المؤلفون: van Zijl, Maud D.¹, Koullali, Bouchra¹, Oudijk, Martijn A.¹, Kazemier, Brenda M.¹, Pajkrt, Eva¹, Naaktgeboren, Christiana A.^1,2, Vollebregt, Karlijn C.³, Muller, Moira A.⁴, Bekker, Mireille N.⁵, Brons, Jozien T. J.⁶, Sueters, Marieke⁷, Langenveld, Josje⁸, Franssen, Maureen T.⁹, Schuitemaker, Nico W.¹⁰, van Beek, Erik¹¹, Scheepers, Hubertina C. J.¹², Schuit, Ewoud², de Boer, Karin¹³, Tepe, Eveline M.¹⁴, Huisjes, Anjoke J. M.¹⁵

المصدر: BMC Pregnancy & Childbirth. 9/4/2017, Vol. 17, p1-8. 8p.

مصطلحات موضوعية: *PREMATURE labor, *MULTIPLE birth, *CHILDBIRTH, *PROGESTERONE, *PROGESTERONE receptors, *CERVIX uteri, *CERVIX uteri diseases, *COMPARATIVE studies, *FETAL ultrasonic imaging, *PREMATURE infants, *RESEARCH methodology, *EVALUATION of medical care, *MEDICAL cooperation, *MEDICAL protocols, *PESSARIES, *PREGNANCY, *PROGESTATIONAL hormones, *RESEARCH, *VAGINAL medication, *EVALUATION research, *RANDOMIZED controlled trials, *TREATMENT effectiveness, *DISEASE complications, *PREVENTION

مستخلص: Background: Preterm birth is in quantity and in severity the most important topic in obstetric care in the developed world. Progestogens and cervical pessaries have been studied as potential preventive treatments with conflicting results. So far, no study has compared both treatments.Methods/design: The Quadruple P study aims to compare the efficacy of vaginal progesterone and cervical pessary in the prevention of adverse perinatal outcome associated with preterm birth in asymptomatic women with a short cervix, in singleton and multiple pregnancies separately. It is a nationwide open-label multicentre randomized clinical trial (RCT) with a superiority design and will be accompanied by an economic analysis. Pregnant women undergoing the routine anomaly scan will be offered cervical length measurement between 18 and 22 weeks in a singleton and at 16-22 weeks in a multiple pregnancy. Women with a short cervix, defined as less than, or equal to 35 mm in a singleton and less than 38 mm in a multiple pregnancy, will be invited to participate in the study. Eligible women will be randomly allocated to receive either progesterone or a cervical pessary. Following randomization, the silicone cervical pessary will be placed during vaginal examination or 200 mg progesterone capsules will be daily self-administered vaginally. Both interventions will be continued until 36 weeks gestation or until delivery, whichever comes first. Primary outcome will be composite adverse perinatal outcome of perinatal mortality and perinatal morbidity including bronchopulmonary dysplasia, intraventricular haemorrhage grade III and IV, periventricular leukomalacia higher than grade I, necrotizing enterocolitis higher than stage I, Retinopathy of prematurity (ROP) or culture proven sepsis. These outcomes will be measured up until 10 weeks after the expected due date. Secondary outcomes will be, among others, time to delivery, preterm birth rate before 28, 32, 34 and 37 weeks, admission to neonatal intensive care unit, maternal morbidity, maternal admission days for threatened preterm labour and costs.Discussion: This trial will provide evidence on whether vaginal progesterone or a cervical pessary is more effective in decreasing adverse perinatal outcome in both singletons and multiples.Trial Registration: Trial registration number: NTR 4414 . Date of registration January 29th 2014. [ABSTRACT FROM AUTHOR]

المؤلفون: Gillespie, Shannon L.¹ gillespie.175@osu.edu, Neal, Jeremy L.², Christian, Lisa M.^3,4, Szalacha, Laura A.⁵, Mccarthy, Donna O.⁶, Salsberry, Pamela J.⁷

المصدر: Nursing Research. Mar/Apr2017, Vol. 66 Issue 2, p95-104. 10p.

