Objective: To evaluate the predictive value of maternal neutrophil-to-lymphocyte ratio (NLR) for spontaneous delivery within 24 hours in women with preterm premature rupture of membranes (PPROM). Study Design and setting: Retrospective cohort study in a single, university-affiliated tertiary medical center. Population: Women with PPROM at <33+6 weeks’ gestation planning vaginal delivery. Exclusions included cases of labor induction or cesarean delivery. Main outcome measure: Women who delivered spontaneously within 24 hours from rupture of membrane Methods: Maternal demographic and clinical data, including age, gestational age, body mass index, parity, and mode of conception, were collected. Women who delivered spontaneously within 24 hours of membrane rupture were compared to those who did not via univariate and multivariate Cox analyses.   Results:  Among 145,833 deliveries during the study period, 1,442 women (0.9%) presented with PPROM. After exclusions, 249 women were included, with 115 (46.2%) delivering spontaneously within 24 hours. Cox regression analysis identified NLR >10 (HR = 2.86, 95% CI 1.42–5.7, p = 0.003) and multiple gestation (HR = 5.87, 95% CI 2.57–13.45, p < 0.001) as independent risk factors for spontaneous delivery within 24 hours. Conclusion: An elevated maternal NLR is a promising predictor of spontaneous delivery within 24 hours in PPROM cases. These findings support the potential of NLR as a practical clinical tool for anticipating imminent preterm delivery, aiding in management decisions for this population. Funding: None.

Objective: To identify the clinical characteristics of pregnancy associated group A streptococcus (GAS) infection and predictors for intensive care unit (ICU) admission. Design: A retrospective cohort study of culture-proven pregnancy-related GAS infections. Setting and population: a tertiary university-affiliated hospital between 1/2008-7/2020. Methods: Review patient’s electronic records of patients. Main outcome measures: Incidence of pregnancy associated GAS, proportion given prophylaxis and admission to ICU. Results: Of the 143,750 who delivered during the study period, 66 (0.04%) were diagnosed as having a pregnancy associated GAS infection. Fifty-seven of them (86.3%) presented postpartum, and nine (13.6%) had septic abortions. The most common presenting signs and symptoms among puerperal GAS, were postpartum pyrexia (72%), abdominal pain and/or tenderness (33%), and tachycardia (>100 bpm, 22%). Thirteen women (19.6%) developed streptococcal toxic shock syndrome (STSS): 10 of them delivered vaginally, two had caesarean deliveries. Predictors for STSS and ICU admission were: antibiotic administration >24 hours from presentation postpartum, tachycardia, and a C-reactive protein level >200 mg/L. Women that received antibiotic prophylaxis during labour had a significantly lower rate of STSS (0 vs 10, 22.7%; P = 0.04), as evidenced by the delayed interval from delivery to the first presentation of infection among those who received prophylaxis during labour (8 ± 4.8 vs 4.8 ± 4.2 hours, P = 0.008). Conclusion: Deferral of medical intervention >24 hours from the first registered abnormal sign had the most important impact on deterioration of women with invasive puerperal GAS. Antibiotic prophylaxis during labour in women with GAS may reduce complications

Objective: To assess the clinical significance of a low 180-minute glucose value in a 100gr oral glucose tolerance test (OGTT) and a single high abnormal value. Design: A retrospective cohort study. Setting: A single outpatient health clinic. Population: Women with one abnormal high OGTT glucose value. The study group included women with 180-minute plasma glucose levels of ≤60 mg/dl and one abnormal value in the OGTT. The control group was comprised of women with one abnormal value in the OGTT and normal 180-minute glucose value. Methods: Pregnancy related outcomes and level of glycemic control of both groups were compared. Main outcome measures: The primary outcome was glycemic control, defined as fasting blood glucose measurements>90 mg/dl or post-prandial glucose values >140 mg/dl or 120 md/dl (1-hour and 2-hour post-prandial, respectively) in>30% of the measurements. Secondary outcomes were the rate of insulin treatment and the perinatal outcome consisting of birthweight, large-for-gestational-age and polyhydramnios. Results: 301 women were included, of them, 143 in the study group and 158 in the control group. Pre-pregnancy body mass index, first trimester fasting glucose levels, previous gestational diabetes mellitus, and familial diabetes were similar for both groups. Suboptimal glycemic control was more prevalent among the women in the study group (14% vs. 5.1%, respectively, P=0.01). The need for insulin treatment was similar in both groups (9.8% vs. 4.4%, P=.1). Conclusion: Women with one abnormal value and a 180-minute hypoglycemia in the OGTT are at increased risk for suboptimal glycemic control.