Women In Preterm Labor Research Articles

Accuracy of qualitative maternal cervicovaginal fetal fibronectin test in predicting spontaneous preterm birth in symptomatic pregnant women

Background: The incidence of preterm birth is increasing worldwide. Preterm birth is a common cause of neonatal morbidity and mortality commonly associated with low-birth weight and deficiency of lung surfactants in the newborn. Children who were born preterm have higher rates of cerebral palsy, neurodevelopmental anomalies, learning disabilities, and respiratory illnesses compared with children born at term with attendant psychosocial and financial burden on the parents or carers. These problems may be minimized via the use of a preterm birth prediction test such as the maternal cervicovaginal fetal fibronectin test (FFT) to determine those women in genuine preterm labor and at a higher risk for preterm birth. Effective treatment can then be focused on this group of women to reduce the incidence of preterm birth. However, the FFT in preterm birth prediction is underutilized in Nigeria. Aim: To determine the role of cervicovaginal fetal fibronectin testing as a predictor of spontaneous preterm birth in symptomatic pregnant women in a local setting. Setting: This study was conducted at the obstetrics unit of the Department of Obstetrics and Gynaecology at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state, Nigeria. The OAUTHC comprises two obstetrics units – Ife Hospital Unit (IHU) and Wesley Guild Hospital Unit at Ilesha (WGH). Design: Cross-sectional, descriptive study. Methods: In this study, 182 booked and unbooked singleton antenatal mothers between 28 weeks and 36 weeks 6 days gestation who had symptoms suggestive of preterm labor were recruited. An interviewer administered questionnaire was filled for each subject and a sterile speculum vaginal examination was then performed to obtain a specimen of the subject's cervicovaginal secretion using a sterile cotton swab. A qualitative FFT was done on each sample collected, then recruited mothers were monitored till delivery and further data obtained. Outcome Measures: The main outcome measures were the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of FFT in predicting spontaneous preterm birth in symptomatic pregnant women. Results: A total of 182 women presenting with symptoms suggestive of preterm labor were recruited: 171 (93.96%) women delivered at term, whereas 11 (6.04%) women had preterm birth with a calculated preterm birth rate of 7.33 per 1000 deliveries during the study period. Also, 7 (3.85%) women had a positive FFT, while 175 (96.15%) women had a negative test. FFT had a sensitivity, specificity, PPV, and NPV of 9.09%, 96.49%, 14.29%, and 94.29%, respectively; a LR+ and LR- of 2.59 (95% confidence interval, CI, 0.34–19.68) and 0.94 (95% CI, 0.78–1.14) respectively; a relative risk of 2.59 (95% CI, 0.341–19.675); a calculated accuracy of 91.21% (95% CI, 86.12%–94.89%); and an area under the receiver operating characteristic curve of 0.60. Conclusion: The high NPV of fetal fibronectin sampling in a population of pregnant women with symptoms supports less intervention for patients with negative results.

817: Correlation of bile acids and aspartate-aminotransferase with adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

To identify laboratory data that correlate with a non-reassuring prognosis and poor obstetrical and neonatal outcomes. A retrospective review of women with intrahepatic cholestasis of pregnancy (ICP), admitted for delivery between January 1, 2013 and December 31, 2017, was performed. Chi-square and Student’s T-test statistical analysis was performed, and receiver-operator characteristic curves were plotted for the prediction of each category of perinatal outcome and the areas under the curves were determined. All p-values were two-sided, and P <0.05 was considered statistically significant. Examination of the pregnancy outcomes and clinical features of the 61 patients diagnosed with ICP showed no occurrence of IUFD, stillbirth, abruption, or neonatal demise. In our cohort, no single factor was identified that correlated with a reassuring outcome and would permit expectant management of pregnancy beyond 37 weeks gestation. ROC curve analysis revealed a statistically significant correlation between bile acid and AST levels and perinatal outcomes. A bile acid level equal to or greater than 37 μmol/L strongly predicted spontaneous preterm labor in women affected by ICP with a sensitivity of 100% and specificity of 60.70% (P value 0.002). A bile acid level equal to or greater than 42 μmol/L strongly predicted meconium-stained amniotic fluid with a sensitivity of 85.70% and specificity of 66.70% (P value 0.006). AST levels equal to or greater than 62 IU/L strongly predicted NICU admission with a sensitivity of 81.30% and specificity of 62.20% (P value 0.002). AST levels equal to or greater than 75 IU/L strongly predicted hyperbilirubinemia in the neonates with a sensitivity of 87.50% and specificity of 69.80% (P value 0.001). There is a statistically significant correlation between elevated bile acid and AST levels and adverse perinatal outcomes. Given this statistically significant correlation, patients with ICP should undergo serial liver function tests, specifically AST levels, along with serial bile acid levels.

