Term Labor Research Articles

العلاقة بين التهاب المسالك البولية والمخاض الباكر للنساء الحوامل في سوريا

Objective: The aim of this study is to determine the prevalence of urinary tract infection (UTI) in pregnant women with preterm labor. In addition to, estimating the association between UTI and occurrence of preterm labor. Patients and Methods: Descriptive Case- Control Study conducted for the period one year (June 2020 –June 2021) at Tishreen University Hospital in Lattakia- Syria. The study included 125 pregnant women without risk factors for preterm labor who were divided into case group (70): with preterm labor, and control group (55) with full term labor. Investigations for presence of UTI were performed in two groups. Results: The mean age was 25.5±5.3 years in the case group and 26.2±4.89 years in control group without significant difference. Previous history of preterm labor was more frequently in case group (17.5% vs.2.7%, p: 0.03). E.COLI was more frequently in the two groups. It was found that 16 patients (22.8%) in the case group and 4 patients (7.3%) in the control group had UTI with significant difference (p<0.05). In the multivariate regression model, UTI was significantly associated with preterm labor (OR: 3.7[1.18- 12.05], P: 0.02. Conclusion: UTI is associated with the risk of preterm labor. Therefore, early detection and treatment of the infection can reduce effectively the risk of preterm labor.

Diagnostic Accuracy of Loop-Mediated Isothermal Amplification Assay for Group B Streptococcus Detection in Recto-Vaginal Swab: Comparison with Polymerase Chain Reaction Test and Conventional Culture.

A rapid method for obtaining group B streptococcus (GBS) screening results has been required in the obstetric field. We aimed to determine the diagnostic performance of the Loop-Mediated Isothermal Amplification (LAMP) assay is acceptable compared to the existing polymerase chain reaction (PCR) assay. The study involved 527 pregnant women aged 19 to 44 years. Rectovaginal swabs were collected between 35 and 37 weeks of gestation or prior to impending preterm births or term labor without GBS screening. We presented the diagnostic performance of the LAMP assay with a 95% confidence interval (CI) compared to the PCR and microbiological culture. In total, 115 (21.8%), 115 (21.8%) and 23 (4.4%) patients showed positive results using the LAMP, PCR assay and microbiological culture method, respectively. The LAMP assay showed 100% sensitivity (95% CI, 96.8–100.0), 100% specificity (95% CI, 99.1–100.0) and 100% diagnostic accuracy (95% CI, 99.3–100.0) with the reference being the PCR assay. Meanwhile, the LAMP assay showed 87.0% sensitivity (95% CI, 71.0–100.0), 81.2% specificity (95% CI, 77.6–84.7), and 81.4% diagnostic accuracy (95% CI, 78.0–84.8) with the microbiological culture as a reference. This study presented the LAMP assay as an acceptable method for GBS screening with a similar performance to the existing PCR method.

Implications of Industry 4.0 on industrial employment: A comparative survey from Brazilian, Chinese, and German practitioners

Industry 4.0 is fundamentally changing industrial employment around the globe. Yet, the burgeoning scientific and societal discourses both highlight the need for more empirical evidence of how Industry 4.0 affects industrial employment by taking into consideration varying circumstances and preconditions. Given the heterogeneity of industrial development and technology proliferation between countries, it is crucial to understand and compare future outlooks of industrial practitioners from different regions. This study analyses how Industry 4.0 will affect industrial employment comparing practitioners’ perceptions from Brazil, China, and Germany. Moreover, in our analysis we provide insights for different industrial sectors and company sizes. The study provides evidence that the effects of Industry 4.0 on staffing requirements differ between domains. Domains generally associated with larger shares of relatively low-skilled labour are expected to experience declines in staffing requirements, suggesting an increase in the polarisation between high- and low-skilled labour in terms of job opportunities. This effect is observable especially in larger companies. Moreover, an increase in the required employee qualifications is expected in all domains. Unlike in the other two countries, the inter-sectoral variability of perceptions is very small in China. There the company size seems to have the reverse effect on required qualifications compared to Brazilian and German companies, where less respondents expect higher qualifications for SMEs. Although we find sectoral differences both within and between countries, there is no clearly discernible trend allowing for generalizable sectoral conclusions, highlighting that impacts of Industry 4.0 on qualification should be further investigated under consideration of underlying contextual factors.

