Preterm Labor Group Research Articles

Zonulin: can it be used as a marker for preterm labor?

Inflammation has been reported to increase zonulin levels, a protein that regulates intestinal permeability. The aim of this study was to investigate the association of serum zonulin levels with preterm labor in pregnant women. A total of 180 pregnant women between 32-42 weeks of gestation were included in the study. Among those whose gestational week is less than 37, preterm labor (group 1), normal course pregnant (group 2), and gestational weeks between 37-42 pregnant women with normal course (group 3), term labor (group 4) groups were formed. Zonulin levels were not statistically different between groups. Among the inflammation markers, only C-reactive protein levels were significantly higher in group 1 compared to groups 2 and 3. There were a total of 18/90 (20%) pregnant women with premature rupture of membranes (PROM) in the delivery groups. The mean zonulin level was higher in those with PROM (155.3±50.2 ng/ml) than those without PROM (128.8±59 ng/ml). However, there was no statistically significant difference between them. In conclusion, serum zonulin levels were not useful as a marker for predicting preterm labor. However, examining large-scale studies about the relationship between PROM and zonulin is still needed.

A Cross Sectional Study on Prevalence of Bacterial Vaginosis in Preterm and Term Labor

Background: The aim is to examine bacterial vaginosis (BV) in women with preterm and term labor, explore the link between bacterial vaginosis and preterm labor (PTL), and analyze complications for both mother and baby related to bacterial vaginosis. Design: Hospital based cross sectional study. Materials and Method: We had conducted an observational study at Basaveshwara Medical College and Hospital, involving 100 pregnant patients with preterm and term labor (50 patients in each group). Eligible patients attending the Obstetrics and Gynecology Outpatient Department (OBG OPD) and inpatient department will be included. Bacterial vaginosis will be determined using Amsel's criteria, which include evaluating discharge characteristics, vaginal pH, amine odor with KOH test, and presence of clue cells under microscopic examination. Additionally, vaginal swabs will undergo Gram staining. Results: The percentage of patients meeting Amsel's criteria for diagnosing bacterial vaginosis was significantly higher in the preterm labor group compared to the term labor group, with a statistically significant difference. According to Amsel's criteria, the prevalence of bacterial vaginosis was 30% in the preterm labor group and 2% in the term labor group. Conclusion: Bacterial vaginosis is a significant risk factor for preterm labor. Hence, conducting tests for bacterial vaginosis and promptly treating it can help reduce the risk of preterm labor.

Neutrophil Elastase as a Predictor of Delivery in Pregnant Women with Preterm Labour.

No previous study has been conducted in Nigeria on the role of neutrophil elastase in predicting preterm birth. The present study aimed to determine the role of the neutrophil elastase test in predicting birth in women with preterm labor. The present prospective cohort study recruited 83 pregnant women with preterm labor between 28 and 36+6 weeks of gestation, and followed up these subjects for 14 days. The controls comprised 85 pregnant women without preterm labor. The cervicovaginal fluid was collected and tested using the neutrophil elastase test. Then, the sensitivity, specificity, and positive and negative predictive parameters were determined. Afterward, the data were scrutinized using the SPSS arithmetic software (Sort23). Among the 168 pregnant women analyzed in the present study, 83 pregnant women were assigned to the preterm labor group, and 85 pregnant women were assigned to the control group. Furthermore, among the 83 pregnant women in the preterm labor group, 11 women had spontaneous preterm delivery, leading to a spontaneous preterm birth proportion of 13.3%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the neutrophil elastase test within 14 days post-enrollment were 93.8%, 61.2%, 36.6%, 97.6%, and 67.5%, respectively, for the general population, and 87.5%, 66.7%, 35.0%, 96.3%, and 70.2%, respectively, for subjects at <35 weeks of gestation. The positive and negative likelihood ratios for preterm birth prediction were 2.62 and 0.19, respectively. The neutrophil elastase test exhibited high predictive accuracy in pregnant women with preterm labor, when compared to the controls, based on the sensitivity and negative predictive value, but this had poor positive predictive values. The neutrophil elastase test may be used as a screening test, but not as a potential predictive test, in the routine clinical setting.