Vaginal versus intramuscular progesterone for prevention of preterm labour in women with a twin pregnancy: A randomized controlled trial

Background: Twins constitute 2-4% of all births and the rate of twining has increased by 76% between 1980 and 2009.Twin pregnancies, compared with singletons, are at increased risk for fetal anomalies, preterm births, aberrant fetal growth, cerebral palsy and perinatal and infant mortality. Maternal complications associated with twin pregnancies include hypertensive disorders, gestational diabetes, cesarean delivery, postpartum hemorrhage and maternal mortality. Aim of the Work: This study aimed to assess the efficacy of vaginal progesterone compared to intramuscular therapy in decreasing the rate of preterm birth in women with twin pregnancies. Patients and Methods: This randomized controlled trial included women presented to Ain- Shams University Maternity Hospital. The study presented for approval from the Ethical Committee of the Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University. Informed consent was signed after explaining the study purpose and methods to the subjects. Data presentation did not include the patient name, but diagnosis was included. Results: There was no statistically significance between the two groups regarding number of neonatal RDS, NICU admission and neonatal death. Birth weight was significantly higher among vaginal group. NICU stay was significantly higher among intramuscular group. Conclusion: Compared with intramuscular 17-OHPC, vaginal progesterone in women with twin pregnancy is associated with lower percentage of preterm labour, less recurrent spontaneous preterm birth, less adverse maternal side effects, fewer NICU admissions and better compliance.

Significant correlation between regulatory T cells and vitamin D status in term and preterm labor

Background and aimVitamin D insufficiency and deficiency have been associated with an increased risk of adverse pregnancy outcomes. Also, vitamin D is known to play a role in promoting the function of regulatory T-cells (Tregs). Tregs play an important role in suppressing the immune response during pregnancy. Our study aimed to investigate Tregs phenotypes in preterm and tem laboring women and its association with vitamin D level. MethodsThis cross-sectional study included 82 pregnant women, divided into 46 term and 36 preterm laboring women in addition to 30 healthy non-pregnant women. The percentage of CD4+CD25+Foxp3+Treg cells and their composition of four different Treg subsets were evaluated using flow cytometric analysis. Also, serum vitamin D levels were measured by ELISA. ResultsThe percentage of the CD4+ CD25+ FoxP3+ Tregs were significantly decreased in term and preterm laboring women compared to the non-pregnant controls. The percentage of CD45RA+ Tregs, was significantly increased in term laboring women than preterm laboring women and non-pregnant women. Also, term labor women had increased proportion of HLA-DRhighTregs. Preterm labor women had significant increased proportion of HLA-DRnegative Tregs compared to term labor women. The overall prevalence of vitamin D deficiency and vitamin D insufficiency was higher in preterm than term laboring women and non-pregnant women. Significant positive correlations were found between serum level of 25 (OH)D and percentage of CD4+ CD25+ Foxp3+Tregs and percentage HLA-DRhighTregs among term and preterm laboring women with vitamin D deficiency. ConclusionThere is a strong association between the percentage of Treg phenotypes and vitamin D level in term and preterm labor women with vitamin D deficiency. Also, the onset of term and preterm labor is associated with changes in the composition of the total Treg pool with different Treg subsets which in turn may be responsible for immunologic mechanisms that associated with labor induction.

Matrix Metalloprotease-1 and Elastase Are Novel Uterotonic Agents Acting Through Protease-Activated Receptor 1.

