Women In Preterm Labor Research Articles

Automatic semantic segmentation of EHG recordings by deep learning: An approach to a screening tool for use in clinical practice

Background and ObjectivePreterm delivery is an important factor in the disease burden of the newborn and infants worldwide. Electrohysterography (EHG) has become a promising technique for predicting this condition, thanks to its high degree of sensitivity. Despite the technological progress made in predicting preterm labor, its use in clinical practice is still limited, one of the main barriers being the lack of tools for automatic signal processing without expert supervision, i.e. automatic screening of motion and respiratory artifacts in EHG records. Our main objective was thus to design and validate an automatic system of segmenting and screening the physiological segments of uterine origin in EHG records for robust characterization of uterine myoelectric activity, predicting preterm labor and help to promote the transferability of the EHG technique to clinical practice. MethodsFor this, we combined 300 EHG recordings from the TPEHG DS database and 69 EHG recordings from our own database (Ci2B-La Fe) of women with singleton gestations. This dataset was used to train and evaluate U-Net, U-Net++, and U-Net 3+ for semantic segmentation of the physiological and artifacted segments of EHG signals. The model's predictions were then fine-tuned by post-processing. ResultsU-Net 3+ outperformed the other models, achieving an area under the ROC curve of 91.4 % and an average precision of 96.4 % in detecting physiological activity. Thresholds from 0.6 to 0.8 achieved precision from 93.7 % to 97.4 % and specificity from 81.7 % to 94.5 %, detecting high-quality physiological segments while maintaining a trade-off between recall and specificity. Post-processing improved the model's adaptability by fine-tuning both the physiological and corrupted segments, ensuring accurate artifact detection while maintaining physiological segment integrity in EHG signals. ConclusionsAs automatic segmentation proved to be as effective as double-blind manual segmentation in predicting preterm labor, this automatic segmentation tool fills a crucial gap in the existing preterm delivery prediction system workflow by eliminating the need for double-blind segmentation by experts and facilitates the practical clinical use of EHG. This work potentially contributes to the early detection of authentic preterm labor women and will allow clinicians to design individual patient strategies for maternal health surveillance systems and predict adverse pregnancy outcomes.

STUDY OF VAGINAL FLORA AND ITS RELATIONSHIP WITH PRETERM LABOUR PAIN AND PPROM

Objective: The aim of this study is to describe the bacterial flora of women in preterm labor with or without premature rupture of membranes. Methods: Prospective studies of 200 patients with preterm labor were performed. Results: 32 of 200 patients with preterm labor (16%) had bacterial vaginosis. 76 of the 200 patients with preterm labor (38 %) developed premature rupture of the membranes (preterm PROM). Of the 76 patients with preterm PROM, 14 (18.4%) had bacterial vaginosis. Therefore, 14 of the 32 patients with bacterial vaginosis (43.75%) developed preterm PROM. An increased number of organisms detected from the vaginal discharge in patients with preterm labor was associated with preterm PROM. An increased number of organisms detected from the vaginal discharge in patients with preterm labor complicated with bacterial vaginosis was significantly associated with preterm PROM. Conclusions: In preterm labor, the number of different species detected in the vagina provide sensitive and specific prediction of preterm PROM in patients with preterm labor.

Serial Cervical Length Measurement for Determining the Risk of Preterm Labor: A Prospective Study

Objective: This study aimed to evaluate whether serial evaluations of cervical length (CL) have the potential to determine preterm labor in women with threatening preterm labor (TPL). Materials and Methods: This prospective study included pregnant women at 24 to 37 weeks of gestation referred to our institute because of TPL. Cervical length was measured at three successive time points using transvaginal sonography (upon admission, one-, and two-weeks post-admission). Data were analyzed using both parametric and non-parametric statistics. Results: The mean age of the 126 patients included was 25.60 ± 6.48 years, with age ranging from 14 to 42 years. The mean pregnancy age, at the time of the sonogram, was 33.54 ± 2.78 weeks. The initial CL had an area under the receiver operating characteristic curve (AUROC) of 0.854. The CLs measured one and two weeks later had AUROCs of 0.868 and 0.870, respectively. Based on these data, the cut-off points of 28.5 and 27.5 mm were identified for the initial and subsequent two-week CL measurements, respectively, capable of predicting preterm delivery. If the CL measured at initial admission was >28.5 mm, the likelihood of timely delivery was 92.22%. However, if the CL measured at initial admission was <28.5 mm, the chance of premature preterm delivery increased by 2.3 times. Patients with a CL <27.5 mm in the second week were 18.75% more likely to have a preterm delivery. If the CL was >27.5 mm, the probability of timely delivery was 89.7%. Conclusion: In this cohort of women, serially measured CLs taken during transvaginal sonography demonstrated promise as a method for indicating the possible risk of preterm delivery. Thus, measured CL may be a useful diagnostic component for prenatal care, as well as for classifying the risk of preterm delivery. Nevertheless, further studies are required to confirm the effectiveness and safety of these sonographic measures in larger and more diverse patient cohorts.

