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Premature Rupture of Membranes

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2561. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Full Text available with Trip Pro

of gestation and that this is associated with a physiological oxidative stress which could be the trigger for the formation of the placental membranes. Abnormal development of these membranes can result in subchorionic hemorrhage and threatened miscarriage with subsequent long-term consequences such as preterm rupture of the membranes and preterm labor, irrespective of the finding of a hematoma on ultrasound. In both euploid and aneuploid missed miscarriages there is clear ultrasound evidence for excessive

2005 Ultrasound in Obstetrics and Gynecology

2562. Fetoscopic and ultrasound-guided decompression of the fetal trachea in a human fetus with Fraser syndrome and congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia. (Abstract)

fetoscopic and ultrasound-guided tracheal decompression was performed using three trocars under general materno-fetal anesthesia at 19 + 5 weeks of gestation. Abnormal fetoplacental blood flow normalized within hours as a result of the intervention. Furthermore, a normalization of lung : heart size and lung echogenicity was observed within days. Resolution of hydrops was complete within 3 weeks. Premature rupture of membranes and premature contractions prompted emergency delivery of the fetus by ex-utero

2006 Ultrasound in Obstetrics and Gynecology

2563. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. (Abstract)

(range, 540-3840) g. Preterm premature rupture of membranes before 34 weeks' gestation occurred in 18% (11/60) at a median of 62 (range, 1-102) days after the procedure. However, only two (3%) women delivered within 28 days of the procedure.Fetoscopic laser coagulation of placental vascular anastomoses or the umbilical cord of the acardiac twin is an effective treatment of TRAP sequence, with a survival rate of 80%, and 67% of pregnancies with surviving pump twins going beyond 36 weeks' gestation

2006 Ultrasound in Obstetrics and Gynecology

2564. Timely diagnosis of twin-to-twin transfusion syndrome in monochorionic twin pregnancies by biweekly sonography combined with patient instruction to report onset of symptoms. (Abstract)

was defined as diagnosis before severe complications of TTTS occurred, such as preterm prelabor rupture of membranes, very preterm delivery (24-32 weeks of pregnancy), fetal hydrops, or intrauterine fetal death. During a 2-year period, a prospective series of 23 monochorionic twin pregnancies was monitored from the first trimester until delivery. At least every 2 weeks we performed ultrasound and Doppler measurements (nuchal translucency thickness, presence of membrane folding, estimated fetal weight (...) , deepest vertical pocket, bladder filling, and Doppler waveforms of the umbilical artery, ductus venosus and umbilical vein). Measurements of TTTS cases were compared with those of non-TTTS cases matched for gestational age. Furthermore, patients were informed about the symptoms caused by TTTS, and instructed to consult us immediately in case of rapidly increasing abdominal size or premature contractions.In all four TTTS cases, the diagnosis was timely. At the time of diagnosis, one case

2006 Ultrasound in Obstetrics and Gynecology

2565. Manufacture of a cell-free amnion matrix scaffold that supports amnion cell outgrowth in vitro. (Abstract)

Manufacture of a cell-free amnion matrix scaffold that supports amnion cell outgrowth in vitro. We manufactured a cell-free extracellular matrix scaffolds in order to obtain a support material for amnion cell outgrowth, eventually being used for repair of prematurely ruptured fetal membrane. Human preterm or term amnion tissue was separated into its collagenous extracellular matrix and cell components. The acellular scaffold was explored for its capacity to support regrowth of isolated human (...) found to grow into dense layers on the surface of the scaffold within 3-4 days and 7-8 days, respectively, and to some extent, invaded the scaffold during the culture period. Manufactured acellular amnion matrix retains structural and functional properties required for cell outgrowth in vitro. It may become useful to repair prematurely ruptured fetal membranes.