Matrix metalloproteinase-1 (MMP-1) and neutrophil elastase are proteolytic enzymes involved in tissue remodeling, but a role for them as uterotonic agents has not been considered. However, both these proteases activate protease-activated receptor 1 (PAR-1) that mediates thrombin-induced contractions. Matrix metalloproteinase-1 and elastase are products of neutrophils that infiltrate intrauterine tissues at the time of labor, so we tested the hypothesis that these proteases might be novel uterotonic agents acting via PAR-1. Decidual tissue was collected from fetal membranes of term not-in-labor (TNL), term labor (TL), and preterm labor (PTL) women and analyzed for gene and protein expression of MMP-1 and neutrophil elastase. Contractile effects of MMP-1 and elastase were tested with uterine strips of day 19 and 20 gestation rats. Expression of MMP-1 and neutrophil elastase was increased in TL and PTL as compared to TNL. Expression of both the pro- and active enzymes of MMP-1 increased progressively from TNL to TL to PTL. Tumor necrosis factor-α, a neutrophil product, increased MMP-1 in decidual and myometrial cells. Both MMP-1 and elastase stimulated strong contractions of myometrial strips, which were prevented by inhibition of PAR-1 and inhibition of inositol trisphosphate receptor or calcium channel blockade. Indomethacin did not prevent protease-induced contractions. These data suggest that MMP-1 and neutrophil elastase may be important but heretofore unrecognized players in stimulating uterine contractions at the time of labor, and they may explain why indomethacin delays, but does not prevent, PTL because indomethacin inhibits the prostaglandin component but not the protease component of labor.

The Efficacy of Progesterone Therapy for the Prevention of Preterm Labor in Women with Mixed Risk-factors: A Systematic Review and Meta-analysis of Randomized Clinical Trials

The Efficacy of Progesterone Therapy for the Prevention of Preterm Labor in Women with Mixed Risk-factors: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Time and sex dependent effects of magnesium sulphate on post-asphyxial seizures in preterm fetal sheep.

We evaluated the effect of magnesium sulphate (MgSO4 ) on seizures induced by asphyxia in preterm fetal sheep. MgSO4 did not prevent seizures, but significantly reduced the total duration, number of seizures, seizure amplitude and average seizure burden. Saline-asphyxia male fetuses had significantly more seizures than female fetuses, but male fetuses showed significantly greater reduction in seizures during MgSO4 infusion than female fetuses. A circadian profile of seizure activity was observed in all fetuses, with peak seizures seen around 04.00-06.00h on the first and second days after the end of asphyxia. This study is the first to demonstrate that MgSO4 has utility as an anti-seizure agent after hypoxia-ischaemia. More information is needed about the mechanisms mediating the effect of MgSO4 on seizures and sexual dimorphism, and the influence of circadian rhythms on seizure expression. Seizures are common in newborns after asphyxia at birth and are often refractory to anti-seizure agents. Magnesium sulphate (MgSO4 ) has anticonvulsant effects and is increasingly given to women in preterm labour for potential neuroprotection. There is limited information on its effects on perinatal seizures. We examined the hypothesis that MgSO4 infusion would reduce fetal seizures after asphyxia in utero. Preterm fetal sheep at 0.7 gestation (104days, term=147days) were given intravenous infusions of either saline (n=14) or MgSO4 (n=12, 160mg bolus+48mgh-1 infusion over 48h). Fetuses underwent umbilical cord occlusion (UCO) for 25min, 24h after the start of infusion. The start time for seizures did not differ between groups, but MgSO4 significantly reduced the total number of seizures (P<0.001), peak seizure amplitude (P<0.05) and seizure burden (P<0.005). Within the saline-asphyxia group, male fetuses had significantly more seizures than females (P<0.05). Within the MgSO4 -asphyxia group, although both sexes had fewer seizures than the saline-asphyxia group, the greatest effect of MgSO4 was on male fetuses, with reduced numbers of seizures (P<0.001) and seizure burden (P<0.005). Only 1 out of 6 MgSO4 males had seizures on the second day post-UCO compared to 5 out of 6 MgSO4 female fetuses (P=0.08). Finally, seizures showed a circadian profile with peak seizures between 04.00 and 06.00h on the first and second day post-UCO. Collectively, these results suggest that MgSO4 may have utility in treating perinatal seizures and has sexually dimorphic effects.

