High Risk Of Preterm Delivery Research Articles

Association of adverse outcomes of intrahepatic cholestasis of pregnancy with zonulin levels

Our aim was to investigate serum zonulin levels in intrahepatic cholestasis of pregnancy (ICP) and to determine the usefulness of zonulin in ICP follow-up. A prospective case-control study was carried out which included 88 pregnant women (44 patients with ICP and 44 controls). Maternal serum samples obtained from all participants and zonulin levels were determined by enzyme-linked immunosorbent assay (ELISA). Compared with controls, women with ICP had significantly higher zonulin levels (mean 0.728 ± 0.520 ng/mL vs. 1.303 ± 0.63 ng/mL, p <.001). According to the receiver operating characteristic (ROC) analysis performed for the predictive value of zonulin levels for ICP, the area under the curve (AUC) was 0.761 (95% CI: 0.661–0.860). Multivariable logistic regression analysis revealed serum zonulin levels was independently associated with adverse perinatal outcomes (OR = 1.278, 95% CI: 0.232–7.041), severity ICP (OR: 7.535, 95% CI: 1.597–13.553) and also unresponsiveness to treatment in ICP (OR: 4.178, 95% CI: 0.929–8.784). IMPACT STATEMENT What is already known on this subject? Zonulin is a regulator protein that increases the intestinal permeability by modulating the intercellular tight junctions (TJ). It is the only physiological protein known to control intestinal permeability and damage of the intestinal barrier is one of the causes of absorption disorders, inflammation and autoimmunity. ICP is a relatively non-threatening condition to women but is linked with a higher risk of preterm delivery, foetal distress and foetal death. What do the results of this study add? This study showed that increased levels of zonulin are associated with adverse perinatal outcomes, severity of ICP and unresponsiveness to treatment in ICP. What are the implications of these findings for clinical practice and/or further research? Focussing on preservation of intestinal permeability may be an alternative preventive strategy to reduce the adverse perinatal outcomes and severity of ICP. Further longitudinal studies are needed to verify the relationships among zonulin levels and pregnancy-related diseases.

Association between antenatal care utilization with severe maternal and perinatal morbidity

Aim: To analyse association between adequate antenatal care utilization with severe maternal morbidity and severe perinatal morbidity.&#x0D; Methods: The prospective observational study was conducted in a Government medical college and hospital, Aurangabad from 1st October 2017 to 30th September 2019 after Institution Ethics Committee approval. Pregnancy after 28 weeks without pre-existing medical disorder and fetal anomaly were studied. The data were analyzed to find out the association between adequate antenatal care utilization and severe maternal and severe perinatal morbidity by using chi-squared test.&#x0D; Results: Among 500 participants, 243 (48.6%) had adequate visits. Women with inadequate antenatal care utilization were at higher risk of preterm delivery, severe maternal and perinatal morbidity.&#x0D; Conclusions: Inadequate antenatal care is can predict increased severity of maternal and perinatal morbidity.&#x0D; Keywords: Antenatal care utilization, focused antenatal care, severe maternal morbidity, severe perinatal morbidity

The Cervicovaginal Mucus Barrier.

Preterm births are a global health priority that affects 15 million babies every year worldwide. There are no effective prognostic and therapeutic strategies relating to preterm delivery, but uterine infections appear to be a major cause. The vaginal epithelium is covered by the cervicovaginal mucus, which is essential to health because of its direct involvement in reproduction and functions as a selective barrier by sheltering the beneficial lactobacilli while helping to clear pathogens. During pregnancy, the cervical canal is sealed with a cervical mucus plug that prevents the vaginal flora from ascending toward the uterine compartment, which protects the fetus from pathogens. Abnormalities of the cervical mucus plug and bacterial vaginosis are associated with a higher risk of preterm delivery. This review addresses the current understanding of the cervicovaginal mucus and the cervical mucus plug and their interactions with the microbial communities in both the physiological state and bacterial vaginosis, with a focus on gel-forming mucins. We also review the current state of knowledge of gel-forming mucins contained in mouse cervicovaginal mucus and the mouse models used to study bacterial vaginosis.

Adverse Pregnancy Outcomes after Multi-Professional Follow-Up of Women with Systemic Lupus Erythematosus: An Observational Study from a Single Centre in Sweden.

