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Preterm labor is known as delivery prior to 37 completed weeks of gestation. Because 10% of total labors are preterm and 70% of neonatal mortality is caused by this problem, preterm labor is a significant problem in obstetrics, pediatrics & midwifery. This study aims at comparing the efficacy as well as adverse effects profile of (human chorionic gonadotropin hormone and magnesium sulphate) in suppression of preterm labor. This study was designed as a prospective comparative randomized clinical trial done from 4th April to 1st September 2020. The study population included pregnant women with preterm labor, who were admitted to Salah Al Din General Hospital, in Tikrit city. Sixty two cases who consented (Informed written consent was obtained from all the patients) were randomly allocated to 2 different intervention groups, named A and B. Group A and B consisted of 30 and 32 pregnant women, respectively. All cases were admitted in labour room and baseline investigations were done. Group A: For patients of group A: received an intravenously loading dose of 4 g (1 g/min) Magnesium sulphate. A continual infusion of 2 g per 1 hr was then administrated. The infusion was continued until 12 h of uterine quiescence is done. Group B: (32 women), intramuscular injection Human Chorionic Gonadotropin was administered as an initial dose of 5000 IU. Half hourly assessment of uterine contractions, maternal vital signs, fetal heart rate monitoring was done. All of the patients were under monitoring in the hospital until 24 h of the end of drug infusion. Also, both of the groups received Betamethasone, 12 mg every 24 hr for 2 doses. Patients were under control until the end of pregnancy. It was foun that Delay of Labour for ≥21 day was higher among Human Chorionic Gonadotropin group (68.8%) than among MgSO4 group (60%), and delivery within

Objectives: Failure to identify women at risk of preterm labor (PTL) leads to failure to implement standard measures. This study designed to evaluate the accuracy of PremaQuick test in detection of PTL in women presented with threatened preterm labor (TPTL). Material and methods: One hundred and twenty-two (122) pregnant women, singleton pregnancy, < 37 weeks, admitted with TPTL included in this study, and were compared to 122 controls. After thorough evaluation, participants were examined using sterile vaginal speculum for cervico-vaginal fluid (CVF) sampling, and PremaQuick test. The CVF sampling was followed by trans-vaginal sonographic (TVS) assessment of cervical length (CL). Participants were managed according to hospitals policy thorough their admission, and after discharge in the ante-natal clinics till delivery. After delivery, the delivery data were compared by the recorded participants` data on admission. Results: The PremaQuick test had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL < 25 mm (p = 0.005, 0.005, 0.01, 0.002; respectively). Conclusions: The PremaQuick is an accurate bedside test in detection of PTL in women presented with TPTL. It had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% overall accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL < 25 mm.

Introduction: Vitamin D deficiency is highly prevalent during pregnancy and in premature infants. This study was done to investigate the maternal and infantile levels of vitamin D in preterm infants. Methods: Using available sampling during 2018-2020, the maternal and umbilical cord serum levels of vitamin D were measured in 294 premature infants in Ghaem Hospital, Mashhad, Iran. A researcher- made questionnaire consisting of neonatal demographic and clinical characteristics was used as the data collection tool. Both maternal and placental vitamin D levels were categorized into four classes: severe deficiency (vitamin D30.1ng ml). Results: Vitamin D deficiency was seen in 89% of premature infants (46.6% severe, 30.6% moderate, and 11.9% mild). Serum levels of vitamin D were 18.28±13.94 ng/ml and 14.10±9.70 ng/ml in mothers and infants, respectively. The infants below and above 32 weeks exhibited vitamin D values of 10.97±6.31 ng/ml and 18.05±11.64 ng/ml, respectively. The difference in vitamin D levels between boys (12.59±8.40 ng/ml) and girls (16.05±11.45 ng/ml) was found to be significant (P=0.009). Moderate and severe vitamin D deficiency was more common at earlier pregnancy ages (P=0.001). Conclusion: Vitamin D deficiency is more common and severe in preterm infants and their mothers. Controlling vitamin D levels during pregnancy, especially in women at risk of preterm labor and preterm infants, may help reduce prematurity problems.

With medical sciences on the verge of advancement, preterm labor still remains a bothersome issue in modern obstetrics. A few therapeutic agents that suppress uterine contractile activity have gained success up to some extent. Tocolytics are medications used to suppress premature labor. These drugs can decrease the strength and frequency of uterine contractions and help in delay the onset of labor but are not able to prolong pregnancy to full-term. Presently, the choice of a best tocolytic drug remains debatable. This review discusses efficacy and safety of various useful agents which have been used so far. Further clinical trials are required to select an effective, and most importantly, safe therapy for the threatened preterm labor.

BackgroundPrenatal corticosteroid administration in preterm labor is one of the most important treatments available to improve neonatal outcomes; however, its beneficial effects on late preterm infants (after the 34th week of gestation) remained unknown. We aimed to assess the effects of betamethasone on the clinical condition of the late preterm infants born between 34 and 36 weeks of gestation.MethodsThis retrospective cohort study was performed on 100 consecutive infants born between 34 and 36 weeks of gestation and received betamethasone before delivery as the cases and 100 neonates with the same delivery conditions but without receiving betamethasone. All neonates were followed up within hospitalization to assess the neonatal outcome.ResultsThe neonates receiving betamethasone suffered more from respiratory distress syndrome (49% versus 31%,p = 0.008, RR = 1.59 95% CI (1.12–2.27)) and requiring more respiratory support (71% versus 50%,p = 0.002, RR = 1.43 95% CI (1.13–1.80)) as compared to the control group. There was no difference between the two groups in other neonatal adverse events or death.Conclusionthe use of betamethasone in the late preterm period (after 34 weeks of gestation) has no beneficial effects on lung maturity or preventing neonatal adverse outcomes, even may lead to increase the risk for RDS and requiring respiratory support.

