Cases Of Preterm Labor Research Articles

Severe Deep Fascial Spaces Infections with Pregnancy: A Retrospective Study.

Background: Odontogenic infections are common and self-limiting in most cases, but, they can lead to severe consequences and considerable morbidity and can even be fetal in spite of modern medical therapy. Patients and Methods: Retrospective study included data of pregnant patients with deep fascial space infections, done in Oral & Maxillofacial Surgery Department, Faculty of Dentistry. Alexandria University, and Oral & Maxillofacial Surgery Department, King Fahd Specialist Hospital, Burayda, Qassim, Saudi Arabia, from June2017 to Dec2022. Data were analyzed to study incidence, etiology, pattern, treatment modalities, outcomes, complications, and effects on pregnancy. Results: Thirty-eight pregnant patients, with a mean age of 30.8 ± 6.21 years, were included. The mean age of pregnancy was 24.5 ± 4.3 weeks. Diabetes mellitus was identified in seven cases (18.42%) and combined with hypertension in one case (2.63%) and with valvular heart disease in another one. The commonest affected single space was the submandibular space that occurred in six cases (15.8%). Canine space was the second single commonly involved one which occurred in five patients (13.2%). Complications occurred in 11 patients. Unesthetic scar occurred in three patients (7.9%). Trismus was observed in two patients (5.3%). Recurrent abscess was found in one case. Complications affecting the developing fetus and considered the most serious occurred in four patients: two cases of preterm labor and two cases of abortion. Conclusion: These infections may lead to serious outcomes and may have irreversible effects on the pregnancy and the developing fetus. Urgent intervention with multidisciplinary team to provide adequate care.

Surgical management of obstructing ureteral stones during pregnancy: A systematic review of different techniques.

Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy. Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools. We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies. Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Methyl-CpG-binding protein 2 regulates CYP27A1-induced myometrial contraction during preterm labor.

Persistent and intense uterine contraction is a risk factor for preterm labor. We previously found that methyl-CpG-binding protein 2 (MeCP2), as a target of infection-related microRNA miR-212-3p, may play an inhibitory role in regulating myometrium contraction. However, the molecular mechanisms by which MeCP2 regulates myometrial contraction are still unknown. In this study, we found that MeCP2 protein expression was lower in myometrial specimens obtained from preterm labor cases, compared to those obtained from term labor cases. Herein, using RNA sequence analysis of global gene expression in human uterine smooth muscle cells (HUSMCs) following siMeCP2, we show that MeCP2 silencing caused dysregulation of the cholesterol metabolism pathway. Notably, MeCP2 silencing resulted in the upregulation of CYP27A1, the key enzyme involved in regulating cholesterol homeostasis, in HUSMCs. Methylation-specific PCR, chromatin immunoprecipitation, and dual luciferase reporter gene technology indicated that MeCP2 could bind to the methylated CYP27A1 promoter region and repress its transcription. Administration of siCYP27A1 in a lipopolysaccharide (LPS)-induced preterm labor mouse model delayed the onset of preterm labor. Human preterm myometrium and the LPS-induced preterm labor mouse model both showed lower expression of MeCP2 and increased expression of CYP27A1. These results demonstrated that aberrant upregulation of CYP27A1 induced by MeCP2 silencing is one of the mechanisms facilitating inappropriate myometrial contraction. CYP27A1 could be exploited as a novel therapeutic target for preterm birth.

Assessment of the diagnostic accuracy of eotaxin-2 as a marker for preterm prelabour rupture of membranes

Background/Aim: Preterm pre-labour rupture of the membranes could be caused by the change in local cytokines concentration due to inflammatory or infectious conditions. Cytokines, such as chemokine generated by immune cells that have been activated are the most extensive category of biochemical factors implicated in the development of preterm pre-labour rupture of the membranes (PPROM). Among this chemokine, eotaxin serves as a specific protein that attracts eosinophils. Aim of this study was to assess the diagnostic accuracy of eotaxin-2 as a marker for the diagnosis of PPROM. Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology at Bagdad Teaching Hospital, Iraq during a period of 10 months. The study sample included 90 pregnant women and was divided into three groups, the first group: 30 women with PPROM, the second group: 30 women with preterm labour and intact foetal membranes and the third group: 30 women at term pregnancy. For all women in the study blood samples were taken for measurement of eotaxin-2 at the same gestational age. Results: The eotaxin-2 level was found to be lower in cases of PPROM than in preterm labour and term cases. The sensitivity of eotaxin-2 was 83.3 %, specificity 70 % and negative predictive value 89.4 %. Conclusion: Eotaxin-2 might be considered as a marker for diagnosis of PPROM.

