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Introduction: Preterm prelabor rupture of membranes (PPROM) remains a major complication of fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome (TTTS). The aim of the study was to determine the impact of cannula size on pregnancy outcomes, with a particular focus on PPROM. Material and methods: The protocol was developed and registered in the PROSPERO database under registration number CRD42022333630. The PubMed, Web of Science, and EMBASE databases were searched electronically on May 18, 2022, and updated on March 2, 2023, utilizing a combination of the relevant MeSH terms, keywords, and word variants for "TTTS" and "laser". Randomized controlled trials, prospective and retrospective cohorts, case–control studies, and case reports/series with more than five participants were considered eligible for inclusion. Studies reporting the cannula diameter and PPROM rate after laser surgery in the treatment of monochorionic pregnancies affected by TTTS between 16‐ and 26 weeks' gestation were included. Data was extracted independently, and when appropriate, a random‐effects meta‐analysis was undertaken to calculate pooled estimates and their confidence intervals. Heterogeneity in the effect estimates of the individual studies was calculated using the I2 statistic. The primary outcome was PPROM rate. Secondary outcomes were survival rate, preterm birth, and incomplete surgery. The quality of the included studies was assessed using a modified quality in prognosis study tool. Results: We included a total of 22 studies, consisting of 3426 patients. Only one study was scored as low quality, seven as moderate quality, and the remaining 14 as high quality. The mean PPROM rate after laser surgery treating TTTS was 22.9%, ranging from 11.6% for 9 French (Fr) to 54.0% for 12 Fr. Subsequent meta‐regression for the clinically relevant PPROM rate before 34 weeks of gestation, showed increased PPROM rates for increased cannula size (p‐value 0.01). Conclusions: This systematic review confirmed PPROM as a frequent complication of fetal laser surgery, with a mean PPROM rate of 22.9%. A larger cannula diameter relates to a significant higher PPROM risk for PPROM before 34 weeks gestation. Hence, the ideal balance between optimal visualization requiring larger port diameters and shorter operation time and more complete procedures that benefit from larger diameters is crucial to reduce iatrogenic PPROM rates. [ABSTRACT FROM AUTHOR]

BACKGROUND: Significant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM. METHODS: We conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5 and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined. RESULTS: In total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9-14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5 during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts. CONCLUSION: Using a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.

Objective To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. Study Design This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created. Results Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67–0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1–13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6–104.6), and male gender (OR: 2.5, CI: 1.4–4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78–0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants. Conclusion IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae. Key Points Factors known at hospital discharge are identified which are independently associated with death or CP by age 2. A model was created and validated using these findings to counsel parents. The risk of death or CP can be calculated at the time of hospital discharge. [ABSTRACT FROM AUTHOR]

Studies on pathogenesis of fetal membrane insufficiency in preterm pregnancy should expand the opportunities of predicting prenatal rupture of amniotic fluid and improve the strategy of anticipant gestation management in cases of premature rupture of the fetal membranes. The clinical significance of studying this obstetric problem is unquestionable due to the high risk of complications and perinatal losses caused by preterm birth. This research is devoted to studying the changes in cytokine profile of amniotic fluid during prenatal rupture of amniotic fluid at 22 to 34 weeks of gestation. The levels of pro-inflammatory (TNFα, IL-6, IL-1β, IL-2, IL-6, IL-8) and anti-inflammatory (IL-4, IL-10) cytokines in amniotic fluid were determined in 30 patients, whose premature pregnancy was complicated by early rupture of the membranes. For reference, the level of these cytokines in the amniotic fluid was studied in 25 pregnant women with a physiological course of pregnancy at full-term gestation. The ELISA technique was used with a test system produced by JSC Vector-Best. The study was carried out on the basis of the Perinatal Center of the Saratov Region. We have found that premature rupture of the membranes is preceded by increased levels of pro-inflammatory cytokines in amniotic fluid. The latter result suggests a significant alteration in feto-placental complex, which may be the starting point both for damage to the fetal membranes, as well as for development of labor activity.

Fetal therapies undertaken to improve fetal outcome or to optimize transition to neonate life often entail some level of maternal, fetal, or neonatal risk. A fetal therapy center needs access to resources to carry out such therapies and to manage maternal, fetal, and neonatal complications that might arise, either related to the therapy per se or as part of the underlying fetal or maternal condition. Accordingly, a fetal therapy center requires a dedicated operational infrastructure and necessary resources to allow for appropriate oversight and monitoring of clinical performance and to facilitate multidisciplinary collaboration between the relevant specialties. Three care levels for fetal therapy centers are proposed to match the anticipated care complexity, with appropriate resources to achieve an optimal outcome at an institutional and regional level. A level I fetal therapy center should be capable of offering fetal interventions that may be associated with obstetric risks of preterm birth or membrane rupture but that would be very unlikely to require maternal medical subspecialty or intensive care, with neonatal risks not exceeding those of moderate prematurity. A level II center should have the incremental capacity to provide maternal intensive care and to manage extreme neonatal prematurity. A level III therapy center should offer the full range of fetal interventions (including open fetal surgery) and be able manage any of the associated maternal complications and comorbidities, as well as have access to neonatal and pediatric surgical intervention including indicated surgery for neonates with congenital anomalies.