Association between preterm labour and pelvic floor muscle function

We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device. Fifty-two pregnant women were hospitalised for tocolytic therapy because of spontaneous preterm labour. Thirty-two of them (10.2%) had a preterm delivery despite the tocolytic therapy. Both the vaginal resting pressure (p = .009, 95%CI: 0.8; 5.9) and the pelvic floor muscle strength (p = .01, 95%CI: 3.5; 13.1) were significantly lower in the women with a preterm labour.Impact statementWhat is already known on this subject? The pelvic floor muscles have an essential role in continence and provide support to the pelvic organs. They also have an impact on labour. The pelvic floor muscles should distend to allow the passage of the foetus during labour. The rotation and flexion of the foetal head is due to the pelvic floor resistance. The effect of a vaginal birth on the pelvic floor’s function is readily understood. On the other hand, the effect of the pelvic floor muscle function on labour is still controversial.What do the results of this study add? This prospective study showed that there is a negative association between the pelvic floor muscle strength and preterm labour. This is the first clinical study indicating that weak pelvic floor muscles may cause a preterm labour.What are the implications of these findings for clinical practice and/or further research? Pelvic floor physical therapy may be an alternative preventive strategy to reduce the risk of a spontaneous preterm birth.

Magnesium sulphate induces preconditioning in preterm rodent models of cerebral hypoxia-ischemia

BackgroundBrain injury in preterm infants represents a substantial clinical problem associated with development of motor impairment, cognitive deficits and psychiatric problems. According to clinical studies, magnesium sulphate (MgSO4) given to women in preterm labor reduces the risk of cerebral palsy in the offspring but the mechanisms behind its neuroprotective effects are still unclear. Our aim was to explore whether MgSO4 induces tolerance (preconditioning) in the preterm rodent brain. For this purpose we established a model of perinatal hypoxia-ischemia (HI) in postnatal day 4 rats and also applied a recently developed postnatal day 5 mouse model of perinatal brain injury. MethodsPostnatal day 4 Wistar rats were exposed to unilateral carotid artery ligation followed by 60, 70 or 80 min of hypoxia (8% O2). On postnatal day 11, brains were collected and macroscopically visible damage as well as white and grey matter injury was examined using immunohistochemical staining. Once the model had been established, a possible preconditioning protection induced by a bolus MgSO4 injection prior to 80 min HI was examined 7 days after the insult. Next, a MgSO4 bolus was injected in C57Bl6 mice on PND 4 followed by exposure to unilateral carotid artery ligation and hypoxia, (10% O2) for 70 min on PND 5. Brains were collected 7 days after the insult and examined with immunohistochemistry for grey and white matter injury. ResultsIn rats, a 60 min period of hypoxia resulted in very few animals with brain injury and although 70 min of hypoxia resulted in a higher percentage of injured animals, the brains were marginally damaged. An 80 min exposure of hypoxia caused cortical tissue damage combined with hippocampal atrophy and neuronal loss in the C3 hippocampal layer.In the rat model, MgSO4 (1.1 mg/g administered i.p. 24 h prior to the induction of HI, resulting in a transient serum Mg2+ concentration elevation to 4.1 ± 0.2 mmol/l at 3 h post i.p. injection) reduced brain injury by 74% in grey matter and 64% in white matter.In the mouse model, MgSO4 (0.92 mg/g) i.p. injection given 24 h prior to the HI insult resulted in a Mg2+ serum concentration increase reaching 2.7 ± 0.3 mmol/l at 3 h post injection, which conferred a 40% reduction in grey matter injury. ConclusionsWe have established a postnatal day 4 rat model of HI for the study of preterm brain injury. MgSO4 provides a marked preconditioning protection both in postnatal day 4 rats and in postnatal day 5 mice.

Role of Vaginal Progesterone in Prevention of Preterm Labor in Women with Previous History of One or More Previous Preterm Births

Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth <37 weeks of gestation or not. Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 - 24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%; P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%; P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length < 25 mm.