Purpose: This study aimed to develop and evaluate the effects of the Unpleasant Symptom-Relief Program to mitigate preterm labor stress, anxiety, physical discomfort, and situational discomfort in hospitalized high-risk pregnant women.Methods: This study used a nonequivalent control group nonsynchronized design and analyzed 23 participants from the experimental group and 23 from the control group. The participants from both the groups were matched and diagnosed with preterm labor, incompetent internal os of the cervix, preterm premature rupture of membrane, placenta previa, or gestational diabetes mellitus. The effects of the Unpleasant Symptom-Relief Program were measured using tools such as preterm labor stress, anxiety, physical discomfort, and situational discomfort. The data were analyzed with IBM SPSS Statistics ver. 21.0 using descriptive statistics, t-test, chi-square test, paired t-test, and repeated measures analysis of variance.Results: The Unpleasant Symptom-Relief Program was effective in reducing preterm labor stress (F= 8.24, p=0.001), anxiety (F=17.80, p≤0.001), and situational discomfort (F=5.95, p=0.004). However, it was not effective in reducing the physical discomfort (F=1.20, p=0.311). Post hoc analysis between time points revealed effective reduction in the preterm labor stress and anxiety in both the groups immediately after the end of the program and at 7 days after the program. Situational discomfort was reduced at 7 days after the end of the program in both the groups.Conclusion: The Unpleasant Symptom-Relief Program can be applied in practice by nurses. It can contribute to alleviating the symptoms and discomfort of high-risk pregnant women.

It is estimated that every year fifteen million premature babies are born worldwide mainly due to spontaneous preterm birth (sPTB). Furthermore, in clinical settings, there still are no reliable and accurate tools to predict preterm labor. Hence, the aim of this pioneering research was to estimate the relationship between the maternal inflammatory indicator and sPTB in a case-control study between 220 South Bulgarian women. The study was conducted at UMBAL, Stara Zagora, Bulgaria (2017-2020) and enrolled a total of 220 women, determined into two groups: 1) TB (n = 110), who were to give birth at term ≥ 37 to ≤ 39 + 6 gestation weeks with active labor at the time of hospitalization; and 2) sPTB (n = 110), women with preterm birth ≤ 32–34 + 6 gestation weeks and declared active labor, who were to give birth within 5-24 hrs. The inflammatory indicators/CRP concentration was quantified in plasma by immunoturbidimetric methods within 2 hrs. in mg/l. The median maternal CRP (8.77 ± 3.91), with cutoff = 4.9 mg/l was identified as optimal inflammation with highest risk of sPTB (sensitivity = 86.6%; specificity = 53.7%, р < 0.0001). Moreover, a cutoff CRP = 4.9 mg/l was found to be most effective in determining maternal age ≤ 19 years, the sensitivity of 68.6%, and positively correlated OR = 8.122 vs. OR = 2.354, with increased total sPTB risk at ≤ 32-34 + 6 weeks, respectively (p < 0.001). In conclusion, increased CRP concentrations and a decreased maternal age were associated with increased risks of sPTB, before ≤ 32-34 + 6 weeks. Minimal inflammation and other factors in combination may also act as sPTB prognosis.

Measure availability and use of fetal fibronectin (fFN) testing and transvaginal ultrasound to measure cervical length (TVCL) for symptomatic preterm labor (PTL) patients. Additionally, assess the presence and impact of PTL triage protocols.Cross-sectional online survey among clinicians from 255 unique hospitals regarding prior 12-month practices (pre-COVID-19).fFN testing was always available in 87% (221) of hospitals, while TVCL was always available in 69% (175) of hospitals. Utilization was lower: fFN specimens were often/always collected in 61% (156) of hospitals and TVCL was often/always performed in 43% (110) of hospitals. fFN testing was significantly more likely than TVCL to be available and used (The most accurate risk assessment approach for imminent spontaneous preterm birth is the implementation of a universal screening program for symptomatic patients, including fFN testing and TVCL.

Mothers who had preterm labor were expected to face difficulties with baby care during the postnatal period. This study aimed to review studies on difficulties experienced by mothers who had premature labor regarding childcare at home during the postnatal period. The literature review was carried out between 2000 and 2019 in databases of PubMed, Medline, CINAHL, Cochrane library, ULAKBIM, Google Scholar, and EMBASE. Mothers who had preterm labor experienced difficulties with diaper use, bathing, umbilical cord care, baby feeding, skin-to-skin contact, and recognition of newborn crying. Therefore, mothers need the support of health professionals for the health status of the newborn and their lack of self-confidence regarding baby care. However, the lack of home care guidelines leaves mothers helpless in meeting these needs. Mothers should be ready for the care of babies born preterm. For this reason, mothers who had preterm labor should be informed about the potential difficulties during their stay in the hospital. Mothers also need to be educated about the care of infants born preterm in the postnatal period. Thus, mothers can experience the home care process positively by becoming fully prepared to take the responsibility for home care. Developing clinical guidelines for postnatal care of babies born preterm can help reduce the concerns of mothers, shorten hospital stay, and reduce morbidity risks.

