Women In Term Labor Research Articles

Hsa-miR-3928–3p targets the CCL3/CCR5 axis to induce amniotic epithelial cell senescence involved in labor initiation

IntroductionSenescence in human amniotic epithelial cells (hAECs) and increased sterile inflammation in the amniotic cavity can lead to the initiation of term labor (TL). We investigated the possible roles of hsa-miR-3928–3p and chemokine ligand 3 (CCL3) in labor initiation and the underlying molecular mechanisms. MethodsMicroarray chip screening was used to analyse the differential expression of miRNAs in amniotic fluid exosomes from women in TL and term not-in-labor. The GEO and miRWalk databases were used to identify differential genes, and a dual luciferase assay was used to verify the relationship. Reverse transcription quantitative PCR (RT-qPCR) and immunofluorescence were used to determine the expression and localization of CCL3/CCR5 in fetal membranes. RT-qPCR and western blotting were used to detect the expression of CCL3/CCR5 in hAECs with hsa-miR-3928–3p knockdown/overexpression. Cell counting kit 8, flow cytometry, EdU proliferation, senescence-associated β-galactosidase, and enzyme-linked immunosorbent assays were performed to detect the impact of hsa-miR-3928–3p on hAEC function. Resultshsa-miR-3928–3p expression was downregulated in TL. CCL3 (macrophage inflammatory protein-1α) was identified as a differentially expressed target gene. hsa-miR-3928–3p targeted the 3′ UTR of CCL3. Downregulation of hsa-miR-3928–3p expression increased CCL3 expression. CCL3, via its CCR5 receptor, decreased the proliferation, but increased the senescence, apoptosis rate, secretion of inflammatory factors (IL-8, TNF-α, and IL-6), and expression of senescence-associated protein p21 in hAECs. Discussionhsa-miR-3928–3p negatively regulates CCL3, promoting hAEC senescence through the CCL3-CCR5 axis and inducing signals for labor initiation. These findings provide novel insights for labor initiation in clinical settings.

Chemokine and cytokine profiles in preterm and term labor, in preterm prelabor rupture of the membranes, and in normal pregnancy

The objective of this study was to investigate the immune mechanisms involved in preterm labor (PTL), preterm prelabor rupture of the membranes (PPROM), and normal pregnancies. The second objective was to explore immune profiles in PTL for association with early ( < 34 gestational weeks (gw)) or instant ( < 48 h) delivery.This prospective observational multi-center study included women with singleton pregnancies with PTL (n = 80) or PPROM (n = 40) before 34 gw, women with normal pregnancies scheduled for antenatal visits (n = 44), and women with normal pregnancies in active labor at term (n = 40). Plasma samples obtained at admission were analyzed for cytokine and chemokine quantification using a multiplex bead assay in order to compare the immune profiles between PTL, PPROM, and normal pregnancies.In PTL, CXCL1 and CCL17 were significantly higher compared to gestational age-matched women at antenatal visits, whereas for PPROM, CXCL1 and IL-6 were increased. Women in term labor had a more pronounced inflammatory pattern with higher levels of CXCL1, CXCL8, and IL-6 compared with PTL (p = 0.007, 0.003, and 0.013, respectively), as well as higher levels of CCL17, CXCL1 and IL-6 (all p < 0.001) compared with the women at antenatal visits. In PTL, CXCL8 was higher in women with delivery before 34 gw, whereas CXCL8, GM-CSF, and IL-6 were significantly higher in women with delivery within 48 h.To conclude, PTL and PPROM were associated with a complex pattern of inflammation, both involving Th17 (CXCL1) responses. Although further studies are needed, CXCL8, GM-CSF, and IL-6 may be potential candidates for predicting preterm birth in PTL.

Accuracy of Leopold's Maneuver Compared to Ultrasound in Estimating Fetal Birth Weight [12B

INTRODUCTION:Estimation of fetal birth weight is a critical data point that can affect the management of women in term labor. However, the superior method of estimating fetal birth weight (EFW) using Leopold's maneuvers versus ultrasound continues to be debated. This study aimed to compare the accur

Accuracy of Clinical Estimated Fetal Weight at Term and Effect on Clinical Management [30C

