scholarly journals Role of oral micronized progesterone versus vaginal progesterone for prevention of preterm labour

2017 ◽  
Vol 6 (5) ◽  
pp. 1797
Author(s):  
Neeta Natu ◽  
Shikha Sonker ◽  
Nootan Chandwaskar ◽  
Sweta Agrawal
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Neonatal Morbidity ◽  
Term Infant ◽  
Optimal Timing ◽  
Limited Information ◽  
Vaginal Progesterone ◽  
Increased Risk ◽  
Term Delivery ◽  
Micronized Progesterone

Background: Preterm birth remains a significant problem in obstetric care, affecting women and babies world-wide. Progesterone has an essential role in maintaining pregnancy by suppression of the calcium–calmodulin–myosin light chain kinase system. This study reflects the use of progesterone in preventing preterm birth.Methods: The data were collected as a retrospective study from SAMC and PGI Obstetric and Gynaecology Department.Results: With the use of Oral micronized progesterone out of 15 cases, term delivery 9 cases i.e. 60% and preterm delivery 6 cases i.e 40% and, with the use of vaginal progesterone suppository out of 15 cases, term delivery 11 cases i.e.73.3%, preterm delivery only 4 cases i.e 26.7%.Conclusions: Progesterone appears to be safe and efficacious in reducing the risk of preterm birth as well as NICU admissions, and neonatal morbidity and mortality in high risk patients. However, there is limited information available relating to longer-term infant and childhood outcomes, the assessment of which remains a priority. Further, trials are required to assess the optimal timing, mode of administration and dose of administration of progesterone therapy when given to women considered to be at increased risk of early birth.

scholarly journals Actual issues of prediction and prevention of preterm birth

2020 ◽  
pp. 8-13
Author(s):  
I.V. Lakhno ◽  
◽  
S.V. Коrovay ◽  
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Premature Birth ◽  
Biochemical Markers ◽  
Cervical Insufficiency ◽  
Short Cervix ◽  
Fetal Fibronectin ◽  
Vaginal Progesterone ◽  
Prediction And Prevention ◽  
Increased Risk

Premature birth is a significant problem in modern medicine. The main aspects of its solution are the prediction and prevention of premature birth. Nowadays, among a large number of biophysical and biochemical markers of preterm birth, ultrasonic cevicometry is the most popular one. It is known that «short cervix syndrome» is not the equivalent of cervical insufficiency. The known strategies of preventive combinations are used in case of an increased risk of preterm birth. Therefore, the issue of developing a differentiated approach to the combined or separate use of progesterone, pessary, or cerclage has not been answered yet. It should be added that in most practical recommendations based on the principles of evidence-based medicine, there are no differences according to the possible pathogenesis of preterm birth. A therapeutic strategy should be set based on the possible use or misuse of any preventive combination, taking into account maternal and fetal contraindications. The combined testing on ultrasound cervicometry and biochemical markers could ameliorate the identification of patients at risk of preterm birth. The fetal fibronectin is known to be the best among all biochemical markers of preterm birth. However, the prognostic value of this test, as well as the phosphorylated transport protein insulin-like growth factor, when used separately, is limited. In pregnant women with a length of the cervix between 1.5 cm and 3 cm, it is recommended to use the analysis for placental alpha-microglobulin-1. The administration of corticosteroids should only be performed when the risk of preterm delivery is confirmed by decreased cervical length and a positive test for placental alpha-microglobulin-1 (there is a high risk of preterm delivery within 7 days). The cerclage is indicated in patients with cervical insufficiency before 16 weeks of gestation. In the presence of a «short cervix» and the lack of anamnestic data, the strategy should be individualized. The efficacy of cerclage or pessary application has not been proven. It is necessary to start with vaginal progesterone administration. In the process of the patient observation (cervicometry in dynamics) will allow you to find out an effective method: cerclage or pessary and vaginal progesterone. In the case of progredient cervical effacement in the second trimester, it is advisable to perform an urgent cerclage. In the case of incompetent cervical stitch, the additional application of a pessary is possible. In women with multiple pregnancies, there is no evidence of elective cerclage or pessary efficacy. However, it is possible to use heroic cerclage, pessary in combination with vaginal progesterone or vaginal progesterone monotherapy. Key words: preterm delivery, prediction, prevention.

scholarly journals Inter-Pregnancy Interval and the Incidence of Preterm Birth

2020 ◽  
Author(s):  
Maryam Asgharnia ◽  
Tahereh Varasteh ◽  
Davoud Pourmarzi
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Health Care Providers ◽  
Smoking Status ◽  
Neonatal Morbidity ◽  
Care Providers ◽  
Term Delivery ◽  
History Of ◽  
And Control ◽  
Inter Pregnancy Interval