ПЕРИНАТАЛЬНЫЕ ИСХОДЫ У ЖЕНЩИН С ВАРИКОЗНОЙ БОЛЕЗНЬЮ В УСЛОВИЯХ ПАНДЕМИИ COVID-19

Objective. To evaluate pregnancy and labor outcomes in women with varicose veins in a COVID-19 pandemic. Material and methods. Sixty-eight pregnant women were included in the study, 38 of whom used compression stockings (main group), and 30 patients were included in the comparison group. During follow-up, 8/38 (21%) patients from the main group and 9/30 (30%) patients from the comparison group had COVID-19 infection. All patients underwent clinical, laboratory, gynecologic, and ultrasound examinations. The primary endpoints of the study were maternal complications of pregnancy and labor. Secondary endpoints were pathologic conditions and perinatal parameters related to the fetus. Results. The number of cases of preterm labor, utero-placental blood flow disorders, preeclampsia, and gestational diabetes mellitus was higher in the control group compared to the comparison group (p>0.99). Fetal distress developed in 2/30 (6.7%) observations from the comparison group of laboring women (p=0.605). The highest number of infants (70-75%) who scored 9 Apgar score at the 5th minute of life was recorded in the main group. Comparative analysis of pregnant women with mild COVID-19 and without COVID-19 found no significant effect of coronavirus infection on obstetric and perinatal outcomes. Conclusion. The results of this study confirm the information about the adverse effect of concomitant varicose veins on the outcomes of pregnancy and childbirth. These findings support the rationale for the combined use of compression and phlebotropic pharmacological therapy in pregnant women with varicose veins.

Preterm Labour Pain & Its Outcome in 50 pts attending at a Tertiary Care Hospital-ICMH

Introduction: Preterm labor is the leading cause of neonatal morbidity all over the world. Over the past two decades despite major preventive efforts, the incidence of preterm birth has remained constant at about 5-10% of live births. The etiology is often multifactorial and poorly understood. Currently preterm labour is one of the most challenging problems confronting the obstetricians and perinatologists. With this background the present study was done to find out perinatal outcome in women presenting with preterm labour. Aims To study the fetal and maternal outcome in preterm labor cases. Materials and Methods: It was Prospective, single centered, observational study. A total of 50 women with preterm labor in the study period i.e. from June 2019 to May 2020 were included for the study sample. This study carried out at the department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh. The data were collected personally through a structural questionnaire. Results: Out of 50 subjects, majority of mothers 32(64%) were in age group of 21-30 years followed by 12(24%) in age group of 20 years. Majority 26(52%) of study subjects were primigravida followed by 24(48%) multigravida. Majority 32(64%) of study subjects were in lower class followed by 15 (30%) cases in middle class, 3(6.0%) cases in affluent class. Maximum 31 (62%) cases were unbooked cases and rest 19 (38%) cases were booked. Out of 50 babies who were <2500 grams, maximum 29 (58.0%) were low birth weight followed by 11(22%) being VLBW babies. 5 cases were >2.5 kgs, which are not LBW babies according to WHO Classification of low birth weight. Majority 17 (47.2%) stayed for 1-10 days followed by 9 (25.0%) babies for 11-20 days. Also 7 (19.4%) babies stayed for 21-30 days. Conclusions: Preterm infants are at high risk of overall morbidity and mortality. Clinical suspicion, early detection and correction of risk factors, institutional delivery and good neonatal care back up facilities can improve the outcome of preterm labour and decrease the maternal complications as well. Medicine Today 2023 Vol.35 (2): 73-77

Study of Cervical Mucus Cytology and Serum Inflammatory Biomarkers in Preterm Labour Compared to Term Pregnancy Cases in a Tertiary Care Center of Western Uttar Pradesh (UP), India.