Introduction: Uterine fibroids/Leiomyoma are uterine smooth muscle tumours that are benign. In the reproductive age group, the incidence ranges from 20% to 50%. Pregnancy rates range from 0.1% to 10%. Women of reproductive age with fibroids have been linked to menstruation abnormalities, pelvic pain, infertility, and obstetric complications/bad obstetric outcome.1 Miscarriage, premature labor, APH, red degeneration, malpresentation, malposition, FGR, LBW, PPH, and an increased incidence of births and caesarean hysterectomy are all obstetric issues related with fibroids in pregnancy. Materials and Methods: A hospital based cross-sectional study was conducted among pregnant women with documented uterine fibroid who was admitted for any complication or delivered in the department of obstetrics and gynaecology, NSCB Medical College, Jabalpur from February 2019 to January 2020 in the department of obstetrics and gynaecology in collaboration with department of pediatrics, NSCB Medical College, Jabalpur. After obtaining informed consent from the participants, the detailed clinical history including spontaneous abortion, preterm labour, premature rupture of membranes, placenta previa, abruptio Placentae, malpresentation, dysfunctional labour, degeneration, maternal weight and sociodemographic profile were then recorded. Results: In this study, over a period of one year (February 2019 to January 2020) there were 8600 deliveries and 92 cases with fibroid uterus with pregnancy were included in the study. Majority of the patient were in the reproductive age range of 30-39 years (73.9%) and 20-29 years (23.9%). Fibroid are found to be more common in primi. Out of 46 patients, 35 (76.1%) were primi followed by P1 (15.2%) and ≥P2 (8.7%). Complications were observed in 20.9%. Atonic PPH occurred in 6.97%; placenta previa was associated with 6.97%, degeneration was seen in 2.32%; abruptio placentae in 2.32%, malpresentation in 2.32%. No maternal death was observed in this study. Conclusion: Pregnancy with myoma is often considered a high-risk pregnancy as it is associated with many complications like abortion, preterm labour, premature rupture of membrane, abruptio placentae, placenta previa, pain due to degeneration, intrauterine growth restriction, malpresentation, dysfunctional labour, PPH, decreased Apgar score, fetal anomalies, fetal death, etc. Pregnant women with myoma can be advised for regular ANC along with TAS for early diagnosis and management of complication. Casearean myomectomy in selected cases may be beneficial. [ABSTRACT FROM AUTHOR]

ObjectivesTo evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO).MethodsELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race.ResultsAmong 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6).ConclusionsEarly HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.

Laparoscopic surgery is safe in pregnancy, but is not without risk. Inadvertent uterine perforation of the gravid uterus is a rare complication. 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. 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.

OBJECTIVE:To evaluate the association between subclinical and clinical chorioamnionitis and risk of preterm birth (PTB). METHODS:Demographic and clinical characteristics were abstracted from medical records and placental examinations performed (N = 1371 pregnancies including spontaneous and medically-indicated PTBs). Pregnancies were classified as having clinical chorioamnionitis (with or without histologic chorioamnionitis), subclinical chorioamnionitis (histologic, but not clinical, chorioamnionitis), or no chorioamnionitis; pregnancies with histologic chorioamnionitis were further evaluated for fetal vasculitis. Relative risks for PTB, early and late PTB, and PTB ± premature rupture of membranes (PROM) were adjusted for maternal characteristics. RESULTS:Clinical (4.3%) and subclinical (24.5%) chorioamnionitis were not associated with PTB overall. In pregnancies without clinical or subclinical chorioamnionitis, the risk of PTB with PROM and early PTB was 2.2% and 8.6%, respectively. In comparison, clinical chorioamnionitis was associated with an increased risk of PTB with PROM (aRR: 3.42 (95%CI: 1.07, 10.98), whereas subclinical chorioamnionitis was associated with increased risk of PTB with PROM (aRR: 3.92 (95% CI: 2.15, 7.12)) and early PTB (aRR: 1.77 (95% CI: 1.18, 2.64)). Histologic chorioamnionitis with fetal vasculitis was associated with increased risk of PTB with PROM (aRR: 7.44 (95% CI: 3.68, 15.05)) and early PTB (aRR: 2.94 (95% CI: 1.78, 4.87)), whereas histologic chorioamnionitis without fetal vasculitis was associated with increased risk of PTB with PROM only (aRR: 2.64, 95% CI: 1.27, 5.50). CONCLUSIONS:Subclinical chorioamnionitis and histologic chorioamnionitis with fetal vasculitis were associated with early PTB and PTB with PROM but not with PTB overall, likely due to inclusion of indicated PTBs.

Maternal lipid profiles during pregnancy are associated with risk for preterm birth. This study investigates the association between maternal dyslipidemia and subsequent preterm birth among pregnant women in the state of California. Births were identified from California birth certificate and hospital discharge records from 2007-2012 (N = 2,865,987). Preterm birth was defined as

The published literature shows that a balanced vaginal microbiota can have a favourable impact on decreasing the prevalence of premature rupture of membranes (PROM). We studied the effects of vaginal probiotics (Lactobacillus rhamnosus and L. gasseri) on the outcomes of PROM in pregnant women between 24 and 36 weeks of gestation. We performed a randomised, triple-blind, placebo-controlled study. A total of 27 participants were divided into two groups—group 1 (probiotics; n = 16) and group 2 (placebo; n = 11). Although most outcomes did not show much variation, the latency period and gestational age at delivery were higher in group 1 than in group 2. Thus, vaginal use of L. rhamnosus and L. gasseri along with standard treatment appears to increase the latency period and gestational age at delivery in women with PROM. What is already known on this subject? Delaying delivery increases the risk of infections, but the prolongation of pregnancy allows further foetal maturation, thus reducing the risk of complications associated with premature birth. Moreover, a more extended latency period in pregnancies of <37 weeks of gestation is associated with a better neonatal prognosis. What do the results of this study add? The use of probiotics (L. rhamnosus and L. gasseri) prolongs the latency period in pregnant women with premature rupture of membranes. What are the implications of these findings for clinical practice and/or further research? Probiotics are an exciting option for extending the time to delivery in cases of premature rupture of the membrane, allowing the maturation of the foetal lung. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted for assessing the maternal and fetal outcome in preterm premature rupture of membrane. Materials & methods: A total of 100 pregnant subjects were enrolled in the present study. Only those subjects were enrolled who were diagnosed with preterm rupture of membrane (PROM). The outcome variables for this study were maternal and fetal outcomes, grouped as favorable and unfavorable (complications). All the results were recorded in Microsoft excel sheet and were analysed by using SPSS software. Results: About 19% of the women showed unfavorable maternal outcomes.79 percent of the subjects were of primigravida. Duration of PROM was less than 12 years in 68 percent of the patients. Out of 19 subjects with maternal complications, sepsis, wound infection and haemorrhage was seen in 10 percent, 5 percent and 4 percent of the patients respectively. Still birth was seen in 7 percent of the patients while need of NICU was seen in 21 percent of the cases. Conclusion: In conclusion, PPROM is associated with a prenatal morbidity and the key to reducing the adverse effects of PPROM is to make a prompt diagnosis, admission and start antibiotic coverage. [ABSTRACT FROM AUTHOR]

