Preterm Labor Research Articles

Molecular Detection of Bacterial vaginosis Isolated from Preterm Labor Patients in Wasit City, Iraq

The aim of this study was to evaluate the role of bacterial vaginosis in preterm labor. There is growing evidence that infections, particularly those that spread from the lower genital tract, might trigger preterm labor. One of the main causes of newborn morbidity and mortality is preterm birth. This is a cross-sectional study which was carried out in the labor facilities in local hospital in Wasit. A total 90 swab samples were collected by gynecologist from patients in Preterm and Full-term labor Bacteriological diagnosis was done using Molecular quantification methods have been reported recently, but the specific risk factors they might identify remain unclear. We carried our study on 90 pregnant women, divided into two groups. First group delivered preterm and other group at full term. There are 38 out of 45 women who had no bacterial infection in the group of full-term pregnancy compared to 19 out of 45 in the preterm group , so the incidence of BV was significantly more in preterm group. The commonest isolated pathogen was G. vaginalis, followed by Megasphaera and Atopobium vaginalis. More than one-third (37.8%) of patients with preterm delivery have Gardnerella infection when compared to only 6.7% of those who delivered at term , Around one-quarter (26.7%) of patients who delivered preterm were diagnosed with Megasphaera. Only 4.4% of full-term patients had positive tests for this infection and 22.2% of patients with preterm labour compared to 4.4% of full-term pregnancies diagnosed with Atopobium infection.

Rescue Cervical Cerclage for Previable Birth Prevention: A Comprehensive Review of Indications, Techniques, and Outcomes.

Cervical cerclage is a surgical intervention aimed at preventing previable birth by providing mechanical support to the cervix through the placement of a suture. This procedure is primarily indicated for cases of cervical incompetence, where the cervix is prone to premature dilation and can lead to early miscarriage or preterm birth. This review seeks to comprehensively analyze rescue cervical cerclage (RCC), focusing on its indications, techniques, and outcomes. The goal is to offer an in-depth understanding of its effectiveness in preventing previable birth and to guide clinical decision-making in managing pregnancies at risk of premature delivery. A thorough literature review examined recent studies and clinical data on RCC. Key aspects evaluated include the criteria for intervention, various surgical techniques employed, and the associated maternal and fetal outcomes. Comparative analysis was also performed with other preventive measures, such as progesterone therapy and bed rest. RCC has demonstrated efficacy in reducing the incidence of previable births, particularly when performed in cases of identified cervical incompetence or shortening. The review highlights variations in the technique, such as McDonald and Shirodkar cerclage, and discusses their relative success rates and potential complications. The procedure is associated with improved pregnancy outcomes and reduced risk of previable birth, though it carries some risks, including infection and cervical laceration. RCC remains a valuable intervention for preventing previable births in selected patients. This review underscores its importance in managing pregnancies at risk due to cervical incompetence and provides a detailed evaluation of its indications, techniques, and outcomes. Future research should optimize criteria for cerclage placement and explore novel strategies to enhance its effectiveness and safety.

Obstetric outcomes in the expectant management of cesarean scar pregnancy with fetal heart activity: a single-center retrospective cohort study.

Cesarean scar pregnancy (CSP) is a high-risk complication characterized by the implantation of a pregnancy within a cesarean scar resulting from a previous delivery. Currently, clinical indicators guiding the expectant management of patients with CSP are lacking. We thus aimed to evaluate pregnancy and neonatal outcomes among women who underwent expectant CSP management and to investigate whether sonographic signs correlated with obstetric outcomes. We retrospective reviewed the electronic medical records and first-trimester transvaginal ultrasonography reports of consecutive patients diagnosed with CSP in the first trimester at the West China Second University Hospital from January 1, 2010 to December 31, 2022. Pregnancy outcomes (emergency surgery, blood loss, and rescue) and neonatal outcomes (gestational age at delivery, neonatal weight, and Apgar scores) were examined. A binary logistic regression analysis was conducted to identify independent risk factors that could predict severe complications. The final analysis included 54 patients. The mean age of the pregnant women was 34±4 years. Among the 54 patients, 14 (25.9%) did not progress to 20 weeks of gestation. Pregnancy continued beyond 20 weeks in 40 patients, with 37 live births (92.5%) and 3 stillbirths (7.5%). Moreover, 7 (17.5%) and 33 (82.5%) patients delivered before and after 34 weeks, respectively. Placenta accreta spectrum (PAS) and placenta previa were confirmed in 29 (72.5%) and 17 (42.5%) patients, respectively. Hysterectomy, emergency cesarean section, and rescue surgery were performed in 5 (12.5%), 15 (37.5%), and 22 (55.5%) patients, respectively. Patients with a visible niche were significantly more likely to have preterm labor, PAS, placenta previa, low-birth-weight newborns, higher blood loss, intraoperative rescue, blood transfusion, and first-trimester vaginal bleeding than were those without one (all P values <0.05). Our study showed that expectant management of CSP to achieve live birth might be feasible. Patients with a visible niche exhibited worse outcomes, with a higher incidence of severe delivery complications.

