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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a prospective study evaluating the expectant management of preterm (26 to 34 weeks) premature rupture of membranes (PROM), the authors compared maternal and neonatal outcome of 17 patients with a marked reduction in amniotic fluid volume with 22 subjects having identifiable pockets of amniotic fluid after membrane rupture. The results demonstrated no significant differences in maternal age, gravidity, cervical dilatation, incidence of labor on admission, use of tocolytics, steroid usage, interval from membrane rupture to delivery, or cesarean section rate. The gestational age at which PROM occurred (31.4 +/- 1.9 versus 29.8 +/- 2.2 weeks) was significantly (P less than .05) more advanced in the adequate fluid patients when compared with the reduced fluid group. Clinical amnionitis was a far more common occurrence in the reduced fluid patients when compared with the adequate fluid group (47 versus 14%, respectively, P less than .05) as was postpartum endometritis (59 versus 18%, P less than .05). The incidence of overt neonatal sepsis was similar between the adequate fluid (14%) and reduced fluid (18%) patients. These results suggest that when a marked reduction in amniotic fluid after PROM is identified, patients are at a three-times greater risk for antepartum amnionitis and postpartum endometritis.
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PMID:Amniotic fluid volume as a risk factor in preterm premature rupture of the membranes. 398 21

The outcome of 53 cases expectantly managed with premature rupture of membranes (PROM) before fetal viability (16 to 25 weeks) was retrospectively reviewed. Forty-one percent of patients developed amnionitis, four had prolonged hospital stays (longer than seven days), and one each had sepsis and pelvic thrombophlebitis. Twenty-two mothers (41%) had no complications. No serious long-term maternal sequelae were noted. Eighteen patients were delivered after 26 weeks, and there were 13 surviving neonates with birth weights ranging from 740 to 2170 g.
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PMID:Premature rupture of membranes before fetal viability. 633 58

A woman with premature rupture of membranes and chorioamnionitis gave birth to a 0.73-kg infant at 28 weeks' gestation. The infant died of fulminant septicemia caused by Hemophilus parainfluenzae. This organism should be recognized as a potential cause of chorioamnionitis and neonatal septicemia.
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PMID:Fulminant neonatal septicemia due to Hemophilus parainfluenzae. 670 33

One hundred thirty-four indigent patients at term who had premature rupture of membranes and a cervix unfavorable for induction of labor (80% effacement or less, 2 cm dilation or less) were randomized to compare expectant with intervention management. Women with any medical or obstetric condition warranting immediate intervention were excluded from the study. Patients treated expectantly were placed at bed rest and observed for labor or infection. Patients managed by intervention were given oxytocin if labor did not ensue within 12 hours of rupture of the membranes. Patients in the intervention protocol had longer labor (P less than .02) and a higher incidence of both cesarean delivery (P less than .05) and intraamniotic infection (P less than .05). There was only one case of proven neonatal sepsis, and this occurred in a patient managed by induction of labor. There was no statistically significant difference between groups in mean length of maternal hospitalization.
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PMID:Management of premature rupture of membranes and unfavorable cervix in term pregnancy. 671 74

The risks to the infant following prolonged premature rupture of the amniotic membranes are those of prematurity and infection. After the 36th week of pregnancy, healthy infants of healthy mothers may be treated as uninfected neonates, as their risk of infection does not appear to be significant. Before this gestational age, infants should receive a complete laboratory evaluation for infection, including blood culture and spinal fluid examination, and antibiotic therapy should not be withheld until these laboratory tests are reported to the clinician. While the indiscriminate use of antibiotic treatment should be avoided, sepsis in the newborn can be a rapidly progressive disease, with minimal physical and laboratory findings at its onset. Therefore, until some method of laboratory evaluation that will detect all cases of neonatal sepsis rapidly, and leave no infected infant unidentified, the clinician must be alerted to the presence of an infant delivered after PROM and institute the appropriate evaluation and treatment as soon as possible.
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PMID:Premature rupture of the membranes (PROM): a neonatal approach. 683 7