Evaluation of Aetiopathogenesis of Spontaneous Preterm Parturition Syndrome: A Cross Sectional Study

Abstract Background: Preterm birth is the multifactorial condition of the pregnancy involving the same parturition pathway as term birth but the different outcome in terms of morbidity for both mother and fetus, various pathological process has been identified and need to be evaluated further. Aim: To evaluate the aetiopathogenesis of spontaneous preterm labour by analysis of maternal risk factors and placental abnormalities. Objectives: (a) To study the prevalence of spontaneous pre term labor in tertiary care centre. (b) To identify associated maternal factors both clinical as well as pathological as the probable cause of pre term labor. (c) To examine the placenta for any gross and his to pathological abnormalities associated with spontaneous pre-term labor. Settings and design: This is the cross sectional observational study carried out in a tertiary health care centre over 2 years from October 2019 to october 2021. Materials and methods: A cross sectional observational study consist of 255 pregnant women between the 20 weeks to 36 weeks 6 days of gestation fulfilling the inclusion criteria were selected excluding the women iatrogenically induced for preterm birth. The methodology and relevance of the study were explained to the women and valid informed written consent was recorded. The ethical clearance for the study obtained from ethical review committee of the tertiary care centre. During the study duration, women presenting with preterm labor were observed till delivery whether delivered or not in our tertiary care centre and finally were included in the study. The following data were collected under the heading of age, occupation, height, weight, body mass index, parity, presenting complaints of pain in abdomen per vaginal leak, par vaginal bleed, high grade fever, headache, edema, epigastric pain, blurring of vision, palpitations vomiting, weight gain, gum bleeding breathlessness, burning micturation, increased frequency of micturation, itching over genital region, dark coloured urine also including the co-morbidites such as asthma, anemia, valvular heart disease, diabetes, thyroid disorder and preeclampsia. Detailed physical examination was done, blood pressure was measured with sphygnometer, detailed per abdominal examination done with the use of measuring tape to measure fundal height, abdominal circumference, all fungal grip were palpated, per speculum examination was done to look for per vaginum discharge, per vaginal bleeding, and the high vaginal swab was taken for further evaluation. In per vaginum examination cervical changes were seen like dilatation, effacement, length. The necessary laboratory findings were done includes complete blood count to look for haemoglobin, total leucocyte count, platelet counts, urine microscopic and culture sensitivity was done to analyse the infection. Later, after the delivery the placenta was send and histopathology examination was done. Conclusion: In our study we made an attempt to identify the risk factors and associated factors involved in spontaneous preterm labor. The study able to identify the risk factors which can be potentially used for predicting outcome. Keywords: Spontaneous preterm; Multifactorial.

Immune Deviation in the Decidua During Term and Preterm Labor.

The maternal-fetal immune disorder is considered to be an important factor of preterm birth (PTB); however, the underlying mechanism is still not fully understood. This study was designed to explore the innate and adaptive immune features in the decidua during term and preterm labor. Women delivered at term or preterm were classified into four groups: term not in labor (TNL, N=19), term in labor (TL, N=17), preterm not in labor (PNL, N=10), and preterm in labor (PIL, N=10). Decidua basalis and parietalis were collected and analyzed for macrophage subtypes (M1 and M2) as well as T helper 1 (Th1), Th2, Th17 and regulatory T (Treg) cells by flow cytometry and immunohistochemistry. Our results demonstrated significantly decreased frequencies of M2 cells and elevated M1/M2 ratio in the PIL group compared to that in the PNL group in both decidua basalis and parietalis, whereas no significant differences were found between the above two groups in both sites in terms of the polarization status of Th cells. On the contrary, macrophage subsets were comparable in the TL and TNL groups, whereas elevated Th1 percentages and Th1/Th2 ratio were observed in TL women compared to that in TNL women in the decidua. Interestingly, although the frequencies and ratios of Th17 and Treg were comparable among the four groups, the Th17/Treg ratios of these groups were significantly increased in decidua basalis than that in decidua parietalis. Collectively, the M1/M2 imbalance is associated with the breakdown of maternal-fetal immune tolerance during PTB, whereas the aberrant Th1/Th2 profile plays an important role in immune disorder during term labor. Moreover, Th17/Treg deviation is more remarkable in decidua basalis than in decidua parietalis.

