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.