OBJECTIVE: The purpose of this study was to evaluate which factors affect the occurrence of neonatal ultrasonographic evidence of severe cerebral lesions in the presence of intrauterine infection.STUDY DESIGN: From a cohort of 567 singleton neonates who were born between 24.0 and 31.6 weeks of gestation, we identified the 180 infants with histologic and/or clinical evidence of intrauterine infection. We excluded stillbirths and congenital anomalies. Obstetric and neonatal variables were related to evidence of severe neonatal ultrasonographic cerebral lesions with the use of logistic regression analysis.RESULTS: Severe cerebral lesions were identified in 10% of infants (18/180). After we controlled for variables that were clinically relevant, logistic regression analysis demonstrated that ultrasound evidence of severe neonatal cerebral lesions was associated independently with antenatal administration of corticosteroids (adjusted odds ratio, 0.3; 95% CI, 0.11-0.88; P = .03) and occurrence of placental abruption (adjusted odds ratio, 5.4; 95% CI, 1.4-20.7; P = .02).CONCLUSION: Antenatal administration of corticosteroids in the presence of intrauterine infection has a protective effect on the risk of ultrasonographic evidence of severe neonatal cerebral lesions.

Objective To investigate the role of pentraxin 3 (PTX3), an acute‐phase protein produced by cells of innate immunity in response to inflammatory signals, in spontaneous preterm delivery (PTD).Design Cohort study.Setting Department of Obstetrics and Gynecology of the University of Milano‐Bicocca.Population Forty‐six pregnant women with preterm rupture of membranes (n= 33) or preterm labour with intact membranes (n= 13) delivering at <34 weeks of gestation and 34 women with uncomplicated pregnancies (control group).Methods We compared plasma and vaginal PTX3 levels between study group and controls, and in women with versus women without clinical or histologic evidence of intrauterine infection using statistical analysis.Main outcome measures Peak PTX3 concentration.Results Peak PTX3 concentration in plasma samples of study group was significantly higher than that in controls (1175, 0–9630 versus 650, 0–1450 pg/ml; P= 0.0003) but not in vaginal swabs (1660, 0–6604 versus 457, 0–4649 pg/ml; P= 0.386). PTX3 levels in plasma were significantly higher in women with placenta vasculopathy compared with that in women with no placental lesions (2910, 0–9630 versus 636, 0–5692 pg/ml; P= 0.04). Peak plasma and vaginal PTX3 concentrations were not significantly different in women with versus women without intrauterine infection (1168, 0–7110 versus 845, 0–9630 pg/ml, P= 0.34 and 1975, 471–6604 versus 1919, 0–4150 pg/ml, P= 0.38, respectively).Conclusions Spontaneous PTD is associated with a significant increase of maternal plasma concentrations of PTX3. PTX3 seems to be a marker of placenta vasculopathy rather than intrauterine infection.

Neonatal necrotizing enterocolitis (NEC) is a significant neonatal morbidity particularly among preterm infants. We evaluated the role of maternal and perinatal variables in predicting this complication. We retrospectively reviewed a cohort of 882 consecutive singleton neonates born after spontaneous or iatrogenic preterm delivery at 24.0-33.6 weeks from 1993 to 2006. Excluded were stillbirths and congenital anomalies. Demographic, obstetric, neonatal and placental histology variables were evaluated in reference to the development of neonatal NEC using Chi-square, ANOVA, and logistic regression with P<0.05 considered significant. Preeclampsia (P=0.06), labor (P=0.05), and cesarean delivery (P=0.06) were more frequent obstetric antecedents of NEC. Neonates with NEC (n=27, 3%) were born at an earlier gestational age (P<0.001), had lower umbilical cord pH (P=0.001), a lower weight at delivery (P<0.001), and more frequently intrauterine growth restriction (IUGR) (47% vs 27%, P=0.003) than babies without NEC (n=855). Logistic regression analysis demonstrated that NEC was independently associated with occurrence of IUGR (P= 0.03, OR 3.5; 95 CI 1.1, 8.2), lower gestational age at delivery (P<0.001, OR 0.61; 95% CI 0.48, 0.75), and lower umbilical cord pH (P=0.005, OR 0.01; 95% CI 0.00, 0.20). Neonates with NEC had higher rates of severe complications, including sepsis (33% vs 7%, P<0.001) and death (40% vs 8%, p<0.001) The only prenatal predictors of NEC among preterm infants are lower gestational age, diagnosis of IUGR, and acidemia, suggesting a vulnerability of the bowel related to immaturity or ischemia.

