Delivery in premature rupture of membranes at 22 to 28 weeks: management tactics, perinatal outcomes


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Abstract

Materials and methods: The investigation was prospective. It enrolled 30 female patients with premature rupture of membranes at 22-28 weeks’ gestation. All the pregnant women with amniorrhea underwent a standard examination and a vaginal microbiome study using the special gene technology - I6S rRNA gene sequencing. Results: Wait-and-see tactics with an increase in the gestational period led to the birth of babies with a larger weight and a better Apgar score at one and five minutes. However, the development of an inflammatory reaction in a pregnant woman increased the risk of chorioamnionitis and neonatal sepsis. An analysis of vaginal microbiome in pregnant women showed that the presence of bacteria of the Ureaplasma genus was associated with low birth weight, an increase in the relative abundance (%) of these bacteria was related to low neonatal survival rates in the first 7 days, and the presence of Dialister bacteria was linked to the development of chorioamnionitis. Conclusion: Prolongation of pregnancy when choosing a wait-and-see management tactic, by increasing the duration of the time between membrane rupture and delivery in premature rupture of membranes at 22 and 28 weeks’ gestation and, accordingly, the gestational period at the time of delivery is associated with an improvement in perinatal outcomes. The appearance of signs of a systemic inflammatory response, the presence of Ureaplasma and Dialister bacteria, and an increase in the relative abundance (%) of Ureaplasma bacteria in the vaginal microbiome is a risk factor for adverse perinatal outcomes.

