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1.
New Microbiol ; 42(4): 237-239, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31609456

RESUMO

Alloscardovia omnicolens is a recently-reported microorganism with unknown pathogenic implications. It has been isolated in various clinical localizations but not in the endocervix. We isolated A. omnicolens in an endocervical sample from a 31-yr-old patient with preterm premature rupture of membranes (PPROM) in week 33+3 of pregnancy. The main risk of PPROM is prematurity and the possibility of developing infectious chorioamnionitis, which can be lethal for the mother and newborn. This is the first report of an association between A. omnicolens and PPROM, although its pathogenic role has not yet been elucidated.


Assuntos
Actinobacteria , Infecções por Bifidobacteriales , Corioamnionite , Ruptura Prematura de Membranas Fetais , Actinobacteria/fisiologia , Adulto , Antibacterianos/uso terapêutico , Infecções por Bifidobacteriales/complicações , Infecções por Bifidobacteriales/tratamento farmacológico , Infecções por Bifidobacteriales/microbiologia , Infecções por Bifidobacteriales/patologia , Colo do Útero/microbiologia , Corioamnionite/tratamento farmacológico , Corioamnionite/microbiologia , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Ruptura Prematura de Membranas Fetais/microbiologia , Idade Gestacional , Humanos , Gravidez , Nascimento Prematuro , Resultado do Tratamento
2.
Int J Gynaecol Obstet ; 147(2): 195-201, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31420867

RESUMO

OBJECTIVE: To examine whether gestational hypertension and pre-eclampsia are associated with spontaneous premature rupture of membranes (PROM). METHODS: A retrospective, population-based cohort study was conducted in Hebei, Zhejiang, and Jiangsu provinces in China from 1993 to 1995. After excluding women with missing data of exposure and outcome, history of chronic hypertension, multiple births, and babies with major birth defects and ambiguous sex, this study comprised 199 231 singleton live births. Logistic regression was used to evaluate the association, adjusting for potential confounders. RESULTS: The incidence of PROM was 17.7% and 8.9% in women with gestational hypertension and pre-eclampsia, respectively, and 5.9% for the normotensive group. Compared with normotension, gestational hypertension was associated with an increase in the odds of PROM of 4.21 times (95% confidence interval [CI] 3.77-4.70), while pre-eclampsia had an increase of 2.27 times (95% CI 1.78-2.88). Additionally, women with hypertensive disorders of pregnancy had higher risks for term PROM (adjusted risk ratio [RR] 3.83, 95% CI 3.43-4.27) than preterm PROM (adjusted RR 3.10, 95% CI 2.18-4.41). Consistent results of the association were also observed in the sensitivity analyses. CONCLUSION: Gestational hypertension and pre-eclampsia were associated with an increased risk for PROM. Increased odds were observed for term PROM compared with preterm PROM.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adulto , Estudos de Casos e Controles , China/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Incidência , Modelos Logísticos , Gravidez , Estudos Retrospectivos , Adulto Jovem
3.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31427852

RESUMO

Background: Laparoscopic surgery is safe in pregnancy, but is not without risk. Inadvertent uterine perforation of the gravid uterus is a rare complication. Cases: Three pregnant women had inadvertent uterine perforation during laparoscopic surgery. All patients were counseled regarding the risks of an "incidental fetoscopy" and elected to continue the pregnancy. Two delivered after preterm premature rupture of membranes at 32 and 36 weeks' gestation, and one twin pregnancy delivered at 30 weeks due to preeclampsia. Conclusion: Surgical planning of the gravid patient undergoing laparoscopic surgery should include demarcation of the most superior aspect of the uterine fundus, either via physical examination or, if not conclusive, via preoperative or intraoperative ultrasound.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Complicações na Gravidez/etiologia , Perfuração Uterina/etiologia , Útero/lesões , Adulto , Apendicite/cirurgia , Cesárea , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Complicações Intraoperatórias/cirurgia , Trabalho de Parto Prematuro/etiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/cirurgia , Resultado da Gravidez , Gravidez Múltipla , Perfuração Uterina/cirurgia
4.
J Perinat Med ; 47(6): 637-642, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31287800

RESUMO

Background Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34-1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04-1.57); preterm delivery (OR 1.56, 95% CI 1.34-1.81); cesarean delivery (OR 1.29, 95% CI 1.17-1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57-5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46-3.65); and congenital malformations (OR 3.26, 95% CI 2.30-4.62). Conclusion SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies.