INTRODUCTION: Although Obstetrics/Gynecology residents are faced with learning a wide variety of complex skills during their training, clinical estimation of fetal weight (EFW) via Leopold's maneuvers, despite the surrounding controversy of use, is a relatively simplistic skill. We wanted to determine the correlation of clinical EFW with actual birth weight (BW) in term pregnancies, and determine if this knowledge had an impact on length of labor or mode of delivery. METHODS: Retrospective chart review of singleton pregnancies between 37 and 42 weeks, admitted for labor and delivery were randomly selected, between 2013 and 2016. For 80% power, 452 women were needed to detect a difference of 10% between EFW and BW. The statistical tests used were Pearson and Spearman-Rho Correlation, Mann Whitney-U Tests and Chi Square test as appropriate. RESULTS: Of 497 women randomly selected, 9 were excluded for missing data. The mean age of was 26.8 (+/- 6.1); 33% were African American, 30% Hispanic, 27.5% White; with macrosomia rate of 7.5%. EFW had a significant, moderate positive correlation with BW (r =.43, p&lt;.001). The accuracy of EFW within 20% of actual BW was 89.2%. A significant relationship between mode of delivery and EFW noted (20.3% cesarean delivery in &lt;8 lbs group while 10.5% in &lt;8 lbs) (p=0.014). However, estimating a larger EFW did not prolong labor (367[219-580] vs 426[223-630] minutes respectively) (p=0.26). CONCLUSION: Continued practice and reinforcement of recording EFW, as part of physical examination, provides clinicians with an accurate and important tool that can aid in management of women in term labor.

Cyclooxygenase inhibitors for treating preterm labour? What is the evidence?

BackgroundPreterm labour, a condition characterized by regular uterine contractions and cervical dilation prior to 37 weeks of pregnancy can result in premature birth of babies that may not be fully developed and/or possess serious health problems such as cerebral palsy and learning disabilities. Is associated with an increase in uterine prostaglandins (PGs) synthesis by cyclooxygenase (COX) enzymes which promotes inflammatory and contractile processes that drive labour. For this reason, COX inhibitors (e.g. indomethacin) have been used to treat/prevent preterm labour. Despite limited success, tocolysis by COX‐inhibition carries serious adverse fetal effects due to inhibition of prostaglandin‐dependent developmental homeostatic functions. The more recent discovery of a second, inducible COX isoform, COX‐2, presented an opportunity to spare homeostatic prostaglandin by selective inhibition of COX‐2. However, subsequent clinical studies have called into question the appropriateness of COX‐2 selective inhibition. This study reviewed the molecular evidence concerning the role of COX‐2 in human parturition that underpins the rationale of use of COX‐2 inhibitors in the treatment of preterm labour and presents evidence of COX‐2 gene expression in term and preterm human myometrium.MethodsFor our systematic literature review, we searched MEDLINE and EMBASE databases to identify papers reporting molecular evidence of COX enzyme expression and activity in gestational tissues at term and preterm. Two independent reviewers evaluated abstracts, and qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. COX‐2 gene expression analysis was conducted on samples of myometrium and decidua from women at term (after 37 weeks) and preterm (below 37 weeks) of gestation, with and without labour using reverse transcriptase‐polymerase chain reaction technique (RT‐PCR).ResultsThirty‐five studies were included in the review. Eight studies on fetal membranes (amnion and chorion) reported significantly higher COX expression or activity with labour. However, in the myometrium and decidua, which are the most relevant therapeutic target tissues for uterine contraction, nine reported no labour‐associated differences COX expression. In the myometrium, four studies reported higher levels of COX mRNA with labour, but did not consider protein expression. Our data show spatial (upper versus lower segment) and temporal (labour versus non‐labour) demonstrate differences in COX‐2 expression; at term, expression of COX‐2 is higher in lower segment myometrium and decidua samples from women in term labour (n=16) compared to term non‐labour (n=18), but no significant differences were observed for upper segment samples. Similarly, COX‐2 expression was higher in lower segment preterm labourThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

High bisphenol A (BPA) concentration in the maternal, but not fetal, compartment increases the risk of spontaneous preterm delivery

Objective: The objective of this study is to determine if BPA exposure, as measured by maternal plasma (MP) and amniotic fluid (AF) BPA concentrations is associated with an increased risk of spontaneous preterm birth (PTB) and preterm premature rupture of membranes (pPROM).Methods: In this nested case–control study, MP samples from women in term labor (n = 30), preterm labor that ended with preterm delivery (n = 25), or who had pPROM (n = 30) and amniotic fluid samples from term labor (n= 45), preterm labor (n = 60), and pPROM (n = 35) were assayed for BPA by enzyme immunoassay.Results: BPA was detectible in 100% of MP and AF samples. Women with MP BPA concentrations in the fourth quartile were at increased risk of PTB (cOR = 4.12, 95% CI = 1.32–12.87; aOR = 4.78, 95% CI = 1.14–20) but not pPROM. High (fourth quartile) AF BPA values also tended to increase the risk of pPROM (cOR = 2.47, 95% CI = 0.96–6.37) but results were not statistically significant.Conclusions: Increased BPA concentration is associated with an increased risk for PTB or pPROM depending on the maternal–fetal compartment(s) affected. High MP plasma BPA concentrations are associated with PTB with intact membranes but high AF BPA concentrations may weakly be associated with pPROM.