مصطلحات موضوعية: *RISK factors in premature labor, *PREMATURE infants, *ALLELES, *BLACK people, *CELL receptors, *CHI-squared test, *CHILDBIRTH, *CONCEPTUAL structures, *CONFIDENCE intervals, *CYTOKINES, *FISHER exact test, *GENETIC polymorphisms, *INTERLEUKIN-1, *INTERVIEWING, *LONGITUDINAL method, *RACE, *REGRESSION analysis, *RESEARCH funding, *STATISTICS, *T-test (Statistics), *TIME, *DATA analysis, *DATA analysis software, *DESCRIPTIVE statistics, *NUCLEIC acid amplification techniques, *GENOTYPES, *PREVENTION

مستخلص: Background: Timing of birth is a major determinant of newborn health. African American women are at increased risk for early birth, particularly via the inflammatory pathway. Variants of the IL1RN gene, which encode the interleukin-1 receptor antagonist (IL-1Ra) protein, are implicated in early birth. The biological pathways linking these variables remain unclear. Evidence also suggests that inflammatory pathways differ by race; however, studies among African American women are lacking. Objectives: We assessed whether an IL1RN variant was associated with timing of birth among African American women and whether this relationship was mediated by lower anti-inflammatory IL-1Ra production or related to a decrease in inhibition of proinflammatory IL-1β production. Methods: A candidate gene study using a prospective cohort design was used. We collected blood samples at 28-32 weeks of gestation among African American women experiencing an uncomplicated pregnancy (N = 89). IL1RN single-nucleotide polymorphism (SNP) rs2637988 was genotyped, and lipopolysaccharide-stimulated IL-1Ra and IL-1β production was quantified. Medical record review determined timing of birth. Results: Women with GG genotype gave birth earlier than women with AA/AG genotypes (b* =.21, p = .04). There was no indirect effect of IL1RN SNP rs2637988 allele status on timing of birth through IL-1Ra production, as evidenced by a nonsignificant product of coefficients in mediational analyses (ab = .006, 95% CI [-0.05, 0.13]). Women with GG genotype showed less inhibition of IL-1β production for a unit positive difference in IL-1Ra production than women with AA/AG genotypes (b* = .93, p = .03). Greater IL-1β production at 28-32 weeks of pregnancy was marginally associated with earlier birth (b* =.21, p = .05). Discussion: Women with GG genotype may be at risk for earlier birth because of diminished IL-1β inhibition, allowing for initiation of a robust inflammatory response upon even mild immune challenge. Study of inflammatory contributions to early birth among African American women may be key to identifying potential prognostic markers of risk and targeted preventive interventions. [ABSTRACT FROM AUTHOR]

المؤلفون: Amis, Debby

المصدر: Journal of Perinatal Education; Spring2019, Vol. 28 Issue 2, p68-80, 13p

مصطلحات موضوعية: PREMATURE labor prevention, RISK factors in premature labor, CHILDBIRTH, CHILDBIRTH education, DOULAS, GESTATIONAL age, HORMONES, INDUCED labor (Obstetrics), PREMATURE infants, OXYTOCIN, PROFESSIONAL associations, EVIDENCE-based medicine, LABOR coaching (Obstetrics), LABOR pain (Obstetrics), PREVENTION

مستخلص: Current evidence and professional organizations identify letting labor begin on its own as one of the most important strategies for promoting normal, physiologic birth. It also prevents iatrogenic prematurity and the need for high-tech medical interventions required for labor induction. Because the American College of Obstetricians and Gynecologists (ACOG) now states that it is reasonable for obstetric care providers to offer induction at 39 weeks to low-risk nulliparous women, it is more important than ever for childbirth educators to be familiar with best evidence on letting labor begin on its own. [ABSTRACT FROM AUTHOR]

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العنوان البديل: Cervical pessary and prevention of preterm birth

المؤلفون: Sentilhes, L.¹ loicsentilhes@hotmail.com, Descamps, P.¹, Legendre, G.¹

المصدر: Gynecologie Obstetrique & Fertilite. Jan2014, Vol. 42 Issue 1, p38-44. 7p.

مصطلحات موضوعية: *PREMATURE labor prevention, *MEDICAL equipment, *CERVICAL syndrome, *PREGNANCY complications, *RANDOMIZATION (Statistics), *PROGESTATIONAL hormones, *CHILDBIRTH

مستخلص: Résumé: Le pessaire cervical est un outil prometteur pour réduire le risque d’accouchement prématuré chez des patientes à risque, identifiées par la mesure échographique de la longueur cervicale au deuxième trimestre de la grossesse. Il est bien toléré par les femmes. Les essais PECEP et ProTWIN ont ouvert tout un champ d’investigations nouvelles pour la prévention de la prématurité. Ils suggèrent que le pessaire cervical pourrait être intéressant pour réduire le risque d’accouchement prématuré dans une population de patientes enceintes (i) de singletons avec une longueur cervicale ≤25 mm entre 18 et 22SA, et (ii) de jumeaux avec une longueur cervicale ≤37mm entre 16 et 22SA. Ces résultats doivent être absolument confirmés par d’autres études randomisées avant la généralisation de son utilisation. Enfin, la place du pessaire cervical par rapport ou en addition à la progestérone et au cerclage reste à déterminer. [ABSTRACT FROM AUTHOR]