Intrauterine infection (II) is a risk factor for cerebral lesions (CL), and part of the damage seems to be attributed to the immune fetal response. We have evaluated which factor have an effect on neonatal ultrasonographic (US) evidence of CL in the presence of histological or clinical evidence of II. From a cohort of 567 consecutive singleton neonates born after preterm delivery at 24.0-31.6 weeks from 1/1993 to 12/2006 we selected 180 infants with histological and/or clinical evidence of II. Obstetric (gestational age, pregnancy complications, use of steroids and antibiotic, fetal distress, mode of delivery) and neonatal (sex, weight, Apgar score, pH, neonatal complications) were evaluated in reference to evidence of neonatal severe US CL, defined as IVH grade 3-4 and/or PVL. Excluded were stillbirths and congenital anomalies. Logistic regression analysis was used to control for confounders with P<0.05 considered significant. Table 1 Logistic regression analysis demonstrated that evidence of neonatal severe US CL is independently associated with antenatal administration of corticosteroids (OR =0.3, 95% CI 0.11, 0.88, P=0.03) and occurrence of abruptio placentae (OR =5.4, 95% CI 1.4, 20.7, P=0.02)Tabled 1VARIABLESevere US CL yes (N = 18)Severe US CL no (N = 162)p-valuePROM7 (39%)79 (43.4%)0.46Abruptio Placentae4 (22.2%)10 (6.2%)0.03Cesarean Delivery7 (39%)76 (47%)0.62Antibiotic16 (89%)140 (86.4%)1Steroids7 (39%)104 (64.2%)0.04GA at delivery27.9 (2.5)28.0 (2.4)0.93RDS11 (61%)84 (46.6%)0.62Sepsis3 (16.6%)26 (14.4%)1 Open table in a new tab Antenatal administration of steroids in the presence of II is independently associated with a lower risk of US evidence of severe CL in the neonate.

OBJECTIVE:The purpose of this study was to investigate the significance of preterm acidosis and its risk factors.STUDY DESIGN:From a cohort of 786 consecutive singleton neonates who were born after spontaneous or iatrogenic preterm delivery at 24.0-33.6 weeks of gestation from January 1993 to December 2005 with an evaluation of umbilical artery pH at delivery, we extracted demographic, obstetric, neonatal, and placental histologic variables and related them to umbilical artery evidence of fetal acidemia, which was defined as pH <7.10. Excluded were stillbirths and neonates with major congenital anomalies. Fetal distress was defined as nonreassuring fetal hearth rate tracing or biophysical profile or appearance of thick meconium at delivery. Statistical analysis included 1-way analysis of variance and logistic regression with a probability value of <.05 considered significant.RESULTS:Neonates with umbilical cord evidence of acidosis (n = 34) were born more frequently after abruption (P < .001), fetal distress (P < .001), and by cesarean delivery (P < .04) and were born less frequently after a complete course of corticosteroids (P = .03) and labor (P = .05) than nonacidotic babies (n = 752). Acute inflammatory lesions at placental histologic evaluation were less frequent (P = .049), and placental vascular lesions were more common in acidotic than in nonacidotic preterm neonates (P = .039). Logistic regression analysis demonstrated that cord acidosis was associated independently with the occurrence of abruptio placentae (odds ratio, 7.3; 95% CI, 2.9, 18.8), fetal distress (odds ratio, 12.0; 95% CI, 4.9, 18.3), and vascular placental lesions (odds ratio, 2.8; 95% CI, 1.2, 6.8)CONCLUSION:In preterm infants, umbilical artery acidosis is significantly more common in the presence of placental abruption, fetal distress, and histologic evidence of placental vascular disease.

