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Spontaneous Preterm Labour

Eline Houben, Elisabeth Smits, Jeanne M Pimenta, Libby K Black, Irene D Bezemer, Fernie Ja Penning-van Beest
AIM: Recent evidence is emerging indicating long-term effects in infants born after an episode of preterm labour (PTL), even if birth is at term. This population-based study compared long-term rates of outcomes and health-care utilisation (HCU) in children born following spontaneous preterm labour, irrespective of gestational age at delivery or of an uncomplicated pregnancy (SPTLu), with children born following full-term labour (FTL), overall stratified by comorbidity status and assessed using a composite morbidity measure (CM)...
October 4, 2018: Journal of Paediatrics and Child Health
Lynne Sykes, Phillip R Bennett
Preterm birth (PTB) occurs in 5-18% of pregnancies and is the leading cause of neonatal morbidity, mortality and infant death. Up to 30% of PTBs are due to iatrogenic reasons, but the remainder are due to the spontaneous onset of labour or pre-labour premature rupture of membranes (P-PROM). During pregnancy, the uterus remains quiescent and the cervix remains long and closed. Although the exact mechanisms that lead to spontaneous PTB (sPTB) are not fully understood, it is likely that the terminal pathways that are common to term labour are activated prematurely...
September 8, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Yasaswi Kaumadha Wijesuriya, Martha Lappas
BACKGROUND: Preterm birth is the most prominent complication attributing to poor pregnancy and neonatal outcome. Infection is most commonly implicated in preterm birth; it initiates a cascade of inflammatory events that leads to the rupture of fetal membranes and spontaneous uterine contractions. Anti-inflammatory agents may thus be a therapeutic approach to prevent the premature rupture of fetal membranes and block contractions. In non-gestational tissues, the polyphenol honokiol has been shown to possess potent anti-inflammatory properties...
October 1, 2018: Phytomedicine: International Journal of Phytotherapy and Phytopharmacology
Scott D Barnett, Iain L O Buxton
Preterm birth before 37 weeks of completed gestation results in numerous health consequences for the foetus. Preterm labour leads to preterm birth in over 50% of cases, and no FDA-approved treatment can prevent labour or help a foetus remain in the womb until term. Examination of nitric oxide mediated relaxation signaling in the uterine smooth muscle reveals a role for protein S-nitrosation. The recent discovery of upregulated S-nitrosoglutathione reductase (GSNOR) in spontaneously preterm labouring women has emphasized the need to explore the function of S-nitrosation regulation in the maintenance of uterine quiescence...
September 6, 2018: Journal of Cellular and Molecular Medicine
Francesco D'Antonio, Anthony Odibo, Vincenzo Berghella, Asma Khalil, Karien Hack, Gabriele Saccone, Federico Prefumo, Danilo Buca, Marco Liberati, Giorgio Pagani, Ganesh Acharya
OBJECTIVE: To quantify the rate of perinatal mortality in monochorionic monoamniotic (MCMA) twin pregnancies according to gestational age and to ascertain the incidence of mortality in pregnancies managed as inpatient compared to outpatient. METHODS: Medline, Embase and Cinahl databases were searched. The primary outcomes explored were the incidence of intrauterine death (IUD), neonatal death (NND) and perinatal (PND) death in MCMA twin pregnancies at different gestational age windows (24-30, 31-32, 33-34, 35-36 and beyond 37 weeks of gestation)...
August 20, 2018: Ultrasound in Obstetrics & Gynecology
Jin-Wen Zhang, Ware Branch, Matthew Hoffman, Ank De Jonge, Sheng-Hui Li, James Troendle, Jun Zhang
OBJECTIVES: To identify obstetrical subgroups in which (1) the caesarean delivery (CD) rate may be reduced without compromising safety and (2) CD may be associated with better perinatal outcomes. DESIGN: A multicentre cross-sectional study. SETTING: 19 hospitals in the USA that participated in the Consortium on Safe Labor. PARTICIPANTS: 228 562 pregnant women in 2002-2008. MAIN OUTCOME MEASURES: Maternal and neonatal safety was measured using the individual Weighted Adverse Outcome Score...