Association of Maternal Serum Magnesium Level with Preterm Labour

Background: Preterm labour is a major health problem in obstetrics. The cause of preterm labour is still unknown. The role of magnesium is also not clear. Recently, involvement of magnesium in physiological and pathological process of labour has been clearly demonstrated. Aims and Objectives: To see the association between maternal scrum magnesium level and preterm labour. Materials and Method: This cross-sectional comparative study was conducted in Department of Obstetrics and Gynecology, Sylhet M.A.G. Osmani Medical College Hospital, between January 2017 and December 2018. Thirty-five pregnant women with preterm labour were selected as case and 35 preterm age and gestational age matched pregnant women without having preterm labour were selected as control group. Serum magnesium concentration was measured. Results: The mean age (25.43 ± 4.62 years versus 24.40 ± 3.99 years; p=0.332) and the gestational age (31.31 ± 1.78 weeks versus 31.34 ± 1.84 weeks; p=0.974) did not differ between preterm labour group and control group. Serum magnesium level (mg/dl) was significantly lower in prelabour group compared to control group (0.90 ± 0.37 versus 1.69 ± 0.33; p&lt;0.001). Conclusion: It is strongly suggested that maternal serum magnesium associated with preterm labor of unknown etiology

Prevalence of Bacterial Vaginosis in Preterm Labour and Its Fetal and Maternal Outcome

Introduction: Preterm births accounts for about 11.1 % of births worldwide. Infection accounts for 20% – 40% of these cases and Bacterial vaginosis has been found in 15 % of preterm labor group.&#x0D; Objective: To find the prevalence of Bacterial vaginosis among the cases who presented with preterm labour and to determine its maternal and neonatal outcome.&#x0D; Methodology: A prospective cross- sectional analytical study on 100 preterm labour cases conducted over a year in the obstetric ward in Manipal Teaching Hospital. Three high vaginal swabs from posterior fornix were taken and tested in Microbiology laboratory. The maternal and neonatal outcome of women with preterm labour due to bacterial vaginosis were noted. The data were analyzed using SPSS 21. Chi2 test was used for comparing maternal and neonatal complications positive or negative with Bacterial Vaginosis.&#x0D; Results: In the study period, 584 women had preterm deliveries. The total deliveries during that period was 2,531. The prevalence of Bacterial vaginosis in PTB was found to be 17 %.The accuracy of Gram stain was found to be 90% (sensitivity-57%, specificity-92%, PPV-36%, NPV-96%). The accuracy of wet mount was 90 % (sensitivity-42.85%, specificity-93.5%, PPV-33.3%, NPV95.6%). There were increased cases of chorioamnionitis among women who were BV positive (p-value=0.02). Newborn born to women with BV positive had increased chance of poor Apgar score at 5 minutes (p-value &lt;0.05).&#x0D; Conclusion: Maternal and neonatal complications were more common in women with preterm labour associated with Bacterial Vaginosis. Gram stain and wet mount are fairly accurate and can be used as an adjunct to culture for the diagnosis of Bacterial Vaginosis.

Correlation of cervical progesterone levels to plasma progesterone levels in normal pregnancy and preterm labor: A cross-sectional study

Background: The theory of “functional progesterone withdrawal” explains the role of progesterone prior to delivery. Previous studies mentioned the existence of progesterone regulation in the cervix that plays a role in maintaining the integrity of the cervix and cervical ripening. Cervical progesterone levels relate to activities of progesterone at the cervix, compared to its amount in circulation. The objective of this study was to measure cervical mucus progesterone levels and its correlation to plasma progesterone levels in pregnancy. Methods: This was a cross-sectional study conducted in January-September 2010 at Persahabatan Hospital. The subjects were pregnant women in the 28th – 34th weeks of gestational age. In total, 72 subjects who met the criteria were divided into normal pregnancy group and preterm labor group. The cervical and plasma progesterone levels were measured using The Advia Centaur® Progesterone kit, which is a commercial immunoassay with direct chemiluminescence method. Results: There was a positive correlation (r=0.539) between cervical progesterone levels with plasma progesterone levels in the preterm labor group. There was no correlation between cervical progesterone levels with plasma progesterone levels in the normal pregnancy group. Conclusion: This study showed that cervical progesterone levels could be measured through cervical mucus. A significant positive correlation was found by this study between cervical progesterone levels and plasma progesterone levels in the preterm labor group. This study is expected to provide new insights for understanding the metabolism and the role of progesterone in maintaining cervical integrity during pregnancy, and its relation to prevention of preterm birth.

