High Risk Of Preterm Labor Research Articles

Pregnancy outcomes of cerclage in twin gestations: a multicenter retrospective cohort study

Objectives To determine the effects of cerclage on twin pregnancies. Methods A multicenter, retrospective, cohort study was conducted at 10 tertiary centers using a web-based data collection platform. The study population included twin pregnancies delivered after 20 weeks of gestation. Patients with one or two fetal deaths before 20 weeks of gestation were excluded. Maternal characteristics, including prenatal cervical length (CL) and obstetric outcomes, were retrieved from the electronic medical records. Results A total of 1,473 patients had available data regarding the CL measured before 24 weeks of gestation. Seven patients without CL data obtained prior to cerclage were excluded from the analysis. The study population was divided into two groups according to the CL measured during the mid-trimester: the CL ≤2.5 cm group (n = 127) and the CL >2.5 cm group (n = 1,339). A total of 127 patients (8.7%) were included in the CL ≤2.5 cm group, including 41.7% (53/127) who received cerclage. Patients in the CL >2.5 cm group who received cerclage had significantly lower gestational age at delivery than the control group (hazard ratio (HR): 1.8; 95% confidence interval (CI): 1.11–2.87; p = .016). Patients in the CL ≤2.5 cm group who received cerclage had a significantly higher gestational age at delivery than the control group (HR: 0.5; 95% CI: 0.30–0.82; p value = .006). Conclusions In twin pregnancies with a CL ≤2.5 cm, cerclage significantly prolongs gestation. However, unnecessary cerclage in women with a CL >2.5 cm may result in a higher risk of preterm labor and histologic chorioamnionitis although this study has a limitation originated from retrospective design.

Maternal and Neonatal Outcomes of Gestational Thrombocytopenia in Pregnant Women from Kirkuk City, Iraq: A Case-Control Study

Background: Thrombocytopenia is the most common hematological disorder in pregnant women, second only to anemia. A platelet count of less than 150x109/L is regarded as low. It is the most common cause of thrombocytopenia during pregnancy when the platelet count does not fall below 70x109\L. Methods: A case-control study was carried out in the department of obstetrics and gynecology at Azadi Teaching Hospital, Kirkuk, Iraq. Two hundred pregnant women were enrolled in the study; they were divided into 100 cases and 100 controls. All participants were in labor at the time of admission. The cases were pregnant women with gestational thrombocytopenia, while the controls were pregnant women with a normal platelet count. A platelet count was performed for all participants using the Swelab Alfa Plus system. Results: mean gestational age and platelet count were significantly lower in patients than controls, while there was no statistically significant difference in age or parity between the study groups. Preterm labor, postpartum hemorrhage (PPH), intrauterine fetal growth restriction (IUGR), and intrapartum fetal distress were significantly higher in the patients than in the controls, and the mean APGAR score at 5 minutes was significantly lower in the patients compared to the controls. Conclusions: Pregnant women with gestational thrombocytopenia may be at higher risk of preterm labor, postpartum hemorrhage, IUGR, intrapartum fetal distress and a low neonatal APGAR score.

Role of Uterocervical Angle, Cervical Length, and Cervicovaginal Fetal Fibronectin in the Prediction of Preterm Birth

BACKGROUND:Cervical length measurement and fetal fibronectin (FFN) are widely used to estimate the risk of preterm birth. Another potential predictor of preterm birth is the uterocervical angle, and this additional measurement may improve the risk assessment. This study aimed to predict the onset of labor in women who present with preterm labor through cervical length, uterocervical angle, and FFN.METHODS:A prospective cohort study was carried out on 90 symptomatic women at high risk of preterm labor attending the Gynecology and Obstetrics department at Fayoum University Hospital. FFN in the cervicovaginal fluid was assessed by ELISA technique. The uterocervical angle and cervical length were measured by transvaginal ultrasound. Maternal history and pregnancy data were recorded. Delivery data were subsequently collected.RESULTS:The average age was 21.79 ± 3.3 years, and the average body mass index (BMI) was 24.6 ± 5.8 kg/m2. The mean gestational age (GA) was 32.83 ± 2.3 weeks. Twelve women in our cohort reported previous preterm labor. The cervical length and FFN showed better sensitivity and specificity compared with the uterocervical angle in predicting preterm birth. Logistic regression analysis demonstrated that preterm birth depended only on the cervical length and quantitative FFN.CONCLUSION:The combination of FFN and cervical length could improve preterm birth prediction accuracy.