August 5, 2018: BMJ Open
Ruth McCuaig, Diana Wong, Fergus W Gardiner, William Rawlinson, Jane E Dahlstrom, Stephen Robson
INTRODUCTION: Preterm birth is a common cause of adverse neonatal and childhood outcomes. It is commonly associated with infection of the maternal-fetal interface. The relationship between periodontitis and preterm labour is controversial. METHODS: Control placental tissues from uncomplicated term births were compared with those from spontaneous preterm births for incidence of common periodontal bacteria. A chi-square analysis was used to compare the populations, with significance determined at p=<0...
August 2018: Placenta
Sha Huang, Wei Xia, Xia Sheng, Lin Qiu, Bin Zhang, Tian Chen, Shunqing Xu, Yuanyuan Li
OBJECTIVES: Maternal exposure to lead (Pb) has been suggested to correlate with adverse birth outcomes, but evidence supporting an association between Pb exposure and premature rupture of membranes (PROM) is limited. The aim of our study was to investigate whether maternal Pb exposure was associated with PROM and preterm PROM. DESIGN: Cross-sectional cohort study. STUDY POPULATION: The present study involved 7290 pregnant women from the Healthy Baby Cohort in Wuhan, China, during 2012-2014...
July 23, 2018: BMJ Open
Nanna Mørk, Finn Friis Lauszus, Rubab Hassan Agha Krogh
In this case report a unicorn uterus was diagnosed at a caesarean delivery in a 23-year-old woman with known foetal breech presentation and suspected low foetal weight. She had had a failed attempt of cephalic version two weeks before delivery, and her baby's weight was checked regularly in third term. Unicorn uterus is associated with a higher risk of spontaneous abortions, infertility, preterm labour, foetal malpresentation, low birth weight, caesarean delivery and renal malformations. Although pregnancies in these women can be uneventful, it is advised, that women with unicorn uteri are followed closely during their pregnancies...
July 2, 2018: Ugeskrift for Laeger
Winnie Huiyan Sim, Hamon Ng, Penelope Sheehan
PURPOSE: To provide center-based outcome data on obstetric and neonatal complications arising from expectantly managed pregnancies affected by preterm prelabor rupture of membranes (PPROM) before viability. MATERIALS AND METHODS: We collected data on 130 consecutive pregnancies complicated by spontaneous rupture of membranes before 24 week's gestation, occurring over a 7-year period. These were women who delivered >24 h after membrane rupture, and had no signs of chorioamnionitis or advanced labor at admission...
August 13, 2018: Journal of Maternal-fetal & Neonatal Medicine
Aline C Freitas, Alan Bocking, Janet E Hill, Deborah M Money
BACKGROUND: The bacterial community present in the female lower genital tract plays an important role in maternal and neonatal health. Imbalances in this microbiota have been associated with negative reproductive outcomes, such as spontaneous preterm birth (sPTB), but the mechanisms underlying the association between a disturbed microbiota and sPTB remain poorly understood. An intrauterine infection ascending from the vagina is thought to be an important contributor to the onset of preterm labour...
June 28, 2018: Microbiome
Jane E Norman, Neil Marlow, Claudia-Martina Messow, Andrew Shennan, Philip R Bennett, Steven Thornton, Stephen C Robson, Alex McConnachie, Stavros Petrou, Neil J Sebire, Tina Lavender, Sonia Whyte, John Norrie
BACKGROUND: Progesterone prophylaxis is widely used to prevent preterm birth but is not licensed and there is little information on long-term outcome. OBJECTIVE: To determine the effect of progesterone prophylaxis in women at high risk of preterm birth on obstetric, neonatal and childhood outcomes. DESIGN: Double-blind, randomised placebo-controlled trial. SETTING: Obstetric units in the UK and Europe between February 2009 and April 2013...
June 2018: Health Technology Assessment: HTA
Svetlana V Glinianaia, Judith Rankin, Asma Khalil, Julia Binder, Gareth Waring, Stephen N Sturgiss, Basky Thilaganathan, Therese Hannon
OBJECTIVES: To determine the prevalence of monochorionic monoamniotic (MCMA) twin pregnancies and to describe perinatal outcomes and clinical management of these pregnancies. METHODS: This multicentre cohort study used population-based data on MCMA twin pregnancies from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) maternity units for the prevalence estimation of MCMA twinning. Pregnancy outcomes at <24 weeks' gestation, antenatal parameters and perinatal outcomes (from ≥24 weeks to the first 28 days of life) were analysed using combined data on pregnancies with confirmed MCMA chorionicity from the NorSTAMP and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort for 2000-2013...
