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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Late miscarriage is a well-known complication in multiple pregnancies. Two cases were presented with rupture of the membranes and prolapse of the cord with the death of the presenting fetus are reported. In both cases extraction of the presenting fetus was carried out at 21 weeks of pregnancy followed by cervical cerclage. A triplet pregnancy which was reduced to two fetuses reached 30 weeks and two healthy infants were delivered. A twin pregnancy which was reduced to one fetus, resulted in that one being lost two weeks later when the patient developed chorioamnionitis and septicaemia.
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PMID:[Premature rupture of membranes in multiple pregnancies. Active echo-guided extraction of one fetus and continuation of the pregnancy. Report of 2 cases]. 195 69

The article reports on a twin pregnancy with EPH gestosis in a 20-year old primipara which could be prolonged by tocolysis and emergency cerclage after signs of premature delivery and prolapse of the amniotic sac in the 28th/29th pregnancy week. At the beginning of the 30th gestation week there was an unavoidable delivery of the first twin (920 g) who survived for 5 days only due to immaturity and hypotrophy. Directly after delivery of the first twin the pregnancy for the second twin was prolonged by renewed tocolysis and renewed circular suture of the cervix. This enabled the second child, whose growth had been retarded like that of the first one, to continue to grow for some time. Unavoidable delivery of the second twin (1,650 g) eventually occurred at the beginning of the 32nd week of pregnancy. The eutrophic child survived without the slightest complication. This case is presented in detail and discussed, including the histology of the placenta. The most important points for enabling the survival of a twin foetus are sufficient tocolysis, a satisfactory technique for occlusion of the os uteri, as well as exclusion and prevention of chorioamnionitis.
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PMID:[Successful further prolongation of immature twin pregnancy by tocolysis and re-cerclage following unavoidable delivery of the first foetus after emergency cerclage (author's transl)]. 691 9

Premature rupture of membranes is defined as expulsion of the amniotic liquid occurring at least 1 hour before initiation of uterine contractions and without apparent cervical changes. According to the literature, premature rupture of membranes occurs in 2-15% of all pregnancies, with an average of 10%. The etiology is considered multifactorial, and treatment remains controversial. A retrospective review was conducted to determine the occurrence of maternal or perinatal morbidity and mortality in 230 cases of premature rupture of membranes in a social security hospital in Santo Domingo, Dominican Republic, observed between 1983-88. Premature rupture occurred in 3.5% of cases according to the records. 37.4% of affected mothers were 21-25 years old and 69.6% were 21.30. 62.9% of the women were nulliparas. 2.2% had had no prenatal care, 59.1% had insufficient prenatal care, defined as 1-5 visits and only 36.1% had 6 or more visits. 81.3% of ruptures occurred at 37-42 weeks of gestation. In 64.8% of cases the pregnancy was terminated within 1-24 hours and 35.2% were considered prolonged. Prematurity and low birth weight was the most common perinatal disorders, affecting 10.9%. Respiratory difficulty syndrome affected 4.3%. 60% of infants with respiratory problems were born at less than 37 weeks gestation. Neonatal sepsis occurred in 3% of cases and prolapse of the umbilical cord in 1.3%. Perinatal mortality averaged 2.6%. Prematurity was a factor in all cases. Respiratory distress syndrome and neonatal sepsis were each present in 50% of cases and hyperbilirubinemia in 33%. 8.7% of the mothers developed chorioamnionitis. Only 23.9% terminated their pregnancies spontaneously. Oxytocin was used to induce labor in 30.4% and cesareans were performed in 44.8%.
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PMID:[Premature rupture of membranes: maternal - perinatal morbidity and mortality in the Dominican Republic]. 1231 12