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About the authors

Natalia B. Kuznetsova

Rostov State Medical University, Ministry of Health of Russia

Email: lauranb@inbox.ru
MD, Professor, Simulation Training Centre

Violetta S. Dybova

Rostov State Medical University, Ministry of Health of Russia; Perinatal Center

Email: viola-kovaleva@mail.ru
Postgraduate Student

References

  1. NIH Human Microbiome Portfolio Analysis Team. A review of 10 years of human microbiome research activities at the US National Institutes of Health, Fiscal Years 2007-2016. Microbiome. 2019; 7(1): 31. https://dx.doi.org/10.1186/s40168-019-0620-y.
  2. Toukam M., Luisin M., Chevreau J., Lanta-Delmas S., Gondry J., Tourneux P. A predictive neonatal mortality score for women with premature rupture of membranes after 22-27 weeks of gestation. J. Matern. Fetal Neonatal Med. 2019; 32(2): 258-64. https://dx.doi.org/10.1080/14767058.2017.1378327.
  3. Brown R.G., Marchesi J.R., Lee Y.S., Smith A., Lehne B., Kindinger L.M. et al. Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin. BMC Med. 2018; 16(1): 9. https://dx.doi.org/10.1186/s12916-017-0999-x.
  4. Приказ Министерства здравоохранения Российской Федерации от 1 ноября 2012 г. № 572н «Об утверждении Порядка оказания медицинской помощи по профилю “акушерство и гинекология (за исключением использования вспомогательных репродуктивных технологий)”». https://minzdrav.gov.ru/documents/9154-prikaz
  5. Приказ Министерства здравоохранения Российской Федерации от 20.10.2020 № 1130н «Об утверждении порядка оказания медицинской помощи по профилю “акушерство и гинекология”». https://docs.cntd.ru/document/566162019
  6. Письмо Министерства здравоохранения Российской Федерации от 17.12.2013 №15-4/10/2-9480 «О направлении клинических рекомендаций (протокола лечения) “Преждевременные роды”». https://docs.cntd.ru/document/456011385
  7. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Преждевременные роды. М.: Российское общество акушеров-гинекологов» (РОАГ), Ассоциация акушерских анестезиологов -реаниматологов (АААР); 2020.
  8. Приказ Министерства здравоохранения Российской Федерации от 10.05.2017 № 203н «Об утверждении критериев оценки качества медицинской помощи». https://docs.cntd.ru/document/436733768?marker=6560IO
  9. Кузнецова Н.Б., Буштырева И.О., Дыбова В.С., Баринова В.В., Полев Д.Е., Асеев М.В., Дудурич В.В. Микробиом влагалища у беременных с преждевременным разрывом плодных оболочек в сроке от 22 до 28 недель беременности. Акушерство и гинекология. 2021; 1: 94-102. https://dx.doi.org/10.18565/aig.2021.1.94-102.
  10. Pryles C.V., Steg N.L., Nair S., Gellis S.S., Tenney B. A controlled study of the influence on the newborn of prolonged premature rupture of the amniotic membranes and/or infection in the mother. Pediatrics. 1963; 31: 608-22.
  11. Kibel M., Asztalos E., Barrett J., Dunn M.S., Tward C., Pittini A. et al. Outcomes of pregnancies complicated by pre-term premature rupture of membranes between 20 and 24 weeks of gestation. Obstet. Gynecol. 2016; 128(2): 313-20. https://dx.doi.org/10.1097/AOG.0000000000001530.
  12. Park J.H., Bae J.G., Chang Y.S. 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. https://dx.doi.org/10.3346/jkms.2021.36.e93.
  13. Drassinower D., Friedman A.M., Obican S.G., Levin H., Gyamfi-Bannerman C. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis. Am. J. Obstet. Gynecol. 2016; 214(6): 743.e1-6. https://dx.doi.org/10.1016/j.ajog.2015.12.031.
  14. Bond D.M., Middleton P., Levett K.M., Ham D.P. van der, Crowther C.A., Buchanan S.L. et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst. Rev. 2017; 3(3): CD004735. https://dx.doi.org/10.1002/14651858.CD004735.pub4.
  15. Galinsky R., Polglase G.R., Hooper S.B., Black M.J., Moss T.J. The consequences of chorioamnionitis: preterm birth and effects on development. J. Pregnancy. 2013; 2013(2): 412831. https://dx.doi.org/10.1155/2013/412831.
  16. Ходжаева З.С., Гусейнова Г.Э., Муравьева В.В., Донников А.Е., Мишина Н.Д., Припутневич Т.В. Характеристика микробиоты влагалища у беременных с досрочным преждевременным разрывом плодных оболочек. Акушерство и гинекология. 2019; 12: 66-74. https://dx.doi.org/10.18565/aig.2019.12.66-74.
  17. Ходжаева З.С., Припутневич Т.В., Муравьева В.В., Гусейнова Г.Э., Горина К.А. Оценка состава и стабильности микробиоты влагалища у беременных в процессе динамического наблюдения. Акушерство и гинекология. 2019; 7: 30-8. https://dx.doi.org/10.18565/aig.2019.7/30-38.
  18. Баринова В.В., Кузнецова Н.Б., Буштырева И.О., Соколова К.М., Полев Д.Е., Дудурич В.В. Микробиом верхних отделов женской репродуктивной системы. Акушерство и гинекология. 2020; 3: 12-7. https://dx.doi.org/10.18565/aig.2020.3.12-17.
  19. Brown R.G., Marchesi J.R., Lee Y.S., Smith A., Lehne B., Kindinger L.M. et al. Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin. BMC Med. 2018; 16(1): 9. https://dx.doi.org/10.1186/s12916-017-0999-x.
  20. Cousens S., Blencowe H., Gravett M., Lawn J.E. Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection. Int. J. Epidemiol. 2010; 39(Suppl. 1): i134-43. https://dx.doi.org/10.1093/ije/dyq030.
  21. Kacerovsky M., Boudys L. Predcasny odtok plodove vody a Ureaplasma urealyticum [Preterm premature rupture of membranes and Ureaplasma urealyticum]. Ceska Gynekol. 2008; 73(3): 154-9.
  22. Kwak D.W., Hwang H.S., Kwon J.Y., Park Y.W., Kim Y.H. Co-infection with vaginal Ureaplasma urealyticum and Mycoplasma hominis increases adverse pregnancy outcomes in patients with preterm labor or preterm premature rupture of membranes. J. Matern. Fetal Neonatal Med. 2014; 27(4): 333-7. https://dx.doi.org/10.3109/14767058.2013.818124.
  23. Oh K.J., Romero R., Park J.Y., Hong J.S., Yoon B.H. The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species. J. Perinat. Med. 2019; 47(5): 516-27. https://dx.doi.org/10.1515/jpm-2019-0003.
  24. Brown R.G., Al-Memar M., Marchesi J.R., Lee Y.S., Smith A., Chan D. et al. Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes. Transl. Res. 2019; 207: 30-43. https://dx.doi.org/10.1016/j.trsl.2018.12.005.
  25. Kosti I., Lyalina S., Pollard K.S., Butte A.J., Sirota M. Meta-analysis of vaginal microbiome data provides new insights into preterm birth. Front. Microbiol. 2020; 11: 476. https://dx.doi.org/10.3389/fmicb.2020.00476.

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