scholarly journals Screening for spontaneous preterm birth and resultant therapies to reduce neonatal morbidity and mortality: A review

2018 ◽  
Vol 23 (2) ◽  
pp. 126-132 ◽  
Author(s):  
Angelica V. Glover ◽  
Tracy A. Manuck
Keyword(s):  
Preterm Birth ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
Spontaneous Preterm Birth

scholarly journals 17-Alpha-Hydroxyprogesterone vs. Placebo for Preventing of Recurrent Preterm Birth: A Systematic Review and Meta-Analysis of Randomized Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Abdulaali R. Almutairi ◽  
Hadir I. Aljohani ◽  
Nouf S. Al-fadel
Keyword(s):  
Systematic Review ◽  
Preterm Birth ◽  
Meta Analysis ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Morbidity And Mortality ◽  
Cochrane Library ◽  
Relative Risk Ratio ◽  
Analysis Model ◽  
Clinical Trial Registries

Background: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality.Objective: To estimate the effect of 17-alpha-hydroxyprogesterone caproate (17-OHPC) compared to placebo in singleton gestations for reducing the risk of recurrent PTB and neonatal morbidity and mortality.Work Design: Systematic review and meta-analysis.Search Strategy: Searching MEDLINE, Embase, Web of Science, SCOPUS, Cochrane Library, and clinical trial registries.Selection Criteria: Randomized controlled trials of singleton gestations with a history of PTB and treated with a weekly intramuscular injection of 17-OHPC or placebo.Data Collection and Analysis: A random meta-analysis model was performed for the PTB outcomes (<32, <35, and <37 weeks) and neonatal outcomes (neonatal death, grade 3 or 4 intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis). Effect estimates were measured by relative risk ratio (RR) with a 95% confidence interval (CI).Main Results: Six works were included. There were no statistically significant reductions in the PTB risk following the use of 17-OHPC at <32 weeks (RR = 0.61, 95% CI: 0.13–2.77, and I2 = 39%), <35weeks (RR = 0.60, 95% CI: 0.10–3.67, and I2 = 51%), and <37 weeks (RR = 0.68, 95% CI: 0.46–1, and I2 = 75%). Furthermore, all the neonatal outcomes were statistically similar between the two groups.Conclusion: Treatment with 17-OHPC is not associated with reducing the risk of PTB or neonatal outcomes compared to placebo.

scholarly journals UMA ANÁLISE INTEGRAL DO TRABALHO DE PARTO PREMATURO

2019 ◽  
Vol 6 (1) ◽  
pp. 54-57
Author(s):  
Renata dos Santos Oliveira ◽  
Maria Luiza Silva Brito ◽  
Delcides Bernardes da Costa Neto
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Early Diagnosis ◽  
Preterm Labor ◽  
Transvaginal Ultrasound ◽  
Treatment Options ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
Fetal Fibronectin ◽  
Appropriate Treatment

A prematuridade é um dos mais significativos desafios da obstetrícia, constituindo a principal causa de morbimortalidade neonatal. A presença de fatores de risco, tanto maternos quanto fetais, geram maior vigilância durante o decorrer da gestação, entretanto cada gravidez ocorre de forma singular e seus fatores devem ser analisados individualmente, motivo que nos leva ao estudo profundo e integral de cada um deles. O diagnóstico do trabalho de parto prematuro é eminentemente clínico e, muitas vezes, de difícil estabelecimento precoce. Para auxiliar na obtenção de um diagnóstico em estágio inicial, tem-se empregado métodos complementares, como o ultrassom transvaginal e a fibronectina fetal. Existem várias opções de tratamento com suas particularidades para a indicação, porém a escolha deve ser feita prontamente a fim de prolongar a gestação, evitando os desfechos desfavoráveis do parto prematuro. Palavras-chave: trabalho de parto prematuro; diagnóstico precoce; tratamento adequado ABSTRACT Prematurity is one of the most significant challenges of obstetrics, being the main cause of neonatal morbidity and mortality. The presence of risk factors, both maternal and fetal, generate greater vigilance during the course of gestation, however each pregnancy occurs in a singular way and its factors must be analyzed individually, reason that leads us to the deep and integral study of each one of them. The diagnosis of preterm labor is eminently clinical and often difficult to establish early. To assist in obtaining an early diagnosis, complementary methods have been employed, such as transvaginal ultrasound and fetal fibronectin. There are several treatment options with their particularities for the indication, but the choice must be made promptly in order to prolong the gestation, avoiding the unfavorable outcomes of the preterm birth. Keywords: preterm labor; early diagnosis; appropriate treatment.