Neonatal outcomes by delivery indication after administration of antenatal late preterm corticosteroids

Antenatal corticosteroids, specifically betamethasone, administered to patients at risk for late preterm delivery have been associated with reduced rates of neonatal respiratory complications. However, whether these risks vary by delivery indication among betamethasone-exposed, late-preterm infants is not known. This study aimed to evaluate if spontaneous preterm labor or preterm prelabor rupture of membranes, compared with indicated late preterm delivery, is associated with better neonatal respiratory outcomes after accounting for betamethasone administration in the late preterm period. This was a secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter, placebo-controlled trial in which patients with singleton pregnancies at risk for delivery at 34 0/7 to 36 5/7 weeks of gestation were randomized to a single course of antenatal corticosteroids (betamethasone) or placebo. Patients were eligible if they had spontaneous preterm labor, preterm prelabor rupture of membranes, or if they were undergoing indicated late preterm delivery. The primary outcome was a composite of need for respiratory support, stillbirth, or neonatal death within 72 hours after delivery. Secondary outcomes included individual neonatal morbidities. Bivariate analyses were performed, and multivariable logistic regression models were used to control for potential confounders. Using the indicated preterm delivery group as the reference group, adjusted odds ratios and 95% confidence intervals were calculated for the outcomes by delivery indication. Subgroup analyses separately examined the treatment and placebo groups to determine the odds of the primary outcome by delivery indication. Of 2827 participants at high risk for late preterm delivery, 1427 (50.5%) received betamethasone. There were 790 (27.9%) infants born after preterm labor, 620 (21.9%) born after preterm prelabor rupture of membranes, and 1417 (50.1%) born after indicated preterm delivery. Compared with indicated preterm delivery, the odds of the primary outcome were lower among those born after preterm labor (7.3% vs 16.4%; adjusted odds ratio, 0.57; 95% confidence interval, 0.40-0.82) and among those born after preterm prelabor rupture of membranes (12.4% vs 16.4%; adjusted odds ratio, 0.49; 95% confidence interval, 0.35-0.69). Preterm labor had lower odds of all neonatal complications except feeding problems, and preterm prelabor rupture of membranes had lower odds of all neonatal complications except newborn intensive care unit admission for ≥3 days when compared with indicated preterm delivery. For the placebo group, the odds of the primary outcome were lower for the preterm labor group (8.2% vs 18.5%; adjusted odds ratio, 0.55; 95% confidence interval, 0.34-0.91) and the preterm prelabor rupture of membranes group (13.2% vs 18.5%; adjusted odds ratio, 0.46; 95% confidence interval, 0.29-0.73) than for the indicated preterm delivery group. For those exposed to betamethasone, the odds of the primary outcome remained lower for the preterm labor group (6.5% vs 14.3%; adjusted odds ratio, 0.58; 95% confidence interval, 0.34-0.99) and the preterm prelabor rupture of membranes group (11.7% vs 14.3%, adjusted odds ratio, 0.56; 95% confidence interval, 0.34-0.91) than for the indicated preterm delivery group. Compared with indicated preterm delivery, preterm labor and preterm prelabor rupture of membranes were associated with reduced odds of neonatal respiratory complications irrespective of betamethasone exposure in the late preterm period.

Preterm Labor and Preterm-PROM at a Lower Gestational Age Are Associated with a Longer Latency-to-Delivery Even in Patients with the Same Intensity of Intra-Amniotic Inflammation: "Carroll-Model" Revisited.