The onset of labor prior to 37 weeks of gestation is preterm labor. Incidence ranges from 5% to 7% of live births in developed countries, but higher in developing countries (10-13%). Preterm birth is a major threat in perinatal health care, as well as a risk factor for neurological impairment and disability. Considering that infection is the major risk factor for preterm labor in rural areas, this study was performed to assess the cytological changes in the cervical mucus of normal-term and preterm labor cases. A hospital-based cross-sectional observational study was conducted in the Department of Obstetrics and Gynecology at a tertiary care center in western Uttar Pradesh (UP), India. The sample size calculated was 90. The neutrophil-to-lymphocyte ratio (NLR) in cervical mucus, along with serum inflammatory biomarkers such as CRP and serum alkaline phosphatase, were compared in both groups. The incidence of preterm labor increased with an increase in parity, and progression to preterm delivery is faster in the higher parity group. C-reactive protein (CRP) (pvalue= < 0.001) and serum alkaline phosphatases (taking 220IU/L as the cutoff value), as well as the NLR (pvalue < 0.001) in cervical mucus in preterm labor, are significantly higher than those in term labor cases, which can be used to predict preterm labor. Higher levels of serum alkaline phosphatase (> 220 IU/L) and CRP positivity can be used as prognostic markers. Using a cutoff value of 5 for the NLR in the cervical mucusof preterm labor patients proved to be a highly accurate predictor (82.2%) for preterm labor diagnosis.

Association of Serum Magnesium with Preterm Labor

In recent years preterm labor is a significant obstetric concern. Alteration of basic biochemical function at cellular level is one of the etiologies of preterm labor. Several trace elements including magnesium are associated with normal cellular function. Magnesium sulfate is used as a tocolytic agent because high magnesium level causes relaxation of smooth muscle. Hypomagnesaemia leads to neuromuscular irritability leading to uterine hyperactivity which leads to cervical dilation. Therefore, this study was performed to find out the association of hypomagnesemia with preterm labor. This cross-sectional study was conducted in 100 women in labor, of them 50 were diagnosed case of preterm labor and 50 women were in labor at term attended in BSMMCH, Faridpur during July 2021 to December 2021. After overnight fasting 5ml blood sample was collected and was analyzed for serum magnesium using standard enzymatic method. Mean value of serum magnesium was compared between two groups by student unpaired t-test. A p-value was considered to be statistically significant at 0.05 at the 95% confidence interval. The mean serum magnesium was found 1.44±0.36 mg/dl in preterm labor and 2.0±0.27 mg/dl in term labor. Low serum magnesium level was significantly higher in preterm labor. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 45-48

Hypoxia-inducible factor 1 signaling drives placental aging and can provoke preterm labor.

Most cases of preterm labor have unknown cause, and the burden of preterm birth is immense. Placental aging has been proposed to promote labor onset, but specific mechanisms remain elusive. We report findings stemming from unbiased transcriptomic analysis of mouse placenta, which revealed that hypoxia-inducible factor 1 (HIF-1) stabilization is a hallmark of advanced gestational timepoints, accompanied by mitochondrial dysregulation and cellular senescence; we detected similar effects in aging human placenta. In parallel in primary mouse trophoblasts and human choriocarcinoma cells, we modeled HIF-1 induction and demonstrated resultant mitochondrial dysfunction and cellular senescence. Transcriptomic analysis revealed that HIF-1 stabilization recapitulated gene signatures observed in aged placenta. Further, conditioned media from trophoblasts following HIF-1 induction promoted contractility in immortalized uterine myocytes, suggesting a mechanism by which the aging placenta may drive the transition from uterine quiescence to contractility at the onset of labor. Finally, pharmacological induction of HIF-1 via intraperitoneal administration of dimethyloxalyl glycine (DMOG) to pregnant mice caused preterm labor. These results provide clear evidence for placental aging in normal pregnancy, and demonstrate how HIF-1 signaling in late gestation may be a causal determinant of the mitochondrial dysfunction and senescence observed within the trophoblast as well as a trigger for uterine contraction.

Hypoxia-inducible factor 1 signaling drives placental aging and can provoke preterm labor

