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Background: Pregnant women have a higher risk of severe illness and adverse pregnancy outcomes due to a SARS-CoV-2 infection. COVID-19 vaccination can prevent (severe) infection. Observational studies are needed to ascertain safety of COVID-19 vaccination during pregnancy. Aim: Estimate whether COVID-19 vaccination during pregnancy is associated with the risk of preterm labor (PL). Methods: In this prospective cohort study, we included 5,910 pregnant women (mean age: 33.0 ± 3.7 years) who entered the Dutch Pregnancy Drug Register between February 2021 and August 2022. Information on COVID-19 vaccinations, PL, and confounders were self-reported using web-based questionnaires. The hazard ratio (HR) on PL, comparing those who received ≥1 COVID-19 vaccine during any moment of pregnancy to those who did not, was estimated using survival analyses with vaccination as time-varying exposure. Additionally, we estimated the risk of PL after COVID-19 vaccination prior to pregnancy, and after COVID-19 vaccination during trimester 1, 2, or 3 of pregnancy. Findings: A total of 5,227 (88%) participants received ≥1 COVID-19 vaccine between gestational week 2 and 37. We observed no statistically significant association of COVID-19 vaccination during pregnancy (adjusted HR = 0.93, 95%CI = 0.59; 1.45) nor of COVID-19 vaccination prior to pregnancy (adjusted HR = 1.09, 95%CI = 0.70; 1.71) with the risk of PL. Moreover, we observed no association between the risk of PL and COVID-19 vaccination in any trimester of pregnancy. Discussion: We demonstrated that COVID-19 vaccination prior to or during pregnancy is not associated with an increased risk of PL. Conclusion: These results add to the growing evidence supporting safety of COVID-19 vaccination during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Preterm birth, defined as birth before 37 weeks of gestation, is the leading cause of death of children under the age of five years worldwide. Globally there has been no change in the preterm birth rate between 2010 and 2020, when rates were calculated to be 9.8% and 9.9% of all livebirths, respectively. The analysis of amniotic fluid has been advocated by many to identify the mechanisms driving threatened preterm labor. Amniocentesis is largely considered to be safe, but care provider concerns about complications in the setting of threatened preterm labor (tPTL) exist. This systematic review will critically review the data regarding safety and outcomes of amniocentesis in cases of PPROM and tPTL and help in the counseling and clinical decision-making of patients and care providers alike. Methods: This systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA). All English language, peer-reviewed human studies where amniocentesis was used to sample the amniotic fluid of patients presenting with tPTL or PPROM and published between January 1990 and March 2022 were included. Data on the uptake rates, success rates, and safety profile associated with amniocentesis in this context of tPTL or PPROM were analyzed as part of the systematic review. Included studies compromised of randomized control trials, cohort studies, and case-control studies. Conference abstracts and abstracts with no full text were excluded. Results: 10,215 studies were returned after searches were conducted in MEDLINE, EMBASE, EMCARE, Web of Science, and SCOPUS databases using free text and Medical Subject Headings (MESH). 399 studies were assessed for eligibility with 15 studies being included in the final review. The main reason for exclusion from the review was an absence of safety data. Four studies gave information on uptake rates of amniocentesis in cases of PPROM and tPTL, with a range of 55% in an observational study to >99% in centers offering it as part of routine care. Eleven studies detailed success rates of amniocentesis, with all centers reporting >90% success rates. However, in some centers, a "successful" amniocentesis was deemed to be a retrieval of >0.5 ml. Three studies reported risks associated with amniocentesis. There were four reported complications (all transitory) in a series of 1119 cases (0.35%). Discussion: This systematic review found that amniocentesis in cases of PPROM or threatened preterm labor is a safe and feasible procedure. These data should give care providers confidence to counsel patients appropriately. [ABSTRACT FROM AUTHOR]

Objective Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) are diagnostic tools used to predict impending spontaneous preterm birth (sPTB) among women presenting with preterm labor (PTL). We evaluated the association between fFN testing or TVUS cervical length (CL) measurement in predicting sPTB, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, and sPTB-related costs. Study Design We conducted a retrospective cohort study using data from the Kaiser Permanente Southern California electronic health system (January 1, 2009–December 31, 2020) using diagnostic and procedure codes, along with a natural language processing algorithm to identify pregnancies with PTL evaluations. PTL evaluation was defined as having fFN and/or TVUS assessment. Outcomes were ascertained using diagnostic, procedural, and diagnosis-related group codes. Multivariable logistic regression assessed the association between fFN and/or TVUS results and perinatal outcomes. Results Compared with those without PTL evaluations, those with positive fFN tests had higher adjusted odds ratio (adj.OR) for sPTB (2.95, 95% confidence interval [CI]: 2.64, 3.29), RDS (2.34, 95% CI: 2.03, 2.69), and NICU admission (2.24, 95% CI: 2.01, 2.50). In contrast, those who tested negative had lower odds for sPTB (adj.OR: 0.75, 95% CI: 0.70, 0.79), RDS (adj.OR: 0.67, 95% CI: 0.61, 0.73), and NICU admission (adj.OR: 0.74, 95% CI: 0.70, 0.79). Among those with positive fFN results, the odds of sPTB was inversely associated with CL. Health care costs for mothers and neonates were lowest for those with fFN testing only. Conclusion This study demonstrates that positive fFN results were associated with an increased odds of sPTB, RDS, and NICU admission and the association with sPTB was inversely proportional to CL. Additionally, negative fFN results were associated with decreased odds of sPTB, RDS, and NICU admissions. fFN testing may predict these and other sPTB-related adverse outcomes hence its utility should be explored further. Moreover, fFN testing has some cost savings over TVUS. Key Points Patients with positive fFN tests had higher odds of sPTB, RDS, and NICU admission. Inverse relationship between sPTB and CL among those with positive fFN tests was observed. Health care costs for mothers and neonates were lowest for those with fFN testing only. [ABSTRACT FROM AUTHOR]

Problem: Intrauterine infection is one of the most jeopardizing conditions associated with adverse outcomes, including preterm birth; however, multiple tolerance mechanisms operate at the maternal–fetal interface to avoid the rejection of the fetus. Among the factors that maintain the uterus as an immunoprivileged site, Galectin‐1 (Gal‐1), an immunomodulatory glycan‐binding protein secreted by the maternal‐fetal unit, is pivotal in promoting immune cell homeostasis. This work aimed to evaluate the role of Gal‐1 during a lipopolysaccharide (LPS)‐induced‐inflammatory milieu. Method of Study: Using an ex vivo culture with two independent compartments, human fetal membranes at term were pretreated with 40 and 80 ng/mL of Gal‐1, then to reproduce an intraamniotic inflammation, the fetal side of membranes was stimulated with 500 ng/mL of LPS for 24 h. The concentrations of tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6, monocyte chemoattractant protein (MCP1), macrophage inflammatory protein (MIP1) α, regulated upon activation normal T cell expressed and secreted (RANTES), and matrix metalloproteinase (MMP)‐9 were measured in both amnion and choriodecidua compartments. Results: In a tissue‐specific fashion profile, pretreatment with the physiologic concentration of Gal‐1 significantly diminished the LPS‐dependent secretion of TNF‐α, IL‐1β, Il‐6, MCP1, MIP1α, RANTES, and MMP‐9. Conclusion: Gal‐1 elicits an anti‐inflammatory effect on the human fetal membranes stimulated with LPS, which supports the hypothesis that Gal‐1 is part of the immunomodulatory mechanisms intended to stop the harmful effect of inflammation of the maternal–fetal interface. [ABSTRACT FROM AUTHOR]

Streptococcus agalactiae, or Group B Streptococcus (GBS), is a leading cause of neonatal sepsis. Materno-fetal transmission of the microorganisms present in the lower genital tract/perineum is considered to be the most frequent mode for acquisition of infection. It has also been proposed that, in a subset of cases, GBS causes acute chorioamnionitis, intraamniotic infection, and fetal/neonatal sepsis. However, the evidence to support this ascending pathway is derived from microbiologic studies that rely on cultivation methods, which do not have the resolution to determine if the microorganisms causing neonatal sepsis are the same as those found in the amniotic fluid and the vaginal ecosystem. We used whole genome sequencing of the microorganisms isolated from the vagina, amniotic fluid, chorioamniotic membranes, and neonatal blood (four isolates) in a case of early neonatal sepsis. Using hybrid genome assembly, we characterized the genomic features including virulence factors and antimicrobial resistance in four isolates from the same mother, placenta, and newborn. Whole genome sequencing revealed that the microorganisms in the four clinical isolates corresponded to S. agalactiae sequence type 1, clonal complexes 1, and serotype Ib. Comparative genomic analysis illustrated similar DNA sequences of the four genomes. This study presents the first evidence of the genomic similarity of microorganisms in the vaginal ecosystem, the space between the chorioamniotic membranes of the placenta, amniotic fluid, and neonatal blood. [ABSTRACT FROM AUTHOR]