Safety of quadrivalent recombinant influenza vaccine in pregnant persons and their infants

BackgroundThe Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that all pregnant persons receive any licensed, recommended, and age-appropriate inactivated influenza vaccine (SD-IIV) or recombinant influenza vaccine (RIV) to protect against influenza and influenza-related complications. RIV was safe and efficacious in pre- and postlicensure studies, however there is limited RIV safety data in pregnant persons. ObjectiveTo evaluate the safety of quadrivalent recombinant influenza vaccine (RIV4) versus a quadrivalent standard-dose, inactivated influenza (SD-IIV4) in a large cohort of pregnant persons and their infants. Study DesignThis postlicensure observational safety study conducted at Kaiser Permanente Northern California evaluated the subset of pregnant persons vaccinated in routine care as part of a larger cluster-randomized vaccine effectiveness study comparing RIV4 vs. SD-IIV4 (ClinicalTrials.gov NCT03694392). We identified pregnancy (spontaneous abortion, preterm labor, stillbirth/fetal death, congenital/fetal anomalies detected during pregnancy, eclampsia/pre-eclampsia, placental abruption), birth (preterm birth, low birth weight, small for gestational age), and neonatal/infant outcomes (infant death, failure to thrive, congenital anomalies detected after delivery) using diagnostic codes among pregnant persons ≥18 years immunized with RIV4 or SD-IIV4 during the 2018/19 and 2019/20 influenza seasons and their infants. We used conditional logistic regression adjusted for age group, race, ethnicity, trimester of influenza vaccination, comorbidities, and BMI, stratified by gestational age to estimate the odds ratio (OR) of pregnancy outcomes following vaccination with RIV4 vs. SD-IIV4. Using logistic regression, we separately estimated the adjusted OR of birth and neonatal/infant outcomes in the first year of life (eg, death) in infants of RIV4 vs. SD-IIV4 vaccinated pregnant persons. ResultsThe study population included 48,781 pregnant persons (RIV4 = 14,981; SD-IIV4 = 33,800) and 47,394 live births (RIV4 = 14,538; SD-IIV4 = 32,856). There was no statistical difference in any pregnancy outcome or in birth and neonatal/infant outcome between RIV4 vs. SD-IIV4 vaccinated pregnant persons and their infants. ConclusionCompared with receipt of a SD-IIV4 during pregnancy, this large study did not identify any pregnancy, birth, or neonatal/infant safety concerns following receipt of a RIV4 during pregnancy and demonstrates that the safety of RIV4 in pregnancy was similar to SD-IIV4. This study provides additional evidence regarding the safety of influenza vaccination in pregnant persons and further supports ACIP and ACOG recommendations that all pregnant persons receive an inactivated or recombinant influenza vaccine.

Duration of Induction of Labor for Second-Trimester Medication Abortion and Adverse Outcomes.

To evaluate the relationship between duration of labor during second-trimester medication abortion and adverse outcomes. We conducted a retrospective cohort study including all individuals with a singleton gestation undergoing second-trimester medication abortion without evidence of advanced cervical dilation, rupture of membranes, or preterm labor at four centers. The primary exposure was duration of labor (ie, hours spent from receiving misoprostol to fetal expulsion). The primary outcome was composite morbidity , defined as uterine rupture, need for blood transfusion, clinical chorioamnionitis, intensive care unit admission, or need for readmission. We performed bivariate and multivariate negative binomial analyses. A post hoc subgroup analysis was performed to assess for the risk of the primary outcome by gestational age. We performed tests of homogeneity based on history of uterine scarring and parity. Six hundred eighty-one individuals were included. The median duration of labor was 11 hours (interquartile range 8-17 hours). One hundred thirty-one (19.2%) experienced the primary outcome. When duration of labor was evaluated continuously, a longer duration of labor was associated with an increased frequency of morbidity (adjusted β=0.68, 95% CI, 0.32-1.04). When duration of labor was evaluated categorically, those experiencing the highest quartile of duration (ie, 17 hours or more) had a statistically higher risk for experiencing morbidity compared with individuals in all other quartiles (adjusted relative risk 1.99, 95% CI, 1.34-2.96). When we focused on components of the composite outcome, clinical chorioamnionitis was significantly different between those experiencing a longer duration and those experiencing a shorter duration of labor (26.2% vs 10.6%, P <.001). On subgroup analysis, gestational age was not associated with the risk of composite morbidity. Tests of homogeneity demonstrated no significant difference in the risk for morbidity among individuals with a history of uterine scarring or based on parity. Duration of labor was independently associated with risks for adverse maternal outcomes during second-trimester medication abortion, specifically clinical chorioamnionitis.