While the management of pregnant patients with systemic lupus erythematosus (SLE) has improved over the last decades, the risk of maternal, foetal, and neonatal complications is still substantial. We evaluated the occurrence of adverse pregnancy outcomes (APO) occurring in 2002–2018 among patients with SLE from the catchment area of the Department of Rheumatology in Lund, Sweden. Longitudinal clinical and laboratory data were collected and analysed. Results were stratified according to the sequence of conception. We investigated a total of 59 pregnancies in 28 patients. Prior lupus nephritis was the clinical feature that, in a multivariable regression analysis, displayed the strongest association with APO overall (OR 6.0, p = 0.02). SLE combined with antiphospholipid syndrome (APS) was associated with the risk of miscarriage (OR 3.3, p = 0.04). The positivity of multiple antiphospholipid antibodies (aPL) was associated with APO overall (OR 3.3, p = 0.05). IgG anti-cardiolipin during pregnancy resulted in a higher risk of preterm delivery (OR 6.8, p = 0.03). Hypocomplementaemia was associated with several APO, but only in the first pregnancies. We conclude that, despite the close follow-up provided, a majority of pregnancies resulted in ≥1 APO, but a few of them were severe. Our study confirms the importance of previous lupus nephritis as a main risk factor for APO in patients with SLE.

Maternal Fetal Health

Maternal Fetal Health

Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes

To assess trends, predictors, and perinatal outcomes of ovarian hyperstimulation syndrome (OHSS) associated with invitro fertilization (IVF) cycles in the United States. Retrospective cohort study using National Assisted Reproductive Technology Surveillance System (NASS) data. Not applicable. Fresh autologous and embryo-banking cycles performed from 2000 to2015. None. OHSS, first-trimester loss, second-trimester loss, stillbirth, low birth weight, and preterm delivery. The proportion of IVF cycles complicated by OHSS increased from 10.0 to 14.3 cases per 1,000 from 2000 to 2006, and decreased to 5.3 per 1,000 from 2006 to 2015. The risk of OHSS was highest for cycles with more than 30 oocytes retrieved (adjusted risk ratio [aRR] 3.85). OHSS was associated with a diagnosis of ovulatory disorder (aRR 2.61), tubal factor (aRR 1.14), uterine factor (aRR 1.17) and cycles resulting in pregnancy (aRR 3.12). In singleton pregnancies, OHSS was associated with increased risk of low birth weight (aRR 1.29) and preterm delivery (aRR 1.32). In twin pregnancies, OHSS was associated with an increased risk of second-trimester loss (aRR 1.81), low birth weight (aRR 1.06), and preterm delivery (aRR 1.16). Modifiable predictive factors for OHSS include number of oocytes retrieved, pregnancy following fresh embryo transfer, and the type of medication used for pituitary suppression during controlled ovarian hyperstimulation. Patients affected by OHSS had a higher risk of preterm delivery and low birth weight. Clinicians should take measures to reduce the risk of OHSS whenever possible.

Both Low and High PAPP-A Concentrations in the First Trimester of Pregnancy Are Associated with Increased Risk of Delivery before 32 Weeks in Twin Gestation.

In twin gestation, the relationship between pregnancy associated plasma protein (PAPP-A) and perinatal outcome is unclear. The aim of the study was to determine if low and high concentrations of PAPP-A in the first trimester are related to perinatal outcome in twins. A retrospective study was conducted. Medical data of women in twin pregnancies who delivered between 2013 and 2018 were analyzed. PAPP-A concentrations were measured between 10 + 0 and 13 + 6 weeks. The associations between low (<10th percentile) and high (>90th percentile) values of PAPP-A and pregnancy complications were analyzed. A total of 304 patients were included. PAPP-A <10th percentile was associated with a high risk of preterm delivery (OR 6.14; 95% CI 2.1–18), delivery <34 weeks (OR 2.39; 95% CI 1.1–5.1) or <32 weeks (OR3.06; 95% CI 1.4–6.8). Significant relations between PAPP-A >90th percentile and delivery <34 weeks (OR4.09; 95% CI 1.8–9.1) or <32 weeks (OR 2.83; 95% CI 1.2–6.6) were found. PAPP-A >90th percentile was related to high risk of intrauterine fetal demise (OR 10; 95% CI 2.4–42.5). Both low and high PAPP-A concentrations seem to be related to pregnancy outcome. Further research is needed to investigate evaluation of risk of pregnancy complications according to PAPP-A concentrations as a continuous variable.