The use of antenatal corticosteroids in preterm labour for the prevention of perinatal mortality in hospitals in Tanzania.

Antenatal corticosteroids (ACS) are given to pregnant women at risk of preterm delivery to hasten the maturation of the lungs, lowering the risk of newborn respiratory distress syndrome (RDS) and perinatal mortality. The aim of this study was to determine whether exposure to ACS was associated with lower rates of perinatal mortality and RDS in preterm infants delivered by women with preterm labour. This is a secondary analysis of data from four hospitals in Mwanza, Tanzania. All singletons and twins born to women who were in preterm labour between July 2019 and February 2020 and delivered in-hospital between 24 and 34 weeks of gestation were included. Data were recorded from participants' medical records and analysed using STATA Version 14. Over an eight-month period, 588 preterm infants were delivered to 527 women. One hundred and ninety (36.1%) women were given ACS. Infants who were exposed to ACS in utero had a lower rate of perinatal mortality (6.8% vs 19.1%) and RDS (12.3% vs 25.9%) compared to those not exposed to ACS. In adjusted multivariable models, ACS exposure was related to a lower risk of perinatal mortality, aRR 0.23 (95% CI 0.13 - 0.39), and RDS, aRR 0.45 (95% CI 0.30 - 0.68). ACS significantly reduced the risk of perinatal mortality and RDS among preterm infants exposed to ACS in utero and delivered by women in preterm labour. The use of ACS should be encouraged in low-resource settings where preterm birth is prevalent to improve perinatal outcomes.

Clinical application of amino-terminal pro-brain natriuretic peptide concentration in amniotic fluid for the prediction of preterm birth in symptomatic women

BackgroundPreterm birth accounts for 60-80% of neonatal mortality. Approximately one-third of preterm births are caused by the spontaneous onset of preterm labor. Nevertheless, 70%-90% of women diagnosed with preterm labor will not deliver within seven days. Thus, many women will be unnecessarily treated by preterm labor with risk medications. Better tools are needed to categorize women in preterm labor into high or low risk of preterm delivery. ObjectiveTo evaluate the amino-terminal pro-brain natriuretic peptide concentration in the amniotic fluid as a prognostic test to predict the risk of delivery within 48 h or 7 days and before 34+0 or 37+0 weeks in women in preterm labor. Study Design102 pregnant women presenting signs and symptoms of spontaneous preterm birth (22+0 to 34+0 weeks of gestation) were included. Amniotic fluid was obtained by amniocentesis, and amino-terminal pro-brain natriuretic peptide concentration was measured. Below normal concentration was defined as < 0.5 multiples of the median of the standard curve according to gestational age. We estimated the risk of preterm delivery risk according to normal or lower-than-normal concentrations of amino-terminal pro-brain natriuretic peptide. The predictive capacity of the test (below normal concentration of amino-terminal pro-brain natriuretic peptide) was evaluated to identify spontaneous preterm birth at 48 h or 7 days from amniocentesis, and less than 34+0 or 37+0 weeks at delivery. ResultsFor the outcome delivery within 48 h, lower than normal amino-terminal pro-brain natriuretic peptide concentration had 94.6% sensitivity, 73.8% specificity, 96% negative predictive value, and positive and negative likelihood ratios 3.6 and 0.07, respectively. For the outcome delivery within 7 days, the test had 93.9% sensitivity, 88.7% specificity, 94% negative predictive value, and positive and negative likelihood ratios 8.3 and 0.07, respectively. For the outcome of spontaneous preterm birth before 34+0 and 37+0 weeks, below normal amino-terminal pro-brain natriuretic peptide had 80% sensitivity, 83% specificity, 78% negative predictive value, positive and negative likelihood ratio 4.7 and 0.24 and 64.1% sensitivity, 91.7% specificity, 44% negative predictive value, positive and negative likelihood ratio 7.7 and 0.39 respectively. ConclusionAmong patients in spontaneous preterm labor, the detection of lower-than-normal concentrations of amino-terminal pro-brain natriuretic peptide (< 0.5 multiples of the median) in amniotic fluid has an excellent predictive capacity to identify those patients at low risk of preterm delivery within 48 h or 7 days.

