Premature Rupture Of Fetal Membranes Research Articles

A recurrent de novo missense mutation in COL1A1 causes osteogenesis imperfecta type II and preterm delivery in Normande cattle

BackgroundNine male and eight female calves born to a Normande artificial insemination bull named “Ly” were referred to the French National Observatory of Bovine Abnormalities for multiple fractures, shortened gestation, and stillbirth or perinatal mortality.ResultsUsing Illumina BovineSNP50 array genotypes from affected calves and 84 half-sib controls, the associated locus was mapped to a 6.5-Mb interval on chromosome 19, assuming autosomal inheritance with germline mosaicism. Subsequent comparison of the whole-genome sequences of one case and 5116 control genomes, followed by genotyping in the affected pedigree, identified a de novo missense substitution within the NC1 domain of the COL1A1 gene (Chr19 g.36,473,965G > A; p.D1412N) as unique candidate variant. Interestingly, the affected residue was completely conserved among 243 vertebrate orthologs, and the same substitution in humans has been reported to cause type II osteogenesis imperfecta (OI), a connective tissue disorder that is characterized primarily by bone deformity and fragility. Moreover, three COL1A1 mutations have been described to cause the same syndrome in cattle. Necropsy, computed tomography, radiology, and histology confirmed the diagnosis of type II OI, further supporting the causality of this variant. In addition, a detailed analysis of gestation length and perinatal mortality in 1387 offspring of Ly and more than 160,000 progeny of 63 control bulls allowed us to statistically confirm in a large pedigree the association between type II OI and preterm delivery, which is probably due to premature rupture of fetal membranes and has been reported in several isolated cases of type II OI in humans and cattle. Finally, analysis of perinatal mortality rates and segregation distortion supported a low level of germ cell mosaicism in Ly, with an estimate of 4.5% to 7.7% of mutant sperm and thus 63 to 107 affected calves born. These numbers contrast with the 17 cases reported and raise concerns about the underreporting of congenital defects to heredo-surveillance platforms, even for textbook genetic syndromes.ConclusionsIn conclusion, we describe a large animal model for a recurrent substitution in COL1A1 that is responsible for type II OI in humans. More generally, this study highlights the utility of such datasets and large half-sib families available in livestock species to characterize sporadic genetic defects.

Induction of human-fetal-membrane remodeling in-vitro by the alpha hemolysin of Escherichia coli

IntroductionAlmost 80% of urinary tract infections during pregnancy are caused by uropathogenic strains of Escherichia coli. Alpha-hemolysin, toxin secreted by them, has a fundamental role in this pathology development. Considering that urinary tract infections are related with premature rupture of fetal membranes, we proposed to evaluate the effects that alpha-hemolysin induces on human-fetal-membranes. MethodsThirteen fetal membranes obtained from elective cesarean sections (>37 weeks) were mounted in a transwell-device generating two independent chambers. To mimic an ascendant-urinary-tract infection, membranes were incubated with different concentrations of pure alpha-hemolysin from the choriodecidual side during 24h. Extensive histological analyses were performed and transepithelial electrical-resistance were determined. Cell viability, metalloproteinase activity and cyclooxygenase-2- gene expression was estimated by lactate-dehydrogenase–release assay, zymography and RT-qPCR, respectively. Finally, four fetal membranes were treated with hemolysin preincubated with polyclonal anti-hemolysin antibodies. Cell viability and metalloproteinase activity were monitored. ResultsAfter 24 h of treatment, fetal membranes evidenced a structural damage and a decrease in membrane resistance that progressed as the concentration of alpha hemolysin increased. While the amniotic-epithelial-layer remained practically unaffected, the chorion cells manifested an increase in vacuolization and necrosis. In addition, the extracellular matrix exhibited collagen-fiber disorganization, a marked decrease in fiber content, and became thicker in presence of the toxin. Cyclooxigenase-2 expression and metalloproteinase activity were also higher in the treated groups than in untreated ones. Finally, a preincubation of hemolysin with specific antibodies prevented the cytotoxicity on the chorion cells and the increase in metalloproteinase activity. DiscussionHemolysin induces structural and molecular changes associated with the remodeling of human-fetal-membranes in-vitro.