المؤلفون: Um‐Bergström, Miranda, Papadogiannakis, Nikos, Westgren, Magnus, Vinnars, Marie‐Therese

المصدر: Acta Obstetricia et Gynecologica Scandinavica; Jan2018, Vol. 97 Issue 1, p74-81, 8p

مصطلحات موضوعية: CORTICOSTEROIDS, STEROID receptors, CHILDBIRTH, PREMATURE infants, PREGNANCY complications, PRENATAL care, PREMATURE labor, CHORIONIC villi, GESTATIONAL age, GLUCOCORTICOIDS, PLACENTA, RISK assessment, PLACENTA diseases, STATISTICS, RETROSPECTIVE studies, PREVENTION, DIAGNOSIS

مصطلحات جغرافية: SWEDEN

مستخلص: Introduction: Mothers at risk of preterm birth are treated with antenatal corticosteroids, which have advantageous effects for prematurely born infants. Accelerated villous maturation in the placenta is also associated with improved perinatal outcome. The primary aim of this study was to examine the association between antenatal corticosteroids and accelerated villous maturation. The secondary aim was to study associations with other placental pathologies.Material and Methods: A retrospective cohort study including 105 women who had (n = 75) or had not (n = 30) been treated with antenatal corticosteroids. The women gave birth between 22+0 and 26+6  weeks of gestation in Stockholm County between 1 April 2004 and 31 March 2007. A pathologist blinded to all clinical data except gestational age examined the placental slides to identify pathology parameters. The outcomes were correlated with antenatal corticosteroid treatment, and confounding factors were adjusted using logistic regression.Results: Accelerated villous maturation was significantly higher in the group treated with corticosteroids (odds ratio 16, 95% CI 2.4-690, p = 0.0005). After adjustment for gestational age and preeclampsia, the difference remained significant (odds ratio 8.9, 95% CI 1.2-389, p = 0.021). No significant associations were found regarding the secondary outcome variables, after adjusting for possible confounders.Conclusions: Antenatal corticosteroid treatment before preterm birth is associated with accelerated villous maturation. This could be one of the pathways by which corticosteroids are beneficial for preterm infants. [ABSTRACT FROM AUTHOR]

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المؤلفون: Rempis, Eva M., Schnack, Alexandra, Decker, Sarah, Braun, Vera, Rubaihayo, John, Tumwesigye, Nazarius Mbona, Busingye, Priscilla, Harms, Gundel, Theuring, Stefanie

المصدر: BMC Pregnancy & Childbirth; 3/7/2017, Vol. 17, p1-12, 12p

مصطلحات موضوعية: PREGNANT women, HIV prevention, CHILDBIRTH, STILLBIRTH, PREMATURE labor, PUBLIC health, HIV infection transmission, VERTICAL transmission (Communicable diseases), ANTI-HIV agents, BIRTH size, COMMUNICABLE diseases, HIV infections, PREMATURE infants, PERINATAL death, PREGNANCY complications, PRENATAL care, CROSS-sectional method, PREVENTION

مصطلحات جغرافية: UGANDA

مستخلص: Background: While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda.Methods: A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters.Results: Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria.Conclusion: In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Pregnancy & Childbirth is the property of BioMed Central 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.)

المؤلفون: Shachar, BZ, Mayo, JA, Lyell, DJ, Baer, RJ, Jeliffe‐Pawlowski, LL, Stevenson, DK, Shaw, GM

المصدر: BJOG: An International Journal of Obstetrics & Gynaecology; Nov2016, Vol. 123 Issue 12, p2009-2017, 9p

مصطلحات موضوعية: PREGNANCY, PREGNANCY complications, CHILDBIRTH, MOTHER-child relationship, PREMATURE labor, ABORTION, BIRTH intervals, COMPARATIVE studies, GESTATIONAL age, PREMATURE infants, INFANT mortality, LONGITUDINAL method, MATERNAL age, RESEARCH methodology, EVALUATION of medical care, MEDICAL cooperation, OBESITY, PERINATAL death, RESEARCH, EVALUATION research, BODY mass index, DISEASE incidence, RETROSPECTIVE studies

