Outcome of Prolapsed Chorioamniotic Membrane: Relationship between the Degree of Herniation, Infection, and Pregnancy Prolongation

ABSTRACT

Our objective was to determine the outcome predictor of conservative bed rest therapy for prolapsed chorioamniotic membrane. We could perform tocolysis for 61 women, 41 of visible membrane (group A) and 20 of protruding membrane (group B). The duration of pregnancy prolongation and gestational age (in weeks) at delivery in group A were significantly larger than in group B (p < 0.05). Outcome of neonates was also significantly different between two groups (p < 0.05). In 37 women of group A (90%) and 10 of group B (50%; group D), signs of infection were negative throughout the admission to delivery with conservative therapy (white blood cell counts ≤ 13000/μL and CRP values ≤ 1.0 mg/dL). In group D, pregnancy was prolonged 23.9 days, which was significantly longer than in group B (p < 0.05). This study suggests that pregnancy prolongation for prolapsed membrane with conservative therapy depends on the success of prophylactic treatment for infection.

KEYWORDS

Prolapsed chorioamniotic membrane - bed rest treatment - chorioamnionitis

REFERENCES

• 1 Scheerer L J, Lam F, Bartolucci L, Katz M. A new technique for reduction of prolapsed fetal membranes for emergency cervical cerclage.  Obstet Gynecol . 1989;  74 408-410
• 2 MacDougall J, Siddle N. Emergency cervical cerclage.  Br J Obstet Gynaecol . 1991;  98 1234-1238
• 3 Wong G P, Farquharson D F, Dansereau J. Emergency cervical cerclage: a retrospective review of 51 cases.  Am J Perinatol . 1993;  10 341-347
• 4 Aarts J M, Brons J T, Bruinse H W. Emergency cerclage: a review.  Obstet Gynecol Surv . 1995;  50 459-469
• 5 Wu M Y, Yang Y S, Huang S C, Lee T Y, Ho H N. Emergent and elective cervical cerclage for cervical incompetence.  Int J Gynaecol Obstet . 1996;  54 23-29
• 6 Schorr S J, Morales W J. Obstetric management of incompetent cervix and bulging fetal membranes.  J Reprod Med . 1996;  41 235-238
• 7 Latta R A, McKenna B. Emergent cervical cerclage: predictors of success or failure.  J Matern Fetal Med . 1996;  5 22-27
• 8 Lipitz S, Libshitz A, Oelsner G. et al . Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence.  Am J Perinatol . 1996;  13 419-422
• 9 Chasen S T, Silverman N S. Mid-trimester emergent cerclage: a ten year single institution review.  J Perinatol . 1998;  18 338-342
• 10 Cardosi R J, Chez R A. Comparison of elective and empiric cerclage and the role of emergency cerclage.  J Matern Fetal Med . 1998;  7 230-234
• 11 Yip S K, Fung H Y, Fung T Y. Emergency cervical cerclage: a study between duration of cerclage in situ with gestation at cerclage, herniation of forewater, and cervical dilatation at presentation.  Eur J Obstet Gynecol Reprod Biol . 1998;  78 63-67
• 12 Minakami H, Matsubara S, Izumi A. et al . Emergency cervical cerclage: relation between its success, preoperative serum level of C-reactive protein and WBC count, and degree of cervical dilatation.  Gynecol Obstet Invest . 1999;  47 157-161
• 13 Kurup M, Goldkrand J W. Cervical incompetence: elective, emergent, or urgent cerclage.  Am J Obstet Gynecol . 1999;  181 240-246
• 14 Mays J K, Figueroa R, Shah J, Khakoo H, Kaminsky S, Tejani N. Amniocentesis for selection before rescue cerclage.  Obstet Gynecol . 2000;  95 652-655
• 15 Caruso A, Trivellini C, De Carolis S, Paradisi G, Mancuso S, Ferrazzani S. Emergency cerclage in the presence of protruding membranes: is pregnancy outcome predictable?.  Acta Obstet Gynecol Scand . 2000;  79 265-268
• 16 Olatunbosun O A, al-Nuaim L, Turnell R W. Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy.  Int Surg . 1995;  80 170-174
• 17 Goodlin R C. Cervical incompetence, hour-glass membranes, and amniocentesis.  Obstet Gynecol . 1979;  54 748-750
• 18 Romero R, Gonzalez R, Sepulveda W. et al . Infection and labor. VIII: microbial invasion of the amniotic cavity in patients with suspected cervical incompetence-prevalence and clinical significance.  Am J Obstet Gynecol . 1992;  167 1086-1091
• 19 Varma T R, Patel R H, Pillai U. Ultrasonic assessment of cervix in “at risk” patients.  Int J Gynaecol Obstet . 1987;  25 25-34
• 20 Kaga N, Katsuki Y, Futamura Y, Obata M, Shibutani Y. Role of urinary trypsin inhibitor in the maintenance of pregnancy in mice.  Obstet Gynecol . 1996;  88 872-882
• 21 Kanayama N, Maradny E E, Yamamoto N, Tokunaga N, Maehara K, Terao T. Urinary trypsin inhibitor-a new drug to treat preterm labor: a comparative study with ritodrine.  Eur J Obstet Gynecol Reprod Biol . 1996;  67 133-138