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Retrospective cohort study: a comparison of two different management strategies in patients with preterm premature rupture of membranes

  • Maternal-Fetal Medicine
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Abstract

Purpose

Perinatal outcomes were compared before and after changes in the treatment policy to improve the management for preterm PROM (pPROM).

Methods

This is a retrospective analysis of 99 cases of pPROM diagnosed between 27 and 34 weeks of gestation, which were managed according to the following two different protocols. Group A (47 cases): tocolytic therapy was continued to prevent preterm delivery until clinical chorioamnionitis (CAM) was diagnosed between January 2000 and June 2004. Group B (52 cases): labor was induced or cesarean section performed when oligohydramnios was diagnosed and/or elevation elastase (EL) of amnion was detected by amniocentesis between July 2004 and July 2009. The outcomes of the cases in each group were compared with regard to the extension of pregnancy period, reasons for delivery, perinatal complications, stage of pathological CAM and funisitis (FUN), neonatal serum IgM concentration, mortality, and morbidity.

Results

The incidences of pathological CAM and FUN were significantly lower in Group B than in Group A. The concentration of neonatal serum IgM was also significantly lower in Group B than in Group A.

Conclusions

The addition of oligohydramnios and elevation EL of amnion as indicative factors of intrauterine infection might lead to a reduction in the severity of fetal infection in cases of pPROM.

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References

  1. Goldenberg RL, Rouse DJ (1998) Prevention of premature birth. N Engl J Med 339(5):313–320. doi:10.1056/NEJM199807303390506

    Article  PubMed  CAS  Google Scholar 

  2. Mercer BM, Goldenberg RL, Meis PJ, Moawad AH, Shellhaas C, Das A, et al (2000) The Preterm Prediction Study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 183(3):738–745. pii:S0002-9378(00)64569-6

  3. (2007) ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 109(4):1007–1019. doi:10.1097/01.AOG.0000263888.69178.1f

  4. Mercer BM (1992) Management of premature rupture of membranes before 26 weeks’ gestation. Obstet Gynecol Clin North Am 19(2):339–351

    PubMed  CAS  Google Scholar 

  5. Beydoun SN, Yasin SY.(1986) Premature rupture of the membranes before 28 weeks: conservative management. Am J Obstet Gynecol. 155 (3):471–479. pii:0002-9378(86)90257-7

  6. Garite TJ, Freeman RK (1982) Chorioamnionitis in the preterm gestation. Obstet Gynecol 59(5):539–545

    PubMed  CAS  Google Scholar 

  7. Simpson GF, Harbert GM Jr (1985) Use of beta-methasone in management of preterm gestation with premature rupture of membranes. Obstet Gynecol 66(2):168–175

    PubMed  CAS  Google Scholar 

  8. Vergani P, Ghidini A, Locatelli A, Cavallone M, Ciarla I, Cappellini A, et al (1994) Risk factors for pulmonary hypoplasia in second-trimester premature rupture of membranes. Am J Obstet Gynecol 170(5 Pt 1):1359–1364. pii:S0002937894000323

    Google Scholar 

  9. Ananth CV, Savitz DA, Williams MA.(1996) Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol 88(2):309–318. pii:0029784496000889

    Google Scholar 

  10. Gonen R, Hannah ME, Milligan JE (1989) Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae? Obstet Gynecol 74(3 Pt 1):347–350

    PubMed  CAS  Google Scholar 

  11. Mercer BM (2003) Preterm premature rupture of the membranes. Obstet Gynecol 101(1):178–193. pii:S0029784402023669

    Google Scholar 

  12. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ et al (2001) Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 107(1):E1

    Article  PubMed  CAS  Google Scholar 

  13. Locatelli A, Ghidini A, Paterlini G, Patane L, Doria V, Zorloni C et al (2005) Gestational age at preterm premature rupture of membranes: a risk factor for neonatal white matter damage. Am J Obstet Gynecol 193(3 Pt 2):947–951. doi:10.1016/j.ajog.2005.06.039

    Article  PubMed  Google Scholar 

  14. Yoon BH, Romero R, Park JS, Kim CJ, Kim SH, Choi JH, et al (2000) Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol 182(3):675–681. pii:S0002937800209708

    Google Scholar 

  15. Spinillo A, Capuzzo E, Stronati M, Ometto A, Orcesi S, Fazzi E (1995) Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age. Br J Obstet Gynaecol 102(11):882–887

