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Premature Rupture of Membranes

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2661. 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

2662. 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

2663. 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

2664. Genital Herpes in Pregnancy

of labour Caesarean section is recommended. Where vaginal delivery occurs: Consider intravenous aciclovir for both mother and neonate. Invasive procedures (fetal scalp monitoring, artificial rupture of membranes and instrumental delivery) should be avoided where possible as this is thought to increase risk of transmission. The neonate should be treated with intravenous aciclovir and swabs should be taken from the eyes, skin, oropharynx and rectum. Management of recurrent infection Confirm the diagnosis (...) . There is no evidence that there is any increased risk of premature labour or intrauterine growth restriction for women seropositive for HSV. If the woman has a history of recurrent genital herpes, she should be reassured that the risk of transmitting the infection to her baby is very small, even if she does have active lesions at delivery. The risk is approximately 0-3% for vaginal delivery. Maternal antibodies will give some protection to the baby but neonatal infection can still occasionally occur. Antiviral

2008 Mentor

2665. Fetal Distress

of antenatal fetal distress require monitoring with a view to induction of labour or planned caesarean section. Immediate delivery of a preterm fetus with suspected fetal distress may reduce the risk of intrauterine hypoxia but increases the risks associated with prematurity. Benefit may be gained by deferring delivery, especially if there is uncertainty; however, evidence is lacking to guide this decision [ ] . Continuing fetal distress during labour may indicate the need for delivery to be expedited (...) that very short 'decision-to-incision' time (<20 minutes) may be inversely proportional to neonatal outcomes, ie lower umbilical pH and Apgar scores [ ] . Amnioinfusion has been shown to be beneficial in suspected umbilical cord compression (particularly when there is oligohydramnios), with a reduced risk of caesarean section [ ] : In this process, sodium chloride or Ringer's lactate is infused transcervically or, if the membranes are still intact, via a needle inserted under ultrasound guidance through

2008 Mentor

2666. Haemophilus Influenzae

months to 4 years. Hib causes septic arthritis and cellulitis in children younger than 2 years. Hib septic arthritis also occurs in adults. Neonatal infection: Often due to non-typeable H. influenzae , which colonises the maternal genital tract. Infection is associated with premature birth, premature rupture of membranes, low birth weight and maternal chorioamnionitis. Presentations include meningitis, pneumonia, respiratory distress, scalp abscess, conjunctivitis and vesicular eruption

2008 Mentor

2667. Full Blood Count

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: seen in chronic lymphocytic leukaemia (...) : 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, leukaemic blasts

2008 Mentor

2668. External Eye - Lashes Eyelids and Lacrimal System

oculoplastic surgery. Poliosis [ ] This is premature, localised whitening of the lashes and eyebrows (it may involve any hairy area of the body). Microscopically there is decreased or absent melanin in the affected hair follicles. Classically, poliosis is associated with several genetic syndromes, including piebaldism, Waardenburg's syndrome and tuberous sclerosis. It may be associated with inflammation: ocular causes include chronic anterior blepharitis and sympathetic ophthalmitis. In rare cases, it has (...) is not appropriate for children. Symptoms resolve rapidly following stye rupture/drainage. Consider referral if there are symptoms/signs of associated cellulitis (preseptal or orbital) or if the patient is systemically unwell. Also, consider referring if the stye is persistent or particularly large and painful and has not responded to conservative treatment. If the stye has an atypical appearance or recurs in the same location, think of the possibility of malignancy. Cysts . Various cysts can arise around

2008 Mentor

2669. Exomphalos and Gastroschisis

cord through the umbilical ring. The viscera, which often includes the liver, is covered by a thin membrane consisting of peritoneum and amnion. Gastroschisis means 'stomach cleft'. It is a congenital defect of the abdominal wall, usually to the right of the umbilical cord insertion. Abdominal contents herniate into the amniotic sac, usually just involving the small intestine but sometimes also the stomach, colon and ovaries. Unlike exomphalos, there is no covering membrane. [ ] Epidemiology (...) are not usually present. Differential diagnosis Exomphalos and gastroschisis need to be differentiated from each other and from other causes of an abdominal wall mass. Exomphalos is more centrally placed than gastroschisis, is covered with a membrane and is more likely to be associated with other congenital defects. The hernial sac in the two conditions also feels different. An exomphalic sac feels firm and may contain liver and tightly packed bowel, whereas in gastroschisis the sac contains only free loops

