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Spontaneous Preterm Labour

Jane E Norman, John Norrie, Graeme Maclennan, David Cooper, Sonia Whyte, Sarah Cunningham Burley, Joel B E Smith, Andrew Shennan, Stephen C Robson, Steven Thornton, Mark D Kilby, Neil Marlow, Sarah J Stock, Philip R Bennett, Jane Denton
INTRODUCTION: The STOPPIT-2 study aims to determine the clinical utility of the Arabin cervical pessary in preventing preterm birth in women with a twin pregnancy and a short cervix, about which there is current uncertainty. STOPPIT-2 will resolve uncertainty around effectiveness for women with a twin pregnancy and a cervical length of 35 mm or less, define adverse effects, ascertain acceptability and estimate National Health Service costs and savings. METHODS: STOPPIT-2 is a pragmatic multicentre open-label randomised controlled trial...
December 6, 2018: BMJ Open
Lucy C Chappell, Jenny Chambers, Peter H Dixon, Jon Dorling, Rachael Hunter, Jennifer L Bell, Ursula Bowler, Pollyanna Hardy, Edmund Juszczak, Louise Linsell, Catherine Rounding, Anne Smith, Catherine Williamson, Jim G Thornton
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder specific to pregnancy and presents with maternal pruritus, raised concentrations of serum bile acids and abnormal liver function tests. ICP is associated with increased rates of spontaneous and iatrogenic preterm labour, fetal hypoxia, meconium-stained amniotic fluid and intrauterine death. Some clinicians treat ICP with ursodeoxycholic acid (UDCA) to improve maternal pruritus and biochemical abnormalities...
November 27, 2018: Trials
Karim Tararbit, Nathalie Lelong, François Goffinet, Babak Khoshnood
Objectives: To quantify the risk of preterm birth (PTB) for newborns with congenital heart defects (CHDs) conceived following infertility treatments, and to examine the role of multiple pregnancies in the association between infertility treatments and PTB for newborns with CHD. Methods: We used data from a population-based, prospective cohort study (EPICARD EPIdémiologie des CARDiopathies congénitales) including 2190 newborns with CHD and excluding cases with atrial septal defects born to women living in the Greater Paris area between May 2005 and April 2008...
2018: Open Heart
Jonas Bacelis, Julius Juodakis, Kristina M Adams Waldorf, Verena Sengpiel, Louis J Muglia, Ge Zhang, Bo Jacobsson
OBJECTIVES: To determine whether uterine distention is associated with human pregnancy duration in a non-invasive observational setting. DESIGN: Retrospective cohort study modelling uterine distention by interaction between maternal height and uterine load. SETTING: The study is based on the 1990-2013 population data from all delivery units in Sweden. PARTICIPANTS: Uncomplicated first pregnancies of healthy Nordic-born mothers with spontaneous onset of labour...
October 31, 2018: BMJ Open
Martha Lappas
Preterm birth remains the primary cause of early neonatal death and is a major determinant for long-term health consequences. Aberrant intrauterine inflammation and infection are known to augment the synthesis of proinflammatory cytokines and induce uterine contractions, which can subsequently lead to preterm birth. The transforming growth factor- β (TGF- β ) superfamily members regulate numerous cellular processes through the activation of intracellular mediators known as mothers against decapentaplegic homolog (SMADs)...
2018: Mediators of Inflammation
Mohammed Walid Zimmo, Katariina Laine, Sahar Hassan, Bettina Bottcher, Erik Fosse, Hadil Ali-Masri, Kaled Zimmo, Ragnhild Sørum Falk, Marit Lieng, Åse Vikanes
OBJECTIVE: To analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS). DESIGN: A population-based birth cohort study. SETTING: Obstetrical departments in three governmental hospitals in Gaza. PARTICIPANTS: All women (18 908) who gave birth between 1 January 2016 and 30 April 2017. METHODS: The contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group...
October 24, 2018: BMJ Open
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...
December 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
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