial fetal de oxígeno durante el período de dilatación / Influence of epidural analgesia on fetal oxygen saturation during labor

Objetivo: Valorar la influencia de la analgesia vía epidural en la saturación de oxígeno fetal (SpO2) intraparto y los patrones de frecuencia cardíaca fetal. Material y métodos: Se realizó un estudio prospectivo con 50 gestantes a las que, durante el período de dilatación, se les administró analgesia por vía epidural, y que fueron monitorizadas mediante cardiotocografía y pulsioximetría fetal a través de una sonda Nellcor FS-14®. Resultados: El valor de SpO2 preepidural fue del 48,5 ± 7,8%. Durante los primeros 15 min postepidural se obtuvo la cifra de 47,4 ± 9,7 (p = NS), y la significación estadística se alcanzó a partir de los 30min posteriores a su instauración. En un 76% de los casos aparecieron alteraciones del registro cardiotocográfico en los primeros 120 min tras la perfusión analgésica. Conclusiones: La disminución de la saturación arterial de oxígeno a partir de los 30 min postepidural puede estar relacionada con la administración de analgésicos por vía epidural (AU)

Objective: To evaluate the influence of maternalepidural analgesia on fetal oxygen saturation (SpO2) and fetal heart rate (FHR) patterns during labor. Material and methods: We performed a prospective study in 50 pregnant women. During labor, epidural analgesia was administered and the women were monitored by means of cardiotocography (CTG) and fetal pulse oximetry, using a Nellcor FS-14® sensor. Results: The mean SpO2 value before analgesia administration was 48.5 ± 7.8%. During the first 15 minutes after administration, this value was 47.4 ± 9.7 (p: NS). A statistically significant decrease in SpO2 was found 30 minutes after initiation of epidural analgesia in 76 % of the patients, alterations in the CTG appeared during the first 120 minutes after maternal epidural analgesia. Conclusions: The decrease in SpO2 30 minutes after administration of epidural analgesia could be influenced by the use of epidural analgesic drugs (AU)

Rotura uterina asociada a desprendimiento prematuro de placenta normalmente inserta en gestante de 25 semanas / Uterine rupture associated with premature separation of a normally inserted placenta at 25 weeks’ gestation

Se presenta un caso de rotura uterina en paciente secundípara de 25 semanas que ingresó en nuestro centro por rotura prematura de membranas. Se practicó una cesárea de urgencia ante la sospecha de desprendimiento prematuro de placenta normalmente inserta y se objetivó rotura de la cicatriz de la cesárea anterior (AU)

We report a case of uterine rupture in a secundipara at 25 weeks’ gestation who was admitted to our center for premature rupture of membranes. Emergency cesarean section was performed due to suspicion of premature separation of a normally inserted placenta. Rupture of a previous cesarean section scar was observed (AU)

Asociación entre la colonización materna de Streptococcus del grupo B serotipo III y la rotura prematura de membranas / Association between maternal colonization with serotype III group B Streptococcus and premature rupture of membranes

Objetivo. Examinar la asociación entre la colonización genital de mujeres embarazadas con el serotipo III de Streptococcus del grupo B (SGB) y la rotura prematura de membranas (RPM) en comparación con el resto de los serotipos de SGB. Material y métodos. Por medio de un estudio de cohorte retrospectiva se serotipificaron cepas de SGB de mujeres embarazadas. Se definieron dos grupos: expuestos, pacientes en las que se documentó SGB serotipo III en cultivos vaginales o urinarios, y no expuestos, pacientes en las que se documentó cualquier serotipo diferente al III de SGB, en cultivos vaginales o urinarios. Resultados. Se serotipificaron 135 cepas de SGB: en el grupo de los expuestos se incluyó a 43 mujeres embarazadas, mientras que en el de los no expuestos se incluyó a 92 mujeres. Se documentó RPM en 27 pacientes expuestas (62,7%) y en 17 pacientes no expuestas (18,4%) (RR = 3,3; IC del 95%, 1,2-7; p < 0,05). Conclusiones. El serotipo III se asocia tres veces a RPM (AU)

