Endometrial immune profiling: Bridging pre-eclampsia research with infertility solutions.

Objective To discuss detect cervical length and funnel-like change for preterm premature rupture of the membranes(PPROM) high-risk pregnant women by transvaginal ultrasonography(TVS)to predict the occurrence of PPROM. Methods A total of 68 cases of PPROM high-risk pregnant women hospitalized in Tianjin Central Hospital of Gynecology Obstetrics from June 2009 to December 2013 were selected as study subjects, according to whether PPROM occurred or not after admission, they were divided into PPROM group(n=28) and non PPROM group(n=40). All subjects were given TVS to detect cervical length and the occurrence of cervical funnel-like changes, statistically analyzed the differences of cervical length and cervical funnel-like change rate of pregnant women between two groups, and the accuracy of different cervical length and funnel-like change to predict occurrence of PPROM and the relationship with PPROM occurrence. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Tianjin Central Hospital of Gynecology Obstetrics.Informed consent was obtained from each participant.There were no significant differences between two groups in general clinical data such as maternal age, pre-pregnant body weight and gestational age(P>0.05). Results ①Cervical length of pregnant women of PPROM group was significantly shorter than that of non PPROM group, the cervical funnel-like change rate was significantly higher than that of non PPROM group, and the differences were statistically(t=2.273, 5.909; P<0.05). ②With the length of cervical getting shorter and cervical funnel-like change rate getting higher, the prediction specificity and positive predictive value of PPROM increased gradually, and cervical length<5 mm or 75%<funnel-like change rate≤100% had highest prediction specificity of PPROM (97.2% and 96.3%) and positive predictive value(79.6% and 76.3%), they had the closest relationship with PPROM occurrence(OR=6.47, 95%CI: 1.33-38.21, P<0.05; OR=5.80, 95%CI: 1.11-30.22, P<0.05). Conclusion TVS detecting cervical length and cervical funnel-like change can effectively predict the occurrence of PPROM of high risk PPROM pregnant women; Cervical length 75% have the highest prediction value of PPROM occurrence. Key words: Transvaginal ultrasonography; Preterm premature rupture of the membranes; Cervix uteri; Forecasting

Polymorphisms in the tumor necrosis factor-α gene at position −308 and the inducible 70 kd heat shock protein gene at position +1267 in multifetal pregnancies and preterm premature rupture of fetal membranes

658: Latency and infectious complications following preterm premature rupture of the membranes: Impact of body mass index

To characterize the population of women who underwent mid-trimester preterm premature rupture of membrane (PPROM) in a country where mid-trimester abortions are legal and available. A retrospective cross-sectional cohort study was conducted at a tertiary referral hospital, during 2013-2016. Mid-trimester defined as gestational age 13 + 0 to 23 + 6weeks. Rupture of membrane was defined by documentation of fluid passing through the cervix on sterile speculum examination, and a positive Nitrazine (Bristol-Myers Squibb, Princeton, NJ) or erning test. All records were evaluated for medical history, laboratory data, postnatal examination, and autopsy findings, and a database was constructed. A total of 61 women were hospitalized for mid-trimester PPROM during the study period. Mean maternal age was 32 ± 5.98, range 20-45years old. The majority (50, 82%) of patients decided to terminate their pregnancy before reaching the limit of viability at 24weeks gestation. The overall prognosis of pregnancies reaching term was better than expected, with six (9.8%) patients delivering live babies and four of them born at term (36 ± 5 to 40 ± 6weeks gestation), all after PPROM following amniocentesis or selective fetal reduction. A total of 60% of women with hypothyroidism had unbalanced TSH levels above 4.0 mIU/L prior to their pregnancy. A notable number of women (15, 24.6%) had PPROM following a pregnancy achieved by assisted reproductive technology (ART). Most women with diagnosed mid-trimester PPROM opted for pregnancy termination before the limit of viability when granted the choice. Possible risk factors for early PPROM are unbalanced hypothyroidism and ART. PPROM following amniocentesis can in some cases reseal and reach term, suggesting conservative treatment is a reasonable management for those cases.

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

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BackgroundOne of the most critical functions of the fetal membranes is to remain intact until the onset of labor to maintain the protective intrauterine fluid environment. In most pregnancies, spontaneous rupture usually occurs near the end of the first stage of labor. Preterm premature membrane rupture (PROM) occurs when the fetal membrane ruptures before 37 weeks of pregnancy, and it contributes to adverse maternal, fetal, and neonatal outcomes. Therefore, this study aimed to determine the association of determinant factors with adverse perinatal outcomes.MethodsA prospective cohort study was conducted on pregnant women with preterm premature membrane rupture (n = 160) attending the teaching hospitals at Addis Ababa University. Socio-demographic and obstetric risk factors with adverse perinatal outcomes include the 5th minute Apgar score, neonatal intensive care unit (NICU) admission, early-onset neonatal sepsis (EONS), respiratory distress syndrome (RDS), perinatal mortality, Chorioamnionitis, and placental abruption were assessed. SPSS version 24, t-test, χ2 test, and logistic regression analysis were used. P-values <0.25 in the bivariate and p < 0.05 in the multiple logistic regression were considered statistically significant.ResultsThe preterm (PROM) rate was 2.2% with perinatal mortality rate of 206/1,000. Gestational age (GA) at delivery was the determinate for low Apgar score at the 5th minute (AOR: 7.23; 95% CI, 1.10, 47.6; p = 0.04). Unable to use steroid (AOR: 8.23; 95% CI, 1.83, 37.0; p = 0.000), GA at membrane rupture (AOR: 4.61; 95% CI, 1.98, 31.8; p = 0.000) and delivery (AOR: 4.32; 95% CI, 1.99, 30.9; p = 0.000) were determinates for NICU admission. EONS was significantly affected by GA at membrane rupture (AOR: 5.9; 95% CI, 1.01, 37.0; p = 0.04). Placental abruption was significantly affected by GA at delivery (AOR: 7.52; 95% CI, 1.15, 48.96; p = 0.04).ConclusionGA at membrane rupture and delivery was the most critical predictors of adverse perinatal outcomes. Local guidelines on the approach and preterm PROM outcome management need to be prepared.