    Article  PubMed  CAS  Google Scholar 

  16. Lieberman E, Lang J, Richardson DK, Frigoletto FD, Heffner LJ, Cohen A (2000) Intrapartum maternal fever and neonatal outcome. Pediatrics 105(1 Pt 1):8–13

    Article  PubMed  CAS  Google Scholar 

  17. Ramsey PS, Lieman JM, Brumfield CG, Carlo W (2005) Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. Am J Obstet Gynecol 192(4):1162–1166. doi:10.1016/j.ajog.2004.11.035

    Article  PubMed  Google Scholar 

  18. Park JS, Yoon BH, Romero R, Moon JB, Oh SY, Kim JC et al (2001) The relationship between oligohydramnios and the onset of preterm labor in preterm premature rupture of membranes. Am J Obstet Gynecol 184(3):459–462. doi:10.1067/mob.2001.109398

    Article  PubMed  CAS  Google Scholar 

  19. Yoon BH, Kim YA, Romero R, Kim JC, Park KH, Kim MH, et al (1999) Association of oligohydramnios in women with preterm premature rupture of membranes with an inflammatory response in fetal, amniotic, and maternal compartments. Am J Obstet Gynecol 181(4):784–788. pii:S0002937899005840

    Google Scholar 

  20. Vintzileos AM, Campbell WA, Nochimson DJ, Weinbaum PJ (1985) Degree of oligohydramnios and pregnancy outcome in patients with premature rupture of the membranes. Obstet Gynecol 66(2):162–167

    PubMed  CAS  Google Scholar 

  21. Vintzileos AM, Campbell WA, Nochimson DJ, Weinbaum PJ, Escoto DT, Mirochnick MH (1986) Qualitative amniotic fluid volume versus amniocentesis in predicting infection in preterm premature rupture of the membranes. Obstet Gynecol 67(4):579–583

    PubMed  CAS  Google Scholar 

  22. Kim BJ, Romero R, Mi Lee S, Park CW, Shin Park J, Jun JK et al (2011) Clinical significance of oligohydramnios in patients with preterm labor and intact membranes. J Perinat Med 39(2):131–136. doi:10.1515/JPM.2010.168

    Article  PubMed  Google Scholar 

  23. Mercer BM, Arheart KL (1995) Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet 346(8985):1271–1279. pii:S0140-6736(95)91868-X

    Google Scholar 

  24. Kidokoro K, Furuhashi M, Kuno N, Ishikawa K (2006) Amniotic fluid neutrophil elastase and lactate dehydrogenase: association with histologic chorioamnionitis. Acta Obstet Gynecol Scand 85(6):669–674. doi:10.1080/01443610600604432

    Article  PubMed  CAS  Google Scholar 

  25. Mikamo H, Kawazoe K, Sato Y, Tamaya T (1999) Elastase activity of anaerobes isolated from amniotic fluid with preterm premature rupture of membranes. Am J Obstet Gynecol 180(2 Pt 1):378–380. pii:S0002937899000988

    Google Scholar 

  26. Helmig R, Uldbjerg N, Ohlsson K (1995) Secretory leukocyte protease inhibitor in the cervical mucus and in the fetal membranes. Eur J Obstet Gynecol Reprod Biol 59(1):95–101

    Article  PubMed  CAS  Google Scholar 

  27. Kawagoe Y, Sameshima H, Ikenoue T, Yasuhi I, Kawarabayashi T (2011) Magnesium sulfate as a second-line tocolytic agent for preterm labor: a randomized controlled trial in kyushu island. J Pregnancy 2011:965060. doi:10.1155/2011/965060

    PubMed  Google Scholar 

  28. Combs CA, McCune M, Clark R, Fishman A (2004) Aggressive tocolysis does not prolong pregnancy or reduce neonatal morbidity after preterm premature rupture of the membranes. Am J Obstet Gynecol 190(6):1723–1728. doi:10.1016/j.ajog.2004.02.042 (discussion 8-31)

    Google Scholar 

  29. How HY, Cook CR, Cook VD, Miles DE, Spinnato JA (1998) Preterm premature rupture of membranes: aggressive tocolysis versus expectant management. J Matern Fetal Med 7(1):8–12. doi:10.1002/(SICI)1520-6661(199801/02)7:1<8:AID-MFM2>3.0.CO;2-S

