Threatened Preterm Labor Research Articles

UTILITY OF PLACENTAL LEUCINE AMINOPEPTIDASE/OXYTOCINASE IN THE PREDICTION OF PRETERM DELIVERY IN PREGNANT WOMEN WITH THREATENED PRETERM LABOR

Objective: The study objective was to assess the utility of placental leucine aminopeptidase (P-LAP) marker for the prediction of delivery in patients presented with threatened preterm labor (TPL).
 Setting: This study was conducted at the Obstetrics and Gynaecology Department of Al-Yarmouk Teaching Hospital in the period from March 2017 to June 2018.
 Type of Study: This is a prospective case control study.
 Methods: This study included 90 pregnant women with gestational age from (28-36+6) weeks; 45 of them who presented with preterm uterine contractions were considered as the study group which was further subdivided into three subgroups according to gestational age 28–31+6 weeks, 32– 33+6 weeks, and 34–36+6 weeks. The other 45 pregnant women who presented to the hospital for regular antenatal care visit at comparable gestational age to the study group were considered as the control group. Hence, this study aimed to assess the serum level of P-LAP in both groups and compare it between those delivered preterm from term to assess its applicability as a predictor of preterm labor.
 Results: Serum level of P-LAP in pregnant women presented with TPL was found to be significantly lower in those delivered preterm (p<0.001), compared to those continued to term and control group especially in gestational ages ≥32 weeks, while the study found P-LAP level to be statistically insignificant in gestational age <32 weeks (p=0.052). The cutoff point for P-LAP serum level was = 21 (IU/ml) that below it, the pregnant women with TPL most probably deliver before 37 weeks of gestation with Sensitivity (85.7%) Specificity (90.3%), Positive predictive value (80.0%) Negative predictive (93.3%).
 Conclusion: The serum level of P-LAP was lower in women delivered preterm than those delivered at term, so it can be used as one of the markers for the prediction of preterm delivery, especially at gestational age >32 weeks.

Can myometrial thickness/cervical length ratio predict preterm delivery in singleton pregnancies with threatened preterm labor? A prospective study.

To investigate whether myometrial thickness (MT) to cervical length (CL) ratio could be used in the prediction of preterm birth (PTB) in singleton pregnancies presented with threatened preterm labor (TPL). After 48h of successful tocolysis, MT was measured transabdominally from the fundal, mid-anterior walls and the lower uterine segment (LUS) in 46 pregnancies presented with TPL. MT measurements were divided into CL, individually. The main outcome was PTB before 37weeks of gestation. The patients were divided into two groups as women delivered ≥ 37weeks (38.68 ± 1.01weeks) (n = 25) and those delivered < 37weeks (34.28 ± 2.53weeks) (n = 21). The mean ± SD CL in the preterm delivery group was significantly shorter than the term delivery group (23.77 ± 9.23 vs 29.91 ± 7.03mm, p < 0.05). Fundal, mid-anterior or LUS MT values were similar in both groups. However, in those who delivered preterm, the ratios of fundal MT-to-CL (p = 0.026) and mid-anterior MT-to-CL (p = 0.0085) were significantly different compared to those delivered at term. The optimal cutoff values for CL, fundal MT-to-CL and mid-anterior MT-to-CL ratios in predicting PTB were calculated as 31.1mm, 0.19 and 0.20, respectively. Fundal MT-to-CL ratio predicted preterm delivery with 71% sensitivity, 72% specificity, 68% positive and 75% negative predictive values. For mid-anterior MT-to-CL ratio, respective values were 76, 76, 73 and 79%. Measurement of MT along with CL may offer a promising method in the management of women presented with TPL.

New ultrasound marker to assess the cervix when predicting preterm birth in the first trimester of pregnancy

The marker for preterm labor in routine practice at this time is only the measurement of the length of the cervix. However, the low sensitivity of this test (approximately 38 % in the first trimester of pregnancy) initiates a search for new markers of the threat of preterm labor. The indicators of the glandular zone of the cervical canal (GI, CGA, EGE), studied using statistical methods in the first trimester of pregnancy, showed the presence of a direct average correlation strength of this indicators and the term of labor, the sensitivity of 57 % with a specificity of 98,9 %. Thus, performing cervicometry during pregnancy, especially in early periods, it is necessary to evaluate not only the length, but also the structure of the cervix. The echo negative zone of the cervical canal is presented to the authors of this article as a kind of "ultrasonic marker for fibronectin" and undoubtedly requires further study.

