Diagnosis Of Preterm Labor Research Articles

Possibilities for diagnosis and prediction of preterm labor at the present stage

Preterm birth is one of the main causes of perinatal morbidity and mortality, which does not tend to decrease in rate. The risk of death in premature babies is 2535 times higher than that of full-term babies, and stillbirths are registered 813 times more often than in timely delivery. To date, there are no effective ways to prevent preterm birth. Therefore, the timeliness of therapy, which largely determines the outcome of pregnancy in general, depends on the effectiveness of assessing the likelihood of their development. At the International Federation of Gynecology and Obstetrics (FIGO) Congress (2018), preterm birth is identified as a problem that has not yet been solved at the current stage of science and technology development. The result of the unsolved problems is a situation wherein the modern world over the past 60 years there has been no decrease in the premature birth rate, which is 9.5% of births and annually ends with the birth of 15,000,000 premature babies. The study aimed to research modern methods of diagnosis and prediction of spontaneous preterm birth. An analytical method was used in the study: a detailed systematic analysis of modern domestic and foreign literature on the diagnosis and prognosis of preterm birth. We used eLibrary, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library bibliographic databases (until August 2020). The article deals with the diagnosis and prediction of preterm birth probability, which will optimize the management of patients from the risk group and, in the future, will reduce the rate of perinatal morbidity and mortality of premature babies. Despite a significant number of researches devoted to the study of possibilities for diagnosing and predicting spontaneous preterm birth, currently, there are no methods with absolute diagnostic value. Most -existing studies indicate that when assessing the probability of preterm birth, a comprehensive approach should be preferred taking into account the results of several main and additional methods.

Diagnosis and Management of Preterm Labour

Diagnosis and Management of Preterm Labour

Different impacts of various tocolytic agents on increased risk of postoperative hemorrhage in preterm labor women undergoing Cesarean delivery: A population-based cohort study.

Tocolytic agents, commonly used for inhibiting preterm labor, pose the risk of uterine atony, leading to postpartum hemorrhage. This study elucidated the effects of different tocolytic agents on postoperative hemorrhage among women in preterm labor undergoing Cesarean delivery (CD). Data from Taiwan National Health Insurance Research Database were analyzed. The risk (adjusted hazard ratio [aHR] and 95% confidence intervals [CI]) of postoperative hemorrhage in CD women with preterm labor diagnosis using tocolytic agents (Tocolysis group) comparing to CD women not using tocolytic agents (Control group) were determined. Impacts of different tocolytic agents in this regard were also investigated. Our data revealed that the incidence (11.7% vs 2.6%, P < .001) and risk (aHR: 1.21, 95% CI: 1.12–1.31, P < .001) of postoperative hemorrhage were significantly higher in the Tocolysis group (n = 15,317) than in the Control group (n = 244,096). Ritodrine was the most frequently used tocolytic agent (80.5%), followed by combination therapy (using more than one tocolytic agents) (8.5%), magnesium sulfate (MgSO4, 4.6%), calcium channel blockers (3.8%), betamimetics other than ritodrine (1.9%), prostaglandin synthase inhibitors (0.5%), and nitrates (0.1%). Barring those using calcium channel blockers and combination therapy, the use of MgSO4 (aHR: 1.43, P = .001), betamimetics other than ritodrine (aHR: 1.71, P < .001), prostaglandin synthase inhibitors (aHR: 2.67, P < .001) and nitrates (aHR: 3.30, P = .001) was associated with higher risks of postoperative hemorrhage compared with ritodrine. In conclusion, CD women with preterm labor diagnosis using tocolytic agents exhibit an increased risk of postoperative hemorrhage and that this risk varies with the use of different tocolytic agents.