Most cases of preterm labor have unknown cause, and the burden of preterm birth is immense. Placental aging has been proposed to promote labor onset, but specific mechanisms remain elusive. We report findings stemming from unbiased transcriptomic analysis of mouse placenta, which revealed that hypoxia-inducible factor 1 (HIF-1) stabilization is a hallmark of advanced gestational timepoints, accompanied by mitochondrial dysregulation and cellular senescence; we detected similar effects in aging human placenta. In parallel in primary mouse trophoblasts and human choriocarcinoma cells, we modeled HIF-1 induction and demonstrated resultant mitochondrial dysfunction and cellular senescence. Transcriptomic analysis revealed that HIF-1 stabilization recapitulated gene signatures observed in aged placenta. Further, conditioned media from trophoblasts following HIF-1 induction promoted contractility in immortalized uterine myocytes, suggesting a mechanism by which the aging placenta may drive the transition from uterine quiescence to contractility at the onset of labor. Finally, pharmacological induction of HIF-1 via intraperitoneal administration of dimethyloxalyl glycine (DMOG) to pregnant mice caused preterm labor. These results provide clear evidence for placental aging in normal pregnancy, and demonstrate how HIF-1 signaling in late gestation may be a causal determinant of the mitochondrial dysfunction and senescence observed within the trophoblast as well as a trigger for uterine contraction.

Prevalence of Bacterial Vaginosis in Preterm Labour and Its Fetal and Maternal Outcome

Introduction: Preterm births accounts for about 11.1 % of births worldwide. Infection accounts for 20% – 40% of these cases and Bacterial vaginosis has been found in 15 % of preterm labor group.&#x0D; Objective: To find the prevalence of Bacterial vaginosis among the cases who presented with preterm labour and to determine its maternal and neonatal outcome.&#x0D; Methodology: A prospective cross- sectional analytical study on 100 preterm labour cases conducted over a year in the obstetric ward in Manipal Teaching Hospital. Three high vaginal swabs from posterior fornix were taken and tested in Microbiology laboratory. The maternal and neonatal outcome of women with preterm labour due to bacterial vaginosis were noted. The data were analyzed using SPSS 21. Chi2 test was used for comparing maternal and neonatal complications positive or negative with Bacterial Vaginosis.&#x0D; Results: In the study period, 584 women had preterm deliveries. The total deliveries during that period was 2,531. The prevalence of Bacterial vaginosis in PTB was found to be 17 %.The accuracy of Gram stain was found to be 90% (sensitivity-57%, specificity-92%, PPV-36%, NPV-96%). The accuracy of wet mount was 90 % (sensitivity-42.85%, specificity-93.5%, PPV-33.3%, NPV95.6%). There were increased cases of chorioamnionitis among women who were BV positive (p-value=0.02). Newborn born to women with BV positive had increased chance of poor Apgar score at 5 minutes (p-value &lt;0.05).&#x0D; Conclusion: Maternal and neonatal complications were more common in women with preterm labour associated with Bacterial Vaginosis. Gram stain and wet mount are fairly accurate and can be used as an adjunct to culture for the diagnosis of Bacterial Vaginosis.

Preterm Labour Management with Glyceryl Trinitrate Patch and Isoxsuprine: A Longitudinal Study

Introduction: Nitric oxide donors in the form of nitroglycerine and β-mimetic drugs (Isoxsuprine hydrochloride) are commonly used in managing preterm labour. It is one of the most challenging obstetric complications encountered by obstetricians, as well as preterm neonates for paediatricians. Preterm labour refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of the cervix between 20 and 37 weeks of gestation. Aim: To compare the effects of transdermal Glyceryl Trinitrate (GTN) with Isoxsuprine in terms of maternal complications, perinatal outcomes, and their tocolytic effectiveness. Materials and Methods: A hospital-based longitudinal study was conducted in the Department of Obstetrics and Gynaecology at JNU Medical College and Research Centre, Jaipur, Rajasthan, India. The study duration of the study was one year, from March 2022 to February 2023. A total number of 100 cases of preterm labour were enrolled and equally divided into two groups: Groups A (GTN patch) and group B (Isoxsuprine) with a defined dosing schedule. Singleton pregnancies with intact membranes and gestational age of 26-36 weeks were included in the study, metting the diagnostic criteria for preterm labour. Both the groups received pharmacological intervention, and outcome measures such as success rate of treatment (i.e., prolongation of labour),. maternal side effects, and foetal outcomes {Neonatal Intensive Care Unit (NICU) admission and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score) were measured and evaluated. Predefined parameters and other data were tabulated in Microsoft Excel and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test was applied to identify significant differences. Results: The incidence of preterm labour was highest in the age group of 21-30 years (76% in Group A and 70% in Group B) among patients treated with nitroglycerine and isoxsuprine, respectively. The mean prolongation of pregnancy in the nitroglycerine group was 21.42 days, and in the isoxsuprine group, it was 16.22 days (p=0.042). The most common side effect in the nitroglycerine group was headache (60%), while in the isoxsuprine group, it was maternal hypotension (24%). The mean APGAR score in Group A and Group B was 8.18 and 8.06, respectively. It was observed that 24% of newborns in the nitroglycerine group and 36% in the isoxsuprine group required NICU admission. The success rate was 90% in the nitroglycerine group and 80% in the isoxsuprine group. Conclusion: Both drugs were effective in prolonging pregnancy for the first 48 hours, but nitroglycerine was found to be slightly better in terms of success rate. Nitroglycerin was more acceptable to patients with preterm labour, as it did not have to be administered through painful injections.

