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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.06.049 Byline: Thaddeus P. Waters, Brian M. Mercer Keywords: periviable; preterm premature rupture of membranes; previable Abstract: Preterm premature rupture of the membranes near the limit of fetal viability is an uncommon complication of pregnancy, affecting approximately 4 in 1000 gravidas. However, maternal, fetal, and neonatal complications resulting from this condition are significant and include chorioamnionitis, pulmonary hypoplasia, restriction deformities, fetal loss, and complications of extreme prematurity among surviving infants. In this article, we review the literature regarding pregnancy outcomes after preterm premature rupture of the membranes near the limit of viability, and the data on traditional and nontraditional interventions to improve outcomes. An approach to patients who present with preterm premature rupture of the membranes near the limit of viability will be proposed. Author Affiliation: Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio Article History: Received 20 March 2009; Revised 1 May 2009; Accepted 23 June 2009 Article Note: (footnote) Reprints not available from the authors.

The rate of successful trial of labor after previous cesarean delivery for dystocia is assessed in a large cohort based on the relative birth weights of the two pregnancies. It is likely that increased fetal size relative to previous birth weight plays a significant role in the outcome of a subsequent trial of labor for patients with previous cesarean delivery for dystocia, reducing chances of vaginal delivery.

The success rates of vaginal birth after cesarean (VBAC) delivery, uterine rupture and major maternal/perinatal outcomes are compared between women, with previous cesarean deliveries undergoing trial of labor (TOL) with preterm and term pregnancies, and also maternal and neonatal morbidities in women with preterm pregnancies undergoing a TOL versus repeat cesarean delivery without labor (RCD). The likelihood of VBAC success after TOL in preterm pregnancies is comparable to term gestations, with a lower risk of uterine rupture, and perinatal outcomes are similar with preterm TOL and RCD.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.06.043 Byline: Amy Merlino (a), Laura Laffineuse (a), Marc Collin (b), Brian Mercer (a) Abstract: Low maternal pre-pregnancy body-mass index (BMI) has been associated with preterm birth (PTB). Women delivering preterm are at increased for recurrent PTB. Our goal was to determine whether change in BMI between pregnancies alters the risk of PTB. Author Affiliation: (a) Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (b) Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH Article History: Received 10 March 2006; Revised 2 June 2006; Accepted 10 June 2006 Article Note: (footnote) Presented at the 26th Annual Meeting of the Society for Maternal Fetal Medicine, January 30-February 4, 2006, Miami, FL. Reprints not available from the authors.

A study was undertaken to determine whether women with recurrent spontaneous preterm births (rSPBs) having different clinical characteristics or systemic markers than those with isolated preterm (iSPBs) or recurrent term births (rTBs), when assessed remote from delivery. Women with rSPBs are leaner, contract more, have shorter cervixes, and have more advanced Bishop scores than women with iSPBs or rTBs.

A study to evaluate the association between measured amniotic fluid volume and outcome after preterm premature rupture of membranes (PROM) was conducted. Preterm PROM is responsible for approximately one third of preterm births whereas low residual amniotic fluid volume subsequent to membrane rupture, assessed by either single or multiple measurements was associated with early delivery as well as subsequent infectious morbidity.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.06.083 Byline: Sunny Arikat (a), Ryan W. Novince (a), Brian M. Mercer (b), Deepak Kumar (a), Jennifer M. Fox (a), Joseph M. Mansour (c), John J. Moore (a)(b) Abstract: This study was undertaken to determine the sequence of events that occur during fetal membrane (FM) rupture and to compare the biophysical properties of intact FM with its separated individual components (amnion and choriodecidua). Author Affiliation: (a) Departments of Pediatrics (b) Reproductive Biology, MetroHealth Medical Center, Case Western Reserve University (c) Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH Article Note: (footnote) Supported in part by NIH HD39159 and HD48467 to J.J.M. Presented at the Fifty-Second Annual Meeting of the Society of Gynecologic Investigation in Los Angeles, CA, March 23-26, 2005.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.03.062 Byline: Kim A. Boggess (a), Jennifer L. Bailit (b)(c), Mendel E. Singer (c)(d)(e), Valerie M. Parisi (a), Brian M. Mercer (b) Abstract: The purpose of this study was to compare strategies of corticosteroid administration for the prevention of neonatal morbidity and death. Author Affiliation: (a) Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (b) Metrohealth Medical Center (c) Center for Health Care Research and Policy (d) Department of Epidemiology and Biostatistics (e) Case Western Reserve University; Center for Quality Improvement Research, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH Article History: Received 9 November 2004; Revised 25 March 2005; Accepted 26 March 2005 Article Note: (footnote) Supported by National Institute of Child and Human Development, National Institutes of Health grant nos. 1K08 HD 043284 (K.A.B.) and K12 HD98004 (J.L.B.). Reprints not available from the authors.