To evaluate whether in preterm infants, cases of low Apgar scores associated with acidosis have distinguishing characteristics compared with those without acidosis. From a cohort of 653 consecutive singleton neonates born after spontaneous or iatrogenic preterm delivery at 24.0-33.6 weeks from 1/1993 to 12/2002 we selected those with 5-minute Apgar score <7. Demographic, obstetric (gestational age, pregnancy complications, mode of delivery), neonatal (sex, weight, unfavorable outcome) and placental histology variables were evaluated in reference to umbilical artery evidence of fetal acidemia, defined as pH <7.10. Excluded were stillbirths and congenital anomalies. Statistical analysis included Spearman's correlation, Fisher's exact test and Student t-test with P<0.05 considered significant. We observed a significant correlation between Apgar score at 5 minutes and pH of umbilical artery (R = 0.5356, p<0.001). A 5-minute Apgar score <7 was recorded in 70/653 (10.7%) infants born at <34 weeks, and 13 of them (19%) had umbilical artery gas analysis suggestive of acidosis. Acidotic babies differed from non-acidotic babies with low 5-minute Apgar score in rates of indicated prematurity (69% vs 31%, P=0.02) and presence of vascular placental lesions (69% vs 29%, P=0.02) but not in rates of obstetric complications, labor, delivery, and neonatal characteristics and complications. Preterm deliveries at <34 weeks with 5-minute Apgar scores <7 are at increased risk for acidosis if prematurity is obstetrically indicated and placenta pathology shows evidence of vascular lesions.

Objective: The purpose of this study was to assess whether the duration of labor has any effect on the occurrence of cerebral white-matter damage in very preterm infants who are delivered in the presence of intrauterine infection.Study design: From a cohort of infants who were born spontaneously at < 32 weeks of gestation for whom placental information was available and who survived 7 days from birth, 126 infants had clinical, laboratory, or histologic evidence of intrauterine infection. Among them, variables were compared between those infants with white-matter damage (defined as intraventricular hemorrhage grade 3 plus, periventricular leukomalacia, or ventriculomegaly not associated with hydrocephaly [n = 13]) and those infants without it (n = 113). Comparisons were made with t test, chi-squared test, and survival analysis; a probability value of <.05 was considered significant.Results: There were no differences between the 2 groups in gestational age at delivery and rates of labor or cesarean delivery. Duration of active labor (66 +/- 45 minutes vs 88 +/- 75 minutes; P = .49) and of clinical chorioamnionitis (310 +/- 186 minutes vs 529 +/- 544 minutes; P =.44) were similar in cases with and without neonatal white-matter damage.Conclusion: In 126 infants who were born at < 32 weeks of gestation with intrauterine infection, we found no correlation between the duration of labor or clinical chorioamnionitis and neonatal white-matter damage. (C) 2005 Mosby, Inc. All rights reserved.

Objective: Gestational age at delivery and spontaneous prematurity are independent risk factors for white matter damage (WMD). However, among infants delivered spontaneously after preterm premature rupture of membranes (PPROM), latency of PPROM has been inconsistently correlated with risk of WMD. We have explored whether gestational age at membrane rupture is independently associated with WMD.Study design: Using a cohort of 196 liveborn singleton nonanomalous neonates born at 24.0 to 33.6 weeks from January 1993 to December 2002 after pPROM and who survived 7 days, we compared the characteristics of those who developed WMD (n = 15) with those who did not (n = 181) using Fisher exact test, Student t test, and logistic regression analysis, with a 2-tailed P <.05 or odds ratio (OR) with 95% CI not inclusive of the unity considered significant.Results: Stepwise logistic regression analysis demonstrated that gestational age at PPROM (P <.001, OR 0.79) was significantly associated with WMD. The association was independent of corticosteroid administration (P = .016), latency interval (P =.69), gestational age at delivery (P =.99), and birth weight (P =.62).Conclusion: Among premature infants born at <34 weeks after pPROM, gestational age at diagnosis is independently associated with WMD. (C) 2005 Mosby, Inc. All rights reserved.