Objective (s): The most common cause of death and mortality of infants is preterm labor. The identification of factors associated with preterm labor will reduce preterm infant mortality. This study aimed to determine the relationship between preterm delivery and oral, kidney and urinary tracts infections in pregnant women Methods: This was a case-control study that carried on the 198 pregnant women (66 pregnant women with premature labor as case group and 132 pregnant women with term delivery as control group) in selected hospitals in Isfahan, Iran, in 2018. For data collection we used demographic and fertility questionnaire, and the Holbrook standard checklist. Data were analyzed using descriptive statistics and t–test, chi-square, Mann-Whitney, Fisher’s exact test, logistic regression. Results: The results showed that there was no significant relationship between preterm labor and kidney, urinary tracts infections (p=0.626). While the logistic regression showed significant association between the onset of uterine contractions (preterm birth) and of the mouth and teeth infections (p=0.012) Conclusion: The findings suggest that there is relationship between preterm deliveries and oral infections. Therefore, it is recommended that preventive necessary measures be taken or treat oral infections faster in women before and during pregnancy.

Background: Prematurity is the leading cause of neonatal morbidity and mortality. Although perinatal care advanced in the last few decades, preterm labor did not decrease but even is increasing and creating a great social and economic problem. Objective: To test the effectiveness of progesterone vaginal suppository in prevention of preterm labor in patients with previous history of preterm labor. Patients and Methods: This was a randomized , prospective, single blind study after approval of the medical ethical committee at Al-Azhar university Hospitals, Department of Obstetrics and Gynecology, and after patients giving written consents, during the period from February 2020 to October 2020 . We enrolled 168 women for the study at high risk for preterm labor who were randomly divided into two groups (progesterone group and placebo group). Two hundred mg of vaginal progesterone pessary or placebo were used by the patient from 24 to 36 weeks of gestation. Uterine contractions were recorded by external tocodynamometer every other week from 28 to 36 weeks of gestations. Results: There was a statistically significant reduction in the incidence of preterm delivery between the two groups from 38.5% in placebo group, compared with 21% in progesterone group. There was also a statistically significant reduction in the incidence of early preterm delivery (

The purpose of this study was to check whether the impact of abnormal vaginal colonization on perinatal outcomes would be different in patients with preterm labor (PTL) and premature membrane ruptu...

Introduction Thrombospondin 1, desmoplakin and stratifin are putative biomarkers for the prediction of preterm birth. This study aimed to validate the predictive capability of these biomarkers in patients at risk of preterm birth. Materials and Methods We included 109 women with symptoms of threatened spontaneous preterm birth between weeks 20 0/7 and 31 6/7 of gestation. Inclusion criteria were uterine contractions, cervical length of less than 25 mm, or a personal history of spontaneous preterm birth. Multiple gestations were also included. Samples of cervicovaginal fluid were taken before performing a digital examination and transvaginal ultrasound. Levels of cervicovaginal thrombospondin 1, desmoplakin and stratifin were quantified by enzyme-linked immunosorbent assays. The primary endpoint was spontaneous preterm birth before 34 + 0 weeks of gestation. Results Sixteen women (14.7%) delivered before 34 + 0 weeks. Median levels of thrombospondin 1 were higher in samples where birth occurred before 34 weeks vs. ≥ 34 weeks of gestation (4904 vs. 469 pg/mL, p Conclusion Thrombospondin 1 allowed long-term risk estimation of spontaneous preterm birth.

Introduction: Sickle cell anemia (SCA) is generally diagnosed in the early childhood and the disease is usually diagnosed in the first years of life by its clinical manifestations. The crises of this disease worsens during pregnancy. In this report, a 24-year-old pregnant woman with gestational age of 29 weeks and six days, G2P2A0L1, is presented. She complained of severe back and lower extremity pain. Considering the refractory pain, severe anemia, and absence of delivery process signs, further tests detected SCA for her. Preterm termination of pregnancy were performed by cesarean section regarding severe non-controlled pain, severe IUGR (intrauterine growth retardation), severe oligohydramnios, and previous caesarian section. A female baby was born with Apgar score of 8 and a birth weight of 1250 grams. Considering the high probability of vascular occlusion crisis and severe anemia associated with SCA during pregnancy, it is reasonable to seek sickle cells in all the pregnant patients with severe unexplained anemia or pain.

OBJECTIVE We tested the hypothesis that administration of vaginal progesterone in women with arrested preterm labor would result in lower rates of preterm birth

Background and objective: Vaginal bleeding is a common complication in pregnancy and is associated with poor perinatal outcomes. This study aimed to determine the efficacy of tranexamic acid in stopping vaginal bleeding during pregnancy and improving perinatal outcomes. Methods: A prospective clinical trial was conducted on 137 pregnant women with vaginal bleeding of unknown causes in the second and third trimesters of pregnancy who were admitted to Maternity Teaching Hospital, Erbil city, Kurdistan region, Iraq from February 2016 to November 2019. Tranexamic acid was administered to one group and normal supportive care to another group in a sequential manner. The Mann–Whitney test was used to compare the mean rank of the times of admission. Factors that were significantly associated with stoppage of bleeding were entered into a binary logistic regression model. Results: Bleeding was stopped in 90% of women who received tranexamic acid. There was a significant difference in low Apgar score, the rate of low birth weight, and the rate of unfavorable perinatal outcome in the supportive care group than that in the tranexamic acid group. Predictors for not stopping bleeding were supportive care management compared with tranexamic acid (odds ratio (OR) = 13.38; 95% confidence interval (CI) = 3.60–49.67), and 21–32 weeks gestation compared with ≥ 37 weeks (OR = 6.52; 95% CI = 1.66–25.63). Conclusion: Tranexamic acid in second and third trimesters bleeding is effective for rapidly arresting bleeding with a favorable neonatal outcome. Keywords: Antifibrinolytic agent; Miscarriage; Neonatal death; Preterm labor; Tranexamic acid.