مصطلحات جغرافية: CALIFORNIA

مستخلص: Objectives: We assessed whether interpregnancy interval (IPI) length after live birth and after pregnancy termination was associated with preterm birth (PTB).Design: Multiyear birth cohort.Settings: Fetal death, birth and infant death certificates in California merged with Office of Statewide Health Planning and Development.Population: One million California live births (2007-10) after live birth and after pregnancy termination.Methods: Logistic regression was used to estimate odds ratios (ORs) of PTB of 20-36 weeks of gestation and its subcategories for IPIs after a live birth and after a pregnancy termination. We used conditional logistic regression (two IPIs/mother) to investigate associations within mothers.Main Outcome Measure: PTB relative to gestations of ≥ 37 weeks.Results: Analyses included 971 211 women with IPI after live birth, and 138 405 women with IPI after pregnancy termination with 30.6% and 74.6% having intervals of <18 months, respectively. IPIs of <6 months or 6-11 months after live birth showed increased odds of PTB adjusted ORs for PTB of 1.71 (95% CI 1.65-1.78) and 1.20 (95% CI 1.16-1.24), respectively compared with intervals of 18-23 months. An IPI >36 months (versus 18-23 months) was associated with increased odds for PTB. Short IPI after pregnancy termination showed a decreased OR of 0.87 (95% CI 0.81-0.94). The within-mother analysis showed the association of increased odds of PTB for short IPI, but not for long IPI.Conclusions: Women with IPI <1 or >3 years after a live birth were at increased odds of PTB-an important group for intervention to reduce PTB. Short IPI after pregnancy termination was associated with reduced odds for PTB and needs to be further explored.Tweetable Abstract: Short and long IPI after live birth, but not after pregnancy termination, showed increased odds for PTB. [ABSTRACT FROM AUTHOR]

: Copyright of BJOG: An International Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell 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.)

المؤلفون: Denney, Jeffrey M., Culhane, Jennifer F., Goldenberg, Robert L.

المصدر: Women's Health (17455057); Nov2008, Vol. 4 Issue 6, p625-638, 14p

مصطلحات موضوعية: BIRTH rate, PREMATURE labor, CHILDBIRTH, PREGNANT women, MULTIPLE birth, CONCEPTION, MATERNAL health services

مصطلحات جغرافية: UNITED States

مستخلص: The preterm birth rate in the USA is nearing 13%. The recent rise has been attributed to increased indicated preterm births and multiple births following artificial conceptions. There are few obstetrical interventions that successfully delay or prevent spontaneous preterm birth or reduce the risk factors leading to indicated preterm birth. On the other hand, there are many strategies that have improved outcomes for those infants who are born preterm. These include the use of corticosteroids for fetal maturation and regionalization of perinatal care for high-risk mothers and their infants. Several interventions, including progesterone use and cerclage, demonstrate promise in reducing spontaneous preterm births. The most pressing need is to better define the populations of pregnant women for whom these and other interventions will effectively reduce preterm birth. [ABSTRACT FROM AUTHOR]

: Copyright of Women's Health (17455057) is the property of Sage Publications Inc. 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.)

المؤلفون: O'Brien, J. M., Adair, C. D., Lewis, D. F., Hall, D. R., Defranco, E. A., Fusey, S., Soma-pillay, P., Porter, K., How, H., Schackis, R., Eller, D., Trivedi, Y., Vanburen, C., Khandelwa, M., Trofatter, K., Vidyadhari, D., Vijayaraghavan, J., Weeks, J., Dattel, B., Newton, E.

المصدر: Ultrasound in Obstetrics & Gynecology; Oct2007, Vol. 30 Issue 5, p687-696, 10p, 2 Charts, 2 Graphs

مصطلحات موضوعية: PROGESTERONE, PROGESTATIONAL hormones, PREGNANCY, PREMATURE labor, CHILDBIRTH, PARTURITION, LABOR complications (Obstetrics)

مصطلحات جغرافية: UNITED States

مستخلص: The article assesses whether prophylactic administration of progesterone vaginal gel reduces the risk of preterm birth in women with a history of spontaneous preterm birth. A randomized, double-blind, placebo-controlled multinational trial of 659 pregnant women in the U.S. with a history of spontaneous preterm birth is considered. Findings show that the effect of progesterone administration in patients at high risk for preterm delivery requires further investigation.

المؤلفون: Morris, Jonathan

المصدر: Evidence Based Medicine; Jun2013, Vol. 18 Issue 3, following pe23-e23, 2p

مصطلحات موضوعية: FAMILY planning, NEONATAL diseases, SEPTICEMIA prevention, CHILDBIRTH, PREMATURE labor, PREGNANCY complications, PREVENTION

مستخلص: The author comments on a study by van der Ham DP and colleagues which evaluate the effect of planned early birth compared with expectant management for pregnancies complicated with preterm prelabour rupture of membranes (PPROM). It mentions that early planned birth may help to reduce neonatal sepsis as compared to expectant management. The author comments that there is no indication to suggest planned early birth for women who present with PPROM close to term.