A previous study by Carroll et al. demonstrated that the time from preterm-PROM to delivery was longer at a lower gestational age (GA) when the membranes rupture, although the presence or absence of intra-amniotic inflammation (IAI) was not examined in that study. However, patients with either preterm labor (PTL) or preterm-PROM at a lower GA had more frequent IAI, which was associated with a shorter amniocentesis-to-delivery (ATD) interval as compared with inflammation-free amniotic fluid (AF). Up to now, there is no information about whether PTL and preterm-PROM at a lower GA are associated with a shorter or longer latency to delivery in cases with the same intensity of IAI. The objective of the study is to examine this issue. AF MMP-8 was measured in 476 singleton early preterm-gestations (21.5 < GA at amniocentesis < 34 wks) with PTL (n = 253) and preterm-PROM (n = 223). Patients were divided into three groups according to GA at amniocentesis (i.e., group-1: <26 wks; group-2: 26–30 wks; group-3: 30–34 wks). IAI was defined as an elevated AF MMP-8 (≥23 ng/mL), and IAI was classified into either mild IAI (AF MMP-8: 23–350 ng/mL) or severe IAI (AF MMP-8 ≥ 350 ng/mL). ATD interval was examined according to GA at amniocentesis in the context of the same intensity of IAI (i.e., inflammation-free AF, mild IAI, and severe IAI) among pregnant women with either PTL or preterm-PROM. IAI was more frequent at a lower GA in cases with PTL (group-1 vs. group-2 vs. group-3; 59.5% vs. 47.4% vs. 25.1%; X2 test, p = 0.000034 and linear by linear association [LBLA], p = 0.000008) and in those with preterm-PROM (group-1 vs. group-2 vs. group-3; 69.2% vs. 50.0% vs. 32.0%; X2 test, p = 0.000104, and LBLA, p = 0.000019). Of note, cases without IAI at a lower GA had a longer ATD interval in both PTL (Spearman’s rank correlation test, γ = −0.360, p = 0.000003) and preterm-PROM (γ = −0.570, p = 0.000001) groups. Moreover, the lower the GA, the longer the ATD interval, even among patients with mild and severe IAI in both PTL (Spearman’s rank correlation test; mild IAI, γ = −0.290, p = 0.039; severe IAI, γ = −0.299, p = 0.048) and preterm-PROM (mild IAI, γ = −0.565, p = 0.000013; severe IAI, γ = −0.363, p = 0.015) groups. In conclusion, PTL and preterm-PROM at a lower GA are associated with a longer latency to delivery, even in patients with the same intensity of IAI. This finding suggests that a more intense IAI may be needed for spontaneous preterm birth at a lower GA.

Low Methylation of Matrix Metalloproteinase 1 (MMP1) is Associated with Preterm Labour in Malaysian Mothers

Preterm births comprise 10.6% of livebirths worldwide and account for 35% of deaths among newborn babies. Understanding DNA methylation may offer basic knowledge in the understanding of pathogenesis of preterm labour. The study was undertaken to determine DNA methylation of matrix metalloproteinase 1 (MMP1) promoter in term and preterm labour using methylation-specific polymerase chain reaction (MSP). Thirty maternal venous blood samples (n=15 each) of term and preterm labour was subjected to bisulfite treatment prior to MSP. This result was then validated using DNA sequencing. Evaluation of the sequencing results by CpG islands analysis was performed using the ClustalW and SPSS software. Primers for MMP1 were located between -1226 and -1378 upstream from the transcription start site (TSS) that consisted five CpG islands. Preterm labour group had significantly lower methylated CpG islands with 39 out of total 75 (52%) compared to the term labour that has 49 out of 75 methylated CpG islands (65.33%) (t=0.694, p&lt;0.05). Methylation occurred in 4 out of 5 methylated CpG islands in the MMP1 promoter where it only involved 2 preterm samples (13.33%) and 7 term samples (46.47%). This data suggested there were significant lower percentage of methylated MMP1 in preterm labour. Higher percentage of methylated MMP1 as observed in the term labour, will probably reduce the expression of MMP1, thus maintaining fibrillar collagen strength on the amniotic membrane and subsequently maintain the pregnancy till term. In conclusion, preterm labour has higher percentage of methylated CpG compared with term labour in MMP1 gene.

PERBANDINGAN KADAR INTERLEUKIN 6 PADA PERSALINAN PRETERM DAN KEHAMILAN NORMAL

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Preterm labor occurs between 20 weeks and before 37 weeks of pregnancy. It is indicated by regular contractions of the uterus and it may cause the thinning and flattening of the cervix. Preterm labor also causes the high rates of perinatal morbidity and mortality. Increasing levels of interleukin 6 during pregnancy can stimulate the preterm labor. The design of this reseacrh was a comparative cross sectional study. It was conducted in Rasidin District Hospital, Siti Rahmah Hospital and Biomedical Laboratory, Faculty of Medicine, Andalas University, Padang on March to June 2018. There were 50 samples in this reseach. It was selected by consecutive sampling. The samples were divided into two groups: preterm labor and normal pregnancy. The interleukin 6 levels were examined by the ELISA method. Then, the data were analyzed by using the t test. The results of this reseach showed that the mean level of IL-6 in the preterm labor group was 90.22 ± 21.41ng / L. Then, 75.57 ± 14.01 ng / L for the mean level of IL-6 in the normal pregnancy group with p= 0.006. Moreover, statistical test inffered that there were significant differences between IL-6 levels in preterm labor and normal pregnancy. In short, it can be concluded that IL-6 levels in the preterm labor group were higher than normal pregnancy group.&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: IL-6 levels, preterm labor&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Study of Nitric Oxide and Lipid Peroxidation in Preterm Labour: A Case-control Study