COVID-19 related Complications during Pregnancy: A Systematic Review

Background: The topic of COVID-19 (coronavirus disease)-associated complications during pregnancy is poorly postulated and remains an area that requires elucidation for the underlying pathophysiology mechanism in order to evaluate a new therapeutic strategy and optimize current therapies. Aim: The study aimed to assess the proportion of associated complications with COVID-19 and the underlying pathophysiology in pregnant women. Methods: The MedLine and Embase databases were searched for studies relevant to the study topic. Results: Preterm delivery and C-section have been found to be the most frequently reported complications. Approximately, 28.55% of pregnant women with symptomatic COVID-19 have been reported to require a C-section and 8.8% preterm delivery. In addition, anxiety and depression have also been frequently reported in 57% and 37% of pregnant women, respectively. Conclusion: Symptomatic pregnant women with COVID-19 have a high risk of preterm labor, mortality and morbidity rates, and C-section requirements. The underlying pathophysiology of COVID-19-associated complications during pregnancy includes homeostatic disturbances of the immune system, pulmonary system, and hemostatic system. In addition to endothelial dysfunction, excessive immune response, coagulopathy, hypoxemia, and hypotension are involved in the pathogenesis that negatively affects neonates' health outcomes.

Risk Factors and Foeto-Maternal Outcome in Preterm Labour

Background: Preterm labor is one of the biggest health issues in the globe and is associated with high perinatal mortality and morbidity. A healthy pregnancy can turn into one that is at high risk for both the mother and the fetus in one of these clinical scenarios. Objective: The aim of the present study is to determine the risk factor and maternal and perinatal outcome of patients presenting with preterm labor and to evaluate the preventable causes of preterm labour. Methods: A Case control study conducted in the Department of Gynaecology and Obstetrics Dhaka Medical College Hospital, during February 2010 to July 2010. Results: A total of 50 cases having preterm labour in between 28 - 36 weeks of gestation and 50 controls having 37-40 weeks pregnancy with lobour pain were screened and enrolled in the study. Several significant risk factors were associated with preterm labour and the following risk factors were identified. Low socio-economic class, rupture of membrane (OR = -2.45), previous history of abortion (OR = 2.25), Preterm delivery (OR -9.33), and Anaemia (OR = 8.31). Conclusions: As preterm labour is grave consequences for both the mother and the newborn of preterm labor should be aim and developing awareness of pregnant mother who are high risk for preterm labor.

Risk Factors and Perinatal Outcome in Preterm Labor

Background: One of the world's major health problems, preterm labor is characterized by significant perinatal mortality and morbidity. In one of these clinical situations, a healthy pregnancy might become one that is at high risk for both the mother and the fetus. Objective: To detect the risk factors and perinatal outcome in with complication in preterm labor. Materials and Methods: A case control study was carried out from February 2010 to July 2010 in the department of gynecology and obstetrics at the Dhaka Medical College Hospital. Results: A total of 50 instances of preterm labor occurring between 28 and 36 weeks of pregnancy and 50 control cases of lobour pain occurring between 37 and 40 weeks of pregnancy were screened and recruited in the research. The following risk variables were identified as being significantly linked with premature labor. Preterm delivery (OR -9.33), and Anaemia (OR = 8.31). Perinatal outcome in preterm lobour were Still birth, low APGAR score, neonatal resuscitation and neonatal complications significantly (p<0.05) higher in case group. Conclusion: The purpose should be to raise awareness of pregnant women who are at high risk for preterm labor since preterm labor has serious repercussions for both the mother and the infant.

