title: Factors associated with delivery at or after 28 weeks gestation in women with bulging fetal membranes before 26 weeks gestation.
abstract: OBJECTIVE
  To elucidate the factors that contribute to prolonged pregnancy and promote neonate survival in women with bulging fetal membranes.
  
  
  METHODS
  A database was reviewed to identify women with singleton pregnancies who underwent amniocentesis on admission to determine amniotic fluid neutrophil elastase levels before 26 + 0 weeks gestation between July 2001 and January 2015. Following delivery, the placentas of these patients were examined for histologic chorioamnionitis.
  
  
  RESULTS
  Ninety-seven women delivered before 28 weeks gestation, and 117 women delivered at or after 28 weeks gestation. Rescue cerclage performed via the McDonald procedure (adjusted odds ratio [aOR]: 3.78; 95% confidence interval [CI]: 1.35-11.80) was associated with a higher likelihood of reaching at least 28 weeks gestation before delivery, whereas protruding membranes (aOR: 0.38; 95% CI: 0.18-0.78), elevated amniotic neutrophil elastase levels (≥0.15 μg/ml) (aOR, 0.41; 95% CI: 0.20-0.82) and elevated peripheral C-reactive protein levels (≥0.4 mg/dl) (aOR: 0.34; 95% CI: 0.180.65) were associated with a significantly reduced likelihood of reaching this gestational age before delivery. Among women who underwent rescue cerclage, amniorrhexis was associated with a negative prognosis (aOR: 0.18; 95% CI: 0.05-0.51).
  
  
  CONCLUSIONS
  Intra-amniotic inflammation, protrusion of fetal membranes and amniorrhexis are factors that may prevent pregnancy prolongation. Rescue cerclage improves pregnancy outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ito
authors.affiliation: a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Maseki
authors.affiliation: a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan.
authors.forename: Sayako
authors.initials: S
authors.lastname: Ikeda
authors.affiliation: a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Tezuka
authors.affiliation: a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Kuribayashi
authors.affiliation: a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Furuhashi
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D023802:Cerclage, Cervical; D002821:Chorioamnionitis; D036861:Delivery, Obstetric; D005321:Extraembryonic Membranes; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D019272:Leukocyte Elastase / Q000032:analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D002581:Uterine Cervical Incompetence / Q000175:diagnosis* / Q000601:surgery
chemical_list: D002097:C-Reactive Protein; D019272:Leukocyte Elastase
keywords: Amniotic fluid; bulging fetal membranes; chorioamnionitis; neutrophil elastase; rescue cerclage