Clinical chorioamnionitis at term II: the intra-amniotic inflammatory response.

Recent studies indicate that clinical chorioamnionitis is a heterogeneous condition and only approximately one-half of the patients have bacteria in the amniotic cavity, which is often associated with intra-amniotic inflammation. The objective of this study is to characterize the nature of the inflammatory response within the amniotic cavity in patients with clinical chorioamnionitis at term according to the presence or absence of 1) bacteria in the amniotic cavity and 2) intra-amniotic inflammation. A retrospective cross-sectional case-control study was conducted to examine cytokine and chemokine concentrations in the amniotic fluid (AF). Cases consisted of women with clinical chorioamnionitis at term (n=45). Controls were women with uncomplicated pregnancies at term who did not have intra-amniotic inflammation and were in labor (n=24). Women with clinical chorioamnionitis were classified according to the results of AF cultures, broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry, and AF concentration of interleukin-6 (IL-6) into those: 1) without intra-amniotic inflammation, 2) with microbial-associated intra-amniotic inflammation, and 3) with intra-amniotic inflammation without detectable bacteria. The AF concentrations of 29 cytokines/chemokines were determined using sensitive and specific V-PLEX immunoassays. 1) The AF concentrations of pro- and anti-inflammatory cytokines/chemokines such as interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), macrophage inflammatory protein-1 beta (MIP-1β), and interleukin-8 (IL-8) (except Eotaxin-3) were significantly higher in women with clinical chorioamnionitis at term than in controls (term labor without intra-amniotic inflammation); 2) patients with microbial-associated intra-amniotic inflammation, and those with intra-amniotic inflammation without detectable bacteria, had a dramatic differential expression of cytokines and chemokines in AF compared to patients with spontaneous labor without intra-amniotic inflammation. However, no difference could be detected in the pattern of the intra-amniotic inflammatory response between patients with intra-amniotic inflammation with and without detectable bacteria; and 3) in patients with clinical chorioamnionitis at term but without intra-amniotic inflammation, the behavior of cytokines and chemokines in the AF was similar to those in spontaneous labor at term. Patients with clinical chorioamnionitis who had microbial-associated intra-amniotic inflammation or intra-amniotic inflammation without detectable bacteria had a dramatic upregulation of the intra-amniotic inflammatory response assessed by amniotic fluid concentrations of cytokines. A subset of patients with term clinical chorioamnionitis does not have intra-amniotic infection/inflammation, as demonstrated by elevated AF concentrations of inflammation-related proteins, when compared to women in term labor with uncomplicated pregnancies, suggesting over-diagnosis. These observations constitute the first characterization of the cytokine/chemokine network in the amniotic cavity of patients with clinical chorioamnionitis at term.

Frequency of Fetal Heart Rate Categories and Short-Term Neonatal Outcome

To estimate the time spent in each fetal heart rate category during labor and during the last 2 hours before delivery in term singleton pregnancy and to estimate the relationship between the time spent in each category and short-term neonatal outcomes. This study reviewed fetal heart rate data and newborn outcomes of women in term labor in 10 hospitals over 28 months. Fetal heart rate characteristics were assessed by labor and delivery nurses, and categories were assigned by computer using definitions from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The duration of time in each category was calculated and correlated with newborn outcome. Forty-eight thousand four hundred forty-four patients were identified. Considering all of labor, category I was present 77.9% of the time, category II was present 22.1% of the time, and category III was present 0.004% of the time. In the last 2 hours before delivery, category I decreased to 60.9% of the duration, category II increased to 39.1%, and category III increased to 0.006%. Newborns of women whose last 2 hours were exclusively category I did well; only 0.6% had 5-minute Apgar scores less than 7, and 0.2% had low Apgar scores with neonatal intensive care unit (NICU) admission. When more than 75% of the last 2 hours was category II, low 5-minute Apgar score increased to 1.3% of patients, and low 5-minute Apgar score with NICU admission increased to 0.7% (both P<.001). Category I and category II fetal heart rate patterns are common in labor, and category III patterns are rare. Increasing time in category II in the last 2 hours of labor is associated with increased short-term newborn morbidity. III.

