Prevention Of Premature Birth Research Articles

Prevention of premature birth in female patients with bacterial vaginosis using a complex of natural antimicrobial peptides and cytokines

Introduction. The prevalence of bacterial vaginosis (BV) comprises 23–29 %, which in pregnant women is a known risk factor for premature birth (PB) that rates increases by 2.9-fold. BV treatment with antibiotics has no effect PB incidence, therefore stressing a need to search for alternative remedies.Aim: to evaluate the effectiveness of treatment, including antibacterial therapy and a complex preparation containing natural antimicrobial peptides and cytokines, to reduce the incidence of birth defects in pregnant women with BV.Materials and Methods. Design: a prospective open comparative cohort study in parallel groups was conducted with 101 pregnant women: Group I (n = 69) received the antibiotic Metronidazole, 500 mg tablets orally twice a day for 7 days, and a complex preparation containing exogenous natural antimicrobial peptides and cytokines (Superlymph®) suppositories per 25 IU once a day vaginally in the evening for 20 days; Group II (n = 32) received Metronidazole alone (the same regimen). Patient examination was carried out using approaches included clinical methods, accepted in obstetrics, and laboratory tests – microscopy of vaginal content smears, real-time polymerase chain reaction (PCR).Results. The PB (within 240–366 weeks) incidence in Group I was significantly lower than in Group II and comprised 2.9 % vs. 21.9 %, respectively (p = 0.004), with an 8-fold decline in developing PB risk (relative risk (RR) = 0.13; 95 % confidence interval (CI) = 0.03–0.60), whereas inter-group percentage of pregnant women with high risk (PB history) was comparable (p = 0.39) so that PB incidence did not differ from pregnant women without former PB. Microbiological recovery after treatment for BV was achieved in 85.5 % of patients from Group I vs. 56.3 % in Group II (RR = 1.52; 95 % CI = 1.10–2.10; p = 0.002) based on real-time PCR data. The persistence of anaerobic flora after treatment was significantly lower in Group I vs. Group II reaching 7.2 and 34.4 % (p < 0.001), respectively, with a 5-fold lower PB risk (RR = 0.21; 95 % CI = 0.08–0.56). Cessation of viral shedding compared to the number of patients with initial viral shedding was achieved in 94.6 % vs. 8.3 % of patients, respectively, with a 50-fold decline in risk (RR = 0.02; 95 % CI = 0.005–0.08; p < 0.001). The number of newborns weighing less than 2500 g was significantly lower from paired mothers who received Superlymph® + Metronidazole comprising 2.9 % vs. 15.6 % treated with Metronidazole alone (p = 0.03), whereas a risk of low birth weight neonates was decreased by 6-fold (RR = 0.16; 95 % CI = 0.03–0.88). The condition of the neonates assessed by birth Apgar score was comparable.Conclusion. The use of a complex preparation Superlymph® (suppositories per 25 IU once an day vaginally, for 20 days) along with oral antibiotic Мetronidazole in pregnant women with BV facilitates a decline in PB incidence down to 2.9 % at gestational age of 240–366 weeks lowering a risk of PB exceeding that of antibacterial therapy by 8-fold, including patients with former PB.

Pregnancy and childbirth in women with a kidney transplant (clinical observation)