Maternal and perinatal health is one of today's global health priorities. Cardiovascular disease and stroke are the leading causes of maternal mortality. Placental abruption remains a critical concern for maternal morbidity because it has been associated with long-term vascular disease. However, there is neither much literature available in Spanish nor recent evidence elucidating some questions on this topic. Thus, this review aims to synthesize recent evidence on the long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption. It was found that, through complex pathophysiological mechanisms involving the structure and functionality of the placental vascular network with subsequent extension of vascular injury and production of proinflammatory and procoagulant factors which remain after delivery, major cardiovascular events are precipitated in the medium and long term. High-quality evidence has shown that the risk of maternal complications in women with placental abruption accounts for 2.14, rising even higher for those with severe placental abruption. In the medium and long term, the mortality risk caused by coronary heart diseases is 2.64 and by cerebrovascular disorders is 1.70, with equal risk for both ischemic and hemorrhagic strokes. It can therefore be concluded that cardiovascular and cerebrovascular risk is imminent in women with a history of placental abruption due to a number of vascular pathophysiological mechanisms. However, this risk is considerably increased when associated with traditional and non-traditional modifiable factors. [ABSTRACT FROM AUTHOR]

Purpose: To determine the factors associated with the latent period in patients with preterm premature rupture of membranes (PPROM). Material and Methods: 53 patients who applied to our clinic within 1 year and were diagnosed with PPROM and met the inclusion criteria participated in this prospective cross-sectional study. Factors thought to affect the latent period in these patients were examined in terms of delivery time and mode. Results: Latent period; was negatively correlated with dilatation and positively correlated with collum length. The mean latent time of patients with contraction was statistically significantly lower than those without. In another model, gestational week, collum length and birth weight were found to be the most significant factors associated with the latent period. In the latent period groups; Statistically, a significant difference was found in the mean dilatation and collum length. The contraction rate was higher in those with a latency period of 2 days or less. Conclusion: Latent duration is inversely proportional to dilatation and directly proportional to collum length. Uterine contraction is higher in patients with a latency period of fewer than 2 days. Other statistically significant factors related to the latent period are the gestational week and the fetal weight. [ABSTRACT FROM AUTHOR]

Inflammation is among the factors promoting development of premature rupture of the membranes (PPROM). Upon the conditions of physiological immune imbalance in pregnancy, inflammation modifies its course and can even change the immune response. Appropriate indexes may be quantitative and functional. We used a marker of mitochondrial membrane potential (MPM, Ay) as an integral index of the functional state of immunocompetent blood cells (IBC) in 159 women who were examined at 8-14 weeks of gestation; they were observed up to 34-36 weeks. Of these cohort, 121 women were referred to a comparison group. The main group (n = 46) consisted of pregnant women with PPROM at the term of 28-33 weeks. The examination was carried out according to current medical standards, with informed consent, being approved by the Ethics committee at the Khabarovsk branch of Far Eastern Scientific Centre of Physiology and Pathology of Respiration — Research Institute of Maternity and Childhood Protection. Additionally, MPM and lymphocyte populations were determined by flow cytometry. The degree of disturbed energy supply in the IBC was based on the data of simultaneous determination of lymphocyte, granulocyte and monocyte numbers with reduced MPM values (application for invention No. 2020115963), thus revealing 3 degrees of energy deficiency: 1st degree, monovariant IBC composition with reduced MPM; 2nd degree, bivariant composition, 3rd degree, total changes. A relative and absolute decrease in CD3 (72% vs 78% and 1624 vs 1980), CD8 (28% vs 33% and 651 vs 851), an increase in CD19 (14% vs 9% and 304 vs 219) were revealed in pregnant women with PPROM. When assessing MPM values in the IBC populations, a decreased proportion of women without energy deficiency from the 1st to the 2nd trimester (from 41% to 30%), due to the 3rd degree of energy deficiency (from 17% to 26%) was detected. A shift of affected pools at the 2nd degree of energy deficiency in favor of lymphocytic-granulocytic association (from 7% to 25%) from lymphocytic-monocytic compartment (from 73% to 50%) was found. From the 2nd to 3rd trimester, we have detected redistribution of granulocyte pools at the 1st degree (0 to 8%) and from the lymphocytic-granulocytic association (25% and 5%) to monocytic-granulocytic (25% and 40%). In the group with PPROM, there was a decreased proportion of pregnant women without energy deficiency (13% and 27%), as well as with the 1st and 2nd degrees (17% vs 31% and 9% vs 17%), due to the 3rd degree of energy deficiency (61% and 26 %), relative to the comparison group. The IBC pools of in the main group were redistributed at the 1st degree in favor of granulocytes (25% and 8%), at the 2nd, in favor of the lymphocytic-monocytic association (100% and 55%) from the granulocytic-monocytic (0% and 40%). Such imbalance of bioenergetic processes in the IBC can be an important factor of pathologically ongoing inflammation. These changes could be caused by both higher incidence of infections in such patients and by alloimmune interactions between mother and fetus. However, they may also determine the pathological course of inflammation. Preterm birth, which is usually caused by PPROM, is a multifactorial pathological condition. However, independent on specific triggers, the changes in energy supply of IBC, at least, may serve as a significant biomarker of probability for this disorder.

BackgroundPreterm Premature Rupture of Membranes (PPROM) precedes many deliveries and experts agree with expectant management until 34 weeks gestation. However, there is controversy regarding the gestational age (GA) for administration of corticosteroids.Study designWe performed a retrospective cohort study in the University of California Fetal Consortium (UCfC). We searched available charts of singleton pregnancies with PPROM between 32 and 33 6/7 weeks GA. Outcomes from the groups were analyzed.ResultsOf 191 women with PPROM at 32 to 33 6/7 weeks, 150 received corticosteroids. The median GA at admission was earlier for the exposed versus unexposed group (32 4/7 versus 33 0/7 weeks, respectively, p = 0.001). The mean GA at delivery in the exposed was 33 2/7 (32 0/7 to 35 0/7) weeks versus 33 5/7 (32 0/7 to 36 1/7) weeks in the unexposed (p = 0.001). There was no difference in chorioamnionitis or RDS.ConclusionIn women with PPROM at 32 to 33 6/7 weeks, our data suggests that corticosteroids are associated with similar outcomes despite earlier GA at delivery and no differences in major morbidities. A larger prospective study is needed to determine if the benefit of corticosteroids outweighs the potential risks in PPROM.