Effect of prolonged hospitalization on fetal growth in threatened preterm labor.

We aimed to demonstrate the effect of prolonged hospitalization on fetal growth in cases of threatened preterm labor (TPL). In this retrospective cohort study, we included women who received prenatal care for TPL but delivered their child after 36 weeks of gestation. These were compared with a control group of healthy pregnant women and fetuses delivered at term. Fetal growth was compared using biparietal diameter, abdominal circumference (AC), femur length, and estimated fetal weight (EFW) assessed using ultrasonography at 18, 26, 30, and 36 weeks of gestation. Neonatal parameters at birth were also compared. In total, we enrolled 228 control women and 114 women with TPL who were treated with hospitalization,including bed rest. The AC at 30 and 36 weeks of gestation and EFW at 36 weeks of gestation were smaller in women treated with bed rest than for normal pregnant women. The mean duration of pregnancy was shorter in the hospitalization group than in the control group. Neonatal weight, length, head circumference, and chest circumference at birth were smaller after prolonged hospitalization for TPL than after normal pregnancy. Prolonged hospitalization for threatened preterm labor is associated with impaired fetal growth, particularly AC. J.Med.Invest.66:153-156, February, 2019.

The efficacy of quantitative fetal fibronectin in predicting spontaneous preterm birth in symptomatic women: A retrospective cohort study.

Recent data suggest that quantitative measurements of fetal fibronectin can be used accurately to predict increased risk of preterm birth. The purpose of this study was to demonstrate that the quantification of fetal fibronectin improves diagnostic accuracy in women who present with symptoms suggestive of threatened preterm labour (TPL) using a quantitative fetal fibronectin (qfFN) bedside analyser. This was a retrospective cohort study of pregnant women who presented between 22+6 and 32+6 weeks gestation with symptoms of TPL who had qfFN measured using the Rapid fFN Q10 system. The ability to predict spontaneous preterm birth (sPTB) within 48h, 14days and <34weeks gestation at qfFN thresholds of 10, 50 and 200ng/mL was assessed. The overall rate of sPTB <34weeks was 4.1% (n=373). For deliveries within 48h, within 14days and <34weeks, a qfFN threshold of 200ng/mL had positive predictive values of 26.7%, 42.9% and 46.7%, respectively, when compared to patients with qfFN values of 0-9ng/mL. The corresponding relative risks were 68.5, 53.8 and 38.0, respectively CONCLUSION: Quantitative fetal fibronectin testing with thresholds of 10, 50 and 200ng/mL allows for more accurate prediction of preterm birth in symptomatic women. This higher degree of discrimination allows for more directed interventions for high-risk patients and reduces the cost and burden of unnecessary treatment for low-risk patients.

The effects of antenatal corticosteroid exposure on the rate of hyperbilirubinemia in term newborns.

Objective:Neonatal hyperbilirubinemia is a short-lasting benign condition that affects approximately 60% of infants born at term infants. This study aimed to evaluate the effects of antenatal corticosteroid (ACS) exposure on the rate of hyperbilirubinemia in term newborns.Methods:This retrospective study was conducted at the Health Sciences University Kayseri Education and Research Hospital, Turkey from June 2017 to June 2018. A total of 6254 pregnant participants aged between 18 and 35 years with a singleton pregnancy were included in the study. The study group included 354 women with low-risk pregnancies (no perinatal risk except threatened preterm labor) who received ACS treatment and were hospitalized because of the threat of preterm labor before the 34th gestational week but delivered after 37 weeks of gestation. The control group was composed of 5900 women with low-risk pregnancies who did not receive ACS treatment throughout their pregnancy and delivered after 37 weeks of gestation.Results:Maternal age, mean body mass index, gestational week at delivery, nulliparity, previous cesarean history, sex of the baby, fetal weight, labor induction, vaginal delivery, and five minutes. Apgar score were similar in both groups. The neonatal hyperbilirubinemia rate was 20/354 (5.6%) in the ACS treatment group and 564/5900 (9.6%) in the control group.Conclusions:The neonatal hyperbilirubinemia was significantly decreased in term-born babies exposed to ACS before 34 weeks.