The comparative analysis of laparoscopic or transvaginal cerclage in pregnancies with cervical insufficiency: a retrospective cohort study.

To evaluate the efficacy and safety of prophylactic cervical cerclage by laparoscopy in pregnant women versus transvaginal way. Retrospective, monocentric cohort study was performed. The First Affiliated Hospital of Sun Yat-sen University. Cases with cervical insufficiency (defined by previous history of painless second or early third trimester pregnancy loss/losses) were selected. Laparoscopic or transvaginal cerclage were conducted. The maternal information and the neonatal data were collected and compared. The pregnancy outcomes including the incidence of full-term labor and gestational weeks at delivery were defined as the primary outcomes. Neonatal survival and birth weight, neonatal complications were evaluated as the secondary outcomes. Totally 36 twin pregnant cases and 82 singleton pregnant cases were managed with cerclage, either trans-laparoscopy (totally 78 cases) or transvaginal (totally 40 cases). Demographic characteristics showed no significant differences. Cases in laparoscopic group had a prolonged gestational age at delivery (36.43 ± 0.93weeks and 33.60 ± 2.78weeks, respectively, P < 0.001), a higher incidence of full-term labor (60.26% vs 42.50%, P = 0.05) with no significant difference of perinatal mortality (P = 0.661). Meanwhile, higher incidence of normal birth weight infants (88.46% vs 67.50%, P = 0.007) was shown in laparoscopic group with no more complications such as the cases of neonatal with Apgar < 7 (P = 0.296), and the incidence of NICU admission (P = 0.237). Besides, LTC showed good efficiency on VTC in the incidence of full-term labor: HR 0.24 (95% CI 0.070-0.85), P < 0.001. While LSC showed the similar efficiency on VSC: HR 0.734 (95% CI 0.36-1.49), P = 0.857, showing that cases with twin pregnancy may benefit more from laparoscopic cerclage. The comparative effect between laparoscopic and transvaginal cerclage in pregnant women showed that laparoscopic cerclage may be a relatively effective and safety prophylactic way for cervical insufficiency. This would be an acceptable and safe replace for traditional transvaginal cervical cerclage.

Stretch Causes Cell Stress and the Downregulation of Nrf2 in Primary Amnion Cells

Nuclear-factor-E2-related factor 2 (Nrf2) is a key transcription factor for the regulation of cellular responses to cellular stress and inflammation, and its expression is significantly lower after spontaneous term labor in human fetal membranes. Pathological induction of inflammation can lead to adverse pregnancy outcomes such as pre-eclampsia, preterm labor, and fetal death. As stretch forces are known to act upon the fetal membranes in utero, we aimed to ascertain the effect of stretch on Nrf2 to increase our understanding of the role of this stimulus on cells of the amnion at term. Our results indicated a significant reduction in Nrf2 expression in stretched isolated human amnion epithelial cells (hAECs) that could be rescued with sulforaphane treatment. Downregulation of Nrf2 as a result of stretch was accompanied with activation of proinflammatory nuclear factor-kB (NF-kB) and increases in LDH activity, ROS, and HMGB1. This work supports stretch as a key modulator of cellular stress and inflammation in the fetal membranes. Our results showed that the modulation of the antioxidant response pathway in the fetal membranes through Nrf2 activation may be a viable approach to improve outcomes in pregnancy.