PROLONG Clinical Study Protocol: Hydroxyprogesterone Caproate to Reduce Recurrent Preterm Birth

2018 ◽  
Vol 35 (12) ◽  
pp. 1228-1234 ◽  
Author(s):  
Cynthia Gyamfi-Bannerman ◽  
Joseph Biggio ◽  
Suneet Chauhan ◽  
Brenna Hughes ◽  
Judette Louis ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Sample Size ◽  
Neonatal Morbidity ◽  
Total Sample ◽  
Morbidity And Mortality ◽  
Safety And Efficacy ◽  
Mortality Index ◽  
Hydroxyprogesterone Caproate ◽  
Secondary Outcomes

AbstractThe objective of this commentary is to describe the background, rationale, and methods of the PROLONG (Progestin's Role in Optimizing Neonatal Gestation) trial, which is a multicenter, multinational, placebo-controlled, randomized clinical trial (RCT) designed to assess the safety and efficacy of Makena (hydroxyprogesterone caproate injection, 250 mg/mL) in reducing the risk of preterm birth (PTB) and neonatal morbidity/mortality in women pregnant with a singleton gestation who had a previous singleton spontaneous PTB. The total sample size of the RCT will include 1,707 women. The trial has two coprimary outcomes: PTB less than 35 weeks and a composite neonatal morbidity and mortality index. This study sample size will provide 90% power to assess for a 35% reduction in neonatal morbidity and mortality. Secondary outcomes will include 2-year follow-up of infants. The trial is ongoing and targeted to complete recruitment in 2018.

scholarly journals Possibilities for diagnosis and prediction of preterm labor at the present stage

2021 ◽  
Vol 102 (1) ◽  
pp. 47-59
Author(s):  
V A Mudrov ◽  
A M Ziganshin ◽  
A G Yashchuk ◽  
L A Dautova ◽  
R Sh Badranova
Keyword(s):  
Preterm Birth ◽  
Morbidity And Mortality ◽  
Cochrane Library ◽  
Bibliographic Databases ◽  
Modern World ◽  
Perinatal Morbidity ◽  
Spontaneous Preterm Birth ◽  
Risk Of Death ◽  
Premature Babies ◽  
Gynecology And Obstetrics

Preterm birth is one of the main causes of perinatal morbidity and mortality, which does not tend to decrease in rate. The risk of death in premature babies is 2535 times higher than that of full-term babies, and stillbirths are registered 813 times more often than in timely delivery. To date, there are no effective ways to prevent preterm birth. Therefore, the timeliness of therapy, which largely determines the outcome of pregnancy in general, depends on the effectiveness of assessing the likelihood of their development. At the International Federation of Gynecology and Obstetrics (FIGO) Congress (2018), preterm birth is identified as a problem that has not yet been solved at the current stage of science and technology development. The result of the unsolved problems is a situation wherein the modern world over the past 60 years there has been no decrease in the premature birth rate, which is 9.5% of births and annually ends with the birth of 15,000,000 premature babies. The study aimed to research modern methods of diagnosis and prediction of spontaneous preterm birth. An analytical method was used in the study: a detailed systematic analysis of modern domestic and foreign literature on the diagnosis and prognosis of preterm birth. We used eLibrary, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library bibliographic databases (until August 2020). The article deals with the diagnosis and prediction of preterm birth probability, which will optimize the management of patients from the risk group and, in the future, will reduce the rate of perinatal morbidity and mortality of premature babies. Despite a significant number of researches devoted to the study of possibilities for diagnosing and predicting spontaneous preterm birth, currently, there are no methods with absolute diagnostic value. Most -existing studies indicate that when assessing the probability of preterm birth, a comprehensive approach should be preferred taking into account the results of several main and additional methods.

scholarly journals The pregnancy microbiome and preterm birth

2020 ◽  
Vol 42 (4) ◽  
pp. 487-499 ◽  
Author(s):  
Erna Bayar ◽  
Phillip R. Bennett ◽  
Denise Chan ◽  
Lynne Sykes ◽  
David A. MacIntyre
Keyword(s):  
Preterm Birth ◽  
Global Health ◽  
Human Microbiome ◽  
Neonatal Morbidity ◽  
Neonatal Care ◽  
Morbidity And Mortality ◽  
Health Concern ◽  
Vaginal Microbiome ◽  
Complex Interplay ◽  
In Pregnancy