The number of pregnant women with kidney transplant is growing and will continue to increase in Ukraine and all over the world, taking into account the development of transplantology. Such patients belong to the high-risk group, however, a clear understanding and adequate evaluation of the prognostic factors which are described in the literature will allow to transfer from prohibition and intimidation to the stage of supporting motherhood and providing highly qualified medical care to women with kidney transplants.This article presents two clinical cases of pregnancy and childbirth in women with kidney transplants, which occurred in the Department of Internal Pathology of Pregnant Women of the State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O. M. Lukyanova National Academy of Sciences of Ukraine”. Both patients with kidney transplants that functioned for 4 and 5 years, respectively, visited the doctor in early pregnancy.The anamnesis of the first pregnant woman was without peculiarities, while the second patient already had an episode of acute transplant rejection in the anamnesis and organ retransplantation from her mother. In addition, she had viral hepatitis B and C, as well as an insufficient level of immunosuppression. The function of the transplants in both women was satisfactory, each of the persons suffered from secondary nephrogenic anemia. Correction of immunosuppression in both patients was difficult, especially at 28 weeks, which is associated with hemodilution of pregnant women. Both women experienced an episode of urinary tract infection, which is experienced by about 40 % of pregnant kidney recipients.The first pregnant woman was practically healthy at full term pregnancy and had no indications for abdominal operation delivery, however, due to a clinically narrow pelvis she had cesarean section, which is a technically difficult surgery in such cases. In the second patient, the last weeks of pregnancy were complicated by hypertension of non-placental origin and transplant function disorders, which became an indication for cesarean section at 38 weeks. In the postpartum period kidney function began to recover. The condition of both newborns was satisfactory.Therefore, despite the reliable pregnancy outcomes in kidney transplant patients, an increased risk of obstetric complications and adverse perinatal outcomes remains. Interdisciplinary monitoring with timely correction of kidney transplant function disorders, monitoring of immunosuppressive therapy, prevention of premature births, careful control of blood pressure and adequate fetal monitoring allows to hope for favorable obstetric and perinatal outcomes in this group of patients.

Chinese Herbal Medicines Have Potentially Beneficial Effects on the Perinatal Outcomes of Pregnant Women

Introduction: Tocolytic treatment is beneficial to pregnant women with a risk of premature labor or miscarriage. However, previous reports have shown that progestogen might not be effective and ritodrine may increase the risk of maternal vascular-related diseases. Chinese herbal products (CHP) are used as alternative therapies for pregnant women. The goal was to evaluate the efficacy of combined tocolytic therapy and CHP therapy in pregnancy outcomes for pregnant women in Taiwan. Materials and Methods: We conducted a retrospective cohort study based on the National Health Insurance Research Database. A total of 47,153 pregnant women treated with tocolytics aged 18–50 years from 2001 to 2015 were selected from two million random samples. According to the medical use of tocolytics and CHP, we divided the users into two groups: western medicine (WM) only (n = 40,961) and WM/CHP (n = 6,192) groups. A propensity score (PS)-matched cohort (6,192 pairs) was established based on baseline confounders. All participants were followed up to perinatal outcomes. Conditional logistic regression analysis was used to examine the effects of CHP use on the odds of miscarriage and preterm birth. Results: The adjusted odds ratio (OR) for premature birth in the WM/CHP group (n = 411, 6.64%) was significantly lower than in the WM group (n = 471, 7,61%) (0,86, 95% confidence interval [CI], 0.74–0.99). Further subgroup analysis based on the usage of formulae that activate blood and remove stasis or purgative formulae, the adjusted OR of preterm birth of those using these formulae was significantly lower in the WM/CHP group (n = 215, 6.32%) than that in the WM group (n = 265, 7.77%) (OR: 0.79, 95% CI: 0.65–0.96). Conclusion: We found that the combination of CHP and tocolytics can be beneficial to pregnant women in the prevention of premature birth. Further research is required to investigate causal relationships.

Evaluation of the predictive role of anterior uterocervical angle in preterm labor in twin gestation through meta-analysis: anterior uterocervical angle and preterm labor in twin gestation

Multiple gestations are high-risk pregnancies with increased obstetric and perinatal risks. Preterm labor occurs in about half of twin pregnancies. Thus, prediction of the time of delivery and prevention of premature birth are very important in multiple gestations. Anterior uterocervical angle is a successful tool that has been used in the prediction of preterm labor in recent years. However there is only limited data about this issue for twin pregnancies in the literature. Here, we aimed to demonstrate the relationship between uterocervical angle and preterm labor in twin pregnancies more clearly and reliably with this meta-analysis. In this context, “twin gestation, uterocervical angle, cervical angle, angle, cervix, cervical, preterm and preterm labor” keywords were used and PubMed, Medline, ClinicalKey, Scopus, Science Direct, Web of Science, and Google Scholar database were searched between 1 January 2010 and 27 December 2020. Finally, a total of three studies were included in the analysis. Here, we found that uterocervical angle was associated with a higher risk of preterm delivery in the overall effect.

