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Premature Rupture of Membranes

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2621. Risk factors for periventricular leukomalacia. (Abstract)

type I (RDS I), seizures, sepsis, required more days of both mechanical ventilation and oxygen administration, while the duration of their hospitalization was longer compared to controls. Also, they were born more frequently to mothers who suffered from preterm premature rupture of membranes (PPROM) and clinical chorioamnionitis. We found that male gender, PPROM, preeclampsia, hypocarbia and IVH were independently associated with PVL.This study revealed that preterm neonates born to mothers

2008 Acta Obstetricia et Gynecologica Scandinavica

2622. Second-trimester fetal growth and the risk of poor obstetric and neonatal outcomes. Full Text available with Trip Pro

malformations, second-trimester rupture of membranes, and multiple pregnancies.Second-trimester EFW < 25(th) percentile was significantly associated with higher rates of fetal or neonatal death, third-trimester small for gestational age (SGA), Doppler abnormalities, indicated preterm birth, gestational hypertension or pre-eclampsia before labor, lower birth weight, birth weight < 10(th) percentile, birth weight < 5(th) percentile, and admission to the neonatal intensive care unit. Many of these associations

2008 Ultrasound in Obstetrics and Gynecology

2623. Is there value for serial ultrasonographic assessment of cervical lengths after a cerclage? (Abstract)

patients (56%) had absent CLA at 26.7 +/- 4.4 weeks. Of these, 16 (50%) were delivered for preterm premature rupture of membranes (PPROM) and chorioamnionitis (sensitivity of 100%, specificity of 61%, positive predictive value of 50%, and negative predictive value of 100%).Although the overall cervical length by serial TVS after cerclage did not predict preterm birth, absent CLA is associated with preterm delivery, chorioamnionitis, and PPROM. (...) Is there value for serial ultrasonographic assessment of cervical lengths after a cerclage? The objective of the study was to determine the value of serial ultrasonographic cervical length (CL) measurements after cerclage to predict preterm delivery.Retrospective ultrasonographic and outcome data from singleton pregnancies with cerclage were reviewed. Using transvaginal ultrasound (TVS), overall CL obtained before cerclage placement, 2 weeks after cerclage, and before delivery were compared

2008 American Journal of Obstetrics and Gynecology

2624. Pregnancy following gastric bypass surgery for morbid obesity: maternal and neonatal outcomes. (Abstract)

-10.50), preterm premature rupture of membranes (OR 0.24, 95% CI 0.02-3.38), oligohydramnios (OR 2.39, 95% CI 0.66-8.61), and delivery > or =41 weeks (OR 0.57, 95% CI 0.11-2.97).Obstetric and neonatal outcomes after RYGB are similar to those of our general obstetric population.

2008 Obesity Surgery

2625. Twin pregnancy as a risk factor for mother-to-child transmission of HIV-1: trends over 20 years. (Abstract)

should take into account the risks of premature rupture of the membranes and preterm delivery. (...) was considered to have transmitted if at least one of the twins was infected. Univariate and multivariate analyses of risk factors for MTCT were performed for deliveries in the periods up to 1996.Overall, 2.1% (192/9262) of all the deliveries were twins. The rate of prematurity was greater in twins than in singletons (54% and 13%, respectively). Up to 1996 the rate of MTCT of HIV-1 was 28.3% (15/53) in twin pregnancies, versus 13.5% (414/3077) in singletons [odds ratio (OR), 2.5; 95% confidence interval (CI

2007 AIDS

2626. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Full Text available with Trip Pro

and three elective abortions. During 39 of the 49 completed pregnancies, complications were observed. The most important cardiac complication was clinically significant arrhythmia (n=11, 22%), especially occurring in patients with a prior history of arrhythmia. Important general pregnancy complications were preeclampsia (n=5, 10.2%) and pregnancy-induced hypertension (n=4, 8.2%). Obstetric complications included premature rupture of membranes (n=7, 14.3%), premature labour (n=12, 24.4%), premature

2005 European Heart Journal

2627. Pregnancy and delivery in women after Fontan palliation. Full Text available with Trip Pro

five miscarriages (50%) and one aborted ectopic pregnancy. During the remaining four live-birth pregnancies clinically significant complications were encountered: New York Heart Association class deterioration; atrial fibrillation; gestational hypertension; premature rupture of membranes; premature delivery; fetal growth retardation and neonatal death. Four of seven women who had attempted to become pregnant reported female infertility: non-specified secondary infertility (n = 2), uterus bicornis