Abstract Preterm birth is a global health concern and continues to contribute to substantial neonatal morbidity and mortality despite advances in obstetric and neonatal care. The underlying aetiology is multi-factorial and remains incompletely understood. In this review, the complex interplay between the vaginal microbiome in pregnancy and its association with preterm birth is discussed in depth. Advances in the study of bacteriology and an improved understanding of the human microbiome have seen an improved awareness of the vaginal microbiota in both health and in disease.

scholarly journals Clinical Validation of a Proteomic Biomarker Threshold for Increased Risk of Spontaneous Preterm Birth and Associated Clinical Outcomes: A Replication Study

2021 ◽  
Vol 10 (21) ◽  
pp. 5088
Author(s):  
Julja Burchard ◽  
Ashoka D. Polpitiya ◽  
Angela C. Fox ◽  
Todd L. Randolph ◽  
Tracey C. Fleischer ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Fold Increase ◽  
The United States ◽  
Independent Study ◽  
Adverse Outcomes ◽  
Spontaneous Preterm Birth ◽  
Increased Risk ◽  
Adverse Pregnancy

Preterm births are the leading cause of neonatal death in the United States. Previously, a spontaneous preterm birth (sPTB) predictor based on the ratio of two proteins, IBP4/SHBG, was validated as a predictor of sPTB in the Proteomic Assessment of Preterm Risk (PAPR) study. In particular, a proteomic biomarker threshold of −1.37, corresponding to a ~two-fold increase or ~15% risk of sPTB, significantly stratified earlier deliveries. Guidelines for molecular tests advise replication in a second independent study. Here we tested whether the significant association between proteomic biomarker scores above the threshold and sPTB, and associated adverse outcomes, was replicated in a second independent study, the Multicenter Assessment of a Spontaneous Preterm Birth Risk Predictor (TREETOP). The threshold significantly stratified subjects in PAPR and TREETOP for sPTB (p = 0.041, p = 0.041, respectively). Application of the threshold in a Kaplan–Meier analysis demonstrated significant stratification in each study, respectively, for gestational age at birth (p < 001, p = 0.0016) and rate of hospital discharge for both neonate (p < 0.001, p = 0.005) and mother (p < 0.001, p < 0.001). Above the threshold, severe neonatal morbidity/mortality and mortality alone were 2.2 (p = 0.0083,) and 7.4-fold higher (p = 0.018), respectively, in both studies combined. Thus, higher predictor scores were associated with multiple adverse pregnancy outcomes.

Obstetric History and Likelihood of Preterm Birth of Twins

2018 ◽  
Vol 35 (11) ◽  
pp. 1023-1030
Author(s):  
Sarah Little ◽  
Julian Robinson ◽  
Hector Mendez-Figueroa ◽  
Suneet Chauhan ◽  
Sarah Easter
Keyword(s):  
Preterm Birth ◽  
Twin Pregnancy ◽  
Reference Group ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Spontaneous Preterm Birth ◽  
Term Birth ◽  
Obstetric History ◽  
Term Delivery

Objective The objective of this study was to investigate the relationship between preterm birth in a prior pregnancy and preterm birth in a twin pregnancy. Study Design We performed a secondary analysis of a randomized controlled trial evaluating 17-α-hydroxyprogesterone caproate in twins. Women were classified as nulliparous, multiparous with a prior term birth, or multiparous with a prior preterm birth. We used logistic regression to examine the odds of spontaneous preterm birth of twins before 35 weeks according to past obstetric history. Results Of the 653 women analyzed, 294 were nulliparas, 310 had a prior term birth, and 49 had a prior preterm birth. Prior preterm birth increased the likelihood of spontaneous delivery before 35 weeks (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.28–4.66), whereas prior term delivery decreased these odds (aOR: 0.55, 95% CI: 0.38–0.78) in the current twin pregnancy compared with the nulliparous reference group. This translated into a lower odds of composite neonatal morbidity (aOR: 0.38, 95% CI: 0.27–0.53) for women with a prior term delivery. Conclusion For women carrying twins, a history of preterm birth increases the odds of spontaneous preterm birth, whereas a prior term birth decreases odds of spontaneous preterm birth and neonatal morbidity for the current twin pregnancy. These results offer risk stratification and reassurance for clinicians.

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