Magnesium induces preconditioning of the neonatal brain via profound mitochondrial protection

Magnesium sulphate (MgSO4) given to women in preterm labor reduces cerebral palsy in their offspring but the mechanism behind this protection is unclear, limiting its effective, safe clinical implementation. Previous studies suggest that MgSO4 is not neuroprotective if administered during or after the insult, so we hypothesised that MgSO4 induces preconditioning in the immature brain. Therefore, we administered MgSO4 at various time-points before/after unilateral hypoxia-ischemia (HI) in seven-day-old rats. We found that MgSO4 treatment administered as a bolus between 6 days and 12 h prior to HI markedly reduced the brain injury, with maximal protection achieved by 1.1 mg/g MgSO4 administered 24 h before HI. As serum magnesium levels returned to baseline before the induction of HI, we ascribed this reduction in brain injury to preconditioning. Cerebral blood flow was unaffected, but mRNAs/miRNAs involved in mitochondrial function and metabolism were modulated by MgSO4. Metabolomic analysis (H+-NMR) disclosed that MgSO4 attenuated HI-induced increases in succinate and prevented depletion of high-energy phosphates. MgSO4 pretreatment preserved mitochondrial respiration, reducing ROS production and inflammation after HI. Therefore, we propose that MgSO4 evokes preconditioning via induction of mitochondrial resistance and attenuation of inflammation.

Long-term impact of intrauterine neuroinflammation and treatment with magnesium sulphate and betamethasone: Sex-specific differences in a preterm labor murine model

Preterm infants are at significantly increased risk for lifelong neurodevelopmental disability with male offspring disproportionately affected. Corticosteroids (such as betamethasone) and magnesium sulphate (MgSO4) are administered to women in preterm labor to reduce neurologic morbidity. Despite widespread use of MgSO4 in clinical practice, its effects on adult offspring are not well known nor have sex-specific differences in therapeutic response been explored. The objective of our study was to examine the long-term effects of perinatal neuroinflammation and the effectiveness of prenatal MgSO4/betamethasone treatments between males and females in a murine model via histologic and expression analyses. Our results demonstrate that male but not female offspring exposed to intrauterine inflammation demonstrated impaired performance in neurodevelopmental testing in early life assessed via negative geotaxis, while those exposed to injury plus treatment fared better. Histologic analysis of adult male brains identified a significant reduction in hippocampal neural density in the injured group compared to controls. Evaluation of key neural markers via qRT-PCR demonstrated more profound differences in gene expression in adult males exposed to injury and treatment compared to female offspring, which largely showed resistance to injury. Prenatal treatment with MgSO4/betamethasone confers long-term benefits beyond cerebral palsy prevention with sex-specific differences in response.

Профілактика передчасних пологів у жінок із доброякісною патологією шийки матки в анамнезі

The article presents the prophylactic and therapeutic complex developed by us, which reduces the frequency of early and late spontaneous abortions, premature births, reduces placental dysfunction, anomalies of labor, fetal distress, the percentage of cesarean sections, the pathology of the postpartum period in women with benign pathology of the cervix ) in the anamnesis. The objective: was to decrease the frequency of preterm labor in women with benign pathology of CM in the anamnesis on the basis of studying clinical and microbiological and endocrinological features, as well as using the developed complex of preventive and curative measures. Materials and methods. The study was conducted in two stages. At the first stage, the features of the course of pregnancy, childbirth, the postnatal and neonatal periods were studied in 50 patients with a benign pathology of CM in a history, which was carried out by conventional preventive and therapeutic measures (first group); for the comparative characteristics, similar parameters were studied in 50 obstetric and somatically healthy primiparas (control group). At the second stage, clinical and instrumental-laboratory evaluation of the prophylactic-therapeutic complex developed by us was carried out, which was used before and during pregnancy in 50 women with a benign pathology of CM in the anamnesis (II main group). Results. The use of the proposed treatment-and-prophylactic complex prevented recurrence of benign pathology of CM by results of colposcopic and cytological studies – 26% in the 2-nd main group against 62% in the I primary group (p&lt;0.05). No cases of prematurity or perinatal death in newborns from mothers assigned to the prophylactic-therapeutic complex proposed by us have been recorded. Сonclusion. The prophylactic and therapeutic complex developed by us includes the use, starting from early pregnancy, of natural micronized progesterone, diosmin, succinic acid, levocarnitine and a local antiseptic with probiotic, which allows reducing the frequency of preterm birth and other obstetric and perinatal complications. This helps to improve the results of delivery in women with benign cervical pathology in history. Key words: pregnancy, childbirth, benign pathology of the cervix, fetoplacental complex.