Gender and Decolonisation in Zambia: Re-Examining Women’s Contributions to the Anti-Colonial Struggle

Zambia obtained its independence from British colonial rule in 1964. While significant portions of historiography focus on how the struggle was predominantly fought by men, some more recent literature examines the various ways in which women contributed to the movement. This paper re-examines women’s participation in the anti-colonial movement of the 1950s and early 1960s by taking a cue from the development studies theories of women in development, women and development, and gender and development (WID, WAD and GAD respectively). The paper uses primary interviews and archival sources to focus on specific woman-led protests and their participants to investigate how women contributed to the struggle. It assesses the ways historians have portrayed women’s participation in decolonisation through specific lenses, critiquing the historiographical framing of women’s roles in the movement. I assert that the existing literature compartmentalises women’s contributions into political and non-political endeavours, and this limits how we can understand their work. This paper addresses the question of how we can better understand women’s contributions to the Zambian independence movement by realising that historiography has framed female labour in terms of reflecting the WID and WAD paradigms and by reframing the narratives through a lens reflective of the GAD paradigm. I argue that we can see how women’s labour has been characterised in ways that prevent us from seeing the larger picture: that both men’s and women’s work were essential to dismantling colonialism. I argue that a gendered lens, which views male and female contributions together, is necessary to a comprehensive understanding of the movement.

The Bradykinin System Contributes to the Regulation of Prostaglandin-Endoperoxide Synthase 2 Expression in Human Amnion Fibroblasts: Implications for Term and Preterm Birth.

BackgroundBradykinin (BK) and its biologically active metabolite des-Arg9 bradykinin (DABK) play a pivotal role in inflammation. Since chorioamnionitis is the leading cause of preterm birth and prostaglandin E2 (PGE2) derived from the amnion is key to labor initiation, we investigated if bradykinin peptides are part of the regulatory network of PGE2 synthesis in human amnion at parturition.MethodsHuman amnion tissue was obtained from term and preterm birth for the study of the changes of the bradykinin system at parturition. Cultured primary human amnion fibroblasts, the major source of PGE2, were used to study the effects of bradykinin peptides on PTGS2 expression and PGE2 production as well as the effects of infection mediators on bradykinin receptors.ResultsBradykinin peptides and their receptors BDKRB1 and BDKRB2 were present in human amnion, and their abundance increased in term and preterm labor. However, transcripts of the genes encoding the bradykinin precursor and its proteolytic cleavage enzymes were hardly detectable in human amnion despite the increased abundance of bradykinin peptides in term and preterm labor, suggesting that there is an alternative source of bradykinin peptides for human amnion and their actions are enhanced in human amnion at parturition. In-vitro studies in cultured human amnion fibroblasts showed that both BK and DABK increased the expression of prostaglandin-endoperoxide synthase 2 (PTGS2), the rate-limiting enzyme in prostaglandin synthesis, and subsequent PGE2 production. These effects of BK and DABK were mediated through BDKRB2 and BDKRB1 receptors, respectively, with subsequent activation of the p38 and ERK1/2 pathways. Moreover, lipopolysaccharide (LPS) and serum amyloid A1 (SAA1), the important mediators of infectious inflammation, induced the expression of both BDKRB1 and BDKRB2 through toll-like receptor 4 (TLR4). Induction of BDKRB1 and BDKRB2 expression by LPS and SAA1 enhanced BK- or DABK-induced PTGS2 expression and PGE2 production in human amnion fibroblasts.ConclusionsThis study demonstrated for the first time that the human amnion is a target tissue of bradykinin peptides and the bradykinin system may be part of the regulatory network of PTGS2 expression and PGE2 production in human amnion fibroblasts at both term and preterm birth, which may be enhanced by infection.

