Risk Factors For Premature Birth Research Articles

Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review.

Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation. This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women. A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted. This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied. Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions' effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes. PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847.

Is Periodontal Disease a Risk Factor for Premature Birth and Low Birth Weight

Aim: Premature birth or low birth weight has an important place in neonatal mortality and morbidity. Today, there are still cases whose etiology has not been fully elucidated. The aim of this study is to evaluate the effect of periodontal diseases on adverse pregnancy outcomes by using the current classification system accepted at the 2017 World Workshop. Materials and Methods: This study was carried out on 172 women who were followed up and delivered in the department of obstetrics and gynecology of our university’s medical faculty hospital. Demographic characteristics of all individuals were recorded and laboratory values were examined. While those with a gestational age <37 weeks and/or baby birth weight < 2500 g were constituted to the case group (n=85), those with a gestational age ≥ 37 weeks and/or baby birth weight ≥ 2500 g constituted the control group (n=87). Clinical periodontal and radiographic evaluations including plaque index (PI), gingival index (GI), bleeding on probing (BOP %), probing pocket depth (PPD) and clinical attachment level (CAL) values were performed for all individuals, and the diagnoses were made by the applied classification system. Analyzes were performed between the two groups to examine the relationship between periodontal disease and adverse pregnancy. Results: PI, GI, BOP %, and PPD values in the case group were significantly higher compared to the control group (p<0.001). Although the CAL value was higher in the case group, the difference was not significant (p=0.058). WBC (p=0.020) and PLT (p<0.001) values were significantly higher in the case group. Conclusion: According to the results of this study, periodontal diseases are associated with adverse pregnancy outcomes independent of other risk factors. Women should pay attention to their oral hygiene and dental examinations before and during pregnancy.

Serum ferritin and 25-hydroxyvitamin D levels as predictors for premature birth in pregnant women with preeclampsia.

This study aimed to investigate the expression levels of serum ferritin (SF) and 25-hydroxyvitamin D (25-[OH]-D) and analyze their predictive value for premature birth in pregnant women with preeclampsia. Between December 2018 and December 2021, 104 pregnant women with preeclampsia were selected as the observation group and 52 pregnant women with normal blood pressure as the control group. The observation group were divided into occurrence and nonoccurrence groups according to gestational age at birth. Relevant laboratory indicators were examined in both the occurrence and nonoccurrence groups, and the predictive value of SF and 25-(OH)-D levels for premature births in pregnant women with preeclampsia was analyzed. The incidence of premature delivery in the 104 pregnant women with preeclampsia was 20.19% (21/104). Pre-pregnancy body mass index (BMI), systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, triglycerides, and SF levels of the pregnant women in the observation group were significantly higher, and the 25-(OH)-D levels were significantly lower, than those in the control group (P < .05). Furthermore, the pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, and SF levels of pregnant women in the occurrence group were significantly higher, and the 25-(OH)-D levels were significantly lower, than those in the nonoccurrence group (P < .05). Logistic regression analysis showed that high pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, 24 hours urinary protein, and SF levels were risk factors for premature birth in pregnant women with preeclampsia (OR > 1, P < .05) and that high serum 25-(OH)-D was a protective factor (OR < 1, P < .05). In conclusion, SF and 25-(OH)-D levels are abnormally expressed in pregnant women with preeclampsia and are associated with premature birth in these women.

Clinical assessment of the placenta function in women at risk and threat of premature delivery