BackgroundCounseling for patients with impending premature delivery traditionally has been based primarily on the projected gestational age at delivery. There are limited data regarding how the indications for the preterm birth affect the neonatal outcome and whether this issue should be taken into account in decisions regarding management and patient counseling.ObjectiveWe performed a prospective study of pregnancies resulting in premature delivery at less than 32 weeks to determine the influence of both the indications for admission and their associated indications for delivery on neonatal mortality and complications of prematurity.Study designThis is a multicenter, prospective study in 10 hospitals where all data from the neonatal intensive care unit routinely was imported to a deidentified data warehouse. Maternal data were collected prospectively at or near the time of delivery. Eligible subjects included singleton deliveries in these hospitals between 23 0/7 and 31 6/7 weeks. The primary hypothesis of the study was to determine whether there was a difference in the primary outcome, which was defined as neonatal composite morbidity, between those neonates delivered after admission for premature labor vs premature rupture of membranes, because these were expected to be the 2 most frequent diagnoses leading to premature birth. The sample size was calculated based on a 10% difference in outcomes for these 2 entities. We based this hypothesis on the knowledge that premature rupture of membranes has a greater incidence of intra-amniotic infection and inflammation than premature labor and that outcomes for premature neonates are worse when delivery is associated with intra-amniotic infection. Additional outcomes were analyzed for all other indications for admission and delivery. Composite morbidity was defined as ≥1 of the following: respiratory distress syndrome (oxygen requirement, clinical diagnosis, and consistent chest radiograph), bronchopulmonary dysplasia (requirement for oxygen support at 28 days of life), severe intraventricular hemorrhage (grades 3 or 4), periventricular leukomalacia, blood culture-proven sepsis present within 72 hours of birth, necrotizing enterocolitis, or neonatal death before discharge from the hospital. A secondary composite of serious neonatal morbidity also was defined prospectively.ResultsThe study included 1089 mother/baby pairs. Composite morbidity between those with premature labor (77.2%) and premature rupture of membranes (73.2%) was not significantly different (P = .29). A few neonatal complications were associated with indications for admission and delivery, but on logistic regression adjusting for gestational age and other confounders, suspected intrauterine growth restriction was the only indication for admission or delivery associated with an increase in serious morbidity (odds ratio 4.5, [2.1 to 9.8], P < .003). Other factors not related to the indications for admission including cesarean delivery, and low 5-minute Apgar were associated with an increase in morbidity.ConclusionStudies of many single factors related to the indications for preterm delivery have been shown to be associated with adverse neonatal outcome. In this study evaluating all of the most frequent indications, however, we found only suspected intrauterine growth restriction as an indication for admission and delivery was found to be so. Thus, it seems that in almost all situations counseling patients can be based primarily on gestational age along with other factors including estimated fetal weight, sex, race, plurality, and completion of a course of antenatal corticosteroids.

Background Inhaled nitric oxide (iNO) is being increasingly used in preterm infants

BackgroundThe Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal closure of myelomeningocele. The trial was stopped early at recommendation of the data and safety monitoring committee and outcome data for 158 of the 183 randomized women published.ObjectiveIn this report, pregnancy outcomes for the complete trial cohort are presented. We also sought to analyze risk factors for adverse pregnancy outcome among those women who underwent prenatal myelomeningocele repair.Study designPregnancy outcomes were compared between the 2 surgery groups. For women who underwent prenatal surgery, antecedent demographic, surgical, and pregnancy complication risk factors were evaluated for the following outcomes: premature spontaneous membrane rupture ≤34 weeks 0 days (preterm premature rupture of membranes), spontaneous membrane rupture at any gestational age, preterm delivery at ≤34 weeks 0 days, nonintact hysterotomy (minimal uterine wall tissue between fetal membranes and uterine serosa, or partial or complete dehiscence at delivery), and chorioamniotic membrane separation. Risk factors were evaluated using χ2 and Wilcoxon tests and multivariable logistic regression.ResultsA total of 183 women were randomized: 91 to prenatal and 92 to postnatal surgery groups. Analysis of the complete cohort confirmed initial findings: that prenatal surgery was associated with an increased risk for membrane separation, oligohydramnios, spontaneous membrane rupture, spontaneous onset of labor, and earlier gestational age at birth. In multivariable logistic regression of the prenatal surgery group adjusting for clinical center, earlier gestational age at surgery and chorioamniotic membrane separation were associated with increased risk of spontaneous membrane rupture (odds ratio, 1.49; 95% confidence interval, 1.01-2.22; and odds ratio, 2.96, 95% confidence interval, 1.05-8.35, respectively). Oligohydramnios was associated with an increased risk of subsequent preterm delivery (odds ratio, 9.21; 95% confidence interval, 2.19-38.78). Nulliparity was a risk factor for nonintact hysterotomy (odds ratio, 3.68; 95% confidence interval, 1.35-10.05).ConclusionDespite the confirmed benefits of prenatal surgery, considerable maternal and fetal risk exists compared with postnatal repair. Early gestational age at surgery and development of chorioamniotic membrane separation are risk factors for ruptured membranes. Oligohydramnios is a risk factor for preterm delivery and nulliparity is a risk factor for nonintact hysterotomy at delivery.

Objective: To perform a systematic review and meta-analysis of randomized clinical trials that compared the use of antibiotics versus placebo in premature rupture of membranes preterm and evaluated maternal, fetal and neonatal outcomes in pregnant women with premature rupture of ovular membranes at a gestational age between 24 and 37 weeks. Methods: A search was conducted using keywords in PubMed, Cochrane, Biblioteca Virtual em Saúde and Biblioteca Digital de Teses e Dissertações da USP between August 2018 and December 2021. A total of 926 articles were found. Those included were randomized clinical trials that compared the use of antibiotics versus placebo in the premature rupture of preterm membranes. Articles referring to antibiotics only for streptococcus agalactiae prophylaxis were excluded. The retrieved articles were independently and blindly analyzed by two reviewers. A total of 24 manuscripts met the inclusion criteria and 21 articles were included for quantitative analysis. Results: Among the maternal outcomes analyzed, there was a prolongation of the latency period that was =7 days. In addition, we observed a reduction in chorioamnionitis in the group of pregnant women who used antibiotics. As for endometritis and other maternal outcomes, there was no statistically significant difference between the groups. Regarding fetal outcomes, antibiotic prophylaxis worked as a protective factor for neonatal sepsis. Necrotizing enterocolitis and respiratory distress syndrome showed no statistically significant differences. Conclusion: The study showed positive results in relation to antibiotic prophylaxis to prolong the latency period, new randomized clinical trials are needed to ensure its beneficial effect. [ABSTRACT FROM AUTHOR]