2008 Mentor

2670. Gravidity and Parity Definitions (and their Implications in Risk Assessment)

should have 10 routine antenatal appointments (versus 7 in parous women) [ ] . Good antenatal and parenting education, support during labour and pain control (if desired) are especially important in a first pregnancy, as anxiety levels are likely to be high. Where there is delay in the first stage of labour in a primagravida, active management is with artificial rupture of membranes and/or oxytocin to augment labour. The second stage of labour can be allowed to continue for longer than (...) the potential lack of standardisation in our documentation [ ] . A more elaborate coding system used elsewhere, including America, is GTPAL (G = gravidity, T = term deliveries, P = preterm deliveries, A = abortions or miscarriages, L = live births). Epidemiology The current total fertility rate (the average number of children a woman would have if she experienced the fertility rate of a particular year for her entire childbearing years) stands at 1.91 (2012 figures) [ ] . Women are commencing

2008 Mentor

2671. What is the up-to-date thinking on investigation of recurrent miscarriage and its treatment?

for recurrent miscarriage is questionable since it is associated with patient discomfort, carries a risk of pelvic infection and offers the same diagnostic sensitivity as non-invasive pelvic ultrasound assessment of the uterine cavity. Cervical incompetence is often over-diagnosed as a cause of mid-trimester miscarriage. Cervical cerclage should only be considered when the history of miscarriage is preceded by spontaneous rupture of membranes or painless cervical dilatation. The MAC/RCOG trial of the use (...) or observational studies Grade C: more limited evidence but the advice relies on expert opinion and has the endorsement of respected authorities Intervention Trial Arms Losses/Total pregnancies Percent (95% CI) None, usual care 4 30/80 37 (27 to 48) Aspirin alone 6 50/129 39 (30 to 47) Low MW heparin plus aspirin 6 36/155 23 (17 to 30) They also add that use of prednisolone was associated with higher rates of premature birth and admission to neonatal intesive care units with no evidence of preventing pregnancy

2002 TRIP Answers

2672. Term PROM. (Abstract)

Term PROM. 7621120 1995 08 31 2015 11 16 1355-8404 108 1285 1995 Feb Midwives : official journal of the Royal College of Midwives Midwives (1995) Term PROM. 47-8 Marshall G G eng Clinical Trial Comparative Study Journal Article Multicenter Study Randomized Controlled Trial England Midwives (1995) 9506689 1355-8404 50-56-6 Oxytocin K7Q1JQR04M Dinoprostone N Dinoprostone therapeutic use Female Fetal Membranes, Premature Rupture drug therapy Humans Labor, Induced methods Oxytocin therapeutic use

1995 Midwives : official journal of the Royal College of Midwives Controlled trial quality: uncertain

2673. Is obstetric progress dependent on rigorous randomized controlled trials? (Abstract)

-Bacterial Agents therapeutic use Bacterial Infections prevention & control Female Fetal Membranes, Premature Rupture drug therapy Humans Infant, Newborn Pregnancy Premedication Randomized Controlled Trials as Topic 1990 5 1 1990 5 1 0 1 1990 5 1 0 0 ppublish 2187362 0002-9378(90)90076-J

1990 American Journal of Obstetrics and Gynecology Controlled trial quality: predicted high

2674. PROM at term and group B strep. (Abstract)

PROM at term and group B strep. 9487313 1998 03 19 2004 11 17 0094-3509 46 2 1998 Feb The Journal of family practice J Fam Pract PROM at term and group B strep. 116 Yaekle S S Oakwood Hospital Family Practice, Residency Program, Dearborn, Michigan, USA. French L L eng Clinical Trial Journal Article Randomized Controlled Trial United States J Fam Pract 7502590 0094-3509 AIM IM Female Fetal Membranes, Premature Rupture therapy Humans Infant, Newborn Labor, Induced methods Pregnancy Pregnancy

1998 The Journal of family practice Controlled trial quality: uncertain

2675. Generic Database of Very Low Birth Weight Infants

of death or discharge from the hospital. The data collected includes information on: Demographics of mother and infant Mother's health (e.g., pregnancy history and complications) Labor and deliver (e.g., rupture of the membranes, steroids and antibiotics given, mode of delivery) Infant's health (gestational age, Apgar scores, weight, length, delivery room resuscitation, respiratory support, etc.) Infant's medical outcome (heart, lung, nervous system, gastrointestinal system, hearing, and vision, known (...) of the infants. The information collected is not specific to a disease or treatment (i.e., it is "generic"). Data are analyzed to find associations and trends between baseline information, treatments, and infant outcome, and to develop future NRN trials. Condition or disease Infant, Newborn Infant, Low Birth Weight Infant, Small for Gestational Age Infant, Premature Detailed Description: The Generic Database (GDB) is a registry of very low birth weight infants born alive in NICHD Neonatal Research Network