Assuntos
Complicações na Gravidez , Síndrome de Sjogren , Adulto , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Classificação Internacional de Doenças , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Prevalência , Estudos Retrospectivos , Medição de Risco , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia
5.
Infect Dis Obstet Gynecol ; 2019: 4376902, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31019362

RESUMO

Introduction: Young women (20-35 years) are at high risk of HPV infection, although the majority of the infections are asymptomatic and are cleared spontaneously by the host immune system. These are also the group of women who are sexually active and are in the population of pregnant women. During pregnancy, the changes in the hormonal milieu and immune response may favor persistence of HPV infection and may aid in transgenerational transmission thereby furthering the cancer risk. In the present study, we determined the prevalence of vaginal HPV infection in early pregnancy and attempted to relate with pregnancy outcome. Material and Methods: Vaginal cytology samples were collected from the condoms used to cover the vaginal sonography probe during a routine first trimester visit to the hospital. All women were followed up throughout pregnancy and childbirth. Maternal and neonatal outcomes were recorded. Results: We found a prevalence of HPV infection around 39.4% in our population. Interestingly all HPV positive women were infected with one or more high risk HPV viruses with an overlap of intermediate and low risk in 43% and 7.3%, respectively. Women with preterm prelabor rupture of membranes (PPROM) showed a statistically higher incidence in HPV positive (7.3%) group as compared to the HPV negative (3.2%) group. Conclusion: The prevalence of genital HPV infection is high during pregnancy (around 40%) and was associated with higher incidence of PPROM.


Assuntos
Infecções por Papillomavirus/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Estudos de Coortes , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Infecções por Papillomavirus/complicações , Gravidez , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Prevalência , Estudos Prospectivos , Adulto Jovem
6.
Eur J Obstet Gynecol Reprod Biol ; 236: 210-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30922526

RESUMO

OBJECTIVE: To evaluate the relationships between excisional treatment for high-grade cervical intra-epithelial neoplasia (CIN2+) and obstetric outcomes in terms of preterm delivery risk, premature rupture of membrane (PROM) and type of delivery, and between pre-term delivery and the type of excisional technique (radio frequency excision, laser conization). METHODS: This was a retrospective study of the obstetric outcomes of 2316 women aged 25-45 years who underwent excisional treatment for CIN2+ at the Obstetric and Gynecological Clinic of Ospedale Maggiore della Carità in Novara and at the Obstetric and Gynecological Department of Ospedale Sant'Anna in Torino in the period 2005-2014 and were evaluated until April 2016, and 57,937 untreated women of the same age, from the same centers. RESULTS: After treatment, 320 women had at least one pregnancy leading to delivery after a mean of 3.35 years. Treatment significantly increased the risk of preterm delivery. Compared with no treatment, the risk of preterm birth was higher in women who had undergone treatment (33.13% vs. 6.60%). Techniques removing or ablating more tissue, such as large loop excision of the transformation zone, were associated with worse outcomes (OR 2.96, 95% IC 1.72-5.10). Smoking habits significantly increase the risk of preterm delivery in the treated women (OR 2.82, 95% IC 1.61-4.9). The risk of premature rupture of the membranes (PROM) (40% vs. 23.22%), the risk of preterm PROM (pPROM) (13.13% vs. 2.71%) and dystocic births (18.75% vs 4.48%) were also significantly increased after treatment. Caesarean sections were less frequent among the treated women (15.94% vs. 32.41%). CONCLUSIONS: Our findings reveal a relationship between cervical excisional treatment and pre-term delivery, PROM, and the method of delivery. In order to minimise risk and guarantee the best obstetric outcome, patient treatment and follow-up should be personalised.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/efeitos adversos , Ruptura Prematura de Membranas Fetais/etiologia , Terapia a Laser/efeitos adversos , Nascimento Prematuro/etiologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
7.
Metas enferm ; 22(2): 12-20, mar. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183515

