Management Of Preterm Labor Research Articles

Comprehensive treatment in severe dengue during preterm and term labor: could tocolysis be useful?

Objective: There is lack of data on the management of severe dengue infection during labor. The objective of this study was to describe our experience in the management of preterm and term labor of pregnant patients with severe dengue infection and thrombocytopenia.Materials and methods: We describe patients with dengue infection confirmed by dengue serology or NS1 antigen in Cali, Colombia. All of the patients had warning or severity signs for dengue and initiated labor, either term or preterm, during their hospital stay. All had thrombocytopenia at the moment labor started. Therefore, we treated them with support management, including intravenous fluids and a tocolytic agent (either atosiban, magnesium sulfate or nifedipine). Tocolytics aimed to stop contractions until platelets were in a safe range previous to delivery. Platelets transfusions were performed if the count was less than 10,000 cells/ml and active bleeding was present. The primary outcome we evaluated was postpartum hemorrhage (defined as a loss of >500 ml following a vaginal delivery or >1000 ml after cesarean section) or maternal and neonatal morbidity and mortality.Results: We present a total of six pregnant women. The median platelet count 24 h previous to delivery was 94,000 cells/ml and after tocolysis was 132,500 cells/ml. Two patients suffered postpartum hemorrhage despite the management. Only one woman required platelet transfusion. No maternal or newborn mortality were present. Three patients were diagnosed with preeclampsia. Four patients had delivery via cesarean section. Five out of six newborns required hospitalization, three of them due to neonatal respiratory distress syndrome.Conclusion: Comprehensive treatment including fluids resuscitation and uterine inhibition in pregnant women with severe dengue in preterm or term labor could be useful. More clinical studies are required to evaluate the benefit of this intervention in tropical countries.Brief rationale: We present an original research article and literature review entitled “Comprehensive treatment in severe dengue during preterm and term labor: could tocolysis be useful?”. Our article describes the clinical manifestation, laboratory findings, complications and management provided to a group of six patients that presented to the hospital with acute dengue virus infection and initiated labor while viremic and thrombocytopenic in this study.In the present study, we found that most of our patients (5 out of 6), presented with signs of severe dengue fever and all of the patients had warning signs. In this population, we decided to provide support treatment and tocolytic agents to these patients with the aim of delaying labor to allow platelet count to rise, thus reducing the odds of hemorrhagic complications. We concluded that although tocolysis is not regularly used in patients with dengue fever, our results suggest that our protocol could benefit pregnant patients with thrombocytopenia due to dengue; however, prospective studies which determine the safety and effectiveness of our intervention are needed.

A Comparative Study of Tocolysis with Atosibanvs Progesterone in Management of Preterm Labor

A Comparative Study of Tocolysis with Atosibanvs Progesterone in Management of Preterm Labor

Management of preterm labour In Sohag University hospital: A clinical audit

Objective : Auditing the current management of preterm labor in department of Obstetrics and Gynaecology, Sohag University hospital against RCOG recommendations ,Identifying the gap between the current practice and ideal practice and Setting recommendations for filling the gap(if present) to improve neonatal and maternal out comes. Methods : This is an observational study which was conducted at Sohag University hospital durin the period from 1 march 2017 to 31 December 2017. All patients with preterm birth who admitted to Sohag university hospital during the study period were included into the study and their data were recorded in a special check list sheet. IBM-SPSS ( version 24) was used for statistical data analysis. Results : The mean age of our studied group was 26.01±5.15 and 81.1 % of them were rural,48 cases had scarred uterus due to mostly previous caesarean section, while the other 79 cases had non scarred uterus. Also, a little more than half of our cases (66 cases, 52%) .UTI were the only indication for the use of antibiotics .Antibiotics not used for prophylactic in management of preterm birth in our study which is recommended by RCOG .Vaginal swab for oncofetal fibronictine or GBS/vaginal infection were not done as it is not accepted in our department which is against RCOG recommendation .Tocolysis failed in 12 cases out of the 15 multiple pregnancy cases, with a significant difference from the failure rate among singleton pregnancy women .As regard RCOG recomendatins : There is insufficient evidence for any firm conclusions about whether or not tocolysis leads to any benefit in preterm labour in multiple pregnancy. Conclusion : The use of Mgso4 as IV tocolytic drug in our hospital play effective role in prevention of preterm labour and giving the chance for receving the dexamethasone but we need to modyfiy our strategy and using other tocolytic drugs as Ca channel blocker as recommended