2003 Clinical Trials

2676. Antibiotics to Reduce Chorioamnionitis-Related Perinatal HIV Transmission

is more common in preterm infants, and there is now evidence that subclinical chorioamnionitis is a substantial risk factor for MCT. For this study, the primary hypothesis is that early and appropriate treatment of subclinical chorioamnionitis prior to the onset of spontaneous preterm labor, and/or antibiotic treatment during labor, to prevent premature rupture of membrane-associated-chorioamnionitis, will reduce the risk of perinatal HIV transmission. [Note: As of 02/21/03, enrollment into this study (...) Drug: Nevirapine Drug: Ampicillin sodium Drug: Metronidazole Phase 3 Detailed Description: Obstetric risk factors for HIV maternal-child transmission (MCT) include preterm birth, prolonged rupture of the membranes, and chorioamnionitis. Many preterm births are associated with and likely caused by chorioamnionitis. The relationship between bacterial vaginosis, preterm birth, histologic chorioamnionitis, and perinatal transmission of HIV has been consistently demonstrated. Perinatal HIV transmission

2001 Clinical Trials

2677. Beneficial Effects of Antenatal Magnesium Sulfate (BEAM Trial)

be markers for subsequent development of cerebral palsy. This multicenter trial tests whether prophylactic magnesium sulfate given to women, for whom preterm delivery is imminent, reduces the risk of death or moderate to severe cerebral palsy in their children. Women presenting from 24.0 to 31.6 weeks gestation with advanced preterm labor or premature rupture of the membranes (pPROM) and no recent exposure to magnesium sulfate are randomized to receive either intravenous magnesium sulfate or masked study (...) labor Membrane rupture or delivery definitely planned within 24 hours Gestational age > 24.0 and < 31.6 wks, viable fetus Exclusion Criteria: Prior IV magnesium sulfate therapy within 12 hours of screening Delivery expected <2 hrs Cervical dilation > 8 cm More than 2 fetuses Known major fetal anomalies Hypertension or preeclampsia Maternal medical complications contraindicating magnesium sulfate treatment Participation in any intervention study which influences infant neurological outcome Previous

2001 Clinical Trials

2678. Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study Full Text available with Trip Pro

of short and long interpregnancy intervals on maternal death, pre-eclampsia, eclampsia, gestational diabetes mellitus, third trimester bleeding, premature rupture of membranes, postpartum haemorrhage, puerperal endometritis, and anaemia.Short (<6 months) and long (>59 months) interpregnancy intervals were observed for 2.8% and 19.5% of women, respectively. After adjustment for major confounding factors, compared with those conceiving at 18 to 23 months after a previous birth, women with interpregnancy (...) intervals of 5 months or less had higher risks for maternal death (odds ratio 2.54; 95% confidence interval 1.22 to 5.38), third trimester bleeding (1.73; 1.42 to 2.24), premature rupture of membranes (1.72; 1.53 to 1.93), puerperal endometritis (1.33; 1.22 to 1.45), and anaemia (1.30; 1.18 to 1.43). Compared with women with interpregnancy intervals of 18 to 23 months, women with interpregnancy intervals longer than 59 months had significantly increased risks of pre-eclampsia (1.83; 1.72 to 1.94

2000 BMJ : British Medical Journal

2679. A Study of Zidovudine in HIV-Infected Pregnant Women and Their Children

to recurrent spontaneous abortions, previous preterm or low-birth-weight infant, congenital anomalies (past or present pregnancy), premature rupture of membranes, multiple gestation, intrauterine fetal death (this pregnancy), and placenta previa or abruptio (this pregnancy). Medical complications: Conditions including but not limited to insulin-dependent diabetes mellitus (IDDM), hypertensive disorders which include preeclampsia, eclampsia, chronic hypertension, cardiovascular disease including rheumatic

1999 Clinical Trials

2680. A program of cell death and extracellular matrix degradation is activated in the amnion before the onset of labor. Full Text available with Trip Pro

A program of cell death and extracellular matrix degradation is activated in the amnion before the onset of labor. Fetal membranes usually rupture during the process of labor. Premature fetal membrane rupture occurs not infrequently and is associated with significant fetal and maternal morbidity. The mechanisms of normal and pathologic fetal membrane rupture are not well understood. We have examined structural and biochemical changes in the rat amnion as labor approaches in order (...) by interstitial collagenase. Western blot and immunohistochemical analyses confirmed that interstitial collagenase protein appears in association with the loss of amnion type I collagen. We conclude that amnion epithelial cells undergo a process of programmed cell death associated with orchestrated extracellular matrix degradation which begins before the onset of active labor. Thus, fetal membrane rupture is likely to be the result of biochemical changes as well as physical forces.

1996 Journal of Clinical Investigation

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