RESUMO

Objetivo: analizar los beneficios y riesgos de la conducta expectante frente a la inducción en mujeres gestantes a término con rotura prematura de membranas (RPM) sobre los resultados obstétricos y neonatales. Método: estudio observacional retrospectivo. Se incluyeron mujeres gestantes con RPM a término y sus recién nacidos (RN) ingresadas en el Hospital Universitario Marqués de Valdecilla (Santander) desde el 31 de mayo de 2016 al 1 de junio de 2017. Los datos se recuperaron de las historias clínicas. Se establecieron tres grupos de mujeres gestantes diferenciados en relación a la gestión del parto: manejo expectante, manejo activo y ambos manejos. Para el análisis inferencial se realizó una división de la muestra en función de dichos grupos. Se consideró significación estadística para p< 0,05. Se usó el programa estadístico SPSS versión 20.0. Resultados: la muestra fue de 464 mujeres gestantes. La muestra de RN que necesitaron ingreso por complicaciones fue de 42. El 81,9% (n= 380) comenzó por manejo expectante y un 17% (n=79) por manejo activo. A lo largo del proceso de parto, en algunos casos, se modificaba el plan de acción inicial. De las 380 mujeres gestantes que iniciaron con manejo expectante cambiaron su plan a inducción el 47,9% (n= 182). El 64,5% inició el parto en las primeras 12 horas de evolución espontánea, y el 82,8% a las 24 horas. No se hallaron diferencias estadísticamente significativas en cuanto a morbimortalidad materno-fetal durante las primeras 24 horas. Conclusiones: tanto el manejo expectante como activo son válidos en las primeras 24 horas de RPM


Objective: to analyze the benefits and risks of expectant management vs. induction in women with pregnancy to term who suffer a premature membrane rupture (PMR), regarding obstetric and neonatal results. Method: an observational retrospective study, including women with pregnancy to term and PMR and their newborns (NBs), admitted to the Hospital Universitario Marqués de Valdecilla (Santander) from May, 31st, 2106 to June, 1st, 2017. Clinical record data were collected. Pregnant women were classified into three different groups according to delivery management: expectant management, active management, and both managements. The sample was split according to said groups in order to conduct inferential analysis. Statistical significance was considered for p< 0.05.; and the SPSS version 20.0 statistical program was used. Results: the sample included 464 pregnant women; the sample of NBs who required admission due to complications was of 42. Expectant management was initially used for 81.9% (n= 380), and active management for 17% (n=79). Throughout the delivery process, the initial plan of action was modified in some cases. Of the 380 pregnant women for whom expectant management was initially used, this plan was switched to induction in 47.9% (n= 182); 64.5% of them initiated delivery within the first 12 hours of spontaneous evolution, and 82.8% at 24 hours. No statistically significant differences were found in terms of maternal-fetal morbimortality during the first 24 hours. Conclusions: both expectant and active management are valid within the first 24 hours of PMR


Assuntos
Humanos , Feminino , Gravidez , Ruptura Prematura de Membranas Fetais/etiologia , Trabalho de Parto Induzido , Corioamnionite , Conduta Expectante/métodos , Estudos Retrospectivos , Análise Estatística , Idade Materna , Ruptura Prematura de Membranas Fetais/epidemiologia
8.
J Korean Med Sci ; 34(3): e20, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30662386

RESUMO

Background: The purpose of this study was to determine prognostic factors that can affect the fetal survival immediate after fetoscopic laser ablation. Methods: The study population consisted of consecutive twin pregnant women who underwent fetoscopic laser ablation with the diagnosis of twin to twin transfusion syndrome (TTTS) from 2011 to 2018 in Seoul National University Hospital. Fetal survival immediate after procedure was defined as survival to 48 hours after procedure and neonatal survival was defined as survival to 28 days of life. Clinical characteristics and ultrasound findings were compared according to the fetal survival immediate after procedure. Results: A total of 57 pregnant women with TTTS were included, and the overall fetal survival immediate after procedure was 71.1% (81/114) after fetoscopic laser ablation. Fetuses who survived immediate after procedure had higher gestational age at procedure and lower frequency of abnormal Doppler studies than those did not survive. However, the frequency of hydrops was not different between cases with fetal survival and those with fetal death. The earlier gestational age at procedure and the presence of abnormal Doppler studies were significant risk factors for fetal death even after adjustment. Conclusion: Based on this data, the fetal survival immediate after procedure (fetoscopic laser treatment) in TTTS can be affected by the gestational age at procedure and the presence of abnormal Doppler studies.