Objective: Preterm birth is associated with high rates of neonatal morbidity and mortality. This study aimed to investigate the relationship between inter-pregnancy interval and the incidence of preterm birth. Materials and methods: In a case-control study, 185 women with preterm delivery and 185 women with term delivery were included. Data including inter-pregnancy interval, demographic characteristics, history of prenatal and neonatal complications, parity, gravidity, type of delivery, and smoking status were collected. Results: The mean of the inter-pregnancy interval in the case and control groups were 79.84 ± 45.55 months and 78.49 ± 41.29 months, respectively (P = 0.767). Inter-pregnancy interval 12-month or less in comparison with Inter-pregnancy interval more than 24 months significantly increased the odds of preterm delivery (OR: 4.05, 95% CI: 1.06-15.39, p = 0.040). However, inter-pregnancy interval of 13-24 months was not a risk factor when compared with more than 24-month inter-pregnancy interval (OR: 1.54, 95% CI: 0.62-3.80, p = 0.351). Having an educational level less than high school in comparison with tertiary level decreased the odds of preterm delivery (OR: 0.25, 95% CI: 0.11-0.56, P = 0.040). With each increase in number of gravidity odds of preterm delivery increased by 1.5 times (95% CI: 1.11-2.04, P = 0.009). Having a history of preterm delivery (OR: 2.57, 95% CI: 1.17-5.64, P = 0.019) and experiencing preeclampsia (OR: 1.98, 95% CI: 1.06-3.68, P = 0.032) increased the odds of preterm delivery. Conclusion: Inter-pregnancy interval of 12-month or less in comparison with more than 2-year inter-pregnancy interval, experiencing preeclampsia, history of preterm delivery and increased number of gravidity increase the risk of preterm delivery. Health care providers need to be informed with the appropriate inter-pregnancy interval and counsel women to make an informed decision regarding their pregnancy.

Toll-like Receptor-4: A New Target for Preterm Labour Pharmacotherapies?

2018 ◽  
Vol 24 (9) ◽  
pp. 960-973 ◽  
Author(s):  
Sarah A. Robertson ◽  
Hanan H. Wahid ◽  
Peck Yin Chin ◽  
Mark R. Hutchinson ◽  
Lachlan M. Moldenhauer ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Platelet Activating Factor ◽  
Neonatal Morbidity ◽  
Ischaemic Injury ◽  
E Coli ◽  
Normal Term ◽  
Inflammatory Activation ◽  
Cervical Disease ◽  
Term Labour

Inflammatory activation, a major driver of preterm birth and subsequent neonatal morbidity, is an attractive pharmacological target for new preterm birth therapeutics. Inflammation elicited by intraamniotic infection is causally associated with preterm birth, particularly in infants delivered ≤34 weeks’ gestation. However, sterile triggers of PTB, including placental ischaemic injury, uterine distention, cervical disease, or imbalance in the immune response, also act through inflammatory mediators released in response to tissue damage. Toll-like Receptors (TLRs) are critical upstream gate-keepers controlling the inflammatory activation that precedes preterm delivery, as well as in normal term labour. In particular, TLR4 is implicated for its capacity to sense and integrate a range of disparate infectious and sterile pro-inflammatory triggers, and so acts as a point-ofconvergence through which a range of infectious and sterile agents can activate and accelerate the parturition cascade. Recent studies point to the TLR4 signalling complex as a tractable target for the inhibition of fetal, placental & intraamniotic inflammatory cytokine production. Moreover, studies on mice show that novel small molecule antagonists of TLR4 signalling are highly effective in preventing preterm birth induced by bacterial mimetic LPS, heat-killed E. coli or the TLR4-dependent pro-inflammatory lipid, Platelet Activating Factor (PAF). In this review, we discuss the role of TLR4 in regulating the timing of birth and the potential utility of TLR4 antagonists as novel therapeutics for preterm delivery.

scholarly journals An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maren Goetz ◽  
Mitho Müller ◽  
Raphael Gutsfeld ◽  
Tjeerd Dijkstra ◽  
Kathrin Hassdenteufel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Preterm Birth ◽  
Kidney Disease ◽  
Preterm Delivery ◽  
Claims Data ◽  
Maternal Risk ◽  
Live Births ◽  
Increased Risk ◽  
History Of

AbstractWomen with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.

Cross-Generational Contributors to Preterm Birth in California: Singletons Based on Race/Ethnicity

2018 ◽  
Vol 36 (04) ◽  
pp. 383-392
Author(s):  
Juan Yang ◽  
Rebecca Baer ◽  
Paul Chung ◽  
Laura Jelliffe-Pawlowski ◽  
Tumaini Coker ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Preterm Birth ◽  
Preterm Delivery ◽  
Clinical Characteristics ◽  
Birth Registry ◽  
Live Births ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Racial Ethnic