    Article  PubMed  CAS  Google Scholar 

  30. Garite TJ, Keegan KA, Freeman RK, Nageotte MP (1987) A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation. Am J Obstet Gynecol 157(2):388–393

    PubMed  CAS  Google Scholar 

  31. Wolfensberger A, Zimmermann R, von Mandach U (2006) Neonatal mortality and morbidity after aggressive long-term tocolysis for preterm premature rupture of the membranes. Fetal Diagn Ther 21(4):366–373. doi:10.1159/000092467

    Article  PubMed  Google Scholar 

  32. Lencki SG, Maciulla MB, Eglinton GS (1994) Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis. Am J Obstet Gynecol 170(5 Pt 1):1345–1351. pii:S0002937894000311

    Google Scholar 

  33. Blanc W (1981) Pathology of placenta, membranes, and umbilical cord in bacterial, fungal, viral infections in man. Williams and Wilkins, Baltimore

    Google Scholar 

  34. Greci LS, Gilson GJ, Nevils B, Izquierdo LA, Qualls CR, Curet LB (1998) Is amniotic fluid analysis the key to preterm labor? A model using interleukin-6 for predicting rapid delivery. Am J Obstet Gynecol 179(1):172–178. pii:S0002937898702698

    Google Scholar 

  35. Harirah H, Donia SE, Hsu CD (2002) Amniotic fluid matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection. Obstet Gynecol 99(1):80–84. pii:S0029784401016325

    Google Scholar 

  36. Thomakos N, Daskalakis G, Papapanagiotou A, Papantoniou N, Mesogitis S, Antsaklis A (2010) Amniotic fluid interleukin-6 and tumor necrosis factor-alpha at mid-trimester genetic amniocentesis: relationship to intra-amniotic microbial invasion and preterm delivery. Eur J Obstet Gynecol Reprod Biol 148(2):147–151. doi:10.1016/j.ejogrb.2009.10.027

    Article  PubMed  CAS  Google Scholar 

  37. Miura H, Ogawa M, Hirano H, Sanada H, Sato A, Obara M et al (2011) Neutrophil elastase and interleukin-6 in amniotic fluid as indicators of chorioamnionitis and funisitis. Eur J Obstet Gynecol Reprod Biol 158(2):209–213. doi:10.1016/j.ejogrb.2011.05.009

    Article  PubMed  CAS  Google Scholar 

  38. Romero R, Emamian M, Quintero R, Wan M, Hobbins JC, Mazor M, et al (1988) The value and limitations of the Gram stain examination in the diagnosis of intraamniotic infection. Am J Obstet Gynecol 159(1):114–119. pii:0002-9378(88)90503-0

    Google Scholar 

  39. Fujimura M, Takeuchi T, Ando M, Funato M, Shimada S, Tsujimoto A, et al (1983) Elevated immunoglobulin M levels in low birth-weight neonates with chronic respiratory insufficiency. Early Hum Dev 9(1):27–32. pii:0378-3782(83)90099-3

    Google Scholar 

  40. Berg T (1968) Immunoglobulin levels in infants with low birth weights. Acta Paediatr Scand 57(5):369–376

    Article  PubMed  CAS  Google Scholar 

  41. Benirschke K (1960) Routes and types of infection in the fetus and the newborn. AMA J Dis Child 99:714–721

    PubMed  CAS  Google Scholar 

  42. Fujimura M, Takeuchi T, Kitajima H, Nakayama M (1989) Chorioamnionitis and serum IgM in Wilson-Mikity syndrome. Arch Dis Child 64(10 Spec No):1379–1383

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by the Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan (Grant 21592113).

Conflict of interest

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan

    Azusa Shinjo, Katsufumi Otsuki, Maki Sawada, Hajime Ota, Mayumi Tokunaka, Tomohiro Oba, Ryu Matsuoka & Takashi Okai

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  1. Azusa Shinjo
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Correspondence to Katsufumi Otsuki.

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Shinjo, A., Otsuki, K., Sawada, M. et al. Retrospective cohort study: a comparison of two different management strategies in patients with preterm premature rupture of membranes. Arch Gynecol Obstet 286, 337–345 (2012). https://doi.org/10.1007/s00404-012-2271-0

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  • DOI: https://doi.org/10.1007/s00404-012-2271-0

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