Analysis of risk factors and hypoxic-ischemic damage consequences to central nervous system in newborns

Perinatal damage to the central nervous system (CNS) is currently a pressing issue within the structure of neonatal pathology, leading to the development of various neurological complications and causing disability and death.The purpose. Identifying risk factors contributing to perinatal third-degree hypoxic-ischemic damage of the CNS in newborns and to examine the data of clinical, laboratory and instrumental studies.Results. In the course of this study, it was revealed that the leading syndromes at the birth of the majority of infants from the main group were the suppression syndrome and the syndrome of muscular hypotension. The highest proportion among extragenital pathologies was represented by infectious diseases of various etiologies, which the newborns’ mothers had suffered during pregnancy and childbirth. Most commonly reported pregnancy complications in mothers of the main group were anemia, fetal bladder abnormality and premature rupture of fetal membranes. Neurosonography revealed subependymal cysts, signs of cerebral ischemia and ventriculomegaly as most сommonly visualized abnormalities.Conclusions. It was established during the study that the primary risk factors for the development of hypoxic-ischemic damage to the CNS were complications during pregnancy and infectious diseases of various etiologies, which the mothers had suffered during pregnancy and childbirth.

Obstetric and perinatal outcomes after a new coronavirus infection in the first and second trimesters of pregnancy

Introduction. The management of pregnant women in the conditions of the spread of a new coronavirus infection has become a priority task for doctors of all specialties, since it is with this pathology that an increase in the frequency of unfavorable gestation outcomes is currently associated.The aim of the study: to study obstetric and perinatal outcomes after a new coronavirus infection in the I and II trimesters of pregnancy.Objective. To study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.Materials and methods. A comparative study of the birth histories of women after coronavirus infection in 2021 was carried out. Group 1 (n = 26) consisted of patients with COVID-19 infection in the first trimester, group 2 (n = 30) – in the second trimester. The 3rd group is represented by relatively healthy women (n = 35). Statistical analysis was performed using the Statistica 7.0, SPSS 17 packages, as well as the statistical functions of MS Excel 2013.Results and discussion. The course of pregnancy after COVID-19 infection suffered in the first and second trimesters is associated with an increased risk of placental insufficiency (26.9 and 30%, respectively), the development of sympthoms of threatening termination (61.5 and 46.7%), anemia (38.5 and 43.3%), gestational hypertension (15.4 and 16.7%), bacterial vaginosis (19.2 and 20.0%), premature rupture of fetal membranes (34.6 and 16.7%), with the prevalence of urgent labor, but an increase in premature (13.3%) and operative labor (36.7%) with the manifestation of the disease in the second trimester. Newborns of mothers with COVID-19 infection are more often born in a state of asphyxia (65.4 and 53.3%). The structure of perinatal pathology is dominated by cerebral ischemia (42.3 and 40%), perinatal hypoxic damage to the central nervous system (19.2 and 23.3%), neonatal jaundice (11.5 and 23.3%), intrauterine pneumonia (15.4 and 10.0%), congenital malformations (7.7 and 30.0%; p1-2 = 0.04).Conclusion. The results of the study once again have confirmed the need for further study of the problem in order to find measures to reduce obstetric and perinatal complications in women after COVID-19 infection.

Experience in the use of immunochromatographic test of insulin-like growth factor binding protein-1 in the diagnosis of premature rupture of fetal membranes

Experience in the use of immunochromatographic test of insulin-like growth factor binding protein-1 in the diagnosis of premature rupture of fetal membranes

Retraction Note to: Fetal fibronectin (Quick Check fFN test®) for detection of premature rupture of fetal membranes.

Retraction Note to: Fetal fibronectin (Quick Check fFN test®) for detection of premature rupture of fetal membranes.