The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China

BackgroundThe adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact. While China is the most populous country in the world, and 8.5% of the women aged 10–50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnancy in Hebei Province, China.MethodsThere were 238,598 singleton pregnant women aged 10–34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10–19 years) and adult group (aged 20–34 years). The adolescent group was divided into two subgroups (aged 10–17 years, aged 18–19 years), the adult group was divided into two subgroups (aged 20–24 years, aged 25–34 years). We compared the risk of adverse pregnancy outcomes using univariate and multivariate logistic regression. We also made a stratified analysis of nulliparous and multiparous adolescent pregnancy.ResultsCompared with women aged 20–34 years, women aged 10–19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70–0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95%CI: 0.41–0.73). Women aged 10–19 years had higher risk of preterm delivery (aRR: 1.76, 95%CI: 1.54–2.01), small for gestational age (SGA) (aRR: 1.19, 95%CI: 1.08–1.30), stillbirth (aRR: 2.58, 95%CI: 1.83–3.62), neonatal death (aRR: 2.63, 95%CI: 1.60–4.32). The adolescent women aged 10–17 years had significantly higher risk of stillbirth (aRR: 5.69, 95%CI: 3.36–9.65) and neonatal death (aRR: 7.57, 95%CI: 3.74–15.33) compared with the women aged 25–34 years. Younger adults (20–24 years) also had higher risks of preterm delivery (aRR: 1.26, 95%CI: 1.20–1.32), stillbirth (aRR: 1.45, 95%CI: 1.23–1.72), and neonatal death (aRR: 1.51, 95%CI: 1.21–1.90) compared with women aged 25–34 years. The structural equation model showed that preterm delivery and cesarean delivery had an indirect effect on neonatal death in adolescent pregnancy.ConclusionsThe adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm delivery, stillbirth and neonatal death, especially in younger adolescent pregnancies.

Maternal serum levels of C-reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study.

BackgroundA considerable evidence suggests that maternal inflammation dysregulation may play as a risk factor for both maternal and neonatal outcomes. Objective: The study's objectives were designed to evaluate the correlation between serum C-reactive protein (CRP) levels, as an inflammation factor, preterm delivery, and small for gestational age (SGA) births.Materials and MethodsThis prospective cohort study was conducted on 120 singleton pregnant women with gestational age less than 20 wk. Maternal CRP serum concentration was measured before 20 wk gestation. Patients were followed-up until the delivery and final outcomes of pregnancy were recorded in terms of preterm delivery and SGA births. Results: Serum CRP levels in participants with normal fetuses and SGA births were 4.09 1.35 mg/l and 6.04 3.29 mg/l, respectively (p = 0.19), while in cases of preterm delivery, it was 9.63 5.78 mg/l (p 0.001). By using receiver operating characteristic (ROC) curve, serum CRP levels (cut-off point 5.27 mg/l, area 0.836) had acceptable diagnostic accuracy value in distinguishing preterm delivery (sensitivity (75%), specificity (86.1%), positive predictive value (37.5%), negative predictive value (96.87%), accuracy (85%)) and serum CRP levels (cut-off point 6.67 mg/l, area 0.673) in distinguishing SGA births (sensitivity (50%), specificity (91.2%), positive predictive value (23.07%), and negative predictive value (97.19%), and accuracy (89.16 %)).ConclusionHigher maternal serum CRP levels measured early in pregnancy may associate with higher risk of preterm delivery and SGA.