Body stalk anomaly presenting as an emergency in Ethiopia: a case report

BackgroundBody stalk anomaly is a generally lethal malformation of the thorax and/or abdomen. It is often associated with limb defects. The intrathoracic and abdominal organs lie outside the abdominal cavity. These are contained within a sac composed of amnioperitoneal membrane attached directly to the placenta. The umbilical cord may be totally absent or extremely shortened. Severe kyphoscoliosis is often present. This case is reported to highlight this rare malformation and its clinical presentation.Case presentationWe present a case of a 27-year-old primigravida Oromo woman who had been amenorrheic for 9 months. She presented with an urge to bear down of 10 hours and passage of liquor of the same duration. The patient was referred from a district primary hospital with a diagnosis of preterm labor and hand prolapse. A lower uterine segment cesarean section was performed at Jimma University Medical Center for an indication of active first stage of labor with nonreassuring fetal heart rate pattern (fetal bradycardia) and hand prolapse to effect an anomalous fetus that had only a rudimentary right lower extremity and liver and intestine found outside the abdominal cavity contained within a sac composed of transparent membrane attached directly to the placenta. The umbilical cord was very short, measuring about 7 cm. The fetus had severe scoliosis. It also had a heartbeat upon extraction, which stopped after 5 minutes of delivery. The placenta and fetal body parts together weighed 2400 g.ConclusionTermination of pregnancy is usually offered because this abnormality is generally considered lethal. If the pregnancy is continued undetected as in our patient’s case, vaginal delivery is recommended, given the highly lethal nature of this anomaly. Good prenatal screening and counseling are recommended for early detection and management.

Application of Artificial Intelligence in Early Diagnosis of Spontaneous Preterm Labor and Birth.

This study reviews the current status and future prospective of knowledge on the use of artificial intelligence for the prediction of spontaneous preterm labor and birth (“preterm birth” hereafter). The summary of review suggests that different machine learning approaches would be optimal for different types of data regarding the prediction of preterm birth: the artificial neural network, logistic regression and/or the random forest for numeric data; the support vector machine for electrohysterogram data; the recurrent neural network for text data; and the convolutional neural network for image data. The ranges of performance measures were 0.79–0.94 for accuracy, 0.22–0.97 for sensitivity, 0.86–1.00 for specificity, and 0.54–0.83 for the area under the receiver operating characteristic curve. The following maternal variables were reported to be major determinants of preterm birth: delivery and pregestational body mass index, age, parity, predelivery systolic and diastolic blood pressure, twins, below high school graduation, infant sex, prior preterm birth, progesterone medication history, upper gastrointestinal tract symptom, gastroesophageal reflux disease, Helicobacter pylori, urban region, calcium channel blocker medication history, gestational diabetes mellitus, prior cone biopsy, cervical length, myomas and adenomyosis, insurance, marriage, religion, systemic lupus erythematosus, hydroxychloroquine sulfate, and increased cerebrospinal fluid and reduced cortical folding due to impaired brain growth.

Risk Score for Prediction of Preterm Labor Inhibition Failure

Objective: To develop a risk scorecard for prediction of failure in preterm labor inhibition by selecting the most significant risk factors. Materials and Methods: Retrospective cross-sectional analytic study collected 200 medical records of pregnant women between 24⁰⸍⁷ and 33⁶⸍⁷ weeks of gestation with the diagnosis of preterm labor who received tocolytic drugs at Chonburi Hospital. The 200 data were split into train and test datasets. Seventy percent (140) were allocated for training the model. The remaining 30% (60) were for testing the model’s accuracy. The present study analyzed risk factors related to failure of preterm labor inhibition and selected those with most predictive power. Finally, a risk scorecard was developed using logistic regression. Results: The significant risk factors were age, previous preterm labor, cervical dilatation, cervical effacement, duration, and interval of uterine contraction. Models were created and tested for accuracy of prediction of failure in preterm labor inhibition. The final model achieved 90% of AUC, 89% of sensitivity, and 78% of specificity in the test dataset. These four risk factors, which are history of previous preterm labor, cervical dilatation, duration, and interval of uterine contraction, were included in the final scorecard, and ranged from 0 to100. The score of 0 means high risk and 100 means low risk of failure in preterm labor inhibition. Conclusion: The authors developed a scorecard that can accurately classify preterm labor patients into two groups, failed and successful. The model was tested and proved that it has good AUC, sensitivity, and specificity statistics. Keyword: Inhibition of preterm labor, Risk score, Tocolytic drugs