Objective Multiple studies have examined cross-generational patterns of preterm birth (PTB), yet results have been inconsistent and generally focused on primarily white populations. We examine the cross-generational PTB risk across racial/ethnic groups. Study Design Retrospective study of 388,474 grandmother–mother–infant triads with infants drawn from birth registry of singleton live births between 2005 and 2011 in California. Using logistic regression (odds ratios [ORs] and confidence intervals [CIs]), we examined the risk of preterm delivery by gestational age, sociodemographic, socioeconomic, and obstetric clinical characteristics stratified by maternal race/ethnicity. Results The risk of having a preterm infant <32 weeks was greater for women born at <32 weeks (OR: 2.09, 95% CI: 1.62–2.70) and 32 to 36 weeks (OR: 1.51, 95% CI: 1.35–1.70). This increased risk of preterm delivery was present among women in all race/ethnicity groups (white [AOR: 2.00, 95% CI: 1.52–2.63), black [AOR: 1.79, 95% CI: 1.37–2.34], Hispanic [AOR: 2.39, 95% CI: 2.05–2.79], and Asian [AOR: 2.12, 95% CI: 1.20–3.91]), with hypertension as the only consistent risk factor associated with increased risk of preterm delivery. Conclusion Our findings suggest a cross-generational risk of PTB that is consistent across race/ethnicity with hypertension as the only consistent risk factor.

scholarly journals The impact of interpregnancy interval on occurance of preterm births in the present pregnancy

2021 ◽  
Vol 10 (5) ◽  
pp. 2020
Author(s):  
Balaji Thanjavur Elumalai ◽  
Vaishnavi Govindarajan
Keyword(s):  
Preterm Birth ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
P Value ◽  
Interpregnancy Interval ◽  
Maternal Characteristics ◽  
Increased Risk ◽  
Pregnancy Intervals ◽  
The Impact ◽  
Present Pregnancy

Background: The pregnancy outcomes are influenced by the inter pregnancy intervals. Both short and long inter pregnancy intervals are known to adversely affect the mother and the baby. The main aim of birth spacing was to achieve ideal inter pregnancy intervals and thus to decrease maternal, neonatal morbidity and mortality.Methods: It is a prospective observational study. In this study, about 500 gravida 2 women who has delivered vaginally in the index pregnancy, with gestational age more than 28 weeks of gestation and with known interpregnancy interval were included in the study. They followed up to to delivery and occurance of preterm births in relation to maternal characteristics and interpregnancy interval were analysed.Results: Our study showed that Inter pregnancy intervals of 18-24 months were found to have the least number of preterm births when compared to intervals <18 months and >24 months. This association was found to be statistically significant (p value, Pearson chi square 0.0008). This relationship between inter pregnancy intervals and preterm births persisted when stratified according to maternal age, education, residence and BMI.A previous preterm birth was associated with increased risk of recurrent preterm birth (p value -0.034) and was statistically significant. The history of PROM in present pregnancy associated with preterm birth (p value -0.001) and association was statistically significant.Conclusions: From this study it was found that the 18-24 months birth to pregnancy interval is associated with the least incidence of preterm births. 

scholarly journals Etiological factors of preterm delivery

2013 ◽  
Vol 3 (2) ◽  
pp. 159-163
Author(s):  
Elvira Brkičević ◽  
Gordana Grgić ◽  
Dženita Ljuca ◽  
Edin Ostrvica ◽  
Azur Tulumović
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Multiple Pregnancy ◽  
Neonatal Morbidity ◽  
Etiological Factor ◽  
Premature Delivery ◽  
Control Group ◽  
Etiological Factors ◽  
Experimental Group

Introduction: Preterm delivery is the delivery before 37 weeks of gestation are completed. Preterm birth is a major course of neonatal morbidity and mortality, the incidence of premature delivery in developedcountries is 5 to 9%. Aims of this study were to determine the common etiological factors for preterm delivery, most common weeks of gestation for pretern delivery, and most commom way of delivery for preterm delivery.Methods: The study included 600 patients divided into two groups, experimental group (included 300 preterm delivered pregnant women), control group (included 300 term delivered women).Results: The incidence of preterm delivery in pregnant women younger than 18 years was 4.4%, and in pregnant women older than 35 years was 14%. 44.6 % of preterm delivered women at the experimentalgroup had lower education. In the experimental group burdened obstetrical history had 29%, 17.2% had a preterm delivery, 35.6% had a premature rupture of membranes, 15% had a preterm delivery before32 weeks of gestation, 12.4% between 32-33.6 weeks of gestation, while 72.6% of deliveries were between 34- 36.6 weeks of gestation. Multiple pregnancy as an etiological factor was present in 10.07% ofcases. Extragenital diseases were present in 10.4%. In the experimental group there were 29%, while in the control group there were 15% subjects with burdened obstetrical history.Conclusions: Preterm birth more often occurs in a pregnant women younger than 18 and older than 35 years, and in a pregnant women of lower educational degree. Preterm delivery in the most commoncases was fi nished in period from 34 to 36.6 weeks of gestation. The most common etiological factor of preterm delivery in the experimental group was preterm rupture of membranes and idiopathic pretermdelivery.

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