Despite advances in perinatal medicine in the past decade, the diagnosis and treatment of premature rupture of membranes remain controversial. Premature rupture occurs in 2.7-7.0% of pregnancies and most cases occur spontaneously without apparent cause. The disparity in reported rates of premature rupture is due to differences in the definition and diagnostic criteria for premature rupture and lack of comparability in the populations studied. Mexico's National Institute of Perinatology has adopted the definition of the American COllege of Gynecology and Obstetrics which views premature rupture as that occurring before regular uterine contractions that produce cervical dilation. 8.8% of its patients have premature rupture according to this definition. 20% of cases occur before the 36th week of pregnancy. Treatment of rupture occurring before 37 weeks must balance the threat of amniotic infection with the dangers of premature birth. Infections appear more common in low income patient populations. Chorioamnionitis is a serious complication of pregnancy and is the main argument against conservative treatment of premature rupture. The rate of maternal infection is directly related to the time elapsing between rupture of the membranes and birth. The rate increases after the 1st 24 hours and is at least 10 times higher after 72 hours. But recent studies suggest that there is no considerable increase in infection if vaginal explorations are avoided and careful techniques are used in treating the patient. Those who advise conservative treatment believe that prenatal outcomes are better because respiratory disease syndrome due to prematurity is avoided. Conservative management requires a white cell count at least every 24 hours and measurement of pulse, maternal temperature, and fetal heart rate ideally every 4 hours. Perinatal mortality rates due to premature rupture of membranes range from 2.5-50%. The principal causes are respiratory disease syndrome, infection, asphyxia, and congenital malformations. Neonatal sepsis occurs in about 5% of live births following premature rupture, but the rate triples after 24 hours, especially in premature infants. The rate of neonatal asphyxia also increases considerable after 24 hours. Congenital malformations, prolapse of the cord, and pelvic presentation are positively associated with premature rupture of membranes. If the decision is made to interrupt the pregnancy, it should be done between 12-24 hours after rupture because the risks of infection and respiratory difficulty are most balanced at that point. Vaginal deliveries should be preferred only if conditions are favorable for a prompt delivery. The gestational age, presence of infection, obstetric condition of the mother, and indication for hysterectomy are the most important points to consider i management of premature rupture.
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PMID:[Premature rupture of membranes and chorioamnionitis]. 1234 87

BACKGROUND: This report describes a patient counseling approach and non-surgical management of a dichorionic-diamniotic twin pregnancy where delivery of the second twin followed the delivery of the first by 110 days. CASE PRESENTATION: An early transvaginal sonogram at 19 1/2 weeks suggested cervical dilation with protruding amniotic membranes. Tocolytic and antibiotic therapy was initiated; no cerclage was placed. Spontaneous rupture of membranes and cord prolapse occurred 48 h later, resulting in delivery of a stillborn female infant. Conservative management was offered after counseling for possible risks associated with maternal sepsis, need for extended hospitalization, potential for hysterectomy and death. The cervix appeared closed after delivery and the umbilical cord was ligated, with subsequent spontaneous cord retraction in utero. Reassuring fetal status was observed for twin B without evidence of contractions or chorioamnionitis. A viable male infant (2894 g) was delivered vaginally at 35 1/2 weeks. CONCLUSIONS: This report outlines a counseling approach useful for patients with premature delivery of one twin, and presents application of conservative obstetrical management principles for the aftercoming twin even when delivery interval is extreme.
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PMID:Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth. 1558 27

Preterm premature rupture of the membranes (PPROM) begins a high-risk period for both mother and fetus. This literature review updates the knowledge on latency-period complications and proposed monitoring strategies. Four latency-period complications are described: spontaneous onset of labor, infection (chorioamnionitis), abruptio placentae, and fetal, distress which can be linked to umbilical cord prolapse. Admittedly, the infection/inflammation process plays a key role during the latency period. Conservative management of PPROM is recommended and is associated with significant pregnancy prolongation. This strategy allows a gain in fetal maturity, but increases the risk of complications. The prediction of infection seems to be essential; classical markers, such as blood count and reactive C protein are not very effective. New markers have been tested, with IL-6 appearing to be one of the best infection markers. Fetal pulmonary maturity can be evaluated with a rapid screening test and can yield arguments for the management strategy.
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PMID:[Complications and monitoring of the latency period after a preterm premature rupture of the fetal membranes: literature review]. 1848 58

In multiple gestation, premature rupture of fetal membranes (PROM) is an important risk factor for premature delivery and intrauterine infection. The incidence of PROM in twin gestations is threefold of that in singleton pregnancies. The incidence in triplets occurs even more frequently underlining the role of PROM as a leading cause of infant mortality and morbidity. Besides prematurity the complications of PROM include umbilical cord compression due to oligohydramnios, cord prolapse, placental abruption, and chorioamnionitis. Together with PROM, chorioamnionitis is held responsible for significant maternal and neonatal morbidity including endometritis and sepsis in the mother and early-onset sepsis, respiratory distress syndrome, inborn pneumonia, bronchopulmonary dysplasia, intraventricular hemorrhage, and periventricular white matter injury in the neonate. Furthermore, in twin gestations, PROM remains an independent risk factor for long-term neonatal care. An uncommon situation develops when in multiple gestation PROM affects only one of the fetuses. In such cases, the co-existence in the uterine cavity of the properly developing fetus(es) can be a challenge for the process of medical decision-making. In the present work, limited world literature on the topic was critically reviewed in search of the best possible recommendations for clinical management.
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PMID:[Premature rupture of membranes one fetus from a multiple pregnancy]. 2237 42