This prospective cohort study aimed to evaluate the performance of Flora select™ (FS), a newly developed real-time PCR test, for the assessment of the vaginal microbiome during early pregnancy. Five hundred and fifty-six pregnant women underwent examinations of FS, Nugent score—a Gram-staining scoring system for the diagnosis of bacterial vaginosis (BV)—and conventional bacterial culture between 8 weeks and 12 gestational weeks. Nugent scores of 0–3, 4–6, and ≥7 were found in 469 (84.2%), 41 (7.4%), and 47 (8.5%) of the women, respectively. Relative dominance rates of Lactobacillus species of high (≥80% medium (50%≤, <80%), and low (0.1≤, <50%), and no detection (<0.1%) were 63.0%, 8.8%, 17.1%, and 11.2%, respectively. Gardnerella, Prevotella, Atopobium, Streptococcus, Ureaplasma, and Mycoplasma species were detected in 23.9%, 17.6%, 17.1%, 7.0%, 23.0%, and 4.9% of the women, respectively. Gardnerella species were detected in all women with Nugent scores ≥7 and Ureaplasma were detected in 40.4% of them. BV-associated bacterial species were also detected in 70.7% of women with Nugent scores of 4–6. Gardnerella, Prevotella, Atopobium, Streptococcus, Ureaplasma, and Mycoplasma species were highly prevalent in women with Nugent scores ≥4 or Lactobacillus species <50%. FS detected Gardnerella, Prevotella, and Atopobium species more effectively than conventional bacterial culture. FS could determine relative dominance rates of Lactobacillus species in the vaginal microbiome, and simultaneously detect four kinds of BV-associated bacteria, Ureaplasma and Mycoplasma species. Therefore, FS may be clinically useful for the screening of the vaginal microbiome during pregnancy to prevent preterm birth and for the assessment of the vaginal microbiome after BV treatments. [ABSTRACT FROM AUTHOR]

Background: One of the main reasons for neonatal deaths is preterm delivery, and infants who have survived preterm birth (PB) are at risk of significant health complications. However, an effective method for reliable and accurate prediction of preterm labor has yet to be proposed. Objective: This study proposes an artificial neural network (ANN)-based approach for early prediction of PB, and consequently can hint physicians to start the treatment earlier, reducing the chance of morbidity and mortality in the infant. Material and Methods: This historical cohort study proposes a feed-forward ANN with 7 hidden neurons to predict PB. Thirteen risk factors of PB were collected from 300 pregnant women (150 with preterm delivery and 150 normal) as the ANN inputs from 2018 to 2019. From each group, 70%, 15%, and 15% of the subjects were randomly selected for training, validation, and testing of the model, respectively. Results: The ANN achieved an accuracy of 79.03% for the classification of the subjects into two classes normal and PB. Moreover, a sensitivity of 73.45% and specificity of 84.62% were obtained. The advantage of this approach is that the risk factors used for prediction did not require any lab test and were collected in a questionnaire. Conclusion: The efficacy of the proposed approach for the early identification of pregnant women, who are at high risk of preterm delivery, leads to necessary care and clinical interventions, applied during the pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Coronavirus disease 2019 (COVID-19) is the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute respiratory distress and preterm delivery are the two major complications induced by SARS-CoV-2 infection during pregnancy. In the presence of dyspnea, the use of systemic corticosteroids was recommended in pregnant and non-pregnant groups. Our primary aim was to investigate the effect of early-onset steroid treatment on mortality and adverse effects in pregnant women with COVID-19. Our secondary aim was to investigate the effect of steroid treatment on the length of hospital stay and intensive care unit (ICU) stay, and duration of treatment. The study also investigated infection, preterm birth, and ideal body weight (lbw) in newborns. Methods: In this retrospective study, 253 patients were divided into three groups according to steroid administration. In Group 1 patients (n:112), treatment was started at the time of hospitalization. In Group 2 patients (n:90), treatment was started at least 24 h after hospitalization. Group 3 consisted of patients (n:51) who did not receive steroid treatment. Methylprednisolone (32 mg/day) was given to pregnant patients with a gestational age below 24 weeks or above 34 weeks, and dexametazone (6 mg/day) was given in four doses followed by 32 mg/day methylprednisolone for the others (whose baby was at a gestational age of 24 weeks and above but less than 34 weeks). Result: The hospital stay, ICU stay, and steroid administration time were significantly lower in the Group 1 when compared to the others (p < 0.05). The steroid treatment requirement was 4.4 days in Group 1 and 5.7 days in Group 2 (p < 0.05). While no death was observed in Group 1, one patient died in Group 2 and three patients died in Group 3. There was no difference between the groups in terms of complications, including preterm labor. Conclusions: No death was also observed with early-onset treatment. Early-onset treatment may be beneficial for fewer hospitalizations, fewer ICU stays, and less mechanical ventilation requirement in pregnant women with COVID-19. In addition, with early treatment, the total number of steroid administration days was reduced, which is important in terms of reducing the risk of side effects. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the efficacy of cervical cerclage with spontaneous follow-up strategy on pregnancy duration and neonatal outcomes in women with visible or prolapsed fetal membranes. Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks. A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 ± 6 [median=30 (19–38)] weeks in the cerclage group and 25.8 ± 2.9 [median=25 (19–32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 ± 48.6 days [median=28 (3–138)] vs. 12 ± 17.9 days [median=9 (1–52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7–78.2). Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is a condition with altered vaginal flora with gross hydrogen peroxide-producing Lactobacilli strains decreasing with excessive anaerobe growth. Also, a decrease in vaginal lactic acid content is seen with increased vaginal pH to >4.5 and increased bacterial counts to 100-1000 folds. Aim: The present study was aimed at assessing the correlation between bacterial vaginosis to low birth-weight neonates and puerperal sepsis in females with preterm labor. Methods: The study assessed 450 females admitted to the institute with pre-term labor. In all the subjects demographic data were recorded followed by obstetric history recording including gestational age, parity, and birth weight of the infants. The subjects were then divided into two groups: bacterial vaginosis and no bacterial vaginosis. The association of birth weight to bacterial vaginosis and of bacterial vaginosis to puerperal sepsis was assessed and compared. Results: The study results showed a significantly higher presence of bacterial vaginosis in subjects with normal baby weight group with p=0.001. A significantly higher presence of puerperal sepsis was seen in subjects with bacterial vaginosis compared to the subjects with no bacterial vaginosis with p=0.002. Conclusions: The present study, considering its limitations, concludes that bacterial vaginosis has a high prevalence in subjects with normal baby weight compared to small or large gestational age subjects. The study also concludes that puerperal sepsis has a significantly higher prevalence in subjects with bacterial vaginosis compared to subjects without bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11–14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Preterm labor is one of the most important pregnancy problems that cause the majority of infant mortality and morbidity even in advanced societies, and it may be possible to improve the outcome of pregnancy by predicting it. The present study was conducted with aim to evaluate the predictive value of the first and the third trimester maternal mean platelet volume (MPV) for prediction of preterm labor. Methods: This prospective cohort study was performed in 2019-2021 on 400 pregnant women with a gestational age of 9-12 weeks in Akbarabadi Hospital, Tehran. According to the inclusion and exclusion criteria of the study, blood sample was taken to check the mean volume of platelets in the first trimester and again in the gestational age of 26-28 weeks and the mothers were monitored up to delivery. At the end, the incidence of preterm delivery was determined and the mean volume of platelets (MPV) in the first and third trimesters of pregnancy were investigated and compared in two groups of preterm delivery and term delivery. In order to determine the accuracy, the ROC curve was drawn and the area under the curve was calculated. P<0.05 was considered significant. Results: Out of 400 studied women, 365 finished the study and were evaluated, and 96 women (26.3%) had preterm labor. MPV of the first trimester did not show significant difference between the two groups of preterm delivery and natural delivery (9.68±1.09 vs 9.57±1.14, p= 0.430). Also, MPV of the third trimester was not significantly different between the two groups of preterm delivery and natural delivery (9.62±1.12 vs 9.46±1.19, p= 0.251). The ROC curve was used to determine the accuracy of mean platelet volume in order to diagnose preterm delivery that considering to the area under the ROC curve as 0.50, it showed no predictive value for preterm labor. Conclusion: The MPV cannot be considered as a suitable index for prediction of preterm labor. [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of inflammatory markers, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), c‐reactive protein (CRP) to albumin ratio (CAR), fibrinogen to albumin ratio (FAR), and fibrinogen to CRP ratio (FCR) in predicting the latency period (≤72 vs. >72 hours) before preterm birth. Materials and Methods: In a retrospective study, we assessed 135 patients meeting the specified criteria with signs of preterm labor (<34 weeks). The patients were categorized into two groups: 71 patients giving birth within 72 h (latency ≤ 72 h) and 64 patients giving birth after 72 h (latency > 72 h). We examined the demographic and medical characteristics and perinatal outcomes of all participants. Categorical variables between groups were compared using the Chi‐square test. The Student's t‐test was utilized for normally distributed continuous variables, and the Mann–Whitney U test was applied for non‐normally distributed data. Receiver operating characteristic (ROC) curve analysis was conducted to identify the optimal cut‐off levels for inflammatory markers in predicting the latency period before birth. Results: Among the parameters examined, significant differences were observed between the groups only in terms of CAR and FCR. While CAR showed a significantly higher value in the group with latency period ≤72 h (0.537 ± 1.239 vs. 0.247 ± 0.325, p = 0.022), FCR showed a significantly lower value in the group with latency period ≤72 h (63.58 (2.99–1165) vs. 88.93 (9.35–1165), p = 0.013). The identified cut‐off value for CAR was 0.190, providing a sensitivity of 57.7% and a specificity of 56.3% (p = 0.022). The cut‐off value for FCR was 71.67, with a sensitivity of 42.3% and a specificity of 42.2% (p = 0.013). Conclusions: The CAR and the FCR, serving as predictive markers for preterm labor, may offer a simple, cost‐effective, and easily accessible approach, particularly in resource‐limited settings. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether various inflammatory-, angiogenic/anti-angiogenic-, and extracellular matrix remodeling-associated proteins in plasma, alone or in combination with conventional blood-based markers, can predict intra-amniotic inflammation and/or microbial invasion of the amniotic cavity (IAI/MIAC) in women with spontaneous preterm labor (PTL). Methods: A total of 193 singleton pregnant women with PTL (23–33 weeks) were included in this retrospective cohort study. Plasma samples were obtained at the time of amniocentesis. Amniotic fluid (AF) was cultured for microorganism detection and consequent MIAC diagnosis. IL-6 levels were determined in AF and used to identify IAI (AF IL-6 ≥ 2.6 ng/mL). Endostatin, haptoglobin, IGFBP-2/3, LBP, M-CSF, MMP-2/8, pentraxin 3, PlGF, S100A8/A9, and VEGFR-1 levels were assayed in plasma samples by ELISA. CRP levels and neutrophil-to-lymphocyte ratio (NLR) were measured. Results: Plasma LBP, MMP-8, and S100A8/A9 levels, CRP levels, and NLR were significantly higher, and plasma IGFBP-2 and MMP-2 levels were significantly lower in women with IAI/MIAC than in those without this condition, whereas no baseline variables differed significantly between the two groups. Using a stepwise regression analysis, a noninvasive prediction model for IAI/MIAC was developed, which included plasma LBP, MMP-2, and MMP-8 levels (area under the curve [AUC], 0.785). The AUC for this prediction model was significantly or borderline greater than that of any single factor included in the model. Conclusions: IGFBP-2, LBP, MMP-2, MMP-8, and S100A8/A9 may represent valuable plasma biomarkers for predicting IAI/MIAC in women with PTL. Combination of LBP, MMP-2, and MMP-8 expression data can significantly improve the predictive potential for IAI/MIAC. [ABSTRACT FROM AUTHOR]