In women with very preterm premature rupture of membranes (PROM), steroids have a protective effect against the occurrence of white matter damage (WMD). However, the effect of steroids is affected by gestational age at PROM. We investigated whether gestational age at steroid administration and interval between steroids and delivery also affect the occurrence of WMD. From a cohort of 659 consecutive singletons born at 24.0-33.6 weeks, we extracted the obstetric and histologic placental variables of those with PROM who underwent at least one full course of steroids (n = 130). Gestational age at PROM, at first and last course of steroids, and interval from last course and delivery were compared between those who developed WMD (n = 8) and those who did not (n = 122) using Fisher´s exact test and Mann-Whitney U test with P <0.05 considered significant. WMD was defined as intraventricular hemorrhage grade 3 plus, periventricular leukomalacia, or ventriculomegaly without hydrocephaly. Gestational age at PROM (22.5 vs 27.2 weeks, P<0.01) was significantly different between those who developed WMD and those who did not, whereas gestational age at delivery (29.1 vs 30.1 weeks, P = 0.2), at first course of steroids (26.6 vs 28.0 weeks, P equals; 0.2), at last course of steroids (27.6 vs 29.0 weeks, P = 0.2), and interval from last course and delivery (10.1 vs 9.9 days, P = 0.9) were not significantly different. All patients received antibiotic prophylaxis. Rates of clinical and histological chorioamnionitis did not differ between the two groups (2/8 vs 21/122, P = 0.63 and 4/8 vs 41/101 placentas available, p = 0.71, respectively). In very preterm PROM, the beneficial effect of steroids on occurrence of WMD is not related to gestational age at steroid administration or interval between last course of steroids and delivery.

OBJECTIVE:Assessment of amniotic fluid volume in association with a non-stress test is a commonly used method to monitor fetal well-being in high-risk pregnancies. The aims of our study were to determine whether oligohydramnios and the trend in amniotic fluid volume have prognostic significance in low-risk pregnancies between 40.0 and 41.6 weeks' gestation.METHODS:Between January 1997 and December 2000, all uncomplicated gestations with a singleton non-anomalous fetus reaching 40.0 weeks' gestation underwent semi-weekly monitoring of amniotic fluid index (AFI) until delivery. Oligohydramnios was defined as an AFI of < or = 5 cm. Changes in AFI were expressed as centimeters per day, and were calculated as: [(last AFI before delivery minus first AFI at 40.0 weeks) / interval in days between the two scans]. Adverse outcome was considered the occurrence of 5-min Apgar score < 7; umbilical artery pH < 7.0; Cesarean section for fetal distress; or fetal death. Comparisons between the groups with favorable and adverse outcomes was performed with chi(2) or Fisher's exact test for categorical variables, and Student's t test for continuous variables. A two-tailed p value < 0.05 was considered significant.RESULTS:A total of 3050 women met the study criteria, and underwent a median number of two (range 1-7) sonographic assessments of AFI after 40.0 weeks, with oligohydramnios detected in 341 women. In 1466 women at least two serial AFI determinations were obtained, allowing computation of an AFI trend. Gestations resulting in adverse perinatal outcome (n = 167, 5.5%) had a significantly higher rate of oligohydramnios (33/167, 19.8% vs. 308/2883, 10.7%, p = 0.001), but a similar rate of reduction in AFI ( -0.65 +/- 0.64 vs. - 0.66 +/- 0.66 cm/day; p = 0.85) than those with favorable outcome. The difference in rate of reduction of AFI between the two groups was not significant, even in the subset of gestations that developed oligohydramnios ( -1.08 +/- 0.87 vs. -1.26 +/- 0.89 cm/day; p = 0.27).CONCLUSION:A sonographic diagnosis of oligohydramnios carries an increased risk of adverse perinatal outcome, even in low-risk pregnancies after 40 weeks. The trend in amniotic fluid volume reduction does not seem to have prognostic significance.