Evaluation of fetal fibronectin for threatened preterm labour in reducing inappropriate interventions.

Preterm birth is associated with significant perinatal morbidity and mortality. The fetal fibronectin test (fFN) is used to manage women presenting with threatened preterm labour (TPTL). To evaluate the use of fFN in women presenting with TPTL with regard to hospital admission, tertiary hospital transfer and use of tocolytics and steroids in our hospital, against recommended guidelines. The ability of fFN <10ng/mL, 10-49ng/mL, 50-199ng/mL and >200ng/mL to predict outcome was also examined. This was a single-centre retrospective study from January 2015 to June 2017. All women who presented to Ipswich hospital, a level two facility for births at >32weeks of gestation, between 23 and 346 weeks of gestation with TPTL and who had fFN tests were included in the study. Fetal fibronectin <50ng/mL had a negative predictive value of 93.5% (95% CI 86.5-97.1). Despite this assurance, one in four presentations resulted in hospital admission and nearly one in ten in steroids and tocolysis administration. Birth <34weeks was 0% for fFN <10 and 2% for women with fFN levels <200ng/mL compared to nearly 30% for levels >200ng/mL. There is noncompliance with use of fFN to its full potential. This small study also provides support for the use of a 200ng/mL cut-off fFN level for birth <34weeks. This would avoid the need to transfer to a tertiary facility many women who present with TPTL.

INFLUENCE OF DIFFUSE NON-TOXIC GOITER ON THE PROBABILITY OF INCREASING THE CHANCES OF COMPLICATIONS DURING PREGNANCY AND CHILDBIRTH

Diffuse nontoxic goiter is the most common form of thyroid pathology among women, which is often found during pregnancy.The aim of the study. Evaluate the probability increase the chances of complications during pregnancy and childbirth in women with diffuse non-toxic goiter.Materials and methods. A retrospective analysis of the history of labor was conducted to assess the relationship between the presence of diffuse non-toxic goiter and the occurrence of complications during pregnancy and childbirth. The estimated probability of complications in women with diffuse nontoxic goiter without disturbance functions of the thyroid gland and hypothyroidism of the thyroid gland.Results of the research. In women with diffuse non-toxic goiter, compared with persons without goiter, statistically significantly more often, there are complications during pregnancy and childbirth, accordingly, increases the chance of threat spontaneous abortion (2.77; 95% CI 2.02-3.79) and threat of preterm labor (3.44; 95% CI 2.02-5.85), occurrence of placental dysfunction (6.51; 95% CI 4.80-8.84), growth retardation of the fetus (4.65; 95% CI 2.51-8.61), preeclampsia (1.65; 95% CI 1.05-2.58), iron deficiency anemia (2.55; 95% CI 1.85-3.52), preterm labor (3.71; 95% CI 1.93-7.12), untimely discharge of amniotic fluid (1.84; 95% CI 1.36-2.49) and anomalies of labor activity (3.16; 95% CI 2.15-4.66). In women with diffuse nontoxic goiter without thyroid disturbance, in comparison with women without goiter, the chance of occurrence of placental dysfunction (4.83; 95% CI 3.45-6.77), fetal growth retardation (3.09; 95% CI 1.55-6.15), iron deficiency anemia (1.82; 95% CI 1.26-2.63), anomalies of labor activity (2.13; 95% CI 1.37-3.31), untimely discharge of amniotic fluid (1.64; 95% CI 1.16-2.31). In women with diffuse nontoxic goiter and subclinical hypothyroidism the chance of a threat of abortion (6.78; 95% CI 4.56-10.08) and preterm labor (6.53 95% CI 3.66-11.63), premature delivery (6.88; 95% CI 3.43-13.81), placental dysfunction (11.17; 95% CI 7.30-17.11), growth retardation (7.39; 95% CI 3.79-14.41), preeclampsia (2.20; 95% CI 1.29-3.74), anemia (4.10; 95% CI 2.77 -6.08),untimely withdrawal of amniotic fluid (2.20; 95% CI 1.50-3.23), anomalies of labor (5.24; 95% CI 3.35-8.19) and caesarean section (1.93; 95% CI 1.20-3.12).Conclusion. The presence of diffuse non-toxic goiter in pregnant women increases the chance of complications during pregnancy and in childbirth. The most probable chance of occurrence of complications during pregnancy and childbirth is the presence of diffuse non-toxic goiter on the background of subclinical hypothyroidism.