Parturition Premature Imminens Management : A Review Article

Introduction : Parturition Premature Imminens (PPI) or the threat of premature birth is the presence of uterine contractions accompanied by cervical changes in the form of dilatation and effacement before 37 weeks of gestation and can cause premature birth. Premature birth is a problem with a high prevalence in the world and is a challenge for doctors, especially obstetricians, to find out the causes and prevention of premature birth. The main problem with premature birth is the lack of success in its managemen. Discussion : The mechanism of preterm labor is not different from that of term labor, namely uterine contractility, cervical ripening, and membrane rupture. The fundamental difference is that the activation process in term labor is part of the physiological activation, whereas in preterm labor it is pathological. The usual path of delivery can be seen based on anatomy, biochemistry, immunology, endocrinology, and clinical symptoms. Prevention should be done in PPI management, as Performed prenatal care, diet, administration of vitamins, hygiene, Activity (work, coitus) is restricted in patients with a history of preterm labor, Immediate treatment if there is infection or comorbidities, Abdominal surgery and dental procedures are postponed until delivery. Special condition as Patients with multiple pregnancies should be on bed rest from the 28th to the 36th week. Fibromyoma, if there are complaints, can be treated with bed rest and analgesics. Surgery is avoided as much as possible. Placenta previa is treated with complete bed rest and blood transfusions to delay the birth of the baby until it is viable. Incompetent cervix should be sutured in the first part of the second trimester as long as all requirements are met. Elective SC and repeat is only done if it is believed that the baby is old enough. Medicines can be used to stop labor. Conslusion : In general, the management of preterm labor includes the administration of a single dose of corticosteroid in women 24-34 weeks' gestation with a risk of delivery within 7 days. In addition, magnesium sulfate can reduce the severity and risk of cerebral palsy in infants when born before 32 weeks of gestation. First-line tocolytics such as beta adrenergic agonists, calcium channel blockers, NSAIDs can be given for prolongation of pregnancy up to 48 hours (administration of antenatal steroids).

ON PATIENT SAFETY: IMPLEMENTATION OF THE M. ROBSON CLASSIFICATION AS A POSSIBILITY TO CONTROL THE FREQUENCY OF CESAREAN SECTION

Purpose. Delivery by caesarean section (CS) is now becoming an “epidemic” — in some countries it reaches 50% or more; often the operation is carried out at the request or the slightest doubt of the woman. An increase in CS frequency is not always accompanied by a predicted improvement in perinatal mortality. Objective: To develop a strategy for women to gain a positive pregnancy experience based on the analysis of the frequency of caesarean section in the database of a linear maternity hospital using the Robson classification. Materials and methods. Retrospective analysis of childbirth histories of an urban maternity hospital with a specialization in preterm birth management in 2015–2019. Research results. When analyzing 10,345 births, it was found that 3598 or 34.78% of women were delivered by CS surgery. The frequency of CS in group 1 averages (15.71±2.34)% (12.93–20.03)%. Most often, primary CS is performed in the 2nd (84.45±1.62)%, 4th (68.97±4.93)% and 6th (97.08±1.7)% groups, and these groups are subsequently the largest in terms of repeated CS. Traditionally, a high frequency of CS is noted in the 7th (96.69±2.05)%, 8th (86.66±7.02)% and 10 groups (40.02±5.14)%. The most common indications for primary CS were fetal distress, breech presentation, multiple pregnancies, obstructive labor, and extragenital indications. It is necessary to note the socio-ethical indications as an urgent requirement of the patient. Conclusions. The use of Robson’s classification made it possible to determine the main directions for improving the organization of medical care for women in labor in order to ensure safe childbirth: the development of uniform standards and their active implementation in the group of pregnant women in need of pre-induction and induction of labor, training and active use of simulation methods of training medical personnel in the management of childbirth. in breech presentation and multiple pregnancies, prevention of premature birth, psychoprophylactic work with women and family members. Key words: cesarean section, Robson’s classification.