Preterm labour: an open problem in XXI century

Preterm labour (PL) is a relevant problem in maternal and child healthcare displaying a persistent trend. The risk of death is 25–35 times higher in premature infants than in normal children, whilst PL-associated stillbirth is 8–13 times more frequent over term labours. Severity of complications with prematurity is inversely proportional to the term of gestation. In general, PLs account for up to 70% of perinatal mortality. At the last FIGO Congress in 2018, PL was identified as an unsolved problem with no current treatment. Lack of scientific grounds for the PL aetiology and pathogenesis precludes practical success alike in prevention and treatment of this complication of pregnancy. In the bottom line, the past 60 years have not witnessed a global decline in the PL rate, it reaches to 9.5% of total births (with a slight variation depending on national commonwealth), and 15m premature infants are born annually. Two challenges currently face improvement of the PL perinatal outcomes: understanding the mechanism of PL and developing a strategy to render support at each stage of medical care to postpone, prevent the distress syndrome and sustain the foetus. The article tackles major issues in the diagnosis, treatment and prevention of preterm labour, aside with its impact on neonatal morbidity and mortality.

Exploratory and confirmatory analysis to investigate the presence of vaginal metabolome expression of microbial invasion of the amniotic cavity in women with preterm labor using high-performance liquid chromatography

Although the influence of microbial invasion of the amniotic cavity on the development of spontaneous preterm delivery is unquestionable, the use of an invasive procedure to diagnose the status of an infection limits its clinical translation. This study aimed to use exploratory and confirmatory analyses to investigate the presence of vaginal metabolome expression of microbial invasion of the amniotic cavity in women diagnosed as having preterm labor using high-performance liquid chromatography. In 140 women with singleton pregnancies and a diagnosis of preterm labor at <34 weeks' gestation, we analyzed vaginal amino acid concentrations using high-performance liquid chromatography. Vaginal samples were collected shortly after the amniocentesis performed at admission to rule out microbial invasion of the amniotic cavity. Data were normalized for the median of all the amino acid concentrations evaluated. Microbial invasion of the amniotic cavity was defined as a positive aerobic or anaerobic amniotic fluid culture for the presence of bacteria or yeast or Ureaplasma species or Mycoplasma hominis in the mycoplasma culture or a positive polymerase chain reaction result for 16S rRNA gene sequence. Exploratory analysis was performed in half of the sample and confirmatory analysis in the other half. We compared vaginal amino acid concentrations between women with and without microbial invasion of the amniotic cavity in both cohorts. The area under the curve with 95% confidence interval values were calculated for vaginal amino acids with significant differences. In the exploratory cohort (2014-2015), 17 of 76 women (22.3%) had microbial invasion of the amniotic cavity compared with 14 of 72 (19.4%) in the confirmatory cohort (2016-2017). In the exploratory cohort, we found significantly higher amino acid concentrations of vaginal taurine, lysine, and cysteine and significantly lower concentrations of vaginal glutamate, aspartate, and the aspartate to asparagine ratio. These significant differences were confirmed in the confirmatory cohort. The area under the curve of these vaginal amino acids to predict microbial invasion of the amniotic cavity ranged between 0.72 and 0.79, with cysteine being the amino acid with the best performance with an area under the curve of 0.79 (95% confidence interval, 0.71-0.88). We found the vaginal metabolome expression of microbial invasion of the amniotic cavity in women with preterm labor and intact membranes. These findings might open the possibility to develop noninvasive diagnostic tools of microbial invasion of the amniotic cavity with the aim of selecting women who would most likely benefit from an amniocentesis for this indication.

Disparities in Emergency Transport of Women with a Preterm Labor Diagnosis in Urban vs Rural Areas in the US.