Correlation of Cervical Length, Anterior Uterocervical Angle, and Cervical Elastography with the Incidence of Preterm Labor

Abstract Objectives The aim of this study is to find the correlation of cervical length, anterior uterocervical angle, and cervical elastography with the incidence of preterm labor through evaluation by transvaginal ultrasonography during routine anomaly scan and to analyze the correlation of the parameters with each other. Methods Cross-sectional comparative study was undertaken on singleton pregnant women coming for anomaly scan between 18 and 24 weeks. Cervical length and anterior uterocervical angle were measured in the mid-sagittal section. Strain elastography was used for measuring cervical strain. Color map was obtained for the entire cervix and the color code for the degree of cervical stiffness was noted. Results Though the mean value of cervical length was significantly lower in preterm group (3.2 cm) than in term group (3.6 cm), it was more than the cutoff value of 2.5 cm, below which it is routinely considered as short cervix indicative of preterm labor. Mean value of anterior uterocervical angle was significantly higher in women with preterm (112.3 degrees) delivery than those with term (82.2 degrees) delivery. Mean strain values of cervical elastography were significantly different in term (0.130) and preterm groups (0.179). Color code in elastography was independent of preterm labor. There was a significant positive correlation of cervical length with gestational age at delivery (GAD). A significant negative correlation was observed between acute anterior uterocervical angle with the GAD. Conclusion Anterior uterocervical angle has a definitive role in the prediction of preterm labor and so it can be combined with the conventional cervical length screening in identifying women with normal cervical length who are at high risk of preterm labor. Cervical elastography assesses the cervical consistency and also has the potential for identifying high-risk women.

Does Progesterone Prevent Preterm Labor in Complicated Monochorionic Twin Pregnancies after Radiofrequency Ablation of One Fetus?

Background: Twin pregnancies have a higher risk of preterm labor than singletons. Otherwise, progesterone using to reduce the risk of preterm labor in twin pregnancies remains controversial. Therefore, this study evaluated the effect of intramuscular progesterone to prevent preterm labor in complicated monochorionic diamniotic twin pregnancies after Radiofrequency Ablation (RFA) of one fetus.
 Methods: Pregnant women with monochorionic diamniotic twin pregnancies of 16 to 26 weeks of gestational age in an academic center were randomly assigned to receive intramuscular 17-hydroxy progesterone caproate weekly until 36 weeks of gestational age after RFA of one fetus and a control group who did not receive intervention after RFA. Demographic and obstetrical characteristics, as well as maternal, fetal and neonatal outcomes were compared between groups.
 Results: In total, 79 participants were recruited in the study. The mean±SD of gestational age at delivery in case and control groups were 34.6±3.8 and 34.6±5.1 with no significant difference (p=0.967). Neonatal outcomes including birth weight (p=0.870), intensive care unit admission (p=0.415), premature preterm rupture of membrane (p=0.115) and pregnancy outcome (live birth, fetal demise or neonatal death) (p=0.524) were not different either. Indeed, gestational age at delivery was inversely related to cervical length at the time of procedure and maternal body mass index, but these differences were not statistically significant. Also, there was no significant difference in terms of gestational diabetes, which was a worrying complication of 17-hydroxy progesterone caproate.
 Conclusion: Although 17-hydroxy progesterone caproate seems to be safe with no apparent maternal and neonatal side effects, it does not prolong pregnancy after RFA. Further studies with longer follow up and larger sample size are suggested.

Contribution of labor related gene subtype classification on heterogeneity of polycystic ovary syndrome.

As one of the most common endocrine disorders in women of reproductive age, polycystic ovary syndrome (PCOS) is highly heterogeneous with varied clinical features and diverse gestational complications among individuals. The patients with PCOS have 2-fold higher risk of preterm labor which is associated with substantial infant morbidity and mortality and great socioeconomic cost. The study was designated to identify molecular subtypes and the related hub genes to facilitate the susceptibility assessment of preterm labor in women with PCOS. Four mRNA datasets (GSE84958, GSE5090, GSE43264 and GSE98421) were obtained from Gene Expression Omnibus database. Twenty-eight candidate genes related to preterm labor or labor were yielded from the researches and our unpublished data. Then, we utilized unsupervised clustering to identify molecular subtypes in PCOS based on the expression of above candidate genes. Key modules were generated with weighted gene co-expression network analysis R package, and their hub genes were generated with CytoHubba. The probable biological function and mechanism were explored through Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway analysis. In addition, STRING and Cytoscape software were used to identify the protein-protein interaction (PPI) network, and the molecular complex detection (MCODE) was used to identify the hub genes. Then the overlapping hub genes were predicted. Two molecular subtypes were found in women with PCOS based on the expression similarity of preterm labor or labor-related genes, in which two modules were highlighted. The key modules and PPI network have five overlapping five hub genes, two of which, GTF2F2 and MYO6 gene, were further confirmed by the comparison between clustering subgroups according to the expression of hub genes. Distinct PCOS molecular subtypes were identified with preterm labor or labor-related genes, which might uncover the potential mechanism underlying heterogeneity of clinical pregnancy complications in women with PCOS.