Objetivo: Caracterizar las gestantes de Alto Riesgo Obstétrico ( ARO ) que acuden a una IPS pública en el departamento de Sucre, Colombia (periodo enero, febrero y marzo de 2015. Material y métodos: Estudio cuantitativo, descriptivo. La muestra la conformaron 123 gestantes ARO . Se utilizó un instrumento elaborado por las investigadoras; se sometió a validez de constructo y contenido, y análisis de consistencia interna mediante el alfa de Cronbach. Resultados: El 13,18 % de las gestantes eran menores de 18 años; 38,2% procedentes de la capital y 19,5 % de la región del San Jorge; 66 % no manifestaron antecedentes patológicos; 13,8 % presentaron complicaciones de amenaza de aborto o de parto pretérmino; 37 % eran nulípara; 20.3 % tenían cesárea anterior; 22.8 % sufrieron abortos; 54.5 % manifestaron tensión emocional y mal humor; 82.9% no programaron el embarazo; 24 % con periodo intergenésico de 1 año; 55.3 % (68 gestantes) se encontraban entre la semana 30 y 40 de gestación al momento de participar en el estudio. Conclusiones: La subregión de la Sabana y San Jorge fueron las que presentaron mayor número de gestantes de alto riesgo. Entre las patologías preexistentes más frecuentes se encontró anemias y migrañas, así como las del sistema endocrino y respiratorio. Esta investigación servirá como referente para proporcionar conocimiento respecto al perfil de las gestantes de alto riesgo en Sucre, para que los profesionales involucrados en su atención desempeñen un rol que permita contribuir al control y prevención de las complicaciones en ellas y en la reducción significativa de la mortalidad materna.

Aim: This study aimed to determine whether a novel ultrasonographic marker, uterocervical angle, correlates with risk of spontaneous preterm birth.Materials and Methods: In the present prospective, cohort, study, we included 197 singleton pregnant women at Ain shams university maternity hospital (outpatient obstetrics clinics and emergency department. The mean age of the included women was 27.2 ± 4.8 years while the mean party was 2.2 ±1.3. The mean BMI was 33.4 ± 2.6Kg/m2.Results: In the present study, we found that there were statistically significant differences between both groups in terms of history of preterm labor (p

Objective To determine the effect of nifedipine on the fetal pulmonary system by acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform. Methods This prospective study was conducted in a high-risk pregnancy clinic with pregnant women who required nifedipine treatment to prevent preterm labor between 24 and 34 weeks of gestation. An ultrasound examination that included measurements of the acceleration time (AT), ejection time (ET), and AT/ET ratio (PATET) were performed before and 48 h after the first nifedipine dose. Results Forty-three pregnant women were included in this study. AT and PATET found higher in the after nifedipine group when compared with before nifedipine group. When the ET parameters were compared, no differences were detected between the groups. Conclusion Nifedipine increases fetal pulmonary blood flow which appears to increase AT and PATET on Doppler parameters in pregnant women with preterm labor after 48h treatment.

To determine the prevalence of Ureaplasma spp. DNA and its load in the cervical fluid in women with preterm labor with intact membranes (PTL) complicated by intra-amniotic infection (the presence o...

Background: Preterm birth (PTB) remains a major cause of perinatal morbidity and mortality worldwide. Compared with term deliveries, early PTB (< 34 weeks' gestation) carries a 7-fold increased risk of neonatal death. Objective: To compare the Fetal Zone Depth (FZD) of fetal adrenal gland in term and preterm labor cases Patients and Methods: Thirty-three preterm pregnant women at 29-36 weeks of gestation with single pregnancy and clinical diagnosis of preterm labor and control group of 33 pregnant women at 37-40 weeks with term pregnancy were included in this study. FZD and Total Gland Depth (TGD) of fetal adrenal gland were ultrasonographically measured and FZD/TGD ratios were calculated and compared between the two groups. Results: No difference was found between the two groups in respect of age and number of pregnancies (P > 0.05). Yet, preterm birth history rupture of membrane, cervical dilatation and mode of delivery were higher in preterm group (P

Background: Premature birth (PTB) occurs in one in ten pregnancies. There are about 13 million PTBs annually worldwide. Antenatal corticosteroids are administered to enhance fetal lung maturation in cases of threatened preterm delivery between 24- and 34-weeks’ gestational age (GA). Objective: This study aimed to study the cardiotocograp (CTG) before and after antenatal corticosteroids administration in patients at high risk of preterm labor to reduce preterm risks. Patients and Methods: A prospective cohort study included 52 women who were at risk of premature birth. Each woman received the recommended course of corticosteroids consists of 4 doses of dexamethasone 6 mg for 48 hours (Dexamethasone 8 ml intramuscularly, 12 h apart). CTG examination: Fetal heart rate was monitored with fetal monitor cardiotocogram machine. Cardiotocography strips were interpreted visually. Results: In our study we recorded decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant. Decelerations were not present at all before or after the course. The STV showed a significant change before the course, all participants had moderate STV, but after the course, 8 (15.4%) showed marked variability, which was significant. We found that most of participants (90.4%) had decreased fetal kicks after injection relying on maternal perception. Conclusion: There was a decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant.