Premature birth, despite the significant achievements of perinatal medicine in recent decades, remains an urgent global and national medical and social problem, as it is the leading cause of perinatal morbidity and mortality. According to modern views, placental dysfunction can be one of the causes of premature birth, and its frequency, according to randomized studies, can be from 78 to 91%, depending on the gestational age. At the same time, the research conducted to date does not provide a clear understanding of the role of timely diagnosis and prevention of placental dysfunction in preventing premature birth.The objective: to perform clinical evaluation of the prevalence of placental dysfunction in women at risk of preterm birth and with threat of preterm birth.Materials and methods. 180 pregnant women were took part in the study. To achieve the research aim, three research groups were formed. I group – 73 pregnant women with threat of premature birth; II group – 77 pregnant women with risk factors for premature birth. Women with risk factors for premature birth were included in the study at the stage of pregnancy planning (IIA subgroup, 39 women) or from the moment of applying to a women’s outpatient clinic to monitor the course of pregnancy (IIB subgroup, 38 pregnant women). The control group included 30 pregnant women with an uncomplicated course of pregnancy.Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum were performed at 18–21+6 and 28–30 weeks of gestation.Results. Analysis of the prevalence of risk factors for placental dysfunction and preterm birth in patients of the studied cohort showed that in pregnant women with preterm birth (I group), the combination of risk factors was 5.2; in pregnant women who received pre-gravid training (IIA subgroup) – 3.2; in pregnant women who were included in the study in the I trimester of pregnancy (IIB subgroup) – 4.7, while in pregnant women of the control group – only 0.8 (p&lt;0.05).The threat of early spontaneous miscarriage with the formation of a retrochorial hematoma as a clinical manifestation of primary placental dysfunction was determined in 43.8% of pregnant women whose premature delivery was carried out for medical reasons. Placenta abruption in these patients can be considered as decompensation of the primary dysfunction of the placenta with the transition to acute placental insufficiency.The formation of chronic placental dysfunction, clinically manifested by the syndrome of fetal growth retardation, was most often observed in patients whose pregnancy ended in spontaneous premature birth at 34–36+6 weeks in the presence of an untouched amnion, – 68.6% compared to births at 28–33+6 weeks of gestation – 25.9% and with childbirth at 22–37+6 weeks – 13.3%.Conclusions. Clinical manifestations of placental dysfunction were detected in 30.6% of patients with premature birth, with morphological signs in 60.4% of cases, which indicates the hidden course of placental insufficiency before the development of premature birth.Morphological signs of placental dysfunction were determined in 87.5% of cases of premature births for medical reasons and in 100.0% of cases of spontaneous births at 22–27+6 weeks of gestation (with a combination of risk factors from 2.1 to 3.0), in 66.7% – with premature births at 28–33+6 weeks of pregnancy, in 40.0% – with premature births at 34–36+6 weeks of pregnancy and only in one (5.6%) case – with term births.The frequency of fixation of morphological characteristics of placental dysfunction correlates with the frequency of early pregnancy complications, primarily with the formation of retrochorial hematomas in the first half of pregnancy.

Evaluation of Preterm Birth and its Associated Risk Factors in Southeast Iran in 2020: A Glance to Social and Care Factors

Aims: This study aimed to assess pregnancy health care and the incidence of PTB in the south of Kerman province. Background: For the plan and management of prevention programs effectively, it is important to consider the incidence and trend of preterm births (PTB). Methods: In this cross-sectional (descriptive and analytical) study, the national code of mothers of premature infants was extracted by reporting from the national system of the Ministry of Health. The data collection tool was a researcher-made checklist. Data analysis was carried out by SPSS version 20 software and the significance level was &lt;0.05. Results and Discussion: A total of 554 premature infants were examined, and 55% of them were boys. The gender of the infant and the number of cares received (p&lt;0.01), the level of education of the mother and father (p &lt; 0.001), the mother’s occupation (p &lt; 0.01), the father's occupation (p &lt; 0.001), monthly income and participation in preparatory classes of childbirth (p&lt;0.01), place of residence (p&lt;0.05), appropriateness of receiving care with pregnancy age (p&lt;0.001) had statistically significant relationship with the number of care received. Conclusion: This study showed potential risk factors associated with preterm delivery and subsequent management to prevent preterm delivery in low-risk and high-risk women with singleton or multiple pregnancies. A history of premature birth is the most important risk factor for premature birth in the next pregnancy.

Adverse effects of maternal age, weight and smoking during pregnancy in Pleven, Bulgaria

Aim: This paper aims to study the relationship between mothers’ age, body mass index (BMI), gestational weight gain (GWG) and smoking and the risk for premature birth in Pleven, Bulgaria.&#x0D; Methods: A case-control study was conducted in Pleven in 2007. The study was comprehensive for all premature children (N=58) and representative for full-term infants (N=192, or 10.4% of all of the 1827 full-term children) born in 2007 at the University Hospital of Pleven and resident in the city of Pleven. Retrospective data on determinants under study were collected from all the mothers included in this study (N=250).&#x0D; Results: Mothers of premature children were more likely to be above 35 years old (27.6%), with a BMI ≥25 kg/m2 (23.1%), GWG below the recommended value (38.5%) and to smoke during pregnancy (37.9%). The odds of being a smoker during pregnancy were five times higher among mothers with low birth weight (LBW) newborns compared with their counterparts with normal birth weight newborns (OR=5.1, 95%CI=2.4-10.6). There was a positive association between BMI and LBW in infants whose mothers were overweight (OR=2.1, 95%CI=1.0-4.0). The risk of LBW increased when GWG was less than recommended (OR=1.8, 95%CI=1.0-3.1).&#x0D; Conclusion: Our results indicate that pre-pregnancy BMI ≥25 kg/m2, less than recommended GWG and smoking during pregnancy are risk factors for premature birth in Pleven region. Findings from this study suggest the need for active health and educational actions by health professionals in order to avoid premature births in Bulgaria.

Effect of vaginal flora on clinical outcome of frozen embryo transfer.

Vaginal microbiota imbalance is a high risk factor for premature birth, and is closely related to female pelvic inflammation and sexually transmitted diseases. The effect of vaginal microbiota on the outcome of assisted reproductive technology is still unclear. In this study, the vaginal microbial composition and the pregnancy outcome of frozen embryo transfer (FET) was investigated. From October 2020 to December 2021, 275 FET cycles were selected from the center of reproductive medicine in Affiliated Hospital of Nantong University. Vaginal secretions were collected on the day of endometrium transformation, and smears were Gram stained. According to the Nugent score they were divided into three groups, including normal group, mild dysbiosis group and sever dysbiosis group. The clinical outcomes of each group were compared. In 275 FET cycles, the embryo implantation rate, clinical pregnancy rate and ongoing pregnancy rate in the normal group (66.9%,84.3% and 83.1%) were significantly higher than those in the mild dysbiosis group (45.5%, 57.3% and 49.3%) and in sever dysbiosis group (29.6%, 34.2% and 27%). The difference was statistically significant (P<0.01). When compared the preclinical pregnancy loss rate and the miscarriage rate, the normal group (1.3% and 1.3%) was significantly lower than those in the mild dysbiosis group (20.4% and 14.0%) and the sever dysbiosis group (25.5% and 21.1%). The difference was statistically significant (P<0.01), but there was no significant difference between the mild dysbiosis group and sever dysbiosis group (P>0.05). Nugent score is directly related to the clinical outcome of FET. The Lactobacilli-dominant vaginal flora was a favorable factor for the good clinical outcome of FET, while asymptomatic bacterial vaginosis had a negative correlation with the outcome of FET.

Identifying Risk Factors for Premature Birth in the UK Millennium Cohort Using a Random Forest Decision-Tree Approach

Prior research on causes of preterm birth has tended to focus on pathophysiological processes while acknowledging the role of socioeconomic indicators. The present research explored a wide range of factors plausibly associated with preterm birth informed by pathophysiological and evolutionary life history perspectives on gestation length. To achieve this, a machine learning ensemble classification data analysis approach, random forest (RF), was applied to the UK Millennium Cohort (18,201 births). The results highlighted the importance of socioeconomic variables and parental age in predicting preterm (before 37 completed weeks) and very preterm (before 32 weeks) birth. Infants born in households with low income and with young fathers had an increased risk of both very preterm and preterm birth. Maternal health and health problems during pregnancy were not found to be useful predictors. The best-performing algorithm was for very preterm birth and had 93% sensitivity and 100% specificity using six variables. Algorithms predicting preterm birth before 37 weeks showed increased error, with out-of-bag error rates of about 7% versus only 1% for those predicting very preterm birth. The poorer performance of algorithms predicting preterm births to 37 weeks of gestation suggests that some preterm birth may not result from pathology related to poor maternal health or social or economic disadvantage, but instead represents normal life-history variation.

Evaluation of the effectiveness of correction of vagina dysbiosis with the use of vaginal prebiotic complex in women with risk factors of spontaneous premature birth

Dysbiotic changes in microbial ecosystem of the female lower genital tract are risk factors for spontaneous abortions, spontaneous preterm births, intra-amniotic infection, postpartum endometritis, and adverse perinatal outcomes. However, the opinions about the expediency of antimicrobial therapy in women with bacterial vaginosis and a history of preterm birth are controversial, and discussions and the search for an effective method of treatment are still continuing. Treatment of dysbiosis of the vaginal microbiota requires a complex approach for not only the pathogen elimination, but also for the restoring of the normal vaginal biotope. The objective: to evaluate the effectiveness of correction of dysbiotic disorders of the vaginal microbiota in women with risk factors for premature birth using the prebiotic topical therapy.Materials and methods. The studied cohort included 105 women with risk factors for premature birth. I group included 38 women at the stage of pregnancy planning, II group – 39 pregnant women, III group – 28 pregnant women from the moment of their first visit to the female consultation for pregnancy monitor. The control group included 20 conditionally healthy pregnant women at the same gestational age. The patients of the I and II groups after diagnosis of bacterial vaginosis (BV), vulvovaginal candidiasis, or aerobic vaginitis received etiotropic topical therapy in accordance with the recommendations of the Centers for Disease Control and Prevention and International Union against sexually transmitted infections. Bacterial vaginosis was treated by clindamycin cream (2 %) once a day for 7 days; aerobic vaginitis – vaginal tablets which contain 10 mg of dequalinium chloride for 6 days; candida vaginitis – fenticonazole 600 mg in one vaginal capsule once followed by topical application of a prebiotic complex (oligosaccharide, sodium hyaluronate, xylitol, vitamins, lactose) for 10 days. Then pH balance and normocenosis of the vagina were supported by the use of one vaginal capsule of the prebiotic complex per week till the 22nd week of gestation. The pregnant women in the III group with similar pathologies received only classical antimicrobial therapy with antibiotics and/or antifungal drugs.The assessment of the vaginal microbiota was carried out at the time of the patients inclusion in the study and at the 17–19 weeks of gestation by determination of the vaginal pH and using molecular biological and bacterioscopic methods. Results. The effectiveness of BV and mixed vaginitis therapy in all groups was high, the frequency of BV detection after treatment decreased from 28.9 % to 2.6 % in the I group and from 32.1 % to 3.6 % – in the III group.In the I and II groups, in which the patients received complex treatment with the prebiotic complex, the quantity of women with normocenosis of the vagina increased significantly (from 39.5 % to 89.5 % in the I group; from 35.9 % to 89.7 % in the II group), the frequency of the intermediate state of the vaginal microbiota decreased twice (from 13.2 % to 7.9 % in the I group and from 15.4 % to 7.7 % in the II group). In patients of the III group, the incidence of normocenosis increased slightly (from 32.1 % to 39.3 %), but the rate of pregnant women with an intermediate state of vaginal microbiota increased significantly (from 14.3 % to 46.4 %), which is a threat to the recurrence of dysbiotic processes.Conclusions. The topical use of the prebiotic complex, which contains oligosaccharide, sodium hyaluronate, xylitol, vitamins and lactose, is effective in the management of symptoms and pathogenic load in uncomplicated vaginal infection, which is manifested by a decrease in the prevalence of intermediate states of the microbiota and a steady increase in normocenosis. The complex therapy with antibiotics/antifungal agents with a vaginal prebiotic complex provides an effective restoration of the vaginal flora to the state of normocenosis compared to treatment with antibiotics/antifungal agents only.

Placental dysfunction in women at risk and threat of premature delivery

Premature birth remains one of the most urgent problems of modern obstetrics. It is not possible to reliably establish the cause in 70–80% of premature births, so the search for risk factors and markers of premature termination of pregnancy is justified. According to many authors, 25–30% of women at risk of premature birth have placental dysfunction.The objective: was to assess the prevalence of placental dysfunction in women at risk of preterm birth and with preterm birth.Materials and methods. 80 pregnant women were under observation. The criteria for inclusion in the study were the presence of risk factors for premature birth – Group I (30 women) or the threat of premature birth – Group II (30 women). The control group consisted of 20 conditionally healthy pregnant women. Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum was performed at 18–21+6 and 28–30 weeks of gestation.Results. The average age of the patients was 31.4±2.5 years, there was no significant difference in age, life history, social status, somatic pathology between the formed groups. Pregnant women of groups I and II probably had a history of pelvic inflammatory disease more often than in controls; colpitis; sexually transmitted infections; pathology of the cervix and operations on the uterus and appendages. The course of this pregnancy in most of the women of the studied cohort was complicated by the threat of termination of pregnancy, 36.7% of pregnant women of the I group and 46.7% of the II group had premature births. Signs of premature ripening of the placenta were detected in 13 (43.3%) pregnant women of the experimental cohort and in 1 (5.0%) of the control group (Р&lt;0.0001), which was accompanied by changes in parameters during dopplerometry of utero-placental blood flow. Clinical manifestations of placental dysfunction occurred in 36.7% of patients in the risk group of premature birth and pregnant women with a threat of premature birth, and were manifested by a decrease in the level of progesterone, a plateau in the increase in the level of placental lactogen. Morphological signs of placental dysfunction were found in 43.3% of cases of premature birth, which correlates with the frequency of early complications of pregnancy, primarily with the formation of retrochorial hematoma.Conclusions. Clinical manifestations of placental dysfunction (fetal growth retardation, preeclampsia) occur in a third of patients of the risk group and pregnant women with a threat of premature birth, which correlates with changes in the hormone-producing function of the placenta.

“I would never be able to forgive myself if it ended up having consequences for the child”: A qualitative study of perceptions of stress and worries among healthy first-time pregnant Danish women

BackgroundBecoming a mother is one of the most transitional experiences in life. It requires psychological, physical, and social adjustment and adaptation in various areas and can be conceived as both a stressful and joyful experience by many women. Especially, first-time pregnancies are recognised as a period of emotional sensitivity. Moreover, stress is a well-established risk factor for premature birth and low birth weight and might affect the health of the offspring. Thus, this study explores the perception of stress and worries in healthy Danish pregnant nulliparous women. MethodsWe used a qualitative, inductive, exploratory design. Three focus group interviews were conducted with 16 healthy pregnant nulliparous women. Data from the focus group interviews were analysed using content analysis according to Graneheim and Lundman. FindingsThree main categories contributed to the core theme “Identity Limbo”. The categories were: (1) The great responsibility, (2) Imagining picture-perfect, and (3) Two-in-one body. The participants expressed that holding on to their current identity was extremely important. They simultaneously tried to incorporate their new identity as mothers, which imposed sadness about saying goodbye to their old life, leaving them in an identity limbo. These women did not experience classic stressors such as bereavement, poverty, or trauma. Still, the great responsibility for the child's future, changes to their work and career, and saying goodbye to their pre-pregnancy identity were all essential contributors to feelings of stress in the women's current pregnancy and life. ConclusionOur findings suggest that the identity limbo triggered by pregnancy can make the transition to motherhood stressful for some women. Therefore, with the potentially severe consequences of stress in mind, developing tools that can help women and midwives focus on the mental transition of pregnancy is needed.

High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population

ObjectiveTo clarify high-risk factors for adverse pregnancy outcomes (APOs) in systemic lupus erythaematosus (SLE).DesignA retrospective chart review study.SettingData were collected in a tertiary medical centre, Shanghai, China, from November 2010...

Obesity and pregnancy.

Introduction: Obesity is the most frequent metabolic disturbance that can target women of reproductive age, among other population groups, and when obese pregnant women become patients, it represents a serious risk factor for both mother and fetus. Aim: The aim of this study is to offer an overview of the effects exerted by this disturbance on pregnancy. Materials and methods: The study targets 157 pacients admitted to "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Polizu (INSMC), Bucharest, Romania. In order to define the criterion for obesity, WHO classification (body mass index > 30 kg/m²) was used. Data was collected restrospectively after acceptance by the Ethics Committee. Also, we gathered anthropometric data (weight, body mass index and analysis regarding the metabolic profile, including total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, blood sugar, glycosylated haemoglobin) from all subjects. Each analysis was correlated with each patient's body mass index. Another correlation was made between metabolic profile, antenatal complications and onset of gestational diabetes and premature birth. Statistical analysis was conducted using GraphPad 8 and MedCalc 14.1. Results: Patients had an average body weight of 66.75 kg with a standard deviation of 12.99 kg and a median of 64 kg. Average body mass index was 25.05 kg/m², with a standard deviation of 5,03 kg/m² and a median of 24.2 kg/m². There is a directly proportional and statistically significative correlation between the values of blood sugar, glycosylated haemoglobin, LDL, TG, uric acid and BMI. Also, there is a inversely proportional and statistically significative correlation between the values of HDL and BMI. The CT/HDL ratio, low HDL level and elevated LDL level are the main risk factors for premature birth, while the CT/HDL ratio, low HDL level and elevated TG are the main risk factors for the onset of gestational diabetes. Conclusions: According to the results of this study, the onset of obesity in pregnant woman is rather dependent on each patient's metabolic profile than body weight.

Associação entre infecção por Chlamydia trachomatis e parto prematuro: um artigo de revisão

A Chlamydia trachomatis (CT) é a mais comum das infecções sexualmente transmissíveis (IST) por bactérias em todo o mundo. No Brasil são raros os serviços de saúde que oferecem sistematicamente a pesquisa dessa bactéria como parte de uma consulta ginecológica ou de pré-natal. O objetivo deste trabalho foi verificar a relação da Chlamydia trachomatis como um fator de risco para o parto prematuro, mediante as alterações apresentadas durante o período gravídico, e ressaltando a necessidade de medidas preventivas durante o pré-natal. Este estudo faz parte de uma revisão de literatura voltada para a possível correlação entre a infecção por CT em gestantes e o parto prematuro. Ao fazer um levantamento do perfil do estudo foi verificado que a prevalência está dentro da faixa relatada em todo o mundo. O acompanhamento no pré-natal é de grande importância para detecção e tratamento dessa IST tanto para o neonato quando para a mãe, um dos fatores que ainda implicam para esse diagnóstico precoce e de suma importância é a realização do exame como forma de rastreio que não é disponibilizado pelo SUS. Mediante os principais achados nos estudos, a infecção por CT percebe-se uma associação positiva da prematuridade.

FEATURES OF THE NEONATAL PERIOD IN PREMATURE INFANTS WITH THE BIRTH WEIGHT LESS THAN 1500 G, DEPENDING ON THE PLACENTAL CHANGES

Summary. Every year the number of preterm infants in the world and in Ukraine gradually increases - every 10th baby is born prematurely, and premature birth remains the leading cause of 50% neonatal morbidity and mortality. The general condition of this category of infants requires special knowledge and skills, psychological support, patience for both medical staff and parents, and certainly enormous material costs. This is due to the features of the neonatal period of such infants, namely the duration of respiratory support and the need for oxygen therapy, the provision of trophic and complete enteral nutrition, unstable tolerance, and the need for long-term inpatient treatment. However, all these efforts and resources don’t guarantee that the further development of premature babies will be physiological. Placental status provides an important information about explanatory factors that contributed to preterm birth, however, placental features haven’t been properly studied and the correlation between placental changes and neonatal outcomes remains poorly understood. According to the world literature, infection is one of the most important risk factors for premature birth, but the accumulation of evidence based on pathomorphological examination of the placenta and its membranes indicates that the role of specific bacterial and viral infections is not completely convincing and, as a consequence, can be less common cause of premature birth than previously suspected. Different auxiliary activities for preventing premature birth and improving the prognosis for the life and health of premature babies in later childhood’s periods are very important. A better understanding of the underlying mechanisms that regulate uterine-placental blood flow and the impact of other factors on the placenta status can improve diagnostic approaches in early pregnancy and further optimize the principles of preventive activities for both mother and baby.Aim. To establish a connection between pathomorphological changes in the placenta and the effects of premature birth.Materials and methods. A pathomorphological study of the placenta of mothers of 220 premature infants weighing less than 1500 g was performed and based on its results, 5 groups were formed according to the classification of the placental changes. The research was carried out on the basis of the Municipal non-commercial enterprise “Vinnitsa Regional Pathological bureau of Vinnitsa Regional Council” in accordance with the protocol of pathological examination of placenta (form № 013‒1 / o). The investigation was conducted with the support of the director of MNE VRPB Vinnytsia Regional Council Kholod L.P. and the head of the main department of general pathology with histological examinations Hormash P.P. The following research methods were used: macroscopy, slice staining, electronic microscopy and immunohistochemistry, etc. The health of these 220 children in the neonatal period was assessed at the stage of treatment in the Department of Anesthesiology and Neonatal Intensive Care (DANIC), and later - in the Department of Premature Newborns (DPN) of Vinnytsia Regional Children's Clinical Hospital in 2012-2018. Such clinical parameters were analyzed as gestational age, body weight, severity at birth on the Apgar scale for 1 minute, duration of respiratory support and length of hospital stay. Also the frequency of pathological conditions that caused the severity of the neonatal period was taken into account.Results. The study found that pathological changes in the placenta increase the risk of premature birth, the need for respiratory support and oxygen therapy, as well as increase the duration of inpatient treatment. The analysis of clinical indicators of 220 premature infants and pathomorphological studies of the placentas of their mothers showed that the most severe course of the neonatal period was observed in children with inflammatory changes and signs of placental immaturity. Newborns of these groups were diagnosed with a significantly higher frequency of generalized intrauterine infections and neonatal sepsis, severe CNS damage with the development of intraventricular hemorrhage and leukomalacia. The course of the neonatal period in groups of children with signs of premature placental aging and circulatory disorders was characterized by a low incidence of infections, but periventricular leukomalacia, which is an equivalent of adverse effects of preterm birth, was confirmed 5 times more often over the comparison group.Conclusions. All children included in the study had a combination of pathologies that caused the severity of the condition in the neonatal period. The condition of the placenta significantly affected the course of the neonatal period and its inherent pathologies. Thus, newborns with signs of inflammatory changes and immaturity were 10 times more likely to suffer from generalized intrauterine infections and neonatal sepsis. There were more frequent cases of intraventricular hemorrhages, leukomalacia and bronchopulmonary dysplasia in these groups of children.

Cerclaje transabdominal con abordaje laparoscópico en el primer trimestre con nacimiento a término

El parto pretérmino es una de las principales causas de muerte neonatal y de hospitalización antenatal. La insuficiencia cervical constituye un factor de riesgo para dicha patología, el objetivo del artículo es describir un caso de insuficiencia cervical manejado con cerclaje transabdominal por vía laparoscópica. Presentación del caso Paciente de 37 años con antecedente de tabique uterino corregido por histeroscopia a quien en su primera gestación se le realizó cerclaje vaginal fallido por parto pretérmino a las 24 semanas de gestación con producto fallecido por prematurez extrema. En el siguiente embarazo se le realizó un cerclaje transabdominal por vía laparoscópica, consiguiendo embarazo a término con recién nacido sano de 38 semanas de gestación y peso de 2840 gramos. Conclusiones: el cerclaje transabdominal por vía laparoscópica presenta tasas elevadas de éxito durante el embarazo, asociado a bajas complicaciones, menor perdida sanguínea intraoperatoria y menor estancia hospitalaria constituyéndose como una técnica factible y segura en pacientes con diagnóstico de insuficiencia cervical con algunas indicaciones tales como cerclaje vaginal previo fallido.

