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Progesterone in preterm birth

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https://www.readbyqxmd.com/read/28889957/pathophysiology-of-preterm-labor-with-intact-membranes
#1
REVIEW
Asha N Talati, David N Hackney, Sam Mesiano
Preterm labor with intact membranes is a major cause of spontaneous preterm birth (sPTB). To prevent sPTB a clear understanding is needed of the hormonal interactions that initiate labor. The steroid hormone progesterone acting via its nuclear progesterone receptors (PRs) in uterine cells is essential for the establishment and maintenance of pregnancy and disruption of PR signaling (i.e., functional progesterone/PR withdrawal) is key trigger for labor. The process of parturition is also associated with inflammation within the uterine tissues and it is now generally accepted that inflammatory stimuli from multiple extrinsic and intrinsic sources induce labor...
September 7, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28889776/risk-of-spontaneous-preterm-birth-in-ivf-conceived-twin-pregnancies
#2
Gabriele Saccone, Fabrizio Zullo, Amanda Roman, Andrew Ward, Giuseppe Maruotti, Pasquale Martinelli, Vincenzo Berghella
OBJECTIVE: To compare the mean transvaginal ultrasound (TVU) cervical length (CL) at midtrimester in screening for preterm birth in in vitro (IVF)-conceived twin pregnancies versus spontaneously-conceived twin pregnancies. METHODS: This was a retrospective cohort study. Potential study subjects were identified at the time of a routine second trimester fetal ultrasound exam at 18 0/7 - 23 6/7-week gestation. All women with twin diamniotic pregnancies screened with a singlet TVU CL for this trial were included...
September 10, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28870155/pessary-or-progesterone-to-prevent-preterm-delivery-in-women-with-short-cervical-length-the-quadruple-p-randomised-controlled-trial
#3
Maud D van Zijl, Bouchra Koullali, Christiana A Naaktgeboren, Ewoud Schuit, Dick J Bekedam, Etelka Moll, Martijn A Oudijk, Wilhelmina M van Baal, Marjon A de Boer, Henricus Visser, Joris van Drongelen, Flip W van de Made, Karlijn C Vollebregt, Moira A Muller, Mireille N Bekker, Jozien T J Brons, Marieke Sueters, Josje Langenveld, Maureen T Franssen, Nico W Schuitemaker, Erik van Beek, Hubertina C J Scheepers, Karin de Boer, Eveline M Tepe, Anjoke J M Huisjes, Angelo B Hooker, Evelyn C J Verheijen, Dimitri N Papatsonis, Ben Willem J Mol, Brenda M Kazemier, Eva Pajkrt
BACKGROUND: Preterm birth is in quantity and in severity the most important topic in obstetric care in the developed world. Progestogens and cervical pessaries have been studied as potential preventive treatments with conflicting results. So far, no study has compared both treatments. METHODS/DESIGN: The Quadruple P study aims to compare the efficacy of vaginal progesterone and cervical pessary in the prevention of adverse perinatal outcome associated with preterm birth in asymptomatic women with a short cervix, in singleton and multiple pregnancies separately...
September 4, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28863997/micronized-progesterone-pretreatment-affects-the-inflammatory-response-of-human-gestational-tissues-and-the-cervix-to-lipopolysaccharide-stimulation
#4
Tai-Ho Hung, Szu-Fu Chen, Chung-Pu Wu, Meng-Jen Li, Yi-Lin Yeh, T'sang-T'ang Hsieh
INTRODUCTION: Vaginal administration of micronized progesterone (utrogestan capsule, UG) reduces the risk of preterm birth (PTB) in asymptomatic women with a sonographic short cervix at mid-trimester or with a prior history of spontaneous PTB; however, its exact mechanisms remain unclear. We hypothesized that UG limits the inflammatory processes within the gestational tissues and the cervix. METHODS: Fetal membranes and villous tissues were obtained from normal term placentas from women with cesarean delivery before labor onset...