ИСТМИКО-ЦЕРВИКАЛЬНАЯ НЕДОСТАТОЧНОСТЬ И ГЕНИТАЛЬНАЯ ИНФЕКЦИЯ

Despite the availability of diagnostics and modern methods of treatment, preterm birth with cervical insufficiency occurs in 44-57% of cases, while early preterm birth reaches 38,8%. To date, there is no doubt about the connection of premature labor and intraamnial inflammation, the frequency of which in cervical insufficiency reaches 80%. Most researchers are unanimous in the opinion that the ascending route of infection in intraamnial infection is a priority. It has been proven that a decrease in the absolute and relative amount of Lactobacillus spp., A change in the species composition of lactoflora or atypical vaginal colonization associated with premature birth and premature rupture of membranes. Conditionally pathogenic microorganisms of the vaginal biotope with an insufficient number of lactobacilli are capable of producing various proteases that destroy collagen, constituting the basis of connective tissue and determining the elasticity of the membranes, which allows us to consider cervicovaginal infections as one of the mechanisms of premature remodeling of the cervix and rupture of membranes. In that way, it is relevant to study the frequency and structure of genital infection in cervical insufficiency. The analysis of medical literature data, presented in the electronic libraries Elibrary and Pubmed for the last 10 years, devoted to the study of genital infection in cervical insufficiency. The issue of the relationship of cervicovaginal infections with premature remodeling of the cervix of the uterus was discussed, as well as studies on the role of intrauterine infection in the genesis of preterm labor. The results of scientific studies are presented, indicating both the direct influence of cervical incompetence on the risk of intraamnial infection and the root cause of genital infection in the pathogenesis of cervical insufficiency. Convincing data are given that timely diagnosis and treatment of violations of the vaginal biocenosis is one of the significant links in the prevention of premature birth. It is necessary to further study the pathogenetic relationship of cervicovaginal infections and cervical insufficiency.

Ефективність превентивних методів їх комбінацій у профілактиці передчасних пологів

Prediction and prevention of premature birth is a significant problem of modern obstetrics. The use of ultrasound cervicometry and the index of placental angiogenesis for the prediction of premature birth is promising. The aim of the study was to investigate the effectiveness of cerclage, pessary, intravaginal progesterone or their combinations in the prevention of premature birth. A total of 292 pregnant women were examined. They were divided into several groups according to the results of the detection of cervical length and the level of the ratio between placental growth factor (PlGF) and fms-like tyrosine kinase (sFlt-1). Group I included women with a negative screening’ resuls. Other groups included women with a «short» cervix and disturbed placental angiogenesis. In group II, women with cervical cerlage were observed. In group III — used a pessary; Group IV — vaginal progesterone; V — cobined use of cerclage and pessary; and in VI — use of cerclage and vaginal progesterone. The pregnancy was completed at term in 159 patients, and 133 women had preterm delivery. Among patients who had positive miscarriage screening results, the use of preventive measures or combinations resulted in fairly equal results. However, the use of progesterone and cervical cerclage has shown the best efficacy. Some limitations in this study were the small sample size and the lack of information on the use of anticoagulants, disaggregants and tocolytics in the examined women.

To study the short term outcome and risk factors for premature neonate born at Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, CG