Are Women With Threatened Preterm Labor More Dehydrated Than Women Without It?

ObjectiveTo determine if women who present to the labor and delivery unit at 23 0/7 to 36 6/7 weeks gestation with threatened preterm labor (TPTL) are more likely to be dehydrated than women who present at the same gestational age for other reasons. DesignRetrospective cohort study. SettingAn academic medical center in the northeastern United States. ParticipantsAll women at preterm gestational ages 23 0/7 to 36 6/7 weeks who presented to the labor and delivery unit for care in 2014. MethodsWe compared hydration status by urine specific gravity of women with TPTL to that of women with other chief complaints. Women for whom data were missing and those with hypertension, diabetes, renal disease, vaginal bleeding, ruptured membranes, advanced dilation (>3 cm), multiple gestation, or fetal demise were excluded. Chi-square statistic and a receiver operating characteristic (ROC) curve were used for data analysis. ResultsA total of 840 women at 23 0/7 to 36 6/7 weeks gestation presented during the study period; 188 of these had TPTL, 261 had other chief complaints, and 391 were excluded. The proportion of women diagnosed with dehydration was similar between those with TPTL (39%) and those with other complaints (46%, p = .12). An ROC curve showed no association between TPTL and hydration status (area under the curve = 0.57, 95% confidence interval [0.46, 0.67]). ConclusionAt 23 0/7 to 36 6/7 weeks gestation, the hydration status of women with TPTL was not different from those without TPTL. Because there is no relationship, it is unlikely that hydration is a worthwhile therapy for women with TPTL, although additional prospective study is warranted.

Changes in the content of progesterone, insulin and cortisol in treatment course of pregnant women with the threat of preterm labor in chronic stress conditions

Despite the fact that many national and foreign scientific groups are working to address the issue of preterm labor, the rate of miscarriage ranges from 5.0 to 10.0 % without decreasing trend. The aim: to determine the efficacy of progesterone and thiotriazoline combination in the risk of premature birth on the basis of studying the hormonal profile dynamics and perinatal consequences. Materials and methods. Serum progesterone levels as the main hormone of pregnancy, insulin, cortisol were measured in pregnant women with the threat of preterm labor (TPL) and in the umbilical cord blood; insulin-cortisol index was calculated. Pregnant women were divided into two groups: 1 - basic (n = 22), and 2 – comparison group (n = 22). For hormonal disorders correction and pregnancy prolongation patients of basic group with TPL at 22–34 weeks of gestation received preparations of progesterone and thiatriazoline: natural micronized progesterone vaginal suppositories, 100 mg, twice-daily and0.2 g of thiatriazoline rectal suppositories 1 time per day for 10 days. Comparison group patients at the 22–34 weeks of gestation received standard treatment according to approved clinical protocols. Results: Analysis of the progesterone, cortisol and insulin blood serum baseline levels of both pregnant women study groups showed no significant difference. In the basic group the progesterone level during 10 days of treatment decreased from 162.5 ng / ml to 148.8 ng / ml (P > 0.05). There was no significant difference between the progesterone contents before and after treatment in both groups. In pregnant women the insulin level increased from 15.9 μMe / ml to 34.7 μMe / ml (P 0.05). In the comparison group the cortisol level before and after treatment did not change significantly – 536.6 ± 321.6 ng / ml and 546.5 ± 334.2 ng / ml, respectively. There was a significant increase in insulin / cortisol index from 0.027 U.M. to 0.066 U.M. (P < 0.05) in the pregnant women of the basic group after 10 days of treatment. The baseline level of insulin / cortisol index in pregnant women of comparison group, as in the basic group, was 0.027 U.M. After a week of standard therapy it significantly increased up to 0.033 U.M. (P < 0.05). There was no significant difference in the progesterone level in the umbilical cord blood of both study groups (1 – 1483 ng / ml, 2 – 1662 ng / ml). Insulin content in the umbilical cord blood in the basic group was the lowest (3.78 μMe / ml) and significantly differed from that of comparison group (4.29 μMe / ml) (P < 0.05). The levels of cortisol in the umbilical cord blood did not differ between women of the basic and comparison groups – 264.5 ng / ml versus 305.2 ng / ml. The insulin-cortisol index in all groups was not significantly different. Conclusions. In women with a risk of preterm birth the decrease in insulin and cortisol levels in the umbilical cord blood indicates the physiological adaptation to stress factors during pregnancy and the therapeutic strategy chosen effectiveness. The use of micronized progesterone in combination with antioxidants increases the stress hormonal index in the basic group by 2.5 times, indicating the proposed treatment regimen effectiveness and preventing premature birth.