Retrospective Study of Neonatal Outcomes with the Use of Magnesium Sulfate in Case of Preterm Labor

The use of magnesium sulphate for pregnancy toxemia or preterm labor was not widely accepted because the majority of reports over the last decade showed magnesium disturbances in the neonate. However, its use has been increased in order to prevent uterine contractions during preterm labor, and it is now a commonly used tocolytic drug. Recently, a few studies have indicated that the use of magnesium sulfate has a neuroprotective effect on the neonate, but it has some toxic effects when used for an extended period of time. The goal of this study is to assess the neonatal outcomes of preterm births, because it is still unclear how to describe the neonatal outcomes with the use of magnesium sulphate during preterm labor. STUDY DESIGN: Retrospective observational analysis was carried out in 63 neonates to figure out the effects of magnesium sulphate who were prematurely born. The outcomes were obtained and calculated in percentage. RESULTS: Out of 565 pregnancies, 75 were found to be preterm labor cases in which 63 patients were given magnesium sulfate making an incidence of 11.15% as preterm labor and preterm birth. CONCLUSION: The neonatal outcomes with the use of magnesium sulphate were found and shown the morbidity, mortality or complications. Early Admission in NICU promoted to prevent neonatal morbidity and mortality.

Association of Single Nucleotide Polymorphisms from Angiogenesis-Related Genes, ANGPT2, TLR2 and TLR9, with Spontaneous Preterm Labor

In this study, we hypothesized that the changes localized at angiopoietin-2 (ANGPT2), granulocyte-macrophage colony-stimulating factor (CSF2), fms-related tyrosine kinase 1 (FLT1) and toll-like receptor (TLR) 2, TLR6 and TLR9 genes were associated with spontaneous preterm labor (PTL), as well as with possible genetic alterations on PTL-related coagulation. This case-control genetic association study aimed to identify single nucleotide polymorphisms (SNPs) for the aforementioned genes, which are correlated with genetic risk or protection against PTL in Polish women. The study was conducted in 320 patients treated between 2016 and 2020, including 160 women with PTL and 160 term controls in labor. We found that ANGPT2 rs3020221 AA homozygotes were significantly less common in PTL cases than in controls, especially after adjusting for activated partial thromboplastin time (APTT) and platelet (PLT) parameters. TC heterozygotes for TLR2 rs3804099 were associated with PTL after correcting for anemia, vaginal bleeding, and history of threatened miscarriage or PTL. TC and CC genotypes in TLR9 rs187084 were significantly less common in women with PTL, compared to the controls, after adjusting for bleeding and gestational diabetes. For the first time, it was shown that three polymorphisms—ANGPT2 rs3020221, TLR2 rs3804099 and TLR9 rs187084 —were significantly associated with PTL, adjusted by pregnancy development influencing factors.

The role of the placenta in spontaneous preterm labor and delivery with intact membranes.

To determine whether placental vascular pathology and impaired placental exchange due to maturational defects are involved in the etiology of spontaneous preterm labor and delivery in cases without histologic acute chorioamnionitis. This was a retrospective, observational study. Cases included pregnancies that resulted in spontaneous preterm labor and delivery (<37 weeks), whereas uncomplicated pregnancies that delivered fetuses at term (≥37-42 weeks of gestation) were selected as controls. Placental histological diagnoses were classified into three groups: lesions of maternal vascular malperfusion, lesions of fetal vascular malperfusion, and placental microvasculopathy, and the frequency of each type of lesion in cases and controls was compared. Moreover, we specifically searched for villous maturational abnormalities in cases and controls. Doppler velocimetry of the umbilical and uterine arteries were performed in a subset of patients. There were 184 cases and 2471 controls, of which 95 and 1178 had Doppler studies, respectively. The frequency of lesions of maternal vascular malperfusion was greater in the placentas of patients with preterm labor than in the control group [14.1% (26/184) vs. 8.8% (217/2471) (p=0.023)]. Disorders of villous maturation were more frequent in the group with preterm labor than in the control group: 41.1% (39/95) [delayed villous maturation in 31.6% (30/95) vs. 2.5% (13/519) in controls and accelerated villous maturation in 9.5% (9/95) vs. none in controls]. Maturational defects of placental villi were associated with approximately 41% of cases of unexplained spontaneous preterm labor and delivery without acute inflammatory lesions of the placenta and with delivery of appropriate-for-gestational-age fetuses.