Predictors, Treatment and Prevention of Preterm Labour: A Review

Preterm labour (PTL) is one of the leading causes of neonatal morbidity and mortality throughout the world. It is also a major public health problem for its long-term disabilities like cerebral palsy and visual disturbance. Preterm labour is a multifactorial problem and its overall global incidence is 11.1 per 100 live births with a significant regional variation. About 45-50% of preterm deliveries are spontaneous, 30% are associated with preterm prelabour rupture of membranes (PPROM) and another 15-25% is induced for maternal and/or foetal risk. Previous history of PTL is an important risk factor; risk is 14.3% after one preterm birth and 28% after two preterm births. Other important risk factors are multiple pregnancy, polyhydramnios, bicornuate uterus, cervical incompetence & bacterial vaginosis. Prediction of PTL is very difficult but identification of risk factors, assessment of cervical length by ultrasonography and detection of foetal fibronectin in cervical secretions are of great help. Advanced cervical dilatation (>3 cm) or PPROM associated with sufficient and frequent uterine contractions confirm the diagnosis of preterm labour. Prevention of PTL has been tried with prophylactic cervical cerclage, antibiotics and progesterone. PTL is treated with various tocolytic agents and glucucorticoids and antibiotics for local or systemic infection. Betamimetics, calcium channel blockers (nifedipine), prostaglandin synthesis inhibitors and magnesium sulfate are the commonly used tocolytics. Nifedipine has significantly fewer maternal adverse effects than betamimetics and magnesium sulphate. Antenatal corticosteroid treatment has been found to lower neonatal mortality, the risk of neonatal respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis. The ultimate goal of prevention and management of preterm labour is to improve neonatal outcome and to reduce morbidity and mortality.Journal of Science Foundation, July 2017;15(2):57-63

Uterosacral Nerve Stimulation via Cuff Electrode: A Preliminary Animal Study for Potential Application to Treatment of Preterm Labor.

Preterm labor occurs in about 12% of all pregnancies, accounting for at least 75% of neonatal deaths. The neonatal outcomes depend on mainly the gestational age at delivery. The lower the gestational age, the higher the risk of morbidity and mortality. The management of preterm labor involves early detection of high-risk women, prevention and treatment. In this study, the feasibility and stability of implantable cuff electrodes detection and inhibition of uterine contractions for preterm labor treatment were investigated by in-vivo mouse test. In order to check functionality of implanted electrodes, acute in-vivo test at mouse uterosacral ligament was performed by using cuff electrode which stimulate and record nerve activity. As results, the electrical stimulation via a stimulating cuff electrode at mouse uterosacral ligament was properly applied and nerve fiber's signal was recorded via the recording electrode. In addition, the implanted cuff electrodes could obtain stable recording signal to the periodic electrical stimulation for 7 weeks.

Comparative Study of Isoxsuprine and Nifedipine in the Management of Preterm Labour

Comparative Study of Isoxsuprine and Nifedipine in the Management of Preterm Labour

Maternal factors influencing late entry into prenatal care: a stratified analysis by race or ethnicity and insurance status