COMPARISON OF MICROBIOTA IN THREATENED PRETERM LABOR AND NORMAL PREGNANCY AT RSUP DR.M. DJAMIL PADANG

One of the threats in pregnancy is threatened preterm labor. Several studies show that thecomposition of the microbiota in the vagina of premature births and normal pregnancies is different.This study aims to determine the comparison of microbiota in pregnancies with premature parturitionand normal pregnancies at Dr M Djamil General Hospital, Padang. This research is an analyticalobservational study with a case–control study design conducted at the Department/SMF of Obstetricsand Gynecology, RSUP Dr. M. Djamil Padang from July – September 2023. The study population in thisresearch were all pregnant women with a gestational age of 20-37 weeks who were diagnosed withimminens preterm labor and normal pregnant women with a gestational age of 20-37 weeks whoreceived antenatal care at RSUP Dr. M. Djamil Padang. Respondents had vaginal swabs taken formicrobiological culture at the Biomedical Laboratory, Andalas University, Padang. There were 33respondents each in the imminence premature birth and normal pregnancy groups. Vaginal swabresults showed that the most common microorganism found in normal pregnancy was Lactobacilussp. (73%) while in threatened preterm labor Staphylococcus aureus (37%), Staphylococcus epidermidis(27%) and E.coli (15%) were more commonly found with only a small proportion of Lactobacilus sp(12%). Chi square analysis showed a significant difference between the vaginal microbiota of normalpregnant women and pregnant women with PPI. The conclusion of this study is that there is anincrease in Staphylococcus aureus, Staphylococcus epidermidis and E.coli in pregnant women on PPIwith a decrease in the number of normal flora, namely Lactobacilus spp.

조기진통 임부에 관한 국내 연구동향

조기진통 임부에 관한 국내 연구동향

Preterm Birth: Screening and Prediction.

Preterm birth (PTB) affects approximately 10% of births globally each year and is the most significant direct cause of neonatal death and of long-term disability worldwide. Early identification of women at high risk of PTB is important, given the availability of evidence-based, effective screening modalities, which facilitate decision-making on preventative strategies, particularly transvaginal sonographic cervical length (CL) measurement. There is growing evidence that combining CL with quantitative fetal fibronectin (qfFN) and maternal risk factors in the extensively peer-reviewed and validated QUanititative Innovation in Predicting Preterm birth (QUiPP) application can aid both the triage of patients who present as emergencies with symptoms of preterm labor and high-risk asymptomatic women attending PTB surveillance clinics. The QUiPP app risk of delivery thus supports shared decision-making with patients on the need for increased outpatient surveillance, in-patient treatment for preterm labor or simply reassurance for those unlikely to deliver preterm. Effective triage of patients at preterm gestations is an obstetric clinical priority as correctly timed administration of antenatal corticosteroids will maximise their neonatal benefits. This review explores the predictive capacity of existing predictive tests for PTB in both singleton and multiple pregnancies, including the QUiPP app v.2. and discusses promising new research areas, which aim to predict PTB through cervical stiffness and elastography measurements, metabolomics, extracellular vesicles and artificial intelligence.

Recurrence quantification analysis of uterine vectormyometriogram to identify pregnant women with threatened preterm labor

Electrohysterography has been shown to provide relevant information on preventing preterm labor. Recent studies have confirmed the feasibility of using the vectormyometriogram (VMG) to assess uterine myoelectric vector displacement, with different physiological implications for the slow and fast waves, without suggesting its implementation in clinical practice. The fast wave VMG component has dynamic behavior in any specific direction on the X-Y plane. Since recurrence is a common feature of dynamic systems, we aimed to determine the recurrence pattern of uterine vector displacement, exploring its clinical potential in detecting imminent and preterm labor in women with threatened preterm labor and a serious preterm birth risk. For this, we analyzed the recurrence patterns from a 2D-vectormyometriogram using four common statistics: determinism, longest diagonal, entropy, and laminarity. We found significantly increased determinism (0.035 ± 0.011 vs. 0.077 ± 0.041), entropy (1.768 ± 0.116 vs. 2.197 ± 0.24) and laminarity (0.086 ± 0.034 vs. 0.173 ± 0.078) from the early (26–30 weeks) to late (35–37 weeks) gestation stages. As pregnancy progresses, the uterine vector displacement becomes more periodic, predictable and stable, while VMG recurrence statistics in the fast wave high bandwidth better detect imminent and preterm labor, outperforming classical EHG parameters from bipolar channels. The proposed method was also resistant to motion artifacts and preserved its discriminative capacity between the groups. Our results on VMG recurrence statistics could thus be another reliable biomarker for preventing preterm labor in women with threatened preterm labor and would favor transferring the EHG technique to clinical practice.

