Preterm Labor and Treatment Efficacy-Safety

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.

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Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

International Journal of Reproductive BioMedicine ◽

10.18502/ijrm.v17i9.5098 ◽

2019 ◽

Author(s):

Bushra Ashraf MBBS

Keyword(s):

Preterm Labor ◽

10Mg Dose ◽

Efficacy And Safety ◽

Medical Sciences ◽

Vaginal Progesterone ◽

Significant Prolongation ◽

Key Words Preterm ◽

Neonatal Icu ◽

Group A ◽

Group B

Background: Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome. Objective: To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL. Materials and Methods: This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20mg of rapid release nifedipine orally. If uterine contraction continued, a 10mg dose was repeated every 20 min with a maximum of 40mg within the first hour. After completing the first hour, 20mg was given every 4–6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200mg daily. Results: Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13 ± 5.08 days in group A while 29.73 ± 3.10 days in group B. (p0.001). Conclusion: Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions. Key words: Preterm labor, Tocolytics, Nifedipine, Progesterone.

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Determinants of Psychosocial Resilience Resources in Obese Pregnant Women with Threatened Preterm Labor—A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010590 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10590

Author(s):

Agnieszka Bień ◽

Ewa Rzońca ◽

Joanna Grzesik-Gąsior ◽

Agnieszka Pieczykolan ◽

Ewa Humeniuk ◽

...

Keyword(s):

Locus Of Control ◽

Pregnant Women ◽

Self Efficacy ◽

Preterm Labor ◽

Health Locus Of Control ◽

Dispositional Optimism ◽

Moderate Level ◽

Premature Labor ◽

Threatened Preterm Labor ◽

Psychosocial Resilience

Background: The purpose of the study was to assess the level of such psychosocial resilience resources as self-efficacy, dispositional optimism, and health locus of control in pregnant women with obesity with threatened premature labor. Methods: The study was performed in the years 2017–2020 in a group of 328 pregnant women hospitalized due to threatened preterm labor and diagnosed with obesity before the pregnancy. The following instruments were applied: the Life Orientation Test, the Generalized Self-Efficacy Scale, and the Multidimensional Health Locus of Control Scale. Results: Obese pregnant women with threatened premature labor have a moderate level of generalized self-efficacy (28.02) and a moderate level of dispositional optimism (16.20). Out of the three health locus of control dimensions, the highest scores were recorded in the “internal control” subscale (26.08). Statistically significant predictors for the self-efficacy variable model included: satisfactory socio-economic standing (ß = 0.156; p = 0.004), being nulliparous (ß = –0.191; p = 0.002), and the absence of comorbidities (ß = –0.145; p = 0.008). Higher levels of dispositional optimism were found in women who were married (ß = 0.381; p = 0.000), reported a satisfactory socio-economic standing (ß = 0.137; p = 0.005), were between 23 and 27 weeks pregnant (ß = –0.231; p = 0.000), and had no comorbidities (ß = –0.129; p = 0.009). Conclusions: Generalized self-efficacy in obese women with threatened preterm labor is associated with satisfactory socio-economic standing, being nulliparous, and the absence of chronic disease. Dispositional optimism in obese pregnant women with threatened preterm labor is determined by their marital status, socio-economic standing, gestational age, and the absence of comorbidities.

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Enterococci and their role in perinatal pathology

Journal of obstetrics and women s diseases ◽

10.17816/jowd64548-54 ◽

2015 ◽

Vol 64 (5) ◽

pp. 48-54

Author(s):

Kristina Albertovna Oganyan ◽

Ol’ga Nikolaevna Arzhanova ◽

Svetlana L’vovna Zatsiorskaya ◽

Alevtina Mikhailovna Savicheva

Keyword(s):

Pregnant Women ◽

Preterm Labor ◽

Perinatal Outcomes ◽

Urogenital Tract ◽

Premature Labor ◽

Fetal Hypoxia ◽

Perinatal Pathology ◽

Normal Microflora ◽

Opportunistic Bacteria ◽

Threatened Preterm Labor

Enterococcus are opportunistic bacteria and are members of the normal microflora of the gastrointestinal tract of humans and animals. The prevalence of enterococcal infections in pregnant women is approximately 28 %. Enterococcus, colonizing the urogenital tract pregnant women mostly do not show pathogenic effect, however, it is known that they can lead to the development of such complications of pregnancy as threatened preterm labor, placental insufficiency, hypotrophy of the fetus. Of complications in childbirth most common in premature labor, untimely discharge of amniotic fluid, fetal hypoxia. According to the literature cause of neonatal bacteremia and sepsis in 10 % of cases are enterococcus. Thus, for the prevention of complications of pregnancy, delivery and perinatal outcomes in the allocation of Enterococcus urogenital tract to undergo antibacterial therapy, given the sensitivity to antibiotics.

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Effects of β-adrenergic agonist infusions on myometrial activity and plasma prostaglandin levels in the nonpregnant sheep

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y87-364 ◽

1987 ◽

Vol 65 (11) ◽

pp. 2297-2301 ◽

Cited By ~ 3

Author(s):

S. J. Lye ◽

P. Christopher ◽

R. F. Casper

Keyword(s):

Contractile Activity ◽

Vena Cava ◽

Emg Activity ◽

Adrenergic Agonists ◽

Adrenergic Agonist ◽

Uterine Contractions ◽

Uterine Contractile ◽

Differential Increase

Recent studies have reported that β-adrenergic agonists stimulate the production of stimulatory prostaglandins (PGs) by intrauterine tissues in vitro. These drugs are used clinically to inhibit uterine contractions; consequently an increase in stimulatory PGs in vivo might have potentially adverse effects. We have, therefore, investigated whether β-adrenergic agonists increase plasma PG concentrations in vivo. Samples of peripheral (aorta) and uterine venous enriched (vena cava) blood from nonpregnant sheep were collected at 15-min intervals for 1 h before, 3 h during, and 1 h postinfusion of either (a) the β-adrenergic agonist isoproterenol (Isop) at a dose of 0.16 μg∙kg−1 min−1; (b) Isop at a dose of 0.08 μg∙kg−1∙min−1; or (c) saline, 1 mL/h via a jugular vein catheter. The sheep were also equipped with intrauterine recording balloons to record intrauterine pressure and myometrial electromyographic (EMG) electrodes to measure EMG activity. Infusion of Isop at 0.16 μg∙kg−1∙min−1 produced a significant initial inhibition of uterine activity, although contractions returned (within 60 min) despite continued administration of Isop. Plasma PGE2 (but not PGF2α or 13,14-dihydro-15-keto-PGF2α (PGFM)) concentrations were significantly elevated during the Isop infusion. Administration of Isop at 0.08 μg∙kg−1∙min−1 produced no effects on uterine contractile activity but was associated with a significant elevation in plasma PGE2 (but not PGF2α or PGFM) concentrations. No changes in plasma PGE2, PGF2α, or PGFM occurred during saline infusion. The data suggest that β-adrenergic agonist infusion is associated with a differential increase in plasma PG levels in vivo, but that this effect is probably not related to the failure of Isop (0.16 μg∙kg−1∙min−1) to maintain inhibition of myometrial contractions.

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Cigarette smoke extract enhances oxytocin-induced rhythmic contractions of rat and human preterm myometrium

Reproduction ◽

10.1530/rep.1.00908 ◽

2006 ◽

Vol 132 (2) ◽

pp. 343-353 ◽

Cited By ~ 20

Author(s):

Tsuyoshi Nakamoto ◽

Katsuhiko Yasuda ◽

Masahiro Yasuhara ◽

Tatsuya Nakajima ◽

Tomomi Mizokami ◽

...

Keyword(s):

Preterm Delivery ◽

Cigarette Smoke ◽

Contractile Activity ◽

Underlying Mechanism ◽

Cigarette Smoke Extract ◽

Control Group ◽

Smoking During Pregnancy ◽

Expression Levels ◽

Uterine Contractions ◽

Uterine Contractile

Although smoking during pregnancy is a major risk factor for preterm delivery, the underlying mechanism by which smoking stimulates uterine contractions is still poorly understood. In the present study, we tried to clarify the effects of smoking on myometrial contractility induced by oxytocin (OT) using cigarette smoke extract (CSE). Myometrial strips, which were taken from the rat on day 16 of pregnancy, and from human preterm and term delivery groups, were incubated overnight with several doses of CSE at 37 ° C under non-hormonal conditions. The uterine contractile sensitivity and activity (force and frequency) upon exposure to OT were investigated. Furthermore, the expression levels of oxytocin receptor (OTR) mRNA in the myometrial strips were investigated by real-time PCR. Contractile sensitivity to OT in the rat CSE (10−7pieces/ml) group was found to be significantly higher than in the control group (P< 0.05). Contractile activity did not differ between the CSE and control groups. The expression levels of rat OTR mRNA in the CSE (10−7pieces/ml) group were significantly higher than in the control group (P< 0.01). Similarly, in preterm myometrial strips, the expression levels of human OTR mRNA in the CSE (10−7pieces/ml) group were significantly higher than in the control group (P< 0.05). These findings suggest that CSE directly increases the contractile sensitivity of preterm myometrium in response to OT by upregulating the expression of OTR mRNA and thereby increases the risk of preterm delivery in women, who smoke during pregnancy.