Objective: Examine factors influencing late (> sixth month of gestation) entry into prenatal care by race/ethnicity and insurance payer.Methods: The study population was drawn from singleton live births in California from 2007 to 2012 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes linked birth certificate and mother and infant hospital discharge records. The sample was restricted to infants delivered between 20 and 44 weeks gestation. Logistic regression was used to calculate relative risks (RR) and 95% confidence intervals (CI) for factors influencing late entry into prenatal care. Maternal age, education, smoking, drug or alcohol abuse/dependence, mental illness, participation in the Women, Infants and Children’s program and rural residence were evaluated for women entering prenatal care > sixth month of gestation compared with women entering < fourth month. Backwards stepwise logistic regression was used to create final multivariable models of risk and protective factors for late prenatal care entry for each race or ethnicity and insurance payer.Results: The sample included 2,963,888 women. The percent of women with late entry into prenatal care was consistently higher among women with public versus private insurance. Less than 1% of white non-Hispanic and Asian women with private insurance entered prenatal care late versus more than 4% of white non-Hispanic and black women with public insurance. After stratifying by race or ethnicity and insurance status, women less than 18 years of age were more likely to enter prenatal care late, with young Asian women with private insurance at the highest risk (15.6%; adjusted RR 7.4, 95%CI 5.3–10.5). Among all women with private insurance, > 12-year education or age >34 years at term reduced the likelihood of late prenatal care entry (adjusted RRs 0.5–0.7). Drugs and alcohol abuse/dependence and residing in a rural county were associated with increased risk of late prenatal care across all subgroups (adjusted RRs 1.3–3.8). Participation in the Women, Infants, and Children’s program was associated with decreased risk of late prenatal care for women with public insurance (adjusted RRs 0.6–0.7), but increased risk for women with private insurance (adjusted RRs 1.4–2.1).Conclusions: The percent of women with late entry into prenatal care was consistently higher among women with public insurance. Younger women, women with <12-year education, those who used drugs or alcohol or resided in rural counties were more likely to enter prenatal care late, with Asian women <18 years at especially high risk. Participation in the Women, Infants, and Children’s program and maternal age >34 years at delivery increased the likelihood of late prenatal care for some subgroups of women and decreased the likelihood for others. These findings can inform institutional factors influencing late prenatal care, especially among lower income women, and may assist efforts aimed at encouraging earlier entry into prenatal care.Rationale: Optimal prenatal care includes initiation before the 14th week of gestation. Beginning care in the first trimester provides an opportunity for sonographic pregnancy dating or confirmation with best accuracy, which can later prove critical for management of preterm labor, maternal or fetal complications, or prolonged pregnancy. In order to improve maternal and infant health by increasing the number of women seeking prenatal care in the first trimester, it is important to examine the drivers for late entry. Here, we examine factors influencing late (> sixth month of gestation) entry into prenatal care by race/ethnicity and insurance payer. We found the percent of women with late entry into prenatal care was consistently higher among women with public insurance. Younger women, women with <12-year education, those who used drugs or alcohol or resided in rural counties were more likely to enter prenatal care late, with Asian women <18 years at especially high risk. These findings can inform institutional factors influencing late prenatal care, especially among lower income women, and may assist efforts aimed at encouraging earlier entry into prenatal care.

Developmental neurotoxicity resulting from pharmacotherapy of preterm labor, modeled in vitro: Terbutaline and dexamethasone, separately and together

Terbutaline and dexamethasone are used in the management of preterm labor, often for durations of treatment exceeding those recommended, and both have been implicated in increased risk of neurodevelopmental disorders. We used a variety of cell models to establish the critical stages at which neurodifferentiation is vulnerable to these agents and to determine whether combined exposures produce a worsened outcome. Terbutaline selectively promoted the initial emergence of glia from embryonic neural stem cells (NSCs). The target for terbutaline shifted with developmental stage: at later developmental stages modeled with C6 and PC12 cells, terbutaline had little effect on glial differentiation (C6 cells) but impaired the differentiation of neuronotypic PC12 cells into neurotransmitter phenotypes. In contrast to the specificity shown by terbutaline, dexamethasone affected both neuronal and glial differentiation at all stages, impairing the emergence of both cell types in NSCs but with a much greater impairment for glia. At later stages, dexamethasone promoted glial cell differentiation (C6 cells), while shifting neuronal cell differentiation so as to distort the balance of neurotransmitter phenotypes (PC12 cells). Finally, terbutaline and dexamethasone interacted synergistically at the level of late stage glial cell differentiation, with dexamethasone boosting the ability of terbutaline to enhance indices of glial cell growth and neurite formation while producing further decrements in glial cell numbers. Our results support the conclusion that terbutaline and dexamethasone are directly-acting neuroteratogens, and further indicate the potential for their combined use in preterm labor to worsen neurodevelopmental outcomes.