Background: Prematurity is the leading cause of perinatal morbidity and mortality worldwide,23 affecting 5-10% of births. Preterm neonates have a 120 times higher risk of death than neonates. The prevention of premature birth is the single most important challenge to modern obstetrics today. Progress in this area has been hampered by lack of understanding of the basic mechanisms responsible for premature labour and delivery. Thus, the following is a study on the short term outcomes and risk factors of preterm babies born at Dr B R Ambedkar Memorial hospital, conducted to evaluate the early outcomes of premature infants at the time of discharge and the identification of different risk factors for preterm births.Methods: This is a prospective hospital based observational study, conducted over a period of 1 year (March 2018 – march 2019), including a total of 1472 preterm babies. Results: A total of 1472 preterm were born during the study period. Preterm male: female was 1.1:1. Obstetrics history of mothers showed 47.35% were having parity-1, 30.71% were having parity-2. Common risk factors noted were multiple pregnancy (28.46%) followed by pre-eclampsia (27.03%). A total of 66.71% of neonates were born beyond 34 weeks of gestation, 60.46% were having birth weight between 1500 and 2499 gm, 18.14% were very low birth weight (VLBW) and 4.35% were extremely low birth weight (ELBW). A total of 545 (37.02%) required NICU admission. Major morbidities noted were respiratory distress syndrome (55.59%) followed by sepsis (30.64%), perinatal asphyxia (11.19%), neonatal jaundice (10.64%) and retinopathy of prematurity (9.91%). A negative correlation was noted between gestational age and duration of stay in NICU (r = 0.98, p = 0.022). Birth weight and gestational age of neonates were significantly associated with the treatment outcome(p=0.000). Very low birth weight neonates had highest mortality (40.85%) followed by ELBW (28.05%). Mortality of 11.14% was noted with respiratory distress syndrome (10.83%) being the major cause followed by sepsis (8.07%). Conclusions: The most common maternal risk factors noted were multiple pregnancies, preeclampsia, eclampsia, antepartum haemorrhage and gestational hypertension. Common morbidities observed in preterm babies were respiratory distress syndrome, sepsis, perinatal-asphyxia and neonatal-jaundice. The common causes of death were respiratory distress syndrome, sepsis and prematurity. Results show that preterm babies have higher risk for morbidity and mortality. Mortality decreased with increase in gestational age and birth weight.

Актуальні питання прогнозування і профілактики передчасних пологів

Premature birth is a significant problem in modern medicine. The main aspects of its solution are the prediction and prevention of premature birth. Nowadays, among a large number of biophysical and biochemical markers of preterm birth, ultrasonic cevicometry is the most popular one. It is known that «short cervix syndrome» is not the equivalent of cervical insufficiency. The known strategies of preventive combinations are used in case of an increased risk of preterm birth. Therefore, the issue of developing a differentiated approach to the combined or separate use of progesterone, pessary, or cerclage has not been answered yet. It should be added that in most practical recommendations based on the principles of evidence-based medicine, there are no differences according to the possible pathogenesis of preterm birth. A therapeutic strategy should be set based on the possible use or misuse of any preventive combination, taking into account maternal and fetal contraindications. The combined testing on ultrasound cervicometry and biochemical markers could ameliorate the identification of patients at risk of preterm birth. The fetal fibronectin is known to be the best among all biochemical markers of preterm birth. However, the prognostic value of this test, as well as the phosphorylated transport protein insulin-like growth factor, when used separately, is limited. In pregnant women with a length of the cervix between 1.5 cm and 3 cm, it is recommended to use the analysis for placental alpha-microglobulin-1. The administration of corticosteroids should only be performed when the risk of preterm delivery is confirmed by decreased cervical length and a positive test for placental alpha-microglobulin-1 (there is a high risk of preterm delivery within 7 days). The cerclage is indicated in patients with cervical insufficiency before 16 weeks of gestation. In the presence of a «short cervix» and the lack of anamnestic data, the strategy should be individualized. The efficacy of cerclage or pessary application has not been proven. It is necessary to start with vaginal progesterone administration. In the process of the patient observation (cervicometry in dynamics) will allow you to find out an effective method: cerclage or pessary and vaginal progesterone. In the case of progredient cervical effacement in the second trimester, it is advisable to perform an urgent cerclage. In the case of incompetent cervical stitch, the additional application of a pessary is possible. In women with multiple pregnancies, there is no evidence of elective cerclage or pessary efficacy. However, it is possible to use heroic cerclage, pessary in combination with vaginal progesterone or vaginal progesterone monotherapy. Key words: preterm delivery, prediction, prevention.