Preterm delivery is associated with perinatal outcomes such as neonatal complications and deaths. Uterine contraction suppressants are administered to treat. In Japan, ritodrine hydrochloride (ritodrine) and magnesium sulfate (magnesium) are covered by insurance. However, ritodrine was withdrawn from the United States market in 2011, and in Europe, its administration was only limited for short-term use in 2013. In this study, we analyzed in the use of ritodrine and magnesium using the NDB Open Data Japan and annual trends in the number of births issued by the Ministry of Health, Labor, and Welfare for 2019-2021. Ritodrine prescribed per birth decreased from 2019 to 2020, while the level 2021 was the same as 2020. Magnesium decreased between 2019 and 2021. The ages were administered ranged from 15-49 years. The results of this study suggest that ritodrine and magnesium are still frequently used in Japan for the treatment of preterm labor. Recently, the American College of Obstetricians and Gynecologists advocated the use of calcium antagonists such as nifedipine as the first choice. We extracted trends in the use of nifedipine, in the target age group for the treatment of imminent preterm labor. The number of nifedipine prescriptions increased every year. However, nifedipine has no indication for the treatment of imminent preterm labor in Japan, it should be noted that this is not accounting for the treatment of impending preterm labor because the prescriptions were classified as vasodilators in the NDB Open Data. [ABSTRACT FROM AUTHOR]

Preterm premature rupture of membranes (pPROM) before 22–24 weeks of gestation is considered previable and poses a high risk to the chances of successful delivery. Multicystic dysplastic kidney (MCDK) is the most common form of dysplasia of this organ, usually affecting 1 kidney. A prenatal suspicion of MCDK requires escalation of the clinical process to a reference center qualified and equipped for further diagnosis and treatment. We present a unique case of prenatal pPROM at 19 weeks of gestation in a pregnancy complicated by fetal MCDK as an interesting obstetric and neonatal patient story. We have not found any published evidence on the impact of coexisting fetal congenital malformations on a pregnancy affected by previable pPROM. The aim of this study is to highlight the importance of a multidisciplinary team approach in the management of previable pPROM and the difficulties of decision-making involving both health professionals and the mother. Initially, medical management focuses on the safety of the mother, and as the fetus reaches viability, the focus shifts to the high standard of care for the child. The final successful outcome and follow-up was the effect of coordinated prenatal and postnatal medical care. [ABSTRACT FROM AUTHOR]

Problem: Preterm birth (PTB) is a leading cause of infant mortality and morbidity. The pathogenesis of PTB is complex and involves many factors, including socioeconomy, inflammation and infection. Asymmetric dimethylarginine, ADMA and symmetric dimethylarginine, SDMA are involved in labor as inhibitors of nitric oxide, a known relaxant of the uterine smooth muscles. Arginines are scarcely studied in relation to PTB and we aimed to investigate arginines (ADMA, SDMA and L‐arginine) in women with spontaneous PTB and term birth. Methods of the Study: The study was based on data from the population‐based, prospective cohort BASIC study conducted in Uppsala County, Sweden, between September 2009 and November 2018. Arginines were analyzed by Ultra‐High Performance Liquid Chromatography using plasma samples taken at the onset of labor from women with spontaneous PTB (n = 34) and term birth (n = 45). We also analyzed the inflammation markers CRP, TNF‐R1 and TNF‐R2 and GDF‐15. Results: Women with spontaneous PTB had higher plasma levels of ADMA (p < 0.001), and L‐Arginine (p = 0.03). In addition, inflammation marker, TNF‐R1 (p = 0.01) was higher in spontaneous PTB compared to term birth. Further, in spontaneous PTB, no significant correlations could be observed when comparing levels of arginines with inflammation markers, except ADMA versus CRP. Conclusions: These findings provide novel evidence for the potential involvement of arginines in the pathogenesis of spontaneous PTB and it seems that arginine levels at labor vary independently of several inflammatory markers. Further research is warranted to investigate the potential of arginines as therapeutic targets in the prevention and management of spontaneous PTB. [ABSTRACT FROM AUTHOR]

The use of indomethacin to delay delivery in preterm labor (PTL) is widely accepted; however, the optimal dosage of indomethacin in pregnancy is unknown. Here, we perform population pharmacokinetic (PK) and pharmacodynamic (PD) analyses, characterize the plasma disposition of indomethacin in pregnant women with PTL, and relate indomethacin exposure to delayed delivery and maternal/neonatal safety. We analyzed plasma and urine samples collected from a multicenter, prospective, opportunistic PK/PD study of indomethacin in pregnant women 12‐32 weeks gestation admitted with PTL. Ninety‐four participants with 639 plasma concentrations for indomethacin were included in the analysis. The final population PK (popPK) model for indomethacin was a 2‐compartment structural model with first‐order absorption and elimination and a covariate effect of body mass index on apparent oral clearance. We observed a 21%‐60% increase in apparent oral clearance observed during pregnancy. There was no clear association between indomethacin exposure and maternal or neonatal safety outcomes, or with the magnitude of delayed delivery; however, 96.7% of women treated with indomethacin had a delivery that was delayed at least 48 hours. Given the changes to indomethacin apparent oral clearance during pregnancy, and the lack of relationship between indomethacin exposure and safety, dose‐finding studies of indomethacin in pregnant women with PTL may help clarify the most safe and efficacious dosage and duration of indomethacin. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the perinatal and maternal outcomes of women ranging in age from 40 to 45 years who gave birth after in vitro fertilization or oocyte donation, compared to spontaneous conception. Methods: This retrospective cohort study used electronic data from a national healthcare service from 2000 through 2019. Three groups were compared: spontaneous pregnancy (SC), in vitro fertilization (IVF) utilizing autologous oocytes, and pregnancies resulting from oocyte donation (OD). The primary study outcomes were preterm labor (PTL) before 37 weeks of gestation, and infants classified as small for gestational age (SGA). Results: The cohort included 26,379 SC, 2237 IVF pregnancies, and 300 OD pregnancies for women ages 40–45 years at delivery. Women with OD or IVF had a higher incidence of PTL < 37 weeks compared to women with SC (19.7% vs. 18% vs. 6.9%, p = 0.001), PTL < 34 (7% vs. 4.5% vs. 1.4%, p = 0.001), PTL < 32 (3.7 vs. 2.1 vs. 0.6, p = 0.001). A multivariable logistic regression for PTL < 37 weeks demonstrated that age (OR = 1.18) and hypertensive diseases (OR = 3.4) were statistically significant factors. The OD group had a lower rate of SGA compared to SC (1% vs. 4.3%, p = 0.001), while the IVF group had a higher rate of SGA compared to SC (9.1% vs. 4.3%, p = 0.001). Hypertensive diseases in pregnancy were significantly higher among the OD group and the IVF group compared to SP pregnancies (3.3% vs. 1%, p = 0.002; 2.3% vs. 1%, p = 0.001, respectively). Conclusions: Women ages 40–45 undergoing IVF or OD have a greater risk of PTL, possibly due to higher rates of hypertensive disorders of pregnancy. [ABSTRACT FROM AUTHOR]