September 2017: Placenta
https://www.readbyqxmd.com/read/28857251/hospital-admission-for-hyperemesis-gravidarum-in-women-at-increased-risk-of-spontaneous-preterm-birth
#5
Ira Kleine, Ana Da Silva, Wafaa Ahmed, Frida Forya, Sara M Whitten, Anna L David, Catherine P James
BACKGROUND: Progesterone administration prevents spontaneous preterm birth (sPTB) in women at increased risk. Progesterone concentration is lower in women with subsequent sPTB. Conversely, high concentrations of progesterone are implicated in the pathogenesis of hyperemesis gravidarum (HG). We hypothesized that women at increased risk of sPTB or spontaneous late miscarriage would be less likely to have a diagnosis of HG. To explore this hypothesis, we compared the incidence of HG in women at increased risk of sPTB and women with no identifiable risk factors...
August 30, 2017: Birth
https://www.readbyqxmd.com/read/28833362/evaluation-of-progesterone-utilization-and-birth-outcomes-in-a-state-medicaid-plan
#6
Tasmina Hydery, Mylissa K Price, Bonnie C Greenwood, Mito Takeshita, Parag S Kunte, Rose P Mauro, Kimberly Lenz, Paul L Jeffrey
OBJECTIVES: Progesterone (hydroxyprogesterone caproate injection and vaginal progesterone) has been shown to reduce preterm birth (PTB) rates by one-third among pregnant women at high risk. The purpose of this analysis is to report birth outcomes and medication adherence among Massachusetts Medicaid (MassHealth) members receiving progesterone, evaluate the association between member characteristics and birth outcomes and medication adherence, and compare cost of care to a prior preterm pregnancy...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28798414/comparison-of-neonatal-outcomes-following-progesterone-use-during-ovarian-stimulation-with-frozen-thawed-embryo-transfer
#7
Xiuxian Zhu, Hongjuan Ye, Yonglun Fu
Progesterone soft capsules (brand name: Utrogestan) were demonstrated to be an effective oral alternative to prevent premature LH surges both in normal-ovulatory and polycystic ovarian syndrome (PCOS) patients. However, its safety in terms of neonatal outcomes is unclear. To evaluate whether Utrogestan use increase the risk of adverse neonatal outcomes compared with short protocol in patients undergoing IVF/ICSI treatments in combination with frozen-thawed embryo transfer (FET), we performed a retrospective analysis including 1008 FET cycles, with embryos originated from either Utrogestan + hMG protocol (n = 499), or short protocol (n = 509), which led to 546 live-born infants...
August 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28791263/second-trimester-cervical-length-measurement-for-prediction-spontaneous-preterm-birth-in-an-unselected-risk-population
#8
Alberto Borges Peixoto, Taciana Mara Rodrigues da Cunha Caldas, Luisa Almeida Tahan, Caetano Galvão Petrini, Wellington P Martins, Fabricio Da Silva Costa, Edward Araujo Júnior
OBJECTIVE: To assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population. METHODS: A retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os...
July 2017: Obstetrics & Gynecology Science
https://www.readbyqxmd.com/read/28777967/optimal-routes-of-administration-vehicles-and-timing-of-progesterone-treatment-for-inhibition-of-delivery-during-pregnancy
#9
Dajun Fang, Mario Moreno, Robert E Garfield, Ruben Kuon, Huimin Xia
OBJECTIVES: Progestins, notably progesterone (P4) and 17 alpha hydroxyprogesterone caproate, are presently used to treat pregnant women at risk of preterm birth. The aim of this study was to assess the optimal treatment options for progesterone (P4) to delay delivery using a sensitive bioassay for progesterone. STUDY DESIGN: Pregnant rats, known to be highly sensitive to progestins, were treated with P4, including Prochieve(®) (also known as Crinone(®)), in various vehicles from day 13 of gestation and in late gestation, days 19 to 22, and delivery times noted...
September 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28768474/progesterone-in-women-with-arrested-premature-labor-a-report-of-a-randomised-clinical-trial-and-updated-meta-analysis
#10
Stephen Wood, Yacov Rabi, Selphee Tang, Rollin Brant, Susan Ross
BACKGROUND: Progesterone may be effective in prevention of premature birth in some high risk populations. Women with arrested premature labor are at risk of recurrent labor and maintenance therapy with standard tocolytics has not been successful. METHODS: Randomized double blinded clinical trial of daily treatment with 200 mg vaginal progesterone in women with arrested premature labor and an updated meta-analysis. RESULTS: The clinical trial was terminated early after 41 women were enrolled...