Evaluation of the role of azithromycin on pregnancy prolongation in patients at high risk for preterm labor

Evaluation of the role of azithromycin on pregnancy prolongation in patients at high risk for preterm labor

Kliničke karakteristike i laboratorijski rezultati trudnice sa SARS-CoV-2 infekcijom

Introduction/Aim: The most common symptoms and laboratory signs of SARS-CoV-2 infection in pregnancy are the following: fever, cough, dyspnea, diarrhea, lymphocytopenia, leukocytosis and a high level of CRP. However, pregnant women with comorbidities are at an increased risk of severe forms of COVID-19. Numerous studies point to the fact that pregnant women with the confirmed SARS-CoV-2 infection have more than two times higher risk of preterm labor, and that they are at an increased risk of preeclampsia and emergency Cesarean section. The aim of this paper is to analyze the course and outcome of SARS-CoV-2 confirmed in a young woman in the 39th week of pregnancy. Case report: A pregnant woman with the confirmed SARS-CoV-2 infection in the 39th week of pregnancy delivered a baby on the sixth day from the appearance of symptoms and signs of disease. At the beginning of infection, the patient reported fever, poor general health status, and then cough and chest pain. The infection was accompanied by increased levels of C reactive protein, D-dimer and lymphocytopenia. The patient is a young woman without comorbidities, but pneumonia with a tendency toward progression was diagnosed six days after symptoms and signs appeared, due to which her hospitalization after delivery was prolonged. The findings of computerized tomography showed bilateral interstitial COVID-19 pneumonia. The patient was hemodinamically stable all the time during hospitalization and did not need oxygen support. The baby was delivered vaginally with good general health status (Apgar score 9/10, body weight). SARS-CoV-2 infection was not confirmed with the rapid antigen test in the newborn. Conclusion: Further research is needed in this field, especially research on the course and outcome of infection in pregnant women during the first and second trimester of pregnancy, as well as on the ways how to reduce unwanted neonatal outcomes in pregnant women with SARS-CoV-2 infection.

Role of vaginal progesterone on uterine artery Doppler changes in pregnant women at risk of preterm labor

BackgroundProgesterone is increasingly being used in women at high risk for preterm labor and for maintenance tocolysis. Ultrasound evaluation of uterine in pregnant women in the second trimester of pregnancy can be a predictor of birth complications.ObjectiveTo study the effect of vaginal progesterone on uterine by doppler sonography among women in the second and third trimesters of pregnancy who are at risk of preterm labor.Patients and methodsA prospective study was carried out on 60 patients attending Obstetrics and Gynecology Department, Menoufia Teaching Hospital, Menoufia, Egypt, during the period from March 2019 to March 2020. The patients were admitted to the hospital for preterm labor, which was arrested by acute tocolysis within 48 h. All participants were subjected to routine baseline investigations and Doppler flow assessment.ResultsThere was a highly statistically significant difference (P < 0.001) in uterine artery pulsatility index (PI) before and after treatment (P = 0.000). Uterine artery PI decreased significantly after treatment (0.817 ± 0.16) than before treatment (0.969 ± 0.27). Uterine artery PI decreased significantly after treatment than before treatment in different periods of gestation (weeks). Moreover, there was no statistically significant difference (P>0.05) between the studied women as change in umbilical artery PI before and after treatment in different periods of gestation (weeks). Moreover, uterine artery PI was significantly correlated (P < 0.05) with period of gestation (week) before and after progesterone treatment.ConclusionUterine artery pulsatility index (PI) decreased significantly after progesterone treatment than before treatment in different periods of gestation (weeks). Umbilical artery PI and middle cerebral artery Doppler PI were not significant different among the studied patients before and after progesterone treatment in different periods of gestation (weeks). Uterine artery PI and middle cerebral artery Doppler PI were negatively associated with period of gestation (week) before and after progesterone treatment.

Management of Cerclage in Patients With Preterm Prelabor Rupture of Membranes.