A molecular signature of an arrest of descent in human parturition

This study was undertaken to identify the molecular basis of an arrest of descent. Human myometrium was obtained from women in term labor (TL; n = 29) and arrest of descent (AODes; n = 21). Gene expression was characterized using Illumina HumanHT-12 microarrays. A moderated Student t test and false discovery rate adjustment were applied for analysis. Confirmatory quantitative reverse transcription-polymerase chain reaction and immunoblot were performed in an independent sample set. Four hundred genes were differentially expressed between women with an AODes compared with those with TL. Gene Ontology analysis indicated enrichment of biological processes and molecular functions related to inflammation and muscle function. Impacted pathways included inflammation and the actin cytoskeleton. Overexpression of hypoxia inducible factor-1a, interleukin -6, and prostaglandin-endoperoxide synthase 2 in AODes was confirmed. We have identified a stereotypic pattern of gene expression in the myometrium of women with an arrest of descent. This represents the first study examining the molecular basis of an arrest of descent using a genome-wide approach.

Modified Ritgen’s Maneuver for Anal Sphincter Injury at Delivery

To investigate whether Ritgen's maneuver decreases the risk of third- to fourth-degree perineal tears compared with simple perineal support. A total of 1,623 nulliparous women in term labor, singleton pregnancy, and cephalic presentation were randomly assigned to Ritgen's maneuver or standard care. Ritgen's maneuver denotes extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery. Ritgen's maneuver was performed during a uterine contraction, rather than, as originally recommended, between contractions. Our standard care entailed perineal support with one hand and control of the speed of crowning with the other, and use of Ritgen's maneuver only on specific indications. Women delivered by cesarean delivery (n=10) or instrumentally (n=142) were excluded, as well as 39 erroneously included women (parous or in preterm labor), six inaccurately assigned participants, one with missing data, and two participants who withdrew consent. For the remaining 1,423 women, the result was analyzed according to intention to treat. Ritgen's maneuver was performed in 554 (79.6%) of 696 women randomly assigned to this procedure and in 31 (4.3%) of 727 women randomly assigned to simple perineal support. The rate of third- to fourth-degree tears was 5.5% (n=38) in women assigned to Ritgen's maneuver and 4.4% (n=32) in those assigned to simple perineal support (relative risk 1.24; 95% confidence interval 0.78-1.96). Ritgen's maneuver does not decrease the risk of anal sphincter injury at delivery, at least not when performed during a contraction.

A prospective randomized trial of acute tocolysis in term labour with atosiban or ritodrine

Objective To study the effects of the tocolytics atosiban and ritodrine in term labour. Study design Women in term labour, requiring acute tocolysis, were prospectively randomized for treatment with either atosiban i.v. ( n = 70) or ritodrine i.v. ( n = 70). There were three indications for acute tocolysis: (1) fetal distress followed by continuation of labour, (2) fetal distress followed by emergency caesarean section (CS), and (3) arrest of contractions in women waiting for a secondary CS in the absence of fetal distress. Primary endpoints were maternal blood pressure (MBP) and maternal heart rate (MHR). Secondary endpoints were intra-uterine pressure, fetal heart rate (FHR), 5′-Apgar score and umbilical arterial pH. Results Baseline characteristics did not differ between the study groups. The ritodrine group showed a significant rise in MHR ( p < 0.001), MHR remained unaltered in the atosiban group ( p = 0.31). No significant changes occurred in systolic and diastolic BP in either group. FHR rose by a maximum of 11.6 bpm (8.5%) in the ritodrine group ( p < 0.001) compared to a rise of 4.9 bpm (4.8%) in the atosiban group ( p = 0.27). No differences were found in blood loss and fetal outcome. Compared to baseline, uterine pressure was reduced by a maximum of 55% ( p < 0.001) after ritodrine administration, compared to a maximal reduction of 54% ( p < 0.001) after atosiban administration. These effects did not differ between the two treatment groups. Conclusion Considering the maternal effects, our results suggest a possible role for atosiban bolus in acute tocolysis in term labour.