Nifedipine versus magnesium sulfate in the management of preterm labour- A randomised controlled trial

Preterm labour is the leading cause of perinatal morbidity and mortality worldwide. Preterm birth accounts for 75% of neonatal deaths and 50% of long-term morbidity including respiratory disease and neuro-developmental impairment. The use of tocolysis in women in preterm labour aims to inhibit uterine contractions and reduce perinatal morbidity and mortality associated with early delivery.To study the effect and compare the efficacy of Nifedipine and Magnesium sulphate in management of preterm labour.: This randomized controlled trial was performed on 80 women with preterm labor between 28 and 37 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. All patients were checked for successful prolongation of pregnancy who had not been delivered at 48 hours [primary tocolytics effects] and more than 7 days [secondary tocolytics effects] after beginning the treatment and side effects of tocolysis.: From 80 patients, 40 received nifedipine and 40 received MgSO4. There were no differences in suppression of labor pain in 24 hours, 48 hours and 7 days between the two groups. Even though there were no statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome between the groups neonates of MgSO4 group had more NICU admission which is significant (p value 0.049).: Oral nifedipine is as effective as magnesium sulfate with regard to inhibition of preterm labor.

Labour and premature delivery differentially affect the expression of the endocannabinoid system in the human placenta

Plasma concentrations of N-arachidonyletholamine (AEA), N-oleoylethanolamide (OEA) and N-palmitoylethanolamide (PEA) increase at term and can predict when a woman is likely to go into labour. We hypothesised that increased plasma AEA concentrations in women in preterm and term labour might also be increased and have a function in the placenta at the end of pregnancy. Here we examined the expression of the N-acylethanolamine-modulating enzymes fatty acid amide hydrolase (FAAH) and N-acyl-phosphatidylethanolamine-specific phospholipase-D (NAPE-PLD) and of the cannabinoid receptors (CB1 and CB2) in the placenta and their activation in an in vitro model of the third-trimester placenta to determine if those expressions change with labour and have functional significance. Expression of CB1, CB2, FAAH and NAPE-PLD was examined by immunohistochemistry (IHC) and RT-qPCR in placental samples obtained from four patient groups: preterm not in labour (PTNL), term not in labour (TNL), preterm in labour (PTL) and term in labour (TL). Additionally, the effects of AEA on a third-trimester human cell line (TCL-1) were evaluated. All ECS components were present in the third-trimester placenta, with NAPE-PLD and CB2 being the key modulated proteins in terms of expression. Functionally, AEA reduced TCL-1 cell numbers through the actions of the CB2 receptor whilst CB1 maintained placental integrity through the expression of the transcription regulators histone deacetylase 3, thyroid hormone receptor β 1 and the modulation of 5α reductase type 1. The placenta in the third trimester and at term is different from the placenta in the first trimester with respect to the expression of CB1, CB2, FAAH and NAPE-PLD, and the expression of these proteins is affected by labour. These data suggest that early perturbation of some ECS components in the placenta may cause AEA-induced PTL and thus PTB.

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Scaling up an intervention to protect preterm infants from neurodevelopmental disabilities — findings from a qualitative process evaluation comparing standard with enhanced quality improvement support packages for maternity units in England