Objective. To examine the association between maternal colonization with serotype III group B Streptococcus (GBS) and premature rupture of membranes (PROM) in comparison with other GBS serotypes. Material and method. We performed a retrospective cohort study. GBS strains were serotyped in pregnant women. The women were divided into 2 groups: group I consisted of patients with a positive vaginal or urinary culture for GBS serotype III and group II consisted of patients with a positive culture for serotypes Ia, Ib, II, IV, V or VI. Results. There were 135 GBS isolations. Group 1 included 43 pregnant women and group 2 included 92 pregnant women. PROM occurred in 27 patients in group I (62.7%) and in 17 patients in group 2 (18.4%) (RR = 3.3; 95% CI, 1.2-7.4; p < 0.05). Conclusions. Vaginal colonization with serotype III of GBS was associated with a 3-fold increase in the risk of PROM (AU)

Factores de riesgo del parto pretérmino / Risk factors for preterm birth

Objetivo: Determinar cuáles son, en nuestro medio, los factores de riesgo de los partos pretérmino espontáneos y por rotura prematura de membranas. Pacientes y método: Realizamos un estudio retrospectivo, de casos y controles, en el Complejo Hospitalario Universitario de Albacete, en el que se comparó a 315 gestantes con partos pretérmino espontáneos o por rotura prematura de membranas y un grupo control de 315 gestantes con partos a término. Las variables se clasificaron en sociobiológicas, antecedentes obstétricos y características de la gestación actual. Resultados: El antecedente de parto pretérmino (odds ratio [OR] = 3,4; intervalo de confianza [IC] del 95%, 1,7-6,7), los abortos previos (p = 0,002), la gestación múltiple (OR = 28,1; IC del 95%, 6,7-116,8), las técnicas de reproducción asistida (OR = 5,8; IC del 95%, 2,3-14,1), los episodios de ingreso hospitalario con necesidad de tocólisis (OR = 10,8; IC del 95%, 4,2-27,7) y el cerclaje (OR = 5,6; IC del 95%, 1,2-25,7) son más frecuentes entre los casos; sin embargo, ajustando por otras variables, el riesgo desaparece para el cerclaje (ORa = 2,8; IC del 95%, 0,5-14). Conclusiones: Encontramos que los antecedentes de parto pretérmino y abortos previos, la gestación múltiple, las técnicas de reproducción asistida y la hospitalización con necesidad de tocólisis son los factores de riesgo de parto pretérmino en nuestra población

Objective: To determine the risk factors for preterm births occurring spontaneously or due to premature rupture of membranes in our environment. Patients and method: We performed a retrospective case-control study at the Complejo Hospitalario Universitario de Albacete (Spain) that compared 315 pregnant women with preterm labor occurring spontaneously or due to premature rupture of membranes with 315 women selected as controls who delivered at term. The variables were grouped into sociobiological parameters, obstetric history, and characteristics of the current pregnancy. Results: Previous preterm birth (OR = 3.4; 95% CI, 1.7-6.7), prior abortions (p = 0.002), multiple gestation (OR = 28.1; 95% CI, 6.7-116.8), assisted reproductive technology (ART) (OR = 5.8; 95% CI, 2.3-14.1), hospitalization and tocolytic therapy (OR = 10.8; 95% CI, 4.2-27.7), and cerclage (OR = 5.6; 95% CI, 1.2-25.7) were more frequent in cases. However, when OR were adjusted (aOR) by other variables, the risk for cerclage disappeared (aOR = 2.8; 95% CI, 0.5-14). Conclusions: Risk factors for preterm birth in our population were a history of preterm birth and abortions, multiple gestation, ART, and hospitalization with tocolytic therapy

Factores de riesgo en niños con parálisis cerebral infantil en el Centro de Rehabilitación Infantil Teletón, Estado de México / Risk factors in children with infantile cerebral palsy in the Infantile Rehabilitation Center Teleton, Mexico