2007 Placenta

2566. Patterns of brain injury in term neonatal encephalopathy. (Abstract)

defined on the basis of the predominant site of injury: watershed predominant, basal ganglia/thalamus predominant, and normal.The watershed pattern of injury was seen in 78 newborns (45%), the basal ganglia/thalamus pattern was seen in 44 newborns (25%), and normal MRI studies were seen in 51 newborns (30%). Antenatal conditions such as maternal substance use, gestational diabetes, premature rupture of membranes, pre-eclampsia, and intra-uterine growth restriction did not differ across patterns

2005 Journal of Pediatrics

2567. Fetal cortisol response to intrauterine microbial colonisation identified by the polymerase chain reaction and fetal inflammation. (Abstract)

weight 1350 g) had at least one positive intrauterine sample for microbial genes and 18 infants (31 weeks, 1320 g) did not. The cord blood cortisol concentration was significantly higher in fetuses exposed to intrauterine infection and significantly increased in fetuses/mothers presenting in preterm labour with intact membranes compared with infants delivered by elective prelabour caesarean section (p<0.05). The cord blood cortisol concentration was increased in the mothers with prelabour premature (...) rupture of membranes but this was not significant compared with the caesarean section group. The cord blood cortisol concentration was significantly increased in the presence of chorioamnionitis or funisitis and was moderately correlated with cord blood IL6 (r = 0.64, p<0.01) and IL8 (r = 0.52, p<0.01).In this study, cord blood cortisol was increased in the colonised group compared with non-colonised infants. It is unclear if infants born following prelabour premature rupture of the membranes mount

2007 Archives of Disease in Childhood. Fetal and Neonatal Edition

2568. Relationship between antenatal inflammation and antenatal infection identified by detection of microbial genes by polymerase chain reaction. Full Text available with Trip Pro

to 36 mothers and analyzed for the presence of 16s ribosomal RNA (16s rRNA) genes using PCR and for the proinflammatory cytokines IL-6 and IL-8. In 16 (44%) mother-baby pairings, at least one sample was found to be positive for the presence of 16s rRNA genes. All but one of the positive samples were from mothers presenting with preterm prelabor rupture of membranes (pPROM) or in spontaneous idiopathic preterm labor. A strong association was found between the presence of 16s rRNA genes (...) Relationship between antenatal inflammation and antenatal infection identified by detection of microbial genes by polymerase chain reaction. Although antenatal infection is thought to play an important role in the pathogenesis of preterm labor and neonatal diseases, the exact mechanisms are largely unknown. We sought to clarify the relationship between antenatal infection and intrauterine and neonatal inflammation. Samples were obtained from 41 preterm infants of <33 wk gestation delivered

2005 Pediatric Research

2569. Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. (Abstract)

Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. Most cases of neonatal group B streptococcal disease with early onset have an intrapartum pathogenesis. Attack rates are increased substantially in infants born to mothers with prenatal group B streptococcal colonization and various perinatal risk factors (premature labor, prolonged membrane rupture, or intrapartum fever). In a randomized controlled trial, we studied the effect

1986 NEJM Controlled trial quality: uncertain

2570. Randomised controlled trial of routine cervical examinations in pregnancy. European Community Collaborative Study Group on Prenatal Screening. (Abstract)

% in the experimental group and 7.7% in the controls (non-significant). Premature rupture of membranes was not significantly more frequent in the experimental group (27.1% vs 26.5%). Our findings do not support the routine use of cervical examinations during pregnancy. (...) Randomised controlled trial of routine cervical examinations in pregnancy. European Community Collaborative Study Group on Prenatal Screening. Preterm delivery is strongly associated with neonatal mortality and morbidity. In some European countries, cervical examinations are used routinely during pregnancy to identify women at risk of preterm delivery. We sought to evaluate the efficacy and secondary effects of these routine cervical examinations. We did a randomised controlled trial in seven

1994 Lancet Controlled trial quality: uncertain

2571. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. (Abstract)

and the conclusion of the data safety monitoring board that further recruitment would not result in significant differences between the groups. Eight of 11 fetuses (73 percent) in the tracheal-occlusion group and 10 of 13 (77 percent) in the group that received standard care survived to 90 days of age (P=1.00). The severity of the congenital diaphragmatic hernia at randomization, as measured by the lung-to-head ratio, was inversely related to survival in both groups. Premature rupture of the membranes (...) and preterm delivery were more common in the group receiving the intervention than in the group receiving standard care (mean [+/-SD] gestational age at delivery, 30.8+/-2.0 weeks vs. 37.0+/-1.5 weeks; P<0.001). The rates of neonatal morbidity did not differ between the groups.Tracheal occlusion did not improve survival or morbidity rates in this cohort of fetuses with congenital diaphragmatic hernia.Copyright 2003 Massachusetts Medical Society

