Vaginal Microbiome in Preterm Rupture of Membranes
There is an association between vaginal microbiota dysbiosis and preterm premature rupture of membranes (PPROM). In PPROM, reduced Lactobacillus spp abundance is linked to the emergence of high-risk vaginal microbiota, close to the time of membrane rupture. Although PPROM itself can change vaginal microbial composition, antibiotic therapy profoundly effects community structure. Erythromycin may have a beneficial effect in women deplete in Lactobacillus spp but damages a healthy microbiome by targeting Lactobacillus spp. Increased rates of chorioamnionitis and early-onset neonatal sepsis are associated with vaginal microbio...
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Phillip Robert Bennett, Richard Gailon Brown, David Alan MacIntyre Source Type: research
The Short Cervix
A short cervix in the second trimester is a significant risk factor for spontaneous preterm birth, preterm prelabor rupture of membranes, and subsequent adverse perinatal outcome. The pathophysiology is complex and multifactorial with inflammatory and/or infectious processes often involved. Biomarkers have been developed in an effort to predict preterm birth with varying degrees of success. The treatment options of cerclage, progesterone, pessary, and combination therapy are reviewed. Evidence-based protocols are summarized for singleton and multiple gestation. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Eboni O. Jones, Zi-Qi Liew, Orion A. Rust Source Type: research
Premature Rupture of Membranes with Concurrent Viral Infection
Treatment of viral infections is geared toward ameliorating maternal symptoms and minimizing perinatal transmission. Multidisciplinary teams often are required to manage sequelae due to viral diseases in patients with preterm premature rupture of membranes (PPROM). although data are scarce regarding the antepartum management of common viruses in PPROM, essential principles may be extrapolated from national guidelines and studies in gravid patients. The well-established risks of prematurity are weighed against the often unclear risks of vertical transmission. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Luke A. Gatta, Brenna L. Hughes Source Type: research
Unique Considerations
Two unique aspects of antenatal care occur in the setting of fetal surgery and multiple gestations. As fetal interventions increase, so do the number of cases of iatrogenic preterm prelabor rupture of membranes (PPROM). Because of the amniotic sac ’s inability to heal, the risk of PPROM after surgery is directly correlated with the number of interventions, the size of the defect, and the surgery performed. Higher order gestations also carry an increased risk of PPROM. This paper reviews the risks and management of PPROM in the setting of th e various prenatal interventions as well as in the setting of multiple gestations...
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Braxton Forde, Mounira Habli Source Type: research
Antenatal Monitoring After Preterm Prelabor Rupture of Membranes
Preterm prelabor rupture of membranes is a complication of pregnancy with significant associated maternal and fetal risks. Expectant management of this complication requires inpatient admission with close monitoring of maternal and fetal status until delivery. Close antepartum monitoring ensures rapid intervention if indicated, allowing for best possible maternal and neonatal outcomes. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Angela K. Shaddeau, Irina Burd Source Type: research
Mechanism of Human Fetal Membrane Biomechanical Weakening, Rupture and Potential Targets for Therapeutic Intervention
Using a novel in vitro model system combining biochemical/histologic with bioengineering approaches has provided significant insights into the physiology of fetal membrane weakening and rupture along with potential mechanistic reasons for lack of efficacy of currently clinically used agents to prevent preterm prem ature rupture of the membranes (pPROM) and preterm births. Likewise, the model has also facilitated screening of agents with potential for preventing pPROM and preterm birth. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Deepak Kumar, Robert M. Moore, Brian M. Mercer, Joseph M. Mansour, John J. Moore Source Type: research
Preterm Premature Rupture of the Membranes in the Twenty-First Century
Preterm rupture of the membranes continues to vex the obstetric community in the twenty-first century. This is one of the most frequent problems seen by the obstetric community that continues to contribute to significant morbidity and mortality, making it an important topic to be addressed in this issue of Obstetrics and Gynecology Clinics of North America. Within this issue, topics are divided into 3 sections: Prediction and Prevention, Interventions, and Special Topics. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Edward Chien, Brian M. Mercer Tags: Preface Source Type: research
Premature Rupture of Membranes: The Most Common Factor Leading to Preterm Birth
Preterm premature rupture of the membranes (PPROM) before 37 weeks, 0 days is responsible for or associated with one in every 3 preterm births and is the most commonly identified factor associated with preterm birth. This issue of Obstetrics and Gynecology Clinics of North America, capably coedited by Edward Chien, MD, MBA and Brian M. Mercer, MD, from Cas e Western Reserve University, addresses problems resulting from premature rupture of the membranes that contribute to significant morbidity and mortality. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research
Preterm Premature Rupture of Membranes
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Authors: Edward Chien, Brian M. Mercer Source Type: research
Copyright
Elsevier (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Source Type: research
Contributors
WILLIAM F. RAYBURN, MD, MBA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Source Type: research
Contents
William F. Rayburn (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Source Type: research
Forthcoming Issues
Multispecialty Approaches to Select Women's Health Issues (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 27, 2020 Category: OBGYN Source Type: research
Periviable Premature Rupture of Membranes
This article discusses standard and experimental interventions that may offer neonatal benefit. Antenatal corticosteroids, antibiotics, and magnesium sul fate may improve outcomes but data to support an improvement in outcome are limited. Studies specifically evaluating these interventions are needed. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 7, 2020 Category: OBGYN Authors: Kelly S. Gibson, Kerri Brackney Source Type: research
Tocolytic Therapy in Preterm Premature Rupture of Membranes
“Trials evaluating tocolytic use in preterm premature rupture of membranes (PPROM) have been small and lacked adequate power to evaluate uncommon outcomes. There still is much controversy on the benefit, length of use, route, and drug of choice among clinicians treating patients with PPROM. Most p rofessional medical societies would propose to consider the use of tocolytics for 48 hours to allow for corticosteroid administration or to allow for maternal transfer to a higher level of care. Longer treatment regimens may lead to adverse maternal and perinatal outcomes. Insufficient data are ava ilable to make stronger and ...
Source: Obstetrics and Gynecology Clinics - October 6, 2020 Category: OBGYN Authors: Hector Mendez-Figueroa, Suneet P. Chauhan Source Type: research
