Inhibition Of Preterm Labor Research Articles

Nifedipine versus magnesium sulfate in the management of preterm labour- A randomised controlled trial

Preterm labour is the leading cause of perinatal morbidity and mortality worldwide. Preterm birth accounts for 75% of neonatal deaths and 50% of long-term morbidity including respiratory disease and neuro-developmental impairment. The use of tocolysis in women in preterm labour aims to inhibit uterine contractions and reduce perinatal morbidity and mortality associated with early delivery.To study the effect and compare the efficacy of Nifedipine and Magnesium sulphate in management of preterm labour.: This randomized controlled trial was performed on 80 women with preterm labor between 28 and 37 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. All patients were checked for successful prolongation of pregnancy who had not been delivered at 48 hours [primary tocolytics effects] and more than 7 days [secondary tocolytics effects] after beginning the treatment and side effects of tocolysis.: From 80 patients, 40 received nifedipine and 40 received MgSO4. There were no differences in suppression of labor pain in 24 hours, 48 hours and 7 days between the two groups. Even though there were no statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome between the groups neonates of MgSO4 group had more NICU admission which is significant (p value 0.049).: Oral nifedipine is as effective as magnesium sulfate with regard to inhibition of preterm labor.

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.

The importance of experience in using cervical pessary for prevention of preterm birth

Cervical pessary is a new treatment for preterm birth and have obtained a lot of space in clinical practice because its real efficacy, which unconsidered the bias produced by some research. There is a lack of evidence about cervical pessary in many aspects and only those who handle this device every day can note and call for attention. Experience is the central point about cervical pessary in this article, and important centers with training and expertise must be taken the front of this issue, because low experience probably is one of the causes of contradictory results in literature. In fact, we have a lot of aspects that need attention and never were treated because always the efficacy is questioned and do not open space for other important aspects. We have a lot of o issues to discuss during this article such as the indication of a cervical pessary, the needs of guidelines about pessary, including a learning curve of pessary treatment, the relevant aspects about insertion of the device, its association with other medications, needs for hospitalization, which is the best management for the vaginal discharge pessary related, how to handle the pelvic pain after insertion, the urinary symptoms, the obstipation, and the inhibition of preterm labor during pessary treatment, and finally, what are the relevant aspects about the withdrawal of cervical pessary?

Study the Suppression of Preterm Labor Using Human Chorionic Gonadotropin Hormone Compared with Magnesium Sulphate

Preterm labor is known as delivery prior to 37 completed weeks of gestation. Because 10% of total labors are preterm and 70% of neonatal mortality is caused by this problem, preterm labor is a significant problem in obstetrics, pediatrics & midwifery. This study aims at comparing the efficacy as well as adverse effects profile of (human chorionic gonadotropin hormone and magnesium sulphate) in suppression of preterm labor. This study was designed as a prospective comparative randomized clinical trial done from 4th April to 1st September 2020. The study population included pregnant women with preterm labor, who were admitted to Salah Al Din General Hospital, in Tikrit city. Sixty two cases who consented (Informed written consent was obtained from all the patients) were randomly allocated to 2 different intervention groups, named A and B. Group A and B consisted of 30 and 32 pregnant women, respectively. All cases were admitted in labour room and baseline investigations were done. Group A: For patients of group A: received an intravenously loading dose of 4 g (1 g/min) Magnesium sulphate. A continual infusion of 2 g per 1 hr was then administrated. The infusion was continued until 12 h of uterine quiescence is done. Group B: (32 women), intramuscular injection Human Chorionic Gonadotropin was administered as an initial dose of 5000 IU. Half hourly assessment of uterine contractions, maternal vital signs, fetal heart rate monitoring was done. All of the patients were under monitoring in the hospital until 24 h of the end of drug infusion. Also, both of the groups received Betamethasone, 12 mg every 24 hr for 2 doses. Patients were under control until the end of pregnancy. It was foun that Delay of Labour for ≥21 day was higher among Human Chorionic Gonadotropin group (68.8%) than among MgSO4 group (60%), and delivery within <2 days was higher among HCG group (9.4%) than among MgSO4 group (6.7%). The mean duration in hours from time of start of treatment with Magnesium sulphate to the contraction suppression was (2.9±0.08) lower than of the HCG treatment group (3.11±0.13). The commonest side effect of MgSO4 was thirst (50%), hyperthermia (46.67), and head ache (30%), dizziness (30%), while there is no side effect among HCG group except single case complained of head ache (3.13%), It was concluded that magnesium sulphate is better than Human Chorionic Gonadotropin in stopping preterm labour with faster onset of action than Human Chorionic Gonadotropin but had side effects for mothers more than Human Chorionic Gonadotropin.