Annual Report of the Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2016: Overall report on a comprehensive retrospective study of obstetric management of preterm labor and preterm premature rupture of the membranes.

We conducted a questionnaire survey on the current obstetric management of preterm labor (PL) and preterm premature rupture of the membranes (pPROM). The questionnaire covered approximately a third of all preterm deliveries and nearly half of the preterm deliveries before 32 gestational weeks. The diagnostic criterion for PL was either painful uterine contractions or cervical dilatation. Tocolytic agents were primarily used as long-term maintenance therapy. Intrauterine infection was clinically diagnosed at most responding institutions. Amniocentesis was performed for PL or pPROM at only a small number (10%) of institutions. Prenatal steroids were administered for PL or pPROM, if indicated, at approximately 40-60% of responding institutions. Prophylactic antibiotics to maintain pregnancy were administered for pPROM at approximately 90% and for PL at approximately 20% of institutions. Maintenance therapy with a tocolytic agent was used for pPROM at approximately 90% of institutions.

Implementing the WHO integrated tool to assess quality of care for mothers, newborns and children: results and lessons learnt from five districts in Malawi

BackgroundIn 2014 the World Health Organization (WHO) developed a new tool to be used to assess the quality of care for mothers, newborns and children provided at healthcare facility level. This paper reports on the feasibility of using the tool, its limitations and strengths.MethodsAcross 5 districts in Malawi, 35 healthcare facilities were assessed. The WHO tool includes checklists, interviews and observation of case management by which care is assessed against agreed standards using a Likert scale (1 lowest: not meeting standard, 5 highest: compliant with standard). Descriptive statistics were used to provide summary scores for each standard. A ‘dashboard’ system was developed to display the results.ResultsFor maternal care three areas met standards; 1) supportive care for admitted patients (71% of healthcare facilities scored 4 or 5); 2) prevention and management of infections during pregnancy (71% scored 4 or 5); and 3) management of unsatisfactory progress of labour (84% scored 4 or 5). Availability of essential equipment and supplies was noted to be a critical barrier to achieving satisfactory standards of paediatric care (mean score; standard deviation: 2.9; SD 0.95) and child care (2.7; SD 1.1). Infection control is inadequate across all districts for maternal, newborn and paediatric care. Quality of care varies across districts with a mean (SD) score for all standards combined of 3 (SD 0.19) for the worst performing district and 4 (SD 0.27) for the best. The best performing district has an average score of 4 (SD 0.27). Hospitals had good scores for overall infrastructure, essential drugs, organisation of care and management of preterm labour. However, health centres were better at case management of HIV/AIDS patients and follow-up of sick children.ConclusionsThere is a need to develop an expanded framework of standards which is inclusive of all areas of care. In addition, it is important to ensure structure, process and outcomes of health care are reflected.

Decision‐making at the borderline of viability: Who should decide and on what basis?

Parents and medical staff usually agree on the management of preterm labour at borderline viability, when there is a relatively high risk of long‐term neurodevelopmental problems in survivors. If delivery is imminent and parents and staff cannot agree on the best management, however, who should decide what will happen when the baby is delivered? Should the baby be resuscitated? Should intensive care be initiated? Three ethicists, one of whom is also a neonatologist, discuss this complex issue.

