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Premature Rupture of Membranes

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2501. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. (Abstract)

of the 1995 to 1997 Multiple Birth File of the United States.After an adjustment was made for important confounding factors, the risks of pregnancy-associated hypertension and eclampsia, anemia, diabetes mellitus, abruptio placenta, premature rupture of membrane, and cesarean delivery were increased in women with triplet pregnancies and quadruplet and higher-order multiple gestations than in women with twin pregnancies. A dose-response relationship was observed for pregnancy-associated hypertension

2004 American Journal of Obstetrics and Gynecology

2502. Symptomatic hypocalcemia after tocolytic therapy with magnesium sulfate and nifedipine. (Abstract)

bilateral hand contractures 12 hours after discontinuation of magnesium sulfate. Total serum calcium was 5.4 mg/dL. A 35-year-old gravida presented at 26 weeks' gestation with ruptured membranes and received magnesium sulfate until it was discontinued prematurely because of pulmonary edema. Twenty hours later she experienced bilateral hand contractures; total serum calcium was 5.9 m/dL. Symptoms for both patients resolved with calcium gluconate therapy.Hypocalcemia is a well-recognized complication (...) Symptomatic hypocalcemia after tocolytic therapy with magnesium sulfate and nifedipine. In this study, we presented 2 cases and evaluated the evidence for symptomatic hypocalcemia after treatment with magnesium sulfate alone or combined with use of nifedipine.Case reports, such as the one that follows, and literature review were used. A 25-year-old gravida presented at 33 weeks' gestation with advanced preterm labor. She received magnesium sulfate followed by nifedipine and experienced

2004 American Journal of Obstetrics and Gynecology

2503. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. (Abstract)

treatments (odds ratios, 2.3; 95% confidence interval, 1.6-3.8; P<.001), premature rupture of membranes (odds ratios, 1.9; 95% confidence interval, 1.3-2.7; P=.001), labor induction (odds ratios, 2.1; 95% confidence interval, 1.6-2.7; P<.001), fetal macrosomia (birth weight, >4 kg; odds ratios, 2.1; 95% confidence interval, 1.4-3.0; P<.001), and obesity (odds ratios, 8.8; 95% confidence interval, 6.1-12.9; P<.001). No significant differences were noted between the groups regarding other pregnancy (...) , premature rupture of membranes, labor induction, diabetes mellitus, hypertensive disorders and fetal macrosomia) by the Mantel-Haenszel technique, the correlation between previous bariatric surgery and cesarean delivery remained significant.Previous bariatric surgery, although an independent risk factor for cesarean delivery, is not associated with adverse perinatal outcome.

2004 American Journal of Obstetrics and Gynecology

2504. Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. (Abstract)

obtained by IVF (one miscarriage, one ongoing twin pregnancy, and one triplet pregnancy necessitating cesarean section at 29 weeks for premature rupture of the membranes, with two surviving infants). The live birth rate was 82%. The women who did and did not conceive did not differ in terms of mean follow-up, mean age, body mass index (BMI), parity, smoking, use and duration of oral contraception (OC), duration of infertility, or the length of the resected colorectal segment. Uterine adenomyosis

2005 Fertility and Sterility

2505. Placental expression of enzymes regulating prostaglandin synthesis and degradation. (Abstract)

Placental expression of enzymes regulating prostaglandin synthesis and degradation. The purpose of this study was to characterize placental expression of the prostaglandin synthase enzymes cyclooxygenase (COX) -1 and -2 and prostaglandin dehydrogenase (PGDH, a degrading enzyme).Forty-one women between 20 and 37 weeks' gestation and 39 matched term controls with either spontaneous labor or premature rupture of membranes were enrolled in a prospective case-control study. The relative amounts

2005 American Journal of Obstetrics and Gynecology

2506. Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study. (Abstract)

hemorrhage [IPH]).This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery.We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born (...) Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study. The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal

2005 American Journal of Obstetrics and Gynecology

2507. Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix? (Abstract)

), chorioamnionitis (2.4% vs 23.2 %, P = .0002), abruption (1.2% vs 13.4 %, P = .007), preterm rupture of membranes (6.1% vs 23.4%, P = .002), and cerclage placement (23.2% vs 43 %, P = .008). The neonates in the no funnel group delivered later (36.2% +/- 4.6 vs 33.8 +/- 5.4 weeks , P = .003), and had less morbidity and mortality (17.1% vs 37.8 %, P = .02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length ( R(2) = 0.07, P = .02 (...) ) and cervical funneling as a categorical variable ( r = 0.3, P = .0002) did correlate with earlier delivery.The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent).