Визначення особливостей перебігу вагітності та пологів, стану плода і новонародженого у вагітних після застосування допоміжних репродуктивних технологій (дані ретроспективного аналізу)

The rapid growth in the number of infertile couples leads to the development of assisted reproductive technologies (ART). Among the most common forms of infertility are tubo-peritoneal, endocrine, and caused by the male factor, and prevention of pregnancy complications caused by ART treatment cycles becomes one of the main tasks of practicing clinicians. Purpose - to determine the features of the course of pregnancy and childbirth; to assess the condition of the fetus and newborn in pregnant women after the application of ART to improve the perinatal outcomes of pregnancy and childbirth. Materials and methods. A retrospective clinical and statistical analysis of 334 histories of pregnancy and childbirth of women, as well as medical records of newborns from women, was conducted over the past five years, which formed the ART group - 221 history of pregnancy and childbirth, and the group of spontaneous pregnancy - 113 history of pregnancy and childbirth. Results. The structure of the subjects was statistically significant dominated by pregnant women over the age of 35 years and pregnant women in late reproductive age. The main characteristics of women after the ART application were a statistically significant predominance of somatic and gynecological pathology. The structure of pregnancy complications in women after ART application was dominated by threatening late spontaneous miscarriages, isthmic-cervical insufficiency and vaginitis, and in the structure of labor complications - anomalies of labor activity and premature rupture of fetal membranes. Among newborns from women in the ART group, perinatal mortality was 18.0%. Conclusions. The revealed features of somatic and gynecological anamnesis, as well as aspects of the course of pregnancy and childbirth and the condition of newborns in women after ART application are the basis for an in-depth examination of this category of pregnant women in order to improve approaches to predicting, diagnosing and optimizing preventive measures, as well as to improve the perinatal consequences of pregnancy and childbirth. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. No conflict of interests was declared by the authors.

Birth spacing and risk of adverse pregnancy and birth outcomes: A systematic review and dose-response meta-analysis.

The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing. We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation. A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear < 0.005 and pnon-linear < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05). Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.

Clinical observation of delivery in a COVID-19-convalescent woman with preeclampsia developing fetal distress during preterm labor

The course of the pandemic revealed that despite the general populational risks for developing novel coronavirus infection (NCI) COVID-19, pregnant women are more susceptible to its severe course and unfavorable perinatal outcomes. Currently, NCI is associated with a high risk of spontaneous miscarriages, premature rupture of fetal membranes, preterm delivery, development of fetoplacental insufficiency, fetal growth retardation, fetal distress, exacerbation of chronic somatic pathology, and postpartum bleeding. A brief literature review and the described clinical case demonstrate a need to thoroughly examine puerperal women with preterm delivery.

New Interpretation of Neonatal Outcomes by Phenotypically Classified Preterm Syndrome: A Retrospective Cohort Study.

The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology, classification, and diagnosis. This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes; to what extent would these outcomes be modified after the obstetric interventions, including use of glucocorticoid, magnesium sulfate, and progesterone. This was a retrospective cohort study conducted at Tongji Hospital (composed of Main Branch, Optical Valley Branch and Sino-French New City Branch) in Wuhan. A total of 900 pregnant women and 1064 neonates were retrospectively enrolled. The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery, the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes, and to what extent these outcomes could be modified by obstetric interventions. Eight clusters were identified using two-step cluster analysis, including premature rupture of fetal membranes (PPROM) phenotype, abnormal amniotic fluid (AF) phenotype, placenta previa phenotype, mixed condition phenotype, fetal distress phenotype, preeclampsia-eclampsia & hemolysis, elevated liver enzymes, and low platelets syndrome (PE-E&HELLP) phenotype, multiple fetus phenotype, and no main condition phenotype. Except for no main condition phenotype, the other phenotypes were associated with one or more complications, which conforms to the clinical practice. Compared with no main condition phenotype, some phenotypes were significantly associated with short-term adverse neonatal outcomes. Abnormal AF phenotype, mixed condition phenotype, PE-E&HELLP phenotype, and multiple fetus phenotype were risk factors for neonatal small-for gestation age (SGA); placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min; mixed condition phenotype was associated with low APGAR scores, SGA, mechanical ventilation, and grade HI-W intraventricular hemorrhage (IVH); fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation; PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min, SGA and neonatal intensive care unit (NICU) admission; multiple fetus phenotype was not a risk factor for the outcomes included except for SGA. Not all neonates benefited from obstetric interventions included in this study. Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes. This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically, with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.