Assuntos
Transfusão Feto-Fetal/terapia , Terapia a Laser , Adulto , Área Sob a Curva , Edema/etiologia , Feminino , Morte Fetal/etiologia , Ruptura Prematura de Membranas Fetais/etiologia , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/diagnóstico , Fetoscopia , Idade Gestacional , Humanos , Terapia a Laser/efeitos adversos , Modelos Logísticos , Gravidez , Gravidez de Gêmeos , Curva ROC , Ultrassonografia Doppler
9.
Minerva Ginecol ; 71(2): 163-170, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30486637

RESUMO

INTRODUCTION: Spina bifida is the most common non-lethal congenital birth defect of the central nervous system that causes chronic disability due to the combined effects of local nerve damage and the sequelae of non-communicating hydrocephalus. This abnormality can be identified early in gestation and the damage can be progressive over the course of pregnancy. Advances in fetal treatment have made minimally invasive prenatal surgery a realistic consideration for spina bifida in order to improve the outcome for children affected this condition. EVIDENCE ACQUISITION: Prenatal surgery for spina bifida via open fetal surgery with hysterotomy decreases the rate of ventriculoperitoneal shunt placement and improves motor function compared to standard postnatal surgery. Maternal risks of open fetal surgery are primarily related to complications of the hysterotomy including thinning or rupture that begins in the index pregnancy but persists for every future pregnancy. Minimizing maternal risks is the largest impetus to explore and optimize a minimally invasive fetoscopic alternative. Techniques vary from using a complete percutaneous approach to open fetoscopy, which requires laparotomy but is minimally invasive to the uterus. This allows vaginal delivery at term and no scar complications are reported thus far. Fetal short-term neurosurgical outcomes compare favorably with improvement in hindbrain herniation >70% and decreased need for treatment for hydrocephalus between 40-45% after prenatal surgery performed either fetoscopically or through open fetal surgery. EVIDENCE SYNTHESIS: Maternal obstetric outcomes are superior for fetoscopic spina bifida repair compared to open fetal surgery and avoids the ongoing risk in future pregnancy. Neonatal and infant benefits appear equivalent. The open fetoscopic approach minimizes the risk of ruptured membranes and subsequent preterm delivery as opposed to a completely percutaneous procedure. International collaboration is ongoing to share experience and assess long term treatment effects. CONCLUSIONS: Continued refinement of a minimally invasive strategy for prenatal treatment of spina bifida is necessary to maximize benefits to the child and further minimize maternal risks and preterm birth.


Assuntos
Fetoscopia/métodos , Resultado da Gravidez , Disrafismo Espinal/cirurgia , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Disrafismo Espinal/fisiopatologia
10.
Pediatr Int ; 61(1): 58-62, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30460724

RESUMO

BACKGROUND: Ureaplasma spp. in the maternal genitourinary tract has come to attention as a cause of preterm labor, spontaneous abortion, chorioamnionitis and adverse outcomes. A few controversies, however, still remain, namely, whether it should be treated aggressively or not. The aim of this study was to evaluate the effect of maternal azithromycin (AZ) treatment for Ureaplasma colonization on neonatal morbidities including bronchopulmonary dysplasia (BPD). METHODS: A retrospective case-control study of preterm babies delivered at ≤30 weeks of gestational age (GA) from 2012 to 2016 was conducted. Infants whose mothers had confirmed Ureaplasma colonization and treatment with AZ (m-AZ, cases) were matched by GA to control subjects whose mothers did not have Ureaplasma colonization. A subgroup analysis (nUU(+), infants with neonatal respiratory Ureaplasma colonization; nUU(-), infants without colonization) was also performed. RESULTS: Fifty-five control subjects were matched to 110 m-AZ subjects. The incidence of preterm premature rupture of membranes (P = 0.003) and of moderate-severe BPD (P = 0.010) was significantly higher in the m-AZ group. On subgroup analysis with post-hoc analysis (m-AZ + nUU(+) [I, n = 55] vs m-AZ + nUU(-) [II, n = 55] vs controls [n = 55]), the incidence of moderate-severe BPD was significantly different: 26% (I) vs 22% (II) vs 7% (controls), P = 0.033. CONCLUSIONS: Maternal Ureaplasma colonization was associated with moderate-severe BPD despite the use of AZ treatment. In addition, if the neonatal respiratory tract was colonized, then moderate-severe BPD developed even with maternal AZ treatment. Hence, selective antenatal and postnatal treatment of Ureaplasma colonization would be needed to control BPD development.