To Determine the Safety and Efficacy of Transdermal Nitroglycerine Patch as Shortterm Tocolytic in Preterm Labor

Background and Objectives: Preterm labour complicates 5-10% of pregnancies and is a leading causeof neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life,long-term disability (cerebral palsy, blindness, deafness, chronic lung disease) and health care costs both inthe developing and the developed world.There is need for tocolytic therapy to reduce perinatal mortality and morbidity by delaying delivery at leastfor 48 hours to allow time for therapeutic effects of corticosteroidsMethodology : This study was undertaken at Sri Siddhartha medical college and hospital research centretumakuru between October 2017 to October 2019.76 Antenatal cases with gestational age 28weeks-37weeks as per the inclusion and exclusion criteria’s whowere admitted and clinically diagnosed as preterm labour were selected . The selected patients were treatedwith Nitro-glycerine patchResults : Success rate for acute tocolysis was 88.2%.Mean prolongation of pregnancy was 14.46 days andmean birth weight of babies was 2.19 kilograms. Most common side effect with Nitroglycerine patch washeadache (5.3%).Conclusion: Nitroglycerine patch is effective in suppression of preterm labor as short term tocolytic inprolongation of pregnancy. Nitroglycerine is well tolerated and safe for the mother and fetus with minorside effects

Risk Score for Prediction of Preterm Labor Inhibition Failure

Objective: To develop a risk scorecard for prediction of failure in preterm labor inhibition by selecting the most significant risk factors. Materials and Methods: Retrospective cross-sectional analytic study collected 200 medical records of pregnant women between 24⁰⸍⁷ and 33⁶⸍⁷ weeks of gestation with the diagnosis of preterm labor who received tocolytic drugs at Chonburi Hospital. The 200 data were split into train and test datasets. Seventy percent (140) were allocated for training the model. The remaining 30% (60) were for testing the model’s accuracy. The present study analyzed risk factors related to failure of preterm labor inhibition and selected those with most predictive power. Finally, a risk scorecard was developed using logistic regression. Results: The significant risk factors were age, previous preterm labor, cervical dilatation, cervical effacement, duration, and interval of uterine contraction. Models were created and tested for accuracy of prediction of failure in preterm labor inhibition. The final model achieved 90% of AUC, 89% of sensitivity, and 78% of specificity in the test dataset. These four risk factors, which are history of previous preterm labor, cervical dilatation, duration, and interval of uterine contraction, were included in the final scorecard, and ranged from 0 to100. The score of 0 means high risk and 100 means low risk of failure in preterm labor inhibition. Conclusion: The authors developed a scorecard that can accurately classify preterm labor patients into two groups, failed and successful. The model was tested and proved that it has good AUC, sensitivity, and specificity statistics. Keyword: Inhibition of preterm labor, Risk score, Tocolytic drugs

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Comparative study of oral Nifedipine tablet and transdermal Nitroglycerin patch in preterm labour

