Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study...Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.展开更多
BACKGROUND Healthcare workers(HCWs)are at an increased risk for exposure to infections.Serratia marcescens(S.marcescens)is a gram-negative,opportunistic and nosocomial pathogen belonging to the Enterobacterieae family...BACKGROUND Healthcare workers(HCWs)are at an increased risk for exposure to infections.Serratia marcescens(S.marcescens)is a gram-negative,opportunistic and nosocomial pathogen belonging to the Enterobacterieae family.A few case reports have been published of chorioamnionitis caused by S.marcescens infection.Immunological changes during pregnancy can also affect the risk of infection.However,few studies have examined hospital-acquired bacterial infection in pregnant HCWs.CASE SUMMARY A 33-year-old woman,a resident in anesthesiology,was admitted at 14 wk gestation for fever with chills.She had no medical history other than contact dermatitis of both hands that started from the beginning of the trainee.There was no obvious infection focus and no bacterial growth in blood cultures.She was discharged after 1 wk of empirical antibiotic treatment.At three weeks before the fever started,she had a blister on the site of contact dermatitis on both hands,she applied antibiotic ointment for three days and the blisters had healed.At 19 wk gestation,she had a high fever and was readmitted.Physical examination and image studies were nonspecific and the patient had no other symptoms.S.marcescens grew in blood cultures at 19 wk gestation.Treatment with intravenous antibiotics was started.However,she suffered a miscarriage at 224/7 wk gestation.Pathologically,the amniotic membrane showed chorioamnionitis with a focal infarct.Subsequently,a placenta tissue culture grew S.marcescens.CONCLUSION HCWs can be exposed to pathogens that can cause opportunistic infections such as S.marcescens.Pregnancy affects the immune system,making it susceptible to opportunistic infections.Therefore,pregnant HCWs may require more preventive measures,including hand hygiene and avoid risk factors(ex.wrapping the skin).展开更多
Group B streptococcus infection (GBS) is an important cause of perinatal infection. Maternal colonization by GBS can cause amniotic infection and thus fetal infection, sometimes causing fetal death. This infection gen...Group B streptococcus infection (GBS) is an important cause of perinatal infection. Maternal colonization by GBS can cause amniotic infection and thus fetal infection, sometimes causing fetal death. This infection generally occurs in association with premature rupture of membranes. We present here an infrequent case of GBS chorioamnionitis in full-term gestation with intact amniotic membranes. The curiosity of the case lies in the integrity of the amniotic membranes, the asymptomatic clinical presentation, and the adverse result (term fetal death).展开更多
Perinatal exposure to infection/inflammation is highly associated with neural injury,and subsequent impaired cortical growth,disturbances in neuronal connectivity,and impaired neurodevelopment.However,our understandin...Perinatal exposure to infection/inflammation is highly associated with neural injury,and subsequent impaired cortical growth,disturbances in neuronal connectivity,and impaired neurodevelopment.However,our understanding of the pathophysiological substrate underpinning these changes in brain structure and function is limited.The objective of this review is to summarize the growing evidence from animal trials and human cohort studies that suggest exposure to infection/inflammation during the perinatal period promotes regional impairments in neuronal maturation and function,including loss of high-frequency electroencephalographic activity,and reduced growth and arborization of cortical dendrites and dendritic spines resulting in reduced cortical volume.These inflammation-induced disturbances to neuronal structure and function are likely to underpin subsequent disturbances to cortical development and connectivity in fetuses and/or newborns exposed to infection/inflammation during the perinatal period,leading,in the long term,to impaired neurodevelopment.The combined use of early electroencephalography monitoring with neuroimaging techniques that enable detailed evaluation of brain microstructure,and the use of therapeutics that successfully target systemic and central nervous system inflammation could provide an effective strategy for early detection and therapeutic intervention.展开更多
Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening, but concerns about infection risk restrict its use in cases of prolonged prelabour rupture of membranes (PROM). This study aims to ...Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening, but concerns about infection risk restrict its use in cases of prolonged prelabour rupture of membranes (PROM). This study aims to evaluate the efficacy and safety of the FC compared to oral misoprostol for cervical ripening after PROM. Study Design: A retrospective data-analysis of 128 pregnant women was conducted. Of these, 49 underwent cervical ripening with an FC and 79 with oral misoprostol. We included all women with a vital singleton pregnancy at 37 - 42 weeks of gestation who underwent cervical ripening after ≥ 24 hours of PROM in specific time frames in two Dutchsecondary care and teaching hospitals. The primary outcome was the incidence of intrapartum infection, a composite of maternal and neonatal infection. In addition, we evaluated the mode of delivery, duration of priming and priming-to-delivery interval. Secondary endpoints included uterine hyperstimulation, umbilical cord prolapse, birth weight, Apgar scores, length of admission to the neonatal low dependency unit, admission to the (neonatal) Intensive Care Unit (ICU) and mortality. Statistical analyses included bivariate and multivariate techniques. Results: Cervical ripening with FC, compared with oral misoprostol, showed a higher incidence of intrapartum infection, respectively 32.7% (n = 16) vs. 12.7% (n = 10) (p = 0.006). However, after adjusting for epidural anaesthesia and pregestational BMI, the association was no longer significant. No difference was found in mode of delivery and total priming-to-delivery interval (median 21.3 hours vs. 22.0, p = 0.897). Furthermore, FC, compared with oral misoprostol, showed a longer duration of cervical ripening and hence a shorter duration of active labour (p 0.001). Apart from the 1-min Apgar score, secondary maternal and neonatal outcomes did not differ between the groups. Conclusion: In women who require cervical ripening after prolonged PROM at term, the FC and oral misoprostol are similar in terms of efficacy and safety. Advantages associated with the FC are its safe application in women with a history of caesarean section, although we did not study these women, and an implied shorter duration of active labour. Our study adds to the limited available data on the use of the FC after the rupture of membranes and a large randomized controlled trial is needed to strengthen our findings.展开更多
Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to estab...Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.展开更多
Eikenella corrodens is a part of normal human oral flora and a rare cause of intrauterine and neonatal infections. We describe a case of congenital E. corrodens sepsis with positive blood cultures at birth in the sett...Eikenella corrodens is a part of normal human oral flora and a rare cause of intrauterine and neonatal infections. We describe a case of congenital E. corrodens sepsis with positive blood cultures at birth in the setting of low maternal risk factors for infection. Our case is one of two reported cases of congenital E. corrodens sepsis resulting in newborn survival.展开更多
Objective: To investigate changes of cytokines and matrix metalloproteinases in patients with premature rupture of membranes (PROM) with chorioamnionitis (HCA) and its clinical significance. Methods: A total of 80 pre...Objective: To investigate changes of cytokines and matrix metalloproteinases in patients with premature rupture of membranes (PROM) with chorioamnionitis (HCA) and its clinical significance. Methods: A total of 80 pregnant women with premature rupture of membranes were selected as PROM group and 80 normal pregnant women as control group. The PROM group was subgrouped into HCA group (n=45) and non HCA group (n=35) according to the presence or absence of HCA. Matrix metalloproteinases (MMP-8, MMP-9) and cytokines (IL-8, IL-10, TNF-α) in pregnant women were compared. Results: The level of IL-8, TNF-αwere (420.45±110.26) ng/L, (413.53±125.19) ng/L in the PROM group, which were significantly higher than those in the control group;the levels of IL-10 were(332.07±48.12) ng/L in the PROM groups, which were significantly lower than the control group. The levels