Prevention Of Preterm Delivery Research Articles

Prophylactic Cervical Cerclage in Cases Following Cervical Conization at a Japanese Perinatal Center.

The objective of this study was to re-examine the effect of cerclage on the possible factors associated with preterm delivery in women who had cervical conization. This was a retrospective cohort study comparing the obstetric outcomes of women with or without prophylactic cervical cerclage in pregnancy following a prior conization and managed at our institute between 2004 and 2023. In this study, there were 75% of pregnant women with a history of cervical conization. In 13 women of these (17%), prophylactic cervical cerclage was performed at 12-17 weeks' gestation. The incidence of preterm delivery was 15 (9/62) and 31% (4/13, p = 0.38) in cases with and without cervical cerclage, respectively. The prevalence of histological chorioamnionitis (CAM) in cases of preterm delivery following cervical cerclage was 100%. Prophylactic cervical cerclage in the cases following conization did not contribute to the prevention of preterm delivery associated with the development of CAM.

Emergency cerclage using double-level versus single-level suture in the management of cervical insufficiency (Cervical Occlusion double-level Stitch Application, COSA): study protocol for a multicentre, non-blinded, randomised controlled trial

IntroductionCervical insufficiency accounts for 15% of recurrent pregnancy losses between 16 and 28 weeks of gestation. The aim of the study is to verify the effectiveness of emergency double-level cerclage...

Exploring the Potential of Lactoferrin in Neonatology and Obstetrics - Promising Advancements for Maternal and Infant Health

Introduction and purpose:
 Lactoferrin (Lf), a glycoprotein found in body fluids, plays a key role in many of the biological mechanisms that occur in the human body. Over the years, more and more studies have contributed to the expansion of the clinical applications of lactoferrin. In this article, we want to focus on using lactoferrin in Neonatology and Obstetrics. The applications of lactoferrin in obstetrics continue to expand, some of which include the prevention of preterm delivery (PTD) and anaemia in pregnant women. Lf also helps to reduce the incidence of necrotizing enterocolitis and sepsis in newborns by mobilising the immune system and participating in the defence against pathogens and has been under investigation as a potential therapeutic agent for genital infections. The aim of this review is to summarise the current state of knowledge, regarding lactoferrin's broad spectrum of action and to highlight its potential therapeutic applications in these contexts.
 
 State of knowledge:
 This article aims to review the current knowledge on the properties of the lactoferrin and its applications in medicine, especially neonatology and obstetrics. Studies available in the PubMed and Google Scholar databases were included in the analysis.
 
 Conclusion:
 While lactoferrin shows promise in improving neonatal and maternal health, additional research is required to fully understand its precise mechanisms of action and optimise its use as a therapeutic agent. There is also a need for further studies to assess the safety and efficacy of lactoferrin in a variety of patient populations. Despite the challenges, lactoferrin continues to be an intriguing subject of scientific research, with potential therapeutic benefits in various medical fields.

Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications.

As the leading cause of neonatal morbidity and mortality, preterm birth is recognized as a major public health concern around the world. The purpose of this review is to analyze the connection between infections and premature birth. Spontaneous preterm birth is commonly associated with intrauterine infection/inflammation. The overproduction of prostaglandins caused by the inflammation associated with an infection could lead to uterine contractions, contributing to preterm delivery. Many pathogens, particularly Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Actinomyces, Candida spp., and Streptococcus spp. have been related with premature delivery, chorioamnionitis, and sepsis of the neonate. Further research regarding the prevention of preterm delivery is required in order to develop effective preventive methods with the aim of reducing neonatal morbidity.

A Prospective Study of Mid-Trimester MCP-1 Levels as a Predictor of Preterm Delivery.

