RESUMEN

Bacterial infection is one of the main causes of preterm premature rupture of membranes (PPROM) leading to preterm delivery, pulmonary hypoplasia, sepsis and joint deformities. Expectant management, broad-spectrum antibiotics and antenatal corticosteroids are routinely used in this condition with very limited success to prevent bacteremia, chorioamnionitis, funisitis and intra-amniotic infection syndrome. Here, we report a case in which we attempted to treat PPROM at 26+3 weeks of gestation with anhydramnion colonized by multiresistant Klebsiella. A perinatal port system was implanted subcutaneously at 28+0 weeks of gestation, enabling long-term continuous lavage of the amniotic cavity with a hypotonic aqueous composition similar to human amniotic fluid combined with intra-amniotic antibiotic application. The patient gave birth to a preterm female infant at 31+1 weeks without any signs of infection. The girl was discharged with a weight of 2,730 g in very good condition. In the follow-up examinations at 5 months and 1 year of age, there was no apparent neurological disturbance, developmental delay or Klebsiella colonization.

Asunto(s)

Líquido Amniótico/microbiología , Profilaxis Antibiótica , Terapia Biológica , Rotura Prematura de Membranas Fetales/terapia , Klebsiella pneumoniae/crecimiento & desarrollo , Oligohidramnios/terapia , Irrigación Terapéutica , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/efectos adversos , Terapia Biológica/efectos adversos , Catéteres de Permanencia/efectos adversos , Corioamnionitis/prevención & control , Terapia Combinada/efectos adversos , Farmacorresistencia Bacteriana Múltiple , Quimioterapia Combinada/efectos adversos , Femenino , Rotura Prematura de Membranas Fetales/microbiología , Humanos , Recién Nacido , Infusiones Intralesiones , Kazajstán , Klebsiella pneumoniae/efectos de los fármacos , Nacimiento Vivo , Oligohidramnios/microbiología , Oligohidramnios/fisiopatología , Embarazo , Índice de Severidad de la Enfermedad , Irrigación Terapéutica/efectos adversos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: Previous studies reported that the clinical significance of intra-amniotic inflammation with a negative amniotic fluid (AF) culture is similar to that of intra-amniotic inflammation with microbiologically-proven AF infection. However, the magnitude of the fetal inflammatory response in these two conditions is different as gauged by umbilical cord C-reactive protein (CRP) concentrations. We undertook this study to determine if the frequency of oligohydramnios is different in these two conditions. METHODS: The amniotic fluid index (AFI) was measured in 205 patients with preterm premature rupture of membranes (PROM) (23 ng/mL). Patients were divided into three groups according to the results of AF culture and the presence or absence of intra-amniotic inflammation: 1) without intra-amniotic inflammation and a negative culture (n=109); 2) with intra-amniotic inflammation and a negative culture (n=44); and 3) a positive culture (n=52). RESULTS: Patients with a positive culture had a higher frequency of oligohydramnios and a lower median AFI than those with a negative culture but with intra-amniotic inflammation (P<0.01). However, there was no significant difference in the median AFI or in the frequency of oligo-hydramnios according to the presence or absence of intra-amniotic inflammation among patients with a negative culture (P>0.1). CONCLUSION: Oligohydramnios was more frequent in patients with culture-proven AF infection than in those with intra-amniotic inflammation and a negative AF culture.