ObjectiveThis study evaluated patterns of utilization and costs of emergency transport among women with a diagnosis of preterm labor in the US.MethodsThe IBM® Treatment Pathways® tool was used to interrogate a cohort randomly selected from the IBM’s MarketScan® dataset. Differences in costs and utilization patterns were assessed by the type of emergency transport service and geography.ResultsA cohort of 12,995 women between the ages of 16 and 45 met the inclusion criteria. About 1,029 (7.9%) of these women had evidence of emergency transport within a day of the preterm labor diagnosis. In this cohort, the median cost of emergency ground transportation was US$834; air transport had a median cost of US$22,922. Additionally, 3.1% (284) women out of a cohort of 8,728 women ages of 16 and 45 with a diagnosis of false labor required emergency transport within 7 days suggesting that they were discharged too soon.DiscussionThe prevalence of emergency transport for preterm labor in rural areas is significantly higher compared to non-rural areas. In addition, the disproportionate use of air transport in rural areas increases the costs of the preterm labor event. Moreover, disparities in both utilization rates and costs were identified for different parts of the country.

The effect of mode of delivery in twin pregnancies on the latency period between diagnosis of preterm labor and birth

Introduction The optimal mode of delivery in twin pregnancies presenting with preterm labor is controversial. Current literature regarding these cases is based on observational studies, innately prone to bias. A possibly substantial, yet hitherto unexplored, source of bias is an effect of mode of delivery on the timing of delivery. The aim of our study is to examine whether the mode of delivery affects the latency period between preterm labor (PTL) presentation and actual delivery and to assess the possible effect of latency on neonatal outcome. Material and methods A retrospective cohort study at a single tertiary center from the year 2011 to 2018. All twin pregnancies (dichorionic or monochorionic-diamniotic) between 24 and 36 weeks of gestation admitted due to PTL were included in the study. Results A total of 469 twin deliveries met the study criteria, of them, 204 delivered by cesarean section and 265 delivered vaginally. Cesarean delivery significantly decreased the chances of reaching a latency period of 1 or more days (OR = 0.53, 95% CI = 0.33–0.84), 2 or more days (OR = 0.47, 95% CI = 0.27–0.82) and 3 or more days (OR = 0.28, 95% CI = 0.09–0.9). In a regression model adjusting for gestational age at delivery, mode of delivery was not associated with neonatal morbidity or mortality. However, in a regression model adjusting for gestational age at PTL presentation, thereby accounting for differences in the latency period, cesarean delivery was found to significantly increase the risk of respiratory distress syndrome (OR = 1.62, 95% CI = 1.04–2.54). Conclusions In PTL of twin pregnancies, the latency period is significantly longer in vaginal deliveries compared to cesarean deliveries. The possibility of longer latency period in vaginal deliveries should be considered when counseling patients on the mode of delivery in preterm twin pregnancies.

Development and validation of a multivariable prediction model of spontaneous preterm delivery and microbial invasion of the amniotic cavity in women with preterm labor

Early spontaneous preterm delivery is often associated with microbial invasion of the amniotic cavity and/or intraamniotic inflammation. The objective of the study was to develop and validate clinically feasible multivariable prediction models of spontaneous delivery within 7 days and microbial invasion of the amniotic cavity in women admitted with diagnose of preterm labor and intact membranes below 34 weeks. We used data from a cohort of women admitted from 2012 to 2018 with diagnosis of preterm labor below 34 weeks who had undergone amniocentesis to rule out microbial invasion of the amniotic cavity. The main outcome was spontaneous delivery within 7 days from admission. The secondary outcome was microbial invasion of the amniotic cavity, defined by a positive culture and/or 16S ribosomal RNA gene in the amniotic fluid. The sample (n= 358) was divided into derivation (2012-2016) and validation cohorts (2017-2018). Logistic regression models using a stepwise selection of variables were developed for the outcomes evaluated. We explored as predictive variables ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, amniotic fluid glucose, and interleukin-6 (expressed as log units). Models were developed in the derivation cohort and applied to the validation cohort and diagnostic performance was calculated. The derivation cohort included 263 women and the validation cohort 95 women. One hundred five of the women (39%, 105 of 268) spontaneously delivered in the following 7 days and 68 (19%, 68 of 358) had microbial invasion of the amniotic cavity. For spontaneous delivery within 7 days after admission, 4 predictors were identified: cervical length at admission, gestational age, amniotic fluid glucose, and interleukin-6. The diagnostic performance of the model was assessed in the validation cohort using the receiver operating characteristic curve and showed an area under curve of 0.86 (95% confidence interval, 0.77-0.95) with a detection rate of spontaneous delivery within 7 days of 87%, a false-positive rate of 33%, a negative predictive value of 80%, and a negative likelihood ratio of 0.1908. For microbial invasion of the amniotic cavity, 2 independent predictors of the amniotic cavity were identified: amniotic fluid glucose and maternal C-reactive protein. The receiver operating characteristic curve and an area under curve in the validation cohort was 0.83 (95% confidence interval, 0.70-0.96) with a detection rate of 76%, a false-positive rate of 8%, a negative predictive value of 93%, and a negative likelihood ratio of 0.2591. In women with preterm labor, we propose 2 clinically feasible prediction models to classify as low vs high risk of spontaneous delivery within 7 days and of microbial invasion of the amniotic cavity. The models showed a high diagnostic performance and could be of value to optimize clinical management.