Objective To compare the efficacy of S-adenosyl-L-methionine and ursodeoxycholic acid in improving serum biochemical abnormalities in gestational cholestasis.Design Randomised clinical trial.Setting University hospital.Population All women at <36 weeks of gestation with severe gestational cholestasis during June 1996 to December 2001.Methods Enrolled women were randomly assigned oral S-adenosyl-L-methionine 500 mg twice daily or oral ursodeoxycholic acid 300 mg twice daily until delivery.Main outcome measures Reduction in the concentration of serum bile acids. Other variables considered included obstetric and neonatal outcome, clinical symptoms and other laboratory measurements (serum levels of transaminases and bilirubin). The two groups were compared using Student's t test, Wilcoxon's signed rank sum test and Fisher's exact test, with a two-tailed P < 0.05 being considered significant.Results Of the 46 women enrolled, 24 received ursodeoxycholic acid and 22 S-adenosyl-L-methionine. At enrolment, gestational age, duration of therapy, rate of nulliparity, pruritus score and biochemical characteristics were similar between the groups. Both therapies significantly and equally improved pruritus. Women receiving ursodeoxycholic acid had a significantly greater improvement in the concentration of serum bile acids (P = 0.001), aspartate aminotransferase (P = 0.01), alanine aminotransferase (<0.001) and bilirubin (P = 0.002) compared with those receiving S-adenosyl-L-methionine. Duration of therapy was significantly greater in women receiving ursodeoxycholic acid compared with S-adenosyl-L-methionine (P = 0.04), whereas gestational age at delivery and rate of prematurity were similar in the two groups.Conclusions In women with intrahepatic cholestasis of pregnancy, ursodeoxycholic acid is more effective than S-adenosyl-L-methionine at improving the concentration of serum bile acids and other tests of liver function, whereas both therapies are equally effective at improving pruritus.

OBJECTIVE:We sought to evaluate whether serial amnioinfusions for persistent oligohydramnios can affect the perinatal and long-term outcomes in extreme cases of preterm premature rupture of membranes. STUDY DESIGN:All singleton pregnancies with preterm premature rupture of membranes at <26 weeks'gestation and lasting >4 days between January 1991 and December 2001 were included. Amniotic fluid volume was assessed as the maximum cord-free pocket with serial ultrasonographic examinations. Consenting women with persistent (>4 days) oligohydramnios (amniotic fluid=2 cm) received serial transabdominal amnioinfusions to maintain an amniotic fluid pocket >2 cm. The pregnancy, neonatal, and long-term neurologic outcomes of the cases that spontaneously maintained a median amniotic fluid pocket >2 cm were compared with those of women with oligohydramnios who underwent amnioinfusion but continued to have persistent oligohydramnios and with those of women in whom oligohydramnios was alleviated. Statistical analysis included the Wilcoxon rank-sum test and the Fisher exact test with a 2-tailed P<0.05 considered significant. Stepwise logistic regression analysis with the Nagelkerke adaptation of the Cox-Snell R2 was performed to assess prenatal predictors of survival in the persistent ologohydramnios group. RESULTS:Among the 49 women included in the study, 13 (26.5%) did not have oligohydramnios, the neonatal survival rate was 92%, and normal fetal lung development and neurologic outcome were achieved in all survivors. The remaining 36 women had oligohydramnios, and all underwent serial amnioinfusions, which successfully restored a median amniotic fluid pocket >2 cm for =48 hours in 11 (30%) patients. This successful amnioinfusion group was comparable with the persistent oligohydramnios group (n=25) in gestational age at first amnioinfusion (median, 20.2 weeks; range, 16-25.6 weeks; vs median, 20.3 weeks; range, 16.5-24.2 weeks; P=.4), number of amnioinfusions (median, 3; range, 1-9; vs median, 3; range, 1-5; P=.4), and interval between amnioinfusions (median, 6 days; range, 4-14 days; vs median, 8 days; range, 6-43 days; P=.1). However, patients in the persistent oligohydramnios group had a significantly shorter interval to delivery, lower neonatal survival (20%), and higher rates of pulmonary hypoplasia (62%) and abnormal neurologic outcomes (60%) than the patients in the groups in which amnioinfusion was not necessary or was successful (all P=.01). Logistic regression analysis demonstrated that after taking into consideration successful amnioinfusion (P=0.019) and administration of steroids (P=0.022), none of the other variables, including gestational age at delivery, contributed significantly to the prediction of perinatal survival in the persistent oligohydramnios group. CONCLUSION:Pregnancies with preterm premature rupture of membranes-related oligohydramnios at <26 weeks' gestation in which serial amnioinfusions successfully alleviate oligohydramnios have a perinatal outcome that is significantly better than the outcome in those with persistent oligohydramnios and is comparable with gestations with preterm premature rupture of membranes in which oligohydramnios never develops. In the persistent oligohydramnios group, successful procedures and prenatal administration of corticosteroids are the only independent predictors of perinatal survival.