Sex-specific maternofetal innate immune responses triggered by group B Streptococci

Group B Streptococcus (GBS) is one of the most common bacteria isolated in human chorioamnionitis, which is a major risk factor for premature birth and brain injuries. Males are at greater risk than females for developing lifelong neurobehavioural disorders, although the origins of this sex bias remain poorly understood. We previously showed that end-gestational inflammation triggered by GBS led to early neurodevelopmental impairments mainly in the male rat progeny. Identifying key inflammatory players involved in maternofetal immune activation by specific pathogens is critical to develop appropriate novel therapeutic interventions. We aimed to map out the GBS-induced profile of innate immune biomarkers in the maternal-placental-fetal axis, and to compare this immune profile between male and female tissues. We describe here that the GBS-induced immune signalling involved significantly higher levels of interleukin (IL)-1β, cytokine-induced neutrophil chemoattractant-1 (CINC-1/CXCL1) and polymorphonuclear cells (PMNs) infiltration in male compared to female maternofetal tissues. Although male – but not female – fetuses presented increased levels of IL-1β, fetuses from both sexes in-utero exposed to GBS had increased levels of TNF-α in their circulation. Levels of IL-1β detected in fetal sera correlated positively with the levels found in maternal circulation. Here, we report for the first time that the maternofetal innate immune signalling induced by GBS presents a sexually dichotomous profile, with more prominent inflammation in males than females. These sex-specific placental and fetal pro-inflammatory responses are in keeping with the higher susceptibility of the male population for preterm birth, brain injuries and neurodevelopmental disorders such as cerebral palsy and autism spectrum disorders.

Smartphone-based prenatal education for parents with preterm birth risk factors

ObjectiveTo develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth. MethodsParent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18–22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use. ResultsFor pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8 h. ConclusionParents with increased risk for preterm birth may benefit from this mobile app educational program. Practice implicationsIf the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices.

Fatores de risco para o parto prematuro em uma maternidade estadual de referência

Objetivo: Analisar a presença de fatores de risco para o parto prematuro em puérperas de uma maternidade Estadual de referência. Métodos: A pesquisa é um estudo de campo de natureza exploratória descritiva, com abordagem quantitativa. Sendo desenvolvida em uma Maternidade Estadual de referência situada no município de Teresina-PI na qual teve como participantes da pesquisa 57 puérperas que tiveram seus partos prematuros entre os meses de abril e maio de 2014. A coleta de dados ocorreu após aprovação do Comitê de Ética em Pesquisa, através de informações obtidas em entrevistas com as puérperas, além da avaliação dos registros sobre seus partos, contidos nos prontuários. Posteriormente os mesmos foram analisados, digitados e tabulados no Microsoft Excel 2010, que se configura como uma ferramenta de tratamento de dados e análise estatística. Resultados: Quanto ao perfil: 35,9% tinham entre 19 e 25 anos de idade, 78,94% eram casadas ou em união estável, 26,30% ensino fundamental incompleto, 50,90% eram trabalhadoras do lar e 59,60% tinham renda de 1 a 3 salários mínimos; quanto a historia clinica: 61,40% eram primíparas, 12,28% já tinham tido parto prematuro prévio, e aborto prévio 14,03%, tiveram hipertensão arterial sistêmica durante a gestação 36,84%, bacteriúria 31,57%, e metrorragia após a 12° semana de gestação 19,29%. Observou-se ainda a presença de patologias encontradas com frequência nas puérperas que tiveram seus recém-nascidos prematuros, sendo elas: pré-eclâmpsia, eclâmpsia, oligodramnia, aminiorrexe prematura, descolamento prematuro de placenta e vulvovaginite. Conclusões: O estudo mostrou que o parto prematuro ocorre com frequência entre mulheres jovens, com situação civil estável, que não trabalham fora de casa e com baixa renda. Outro ponto observado foi a presença de parto prematuro anterior ou aborto prévio, além de problemas como bacteriúria, metrorragia, hipertensão arterial sistêmica e outras doenças que poderiam ter tido um acompanhamento melhor, diminuindo os riscos de parto prematuro.

Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.

Background:Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes.Methods:The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses.Results:The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ2 = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001).Conclusions:Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.