Introduction: Preterm Labour (PTL) is a major obstetric health problem. It contributes to 75% of neonatal mortality worldwide. According to a World Health Organisation (WHO) report, 15 million preterm birth occur every year. Nitric Oxide (NO), synthesised by three isoforms of NO Synthase (NOS) play physiological role in uterine muscle relaxation and prevention of preterm labour contractions. NO is also demonstrated to react with Reactive Oxygen Species (ROS). Aim: To assess the level of serum NO, Malondialdehyde (MDA) (end product of lipid peroxidation), total protein, albumin, calcium, and inorganic phosphorus in PTL) and also to compare these parameters with full-term labour. Materials and Methods: A case-control study was conducted in the Department of Biochemistry and Obstetrics and Gynaecology, Government Medical College, Miraj, Maharashtra, India, during the period of November 2014 to May 2015. Study included 60 women with age ranged between 21-31 years and gestational age between 28 to 37 weeks. Out of total 60 women, 30 were full-term labour, served as control and 30 women who had regular uterine contraction before 37 weeks were selected as cases. Estimation of NO (as nitrite) and MDA, Total Protein (TP), Albumin, Calcium and Inorganic Phosphorus was done. Data were analysed by applying a Student’s t-test and Pearson correlation test. Results: The mean maternal age was 26.53±3.42 years for cases and for control 27.63±2.51 years. The mean gestational age in cases was 31.1±2.795 weeks, whereas in controls was 37.26±0.520 weeks. A highly significant decrease in NO (7.1967±1.236 μmol/L and 15.900±3.897 µmol/L in PTL and control group), TP (4.996±0.509 g/dL and 6.906±0.480 g/ dL in PTL and control group), Albumin (3.460±0.440 g/dL and 4.406±0.390 g/dL in PTL and control group), calcium (8.240±0.431 mg/dL and 8.950±0.486 mg/dL in PTL and control group) and inorganic phosphorus (2.006±0.532 mg/dL and 3.786±0.537 mg/dL in PTL and control group) concentration was observed in PTL as compared to the controls. Lipid peroxidation (MDA) (10.590±0.8715 mg/dL and 5.6500±0.4725 mg/dL in PTL and control group) was found to be significantly increased in PTL as compared to controls. Conclusion: There was significant drop in the NO and increase in ROS reflected by increase in serum MDA levels in PTL group as compared to normal full-term labour. These parameters may have role in the diagnosis and prevention of PTL after appropriate larger cohort studies.

NLRP3 inflammasome is involved in uterine activation for labor at term and preterm.

The nucleotide binding and oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome plays a critical role in various inflammatory diseases. We sought to investigate the role of NLRP3 inflammasome in uterine activation for labor at term and preterm. We found that NLRP3 inflammasome was activated in the myometrium tissues obtained from the pregnant women undergoing labor at term (TL) compared with those not undergoing labor (TNL) at term. NLRP3 inflammasome was also activated in amnion and chorion-deciduas in TL and preterm labor (PTL) groups. In the mouse model, uterine NLRP3 inflammasome and nuclear factor kappaB (NF-κB) were activated toward term and during labor. Treatment of pregnant mice with lipopolysaccharide (LPS) and RU38486 induced preterm birth (PTB) and also promoted uterine NLRP3 inflammasome and NF-κB activation. Treatment of pregnant mice with NLRP3 inflammasome inhibitor BAY11-7082 and MCC950 delayed the onset of labor and suppressed NLRP3 inflammasome and NF-κB activation in uterus. MCC950 postponed labor onset of the mice with LPS and RU38486 treatment and inhibited NLRP3 inflammasome activation in uterus. Our data provide the evidence that NLRP3 inflammasome is involved in uterine activation for labor onset in term and PTB in humans and mouse model.

The Role of IL-27 in the Systemic Inflammatory Response That Accompanies Preterm Labour.