BackgroundA quality improvement strategy (PReCePT) was used in a standard and enhanced format to scale up a clinical intervention (administering magnesium sulphate to women in preterm labour) across all maternity units in England to protect prematurely born infants from neurodevelopmental disabilities. Formal evaluations reported the effectiveness of the standard package alone in increasing the administration of magnesium sulphate. In this paper, we focus on the findings of the process evaluations, using normalisation process theory to explain how different implementation contexts generated the observed outcomes relating to normative and relational restructuring and sustainment.MethodsInterviews were conducted with key individuals in implementation of leadership positions nationally and locally. Interviews were analysed initially using the framework method. We then engaged recursively with NPT constructs to generate generalisable insights with pragmatic applicability in other settings.ResultsIn total, 72 interviews were conducted with good representation from units across England and staff from the National Academic Health Science Network. We found that all units irrespective of whether they received a standard or enhanced QI package were successful in the ‘normative restructuring’ of their setting to enable magnesium sulphate to be administered. This suggests that this implementation outcome is necessary to achieve improvements. However, it may not be sufficient to sustain the changes once additional resources have been withdrawn. Sustainment, our findings suggest, required ‘relational restructuring’ to accommodate altered workflows and facilitate the sharing of responsibilities and tasks in daily practice. Relational restructuring was more likely to have been achieved units receiving enhanced QI support but also happened in units with standard QI support, especially in those where perinatal team working was already well established.ConclusionUnlike other large QI-focused spread-and-scale programmes which failed to show any impact on outcomes, the PReCePT programme in both the enhanced and standard support packages led to improvements in the uptake of magnesium sulphate. The findings suggest that QI programmes interact with the enabling factors, such as strong interprofessional team working, already present in the setting. A standard package with minimal support was therefore sufficient in settings with enabling factors, but enhanced support was required in units where these were absent.

Antenatal magnesium sulfate and the need for mechanical ventilation in the first three days of life

Antenatal administration of magnesium sulfate (MgSO4) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO4 exposure with neonatal respiratory outcomes. Very low birth weight (VLBW) infants exposed to antenatal MgSO4 were included. Infants who were intubated anytime during the first three days of life were compared to those who were not intubated regarding their demographic and clinical characteristics, MgSO4 therapy, immediate respiratory outcomes, and occurrence of intraventricular hemorrhage (IVH) using student t-test, chi square testing and logistic regression analysis to control for confounding variables. Correlation coefficient of MgSO4 cumulative dose given and duration of infusion with delivery room resuscitation and need for mechanical ventilation in the first 3 days of life were also calculated. Multilinear regression analysis was used to control for confounding factors. Intubated group included 96 infants while non-intubated group included 171 infants. Although, intubated group has younger gestational age (26 vs. 29 weeks, p<0.01) and lower birth weight (786 vs. 1115g (g), p<0.01), there were no significant differences between groups in regard to MgSO4 cumulative dose (24 vs. 27g, p=0.29), infusion time (14.6 vs. 18h, p=0.19) or infants' serum magnesium level (2.6 vs. 2.8 milliequivalents (mEq)/L p=0.86). There was no correlation between cumulative MgSO4 dose with endotracheal intubation or cardiac resuscitation in the delivery room (cc: -0.03, p=0.66; and 0.02, p=0.79, respectively) or the need for mechanical ventilation in the first 3 days of life (cc: -0.04 to -0.07, p=0.21-0.51). In addition, there was no relationship between MgSO4 dose, duration of infusion, or infant's serum magnesium level and occurrence of IVH. Regardless of dose or duration of infusion, antenatal MgSO4 exposure is not associated with increased intubation or mechanical ventilation early in life.

Results of Histological Examination of the Placenta in Preterm Birth Among Residents of the Kaliningrad Region With Hereditary Maladaptation of Hemostasis

In modern obstetrics, the problem of premature birth is very relevant. Despite the active development of medical technologies, the number of preterm births stably remains at the level of 5-10% of the total number of births, and recurrent miscarriage reaches 20%. As is known, one of the causes of preterm birth and recurrent miscarriage is the carriage of genes associated with thrombophilia. We are studying the effect of thrombogenic allelic polymorphisms on the course of pregnancy and the outcome of childbirth in the population of the Kaliningrad region. One of the points of our research is devoted to the description of structural changes in the placenta during preterm labor in women with hereditary maladaptation of hemostasis.

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.