Prevention of premature birth in pregnant women with vaginal candidiasis

Candida vulvovaginitis is an infectious lesion of the vulvar and vaginal mucosa caused by Candida yeast fungi. Vaginal candidiasis during pregnancy is associated with spontaneous miscarriages, premature rupture of the fetal membranes, premature birth, and low birth weight babies. Considering the potential risk of premature delivery at fungal invasion at the level of the lower reproductive tract of a pregnant woman, the search for a complex of preventive measures and timely treatment of сandida vulvovaginitis during gestation is of particular interest. The article presents the results of the use of the drug Zalain in 36 pregnant women, with a gestation period of 28 weeks or more with acute candidal vulvaginitis. In the course of the work, the results of local therapy with Zalain were evaluated and its clinical efficacy in the prevention of preterm labor was confirmed. The results of treatment contribute to a significant reduction in the frequency of initiation of preterm labor, as well as a persistent effect for 2-4 weeks after completion of the course in the postpartum period and the absence of early and distant manifestations of candidiasis in newborns.

Total flavonoids from Semen Cuscutae target MMP9 and promote invasion of EVT cells via Notch/AKT/MAPK signaling pathways

Miscarriage is a common condition during pregnancy and its mechanisms remain largely unknown. Extravillous trophoblast (EVT) cell invasion is required to maintain normal pregnancy and its malfunction has been proposed as a major cause for miscarriage. Homeostasis of matrix metalloproteinase 9 (MMP9) is a key to regulate EVT cell invasion. Total flavonoids from Semen Cuscutae (TFSC) have been applied clinically used for preventing or treating miscarriage in the past. Given its potential clinical benefit on preventing miscarriage, this study aims at examining the therapeutic effect of TFSC in the prevention of premature birth by upregulating MMP9 and promote EVT cell invasion. HTR-8 cells migration and invasion functions were analyzed using wound healing and transwell assays. The regulatory effect of TFSC on MMP9 expression and relevant signaling pathways were analyzed by Western Blot. The results show compared to control group, TFSC significantly promoted the migration of EVT cells in a dose and time-dependent manner. The migration and invasion of EVT cells were maximized at the highest dosage of 5 μg/ml of TFSC. The expression of MMP9 in EVT cells was significantly increased after TFSC treatment. Furthermore, cells treated with TFSC significantly upregulated protein expressions in Notch, AKT and p38/MAPK signaling pathways. We believe TFSC can promote the migration and invasion of EVT cells by increasing MMP9 expression, and prevent miscarriage by activating Notch, AKT, and MAPK signaling pathways.

Progesterone in women with arrested premature labor, a report of a randomised clinical trial and updated meta-analysis

BackgroundProgesterone may be effective in prevention of premature birth in some high risk populations. Women with arrested premature labor are at risk of recurrent labor and maintenance therapy with standard tocolytics has not been successful.MethodsRandomized double blinded clinical trial of daily treatment with 200 mg vaginal progesterone in women with arrested premature labor and an updated meta-analysis.ResultsThe clinical trial was terminated early after 41 women were enrolled. Vaginal progesterone treatment did not change the median gestational age at delivery: 36+2 weeks versus 36+4 weeks, p = .865 nor increase the mean latency to delivery: 44.5 days versus 46.6 days, p = .841. In the updated meta-analysis, progesterone treatment did reduce delivery <37 weeks gestation and increase latency to delivery, but this treatment effect was not evident in the high quality trials: (OR 1.23, 95% CI 0.91, 1.67) and (−0.95 days, 95% CI −5.54, 3.64) respectively.ConclusionProgesterone is not effective for preventing preterm birth following arrested preterm labor.