2005 American Journal of Obstetrics and Gynecology

2508. Short-term outcomes in low birth weight infants following antenatal exposure to betamethasone versus dexamethasone. (Abstract)

(mothers and infants) were the same in both groups, with the exception of the number of steroid courses administered, the number of women with premature rupture of membranes (defined as > 24 hours), and the number of women who had received tocolysis. No significant difference was found between the 2 groups with respect to intraventricular hemorrhage and cystic PVL frequencies. No significant differences were found in the incidence of short-term outcomes examined, despite the fact that the dexamethasone (...) treatment. We compared brain ultrasound findings, such as intraventricular hemorrhage and cystic periventricular leukomalacia (PVL), as well as other clinical findings, including respiratory distress syndrome (RDS), necrotizing enterocolitis, retinopathy of prematurity, and bronchopulmonary dysplasia, for all premature infants whose mothers received either dexamethasone (from January 1, 1999 to June 30, 2000, n = 263) or betamethasone (July 1, 2000 to December 31, 2001, n = 287).Patient characteristics

2004 Obstetrics and Gynecology

2509. Perinatal infections due to group B streptococci. (Abstract)

, new national guidelines were released recommending 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios. Yet many clinical issues remain, including implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth weight infants, emergence of resistant organisms, and vaccine

2004 Obstetrics and Gynecology

2510. The effect of loop electrosurgical excision procedure on future pregnancy outcome. (Abstract)

preterm overall (7.9% versus 2.5%; odds ratio [OR] 3.50, 95% confidence interval [CI] 1.90-6.95; P < .001) and to deliver preterm after premature rupture of membranes (PROM) (3.5% versus 0.9%; OR 4.10, 95% CI 1.48-14.09). The increase in delivery at less than 34 weeks was not statistically significant (1.25% versus 0.36%; OR 3.50, 95% CI 0.85-23.49; P = .12). Women with LEEP also delivered more low birth weight (LBW) infants (5.4% versus 1.9%; OR 3.00, 95% CI 1.52-6.46; P = .003). There were (...) , Nova Scotia. The comparison group comprised women with no history of cervical surgery who were matched for age, parity, smoking status, and year of delivery. There were 571 women in each group. The primary outcome was rate of preterm delivery at less than 37 weeks of gestation. Secondary outcomes included delivery at less than 34 weeks and various neonatal and maternal outcomes. The effect of specific LEEP characteristics was analyzed separately.Women who had a LEEP were more likely to deliver

2005 Obstetrics and Gynecology

2511. Nulliparity and duration of pregnancy in multiple gestation. (Abstract)

preterm birth and/or midtrimester loss. There were no differences between groups in the likelihood of delivering before 20, 24, or 28 weeks. In linear regression analysis, ongoing fetal number (P <.001), premature rupture of membranes (PROM; P <.001), cerclage (P =.002), and death of 1 or more fetuses (P <.001) were associated with shorter gestation. Cesarean delivery was associated with longer gestation (P <.001). Nulliparous women were significantly more likely to have a pregnancy complicated

2004 Obstetrics and Gynecology

2512. Umbilical cord prolapse. (Abstract)

Umbilical cord prolapse. Prolapse of the umbilical cord is a rare obstetric emergency that in the viable fetus necessitates an expeditious delivery. A case of a periviable pregnancy complicated by preterm premature rupture of membranes and overt umbilical cord prolapse was prolonged 2 weeks with expectant management is described. An extensive review of the literature regarding the etiology, risk factors, and management options for umbilical cord prolapse in both viable and previable pregnancies

2006 Obstetrical & Gynecological Survey

2513. Second-trimester asynchronous multifetal delivery results in poor perinatal outcome. (Abstract)

attempt (tocolysis and/or emergent cerclage placement) to increase latency between delivery of the first fetus and subsequent fetuses.Fourteen cases of asynchronous delivery were identified out of 96922 deliveries including 1352 pregnancies complicated by multifetal gestation. The occurrence rate of asynchronous delivery was 0.14 per 1000 births. The etiology of preterm birth of the first fetus in 12 (86%) of 14 cases was second-trimester rupture of membranes. The mean gestational age for delivery (...) of the first fetus was 21.+/- 2.0 weeks. All women received tocolysis and intravenous antibiotics. Two of 3 attempts at cerclage placement were successful. Median latency obtained was 2 days (range less than 1-70 days). There was 1 survival of a first born. There were 19 retained fetuses, 2 died in utero, 10 died between birth and day 57 of life, and 7 survived (37%; 95% confidence interval 16%, 62%) until hospital discharge. Six of 7 survivors had major sequelae from prematurity. One of 19 fetuses

2004 Obstetrics and Gynecology

2514. Maternal and obstetric risk factors for sudden infant death syndrome in the United States. (Abstract)

] 1.24, 2.33), abruptio placentae (OR 1.57; 95% CI 1.24, 1.98), premature rupture of membranes (OR 1.48; 95% CI 1.33, 1.66), or small for gestational age (OR 1.40; 95% CI 1.30, 1.50 for the 10th percentile). SIDS cases were also more likely to be male. Mothers of cases were more likely to be younger, less educated, and nonwhite, and more of them smoked during pregnancy and did not attend prenatal care.This analysis confirms the importance of several well known demographic and lifestyle risk factors