of IL-8 and TNF-α in PROM combined with HCA group were significantly higher than those in non-HCA group, the levels of IL-10 were significantly lower than those in non-HCA group. The level of MMP-8, MMP-9 were (11.02±2.48) ng/mL, (648.42±73.35) ng/L in the PROM group, which were significantly higher than the control group. The levels of MMP-8, MMP-9 in PROM combined with HCA were significantly higher than those in non-HCA group with the difference was statistically significant. Conclusion: When premature rupture of membranes and chorioamniositis occurring, pregnant women were accompanied by the level changes of cytokines and matrix metalloproteinases, so timely monitoring of these indicators can offer basis for the early diagnosis the premature rupture of membranes and chorioamnionitis, which will help to reduce morbidity and mortality of the perinatal pregnant women and newborns with important clinical value.展开更多
Preterm birth(PTB),predominantly induced by intraamniotic inflammation,stands as the foremost contributor to neonatal morbidity and mortality globally.Fetal inflammatory response syndrome,stemming from the activation ...Preterm birth(PTB),predominantly induced by intraamniotic inflammation,stands as the foremost contributor to neonatal morbidity and mortality globally.Fetal inflammatory response syndrome,stemming from the activation of the innate immune system,signifies the occurrence of funisitis or chorionic vasculitis.Maternal-fetal complications associated with infection-related PTB encompass maternal sepsis,fetal demise,neonatal sepsis,neonatal neurological impairment,and chronic lung disease.The inflammatory cascade is initiated when Toll-like receptors present on immune cells within the fetal membranes and the female reproductive tract encounter pathogen-associated molecular patterns derived from infectious agents.Subsequently,the nuclear factor kappalight-chain-enhancer of activated B cells facilitates the transcription of cytokines.The accumulation of neutrophils compromises the tissue integrity of the fetal membranes,leading to membrane rupture via the secretion of matrix metalloproteinases.Elevated prostaglandin levels prompt uterine contractions and cervical remodeling,resulting in progressive cervical effacement and dilation,ultimately culminating in fetal delivery.The diagnosis of PTB should encompass three pivotal criteria:gestational age,uterine activity,and the consequences of that uterine activity.The diagnosis of chorioamnionitis is established through a combination of clinical manifestations,laboratory findings,identification of infectious microorganisms,and placental pathology.Fetal monitoring involves antenatal ultrasonography and non-stress testing.The management of infection-related PTB involves controlling and treating the infection,timing delivery to coincide with optimal fetal lung maturity,and optimizing outcomes for both the mother and neonate.Current preventive strategies for PTB primarily focus on inhibiting myometrial contractions that arise from the inflammatory cascade initiating PTB.An understanding of these pathways serves as the cornerstone for the development of therapeutic interventions aimed at preventing PTB.展开更多
Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidi...Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention,cesarean birth,postpartum uterine atony with hemorrhage,endometritis,peritonitis,sepsis,adult respiratory distress syndrome and,rarely,death.Chorioamnionitis can result from an ascending infection,iatrogenic causes or transplacental passage from maternal blood-borne infections.The clinical findings of chorioamnionitis include maternal fever(≥38°C),maternal(>100 beats per minute)and/or fetal tachycardia(>160 beats per minute),maternal leukocytosis on complete blood count(>15000 cells/mm 3),and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid.The management of chorioamnionitis mainly includes antibiotic therapy and delivery.Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach.The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible,with appropriate neonatal resuscitation available.展开更多
