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Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study

BACKGROUND: Preterm premature rupture of membranes (PPROM) complicates 1 % of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of th...

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Autores principales: Linehan, Laura Aoife, Walsh, Jennifer, Morris, Aoife, Kenny, Louise, O’Donoghue, Keelin, Dempsey, Eugene, Russell, Noirin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734873/
https://www.ncbi.nlm.nih.gov/pubmed/26831896
http://dx.doi.org/10.1186/s12884-016-0813-3
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author Linehan, Laura Aoife
Walsh, Jennifer
Morris, Aoife
Kenny, Louise
O’Donoghue, Keelin
Dempsey, Eugene
Russell, Noirin
author_facet Linehan, Laura Aoife
Walsh, Jennifer
Morris, Aoife
Kenny, Louise
O’Donoghue, Keelin
Dempsey, Eugene
Russell, Noirin
author_sort Linehan, Laura Aoife
collection PubMed
description BACKGROUND: Preterm premature rupture of membranes (PPROM) complicates 1 % of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of this retrospective descriptive cohort study was to investigate the natural history of midtrimester PPROM in a jurisdiction where termination of pregnancy in the absence of maternal compromise is unavailable. METHODS: Cases of midtrimester PPROM diagnosed between 14 and 23 + 6 weeks’ gestation during April 2007 to June 2012 were identified following a manual search of all birth registers, pregnancy loss registers, annual reports, ultrasound reports, emergency room registers and neonatal death certificates at Cork University Maternity Hospital - a large (circa 8500 births per annum) tertiary referral maternity hospital in southwest Ireland. Cases where delivery occurred within 24 h of PPROM were excluded. RESULTS: The prevalence of midtrimester PPROM was 0.1 % (42 cases/44,667 births). The mean gestation at PPROM was 18 weeks. The mean gestation at delivery was 20 + 5 weeks, with an average latency period of 13 days. Ten infants were born alive (23 %; 10/42). The remainder (77 %; 32/42) died in utero or intrapartum. Nine infants were resuscitated. Two infants survived to discharge. The overall mortality rate was 95 % (40/42). Five women had clinical chorioamnionitis (12 %; 5/42) but 69 % demonstrated histological chorioamnionitis. One woman developed sepsis (2.4 %; 1/42). Other maternal complications included requirement of intravenous antibiotic treatment (38 %; 17/42), retained placenta (21 %, 9/42) and post-partum haemorrhage (12 %; 5/42). CONCLUSIONS: This study provides useful and contemporary data on midtrimester PPROM. Whilst fetal and neonatal mortality is high, long-term survival is not impossible. The increased risk of maternal morbidity necessitates close surveillance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0813-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-47348732016-02-02 Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study Linehan, Laura Aoife Walsh, Jennifer Morris, Aoife Kenny, Louise O’Donoghue, Keelin Dempsey, Eugene Russell, Noirin BMC Pregnancy Childbirth Research Article BACKGROUND: Preterm premature rupture of membranes (PPROM) complicates 1 % of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of this retrospective descriptive cohort study was to investigate the natural history of midtrimester PPROM in a jurisdiction where termination of pregnancy in the absence of maternal compromise is unavailable. METHODS: Cases of midtrimester PPROM diagnosed between 14 and 23 + 6 weeks’ gestation during April 2007 to June 2012 were identified following a manual search of all birth registers, pregnancy loss registers, annual reports, ultrasound reports, emergency room registers and neonatal death certificates at Cork University Maternity Hospital - a large (circa 8500 births per annum) tertiary referral maternity hospital in southwest Ireland. Cases where delivery occurred within 24 h of PPROM were excluded. RESULTS: The prevalence of midtrimester PPROM was 0.1 % (42 cases/44,667 births). The mean gestation at PPROM was 18 weeks. The mean gestation at delivery was 20 + 5 weeks, with an average latency period of 13 days. Ten infants were born alive (23 %; 10/42). The remainder (77 %; 32/42) died in utero or intrapartum. Nine infants were resuscitated. Two infants survived to discharge. The overall mortality rate was 95 % (40/42). Five women had clinical chorioamnionitis (12 %; 5/42) but 69 % demonstrated histological chorioamnionitis. One woman developed sepsis (2.4 %; 1/42). Other maternal complications included requirement of intravenous antibiotic treatment (38 %; 17/42), retained placenta (21 %, 9/42) and post-partum haemorrhage (12 %; 5/42). CONCLUSIONS: This study provides useful and contemporary data on midtrimester PPROM. Whilst fetal and neonatal mortality is high, long-term survival is not impossible. The increased risk of maternal morbidity necessitates close surveillance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0813-3) contains supplementary material, which is available to authorized users. BioMed Central 2016-01-29 /pmc/articles/PMC4734873/ /pubmed/26831896 http://dx.doi.org/10.1186/s12884-016-0813-3 Text en © Linehan et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Linehan, Laura Aoife
Walsh, Jennifer
Morris, Aoife
Kenny, Louise
O’Donoghue, Keelin
Dempsey, Eugene
Russell, Noirin
Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
title Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
title_full Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
title_fullStr Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
title_full_unstemmed Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
title_short Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
title_sort neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734873/
https://www.ncbi.nlm.nih.gov/pubmed/26831896
http://dx.doi.org/10.1186/s12884-016-0813-3
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