AFJOG

ORIGINAL RESEARCH regarding the cause of cerebral palsy. This would infer that neonates who were found to have histological signs of placental infection would require follow-up to monitor long-term outcome. From the results of this study we can observe that FIRS is difficult to predict. We cannot rely on the woman’s presenting clinical picture alone to confirm the diagnosis. Whilst antibiotics may increase the latency period and decrease the incidence of chorioamnionitis, it does not eradicate intrauterine infection. 2-4 We ought to have a high index of suspicion in women who present with preterm rupture of membranes. It is of the utmost importance to find therapies to treat FIRS or to alleviate its consequences. Strategies that have been considered include IL-1RA, therapeutic hypothermia, regulation of T cells, exendin-4, MgSO4, and exercise. 4 While none of these strategies alone might totally reverse the injuries triggered by FIRS, a combination of these treatments may prevent or attenuate its consequences. Interventions may have to be individualized based on the women’s inflammation status at a given point since the efficacy of mid-trimester short-term interventions may depend on the degree of inflammation. 3, 4, 7, 10 Injury to the brain secondary to FIRS may be hard to prevent, and it would be important to examine whether neurorestorative treatments may still improve these injuries after their development The strength of our study is that we prospectively investigated the prevalence and clinical prediction of FIRS in an unselected cohort of women presenting with PROM, in a pragmatic, resource-restricted setting, with a high HIV prevalence. Standard practice in a busy delivery unit does not always allow for submission of placentas for further histopathological examination. This limitation can be overcome if examination of placentas following PROM is recommended as part of routine practice. A larger study with longitudinal follow up of the offspring of pregnancies affected with FIRS should be considered in future. CONCLUSION Preterm birth is a leading cause of neonatal death and disease globally. Up to 15% of these births are caused by preterm rupture of membranes. Our study found no correlation between the clinical presentation or neonatal outcome and FIRS. However, there is an established correlation between FIRS and cerebral palsy, neurological dysfunction and organ dysfunction. Therefore, we recommend that clinicians must have a high index of suspicion when treating women with preterm rupture of membranes, and to consider histopathological examination of the placentas in these pregnancies. We also recommend that the affected children be followed up for signs of cerebral palsy or neurological deficit in their early childhood. REFERENCES ¡ ¦ ª ¡ ¡ ª ¨ § ¹ ¦ ª ¬ ¬ ¡ ª ¡ ¡ ¡ ª ¡ § ª § ¡ ¡ § § ¦ ¦ ¡ ¡ ª ª § ¡ ¦¹ ¹ § ¡¡ ª » ¬ §¦ § § § ¨¨ ¨ ¨ ¨ ¦ ¦ £ · ª ° § ¨« « ¯ § µ § African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 29