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Premature Rupture of Membranes

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2681. Is the incidence of fetal-to-maternal hemorrhage increased in patients with third-trimester bleeding? (Abstract)

by third trimester bleeding compared with three control groups.Pregnancies that were complicated by third-trimester bleeding, preterm premature rupture of the membranes, and preterm labor were identified prospectively on admission. A group of preterm patients with no complications was also collected prospectively. Patients with any history and/or clinical evidence of trauma were excluded. Kleihauer-Betke tests were performed with all patients, and the results were blinded until study completion. Sample (...) size calculations were performed to determine the minimum number of cases needed in each group.A total of 403 patients were collected during the study period: 91 patients had third-trimester bleeding, 101 patients had preterm premature rupture of the membranes, 116 patients had preterm labor, and 95 patients were in the no complication group. There was no statistical difference identified in the Kleihauer-Betke test results between any of the study groups.The incidence of fetal-to-maternal

2003 American Journal of Obstetrics and Gynecology

2682. Pregnancy following treatment of symptomatic myomas with laparoscopic bipolar coagulation of uterine vessels. (Abstract)

and after LBCUV (P = 0.002), but no significant difference in myoma volume when comparing post-partum size with post-LBCUV size (P = 0.269). Pregnancy outcomes included seven miscarriages in the first trimester and one premature rupture of membrane (PPROM). Although the other pregnancies were regarded as uncomplicated, only two women were delivered of normal neonates as the other seven pregnancies were terminated secondary to patient request.The pregnancy and term pregnancy rates in sexually active

2003 Human Reproduction

2683. Streptococcus bovis bacteremia and fetal death. (Abstract)

Streptococcus bovis bacteremia and fetal death. Preterm premature rupture of membranes leading to intraamniotic infection and fetal death may be due to unusual bacterial species.A young multipara presented at 24 weeks and 6 days' gestation with rupture of membranes of 2 days' duration. She was febrile and hypotensive. No fetal heart activity was noted. Antibiotics, fluid resuscitation, and oxytocin were begun with delivery of a 798-g stillborn fetus. Maternal and fetal cultures demonstrated

2002 Obstetrics and Gynecology

2684. Pregnancy after uterine artery embolization. (Abstract)

Pregnancy after uterine artery embolization. Uterine artery embolization is an increasingly popular alternative to hysterectomy and myomectomy as a treatment for uterine leiomyoma. Whether this procedure is safe for women desiring future fertility is controversial.A primigravida who had previously undergone uterine artery embolization had premature rupture of membranes at 24 weeks. She had a cesarean delivery at 28 weeks, which was followed by uterine atony requiring hysterectomy (...) . A primigravida who had previously undergone uterine artery embolization delivered appropriately grown dichorionic twins at 36 weeks. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: malpresentation (17%), small for gestational age (7%), premature delivery (28%), cesarean delivery (58%), and postpartum hemorrhage (13%).Women who become pregnant after uterine artery embolization are at risk for malpresentation, preterm birth, cesarean

2002 Obstetrics and Gynecology

2685. Longitudinal evaluation of markers of endothelial cell dysfunction and hemostasis in treated antiphospholipid syndrome and in healthy pregnancy. (Abstract)

restriction and preeclampsia; one antiphospholipid syndrome pregnancy (4%) was complicated by preterm rupture of membranes. Six women with antiphospholipid syndrome (26%) had thrombotic events. Differences in concentrations of endothelial cell activation markers between antiphospholipid syndrome and control pregnancies were not significant.Despite poorer pregnancy outcome, there was no evidence of greater endothelial cell activation in antiphospholipid syndrome pregnancies that were treated.

2003 American Journal of Obstetrics and Gynecology

2686. Physical properties of the chorioamnion throughout gestation. (Abstract)

Physical properties of the chorioamnion throughout gestation. Our purpose was to assess the tensile strength of the chorioamnion at various gestational ages.Segments of chorioamnion were obtained from 35 patients delivered at gestational ages ranging from 17 to 41 weeks. Clinical information including gestational age, chorioamnionitis, premature rupture of membranes, and onset of labor was recorded. Tensile strength (grams to burst and deflection at rupture) was measured on 2 to 16 specimens (...) and therapies on membrane strength and may provide insight into spontaneous rupture of membranes.