THE ROLE OF THE CONCEPT “LABOUR” IN ENGLISH LANGUAGE ARTICLE

Today the role of English language is growing at a high speed worldwide. It is important to say that, English has already become a lingua- franca. There are a lot of words in English language. All words are special in its meaning. In this article, we would analyze the word labour in terms of its semantics. The word “labour” is very commonly used in both English literature and speech contexts. Moreover, we provide some definitions of the word “labour”.

Inflammation and Preterm Birth: A Systematic Review

Inflammatory mechanisms have a critical role in parturition, which results from a gathering of different stimuli that collectively initiate labour. In fact, a sophisticated interaction occurs between contractile and immuno-inflammatory pathways, whereby proinflammatory amplification is intensified by collaborative connections between cells, ligands, and tissues. Preterm birth (PTB) is one of the major challenges of modern obstetrics and still lacks an efficient treatment. Therefore, the scientific research of modern therapies is warranted. This systematic review aims to provide an overview of recent research into inflammation and PTB. The main inclusion criterion was articles concerning birth and inflammation, and searches were performed in the electronic databases MEDLINE, Embase, Scopus, Web of Science and Cochrane Library, from 2017 to 2021. A literature search from all databases yielded 1989 results which, applying the specified eligibility criteria, resulted in the 16 articles included in this review. Delivery is the consequence of an inequity between maternal inflammation and hormonal-driven uterine quiescence. Studies show that the distinction between term and preterm labour could consist of a pre-existing disproportion of decidual inflammatory signalling, or an unusual stimulus eliciting inflammatory pathways, comparable to both. Thus, controlling inflammation could be hopeful for detaining PTB.

Successful Peripartum Venoarterial Extracorporeal Membrane Oxygenation for Pheochromocytoma-Induced Cardiogenic Shock

We describe a 37-year-old multiparous woman with cardiogenic shock resulting from pheochromocytoma crisis. She had term labor induction after developing hypertension attributed to preeclampsia. Severe hemodynamic instability followed on postpartum day 2 requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). Suspicion for pheochromocytoma arose after a computed tomography scan showed a large adrenal mass, and the diagnosis was confirmed with plasma and 24-hour urine metanephrine levels. She initially had cardiomyopathy with left ventricular ejection fraction less then 10%, which rapidly improved, and she was successfully weaned off VA-ECMO. This patient case illustrates the clinical challenges concerning pheochromocytoma during pregnancy.

The function of nuclear hormone receptor 4A signaling in the human reproductive system: A review.

This review aims to summarize the research focused upon the functions of nuclear hormone receptor 4A (NR4A) in the human reproductive system. The research questions addressed are to decipher what role the NR4A subfamily plays in the regulation of the human reproductive system and effects upon fertility issues through regulation of the expression of the NR4A subfamily. The electronic database PubMed was searched for studies published before November 2021. Keywords included "NR4A," "trophoblast," "decidualization," "folliculogenesis," "estrogen," "pregnancy," "Leydig cells," "fertility," and "reproductive." Relevant references from retrieved manuscripts and review articles were also searched manually. NR4A subfamily are involved in trophoblast differentiation, endometrial decidualization, embryo adhesion, secretion of related hormones, and regulation of spontaneous term labor. Besides, many studies have provided strong evidence that they play critical roles in spermatogenesis. Furthermore, Multiple mechanisms can affect the expression of NR4As. Broadly, NR4A family receptors affect the human reproductive system in multiple ways. Further research is needed to specifically dissect the functions and regulatory mechanisms of these receptors and their pharmaceutical antagonists and agonists. The connection between the NR4A subfamily and a variety of reproductive disorders needs to be proven experimentally such that further examination of human tissue is required to assess the role of these receptors in human reproductive diseases.

Placental Inflammasome mRNA Levels Differ by Mode of Delivery and Fetal Sex.

