الفهرس 
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Abstract
Preterm prelabor rupture of membranes (PPROM) is responsible for about one third of preterm deliveries which defined as a delivery before completed 37 weeks of gestation.
Conditions leading to preterm labour:
1) Presence of maternal or fetal indications.
2) Spontaneous preterm labor with intact membranes.
3) Preterm premature rupture of the membranes (PPROM), whether vaginal labor or by caesarean section.
About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity that is due to microbial invasion of the amniotic cavity that triggers a cascade of inflammatory processes, followed by the infiltration of neutrophils in the fetal membrane, the placenta and umbilical cord. This condition is known as histologic chorioamnionitis (HCA).
Preterm births account for 75% of perinatal mortality and more than half the long-term morbidity. Although most preterm babies survive, they are at increased risk of neurodevelopmental impairments and respiratory and gastrointestinal complications.
The earlier the gestational age at which women present with preterm labor, the higher the frequency of intrauterine infection. At 21–24 weeks’ gestation, most spontaneous births are associated with histological chorioamnionitis compared with about 10% at 35-36 weeks the presence of intrauterine infection could stimulate the fetal hypothalamic-pituitary-adrenal gland axis with subsequent enlargement of the fetal adrenal glands and thus elevation of levels of fetal adrenal gland hormones. And then stress-related thymus involution is the result.
The aim of Our study is to determine whether the assessment of fetal transverse diameter of the fetal thymus in pregnancies complicated by preterm premature rupture of membranes (PPROM) is of value in the prediction of intrauterine infection.
Grouping: 50 singlton pregnent women aged 28w up to 36 w complaining of PPROM included in this study.
Multiple pregnancy, presence of congenital anomalies, any complicating factors, active labour or clinical signs of chorioamnionitis were considered among exclusion criteria.
All patients came to department of obstetrics and gynecology were subjected to full history taking,clinical examination and laboratory investivations including TLC, ESR and CRP.
Serial ultrasonographic examination and measurement of fetal thymus transverse diameter was performed. In the axial section, the fetal thymus is located in the upper mediastinum in front of the three-vessel view as an oval-shaped mass between the fetal lungs; and it is more hypoechoic compared to the surrounding tissue.
After birth assessment of neonatal health state with exclusion of neonatal sepsis was done.
Our study showed that the prediction for the presence of intrauterine infection using the thymus transverse diameter measurement (below the 5th percentile) had an accuracy = 80.39%, sensitivity = 84.09% and specificity = 57.14%. Also there was high statistical significant relation between neonatal sepsis and thymus involution.
This study concluded that fetal thymus measurements being a new noninvasive method can be used in early diagnosis of intrauterine infections among high risk patients.