Microbial Isolates And Antibiotic Sensitivity Among Pregnant Women With Abnormal Vaginal Discharge At Nuhu Bamalli Maternity Hospital, Kano

Background: Abnormal vaginal discharge in a pregnant woman increases risk of complications such as abortion, premature rupture of fetal membranes, low birth weight and transmission of HIV to the fetus. Objective: To determine the microbial isolates and antimicrobial sensitivity pattern of abnormal vaginal discharge in pregnant women in Nuhu Bamali maternity hospital Kano. Methods: This was a cross-sectional descriptive study where semi structured interviewer administered questionnaires were employed to a sample of 200 respondents using a simple random sampling technique. High vaginal swab samples were collected from pregnant women with abnormal vaginal discharge at the antenatal clinic. Result: Prevalence of abnormal vaginal discharge among pregnant women in this study was 5.25%. Young maternal age, low parity, lack of western education and unemployment were found to be associated with risk of abnormal vaginal discharge (p˂0.001). The prevalence of positive culture was 83.5% in women with abnormal vaginal discharge; C. albicans (33%), E. coli (23%), S. aureus (17.5%), Klebseilla sp. (7.5%), and Streptococcus sp. (2.5%). Eighty-three percent of microorganism were sensitive to Augmentin, 79% to erythromycin, 62% to Ofloxacin and 41% to gentamicin. Most of the organisms were resistant to amoxicillin and ampicillin. Conclusion: The prevalence of abnormal vaginal discharge in pregnancy is 5.25% with C. albicans and E. coli being the commonest causes. Most of the organisms are sensitive to Augmentin and Erythromycin. Both antibiotics are safe in pregnancy.

8-Hydroxy-2-deoxyguanosine, a product of oxidative DNA degradation, is increased in the amniotic fluid of preterm births.

8-Hydroxy-2-deoxyguanosine (8-OH-2dG) is a measurable biomarker of oxidative DNA damage. This study was designed to determine amniotic fluid 8-OH-2dG levels in healthy full-term pregnant women and preterm pregnant women. To reveal the effect of reactive oxygen species on 8-OH-2dG levels, amniotic fluid total oxidant capacity (TOS), total antioxidant capacity (TAC) and oxidative stress index (OSI) were also measured. A total of 60 patients, 35 patients with full-term pregnancy and 25 patients with preterm pregnancy, participated in the study. Labor occurring before 37 weeks of gestation was considered as spontaneous preterm birth. Amniotic fluid samples were collected from full-term patients during cesarean section or normal vaginal delivery. 8-OH-2dG concentrations in amniotic fluid samples were measured quantitatively by Enzyme-Linked Immunosorbent Assay (ELISA). Amniotic fluid total antioxidant capacity (TAC) and total oxidant capacity (TOC) was determined in amniotic samples. The amniotic fluid 8-OH-2dG levels of the preterm group were significantly higher than the full-term group (60.8±7.02 ng/mL vs. 33.6±4.11 ng/mL, p<0.01). Similarly, TOC levels of the preterm group were significantly higher than the full-term group (89.7±4.80 µmol/L vs. 54.3±6.60 µmol, p<0.02). TAC was significantly higher in the full-term group compared to the preterm group (1.87±0.10 mmol/L vs. 0.97±0.44 mmol/L, p<0.01). The OSI values of the preterm group were significantly higher than the full-term group. A negative and significant correlation was found between gestational age and amniotic fluid 8-OH-2dG levels in the full-term pregnancy group (r=-0.78, p<0.01). A negative and significant correlation was observed between TAC and amniotic fluid 8-OH-2dG levels in the full-term group (r=-0.60, p<0.02). A positive and significant correlation was also detected between TOC, OSI and amniotic fluid 8-OH-2dG levels in the full-term group. There was a negative but insignificant correlation between fetal weight and amniotic fluid 8-OH-2dG levels. The correlation analysis results of the preterm pregnancy group were similar to the full-term group. Increased reactive oxygen derivatives in preterm birth increase amniotic fluid levels of DNA degradation product 8-OH2dG and may lead to premature rupture of fetal membranes. This is the first clinical study investigating 8-OH-2dG levels in amniotic fluid of preterm birth.