August 2, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28762599/diversity-of-progesterone-action-on-lipopolysaccharide-induced-expression-changes-in-cultured-human-cervical-fibroblasts-according-to-inflammation-and-treatment-timing
#11
Yoshimitsu Kuwabara, Akira Katayama, Sachiko Kurihara, Marie Ito, Mirei Yonezawa, Nozomi Ouchi, Ryuhei Kurashina, Tomoko Ichikawa, Rintaro Sawa, Akihito Nakai, Hideo Orimo, Toshiyuki Takeshita
PROBLEM: The effectiveness of progesterone (P4) treatment for preventing preterm births is unclear. Its effects on the uterine cervix were tested using cultured human uterine cervical fibroblasts (UCFs). METHOD OF STUDY: UCFs were incubated with lipopolysaccharide (LPS) in the presence or absence of P4 under various conditions. mRNA was subjected to PCR arrays and real-time RT-PCR to assess IL-6, IL-8, IL-1beta, PTGS2, MMP-1, and CXCL10 expression. RESULTS: When exposed to a high-LPS concentration (2...
August 1, 2017: American Journal of Reproductive Immunology: AJRI
https://www.readbyqxmd.com/read/28754971/in-vivo-raman-spectral-analysis-of-impaired-cervical-remodeling-in-a-mouse-model-of-delayed-parturition
#12
Christine M O'Brien, Jennifer L Herington, Naoko Brown, Isaac J Pence, Bibhash C Paria, James C Slaughter, Jeff Reese, Anita Mahadevan-Jansen
Monitoring cervical structure and composition during pregnancy has high potential for prediction of preterm birth (PTB), a problem affecting 15 million newborns annually. We use in vivo Raman spectroscopy, a label-free, light-based method that provides a molecular fingerprint to non-invasively investigate normal and impaired cervical remodeling. Prostaglandins stimulate uterine contractions and are clinically used for cervical ripening during pregnancy. Deletion of cyclooxygenase-1 (Cox-1), an enzyme involved in production of these prostaglandins, results in delayed parturition in mice...
July 28, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28753545/adjuvant-administration-of-17-%C3%AE-hydroxy-progesterone-caproate-in-women-with-three-or-more-second-trimester-pregnancy-losses-undergoing-cervical-cerclage-is-no-more-effective-than-cerclage-alone
#13
Fernand D Samson, Amanda L Merriman, Danielle L Tate, Katherine Apostolakis-Kyrus, Luis M Gomez
OBJECTIVE: To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage. MATERIAL AND METHODS: Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59)...
July 28, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28747362/alterations-of-adrenal-steroidomic-profiles-in-preterm-infants-at-birth
#14
Simon Travers, Laetitia Martinerie, Pascal Boileau, Marc Lombès, Eric Pussard
OBJECTIVE: Preterm infants have relative adrenal and kidney immaturity. Recently, we linked their urine sodium loss to a hypoaldosteronism at variance with an appropriate stimulation of the renin-angiotensin system. To investigate this defective aldosterone secretion, we analyse the biosynthesis pathways of adrenal steroids in neonates according to gestational age (GA). DESIGN: Multicentre study (Premaldo) including 152 neonates classified into three groups: group 1 (very preterm (VPT)): <33 ‰gestational weeks (GW); group 2 (preterm (PT)): 33-36 GW and group 3 (term (T)): ≥37 GW...
July 26, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28742594/cervical-evaluation-in-pregnancy-proper-measurement-evaluation-and-management
#15
Joseph R Wax, Angelina Cartin, Michael G Pinette
Preterm birth is the leading cause of perinatal morbidity and mortality in developed nations. The heterogeneous causes of spontaneous preterm birth make prediction and prevention difficult. The primary importance of transvaginal cervical sonography and cervicovaginal fetal fibronectin lies in their high negative predictive values in assessing risk for preterm birth. Cervical length may be useful in identifying women who are candidates for cervical cerclage or progesterone therapy for preterm birth prevention...
September 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28731465/pr-set7-deficiency-limits-uterine-epithelial-population-growth-hampering-postnatal-gland-formation-in-mice
#16
Tongtong Cui, Bo He, Shuangbo Kong, Chan Zhou, Hangxiao Zhang, Zhangli Ni, Haili Bao, Jingtao Qiu, Qiliang Xin, Danny Reinberg, John P Lydon, Jinhua Lu, Haibin Wang
Formation of secretary endometrial glands in the uterus known as adenogenesis is a typical process of branching morphogenesis involving dynamic epithelial growth and differentiation. Unsuccessful adenogenesis often leads to female infertility. However, it remains largely unexplored so far regarding the epigenetic machinery governing normal endometrial gland formation. Here, we demonstrated that PR-Set7, an epigenetic regulator for H4K20me1 modification, was extensively expressed in the postnatal uteri, and its conditional deletion resulted in a complete lack of endometrial glands and infertility in mice...