An Automatic Method for the Segmentation and Classification of Imminent Labor Contraction From Electrohysterograms

Preterm birth is the first cause of perinatal morbidity and mortality. Despite continuous clinical routine improvements, the preterm rate remains steady. Moreover, the specificity of the early diagnosis stays poor as many hospitalized women for preterm delivery threat finally deliver at term. In this context, the use of electrohysterograms may increase the sensitivity and the specificity of early diagnosis of preterm labor. This paper proposes a clinical application of electrohysterogram processing for the classification of patients as prone to deliver within a week or later. The approach relies on non-linear correlation analysis for the contraction bursts extraction and uses computation of various features combined with the use of Gaussian mixture models for their classification. The method is tested on a new dataset of 68 records collected on women hospitalized for preterm delivery threat. This paper presents promising results for the automatic segmentation of the contraction and a classification sensitivity, specificity, and accuracy of, respectively, 80.7%, 76.3%, and 76.2%. These results are in accordance with the gold standards but have the advantage to be non-invasive and could be performed at home. Diagnosis of imminent labor is possible by electrohysterography recording and may help in avoiding over-medication and in providing better cares to at-risk pregnant women.

Pro-inflammatory cytokine-induced microRNA-212-3p expression promotes myocyte contraction via methyl-CpG-binding protein 2: a novel mechanism for infection-related preterm parturition.

Preterm labour is a common pregnancy complication contributing to major maternal and fetal morbidity and mortality. We have found microRNA (miR)-212-3p, a potential infection-associated molecule, was significantly over-expressed during human preterm labour. However, the mechanism remains unknown. In this study, we have adopted a lipopolysaccharide (LPS)-induced Institute of Cancer Research murine preterm model to examine the role of miR-212-3p in the infection-induced preterm labour. Myometrial miR-212-3p expression was increased by nearly 4-fold in the term labour group (P = 0.10) and 12-fold (P = 0.03) in the LPS-induced preterm labour group compared with the non-labour group. In vitro cellular experiments confirmed that a series of pro-inflammatory cytokines, including interleukin (IL)1B (P = 0.02) and IL-6 (P = 0.01), rather than LPS (P = 0.08) itself could significantly upregulate miR-212-3p expression in human myometrial smooth muscle cells. Methyl-CpG-binding protein 2 (MeCP2), as a target gene of miR-212-3p confirmed by our dual luciferase assay, influenced myocyte contractility and connexin 43 expression which is an important contraction-associated protein. Therefore, we conclude that miR-212-3p may be involved in infection-induced preterm labour through MeCP2 and it is a promoting molecule and novel target for the diagnosis and treatment of preterm labour in the future.