Advances in the role of oxytocin receptors in human parturition

Oxytocin (OT) is a neurohypophysial hormone which has been found to play a central role in the regulation of human parturition. The most established role of oxytocin/oxytocin receptor (OT/OTR) system in human parturition is the initiation of uterine contractions, however, recent evidence have demonstrated that it may have a more complex role including initiation of inflammation, regulation of miRNA expression, as well as mediation of other non-classical oxytocin actions via receptor crosstalk with other G protein-coupled receptors (GPCRs). In this review we highlight both established and newly emerging roles of OT/OTR system in human parturition and discuss the expanding potential for OTRs as pharmacological targets in the management of preterm labour.

Comparative study between progesterone and ritodrine for maintenance tocolysis in management of preterm labour

Comparative study between progesterone and ritodrine for maintenance tocolysis in management of preterm labour

Uterus-targeted liposomes for preterm labor management: studies in pregnant mice.

Preterm labor caused by uterine contractions is a major contributor to neonatal morbidity and mortality. Treatment intended to reduce uterine contractions include tocolytic agents, such as indomethacin. Unfortunately, clinically used tocolytics are frequently inefficient and cross the placenta causing fetal side effects. Here we show for the first time in obstetrics the use of a targeted nanoparticle directed to the pregnant uterus and loaded with a tocolytic for reducing its placental passage and sustaining its efficacy. Nanoliposomes encapsulating indomethacin and decorated with clinically used oxytocin receptor antagonist were designed and evaluated in-vitro, ex-vivo and in-vivo. The proposed approach resulted in targeting uterine cells in-vitro, inhibiting uterine contractions ex-vivo, while doubling uterine drug concentration, decreasing fetal levels, and maintaining the preterm birth rate in vivo in a pregnant mouse model. This promising approach opens new horizons for drug development in obstetrics that could greatly impact preterm birth, which currently has no successful treatments.

Recent Update on Tocolytics for the Management of Preterm Labour

Tocolysis is the relaxation of the pregnant uterus to postpone delivery. Tocolytics are a wide variety of agents used to suppress uterine contraction given when delivery would result in preterm birth. Preterm birth the most important single determinant of adverse outcome in terms of both survival and quality of life of baby. Although preterm birth is defined as being before 37 completed weeks most mortality and morbidity is experienced by babies born before 34 weeks. Prevention and treatment of preterm birth is important though it is not possible when labour is too advanced, cervix is dilated for more than 4 cm and prolongation of pregnancy is hazardous because of intrauterine infection, placental abruption, IUGR, lethal congenital anomaly, severe PIH, eclampsia, active vaginal bleeding or cardiac disease 1,2. The aim of this paper is to review available data about the tocolytics. The tocolytic therapy also helpful for getting time for the administration of dexamethasone/betamethasone, a glucocorticoid drug which greatly accelerates fetal lung maturity. There is no clear first line tocolytic agent 3,4. Various types of drugs are used, with varying success rates and side effects that includes calcium-channel blockers, ? adrenergic receptor agonists, magnesium sulphate, prostaglandin-synthetase inhibitors, oxytocin receptor antagonists. Their specific effects on myometrial contractility, their safety, their efficiency, doses, route of entry, and side effects profile for the mother and the fetus are presented. The main question which tocolytic should be administrated is discussed.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 21-26

Acyclovir-induced nephrotoxicity in a pregnant woman with chickenpox

Acyclovir is a commonly used antiviral agent for the treatment of herpes simplex and herpes zoster infection. According to the Food and Drug Administration, it is classified as a category B drug and is safe for use during pregnancy [1]. Adverse effects of acyclovir include mild symptoms, such as nausea, vomiting, and diarrhea, to more severe symptoms, including neutropenia, hepatitis, and StevenseJohnson syndrome [2]. Reversible nephrotoxicity can be diagnosed in approximately 5e10% of patients undergoing intravenous (IV) administration. The precipitation of acyclovir crystals results in kidney damage and a rapid rise in serum creatinine [3,4]. However, drug-associated complications during pregnancy have not been documented. A 33-year-old pregnant woman, G2P1, at 31 weeks' gestation presented at the outpatient department with a 2-day history of generalized tiny vesicles on the erythematous base over her trunk and genital area. She was previously started on oral acyclovir (800 mg 4 times daily) under the impression of chickenpox by a dermatologist. Additionally, she reported abdominal tightness, poor intake, and general weakness. Fetal nonstress test showed uterine contractions. The patient was admitted for management of preterm labor in association with chickenpox. Upon admission, her blood pressure was 118/67 mmHg, dipstick test of urinalysis showed trace proteins, and laboratory findings revealed a hemoglobin level of 10.7 g/dL and a hematocrit of 33.9%. The differential counts of lymphocytes and monocytes were 10.7% and 11.2%,

