An analysis of antenatal tests to detect infection in preterm premature rupture of membranes

Article Abstract:

Premature rupture of the membranes (PROM) surrounding the fetus develops in 30 to 40 percent of all deliveries occurring before the 36th week of pregnancy (preterm delivery). To allow the fetus more time to develop, a wait-and-see approach is used to manage patients with PROM. However, infection is a potential complication of PROM and carries a high fetal mortality rate. The management of PROM remains controversial. To determine the effectiveness of tests that diagnose chorioamnionitis, swelling of the fetal membranes caused by infection, published studies of prenatal tests were evaluated. Of the 39 studies available, 23 met the criteria for review. Tests on maternal blood and amniotic fluid and ultrasonographic evaluation of the pregnancy have not resulted in any definitive tests for detecting chorioamnionitis or neonatal sepsis (pregnancy-acquired infant infection). The most promising test measures C-reactive protein in the mothers's blood. C-reactive protein combines with a substance produced by bacteria. The combined protein is found in the blood of patients with inflammation caused by infections, cancer or tissue injury. C-reactive protein measured in mother's blood is high in the presence of a chorioamniotic infection. Another promising test, real-time ultrasonography, visualizes fetal activity, body movements and breathing, using high-frequency sound. Altered fetal activity is associated with chorioamnionitis. No absolute standard for diagnosing infection emerged from this review. Although the accuracy of fetal activity tests and C-reactive protein has not been confirmed, their effectiveness in predicting maternal or fetal infections appears promising. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Patient outcomes, Mortality, Diagnosis, Fetus, Fetal membranes, Chorioamnionitis

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Maternal colonization with group B Streptococcus and prelabor rupture of membranes at term: the role of induction of labor

Article Abstract:

Group B streptococci infections appear to be transmitted less frequently from mother to newborn if oxytocin is used to induce labor among women whose membranes rupture at term. Newborn infection rates were analyzed among 5,041 women with pre-labor membrane rupture either immediately induced with oxytocin or prostaglandin E2 gel or expectantly monitored and later induced with either method. Women induced with oxytocin had infants with the lowest group B streptococci infection rates when compared with other treatment groups. This trend was observed even among women testing positive for the infection.

Usage, Oxytocin, Labor, Induced (Obstetrics), Induced labor, Streptococcus agalactiae

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International Multicenter Term PROM Study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term

Article Abstract:

Pregnant women who carry the group B streptococci and have a placental infection are likely to infect their baby when their membranes rupture prematurely. This was one of the conclusions of the International Multicenter Term PROM study, which followed 5,028 pregnant women who had premature rupture of membranes (PROM). Women whose labor was delayed more than 48 hours after membrane rupture were also more likely to infect their babies. Women at high risk of transmitting infection to their babies must be quickly identified so the baby can be treated.

Streptococcal infections, Diseases, Infants (Newborn), Neonatal diseases

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