Document Detail


The NICHD-MFMU antibiotic treatment of preterm PROM study: impact of initial amniotic fluid volume on pregnancy outcome.
MedLine Citation:
PMID:  16458643     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate the associations between measured amniotic fluid volume and outcome after preterm premature rupture of membranes (PROM). STUDY DESIGN: This was a secondary analysis of 290 women, with singleton pregnancies, who participated in a trial of antibiotic therapy for preterm PROM at 24(0) to 32(0) weeks. Each underwent assessment of the 4 quadrant amniotic fluid index (AFI) and a maximum vertical fluid pocket (MVP) before randomization. The impact of low AFI (< 5.0 cm) and low MVP (< 2.0 cm) on latency, amnionitis, neonatal morbidity, and composite morbidity (any of death, RDS, early sepsis, stage 2-3 necrotizing enterocolitis, and/or grade 3-4 intraventricular hemorrhage) was assessed. Logistic regression controlled for confounding factors including gestational age at randomization, GBS carriage, and antibiotic study group. RESULTS: Low AFI and low MVP were identified in 67.2% and 46.9% of women, respectively. Delivery occurred by 48 hours, 1 and 2 weeks in 32.4%, 63.5% and 81.7% of pregnancies, respectively. Both low AFI and low MVP were associated with shorter latency (P < .001), and with a higher rate of delivery at 48 hours, 1, and 2 weeks (P = .02 for each). However, neither test offered significant additional predictive value over the risk in the total population. Low AFI and low MVP were not associated with increased amnionitis. After controlling for other factors, both low MVP and low AFI were associated with shorter latency (P < or = .002), increased composite morbidity (P = .03), and increased RDS (P < or = .01), but not with increased neonatal sepsis (P = .85) or pneumonia (P = .53). Alternatively, after controlling for fluid volume, gestational age, and GBS carriage, the antibiotic study group had longer latency, and suffered less common primary outcomes and neonatal sepsis. CONCLUSION: Oligohydramnios should not be a consideration in determining which women will be candidates for expectant management or antibiotic treatment when it is identified at initial assessment of preterm PROM remote from term.
Authors:
Brian M Mercer; Yolanda A Rabello; Gary R Thurnau; Menachem Miodovnik; Robert L Goldenberg; Anita F Das; Paul J Meis; Atef H Moawad; Jay D Iams; J Peter Van Dorsten; Mitchell P Dombrowski; James M Roberts; Donald McNellis;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  194     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-06     Completed Date:  2006-04-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  438-45     Citation Subset:  AIM; IM    
Affiliation:
NICHD-MFMU Network, Bethesda, MD, USA.
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MeSH Terms
Descriptor/Qualifier:
Amniotic Fluid*
Anti-Bacterial Agents / therapeutic use*
Female
Fetal Membranes, Premature Rupture / drug therapy*
Humans
Logistic Models
Pregnancy
Pregnancy Outcome*
Randomized Controlled Trials as Topic
Risk Factors
Grant Support
ID/Acronym/Agency:
HD-19897/HD/NICHD NIH HHS; HD-21414/HD/NICHD NIH HHS; HD-21434/HD/NICHD NIH HHS; HD-27860/HD/NICHD NIH HHS; HD-27861/HD/NICHD NIH HHS; HD-27869/HD/NICHD NIH HHS; HD-27883/HD/NICHD NIH HHS; HD-27889/HD/NICHD NIH HHS; HD-27905/HD/NICHD NIH HHS; HD-27915/HD/NICHD NIH HHS; HD-27917/HD/NICHD NIH HHS; HD36801/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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