Parturition signals the end of immune tolerance in pregnancy. Term labour is usually a sterile inflammatory process triggered by damage associated molecular patterns (DAMPs) as a consequence of functional progesterone withdrawal. Activation of DAMPs recruits leukocytes and inflammatory cytokine responses in the myometrium, decidua, cervix and fetal membranes. Emerging evidence shows components of the inflammasome are detectable in both maternal decidua and placenta. However, the activation of the placental inflammasome with respect to mode of delivery has not been profiled. Placental chorionic villus samples from women delivering at term via unassisted vaginal (UV) birth, labouring lower segment caesarean section (LLSCS, emergency caesarean section) and prelabour lower segment caesarean section (PLSCS, elective caesarean section) underwent high throughput RNA sequencing (NextSeq Illumina) and bioinformatic analyses to identify differentially expressed inflammatory (DE) genes. DE genes (IL1RL1, STAT1, STAT2, IL2RB, IL17RE, IL18BP, TNFAIP2, TNFSF10 and TNFRSF8), as well as common inflammasome genes (IL1B, IL1R1, IL1R2, IL6, IL18, IL18R1, IL18R1, IL10, and IL33), were targets for further qPCR analyses and Western blotting to quantify protein expression. There was no specific sensor molecule-activated inflammasome which dominated expression when stratified by mode of delivery, implying that multiple inflammasomes may function synergistically during parturition. Whilst placentae from women who had UV births overall expressed pro-inflammatory mediators, placentae from LLSCS births demonstrated a much greater pro-inflammatory response, with additional interplay of pro- and anti-inflammatory mediators. As expected, inflammasome activation was very low in placentae from women who had PLSCS births. Sex-specific differences were also detected. Placentae from male-bearing pregnancies displayed higher inflammasome activation in LLSCS compared with PLSCS, and placentae from female-bearing pregnancies displayed higher inflammasome activation in LLSCS compared with UV. In conclusion, placental inflammasome activation differs with respect to mode of delivery and neonatal sex. Its assessment may identify babies who have been exposed to aberrant inflammation at birth that may compromise their development and long-term health and wellbeing.

Validation of three models (Tolcher, Levine, and Burke) for predicting term cesarean section in Chinese population

Background: Some models predicting cesarean section (CS) have been proposed, with Tolcher, Levine, and Burke model well acknowledged. Tolcher model targets nulliparous women with term labor induction; Levine model targets women with term labor induction with intact membranes and an unfavorable cervix. Burke model targets term nulliparous woman with an uncomplicated pregnancy. Our objective was to assess the predictive performance of these three models, and to disclose the variables which may predict the risk of CS in Chinese population. Methods: A retrospective study was conducted on women with singleton, term, cephalic pregnancies at a tertiary academic center (2011–2017). A predicted probability for CS was calculated for women in the dataset by the algorithm of each model. The performance of the model was evaluated for discrimination. Univariate analysis was used to screen out the factors that may increase the risk of CS. Results: The three models predicted CS as following (expressed by an area under the receiver operating characteristic curve [AUC ROC]) (in the population defined/employed by each model): Tolcher model with AUC ROC of 0.659; Levine model with 0.697; and Burke model as 0.623. Different interventional measures or characteristics of labor were also evaluated; the nulliparous and multiparous were analyzed separately. Still, most of the results were unsatisfactory (AUC ROC &lt;0.7). Univariate analyses on the clinical parameters that may affect the incidence of CS were performed. The followings affected the incidence/probability of CS: maternal age, height, body mass index (BMI), weight gain during pregnancy, gestational age, mode of labor induction, meconium-stained amniotic fluid, presence of complications, neonatal weight/gender. Conclusion: These three models may not be suitable for predicting CS for Chinese population. Some maternal and fetal characteristics increased the risk of CS, which should be taken into account in creating some appropriate models for predicting CS in Chinese population.

Cardiotocography and Clinical Risk Factors in Early Term Labor: A Retrospective Cohort Study Using Computerized Analysis With Oxford System.