The frequency of inflammatory cytokine and Toll-like receptor gene polymorphisms in women with and without bacterial vaginosis (BV) in pregnancy is estimated. Results conclude that after controlling for race, polymorphisms at the interleukin (IL) 1beta Exon 5 + 3954, IL6-174, and IL8-845 loci are associated with an altered rate of BV in pregnancy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.05.047 Byline: Amy A. Goodwin, Brian M. Mercer Abstract: There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. Author Affiliation: Department of Obstetrics and Gynecology, MetroHealth Medical Center at Case Western Reserve University School of Medicine, Cleveland, OH Article History: Received 28 February 2005; Revised 3 May 2005; Accepted 10 May 2005 Article Note: (footnote) Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev. Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.05.040 Byline: Brian Mercer (a), Cynthia Milluzzi (a), Marc Collin (b) Abstract: Early preterm birth at 20 to 26 weeks of gestation (periviable birth) carries extreme risks of infant death and morbidities. Prevention of periviable birth could improve infant outcomes significantly. We sought to characterize the causes of periviable birth and to determine whether periviable birth can be predicted by previous pregnancy outcome. Author Affiliation: (a) Departments of Reproductive Biology (b) Pediatrics MetroHealth Medical Center at Case Western Reserve University, Cleveland, OH Article History: Received 1 March 2005; Revised 2 May 2005; Accepted 9 May 2005 Article Note: (footnote) Presented at the 25th Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nevada. Reprints not available from the authors.

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 are compared. 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.

The success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery are identified. A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity.

The relationship between prepregnancy maternal body mass index (BMI) and the rate of spontaneous and indicated preterm birth is evaluated. It is concluded that obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.05.047 Byline: Judette M. Louis (a), Hugh M. Ehrenberg (a), Marc F. Collin (b), Brian M. Mercer (a) Abstract: The purpose of this study was to evaluate trends in the level of obstetric and neonatal intervention near the limit of viability and perinatal morbidity and mortality rates over time. Author Affiliation: (a) Departments of Reproductive Biology and Obstetrics and Gynecology (b) Pediatrics, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio Article Note: (footnote) Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal Medicine, February 2-7, 2004, New Orleans, La. Reprints not available from the authors.

The study was undertaken to determine the relative contribution of abnormal pregravid maternal body habitus and diabetes on the prevalence of large-for-gestational-age (LGA) infants. Having shown pregravid maternal obesity to have a strong independent affect on the risk of delivering a LGA infant.

The purpose of this study was to evaluate the independent influence of pregravid obesity and diabetes on the occurrence of primary cesarean delivery. Pregravid obesity and diabetes independently increase the risk for cesarean delivery.

The purpose of study was to determine the impact of maternal pregravid body mass index (BMI) and weight gain between pregnancies on vaginal birth after cesarean section (VBAC) success in women after a single low transverse cesarean delivery. Increasing pregravid BMI and weight gain between pregnancies reduce VBAC success after a single low transverse cesarean delivery.

Patients do not cause demonstrating the increases in the cesarean delivery rate with combinations of characteristics putting them at higher risk for cesarean delivery. The increasing cesarean delivery rate may result from changes in physician behavior, institutional factors, and increasing patient demand for elective cesarean delivery.

A study was conducted to evaluate the relationship between preterm premature rupture of the membranes (PPROM) and homocysteine levels when compared with those of matched asymptomatic control women delivering at term. It was found that women presenting with PPROM did not have a significantly increased serum homocysteine levels when compared with control women.