Risk factors and early markers for echovirus type 11 associated haemorrhage-hepatitis syndrome in neonates, a retrospective cohort study.

Echovirus type 11(E-11) can cause fatal haemorrhage-hepatitis syndrome in neonates. This study aims to investigate clinical risk factors and early markers of E-11 associated neonatal haemorrhage-hepatitis syndrome. This is a multicentre retrospective cohort study of 105 neonates with E-11 infection in China. Patients with haemorrhage-hepatitis syndrome (the severe group) were compared with those with mild disease. Clinical risk factors and early markers of haemorrhage-hepatitis syndrome were analysed. In addition, cytokine analysis were performed in selective patients to explore the immune responses. In addition to prematurity, low birth weight, premature rupture of fetal membrane, total parenteral nutrition (PN) (OR, 28.7; 95% CI, 2.8-295.1) and partial PN (OR, 12.9; 95% CI, 2.2-77.5) prior to the onset of disease were identified as risk factors of developing haemorrhage-hepatitis syndrome. Progressive decrease in haemoglobin levels (per 10 g/L; OR, 1.5; 95% CI, 1.1-2.0) and platelet (PLT) < 140 × 10⁹/L at early stage of illness (OR, 17.7; 95% CI, 1.4-221.5) were associated with the development of haemorrhage-hepatitis syndrome. Immunological workup revealed significantly increased interferon-inducible protein-10(IP-10) (P < 0.0005) but decreased IFN-α (P < 0.05) in peripheral blood in severe patients compared with the mild cases. PN may potentiate the development of E-11 associated haemorrhage-hepatitis syndrome. Early onset of thrombocytopenia and decreased haemoglobin could be helpful in early identification of neonates with the disease. The low level of IFN-α and elevated expression of IP-10 may promote the progression of haemorrhage-hepatitis syndrome.

Obstetrical outcomes in cases of maternal heart disease with a risk of cardiac decompensation: A retrospective study since the establishment of a multidisciplinary consultation meeting “heart and pregnancy”

BackgroundPregnant women with chronic heart failure (CHF) are at increased risk for cardiac complications. However, the frequency of obstetrical and neonatal complications in pregnant women with CHF remains unclear. ObjectiveThe objective of our study was to describe obstetrical and neonatal outcomes in pregnant with CHF. MethodThis single-center retrospective cohort study involves pregnant women with a CHF who delivered at Jeanne de Flandre, the Lille's university hospital, from 2017 to 2021. The frequency of obstetrical, neonatal, and cardiovascular complications was collected. ResultDuring this period, we identified 26 pregnant women with a CHF. The main cardiac diseases responsible for CHF were cardiomyopathies (53.8%) and congenital heart disease (46.2%). Acute heart failure occurred in 30.8% of the cases and mainly concerned patients with no follow-up of their heart disease. The main obstetrical complications were fetal growth restriction (38.5%) and premature rupture of fetal membranes (19.2%). The 26 pregnancies comprised 25 live births and 1 stillbirth. Newborn infants were delivered via cesarean in 69.2%. Of the live births, 60% were preterm at a median gestational age of 36 (34–38) weeks. ConclusionPregnant women with CHF had a higher risk for obstetrical and neonatal outcomes.

Study on Correlation between SIRT6, MMPs and Premature Rupture of Fetal Membrane

Study on Correlation between SIRT6, MMPs and Premature Rupture of Fetal Membrane

Effect of Human Amniotic Epithelial Stem Cell Transplantation on Preterm Premature Rupture of Fetal Membrane Using the Amniotic Pore Culture Technique in vitro