ObjectiveThe role of cardiotocography (CTG) in fetal risk assessment around the beginning of term labor is controversial. We used routinely collected clinical data in a large tertiary hospital to investigate whether infants with “severe compromise” at birth exhibited fetal heart rate abnormalities in their first-hour CTGs and/or other clinical risks, recorded as per routine care.Materials and MethodsRetrospective data from 27,927 parturitions (single UK tertiary site, 2001–2010) were analyzed. Cases were included if the pregnancy was singleton, ≥36 weeks' gestation, cephalic presentation, and if they had routine intrapartum CTG as per clinical care. Cases with congenital abnormalities, planned cesarean section (CS), or CS for reasons other than “presumed fetal compromise” were excluded. We analyzed first-hour intrapartum CTG recordings, using intrapartum Oxford System (OxSys) computer-based algorithms. To reflect the effect of routine clinical care, the data was stratified into three exclusive groups: infants delivered by CS for “presumed fetal compromise” within 2 h of starting the CTG (Emergency CS, n = 113); between 2 and 5 h of starting the CTG (Urgent CS, n = 203); and the rest of deliveries (Others, n = 27,611). First-hour CTG and clinical characteristics were compared between the groups, sub-divided to those with and without severe compromise: a composite outcome of stillbirth, neonatal death, neonatal seizures, encephalopathy, resuscitation followed by ≥48 h in neonatal intensive care unit. Two-sample t-test, X2 test, and Fisher's exact test were used for analysis.ResultsCompared to babies without severe compromise, those with compromise had significantly higher proportion of cases with baseline fetal heart rate ≥150 bpm; non-reactive trace; reduced long-term and short-term variability; decelerative capacity; and no accelerations in the first-hour CTG across all groups. Prolonged decelerations(≥3 min) were also more common. Thick meconium and small for gestational age were consistently more common in compromised infants across all groups. There was more often thick meconium, maternal fever ≥38 C, sentinel events, and other clinical risk factors in the Emergency CS and Urgent CS compared to the Others group.ConclusionA proportion of infants born with severe compromise had significantly different first-hour CTG features and clinical risk factors.

A single-cell atlas of the myometrium in human parturition.

Parturition is a well-orchestrated process characterized by increased uterine contractility, cervical ripening, and activation of the chorioamniotic membranes; yet, the transition from a quiescent to a contractile myometrium heralds the onset of labor. However, the cellular underpinnings of human parturition in the uterine tissues are still poorly understood. Herein, we performed a comprehensive study of the human myometrium during spontaneous term labor using single-cell RNA sequencing (scRNA-Seq). First, we established a single-cell atlas of the human myometrium and unraveled the cell type–specific transcriptomic activity modulated during labor. Major cell types included distinct subsets of smooth muscle cells, monocytes/macrophages, stromal cells, and endothelial cells, all of which communicated and participated in immune (e.g., inflammation) and nonimmune (e.g., contraction) processes associated with labor. Furthermore, integrating scRNA-Seq and microarray data with deconvolution of bulk gene expression highlighted the contribution of smooth muscle cells to labor-associated contractility and inflammatory processes. Last, myometrium-derived single-cell signatures can be quantified in the maternal whole-blood transcriptome throughout pregnancy and are enriched in women in labor, providing a potential means of noninvasively monitoring pregnancy and its complications. Together, our findings provide insights into the contributions of specific myometrial cell types to the biological processes that take place during term parturition.

Comparison of Effects of Companionship During Labour on The Perception of Pain and Timely Initiation of Breast-Feeding

Objective: To compare the effect of companionship in labour in terms of pain reduction in the active phase of labour and timely initiation of breastfeeding.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynecology, Holy Family Hospital, from Jan to Jul 2016.&#x0D; Methodology: Sixty-two primigravida women with singleton pregnancy and cephalic presentation presenting in the active phase of labour were allocated randomly by lottery method into the intervention companion-group and the control group without a companion. The companion-group received standardized instructions. The pain during labour was measured using the numeric rating scale. Women were interviewed in the postnatal ward one hour after the delivery for timely breastfeeding initiation.&#x0D; Results: The mean age of the intervention and the control groups was approximately similar, i.e., 25 ± 3 years. The mean pain score in the intervention group (7.27 ± 1.06) was significantly lower than the mean pain score in the control group (8.21 ± 0.81) (p=0.038). Women in the intervention group had a significantly higher frequency of timely breastfeeding initiation than women in the control group (p=0.001). There was no significant difference in pain reduction based on the relationship of the companion. However, the frequency of timely breastfeeding initiation was significantly higher (p=0.02) when the companion was the mother of the parturient.&#x0D; Conclusion: The presence of a companion during labour decreases pain and increases the frequency of timely breastfeeding initiation compared to having no companion.