МОЖЛИВОСТІ ЛІКУВАННЯ ЗАГРОЗИ ПЕРЕДЧАСНИХ ПОЛОГІВ ПРИ БАГАТОПЛІДНІЙ ВАГІТНОСТІ З ВИКОРИСТАННЯМ СУБЛІНГВАЛЬНОЇ ФОРМИ МІКРОНІЗОВАНОГО ПРОГЕСТЕРОНУ

Мета дослідження – оцінити ефективність застосування сублінгвальної форми мікронізованого прогестерону (Лютеіна) у жінок із багатоплідною вагітністю з високим ризиком загрози передчасних пологів.Матеріали та методи. Обстежено 85 вагітних із двійнятами з ознаками невиношування у термінах 22–36 тижнів вагітності, котрі склали основну групу, сформовано дві підгрупи: Іа – 43 жінки, котрі отримували в комплексі лікування загрози передчасних пологів мікронізований прогестерон сублінгвально; підгрупа Іб – 42 вагітні, які не отримували під час лікування препарати прогестерону. Ретроспективно було проаналізовано 40 історій передчасних пологів при одноплідній вагітності (група порівняння). В основній групі було проведено загальноклінічне та біохімічне обстеження вагітних, визначення вмісту в сироватці крові АЛТ, АСТ, рівнів білірубіну та прогестерону. Проведений аналіз перебігу вагітності, пологів, післяпологового періоду та стану неонатальної адаптації новонароджених в обстежуваних вагітних.Результати дослідження та їх обговорення. Доведені основні чинники ризику розвитку передчасних пологів при багатоплідній вагітності, а також роль інфекційного анамнезу, даних трансвагінальної цервікометрії, неповного обстеження та несвоєчасного початку лікування загрози передчасних пологів, недостатньої профілактики ускладнень при багатоплідній вагітності. Динаміка вкорочення шийки матки була значно повільнішою у пацієнток Іа підгрупи, яким було призначено мікронізований прогестерон, це є ефективним методом профілактики та лікування невиношування у жінок із багатоплідною вагітністю, зниження частоти пізнього аборту та передчасних пологів, перинатальних втрат. Встановлено, що в жінок основної групи рівні АЛТ та АСТ, а також загального білірубіну не відхилялися від норми. Відмічено зниження рівня прогестерону в обох підгрупах. У вагітних Іа підгрупи на тлі лікування мікронізованим прогестероном відмічалося суттєве зростання рівня прогестерону у сироватці крові вже на 3-тю добу лікування до (1109±27) нмоль/л, а до кінця першого тижня лікування цей показник зростав до рівня (1280±39) нмоль/л, тоді як у Іб підгрупі його динаміка не змінювалась ((886±29) нмоль/л та, відповідно, (891±33) нмоль/л). Використання сублінгвальної форми мікронізованого прогестерону у період вираженої клінічної симптоматики загрози передчасних пологів при багатоплідній вагітності дозволяє отримати максимально швидкий терапевтичний ефект, що сприяє швидкому усуненню клінічних симптомів, регресу ультразвукових маркерів загрози переривання вагітності та запобігає подальшому прогресуванню структурних змін з боку шийки матки.Висновки. 1. При ознаках загрози передчасних пологів застосування сублінгвальної форми мікронізованого прогестерону дає можливість швидко відновити рівень прогестерону в сироватці крові до фізіологічних показників і тим самим знизити частоту передчасних пологів та покращити перинатальні наслідки у новонароджених. 2. Застосування сублінгвальної форми мікронізованого прогестерону у вагітних із загрозою передчасних пологів не впливає на функцію печінки. 3. Комплексна терапія загрози передчасних пологів із використанням мікронізованого прогестерону має високу ефективність терапевтичної дії та може бути рекомендована для широкого використання, сприяє коротшому періоду перебування в стаціонарі, зменшенню кількості ускладнень.

