Perinatal outcomes of preterm premature rupture of membranes before 36 weeks of pregnancy

Abstract

The purpose - to evaluate the clinical status of newborns in women with pregnancy complicated by preterm premature rupture of membranes (pPROM) and its relationship with the course of pregnancy and childbirth, the duration of the latency period between pPROM and delivery (LP), as well as with the levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in the mother’s blood.

Materials and methods. The condition and morbidity of newborns with preterm birth due to pPROM have been carefully studied. The levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in the blood serum of 109 women with singleton pregnancy complicated by pPROM at 23-36 weeks of gestation and 20 pregnant women of the control group with intact membranes, who subsequently gave birth to full-term babies, were studied by enzyme-linked immunosorbent assay.

Results. No significant relationship between the condition of newborns and the duration of LP was found. Medical tactics of pregnancy management with pPROM led to the presence of a direct relationship between the prolongation of LP and the prevention of respiratory distress syndrome with dexamethasone/betamethasone (r=+0.36; p<0.001), tocolytic therapy with nifedipine (r=+0.30; p<0.01) against the background of antibacterial therapy. Groups of pregnant women with different duration of LP were statistically comparable in terms of gestation at the time of delivery.

The average content of vitamin 25(OH)D in the blood of pregnant women with pPROM was reduced by half (26.3±0.9 pg/ml vs. 52.9±2.4 pg/ml), and the expression level of β-defensins 2 - by 1.4 times compared to the control group (78.4±1.8 pg/ml vs. 107.4±2.6 pg/ml). It has been confirmed that the level of vitamin 25(OH)D in the blood of women with pregnancy complicated by pPROM is directly associated with the gestational age of the newborn (r=+0.22; p<0.05) and the corresponding assessments of its condition. Reliable associations of the expression level of β-defensins 2 in the mother's blood with the indicators of the course of pregnancy and perinatal period, as well as with certain characteristics of the condition of newborns were found.

Conclusions. No reliable association between the condition of newborns and the LP was found, which can be explained by the adequate tactics of managing pregnant women with pPROM. A significant decrease in the levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in blood serum of the examined pregnant women with pPROM compared to the control group was determined.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies.

No conflict of interests was declared by the authors.