Extracellular DNA levels and cytokine profiles in preterm birth: a cohort study.

The content of eight different cytokines, cell-free DNA (cfDNA) and cell-free fetal DNA (cffDNA) in women's plasma during preterm birth (PB) was studied. The purpose of this study was to identify the relationships between the investigated factors and determine their prognostic significance. Venous blood samples were collected from 45 women with PB and 35 women with full-term labor at 22-31 and 32-36weeks of gestation, as well as from 17 women during labor at 39-40weeks of gestation. The concentration of IL-2, IL-4, IL-6, IL-8, IL-10, GM-CSF, IFN-γ and TNF-α cytokines in peripheral blood plasma was measured by multiplex method. The level of cfDNA and cffDNA was evaluated using PCR analysis. It was found that, the level of IL-6, IL-8 and cfDNA in the blood was significantly increased in women with PB at 22-31weeks of gestation (p = 0.044, p = 0.001, p < 0.001) and 32-36weeks of gestation (p = 0.025, p = 0.001, p = 0.002) compared to women with physiological pregnancy at the same terms. The level of cffDNA (p = 0.014) was significantly increased in women with PB at 32-36weeks of gestation. The IL-8 content had a significant correlation with the cfDNA level in women with PB at all stages of labor and with the cffDNA level in the group who gave birth at 32-36weeks of gestation. There was no correlation between IL-8, cfDNA and cffDNA, but there was consistency with other cytokines at all studied terms and during delivery in the term-delivery group. The results of the study suggest that cfDNA is a potential marker of PB and show that the aberrant relationship between cfDNA and IL-8 may be important in the genesis of PB.

Maternal plasma lipids are involved in the pathogenesis of preterm birth.

BackgroundPreterm birth is defined by the onset of labor at a gestational age shorter than 37 weeks, and it can lead to premature birth and impose a threat to newborns’ health. The Puerto Rico PROTECT cohort is a well-characterized prospective birth cohort that was designed to investigate environmental and social contributors to preterm birth in Puerto Rico, where preterm birth rates have been elevated in recent decades. To elucidate possible relationships between metabolites and preterm birth in this cohort, we conducted a nested case-control study to conduct untargeted metabolomic characterization of maternal plasma of 31 women who experienced preterm birth and 69 controls who underwent full-term labor at 24–28 gestational weeks.ResultsA total of 333 metabolites were identified and annotated with liquid chromatography/mass spectrometry. Subsequent weighted gene correlation network analysis shows that the fatty acid and carene-enriched module has a significant positive association (P = 8e−04, FDR = 0.006) with preterm birth. After controlling for potential clinical confounders, a total of 38 metabolites demonstrated significant changes uniquely associated with preterm birth, where 17 of them were preterm biomarkers. Among 7 machine-learning classifiers, the application of random forest achieved a highly accurate and specific prediction (AUC = 0.92) for preterm birth in testing data, demonstrating their strong potential as biomarkers for preterm births. The 17 preterm biomarkers are involved in cell signaling, lipid metabolism, and lipid peroxidation functions. Additional modeling using only the 19 spontaneous preterm births (sPTB) and controls identifies 16 sPTB markers, with an AUC of 0.89 in testing data. Half of the sPTB overlap with those markers for preterm births. Further causality analysis infers that suberic acid upregulates several fatty acids to promote preterm birth.ConclusionsAltogether, this study demonstrates the involvement of lipids, particularly fatty acids, in the pathogenesis of preterm birth.