Introduction Preterm prelabor rupture of membrane (PPROM) contributes to increasing rates of preterm birth, causing greater health risks for newborns. While the mechanisms driving PPROM are not well understood, one hypothesis is that it is due to systemic inflammation, which can be caused by obesity defined as a BMI [Formula: see text]30 kg/m 2 . The specific aim of the study was to compare neonatal outcomes after PPROM between patients who were obese vs not obese in early pregnancy at a tertiary medical center serving an Appalachian population. Methods An observational, descriptive retrospective review was conducted of the medical records of patients who were diagnosed with PPROM from January 2017 through December 2020. Patients with a single gestation at the time of PPROM without evidence of clinical infection requiring immediate delivery were included. Maternal characteristics, latency management, and birth outcomes were compared between obese ([Formula: see text]30 BMI) and non-obese (<30 BMI) patients. Results Of the 214 women in the study, 129 (60.3%) were obese pre-pregnancy and 85 (39.7%) were not. Most PPROM occurred between 32 and 36 weeks of gestation (145 patients, 67.8%), with 19.2% occurring at 26-31 weeks (41 patients), and 13.2% at <26 weeks of gestation (28 patients). Latency, defined as the days between PPROM and delivery, ranged from 0 to 80 days with a mean of 4.9 + 10.9 days. At least one day of latency was achieved for most patients (144/214; 67.3%). When outcomes were compared between obese and nonobese patients, the obese patients experienced significantly more complications (10.1% vs 2.4%; p=0.031), which were accompanied by greater neonatal morbidity 67 of 129 ((51.9%) vs 30 of 85 (35.3%); p=0.018). Obese women had greater odds that their newborns would experience neonatal morbidity than nonobese women (odds ratio, 1.98; 95% confidence interval, 1.1-3.5). Conclusion This study of Appalachian women found that pre-pregnancy BMI [Formula: see text]30 increased the risk of complications and neonatal morbidity after PPROM. To improve birth outcomes, healthcare workers and policymakers must work together to decrease rates of obesity in Appalachian women at or near childbearing age., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Charleston Area Medical Center/West Virginia University-Charleston Division issued approval 19-621. Charleston Area Medical Center/West Virginia University-Charleston Division Institutional Review Board (IRB) approved this study prior to its conduct. For this type of study, formal consent was waived. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Robinson et al.)

Preterm prelabor rupture of membranes (PPROM) is the main cause of preterm delivery, resulting in increased perinatal morbidity and mortality. Several techniques have been studied for the healing of ruptured membranes, with some success. Before new techniques using tissue/organ engineering are applied in clinical practice, these techniques must be validated in clinical trials. To address this issue, the objective of this study was to summarize the current literature on interventions to seal or heal the amniotic membranes after PPROM. An electronic search was conducted using the keywords "fetal membranes," "premature rupture," "amnion," "tissue engineering," "fibrin tissue adhesive," "regenerative medicine," "tissue adhesive," "wound healing," and "fetoscopy" through the MEDLINE, Embase, and Cochrane CENTRAL databases, with the limitation of English-language studies. Through a review of the identified studies, it was found that spontaneous healing of the fetal membrane has not been successful. Several efforts have been made to seal membranes before or after rupture using different methods, including amniopatches, collagen, tissue patches, fibrin sealant, mussel-mimetic sealant, engineered cell matrix, and immunological supplements. However, most studies have been conducted in ex vivo or in vivo settings, so the safety and applicability of these techniques to spontaneous rupture of membranes in clinical settings have not been sufficiently tested. Overall, the current evidence is limited regarding the safety and effectiveness of interventions against PPROM. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objectives: Accurate diagnosis of preterm rupture of membrane (PROM) is critical during pregnancy, and researchers are seeking ways to decrease the rate of false negative results in diagnostic tests. In the present study, we compare diagnostic properties of Amnisure test and human chorionic gonadotropin (hCG) test for diagnosis of PROM. Methods: The study was performed on singleton pregnant women (gestational age: 20 to 41 weeks) who were referred to the Taleghani Hospital in Tehran (Iran) between December 2016 and December 2017. The study included 44 PROM patients and 44 control pregnant women. Speculum examination for cervicovaginal fluid washing, hCG test and Amnisure test were performed for all of patients. Statistical analysis of data was performed in SPSS software package (Version 18, Chicago, IL, USA) using t-test, Chi-square test, and Mann-Whitney test. P-values less than 0.05 were considered statistically significant. Results: The Amnisure test had better sensitivity and specificity compared with the β-hCG test (95.5% and 97.7% vs. 93.2% and 95.5%). The Amnisure test also had higher positive and negative predictive values than the β-hCG test (97.7% and 95.5% vs. 93.3% and 94.3%). Diagnostic accuracy of the Amnisure test was also higher than that of the β-hCG test (96.6% vs. 94.3%). Conclusion: According to the results, the two tests have almost equal diagnostic power for detection of PROM during pregnancy. Keywords: Chorionic Gonadotropin, Fetal Membranes, Premature Rupture

Preterm birth is a worldwide problem with a high economic impact and morbimortality in children. Therefore, the literature has focused on finding modifiable factors associated with this entity, such as the study "Risk factors associated with preterm birth in a second level hospital," which concluded that "100% of risk factors associated with preterm birth are potentially preventable". Our team reanalyzed the results and found in the regression model that premature rupture of membranes was the only variable associated with preterm birth. This variable is not 100% preventable, so the results found are different from the authors' conclusions. [ABSTRACT FROM AUTHOR]