Objectives: The objective of this study was to evaluate the efficacy of cell therapy using human amniotic epithelial stem cells (hAESCs) for the treatment of premature rupture of membranes (PROM) in vitro. Design: Using the amniotic pore culture technique (APCT), we mimicked the environment of PROM in vitro, thus enabling the observation of the healing process of hAESC-treated amniotic membranes. Materials: Amniotic membrane samples were collected from placentas of pregnant women who underwent elective cesarean sections. APCT model and isolated hAESCs were used in this study. All patients who participated in this study provided their written informed consent prior to the commencement of the study. Settings: To create the APCT model in vitro, isolated amniotic membranes were punched to create 5 mm diameter circles and re-punched to form a 1-mm pore at the center. Membranes were cultured in α-minimal essential medium, and the hAESCs were collected and cultured as well. Subsequently, the APCT models were divided into two groups: hAESC treated and control. Methods: Within the culture period, pore sizes were calculated to evaluate the degree of tissue regeneration in both groups. We then evaluated the histology, cell density, and epithelial thickness of the regenerated tissues. Statistical analyses were performed using SPSS software ver. 20.0 (IBM, Armonk, NY, USA) with repeated-measures one-way analysis of variance or paired samples t test. The significance level was set at p < 0.05. Results: As per the evaluation of the APCT model in vitro, the pore size in the hAESC-treated group reduced by 62.2% on day 6 (62.2 ± 0.19, n = 24), whereas in the control group, it shrank by only 36.8% (p < 0.05) (36.8 ± 0.19, n = 24). Furthermore, the epithelial thickness in the amniotic epithelial stem cell-treated group (10.08 ± 1.26 μm, n = 8) was significantly higher than that in the control group (5.87 ± 0.94 μm, n = 8). Cell density in the regenerated tissue in the amniotic epithelial stem cell-treated group (57 ± 2.77, n = 8) was significantly higher than that in the control group (49 ± 2.23, n = 8). Limitations: In this study, we did not explore the molecular mechanisms by which hAESCs participate in membrane healing in the APCT model. Although our results showed a significant difference, this difference was not too obvious. Therefore, further research on the mechanisms of hAESCs is needed, with more amniotic tissues and APCT samples being tested. Conclusions: We developed an APCT model to investigate the PROM conditions in vitro. By implanting donor hAESCs in the pores of the APCT model, we observed that hAESCs seeding accelerated pore healing in vitro. Thus, hAESCs may be a valuable source of cells for cell therapies in regenerative medicine.

Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period.

Maternal sepsis results in poor outcomes such as fetal or maternal death. The incidence and mortality rates of maternal sepsis vary in different places because of differences in economic development, race and medical conditions. Identifying the clinical features and determining possible mechanisms for avoiding morbidity and preventing poor outcomes would benefit committed patients. Therefore, this was an epidemiological study at a maternity transfer center in Southeast China that aimed to identify local disease features of maternal sepsis. To investigate the incidence and risk factors associated with maternal sepsis and its progression to severe sepsis in a large population-based birth cohort. This local epidemiological study was conducted in at a tertiary care center in Guangzhou, China, from 2015 to 2019. A total of 74,969 pregnant women experiencing childbirth were included in this study; Of these, 74 patients with maternal sepsis were diagnosed according to the sepsis criterion, and 118 patients without sepsis in the same period were selected randomly as the control group to study possible reasons for postpartum sepsis. This retrospective analysis covered the entire period from the first trimester to puerperium. Clinical data were collected using the hospital’s electronic medical record system. Multivariate logistic regression was used to analyze risk factors for maternal sepsis. The incidences of maternal sepsis, the maternal mortality, and the fetal mortality were 0.099%, 0.004%, and 0.007%, respectively. Septic shock was associated with a higher severity of illness. All poor outcomes (maternal or fetal death) occurred during pregnancy. Postpartum sepsis had the longest onset period, and was associated with premature rupture of fetal membranes and preeclampsia. Sepsis is an important cause of both maternal and fetal mortality. Herein, we describe an epidemiological study that evaluated the incidence, development, and prognosis of local maternal sepsis. Furthermore, the characteristics of maternal sepsis are likely due to unknown pathological mechanisms, and patients would benefit from identifying more effective treatments for maternal sepsis.

Effect of Multidisciplinary Team Continuous Nursing on Glucose and Lipid Metabolism, Pregnancy Outcome, and Neonatal Immune Function in Gestational Diabetes Mellitus.