Quel bilan proposer après une grossesse compliquée de pathologie vasculo-placentaire ?

Vasculo-placental disorders include pregnancy complications resulting from placental dysfunction of vascular origin, i.e. pre-eclampsia, HELLP syndrome, intrauterine growth retardation (IUGR), placental abruption and stillbirth of vascular origin. Pre-eclampsia should be investigated for antiphospholipid syndrome (APS) in case of severe pre-eclampsia and premature delivery before 34 weeks of gestation. In addition to testing for APS, pathological report of the placenta can identify some anatomical predispositions to placental vascular malperfusion, as well as chronic placental inflammatory lesions and excess fibrin deposits. The latter two are associated with IUGR and recurrent stillbirth, reflecting a dysimmune process of maternal origin. The internal medicine and obstetrics consultation, organized two months after delivery, combines the postnatal visit with an assessment of the causes of vasculo-placental disorders, and enables to inform patients about the management of future pregnancies and their cardiovascular health.

An interplay between orthopaedic trauma and pregnancy—A case series of 42 patients

BackgroundPregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management. Methods and materialA retrospective-study was conducted at a Level-1 trauma-care-center, focusing on 54 pregnant women who sustained trauma between January 2015 and December 2022. The study included patients with closed or open fractures, but excluded those without fractures. Forty-two patients were available with minimum 1 year follow-up. Data was collected from hospital records and PACS, including demographic details, emergency care, and laboratory parameters. Changes made in protocol in fracture management due to pregnancy (primary definitive fixation vs staged management), and impact of trauma on pregnancy outcome; mode-of-delivery, maternal and fetal loss were evaluated. ResultsThe mean age was 30-years (range: 21–43years). Road-traffic-collision was most-common mode-of-injury (66.7 %). 38.1 % were in the first-trimester, 35.7 % in second, and 26.2 % in third-trimester. Eight patients had polytrauma, seven had multiple-injuries, and 27 had isolated-injuries. The maternal-mortality-rate was 0.45 %. Three polytraumatized patients ended up with intrauterine death, two polytrauma patients underwent elective abortion, one patient presented with spontaneous-abortion, and fetal loss was 14.3 % (6-of-42). Out of 42 patients, 10 had open-injuries and 32 had closed-injuries. Nine patients underwent LSCS(lower-segment-caesarean-section), six of them were planned for elective-LSCS due to injury and associated fractures (two patients with pelvic injuries, two neck femur fracture patients, one open distal femur fracture, and one ankle fracture dislocation). ConclusionOrthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery.

Effect and Predictive Value of Blood HbA1c, FBG, 2hPBG, and FINS on the Pregnancy Outcome in Patients with Gestational Diabetes Mellitus.

This study aimed to investigate the effects of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 2-hours postprandial blood glucose (2hPBG), and fasting insulin (FINS) levels on pregnancy outcomes and their predictive value in patients with gestational diabetes mellitus (GDM). A total of 109 pregnant women with GDM (GDM group) were included and assayed for serum FBG, 2hPBG, HbA1c, and FINS levels. The incidence of adverse pregnancy outcomes was recorded. GDM patients were divided into the poor pregnancy outcome group and the favorable pregnancy outcome group and analyzed for HbA1c, FBG, 2hPBG, and FINS. The predictive value of serum index combined detection on GDM pregnancy outcome was assessed, and the effect of serum indices on pregnancy outcome was evaluated in GDM patients with logistic regression. In the GDM group, there were 8 cases of premature membranes breaking (7.34%), 6 cases of premature delivery (5.50%), 3 cases of hyperamniotic fluid (2.75%), 2 cases of neonatal asphyxia (1.83%), 5 cases of fetal growth restriction (4.59%), and 3 cases of low-birth-weight infants (2.75%). The total incidence of adverse preg-nancy outcomes was 24.77% (27/109). HbA1c, FBG, 2hPBG, and FINS in the poor pregnancy outcome group were higher than those in the favorable pregnancy outcome group. The AUC value of blood biochemical indicators combined detection in predicting pregnancy outcome in GDM patients was higher than of HbA1c, FBG, 2hPBG, and FINS alone detection. HbA1c ≥ 6.94%, FBG ≥ 7.18 mmol/L, 2hPBG ≥ 9.36 mmol/L, and FINS ≥ 13.07 U/L were the risk factors affecting pregnancy outcomes in GDM patients. The changes of HbA1c, FBG, 2hPBG, and FINS levels in GDM patients are associated with adverse pregnancy outcomes, and the combined detection of serum indicators has predictive value for pregnancy outcomes in GDM patients.