Collagenase Activity of Vaginal Microbes Associated with Preterm Labour

Collagens in the cervix (type I) and chorioamniotic membranes (type I, IV) play important biomechanical roles in maintaining healthy pregnancy and undergo significant modulation during natural labour progression. However, timing is key: inappropriate remodeling of collagens can trigger premature cervical dilation, chorioamniotic membrane rupture and preterm labour. While up to 40% of preterm labour cases arise from microbial infection, the mechanisms underlying this process are not understood. Notably, select members of the vaginal microbiome have been significantly associated with preterm labour including Sneathia, Prevotella and Porphyromonas species.

Vaginal microbiome as a tool for prediction of chorioamnionitis in preterm labor: a pilot study

Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc’s classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1–V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765–0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.

Ultrasound Assessment of Fetal Adrenal Gland in Term and Preterm Labor Cases

Background: Preterm birth (PTB) remains a major cause of perinatal morbidity and mortality worldwide. Compared with term deliveries, early PTB (< 34 weeks' gestation) carries a 7-fold increased risk of neonatal death. Objective: To compare the Fetal Zone Depth (FZD) of fetal adrenal gland in term and preterm labor cases Patients and Methods: Thirty-three preterm pregnant women at 29-36 weeks of gestation with single pregnancy and clinical diagnosis of preterm labor and control group of 33 pregnant women at 37-40 weeks with term pregnancy were included in this study. FZD and Total Gland Depth (TGD) of fetal adrenal gland were ultrasonographically measured and FZD/TGD ratios were calculated and compared between the two groups. Results: No difference was found between the two groups in respect of age and number of pregnancies (P > 0.05). Yet, preterm birth history rupture of membrane, cervical dilatation and mode of delivery were higher in preterm group (P <0.05). Fetal adrenal gland FZD/TGD ratio was statistically significantly higher in preterm group compared to the term group (52% ± 5% vs. 29% ±9%; P <0.001). Conclusion: The growth in FZ as a fetal adaptation mechanism in increased fetal stress in preterm labor cases was at a significant level. Once supported by more comprehensive studies, we think that this result would be beneficial in the prediction of preterm labor in clinical practice.

Preterm Birth Is Correlated With Increased Oral Originated Microbiome in the Gut.

BackgroundPreterm birth is one of the leading causes of perinatal morbidity and mortality. Gut microbiome dysbiosis is closely related to adverse pregnancy outcomes. However, the role of the gut microbiome in the pathogenesis of preterm birth remains poorly studied.MethodWe collected fecal samples from 41 women (cases presenting with threatened preterm labor =19, 11 of which delivered preterm; gestational age-matched no-labor controls, all of which delivered at term = 22) were recruited for the study. We performed 16S rRNA amplicon sequencing to compare the composition of the gut microbiome in threatened preterm labor cases and controls and among women who delivered preterm and at term. By annotating taxonomic biomarkers with the Human Oral Microbiome Database, we observed an increased abundance of potential oral-to-gut bacteria in preterm patients.ResultsPatients with preterm birth showed a distinct gut microbiome dysbiosis compared with those who delivered at term. Opportunistic pathogens, particularly Porphyromonas, Streptococcus, Fusobacterium, and Veillonella, were enriched, whereas Coprococcus and Gemmiger were markedly depleted in the preterm group. Most of the enriched bacteria were annotated oral bacteria using the Human Oral Microbiome Database. These potential oral-to-gut bacteria were correlated with clinical parameters that reflected maternal and fetal status.ConclusionsThis study suggests that patients who deliver preterm demonstrate altered gut microbiome that may contain higher common oral bacteria.

Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series.

BackgroundCoronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes.Case presentationThis case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results.ConclusionClinical manifestations and paraclinical results were similar to non-pregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually.