Pregnancy Prolongation In Women Research Articles

A Comparative Study of the Effectiveness of Transdermal Nitroglycerine Patches and Oral Nifedipine in Prolongation of Pregnancy in Women With Preterm Labour.

Backgrounds A significant contributor to newborn morbidity and mortality is preterm birth. Several techniques have been employed to identify patients at risk of premature labour. However, these predictors are not always effective because of their multifactorial aetiology. Preterm labour can be suppressed largely through tocolysis. This study compared the effectiveness and safety of transdermal nitroglycerine and oral nifedipine in preventing premature labour. Methods This study was done at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, from December 2020 to November 2022, on 130 women presenting with preterm labour pains between 28 and 37 weeks of gestational age. All the women selected were randomized into two equal groups by using the envelope method. Sixty-five women were given a nitroglycerine patch (Group A), and the rest (65 women) were given an oral nifedipine tablet (group B). The variables studied were mean days of prolongation of pregnancy, treatment outcome, steroid coverage, along with feto-maternal outcomes among both groups. Results The percentage of women whose pregnancy was prolonged for at least 48 hours in the nitroglycerine group was 75.3%, and in the nifedipine group it was 93.8%. Failure to achieve tocolysis, defined as delivery within 48 hours, was seen significantly more in the nitroglycerine group (24.6%) than in the nifedipine group (6.1%). The overall foetal outcomes were comparable in both groups. Conclusion Oral nifedipine was found to be superior to transdermal nifedipine patches in terms of efficacy and safety in the management of preterm labour, with a better side effect profile.

Role of Human Chorionic Gonadotropin in Suppression of Preterm Labor

Objective: To determine the mean prolongation of pregnancy via human Chorionic gonadotropin (H.C.G) in patients presenting with preterm labor. Materials and methods: This descriptive case study was conducted in obstetrics and gynecology department, Women and children teaching hospital Dera Ismail khan from October 21, 2019, to April 20, 2020. Result: A total of 123 pregnant women with preterm labor were included in the study. Average age was 25.44 years+4.70sd with range 16-35 years. Prolongation of pregnancy by human chorionic gonadotropin (HCG) of more than 30 days. Fifty-eight (47.2%) of preterm women were observed with prolongation of pregnancy of less than 30 days. Practical implication: Suppression of Preterm Labor in the females using H.C.G. Conclusion: The trial concluded that HCG is the better option in the prolongation of pregnancy in women with preterm delivery. Keywords: Preterm delivery, Prolongation of pregnancy, NICU.

ASSESSMENT OF PERINATAL OUTCOME AFTER USING NIFEDIPINE VERSUS PLACEBO IN THE TREATMENT OF PRETERM PRELABOR RUPTURE OF MEMBRANES (Randomized controlled study)

Background: Preterm birth is the most common cause of neonatal morbidity and mortality worldwide and accounts for approximately 75% of all neonatal deaths and 50% of childhood neurological morbidities. Around one-third of preterm deliveries start with preterm pre-labor rupture of membranes (PPROM). Objective: To assess the value of Nifedipine to change the perinatal outcome in cases of preterm pre-labor rupture of membranes. Patients and methods: This was a randomized, controlled study that included and followed 200 pregnant women. One hundred pregnant women were recruited in the Nifedipine group in addition to 100 pregnant women were recruited as a control group from Obstetric Department of Shebin El Kom Teaching Hospital during the period form to 2017-2019. Results: In this randomized clinical trial among women with PPROM without contractions, we found no significant differences between treatment with nifedipine or placebo in terms of perinatal outcomes and prolongation of pregnancy. Conclusion: On perinatal outcomes or prolongation of pregnancy in women with PPROM without contractions.

Possibilities of vaginal biotope correction in pregnant women after application of auxiliary reproductive technologies

Research objective: to determine the role and effectiveness of the proposed therapeutic and prophylactic complex in the correction of vaginal biocenosis disorders in the dynamics of pregnancy in pregnant women after assisted reproductive technologies (ART) to improve the tactics of antenatal observation and prevention of obstetric and perinatal complications.Materials and methods. 299 pregnant women were examined: the main group included 249 women with pregnancy after ART, the control group consisted of 50 pregnant women with spontaneous pregnancy.Therapeutic and prophylactic measures for pregnant women after ART included: micronized progesterone, magnesium oxide, folic acid, L-arginine aspartate, ω-3-polyunsaturated fatty acids, long-term psychological correction (on the eve of the ART program, at 8–10 weeks, 16–18 weeks and 28–30 weeks of pregnancy). The drug for antibiotic therapy for local sanitation of the genital tract was chosen taking into account the sensitivity to antibiotics of certain microbial associates and was prescribed for 7–10 days.At the second stage of sanitation of the genital tract probiotics were prescribed under the control of pH-metry to maintain the acidic environment of the vaginal contents, colonize the vagina and the vaginal part of the cervix with lactobacilli.Results. There was a significant decrease in the proportion of women with a large number of epithelial cells in the main groups, which are a sign of alterative inflammation, and this is coincides with a similar indicator in the control group. Women with moderate leukocyte count and mixed Gram-negative microflora prevailed in IB, IIB and IIIB subgroup, who received conventional therapy. There was no significant difference in IIIA and IIIB subgroups.In the vaginal biocenosis significantly increased the Lactobacillus spp. content against the background of probiotics with local and general action in ІА, ІІА and ІІІА subgroups. The average Lactobacillus spp. concentration was significantly different from the average indicators of subgroups receiving conventional therapy for vaginal sanitation, with a significant decrease in the biocenosis of aerobic and anaerobic microorganisms and Candida albicans, which indicates the effectiveness of the proposed two-stage treatment.Conclusions. The proposed improved two-stage sanitation of the genital tract with a selective probiotic against the background of long-term progesterone and magnesium support ensures the stabilization of the vaginal pH at the physiological level corresponding to the normocenosis, and contributes to a significant increase in Lactobacillus spp. within the physiological norm with a significant decrease of Candida albicans concentration in the biotope, as well as opportunistic pathogens of aerobic and anaerobic origin. This is provides conditions for the prolongation of pregnancy in women after ART treatment cycles.

Pregnancy duration with use of 17-α-hydroxyprogesterone caproate in a retrospective cohort at high risk of recurrent preterm birth

The use of 17-α-hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm birth has become widespread, yet there are conflicting data regarding its efficacy. We sought to determine whether administration of 17-α-hydroxyprogesterone caproate was associated with pregnancy prolongation in women at a high risk of recurrent spontaneous preterm birth. This is a retrospective cohort study of women with singleton pregnancies and a history of spontaneous preterm birth at <37 weeks' gestation who received care at our academic tertiary care center between 2009 and 2019. We included women with gestations that progressed beyond 16 weeks. We excluded those who underwent history-indicated cerclage placement. We first examined the characteristics of women who received 17-α-hydroxyprogesterone caproate and those who did not. Covariates with a P value of ≤.2 on this univariate analysis were considered for incorporation into a Cox proportional hazards model to assess the association between 17-α-hydroxyprogesterone caproate use and pregnancy prolongation up to 35 weeks. Of 861 women included in the study, 570 (66.2%) reported non-Hispanic black racial identity, 237 (27.5%) lived in zip codes with a high infant mortality rate (≥12.1/1000 infants), 287 (33.3%) had more than 1 previous spontaneous preterm birth, 372 (43.2%) had previous spontaneous preterm birth at ≤32 weeks' gestation, and 242 (28.1%) were smokers. Here, 152 pregnancies (17.6%) were complicated by spontaneous preterm birth at <35 weeks' gestation. Factors independently associated with pregnancy duration up to 35 weeks included weight gain of <0.2 kg (0.5 lb) per week, first recorded weight of <98 kg (215 lb), obstetrical history, non-Hispanic white racial identity, lack of prenatal care, and vaginal bleeding. Gestational age at delivery was also independently associated with interventions typically employed for midtrimester cervical shortening and/or dilation, including ultrasound- and examination-indicated cerclage, pessary placement, and vaginal progesterone administration. The use of 17-α-hydroxyprogesterone caproate was not associated with pregnancy prolongation (adjusted hazard ratio, 0.83; 95% confidence interval, 0.60-1.15). The risk profile of our cohort is similar to that of women enrolled in the landmark trial that led to the Food and Drug Administration's approval of 17-α-hydroxyprogesterone caproate. Despite the high-risk nature of the pregnancies examined, we found no association between use of the medication in daily clinical practice and pregnancy prolongation up to 35 weeks. This finding adds to the mounting evidence that calls into question the drug's efficacy in reducing the risk of recurrent spontaneous preterm birth.

928: Use of 17-α-hydroxyprogesterone-caproate did not predict pregnancy prolongation in women with prior spontaneous preterm birth

928: Use of 17-α-hydroxyprogesterone-caproate did not predict pregnancy prolongation in women with prior spontaneous preterm birth

Effectiveness and safety of late midtrimester cervical cerclage

Objectives: To evaluate the safety and effectiveness of late cervical cerclage performed beyond 17 weeks of gestation. The outcomes of interest were effectiveness of late cerclage in prolongation of pregnancy and evaluation of pregnancy outcome including maternal and fetal complications.Study design: A total of 30 patients underwent late cervical cerclage during the study period. Of them, two were twin pregnancies. A late cerclage was performed after the diagnosis of cervical shortening or dilatation in 20 patients. We performed a retrospective case series review. One case was lost to follow up (delivery in another medical center). Medical information was retrieved from all cases of patients who underwent a late cervical cerclage between the years 2010 and 2016 at the Soroka University Medical Center, a tertiary medical center. Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as proportions.Results: The average gestational age at birth was 35 ± 5.1 weeks of gestation. The mean interval between cerclage and delivery in the study population was 17 ± 5.62 weeks. Nine cases (32.1%) resulted in preterm deliveries, three of them below 34 weeks of gestation (one twin pregnancy and two pregnancies diagnosed with cervical dilation prior to cerclage). Among all the preterm deliveries, there were four cases of preterm prelabor rupture of membranes (13.3%). Of the 28 deliveries, 24 women (85.7%) had a vaginal delivery, while four women (14.3%) underwent a cesarean section. No cases of cervical tear were described. The cerclage was sent to bacteriology after removal, showing positive cultures for Candida species in nine cases (31%).Conclusions: In our study population, late cervical cerclage was found to be a safe procedure resulting in almost 90% of successful vaginal deliveries without maternal or fetal complications. This procedure might be effective in the prolongation of pregnancy in women with cervical dynamics in the late second trimester.

Nifedipine versus placebo in the treatment of preterm prelabor rupture of membranes: a randomized controlled trial: Assessment of perinatal outcome by use of tocolysis in early labor—APOSTEL IV trial

ObjectivePreterm birth is the most common cause of neonatal morbidity and mortality. Around one third of preterm deliveries starts with preterm prelabor rupture of membranes (PPROM). The aim of this trial was to study the effect of prolonged tocolysis with nifedipine versus placebo in women with PPROM on perinatal outcome and prolongation of pregnancy. Study designThe Apostel IV was a nationwide multicenter randomized placebo controlled trial. We included women with PPROM without contractions between 24+0 and 33+6 weeks of gestation. Participants were randomly allocated to daily 80mg nifedipine or placebo, until the start of labor, with a maximum of 18 days. The primary outcome measure was a composite of poor neonatal outcome, including perinatal death, bronchopulmonary dysplasia, periventricular leukomalacia>grade 1, intraventricular hemorrhage>grade 2, necrotizing enterocolitis>stage 1 and culture proven sepsis. Secondary outcomes were gestational age at delivery and prolongation of pregnancy. Analysis was by intention to treat. To detect a reduction of poor neonatal outcome from 30% to 10%, 120 women needed to be randomized. Trial registry: NTR 3363. ResultsBetween October 2012 and December 2014 we randomized 25 women to nifedipine and 25 women to placebo. Due to slow recruitment the study was stopped prematurely. The median gestational age at randomization was 29.9 weeks (IQR 27.7–31.3) in the nifedipine group and 27.0 weeks (IQR 24.7–29.9) in the placebo group. Other baseline characteristics were comparable. The adverse perinatal outcome occurred in 9 neonates (33.3%) in the nifedipine group and 9 neonates (32.1%) in the placebo group (RR 1.04, 95% CI 0.49–2.2). Two perinatal deaths occurred, both in the nifedipine group. Bronchopulmonary dysplasia was seen less frequently in the nifedipine group (0% versus 17.9%; p=0.03). Prolongation of pregnancy did not differ between the nifedipine and placebo group (median 11 versus 8 days, HR 1.02; 95% CI 0.58–1.79). ConclusionThis randomized trial did not show a beneficial effect of prolonged tocolysis on neonatal outcomes or prolongation of pregnancy in women with PPROM without contractions. However, since results are based on a small sample size, a difference in effectiveness cannot be excluded.

Abstract P093: The Sflt-1/plgf Ratio Associates with Prolongation of Pregnancy

Objective: To evaluate whether a single determination of the serum sFlt-1/PlGF ratio associates with pregnancy prolongation in women with suspected or confirmed preeclampsia (PE). Methods: In this ongoing observational Dutch multicenter study (600 pts to be enrolled) blood was drawn at admission. Values of sFlt-1 and PlGF were measured postpartum using the automated Elecsys system to prevent influence of this information on decision-making of the treating physicians and the defining time point of delivery. Clinical characteristics and pregnancy outcomes were retrieved from medical records. Cutoffs of &lt; 33 to rule out and &gt; 85 to rule in the occurrence of delivery for selected time points were used. Results: We have included 412 patients, so far complete data of 147 patients (age 18 to 48 yrs. singleton pregnancies, median pregnancy duration 32 weeks (range 20-36 weeks) is available. At time of inclusion 67 pregnancies were complicated with PE, of which 12 with superimposed PE, 8 with HELLP, 20 with gestational hypertension (GH) and 60 without pregnancy induced hypertension (PIH). The median (range) ratio in patients who delivered within 7 days was 146 (9-1803) compared to 14 (1-469) in those who delivered after &gt; 7 days (p&lt; 0.001). Delivery within 7 days occurred in 59% patients with a ratio &gt; 85 compared to 7% with a ratio &lt;33 (p=0.002) and 39% with a ratio 33-85 (p=0.048). Conclusion: In this high risk group a low ratio is inversely correlated with prolongation of pregnancy.

O80. The SFLT-1/PlGF ratio associates with prolongation of pregnancy

The sFlt-1/PlGF ratio has emerged as a biomarker for the timely diagnosis of preeclampsia (PE) and prediction of pregnancy outcome. Because of this property we hypothesized that this ratio. To evaluate whether a single determination of the serum sFlt-1/PlGF ratio associates with pregnancy prolongation in women with suspected or confirmed preeclampsia (PE). In this ongoing observational Dutch multicenter study (600 pts to be enrolled) blood was drawn at admission. Values of sFlt-1 and PlGF were measured postpartum using the automated Elecsys system to prevent influence of this information on decision-making of the treating physicians and the defining time point of delivery. Clinical characteristics and pregnancy outcomes were retrieved from medical records. Cutoffs of <33 to rule out and ⩾85 to rule in the occurrence of delivery for selected time points were used. So far complete data of 147 patients (age 18–48 yrs. singleton pregnancies, median pregnancy duration 32 weeks (range 20–36 weeks) are available. At time of inclusion 67 pregnancies were complicated with PE, of which 12 with superimposed PE, 8 with HELLP, 20 with gestational hypertension (GH) and 60 without pregnancy induced hypertension (PIH). The median (range) ratio in patients who delivered within 7 days was 146 (9-1803) compared to 14 (1-469) in those who delivered after >7 days (p < 0.001). Delivery within 7 days occurred in 59% patients with a ratio >85 compared to 7% with a ratio <33 (p = 0.002) and 39% with a ratio 33–85 (p = 0.048). In this high risk group a low ratio is inversely correlated with prolongation of pregnancy.Download : Download full-size image

The possibilities of prolongation of pregnancy in women with leaking of amniotic fluid in the second and in the beginning of third trimester