To explore the relationship between gestational diabetes mellitus with premature rupture of membranes and vaginal microbial infection and pregnancy outcome. Methods: From June 2019 to June 2020, pregnant women with gestational diabetes mellitus and PPROM in our hospital were selected as the study group (n=64) and normal pregnant women in our hospital at the same time as the control group (n=50). Vaginal secretions were collected for the detection of group B streptococcus (GBS), bacterial vaginosis (BV) and Candida (CM). Cervical secretions were used for the detection of Ureaplasma urealyticum (UU) and Chlamydia (CT). The vaginal microbial infection and pregnancy outcomes were recorded. Results: There was significant difference in GBS, UU and CT infection between the two groups (P＜0.05), but there was no significant difference in BV and CM infection (P＞0.05). GDM combined with PPROM was positively correlated with GBS, UU and CT infection (r=0.293, 0.202, 0.189, respectively), and GBS infection was most significantly related. The incidence of chorioamnionitis was significantly higher in GBS and CT infection groups (r=0.375, 0.277), neonatal pneumonia was significantly higher in GBS, CT and BV infection groups (r=0.248, 0.239, 0.245), and the incidence of pathological jaundice in UU and CT infection groups was significantly higher (r=0.489, 0.292). Conclusions: It is of great significance to carry out vaginal microbiological detection in women with gestational diabetes mellitus, and the infection of GBS may lead to the occurrence of PPROM, and further lead to adverse pregnancy outcomes, such as chorioamnionitis and neonatal pneumonia. [ABSTRACT FROM AUTHOR]

Introduction: In women with preterm ruptured membranes and contractions, the administration of tocolysis is controversial. This study compares tocolysis with no tocolysis in women with threatened preterm birth and ruptured membranes.Objective: To compare tocolysis with no tocolysis in women with threatened preterm birth and ruptured membranes.Study Design: Data from the APOSTEL III RCT was combined with data from the National Maternity Hospital, Dublin. In the APOSTEL III trial, women with threatened preterm birth were randomized to atosiban or nifedipine. Patient data from Ireland were obtained from a cohort of women with threatened preterm birth with ruptured membranes. The Irish women received no tocolytic treatment. Only women with ruptured membranes and contractions were selected. We studied women with singleton or twin pregnancies and a gestational age between 25+0 and 33+6 weeks. Propensity score matching was performed to create comparable groups. Primary outcome was a composite adverse neonatal outcome. Secondary outcomes were individual components of the primary outcome, as well as neonatal intensive care unit (NICU) admission, gestational age at delivery, prolongation of pregnancy and mode of delivery.Results: 153 women from the Apostel III trial were compared with 51 eligible women of the Irish cohort. We could match 46 women who received tocolysis and 46 women who received no tocolysis. All women had ruptured membranes. Maternal age, BMI, parity and gestational age at study entry were comparable between the groups after matching. There were no statistically significant differences in neonatal composite outcome (9.6 % in the tocolysis group versus 18 % in the control group, OR 0.46, 95 % CI 0.13-1.63). We found a lower incidence of NICU admission in the tocolysis group (63 %) than in the control group (94 %; OR 0.11, 95 % CI 0.03-0.41), which could be explained by differences in national admission policies. There were no statistically significant differences between tocolysis and no tocolysis in any of the other outcomes including sepsis, gestational age at delivery and time to delivery.Conclusion: In this propensity score analysis of women with threatened preterm birth and ruptured membranes, tocolytic therapy did not alter composite adverse neonatal outcome or time to delivery. [ABSTRACT FROM AUTHOR]

Aim: Preterm premature rupture of membranes (PPROM) is common in preterm births. Fetal inflammatory response syndrome (FIRS) is present in nearly 50% of PPROM cases. We created a risk score to predict FIRS using maternal factors after PPROM. Methods: We conducted a retrospective study of singleton pregnancies complicated by PPROM that resulted in delivery at 23–35 weeks of gestation. Antepartum maternal factors and umbilical cord blood interleukin‐6 (IL‐6) data were analyzed. FIRS was defined as IL‐6 > 11 pg/mL. Results: Umbilical cord blood IL‐6 and maternal blood data within 24 h before parturition were available for 158 cases; 66 were diagnosed with FIRS (41.8%; median IL‐6, 57.55 pg/mL). We created a risk score (FIRS score) comprising expected delivery weeks (≤30 weeks), maternal C‐reactive protein (≥1.2 mg/dL), maternal white blood cell count (≥13 000/μL), corticosteroid use (none) and PROM latency period (≥3 days) from the multivariate logistic regression model predicting FIRS. Receiver operating characteristic curve analysis of the score produced the following results: area under the curve, 0.82; 95% CI, 0.76–0.89; cut‐off value, 7.5; sensitivity, 89%; specificity, 63%; positive predictive value, 63% and negative predictive value, 89%. The probability of FIRS according to the categories of the FIRS score was 11% for those with a score of 0–7, 50% for a score of 8–15, and 88% for a score of 16–22. Conclusion: The devised maternal risk score could predict FIRS and be helpful to decide the delivery timing for the cases of PPROM. [ABSTRACT FROM AUTHOR]

Objective To explore the expressions of nucleotide-binding oligomerization domain-containing 1 (NOD1) and silent information regulator 1(SIRT1) in the fetal membranes and to investigate their relationship with matrix metalloproteinase -3 (MMP-3) and IL-1β levels in amniotic fluid from women with premature rupture of the membranes (PROM), and to provide guidance for further understanding the pathogenesis and treatment of PROM. Methods A total of 90 pregnant women were separated into three groups: term premature rupture of the membranes (tPROM) group, preterm premature rupture of the membranes (pPROM) group and healthy control group. The location and expression levels of NOD1 and SIRT1 in the fetal membranes were measured by immunohistochemistry and Western blot assay. IL-1β and MMP-3 levels in amniotic fluid were detected with ELISA. The relationship between the expressions of NOD1, SIRT1, IL-1β and MMP-3 was assessed. Results The expressions of NOD1, IL-1β and MMP-3 were significantly higher in PROM group compared with those of healthy control group, but the expression of SIRT1 was lower than that of healthy control group (P＜ 0.05). Furthermore, the expressions of NOD1, IL-1β and MMP-3 were significantly higher in pPROM group than those in tPROM group (P＜0.05). There was no significant difference in the SIRT1 expression between tPROM group and pPROM group (P＞0.05). The expression of NOD1 was positively correlated with the levels of IL-1β and MMP-3 (P＜0.01). The expression of SIRT1 was negatively correlated with the levels of IL-1β and MMP-3 (P＜0.01). Conclusion The level of NOD1 in fetal membranes and levels of IL-1β and MMP-3 in amniotic fluid are increased. The level of SIRT1 in fetal membranes is decreased. Changes of the expressions of the four proteins are correlative and related with the occurrence of PROM. [ABSTRACT FROM AUTHOR]