Authors’ Response

Preterm premature rupture of membranes (PPROM) likely results from weakening of the constituent connective tissue. It is uncertain if the alterations are limited to the fetal membranes or are also present in other sites such as the skin. The aim of the study was to compare the dermal structure of women suffering from recurrent PPROM with the dermis of both non-pregnant women and women with uneventful gestation. Skin biopsies were taken from 42 women who recently underwent PPROM, 33 women with uneventful gestation and 33 non-pregnant women. Histochemistry, immunohistochemistry, and electron microscopy were performed on these specimens and analyzed blindly. Morphologic changes were found in the dermis of most (33 of 42 at optical microscopy and 40 of 42 at ultrastructure) of the women suffering from PPROM. They were reminiscent of those found in some types of Ehlers-Danlos Syndrome (EDS). However, there was no clinical evidence suggesting a recognized form of EDS. We conclude that some cases of PPROM are a systemic connective tissue disorder representing a yet unidentified type of EDS.

Background: The major cause of neonatal morbidity and mortality is preterm birth due to: preterm premature rupture of membrane (PPROM), preterm labour, and early delivery resulting from medical intervention. PPROM is defined as a rupture of the amniotic membranes before 37 weeks’ gestation and before the onset of labour, while extreme PPROM occurs before 26 weeks’ gestation. PPROM is a serious condition leading to approximately one-third of preterm births and it complicates about 3% of pregnancies [1].Advances in Knowledge: Few studies have looked at preterm premature rupture of membranes (PPROM) or possible outcomes for mothers and fetuses. This complication carries a significant morbidity and mortality rate and affects the perinatal outcome.Application to Patient Care: The results of this study will help in increasing awareness of PPROM for both the obstetricians and neonatologists and encourage close follow-up, proper management and counselling for this high risk group.Aim: To study perinatal outcome in preterm premature rupture of membrane and their associated risk factors.Methods: A retrospective cohort study with a sample size of 100 consecutive pregnant women was conducted from January 2018 to December 2018. All the participants were women who presented with PPROM.Results:Discussion: PPROM was more common in age group of less than 25 years with a incidence of 58%. Ina study by Noor et al in Ayub medical college in 2006 demonstrated that (58.8%) higher incidence among younger age group.Conclusion: PPROM was more common in younger age group. PPROM was not associated with previous history, booking status or previous abortion. Majority of neonatal morbidity was due to RDS In present study RDS was common in early preterm group In current study most of patients delivered vaginally compared to 36% of LSCS.

Preterm premature rupture of membranes (PPROM) is defined as a spontaneous membrane rupture that occurs before the onset of labor and 37 weeks gestation. Subclinical intrauterine infection has been suggested as a very important etiological factor in the pathogenesis and subsequent morbidity related with PPROM. This study was performed to assess the levels of maternal proadrenomedullin (pro-ADM) and serum amyloid A (AA) in PPROM and its association with fetomaternal infectious morbidity. A total of 63 pregnant women, of which 43 with PPROM between 24 and 34 weeks gestation and 20 normal pregnant women without PPROM were included in the study. The study group was separated into 2 subgroups as PPROM and PPROM-histological chorioamnionitis (PPROM-HC). The blood samples were taken before the administration of any medication. The mean serum interleukin-6 (IL-6), AA, and pro-ADM values in the PPROM-HC group were significantly higher than the PPROM and control group. The cutoff values of pro-ADM and AA were determined as 4.2 nM and 69 μg/mL, respectively. Both of them showed similar sensitivity, specificity to IL-6 and a better sensitivity and specificity as compared to C-reactive protein and white blood cell count. We determined the predictive value of pro-ADM and serum AA measurements in PPROM and PPROM with histological chorioamnionitis. We suggest using pro-ADM and serum AA biomarkers for detecting the histological chorioamnionitis at an earlier stage in PPROM without any clinical signs.

Individualized treatment of preterm premature rupture of membranes to prolong the latency period, reduce the rate of preterm birth, and improve neonatal outcomes

Absence of circadian rhythms of preterm premature rupture of membranes and preterm placental abruption

530: Reduced fetal urine production rate (FUPR) in preterm premature rupture of membranes (PPROM) predicts adverse neonatal outcome (ANO)

Twenty percent of very preterm neonates (23-32 weeks of gestation) are born with bacteremia caused by genital Mycoplasmas