Objective To investigate the effect of multidisciplinary team (MDT) continuous nursing on glucose and lipid metabolism, pregnancy outcome, and neonatal immune function in gestational diabetes mellitus (GDM). Methods A total of 90 patients with gestational diabetes mellitus (GDM) from January 2018 to December 2019 were recruited and assigned to receive routine care (routine group) or MDT continuous care (study group) according to different nursing methods. Outcome measures included glucose and lipid metabolism, pregnancy outcomes, and neonatal immune function. Results There were no significant differences in glucose and lipid metabolism indices and self-rating anxiety scale (SAS) scores, before nursing. After nursing, MDT continuous care resulted in significantly lower levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbAlc), triglyceride (TG), and homeostasis model insulin resistance index (HOMA-IR) versus routine care. After nursing, the SAS scores in the two groups were significantly decreased, with lower results in the study group. Patients in the study group showed better compliance than those in the routine group. MDT continuous care was associated with a significantly lower incidence of premature rupture of fetal membranes, cesarean section, premature delivery, macrosomia, and hypoglycemia versus routine nursing. There were no significant differences in immunoglobulin (Ig) A and IgM levels. Patients in the study group showed a higher IgG level and lower CD3, CD4, CD8, and CD4/CD8 levels than those in the routine group. Conclusion MDT continuous nursing could effectively regulate glucose and lipid metabolism and improve pregnancy outcomes and neonatal immune function in patients with GDM.

Potential Serum Biomarkers Associated with Premature Rupture of Fetal Membranes in the First Trimester.

Premature rupture of the fetal membranes (PROM) is a common and important obstetric complication with increased risk of adverse consequences for both mothers and fetuses. An accurate and timely method to predict the occurrence of PROM is needed for ensuring maternal and fetal safety. Untargeted metabolomics was applied to characterize metabolite profiles related to PROM in early pregnancy. 41 serum samples from pregnant women who developed PROM later in gestation and 106 from healthy pregnant women as a control group, were analyzed. Logistic regression analysis was adjusted to analyze a PROM prediction model in the first trimester. A WISH amniotic cell viability assay was applied to explore the underlying mechanisms involved in PROM, mediated by C8-dihydroceramide used to mimic a potential biomarker (Cer 40:0; O2). Compared with healthy controls, 13 serum metabolites were identified. The prediction model comprising four compounds (Cer 40:0; O2, sphingosine, isohexanal and PC O-38:4) had moderate accuracy to predict PROM events with the maximum area under the curve of a receiver operating characteristics curve of approximately 0.70. Of these four compounds, Cer 40:0; O2 with an 1.81-fold change between PROM and healthy control serum samples was defined as a potential biomarker and inhibited the viability of WISH cells. This study sheds light on predicting PROM in early pregnancy and on understanding the underlying mechanism of PROM. Trial Registration: This study protocol has been registered at www.ClinicalTrials.gov, CT03651934, on 29 August 2018 (prior to recruitment).

Cytokines and pregnancy complications: modulation for prevention and treatment

“There is many a slip twist the cup and the lip” is a proverb that dates back to the 3rd century. This proverb comes to mind while writing a review on pregnancy loss; so many complications can occur between fertilization and development of the embryo through the long period of gestation until successful delivery of the baby. These include failure of implantation of the embryo, spontaneous miscarriage in the first trimester, pre-eclampsia in the second trimester, premature rupture of fetal membranes, pre-term labour, and pre-term delivery. The maternal immune system which does a phenomenal job of protecting the host from a daunting variety of infections, sometimes also mounts adverse reactions that complicate pregnancy and endanger the fetus. Maternal immune reactions that can adversely affect pregnancy have been shown to be mediated by lymphocytes, macrophages and natural killer cells, and by cytokines secreted by these cellular effectors. This review summarizes the deleterious effects of cytokines leading to recurrent spontaneous miscarriage, pre-eclampsia and pre-term delivery, which are the major complications of pregnancy. It then goes on to discuss the potential use of progesterone and dydrogesterone, an orally-administered progestogen, as immunomodulatory molecules that can be considered for the prevention and/or treatment of these complications.