Association of Preterm Delivery with Urinary Tract Infection and Preventive Role of Ceftriaxone

Urinary tract infections (UTIs) are the leading cause of maternal morbidity and poor birth outcomes. Pregnancy changes increase UTI risk. A larger bladder, less tone, and a shift in vaginal flora are changes. Eradicating pathogens in the urogenital tract can lower the risk of infection-related preterm labor by stopping the progression of asymptomatic bacteriuria into a more serious infection. Objective: To determine the association of preterm labor with urinary tract infection and the preventive role of ceftriaxone. Methods: A case-control study was conducted at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, from 14 December 2021 to 10 June 2022. 130 pregnant women who met the selection criteria were recruited from the hospital's post-delivery wards. The participants were then separated into a case group and a control group. Protocols for treating UTIs in female were followed. Ceftriaxone was administered to the group of participants who were UTI-positive. Results: The mean age of female in the case group was 28.88 ± 7.18 and in the controls group was 28.97 ± 6.85 years. The mean gestational age at delivery in cases was 34.28 ± 1.34 weeks and in controls 39.4 ± 1.11 weeks. There was a significant association between preterm labor and urinary tract infection (p= &lt;0.05). Administration of ceftriaxone reduced the risk of preterm labor (p=0.001). Conclusions: It was concluded that there is a significant correlation between UTIs and premature labor and ceftriaxone plays an important role in reducing preterm delivery of UTI patients.

Pregnancies after kidney transplantation “the journey of hope”. Experience of the University Hospital of Batna, Algeria

Introduction. Renal transplantation is the treatment of choice for chronic end-stage renal failure. Transplantation restores the fertility of transplant recipients, which explains the increase in the number of successful pregnancies in this population. However, it remains a high maternal risk pregnancy fetal and/or neonatal which requires a multidisciplinary approach. Objective. The aim of this study is to provide the results of our experience on pregnancies in kidney transplant patients and to evaluate the impact of pregnancy on kidney graft function. Patients and methods. 79 pregnancies in kidney transplant recipients were analyzed and the long-term results of kidney transplantation were studied. We analyzed the results from clinical and biological data before, during and after pregnancy. Results. Average age of the patients was 35.3 ± 3 years and the time between transplantation and the start of pregnancy was 56.4 ± 31.5 months. There was no significant difference between biological data before and after pregnancy. We did not observe any acute rejection. The average maternal complications were preeclampsia in 30% of cases, low birth weight in 29% of cases, prematurity in 44% and cesarean sections in 57%. There was no impact of pregnancy on the kidney graft during follow-up. Conclusion. Despite the frequency of premature deliveries and comorbidities, monitoring and management of kidney transplant recipients revealed good functional results of the kidney graft.

The effect of Orem's Self-Care Deficit Theory-based care during pregnancy and postpartum period on health outcomes: A systematic review and meta-analysis.

To examine the effect of the provision of care on health outcomes when provided based on Orem's Self-Care Deficit Theory during perinatal period. The perinatal period is a process with multidimensional care needs for the mother, baby and family. Care based on nursing theories can improve the quality of perinatal care. A systematic review and meta-analysis. Studies on this topic from 2006 to 2020 have been accessed by nine database searches. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies, developed by the Joanna Briggs Institute. This study was conducted by following the Preferred Reporting System for Systematic Reviews and Meta-Analyses. This systematic review included nine studies with a total sample size of 839 women. These studies showed that care based on Orem's theory significantly helped prolong the mean duration of pregnancy, reduced the incidence of preterm labor, improved hygiene behaviour and increased empowerment. Concerning the perinatal period, this intervention significantly improved self-care and readiness for hospital discharge, adaptation and breastfeeding self-efficacy and reduced nipple pain and pain due to abdominal distension. The implementation of this theory into care during the perinatal period can contribute to improved health outcomes. What is already known about this topic? The quality of pregnancy and postpartum care is important for the maternal health. The use of nursing theories-which nursing knowledge is produced-improves care quality and ensures that care is organized systematically. What this paper adds? There is insufficient research that supports Orem's theory of self-care deficit in pregnancy and postpartum care and also no systematic review about this topic, but the current meta-analysis showed that postnatal and prenatal treatments based on Orem's theory have a positive impact on the self-care agency. The implications of this paper: The use of Orem's theory helps nurses understand women and their needs during pregnancy and postpartum periods. Integrating Orem's theory of self-care deficit into pregnancy and postpartum nursing care services can help increase women's self-care power.