Preterm labour (PTL) is defined as the onset of labour in pregnancy from 28 weeks to 36weeks and 6 days. One of the most challenging problem of obstetrician in the era of modern obstetrics is the management of preterm labour and preterm births (PTB); Being the most common cause of perinatal morbidity and mortality PTB accounts for 70-80% of perinatal deaths. More than a million preterm infants die per year, worldwide. Aim: To Compare the Tocolytic effect of Oral Nifedipine tablet and Transdermal Nitroglycerin (TDN) patch in preterm labour and its effect on maternal and fetal outcome. Materials and Methods: It was a Double Blinded placebo controlled study conducted at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, from November 2018 to April 2019. The study population comprised of patients who attended the casualty and outpatient department. Eighty-eight women with singleton pregnancy from 28weeks to 36weeks 6 days in preterm labour with intact membranes and cervical dilatation from 1 up to 3 cm; without contraindication for tocolysis were enrolled in the study. After taking the informed consent, subjects were randomised into two groups; 46 subjects in group A received oral Nifedipine tablet, out of which 4 left the study and 46 in group B received TDN patch. The variables analysed were, delay in delivery for 48 hours, 7 days or more than 7 days, period of gestation at delivery, effect on maternal and fetal outcome and side-effect profile of drugs. Result: The percentage of women delivering after 48 hours of administration of oral Nifedipine were 66.67% and TDN patch were 76%. Failure of tocolysis, defined as delivery within 48 hours, was significantly more with Nifedipine group (8/42-19.05%) as compared to TDN patch group (3/46-6.5%). Headache was significantly higher in group B as compared to group A (p< 0.001). Maternal tachycardia was more common in group A compared to group B (p< 0.001). Conclusion: Transdermal Nitroglycerin (TDN) patch is more effective than oral tablet Nifedipine in suppression of preterm labour and prolonging pregnancy. Although the rate of side effects were more with Nitroglycerin, most common was headache which can be controlled with analgesics. Cardiovascular side effect were nil compared with Nifedipine. Nitroglycerin is well tolerated and safe for the mother and fetus.

Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor.

Two tocolytic drugs-atosiban and nifedipine-are currently used for first-line treatment of preterm labor (PTL). To compare the efficacy and safety of atosiban with nifedipine for PTL treatment. In May 2017, we searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Clinical Trials with search terms including "nifedipine", "atosiban", and "preterm labor". Randomized controlled trials of women with PTL. Data were extracted for study design, patient characteristics, risk of bias domains, and study outcomes. A random-effects model was used to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). We included seven studies that enrolled 992 patients. There was no significant difference between atosiban and nifedipine for pregnancy prolongation of 48hours or more regarding efficacy (RR 1.06, 95% CI 0.92-1.22; P=0.440) or effectiveness (0.93, 0.84-1.03; P=0.177). Pregnancy prolongation for 7days or more also did not differ between groups for efficacy (RR 1.04, 95% CI 0.89-1.21; P=0.656) or effectiveness (0.91, 0.79-1.05; P=0.177). Atosiban-however-was associated with fewer maternal side-effects than nifedipine. Atosiban resulted in fewer maternal side-effects than nifedipine, with no difference in pregnancy prolongation. PROSPERO registration: CRD42018090223.

Nifedipine Versus Magnesium Sulfate for Treatment of Preterm Labor: Comparison of Efficacy and Adverse Effects in a Randomized Controlled Trial

Objectives: The study aimed to compare the efficacy and side effects of intravenous magnesium sulfate (MgSO4) and oral nifedipine for inhibition of preterm labor. Methods: This randomized controlled trial was performed on 220 women with preterm labor between 32 and 34 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. The primary outcome was inhibition of preterm labor, defined as prevention of delivery for 48 hours with inhibition of uterine contraction, and the secondary outcome was maternal side effects. Results: From 220 patients, 110 received nifedipine and 110 received MgSO4. There were no differences in suppression of labor pain in 24 hours and 48 hours between the two groups. Also, there were not statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome, and NICU admission between the two groups. Maternal hypotension was higher in the nifedipine group, but the difference was not significant (P = 0.08). Dyspnea (P = 0.01) and minor maternal side effects (P ≤ 0.001) were significantly higher in the MgSO4 group than the nifedipine group. Serious maternal adverse effects and severe hypotension were not seen in any of the groups. Conclusions: Nifedipine is as effective as MgSO4 in arresting labor and delaying delivery for 48 hours. However, nifedipine is associated with significantly fewer maternal adverse effects.

Differing In Vitro Potencies of Tocolytics and Progesterone in Myometrium From Singleton and Twin Pregnancies.

We compared the relaxant effect of 2 known tocolytics; indomethacin and atosiban and progesterone, on pregnant human myometrial spontaneous and oxytocin-induced contractions from singleton and twin pregnancies. All agents exerted a concentration-dependent relaxant effect on myometrial contractions. There was no significant difference in the concentration-response curves between singletons and twins for progesterone or indomethacin on spontaneous contractions or atosiban on oxytocin-induced contraction. Under oxytocin however, the concentration-response curves for indomethacin and progesterone were significantly shifted to the right for both amplitude of contraction (P < .01) and activity integral (P < .01). When compared to singleton myometrium however, the concentration-response curves were significantly shifted to the right in the twin myometrium group (P < .05 progesterone and P < .001 indomethacin). We conclude that a greater concentration of progesterone and indomethacin is required to inhibit oxytocin-induced myometrial contractions in twins compared to singletons in vitro. The differences noted in the tissue pharmacologies may have implications for the successful prevention or inhibition of preterm labor in twin pregnancy.