EQUIPTT: The Evaluation of the QUiPP app for Triage and Transfer protocol for a cluster randomised trial to evaluate the impact of the QUiPP app on inappropriate management for threatened preterm labour

BackgroundAccurate diagnosis of preterm labour is needed to ensure correct management of those most at risk of preterm birth and to prevent the maternal and fetal risks incurred by unnecessary interventions given to the large majority of women, who do not deliver within a week of presentation. Intervention “just-in-case” results in many avoidable admissions, women being transferred out of their local hospital unnecessarily and most women receiving unwarranted drugs, such as steroids and tocolytics. It also precludes appropriate transfers for others as neonatal cots are blocked pre-emptively, resulting in more dangerous ex-utero transfers. We have developed the QUiPP App which is a clinical decision-making aid based on previous outcomes of women, quantitative fetal fibronectin (qfFN) values and cervical length. It is hypothesised that using the QUiPP app will reduce inappropriate admissions and transfers.MethodsA multi-site cluster randomised trial will evaluate whether the QUiPP app reduces inappropriate management for threatened preterm labour. The 13 participating centres will be randomly allocated to receive either intervention or control. If the QUiPP app calculates risk of delivery within 7 days to be is less than 5%, clinicians are advised that interventions may be withheld. Women’s experience of threatened preterm labour assessment will be explored using self-completed questionnaires, with a subset of participants being invited to semi-structured interview. A health economics analysis is also planned.DiscussionWe hypothesise that the QUiPP app will improve identification of the most appropriate women for admission and transfer and ensure that therapies known to reduce risk of preterm neonatal morbidities are offered to those who need them. We will determine which women do not require these therapies, thereby reducing over-medicalisation and the associated maternal and fetal risks for these women. The findings will inform future national guidelines on threatened preterm labour. Beyond obstetrics, evaluating the impact of an app in an emergency setting, and our emphasis on balancing harms of over-treatment as well as under-treatment, make EQUIPTT a valuable contribution to translational medicine.Trial registrationThe EQUIPTT trial was prospectively registered on 16th January 2018 with the ISRCTN registry (no. 17846337).

Is cervical length evaluated by transvaginal ultrasonography helpful in detecting true preterm labor?

Objective: To investigate whether sonographic cervical markers can identify women in true preterm labor and predict delivery within 7 d and before 34 or 37 gestational weeks.Methods: This was a prospective observational study of women with singleton pregnancies and intact membranes given a diagnosis of preterm labor between 25 and 34 weeks and 6 d of gestation and who underwent transvaginal evaluation of the following characteristics: cervical length (CL), CL zeta score, absence of endocervical glandular echo, presence of cervical funneling, and presence of amniotic fluid sludge. The outcomes of interest were spontaneous delivery within 7 d of preterm labor and spontaneous delivery before 34 or 37 gestational weeks.Results: The inclusion criteria were met by 126 women, 31 (25%) of whom were excluded and 95 were analyzed. The median gestational age at admission was 31.9 weeks. The median CL at preterm labor was 22.3 mm (range: 0–42.8 mm). The delivery occurred within 7 d of presentation in 13 (13.7%) cases. Delivery before 34 weeks occurred in 16 (16.8%) cases and before 37 weeks in 40 (42.1%) cases. Logistic regression analysis showed CL in millimeters was an independent predictor of delivery within 7 d (OR 0.918, 95% CI 0.862–0.978, p = .008). For birth before 34 weeks, the predictor was gestational age at admission (OR 0.683, 95% CI 0.539–0.866, p = .002) and before 37 weeks, the presence of cervical funneling (OR 3.778, 95% CI 1.460–9.773, p = .006). The CL ≤ 15 mm had sensitivity and specificity values of 77 and 77%, respectively, and good accuracy (88%) for prediction of delivery within 7 d.Conclusion: The evaluation of the cervix by transvaginal ultrasound in women in preterm labor predicted delivery within 7 d and helped distinguish between true and false labor. The analysis of CL zeta score was not an independent factor to predict delivery in 7 d.