2003 NEJM Controlled trial quality: predicted high

2572. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. Full Text available with Trip Pro

of life.The prevalence of early onset group B streptococcal sepsis was 0.57 per 1000 live births. Premature infants comprised 38% of all cases and 83% of the deaths. Prematurity (odds ratio 10.4, 95% confidence interval 3.9 to 27.6), rupture of the membranes more than 18 hours before delivery (25.8, 10.2 to 64.8), rupture of the membranes before the onset of labour (11.1, 4.8 to 25.9), and intrapartum fever (10.0, 2.4 to 40.8) were significant risk factors for infection. Had the interim recommendations (...) in the United Kingdom. Prevention based on risk factors might reduce the prevalence at the cost of treating many women with risk factors. Using rupture of the membranes before the onset of labour as a risk factor might be expected to improve the success of guidelines for prophylaxis.

2002 BMJ

2573. Recurrent Miscarriage

. Only 50% of pregnancies where there is a uterine structural abnormality achieve term delivery. Multiple intramural and submucosal fibroids are associated with an increased risk of miscarriage but whether myomectomy improves the live birth rate is unclear. Cervical incompetence (late miscarriage preceded by spontaneous rupture of membranes or painless cervical dilatation) may often be a cause of mid-trimester recurrent miscarriage. Endocrine Women with polycystic ovary syndrome are at higher risk (...) [ ] . The relationship appears to be strongest for late pregnancy loss as opposed to miscarriage. Women with second-trimester miscarriage should be screened for inherited thrombophilia. Infections Bacterial vaginosis in the first trimester is a risk factor for second-trimester miscarriage and preterm delivery [ ] . Investigations Antiphospholipid and B2-glycoprotein I antibodies: The presence of these is associated with early miscarriages and maternal morbidity and is referred to as primary APS. There is requirement

2008 Mentor

2574. Polyhydramnios

. Serial ultrasound scans should be carried out to monitor the AFI and fetal growth. Induction of labour should be considered if fetal distress develops. Induction by artificial rupture of the membranes (ARM) should be controlled, performed by an obstetrician and with consent to proceed to lower-segment caesarean section if required. Corticosteroids should be given to the mother antenatally if preterm delivery is imminent or considered. [ ] This helps to improve lung maturity. Prostaglandin synthetase (...) There is a higher incidence of . Other complications include premature rupture of the membranes, abruptio placenta, , and . There is a higher incidence of caesarean section. For the mother, the risk of urinary tract infections is increased due to increased pressure on the urinary tract. The mother may have increased dyspnoea due to increased pressure on the diaphragm. There is also a higher risk of hypertension in pregnancy. Studies of pregnancies associated with polyhydramnios but not congenital malformation

2008 Mentor

2575. Perinatal and Neonatal Infections

to exposure to a vast array of new pathogens ex utero. Parturition also places the baby in direct contact with maternal blood or genital secretions and infections may result, especially if there was prolonged or early rupture of membranes. At birth, an infant's immune system remains immature. Some protection is provided by maternal antibodies (IgG) crossing the placenta. This process is less complete in the premature baby, especially if markedly premature. If a mother develops a new infection close (...) after delivery. Hepatitis B See separate article. Hepatitis C See separate article. Group B streptococci (GBS) GBS are found in 12-26% of pregnant women, especially in the urine. Infection has been associated with preterm delivery, and ascending infection following rupture of membranes may result in fetal infection. Maternal carriage of GBS is associated with a higher risk of chorioamnionitis and neonatal disease. Neonatal GBS disease occurs at a rate of 0.5 cases/1,000 births. The rate is increased

