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Progesterone in preterm birth

Siddhidatri Mishra, Rashmi Bagga, Jasvinder Kalra, Vanita Jain, Sourabh Dutta
Women (n = 300) at 'low risk' for a preterm birth (PTB), a singleton pregnancy and for a 16-24 week period of gestation (POG) were randomised to undergo cervical length (CL) measurement by transvaginal sonography (TVS) or not. The aim was to see if routine CL measurement and treatment of a short CL reduced the PTB rate. 'Low risk' was defined by an absence of a prior abortion or PTB of a singleton infant (>16 to <37 weeks) due to a spontaneous preterm labour (PTL) or a preterm pre-labour rupture of membranes (pPROM)...
March 14, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Athena P Souka, Ioannis Papastefanou, Athanasios Pilalis, Dimitrios Kassanos, George Papadopoulos
OBJECTIVES: To assess the feasibility and the results of introducing a policy of universal screening for preterm delivery. METHODS: Transvaginal sonography for cervical length (CL) measurement was performed at 20-24 weeks of gestation. Vaginal progesterone therapy was offered to women with CL ≤ 15mm. RESULTS: 10,969 singleton pregnancies were assessed. The decline rate was 1.32%. Spontaneous preterm delivery at less than 32 weeks (SPD32), less than 34 weeks (SPD34) and less than 37 weeks (SPD37) occurred in 0...
March 14, 2018: Ultrasound in Obstetrics & Gynecology
Christopher M Novak, Maide Ozen, Michael McLane, Sadiq Alqutub, Ji Yeon Lee, Jun Lei, Irina Burd
To assess the fetal neuroprotective potential of progesterone using a well-validated mouse model of lipopolysaccharide (LPS)-induced intrauterine inflammation (IUI). Embryonic day 17 pregnant mouse dams (n = 69) were randomly allocated to receive 17-hydroxyprogesterone caproate (17-OHPC), micronized progesterone (MP), or vehicle 1 hour prior to intrauterine injection of phosphate-buffered saline (PBS) or LPS. After 6 hours, mice were killed for the collection of placentas and fetal brains, or pregnancy continued for the evaluation of preterm birth (PTB) and offspring neuromotor function...
March 1, 2018: American Journal of Reproductive Immunology: AJRI
Yuguang Wang, Vikki M Abrahams, Guoyang Luo, Nicholas G Norwitz, Victoria V Snegovskikh, Shu-Wing Ng, Errol R Norwitz
OBJECTIVE: Progesterone supplementation prevents preterm birth (PTB) in some high-risk women, but its mechanism of action is unknown. One-third of PTB is associated with preterm premature rupture of membranes (PPROMs). We have previously shown that progesterone inhibits basal and Tumor Necrosis Factor (TNF) α-induced apoptosis in an explant model of human fetal membranes. This study investigates the molecular mechanisms responsible for progesterone-mediated inhibition of apoptosis in fetal membranes...
January 1, 2018: Reproductive Sciences
Nancy Medley, Borna Poljak, Silvia Mammarella, Zarko Alfirevic
BACKGROUND: Clinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB). OBJECTIVES: To summarise CPG recommendations for PTB and identify areas of international consensus. SEARCH STRATEGY: In June 2017 we searched for all CPG relavant to PTB without language restrictions. SELECTION CRITERIA: CPG were eligible if the following criteria were met. i.The guideline was published or current from June 2013...
February 20, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
M Christine Livergood, Amanda Trudell
No abstract text is available yet for this article.
November 1, 2017: American Family Physician
Stuart Campbell
No abstract text is available yet for this article.
February 2018: American Journal of Obstetrics and Gynecology
L Story, J Hutter, T Zhang, A H Shennan, M Rutherford
Preterm birth, defined as birth occurring prior to 37 weeks gestation is a common obstetric complication affecting 8% of pregnancies and is associated with significant morbidity and mortality. Infection/inflammation has been implicated in both the aetiology of preterm birth itself and associated neonatal pulmonary and neurological morbidity. Treatment options are currently limited to prolongation of the pregnancy using cervical cerclage, pessaries or progesterone or administration of drugs including steroids to promote lung maturity and neuroprotective agents such as magnesium sulphate, the timing of which are highly critical...
March 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Francis Brako, Bahijja Tolulope Raimi-Abraham, Suntharavathanan Mahalingam, Duncan Q M Craig, Mohan Edirisinghe
Recent evidence has continued to support the applicability of progesterone in preventing preterm birth, hence the development of an appropriate vaginal delivery system for this drug would be of considerable interest. Here, we describe the development of progesterone-loaded bioadhesive nanofibers using pressurized gyration for potential incorporation into a vaginal insert, with a particular view to addressing the challenges of incorporating a poorly water-soluble drug into a hydrophilic nanofiber carrier. Polyethylene oxide and carboxymethyl cellulose were chosen as polymers to develop the carrier systems, based on previous evidence of their yielding mucoadhesive nanofibers using the pressurized gyration technique...
February 2, 2018: International Journal of Pharmaceutics
Fatemeh Abdali, Simin Taghavi, Shabnam Vazifekhah, Mohammad Naghavi Behzad, Mohammad Mirza Aghazadeh Attari
Preterm premature rupture of membranes (PPROM) is a condition leading to an increased risk of maternal and neonatal morbidity and mortality in pregnant women. To prevent this complication, some studies have proposed using prophylactic progesterone. However, due to lack of sufficient relevant data, there is still need for further studies in this regard. This study was performed to determine the effect of rectal progesterone on the latent phase and maternal and neonatal outcome variables in females with PPROM...