What are we telling the parents of extremely preterm babies?

Parent counselling and decision-making regarding the management of preterm labour and birth are influenced by information provided by healthcare professionals regarding potential infant outcomes. The aim of this study was to determine whether perinatal healthcare providers had accurate perceptions of survival and major neurosensory disability rates of very preterm infants born in non-tertiary hospitals ('outborn') and tertiary perinatal centres ('inborn'). A web-based survey was distributed to midwives, nurses, obstetricians and neonatologists working in non-tertiary and tertiary maternity hospitals, and the perinatal/neonatal emergency transport services in Victoria, Australia. Estimates of survival rates at 24 and 28-weeks' gestation were compared with actual survival rates of a population-based cohort of 24 and 28-weeks' gestation infants, born free of lethal anomalies in Victoria in 2001-2009. Estimates of major neurosensory disability rates in 24 and 28-week survivors were compared with actual disability rates in 24 and 28-week children born in Victoria averaged over three eras: 1991-1992, 1997 and 2005. Response rates varied as follows: 83% of non-tertiary midwives, 4% of obstetricians, 55% of tertiary centre staff and 68% of transport team staff responded (total of 30%). Overall, respondents underestimated survival and overestimated major neurosensory disability rates in both outborn and inborn 24 and 28-week infants. Outborn infants were perceived to have much worse prospects for survival and for survival with major disability compared with inborn peers. Many clinicians overestimated rates of adverse outcomes. These clinicians may be misinforming parents about their child's potential for a favourable outcome.

What is New in the Management of Acute Preterm Labor?: Best Articles From the Past Year.

This month we focus on current research in the management of acute preterm labor. Dr. Malone discusses four recent publications, which are concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.

The oxytocin receptor antagonist, Atosiban, activates pro-inflammatory pathways in human amnion via Gαi signalling

Oxytocin (OT) plays an important role in the onset of human labour by stimulating uterine contractions and promoting prostaglandin/inflammatory cytokine synthesis in amnion via oxytocin receptor (OTR) coupling. The OTR-antagonist, Atosiban, is widely used as a tocolytic for the management of acute preterm labour. We found that in primary human amniocytes, Atosiban (10 μM) signals via PTX-sensitive Gαi to activate transcription factor NF-κB p65, ERK1/2, and p38 which subsequently drives upregulation of the prostaglandin synthesis enzymes, COX-2 and phospho-cPLA2 and excretion of prostaglandins (PGE2) (n = 6; p < 0.05, ANOVA). Moreover, Atosiban treatment increased expression and excretion of the inflammatory cytokines, IL-6 and CCL5. We also showed that OT-simulated activation of NF-κB, ERK1/2, and p38 and subsequent prostaglandin and inflammatory cytokine synthesis is via Gαi−2 and Gαi−3 but not Gαq, and is not inhibited by Atosiban. Activation or exacerbation of inflammation is not a desirable effect of tocolytics. Therefore therapeutic modulation of the OT/OTR system for clinical management of term/preterm labour should consider the effects of differential G-protein coupling of the OTR and the role of OT or selective OTR agonists/antagonists in activating proinflammatory pathways.

Assessment and Management of Spontaneous Preterm Labor

Abstract Introduction One of the most significant contributors to neonatal morbidity and mortality is preterm labor and subsequent delivery. For any obstetric provider, this is among the most impor...