Актуальні питання прогнозування і профілактики передчасних пологів

Premature birth is a significant problem in modern medicine. The main aspects of its solution are the prediction and prevention of premature birth. Nowadays, among a large number of biophysical and biochemical markers of preterm birth, ultrasonic cevicometry is the most popular one. It is known that «short cervix syndrome» is not the equivalent of cervical insufficiency. The known strategies of preventive combinations are used in case of an increased risk of preterm birth. Therefore, the issue of developing a differentiated approach to the combined or separate use of progesterone, pessary, or cerclage has not been answered yet. It should be added that in most practical recommendations based on the principles of evidence-based medicine, there are no differences according to the possible pathogenesis of preterm birth. A therapeutic strategy should be set based on the possible use or misuse of any preventive combination, taking into account maternal and fetal contraindications. The combined testing on ultrasound cervicometry and biochemical markers could ameliorate the identification of patients at risk of preterm birth. The fetal fibronectin is known to be the best among all biochemical markers of preterm birth. However, the prognostic value of this test, as well as the phosphorylated transport protein insulin-like growth factor, when used separately, is limited. In pregnant women with a length of the cervix between 1.5 cm and 3 cm, it is recommended to use the analysis for placental alpha-microglobulin-1. The administration of corticosteroids should only be performed when the risk of preterm delivery is confirmed by decreased cervical length and a positive test for placental alpha-microglobulin-1 (there is a high risk of preterm delivery within 7 days). The cerclage is indicated in patients with cervical insufficiency before 16 weeks of gestation. In the presence of a «short cervix» and the lack of anamnestic data, the strategy should be individualized. The efficacy of cerclage or pessary application has not been proven. It is necessary to start with vaginal progesterone administration. In the process of the patient observation (cervicometry in dynamics) will allow you to find out an effective method: cerclage or pessary and vaginal progesterone. In the case of progredient cervical effacement in the second trimester, it is advisable to perform an urgent cerclage. In the case of incompetent cervical stitch, the additional application of a pessary is possible. In women with multiple pregnancies, there is no evidence of elective cerclage or pessary efficacy. However, it is possible to use heroic cerclage, pessary in combination with vaginal progesterone or vaginal progesterone monotherapy. Key words: preterm delivery, prediction, prevention.

Adverse maternal and neonatal outcomes in pregnant women with abnormal glucose metabolism

AimsTo assess the prevalence and risk of adverse perinatal outcomes in pregnant women with abnormal glucose metabolism. Methods3269 Chinese pregnant women with singleton delivery were studied, including 787 diagnosed as gestational diabetes mellitus (GDM), 115 pregnancy with diabetes (PWD), and 2367 normal glucose tolerance (NGT). The prevalence and risk of adverse maternal and fetal outcomes were compared and assessed among the three groups, and the related risk factors of the glucose metabolism for adverse pregnancy outcomes were evaluated by binary logistic regression. ResultsCompared to NGT, maternal GDM and PWD faced increased risk of adverse perinatal outcomes such as pregnancy-induced hypertension (odds ratio (OR) 1.78 [95% confidence interval (CI): 1.17–2.72]; 4.31 [95% CI: 2.32–7.98]), low birth weight (OR 1.51 [95% CI: 1.01–2.28]; 4.05 [95% CI: 2.17–7.55]). And PWD group exhibited remarkably higher risk for preterm delivery (OR 2.88 [95% CI: 1.68–4.94]) and stillbirth (OR 7.78 [95% CI: 2.44–24.84]) than other two groups. The increased fasting insulin and glycated hemoglobin A1c were successively independent risk factors for maternal and neonatal adverse outcomes. ConclusionsGestational abnormal glucose metabolism is associated with the remarkably increased risk of adverse perinatal outcomes, and PWD has higher risk of adverse perinatal outcomes than GDM.

The reduction in anemia through normative innovations (RANI) project: study protocol for a cluster randomized controlled trial in Odisha, India

BackgroundMore than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods.MethodsThe Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40–41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels.DiscussionThis RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia.Trial registrationThis trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.

Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes.

We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011). ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE-race/ethnicity) and in combination (ICE-income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE-income + race/ethnicity. For example, ICE-income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR)=1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR=1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR=1.32, 95% CI: 1.28, 1.37; and RR=1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE-income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR=1.23, 95% CI: 1.18, 1.28; for Hispanic women, RR=1.05, 95% CI: 1.02, 1.09). Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities.

Maternal early pregnancy body mass index and pregnancy outcomes among nulliparous women registered in tertiary care hospital and urban slum hospital of a metropolitan city.

BACKGROUND:Underweight is still prevalent in developing countries like India. Prepregnancy body mass index (BMI) is used as the standard against which the measurements are made in pregnancy.AIM:To study the association between early pregnancy BMI and feto-maternal outcome among nulliparous womenMETHODOLOGY:This is a prospective observational study, with a sample size of 294. The antenatal patients were categorized into four categories of BMI according to the WHO classification, and pregnancy outcomes were compared. Data were analyzed using SPSS Software Version 17.0. Statistical tools used were percentages and mean, and categorical variables were analyzed by Chi-square statistics.RESULTS:48.94% of the patients enrolled in the study had normal early pregnancy BMI, and 44.22% and 6.8% were underweight and overweight, respectively. Obese women who gained more weight were at a higher risk of preterm delivery, cesarean section, and more time required for resumption of normal routine. Underweight women were at higher risk of postterm delivery, low birth weight, and increased hospital stay.CONCLUSION:Adverse maternal and fetal outcomes are seen more commonly with the extremes of BMI.

