ABSTRACT
OBJECTIVE: To find association between fetal urine
production rate (FUPR) and fetal inflammatory response syndrome (FIRS)
in cases of preterm premature rupture of membranes (PPROM).
DESIGN: Prospective cohort
SETTING: Tertiary hospital
SAMPLE: 70 pregnancies complicated by PPROM at 28-34
weeks.
METHODS: Patients were managed conservatively till 34
weeks pregnancy or until spontaneous labor/chorioamnionitis. FUPR was
calculated by doing serial fetal bladder volume measurements and was
repeated weekly till patient delivered. During delivery, cord blood
sample was taken for measuring Interleukin-6 (IL-6) levels. Placental
tissue was examined for histopathologic evidence of FIRS and
chorioamnionitis. Neonatal outcomes were noted as admission to NICU and
severe neonatal morbidity.
MAIN OUTCOME MEASURE: Measurement of FUPR antenatally
and its association with development of FIRS in neonates.
RESULTS: Overall
prevalence of FIRS in cases of PPROM was 62.86%. Mean FUPR at time of
delivery was significantly reduced in neonates with evidence of FIRS as
compared to Non FIRS group (13.89±8.06 ml/h vs 25.89±4.94ml/h). Out of
41 patients with reduced FUPR prior to delivery, 39 babies had FIRS
whereas only 5 out of 29 babies with normal FUPR, had FIRS (p value
<0.0001). The rate of adverse neonatal morbidity was
significantly high in neonates with reduced FUPR.
CONCLUSION: Reduced FUPR is strongly associated with
development of FIRS in cases of PPROM and hence can be used as an early
predictor of adverse neonatal outcomes.
FUNDING: Only institutional funds
KEYWORDS: Preterm premature rupture of membrane, fetal
urine production rate, fetal inflammatory response syndrome,
interleukein-6 levels
TWEETABLE ABSTRACT : A finding of reduced fetal urine
production rate on in utero ultrasound examination in pregnancies
complicated by preterm premature rupture of membrane is an early marker
for development of fetal inflammatory response syndrome in neonates and
is associated with adverse neonatal outcomes.