2006 Heart

2628. Pregnancy after radical trachelectomy: a real option? (Abstract)

who tried to conceive after radical trachelectomy succeeded once or more than once (70%). Patients attempting to conceive need to be informed of the complications and risk factors, in particular, second trimester loss and premature delivery caused by premature rupture of membranes. Once pregnant, patients need to be carefully followed for cervical incompetence and other risk factors for premature rupture of membranes. (...) % of the patients who tried to conceive, cervical stenosis was found and resulted in menstrual disorders or fertility problems. Surgical dilatation resolved this problem in most cases but had to be repeated. Complications during pregnancy involved second trimester loss (13/161) and premature (< or =36 weeks AD) delivery (33/161).Pregnancy after radical trachelectomy is feasible. For various reasons, a number of patients (57%) did not try to get pregnant after the surgical procedure. The majority of the patients

2005 Gynecologic Oncology

2629. Delivery outcome after cold-knife conization of the uterine cervix. (Abstract)

) of the conization group and in 6.6% (n = 1961) of the controls (OR = 4.07 [2.22-7.10], P < 0.001). Preterm premature rupture of the membranes was found in 17.1% (n = 13) of the conization group and in 2.6% (n = 775) of the controls (OR = 7.70 [3.87-14.21], P < 0.001). Birth weight less than 2500 g was found in 18.4% (n = 14) of the conization group and in 7.7% (n = 2280) of the controls (OR = 2.72 [1.40-4.92], P = 0.002). Overall, birth weight in the conization group was not significantly lower (median 3147 g (...) vs. 3287 g, P = 0.115). Cervical tears were found more frequently in the conization group (8.8% [n = 6] vs. 1.3% [n = 236], OR = 7.53 [2.63-17.57], P < 0.001). There was no difference in mode of delivery, duration of labor, head circumference, chorioamnionitis and use of oxytocin.Cold-knife conization is a risk factor for preterm birth and preterm premature rupture of the membranes and seems to be a risk factor for cervical tears.

2006 Gynecologic Oncology

2630. 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

2631. 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

2632. 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

2633. 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

2634. Infant Respiratory Distress Syndrome

to the gestational age of the infant. It affects approximately one half of infants born at 28-32 weeks of gestation. It may (rarely) occur at term. The incidence of IRDS decreases with: The use of antenatal steroids. However, there are uncertainties over the efficacy for some groups such as the very early preterm babies, late preterm babies and multiple gestations. [ ] Pregnancy-induced or chronic maternal hypertension. Prolonged rupture of membranes. Risk factors [ ] Premature delivery. Male infants. Infants (...) preterm delivery. Presents with respiratory distress very soon after birth: tachypnoea, expiratory grunting, subcostal and intercostal retractions, diminished breath sounds, cyanosis and nasal flaring. May rapidly progress to fatigue, apnoea and hypoxia. Differential diagnosis Other causes of respiratory distress in neonates: Pulmonary air leaks (eg, , interstitial emphysema, pneumomediastinum, pneumopericardium). In premature infants, these may occur from excessive positive pressure ventilation

2008 Mentor

2635. Intrapartum Fetal Monitoring

hypoxia: [ , ] Low gestational age (24-30 weeks) plus: postnatal dexamethasone use; patent ductus arteriosus; severe hyaline membrane disease; resuscitation in the delivery room; and intraventricular haemorrhage have all been shown to be associated with higher rates of cerebral palsy. Whereas antenatal corticosteroid use in very preterm infants is associated with a lower rate. [ ] There appears to be at best a tenuous connection between cardiotocographic findings, what they signify about the fetal (...) labour Antenatal maternal risk factors Antenatal fetal risk factors Intrapartum risk factors Previous caesarean section Suspected fetal growth restriction Augmentation of labour using oxytocin Pre-eclampsia or pregnancy-induced hypertension Suspected oligohydramnios or polyhydramnios Epidural analgesia Recurrent antepartum haemorrhage Abnormal presentation: breech, transverse or oblique Fresh vaginal bleeding during labour Prolonged membrane rupture (>24 hours) High or free head in a nulliparous