Women undergoing cerclage placement remain at high risk for preterm labor and preterm prelabor rupture of membranes (PPROMs). The management of cervical cerclage after PPROM is controversial given the potential for prolonged latency when the cerclage is kept in place balanced with a potential increased risk of maternal infectious morbidity. In this review, we compared studies that examined maternal, fetal, and neonatal outcomes in women with cerclage at the time of PPROM. We evaluated latency after PPROM and maternal and neonatal complications in the setting of PPROM with cervical cerclage. Original research articles, review articles, and guidelines on cerclage removal were reviewed. Nine studies comparing cerclage retention versus removal were examined with mixed results, in particular between studies before the routine use of latency antibiotics and corticosteroid administration. There was an associated increase in latency to delivery with retention of cerclage, with a potential increase in maternal infectious morbidity. No significant differences were noted for neonatal mortality, neonatal sepsis, or other neonatal morbidity outcomes. The majority of studies were limited by their retrospective nature and small sample sizes. Cerclage removal at the time of diagnosis of PPROM can be considered due to the concern for increased risk of maternal morbidity without definitive benefit in latency to delivery or neonatal outcomes. However, data are limited, and clinicians should engage in shared decision-making with patients in this setting.

PROPHYLACTIC USE OF PROGESTERONE VAGINAL SUPPOSITORY IN PREVENTION OF RECURRENT PRETERM LABOR

Background: Prematurity is the leading cause of neonatal morbidity and mortality. Although perinatal care advanced in the last few decades, preterm labor did not decrease but even is increasing and creating a great social and economic problem. Objective: To test the effectiveness of progesterone vaginal suppository in prevention of preterm labor in patients with previous history of preterm labor. Patients and Methods: This was a randomized , prospective, single blind study after approval of the medical ethical committee at Al-Azhar university Hospitals, Department of Obstetrics and Gynecology, and after patients giving written consents, during the period from February 2020 to October 2020 . We enrolled 168 women for the study at high risk for preterm labor who were randomly divided into two groups (progesterone group and placebo group). Two hundred mg of vaginal progesterone pessary or placebo were used by the patient from 24 to 36 weeks of gestation. Uterine contractions were recorded by external tocodynamometer every other week from 28 to 36 weeks of gestations. Results: There was a statistically significant reduction in the incidence of preterm delivery between the two groups from 38.5% in placebo group, compared with 21% in progesterone group. There was also a statistically significant reduction in the incidence of early preterm delivery (<34 week) between the two groups from 21.2% in placebo group, compared with 5.7% in progesterone group. There was a significant prolongation of the mean gestational age at delivery from 36.36 ± 2.83 weeks in placebo group compared to 37.57 ± 1.72 weeks in progesterone group. There was no statistically significant difference in the average gestational age for those who had preterm birth between both groups. There were fewer women in progesterone group who reported symptoms of preterm labor of 52.4%, compared with 75% in placebo group. There was a significant more frequent uterine contraction in placebo group of 48.1% compared to progesterone group of 24.8%. Conclusion: Prophylactic vaginal progesterone reduces the rate of preterm labor, prolongs gestational age at delivery, reduces the frequency of uterine contractions, and improves the symptoms of preterm labor in women at high risk of preterm labor.

Elastography and Metalloproteinases in Patients at High Risk of Preterm Labor.

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Its etiopathology is multifactorial; therefore, many of the tests contain the assessment of the biochemical factors and ultrasound evaluation of the cervix in patients at risk of preterm delivery. The study aimed at evaluating the socioeconomic data, ultrasound examinations with elastography, plasma concentrations of MMP-8 and MMP-9 metalloproteinases, and vaginal secretions in the control group as well as patients with threatened preterm delivery (high-risk patients). The study included 88 patients hospitalized in the Department of Obstetrics and Pregnancy Pathology, SPSK 1, in Lublin. Patients were qualified to the study group (50) with a transvaginal ultrasonography of cervical length (CL) ≤ 25 mm. The control group (38) were patients with a physiological course of pregnancy with CL > 25 mm. In the study group, the median length of the cervix was 17.49 mm. Elastographic parameters: strain and ratio were 0.20 and 0.83. In the control group, the median length of the cervix was 34.73 mm, while the strain and ratio were 0.20 and 1.23. In the study group, the concentration of MMP-8 in the serum and secretions of the cervix was on average 74.17 and 155.46 ng/mL, but in the control group, it was significantly lower, on average 58.49 and 94.19 ng/mL. The concentration of MMP-9 in both groups was on the same level. Evaluation of the cervical length and measurement of MMP-8 concentration are the methods of predicting preterm delivery in high-risk patients. The use of static elastography did not meet the criteria of a PTB marker.