PTX-3 is a non-redundant acute-phase protein produced by macrophages and monocytes, among other cells, in response to primary inflammatory signals, including interleukin-1, tumor necrosis factor, and lipopolysaccharide. We have made the novel observation that serum and vaginal concentrations of PTX-3 are elevated in women with preterm labor or PROM, two conditions in which activation of inflammatory signals due to infection play an important role. We have thus evaluated whether PTX3 is a marker of infectious outcome. From 12/2002 to 6/2004 we have serially assessed the serum and vaginal concentrations of PTX3 in consecutive patients with preterm PROM (n = 27) or preterm labor with intact membranes (n = 13). Concentration of PTX3 was determined by use of immunoassays. We compared the last PTX3 concentrations in patients with vs without clinical or histologic evidence of intra-uterine infection using Wilcoxon rank-sum test, with P < 0.05 considered significant. Mean gestational age at delivery was 31.2 weeks (range 22.6-33.6). The interval between last sampling and delivery was 1.5 (0-7) and 1 (0-9) days in the group with vs without intrauterine infection, respectively. Median (range) serum PTX3 concentrations at the last sampling before delivery were not significantly different in the two groups [702 (0-9630) vs 599 (0-2970) pg/ml respectively, P = .88]. Similarly, median (range) vaginal PTX3 concentrations were not significantly higher among women with intrauterine infection that in those without [523 (0-6604) vs 1520 (0-3160) pg/ml respectively, P = .44]. Although PTX-3 is elevated in maternal serum and vaginal concentrations of women with PTL or PROM, it does not signal intrauterine infection. Given that PTX3 also suppresses neovascularization and enhances tissue factor activity, we hypothesize that PTX-3 elevations in PTL and PROM may be related to clotting activation.

OBJECTIVE: Gestational age at delivery and spontaneous prematurity are independent risk factors for white matter damage (WMD).However, among infants delivered spontaneously after PROM, latency of PROM has been inconsistently correlated with risk of WMD.Because latency of PROM is related to gestational age at membrane rupture, we evaluated whether duration of membrane rupture independently predicts risk of WMD.STUDY DESIGN: From a cohort of 659 consecutive singleton neonates born at 24.0 -33.6 weeks from 1/1993 to 12/2002, we extracted the obstetric and histopathologic placental variables of those with PROM (n = 196), and compared those who developed WMD (n = 15) with those who did not (n = 181).WMD was defined as intraventricular hemorrhage grade 3 plus, periventricular leucomalacia, or ventriculomegaly not associated with hydrocephaly.Excluded were stillbirths, infants with congenital anomalies and neonates who died before 7 days.Statistical analysis included Fisher's exact test, Student t-test, and unconditional logistic regression analysis, with a twotailed P !0.05 or odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant.RESULTS: We observed a significantly lower gestational age at PROM, gestational age at delivery and birth weight, and a longer latency between PROM and delivery in those with WMD.Unconditional logistic regression analysis demonstrated that only gestational age at PROM (P !.001,OR = .79)and prenatal steroids (P = .016,OR = .19)were significantly associated with WMD, whereas latency interval (P = .69),gestational age at delivery (P = .99),and birth weight (P = .62)were not.Similar results were obtained when we used stepwise logistic regression analysis in which the variables approaching significance at univariate analysis were entered in the chronological order in which they normally occur.CONCLUSION: Among premature infants born at ! 34 weeks after PROM, gestational age at PROM and lack of prenatal administration of steroids are the only predictors of WMD.