948: Maternal education and childhood neurodevelopment in women at high risk for preterm delivery

948: Maternal education and childhood neurodevelopment in women at high risk for preterm delivery

Comparison of management options for twin pregnancies with cervical shortening

Objective To compare the effectiveness of expectant management (EM), cervical cerclage (CC) and vaginal progesterone (VP) in decreasing the rate of spontaneous preterm birth in twin gestations with midtrimester cervical shortening. Study design This is a retrospective cohort study comparing pregnancy outcomes of twin gestations with midtrimester cervical shortening, defined as a cervical length (CL) on routine transvaginal ultrasound between 15 weeks 0 days and 24 weeks 6 days gestation of <2.5 cm, managed with either EM, CC or VP. Women were categorized by final management strategy. Primary outcome was gestational age at delivery. Secondary outcomes included latency period (defined as number of weeks between a diagnosis of cervical shortening and delivery), gestational age at delivery <32 weeks, mode of delivery, perinatal death, neonatal birthweight and rate of chorioamnionitis. Subanalysis of women with a CL < 1.5 cm was also performed. Logistic regression was used to identify predictors of delivery <32 weeks, controlling for potential confounders. Results Between January 2006 and July 2016, 64 pairs of twins with midtrimester cervical shortening were identified, 18 managed with EM (28.1%), 29 CC (45.3%), and 17 VP (26.6%), 52 of which had information regarding delivery outcomes. 90.4% of women delivered prematurely (<37 weeks). Women in the CC group were diagnosed with cervical shortening at a significantly earlier mean gestational age (CC 20.6 ± 1.7 weeks versus EM 22.2 ± 2.9 weeks and VP 22.2 ± 2.0 weeks, p = .02) and had a shorter mean cervical length at the time of diagnosis (CC 1.18 ± 0.7 cm vs. EM 1.56 ± 0.7 and VP 1.95 ± 0.6, p = .002), as compared to those in the EM and VP groups. There was no difference in gestational age at delivery (EM 30.9 ± 5.2 weeks, CC 30.4 ± 4.9 weeks and VP 32.4 ± 4.1 weeks, respectively) or any of the secondary outcomes listed above. Women with a CL <1.5 cm delivered significantly earlier than those with a cervical length ≥1.5 cm (28.4 ± 4.7 weeks vs. 33.2 ± 3.6 weeks, p = .0001). After adjusting for potential confounders, cervical length <1.5 cm, not the management strategy, was the predictor of PTB before 32 weeks in this twin population [AOR 6.56 (95% CI 1.78, 24.20), p = .005]. Conclusion Twin pregnancies with midtrimester cervical shortening are at high risk for preterm delivery, and outcomes were similar regardless of management strategy. Large prospective trials are needed to evaluate the effect of different management strategies for cervical shortening in twins.

The use of quantitative fetal fibronectin for the prediction of preterm birth in women with exposed fetal membranes undergoing emergency cervical cerclage

ObjectiveEmergency cervical cerclage is often considered a controversial salvage measure for those pregnancies at high risk of mid-trimester loss or early preterm birth. To determine the efficacy and benefit of emergency cerclage insertion, we assessed the predictive value of quantitative fetal fibronectin (fFN) concentration in cervicovaginal fluid for spontaneous preterm birth in women with exposed fetal membranes prior to cerclage insertion. Study designThis was a retrospective observational study from St Thomas’ Hospital, London of a cohort of women with singleton pregnancy and exposed fetal membranes presenting between 18 and 23+6 weeks of gestation (n = 35), in the period 2015-2018. fFN concentrations in cervicovaginal fluid were measured quantitatively at presentation in all women within 24 h prior to cerclage insertion. Results35 eligible women with exposed fetal membranes who underwent an emergency cervical cerclage were identified. The median gestational age was 20 + 0 weeks (18 + 6−21 + 2) at presentation and 29 + 3 weeks (23 + 3−38 + 2) at delivery, with a median time from emergency cerclage to delivery of 65.5 days (17–126.5). In total, 12 women (34 %) delivered within 28 days of emergency cerclage insertion. 60 % of women with an fFN level above 500 ng/mL delivered within 28 days of cerclage insertion, and they all delivered before 37 weeks gestation. No women with fFN levels below 10 ng/mL delivered within 28 days and 75 % of these women delivered at term. Concentration of quantitative fFN at presentation correlated negatively with time to delivery (Spearman's rs = −0.52, p = 0.0016). Mann–Whitney U analysis demonstrated a significant difference in the distribution of qfFN concentrations in women who delivered preterm compared to those who did not, both within 28 days from testing (p = 0.0048) and <37 weeks (p = 0.006). ConclusionQuantitative fFN has a role in predicting spontaneous preterm birth even in women with exposed fetal membranes undergoing emergency cervical cerclage. Given the serious risks associated with cervical cerclage surgery, qfFN could be used to counsel these patients at high risk of preterm delivery, as well as assisting in the decision to insert a cerclage.