Leukotriene receptor antagonist as a novel tocolytic in an in vitro model of human uterine contractility

ObjectiveThis study analyzed the ability of montelukast, a cysteinyl-leukotrienes receptor antagonist and anti-inflammatory agent, to produce a consistent tocolytic effect alone or in combination with nifedipine, a calcium (Ca2+) channel blocker currently used in clinical practice. Study designUterine biopsies were obtained from consenting women undergoing elective cesarean sections at term (n=20). Myometrial microsomal fractions were analyzed by immunoblotting to quantify relative cysteinyl leukotrienes receptor 1 (CysLTR1) levels. Isometric tension measurements were performed in vitro on human myometrial strips (n=120) in isolated organ baths in order to establish concentration–response curves to montelukast and to quantify changes in Ca2+ sensitivity on β-escin permeabilized tissues. ResultsImmunodetection analysis revealed the presence of CysLTR1 receptor in uterine tissues, fetal membranes and placenta. A significant increase in area under the curve (AUC) was quantified following the addition of leukotriene D4 (LTD4) (0.01–0.3μM), an end-product of the lipoxygenase pathway. Conversely, addition of montelukast produced a significant tocolytic effect by decreasing the frequency and AUC (IC50=1μM). Moreover, addition of montelukast also resulted in a reduced Ca2+ sensitivity as compared to control tissues (EC50 values of 654 and 403nM; p=0.02 at pCa 6), while an additive effect was observed in combination with 0.1nM nifedipine (p=0.004). ConclusionThis original study demonstrates the potency of montelukast as a tocolytic agent in an in vitro human uterine model. Montelukast, in combination with nifedipine, could represent a therapeutic approach to reduce inflammation associated with prematurity while facilitating the inhibition of preterm labor.

Fetal &amp; Neonatal Outcomes of the Magnesium Sulfate and Nefidipine in Suppression of Preterm Labor

Objectives: Preterm Labor occurs in 11.8% of all pregnancies and is the most etiology of Neonatal morbidity without Anomalies and after intra partum congenital Anomalies is the second etiology of Neonatal mortality that has high economic & psychiatric cost. Premature infants have Neurotic complications and they are week about physical growth, practical cognitive and lesson tasks. One of usage drugs in prevention of preterm labor is Nefidipin. Materials and Methods: This research is a Double blind RCT. All of pregnant mothers with 26-34 weeks with signs of preterm labor have come to Alzahra & Talegani hospitals were research population. Research samples were 80 pregnant women that have eligibility criteria and treated with Sulphate mg & Nefidipin. Samples allocated randomly in 2 groups by use of rand list soft ware and block of 3 and 6.In group A were used Sulphate mg 4 g first and then 2g/h for 48 h and group B were used Nefidipin 20 mg first and 20 mg /half h after. Success of treatment was measured by Partograph & checklist .Data was analyzed by statistic tests and spss ver. 13. Results: Neonatal complications such as 1 min Apgar and 5 min Apgar score, Sao2 and ABG in 2 groups, that treatment could not prevent contractions, have not significantly different. But there were significant different about Fetal complications such as bit to bit variation, decrease of fetal movement and dropt of base line of FHR (p≤ 0.05). Conclusion: Data showed that Nefidipine was more effective in comparison of Sulphate mg in suppress of uterus contractions and improve of feto-Neonatal outcomes that these will prevent further Growth & Development complications in Neonatal and this drug can be best supplement for Sulphate mg in suppress of preterm contractions of uterus. 1 MSc ,Academic Member of Nursing and Midwifery Faculty, Tabriz University of Medical Sciences , Tabriz, Iran. 2MD, Academic member of Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran. 3PhD, Academic member of Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran. Article History: Received 1 December 2013 Accepted 3 February 2014 Revised 17 January 2014 Available online 4 February 2014

Atosiban and nifedipine in the suppression of pre-term labour: A comparative study