2008 Mentor

2576. Peripheral Blood Film

or prolonged hypoxia. Pelger-Huet anomaly describes bilobed neutrophils which may be hereditary (when the neutrophils are functionally normal) or acquired - eg, myelodysplastic syndrome. Reactive lymphocytes seen in infectious mononucleosis. Right shift is characterised by the presence of hypersegmented polymorphonucleocytes (>5 lobes to their nucleus), seen in liver disease, uraemia and megaloblastic anaemia. Smear cells are lymphocytes whose cell membranes have ruptured in preparation of the blood film (...) on the following: The erythrocytes (RBCs): a note will be made of their size, shape, any membrane changes, colour and stippling. Any inclusion bodies (eg, Howell-Jolly bodies or malarial parasites) will also be noted. Other abnormalities include red cell rouleaux, red cell nucleation and the presence of reticulocytes. The leukocytes (WBCs): the number and morphology of these cells are noted, as well as abnormalities such as toxic granulation or dysplastic changes. Presence of abnormal cells is important (eg

2008 Mentor

2577. Prenatal Diagnosis

therapeutically for severe congenital diaphragmatic hernia, division of amniotic bands, laser coagulation of placental vessels in twin-to-twin transfusion syndrome or in twin pregnancies where one twin has a severe abnormality. [ ] The risk is preterm rupture of membranes. Cordocentesis/percutaneous umbilical blood sampling This technique uses ultrasound guidance to obtain fetal blood cells from the umbilical cord. It enables karyotyping/chromosome analysis as well as being used for the assessment

2008 Mentor

2578. Prolapsed Cord

of gestation. Cord prolapses occurring in hospital have better outcomes than those occurring within the community. Advise women who choose to stay in the community that they will require rapid assessment if they start labour or have a spontaneous rupture of membranes and should seek help as soon as possible. Women with premature rupture of membranes and a non-cephalic presentation should be advised to be admitted. Avoid ARM where possible. When amniotomy to induce labour is necessary, the umbilical cord (...) . You may find one of our more useful. In this article In This Article Prolapsed Cord In this article There are three varieties: Overt cord prolapse - if the presenting part of the fetus does not fit the pelvis snugly after membrane rupture, there is a risk that the umbilical cord can slip past and present at the cervix or descend into the vagina. This is known as overt cord prolapse. It represents an acute obstetric emergency, as prolapse exposes the cord to intermittent compression compromising

2008 Mentor

2579. Placenta Praevia

without placenta praevia [ ] . There may be some initial pain in approximately 10% of cases with coincidental placental abruption. There is a high risk of preterm delivery; in 25% of cases, spontaneous labour appears in the subsequent few days. In a small proportion of cases, less dramatic bleeding occurs or does not start until spontaneous rupture of membranes or onset of labour. High presenting part or abnormal lie; it may be impossible to push the high presenting part into the pelvic inlet. In 15 (...) and the hazards of prophylactic anticoagulation in women at high risk of bleeding. Rare: Fetal haemorrhage, prematurity, intrauterine asphyxia or birth injury. Prognosis A prospective study of 328 European women demonstrated the high maternal and neonatal morbidity associated with placenta praevia [ ] : 42.3% antepartum haemorrhage. 7.1% postpartum haemorrhage. 30% maternal anemia. 4% co-existing placenta accreta. 5.2% hysterectomy. 54.9% preterm birth. 35.6% low birth weight <2500 g. 1.5% fetal mortality

2008 Mentor

2580. Placenta and Placental Problems

or just off-centre. Has a length not associated with length, weight or gender of the baby. Abnormalities of shape, size, surfaces and function [ , ] Circumvallate [ ] In approximately 1% of cases, there is a small central chorionic area inside a paler thick ring of membranes on the fetal side of the placenta. This is associated with an increased rate of antepartum bleeding, prematurity, abruption, multiparity and perinatal death. Succenturiate lobe [ ] These are accessory lobes that develop (...) . It is not of clinical significance. Velamentous cord insertion and vasa praevia Velamentous cord insertion is the term for where the placenta has developed away from the attachment of the cord and the vessels divide in the membrane. If the vessels cross the lower pole of the chorion, this is known as vasa praevia and there is high risk of fetal haemorrhage and death at rupture of membranes. If suspected, vasa praevia can be accurately diagnosed with transvaginal colour Doppler ultrasound. Risk of vasa praevia

2008 Mentor

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