Background: The prevention of preterm delivery (PTD) represents one of the major topics in modern obstetrics. The aim was to design a prospective study and investigate if mid-trimester serum and amniotic fluid levels of MCP-1 could predict the occurence of spontaneous PTD. Methods: The study involved 198 women who underwent genetic amniocentesis and blood sampling in the middle of their trimester. After applying the criteria for inclusion in the study, there were 16 respondents in the study group, and 38 respondents in the control group. Level of MCP-1 in amniotic fluid and serum was measured with commercially available enzyme-linked immunosorbent assays (ELISA) and statistical analysis was conducted. Results: There was no statistically significant difference in serum or amniotic fluid MCP1 levels between PTD and the control groups. Conclusion: The results suggest that MCP-1 is probably not the most relevant marker for predicting PTD. This study provides new normative data for MCP-1 levels in amniotic fluid and maternal sera and is a valuable tool for future diagnostic and comparative studies.

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

BackgroundDespite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions.MethodsThis study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes.ResultsAmong 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference.ConclusionsPreterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe.Trial registrationThe trial is registered with ClinicalTrials.gov, number NCT01824940.

Vaginal and oral probiotics effect in the prevention of preterm delivery in patients visiting Kamali Hospital, Karaj, Iran in 2020.

IntroductionThe prevalence of preterm labor (PTL) is growing, and annually one in ten babies is born prematurely. Various studies have examined the effect of oral or vaginal probiotics on the prevention of preterm labor, which has yielded contrasting results. This study aimed to compare the impact of vaginal and oral probiotics on the prevention of preterm delivery.MethodsThis clinical trial was performed among 185 pregnant women with a gestational age greater than or equal to 25 weeks visiting Kamali Hospital, Karaj, Iran in 2020. The participants were divided into three groups; intervention group 1 receiving Oral probiotic pill once a day until 37 weeks of pregnancy, intervention group 2 receiving probiotic vaginal suppository once a day until 37 weeks of pregnancy, and control group not receiving any intervention. Patients were then followed up until the end of pregnancy.ResultsDemographic characteristics and gestational age at the time of intervention were not significantly different among the three groups. Overall, 26.7 % in the control group, 30 % in intervention group 1 %, and 22.5 % in intervention group 2 had deliveries less than 37 weeks. There was no significant difference in the frequency of preterm labor and the duration of pregnancy among the groups (all p > 0.05).ConclusionProbiotics use does not increase the rate of preterm delivery or reduce the duration of pregnancy, but the rate of preterm delivery was lower in the oral probiotic group. Further clinical studies on the impact of probiotics on PTL can yield valuable results.

437 Assessment of selected microbiological and immunological factors in pregnant women with a short cervix who were treated with pessary placement - preliminary report

Introduction and aim of the study: A short cervix diagnosed in the second trimester of pregnancy and abnormal vaginal biocenosis are the most important risk factors of preterm labor. Progesterone and cervical pessaries are used for treatment and prevention of preterm delivery. However, there are concerns, that pessary placement may impose a negative effect on the vaginal microbiota, leading to the development of pathogenic flora. The aim of the study was to assess whether progesterone treatment and the use of a pessary affect vaginal biocenosis in pregnant women with a short cervix.

Recent Review of Germinal Matrix Hemorrhage-Intraventricular Hemorrhage in Preterm Infants.

Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) is a particular type of intracranial hemorrhage that affects the preterm population. GMH-IVH originates from bleeding within the highly vascular area near the center of the brain known as the germinal matrix. The pathogenesis of GMH-IVH is unclear; it is likely related to hemodynamic changes and fluctuations in cerebral blood flow within a fragile developing brain. Cranial ultrasound is the primary diagnostic test and reveals the degree of GMH-IVH based on a grading system. Management includes prevention of preterm delivery with meticulous antenatal and postnatal preventative strategies. This article discusses current evidence specific to the pathogenesis, risk factors, diagnosis, grading scales, and management approaches with GMH-IVH in preterm infants.

A modified transabdominal cervicoisthmic cerclage with the monofilament thread: Its efficacy and safety for women with extremely short cervix due to cervical conization.