Adverse Pregnancy Outcomes in Patients With Systemic Lupus Erythematosus: A Retrospective Cohort Study

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that may result in adverse pregnancy outcomes, posing a significant risk to both the mother and the fetus. The major purpose of the current study was to investigate the impact of SLE on the outcomes of pregnancy among women with SLE. This was a retrospective cohort study. Two groups of pregnant women, one with Systemic Lupus Erythematosus (SLE) and one without SLE, were included at the Gynecology and Obstetrics Clinic of Ayatollah Mousavi Hospital in Zanjan, Iran, from 2019 to 2020. Participants from both cohorts completed a checklist of study variables based on their medical records. The data were analyzed using binary logistic regression, chi-square test, analysis of variance, and independent samples t-test with SPSS software version 23. The research involved 400 pregnant women, with the mean age of the SLE and non-SLE groups being 36.68±4.90 and 29.46±6.56 years, respectively. The most prevalent adverse outcome was cesarean section (271 [67.8%]), significantly higher in the SLE group (54.5% vs. 10.0%, P=0.0001). The likelihood of experiencing spontaneous abortion, preterm labor, cesarean section, and LBW was increased by more than 6.5 times (odds ratio, 6.54; 95% CI, 2.22-19.27; P=0.001), 3.6 times (odds ratio, 3.67; 95% CI, 1.47-9.18; P=0.005), 18.9 times (odds ratio, 18.94; 95% CI, 6.46-55.49; P=0.0001), and 3 times (odds ratio, 3.04; 95% CI, 1.09-8.46; P=0.030) in individuals with SLE, respectively. Women with SLE have an increased likelihood of encountering spontaneous abortion, preterm labor, cesarean section, and delivering a low-birth-weight infant.

Cervical sliding sign; does it have a contribution in cases of threatened preterm labor in singleton pregnancies with intact membranes?

ObjectiveTo investigate the contribution of the cervical sliding sign to conventional cervical length measurement in patients at risk of preterm labor. MethodsThe study, performed as a prospective cohort study, included patients admitted to a tertiary research hospital with a diagnosis of threatened preterm labor. The participants were divided into two groups: those who gave birth before and after 37 weeks of gestation. The clinical and demographic characteristics, cervical length, presence of a short cervix (SC), and cervical sliding sign (CSS) were compared between the groups. Furthermore, correlation and regression analyses were conducted to investigate the relationship between the presence of a SC, the presence of CSS, and the coexistence of these two findings with preterm delivery, as well as the interval between the symptoms and delivery being less than four weeks. ResultsThe study included 77 patients who delivered prematurely and 65 patients who delivered at term. The following variables were significantly lower in the preterm delivery group: cervical length, gestational age at delivery, neonatal weight, and time between the first examination and delivery (p = 0.003, <0.001, <0.001 and < 0.001, respectively). A higher percentage of women in the preterm delivery group exhibited a diagnosis of a SC, the presence of CSS, and the coexistence of both conditions (p = 0.002, 0.012 and 0.018, respectively). The results of the logistic regression analysis indicated that the odds ratios for preterm delivery were 3.3 in the presence of a SC alone, 2.67 in the presence of CSS alone, and 2.85 in the association of both findings (p = 0.003, 0.013 and 0.021 respectively). The odds ratios for delivery in less than four weeks were 3.08 in the presence of a SC alone, 3.4 in the presence of CSS alone, and 3.54 in the association of both findings (p = 0.004, 0.002 and 0.005 respectively). ConclusionIn singleton pregnant women presenting with threatened preterm labor, the presence of CSS is associated with an increased risk of preterm delivery and a decreased presentation-to-delivery interval. However, its contribution to conventional cervical length measurement appears to be relatively limited.