Purpose To assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth. Methods This retrospective record linkage study evaluated the risks of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities among preterm children born after an attempted vaginal breech delivery. The control group comprised children born in a cephalic presentation at the same gestational age. This study included 23 803 singleton deliveries at gestational weeks 24 + 0–36 + 6 between 2004 and 2014. Results From 1629 women that underwent a trial of vaginal breech delivery, 1122 (66.3%) were converted to emergency cesarean sections. At extremely preterm and very preterm gestations (weeks 24 + 0—31 + 6), no association between a trial of vaginal breech delivery and neurodevelopmental delay occurred. At gestational weeks 32 + 0—36 + 6, the risks of visual disability (aOR 1.67, CI 1.07—2.60) and autism spectrum disorders (aOR 2.28, CI 1.14—4.56) were increased after an attempted vaginal breech delivery as compared to vaginal cephalic delivery. Conclusion A trial of vaginal breech delivery at extremely preterm and very preterm gestations appears not to increase the risk of adverse neurodevelopmental outcomes at the age of four. In moderate to late preterm births, a trial of vaginal breech delivery was associated with an increased risk of visual impairment and autism spectrum disorders compared to children born in cephalic presentation. A trial of vaginal preterm breech delivery requires distinctive consideration and careful patient selection.

El taponamiento cardiaco es la acumulación de líquido dentro del saco pericárdico, lo que conlleva a un aumento de la presión intrapericardica, permitiendo el deterioro de la capacidad del corazón para llenarse y actuar como bomba. Entre sus causas tenemos a la tuberculosis, las colagenopatías, y el cáncer. En el embarazo se pueden enmascarar los signos y síntomas del taponamiento cardiaco por los cambios fisiológicos propios del embarazo. El Gold estándar para su detección es la ecocardiografía. El tratamiento del taponamiento cardiaco es la pericardiocentesis o el drenaje quirúrgico. Se presenta el caso de una paciente de 26 años con: embarazo de 32,6 semanas, trabajo de parto pretérmino, taponamiento cardiaco y post pericardiocentesis de 2 horas, para culminación de embarazo. El manejo anestésico es complejo tanto para la madre y el recién nacido, basándose en mantener estabilidad hemodinámica y posterior traslado a unidad de terapia intensiva.

Prelabor rupture of membranes occurs in 20% of all pregnancies, while in the structure of preterm labor it occurs in 40% of cases. Particular attention to prelabor rupture of membranes is primarily due to the risk of developing septic complications being increased as the duration of the anhydrous interval increases. Currently, there are no effective methods for preventing prelabor rupture of membranes. Therefore, the timeliness of prevention of fetal respiratory distress syndrome depends on the effectiveness of the prognosis of this condition. The aim of this study was to assess the possibilities for predicting prelabor rupture of membranes. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on predicting prelabor rupture of membranes. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library and FIPS from the creation until December 2020. An integrated approach to assessing the likelihood of prelabor rupture of membranes will allow optimizing the tactics of pregnancy and labor management, which in the future will reduce not only the incidence of maternal and perinatal morbidity, but also the frequency of operative delivery.

BACKGROUND: Despite numerous studies, the etiopathogenesis of preterm birth in multiple pregnancy remains unclear, which determines the low effectiveness of measures for the prevention of preterm birth. This fact makes it necessary to study possible ways of implementing preterm birth in multiple pregnancies and to search for new biomarkers of their pathogenetic links. Experimental and clinical studies have demonstrated the contribution of the pleiotropic hormone relaxin to the regulation of a wide range of physiological processes and its role in the implementation of the pathogenetic mechanisms of pregnancy complications, primarily premature birth. The proven autocrine / paracrine mechanism of placental relaxin action, which implements important local effects, determines the prospects for studying the contribution of its dysregulation to the implementation of spontaneous preterm labor in multiple pregnancies. MATERIALS AND METHODS: A morphological examination of 92 placentas from 46 deliveries of dichorionic diamniotic twins was performed: 24 of them were spontaneous premature births and 22 spontaneous term births. Histological examination of placentas along with immunohistochemical verification of relaxin 2 expression in the chorionic villus of the dichorial twins placentas were carried out. RESULTS: Histological examination of the dichorionic twins placentas revealed that those from spontaneous preterm birth were characterized by a higher frequency of chronic placental insufficiency with reduced compensatory and adaptive mechanisms and more pronounced circulatory disorders in the circulatory bed of the villous tree, when compared to placentas from spontaneous term labor. The first verification of relaxin 2 expression in the chorionic villi of the dichorionic twins placenta showed the role of the peptide in the initiation of spontaneous preterm birth. The relative area of relaxin 2 expression in spontaneous preterm labor was significantly higher (p 0.05) compared to that in spontaneous term labor. CONCLUSIONS: The data obtained confirm the hypothesis put forward about the involvement of placental relaxin in the pathogenesis of spontaneous preterm labor in multiple pregnancies. The authors were the first to propose the definition of a relaxin-dependent way of implementing spontaneous preterm labor. To help define new preventive strategies, the prospects for further studies of the role and significance of relaxin in the implementation of pathogenic processes involved in spontaneous preterm birth in multiple pregnancies have been outlined.

Identifying women with preterm labor who will go on to deliver prematurely is crucial to improving outcomes for mother and baby and for saving healthcare resources. Even among those with symptoms, the number of women who deliver preterm is low, and thus the low positive predictive value (PPV) and high negative predictive value (NPV) associated with available biomarkers does not substantially reduce the uncertainty of the clinical diagnosis. While there is some promise in the use of fetal fibronectin (fFN), interleukin 6 (IL-6), or placental alpha microglobulin 1 (PAMG-1) for predicting preterm birth (PTB), their use is unlikely to provide considerable clinical value in populations with a low prevalence. To provide real clinical benefit, a biomarker must demonstrate a high PPV to allow identification of the minority of symptomatic women who will deliver prematurely. As none of the currently available biomarkers exhibit this performance characteristic, we do not recommend their routine clinical use in populations with a pre-test probability of PTB of

In recent years, interest in the evaluation of vitamin D levels and the possible outcomes of their deficiency during pregnancy has increased. However, there is no consensus on when to start vitamin D supplementation, its duration, dosage, and the optimum level during pregnancy. The toxicity of vitamin D is as important as its deficiency. From the history of a 5-day-old male baby who was investigated for hypercalcemia, it was learned that the mother took 300,000 IU vitamin D-five ampoules/oral at 30 weeks of gestation every other day. The infant was born prematurely, postpartum bradycardia required positive pressure ventilation, and his hypercalcemia lasted approximately 4 months despite treatment. Maternal excessive and inappropriate use of vitamin D can cause preterm labor and severe hypercalcemia, which is a life-threatening complication in the neonatal period. This case is presented to draw attention to the negative effects of maternal high-dose vitamin D during pregnancy.