This study aimed to investigate whether interleukin-27 (IL-27) activates maternal peripheral blood mononuclear cells (PBMCs) and induces inflammatory responses in amniotic epithelial cells in preterm labour (PL). The expression of IL-27p28, EBI3 and IL-27Rα was compared in maternal PBMCs of the PL, term labour (TL) and term not in labour (TNL) groups. The relationship between IL-27 and molecules associated with PBMC activation was investigated using bioinformatic and quantitative reverse transcription polymerase chain reaction (qRT-PCR) analyses. We investigated the inflammatory effects of IL-27 in PBMCs and its underlying mechanisms in vitro. In addition, we treated amniotic epithelial cells (WISH cells) with a PBMC-conditioned medium to identify the inflammatory effects of IL-27-treated PBMCs in amniotic epithelial cells. The expression of IL-27p28 and IL-27Rα in PBMCs of the PL group was higher than that in the TL/TNL groups. Bioinformatic analysis revealed that IL-27 was positively correlated with IFNG, IL6, IL1β, CXCL10 and ICAM1 in the whole blood samples of pregnant women in the PL group, which was confirmed using qRT-PCR. Furthermore, rhIL-27 promoted the expression of Th1 cell-related molecules (T-bet, IFN-γ and ICAM-1) and proinflammatory cytokines (IL-6 and IL-1β) in PBMCs in vitro, which was partially mediated by the JAK2/STAT1 pathway. In addition, it enhanced the expression of IL-27p28, EBI3 and IL-27Rα in PBMCs. Moreover, the expression of IL-6, IL-1β and TNF-α in WISH cells was significantly increased by the conditional medium derived from IL-27-treated PBMCs. IL-27 upregulated the expression of Th1 cell-related molecules and proinflammatory cytokines in PBMCs partially mediated by the JAK2/STAT1 pathway. Inflammatory responses were induced in WISH cells by a conditional medium derived from IL-27-treated PBMCs. Therefore, IL-27 may contribute to PL by promoting inflammation in maternal PBMCs and amniotic epithelial cells.

Optimized Clustering Algorithm for Comparative Analysis of Different Prenatal Corticosteroid Neurological Deficits in Premature Infants through Magnetic Reasoning Imaging (MRI).

Objective This study aimed to explore the application of different prenatal corticosteroids in the assessment of neurological deficits and prognosis in premature infants through Magnetic Reasoning Imaging (MRI) under optimized cluster algorithm. Methods 100 pregnant women with threatened preterm labor were retrospectively analyzed, in which 38 pregnant women with lasting threatened preterm labor (group A) were treated with multiple courses of antenatal corticosteroids (dexamethasone treatment) and 62 cases of pregnant women with threatened preterm labor (group B) were treated with single course of dexamethasone treatment. Craniocerebral MRI images based on optimal clustering algorithm were used to examine neonates. Neonatal hypoxic-ischemic encephalopathy (HIE) rate, serum neuron-specific enolase (NSE) concentration, neonatal behavioral neurological score (NBNA), respiratory distress syndrome (RDS) rate, perinatal mortality, neonatal birth weight, and maternal complications rate of two groups were compared. Results Compared with other traditional image segmentation algorithms, this algorithm had the best segmentation effect, the shortest running time (1.43 s), the least number of iterations (5 times), and the highest segmentation accuracy (97.98%). There was no significant difference in the HIE rate, serum NSE concentration, NBNA score, RDS score, and perinatal mortality in group A and group B (P > 0.05). Compared with group B, neonates' body weight in group A was decreased, while the maternal complication rate in group A was increased (P < 0.05). Conclusion MRI images based on optimized clustering algorithm can be used in the diagnosis of neonatal hypoxic-ischemic encephalopathy. There is no significant difference in the application of different antenatal corticosteroids affecting premature nerve function defect and prognosis, but multiple courses of antenatal corticosteroids can affect neonatal body mass and increased maternal complications to a certain extent; therefore, before threatened premature delivery treatment, the pros and cons of multiple courses of antenatal corticosteroids should fully be considered and in the treatment, measures should be actively taken to alleviate the side effect.

