Bila V. V., Zahorodnia O. S., Tymoshchuk K. V., Antonyuk M. I.

VERY PRETERM MEMBRANE RUPTURE MANAGEMENT TACTIC – CLINICAL ASPECTS

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About the author:

Bila V. V., Zahorodnia O. S., Tymoshchuk K. V., Antonyuk M. I.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

The management of premature rupture of membranes is a controversial issue, primarily in terms of the impossibility of diagnosing fetal infection. The article is devoted to the effectiveness of the tactics of choosing the labour time based on the preclinical diagnosis of chorioamnionitis by detecting a low glucose content in the amniotic fluid. For this purpose, we analysed the course of labour in 69 pregnant women with premature rupture of membranes at a gestational age of 25-27 weeks, 34 of whom (group I) received care according to the standard of care, the indications for labour were hypertension, tachycardia and the appearance of laboratory signs of inflammation, and 35 (group II) underwent weekly monitoring of the glucose content in the amniotic fluid. If the value was less than 0.5 μmol/L was an indication for labour, despite the absence of other signs of inflammation. The use of such tactics led to a reduction in the period between rupture of membranes and labour - in 21.6% of group I, it was less than a week, in group II - only 11.7%, a decrease in the gestational age of delivery - in 37.1% of women in the first group it was less than 27 weeks, in group II - 17.6%, an increase in the frequency of abdominal labour - from 17.6% in group I to 31.4% in group II. At the same time, the incidence of hyperthermia was reduced from 20.6% to 8.6% before labour, from 23.5% to 5.7% during labour, and from 29.4% to 2.8% in the postpartum period. Conclusions. 1. The use of the treatment of extremely premature rupture of membranes based on the determination of glucose levels in amniotic fluid, compared with wait-and-see management, leads to a decrease in gestational age at labour and is associated with an increase in the frequency of cesarean section. 2. At the same time, this tactic significantly reduces hyperthermia both before, during and after labour and in the postpartum period.

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Bibliography:

1. Dawes L, Groom K, Jordan V, Waugh J. The use of specialised preterm birth clinics for women at high risk of spontaneous preterm birth: a systematic review. BMC Pregnancy Childbirth. 2020;20(1):58. DOI: 10.1186/s12884-020-2731-7.
2. Deindl P, Diemert A. From structural modalities in perinatal medicine to the frequency of preterm birth. Semin Immunopathol. 2020;42(4):377- 383. DOI: 10.1007/s00281-020-00805-0.
3. Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217. Obstet Gynecol. 2020;135(3):e80-e97. DOI: 10.1097/ AOG.000000000000 3700.
4. Ölmez F, Oğlak SC, Can E. The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes. Z Geburtshilfe Neonatol. 2022;226(4):233-239. DOI: 10.1055/a-1808-1614. Erratum in: Z Geburtshilfe Neonatol. 2022;226(4):e40. DOI: 10.1055/a-1845-2928.
5. Behram M, Oğlak SC, Başkıran Y, Süzen Çaypınar S, Akgöl S, Tunç Ş, et al. Maternal serum IL-22 concentrations are significantly upregulated in patients with preterm premature rupture of membranes. Ginekol Pol. 2021;92(9):631-636. DOI: 10.5603/GP.a2021.0036.
6. Nergiz Avcıoğlu S, Demircan Sezer S, Küçük M, Zafer E, Yüksel H, Akcan B, et al. Maternal serum concentrations of s-Endoglin and IL-6 in pregnancy complicated by preterm premature membrane rupture. J Matern Fetal Neonatal Med. 2016;29(12):1957-62. DOI: 10.3109/14767058.2015.1070 137.
7. Buyuk GN, Oskovi-Kaplan ZA, Durukan H. Maternal Serum Haptoglobin Levels as a Marker of Preterm Premature Rupture of Membranes. Z Geburtshilfe Neonatol. 2021;225(1):47-50. DOI: 10.1055/a-1167-4512.
8. Kacerovsky M, Holeckova M, Stepan M, Gregor M, Vescicik P, Lesko D, et al. Amniotic fluid glucose level in PPROM pregnancies: a glance at the old friend. The J Maternal-Fetal & Neonatal Med. 2022;35(I12):2247-59. DOI: 10.1080/14767058.2020.1783232.
9. Bila V. Fetal inflammatory response syndrome in extremely premature newborns. Reproductive endocrinology. 2024;(72):53-59. DOI: https://doi.org/10.18370/2309-4117.2024.72.53-59.
10. Genevieve L, Taylor T, O’Shea T.Extreme prematurity: Risk and resiliency. Curr Probl Pediatr Adolesc Health Care. 2022;52(2):101132. DOI: 10.1016/j.cppeds.2022.101132.
11. Giovannini E, Bonasoni MP, Pascali JP, Giorgetti A, Pelletti G, Gargano G, et al. Infection Induced Fetal Inflammatory Response Syndrome (FIRS): State-of- the-Art and Medico-Legal Implications-A Narrative Review. Microorganisms. 2023;11(4):1010. DOI: 10.3390/ microorganisms11041010.
12. Lyubomyrska KS, Syusyuka VG, Krut YuYa, Kirilyuk OD, Izbytska NG, Boguslavska NY, et al. Non-invasive prognostic markers the risk of premature rupture of the membranes during premature pregnancy. Women’s Reprod Health. 2022;4(59):23-9.
13. MOZ Ukrainy. Nakaz MOZ Ukrainy № 1533 Standart medychnoi dopomohy Peredchasnyi rozryv plidnykh obolonok. Kyyiv: MOZ Ukrainy; 2023. 19 s. [in Ukrainian].
14. Can E, Oğlak SC, Ölmez F. Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes. J Obstet Gynaecol Res. 2022;48(7):1740-1749. DOI: 10.1111/jog.15239.
15. Park JH, Bae JG, Chang YS. Neonatal Outcomes according to the Latent Period from Membrane Rupture to Delivery among Extremely Preterm Infants Exposed to Preterm Premature Rupture of Membrane: a Nationwide Cohort Study. J Korean Med Sci. 2021;36(14):e93. DOI: 10.3346/jkms.2021.36.e93.
16. Burckova H, Stranik J, Musilova I, Matulova J, Jacobsson B, Kacerovsky M. Intra-amniotic inflammatory complications in preterm prelabor rupture of membranes and long-term neurodevelopmental outcomes of infants: a systematic review. The Journal of Maternal-Fetal & Neonatal Medicine. 2021;35(25):5993-5998. DOI: https://doi.org/10.1080/14767058.2021.1903 859.
17. Yan C, Deng X, Hong F. Analysis of Maternal and Neonatal Outcome of Patients with Preterm Prelabor Rupture of Membranes. J Healthc Eng. 2022;2022:8705005. DOI: 10.1155/2022/8705005.

Publication of the article:

«Bulletin of problems biology and medicine», 2024 Issue 3, 174, 126-133 pages, index UDC 618.414.8-06:618.5-089.888.61

DOI:

10.29254/2077-4214-2024-3-174-126-133