“Investigation of the potential cellular changes induced by magnesium sulfate and salubrinal in a lipopolysaccharide-induced chorioamnionitis model”

Chorioamnionitis is closely associated with preterm labor and poses a significant public health concern. In this pathological process where inflammation plays a key role, intracellular mechanisms such as endoplasmic reticulum stress are crucial. In this study, we aimed to explore the potential positive outcomes of the combined use of salubrinal (SLB) with magnesium (Mg) treatment in chorioamnionitis.Thirty pregnant rats were divided into 5 groups as: Control, LPS (1 mg/kg), LPS + SLB (1 mg/kg), LPS + Mg (Dhaka protocol), LPS + SLB + Mg. Rats were sacrificed 4 h after LPS administration, then placental and fetal brain tissues were collected.LPS administration enhanced the levels of tumor necrosis factor-alpha, vascular endothelial growth factor, caspase-3 immunoexpressions, BAX, eukaryotic initiation factor 2-alpha, s100, and glial fibrillary acidic protein expressions and lowered BCL2 expressions in the placenta or fetal brains. SLB and Mg treatments were observed to reverse all these findings, and the most significant positive effect was in the LPS + SLB + Mg group.The known anti-inflammatory activity of Mg, when used with SLB, preventing the transition to apoptosis and increasing antioxidant enzyme activity, as identified in this study, can contribute significantly to the literature. However, these results need to be supported by additional molecular studies.

Outcome of Pregnancy In Myomatous Uterus in the Gynecology-Obstetrics Department of the Ignace Deen Hospital of the Conakry University Hospital Centre, Guinea

Introduction: the association of myoma and pregnancy is a frequent entity, often prone to obstetric complications. The aim of this study was to analyse the impact of myoma on pregnancy, childbirth and the post-partum period. Patients and methods: this was a prospective descriptive and analytical study conducted over a 6-month period from 6 September 2022 to 5 March 2023 in the gynaecology and obstetrics department of Ignace Deen Hospital. It concerned pregnant women with uterine myomas who had agreed to take part in the study. Results: the frequency of pregnancy in a myomatous uterus was 5.58%. The average age of the pregnant women was 28, with extremes of 21 and 40. The most common age group was 31-35. Nearly 70% (69.86%) of the cases of fibroids associated with pregnancy were discovered by ultrasound. The location of the myomas was interstitial in 47.95% of cases. Medium-sized fibroids (6-10 cm) dominated our series (53.42% of cases). Of the 146 cases collected, 72% gave birth in the department, 77.78% by caesarean section. The indication for caesarean section Dystocic presentations (54.76%) were the major indication in more than half the cases. Over 70% of pregnant women gave birth without complications. These were dominated in the mother by miscarriage (20.93%) and premature delivery (16.27%). Fetal asphyxia (4.65%) and intrauterine growth retardation (4.65%) in the fetus. The study reported a significant association between size, location and the occurrence of obstetric complications (P value: 0.034; 0.009). Conclusion: the association of fibroma and pregnancy is a frequent entity and constitutes a high risk for the mother and the foetus. Morbidity is related to the location of the myoma and changes according to the term of the pregnancy. If pregnancy is to have a successful outcome, it is essential that pregnant women are aware of the importance of antenatal monitoring, with a view to early detection and appropriate management of any complications.

First reported case of Acute Disseminated Encephalomyelitis in pregnancy in Sri Lanka

Acute Disseminated Encephalomyelitis (ADEM) complicating pregnancy is a rare occurrence, posing challenges to the management due to maternal and fetal risks including fetal loss, fetal anomalies, intrauterine fetal growth restriction (FGR) and preterm labour. We report a case of a 21-year-old primiparous woman who was diagnosed with ADEM during the second trimester. She was treated with high dose intravenous (IV) steroids as well as IV immunoglobulin. She made complete neurological recovery within two months, but there were fetal complications including oligohydramnios, intrauterine growth restriction and low birth weight. The baby was delivered via elective caesarean section due to suspicious cardiotocograph and abnormal fetal doppler studies indicative of compromised fetal circulation. The baby was given special baby care unit (SBCU) care. However, both the mother and baby were safely discharged following six days of special neonatal care. This is the first reported case of ADEM in pregnancy in Sri Lanka, and highlights the challenges in management.

Stanniocalcin Protein Expression in Female Reproductive Organs: Literature Review and Public Cancer Database Analysis.