Introducción. Durante el período madurativo del sistema nervioso central pueden ocurrir riesgos que provoquen lesión cerebral en el período intrauterino, en el momento de nacer o después. Objetivo. Conocer los factores de riesgo en pacientes con diagnóstico de parálisis cerebral infantil del Centro de Rehabilitación Infantil Teletón, Estado de México y su frecuencia. Material y métodos. Estudio observacional, retrospectivo. Se revisaron historias clínicas de pacientes de ambos sexos buscando factores de riesgo. Los resultados se analizaron con pruebas estadísticas de tasa, razón y proporción. Resultados. De 1.112 historias clínicas de pacientes con daño neurológico, 773 tuvieron parálisis cerebral, 653 pacientes con factores de riesgo prenatales y natales, y sólo 120 con factores de riesgo posnatal. El factor de riesgo más frecuente en la etapa prenatal fue la ruptura prematura de membranas, en la etapa natal el período expulsivo prolongado y en la etapa posnatal la neuroinfección. El 42,83 % de los niños pertenecía a la primera gestación. Conclusión. La mayoría de los pacientes fueron varones, los riesgos se presentaron en el tercer trimestre del embarazo y en el momento del parto, la edad de los padres influyó poco en el diagnóstico y la puntuación de Apgar no fue parámetro para el daño

Introduction. During the central nervous system maturation period, there may be risks that cause brain lesion in the intrauterine period, at birth or afterwards. Objective. Know the risk factors in children with cerebral palsy in the Rehabilitation Center Teleton, Mexico and its frequency. Material and methods. This is an observational, retrospective study. The clinical histories of the patients of both genders were reviewed, seeking risk factors. The results were analyzed with statistical tests of rates, odds ratio and proportion. Outcomes. A total of 773 out of 1112 patients with brain damage had cerebral palsy: 653 with prenatal and natal risks factors and only 120 with postnatal risk factors. The most frequent prenatal risk factor was premature rupture of the membrane, prolonged labor period at birth and neuroinfection in the postnatal period. A total of 42.83 % of the children belonged to the first pregnancy. Conclusion. Most of the patients were male, the risk occurred in the last quarter of the pregnancy and at birth. The parents' age had little influence on the diagnosis and Apgar score was not a parameter for damage

Rotura prematura de membranas en edad gestacional previable / Preterm premature rupture of membranes before 24 weeks of gestation

Objetivo: Describir los resultados perinatales de las gestaciones con rotura prematura de membranas (RPM) antes de la semana 24 de gestación. Pacientes y métodos: Se incluyó a 50 pacientes consecutivas con RPM antes de las 24 semanas de gestación. Después de 1 semana de ingreso, se ofreció la realización de amniopatch a las pacientes con columna máxima de líquido amniótico (Cmáx) < 1 cm y conducta expectante al resto de las pacientes. Se evaluaron los resultados perinatales de dichas gestaciones. Resultados: La edad gestacional (EG) media +/- desviación estandar (DE) en el momento de la amniorrexis fue de 18,2 +/- 3,6 semanas. En 13 (26%) ocasiones se realizó un amniopatch. De los 50 casos, 15 pacientes optaron finalmente por una interrupción legal del embarazo (ILE) y en 35 casos se adoptó finalmente una conducta expectante. De los 35 casos que decidieron continuar la gestación, 12 (34,3%) pacientes presentaron un fallecimiento intraútero o un parto previo a la viabilidad (antes de la semana 24); en 4 (11,4%) casos hubo una muerte anteparto después de la semana 24 y 4 (11,4%) presentaron una muerte posparto. El lapso de tiempo entre la RPM y el parto mostró una relación inversa y significativa con la EG de la amniorrexis. Presentaron hipoplasia pulmonar 4 (11,4%) neonatos y en 8 (22,9%) casos hubo una corioamnionitis clínica. Un neonato (2,9%) presentó una luxación congénita de rodilla. Conclusiones: Las gestaciones complicadas con RPM antes de las 24 semanas de gestación presentan un 42,9% de supervivencia con una mortalidad neonatal del 57,1%. Sin embargo, para las gestaciones que superan las 24 semanas de gestación, la supervivencia mejora notablemente y en nuestra serie se sitúa en un 65,2%