In the past 40 years, the predominant organisms responsible for neonatal sepsis have changed. Whereas Group A betahemolytic streptococci were originally most common and staphylococci later became the major pathogens, Group B beta-hemolytic streptococci have become increasingly important in recent years. Predisposing factors include premature rupture of membranes, prolonged difficult labor, prematurity and congenital anomalies. The causes and clinical features of early-onset infection (in the first week of life) and late-onset infection are different.
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PMID:Group B beta-hemolytic streptococcal sepsis in the neonate. 699 62

During a 5-year period vaginal cultures were obtained from all women with an obstetric history of premature onset of labor or premature rupture of membranes. With these indications, 1,213 (12.7%) of all parturient patients were cultured and 10.2% of those cultured were colonized with group B beta-hemolytic streptococci. Maternal colonization did not correlate with ABO blood group, although a significantly higher percentage of Rh negative women were colonized (p < 0.01). During this 5-year period, 20 infants had documented early-onset infection (sepsis or meningitis) with group B beta-hemolytic streptococci. All 10 infants had a maternal history of premature onset of labor and/or premature rupture of membranes. Mothers of eight infants were cultured and seven of these cultures were positive. Approximately one of every 20 infants designated at high risk actually developed early-onset disease. Selective maternal culturing effectively identifies those infants as risk for early-onset group B streptococcal disease.
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PMID:Selective maternal culturing to identify group B streptococal infection. 699 8

The management of pregnant patients with premature rupture of membranes (PROM) prior to 32 weeks' gestation or at 32 to 34 weeks' gestation is controversial. In a retrospective analysis of 109 patients with PROM at or prior to 34 weeks' gestation, 53 (49%) were managed conservatively, and labor was eigher induced or occurred spontaneously within 24 hours in 56 (51%). Patients initially presenting with chorioamnionitis were excluded from this study, as were all patients with evidence of a fetal anomaly or a medical indication for delivery. The 53 patients managed conservatively had a mean pregnancy prolongation of 21 days (range, 2 to 105 days median, 7 days). The infants of patients managed conservatively had a lower incidence of respiratory distress syndrome (P less than .0025), mortality (P less than .05), and intracranial hemorrhage (P less than .03). Sixty-four percent of the conservatively managed group versus 45% of the induced/spontaneous labor group were found to be normal upon physical and neurologic examination when discharged from the hospital (P less than .035). The difference in incidence of neonatal sepsis between these 2 groups was not statistically significant (P = .42). Immediate induction of labor and/or delivery for patients with PROM at less than 32 weeks' gestation resulted in a significant increase in perinatal mortality and morbidity.
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PMID:Conservative management of patients with premature rupture of fetal membranes. 707 Jul 33

Lysozyme levels were determined in serum and umbilical cord blood of 352 newborns and prematures. Levels in premature babies were found to be significantly lower than those of matures at the first day of life. A correlation was seen between the serum lysozyme and the birth weight of 219 mature newborns. In 14 premature babies with clinical signs of sepsis the concentrations of serum lysozyme were particularly decreased in cases of septicemia caused by gram-negative organisms. Serum levels of lysozyme in cord blood were significantly lower in 38 newborns with predisposition to septicemia (above all premature rupture of membranes greater than 24 hr.) comparing with healthy infants. The decreased serum levels of lysozyme in newborns with septicemia and the remarkable susceptibility of infections in male newborns are discussed.
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PMID:[Serum lysozyme activity of serum and umbilical cord blood in newborn babies-diagnostic value of the enzyme in infants with susceptibility to infections and in cases of septicemia. (author's transl)]. 719 43

An unusual case of twin unilateral interstitial pregnancy with premature rupture of membranes and leiomyomata uteri is described. A review of the literature reveals only two previous cases of this type. On admission, the patient was diagnosed as having an intrauterine pregnancy of 27 weeks' gestation, with documented premature rupture of the membranes having occurred. An ultrasound was performed revealing a fibroid uterus, an anterior placenta and an gestation. Septicemia ensued, and antibiotics plus pitocin was begun; however, no uterine response occurred. A culdocentesis revealed free intraabdominal blood. Laparotomy followed, revealing a ruptured twin interstitial pregnancy with placenta accreta and leiomyomata of the uterus.
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PMID:Unilateral twin interstitial ectopic pregnancy. A case report. 741 29


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