Doctors report what may be the first known case of a woman who had a spinal cord injury and both legs amputated who became pregnant and successfully delivered the baby. The pregnancy did not go smoothly, and she had recurrent urinary tract infections, premature labor, spinal abscesses, and an abnormally positioned baby. She was delivered by a cesarean and was discharged with her baby on the third postoperative day.

About 28% of pregnant women delivered at one Cleveland hospital were obese between 1997 and 2001, compared to 21% between 1986 and 1996. African American women were most likely to be obese and Asian American women were least likely to be obese. Obesity increased the women's risk of preeclampsia, gestational diabetes, prolonged pregnancy, large babies, and cesarean delivery.

Pregnant women who have increased blood levels of alkaline phosphatase, alpha-fetoprotein, or corticotropin-releasing hormone at 24 or 28 weeks of pregnancy have an increased risk of premature birth. These substances could be used as markers of premature birth.

Pregnant women who deliver prematurely have higher than normal blood levels of ferritin, which is an iron storage protein. High ferritin levels are an indication of inflammation, which supports the theory that premature birth may be caused by a uterine infection.

Gelatin sponges can plug small holes in amniotic membranes, according to researchers who tested this method in the laboratory. However, they may not work on larger holes, especially if the hole has an unusual shape.

Cervical length, fetal fibronectin, maternal alpha fetoprotein, alkaline phosphatase, and granulocyte colony-stimulating factor can predict which pregnant women will deliver prematurely, according to a study of 2,929 women. Premature babies have a high rate of death and future disability.

A positive test for fetal fibronectin and increased levels of interleukin-6 in cervical fluid at 24 weeks' gestation may identify pregnant women who will deliver prematurely. This was the conclusion of a study of 125 pregnant women who delivered prematurely and 125 who delivered at term.

A fetal fibronectin level of more than 50 nanograms in cervical fluid may predict premature birth, according to a study of 2,926 pregnant women. Fetal fibronectin is a protein produced by fetal membranes that probably helps maintain the attachment of the amniotic sac to the placenta.

Manual cervical examination does not appear to increase the risk of infection in pregnant women with premature rupture of fetal membranes, according to a study of 794 women. Manual examinations are usually not done for fear that the doctor's finger might introduce bacteria into the uterus.

A short cervix, a previous history of premature birth, and a positive fetal fibronectin test can predict which pregnant women will deliver prematurely. This was the conclusion of a study of 2,929 women.

Pregnant women who have a genito-urinary chlamydia infection have a two to three times greater risk of premature birth compared to non-infected pregnant women. Chlamydia is one of the most common sexually transmitted diseases.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1067/mob.2000.104951 Byline: Bassam Haddad, Brian M. Mercer, Jeffrey C. Livingston, Ajay Talati, Baha M. Sibai Keywords: Apgar score; resuscitation; neonatal outcome Abstract: Objective: Our purpose was to evaluate the outcome of infants who underwent successful resuscitation after initial Apgar scores of 0 at both 1 and 5 minutes. Study Design: Eligible infants were identified through the perinatal database at the University of Tennessee, Memphis. Hospital records and long-term outcomes, where available, of babies who met the above criteria occurring between January 1986 and February 1999 were reviewed. Results: Thirty-three of 81,603 infants (0.4/1000 births) met our study criteria. Twenty-two (67%) babies died during hospitalization. Mortality decreased significantly from 100% for babies with a birth weight of 0 was significantly higher among survivors than among those who subsequently died (82% vs 33%, P < .05). Nine survivors had hypoxic-ischemic encephalopathy diagnosed before discharge. Of the 7 infants with available follow-up, 4 had significant persisting morbidity. Two infants had normal neurologic examinations at follow-up. Conclusion: Survival in babies born with 1- and 5-minute Apgar scores of 0 is predicted by birth weight, gestational age, and 10-minute Apgar score. Long-term sequelae are common but not ensured. (Am J Obstet Gynecol 2000;182:1210-4.) Author Affiliation: Memphis, Tennessee From the Departments of Obstetrics and Gynecology.sup.a and Pediatrics,.sup.b University of Tennessee, Memphis Article History: Received 14 July 1999; Revised 25 October 1999; Accepted 9 December 1999 Article Note: (footnote) [star] Reprints not available from the authors.

A short cervix and the presence of fetal fibronectin in cervical fluids are independent risk factors for premature birth. This is true regardless of which occurs first.