Objective:To investigate the safety and efficacy of internal electronic fetal heart rate(FHR)monitoring during labor.Methods:This was a retrospective case-control study,which was an analysis of monitoring FHR with a f...Objective:To investigate the safety and efficacy of internal electronic fetal heart rate(FHR)monitoring during labor.Methods:This was a retrospective case-control study,which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe(94 pregnant women per group).In the internal monitoring group,when the opening of the uterine orifice was≥3 cm,the fetal scalp electrode was placed after natural or artificial rupture of the membrane.FHR was simultaneously monitored using a Doppler probe.In the external monitoring group,continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal abdomen.The toco transducer was used to record uterine contractions.Pathological examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group,respectively.Maternal-infant outcomes(e.g.fever,puerperal infection,puerperal morbidity,delivery mode,Apgar score,and scalp injury)were recorded.Umbilical artery blood was extracted for blood gas analysis.Differences between the two groups were compared using the pairedt-test,χ^(2) test,Yates correctedχ^(2) test or Fisher exact test.Results:Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis(1/94(1.06%)vs.3/94(3.19%),respectively;χ^(2)=0.255,P=0.613),cesarean section/operative vaginal delivery(8/94(8.51%)vs.15/94(15.96%),respectively;χ^(2)=2.427,P=0.181),fever during labor(18/94(19.15%)vs.15/94(15.96%),respectively;χ^(2)=0.331,P=0.565),puerperal morbidity(2/94(2.13%)vs.3/94(3.19%),respectively;χ^(2)=0.000,P=1.000),chorioamnionitis(9/49(18.37%)vs.7/48(14.58%),respectively;χ^(2)=0.252,P=0.616),and neonatal asphyxia(0/94(0.00%)vs.1/94(1.06%),respectively;χ^(2)=0.000,P=1.000).There were no puerperal infections,neonatal scalp injuries,or scalp abscesses found in either group.Using the internal monitoring value as reference,the incidence of FHR false deceleration in external FHR monitoring was 20.21%(19/94 women).Conclusion:Internal FHR monitoring during labor does not increase the incidence of adverse perinatal outcomes.External monitoring was associated with FHR false decelerations.展开更多
文摘Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.
基金Supported by a grant of Chonnam National University Hwasun Hospital Research Institute of Clinical Medicine,No.HCRI19012。
文摘BACKGROUND Healthcare workers(HCWs)are at an increased risk for exposure to infections.Serratia marcescens(S.marcescens)is a gram-negative,opportunistic and nosocomial pathogen belonging to the Enterobacterieae family.A few case reports have been published of chorioamnionitis caused by S.marcescens infection.Immunological changes during pregnancy can also affect the risk of infection.However,few studies have examined hospital-acquired bacterial infection in pregnant HCWs.CASE SUMMARY A 33-year-old woman,a resident in anesthesiology,was admitted at 14 wk gestation for fever with chills.She had no medical history other than contact dermatitis of both hands that started from the beginning of the trainee.There was no obvious infection focus and no bacterial growth in blood cultures.She was discharged after 1 wk of empirical antibiotic treatment.At three weeks before the fever started,she had a blister on the site of contact dermatitis on both hands,she applied antibiotic ointment for three days and the blisters had healed.At 19 wk gestation,she had a high fever and was readmitted.Physical examination and image studies were nonspecific and the patient had no other symptoms.S.marcescens grew in blood cultures at 19 wk gestation.Treatment with intravenous antibiotics was started.However,she suffered a miscarriage at 224/7 wk gestation.Pathologically,the amniotic membrane showed chorioamnionitis with a focal infarct.Subsequently,a placenta tissue culture grew S.marcescens.CONCLUSION HCWs can be exposed to pathogens that can cause opportunistic infections such as S.marcescens.Pregnancy affects the immune system,making it susceptible to opportunistic infections.Therefore,pregnant HCWs may require more preventive measures,including hand hygiene and avoid risk factors(ex.wrapping the skin).
文摘Group B streptococcus infection (GBS) is an important cause of perinatal infection. Maternal colonization by GBS can cause amniotic infection and thus fetal infection, sometimes causing fetal death. This infection generally occurs in association with premature rupture of membranes. We present here an infrequent case of GBS chorioamnionitis in full-term gestation with intact amniotic membranes. The curiosity of the case lies in the integrity of the amniotic membranes, the asymptomatic clinical presentation, and the adverse result (term fetal death).