Role of p65 NF-κB, caspase-3 activities and VEGF gene polymorphisms on the development of preterm labor in women with placental dysfunction

The objective: to study the activity of the p65 subunit of the nuclear factor – NF-κB and effector caspase-3, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) in pregnant women with placental disorders and various clinical types of the course of premature labor (with premature rupture of the membranes and without it).Materials and methods. At the clinical base of the Department of Obstetrics and Gynecology No. 1 of O. O. Bogomolets National Medical University, which is located in the non-commercial enterprise “Perinatal Center of Kyiv”, during 2019–2022, a case-control study was conducted with the involvement of 90 pregnant women: 60 women of the main group with placental disorders and the development of spontaneous premature labor in the period of 24–34 weeks of gestation (I group – 30 women with premature labor and premature rupture of membranes, II group – 30 women with premature rupture of the membranes) and 30 women of control group (CG) with term normal delivery and the physiological course of the pregnancy.In pregnant women, the number of total and activated fractions of the p65 subunit of nuclear factor NF-κB and caspase-3 was determined by enzyme-linked immunosorbent assay (ELISA) in placenta lysates with further calculation of their activity based on these data, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) using the polymerase chain reaction.Results. In women with placental disorders and preterm birth a significantly higher values of fraction content and activity of p65 NF-κB and caspase-3 were found, with some peculiarities within the groups compared to the control group. Women of the I group were characterized by a higher activity of p65-subunit of nuclear factor (I group — 61.6 % with 95 % CI 59.7–64.2; II group — 33.8 pg/ml with 95 % CI 31.2-35.2; CG — 27.3 pg/ml, 95 % CI 26.4–28.6; p&lt;0.05). Pregnant women of the II group had higher values of caspase-3 activity (II group — 59.2 % with 95 % CI 57.4–59.8, I group — 39.5 % with 95 % CI 38.5–40.5, CG — 31.2 %, 95 % CI 30.4–31.9; p&lt;0.01). It was established that the presence of the T allele at position 936 of VEGF gene polymorphism is a risk factor for the development of placental disorders with the development of premature labor, the rate of this allele in the main group was 11.7 % versus 1.7 % – in the control cohort (p&lt;0.05).Conclusions. Pregnant women with placental disorders and the development of premature birth are characterized by an increased activity of the p65 subunit of nuclear factor κB and caspase-3 compared to the control group: in women without premature rupture of the fetal membranes, a significant 2.2-fold increase in p65 NF-κB activity was found, and caspase-3 activity – by 1.3 times; in the group of pregnant women with preterm premature rupture of membranes the level of caspase-3 activity exceeded the control group by 1.9 times, and the level of p65-subunit of nuclear factor activity — by 1.2 times (p&lt;0.01 for all groups).936(C/T) single nucleotide polymorphism of the vascular endothelial growth factor gene was determined significantly more often in women with placental disorders and preterm birth (11.7 % in the study group versus 1.7 % in CG, p&lt;0.05), the T-allele on the VEGF gene carriers may be associated with the development of these pregnancy complications. However, a study on a larger sample of women is needed to obtain definitive results.

Study the Role of Congenital Toxoplasmosis with Preterm Labor, and Low Birth Weight

The study included 100 samples of blood from women who suffer from premature birth and low fetal weight, and a hundred samples from women who do not suffer from any injury. This study extends from February 1, 2019 to November 1, 2019, where the study included collecting blood samples from all women who entered the study, in addition to collecting information regarding age, weight, height, and history of infection with parasites, if any, to investigate the parasite’s DNA in blood samples collected from patients. These samples were examined using the standard methods provided by the company in which the tests were conducted. The study included the molecular detection by PCR of toxoplasma genes, where EDTA blood samples were collected from all preterm and term pregnant women in the study. Using laboratory kit for Toxoplasma DNA extraction, samples were extracted and kept in separate sterile tubes using DAN extraction kit (Zymogene, Japan), then the DNA was detected by real-time PCR which was done according to the protocols designed by the manufacturer of the diagnostic kit. The study showed no significant relationship between the two groups regarding mean of ages. But regular contractions, reduced length of cervix and decreased weight of babies was highly related with women presented with preterm birth. The study showed that 87.5% of preterm delivery women with +ve DNA detection of T. gondii have regular contraction comparing with 12.5% of cases with negative T. gondii infection (P&lt;0.001). The study showed the lowest mean of baby weight at birth was recorded in pregnant women with preterm labor women who infected with T. gondii as compared with cases who were negative to T. gondii infection (P&lt;0.001). The study demonstrated that majority of women with +ve T gondii infection were had positive history of abortion.

Uterine activity modifies the response of the fetal autonomic nervous system at preterm active labor.