Ultrasound Assessment of Fetal Adrenal Gland in Term and Preterm Labor Cases

Background: Preterm birth (PTB) remains a major cause of perinatal morbidity and mortality worldwide. Compared with term deliveries, early PTB (< 34 weeks' gestation) carries a 7-fold increased risk of neonatal death. Objective: To compare the Fetal Zone Depth (FZD) of fetal adrenal gland in term and preterm labor cases Patients and Methods: Thirty-three preterm pregnant women at 29-36 weeks of gestation with single pregnancy and clinical diagnosis of preterm labor and control group of 33 pregnant women at 37-40 weeks with term pregnancy were included in this study. FZD and Total Gland Depth (TGD) of fetal adrenal gland were ultrasonographically measured and FZD/TGD ratios were calculated and compared between the two groups. Results: No difference was found between the two groups in respect of age and number of pregnancies (P > 0.05). Yet, preterm birth history rupture of membrane, cervical dilatation and mode of delivery were higher in preterm group (P <0.05). Fetal adrenal gland FZD/TGD ratio was statistically significantly higher in preterm group compared to the term group (52% ± 5% vs. 29% ±9%; P <0.001). Conclusion: The growth in FZ as a fetal adaptation mechanism in increased fetal stress in preterm labor cases was at a significant level. Once supported by more comprehensive studies, we think that this result would be beneficial in the prediction of preterm labor in clinical practice.

The comparison of predictive value of cervical length in singleton spontaneous preterm labor with in vitro fertilization pregnancies: A cohort study.

Background Preterm labor (PTL) is one of the most important factors in neonatal mortality. Some studies have revealed a reverse relationship between cervical length (CL) and PTL, however, further evidence is needed to confirm it.ObjectiveTo investigate the predictive value of CL in spontaneous and in vitro fertilization (IVF) pregnancies.Materials and MethodsThis prospective cohort study was performed on 154 pregnant women from 16-26 wk of gestation with singleton fetus in spontaneous delivery (n = 77) and IVF pregnancies (n = 77) and followed up until delivery. Women with multiple pregnancy, placenta previa, cerclage, and congenital anomalies were excluded from study. The cut-off determination was done according to the Roc analysis.ResultsThe mean CL in term delivery and PTL groups were 37 7 mm and 31 6 mm, respectively (p 0.001). The frequency of PTL in spontaneous and IVF pregnancies were 7.8% and 23.27%, respectively (p = 0.007). According to the Roc analysis, the best cut-off for normal pregnancy was 36 mm with the negative predictive value of 97.9%, the positive predictive value of 11.4%, sensitivity 83.3%, and specificity of 46.5%. While for the IVF group, the cut off was 30 mm, with a negative predictive value of 88.4%, positive predictive value of 57.8%, sensitivity of 63.2%, and specificity of 86%.Conclusion In this study, IVF had a significant direct correlation with PTL. CL also had a significant indirect relationship with PTL.

Hematological Changes in Threatened Preterm Labor (Hemoglobin &amp; Platelets)

In Threatened PTL patients, due to inflammation and possible ongoing ischemia process, platelet activation indices like MPV and PDW should be altered than the controls.The aim of this study was to evaluate the alterations of platelet indices and hemoglobin level and to investigate whether they can be used as a predictor marker for threatened preterm birth or not.This study was a case control study included 60 pregnant women attending to the department which was divided into two groups: Study group (30 women): with threatened preterm labor and Control group (30 women): healthy pregnant wome Hemoglobin levels were measured and Platelet indices: mean platelet volume (MPV); platelet distribution width (PDW). Lower hemoglobin levels in TPL group. Also, MPV was lower in TPL group while PDW was higher in PTL group. hemoglobin level less than 9.07 g/dl may predict TPL also, MPV levels may be used for discriminating high risk population for preterm labor. By using a cut-off value 8.59 for MPV with sensitivity and specificity of 64%, 46% respectively PDW in this study revealed an area under curve (AUC) 63%. By using a cut-off value 15.98 for PDW, sensitivity was 68% and specificity was 47% for TPL. .Conclusion: Preliminary findings of this study showed that hemoglobin level less than 9.07 g/dl may predict TPL also, MPV levels may be used for discriminating high risk population for preterm labor. Further prospective studies with larger sample size are needed to confirm this finding

The cause of birth is associated with neonatal prognosis in late preterm singletons