Background: Preterm premature rupture of membranes (PPROM) is the rupture of fetal membranes before 38 weeks of gestation. The etiology is multifactorial. Maternal anemia is one of the factors leading to PPROM. This study aims to determine the frequency of maternal anemia in patients presenting with PPROM., Materials and Methods: This cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar. This study was conducted from July 1 to December 31, 2021. One hundred and twenty two patients with PPROM presenting to the Department of Obstetrics and Gynecology were included. The diagnosis of PPROM was made based on the history of the PV leak, followed by confirmation with the nitrazine litmus test, microscopic fern test, and ultrasonographic amniotic fluid index measurement. Anemia was determined by examination of hemoglobin levels in the maternal blood samples. Hb <11gm/dl was labeled as anemia. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. was used for statistical analysis., Results:  The age of the patients ranged from 20 to 40 years. The mean age was 29.14 ± 6.194 years. 63 patients (51.6%) were multiparous (parity 2 to 4). Maternal anemia was observed in 39 patients (32.0%). A significant association (p = 0.005) was observed between maternal anemia and grand multiparity (parity 2 to 4)., Conclusion:  Maternal anemia significantly contributes to PPROM, especially in multiple pregnancies. Meticulous family planning and consistent obstetrical monitoring throughout pregnancy are key to addressing this, potentially reducing both maternal anemia risk and PPROM complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khan et al.)

Introduction: Preterm birth is still a major health problem throughout the world, which results in 75% of neonatal mortality. Preterm labor not only inflicts financial and emotional distress, it may also lead to permanent disability. The present study was conducted to determine the related risk factors and preventive measures of preterm labor. Methods: This retrospective cross-sectional study assessed all preterm labors, as well as an equal number of term labors, during seven years, at an educational hospital. Probable risk factors of preterm labor were collected using medical profiles of participants by the aid of a pre-designed checklist. Significant related factors of preterm labor were used for multivariate logistic regression analysis with SPSS 21.0. Result: 810 cases with the mean age of 28.33 ± 6.1 years were evaluated (48.7% preterm). Multipartite; fetal anomaly; prenatal care; smoking; not consuming folic acid and iron supplements; in vitro fertilization; history of infertility, caesarian section, trauma, systemic disease, and hypertension; amniotic fluid leak; rupture of membranes; cephalic presentation; vaginal bleeding; placenta decolman; oligohydramnios; pre-eclampsia; chorioamnionitis; uterine abnormalities; cervical insufficiency; intercourse during the previous week; short time since last delivery; and mother’s weight significantly correlated with preterm labor. Conclusion: Based on the results of the present study, intercourse during the previous week, multipartite, short time from last delivery, preeclampsia, fetal anomaly, rupture of membranes, hypertension, and amniotic fluid leak, respectively, were risk factors for preterm labor. On the other hand, iron consumption, cephalic presentation, systematic disease, history of caesarian section, prenatal care, and mother’s weight could be considered as protective factors.

To investigate the influence of induction time on pregnancy outcomes in women with premature rupture of membranes (PROM) in full-term pregnancy. Methods: A total of 1 474 pregnant women with PROM were selected from Affiliated Hospital of Qingdao University and Linyi Central Hospital from January 2015 to December 2017. They were divided into four groups according to Bishop score and induction time including group A (Bishop score ≥6 points, and patients were induced by oxytocin without labor after 2 h of rupture), group B (Bishop score ≥6 points, and patients were induced by oxytocin without labor after 12 h of rupture), group C (Bishop score＜6 points, and patients were induced by oxytocin without labor after 2 h of rupture), group D (Bishop score＜6 points, and patients were induced by oxytocin without labor after 12 h of rupture). We analyzed the pregnancy outcomes in the four groups. Results: The rate of vaginal delivery had no significant difference between group A and group B (P＞0.05). The vaginal deliver rate in group D was higher than that in group C (P＜0.05). The rates of puerperal infection and complications of induction in group A were lower than those in group B (P＜0.05). The rate of complications of induction, fetal distress and neonatal admission in group C were higher than those in group D (P＜0.05). Conclusions: The induced labor can be conducted after 2 h of rupture when the cervical is mature in patients with PROM, otherwise it should be delay to after 12 h. [ABSTRACT FROM AUTHOR]

Premature rupture of membrane (PROM) often occurs in the second and third trimester. After the membrane rupture, the pathogenic microorganisms in the vagina can induce chorioamnionitis (CA) when enter the amniotic cavity via the broken membrane, resulting in serious complications such as fetal distress or neonatal infection sepsis which associated with high mortality in perinatal children. Most patients are absent of clinical symptoms in the short-term after PROM, and early warning and treatments can significantly reduce the prevalence and mortality of perinatal infants, such as the screening and treatments of type B hemolytic streptococcus in the third trimester. Recently, studies indicated that in addition to traditional laboratory predictions such as interleukin-6 (IL-6), IL-1β, matrix metalloproteinase-8 (MMP-8) and ultrasound measurements of fetal thymus had certain prediction value for CA. Therefore, this review summarized the markers to predict CA in early stage in women complicated with CA in recent years. [ABSTRACT FROM AUTHOR]

