Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate

• Published in: American journal of obstetrics and gynecology 1997-02, Vol.176 (2), p.275-281
• Main Authors: Verma, Uma, Tejani, Nergesh, Klein, Susan, Reale, Mario R., Beneck, Debra, Figueroa, Reinaldo, Visintainer, Paul
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - epidemiology; Cerebral Ventricles - diagnostic imaging; chorioamnionitis; Delivery. Postpartum. Lactation; Disorders; Female; Fetal Membranes, Premature Rupture; Gynecology. Andrology. Obstetrics; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Labor, Induced; Leukomalacia, Periventricular - diagnostic imaging; Leukomalacia, Periventricular - epidemiology; Medical sciences; neurologic injury; Obstetric Labor, Premature; Pregnancy; premature rupture of membranes; preterm labor; Ultrasonography
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(97)70485-X

OBJECTIVE: Neonatal intraventricular hemorrhage and periventricular leukomalacia have a strong correlation with eventual neurologic deficit. Our objective was to correlate obstetric factors with the development of these lesions. STUDY DESIGN: Seven hundred forty-five consecutive inborn neonates with birth weights from 500 to 1750 gm were divided into three clinical groups: premature rupture of membranes, refractory preterm labor with intact membranes, and delivery initiated by the physician for maternal or fetal indications. Neonatal neurosonography was performed on days 3 and 7 of life and results were described as normal or abnormal. Abnormal scans included intraventricular hemorrhage seen within 3 days and echodense or echolucent periventricular leukomalacia seen within 7 days of life. Major abnormalities included intraventricular hemorrhage grades 3 and 4, intraventricular hemorrhage with periventricular leukomalacia, and echolucent periventricular leukomalacia. Abnormal scans were correlated with groups of origin and clinical and histologic chorioamnionitis. RESULTS: Abnormal scans occurred in 33% of cases of premature rupture of membranes and in 38.9% of cases of preterm labor compared with 17.7% of physician-initiated cases ( p < 0.000001). Major lesions occurred in 17.6% of cases of premature rupture of membranes, 21.4% of cases of preterm labor, and 1.1% of physician-initiated cases ( p < 0.0000001). Clinical chorioamnionitis occurred in 19.7% of cases of premature rupture of membranes, 11.9% of cases of preterm labor, and 1.1% of physician-initiated cases ( p < 0.001) and was associated with a significant increase in the incidence ( p ≤ 0.005) and severity ( p ≤ 0.007) of these lesions. Histologic chorioamnionitis occurred in 59.9% of cases of premature rupture of membranes, 43.2% of cases of preterm labor, and 8% of physician-initiated cases and did not correlate significantly with the incidence or severity of abnormal scans. These findings were independent of gestational age. CONCLUSIONS: The incidence and severity of intraventricular hemorrhage and periventricular leukomalacia were significantly increased in premature rupture of membranes and preterm labor compared with the physician-initiated cases. Clinical chorioamnionitis increased the incidence and severity of these lesions.(Am J Obstet Gynecol 1997;176:275-81.)