How Should We Test For Pre-Term Labour? An Economic Model And Cost-Effectiveness Analysis

Objectives: Develop a prognostic model including quantitative fetal Fibronectin for predicting pre-term labour and assess its cost-effectiveness. Methods: Based on data derived from four European studies comprising 1,835 women and 171 events of preterm delivery in the QUIDS IPD meta-analysis, a decision analytic model assessed the cost-effectiveness of alternative prognostic strategies. Costs and probability of correct prognosis were calculated for each strategy, and expressed as net monetary benefit (NMB). Strategies included (i) clinical risk factors alone (CR) (ii) CR plus fetal-fibronectin (fFN), (iii) CR plus quantitative fetal-fibronectin (qfFN), (iv) CR plus transvaginal ultrasound of cervical length (TUCL), (v) CR plus fFN plus TUCL, and (vi) CR plus qfFN plus TUCL. The cost-effectiveness of each strategy is modelled over three gestation periods: extremely premature (<28 weeks), very premature (28-32 weeks), and premature (32-37 weeks). Results: qfFN testing dominated fFN in all three gestational periods with a lower mean cost per patient and greater probability of correct diagnosis at 7 days. qfFN had the greatest NMB for the Extremely Premature model (£17,301 (95% CI: £16,818 - £17750) per correct diagnosis), while in the Very Premature model TUCL had the greatest NMB (£16,375 (95% CI: £15,670 - £17,028) per correct diagnosis), while qfFN + TUCL had the highest NMB in the Premature model (£17,199 (95% Ci: £16,236 - £17,965) per correct diagnosis). Conclusions: Current NICE clinical guidelines support the use of TUCL for predicting pre-term labour in women ≥30 weeks pregnant. Our findings support this recommendation in Very Premature women, however, the optimal choice between qfFN and TUCL varies across the three gestation periods.

A Role for the Inflammasome in Spontaneous Preterm Labor With Acute Histologic Chorioamnionitis.

Inflammasomes are cytosolic multiprotein complexes that orchestrate inflammation in response to pathogens and endogenous danger signals. Herein, we determined whether the chorioamniotic membranes from women in spontaneous preterm labor with acute histologic chorioamnionitis (1) express major inflammasome components; (2) express caspase (CASP)-1 and CASP-4 as well as their active forms; (3) exhibit apoptosis-associated speck-like protein containing a CARD (ASC)/CASP-1 complex formation; and (4) release the mature forms of interleukin (IL)-1β and IL-18. We utilized quantitative reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, immunoblotting, and immunohistochemistry to determine the messenger RNA (mRNA) and protein expression of major inflammasome components, nucleotide-binding oligomerization domain (NOD) proteins, and the pro- and mature/active forms of CASP-1, CASP-4, IL-1β, and IL-18. The ASC/CASP-1 complex formation was determined using an in situ proximity ligation assay. When comparing the chorioamniotic membranes from women in spontaneous preterm labor with acute histologic chorioamnionitis to those without this placental lesion, we found that (1) the mRNA of NLR family pyrin domain-containing protein ( NLRP) 1, NLRP3, NLR family CARD domain-containing protein 4 ( NLRC4), and NOD2 were higher; (2) the NLRP3 protein was increased; (3) the mRNA and active form (p10) of CASP-1 were greater; (4) the mRNA and active form of CASP-4 were increased; (5) the mRNA and mature form of IL-1β were higher; (6) the mature form of IL-18 was elevated; and (7) ASC/CASP-1 complex formation was increased. In conclusion, spontaneous preterm labor with acute histologic chorioamnionitis is characterized by an upregulation of NLRP3 and the active form of CASP-4, as well as increased ASC/CASP-1 complex formation, which may participate in the activation of CASP-1 and the maturation of IL-1β and IL-18 in the chorioamniotic membranes. These findings provide the first evidence that supports a role for the inflammasome in the pathological inflammation implicated in spontaneous preterm labor with acute histologic chorioamnionitis.