Asunto(s)

Líquido Amniótico/microbiología , Corioamnionitis/microbiología , Oligohidramnios/microbiología , Adulto , Femenino , Enfermedades Fetales/etiología , Humanos , Embarazo , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Adulto Joven

RESUMEN

OBJECTIVE: To evaluate the efficacy of transabdominal amnioinfusion on feto-neonatal and maternal morbidity and feto-neonatal mortality. METHODS: We studied 71 patients with preterm premature rupture of membranes (pPROM) at <26 weeks of gestational age. Thirty-four patients were managed expectantly and 37 underwent serial transabdominal amnioinfusion with saline every 7 days in case of persistent oligohydramnios. RESULTS: Latency period pPROM delivery, week of delivery (26.0 vs. 22.4, p<0.001), neonatal weight (922 vs. 602, p<0.01) and the percentage of intrauterine fetal survival were higher in treated than in control groups (64.8 vs. 32.3%, p<0.01). In amnioinfusion-treated patients, we did not note a higher rate of complications from infection during both pregnancy and puerperium. In the amnioinfusion group, fluid loss within 6 h after infusion is the main variable in predicting pulmonary hypoplasia and neonatal survival. CONCLUSIONS: Our data suggest that amnioinfusion seems to be a low fetal and maternal risk technique that modifies the natural history of pPROM, improving fetal intrauterine stay and survival.

Asunto(s)

Amnios/efectos de los fármacos , Rotura Prematura de Membranas Fetales/tratamiento farmacológico , Edad Gestacional , Oligohidramnios/tratamiento farmacológico , Adulto , Amnios/diagnóstico por imagen , Amnios/microbiología , Distribución de Chi-Cuadrado , Femenino , Rotura Prematura de Membranas Fetales/diagnóstico por imagen , Rotura Prematura de Membranas Fetales/microbiología , Humanos , Recién Nacido , Infusiones Parenterales/métodos , Masculino , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/microbiología , Embarazo , Estudios Prospectivos , Cloruro de Sodio/administración & dosificación , Cloruro de Sodio/uso terapéutico , Estadísticas no Paramétricas , Análisis de Supervivencia , Ultrasonografía

RESUMEN

OBJECTIVE: The objective of this study was to determine whether a reduced amniotic fluid volume was associated with the onset of preterm parturition in patients with preterm premature rupture of membranes. STUDY DESIGN: An amniotic fluid index was determined before transabdominal amniocentesis in 129 patients with preterm premature rupture of membranes (gestational age < or = 35 weeks). Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as for mycoplasmas. Survival techniques were used for analysis. RESULTS: Amniotic fluid index was < or = 5 cm in 29% of patients (38/129). Patients with an amniotic fluid index of < or = 5 cm had a significantly higher rate of positive amniotic fluid culture than those with an amniotic fluid index of >5 cm (42% [16/38] vs 18% [16/91]; P<.01). Spontaneous preterm delivery within 24 hours and 48 hours was more frequent among patients with an amniotic fluid index of < or = 5 cm than those with an amniotic fluid index of >5 cm (for 24 hours, 29% vs 12%; for 48 hours, 42% vs 21%; P<.05 for each). The amniocentesis-to-delivery interval was significantly shorter in patients with an amniotic fluid index of < or = 5 cm than in patients with an amniotic fluid index of >5 cm (median, 38 hours; range, 0.2-1310 hours; vs median, 100 hours; range 0.1-2917 hours; P<.01). Moreover, Cox proportional hazards model analysis indicated that an amniotic fluid index of < or = 5 cm was a significant predictor of the duration of the pregnancy after adjustment for gestational age and the results of amniotic fluid culture (odds ratio, 2.4; 95% confidence interval, 1.4-3.9; P<.001). CONCLUSION: Patients with preterm premature rupture of membranes and an amniotic fluid index of < or = 5 cm are at increased risk for a shorter interval to delivery.

Asunto(s)

Rotura Prematura de Membranas Fetales/complicaciones , Trabajo de Parto Prematuro/etiología , Oligohidramnios/complicaciones , Adulto , Amniocentesis , Líquido Amniótico/microbiología , Corioamnionitis/diagnóstico , Femenino , Rotura Prematura de Membranas Fetales/microbiología , Humanos , Trabajo de Parto Prematuro/microbiología , Oligohidramnios/microbiología , Embarazo , Modelos de Riesgos Proporcionales , Análisis de Supervivencia