PTX-3 is a non-redundant acute-phase protein produced by macrophages and endothelial cells which plays a key role in thrombosis and inflammation. We have observed that serum and vaginal concentrations of PTX-3 are elevated in women with preterm labor or PROM. Because corticosteroids have a known antiinflammatory role, we have assessed the effects of corticosteroid therapy on serum and vaginal PTX3 concentrations in patients with preterm labor or premature rupture of membranes (PROM). We compared serial serum and vaginal concentrations of PTX3 in patients with PROM or preterm labor with intact membranes before and after corticosteroid therapy (betamethasone 12 mg I.M. daily × 2 doses) to enhance fetal lung maturity. Concentration of PTX3 was determined by use of immunoassays. Paired Student's t test test was used for statistical analysis with P < .05 considered significant. The paired measurements of PTX3 were obtained in 10 women. Median (range) gestational age at initial testing was 31.6 (21.6-33.2) weeks and the median interval between the two paired tests was 10.7 days (range 2-24). Corticosteroid therapy was associated with a non-significant decrease in serum (577 [0-7710] vs 545 [0-1520] pg/mL, P = .2) concentrations of PTX3. In contrast, vaginal concentrations of PTX3 were significantly reduced by corticosteroid therapy (2240 [0-6530] vs 525 [0-2210] pg/mL, [P = .01]). Corticosteroid therapy decreases significantly vaginal PTX3 concentrations without affecting serum PTX3 levels.

OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricular leukomalacia are characterized by different risk factors.METHODS: In a cohort of 653 consecutive singleton neonates born after preterm membrane rupture, spontaneous preterm labor, or indicated preterm delivery at 24 to 33 weeks of gestation from January 1, 1993, to December 31, 2002, we,evaluated the obstetric and histopathologic placental variables in reference to the development of intraventricular hemorrhage (n = 44), periventricular leukomalacia (n = 19), or no ultrasonographic cerebral lesion (n = 589). Excluded were stillbirths and congenital anomalies. Statistical analysis included Fisher exact test, Student t test, and stepwise logistic regression analysis with a 2-tailed P < .05 considered significant.RESULTS: Multivariate analysis showed that occurrence of neonatal intraventricular hemorrhage and periventricular leukomalacia were associated only with spontaneous prematurity (odds ratio = 1.9; 95% confidence interval 1.1-3.4) and gestational age at delivery in weeks (odds ratio = 0.8; 95% confidence interval 0.7-0.9). Neonates with intraventricular hemorrhage did not differ from those with periventricular leukomalacia in any obstetric or neonatal variable, but there was a higher risk of neurodevelopmental delay associated with periventricular leukomalacia.CONCLUSION: Among premature infants born at less than 34.0 weeks of gestation, intraventricular hemorrhage and periventricular leukomalacia share common clinical characteristics, with spontaneous preterm delivery and gestational age at delivery as the only independent antenatal predictors. (C) 2004 by The American College of Obstetricians and Gynecologists.

The effect of mode of delivery on the occurrence of neonatal cerebral lesions in the presence of intrauterine infection is controversial. However, it is unclear whether duration of labor has any effect on the occurrence of white matter damage (WMD) in preterm infants delivered with clinical or histologic evidence of intrauterine infection. From a cohort of 403 infant born at <32 weeks with placental information available and who survived 7 days from birth, 126 had evidence of intrauterine infection, which included clinical chorioamnionitis (defined as ≥2 of the following: temperature elevation ≥38°C, white blood cell count >15,000 cells/mm, uterine tenderness and foul-smelling vaginal discharge), histologic chorioamnionitis (defined as acute inflammatory lesions independently from their severity and extent) and early neonatal sepsis (defined as positive neonatal blood culture within 72 hours of delivery). WMD was defined as intraventricular hemorrhage grade 3 plus, periventricular leucomalacia, or ventriculomegaly not associated with hydrocephaly. Prenatal and neonatal variables were compared between cases with vs without WMD among those with intrauterine infection using T test and Chi-square, with P < .05 considered significant. Among preterm infants born with intrauterine infection, gestational age at delivery was not significantly different between those who subsequently developed WMD (n = 13) vs those who did not (n = 113) (27.6 ± 2.2 vs 28.4 ± 2.3 weeks, P = .33). Rates of labor (77% vs 85%) and cesarean section (31% vs 39%) were similar in the 2 groups. Duration of active labor (56 ± 44 vs 93 ± 113 min, P = .32) and second stage of labor (11.1 ± 11.4 vs 9.7 ± 9.3 min, P = .69) were also similar in the 2 groups. Non reassuring fetal heart rate tracing was the only prenatal variable different between WMD and non-WMD cases (30% vs 6%, P = .04). In neonates born at <32 weeks with clinical or histologic evidence of intrauterine infection, duration of labor is not correlated with risk of WMD.