2004 Obstetrics and Gynecology

2515. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. (Abstract)

intrauterine fetal deaths (10%), 5 within 24 hours and 4 between 4 and 10 weeks after the procedure. There was 1 termination of pregnancy because of chorioamnionitis. Median gestational age at delivery was 35.4 weeks, with 79% of patients delivering after 32 weeks. Preterm prelabor rupture of the membranes before 25 weeks accounted for all perinatal deaths (n = 5). Of the children older than 1 year of age (n = 67), 62 (92%) have a normal development.Cord coagulation is an effective method for selective

2006 American Journal of Obstetrics and Gynecology

2516. Maternal morbidity after maternal-fetal surgery. (Abstract)

cases by percutaneous techniques. There were no maternal deaths, but significant short-term morbidity was observed. There were no significant differences in the incidence of premature rupture of membranes, pulmonary edema, placental abruption, postoperative vaginal bleeding, preterm delivery, or interval from maternal-fetal surgery to delivery between endoscopic procedures and open surgery. Complications were significantly less in the percutaneous ultrasound-guided procedures. Endoscopic procedures (...) , even with a laparotomy, showed statistically significantly less morbidity compared with the open hysterotomy group regarding cesarean delivery as delivery mode (94.8% vs 58.8%; P < .001), requirement for intensive care unit stay (1.4% vs 26.4%; P < .001), length of hospital stay (7.9 vs 11.9 days; P = .001), and requirement for blood transfusions (2.9% vs 12.6%; P = .022). Chorion-amnion membrane separation (64.7% vs 20.3%; P < .001) was seen more often in the endoscopy group.Short-term morbidities

2006 American Journal of Obstetrics and Gynecology

2517. Targeted prenatal herpes simplex virus testing: can we identify women at risk of transmission to the neonate? (Abstract)

rupture of membranes were also associated with neonatal disease; using all risk factors identifiable at delivery would require screening 60% of pregnancies and identifying 84% of cases.Targeted HSV testing would miss a substantial proportion of neonatal herpes. (...) matched to cases by year of birth.Ninety-one neonatal HSV cases were identified (8.4/100,000 live births). Risk factors for infection included maternal age younger than 25 years (adjusted odds ratio [aOR] = 1.9, 95% CI 1.1-3.3) and paternal age younger than 20 years or unknown (aOR = 1.7, 95% CI 0.7-3.7). Testing couples with either risk factor would require testing 36% of couples and could potentially prevent up to 60% of cases. Maternal history of genital herpes, fever during labor, and premature

2006 American Journal of Obstetrics and Gynecology

2518. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. (Abstract)

between January 1986 and December 2000. Perinatal and neonatal data were evaluated in relation to chorionicity and intertriplet birth weight discordance.The dichorionic triamniotic triplets have an 8-fold higher risk of perinatal death than trichorionic triamniotic gestations (odds ratio, 7.9; 95% CI, 4.4-14.0; P < .001). This is attributed to a higher risk of very low birth weight (P < .01), delivery at < 30 weeks of gestation (P < .001), and premature rupture of membrane (P < .001) in dichorionic (...) triamniotic triplets compared with trichorionic triamniotic pregnancies. Twin-twin transfusion syndrome (odds ratio, 11.5; 95% CI, 4.8-27.7; P < .001), delivery at < 30 weeks of gestation (odds ratio, 40.5; 95% CI, 16.9-97; P < .01), premature rupture of membrane (odds ratio, 6.7; 95% CI, 3.8-11.9; P < .01), and nulliparity (odds ratio, 3.1; 95% CI, 1.6-6.1; P < .05) had independent effects on perinatal loss rate.The dichorionic triplets have an 8 times higher perinatal mortality rate than trichorionic

2006 American Journal of Obstetrics and Gynecology

2519. Surgical management of twin reversed arterial perfusion sequence. (Abstract)

with no incidence of premature rupture of membranes, with 83% perinatal survival, and with a significantly greater gestational age at delivery (36 weeks). There were no significant differences in perinatal outcome relative to the specific surgical technique that was used.Surgical management of twin reversed arterial perfusion sequence is indicated in high-risk patients. The surgical approach and the surgical technique should be tailored to the specific clinical presentation, preferably by performing the surgery (...) who had umbilical cord occlusion was 65% (33/51 patients) versus 42.9% (6/14 patients) for the surgical candidates who did not undergo umbilical cord occlusion (P = .1). However, perinatal outcomes in surgical patients were significantly better than expectantly treated surgical candidates if the dividing membrane was not disrupted purposely (22/28 patients; 78.5%; P = .02). Surgery within the sac of the twin reversed arterial perfusion fetus was feasible in 23.5% of patients and was associated

2006 American Journal of Obstetrics and Gynecology

2520. Urolithiasis in pregnancy: Current diagnosis, treatment, and pregnancy complications. (Abstract)

of pregnancy. Conservative management is the first-line treatment for noncomplicated urolithiasis in pregnancy. If spontaneous passage of the stone does not occur or if complications develop, urologic consultation should be obtained. Several obstetric complications have been associated with urolithiasis, including preterm labor and preterm premature rupture of membranes, although the reported rates of these complications in association with urolithiasis vary widely and overlap normal background rates

2006 Obstetrical & Gynecological Survey

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