Фоновые и БАВ-вызванные изменения функционального состояния эритроцитов у женщин как индикаторы угрозы преждевременных родов (часть 3)

Фоновые и БАВ-вызванные изменения функционального состояния эритроцитов у женщин как индикаторы угрозы преждевременных родов (часть 3)

In women in spontaneous preterm labor, what are the benefits and harms of betamimetics compared with placebo or each other?

In women in spontaneous preterm labor, what are the benefits and harms of betamimetics compared with placebo or each other?

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

Prevalencia de corioamnionitis histológica en pacientes con trabajo de parto pretérmino espontáneo. Popayán, Colombia, 2014–2016

Objetivo: determinar la prevalencia de la co­rioamnionitis histológica en gestantes con trabajo de parto pretérmino espontáneo, evaluar posibles factores de riesgo y la asociación con signos clínicos y paraclínicos.Materiales y métodos: estudio descriptivo de prevalencia, con análisis secundario exploratorio en gestantes con embarazo menor a 37 semanas de gestación, con parto espontáneo, en quienes se dispuso de sus placentas para estudio histopatoló­gico, durante un periodo de 2 años, en un hospital de alta complejidad en Popayán, Colombia. Se ex­cluyeron partos pretérmino secundarios. Muestreo consecutivo, con tamaño muestral de 166 gestantes; se midieron variables sociodemográficas, clínicas, de laboratorio e imágenes diagnósticas, y resultado histopatológico de la placenta. En el análisis se es­timó la prevalencia de periodo de corioamnionitis histológica. Se obtuvo la razón de prevalencias como medida de asociación y el OR diagnóstico (ORD) con su respectivo intervalo de confianza al 95 %.Resultados: en un periodo de 2 años se analizaron 160 gestantes y sus placentas, 110 placentas fueron reportadas como positivas para corioamnionitis his­tológica con una prevalencia de 68,75 % (IC 95 %: 61,49-76,00), esta fue más prevalente en gestaciones menores de 34 semanas (RP = 1,48; IC 95 %: 1,20-1,83). En cuanto a la asociación de los síntomas y signos se encontró asociación significativa con la fiebre (ORD = 4,7; IC 95 %: 1,05-21,09), la taqui­cardia materna (ORD = 4,22; IC 95 %: 1,81-9,81), la taquicardia fetal (ORD = 3,74; IC 95 %: 1,23-11,35), movimientos respiratorios ausentes (ORD = 5,16; IC 95 %: 1,43-18,60), lago de líquido amniótico menor a 2 cm (ORD = 5,67; IC 95 %: 1,24-25,98), y presencia de neutrofilia (ORD = 2,97; IC 95 %: 1,44-6,12).Conclusiones: la prevalencia de corioamnionitis histológica es del 67% en los partos pretérmino y varió en función de la edad gestacional.

Implementation of a Standardized, Evidence-Based Protocol to Triage Women in Preterm Labor

To improve health care outcomes by standardizing care for women in preterm labor. To implement a standardized care model to reduce transfers from outlying facilities, increase cost savings, and improve patient outcomes for the studied region. At a Midwestern, level III hospital with a regional NICU and 700 annual births, a preterm labor (PTL) assessment toolkit was implemented and data were collected before and after the implementation. The toolkit contains a health care provider algorithm and order set for triage of women in preterm labor. A chart audit was completed from a convenience sample of 91 women who were at 24–34 weeks gestation and coded as threatened PTL patients. Initial postimplementation data were then collected after 6 months from 37 patients using the same criteria. Key measures were outlined. In comparison to preimplementation results, postimplementation findings showed increased numbers of sterile vaginal and speculum examinations, doubled fetal fibronectin collection, and increased cervical length measurements. The disposition to decision time decreased from nearly 13 hours to 3 hours, and a decrease in steroid and tocolysis therapy was noted. Standardized PTL assessment protocols have been found to reduce preterm birth rates, decrease costs, and are supported by the American College of Obstetricians and Gynecologists. Furthermore, these protocols have been found to result in a more timely diagnosis and prevent the overtreatment of pregnant women who are not in true PTL.