基金supported by National Health and Medical Research Council of Australia(APP1090890 and APP1164954)Cerebral Palsy Alliance(ERG02123)the Victorian Government’s Operational Infrastructure Support Program。
文摘Perinatal exposure to infection/inflammation is highly associated with neural injury,and subsequent impaired cortical growth,disturbances in neuronal connectivity,and impaired neurodevelopment.However,our understanding of the pathophysiological substrate underpinning these changes in brain structure and function is limited.The objective of this review is to summarize the growing evidence from animal trials and human cohort studies that suggest exposure to infection/inflammation during the perinatal period promotes regional impairments in neuronal maturation and function,including loss of high-frequency electroencephalographic activity,and reduced growth and arborization of cortical dendrites and dendritic spines resulting in reduced cortical volume.These inflammation-induced disturbances to neuronal structure and function are likely to underpin subsequent disturbances to cortical development and connectivity in fetuses and/or newborns exposed to infection/inflammation during the perinatal period,leading,in the long term,to impaired neurodevelopment.The combined use of early electroencephalography monitoring with neuroimaging techniques that enable detailed evaluation of brain microstructure,and the use of therapeutics that successfully target systemic and central nervous system inflammation could provide an effective strategy for early detection and therapeutic intervention.
文摘Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening, but concerns about infection risk restrict its use in cases of prolonged prelabour rupture of membranes (PROM). This study aims to evaluate the efficacy and safety of the FC compared to oral misoprostol for cervical ripening after PROM. Study Design: A retrospective data-analysis of 128 pregnant women was conducted. Of these, 49 underwent cervical ripening with an FC and 79 with oral misoprostol. We included all women with a vital singleton pregnancy at 37 - 42 weeks of gestation who underwent cervical ripening after ≥ 24 hours of PROM in specific time frames in two Dutchsecondary care and teaching hospitals. The primary outcome was the incidence of intrapartum infection, a composite of maternal and neonatal infection. In addition, we evaluated the mode of delivery, duration of priming and priming-to-delivery interval. Secondary endpoints included uterine hyperstimulation, umbilical cord prolapse, birth weight, Apgar scores, length of admission to the neonatal low dependency unit, admission to the (neonatal) Intensive Care Unit (ICU) and mortality. Statistical analyses included bivariate and multivariate techniques. Results: Cervical ripening with FC, compared with oral misoprostol, showed a higher incidence of intrapartum infection, respectively 32.7% (n = 16) vs. 12.7% (n = 10) (p = 0.006). However, after adjusting for epidural anaesthesia and pregestational BMI, the association was no longer significant. No difference was found in mode of delivery and total priming-to-delivery interval (median 21.3 hours vs. 22.0, p = 0.897). Furthermore, FC, compared with oral misoprostol, showed a longer duration of cervical ripening and hence a shorter duration of active labour (p 0.001). Apart from the 1-min Apgar score, secondary maternal and neonatal outcomes did not differ between the groups. Conclusion: In women who require cervical ripening after prolonged PROM at term, the FC and oral misoprostol are similar in terms of efficacy and safety. Advantages associated with the FC are its safe application in women with a history of caesarean section, although we did not study these women, and an implied shorter duration of active labour. Our study adds to the limited available data on the use of the FC after the rupture of membranes and a large randomized controlled trial is needed to strengthen our findings.
文摘Premature rupture of membranes (PROM) complicates 3% of preterm pregnancies and occurs in 60% to 80% of term pregnancies. However, its management remains largely controversial. The objective of this study was to establish the epidemiological profile, to study the management and the prognosis of Premature rupture of membranes (PROM) in our practice. Patients and methods: It was a prospective, descriptive and analytical study from May 1st 2016 to January 31st 2017 at the Pikine National Hospital Center. The target population consisted of all patients received at the hospital with premature rupture of membranes and who had given birth in the structure. The variables studied were: marital status, mode and reason for admission;risk factors;antecedents;prenatal care;the clinical and paraclinical examinations;support and immediate maternal and fetal neonatal complications. Results and comments: The mean maternal age was 27.34 years and the majority of women were aged between 18 and 39 years (94.4%). Fifty-one point three percent of patients were primiparous, large multiparous represented only 2.5%. The majority of patients (385 patients or 66.9%) had consulted in the first 12 hours following the onset of fluid flow. For 20.1% of them this flow was associated with uterine contractions. Hidden risk factors were dominated by the twin pregnancy. The blood count showed that 38.8% of patients had leukocytosis and CRP was positive in 18.3% of patients. An ampicillin-based antibiotics was established in 42.6% of cases, corticosteroid therapy in 5.2% and 1% in tocolysis. An expectation was adopted in 65.7% of cases, induction of labor in 7.3% and a cesarean section immediately in 27% of cases. In total, 65.7% of patients had vaginal delivery and 34.3% cesarean. The perinatal mortality rate was 3.6% or 22 newborns on 610. Two cases of endometritis were observed and one case of immediate postpartum hemorrhage. No maternal deaths were recorded. Conclusion: These results show that the prognosis of premature rupture of membranes remains favorable in our practice. To improve this prognosis, we recommend sensitization of patients during prenatal care regarding signs of danger, a systematic bacteriological sample from all pregnant at the end of their pregnancy and the health personnel to direct patients’ references to structures in case of PROM.