Membrane Separation and Perinatal Outcomes after Laser Treatment for Twin-Twin Transfusion Syndrome

Introduction: Postoperative membrane separation is a complication of selective laser photocoagulation of communicating vessels (SLPCV) for the treatment of twin-twin transfusion syndrome (TTTS). Objective: The aim of this work was to determine whether a quantitative grading system of membrane separation following SLPCV was associated with preterm premature rupture of membranes (PPROM) and preterm delivery (PTD). Methods: Patients with membrane separation after SLPCV on postoperative day 1 were stratified into greatest width of separation <1 cm (Group A) or ≥1 cm (Group B) and compared to patients without separation by the following outcomes: PPROM ≤21 postoperative days, PTD <28 gestational weeks, and PTD <32 gestational weeks. Results: Of 654 patients, 123 (18.8%) had membrane separation. Of these, 120 patients were eligible for study and divided into Groups A (n = 91) and B (n = 29). Multiple logistic regression analysis yielded associations with PPROM ≤21 days for Groups B (OR 8.60, 95% CI 3.38–21.90, p < 0.0001) and A (OR 2.39, 95% CI 1.05–5.40, p = 0.0369) compared to those without membrane separation. In similar models, Group B was associated with PTD <32 weeks (OR 2.41, 95% CI 1.10–5.28, p = 0.0274). Conclusion: Postoperative membrane separation was associated with an increased risk of PPROM ≤21 days. Membrane separation ≥1 cm had a higher risk of PTD <32 weeks.

Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth

Aim To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin’s pessary with cervical cerclage in women at a high risk of pregnancy loss. Materials and methods This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin’s pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. Results Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p = .448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ 2 = 6.500; p = .011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin’s pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. Conclusions Women with a high risk of pregnancy loss treated with Arabin’s pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.

Role of hydroxyprogesterone caproate injection in prevention of preterm labour in high risk patients for preterm delivery.

Preterm labour is occurrence of labour after 24 completed weeks of gestation and before 37 weeks of gestation are completed. In Asia preterm birth rate is quoted to be 9.1% while in Pakistan it is 15.7%. To establish role of hydroxyprogesterone caproate injection in prevention of preterm labour in high risk patients for pre-term delivery. Study Design: Descriptive case series. Setting: Obstetrics &amp; Gynaecology Department at Nishtar Hospital Multan. Period: 25th October 2017 to 25th April 2018. Materials and Methods: 148 pregnant patients who were at high risk of pre-term delivery, women with any parity and singleton pregnancy and ongoing pregnancy between 24 to 36 gestational weeks were taken in the study. Patients having multiple pregnancy, fetal membrane rupture, having any contraindication to progesterone or taking medicines having interaction with progesterone were excluded from the study. All patients included in the study were given 250mg/ml hydroxyprogesterone caproate injection on weekly basis by intramuscular route. Injections were given till 36 completed gestational weeks or till the time of delivery which ever happened earlier. Patients who had pre-term delivery were managed as per standard protocol. Information was recorded in form of efficacy on a specially design proforma. Results: In the study range of age was 18-35 years and mean was 28.486 ± 2.79 years. 30.405 ± 2.42 weeks was mean for gestational age. Mean for prior pre-term delivery was 0.520 ± 0.83 and 26.398± 1.44 kg/m2 was mean BMI. 70.3% patients showed efficacy of drug. Conclusion: Results of study showed that hydroxyprogesterone caproate injection given as 250mg/ml on weekly basis causes significant decline in occurrence of recurrent pre-term delivery in high risk patients for pre-term delivery.