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Objective The objective of this study was to survey national utilization of cervical length (CL) ultrasound on labor and delivery (L&D) for the evaluation of preterm labor (PTL) and identify provider attitudes and barriers to utilization. Study Design Survey was emailed to Obstetrics and Gynecology Residency and Maternal-Fetal Medicine Fellowship program and advertised via links on obstetric-related Facebook interest groups. The survey was open from August 4, 2020 to January 4, 2021. Characteristics between respondents who did and did not report the use of CL ultrasound for PTL evaluation were compared with chi-square analysis. Results There were 214 respondents across 42 states. One hundred and thirty-four respondents (63%) reported any use of CL in the evaluation of PTL and eighty (37%) denied it. There was a significant difference in practice location, practice type, delivery volume, and region between those who did and did not utilize CL ultrasound on L&D. Those who did use CL ultrasound were more likely to report no barriers to use (40 vs. 4%, p < 0.001). The most common barriers involved the availability of transvaginal ultrasound (31%), sterilization of transvaginal ultrasound probe (32%), limited availability of persons able to perform/interpret CL imaging (38%). Nineteen percent believed CL ultrasound had little/no utility in clinical practice. Those who did not use CL ultrasound in the evaluation of PTL were significantly more likely to report the feeling that there was little/no utility of CL ultrasound in clinical practice (37 vs. 7%, p < 0.001) and to report transvaginal ultrasound availability as barriers to use (63 vs. 12%, p < 0.001). Conclusion CL ultrasound is used nationally in PTL evaluation. However, significant barriers limit widespread adoption. These barriers can be addressed through the dissemination of information and practice guidelines, addition of CL ultrasound education in residency training and through CME opportunities after training, and providing support/resources/access for those looking to add this tool to their practice environment. Key Points In a national survey, 63% of obstetricians endorsed any use of cervical length (CL) ultrasound for preterm labor evaluation on labor and delivery. The most common barriers involved the availability of transvaginal ultrasound (31%), sterilization of transvaginal ultrasound probe (32%), limited availability of persons able to perform/interpret CL imaging (38%). Those who did not use CL ultrasound in the evaluation of PTL were significantly more likely to report the feeling that there was little/no utility of CL ultrasound in clinical practice and to report transvaginal ultrasound availability as barriers to utilization. Barriers to utilization of CL ultrasound for preterm labor evaluation can be addressed through practice guidelines, ultrasound education, and support for equipment/training necessary for use. [ABSTRACT FROM AUTHOR]

Objective We aimed to evaluate the correlation and agreement of interleukin (IL)-8 and matrix metalloproteinases (MMP-9) levels between cervicovaginal (CVF) and amniotic fluids (AF) in women with preterm labor (PTL) and to determine the clinical values of these proteins in CVF compared with those in AF. Study Design We designed a retrospective cohort study of 85 singleton pregnant women with PTL at 23 to 34 weeks, who underwent amniocentesis. The AF was cultured, and CVF samples were collected at the time of amniocentesis. Paired AF and CVF samples were assayed for IL-8 and MMP-9 by enzyme-linked immunoassay (ELISA) in duplicate on a single plate, using similar dilution ratios. Results A significant but weak correlation was found for IL-8 levels between AF and CVF (r = 0.333), while no correlation was found for MMP-9 levels between AF and CVF (r = −0.039). Intra-class correlation coefficient for the agreement of IL-8 levels between CVF and AF was 0.4335 and −0.279 for MMP-9, indicating a poor-to-fair level of agreement between the two measured values, respectively. IL-8 and MMP-9 levels in CVF were not associated with the risk of either microbial invasion of the amniotic cavity (MIAC) or spontaneous preterm delivery (SPTD) within 7 days, whereas those in AF provided good-to-excellent predictive values for these two outcomes (area under the curve [AUCs]: 0.82–0.95). AUCs for IL-8 and MMP-9 were significantly larger using AF rather than using CVF for the prediction of MIAC and SPTD. Conclusion In women with PTL, IL-8 and MMP-9 levels in CVF do not precisely reflect the levels of the corresponding proteins in AF. IL-8 and MMP-9 levels in CVF had poor predictive values for the risk of MIAC and SPTD and were significantly inferior to those in AF. Key Points IL-8 and MMP-9 levels in CVF do not precisely reflect levels of the corresponding proteins in AF. Diagnostic accuracy of IL-8 and MMP-9 in CVF alone is not sufficient to predict MIAC and SPTD. IL-8 and MMP-9 levels in AF provide good-to-excellent predictive values for these two outcomes. [ABSTRACT FROM AUTHOR]

Background: The wide uterocervical angle (UCA) has been identified as a predictor of preterm delivery, and the goal of this study is to see how accurate UCA is at predicting spontaneous preterm birth in the second trimester. The aim of study is early prediction of preterm labor by uterocervical angle measurement using transvaginal sonography (TVS) in the second trimester of women at low risk for spontaneous preterm birth (SPB). Methods: This is a prospective cohort study including seventy pregnant women in the second trimester (16-28weeks). They were classified into to preterm (group 1) and term (group 2) according to delivery of 28 and 42 women in each group, respectively. TVS was performed for all participants with measuring UCA. Results: This study shows that all ultrasonographic parameters showed the mean UCA was 124.74±19.69 and 85.95±8.32 degrees in preterm and fullterm delivery, respectively, it had statistically highly significant difference (p <0.001). Conclusions: An elevated risk of spontaneous preterm birth was linked to a wide UCA found during the second trimester. The uterocervical angle may be utilised as a screening tool for spontaneous preterm birth, according to this study. [ABSTRACT FROM AUTHOR]

Significance: Preterm birth is defined as a birth before 37 weeks of gestation and is one of the leading contributors to infant mortality rates globally. Premature birth can lead to life-long developmental impairment for the child. Unfortunately, there is a significant lack of tools to diagnose preterm birth risk, which limits patient care and the development of new therapies. Aim: To develop a speculum-free, portable preterm imaging system (PPRIM) for cervical imaging; testing of the PPRIM system to resolve polarization properties of birefringent samples; and testing of the PPRIM under an IRB on healthy, nonpregnant volunteers for visualization and polarization analysis of cervical images. Approach: The PPRIM can perform 4 x 3 Mueller-matrix imaging to characterize the remodeling of the uterine cervix during pregnancy. The PPRIM is built with a polarized imaging probe and a flexible insertable sheath made with a compatible flexible rubber-like material to maximize comfort and ease of use. Results: The PPRIM device is developed to meet specific design specifications as a speculum-free, portable, and comfortable imaging system with polarized imaging capabilities. This system comprises a main imaging component and a flexible silicone inserter. The inserter is designed to maximize comfort and usability for the patient. The PPRIM shows high-resolution imaging capabilities at the 20 mm working distance and 25 mm circular field of view. The PPRIM demonstrates the ability to resolve birefringent sample orientation and full field capture of a healthy, nonpregnant cervix. Conclusion: The development of the PPRIM aims to improve access to the standard of care for women's reproductive health using polarized Mueller-matrix imaging of the cervix and reduce infant and maternal mortality rates and better quality of life. [ABSTRACT FROM AUTHOR]

Background: Chorangioma are benign vascular tumors of the placenta that are nontrophoblastic in nature. The clinical importance of these tumors correlates with their size, with chorangioma larger than 4 cm being linked to complications for both the mother and the fetus. Case description: We present a rare case of 20-year-old primigravida female patient who presented to us at 35 weeks of gestation with a positive sickling test history and pain in the abdomen. Ultrasound showed a single live fetus with polyhydramnios, and a distinct hypoechoic lesion adjacent to the umbilical cord insertion site along the subchorionic plane of the placenta, suggestive of a chorangioma. Histopathological examination confirmed the placental chorangioma. The uniqueness of this case report lies in the presence of a hypoplastic left transverse sinus and sigmoid sinus following delivery without any fetal complications. However, such accidental diagnoses may cause a lot of complications during and after childbirth. Conclusion: It is crucial to implement routine and timely antenatal care to detect and manage potential complications effectively. [ABSTRACT FROM AUTHOR]

Extracellular vehicles (EVs) have been involved in several aspects of pregnancy, including endometrial receptivity, embryo implantation, and embryo-maternal communication showing them associated with pregnancy disorders, such as preeclampsia, gestational diabetes mellitus, and preterm birth. Further research is warranted to fully comprehend the exact pathophysiological roles of EVs and to develop new therapies targeting EVs thereby improving pregnancy outcomes. Herein, we review the recent knowledge on the multifaceted roles of EVs during pregnancy and address the majority of the molecular interactions between EVs, maternal, and fetal cells with an emphasis on disorders of pregnancy under the influence of EVs. Moreover, we also discuss its applications in clinical trials followed by prospects. [ABSTRACT FROM AUTHOR]

Purpose: The fetal membranes are essential for the maintenance of pregnancy, and their integrity until parturition is critical for both fetal and maternal health. Preterm premature rupture of the membranes (pPROM) is known to be an indicator of preterm birth, but the underlying architectural and mechanical changes that lead to fetal membrane failure are not yet fully understood. The aim of this study was to gain new insights into the anatomy of the fetal membrane and to establish a tissue processing and staining protocol suitable for future prospective cohort studies. Methods: In this proof of principle study, we collected fetal membranes from women undergoing vaginal delivery or cesarean section. Small membrane sections were then fixed, stained for nucleic acids, actin, and collagen using fluorescent probes, and subsequently imaged in three dimensions using a spinning disk confocal microscope. Results: Four fetal membranes of different types were successfully processed and imaged after establishing a suitable protocol. Cellular and nuclear outlines are clearly visible in all cases, especially in the uppermost membrane layer. Focal membrane (micro) fractures could be identified in several samples. Conclusion: The presented method proves to be well suited to determine whether and how the occurrence of membrane (micro) fractures and cellular jamming correlate with the timing of membrane rupture and the mode of delivery. In future measurements, this method could be combined with mechanical probing techniques to compare optical and mechanical sample information. [ABSTRACT FROM AUTHOR]

Background: Undernutrition refers to an overall deficiency of nutrients due to an inadequate intake of a well-balanced diet. Undernourishment during pregnancy is an important contributor to maternal morbidity and mortality. It remains a persistent problem in developing countries, where women usually fall behind men in having access to food, health care, and education. Despite the high prevalence of maternal undernourishment, its direct impact on obstetric outcomes has not been studied in developing countries, including Ethiopia. Objective: This study aimed to assess the effect of maternal undernutrition on adverse obstetric outcomes in Gedeo zone public hospitals. Method: A cohort study design was employed in Gedeo zone public hospitals from June 30, 2022, to February 28, 2023. This study included 721 pregnant women, 237 were exposed group whereas 484 were non-exposed. A systematic random sampling technique was used to select a non-exposed group and the exposed group was selected consecutively. Both groups were followed for 7 months, from 16 weeks of gestation to 24 h of delivery. The pretested interviewer-administered questionnaire and checklist were used. EpiData 4.4.1.2.version was used for data entry and analyzed using Stata version 16 software. A modified Poisson regression model with robust standard errors was used to determine relative risk, and the statistical association was declared at a p-value ≤ 0.05. Finally, the findings were reported in figures, tables, and words. Result: The incidence of adverse obstetrics outcomes among undernourished and normally nourished mothers was hypertensive disorder during pregnancy (HDDP) (7.49% vs. 3.19%), antepartum haemorrhage (7.49% vs. 3.19%), obstructed labor (1.53% vs. 3.49%), premature rupture of the membrane (2.5% vs. 3.33%), preterm labor (6.52% vs. 6.93%), instrumental vaginal delivery (1.8% vs. 4.3%), postpartum haemorrhage (5.95% vs. 3.88%), and sepsis (3.74% vs. 1.94%). The risk of adverse obstetric outcomes among undernourished women was hypertensive disorder during pregnancy (HDDP) (aRR) = 4.07, 95%CI: 2.53–6.55), antepartum haemorrhage (APH) (aRR = 5.0, 95% CI: 2.08–12.72), preterm labor (aRR = 1.8, 95%CI: 1.23–2.62), operative delivery (aRR = 1.24, 95%C: 0.87–1.78), postpartum haemorrhage (aRR = 3.02, 95%CI: 1.91–4.79), and sepsis/chrioaminitis (aRR = 3.55, 95%CI: 1.83–6.89) times higher than normally nourished women. Conclusion: The incidence rates of hypertensive disorder during pregnancy (HDDP), antepartum haemorrhage, postpartum haemorrhage, and sepsis were higher among undernourished women than normally nourished women. Undernourished women during pregnancy have an increased risk of adverse obstetrics outcomes including hypertensive disorder during pregnancy, antepartum, preterm labor, operative delivery, postpartum haemorrhage, and sepsis/chorioamnionitis. [ABSTRACT FROM AUTHOR]

Objective In the setting of a growing obese obstetric population, we sought to determine whether differences in body mass index (BMI) and obesity class influenced both serum magnesium levels and the likelihood of achieving therapeutic levels for eclampsia prophylaxis after standard boluses of magnesium sulfate. Study Design This is a retrospective cohort study of patients treated with magnesium sulfate in the setting of either preeclampsia with severe features or preterm labor between 2010 and 2016. Subjects were categorized by BMI: Normal (BMI < 30 kg/m 2), Class 1 (BMI 30–34.9 kg/m 2), Class 2 (BMI 35–39.9 kg/m 2), and Class 3 (BMI ≥ 40 kg/m 2). Study participants' demographics, intrapartum characteristics, and adverse reactions were compared among the groups. Logistic regression models were used to calculate unadjusted and adjusted odds ratios comparing the likelihood of each BMI class reaching therapeutic eclamptic prophylactic levels. Linear regression models were also evaluated to determine the relationship between BMI and post-bolus serum magnesium levels. Results Of the 760 people who met the inclusion criteria, 313 (41.1%) had normal BMI, 190 (25.0%) had Class 1 obesity, 135 (17.8%) had Class 2 obesity, and 122 (16.1%) had Class 3 obesity. When adjusted for confounders, those with Class 1 obesity were 54% less likely to achieve serum levels deemed therapeutic for seizure prophylaxis compared with normal BMI counterparts. Meanwhile, those with Class 2 or 3 obesity were 90% less likely. Linear regression models also demonstrated an inverse association between BMI and post-bolus serum magnesium levels. Conclusion Increasing BMI has a significant effect on post-bolus serum magnesium levels regardless of standard loading dose used. Immediately after bolus administration, obese gravidas are significantly less likely to reach levels effective for eclamptic seizure prophylaxis. When considering which bolus to administer in an obese gravida, it may be more beneficial to choose a 6 g load. Key Points BMI has an inverse relationship with post-bolus serum magnesium levels. Obese gravidas were less likely to reach eclampsia prophylaxis levels regardless of bolus type. Obesity class, not just the presence or absence of obesity, plays a role in serum magnesium levels. [ABSTRACT FROM AUTHOR]

Aerobic vaginitis (AV) is a distinct clinical entity characterized by inflammation and abnormal vaginal microflora. Often mistaken for bacterial vaginosis, AV remains relatively unknown and underdiagnosed. AV's understanding is evolving, with some experts suggesting it may primarily be an immunological disorder, the prevalence of which has a range of 7–13% in non-pregnant women and 4.1–8.3% during pregnancy. Pregnancy can affect susceptibility to vaginal infections, leading to adverse outcomes for the woman and the newborn. This review summarizes the correlation between AV and adverse pregnancy outcomes, particularly preterm birth, the leading cause of morbidity and mortality among neonates. An improved understanding of AV's impact on pregnancy outcomes can lead to early recognition, proper management, and effective interventions. While some studies support an association between AV and preterm labor, the existing knowledge of this relationship remains limited. The evidence suggests that AV may contribute to adverse pregnancy outcomes, mainly preterm birth, but further research is needed to establish a definitive link. Further studies are needed to investigate the underlying mechanisms and clarify AV's role in premature labor. A comprehensive understanding of AV's impact on pregnancy outcomes is crucial for early recognition, appropriate management, and effective interventions. [ABSTRACT FROM AUTHOR]

Background: Patients with a singleton pregnancy, a history of spontaneous preterm delivery, and a short cervix may benefit from preterm birth prevention strategies that involve vaginal progesterone treatment as well as the placement of a cervical cerclage. Clinical use of vaginal progesterone is preferred over cervical cerclage because it is less expensive and does not require invasive surgery to prevent premature labor. This study aims at comparing the efficacy of using both vaginal and intramuscular progesterone versus cervical cerclage for prevention of the preterm birth among females with previous history of preterm birth. Methods: One hundred and twenty pregnant females with an increased risk of preterm labor (assessed by a previous preterm birth (PTB) or transvaginal ultrasound (TVUS) findings of a shortened cervix which is less than 25 mm participated in this randomized controlled study at the Obstetrics and Gynecological Department of Zagazig University Hospital. Group A: 62 pregnant women had progesterone therapy in the form of vaginal suppositories 400mg twice per day and intramuscular long-acting progesterone per week at 13 weeks to 37 weeks gestational age. Group B: (Cervical Cerclage group) 58 pregnant women who had Cervical Cerclage at 13 weeks’ gestation without progesterone. All data regarding the timing of labor onset, along with maternal and neonatal complications were documented. Results: Cervical length is significantly increased in the cerclage group from 1.877+.41 cm to 2.18+.31 cm with P value <0.001 after doing the cerclage. When compared to the cervical cerclage, progesterone use yielded similar effects with non-statistically significant differences in terms of method of delivery, pregnancy fate, and neonatal outcomes. Conclusion: The progesterone is successful as cervical cerclage in preventing preterm labor, but its usage could be better in clinical as it's noninvasive method and economic. [ABSTRACT FROM AUTHOR]

Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin gestations complicated by symptomatic polyhydramnios between 2010 and 2023 at our tertiary referral center. The indications, procedural techniques and pregnancy and neonatal outcomes were retrieved from an archive database and reviewed with the use of the maternal and child medical record chart, the hospital electronic clinical discharge report and telephone recalls. Our study comprised 86 pregnancies, 65 singletons and 21 twin pregnancies. Fetal anomalies were identified in 79% of cases, mainly gastrointestinal obstructive anomalies; 9.3% of cases were idiopathic. The median gestational age at first amnioreduction was 32.5 weeks, and peri-procedural complications were rare (1 case of placental abruption and 2 cases of preterm delivery). The median gestational age at delivery was 36.5 weeks, with a median prolongation of the pregnancy from the time of first drain until birth of 30 days. Preterm labor < 37 weeks occurred in 48.8% of procedures, with 26.7% of patients delivering before 34 weeks and pPROM < 36 weeks recorded in 23.2% of cases. In conclusion, amnioreduction offered to alleviate maternal symptoms is a reasonably safe procedure with a low complication rate. These pregnancies necessitate management in a tertiary referral center because of their need for a multidisciplinary approach both prenatally and postnatally. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was the evaluation of total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and superoxide dismutase (SOD) levels in women with threatened preterm labor (TPL) and also to compare the levels of these oxidative stress biomarkers of TPL pregnancies that had preterm and term deliveries. Methods: This case–control study was conducted on 46 patients diagnosed with TPL and 47 healthy pregnant women matched for gestational age. Patients with threatened preterm labor were divided into two groups: true preterm birth (TPB) group (n = 16) and false preterm birth (FPB) group (n = 30) groups. Maternal serum SOD, TOS and TAS levels were measured by a spectrophotometric method using a commertial kit. OSI level for each patient was calculated by using the formula: (TOS (μmol·H2O2·equiv/L) × 100)/(TAS (μmol·Trolox·equiv/L)). Results: The mean TAS levels of the TPB and FPB groups were significantly lower than those of the control group (0.96 ± 0.3 vs 1.36 ± 0.34, p1 < 0.001; 0.97 ± 0.22 vs 1.36 ± 0.34, p2 < 0.001, respectively). The mean SOD, TOS and OSI levels of the TPB and FPB groups were significantly higher than those of the control group (p < 0.001). There was no significant difference between the TPB and FPB groups for any oxidative stress biomarkers. Conclusion: The maternal serum oxidative stress biomarkers are increased in pregnancies with TPL. However, these are not effective in predicting preterm birth in pregnancies with TPL. [ABSTRACT FROM AUTHOR]

This systematic review delves into the connections between microRNAs and preterm labor, with a focus on identifying diagnostic and prognostic markers for this crucial pregnancy complication. Covering studies disseminated from 2018 to 2023, the review integrates discoveries from diverse pregnancy-related scenarios, encompassing gestational diabetes, hypertensive disorders and pregnancy loss. Through meticulous search strategies and rigorous quality assessments, 47 relevant studies were incorporated. The synthesis highlights the transformative potential of microRNAs as valuable diagnostic tools, offering promising avenues for early intervention. Notably, specific miRNAs demonstrate robust predictive capabilities. In conclusion, this comprehensive analysis lays the foundation for subsequent research, intervention strategies and improved outcomes in the realm of preterm labor. [ABSTRACT FROM AUTHOR]

Preterm premature rupture of membranes (pPROM) before 22-24 weeks of gestation is considered previable and poses a high risk to the chances of successful delivery. Multicystic dysplastic kidney (MCDK) is the most common form of dysplasia of this organ, usually affecting 1 kidney. A prenatal suspicion of MCDK requires escalation of the clinical process to a reference center qualified and equipped for further diagnosis and treatment. We present a unique case of prenatal pPROM at 19 weeks of gestation in a pregnancy complicated by fetal MCDK as an interesting obstetric and neonatal patient story. We have not found any published evidence on the impact of coexisting fetal congenital malformations on a pregnancy affected by previable pPROM. The aim of this study is to highlight the importance of a multidisciplinary team approach in the management of previable pPROM and the difficulties of decision-making involving both health professionals and the mother. Initially, medical management focuses on the safety of the mother, and as the fetus reaches viability, the focus shifts to the high standard of care for the child. The final successful outcome and follow-up was the effect of coordinated prenatal and postnatal medical care. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of nifedipine use in our clinic for treatment of preterm labor with diferent effacement degrees, and to compare our results with the literature. Methods: 440 Singleton pregnant women with intact amnionic membrane pregnant women in their 23 and 36 weeks were retrospectively evaluated. Because of different criterias defining preterm labor in the literature, patients were divided into two groups as 4 or over contractions in 20 minutes and cervical opening at 2 cm and/or above and/or effachment at 80% or above (Group A, n = 230) and 4 or over contractions in 20 minutes and cervical opening below 2 min and effechment below 80% (Group B, n = 210). Descriptive statistics were conducted using chi-square and Mann Whitney U test, and statistically significance was P < 0.05. Results: Demographics, reproductive history and pregnancy weeks of the groups were similar. The average time between the start of tocolysis and the birth was 4 times higer in Group B (0.1-99.2, mean 28.4) than that of Group A (0.1-78.9, mean 7.4 days, P < 0.001). Delay after tocoloysis at days 1 to 7 was statistically remarkable in Group B (P < 0.001, for each). Preterm labor resulting in early birth was more remarkable in Group A in both before 34 weeks and 37 weeks (P < 0.001, for each; n = 88, 38.3% vs n = 36, 17.1% and n = 171, 74.3% vs n = 98, 46.7%, respectively and n = 269/124, 28.2 vs 61.1%). Delay with nifedipine at day 1 (87.5%), day 2 (79.1%), day 3 (74.8%) and day 7 (65.5%) was also compatable with the literature. Conclusions: Nifedipine is an effective tocolytic agent in preterm labor regardless of the effachment degree. [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) is a leading cause of childhood disability, and it has become a key public health priority recognized by the World Health Organization and the United Nations. Objectives: This review will: (1) summarize current practice in the diagnosis and management of PTB, (2) outline developments in precision-based medicine for diagnostics to improve the care provided to pregnant women at risk of PTB, and (3) discuss the implications of current research in personalized medicine and the potential of future advances to influence the clinical care of women at risk of PTB. Methodology: This is a narrative literature review. Relevant journal articles were identified following searches of computerized databases. Key Results: Current and emerging technologies for the utility of personalized medicine in the context of PTB have the potential for applications in: (1) direct diagnostics to identify and target infection as one of the main known causes of PTB, (2) identifying novel maternal and fetal biomarkers, (3) the use of artificial intelligence and computational modeling, and (4) combining methods to enhance diagnosis and treatment. Conclusions: In this paper, we show how current research has moved in the direction of the targeted use of biomarkers in the context of PTB, with many novel approaches. [ABSTRACT FROM AUTHOR]

Background: Preterm labor (PTL) is a common and serious pregnancy disorder that can cause long-term neurological issues in the infant. There are conflicting studies concerning whether sildenafil citrate (SC) reduces preterm labor complications. Therefore, the meta-analysis aimed to examine the clinical outcomes in women with threatened PTL who received nifedipine plus SC therapy versus only nifedipine. Methods: For the original articles, six databases were searched using relevant keywords without restriction on time or language until January 13, 2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess the risk of bias in randomized and non-randomized studies, and GRADE determined the quality of our evidence. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1. Results: Seven studies with mixed quality were included in the meta-analysis. The study found that combining nifedipine and SC resulted in more prolongation of pregnancy (MD = 6.99, 95% CI: 5.32, 8.65, p < 0.00001), a lower rate of delivery in the 1st to 3rd days after hospitalization (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001), a higher birth weight (252.48 g vs. nifedipine alone, p = 0.02), and the risk ratio of admission to the neonatal intensive care unit (NICU) was significantly lower (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001) compared to nifidepine alone. The evidence was high for prolongation of pregnancy, delivery rate 24–72 h after admission, and NICU admission, but low for newborn birth weight. Conclusions: Given the effectiveness of SC plus nifedipine in increased prolongation of pregnancy and birth weight, lower delivery in the 1st to 3rd days after hospitalization, and NICU admission, Gynecologists and obstetricians are suggested to consider this strategy for PTL management, although additional article rigor is required to improve the quality of the evidence. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to compare performance of a maternal surface electrode patch with ultrasound- and tocodynamometer-based monitoring to detect fetal heart rate and uterine contractility in late preterm labors. Study Design Thirty women between 34 0/7 and 36 6/7 weeks' gestation were monitored simultaneously with a Doppler/tocodynamometer system and a wireless fetal–maternal abdominal surface electrode system. Fetal and maternal heart rate and uterine contraction data from both systems were compared. Reliability was measured by the success rate and percent agreement. Deming regression and Bland–Altman analysis estimated the concordance between the systems. Uterine contractions were assessed by visual interpretation of monitor tracings. Results The success rate for the surface electrode system was 89.5% (95% confidence interval [CI], 85.7–93.3), and for ultrasound it was 88.4% (95% CI, 84.9–91.9; p = 0.73), with a percent agreement of 88.1% (95% CI, 84.2–92.8). Results were uninfluenced by the patients' body mass. The mean Deming slope was 1 and the y-intercept was −3.0 beats per minute (bpm). Bland–Altman plots also showed a close relationship between the methods, with limits of agreement less than 10 bpm. The percent agreement for maternal heart rate was 98.2% (95% CI, 97.4–98.8), and for uterine contraction detection it was 89.5% (95% CI, 85.5–93.4). Conclusion Fetal heart rate and uterine contraction monitoring at 34 0/7 to 36 6/7 weeks using abdominal surface electrodes was not inferior to Doppler ultrasound/tocodynamometry for fetal–maternal assessment. Registration clinicaltrials.gov/February 20, 2017/identifier NCT03057275. Key Points Monitoring the preterm fetal heart rate with surface electrodes is feasible. Preterm contractions can be monitored with surface electrodes. The technique was noninferior to standard external monitors. [ABSTRACT FROM AUTHOR]