Interobserver agreement in intrapartum estimation of fetal head station

Objective To determine interobserver agreement in estimation of fetal head station during labor, and the determinants of agreement. Methods A prospective study of fetal head station in 508 women in term labor. Vaginal examination of station was performed by a researcher at the same time as clinicians performed routine intrapartum assessments of the participants. Station 0 was considered to represent engagement. Results Station could be estimated by both the researcher and clinicians in 446 women (88%). The kappa statistic for agreement was 0.23 (95% confidence interval, 0.17–0.29). There was agreement in 166 cases (37%) and disagreement by 1 cm in 208 (47%) cases. Agreement was best (50%) when the researcher assessed the head at station minus 1. Multiple regression analysis showed that agreement was not influenced by level of experience of the attending clinicians, nor by obstetric factors. Conclusion Estimation of station as a method of determining the level of the fetal head in labor appears imprecise and poorly reproducible.

Level of fetal head above brim: Comparison of three transabdominal methods of estimation, and interobserver agreement

SummaryThis study compared three intra-partum transabdominal methods of estimating the level of the fetal head above the brim, and determined interobserver agreement in fifths estimation of the fetal head. The researcher examined 508 women in term labour and estimated level of head in fifths by the Crichton method, in fifths by the Notelowitz finger-breadth method, and by symphysis-to-sinciput measurement (SSM). The attending clinicians also made their estimates, using the methods of their choice. Two-fifths of head or less was considered engaged. When two-fifths was palpable by the Crichton method, the Notelowitz method gave a mean of 2.40 fifths. The researcher and clinicians agreed on the level of head in 42.9% of examinations. Interobserver agreement was poor (kappa = 0.22). In conclusion, the Crichton method overestimates head descent in comparison with the Notelowitz method. SSM was easy to perform but requires validation. The fifths method of determining level of head appears inexact and poorly reproducible.

High vaginal swab cultures in normal and preterm labor

Previous studies have shown that ascending intrauterine infection is one of the major causes of preterm birth and fetal infection. Which microorganism is associated with preterm labor is still a matter of conflicting reports. Reports about the prediction of intrauterine and fetal infection from lower genital tract cultures are also not consistent. The aim of this study is to find out whether any specific microorganism is associated with preterm birth and whether high vaginal swab (H.V.S) cultures can be used to predict fetal infection. The study took place at Abha Maternity Hospital between September 1999 and June 2000 after approval by the hospital ethics committee. High vaginal swabs were taken from 132 women in preterm labor or preterm premature rupture of the membranes (24–36 weeks gestation) and from a control of 136 women in term labor (=37 weeks). The swabs were cultured aerobically and anaerobically and bacteria identified using conventional methods. After delivery newborns who were admitted to the neonatal intensive care unit were also bacteriologically investigated by blood culture and surface bacteriology. (excerpt)

Maternal serum interleukin‐6, interleukin‐8, tumor necrosis factor‐α and interferon‐γ in preterm labor

Background. To find out whether preterm labor is associated with raised maternal serum concentrations of interleukin (IL)‐6, IL‐8, tumor necrosis factor alpha (TNF‐α) and interferon gamma (IFN‐γ) and whether the measurement of these cytokines can be used to detect early intrauterine infection in preterm labor.Methods. Cross‐sectional study: 77 women in preterm labor, 47 controls of healthy preterm women not in labor and 19 women in term labor. The serum cytokines levels were measured by enzyme‐linked immunosorbent assay (ELISA). The newborns of women who were in labor were followed up for evidence of infection. Differences between groups were tested using analysis of variance, Student's t‐test and χ2‐test.Results. There was no significant difference in the concentration of all the cytokines measured between the different groups. No statistical difference was found in the concentration of the cytokines between women in preterm labor with ruptured membranes and those with intact membranes. There was also no difference found in the concentration of cytokines between women whose newborns had positive bacterial culture and those with negative culture. There was a positive correlation between the concentrations of IL‐6, IL‐8 and TNF‐α.Conclusion. Serum levels of interleukin‐6, interleukin‐8 and tumor necrosis factor‐α were not increased in preterm labor compared to normal control women. There is doubt regarding the usefulness of maternal serum measurement of these cytokines for the detection of early fetal infection in preterm labor, but this needs further evaluation.

