“Reduced fetal urine production rate – An early marker of fetal
inflammatory response syndrome in cases of preterm premature rupture of
membranes: A Prospective Cohort Study”
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