Background and objectives: Accurate diagnosis of preterm rupture of membrane (PROM) is critical during pregnancy, and researchers are seeking ways to decrease the rate of false negative results in diagnostic tests. In the present study, we compare diagnostic properties of Amnisure test and human chorionic gonadotropin (hCG) test for diagnosis of PROM. Methods: The study was performed on singleton pregnant women (gestational age: 20 to 41 weeks) who were referred to the Taleghani Hospital in Tehran (Iran) between December 2016 and December 2017. The study included 44 PROM patients and 44 control pregnant women. Speculum examination for cervicovaginal fluid washing, hCG test and Amnisure test were performed for all of patients. Statistical analysis of data was performed in SPSS software package (Version 18, Chicago, IL, USA) using t-test, Chi-square test, and Mann-Whitney test. P-values less than 0.05 were considered statistically significant. Results: The Amnisure test had better sensitivity and specificity compared with the β-hCG test (95.5% and 97.7% vs. 93.2% and 95.5%). The Amnisure test also had higher positive and negative predictive values than the β-hCG test (97.7% and 95.5% vs. 93.3% and 94.3%). Diagnostic accuracy of the Amnisure test was also higher than that of the β-hCG test (96.6% vs. 94.3%). Conclusion: According to the results, the two tests have almost equal diagnostic power for detection of PROM during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Preterm delivery is a common and eventful phenomenon with long standing complications, heavily burdening the health system. Many risk factors have been suggested to increase the likelihood of this event, one being hypothyroidism and high levels of anti-thyroid antibodies. The present study sought to explore the association between hypothyroidism and anti-thyroid antibodies with preterm delivery. Materials and methods: A case control study was conducted on 400 patients attending Educational-Medical centers of Urmia University of Medical Sciences (Urmia, Iran) between November 2013 and April 2016, in which 200 patients with term deliveries and 200 patients with preterm deliveries were compared for differences in hypothyroidism, existence of anti- thyroperoxidase (TPO) antibodies based on blood samples obtained from the patients which were tested using chemi-luminescence method. Results: In the group of patients with preterm delivery, 85 patients had hypothyroidism (42.5%), and from the term delivery group, 67 patients (33.5%) had hypothyroidism, the difference was not statistically significant (p = 0.14). But, when groups of early and late preterm deliveries were compared in terms of having anti-TPO antibodies, there was a significant difference between them, with early preterm delivery having 8 patients positive out of 44 patients and late preterm delivery having 7 positives out of 141 patients (p = 0.004). Conclusion: Hypothyroidism had an insignificant effect on preterm delivery rates, but the existence of anti–TPO antibodies in the serum had a significant increasing effect on early preterm deliveries and could be regarded as a risk factor.

Abstract: Aim: To compare maternal, fetal and placental trace element (magnesium, zinc and copper) and heavy metal (cadmium and lead) and maternal vitamin (retinol, α [alpha]‐tocopherol, vitamin D3, 25‐hydroxyvitamin D3 and 1,25‐dihydroxyvitamin D3) levels in preterm deliveries with and without preterm premature rupture of membranes (PPROM). Methods: Sixty‐eight patients giving birth preterm were grouped into preterm deliveries with PPROM (n = 35) and without PPROM (n = 33). Following delivery, maternal and umbilical cord blood sera and placental tissue samples were obtained. While magnesium, zinc, copper, cadmium and lead levels were measured in all samples, the levels of retinol, α‐tocopherol, vitamin D3, 25‐hydroxyvitamin D3 and 1,25‐dihydroxyvitamin D3 were measured only in maternal serum. Results: While magnesium level in maternal serum and zinc levels in both maternal and umbilical cord sera were lower, placental magnesium level was higher in preterm deliveries with PPROM (P < 0.01). Umbilical cord serum magnesium, placental tissue zinc and maternal and umbilical cord sera and placental tissue copper, cadmium, and lead levels did not differ between the groups (P > 0.05). In preterm deliveries with PPROM, 25‐hydroxyvitamin D3 and retinol levels were higher, while vitamin D3 and 1,25‐dihydroxyvitamin D3 levels were lower in maternal serum (P < 0.05). Maternal serum α‐tocopherol levels were similar between the groups. Conclusion: Compared to spontaneous preterm births, PPROM is associated with low maternal serum together with high placental tissue magnesium and low maternal and umbilical cord sera zinc levels. Higher retinol and 25‐hydroxyvitamin D3 and lower vitamin D3 and 1,25‐dihydroxyvitamin D3 maternal serum levels are also evident in these patients. [ABSTRACT FROM AUTHOR]

Objective: Preterm delivery is a common and eventful phenomenon with long standing complications, heavily burdening the health system. Many risk factors have been suggested to increase the likelihood of this event, one being hypothyroidism and high levels of anti-thyroid antibodies. The present study sought to explore the association between hypothyroidism and anti-thyroid antibodies with preterm delivery. Materials and methods: A case control study was conducted on 400 patients attending Educational- Medical centers of Urmia University of Medical Sciences (Urmia, Iran) between November 2013 and April 2016, in which 200 patients with term deliveries and 200 patients with preterm deliveries were compared for differences in hypothyroidism, existence of anti- thyroperoxidase (TPO) antibodies based on blood samples obtained from the patients which were tested using chemi-luminescence method. Results: In the group of patients with preterm delivery, 85 patients had hypothyroidism (42.5%), and from the term delivery group, 67 patients (33.5%) had hypothyroidism, the difference was not statistically significant (p = 0.14). But, when groups of early and late preterm deliveries were compared in terms of having anti-TPO antibodies, there was a significant difference between them, with early preterm delivery having 8 patients positive out of 44 patients and late preterm delivery having 7 positives out of 141 patients (p = 0.004). Conclusion: Hypothyroidism had an insignificant effect on preterm delivery rates, but the existence of anti-TPO antibodies in the serum had a significant increasing effect on early preterm deliveries and could be regarded as a risk factor. [ABSTRACT FROM AUTHOR]

Objective: This study is an economic evaluation of immediate birth compared with expectant management in women with preterm prelabour rupture of the membranes near term (PPROMT).Design: A cost-effectiveness analysis alongside the PPROMT randomised controlled trial.Setting: Obstetric departments in 65 hospitals across 11 countries.Population: Women with a singleton pregnancy with ruptured membranes between 34+0 and 36+6 weeks gestation.Methods: Women were randomly allocated to immediate birth or expectant management. Costs to the health system were identified and valued. National hospital costing data from both the UK and Australia were used. Average cost per recruit in each arm was calculated and 95% confidence intervals were estimated using bootstrap re-sampling. Averages costs during antenatal care, delivery and postnatal care, and by country were estimated.Main Outcomes Measures: Total mean cost difference between immediate birth and expectant management arms of the trial.Results: From 11 countries 923 women were randomised to immediate birth and 912 were randomised to expectant management. Total mean costs per recruit were £8852 for immediate birth and £8740 for expectant delivery resulting in a mean difference in costs of £112 (95% CI: -431 to 662). The expectant management arm had significantly higher antenatal costs, whereas the immediate birth arm had significantly higher delivery and neonatal costs. There was large variation between total mean costs by country.Conclusion: This economic evaluation found no evidence that expectant management was more or less costly than immediate birth. Outpatient management may offer opportunities for cost savings for those women with delayed delivery.Tweetable Abstract: For women with preterm prelabour rupture of the membranes, the relative benefits and harms of immediate and expectant management should inform counselling as costs are similar. [ABSTRACT FROM AUTHOR]