文摘Eikenella corrodens is a part of normal human oral flora and a rare cause of intrauterine and neonatal infections. We describe a case of congenital E. corrodens sepsis with positive blood cultures at birth in the setting of low maternal risk factors for infection. Our case is one of two reported cases of congenital E. corrodens sepsis resulting in newborn survival.
文摘Objective: To investigate changes of cytokines and matrix metalloproteinases in patients with premature rupture of membranes (PROM) with chorioamnionitis (HCA) and its clinical significance. Methods: A total of 80 pregnant women with premature rupture of membranes were selected as PROM group and 80 normal pregnant women as control group. The PROM group was subgrouped into HCA group (n=45) and non HCA group (n=35) according to the presence or absence of HCA. Matrix metalloproteinases (MMP-8, MMP-9) and cytokines (IL-8, IL-10, TNF-α) in pregnant women were compared. Results: The level of IL-8, TNF-αwere (420.45±110.26) ng/L, (413.53±125.19) ng/L in the PROM group, which were significantly higher than those in the control group;the levels of IL-10 were(332.07±48.12) ng/L in the PROM groups, which were significantly lower than the control group. The levels of IL-8 and TNF-α in PROM combined with HCA group were significantly higher than those in non-HCA group, the levels of IL-10 were significantly lower than those in non-HCA group. The level of MMP-8, MMP-9 were (11.02±2.48) ng/mL, (648.42±73.35) ng/L in the PROM group, which were significantly higher than the control group. The levels of MMP-8, MMP-9 in PROM combined with HCA were significantly higher than those in non-HCA group with the difference was statistically significant. Conclusion: When premature rupture of membranes and chorioamniositis occurring, pregnant women were accompanied by the level changes of cytokines and matrix metalloproteinases, so timely monitoring of these indicators can offer basis for the early diagnosis the premature rupture of membranes and chorioamnionitis, which will help to reduce morbidity and mortality of the perinatal pregnant women and newborns with important clinical value.
基金supported by the National Natural Science Foundation of China(82171676 and 82201793)the Science and Technology Planning Project of Shenzhen Municipality(JCYJ20200109140614667 and JCYJ20220530160206014)Scientific Research Foundation of PEKING UNIVERSITY SHENZHEN HOSPITAL KYQD2022111 and KYQD2021090.