Assuntos
Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Infecções por Ureaplasma/tratamento farmacológico , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , Estudos de Casos e Controles , Feminino , Doenças Urogenitais Femininas/tratamento farmacológico , Doenças Urogenitais Femininas/microbiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Ureaplasma/efeitos dos fármacos , Infecções por Ureaplasma/complicações
11.
J Obstet Gynaecol Res ; 45(3): 573-577, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30537150

RESUMO

AIM: To obtain the incidence of preterm premature rupture of membranes (PPROM) at Siriraj Hospital during 2012-2016 and to identify its possible risk factors in singleton pregnancies. METHODS: This study was a retrospective case-control study. The institutional ethical committee has approved the study. The medical records of eligible cases were reviewed. To assess the risk factors of PPROM, the data of the cases with PPROM in 2016 were compared with the data of pregnant women who did not have PPROM and delivered at term. Fifteen variables of interest were studied. RESULTS: During the 5-year period, there were 43 727 deliveries at Siriraj Hospital and 1280 (2.93%) cases had PPROM. In 2016, 252 pregnant women were diagnosed PPROM and data of 199 cases were compared with the data of 199 control cases. Mean latency period was 2 days and mean gestational age at birth was 34.7 weeks in PPROM group. Logistic regression analysis showed that diabetes mellitus, poor weight gain and history of previous preterm birth were the factors that significantly associated with PPROM, with adjusted odds ratio (OR) 3.22 (95% confidence interval [CI] 1.47-7.05), 2.58 (95% CI 1.63-4.07) and 8.81 (95% CI 2.81-28.69), respectively (P < 0.05), while multiparity decreased the risk of PPROM (adjusted OR = 0.36, 95% CI 0.23-0.57) (P < 0.001). CONCLUSION: The incidence of PPROM during 5-year period was 2.93%. Diabetes mellitus, poor maternal weight gain and history of previous preterm birth significantly increased risk of PPROM while multigravida reduced the risk.


Assuntos
Diabetes Mellitus/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ganho de Peso na Gestação , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia , Adulto Jovem
12.
Infect Genet Evol ; 68: 172-176, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30582987

RESUMO

Ureaplasma spp. is gaining recognition as an important pathogen associated with preterm birth (PTB) and preterm pre-labour rupture of membranes (PPROM). The aim of this study was to investigate the clonality of this organism in maternal/neonatal pairs with PTB or pre-labour rupture of membranes (PROM) or PPROM and the association between sub-groups and PPROM. In total, 50 of 93 maternal/neonatal pairs that were diagnosed with PTB, PROM or PPROM were identified with Ureaplasma spp. colonized in the amniotic fluid or umbilical cord or placenta. All 104 clinical Ureaplasma spp. samples (50, 30, and 24 cultured from amniotic fluid, umbilical cord, and placenta, respectively) were included for analysis of the genetic lineages using the eMLST scheme. A total of 34 eSTs were revealed, with two predominant eSTs (eST16 and eST41). Interestingly, six maternal/neonatal pairs displayed eST differences in the above three specimen sources. In addition, phylogenetic analysis showed two genetically significant distant clusters, and cluster I included the most clinical strains. Interestingly, there was a significant difference in the prevalence of sub-group 1 of cluster II between women with PPROM and those with PROM. In conclusion, the distribution of cluster I was predominately higher than that of cluster II in maternal/neonatal pairs. In addition, sub-group 1 was prone to associated PPROM through the specific epidemic clonal lineages.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Tipagem de Sequências Multilocus , Infecções por Ureaplasma/complicações , Infecções por Ureaplasma/microbiologia , Ureaplasma/classificação , Ureaplasma/genética , Alelos , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Ligação Genética , Humanos , Filogenia , Gravidez , Prevalência
13.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567082

RESUMO

A spontaneous intra-amniotic haematoma is a rare cause of preterm premature rupture of the membranes (PPROM) but can have significant fetal and maternal consequences. It has previously been reported to occur in the second and third trimesters but not in an earlier gestation. We present a case that presented acutely in the first trimester of pregnancy, which leads to early PPROM at 15 weeks and spontaneous preterm delivery at 28 weeks of gestation. There were no maternal complications during the pregnancy.


Assuntos
Âmnio/irrigação sanguínea , Ruptura Prematura de Membranas Fetais/etiologia , Hematoma/complicações , Complicações Hematológicas na Gravidez , Primeiro Trimestre da Gravidez , Nascimento Prematuro/etiologia , Adulto , Feminino , Hematoma/diagnóstico por imagem , Humanos , Recém-Nascido , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal
14.
Gynecol Obstet Fertil Senol ; 46(12): 1076-1088, 2018 12.
Artigo em Francês | MEDLINE | ID: mdl-30409732