A study on preterm births during 2013–2015, Shiraz, Iran

Preterm birth is the leading cause of neonatal and infant mortality and a substantial portion of neonatal morbidities. The perinatal mortality and morbidity statistics in developing countries are inadequate. In this study, we assessed prevalence and health outcomes of preterm deliveries in tertiary care university hospitals. A retrospective study of hospital records of premature babies born in all the five governmental tertiary care settings during the time interval of 2013–2015 in Shiraz was conducted. Result of this study showed that there was an overall 127.6 premature births per 1000 live births in the study duration. 23.8% of premature newborn had RDS and Incidence of prematurity with RDS was 82.4 per thousand live births. 52.6% of premature newborns were hospitalised in NICU and 8.5% had ROP. Five percent suffered from sepsis and 1% suffered from NEC. Overall mortality was nearly 10% of all the premature newborn. In conclusion, this study showed that premature births and its complications for newborn need to be addressed more in Iran.Impact statementPreterm birth is the leading cause of neonatal mortality and morbidities. Mortality and morbidity statistics related to preterm infants are important healthcare indicators implying the quality of the perinatal health care system and are prerequisite for the identification of problems and implementation of preventive measures. However, the perinatal mortality and morbidity statistics in developing countries are inadequate.The aim of this study was to assess prevalence and health outcome of preterm deliveries in tertiary care university hospitals in Shiraz city, Iran.This study showed that prematurity rate was 12.7%. Among preterm cases, 52.6% were admitted to NICU. RDS occurred among 23.8% of the total premature neonates and 8.2% of the total live births. The incidence of NEC was 1/0% of the total premature neonates and 0.4% of the total live births. The incidence of sepsis was 5% of the premature neonates and 1.9% of the total live births and the incidence of ROP was 8.5% among the premature neonate. The overall mortality of premature neonates was 9.9% of the total premature neonates and 1.2% of the total live births.Rigorous measures for prevention of premature births and its complications for newborns are required in Iran.

Патогенетичні підходи до лікування передчасних пологів на тлі хронічного вогнища інфекції

The objective was to study the effectiveness of the application of the sublingual form of micronized progesterone for the treatment and prevention of premature birth in women with concomitant risk factors against the background of the infectious inflammatory component in the anamnesis. Materials and methods. The study was conducted in two stages. At the first stage, 100 stories of pregnant women with preterm labor were analyzed at a period of 22-36 weeks, which were inpatient treatment in the Ternopil Regional Clinical Perinatal Center «Mother and Child». A comprehensive assessment of risk factors for the development of preterm labor and the effectiveness of their management was carried out. At the second stage of the study, 27 pregnant women (group 1) who were hospitalized with a threat of premature birth and had an anamnesis history, were treated with natural micronized progesterone Lutein in a dose of 100 mg sublingually twice a day. The comparison group (group 2) included 30 pregnant women, who before traditional hospitalization began traditional tocolytic therapy with calcium channel blockers. The control group included 20 pregnant women with a physiological pregnancy. Results. As a result of the proposed therapy, a decrease in the intensity of the pain syndrome in patients taking micronized progesterone was observed at 25 min faster (p &lt;0.05) than after conventional therapy (85.2 ± 7.4 min in the 1st group and 110.6 ± 9.8 min - in the second group). At the same time, anxiety level was 16.1 ± 1.8 points in patients of the 1st group, which corresponded to its absence, while the patients of the 2nd group continued to be in a state of moderate anxiety (19.3 ± 1.4 points). Pregnant women with a threat of preterm birth who had an inflammatory process of any localization in the past had a significant increase in the level of proinflammatory cytokines (IL-2, IL-6, TNF-?) and a decrease in the level of anti-inflammatory cytokines (IL-4, IL- 10) in comparison with the indicators of healthy pregnant women. The use of micronized progesterone and conventional therapy positively affects these indicators. Conclusion. The use of the sublingual form of micronized progesterone in the preparation of Lutein at a dose of 200 mg per day is pathogenetically grounded and provides a rapid arrest of the manifestations of premature birth in women with miscarriage in the background of chronic foci of infection. Key words: premature birth, inflammation, micronized progesterone.

Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition.

