Akademik Veri Yönetim Sistemi
Jinekoloji ve Obstetrik Dergisi, cilt.21, sa.4, ss.184-191, 2007 (Scopus)
OBJECTIVE: To investigate the relationship between tocolysis and corticosteroid treatment which are given to achieve fetal lung maturation, and chorioamnionitis and respiratory distress syndrome in premature rupture of membranes cases. STUDY DESING: A review of medical records of Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology was performed on 228 preterm premature rupture of membranes (PPROM) singleton pregnancy cases between 1996-2005 to reveal the maternal and neonatal consequences in PPROM. RESULTS: In 228 premature rupture of membranes cases, tocolysis was peiformed in 24 (10.5 %) cases. Ritodrine HCl (Pre-par©) was used in 23 (10.1 %) cases, while Nifedipine (Nidilat©) was used in 1 (0.4 %) case. The average period of tocolytic treatment was 3.2±2.9 (range: 1-15) days. Corticosteroids were used in 89 (39 %) cases to accelerate lung maturation, single dose was used in in 7 cases (3.1 %) and multiple doses were used in 82 (36 %) cases. In 172 (75.4 %) cases antibiotic treatment has begun without signs of infection (prophylactic treatment), while in 45 (19.7 %) cases treatment has begun after the onset of signs of infection (therapeutic treatment). In the remaining 11 (4.8 %) cases no antibiotic treatment was given. Ampicillin is the most chosen antiobiotic by 75.4 %. Chorioamnionitis was detected in 42 (18.4 %) cases. The distribution of the chorioamnionitis cases according to the gestational week was found as 37.5 % in ≤28 GW group and only % 6.7 in ≥33 GW group, which was statistically significant (p=0.000). The relationship between the antibiotic use and chorioamnionitis was investigated. The chorioamnionitis incidence was found to be higher in patients receiving profilactic or therapeutic antibiotic treatment in comparison with the patients not receiving antibiotics, with a statistical significance of p=0.000. The relationship between the use of tocolysis and chorioamnionitis was also investigated. The ratio of chorioamnionitis was 33.3 % and 16.7 % in patients receiving and not receiving tocolytic treatment respectively (p=0.04). The effect of corticosteroid use on chorioamnionitis incidence was investigated. We found that chorioamnionitis incidence was 30.3 % and 10.8 % in patients receiving and not receiving corticosteroid treatment, respectively, with a statistical significance of p=0.000. It was detected that chorioamnionitis risk increased as gestational week decreased, latent period lengthened, oligohydramniosis present, tocolysis and corticosteroids used (p<0.05). In multinominal logistic regression analysis oligohydramniosis (p=0.02), antibiotic (0.000) or corticosteroid use (p=0.021) and pre-parturition leucocyte count (p=0.042) were found to be independent variables for chorioamnionitis. CONCLUSION: Individualizing the clinical management of PPROM according to the features of the cases and gestational week appears to be the most suitable option to improve the maternal and neonatal consequences.