December 2017: Acta Medica Iranica
Jeffrey A Keelan
The central role of inflammatory processes in labour and delivery is now well-recognised. However, the biomolecular, immunological and endocrine mechanisms involved in the labour process, and the clinical manifestations of inflammation in pregnancy, are complex, variable and modulated by factors such as aetiology, ethnicity and gestational age. In this review, evidence is presented of the pivotal relationship between progesterone and inflammation in pregnancy in terms of determining the timing of labour and delivery...
February 2018: Journal of Reproductive Immunology
Gabriele Saccone, Giuseppe Maria Maruotti, Antonia Giudicepietro, Pasquale Martinelli
Importance: Spontaneous preterm birth is a major cause of perinatal morbidity and mortality. It is unclear if a cervical pessary can reduce the risk of spontaneous preterm delivery. Objective: To test whether in asymptomatic women with singleton pregnancies and no prior spontaneous preterm birth but with short cervical length on transvaginal ultrasound, use of a cervical pessary would reduce the rate of spontaneous preterm birth at less than 34 weeks of gestation...
December 19, 2017: JAMA: the Journal of the American Medical Association
Alexander Jarde, Anne-Mary Lewis-Mikhael, Jodie M Dodd, Jon Barrett, Shigeru Saito, Joseph Beyene, Sarah D McDonald
OBJECTIVES: To systematically examine the evidence around the combination of interventions to prevent preterm birth. METHODS: Without language restrictions, we searched and five electronic databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science) up to July 7, 2016. We included randomized and non-randomized studies where asymptomatic women at risk of preterm birth received any combination of progesterone, cerclage, or pessary compared with either one or no intervention...
December 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
S Romero
No abstract text is available yet for this article.
November 28, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Joshua D Younger, Elena Reitman, George Gallos
In the United States, the generally accepted indication for tocolytic therapy centers on suppression of preterm labor. This may be in the form of preventative therapy with progesterone in women with prior spontaneous preterm birth or as an acute intervention to suppress established uterine contractions associated with cervical change occurring at less than 37 weeks gestation. This article seeks to apply this perspective to tocolytic therapy. Here, we provide a review of current tocolytic options and what the last decade of discovery has revealed about the regulation of myometrial excitability and quiescence...
December 2017: Seminars in Perinatology
Devin McGee, Arianna Smith, Sharra Poncil, Amanda Patterson, Alison I Bernstein, Karen Racicot
Preterm birth (PTB), or birth before 37 weeks gestation, is the leading cause of neonatal mortality worldwide. Cervical viral infections have been established as risk factors for PTB in women, although the mechanism leading to increased risk is unknown. Using a mouse model of pregnancy, we determined that intra-vaginal HSV2 infection caused increased rates of preterm birth following an intra-vaginal bacterial infection. HSV2 infection resulted in histological changes in the cervix mimicking cervical ripening, including significant collagen remodeling and increased hyaluronic acid synthesis...
2017: PloS One
Lesley A Stewart, Mark Simmonds, Lelia Duley, Kristina Charlotte Dietz, Melissa Harden, Alex Hodkinson, Alexis Llewellyn, Sahar Sharif, Ruth Walker, Kath Wright
BACKGROUND: Preterm birth is the most common cause of death and harm to newborn babies. Babies that are born early may have difficulties at birth and experience health problems during early childhood. Despite extensive study, there is still uncertainty about the effectiveness of progestogen (medications that are similar to the natural hormone progesterone) in preventing or delaying preterm birth, and in improving birth outcomes. The Evaluating Progestogen for Prevention of Preterm birth International Collaborative (EPPPIC) project aims to reduce uncertainty about the specific conditions in which progestogen may (or may not) be effective in preventing or delaying preterm birth and improving birth outcomes...
November 28, 2017: Systematic Reviews
Jeffrey Man Hay Wong, Neha Kanga, Nupur Dogra, Mary Shilalukey Ngoma, Lena Serghides, Michael Silverman
Introduction: Intramuscular and vaginal progesterone are recommended for prevention of preterm labor (PTL) in women with risk factors. Studies are emerging to indicate that HIV-infected women on combination antiretroviral therapy (cART) are at risk of PTL and low birth weight (LBW), and may benefit from supplemental progesterone. This study aims to determine the perceived acceptability of various modes of progesterone supplementation to prevent PTL and LBW in HIV-infected and HIV-uninfected women...
2017: International Journal of Women's Health
Roberto Romero, Agustin Conde-Agudelo, Eduardo Da Fonseca, John M O'Brien, Elcin Cetingoz, George W Creasy, Sonia S Hassan, Kypros H Nicolaides
BACKGROUND: The efficacy of vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix has been questioned after publication of the OPPTIMUM study. OBJECTIVE: To determine whether vaginal progesterone prevents preterm birth and improves perinatal outcomes in asymptomatic women with a singleton gestation and a midtrimester sonographic short cervix. DATA SOURCES: MEDLINE, EMBASE, LILACS, and CINAHL (from their inception to September 2017), Cochrane databases, bibliographies, and conference proceedings...
November 16, 2017: American Journal of Obstetrics and Gynecology
Chloe R McDonald, Andrea L Conroy, Joel L Gamble, Eszter Papp, Michael Hawkes, Peter Olwoch, Paul Natureeba, Moses Kamya, Michael Silverman, Deborah Cohan, Catherine A Koss, Grant Dorsey, Kevin C Kain, Lena Serghides
Background: Combination antiretroviral therapy (cART) use in pregnancy has been associated with hormonal dysregulation. We performed a secondary retrospective analysis of longitudinal progesterone and estradiol levels in pregnancy using specimens from the Protease Inhibitors to Reduce Malaria Morbidity in HIV-infected Pregnant Women study, which randomized Ugandan human immunodeficiency virus (HIV)-infected ART-naive women to initiate either lopinavir/ritonavir (LPV/r)-based or efavirenz (EFV)-based cART...
November 10, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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