Through pregnancy the cervix must simultaneously remain competent for pregnancy maintenance and yet become progressively compliant to ensure on time parturition. Cervical changes precede not only term but also preterm birth. Thus, an understanding of the molecular mechanisms by which the cervix maintains the delicate balance between competence and compliance is required to prevent the potential for lifelong health complications that can result from a premature birth. Recent advances and accumulating evidence support distinct roles for the cervical epithelia and stroma in sustaining competence. Concurrently, structural reorganization of the stromal extracellular matrix allows for the gradual decline in tissue compliance. In recent years, advances in our understanding of the cervical remodeling process has resulted from the collective insights derived from biological, genomics, engineering, and mathematical modeling studies on clinical samples and animal models. This review will highlight recent literature that advances understanding of (1) the importance of barrier function in the lower female reproductive tract in protection against ascending infection, (2) cellular and extracellular matrix changes in the cervical stroma that influence the mechanical function of the cervix, (3) the potential translation of biological insights into clinical tools that impact preterm birth, and (4) the distinction between term and specific pathways of preterm birth. Finally, we present a discussion of future areas of investigation that are likely to advance understanding and lead to the development of clinical tools for accurate detection and prevention of premature birth.

PREMATURE BIRTH AS A MEDICAL AND SOCIAL HEALTHCARE PROBLEM. PART 2

Morbidity and mortality, like a frequency of long-term unfavourable psychomotor developmental outcomes is in inverse relationship with gestational age and birth weight. Now scientists give attention to the risk factors — the infection, preeclampsia, smoking, etc., to look for prevention of premature birth. The outcome of premature baby depends on the birth weight; the methodof labor and the hospital technical support also have an influence. The frequency of neurological impairments — infantile cerebral palsy, visual and hearing disorders, and probability of severe bronchopulmonary dysplasia are also in inverse relationship with gestational age and birth weight. Last decade there are many scientists give attention to the cognitive deficit and behavior disorders in adolescents, born premature. Premature infants with extremely low birth weight have developmental disorders at 8-13%. Not all of cognitive and behavioral problems have symptoms in the first years of life, but have delayed unfavourable effects. The severity of cognitive deficit not always corresponds with structural impairments of brain, detected in functional studies of premature baby in the first year of life.

Progesterone from maternal circulation binds to progestin receptors in fetal brain.

Steroid hormones activate nuclear receptors which, as transcription factors, can regulate critical aspects of neural development. Many regions of the rat forebrain, midbrain and hindbrain express progestin receptors (PR) during perinatal life, suggesting that progesterone may play an important role in the development of the brain. An immunohistochemical approach using two antibodies with differential recognition of ligand-bound PR was used to examine whether fetuses are exposed to maternal progesterone during pregnancy and whether progesterone from maternal circulation can bind to PR within the fetal brain. Findings demonstrate that maternal and fetal serum progesterone levels are positively correlated at the end of gestation, suggesting a common source of progesterone in mothers and fetuses (e.g., the maternal ovary). Additional findings suggest that administration of exogenous progesterone to mothers not only increases fetal serum progesterone levels within 2 h, but appears to increase ligand-bound PR in fetal brain. These findings suggest that progesterone of maternal origin may play a previously overlooked role in neural development. In addition, there are implications for the ongoing prophylactic use of synthetic progestins in pregnant women for the prevention of premature birth. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 767-774, 2017.

Pessaries in clinical practice

Pessaries were used in medicine since ancient times, history of their use goes back thousands of years. Throughout its history, pessaries have not changed significantly, so modern products do not differ from the ancients. In modern obstetrics pessaries are used for treatment of cervical incompetence and prevention of premature birth. Transvaginal ultrasound is the gold standard for the evaluation of the cervix during pregnancy and allows a selection of patients with cervical length ≤25 mm for pessary installation. To date, the installation of pessary may be the main strategy for the treatment and prevention of threatened pregnancy termination in the II and III trimester of pregnancy.

A simple program for prevention of premature birth, and some regrettable contradictions

Prematurity and late abortions are still major problems of modern obstetrics. An important cause is ascending genital infection, which can often be prevented by very early diagnosis of vaginal milieu disturbances by the patients themselves. In cases of recurrent late abortions or early preterm births, an operative total cercix occlusion is probably the most effective method currently available.