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Original Article
Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34-36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes
- Malú Flôres Ferraz
, - Thaísa De Souza Lima ,
- Sarah Moura Cintra ,
- Edward Araujo Júnior ,
- Caetano Galvão Petrini , [ ... ],
- Alberto Borges Peixoto
12-21-2020
Summary
Original ArticleActive Versus Expectant Management for Preterm Premature Rupture of Membranes at 34-36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(11):717-725
12-21-2020- Malú Flôres Ferraz ,
- Thaísa De Souza Lima ,
- Sarah Moura Cintra ,
- Edward Araujo Júnior ,
- Caetano Galvão Petrini ,
- Mario Sergio Silva Gomes Caetano ,
- Marina Carvalho Paschoini ,
- Alberto Borges Peixoto
Views185Abstract
Objective:
To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil.
Methods:
In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used.
Results:
Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138).
Conclusion:
There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.
Key-words Antibiotic prophylaxisMaternal morbidityneonatal morbiditypreterm premature rupture of membranesSee moreViews185
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleActive Versus Expectant Management for Preterm Premature Rupture of Membranes at 34-36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(11):717-725
12-21-2020- Malú Flôres Ferraz ,
- Thaísa De Souza Lima ,
- Sarah Moura Cintra ,
- Edward Araujo Júnior ,
- Caetano Galvão Petrini ,
- Mario Sergio Silva Gomes Caetano ,
- Marina Carvalho Paschoini ,
- Alberto Borges Peixoto
Views185Abstract
Objective:
To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil.
Methods:
In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used.
Results:
Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138).
Conclusion:
There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.
Key-words Antibiotic prophylaxisMaternal morbidityneonatal morbiditypreterm premature rupture of membranesSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Malú Flôres Ferraz
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Original Article
Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):534-540
10-01-2017
Summary
Original ArticleIncidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):534-540
10-01-2017Views94See moreAbstract
Introduction
The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study.
Methods
Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS.
Results
We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria.We didn’t observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group.
Conclusion
The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.
Views94This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleIncidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):534-540
10-01-2017Views94See moreAbstract
Introduction
The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study.
Methods
Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS.
Results
We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria.We didn’t observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group.
Conclusion
The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Artigos Originais
Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):544-549
01-12-2008
Summary
Artigos OriginaisTinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):544-549
01-12-2008DOI 10.1590/S0100-72032008001100003
Views139See morePURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.
Views139This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Artigos OriginaisTinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):544-549
01-12-2008DOI 10.1590/S0100-72032008001100003
Views139See morePURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Prophylactic antibiotic treatment in obstetrics: comparison of regimens
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):509-515
04-09-1998
Summary
Trabalhos OriginaisProphylactic antibiotic treatment in obstetrics: comparison of regimens
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):509-515
04-09-1998DOI 10.1590/S0100-72031998000900004
Views65Purpose: to evaluate the efficacy of four antibiotic regimens in puerperal infection prophylaxis. Patients and Methods: According to vaginal or abdominal delivery and risk the presence or not of factors for puerperal infection, the patients were allocated to groups of low, medium and high risk for its development. Between March 1994 and June 1997 2,263 patients were evaluated. Results: the incidence of puerperal infection was different in each group. It was 3.1% in the low risk group, where no antibiotic was given, and 8.5% in the high risk group where all patients received three doses of 1 g EV cefalotin at six-hour intervals. In the medium risk group, the incidence of puerperal infection was 5.3% for the patients who used three doses of 1 g EV cefoxitin; 5.1% for those who used three doses of 1 g EV cefalotin; 4.0% when a single cefoxitin dose was used and 3.4% when a single cefalotin dose was used. Conclusions: it is not necessary to use prophylactic antibiotic therapy in low risk patients and the first generation cephalosporins (cefalotin) are as efficacious as the second generation cephalosporins (cefoxitin) to prevent puerperal infection, independent of the applied dosage. Cefalotin seems to be effective in preventing puerperal infection in patients at high risk.
Key-words Antibiotic prophylaxisCesarean sectionDelivery, vaginalPuerperal infectionRupture of membranes, prematureSee moreViews65This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisProphylactic antibiotic treatment in obstetrics: comparison of regimens
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):509-515
04-09-1998DOI 10.1590/S0100-72031998000900004
Views65Purpose: to evaluate the efficacy of four antibiotic regimens in puerperal infection prophylaxis. Patients and Methods: According to vaginal or abdominal delivery and risk the presence or not of factors for puerperal infection, the patients were allocated to groups of low, medium and high risk for its development. Between March 1994 and June 1997 2,263 patients were evaluated. Results: the incidence of puerperal infection was different in each group. It was 3.1% in the low risk group, where no antibiotic was given, and 8.5% in the high risk group where all patients received three doses of 1 g EV cefalotin at six-hour intervals. In the medium risk group, the incidence of puerperal infection was 5.3% for the patients who used three doses of 1 g EV cefoxitin; 5.1% for those who used three doses of 1 g EV cefalotin; 4.0% when a single cefoxitin dose was used and 3.4% when a single cefalotin dose was used. Conclusions: it is not necessary to use prophylactic antibiotic therapy in low risk patients and the first generation cephalosporins (cefalotin) are as efficacious as the second generation cephalosporins (cefoxitin) to prevent puerperal infection, independent of the applied dosage. Cefalotin seems to be effective in preventing puerperal infection in patients at high risk.
Key-words Antibiotic prophylaxisCesarean sectionDelivery, vaginalPuerperal infectionRupture of membranes, prematureSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Ampicillin prophylaxis in premature rupture of membranes: randomized and double-blind study
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
08-07-1999
Summary
Trabalhos OriginaisAmpicillin prophylaxis in premature rupture of membranes: randomized and double-blind study
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
08-07-1999DOI 10.1590/S0100-72031999000500002
Views45See morePurpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
Views45This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisAmpicillin prophylaxis in premature rupture of membranes: randomized and double-blind study
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):251-258
08-07-1999DOI 10.1590/S0100-72031999000500002
Views45See morePurpose: to evaluate whether prophylactic use of ampicillin could avoid or reduce maternal and perinatal infectious morbidity caused by premature rupture of membranes (PROM), and to extend the gestation period in those women. Methods: this was a prospective, randomized and double-blind study, carried out evaluating 121 pregnant women with PROM, randomized into two study groups. The treatment group (61 patients) received ampicillin and the control group (60 patients) received placebo. The placebo had the same characteristics as ampicillin (kind of packaging and color of the capsules) and was used in the same time regimen. The considered parameters for maternal infection were febrile morbidity (fever index), and the presence of chorioamnionitis and/or endometritis. The studied neonatal parameters were Apgar score (1st and 5th minutes), bacterial colonization of auditory canal, and blood culture. The statistical tests performed were Fisher's exact test, Wilcoxon, and chi². Results: it was observed that ampicillin did not prolong the gestation, nor did it reduce the postpartum febrile morbidity or the rates of chorioamnionitis and/or endometritis. Ampicillin did not reduce the perinatal infectious morbidity nor improve the birth outcomes. All these results were consistent in cases of less than 72 h PROM. The limited number of cases with time of PROM greater than 72 h did not permit statistical analysis free of type II error. Conclusions: based on these results it was possible to conclude that the prophylactic use of ampicillin by pregnant women with less than 72 h PROM did not reduce either infectious maternal or perinatal morbidity. However, the presence of group B Streptococcus agalactiae in the blood culture from a neonate in the control group showed the necessity to start antibiotic treatment of pregnant women colonized by this microorganism.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Antibiotic prophylaxis Archives - Revista Brasileira de Ginecologia e Obstetrícia
