MORPHOLOGICAL RESEARCH OF PLACENTA IN WOMEN WITH PRETERM LABOR

The Endothelin-Converting Enzyme-1/Endothelin-1 Pathway Plays a Critical Role in Inflammation-Associated Premature Delivery in a Mouse Model

Introduction: Urogenital infections are usually seen during pregnancy and considered as an important cause of preterm labour. Preterm labour is the one of the foremost reason of neonatal morbidity and mortality. Bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and trichomoniasis are responsible for near about 90% of cases of infectious conditions which can lead to eventually gynecological and obstetrical complications such as preterm labour, pelvic inflammatory disease, post-abortion endometritis and chorioamnionitis. Most common infection among women in preterm labour is BV. This study was conducted to find the association between urogenital infections and preterm labour and also to find out prevalence of urogenital infections in preterm and full term labour.
 Method: It was an observational study done in the Department of obstetrics and gynecology IGMC Shimla H.P. from 1st August 2017 to 31st July 2018. A total of 200 women were observed for urogenital infections and their association with preterm labour. Case Group I included 100 women with preterm labour after 24 weeks and before 37 completed weeks of gestation with or without rupture of membranes. Control Group II included 100 women at completed or more than 37 weeks of gestation with no history of preterm labour, matched to the case group with respect to age and parity. Midstream urine was sent for microscopic examination and culture sensitivity. Samples were taken for microbiological study from posterior fornix of vagina. These were studied for microscopic examinations along with Culture sensitivity by standard methods and saline wet mount for BV, VC, Tricomoniasis.
 Results: In present study, overall 18% urogenital infection was observed. Statistical analysis reveals that there was association in high vaginal swab, urine culture and both culture positivities.
 Conclusion: We concluded that in our study, urogenital infection was more common in women with preterm labour compared to those in full term labour patients group which indicates a significant association of urogenital infections in preterm labour.
 Keywords: Urogenital Infections, Bacterial Vaginosis, Vulvovaginal Candidiasis, Premature Labour

Background:Pityriasis rosea is a papulosquamous disease. It may occur during pregnancy; in this setting, it has occasionally been associated with adverse outcomes.Purpose:A woman who developed pityriasis rosea at the beginning of her eighth week of gestation is described. The outcomes in newborns delivered by pregnant women who developed pityriasis rosea during gestation are summarized.Method:A 28-year-old woman developed pityriasis rosea during her eighth week of pregnancy. Her husband had pityriasis rosea two months earlier. PubMed was searched for the following terms: conjugal, craniosynostosis, newborn, pityriasis, pregnancy, rosea, sagittal, spouse. The papers were reviewed and the references cited were evaluated.Results:Our patient delivered a healthy male infant after 41 weeks of gestation. He had normal weight, height, and Apgar scores. Isolated sagittal craniosynostosis was diagnosed and was successfully treated at nine weeks after birth without complications.Conclusion:Several retrospective studies have investigated the possibility of adverse outcomes in infants born to women who developed pityriasis rosea during pregnancy, such as stillbirth, low gestational weight, hypotonia, and premature delivery. However, there are also reports of healthy newborns in women who have had pityriasis rosea during gestation. Our patient carried the fetus one week post-term and delivered a healthy boy via C-section; isolated sagittal craniosynostosis was later diagnosed and successfully repaired. The occurrence of craniosynostosis in a woman who developed pityriasis rosea during her first trimester of pregnancy may be two coincidental events.

