Cardiotocography, Premature Birth, Premature Rupture of Membrane, Rupture of Membranes; Premature, Sepsis
Conditions
Keywords
cardiotocography, Premature Rupture of Membrane, computerized cardiotocography, premature birth
Brief summary
Preterm premature rupture of membranes (PPROM) is associated with neonatal complications leading to a high rate of cerebral palsy, sepsis, and death. Choosing the best time of delivery is crucial to improve fetal outcome. The balance is between a premature delivery exposing the infant to all the risk of prematurity, and keeping the baby in utero, prolonging the exposure to an adverse intrauterine milieu. There are no objective and reproducible tools to help in this decision-making process. Techniques most frequently used for fetal surveillance are biased by high inter- and intra-observer variability. Computerized cardiotocography (cCTG) identifies several objective parameters related to fetal heart rate (FHR) to determine fetal well-being. cCTG has been successfully used in fetuses with intrauterine growth restriction, but it has never been used in prospective studies to assess its role in the management of fetuses with PPROM. The investigators designed a case control study to highlight cCTG differences in PPROM pregnancies versus physiological pregnancies, to establish the effectiveness in predicting adverse outcome, and to develop a score to predict neonatal outcome.
Detailed description
Preterm premature rupture of membranes (PPROM) occurs in 2 to 3% of pregnancies and is associated with higher maternal and neonatal morbidity and mortality. Neonatal complications are primarily due to prematurity and to ascending infection of the amniotic cavity (chorioamnionitis), leading to a high rate of cerebral palsy, intracranial hemorrhage, sepsis, pneumonia, and death. Every physician is confronted with an extremely difficult and at the same time of paramount importance decision, when it comes to establish the timing of the delivery of a premature fetus with PPROM. The balance is between delivering a premature infant exposed to all the risk of prematurity, and keeping the baby in utero, prolonging the exposure to an adverse intrauterine milieu. At present, there are no objective and reproducible tools to help in this decision-making process. The technique most frequently used for fetal surveillance is cardiotocography (CTG). Assessment of the fetal heart rate is classified subjectively as 'reassuring' or 'not reassuring'. Dawes and Redman have suggested computerized CTG (cCTG), which eliminates inter- and intra-observer variability, identifying several objective parameters to determine fetal well-being. After the multicentre TRUFFLE-Study, cCTG became the best tool to manage fetuses with intrauterine growth restriction (IUGR). However, the use of cCTG has never been investigated in prospective studies to assess its role in the management of fetuses with PPROM. Of note, amniotic fluid concentration of glucose, lactate, interleukin-6 (IL-6), and matrix metalloproteinase-8 (MMP-8) have been associated with neonatal septicemia, chorioamnionitis, preterm birth, and/or fetal inflammatory response syndrome in women with pPROM.
Interventions
DIAGNOSTIC_TESTComputerized cardiotocography
To compare Dawes and Redman indices as determined by computer analysis of the fetal heart tracing
Sponsors
University of Campania Luigi Vanvitelli
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Inclusion criteria
* pPROM between 24 and 34 weeks (w)
Exclusion criteria
* multiple pregnancy, structural fetal anomalies, preexisting or gestational diabetes mellitus and\\or hypertension, intrauterine growth restriction.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Preterm birth rate | Less than 37 weeks gestation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Preterm birth rates | Less than 24, 28, 34 weeks gestation | — |
| Birth weight | Time of delivery | Weight of the baby at the time of delivery |
| Low birth weight rate | Time of delivery | Birth weight \<2500g |
| Gestational age at delivery | Time of delivery | — |
| Composite adverse neonatal outcomes | Between birth and 28 days of age | Number of neonates who will have at least one of the following: necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grade 3 or higher), respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), retinopathy (ROP), blood-culture proven sepsis and neonatal death |
| Maternal outcomes | Between birth and 28 days after the birth | Number of mothers who will have at least one of the following: sepsis, histological chorioamnionitis, hysterectomy, intensive care unit admission. |
| Dawes and Redman indices | between 24 and 34 weeks of gestation | determined by computer analysis of the fetal heart tracing |
| Neonatal death rate | Between birth and 28 days of age | — |
Countries
Italy
Contacts
Primary ContactMaddalena Morlando, MD
Backup ContactFabiana Savoia, MD
Outcome results
None listed