June 13, 2018: Ultrasound in Obstetrics & Gynecology
Priya Rajan, Srinivas Murki, Suseela Vavilala, Nirupama Surubhotla
Objectives: To study the recent trends in maternal and perinatal outcomes of triplet pregnancy from a perinatal centre in South India. Methods: All triplet pregnancies booked at Fernandez hospital, Hyderabad (a tertiary care perinatal centre in South India), or those referred between 2000 and 2014 were included in the study. The maternal, fetal and neonatal outcome and any interventions like cerclage, steroid administration were studied. Results: There were 82 triplet deliveries over the study period of 15 years (82 per 69,584 live births)...
June 2018: Journal of Obstetrics and Gynaecology of India
Stella Liong, Ratana Lim, Caitlyn Nguyen-Ngo, Gillian Barker, Helena C Parkington, Martha Lappas
There are currently no effective treatments to prevent spontaneous preterm labor. The precise upstream biochemical pathways that regulate the transition between uterine quiescence during pregnancy and contractility during labor remain unclear. It is well known however that intrauterine inflammation, including infection, is commonly associated with preterm labor. In this study, we identified the immunoproteasome subunit low-molecular-mass protein (LMP)7 mRNA expression to be significantly upregulated in laboring human myometrium...
August 2018: European Journal of Immunology
P J Teoh, A Ridout, P Seed, R M Tribe, A H Shennan
Gender differences in several adverse pregnancy outcomes have been described, including preterm labour and delivery. In the low risk population, the male fetus is at significantly higher risk of spontaneous preterm birth. OBJECTIVES: Our objective was to examine the risk effect of fetal gender on pregnant women at higher risk of preterm birth, and therefore its potential impact on targeting management. STUDY DESIGN: This was an analysis of prospectively collected data from a dedicated inner-city Prematurity Surveillance Clinic over a sixteen-year period...
June 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Priyanka Goradia, Ratana Lim, Martha Lappas
Preterm birth is the primary cause of perinatal morbidity and mortality worldwide. Inflammation induces a cascade of events leading to preterm birth by activating nuclear factor- κ B (NF- κ B). In nongestational tissues, downstream regulatory element antagonist modulator (DREAM) regulates NF- κ B activity. Our aims were to analyse DREAM expression in myometrium and fetal membranes obtained at term and preterm and to determine the effect of DREAM inhibition on prolabour mediators in primary myometrial and amnion cells...
2018: BioMed Research International
Sarah J Stock, Lisa M Wotherspoon, Kathleen A Boyd, Rachel K Morris, Jon Dorling, Lesley Jackson, Manju Chandiramani, Anna L David, Asma Khalil, Andrew Shennan, Victoria Hodgetts Morton, Tina Lavender, Khalid Khan, Susan Harper-Clarke, Ben W Mol, Richard D Riley, John Norrie, Jane E Norman
INTRODUCTION: The aim of the QUIDS study is to develop a decision support tool for the management of women with symptoms and signs of preterm labour, based on a validated prognostic model using quantitative fetal fibronectin (qfFN) concentration, in combination with clinical risk factors. METHODS AND ANALYSIS: The study will evaluate the Rapid fFN 10Q System (Hologic, Marlborough, Massachusetts) which quantifies fFN in a vaginal swab. In part 1 of the study, we will develop and internally validate a prognostic model using an individual participant data (IPD) meta-analysis of existing studies containing women with symptoms of preterm labour alongside fFN measurements and pregnancy outcome...
April 7, 2018: BMJ Open
Ibinabo Ibiebele, Margaret Schnitzler, Tanya Nippita, Jane B Ford
BACKGROUND: Suspected appendicitis is a common non-obstetric indication for emergency abdominal surgery during pregnancy. AIMS: Assess the risk of preterm birth and other maternal and neonatal adverse birth outcomes following appendicectomy during pregnancy. MATERIALS AND METHODS: Population-based data linkage study of women with singleton births in New South Wales, Australia, 2002-2014. Pregnancies with appendicitis and appendicectomy were compared to pregnancies without appendicitis...
March 30, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
Turhan Aran, Ipek Pekgöz, Hasan Bozkaya, Mehmet A Osmanagaoglu
We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device...
March 23, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
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