PIH3 - Efficacy and Safety of Atosiban in Pregnant Women Under Threat of Preterm Labor: Systematic Review

To assess the efficacy and safety of atosiban in pregnant women under threat of preterm birth. A systematic review was carried out, inclusion criteria were adult pregnant women diagnosed with preterm labor threat with the following characteristics: regular uterine contractions lasting at least 30 seconds, contraction frequency greater than 4 every 30 minutes, cervix dilatation from 1 to 3 cm, gestational age from 24 to 33 weeks and normal fetal heart rate (110 – 160 bpm). Atosiban was set as intervention and the comparators were nifedipin, indomethacin, terbutaline, fenoterol and placebo. Assessed outcomes were: Gestational age at birth, delay in the timing of birth, neonatal mortality, neonatal respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, rate of maternal adverse events, rate of neonatal complications. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The comparison measurements found on studies were extracted in order to perform a network meta-analysis. Results were expressed through forest plots. 11 studies were included in network meta-analysis, all of them were randomized controlled clinical trials. The results showed that atosiban has the greater probability of being the most effective alternative on the following outcomes: delay in the timing of birth (0.81), neonatal mortality (0.85) and rate of maternal adverse events (0.99). Atosiban showed similar efficacy for delaying labor in women with preterm labor threat with comparators. However, it showed a greater safety profile with respect to maternal adverse events and a similar level compared to nifedipine for neonatal complications.

Effect of prolonged hospitalization for threatened preterm labor on maternal and fetal vitamin D levels.

We aimed to evaluate the effect of prolonged hospitalization for threatened preterm labor (TPL) on maternal and fetal vitamin D status. This was a retrospective cohort study, spanning 4 years, including 18 women with TPL and 36 women with normal pregnancy who received prenatal care for a singleton pregnancy at our center. TPL cases were women who were admitted to our hospital after the second trimester test for at least 28 days, during which time the third trimester test was also performed. Controls were randomly sampled from women matched for age as well as the season during which the third trimester test was performed. Serum 25-hydroxyvitamin D (25(OH)D) concentration in maternal blood was compared between the two groups at second trimester, third trimester and in the umbilical cord blood at delivery. The mean ± SD of maternal serum 25(OH)D concentration in the TPL group (14.0 ± 3.0 ng/mL) was significantly lower than that in the control group (17.8 ± 5.9 ng/mL) (P < 0.01) in the third trimester, although there was no significant difference in the second trimester (P = 0.30). There was a significant reduction (P < 0.01) in the maternal serum 25(OH)D from the second to third trimester in the TPL group, compared to the control group (P = 0.60). There was no significant difference between the two groups in umbilical cord blood 25(OH)D concentrations at delivery (P = 0.41). Prolonged hospitalization for TPL reduced the maternal vitamin D status but did not influence the neonatal status at delivery.

