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Am J Perinatol 2003; 20(7): 381-390
DOI: 10.1055/s-2003-45287
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

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

Kazuaki Ishikawa, Hiroshi Watanabe, Nozomu Tadokoro, Kyoko Oshima, Masayoshi Nishikawa, Noriyuki Inaba
  • Department of Obstetrics and Gynecology, Dokkyo University School of Medicine, Tochigi, Japan
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Publication History

Publication Date:
04 December 2003 (online)

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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
    PubMedGoogle Scholar
  • 2 MacDougall J, Siddle N. Emergency cervical cerclage.  Br J Obstet Gynaecol . 1991;  98 1234-1238
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Aarts J M, Brons J T, Bruinse H W. Emergency cerclage: a review.  Obstet Gynecol Surv . 1995;  50 459-469
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Schorr S J, Morales W J. Obstetric management of incompetent cervix and bulging fetal membranes.  J Reprod Med . 1996;  41 235-238
    PubMedGoogle Scholar
  • 7 Latta R A, McKenna B. Emergent cervical cerclage: predictors of success or failure.  J Matern Fetal Med . 1996;  5 22-27
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Chasen S T, Silverman N S. Mid-trimester emergent cerclage: a ten year single institution review.  J Perinatol . 1998;  18 338-342
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 13 Kurup M, Goldkrand J W. Cervical incompetence: elective, emergent, or urgent cerclage.  Am J Obstet Gynecol . 1999;  181 240-246
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 17 Goodlin R C. Cervical incompetence, hour-glass membranes, and amniocentesis.  Obstet Gynecol . 1979;  54 748-750
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
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