The study aimed to examine the usefulness of modified transabdominal cervicoisthmic cerclage (TAC) using monofilament thread for the prevention of preterm delivery in women with an extremely short cervix after deep conization. We devised a monofilament thread for picking up the seromuscular layer of the site that is slightly cephalad to the internal ostium to prevent injury of the vessels around the uterine cervix. From 2017 to 2020, we performed this modified operation in eight women (nine pregnancies) at 12-16 weeks of gestation with a history of deep cervical conization. A modified TAC was successfully performed in all patients. There was no measurable bleeding, and all patients were discharged without postoperative complications. Their pregnancy courses after the operation were uneventful. Of nine, one patient had premature uterine contractions and underwent cesarean section at 36 weeks (preterm delivery). In the other eight pregnancies, planned cesarean section was performed after 37 weeks of gestation. The median birth weight of the babies was 2996 g (range 2604-3374 g). All patients were discharged on the sixth postoperative day without complications. A modified TAC can be safely performed and may prolong pregnancy without adverse events in patients with an extremely short cervix.

A review of conventional and sustained-release formulations of oral natural micronized progesterone in obstetric indications.

BackgroundExogenous progesterone is a treatment option for obstetric indications associated with reduced progesterone activity. Oral natural micronized progesterone (NMP) is effective, although it requires multiple daily doses and may cause adverse events due to its active metabolites. A sustained-release formulation of NMP (NMP-SR) has been developed to overcome the limitations of conventional oral NMP.MethodsThis narrative review examines the available evidence for oral NMP and NMP-SR in several obstetric indications of interest.ResultsLiterature searches identified 17 studies of oral NMP (luteal phase support during assisted reproduction, prevention of threatened miscarriage, prevention of preterm delivery), and clinical studies supporting use of NMP-SR (luteal phase support during intrauterine insemination, maintenance of high-risk pregnancy). Oral NMP was effective for luteal phase support during in vitro fertilization and intrauterine insemination, prevention of threatened miscarriage, and prevention of preterm delivery. NMP-SR was comparable to dydrogesterone for luteal phase support during intrauterine insemination and effectively maintained high-risk pregnancies. Oral NMP-SR was well tolerated.ConclusionsBy releasing progesterone gradually and circumventing first-pass metabolism, NMP-SR elicits the desired therapeutic effect with benefits over conventional oral NMP in terms of bioavailability, once-daily dosing and improved tolerability. Oral NMP-SR appears to be a valuable option for treating obstetric conditions associated with insufficient progesterone exposure.

Frequency of Success Rate of Cervical Cerclage in Preventing Preterm Deliveries

Objective: Determination of success rate of cervical cerclage in prevention of preterm deliveries in patients with cervical incompetence. Study Design: Case Series study. Place and Duration of Study: Study was conducted at Khyber Teaching Hospital for a period of six months from 29 March, 2018 to 29 September, 2018. Methodology: 97 pregnant women were recruited who had a history of previous miscarriages or pre-term delivery. Cervical Cerclage was performed on these patients who were then observed till delivery to ascertain the success rate of cervical cerclage in preventing pre-term deliveries in these patients. Results: In this study mean age was 30 years with SD 8.316. 63% patients were nulli para (with previous second trimester losses) and 37% patients were multi para (with previous pre-term deliveries). 78% delivered at term and 22% delivered preterm. 80% of babies delivered with good apgar score and weight greater than 2.5 kg where as 20% of babies delivered with low apgar score and weight less than 2.5kg. Overall success rate of cervical cerclage was 80%. Conclusion: Our study concluded that success rate of cervical cerclage was 80% in preventing pre-term deliveries in patients having cervical incompetence. Keywords: Cervical Cerclage, Pre-term deliveries, Cervical incompetence, Trans-vaginal

FIGO good practice recommendations on progestogens for prevention of preterm delivery.

Women at high risk of preterm birth (either a previous spontaneous preterm birth and/or sonographic short cervix) with a singleton gestation should be offered daily vaginal progesterone or weekly 17‐OHPC treatment to prevent preterm birth. Benefit is most significant in those with prior history of preterm birth and a short cervix. For women with a previous spontaneous preterm birth and a cervix ≥30 mm the effectiveness of progesterone is uncertain. In asymptomatic women with no prior history of previous preterm birth, no mid‐trimester loss, or no short cervical length, progesterone therapy is not recommended for the prevention of preterm birth. For those with unselected multiple pregnancies, progesterone therapy is not recommended for the prevention of preterm birth. Daily vaginal progesterone or weekly 17‐OHPC treatment can be used for the prevention of preterm birth. The preparation used should be decided by the woman and her clinician. There is no evidence of neurological or developmental benefit or harm in babies whose mothers use progestogens for preterm birth prevention antenatally.