Stanniocalcin (STC) 1 and 2 serve as antihyperglycemic polypeptide hormones with critical roles in regulating calcium and phosphate homeostasis. They additionally function as paracrine and/or autocrine factors involved in numerous physiological processes, including female reproduction. STC1 and STC2 contribute to the pathophysiology of several diseases, including female infertility- and pregnancy-associated conditions, and even tumorigenesis of reproductive organs. This comprehensive review highlights the dynamic expression patterns and potential dysregulation of STC1 and STC2, restricted to female fertility, and infertility- and pregnancy-associated diseases and conditions, such as endometriosis, polycystic ovary syndrome (PCOS), abnormal uterine bleeding, uterine polyps, and pregnancy complications, like impaired decidualization, preeclampsia, and preterm labor. Furthermore, the review elucidates the role of dysregulated STC in the progression of cancers of the reproductive system, including endometrial, cervical, and ovarian cancers. Additionally, the review evaluates the expression patterns and prognostic significance of STC in gynecological cancers by utilizing existing public datasets from The Cancer Genome Atlas to help decipher the multifaceted roles of these pleiotropic hormones in disease progression. Understanding the intricate mechanisms by which STC proteins influence all these reviewed conditions could lead to the development of targeted diagnostic and therapeutic strategies in the context of female reproductive health and oncology.

The vasodilator effect of Eugenol on uterine artery – potential therapeutic applications in pregnancy-associated hypertension

Preeclampsia, a gestational associated hypertension, has been reported in 6–8% of pregnant women worldwide leading to premature delivery and low birth weight of newborn due to reduced blood flow to placenta. Although several vasodilators (Methyl dopa, hydralazine, β-blockers and diuretics) are currently in use to treat preeclampsia, still there is a search for safer drugs with better efficacy. Lately, antihypertensive vasodilators from natural sources are gaining importance in treating preeclampsia. Eugenol (Eug), a natural essential oil, has been traditionally used in health and food products without any risk. In the present study, ex vivo experiments were designed to examine the vasorelaxation effect of Eug and its signaling pathways in a middle uterine artery (MUA) of pregnant Capra hircus (Ch). In presence of different blockers (L-NAME, indomethacin, ODQ, Ouabain, glibenclamide, 4-AP, Ba2, Carbenoxolone and 18β Glycyrrhetinic acid), Eug-induced concentration-dependent vasorelaxation response was elicited. The results showed that Eug caused a greater vasorelaxation effect in the MU of pregnant animals, which is mediated by potential activation of eNOS, KATP channels, and Kir channels with moderate activation of Na+- K+- ATPase and sGC and MEGJ. These findings provide a strong basis for developing Eug as a therapeutic candidate in the treatment of pregnancy-associated hypertension.

Pregnancy outcomes in patients with undifferentiated connective tissue disease: An observational cohort prospective study

Background. Undifferentiated connective tissue disease is the subject of research in a large number of medical specialties, as it leads to an aggravated course of various diseases. In the presence of this pathology during pregnancy, the incidence of such complications as preeclampsia, gestational diabetes, and placental abruption increases. Failure to carry a pregnancy to term can be associated with various causes, including the activity of myocytes, while the pathology in question involves the connective tissue of the uterus. In this connection, it seems necessary to study the impact of undifferentiated connective tissue disease on pregnancy outcomes in order to administer timely treatment.Objectives. To assess how undifferentiated connective tissue disease affects the risk of failure to carry a pregnancy to term.Methods. An observational cohort prospective study was conducted among pregnant women who were under antenatal care in 2021–2022. The study was performed at the premises of the Clinical Maternity Hospital of Minsk Region (Republic of Belarus). The patients were divided into two groups: an exposed group comprising 59 patients with diagnosed undifferentiated connective tissue disease and a nonexposed group comprising 59 patients without this pathology. Both groups were divided into subgroups according to the obstetric outcome. The exposed group included a subgroup of 17 undifferentiated connective tissue disease patients who had failed to carry pregnancy to term (miscarriage and preterm labor) and a subgroup of 42 undifferentiated connective tissue disease patients with delivery at term. The nonexposed group included a subgroup of five women without undifferentiated connective tissue disease who had failed to carry pregnancy to term (miscarriage and preterm labor) and a subgroup of 54 women without undifferentiated connective tissue disease and with delivery at term. According to ICD-10, abortive outcomes occurred before 21 weeks and six days gestation; labor that occurred at 22–36 weeks and six days gestation was considered preterm, whereas in the case of delivery at term, the baby was born at 37–41 weeks and six days gestation. The obstetric, gynecological, and somatic history, as well as pregnancy outcomes, were analyzed. Statistical processing of data was performed using the following software: Statistica 12.0 (StatSoft, USA), Microsoft Excel 2016, Epi InfoTM 7.2.6.0 (USA), and MedCalc 15.8 (MedCalc Software, Belgium). In hypothesis testing, differences were considered statistically significant at p &lt; 0.05.Results. In the group of undifferentiated connective tissue disease patients, metrorrhagia was statistically significantly more common than in the patients without undifferentiated connective tissue disease: 18 out of 59 (30.5 %) and six out of 59 (10.2 %), respectively, p = 0.012. The obstetric history revealed no statistically significant intergroup differences, p &gt; 0.05. In the undifferentiated connective tissue disease patients, the following diseases were statistically significantly more common: myopia, spinal scoliosis, lower limb varicose veins, chronic tonsillitis, mitral valve prolapse, and iron deficiency anemia (p &lt; 0.05). The incidence of new cases of failure to carry a pregnancy to term in the cohort during the observation period amounted to 18.6 % for the patients in both groups. The pregnancy ended prematurely in 17 out of the 59 undifferentiated connective tissue disease patients (28.8 %) and in five out of the 59 patients without undifferentiated connective tissue disease (8.5 %), relative risk of 3.4 (95 % CI:1.3–8.6), p = 0.005.Conclusion. Undifferentiated connective tissue disease increases the risk of failure to carry a pregnancy to term by 3.4 times. Timely diagnosis and treatment of undifferentiated connective tissue disease at the stage of preconception preparation can reduce the incidence of failure to carry a pregnancy to term.