THE EFFECT OF RECTAL PROGESTERONE ON DOPPLER PARAMETERS OF THE UTERINE ARTERIES FOR THE PREVENTION OF PRETERM DELIVERY IN IRAQI POPULATION

Objective: The effectiveness of progesterone in the prevention of threatened preterm labor has been established for many years, but the preferable route, dose, and duration of treatment are until now under the evaluation of researches. The aim of this study was to determine the effect of rectal progesterone on Doppler indices of the uterine arteries in pregnant women with threatened preterm delivery.Methods: A prospective case–control study was conducted at the obstetric ward and the Outpatients Department of Al-Yarmouk Teaching Hospital in Baghdad for the period of 1 year from April 1, 2017, to April 1, 2018. 100 women were enrolled in the study, 50 of them were pregnant women with a diagnosis of preterm labor assigned as a study group and the other 50 were apparently healthy pregnant women of the same gestational age assigned as a control group. Doppler study of uterine arteries was done to all participants, and the results were compared for both groups. The patients with preterm labor received nifedipine tocolysis initially until contractions subsided and Doppler study had been repeated for those women after 1 week of rectal progesterone therapy.Results: The study group had a significantly higher resistance index (RI) than the control group (0.58 vs. 0.52) as p&lt;0.05, in spite of the pulsatility index (PI) being higher for the study group compared to the control group (0.78 vs. 0.77) but this difference was not statistically significant. The RI before the therapy (0.58) was significantly higher than the index after therapy (0.52), and the PI was again significantly higher before therapy (0.78) than after therapy (0.71) as p&lt;0.05. During the follow-up period, 3 (6.5%), 4 (8.7), and 39 (84.8%) patients delivered within 1 week, after 1 week, and at term, respectively.Conclusion: Rectal progesterone can arrest threatened preterm labor, and this effect is possible in part explained by its action on uterine arteries.

Predictors, Treatment and Prevention of Preterm Labour: A Review

Preterm labour (PTL) is one of the leading causes of neonatal morbidity and mortality throughout the world. It is also a major public health problem for its long-term disabilities like cerebral palsy and visual disturbance. Preterm labour is a multifactorial problem and its overall global incidence is 11.1 per 100 live births with a significant regional variation. About 45-50% of preterm deliveries are spontaneous, 30% are associated with preterm prelabour rupture of membranes (PPROM) and another 15-25% is induced for maternal and/or foetal risk. Previous history of PTL is an important risk factor; risk is 14.3% after one preterm birth and 28% after two preterm births. Other important risk factors are multiple pregnancy, polyhydramnios, bicornuate uterus, cervical incompetence &amp; bacterial vaginosis. Prediction of PTL is very difficult but identification of risk factors, assessment of cervical length by ultrasonography and detection of foetal fibronectin in cervical secretions are of great help. Advanced cervical dilatation (&gt;3 cm) or PPROM associated with sufficient and frequent uterine contractions confirm the diagnosis of preterm labour. Prevention of PTL has been tried with prophylactic cervical cerclage, antibiotics and progesterone. PTL is treated with various tocolytic agents and glucucorticoids and antibiotics for local or systemic infection. Betamimetics, calcium channel blockers (nifedipine), prostaglandin synthesis inhibitors and magnesium sulfate are the commonly used tocolytics. Nifedipine has significantly fewer maternal adverse effects than betamimetics and magnesium sulphate. Antenatal corticosteroid treatment has been found to lower neonatal mortality, the risk of neonatal respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis. The ultimate goal of prevention and management of preterm labour is to improve neonatal outcome and to reduce morbidity and mortality.Journal of Science Foundation, July 2017;15(2):57-63

An effect of maternal nifedipine therapy on fetoplacental blood flow: a prospective study.

The aim of this study is to assess the effects of maternal nifedipine administration on placental and fetal blood flow. A total of 29 patients with preterm labor diagnosis admitted to the tertiary care center, Zeynep Kamil Hospital, were evaluated. Before and 24-48h after administration of oral nifedipine, Doppler ultrasound scan was carried out to measure fetal middle cerebral artery, ductus venosus, umbilical artery, and maternal uterine artery blood flow. After 24 and 48h of therapy, there were no changes in mean PI and RI in the umbilical arteries and ductus venosus (p > 0.05). Fetal middle cerebral artery and maternal uterine artery PI and RI values showed a significant reduction 24-48h after oral nifedipine therapy (p < 0.05). Our study showed that 24 and 48h after oral nifedipine therapy, there is a significant increase in fetal MCA and maternal uterine artery blood flow, while fetal umbilical artery and ductus venosus Doppler values do not change.