Among patients with preterm labor and intact membranes (PTL), those with intra-amniotic infection (IAI) present the highest risk of adverse perinatal outcomes. Current identification of IAI, based on microbiological cultures and/or polymerase chain reaction amplification of the 16S ribosomal RNA gene, delay diagnosis and, consequently, antenatal management. The aim to of the study was to assess the performance of a multivariable prediction model for diagnosing IAI in patients with PTL below 34.0 weeks using clinical, sonographic and biochemical biomarkers. From 2019 to 2022, we prospectively included pregnant patients admitted below 34.0 weeks with diagnosis of PTL and had undergone amniocentesis to rule in/out IAI. The main outcome was IAI, defined by a positive culture and/or 16S ribosomal RNA gene in amniotic fluid. Based on the date of admission, the sample (n=98) was divided into a derivation (2019–2020, n=49) and validation cohort (2021–2022, n=49). Logistic regression models were developed for the outcomes evaluated. As predictive variables we explored ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, and amniotic fluid glucose and matrix metalloproteinase-8 (MMP-8) levels. The model was developed in the derivation cohort and applied to the validation cohort and diagnostic performance was evaluated. Clinical management was blinded to the model results. During the study period, we included 98 patients admitted with a diagnosis of PTL. Of these, 10 % had IAI. The final model included MMP-8 and amniotic fluid glucose levels and showed an area under the receiver operating characteristic curve to predict the risk of IAI of 0.961 (95 % confidence interval: 0.860–0.995) with a sensitivity of 75 %, specificity of 93.3 %, positive likelihood ratio (LR) of 11.3 and negative LR of 0.27 in the validation cohort. In patients with PTL, a multivariable prediction model including amniotic fluid MMP-8 and glucose levels might help in the clinical management of patients undergoing amniocentesis to rule in/out IAI, providing results within a few minutes. [ABSTRACT FROM AUTHOR]

Purpose: Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation and studies have concluded that approximately 10% of the patients who show signs of preterm labor with intact membranes have an underlying intraamniotic infection, mostly subclinical, carrying an increased risk for preterm birth with its subsequent neonatal and maternal complications. The purpose of the present systematic review is to evaluate the impact of antibiotic therapy on preterm birth rates of women diagnosed with AFS. Methods: We searched Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar, and Clinicaltrials.gov databases for relevant articles published until the 30th of September 2022. Observational studies (prospective and retrospective) that evaluated the impact of antibiotics on preterm delivery rates of patients with AFS were considered eligible for inclusion. Statistical meta-analysis was performed with RStudio and we calculated pooled risk ratios (OR) and 95% confidence intervals (CI). To evaluate the information size, we performed trial sequential analysis (TSA) and the methodological quality of the included studies was assessed using RoBINS tools. Results: Overall, four retrospective cohort studies were included in the present systematic review and 369 women were enrolled. We demonstrated that preterm delivery prior to 34, 32 and 28 weeks of gestational age was comparable among the groups of women that had antibiotics and those that did not (OR: 0.34, 95% CI 0.05, 2.14, 0.40 [0.09, 1.66], 0.35 [0.08, 1.58], respectively) but the statistical heterogenicity of the studies included was high for every gestational period that was examined. Conclusions: According to our study, we cannot conclude that the use of antibiotics in women with amniotic fluid sludge benefit the prognostic risk to deliver prematurely. It is quite clear that data from larger sample sizes and more well adjusted and designed studies are needed. [ABSTRACT FROM AUTHOR]

Type 2 taste receptors (TAS2Rs), traditionally known for their role in bitter taste perception, are present in diverse reproductive tissues of both sexes. This review explores our current understanding of TAS2R functions with a particular focus on reproductive health. In males, TAS2Rs are believed to play potential roles in processes such as sperm chemotaxis and male fertility. Genetic insights from mouse models and human polymorphism studies provide some evidence for their contribution to male infertility. In female reproduction, it is speculated that TAS2Rs influence the ovarian milieu, shaping the functions of granulosa and cumulus cells and their interactions with oocytes. In the uterus, TAS2Rs contribute to uterine relaxation and hold potential as therapeutic targets for preventing preterm birth. In the placenta, they are proposed to function as vigilant sentinels, responding to infection and potentially modulating mechanisms of fetal protection. In the cervix and vagina, their analogous functions to those in other extraoral tissues suggest a potential role in infection defense. In addition, TAS2Rs exhibit altered expression patterns that profoundly affect cancer cell proliferation and apoptosis in reproductive cancers. Notably, TAS2R agonists show promise in inducing apoptosis and overcoming chemoresistance in these malignancies. Despite these advances, challenges remain, including a lack of genetic and functional studies. The application of techniques such as single‐cell RNA sequencing and clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR‐associated endonuclease 9 gene editing could provide deeper insights into TAS2Rs in reproduction, paving the way for novel therapeutic strategies for reproductive disorders. [ABSTRACT FROM AUTHOR]

Preterm delivery is a considerable burden on prenatal healthcare and a major risk factor for neurological impairment and disability. A study looked at whether an aqueous extract of Syzygium cumini (AESC) bark could stop rats from giving birth too early. The DPPH and ABTS radical scavenging assays were used to evaluate the antioxidant activity of AESC in vitro, and the results showed that this extract possesses free radical scavenging activity, which helps to prevent premature labour. A piece of an isolated rat uterus was used for in-vitro pharmacological testing of the AESC at 25 mg/ml and 50 mg/ml. The extract showed free radical scavenging activity, effectively suppressing uterine contractions by 45.7% and 66.9%, respectively. The researchers concluded that AESC has considerable tocolytic activity, resulting in a decrease in the rate of premature birth. The extract showed no significant adverse effects on mothers or their infants, suggesting it may be a safe option for pregnant individuals seeking to prevent preterm labor. The extract also exhibited a dose-dependent effect, with higher doses resulting in a greater reduction in premature birth rates, further supporting its efficacy as a tocolytic agent. [ABSTRACT FROM AUTHOR]

Most preterm births occur in the late preterm period. While prematurity-related adverse outcomes are significantly diminished when birth occurs during this period, these infants are still at increased risk of complications. Parity affects the incidence of obstetric complications. The purpose of this study was to determine whether parity impacts the risk of spontaneous late preterm birth (SLPTB) and associated complications. A retrospective observational cohort study was conducted. Patients were divided into three study groups according to parity. The primary outcome was the rate of SLPTB in each group. Secondary outcomes were unplanned cesarean delivery (UCD), prolonged third stage of labor respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), intraventricular hemorrhage (IVH), neonatal hypoglycemia, duration of NICU admission, neonatal death, and composite adverse neonatal outcome (CANO). Primiparas were more likely to have SLPTB, UCD, and CANO compared to multiparas (2.6% vs. 1.9% OR 1.5 [1.3–1.7] p < 0.01) (4.1% vs. 1.3% OR 2.7 [1.2, 5.9] p < 0.01) (8.5% vs. 4.2 OR 2.1 [1.3–3.5] p = 0.002) and grandmultiparas (2.6% vs. 1.7% OR 1.4 [1.2–1.5] p < 0.001) 8.5% vs. 4.4% OR 2.0 [1.1, 3.8], p = 0.01) but no difference in UCD compared to grandmultiparas (4.1% vs. 3.3% OR 1.2 [0.6–2.7] p = 0.28). Primiparas are at increased risk of SLPTB and UCD, and this is accompanied by an increased risk of adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background and Objective: Infants born prematurely are at an increased risk of experiencing cerebral palsy, respiratory problems and developmental delays. Bacterial vaginosis, a condition that causes inflammation of fetal membranes, vaginitis, and cervicitis, can lead to the premature rupture of membranes and labor. The main objective of this article is to determine the prevalence of bacterial vaginosis among pregnant women experiencing preterm labor between 20 and 36 weeks of gestation. Methods: This cross-sectional study was conducted on 100 cases of preterm labor. To investigate variables associated with bacterial vaginosis. Variables related to bacterial vaginosis and relevant epidemiological and clinical data were collected and analyzed. Amsel's criteria were used to diagnose bacterial vaginosis. Findings: The prevalence of BV among pregnant female with preterm labor was found to be 44 (44%). Among the BV-positive cases, 28 (63.6%) patients aged between 25 and 44 years. 56 people (56%) of those who had a negative bacterial vaginosis test had preterm delivery. A significant correlation was observed between BV and living in urban areas (p<0.05). Furthermore, BV was significantly linked with early rupture of membranes (p<0.05). Vaginal infections were also more prevalent in BV-negative cases (p<0.05). No statistically significant associations were found between BV and threatened abortion or miscarriage. Conclusion: The results of this study showed that the prevalence of bacterial vaginosis in patients with premature labor is relatively high. Bacterial vaginosis is significantly more common among patients living in urban areas and is associated with premature rupture of membranes and certain types of premature labor. [ABSTRACT FROM AUTHOR]