Latar Belakang: Secara global, persalinan preterm menjadi penyebab utama kematian neonatus usia dini 0-7 hari pertama kehidupan dengan menimbulkan dampak morbiditas yang tinggi juga. Indonesia menempati urutan negara ke 5 estimasi persalinan preterm tertinggi di dunia. Beberapa faktor yang dapat berpengaruh terhadap persalinan preterm yaitu idiopatik, iatrogenik, sosio-demografi, maternal dan genetik. Penelitian ini bertujuan untuk melihat hubungan antara usia ibu, pendidikan ibu, pekerjaan ibu dan riwayat persalinan preterm terhadap kejadian persalinan prterm di RSUD Dr. Soetomo Surabaya . Metode: Metode penelitian ini adalah analitik observasional dengan rancang bangun case control . Jumlah populasi sebanyak 1311 orang pada periode 1 Januari - 31 Desember 2018. Sampel dibagi dalam dua kelompok yaitu kelompok kasus (ibu yang bersalin preterm) dan kelompok kontrol (ibu yang bersalin tidak preterm) sebanyak masing-masing kelompok 137 orang yang disesuaikan dengan kriteria inklusi dan eksklusi dan berdasarkan teknik pengambilan sampel yaitu simpel random sampling. Variabel independen terdiri dari usia ibu, pendidikan, pekerjaan dan riwayat persalinan preterm sedangkan variabel dependen adalah persalinan preterm. Analisis data bivariat menggunankan uji Chi-Square test dengan taraf signifikansi α = 0,05 (95% CI). Hasil: Hasil uji Chi-Square menunjukkan bahwa tidak ada hubungan bermakna antara usia ibu bersalin (nilai p = 0,259), pendidikan (nilai p = 1), pekerjaan (nilai p = 0,225) dan riwayat persalinan preterm (nilai p = 0,191) dengan kejadian persalinan preterm. Kesimpulan: Faktor risiko seperti usa ibu bersalin, pendidikan ibu, pekerjaan ibu dan riwayat persalinan preterm tidak memiliki hubungan terhadap kejadian persalinan preterm. Abtract Background : Globally, preterm labor is the main cause of neonatal mortality in the first 0-7 days of life with a high impact of morbidity. Indonesia ranks 5th in the highest estimate of preterm labor in the world. Several factors that can influence preterm labor are idiopathic, iatrogenic, socio-demographic, maternal and genetic. This study aims to look at the relationship between maternal age, maternal education, maternal occupation and a history of preterm labor against the incidence of prenatal labor in RSUD Dr. Soetomo Surabaya. Method : The method of this study is observational analytic with a case-control design. The total population is 1311 people in the period January 1 - December 31, 2018. Samples were divided into two groups, namely the case group (preterm maternity) and the control group (mothers who were not preterm) as many as 137 groups each according to the inclusion criteria and exclusion and based on sampling techniques, namely simple random sampling. Independent variables consisted of maternal age, education, occupation and a history of preterm labor while the dependent variable was preterm labor. Bivariate data analysis used the Chi-Square test with a significance level of α = 0.05 (95% CI). Results : The Chi-Square test results showed that there was no significant relationship between maternal age (p = 0.259), education (p = 1), employment (p = 0.225) and preterm labor history (p = 0.191) with the incidence of preterm labor. Conclusion: Risk factors such as maternal age, maternal education, maternal occupation and a history of preterm labor have no relationship to the incidence of preterm labor.

Aim. To review the current publication highlighting the features of pregnancy and childbirth outcomes in patients with endometriosis. Materials and methods. The analysis of 45 foreign and domestic publications on this topic has been carried out. Results. Patients with endometriosis have fertility problems, and when pregnancy occurs, it was characterized by a higher risk of preeclampsia, placenta previa, gestational diabetes, miscarriage and preterm labor, as well as delivery by caesarean section. Newborns in women with endometriosis have an increased risk of prematurity and small for gestational age. Probably, in addition to the presence of endometriosis, the risk of obstetric and neonatal complications is influenced by the localization and severity of the disease, as well as the use of assisted reproductive technologies. Conclusion. The results obtained indicate that patients with endometriosis have a high risk of perinatal complications and require additional antenatal monitoring and care.

Aim: to study a role of undifferentiated connective tissue dysplasia (uCTD) in etiology of cervical incompetence and its effect on pregnancy and childbirth course.Material and Methods. There were enrolled 60 patients with cervical incompetence. Patients were divided into 3 groups according to the modified CTD scale: group 1 - patients without uCTD (n = 21); group 2 - patients with mild uCTD (n = 25); group 3 - patients with moderate-to-severe uCTD (n = 14). Intensity of CTD clinical signs was assessed based on health status, gynecological and obstetric history, the course of pregnancy, labor and the postpartum period.Results. It was found that patients with more prominent CTD developed earlier (r-Spearman = -0.26) and more marked (r-Spearman = -0.29) cervical shortening and opening of the internal orifice of the uterus (r-Spearman = 0.28). It was also noted that likelihood of occurring preterm labor was significantly higher in patients with CTD (p = 0.02).Conclusion. The data obtained evidence that uCTD affects intensity of manifested cervical insufficiency and rate of preterm delivery.

