The outcome was lethal in 67/395 (17%) patients of which 55% had chorioamnionitis (p > 0.05).In comparison with the control group, mortality was significantly higher in the group of premature infants with gestation at or before 28 weeks whose placentas showed chorioamnionitis (p 0.05). In conclusion, premature neonates from pregnancies complicated by chorioamnionitis are more often born at or before 28 weeks of gestation, and chorioamnionitis in such neonates leads to a significantly higher rate of mortality. A greater incidence of EONS was proven in the group of infants with chorioamnionitis.
The difference between the incidence of BPD in preterm infants born from pregnancies complicated by chorioamnionitis and the control group was not significant, however. Gomez et al (1998)53, studied that the fetal inflammatory response syndrome (FIRS) is characterized by activation of the innate immune system of the fetus exposed to infection/inflammation in utero. FIRS was originally defined on the basis of increased cord blood concentrations of interleukin (IL)-6, which was shown associated with adverse neonatal outcome.
Meanwhile, many other soluble blood markers for FIRS, mainly proinflammatory cytokines like IL-1 and tumour necrosis factor (TNF ), have been introduced and histological funisitis/chorionic vasculitis has been suggested as the histological counterpart of FIRS.Driscoll (1986)54, concluded that of these criteria, intrapartum maternal fever appears to be the most frequent. When at least 2 of the aforementioned criteria are present, the risk of neonatal sepsis is increased. Each clinical sign and symptom of chorioamnionitis, however, is by itself of low predictive value. The signs and symptoms of maternal chorioamnionitis or amniotic fluid infection are very subjective.
Moreover, silent chorioamnionitis is prominent, and thus signs and symptoms in the infected newborn infant take on added significance. Fig 1. Schematic illustration of different approaches to define chorioamnionitis and their interrelationship. Prolonged rupture of membranes:Madan et al (2010)55, studied that the risk of neonatal infection increases as the duration of ruptured membranes lengthens. Chorioamnionitis may initiate uteroplacental bleeding or placental abruption. Intrauterine infection is increased in placenta previa and manifests with vaginal bleeding. Labor and delivery may be rapid in the presence of chorioamnionitis. Alternatively, the infection may cause uterine atony, requiring labor to be augmented with oxytocin. Ultimately, a poor labor pattern may require an instrumented delivery or a caesarean delivery. Each of these antepartum and intrapartum factors must be considered when evaluating the newborn for the presence of bacterial infection.Rupture of membranes more than 18 hours before labor, is found in approximately 8%-10% of all pregnancies (Kilbride & Thibeault, 2001)29. Prolonged rupture of the membrane is an important risk factor for both early onset neonatal sepsis (EONS) and preterm births. Many studies have determined that, besides prematurity being the most common problem, infection was the most serious event and potential complication following prolonged rupture of membranes. This became even more serious if both were combined (Boskabadi et al, 2011). Prolonged rupture of the membrane is significant not only in perinatal morbidity and mortality but also in the long term neonatal complications and sequelae in surviving neonates. Improved prenatal care and antenatal antimicrobial treatment of women with a history of prolonged rupture of the membrane had significantly improved neonatal outcome in association with early detection of sepsis and its aggressive management in neonates (Al-Qaqa & Al-Awaysheh, 2005)4.Rupture of membrane longer than 24hours is considered to be a prolonged rupture and is one of the risk factors for neonatal sepsis. Some texts describe a cut off of more than 18 hrs to be a risk factor for early onset Group B streptococcus infection. Aspiration and ingestion of the infected amniotic fluid may lead to congenital pneumonia or systemic infection, which are manifested before delivery by fetal distress or tachycardia. Acquisition of infection during the process of delivery leads to overt manifestations after 1-2 days. Premature rupture of membranes:This refers to spontaneous rupture of membranes any time during pregnancy beyond 28th week but before the onset of labour (labour should not begin within one hour of rupture). Chance of ascending infection is more if labour fails to start within 24 hrs. The attack rate of neonatal sepsis is 10.7% after 24 hours (Dutta,1995)57. Premature rupture of membranes plus 2 more risk factors raises the risk of neonatal sepsis to 25 fold (Hankins et al, 2002)58. In most cases, this occurs near term, but when membrane rupture occurs before 37 weeks’ gestation, it is known as preterm PROM. Preterm PROM complicates approximately 3 per cent of pregnancies and leads to one-third of preterm births. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications, including a 1 to 2 percent risk of fetal death. Physicians caring for pregnant patients should be versed in the management of preterm PROM because rapid diagnosis and appropriate management can result in improved outcomes (Meis et al, 1987).Maternal Peripartum Infection:Chorioamnionitis and intrapartum fever more than 100.4 F/ 380 C are considered to be major risk factors for neonatal sepsis, while intrapartum fever more than 99.5 F /37.50 C and Group B streptococcus colonisation are minor risk factors (Guerina, 1998)60. Meconium stained liquor:Meconium staining often occurs in conjunction with other causes of fetal distress. It is rare in babies born before 34 weeks gestation. Thirteen per cent of all live births has meconium-stained liquor (Walsh & Fanaroff, 200761).Joachim et al (1999)62, conducted a study to define perinatal factors associated with early-onset neonatal sepsis. Maternal and neonatal variables were analysed retrospectively in 343 infants born before 35 weeks using univariate and multivariate statistical analysis. Logistic regression analysis identified risk factors for probable neonatal sepsis as gestational age at delivery (odds ratio 0.9, 95% confidence interval (CI) 0.91-0.96), premature rupture of membranes (odds ratio 2.9, 95% CI 1.004-8.56), Apgar score
Remember! This is just a sample.
You can get a custom paper by one of our expert writers.
Get your custom essay
Helping students since 2015
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download