This is a retrospective study comparing the efficacy and safety of atosiban and nifedipine in the suppression of pre-term labour. A total of 75 patients were included in this study; 34 received atosiban and 41 received nifedipine. There were no statistically significant differences in the baseline characteristics for both groups. A total of 68.3% of women in the atosiban group remained undelivered at 7 days or more, compared with 64.7% in the nifedipine group, which was not statistically significant. Average birth weight, admission to the neonatal intensive care unit and mode of delivery were similar in both groups. However, the gestational age at delivery was significantly higher in the nifedipine group. We concluded that atosiban and nifedipine are effective in delaying delivery for 7 days or more in women presenting with pre-term labour. They have the same efficacy and associated minor side-effects. However, flushing, palpitation and hypotension were significantly higher in the nifedipine group.

Progesterone versus magnesium sulfate in the management of preterm labour

Preterm labour is the leading cause of prenatal and neonatal mortality morbidity and long term neurodevelopmental problems. Diverse treatments have been employed in past to suppress preterm labour. Magnesium sulfate is often used as first line in suppression of preterm labour. Side effect of this includes thirst, hyperthermia, headache, diplopia, respiratory depression and rare cases respiratory paralysis and arrest. We take a decision that compares the ability of magnesium sulfate with progesterone in suppression of preterm labour. In this randomized clinical trial, 132 cases were chosen from pregnant women between the 26 to 34 weeks of pregnancy who were suffering from preterm contractions of uterus with intact amniotic sac and cervical dilatation of less than 4 cm. These women had been referred to obstetric ward of Ali – Ebne – Abitalib hospital, Zahedan, during the year of 2008 to 2009 and randomly were divided into two equal groups (66 cases in each group). The results were analyzed by Chi-square and T-test with SPSS software. In first group, primarily 4 g of magnesium sulfate was infused. And then 10 g (2 g/h) was continued. In second group, progesterone used 200 mg vaginal suppository as single dose. Sixty six women in magnesium sulfate group in 58 cases (89%) suppressed delivery at least for 48 h. In second group, from 66 women 52 case (79%) suppressed delivery at least for 48 h. In this study, differentiation was not significant (p value = 0.161) in two group. 95% women in first group (magnesium sulfate) had side effects and 5% women progesterone group had involved with side effects. This finding shows that the ability of progesterone in suppression of preterm labour is similar to magnesium sulfate; however, maternal side effect of magnesium sulfate was 95% while it was not for progesterone. Key words: Progesterone, magnesium sulfate, preterm labour, tocolytic.

Efficacy and Safety of Progesterone versus Magnesium Sulfate in the Management of Preterm Labor: A Randomized Study

Introduction: Preterm labor is the leading cause of prenatal and neonatal mortality morbidity and long term neurodevelopmental problems.so that different treatments have been employed in order to suppress preterm labor from several years ago. Magnesium sulfate is often used as first line in suppressing of preterm labor. Side effect of this : thirst, hyperthermia, headache, diplopia, respiratory depression and rare cases respiratory paralysis and arrest.In later pregnancy progesterone may be important in maintaining uterine quiescence by limiting the production of stimulatory prostaglandins and inhibiting the expression of contraction – associated protein genes with in the myometrium natural progesterone administrated vaginally is considered is effective in suppression of preterm birth and safe for both mother and fetus. We take a decision that compare the ability of magnesium sulfate with progesterone in suppression of preterm labor. Methods: In this randomized clinical trial 132 cases were chosen form pregnant women between the 26-34 weeks of pregnancy who were suffering from preterm contractions of uterus with intact amniotic sac and cervical dilatation of less than 4cm.these women had referred to obstetric ward of Ali – Ebne – Abitalib hospital, Zahedan, during the years of 2008-9 and randomly were `divided into two equal groups (66 cases in each group). The results were analyzed by chi square and T test with spss software. Results: In first group primarily 4 grams of magnesium sulfate infused. And then 10 grams (2grams per hours) was continued.in second group progesterone used 200 mg vaginal suppository as single dose.in first group delivery during 48 hour was failure of treatment and second group if no controlled contraction of uterus after 1 hour, changed to magnesium sulfate and this case was failured. From 66 women in magnesium sulfate group in 58 case (89%) suppressed delivery at least for 48 hours.In second group from 66 women 52 case (79%) suppressed delivery at least for 48 hours.in this study differentiation was no significant (p value=0.161) in two group. 95 percent women in first group (magnesium sulfate) had side effects and 5 percent women progesterone group had involved with side effects. Conclusion: This finding show the ability of progesterone in suppression of preterm labor is similar to magnesium sulfate however maternal side effect of magnesium sulfate was 95% while it was no for progesterone.