Perinatal morbidity associated with violence experienced by pregnant women

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Purpose: Clinical investigation into the correlation between AIWA's score and premature labor.Patients: Eight hundred and twenty‐nine (829) mothers delivered single baby at AIWA Maternity Hospital in 2000. The number of primipara (P) was 394, while that of multipara (M) was 435. We eventually analyzed 587 deliveries in 829, because the resting 238 deliveries were not fully followed up before delivery and the resting four were undertaken therapeutic premature termination. These 587 mothers had at least one time of AIWA's scoring in both 14–24 weeks of gestation and 25–32 weeks of gestation.Methods: We have been using the AIWA's score to detect and prevent premature labor for 4 years, which consists of findings of transvaginal ultrasonography (cervical length and funneling of internal os of the uterus), and internal examination (looseness of external os of the uterus and consistency of the cervix). The full score is 12, which means extremely high risk of premature labor. On the other hand, the score zero means no risk of premature labor. The patients, whose score over 8, should go into hospital to have cervical cerclage. and if multipara has histories of premature deliveries and/or threatened premature labor, P‐score (1–3) is added to AIWA's score according to the degree of the risk. Five hundred and eighty‐seven (587) deliveries were divided in four groups, including (1) over 1 week hospitalization (2) having cervical cerclage (3) premature deliveries (4) normal range deliveries (including OPD therapy and <1 week hospitalization). The distribution of AIWA's score was analyzed separately between nullipara and multipara in 14–19, 20–24, 25–28, and 29–32 weeks of gestation, respectively. In hospitalized patients, the most previous scores before hospitalization was analyzed. And, indications for prophylactic cervical cerclage before 27 weeks of gestation were: (1) nullipara and #8807; 8 (AIWA's score alone), multipara and #8807; 8 (AIWA's score + P‐score) (2) few uterine contraction with negative fetal fibronectin (3) agreements of patients and her family with informed consents. The patients with all three indications had prophylactic cervical cerclages.Conclusions: (1) The rate of prophylactic cervical cerclage was 4.5% (nullipara: 1.6%, multipara: 6.6%) in year 2000. This rate was higher than those of many other hospitals. The rate of premature labor after the prophylactic cervical cerclages was 15%, however, all cases of premature labor occurred after 36 weeks of gestation. Eighty‐eight percent (88%) of the operation was performed in 23–27 weeks, while only 12% was operated before 22 weeks of gestation. Seventy‐three percent of cases, which had prophylactic cervical cerclages, had been excellent course during pregnancy without over 1‐month hospitalization and without re‐hospitalization. (2) In the hospitalized case without cervical cerclage for premature labor, total hospitalized days had positive correlation with AIWA's score (P < 0.05). (3) The rate of premature labor and deliveries were 2.8% in nullipara before 37 weeks and 0.7% before 36 weeks, which declined than those in many other hospitals reported before. and there was no delivery before 33 weeks of gestation. (4) The success rates of prediction of premature labor with AIWA's score and #8807; 8 (P), were 48.6% (PPV) and 92.7% (NPV). Those rates seemed better than those of any other hospital reported in the past. (5) According to these four evidences, we can use AIWA's score, which is reproducible and reliable, in order to predict and prevent premature delivery.

Monocyte chemotactic protein-2 and -3 in amniotic fluid is related to microbial invasion of the amniotic fluid, intra-amniotic inflammation, and preterm delivery

To determine the incidence of preterm labour and also to determine the incidence and various cause of Morbidity and Mortality in the perinatal period. A prospective study of patients in preterm labour (delivered > 28 weeks and prior to 37 completed weeks) admitted to the obstetrics department of JSS Hospital Mysore Karnataka. Which is tertiary teaching hospital. The study was conducted between February 2012 to January 2014. Total number of deliveries during the period were 3209 out of which the number of preterm deliveries were 241 which fulfilled our study criteria. Immediately. Following delivery, the following features of baby noted like Sex, weight, APGAR score at 1 and 5-minute, immediate complications, congenital Anomaly, birth injury, gestational age, as assessed by the paediatrician based on modified Ballard scoring. Babies and mother followed up for a period of 7 days. Baby examined for the detection of any complication which were managed accordingly.During the study the various risk facters associated with preterm labour were also determined in detail and the correlation of the risk factors to antenatal care, maternal age, parity, presentation and lie, mode of delivery, indication of caesarean sections was studied in detail. So, this study we studied the behavioural pattern of the mother and baby towards preterm labour in detail. The data collected as mentioned above were analysed using appropriate statistical methods. The total number of preterm deliveries were 241 out of the total number of 3269 deliveries in the period of 2 years of the study. Therefore, the incidence of preterm labour was 7.4%. Out of which the total number of preterm spontaneous labour cases were180 (74.7%) and total number of elective preterm delivery were 61 (25.3%). The total number of mortalities during the perinatal period was 82 which accounts of perinatal mortality of 30%. Out of which the total number of stillbirths were 28 (34%) and total number of early neonatal deaths were 54 (66%).To conclude it was seen that preterm labour was associated with high occurrence of perinatal morbidity and mortality. The main causes were found due to birth asphyxia, respiratory distress syndrome and septicaemia. Preterm labour was more common in primigravida with preterm premature rupture of membrane as triggering factors. Preterm babies were born with number of physiological handicaps and thus predisposed to a large number of pathological conditions which needs anticipation and prompt treatment. Thus, timely identification of the risk factors and prompt treatment would help to bring down the incidence of preterm labour and hence its perinatal mishap. And lastly improvement of health care services and good neonatal intensive care unit are the cornerstone in the management of preterm births.