文摘Preterm birth(PTB),predominantly induced by intraamniotic inflammation,stands as the foremost contributor to neonatal morbidity and mortality globally.Fetal inflammatory response syndrome,stemming from the activation of the innate immune system,signifies the occurrence of funisitis or chorionic vasculitis.Maternal-fetal complications associated with infection-related PTB encompass maternal sepsis,fetal demise,neonatal sepsis,neonatal neurological impairment,and chronic lung disease.The inflammatory cascade is initiated when Toll-like receptors present on immune cells within the fetal membranes and the female reproductive tract encounter pathogen-associated molecular patterns derived from infectious agents.Subsequently,the nuclear factor kappalight-chain-enhancer of activated B cells facilitates the transcription of cytokines.The accumulation of neutrophils compromises the tissue integrity of the fetal membranes,leading to membrane rupture via the secretion of matrix metalloproteinases.Elevated prostaglandin levels prompt uterine contractions and cervical remodeling,resulting in progressive cervical effacement and dilation,ultimately culminating in fetal delivery.The diagnosis of PTB should encompass three pivotal criteria:gestational age,uterine activity,and the consequences of that uterine activity.The diagnosis of chorioamnionitis is established through a combination of clinical manifestations,laboratory findings,identification of infectious microorganisms,and placental pathology.Fetal monitoring involves antenatal ultrasonography and non-stress testing.The management of infection-related PTB involves controlling and treating the infection,timing delivery to coincide with optimal fetal lung maturity,and optimizing outcomes for both the mother and neonate.Current preventive strategies for PTB primarily focus on inhibiting myometrial contractions that arise from the inflammatory cascade initiating PTB.An understanding of these pathways serves as the cornerstone for the development of therapeutic interventions aimed at preventing PTB.
基金This research was supported by the Shenzhen Science and Technology Innovation Commission(JCYJ20180228162311024)
文摘Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention,cesarean birth,postpartum uterine atony with hemorrhage,endometritis,peritonitis,sepsis,adult respiratory distress syndrome and,rarely,death.Chorioamnionitis can result from an ascending infection,iatrogenic causes or transplacental passage from maternal blood-borne infections.The clinical findings of chorioamnionitis include maternal fever(≥38°C),maternal(>100 beats per minute)and/or fetal tachycardia(>160 beats per minute),maternal leukocytosis on complete blood count(>15000 cells/mm 3),and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid.The management of chorioamnionitis mainly includes antibiotic therapy and delivery.Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach.The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible,with appropriate neonatal resuscitation available.
基金National Natural Science Foundation of China(8217061510)Shenzhen Science and Technology Innovation Commission(JCYJ20180228162311024 and JCY20190809101409603)。
文摘Objective:To investigate the safety and efficacy of internal electronic fetal heart rate(FHR)monitoring during labor.Methods:This was a retrospective case-control study,which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe(94 pregnant women per group).In the internal monitoring group,when the opening of the uterine orifice was≥3 cm,the fetal scalp electrode was placed after natural or artificial rupture of the membrane.FHR was simultaneously monitored using a Doppler probe.In the external monitoring group,continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal abdomen.The toco transducer was used to record uterine contractions.Pathological examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group,respectively.Maternal-infant outcomes(e.g.fever,puerperal infection,puerperal morbidity,delivery mode,Apgar score,and scalp injury)were recorded.Umbilical artery blood was extracted for blood gas analysis.Differences between the two groups were compared using the pairedt-test,χ^(2) test,Yates correctedχ^(2) test or Fisher exact test.Results:Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis(1/94(1.06%)vs.3/94(3.19%),respectively;χ^(2)=0.255,P=0.613),cesarean section/operative vaginal delivery(8/94(8.51%)vs.15/94(15.96%),respectively;χ^(2)=2.427,P=0.181),fever during labor(18/94(19.15%)vs.15/94(15.96%),respectively;χ^(2)=0.331,P=0.565),puerperal morbidity(2/94(2.13%)vs.3/94(3.19%),respectively;χ^(2)=0.000,P=1.000),chorioamnionitis(9/49(18.37%)vs.7/48(14.58%),respectively;χ^(2)=0.252,P=0.616),and neonatal asphyxia(0/94(0.00%)vs.1/94(1.06%),respectively;χ^(2)=0.000,P=1.000).There were no puerperal infections,neonatal scalp injuries,or scalp abscesses found in either group.Using the internal monitoring value as reference,the incidence of FHR false deceleration in external FHR monitoring was 20.21%(19/94 women).Conclusion:Internal FHR monitoring during labor does not increase the incidence of adverse perinatal outcomes.External monitoring was associated with FHR false decelerations.