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Chemical Effects and Predictive Factors in Premature Birth

Revista de Chimie ◽

10.37358/rc.18.7.6419 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1796-1801

Author(s):

Adrian Neacsu ◽

Alina Calin ◽

Anca Daniela Braila ◽

Dan Navolan ◽

Mihai Dimitriu ◽

...

Keyword(s):

Extracellular Matrix ◽

Premature Birth ◽

Tissue Concentration ◽

Premature Labor ◽

New Born ◽

Uterine Contractions ◽

Chemical Effects ◽

Equal Importance ◽

Necrosis Factor

Premature birth is considered to be the consequence of independent alterations in the cervix and in the uterus. During labor, for full-term birth, as well as for premature birth, the cervix changes, from firm, long and closed, to soft and pliable, through a biochemical process characterized by the reshaping of the extracellular matrix and a growth of the tissue concentration of inflammatory mediators; the uterus proves an increase in contractility and sensitivity to endogenic hormones, such as oxytocin. Premature labor is associated with the premature activation of the release of cytokines in the decidua (mucosa lining uterus walls) and cervix. Interleukins IL-1 beta, IL-6, IL-8 and the alpha tumoral necrosis factor increase the production and activation of matrix metalloproteinases (MMP-1, MMP-3 and MMP-9) and of cathepsin S, which digests the collagen from the extracellular matrix of the cervix, causing the wiping and softening of the cervix. These cytokines are released by leukocytes in the myometer, leading to the production of prostaglandins and oxytocin, which stimulate uterine contractions. Therefore, the cervical shortening represented by ultrasound is believed to represent premature cervical softening. The obstetrical approach of aspects related to premature birth are based, considerably, on the prognosis expected by the obstetrician regarding the survival of the premature new-born baby, as well as the therapeutic variants to be followed. And not only survival is important, of equal importance is also the quality of life of underweight, immature new-born babies, who are considerably affected both physically, and intellectually.

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Optimization of Imminent Labor Prediction Systems in Women with Threatened Preterm Labor Based on Electrohysterography

Sensors ◽

10.3390/s21072496 ◽

2021 ◽

Vol 21 (7) ◽

pp. 2496

Author(s):

Gema Prats-Boluda ◽

Julio Pastor-Tronch ◽

Javier Garcia-Casado ◽

Rogelio Monfort-Ortíz ◽

Alfredo Perales Marín ◽

...

Keyword(s):

Preterm Labor ◽

Cervical Length ◽

Validation Dataset ◽

Computationally Efficient ◽

K Nearest Neighbors ◽

Predictive Values ◽

Classifier Design ◽

Input Dataset ◽

Threatened Preterm Labor ◽

Learning Machine

Preterm birth is the leading cause of death in newborns and the survivors are prone to health complications. Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy. The current methods used in clinical practice to diagnose preterm labor, the Bishop score or cervical length, have high negative predictive values but not positive ones. In this work we analyzed the performance of computationally efficient classification algorithms, based on electrohysterographic recordings (EHG), such as random forest (RF), extreme learning machine (ELM) and K-nearest neighbors (KNN) for imminent labor (<7 days) prediction in women with TPL, using the 50th or 10th–90th percentiles of temporal, spectral and nonlinear EHG parameters with and without obstetric data inputs. Two criteria were assessed for the classifier design: F1-score and sensitivity. RFF1_2 and ELMF1_2 provided the highest F1-score values in the validation dataset, (88.17 ± 8.34% and 90.2 ± 4.43%) with the 50th percentile of EHG and obstetric inputs. ELMF1_2 outperformed RFF1_2 in sensitivity, being similar to those of ELMSens (sensitivity optimization). The 10th–90th percentiles did not provide a significant improvement over the 50th percentile. KNN performance was highly sensitive to the input dataset, with a high generalization capability.

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