Complement activation fragments in cervicovaginal fluid are associated with intra-amniotic infection/inflammation and spontaneous preterm birth in women with preterm premature rupture of membranes

2021 ◽  
Author(s):  
Subeen Hong ◽  
Se Jin Lee ◽  
Yu Mi Kim ◽  
Young Eun Lee ◽  
Yehyon Park ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Complement Activation ◽  
Multivariate Analyses ◽  
Premature Rupture Of Membranes ◽  
Spontaneous Preterm Birth ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Increased Risk ◽  
Baseline Covariates ◽  
Cervicovaginal Fluid

Objective: We sought to determine whether the levels of complement and other inflammatory and angiogenic mediators in cervicovaginal fluid (CVF) are independently associated with intra-amniotic infection and/or inflammation (IAI) and imminent spontaneous preterm birth (SPTB, ≤48 hours of sampling) in women with preterm premature rupture of membranes (PPROM). Study design: This was a retrospective study consisting of 85 singleton pregnant women with PPROM at 20+0 to 33+6 weeks. Amniotic fluid (AF) obtained via amniocentesis was cultured and assayed for interleukin-6. CVF samples collected at the time of amniocentesis were assayed for complement C3a, C4a, and C5a, HSP70, M-CSF, M-CSF-R, S100 A8, S100 A9, thrombospondin-2, VEGF, and VEGFR-1 by ELISA. Results: Multivariate logistic regression analyses revealed that elevated CVF concentrations of complement C3a, 4a and 5a were significantly associated with an increased risk of IAI and imminent SPTB, whereas those of M-CSF were associated with IAI, but not imminent SPTB (P=0.063), after adjustment for baseline covariates (e.g., gestational age at sampling). However, univariate and multivariate analyses showed that the CVF concentrations of angiogenic (thrombospondin-2, VEGF, and VEGFR-1) and inflammatory (HSP70, M-CSF-R, S100 A8, and S100 A9) proteins were not associated with either IAI or imminent SPTB. Conclusions: In women with PPROM, elevated CVF concentrations of complement C3a, C4a, and C5a are independently related to an increased risk of IAI and imminent SPTB. These findings suggest that complement activation in CVF is significantly involved in mechanisms underlying preterm birth and in the host response to IAI in the context of PPROM.

The Association between Shirodkar Cerclage and Preterm Premature Rupture of Membranes in Singleton Pregnancies

2020 ◽  
Author(s):  
Alberto Muniz Rodriguez ◽  
Andrew Pastor ◽  
Nathan S. Fox
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Control Group ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Increased Risk ◽  
Uterine Anomalies ◽  
Underlying Risk ◽  
Singleton Pregnancies

Objective The aim of this study was to estimate if preterm premature rupture of membranes in women with cerclage is due to the cerclage itself or rather the underlying risk factors for preterm birth in this population. Study Design This was a retrospective cohort study of singleton pregnancies who underwent Shirodkar cerclage by a single maternal–fetal medicine practice between 2005 and 2019. The control group was an equal number of randomly selected women with a singleton gestation who had a prior preterm birth and were treated with 17-OH-progesterone but no cerclage. Patients with major uterine anomalies or fetal anomalies were excluded. The primary outcome was preterm premature rupture of membranes prior to 34 weeks. Chi-square and logistic regression were used. Results A total of 350 women with cerclage (154 [44%] history-indicated, 137 [39%] ultrasound-indicated, and 59 [17%] exam-indicated) and 350 controls were included. Preterm premature rupture of membranes prior to 34 weeks did not differ between the groups (8.9% in cerclage vs. 6.0% in controls, p = 0.149, adjusted odds ratio 0.62, 95% confidence interval: 0.24–1.64) nor between the different cerclage indications (9.1% of history-indicated, 7.3% of ultrasound-indicated, and 11.9% of exam-indicated, p = 0.582). This study had 80% power with an α error of 0.05 to detect an increase in preterm premature rupture of membranes prior to 34 weeks from 6.0% in the control group to 12.0% in the cerclage group. Conclusion Cerclage does not increase the risk of preterm premature rupture of membranes prior to 34 weeks compared with other women at increased risk of preterm birth. The observed association between cerclage and preterm premature rupture of membranes is likely due to underlying risk factors and not the cerclage itself. The risk of preterm premature rupture of membranes prior to 34 weeks in women with cerclage is 10% or less and does not appear to differ based on cerclage indication. Key Points

Risks of Preterm Premature Rupture of Membranes and Preterm Birth Post Fetoscopy Based on Location of Trocar Insertion Site

2018 ◽  
Vol 35 (08) ◽  
pp. 801-808 ◽  
Author(s):  
Andrew Chon ◽  
Lisa Korst ◽  
Arlyn Llanes ◽  
Eftichia Kontopoulos ◽  
Ruben Quintero ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Insertion Site ◽  
Logistic Models ◽  
Patient Characteristics ◽  
Pubic Symphysis ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Trocar Insertion ◽  
Preterm Premature Rupture ◽  
Increased Risk

Objective The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB). Study Design In this study trocar location was documented in the operating room. Lower uterine segment (LUS) location was defined as any insertion <10 cm vertically from the pubic symphysis. Lateral location was defined as ≥5 cm horizontally from the midline. Patient characteristics were tested against three outcomes: PPROM ≤ 21 days postoperative, PTB < 28 weeks, and PTB < 32 weeks. For each outcome, multiple logistic models were fitted to examine the effect of trocar location, controlling for potential risk factors. Results A total of 743 patients were studied. Patients with LUS location were twice as likely as those with a more superior location to have PPROM ≤ 21 days (OR = 2.33, 1.12–4.83, p = 0.0236). Patients with both a LUS and Lateral location were over six times more likely to have PPROM ≤ 21 days (OR = 6.66, 2.36–18.78, p = 0.0003). Trocar insertion site was not associated with PTB. Conclusion We found that trocar insertion in the LUS, particularly the lateral LUS, was associated with an increased risk of PPROM.

scholarly journals Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) – Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes

2019 ◽  
Vol 79 (08) ◽  
pp. 813-833 ◽  
Author(s):  
Richard Berger ◽  
Harald Abele ◽  
Franz Bahlmann ◽  
Ivonne Bedei ◽  
Klaus Doubek ◽  
...  
Keyword(s):  
Preterm Birth ◽  
German Society ◽  
Consensus Conference ◽  
Tertiary Prevention ◽  
Short Version ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Gynecology And Obstetrics ◽  
Self Help Groups

Abstract Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). Recommendations Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.

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