Efficacy of Vaginal and Oral Progesterone After Tocolytic Therapy in Threatened Preterm Labor: A 3-Arm Parallel- Group Randomized Controlled Trial

Background: Progesterone has established roles in preventing preterm labor in women with history of spontaneous preterm labor and short cervix, but there is little evidence to support its use to prevent preterm delivery in women with threatened preterm labor. Objective: To evaluate clinical efficacy of oral and vaginal progesterone on prevention of preterm delivery before 34 and 37 weeks in threatened preterm labor. Materials and Methods: The present study was a 3-arm randomized control trial, 231 singleton pregnancies of 28- to 33-weeks-6-days who had threatened preterm labor were recruited and randomized to three groups,1) 200 mg/day vaginal micronized progesterone, 2) 30 mg/day oral dydrogesterone and 3) control group with no progesterone. All groups received identical standard treatment for threatened preterm labor. Comparison of primary outcomes, which is the preterm delivery before 34 and 37 weeks, across groups were performed using chi-square test. Secondary outcomes, which are latency period, cervical change, maternal morbidity, neonatal morbidity, and mortality, were also compared. Results: Proportion of preterm delivery before 34 weeks was not significantly different across the three treatment groups at 16.0%, 12.0%, and 5.2% in control, oral progesterone, and vaginal progesterone groups, respectively (p=0.098). Concerning pairwise comparison, vaginal progesterone was more efficacious in preventing preterm delivery before 34 weeks than the control group (p=0.030), while oral progesterone was similarly effective to the control group (p=0.638). Proportion of preterm delivery before 37 weeks was not significantly different across the three treatment groups at 41.3%, 45.3%, and 31.2% in control, oral, and vaginal progesterone groups, respectively (p=0.182). Latency period differed across three treatment groups with a median latency of 36.5, 42.0, and 43.0 days in control, oral, and vaginal progesterone groups, respectively (p=0.041). Changes in cervical length and Bishop scores were not different across treatment groups. Conclusion: Vaginal progesterone could prevent preterm delivery before 34 weeks and prolong latency period in women with threatened preterm labor. Keywords: Preterm labor, Progesterone efficacy, Threatened preterm labor, After tocolysis

Impact du parcours de soins sur le taux d’interventions obstétricales dans la prise en charge des fœtus petit pour l’âge gestationnel (Étude IATROPAG)

BackgroundWhile previous studies have demonstrated an improvement in implementation of clinical practices and an improved neonatal prognosis when growth restricted fetuses were followed within a standardized healthcare pathway, the objective of this study was to assess the prevalence of obstetric interventions in small-for-gestational-age (SGA) fetuses followed within a standardized care pathway compared to a traditional care pathway. MethodsWe conducted a retrospective study between 2015 and 2017, in a type III maternity hospital in Lyon, in a population of SGA fetuses, considered as such in case of antenatal diagnosis of fetal weight<10th percentile but>3rd centile without umbilical Doppler abnormality during antenatal surveillance and without ultrasound argument suggesting intrauterine growth retardation (IUGR). We collected the gestational age at diagnosis, obstetrical events and prevention of preterm delivery (antenatal corticosteroids), gestation age at birth, the method of delivery (spontaneous or induced), indication of induction, the method of birth (spontaneous, instrumental extraction or caesarean section), and the immediate neonatal outcome including cord pH, Apgar score at 5minutes, birth weight and fetal sex. After diagnosis, the choice of the pathway was left to the practitioner depending on their habit, their ability to manage the follow-up and their organizational constraints. ResultsOver the study period, and after exclusion of IUGR, 96 SGA were followed up in the traditional pathway and 106 SGA were followed up in the standardized pathway P=0.75. The traditional pathway showed in multivariate analysis a higher prevalence of antenatal corticosteroid therapy for SGA (16,6%) between 2015 and 2017 with OR 7.3 95% CI [1.41-38.43] when compared to the standardized pathway (3,7%). Similarly, the traditional pathway proposes a higher prevalence of induction of labor (54,1%) than the standardized pathway (33,9%) between 2015 and 2017 with OR 3.19 95% CI [1.70-7.80]. The “a posteriori” post-hoc power of the study is 82.9%. ConclusionThis study confirms the absence of excessive obstetrical intervention in the SGA population when followed in a standardized healthcare pathway. The latter would reduce unnecessary obstetrical interventions while respecting the intrinsic neonatal prognosis of small for gestational age fetuses.

Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures

Objective:Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods:Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results:Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion:Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

85 Prevention of preterm delivery after fetoscopy for twin-twin transfusion: a multicenter prospective cohort study

Pre-operative short cervical length (CL) remains a major risk factor for preterm birth after laser surgery for twin-twin transfusion syndrome (TTTS). Interventions to prolong pregnancy remain elusive. The objective of the study is to compare various secondary preventive methods used in the setting of short CL at the time of laser surgery by the North American Fetal Treatment Network (NAFTNet) centers. A prospective cohort study of five NAFTNet centers was conducted from January 2013 to March 2020. Inclusion criteria was monochorionic diamniotic twins complicated by TTTS with pre-operative CL <30mm undergoing fetoscopic laser surgery. Treatments for short CL included no treatment (CRL), progesterone (PRG, prometrium 200 mg daily), pessary (PSR, Arabin, incontinence, Dish or cup-type), cerclage (CLG), or a combination (COM) of two or more treatments. Demographics, ultrasounds, operative records and outcomes were compared. The primary outcome was procedure to delivery interval. 255 women were included. Of these, 151 (59%) had CRL, 32 (13%) had PRG, 21 (8%) had PSR, 21 (8%) had CLG and 30 (12%) had COM. Selected variables and outcomes are listed in the Table. Overall, there were higher proportion of patients in the COM group with prior history of preterm birth compared to CRL. The preoperative cervical length was significantly shorter in the PSR, CLG and COM groups. There was no difference in the gestational age at intervention and stage of TTTS among groups. Preterm premature rupture of membranes (PPROM) was higher in the vaginal progesterone and cerclage group. There were no significant differences in gestational age at delivery, procedure-to-delivery interval, live birth and neonatal survivors among the groups (see Figure). A high percentage of patients had no additional treatment, and this group had longer CL. There were no differences in outcomes among treatments; however, there were significant difference in confounding variables, like history of preterm birth. A large randomized control trial is urgently needed to determine the effects of these treatments.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Low-dose Aspirin for the Prevention of Preterm Delivery in Nulliparous Women With a Singleton Pregnancy (ASPIRIN): A Randomized, Double-blind, Placebo-controlled Trial

(Lancet. 2020;395:285–293) Preterm birth is a common cause of infant morbidity and mortality, especially in low- and middle-income countries with limited resources. Previous studies of aspirin used to prevent preeclampsia also suggested that low-dose aspirin may help lower the incidence of preterm births. However, no large-scale trial has specifically evaluated the use of low-dose aspirin initiated in early pregnancy with the primary purpose of preventing preterm birth. The aim of this study (the ASPIRIN trial) was to determine if low-dose aspirin administered daily starting in early pregnancy reduced the incidence of preterm delivery.

Low-dose aspirin for the prevention of preterm delivery

To read the full abstract: Lancet. 2020 Jan 25;395(10220):285-293. doi: 10.1016/S0140-6736(19)32973-3.

Abdominal cerclage in a patient with a neocervix with planned cesarean hysterectomy at delivery

Pregnancies complicated by congenital uterine anomalies (CUA) with a neocervix present a variety of challenges for the obstetrician. Abdominal cerclage can be utilized to help prevent preterm delivery in a patient with a neocervix. A 14-year-old female presented with right adnexal pain and was found to have a complex uterine anomaly resembling a noncommunicating unicornuate uterus with a cervix embedded in the rudimentary horn. A neocervix was created during surgical removal of the rudimentary horn. The patient became pregnant at age 24, and a transabdominal cerclage served an important role in the prevention of preterm delivery. Although limited data exists regarding the outcomes for the use of abdominal cerclage after the creation of a neocervix, term delivery is possible with said intervention.