Background We report a case of pulmonary edema induced by tocolytic agents that was successfully managed with noninvasive positive-pressure ventilation (NPPV) and resulted in extended gestation. Case presentation A 36-year-old Japanese pregnant woman received tocolytic therapy with ritodrine hydrochloride, magnesium sulfate, nifedipine, and betamethasone from 28 weeks of gestation. She developed respiratory failure. and her chest X-ray showed enlarged pulmonary vascular shadows. At 29 weeks and 1 day of gestation, she was diagnosed with pulmonary edema induced by tocolytic agents. Because respiratory failure worsened 2 days after ritodrine hydrochloride and magnesium sulfate were stopped, NPPV was initiated. Her respiratory status improved and she was weaned off of NPPV after 3 days. She underwent cesarean section because of breech presentation at 30 weeks and 0 days of gestation due to initiation of labor pains. Conclusions NPPV can be safely administered in cases of tocolytic agent-induced pulmonary edema during pregnancy.

Background: Currently, the main goal for the use of tocolytic therapy is to delay the birth so as to allow the use of corticosteroids for accelerating fetal lung maturity and maternal transfer to a tertiary care center and thereby reducing neonatal morbidity and mortality. Aims and Objectives: The aims amd objectives were to compare the safety and efficacy of transdermal nitroglycerine patch with oral nifedipine as a tocolytic agent to arrest preterm labor and prevent preterm birth. Materials and Methods: Based on the selection criteria, 50 patients were selected randomly in Group A and Group B. Group A women were given transdermal nitroglycerin patch, which delivered 10 mg Nitroglycerin (NTG) over 24 h and it was applied to the woman's abdomen followed by another patch of 10 mg after 1 h if contractions persisted. After 24 h, it was replaced by a fresh patch. Group B women were given an oral loading dose of nifedipine 20 mg followed by a similar dose if contractions persisted after 1 h. A maintenance dose of 10 mg thrice daily was given if contractions were suppressed. Patients were monitored from the time of admission to the time of discharge. Results: The mean duration of prolongation of pregnancy in Group B (3.68 ± 1.91 days) was significantly more than Group A (2.78 ± 1.39 days). Headache was seen significantly more in Group A (42%) than group B (6%). Tachycardia, hypotension, and palpitation showed no statistically significant difference between them. There was no statistically significant difference in the birth weight of the babies in both the groups. Conclusion: Nifedipine is a safe and effective drug in prolonging preterm labor and has minimal maternal and neonatal side effects.

Background Despite advances in medicine, there is currently no effective procedure for predicting and the early diagnosis of preterm premature rupture of membranes (pPROM). Objectives To apply measurements of selected biochemical markers of inflammation for diagnosing cases of pPROM without clinical signs of infection. Material and methods This is a prospective cohort study. Three groups were compared, a study group: 82 women between 22 and 37 weeks of pregnancy hospitalized due to pPROM, a control group: 64 women between 22 and 37 weeks of pregnancy in the 1st stage of preterm labor with intact fetal membranes, and a reference group: 99 women between 37 and 42 weeks of pregnancy in the 1st stage of physiological term labor and intact fetal membranes. To assess the concentration of cytokines, a multiplex method was used for measurement of: IGFBP-1, IGFBP-2, BDNF, L-selectin, E-selectin, PECAM-1, ICAM-1, and VCAM-1, MIP-1d, MIP-3b, BLC, eotaxin-1, and eotaxin-2. Results Out of the studied molecules, we found that eotaxin-2 concentrations in the study group were significantly lower than in the control group and the reference group: 9.22 pg/mL compared to 13.76 pg/mL and 14.14 pg/mL (p = 0.014), respectively. We also showed that serum concentration of eotaxin-2 below 8.24 pg/mL could be used as a cut-off level of pPROM (sensitivity: 0.58; specificity: 0.57). Conclusions Findings of significant differences in eotaxin-2 can be the basis for further studies on the use of this molecule as a biochemical marker of pPROM.

BACKGROUND: Previous studies have suggested that chronic periodontal infection may be associate with preterm births and low birth weight. The present study was conducted to evaluate the levels of interleukin-17 (IL-17) in saliva samples of pregnant females as a possible marker in determining whether or not an association exists between chronic periodontitis and preterm labor. AIM: The aim of the study is to assess the relation between the periodontal health status and preterm low birth weight of the new born on the basis of salivary IL-17 levels. MATERIALS AND METHODS: This case–control study included a random sample of 40 female patients, aged 18 to 35 years, who were in their second trimester, assigned to two groups, Group 1 consisted of 20 pregnant females without periodontitis, Group 2 included 20 pregnant females with periodontitis. Saliva samples were obtained in the second trimester and postpartum. Saliva samples were measured by using ELISA for IL-17 levels. RESULTS: IL-17 levels in saliva were significantly higher in Group 2 than that of Group 1(p

Hemolytic disease of the fetus is one of the types of pathological abnormalities in the development of the fetus, the reason of which is isoimmune hemolytic anemia. Depending on the degree of severity of this pathology, it can influence the development of the fetus both in a mild form, practically leaving no trace and in a severe form, which can cause fetal death. When carrying out a timely diagnostic research to detect this pathology, tactics of pregnancy management should differ, that will allow maintaining of pregnancy and ensure normal development of the fetus just until the moment of childbirth. To determine the tactics, which will be used during pregnancy management, it is necessary to identify not only the symptoms of hemolytic diseases of the fetus but its degree as well. Depending on the degree of severity of this disease, the activities will differ. If the disease is developing in a mild form, a pregnant woman is thoroughly observed and repeatedly diagnosed; if it is a severe form, intrauterine fetal blood transfusions are regularly conducted. The tactics of managing pregnancy with the detected fetal hemolytic disease will differ from the standard one and its right choice will ensure normal development of the fetus and term labor with minimum risks for both a mother and a child.