RESUMO

OBJECTIVES: To evaluate the maternal, perinatal and long-term prognosis in the event of previable premature rupture of the membranes (PROM) and to specify the interventions likely to reduce the risks and improve the prognosis. METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Previable PROM is a rare event whose frequency varies from 0.3 to 1% according to estimates (NP4). When occurring as a complication of amniocentesis, the prognosis is generally better than when spontaneous (NP3). Between 23 and 39% of women will deliver in the week following PROM and nearly 40% of women will not have given birth 2 weeks after (NP3). The frequency of medical termination of pregnancy varies greatly according to the studies (NP4), as does that of fetal death (NP4). Hospital survival and survival rates without major morbidity as a proportion of conservatively treated patients range from 17-55% and 26-63%, respectively (NP4). Neonatal prognosis is largely dominated by prematurity and its complications (NP3). The frequency of maternal sepsis varies from 0.8 to 4.8% in the most recent studies (NP4). Only one case of maternal death is reported, although 3 cases were identified in France between 2007 and 2012 (NP3). Information is a major component of the care to be provided to women and their partners (Professional consensus). An initial period of hospitalization may be proposed after previable PROM (Professional consensus). Thereafter, there is no argument to recommend hospital management rather than extra-hospital management when there is no argument in favour of intrauterine infection (Professional consensus). An evaluation of the amount of amniotic fluid by ultrasound may be proposed at the initial consultation and after a period of 7 to 14 days if pregnancy continues (Professional consensus). Prophylactic antibiotic treatment is recommended as soon as PROM is diagnosed (Professional consensus). The gestational age at which corticosteroid therapy may be proposed will depend on the thresholds selected for neonatal resuscitation care. In particular, it will take into account parental positioning (Professional consensus). From the time of the decision to perform neonatal resuscitation until the gestational age of 32 weeks, it is recommended to administer MgSO4 to the woman whose delivery is imminent (Grade A). Tocolysis is not recommended in this context (Professional consensus). In certain situations, meeting strictly the conditions mentioned by the CSP article L. 2213-1, a maternal request for medical interruption of pregnancy may be discussed. CONCLUSION: The levels of evidence of scientific work on the management of previable PROM are low, therefore, most of the recommendations proposed here are based on professional agreement by "reasonable" extension of recommendations valid for later gestational ages.


Assuntos
Ruptura Prematura de Membranas Fetais/terapia , Viabilidade Fetal , Idade Gestacional , Corticosteroides/administração & dosagem , Amniocentese/efeitos adversos , Antibioticoprofilaxia , Feminino , Morte Fetal , Ruptura Prematura de Membranas Fetais/etiologia , França , Humanos , Recém-Nascido Prematuro , MEDLINE , Sulfato de Magnésio/administração & dosagem , Gravidez , Nascimento Prematuro , Prognóstico , Tocólise
15.
J Pregnancy ; 2018: 4823404, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30402288

RESUMO

Background: Premature rupture of the membrane (PROM) is associated with high maternal as well as perinatal morbidity and mortality risks. It occurs in 5 to 10% of all pregnancy while incidence of amniotic membrane infection varies from 6 to 10%. This study aimed to determine the incidence of neonatal sepsis in Cipto Mangunkusumo Hospital and the risk factors. Methods: A cross-sectional study was done in Cipto Mangunkusumo Hospital, Jakarta, from December 2016 to June 2017. The study used total sampling method including all pregnant women with gestational age of 20 weeks or more experiencing PROM, who came to the hospital at that time. Samples with existing comorbidities such as diabetes mellitus or other serious systemic illnesses such as heart disease or autoimmune condition were excluded from the analysis. Results: A total of 405 pregnant women with PROM were included in this study. There were 21 cases (5.2%) of neonatal sepsis. The analysis showed that risk of neonatal sepsis was higher in pregnant women with prolonged rupture of membrane for ≥ 18 hours before hospital admission (OR 3.08), prolonged rupture of membrane for ≥ 15 hours during hospitalization (OR 7.32), and prolonged rupture of membrane for ≥ 48 hours until birth (OR 5.77). The risk of neonatal sepsis was higher in preterm pregnancy with gestational age of <37 weeks (OR 18.59). Conclusion: Risk of neonatal sepsis is higher in longer duration of prolonged rupture of membrane as well as preterm pregnancy.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Sepse Neonatal/etiologia , Estudos Transversais , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Hospitalização , Humanos , Incidência , Indonésia/epidemiologia , Recém-Nascido , Sepse Neonatal/epidemiologia , Parto , Gravidez , Fatores de Risco , Fatores de Tempo
16.
Biomed Res Int ; 2018: 7162478, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30402491