Fetal Heart Rate Variability Before and After Antenatal Corticosteroids in Patients at High Risk of Preterm Labor

Background: Premature birth (PTB) occurs in one in ten pregnancies. There are about 13 million PTBs annually worldwide. Antenatal corticosteroids are administered to enhance fetal lung maturation in cases of threatened preterm delivery between 24- and 34-weeks’ gestational age (GA). Objective: This study aimed to study the cardiotocograp (CTG) before and after antenatal corticosteroids administration in patients at high risk of preterm labor to reduce preterm risks. Patients and Methods: A prospective cohort study included 52 women who were at risk of premature birth. Each woman received the recommended course of corticosteroids consists of 4 doses of dexamethasone 6 mg for 48 hours (Dexamethasone 8 ml intramuscularly, 12 h apart). CTG examination: Fetal heart rate was monitored with fetal monitor cardiotocogram machine. Cardiotocography strips were interpreted visually. Results: In our study we recorded decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant. Decelerations were not present at all before or after the course. The STV showed a significant change before the course, all participants had moderate STV, but after the course, 8 (15.4%) showed marked variability, which was significant. We found that most of participants (90.4%) had decreased fetal kicks after injection relying on maternal perception. Conclusion: There was a decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant.

Preterm labor: issues of prognosis, prevention and management (Literature rewiew)

Preterm labor is the leading cause of neonatal mortality and the most common cause for antenatal hospitalization. Approximately 15 million babies are born preterm each year worldwide. Of those, one million babies die before the age of 5, which is 18% of all deaths of children at this age. 35% of early and late neonatal mortality (under 28 days of age) is associated with preterm birth.The pathophysiology of preterm labor includes at least four major pathogenetic mechanisms. The studied components of this process are premature activation of the maternal or fetal hypothalamic-pituitary-adrenal system, inflammation or infection, decidual hemorrhage and pathological overdistension of the uterus. The diagnosis of preterm labor is based on the determination of concomitant regular uterine contractions and cervical changes. Vaginal bleeding and/or rupture of the amniotic membranes only increase the likelihood of this diagnosis. To improve the accuracy of diagnosis and assess the potential risk of preterm birth in the presence of symptoms in pregnant women, it is proposed to use such diagnostic tests as transvaginal ultrasound to measure cervical length; detection in vaginal fluids of fetal fibronectin (fFN), phosphorylated protein-1, which binds insulin-like growth factor (IGFBP-1), placental alpha-microglobulin, the ratio of insulin-like growth factorebinding protein 4 (IBP4) and sex hormoneebinding globulin (SHBG) – PreTRM-test.Correct identification of women in the true preterm labor allows performing appropriate actions, which results in better outcomes for the newborn. These are using of corticosteroids to prevent respiratory distress syndrome (RDS) of the newborn; prevention of group B streptococcal infection; magnesium sulfate to protect the baby’s nervous system; transportation to the institution of the third level of perinatal care, which can provide a newborn with appropriate medical care. Preventative and therapeutic measures for women, which have a high risk of preterm labor, include taking progesterone, cervical cerclage and an application of obstetric pessary.