The autonomic nervous system of preterm fetuses has a different level of maturity than term fetuses. Thus, their autonomic response to transient hypoxemia caused by uterine contractions in labor may differ. This study aims to compare the behavior of the fetal autonomic response to uterine contractions between preterm and term active labor using a novel time-frequency analysis of fetal heart rate variability (FHRV). We performed a case-control study using fetal R-R and uterine activity time series obtained by abdominal electrical recordings from 18 women in active preterm labor (32-36 weeks of gestation) and 19 in active term labor (39-40 weeks of gestation). We analyzed 20 minutes of the fetal R-R time series by applying a Continuous Wavelet Transform (CWT) to obtain frequency (HF, 0.2-1Hz; LF, 0.05-0.2Hz) and time-frequency (Flux0, Flux90, and Flux45) domain features. Time domain FHRV features (SDNN, RMSSD, meanNN) were also calculated. In addition, ultra-short FHRV analysis was performed by segmenting the fetal R-R time series according to episodes of the uterine contraction and quiescent periods. No significant differences between preterm and term labor were found for FHRV features when calculated over 20 minutes. However, we found significant differences when segmenting between uterine contraction and quiescent periods. In the preterm group, the LF, Flux0, and Flux45 were higher during the average contraction episode compared with the average quiescent period (p<0.01), while in term fetuses, vagally mediated FHRV features (HF and RMSSD) were higher during the average contraction episode (p<0.05). The meanNN was lower during the strongest contraction in preterm fetuses compared to their consecutive quiescent period (p=0.008). The average autonomic response to contractions in preterm fetuses shows sympathetic predominance, while term fetuses respond through parasympathetic activity. Comparison between groups during the strongest contraction showed a diminished fetal autonomic response in the preterm group. Thus, separating contraction and quiescent periods during labor allows for identifying differences in the autonomic nervous system cardiac regulation between preterm and term fetuses.

VAGINAL PROGESTERONE IN RISK REDUCTION OF PRETERM BIRTH IN WOMEN WITH SHORT CERVIX IN MID TRIMESTER OF PREGNANCY

Background: Preterm labour is a major health challenge in obstetrics. Many risk factors being identified, the most common one is short cervical length, can be diagnosed by transvaginal ultrasound scan after 13 weeks of pregnancy. Vaginal progesterone is the most bioavailable form of progesterone that have effect on uterine and cervix. Progesterone is found to inhibit the production of proinflammatory cytokines and prostaglandins within the uterus and to inhibit myometrial contractility Aim:To evaluate the efficacy of vaginal progesterone administration for preventing preterm birth and decrease perinatal morbidity and mortality in asymptomatic women with a singleton gestation and a mid-trimester sonographic cervical length (CL) ≤ 25 mm. Materials And Methods:This is a prospective study of asymptomatic women with a singleton pregnancy and a sonographic short cervix (&lt;25mm) at 19 + 0 to 23 + 6 weeks of gestation. Women were allocated randomly to receive vaginal progesterone or placebo daily starting from 19 + 0 to 23 + 6 weeks until 36 + 6 weeks, rupture of membranes or delivery, whichever occurred first. Randomization sequence was stratified by centre and history of a previous preterm birth. The primary endpoint was preterm birth before 33 weeks of gestation. Analysis was by intention to treat. Results:Out of 100 patients for whom study was done, 20 lost to followup and remaining divided into two groups: 40 Singleton pregnant women with CL&lt;25mm between 19 + 0 to 23 + 6 weeks of gestation with no sign and symptoms were given daily vaginal progesterone for up to 36 + 6 weeks, rupture of membranes or delivery, whichever occurred first. The dose is 200 mg once daily and a group of 40 women with cervical length of &lt;25 mm between 19 + 0 to 23 + 6 weeks of pregnancy were given no treatment, Maximum distribution belongs to age of 19-24 years followed by 30-34 years. Most of women in this study have no history of preterm labour. In those who received vaginal progesterone 5 women had history of previous preterm labour and five women in no treatment group. It was found that there was statistically significant reduction in preterm labour in women with short cervix &lt;2.5cm with 200mg vaginal progesterone. Conclusions:This updated systematic review and meta-analysis reaffirms that vaginal progesterone reduces the risk of preterm birth and neonatal morbidity and mortality in women with a singleton gestation and a mid-trimester CL ≤ 25 mm, without any deleterious effects on neurodevelopmental outcome. Clinicians should continue to perform universal transvaginal CL screening at 19 + 0 to 23 + 6 weeks of gestation in women with a singleton gestation and to offer vaginal progesterone to those with a CL ≤ 25 mm.