RESUMO

Aim: This study aimed to investigate the cause of respiratory distress syndrome (RDS) in neonates from singleton pregnancies with preterm premature rupture of membranes (pPROM) between 24+0 and 36+6 weeks by using regression analysis for various factors. Methods: In 175 singleton pregnancies with pPROM, 95 cases of RDS (54,29%) were diagnosed. In all cases the following information was collected: latency period of PROM, gestational age at birth, Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), fetal distress, antenatal steroids use, delivery type, pregnancy hypertension disease, gestational glucose intolerance or diabetes, neonatal laboratory parameters, gender, weight, Apgar score, and other neonatal complications. Logistic regression analysis was used to investigate the effect of variables on RDS. Results: The results of logistic regression analysis showed that the following variables are closely correlated with RDS: female gender (OR=0.52; 95%CI:0.28-0,97), antenatal steroids use (OR=0,46; 95%CI:0,34-0,64), abnormal UA PI and MCA PI (OR=2.96; 95%CI:1,43-6,12) (OR=2.05; 95%CI:1,07-3,95), fetal distress (OR=2.33; 95%CI:1,16-4,71), maternal HGB (OR=0.69; 95%CI:0,5-0,96), and neonatal RBC, HGB (OR=0.32; 95%CI:0,19-0,55) (OR=0.75; 95%CI:0,65-0,88). Conclusions: The main RDS risk factors in premature neonates are gender, abnormal fetoplacental circulation, and fetal distress. The laboratory parameters such as lower RBC and HGB count are observed in infants with RDS.


Assuntos
Ruptura Prematura de Membranas Fetais , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido , Adulto , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Ruptura Prematura de Membranas Fetais/fisiopatologia , Humanos , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
17.
BMC Pregnancy Childbirth ; 18(1): 386, 2018 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-30268103

RESUMO

BACKGROUND: The incidence of premature rupture of membranes ranges from about 5% to 10% of all deliveries. A woman with premature rupture of membranes is at risk of intra-amniotic infection, postpartum infection, endometritis, and death. A neonate born from premature rupture of membranes mother is at high risk of respiratory distress syndrome, sepsis, intraventricular hemorrhage and death. Little is known regarding the risk factors in Ethiopia. Therefore, this study was conducted to identify risk factors of premature rupture of membranes among pregnant women admitted to public hospitals in Mekelle city, Tigray, Ethiopia. METHODS: Hospital based unmatched case control study design was implemented on 240 samples (160 controls and 80 cases) from pregnant mothers admitted to public hospitals in Mekelle city from February - April/2016. Data was collected by interviewer administered Structured questionnaire and checklist. Binary logistic regression model was used to see the association between dependent and independent variables and multivariable logistic regression was used to identify the independent predictors of premature rupture of membranes. RESULTS: A total of 160 controls and 80 cases were enrolled in the study. Multivariable logistic regression showed that history of abortion [AOR 3.06 (CI: 1.39, 6.71)], history of PROM [AOR 4.45 (CI: 1.87, 10.6)], history of caesarean section [AOR 3.15(CI: 1.05, 9.46)] and abnormal vaginal discharge in the index pregnancy [AOR 3.31(CI: 1.67, 6.56)] were positively associated with premature rupture of membranes. CONCLUSIONS: Past obstetric history and risks in the index pregnancy have an association with premature rupture of membranes. The finding of the study suggests early identification and treatment of genitourinary infection.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/métodos , Aborto Espontâneo/epidemiologia , Estudos de Casos e Controles , Causalidade , Cesárea/estatística & dados numéricos , Etiópia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Hospitais Públicos , Humanos , Recém-Nascido , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Fatores de Risco
18.
Artigo em Inglês | MEDLINE | ID: mdl-30309793

RESUMO

Cervical length (CL) measured by transvaginal ultrasound examination (TVUE) best identifies the risk for preterm birth (PTB). It identifies women at risk who can benefit from corticosteroids or in utero transfer. Early screening improves effectiveness of tocolysis. It reduces iatrogenicity and cost. In preterm premature rupture of membranes (PPROM), CL is devoid of infectious risk and predicts duration of the latency phase but not the risk of perinatal sepsis. Asymptomatic women at risk should be screened at a 2-week interval starting from 16 to 18 weeks, up to 24 weeks. CLs <10th centile are at risk of PTB, especially with decrease in CL after 16 weeks. Repeat ultrasound improves predictive values. Stable CL calls for term delivery. Funneling does not improve predictivity of CL. In twin pregnancies, CL reduces unnecessary interventions. In symptomatic women, fetal fibronectin performs less than CL. Its combination with inconclusive CL has not emerged productive through randomized controlled trials (RCTs), and studies with homogeneous management for preterm labor (PTL) suggest that up to 15% of unjustified hospitalizations and treatment could be avoided.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/fisiopatologia , Nascimento Prematuro/diagnóstico , Biomarcadores/análise , Colo do Útero/diagnóstico por imagem , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Programas de Rastreamento , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/terapia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
19.
Chemosphere ; 210: 1035-1041, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30208528