Risk Factors of the High-Risk Pregnancy and Association with Particulate Matter

Purpose: High-risk pregnancy, resulting in major complications, such as abortion, gestational hypertension, and preterm labor, are on the rise, requiring intervention. Increased concentration of particulate matter that is 10 μg per cubic meter or less in diameter (PM&lt;sub&gt;10&lt;/sub&gt;) due to increased air pollution and industrialization has recently been noted as a risk factor for health problems, and prior studies have reported that PM&lt;sub&gt;10&lt;/sub&gt; is related to abortion, gestational hypertension, and preterm labor.Methods: This study used data from the Korean medical panel between 2008 and 2016 to identify 879 women with normal pregnancies and 301 women diagnosed with high-risk pregnancies. The association between high-risk pregnancy and PM&lt;sub&gt;10&lt;/sub&gt; was analyzed using the annual average regional concentration during the same period by the Korea Environment Corporation.Results: At 35 years of age or older, the risk of abortion (p&lt;0.001; 95% confidence interval [CI], 1.43–2.71) and preterm labor increased (p&lt;0.05; 95% CI, 0.33–0.90). Married pregnant women were at a high risk of preterm labor (p&lt;0.05; 95% CI, 0.25–0.98), and the prevalence of gestational hypertension was high in the metropolitan area (p&lt;0.05; 95% CI, 12.09–25.93). On comparing the average annual concentration of particulate matter according to the level of atmospheric ventilation of the Korea Environment Corporation using a cutoff of ≤50 μg/m&lt;sup&gt;3&lt;/sup&gt;, the probability of preterm labor was 2.2 times higher in groups exposed to particulate matter concentration of ≥50 μg/m&lt;sup&gt;3&lt;/sup&gt; (p&lt;0.01; 95% CI, 1.49–3.25).Conclusion: PM&lt;sub&gt;10&lt;/sub&gt; was related to preterm labor, and the risk of preterm labor was high if the average annual concentration of PM&lt;sub&gt;10&lt;/sub&gt; in the individual’s residential area exceeded 50 μg/m&lt;sup&gt;3&lt;/sup&gt;.

A Randomized Controlled Open Label Crossover Trial to Study Vaginal Colonization of Orally Administered Lactobacillus Reuteri RC-14 and Rhamnosus GR-1 in Pregnant Women at High Risk for Preterm Labor.

Lactobacilli administration has been suggested for the treatment and prevention of bacterial vaginosis, which increases the risk for preterm birth. We aimed to evaluate the vaginal colonization of lactobacilli orally administered to pregnant women at risk for preterm birth. We performed a randomized and controlled crossover study between January 2016 and May 2017. Forty pregnant women at high risk for preterm birth with normal vaginal flora (Nugent score ≤ 3) were randomized to either receive two oral capsules/day each containing 5 × 109 Lactobacilli (L.) rhamnosus GR-1 and L. reuteri RC-14 (n = 20) or no treatment (n = 20) for 2 months. Treatments were then crossed over for an additional two months. A vaginal examination and swabbing were performed for assessment of bacterial vaginosis at baseline and every month until study completion. At the same time points, vaginal samples were cultured and subjected to matrix-assisted-laser-desorption/ionization-time-of-flight-mass-spectrometry (MALDI TOF-MS) for the detection of the specific bacterial strains contained in the capsules. The primary endpoint was the presence of the administered lactobacilli strains in the vagina during the first two months of follow-up. Thirty-eight women completed the study. During the first two months of treatment, L. rhamnosus GR-1 was detected in one (5%) woman on the probiotic treatment and 2 (11%) women receiving no treatment (p = 0.6). L. rhamnosus GR-1 was detected in vaginal samples of 4 (11%) women during probiotic treatment (of both groups) and L. reuteri RC-14 was not detected in any samples. The rest of the endpoints were not different between the groups. Altogether, vaginal colonization of lactobacilli following oral administration is low during pregnancy.

Effect of premature rupture of membranes on preterm labor: a case-control study in Cilegon, Indonesia.

OBJECTIVESThe global prevalence of preterm labor is approximately 11.1% of live births. However, preterm labor contributes to 75-80% of neonatal morbidity and mortality. The morbidity experienced by preterm infants may continue to influence their subsequent development, imposing physical, psychological, and economic burdens. Premature rupture of membranes (PROM) is a causal factor that may affect preterm birth. Previous studies have shown an association between PROM and preterm labor, but this association should be investigated in more diverse populations. Therefore, this study was conducted in Cilegon, Indonesia to determine the magnitude of the risk of preterm labor associated with PROM at Cilegon Hospital from July 2014 to December 2015.METHODSThis case-control study used data from patients’ medical records. The cases were all mothers who delivered at less than 37 weeks of gestation, while the control population comprised all mothers who delivered at greater or equal to 37 weeks. The data were analyzed using logistic regression.RESULTSThe bivariate analysis yielded an odds ratio (OR) of 2.97 (95% confidence interval [CI], 1.92 to 4.59) before controlling for covariates. The model derived through multiple regression analysis after controlling for education, history of preterm labor, and anemia resulted in an OR of 2.58 (95% CI, 1.68 to 3.98).CONCLUSIONSMothers who experience PROM during pregnancy were at a 2.58 times higher risk of preterm labor after controlling for education, history of preterm labor, and anemia.