Efficacy of serum procalcitonin to predict spontaneous preterm birth in women with threatened preterm labour: a prospective observational study

BackgroundA hypothesis of preterm parturition is that the pathogenesis of spontaneous preterm birth (sPTB) may be associated with an inflammatory process. Based on this theory, we have hypothesized that an inflammatory biomarker, procalcitonin (PCT), may be a good predictive marker of sPTB at the admission for threatened preterm labour (TPL). The present study was aimed to investigate the association between serum PCT and sPTB in women with TPL and to evaluate whether PCT levels may predict sPTB in women with TPL within 7 or 14 days.MethodsIn a prospective observational laboratory-based study, women with singleton pregnancies, TPL between 24 and 36 weeks and intact membranes, were enrolled between January 2014 and June 2016. Participants received routine medical management of TPL (tocolysis with atosiban, antenatal corticosteroids, and biological tests at admission (C-reactive protein, white blood cell count, and PCT measured on electrochemiluminescence immunoassay)). The primary endpoint was sPTB before 37 weeks of gestation. The value of serum PCT levels to predict sPTB within 7 or 14 days were evaluated using receiver-operating curves (ROC) analysis.ResultsA total of 124 women were included in our study. PCT levels did not statistically differ between women with sPTB (n = 30, 24.2%) and controls (n = 94) (median in ng/mL [interquartile range]: 0.043 [0.02–0.07] compared to 0.042 [0.02–0.13], respectively; P = 0.56). PCT levels did not also statistically differ between women with sPTB within 7 days (n = 7, 5.6%) or 14 days (n = 12, 9.7%) after testing and controls. Moreover, subgroup analysis revealed no difference among PCT levels at admission between 24 and 28 weeks, between 28 and 32 weeks and over 32 weeks, and controls. On the basis of the receiver-operating characteristic curve, the highest sensitivity and specificity corresponded to a PCT concentration of 0.038 ng/mL, with poor predictive values for sPTB within 7 or 14 days.ConclusionSerum PCT was not relevant to predict sPTB within 7 or 14 days in women admitted with TPL between 24 and 36 weeks, and thus it is not a suitable biological marker to confirm the hypothesis of an inflammatory process associated with preterm parturition.Trial registrationClinicaltrials.gov (NCT01977079), Registered 24 October 2013.

Economic consequences of over-diagnosis of threatened preterm labor.

To investigate whether adherence to a cervical length-based protocol can reduce both unnecessary admissions and the socioeconomic costs associated with inappropriately admitted patients. The present retrospective observational study included women admitted for threatened preterm labor (TPL) at 24-34weeks of pregnancy to a tertiary hospital in the Canary Islands, 2009-2014. Data were reviewed from all patients admitted for TPL. Those with a long cervix (>25mm) were classified as "inappropriate admissions", and both the economic burden based on diagnosis-related group (DRG) and the social costs associated with sick leave for these women were calculated. During the 6-year study period, 430 women were admitted for TPL. The rate of inappropriate hospital admissions was 45% in the first year, but was reduced to 23% in the final year (P<0.001); the premature delivery rates in these years did not differ (P=0.224). The mean DRG-based cost of the admission per patient with a long cervix was EU euros €2099. The total annual costs from inappropriate admission (both social security sick leave costs and hospital costs) were estimated to be up to €571047.37 during the 6-year study period, and reduced from €60420.76 in 2009 to €29998.04 in 2014. Reductions in inappropriate admissions from applying cervical length-based management protocol could reduce healthcare costs without increasing the incidence of premature delivery.