Abstract: With the development of premature rupture of membranes in terms 28–30.5 weeks, prolongation of pregnancy more than 48 hours, held-Niemi prevention of RDS contributes to significant decrease in perinatal mental and postnatal lethality, and lengthening the latent period of more than 168 hours, significantly reduce child morbidity. Keywords: Prolongation of pregnancy, amniotic fluid. The main tasks of Obstetrics are creating optimal condi-tions for the woman function of maternity, maintaining her health and providing the birth of healthy offspring. On the background of low birth rate the perinatal mortality remains rather high and exceeds the 12%, although it has a tendency to decrease over the last 10 years [1; 2].The premature labor has special significance in the structure of perinatal morbidity and mortality are against the backdrop of premature rupture of membranes, which is one of the most frequent reasons for initiating of patrimonial activity in 34.9–56 % of all preterm births [3].Studying of features of pregnancy in case of premature rupture of membranes and determination of optimal duration of of anhydrous interval, methods of preventing of infectious complications, the timing and method of the delivery at vari -ous gestational periods will reduce the number unfavorable outcomes in this serious pathology [4, 5].Taking into account the national particularities, the liv-ing conditions of our women (chronic anemia, endemicity, resulting in frequent thyroid disease, isthmic cervical insuffi-ciency, congenital malformations of the uterus, stress, etc.) the primary goal of our study to highlight the major prognostic factors and the development of preventive measures for pro-longation of incomplete pregnancy complicated by premature rupture of membranes in the second and in the beginning of third of trimesters [3].Searching more information about the mechanisms of premature rupture of membranes allows developing drugs of pathogenetic action, which should help doctors around the world to cope with the problem of reducing the incidence of premature births [6].Now the challenges of prolonging pregnancy for preterm rupture of membranes and determination of the optimal duration of anhydrous interval poorly studied and were not worked out prognostic criteria of prolonging pregnancy.

832: Perinatal outcomes after short versus prolonged indomethacin for tocolysis in women with preterm labor

832: Perinatal outcomes after short versus prolonged indomethacin for tocolysis in women with preterm labor

ACOG Committee Opinion No. 445: Antibiotics for Preterm Labor

The utility of antibiotics to prolong pregnancy and reduce neonatal morbidities in women with preterm labor and intact membranes has been evaluated in numerous randomized clinical trials. Antibiotic use intended only for pregnancy prolongation in women with preterm labor with intact membranes does not have short-term neonatal benefits and may be associated with long-term harm. Thus, antibiotics should not be used for this indication in women with preterm labor and intact membranes.

Pregnancy Prolongation in Women With Preterm Cervical Dilatation Using Outpatient Preterm Labor Services

It is generally accepted that tocolytic therapy becomes less effective in preventing preterm labor (PTL) as cervical dilatation progresses. This cohort study sought to determine the impact of cervical dilatation on pregnancy outcomes in 1435 women with high-risk pregnancies who were hospitalized because of increased uterine activity or persistent signs and symptoms of PTL. Subsequently, they were offered outpatient perinatal services. All had singleton gestations and cervical dilatation of 2 cm or more with intact membranes. They ranged from 22 to 35 weeks gestation when evaluated in the hospital, averaging 32.4 weeks. Participants had a total of 1474 episodes of PTL. Close to 40% had a history of previous preterm delivery. Gestational age at the time of hospitalization averaged 29 weeks, and the mean cervical dilatation was 2.6 cm. After hospitalization, the women gained a mean of 26 days before delivery. More than 85% of women resumed outpatient services, which nearly always emphasized maintenance tocolysis. When cervical dilatation was 3 cm or more, women were more likely to deliver before discharge. Approximately 15% of the group delivered within 1 week of assessment and 2.2% delivered on the first day in the hospital. In women discharged to resume home-care services, labor was deferred for 28 days on average, compared with 16.5 days for those who remained in the hospital. There were no maternal deaths and no serious maternal morbidity. These findings indicate that even women with advanced cervical dilatation are able to gain significant gestational time when evaluated in the hospital and offered outpatient PTL services.

Pregnancy prolongation in women with preterm cervical dilatation utilizing out-patient preterm labor services

Objective: To identify the impact of cervical dilatation on pregnancy prolongation in women with hospital evaluation of preterm labor (PTL) symptoms.Methods: The study population was identified from a database comprising women receiving out-patient perinatal services. Women diagnosed with PTL, having a singleton gestation, with cervical dilatation of ≥2 cm, intact membranes, and at 22.0–34.9 weeks when hospitalized for evaluation of PTLsymptoms were included. Data were analyzed by cervical dilatation at hospital evaluation. The primary study outcome was gestational gain from PTLdiagnosis.Results: A total of 1435 patients were analyzed; mean cervical dilatation at hospitalization was 2.6±0.7 cm at a mean of 32.4±2.1 weeks' gestation. Following hospitalization, patients gained a mean of 26.0±17.2 days. Eighty-seven per cent resumed out-patient services. Approximately 15% delivered within 1 week of PTL evaluation.Conclusion: Even women with advanced cervical dilatation can achieve significant gestational gain. The degree of cervical dilatation has significant impact on latency to delivery in women evaluated for PTL.