Maternal serum interleukin-6, interleukin-8, tumor necrosis factor-α and interferon-γ in preterm labor

To find out whether preterm labor is associated with raised maternal serum concentrations of interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) and whether the measurement of these cytokines can be used to detect early intrauterine infection in preterm labor. Cross-sectional study: 77 women in preterm labor, 47 controls of healthy preterm women not in labor and 19 women in term labor. The serum cytokines levels were measured by enzyme-linked immunosorbent assay (ELISA). The newborns of women who were in labor were followed up for evidence of infection. Differences between groups were tested using analysis of variance, Student's t-test and chi2-test. There was no significant difference in the concentration of all the cytokines measured between the different groups. No statistical difference was found in the concentration of the cytokines between women in preterm labor with ruptured membranes and those with intact membranes. There was also no difference found in the concentration of cytokines between women whose newborns had positive bacterial culture and those with negative culture. There was a positive correlation between the concentrations of IL-6, IL-8 and TNF-alpha. Serum levels of interleukin-6, interleukin-8 and tumor necrosis factor-alpha were not increased in preterm labor compared to normal control women. There is doubt regarding the usefulness of maternal serum measurement of these cytokines for the detection of early fetal infection in preterm labor, but this needs further evaluation.

Use of McRoberts' position during delivery and increase in pushing efficiency

McRoberts' position is used during the second stage of labour to facilitate delivery of the fetal shoulders. Few clinical studies have been done to measure its efficacy. We measured intrauterine pressure in 22 women in term labour, after the vertex reached 3+ station, in the dorsal lithotomy position. Patients pushed with legs either in stirrups or hyperflexed by 1358 (McRoberts' position). Maternal valsalva transiently increased the expulsive force by 32% over naturally occurring contractions. Use of McRoberts' position almost doubled the intrauterine pressure developed by contractions alone (from 1653 mm Hg s to 3262 mm Hg s [97%]).

Association between epidural analgesia and intrapartum fever.

The objective of this paper is to determine whether or not epidural analgesia is an independent risk factor for intrapartum fever. Maternal temperature was measured every 4 h during labor to 1004 consecutive women in term labor. Women with fever or on antibiotics were excluded. Epidural analgesia was administered upon patients' request. Of the 406 (40%) women who received epidural analgesia, 11.8% (n = 48) developed a fever > or = 37.8 degrees C during labor compared with only 0.2% (n = 1) of women not receiving epidural analgesia. Women who received epidural analgesia were more likely to have one or more risk factors for intrapartum infection. Their labor and ruptured membranes were longer, they were more likely to have internal monitoring and have more vaginal examinations. Compared with women who received epidural analgesia and did not develop intrapartum fever, women that did develop fever had longer epidurals and more risk factors for infection. However, in a logistic regression analysis with fever as dependent variable, only the duration of epidural was significantly associated with the occurrence of fever. The rate of fever increased with longer labors, from 5% with labor < 3 h to 28% with labor > 6 h. In 90% of women the fever resolved within a few hours after delivery. Sepsis evaluation was negative in all of the newborns to mother who had intrapartum fever. Our data support a noninfectious etiology for intrapartum fever in the vast majority of our patients. However, infection must be ruled out before a decision is made to withhold antibiotic therapy.

Interleukin 1beta in serum of women with preterm uterine contractions

Preterm delivery is a major obstetric and public health problem, accounting for 50-70% of all perinatal deaths. An enzyme-linked immunoassay (ELISA) test was used to determine serum interleukin 1b (IL-1b) levels in 32 women with preterm contractions compared with 26 women in term labour and 11 normal preterm pregnant women. Women with preterm contractions (with or without treatment) had significantly lower mean serum levels of IL-1b (23.5 pgr/ml) compared with women in term labour (218 57 pgr/ml), but similar levels to pregnant women not in labour at the same weeks of gestation.

Endocervical Pathogens in Women with Preterm and Term Labour

The purpose of this study was to compare the endocervical microflora of women in preterm and term labour and to determine whether the presence of a specific microflora is significantly associated with preterm labor. A prospective study was performed in Lithuania among 212 women in preterm labour (latent phase, n = 110; active phase, n = 102) and among 62 healthy women in term labour. Microbiological assessment included cultures for aerobic bacteria, yeasts, and Trichomonas vaginalis and direct immunofluorescence reaction for Chlamydia trachomatis, Escherichia coli (odds ratio 8.16; 95% confidence interval 1.27-340.23) and Staphylococcus aureus (odds ratio 7.79; 95% confidence interval 1.21-325.40) were significantly more often isolated from women in preterm than from women in term labour. The prevalence of C. trachomatis was the same in the preterm and in the term labour group. The pregnancy outcome during the latent or active phase of preterm labour with or without C. trachomatis infection did not differ. It is concluded that E. coli and S. aureus are significantly more prevalent in endocervical cultures from Lithuanian women in preterm than from those in term labour.