2008 Mentor

2636. Stillbirth and Neonatal Death

abnormality Haemorrhage, during pregnancy or labour Placental insufficiency Placental abruption Pre-eclampsia Obstetric complications Spontaneous premature labour Premature rupture of membranes Polyhydramnios Oligohydramnios Intrapartum asphyxia Birth trauma Cord prolapse Intra-uterine growth restriction Liver disease - obstetric cholestasis, intrahepatic cholestasis of pregnancy Diabetes Infections during pregnancy In England the latest report into causes of perinatal death was the Centre for Maternal (...) factor for stillbirth. A 2012 study of stillbirths in England showed the risk to be significantly higher where the growth restriction was not detected antenatally, suggesting this as an important avenue for reducing stillbirth rates in the future. [ ] It concluded strategy should focus on improving antenatal detection of growth restriction, and subsequent management of pregnancy and delivery. Preterm birth: [ ] This is the biggest risk factor for neonatal death. Obstetric and neonatal care can have

2008 Mentor

2637. Meningitis

[ ] See also separate general article . Neonates are at greater risk of meningitis. Risk factors for the development of meningitis include low birth weight (below 2500 g), premature delivery, premature rupture of membranes, traumatic delivery, fetal hypoxia and maternal peripartum infection. Intrapartum prophylactic antibiotics in pregnant mothers who carry, or who are at risk of colonising, group B streptococci, have been effective in reducing the risk of neonatal group B streptococcal meningitis (...) by local guidelines and close liaison with a microbiologist. Initial 'blind' therapy Children 3 months and older and young people should be given intravenous ceftriaxone as empirical treatment before identification of the causative organism. If calcium-containing infusions are required at the same time, cefotaxime is preferable. Children younger than 3 months should be given intravenous cefotaxime plus either amoxicillin or ampicillin. NB : ceftriaxone should not be used in premature babies

2008 Mentor

2638. Multiple Pregnancy

by caesarean section for twin 2. Triplets and higher multiple deliveries are usually managed by caesarean section and in tertiary-level fetal medicine centres. Vaginal delivery of twins With no complicating factors, the mother can go into spontaneous labour provided the first twin has a cephalic presentation. Where the first twin presents in a breech or transverse position, caesarean section is preferred. In most cases, vaginal birth proceeds as normal. With rupture of membranes, check for prolapse (...) . Ideally these should all be performed at the same scan. Chorionicity should be determined using the number of placental masses, the lambda or T-sign and membrane thickness. The risks are greater if the fetuses share a placenta (monochorionic), so it is important that this is established early. Scanning to screen for structural anomalies takes place as per singleton pregnancies (at 18 to 21 weeks), but the procedure takes longer. Multiple pregnancies should be monitored carefully for intrauterine

2008 Mentor

2639. Management of HIV in Pregnancy

can be reduced to less than 1%. Risk of MTCT This is increased with: Higher levels of maternal viraemia. HIV core antigens. Lower maternal CD4 count. Primary HIV infection occurring during pregnancy. Chorioamnionitis. Co-existing other sexually transmitted disease . Possibly malaria. [ ] Invasive intrapartum procedures - eg, fetal scalp electrodes, forceps, ventouse. Rupture of membranes (especially if delivery is more than four hours after the membranes ruptured). Vaginal delivery. Preterm birth (...) delivery providing they are taking effective ART. Delivery by pre-labour caesarean section between 38-39 weeks to prevent labour and/or ruptured membranes is recommended for: Women taking ART who have a plasma viral load greater than 50 copies/ml . Women taking ZDV monotherapy as an alternative to ART. Delivery by pre-labour caesarean section for obstetric indications or maternal request should be delayed until after 39 weeks in women whose plasma viral load is less than 50 copies/ml, to reduce

2008 Mentor

2640. Deafness in Adults

health professional can look down with a torch. At the end of the canal is the eardrum. This separates the external ear from the middle ear. The eardrum is a tightly stretched membrane, a bit like the skin of a drum. Our picks for Hearing Problems Your ears do the remarkable job of allowing you to hear a huge range of sounds, from a whisper t... 4min The middle ear is an air-filled compartment. Inside it are the three smallest bones in the body, called the malleus, incus and stapes. These bones (...) If there is a problem in the ear canal or the middle ear, this causes what is known as a conductive hearing loss. In conductive hearing loss, the movement of sound (conduction) is blocked or does not pass into the inner ear. This is often as the result of earwax (cerumen) or fluid in the middle ear, although it may also be caused by a burst (ruptured) eardrum or by otosclerosis (see below). Sensorineural hearing loss If the fluid-filled chamber called the cochlea or the hearing nerve is not working properly

2008 Mentor

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