Comparative analysis of the effectiveness of antibiotic therapy and combined administration of antibiotics, lactobacilli, and proanthocyanidins for asymptomatic bacteriuria in young pregnant women: A randomized prospective study

Background. Asymptomatic bacteriuria in pregnant women is not accompanied by visible symptoms; however, it involves the risk of serious complications, including gestational pyelonephritis and/or preterm labor, thereby threatening the health of both mother and child. This condition raises particular concern in light of the growing global problem of antibiotic resistance causing traditional therapies to be less effective or futile. Therefore, a study into alternative medicine approaches to asymptomatic bacteriuria in pregnant women appears highly relevant in terms of developing new solutions for managing this condition while minimizing maternal and child health risks and preventing the spread of antibiotic resistance.Objectives. To conduct a comparative analysis of the effectiveness of antibiotic therapy and combined administration of antibiotics, lactobacilli, and proanthocyanidins for asymptomatic bacteriuria in young pregnant women.Methods. 50 pregnant women aged 15 to 17 and diagnosed with asymptomatic bacteriuria participated in a randomized prospective study. Patients were randomly divided into two groups depending on the treatment. Group 1 received standard antibiotic therapy; group 2 received a combination of antibiotics with lactobacilli and proanthocyanidins. Treatment was carried out in the Republican Clinical Perinatal Center, the Republic of Bashkortostan. Patients were enrolled in the study from February 2021 to January 2022. The observation period included several stages: 10 days after treatment (first control), 30 days after treatment (second control), and 2 months after delivery (final control). The condition of the urinary tract was assessed depending on bacterial concentration, with the diagnosis of asymptomatic bacteriuria being made in case of a 105 CFE/mL (colony forming units of bacteria per milliliter of urine). The endpoint of the study was considered to be the cure of pregnant women from asymptomatic bacteriuria, which was determined by the absence of bacteria in the urine 10 days after the therapy, as well as a recurrence-free period for two months after delivery. Statistical data processing was carried out using Statistica 10.0 (StatSoft, USA) for Windows and Microsoft Excel (Microsoft, USA). A statistical level with p ≤ 0.05 was considered significant.Results. Treatment outcomes showed a significant reduction in bacteriuria and recurrent infection, especially in the group receiving the combined therapy. No bacteriuria was reported in 36 % of patients in group 1 and 76 % in group 2 (Yates’ chi-squared test, p = 0.011). The incidence of preterm labor appeared lower in the combined therapy group (4 % for group 2 and 12 % for group 1). Complications were recorded in 11 young pregnant women of group 1 (44 %) and in 3 women of group 2 (12 %). Statistical analysis indicated significant differences between the groups in terms of complication rate after treatment (Fisher’s exact test, p = 0.015).Conclusion. Combined therapy including antibiotics, lactobacilli, and proanthocyanidins demonstrates high effectiveness as an alternative to conventional treatments of asymptomatic bacteriuria in pregnant women. Due to this approach, bacteriuria as well as recurrence rate decreases, thereby contributing to a more stable health status.