2002 American Journal of Obstetrics and Gynecology

2687. Pregnancy outcome in spontaneous twins versus twins who were conceived through in vitro fertilization. (Abstract)

vitro fertilization twins were more likely to have preterm labor compared with control twins, with no difference in the incidences of pregnancy-induced hypertension, gestational diabetes mellitus, placenta previa, or preterm premature rupture of membranes between the two groups. The cesarean delivery rate was significantly higher in cases of twins who were conceived by in vitro fertilization (76.8% vs 58.0%, P=.026), despite a similar rate of elective cesarean delivery and the incidence of nonvertex (...) to the neonatal intensive care unit, respiratory distress syndrome, a need for mechanical ventilation, and pneumothorax in cases compared with control subjects.When compared with spontaneous twins, in vitro fertilization twins are more likely to be delivered by cesarean delivery and to have a higher incidence of preterm birth and prematurity-related respiratory complications with a longer nursery stay.

2003 American Journal of Obstetrics and Gynecology

2688. Intrauterine head entrapment of a second twin by a uterine synechia. (Abstract)

, as well as intrauterine growth restriction (IUGR). The patient experienced preterm premature rupture of membranes at 24 weeks' gestation and underwent a cesarean delivery for a nonreassuring fetal heart rate tracing of twin B, with findings of a constricting band of fibrous tissue around the neck of twin B.Uterine synechia might cause intrauterine head entrapment and IUGR.

2003 Obstetrics and Gynecology

2689. Successful outcome after serial amnioreductions in triplet fetofetal transfusion syndrome. (Abstract)

, and 26 weeks' gestation to relieve symptomatic polyhydramnios. Premature rupture of membranes occurred at 27 weeks and cesarean delivery was performed. All three babies were discharged home by 4 months of age, and all had normal neurological development when assessed at 6 months of age.The option of serial amnioreduction, with the anticipation and preparation for delivery at around 28 weeks, should be seriously considered when triplet fetofetal transfusion syndrome is encountered.

2003 Obstetrics and Gynecology

2690. Pregnancy outcomes in patients after radical trachelectomy. (Abstract)

to conceive for a median of 11 months (range 1-85). There have been a total of 22 pregnancies in 18 patients (4 patients pregnant twice). Of the 22 pregnancies, 18 were viable, with 12 progressing to term and delivering by caesarean section. Preterm premature rupture of membranes was the primary cause of preterm delivery.This series confirms that pregnancy is a safe and realistic outcome for women undergoing radical trachelectomy for invasive carcinoma of the cervix. Given the apparently high incidence (...) of preterm premature rupture of membranes, these pregnancies should be managed as high risk.

2003 American Journal of Obstetrics and Gynecology

2691. Interleukin-1 receptor antagonist gene polymorphism and multifetal pregnancy outcome. (Abstract)

allele 1 was more than twice as prevalent as the carriage of allele 2. Preterm premature rupture of membranes was observed in 12 of 24 pregnancies (50.0%) in which 2 fetuses tested positive for interleukin-1 receptor antagonist allele 2, as opposed to only 3 of 27 pregnancies (11.1%) in which 1 or neither fetus tested positive for interleukin-1 receptor antagonist allele 2 (P=.005). Similarly, 20 of 26 neonates (76.9%) with documented morbidity tested positive for interleukin-1 receptor antagonist (...) allele 2, as compared with 36 of 78 neonates (46.2%) without morbidity (P=.007). Fetal or maternal interleukin-1beta polymorphisms or maternal interleukin-1 receptor antagonist polymorphisms were unrelated to pregnancy outcome.Fetal carriage of interleukin-1 receptor antagonist allele 2 was associated with both preterm premature rupture of membranes and neonatal morbidity in women with multifetal pregnancies.

2003 American Journal of Obstetrics and Gynecology

2692. Relationship of prenatal care and perinatal morbidity in low-birth-weight infants. (Abstract)

. Women with NPC had more advanced cervical dilation (ACD) greater than 4 cm (ACD: 63% vs 39%) and more amnionitis on admission (2% vs 1%), Ppremature rupture of membranes, antepartum hemorrhage, amnionitis, and ACD. Controlling for other factors, NPC LBW (...) Relationship of prenatal care and perinatal morbidity in low-birth-weight infants. Lack of or no prenatal care (NPC) is associated with preterm birth (PTB) and low birth weight (LBW). Our purpose was to determine whether LBW infants delivered after NPC have worse outcomes than LBW infants with prenatal care (PC).Eight thousand sixty-five consecutive women delivered at six hospitals in Shelby County, Tenn, were evaluated regarding clinical characteristics and perinatal outcomes depending