Objective: To describe neonatal outcomes in preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. Patients and methods: Fifty consecutive patients with PPROM before 24 weeks' gestation were included. If deepest pool of amniotic fluid (DPAF) was = 1.0 cm, expectant management was followed. Perinatal and maternal outcomes were evaluated. Results: The mean gestational age at PPROM was 18.2 weeks (SD +/- 3.6). Amniopatch was performed in 13 patients (26%). Of the 50 patients, 15 chose pregnancy termination and 35 were managed expectantly. In these 35 patients, there were 12 (34.3%) fetal demises or non-viable deliveries before 24 weeks, four (11.4%) fetal demises after 24 weeks and four (11.4%) neonatal deaths. A significant inverse relationship was observed between latency period and gestational age at PPROM. Pulmonary hypoplasia occurred in four neonates (11.4%) and chorioamnionitis in eight neonates (22.9%). There was only one case (2.9%) of congenital luxation of the knee. Conclusions: The overall perinatal survival rate in pregnancies with rupture of membranes before 24 weeks was 42.9% with a neonatal mortality of 57.1%. However, survival markedly improves when pregnancy is prolonged to over 24 weeks and in our series it increased to 65.2%

Aumento de la gestación múltiple. Repercusión en la morbimortalidad maternofetal / Increase multiple gestations. The repercussions on maternal and foetal morbidity

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

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

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

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

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

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

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

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

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

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

Cervical incompetence and the role of emergency cerclage.

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

Alteraciones del trazado de la frecuencia cardíaca fetal durante el parto en gestantes con oligoamnios causado por rotura prematura de membranas / Foetal heart rate changes dirung labour in pregnant women with oligohydramnios due to premature rupture of the membranes

El objetivo del estudio fue poner de manifiesto cuáles son las alteraciones del registro cardiotocográfico intraparto más características y frecuentes, así como los resultados neonatales, en una población seleccionada por el hecho de presentar oligoamnios debido a rotura prematura de membranas. El estudio llevado a cabo por el Hospital Universitario Virgen de las Nieves de Granada incluye casos consecutivos de gestantes que ingresaron con el diagnóstico de RPM en las 24 h previas para inducción del parto en el área de dilatación. La población elegida estaba formada por gestantes con ILA normal en la semana previa a la rotura de las membranas ovulares. En total fueron incluidas 130 gestantes que se asignaron en función del ILA inicial a 2 grupos, siendo el grupo 2 considerado el control con respecto a los casos de oligoamnios. El grupo I estaba formado por gestantes con ILA inicial 5 (n = 82). No se han encontrado diferencias estadísticamente significativas entre ambos grupos respecto de las alteraciones de la frecuencia cardíaca fetal intraparto. Como conclusión, se puede afirmar que, basándonos en estos resultados, no se puede sustentar la hipótesis de que el oligoamnios al inicio del parto causado por RPM aumenta la frecuencia de deceleraciones variables cuando se compara con gestantes que inician el parto con bolsa rota e ILA > 5. Posiblemente, la justificación se encuentre en el hecho de la pérdida progresiva de LA a lo largo del parto que tiende a igualar el ILA en ambos grupos (AU)

The aim of the study was to outline the most common and characteristic intrapartum cardiotocographic changes and neonatal outcome in a selected population with oligohydramnios due to premature rupture of membranes. The study was carried out at the Virgen de las Nieves University Hospital of Granada (Spain), with consecutive cases of pregnant women admitted to the delivery ward for induction of labour due to premature rupture of the membranes during the previous 24 hours. All pregnant women had a normal amniotic fluid index (AFI) the week previous to rupture of the membranes. There were 130 pregnant women inc1uded in the study, and they were divided into 2 groups based on initial AFI value. Group I was pregnant women with an initial AFI value of up to 5 (n = 48), and group II, the control group, of more than 5 (n = 82). No statistically significant differences were found between the 2 groups in intrapartum foetal heart rate pattems. In conclusion, these results do not support the hypothesis that oligohydramnios before the onset of labour due to premature rupture of the membranes increases the incidence of variable decelerations compared to pregnant women with premature rupture of the membranes at the onset of labour and AFI value of greater than 5. This may possibly be because amniotic fluid leakage during labour tends to equalize AFI in both groups (AU)

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

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

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

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

Pregnancy outcome following recurrent spontaneous abortions.

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

Ruptura prematura de membranas / Premature rupture of the membranes

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