July 21, 2017: Cell Death and Differentiation
https://www.readbyqxmd.com/read/28729911/vaginal-progesterone-to-reduce-preterm-birth-among-hiv-infected-pregnant-women-in-zambia-a-feasibility-study-protocol
#17
Joan T Price, Katie R Mollan, Nurain M Fuseini, Bethany L Freeman, Helen B Mulenga, Amanda H Corbett, Bellington Vwalika, Jeffrey S A Stringer
BACKGROUND: Women infected with HIV have a risk of preterm birth (PTB) that is twice that among uninfected women, and treatment with antiretroviral therapy (ART) may further increase this risk. Progesterone supplementation reduces the risk of preterm delivery in women who have a shortened cervix in the midtrimester. We propose to study the feasibility of a trial of vaginal progesterone (VP) to prevent PTB among HIV-infected women receiving ART in pregnancy. Given low adherence among women self-administering vaginal study product in recent microbicide trials, we plan to investigate whether adequate adherence to VP can be achieved prior to launching a full-scale efficacy trial...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28687440/variation-in-coverage-for-progesterone-to-prevent-preterm-birth-a-survey-of-medicaid-managed-care-organizations
#18
Priya Batra, Ashley A Hernandez Gray, Jennifer E Moore
INTRODUCTION: Preterm birth is the leading cause of U.S. infant morbidity and mortality; Medicaid enrollees disproportionately experience preterm deliveries. Data suggest that progesterone-an evidence-based therapy for preventing preterm birth-is not accessible to all eligible Medicaid beneficiaries. This study aimed to identify variation in progesterone coverage guidelines in a sample of state Medicaid managed care organizations (MMCOs). MATERIAL AND METHODS: Using a cross-sectional design, participation in a web-based survey was offered to 20 MMCO members of the Medicaid Health Plans of America...
September 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28667298/evolution-of-gene-expression-in-the-uterine-cervix-related-to-steroid-signaling-conserved-features-in-the-regulation-of-cervical-ripening
#19
Günter P Wagner, Mauris C Nnamani, Arun Rajendra Chavan, Jamie Maziarz, Stella Protopapas, Jennifer Condon, Roberto Romero
The uterine cervix is the boundary structure between the uterus and the vagina and is key for the maintenance of pregnancy and timing of parturition. Here we report on a comparative transcriptomic study of the cervix of four placental mammals, mouse, guinea pig, rabbit and armadillo, and one marsupial, opossum. Our aim is to investigate the evolution of cervical gene expression as related to putative mechanisms for functional progesterone withdrawal. Our findings are: 1) The patterns of gene expression in eutherian (placental) mammals are consistent with the notion that an increase in the E/P4 signaling ratio is critical for cervical ripening...
June 30, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28594783/progestogens-for-maintenance-tocolysis-in-women-with-a-short-cervix-a-randomized-controlled-trial
#20
RANDOMIZED CONTROLLED TRIAL
Fabio Facchinetti, Patrizia Vergani, Mariarosaria Di Tommaso, Luca Marozio, Barbara Acaia, Roberto Vicini, Lucrezia Pignatti, Anna Locatelli, Marina Spitaleri, Chiara Benedetto, Barbara Zaina, Roberto DʼAmico
OBJECTIVE: To assess the efficacy of progestogens for maintenance tocolysis in women undelivered after their first preterm labor episode. METHODS: Women with singleton pregnancies between 22 0/7 and 31 6/7 weeks of gestation with arrested preterm labor and a cervical length 25 mm or less at hospital discharge were eligible. Patients with a previous preterm birth were excluded. In a randomized controlled trial conducted in five university hospitals, women were randomized to receive vaginal progesterone (200 mg per day) or intramuscular 17α-hydroxyprogesterone caproate (341 mg per week) or to an observation groups (control group)...
July 2017: Obstetrics and Gynecology
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