The importance of studying the histochemical and immunohistochemical features of the differentiated trophoblast in chorionic villi of the placenta in preterm labor is determined by the threatening nature of this condition for both mother and fetus, as well as its high prevalence and serious consequences for the health of both. The understanding of the damage to the trophoblast of chorionic villi in the placenta can be expanded by histochemical and immunohistochemical methods, which allow the assessment of the concentration of specific marker molecules in one way or another. Objective. To determine certain histochemical and immunohistochemical characteristics of proteins in the trophoblast of the intermediate and terminal chorionic villi of the placenta in preterm labor. Material and Methods. The obtained material (30 placentas from preterm deliveries and 30 placentas from normal pregnancies) was fixed for 20-24 hours in 10 % neutral formalin solution buffered in Lilly's phosphate buffer. After tissue removal, the placental tissue was dehydrated in an ascending ethanol series and embedded in paraffin at a temperature of approximately 58 °C. Serial histologic sections were cut at 5.0 μm thickness using an MS-2 sliding microtome. After deparaffinization, histological sections were stained with hematoxylin and eosin, histochemical methods for total protein with bromophenol blue according to Bonhéme, and immunohistochemical techniques according to the manufacturer's protocols (Dako, Denmark). In particular, immunohistochemical reactions were performed with monoclonal antibodies against trophoblast hormone-placental lactogen and placental alkaline phosphatase. Visualization of primary antibodies was performed using the Dako polymer visualization system with diaminobenzidine as chromogen (resulting in brown staining of the sites of studied antigens). In addition to the descriptive method of histopathologic research, computer morphometry of digital microphotographs of histologic sections was performed using a Delta Optical Evolution 100 microscope and an Olympus SP550UZ digital camera. Digital copies of the images were processed using a legitimate copy of the ImageJ v1.52f computer program developed for histometric studies (National Institutes of Health, USA). Specifically, the evaluation of staining intensity (optical density) was performed on digital microphotographs using the method of computer microdensitometry. For this purpose, a microprobe method was used to obtain a computer brightness value in an 8-bit analysis system with 256 gray levels - from black (0) to white (255). The obtained values were then transformed into relative optical density values (r.OD) by logarithmic transformation (natural logarithm method). The relative optical density value ranges from 0 (absolute transparency of the object) to 1 (absolute opacity of the object). The obtained digital data were processed using statistical analysis methods. A legitimate copy of the statistical analysis computer program PAST v4.14 was used, with a preliminary check for normal distribution using the Shapiro-Wilk test. Since, according to this test, the hypothesis of normal distribution was not rejected for the statistical samples studied (at p=0.05), parametric methods of statistical analysis were applied: calculation of the mean and its standard error, Student's t-test (two-tailed, unpaired). In addition, the non-parametric Mann-Whitney test was used for the reliability of the Conclusions. The research was conducted as part of the scientific research project «Preservation and Restoration of Reproductive Health in Women and Girls with Obstetric and Gynecological Pathology» at the Department of Obstetrics and Gynecology of Bukovinian State Medical University (state registration number 0121U110020, duration 2021-2025). Results. Microscopic examination of histological sections stained with hematoxylin and eosin did not reveal any differences in the structure of chorionic villus trophoblast in the placenta of preterm labor compared to normal pregnancy. However, histochemical and immunohistochemical methods of investigation revealed a number of features in the trophoblast of chorionic villi, where fundamental events related to substance exchange occur - intermediate immature, intermediate mature, terminal villi, including terminal «specialized villi». Conclusions. According to the obtained histochemical and immunohistochemical data, in preterm labor, compared to normal pregnancy, no changes are observed in the trophoblast of intermediate immature villi, while in intermediate mature and terminal villi, there is a decrease in histochemical staining for total protein and immunohistochemical staining for specific trophoblast proteins - placental lactogen hormone and placental alkaline phosphatase enzyme. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the potential value of placental anatomic features and various types of normal and abnormal cord insertion types in predicting adverse maternal-fetal outcomes in singleton pregnancies. We also tried to assess the association between these outcomes and various types of placental cord insertion. Method: This prospective observational study was performed on singleton pregnancies. For each patient placental features including diameter, thickness, type of cord insertion, and the shortest distance between the cord insertion point and placental edge were recorded. The relationship between these factors and the development of multiple adverse pregnancy outcomes including preterm labor, intrauterine fetal death (IUFD), and the rate of neonatal intensive care unit (NICU) admissions were evaluated and reported. Results: Overall 308 patients were enrolled in the study. Smoker mothers had significantly smaller placentas (P -value =.008), and those with lower diameter placentas were more likely to suffer from IUFD (P -value =.0001). Shorter placental cord insertion distances led to more episodes of preterm labor (P -value =.057). Eccentric-type placental cord insertion was significantly associated with the development of preeclampsia (P -value =.006). Discussion: Abnormalities in placental diameter and cord insertion can lead to significant maternal-fetal complications including preterm labor, IUFD, and preeclampsia. [ABSTRACT FROM AUTHOR]

Background: Preterm birth has a significant impact on neonatal health and the healthcare system as it increases neonatal morbidities and mortality rates. Interleukin-6 is one of the pro-inflammatory cytokines that can trigger the production of chemokines and uterine activation proteins, consequently causing uterine contraction and subsequent cervical change. Hypoxia-inducible factor-1α plays a pivotal role in the hypoxic adaptive response of tissues. It has been suggested that hypoxia has a vital role in the initiating and/or strengthening of uterine contractions, proposing that hypoxia-inducible factor-1α could be involved in this process. Aim: Investigate whether serum concentrations of interleukin-6 and hypoxia-inducible factor-1α would differ between women with threatened preterm labor who deliver prematurely and those who continue their pregnancy till term. Patients and Methods: The case-control study was extended over 12 months, including women in their 28th to 35th weeks of gestation and with a single viable fetus. The women were divided into three groups: women with threatened preterm labor who delivered prematurely (27 women), women with threatened preterm labor who continued their pregnancy till term (23 women), and women with matching gestational age and uncomplicated pregnancies (the controls = 40 women). The serum levels of interleukin-6 and hypoxia-inducible factor-1α were measured by Enzyme-linked immunosorbent assay. Results: The mean values of interleukin-6 and hypoxia-inducible factor-1α were significantly different between the study groups (p-value <0.001 by one-way ANOVA), where women with threatened preterm labor who delivered prematurely had higher serum values of interleukin-6 and hypoxia-inducible factor-1α (124.5 and 102.4, respectively) than the women with threatened preterm labor who continued their pregnancy till term (71.0 and 55.2, respectively), and than the women in the control group (55.3 and 50.0, respectively). There was a significant negative statistical correlation between the values of interleukin-6 and hypoxia-inducible factor-1α and the timing of delivery (R = -0.786 and -0.644, respectively, p-value < 0.001). Conclusions: Both interleukin-6 and hypoxia-inducible factor-1a serum concentrations can help differentiate pregnant women who are genuinely in preterm labor from those who have preterm contractions but are not at risk of imminent delivery. [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) remains a significant challenge in perinatal healthcare, contributing to a substantial portion of neonatal mortality and long-term disabilities. Various risk factors contribute to PTB, necessitating effective preventive measures. Progesterone supplementation has emerged as a promising intervention to reduce the risk of PTB, but the route of administration and its efficacy remain under investigation. Methods: This prospective, randomized comparative study enrolled 600 pregnant patients divided into two groups receiving either oral micronized progesterone (OMP) or vaginal micronized progesterone (VMP). Patients were followed up fortnightly for signs of preterm labor (PTL) and perinatal outcomes. Statistical analyses were performed using unpaired t-tests, Fisher tests, and chi-square tests. Results: The study found significant differences in perinatal outcomes between the OMP and VMP groups. While both groups had similar rates of neonatal sepsis and hypoxemic ischemic encephalopathy, the VMP group demonstrated a higher proportion of asymptomatic births and a lower incidence of birth asphyxia compared to the OMP group. Additionally, the mean APGAR score at 1 minute was significantly lower in the OMP group, while birth weight distribution differed significantly between the two groups. Neonates in the VMP group had higher birth weights and lower rates of NICU admission, with a shorter NICU stay compared to the OMP group. Conclusion: Vaginal micronized progesterone appears to be more effective than oral micronized progesterone in preventing PTL and improving perinatal outcomes, including reducing neonatal morbidity and NICU admissions. These findings underscore the importance of route-specific progesterone administration in mitigating the risks associated with PTB. Further research is warranted to elucidate the mechanisms underlying the differential efficacy of progesterone administration routes and optimize preventive strategies for PTB. [ABSTRACT FROM AUTHOR]