COVID-19 Prevalence and Outcomes in Postpartum Women and Newborns in a Community Hospital System

The epidemiology of threatened preterm labor: A prospective cohort study

The objective of this study was to investigate the immune mechanisms involved in preterm labor (PTL), preterm prelabor rupture of the membranes (PPROM), and normal pregnancies. The second objective was to explore immune profiles in PTL for association with early ( < 34 gestational weeks (gw)) or instant ( < 48 h) delivery.This prospective observational multi-center study included women with singleton pregnancies with PTL (n = 80) or PPROM (n = 40) before 34 gw, women with normal pregnancies scheduled for antenatal visits (n = 44), and women with normal pregnancies in active labor at term (n = 40). Plasma samples obtained at admission were analyzed for cytokine and chemokine quantification using a multiplex bead assay in order to compare the immune profiles between PTL, PPROM, and normal pregnancies.In PTL, CXCL1 and CCL17 were significantly higher compared to gestational age-matched women at antenatal visits, whereas for PPROM, CXCL1 and IL-6 were increased. Women in term labor had a more pronounced inflammatory pattern with higher levels of CXCL1, CXCL8, and IL-6 compared with PTL (p = 0.007, 0.003, and 0.013, respectively), as well as higher levels of CCL17, CXCL1 and IL-6 (all p < 0.001) compared with the women at antenatal visits. In PTL, CXCL8 was higher in women with delivery before 34 gw, whereas CXCL8, GM-CSF, and IL-6 were significantly higher in women with delivery within 48 h.To conclude, PTL and PPROM were associated with a complex pattern of inflammation, both involving Th17 (CXCL1) responses. Although further studies are needed, CXCL8, GM-CSF, and IL-6 may be potential candidates for predicting preterm birth in PTL.

Delivery occurring prior 37 weeks of gestation account to the maximum incidence of Neonatal morbidity and mortality in India. Amongst the various factors that trigger Preterm birth presence of infections in the lower reproductive tract and the female urinary tract constitute to be a common cause. Such infections release noxious toxic radicals that not only initiate premature uterine contractions but also cause damage to the amniotic membrane resulting in pre-labor rupture of the membranes. The objective of this study was to evaluate the various vaginal micro- organisms present and their antibiotic response in women presenting with preterm labor and compare them with those in women who deliver after 37 weeks of gestation.A sample size of 100 women who presented with preterm labor pains were selected and were compared with 100 women who delivered beyond 37 weeks of gestation with matched demographic and physical parameters. The study was done in Institute of Obstetrics and Gynecology, Egmore, a tertiary care institute at Chennai, South India. High vaginal swab culture sensitivity was done along with mid-stream clean catch urine culture sensitivity for women who reported with labor pains prior to 37 completed weeks of gestation. The type of micro-organisms was also compared with those of women who had term delivery. The study revealed that genital infections were twice as more common in women with preterm labor when compared with women with term delivery. It was also evident that preterm labor was more common in multiparas as against primiparas and the age group of common occurrence was around 20-25 years. High vaginal swab culture was positive 52% and urinary pathogens were demonstrated in 66% of the study group women. The risk was high in women belonging to the low socioeconomic group and in women with short inter pregnancy interval. The most common organism isolated in the vaginal tract was Staphylococcus aureus followed by E. coli and Pseudomonas and the commonpathogen in urine was E. coli. The organisms were sensitive to Linezolid, Amikacin and Vancomycin and resistant to cephalosporins and ciprofloxacin.

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.

Objectives: To describe the course of total and ionized magnesium and total calcium levels in maternal serum during low-risk pregnancies and to compare women who developed preterm labor and delivery with those who delivered at term. Methods: 209 women with low-risk pregnancies were enrolled in a prospective trial before the 18th week of gestation. No woman received oral magnesium supplementation. The ionized and total magnesium and total calcium levels in maternal serum were measured every 4–6 weeks. The data were grouped into 3 gestational periods (≤18, 19–27 and ≥28 weeks of gestation) for overall comparison and analyzed with the general linear model for repeated measurements and ANOVA. p values of < 0.05 were considered statistically significant. Results: 145 gestations were available for analysis. 27 women were hospitalized for preterm labor and in 16 of these preterm delivery occurred. Ionized and total magnesium and calcium levels were significantly lower after the 18th week of gestation than before. The cation levels in women with preterm labor and delivery did not differ from those with term delivery. Conclusion: Ionized and total magnesium and calcium levels decrease with increasing gestational age. Preterm labor and delivery do not seem to be related to changes in serum cation levels.