IntroductionRecent studies have shown that the cause of very preterm births may be related to neonatal morbidity and mortality. Even though these risks are lower among late preterm births, this group accounts for the vast majority of all preterm births. The objective of this study was to evaluate the relation of neonatal morbidity and mortality to the cause of late preterm birth. Materials and methodsThis retrospective observational cohort study included all women who gave birth to liveborn singletons from 34 to 36 weeks+6 days of gestation in a French level III maternity hospital in the 5-year period 2013–2017. The causes of preterm delivery were divided into 6 mutually exclusive groups. The main outcome was a composite neonatal morbidity criterion, defined by at least one among the following criteria: neonatal respiratory distress, neurological complications, neonatal sepsis, severe necrotizing enterocolitis, and neonatal hypoglycemia. We analyzed the association between cause of preterm delivery and neonatal morbidity after adjustment for gestational age and antenatal corticosteroid therapy. The reference group was preterm labor, defined by spontaneous preterm labor with intact membranes. ResultsDuring the study period, there were a total of 27 110 births, including 1114 singleton births at 34 to 36 weeks of gestation + 6 days (4.1%). Among the 968 late preterm births included, the risk of neonatal morbidity in the group with preterm premature rupture of membranes (PPROM) was similar to that in the preterm labor (reference) group: adjusted odds ratio (aOR) 1.2 (95% CI, 0.8-1.8). All the other causes of late preterm birth were associated with a higher risk of neonatal morbidity than the reference group: aOR 2.0 [95% CI, 1.1–3.5] for hypertensive disorders without suspected fetal growth restriction (FGR) (9.1% of cases), aOR 2.4 [95% CI, 1.4–4.2] for hypertensive disorders with suspected FGR (8.9%), aOR 4.2 [95% CI, 2.2-8.0] for suspected FGR without hypertensive disorders (5.8%), and aOR 4.4 [95% CI, 2.2-8.8] for vaginal bleeding related to abnormal placental insertion (4.7%). ConclusionAmong infants born from 34 to 36 weeks + 6 days of gestation, PPROM and preterm labor had similar risks of neonatal morbidity, while the other causes were associated with a risk of neonatal morbidity at least twice that with preterm labor.

Is striae gravidarum a sign of spontaneous premature birth?

Background This study aimed to investigate the association of striae gravidarum (SG) and preterm delivery. Material and Methods This prospective cross-sectional study was performed between November 2018 and February 2019. In addition to demographic variables, SG score of the abdomen, presence of striae on breasts, arms, hips, and thighs were recorded. Davey’s scoring system was used to define the severity of SG in the abdomen by the same investigators. Patients with cervical dilatation of 6 cm or more were included in the preterm labor group. Results A total of 292 women were included in the study. Of these, 176 (60.3%) had no SG, 20 (6.8%) had mild SG, and 96 (32.9%) had severe SG. Davey’s score was lower in the group of patients with preterm birth than in the term birth groups (p = .002). SG in the breasts was more common in the preterm labor group than in the term birth group (p = .007). Also, the presence of SG in the legs was less common in the preterm labor group than in the term birth group (p < .001). In a logistic regression model, stria in the breasts revealed most significant in preterm delivery. Conclusions No difference was found in the pregnancy length in gestational weeks among groups of different SG severity. The Davey’s score and the presence of striae in the legs and breasts were found different between the preterm and term birth groups, and the term birth subgroups.

Is maternal serum inhibin A a good predictor in preterm labor? - Experience from a community hospital in Taiwan

BackgroundWe aimed to determine whether inhibin A could be a reliable and accurate predictor of preterm birth, and discuss the possible pathogenic processes of inhibin A leading to preterm birth. MethodsA retrospective cohort study was conducted on consecutive singleton pregnant women who underwent the second-trimester quad screen test at a gestational age of 15–20 weeks at Keelung Chang-Gung Memorial Hospital from March 2011 to May 2015. Data including maternal characteristics and pregnancy outcomes were collected from an electric medical record database. Data regarding pregnancy terminations before a gestational age of 24 weeks and regarding pregnancies that involved chromosomal or congenital anomalies were excluded from this analysis. One-way analysis of variance was used to compare second-trimester α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A in women with preterm deliveries versus those with term deliveries. ResultsAlthough a total of 935 women with singleton pregnancies were enrolled, pregnancy outcome and complete maternal data were obtained from only 770 (82.3%)of them. In total, 687 (89.2%) women delivered at or after 37 weeks of gestation and 83 (10.8%) women delivered before 37 weeks of gestation. The results showed that the inhibin A level was significantly increased in the preterm labor group (p = 0.009). A cutoff inhibin A value above 2.25 was identified statistical significantly in the preterm labor group. ConclusionsFrom our results, an inhibin A level above 2.25 multiples of the median in the quad screen test may be associated with preterm labor afterward. Closely monitoring for uterine contractions or cervical length measurement in the second trimester may be indicated in patients with unexplained elevated inhibin A levels.