Diagnostic Accuracy of PremaQuick versus Actim Partus in Prediction of Preterm Labor in Symptomatic Women within 14 Days

Background: Preterm labor (PTL) remains a major source of neonatal morbidity, and mortality. Currently the trans-vaginal cervical length (TVCL), and/or cervico-vaginal fetal fibronectin (fFN) are the common diagnostic tools used for prediction of PTL. Consequently, many women and their fetuses are exposed unnecessarily tocolysis and hospital admission. Objectives: This study was designed to compare the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days. Patients and Methods: Two-hundred and twenty women (220) were included in this comparative prospective study and classified into two groups: 110 women with threatened preterm labor (TPTL) in the study group, and 110 controls (no TPTL). Women included in the study were subjected to: through history, collection of the cervico-vaginal fluid (CVF) samples for assessment by PremaQuick and Actim Partus tests, followed by trans-vaginal cervical length (TVCL) assessment. Studied women managed according to the hospitals protocol, with follow-up weekly in the obstetrics outpatients’ clinic after discharge from the hospital until delivery. The main outcome measures the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days of admission. Results: PremaQuick test was significantly more specific with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (95.5% and 89.6%; respectively) compared to CL < 25 mm (56.3% and 54.6%; respectively), (P = 0.02 and 0.03; respectively). In addition, PremaQuick test was significantly more sensitive with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (39.8% and 89.6%; respectively) compared to Actim Partus (13.9% and 55.5%; respectively), (P = 0.001 and 0.01; respectively). The Odds ratio and the relative risk for prediction of PTL in symptomatic women within 14 days were significantly high for PremaQuick compared to the CL < 25 mm, and Actim Partus. Conclusion: PremaQuick test seems to be the best complementary test to the CL < 25 in prediction of PTL in symptomatic women within 14 days. PremaQuick test compensates the low specificity and low PPV of the CL < 25 mm in prediction of PTL.

Comparison of intramuscular progesterone with oral nifedipine for treating threatened preterm labor: A randomized controlled trial.

Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent. Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December 2011 to November 2012. Three hundred and fifteen singleton pregnant women aged >18 yrs at 26-34 weeks’ gestation with the diagnosis of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant. IRCT registration number of this study is IRCT201112198469N1 Results: The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery, birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p<0.05). None of the two drugs caused any major side effects. Conclusion: Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the NICU stay.

Perfil clínico de gestantes con amenaza de parto pretérmino que concluyen en parto pretérmino

Objetivo. Describir el perfil clínico de gestantes con amenaza de parto pretérmino que concluyen en parto pretermino. Materiales y métodos. Estudio observacional y descriptivo. Participaron 46 gestantes de 24 a &lt;37 semanas de gestación con amenaza de parto pretérmino cuya gestación concluyo en parto pretérmino, atendidas en el servicio de maternidad del Hospital Víctor Lazarte Echegaray—Essalud de Trujillo durante el periodo mayo a octubre del 2015.

Feasibility of 2-D ultrasound shear wave elastography of fetal lungs in case of threatened preterm labour: a study protocol

Introduction2-D ultrasound shear wave elastography (SWE) could be considered as a new noninvasive tool for monitoring fetal lung development based on evaluation of mechanical properties during pregnancy. Interesting results are...

Can stress biomarkers predict preterm birth in women with threatened preterm labor?

BackgroundPreterm birth is a major paediatric challenge difficult to prevent and with major adverse outcomes. Prenatal stress plays an important role on preterm birth; however, there are few stress-related models to predict preterm birth in women with Threatened Preterm Labor (TPL). ObjectiveThe aim of this work is to study the influence of stress biomarkers on time until birth in TPL women. MethodsEligible participants were pregnant women between 24 and 31 gestational weeks admitted to the hospital with TPL diagnosis (n=166). Stress-related biomarkers (α-amylase and cortisol) were determined in saliva samples after TPL diagnosis. Participants were followed-up until labor. A parametric survival model was constructed based on α-amylase, cortisol), TPL gestational week, age, parity, and multiple pregnancy. The model was adjusted using a logistic distribution and it was implemented as a nomogram to predict the labor probability at 7- and 14-day term. ResultsThe time until labor was associated with cortisol (p=0.001), gestational week at TPL diagnosis (p=0.004), and age (p=0.02). Importantly, high cortisol levels at TPL diagnosis were predictive of latency to labor. Validation of the model yielded an optimum corrected AUC value of 0.63. ConclusionsHigh cortisol levels at TPL diagnosis may have an important role in the preterm birth prediction. Our statistical model implemented as a nomogram provided accurate predictions of individual prognosis of pregnant women.