2003 American Journal of Obstetrics and Gynecology

2693. Specialized prenatal care and maternal and infant outcomes in twin pregnancy. (Abstract)

education.Program Pregnancies were associated with improved pregnancy outcomes (preeclampsia, adjusted odds ratio [AOR] 0.41, 95% CI, 0.23-0.75; preterm premature rupture of membranes, AOR 0.35, 95% CI, 0.20-0.60; delivery <36 weeks, AOR 0.62, 95% CI, 0.43-0.89; low birth weight, AOR 0.42, 95% CI, 0.29-0.61), significantly longer gestations (+7.6 days), higher birth weights (+220 g), lower neonatal morbidity (retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, or ventilator

2003 American Journal of Obstetrics and Gynecology

2694. Myasthenia gravis: consequences for pregnancy, delivery, and the newborn. (Abstract)

a higher rate of complications at delivery (40.9% vs 32.9%, p = 0.05), and in particular the risk of preterm rupture of amniotic membranes was three times higher in the MG group compared to the reference group (5.5% vs 1.7%, p = 0.001). The rate of interventions during birth was raised (33.9% vs 20.0%, p < 0.001) and cesarean sections doubled (17.3% vs 8.6%, p = 0.001). Five children (3.9%) born by MG mothers had severe anomalies, and three of them died.MG is associated with an increased risk

2003 Neurology

2695. Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes. (Abstract)

diagnostic criteria for GDM were used.Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90-34.93); preterm birth (6.42; 1.46-28.34); breech presentation (3.47; 1.11-10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07-5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors.The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.

2002 Diabetes Care

2696. Selective feticide in monochorionic twin pregnancies by ultrasound-guided umbilical cord occlusion. (Abstract)

had a congenital diaphragmatic hernia, and three acardiac twins). One procedure failed due to maternal hemorrhage following insertion of the trocar (both fetuses died after emergency Cesarean section). One cotwin died a few minutes after the procedure and one survivor died within the neonatal period. The mean gestational age at the time of the procedure was 24 weeks of gestation and the mean gestational age at delivery was 31.1 weeks. Premature rupture of membranes occurred in four cases. Eight

2003 Ultrasound in Obstetrics and Gynecology

2697. Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage. (Abstract)

studied. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) compared to those without this finding (9%) P= 0.002.Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery. (...) at delivery. Funneling to the level of the cerclage was associated with an earlier gestational age at delivery 31.3 +/- 5.6 weeks vs. 36.8 +/- 2.8 weeks for those cases without this finding, P < 0.001. A statistically significant association between funneling to the cerclage and preterm delivery was identified irrespective of the indication (prophylactic or emergency) for the procedure. When descent of the membranes to the level of the cerclage was noted, it occurred by 28 weeks' gestation in all patients

2002 Ultrasound in Obstetrics and Gynecology

2698. Cytokines, prostaglandins and parturition--a review. (Abstract)

Cytokines, prostaglandins and parturition--a review. The elaboration of cytokines, chemokines and immunomodulatory proteins in the placenta and gestational membranes has been extensively investigated in the context of both normal and abnormal pregnancy and delivery. Patterns of expression of cytokines in the foetal membranes and decidua suggest that inflammatory activation occurs modestly with term labour, but much more robustly in preterm delivery, particularly in the presence of intrauterine (...) infection. Enhanced chemokine expression, particularly evident in deliveries with an infected amniotic cavity, is presumably responsible for recruiting infiltrating leukocytes into the membranes thereby amplifying the inflammatory process and hastening membrane rupture and delivery. Anti-inflammatory cytokines suppress inflammatory reactions in the placenta, but under some circumstances may act in a pro-inflammatory fashion in the membranes. Intracellular signalling by cytokines is modulated by proteins

2003 Placenta

2699. Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn. (Abstract)

Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn. In May 1996, the CDC recommended obtaining a complete blood count and blood culture (BC) from all asymptomatic "at risk" newborns; those > or =35 weeks gestation born to mothers with group B streptococcal vaginal colonization or those with maternal fever, premature rupture of membranes or previous infant with group B streptococcal disease; who did not receive adequate

2003 Pediatric Infectious Dsease Journal

2700. Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy. (Abstract)

and demographic data.There were 32 cases (0.47/1000 live births) of early-onset GBS infection for the 5-year period. This represented a 76% reduction compared with the rate from 1986 to 1994 (1.95/1000), when there was no protocol for GBS chemoprophylaxis. Thirteen cases (41%) did not have any identifiable maternal risk factor. Of the 19 cases (59%) with risk factors, maternal intrapartum fever was the most frequent (15 [79%]), followed by prematurity (6 [32%]) and prolonged rupture of membranes (6 [32

2003 Pediatrics

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