Inibição do trabalho de parto pré-termo: vivência de mulheres

A qualitative exploratory-descriptive research, whose objective was to understand the experience of women during the inhibition of preterm labor at the obstetric center. Data were collected through semi-structured interviews with six postpartum mothers at a maternity room in Florianopolis, SC, from August to October 2008. They were reviewed in accordance with the proposal of Collective Subject's Discourse. The Central Ideas and Discourses include the following aspects: side effects of drug uterus-inhibitors, orientation received from professionals, experienced feelings, emotional support, care received and distress reported. The side effects of drugs uterus-inhibitor influenced on feelings of ambivalence between the need to continue inhibiting and the desire of childbirth. However, after the discontinuation of clinical decision of inhibition, feelings of relief emerged. Assistance to women during the inhibition of preterm labor might value the emotional aspects as well as the distress resulting from the treatment.

PROGESTERONE AND THE CONTROL OF HUMAN PREGNANCY AND PARTURITION

Almost 80 years ago George Corner and colleagues provided the first evidence that progesterone maintains pregnancy and that it does so, at least in part, by promoting myometrial relaxation. In the 1950s, Arpad Csapo proposed the “progesterone block hypothesis”, which posits that progesterone maintains pregnancy by promoting myometrial relaxation and that its withdrawal initiates a cascade of hormonal interactions that transforms the myometrium to a highly contractile state leading to the onset of labour. Csapo later proposed that contractility of the pregnant myometrium is determined by the balance between relaxation induced by progesterone and contraction induced by a cohort of signals including oestrogens, uterine distention and stimulatory uterotonins such as prostaglandins (PGs) and oxytocin (OT). According to this “seesaw” hypothesis, progesterone promotes myometrial relaxation by directly inducing relaxation and/or by inhibiting the production of, or myometrial responsiveness to, stimulatory uterotonins. These landmark concepts, though derived from studies of experimental animals, form the foundation for current understanding of progesterone's role in the physiology of human pregnancy. Remarkable progress has been made over the last 20–30 years in understanding the signal transduction pathways through which steroid hormones affect target cells. This knowledge has broadened the scope of Csapo's original paradigms and we are now beginning to unravel the specific signaling pathways and molecular interactions by which progesterone affects human myometrium and how its actions are controlled at the functional level. This is important for the development of progestin-based therapeutics for the prevention or suppression of preterm labour and preterm birth. Here we review recent progress in understanding the mechanisms by which progesterone sustains pregnancy and in particular how it promotes myometrial relaxation, how its relaxatory actions are nullified at parturition, and the hormonal interactions that induce progesterone withdrawal to determine the timing of human birth.

A Comparison of Human Chorionic Gonadotropin with Magnesium Sulphate in Inhibition of Preterm Labor

A Comparison of Human Chorionic Gonadotropin with Magnesium Sulphate in Inhibition of Preterm Labor

Evaluation of the pregnancy prolongation index (PPI) as a measure of success of obstetric interventions in the prevention of preterm birth and associated morbidities

This study was undertaken to evaluate the validity of the pregnancy prolongation index (PPI) as a measure of preterm labor treatment success. Analysis of prospectively collected maternal and neonatal data from a national clinical database (Matria Healthcare). Included were patients with singleton, twin, and triplet pregnancies who had outpatient surveillance initiated between 18 and 34 weeks and delivered at 24 to 36 6/7 weeks' gestation with NICU admission. Each patient's PPI score was calculated via the following equation: [(gestational age at delivery - gestational age at start of treatment) / (37.0 - gestational age at start of treatment)] x 100%. The impact of increasing PPI score was measured against NICU length of stay as a surrogate gauge of neonatal morbidity. Data were further stratified by gestational type and reason for delivery. Pregnancy outcomes of 12,642 patients (6,642 singletons, 4,326 twins, and 1,674 triplets) were analyzed. The PPI score increased in a direct, inverse linear relationship with decreasing number of NICU days. The PPI is a sensitive measure for the evaluation of treatment success in the inhibition of preterm labor and delivery.