PREVENTION OF PREMATURE LABOR IN PREGNANT WOMEN WITH PREVIOUS PREVENTION

Introduction.The problem of preterm labor is always relevant component of all complications of pregnancy. One of the most promising methods for predicting preterm labor is, at present, the detection of fetal fibronectin (fFN) and the determination of the content of interleukins in the blood or cervical secretions, in particular, the importance of interleukin 8 (IL-8).Aim. Determine the efficiency of prediction of preterm labor by simultaneously identifying fFN and IL-8 as markers of probable preterm labor.Materials and methods. Clinical and laboratory examination of 60 pregnant women was carried out: 40 - the main group with false contractions up to 37 weeks; 20 - control group, pregnant without this pathology. Definition of fFN andIL-8 was performed simultaneously in blood serum and cervical mucus with the evaluation of the results on the Rider Myltiskan EX immuno-enzyme analyzer using a set of reagents and test systems.Research results. An analysis of the effectiveness of diagnosis of preterm labor in pregnant women with false contractions up to 37 weeks using transvaginal cervicomercia revealed a shortening of the cervix in terms of 22-27 weeks in 5% and in 31-33 weeks in 10% and changes from the FF values in terms of 22- 27 weeks and 28-33 weeks - where its level was elevated both in serum and in cervical mucus and was 331.5 ± 40.4 and 1510 ± 17.9 respectively; 349.3 ± 45.2 and 128.6 ± 22.7 ng / ml. The probable correlation between increased fetal fibronectin and structural changes in the cervix was established (the correlation coefficient of the reciprocal connection was R = 0.50). Taking into account the data of urogenital stroke and the content of IL-8 in cervical mucus, it was found that an increase in the number of leukocytes, indicating inflammation, and an increase in IL-8 in 47.8% during the period of pregnancy 22-27 weeks + 6 days and in the 31- 33 weeks + 6 days in 55.6%, where the mean IL-8 was 132.5 ng / ml and 33.3% of the background cervical cancer.Conclusions. In the presence of false breaks and premature births, regardless of the period of pregnancy, there is a significant increase in IL-8. The probable correlation between increased fetal fibronectin in blood serum and in cervical mucus and structural changes in the cervix (correlation coefficient of mutual communication was R = 0.50) was established.

The cost of preterm labor and preterm birth for mothers with uncomplicated pregnancies and their infants in Italy: a retrospective cohort study

ABSTRACTBackground: Preterm labor (PTL)/preterm birth (PTB) impose significant burden on health-care systems. Women with uncomplicated pregnancies at risk of PTL/PTB have not been widely investigated, and published evidence on the costs of these women and their infants in Italy is absent. We aimed to describe women with uncomplicated pregnancies and associated costs for these women and their infants.Methods: Data on women aged 12–44 years with uncomplicated pregnancies who delivered between 1 September 2009 and 31 December 2014 with PTL diagnosis alone or PTL and PTB were included from four Italian databases. Costs were examined during pregnancy, delivery, and 3 years after delivery for mothers and infants, overall and by gestational age (GA).Results: A total of 3058 mothers linked to 3333 infants were included. Costs during pregnancy were €1777. Costs during delivery for PTL/PTB mothers and their infants ranged from €3174 (GA ≥37) to €21007 (GA <28). Combined maternal and infant costs appeared higher for births with lower GAs (<37) in the three-year follow-up.Conclusions: In Italy, PTL/PTB mothers with uncomplicated pregnancies with infants at lower GAs appeared to incur higher medical costs compared to mothers with infants at higher GAs in all three time periods, with particularly marked differences found when considering mother and infant combined costs.