RESUMO

Heavy metal exposure has been indicated to be linked with reproductive and developmental toxicity. However, human studies on the association between heavy metal exposure and premature rupture of membranes (PROM) are limited. Thus, we aimed to evaluate the associations between urinary metal concentrations in pregnant women and the risk of PROM. The study was conducted among 7290 pregnant women from an ongoing cohort study in China. Levels of urinary metals were determined using an inductively coupled plasma-mass spectrometry and adjusted by creatinine concentration (µg/g creatinine). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for PROM and preterm PROM were estimated using logistic regression models. Among 12 urinary metals detected, vanadium (V) have shown stable positive associations with PROM and preterm PROM. With one unit increase in natural logarithmically transformed urinary V concentration, adjusted OR of 1.57 (95% CI: 1.47, 1.66) for PROM was observed. Compared with the lowest tertile of urinary V, we also observed positive associations between V levels and PROM (for the medium tertile, adjusted OR = 1.66, 95% CI: 1.34, 2.05; for the highest tertile, adjusted OR = 3.75, 95% CI: 3.09, 4.54). In addition, higher adjusted ORs for preterm PROM were observed (for the highest tertile, adjusted OR = 8.14, 95% CI: 4.55, 14.55). Further stratified analysis suggested the associations were more pronounced among women delivering male infants than those with female infants. Our present epidemiological study indicated that pregnant women exposure to higher level of V might lead to an increased risk of PROM.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Ruptura Prematura de Membranas Fetais/urina , Exposição Materna/efeitos adversos , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Vanádio/efeitos adversos , Vanádio/urina , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Nascimento Prematuro/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente
20.
Eur J Clin Microbiol Infect Dis ; 37(12): 2371-2380, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30244363

RESUMO

Our aim was to investigate the association between vaginal Ureaplasma species (spp.) and the subsequent occurrence of chorioamnionitis (CAM), perinatal death, neonatal morbidity, and long-term neurodevelopmental impairments (NDIs) at 3 years of age. We analyzed 55 pregnant women with singleton pregnancy who had preterm premature rupture of the membranes (pPROM) at < 28+0 weeks of gestation, and delivered between 22+0 and 31+6 weeks at our tertiary hospital in 2007-2016. NDIs were defined as either cerebral palsy or developmental delay evaluated at 1.5 and/or 3 years old. The presence of Ureaplasma spp. and Mycoplasma hominis were evaluated using urea-arginine broth and Mycoplasma PPLO Agar. The presence of Ureaplasma spp. in the vagina was positive in 41%. Vaginal Ureaplasma spp. was a significant risk factor for CAM; however, it was not significantly associated with the occurrence of perinatal death, pulmonary hypoplasia, respiratory distress syndrome, transient tachypnea of the newborn, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia defined as oxygen required and occasional ventilatory assistance required at week 36 as modified (BPD36), or NDIs. The crude odds ratio (95% confidence interval) of Ureaplasma spp. for the occurrence of CAM was 9.5 (1.10-82) (p = 0.041). In very preterm birth infants with pPROM, CAM, BPD36, and NDIs occurred in 78, 60, and 36%, respectively. Vaginal Ureaplasma spp. was a significant risk factor for CAM in very preterm birth infants with pPROM. The incidences of BPD36 and NDIs in such infants were very high, nearing 3/5 and 1/3, respectively.


Assuntos
Corioamnionite/microbiologia , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Complicações Infecciosas na Gravidez/microbiologia , Infecções por Ureaplasma/complicações , Vagina/microbiologia , Adulto , Pré-Escolar , Feminino , Ruptura Prematura de Membranas Fetais/microbiologia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Infecções por Mycoplasma/complicações , Mycoplasma hominis/isolamento & purificação , Transtornos do Neurodesenvolvimento/etiologia , Mortalidade Perinatal , Gravidez , Resultado da Gravidez , Nascimento Prematuro , Fatores de Risco , Ureaplasma/isolamento & purificação
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