The vaginal microbiome undergoes dramatic shifts before and throughout pregnancy. Although the genetic and environmental factors that regulate the vaginal microbiome have yet to be fully elucidated, high-throughput sequencing has provided an unprecedented opportunity to interrogate the vaginal microbiome as a potential source of next-generation therapeutics. Accumulating data demonstrates that vaginal health during pregnancy includes commensal bacteria such as Lactobacillus that serve to reduce pH and prevent pathogenic invasion. Vaginal microbes have been studied as contributors to several conditions occurring before and during pregnancy, and an emerging topic in women’s health is finding ways to alter and restore the vaginal microbiome. Among these restorations, perhaps the most significant effect could be preterm labor (PTL) prevention. Since bacterial vaginosis (BV) is known to increase risk of PTL, and vaginal and oral probiotics are effective as supplemental treatments for BV prevention, a potential therapeutic benefit exists for pregnant women at risk of PTL. A new method of restoration, vaginal microbiome transplants (VMTs) involves transfer of one women’s cervicovaginal secretions to another. New studies investigating recurrent BV will determine if VMTs can safely establish a healthy Lactobacillus-dominant vaginal microbiome. In most cases, caution must be taken in attributing a disease state and vaginal dysbiosis with a causal relationship, since the underlying reason for dysbiosis is usually unknown. This review focuses on the impact of vaginal microflora on maternal outcomes before and during pregnancy, including PTL, gestational diabetes, preeclampsia, and infertility. It then reviews the clinical evidence focused on vaginal restoration strategies, including VMTs.

Introduction: Amniotic fluid (AF) interleukin-6 (IL-6) concentration has been associated to preterm delivery and perinatal morbidity and mortality in women with preterm labor and intact membranes. Nevertheless, the clinical significance of this biomarker of intra-amniotic inflammation (IAI) is still unclear due in part to the paucity of large studies. Methods: AF IL-6 concentrations were determined in 452 consecutive women with preterm labor and intact membranes, categorized into 3 groups: 302 without IAI (IL-6 of Results: The severe IAI group had a short pregnancy duration from amniocentesis to delivery (median 3 days) than in without IAI group (median 45 days); meanwhile, the mild IAI group had a latency that was intermediate to the severe and without IAI groups (median 9.5 days). As compared to women without IAI, women with mild and severe IAI had higher rates of preterm delivery at both Conclusions: AF IL-6 concentrations appear to be suitable marker to assess the degree of IAI and are associated with increased risk of adverse outcomes.

Outline ways to improve perinatal outcomes as a result of analysis of the structure and methods of delivery in preterm labor (PL).

BackgroundPreterm birth is a major challenge in obstetric and perinatal care. It is the leading cause of neonatal death. The primary aim of this study was to evaluate the efficacy of oral dydrogesterone on latency period in managing preterm labor. The secondary aims were to evaluate the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, time to recurrent uterine contraction, pregnancy outcomes, neonatal outcomes, compliance and side effects.MethodsThis was a randomized, double blinded, placebo-controlled trial. Forty-eight pregnant women with preterm labor, singleton pregnancy, and gestational age of 24–34 weeks were enrolled into the study. The study group received 10 mg of oral dydrogesterone three times per day and the control group received placebo. All pregnant women received standard treatment with tocolytic and antenatal corticosteroids.ResultsThe median latency periods were not significantly different between the dydrogesterone group (27.5 days) and placebo group (34 days,p= 0.45). Additionally, there were no differences in the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, pregnancy outcomes, neonatal outcomes, compliance and side effects. However, the time to the recurrence of uterine contractions in participants that had recurrent preterm labor was longer in the dydrogesterone group than in the placebo group (30.6 ± 12.3 vs 13.7 ± 5.0 days,p= 0.01).ConclusionsAdjunctive treatment with 30 mg of oral dydrogesterone could not prolong latency period in preterm labor when compared to placebo.Trial registrationClinicalTrials.gov (Clinical trials registration:NCT 03935152, registered on May 2,2019).

Background: Preterm delivery is labor beginning before completing 37 weeks of gestation with progressive effacement and dilatation of the cervix in the presence of regular painful contractions. Preterm labor as one of the biggest challenges for obstetricians is a world health problem and is responsible for approximately two-thirds of early neonatal morbidity and mortality. Objectives: To compare the effectiveness and safety of nifedipine therapy versus combined use of vaginal progesterone and nifedipine as acute tocolysis and their effect on maternal and fetal blood flow measured at 24 and 72 hours after their use. Patients and Methods: This prospective randomized observational comparative clinical study included 52 pregnant women with symptoms and signs of preterm labor that were randomly allocated into two groups each group consisted of 26 patients. This study was conducted in Obstetrics and Gynecology Department, Menoufia University Hospitals in the period between March 2019 and March 2020. Their gestational ages ranged from 28-34 completed weeks. Result: Time interval between last epilat capsules to tocolytic effect in minutes was significantly shorter in group B than in group A. There was no significant difference between the two groups in Doppler parameters with no long-term effect on fetomaternal circulation as tocolytics in acute preterm labor. Conclusion: This study concluded that oral nifedipine plus vaginal progesterone is associated with more rapid response to tocolysis in threatened preterm labor compared to oral nifedipine alone with nearly the same effect on maternal and fetal blood flow.