OBJECTIVE

Preterm birth is a major cause of complications leading to death of children under 5 years old. Infections are important to be identified because antimicrobial treatment may prevent or delay progression to preterm delivery. This study determined if routine screening tests of infections are useful in the clinical management of preterm labor.

A cross-sectional (descriptive) study was done involving 417 pregnant patients who had preterm labor and was subsequently admitted from 2015 to 2019 at a tertiary hospital in the Philippines, using review of past medical records, inpatient charts, and admission charts.

Majority of the patients delivered at less than 34 weeks, most of the culture results turned out negative, and urine tests were more commonly employed as screening tests for preterm labor. The endocervical and rectovaginal swab studies had no significant growths. Asymptomatic bacteriuria was diagnosed in 1 out of 10 patients and they were subsequently started on antibiotic treatment. Majority of the patients who were given antibiotics delivered within 48 hours from admission. 

The routine use of cultures in the assessment of preterm labor is costly and is unlikely to be helpful in the clinical management of patients in preterm labor.

OBJECTIVE

Preterm birth is a major cause of complications leading to death of children under 5 years old. Infections are important to be identified because antimicrobial treatment may prevent or delay progression to preterm delivery. This study determined if routine screening tests of infections are useful in the clinical management of preterm labor.

A cross-sectional (descriptive) study was done involving 417 pregnant patients who had preterm labor and was subsequently admitted from 2015 to 2019 at a tertiary hospital in the Philippines, using review of past medical records, inpatient charts, and admission charts.

Majority of the patients delivered at less than 34 weeks, most of the culture results turned out negative, and urine tests were more commonly employed as screening tests for preterm labor. The endocervical and rectovaginal swab studies had no significant growths. Asymptomatic bacteriuria was diagnosed in 1 out of 10 patients and they were subsequently started on antibiotic treatment. Majority of the patients who were given antibiotics delivered within 48 hours from admission. 

The routine use of cultures in the assessment of preterm labor is costly and is unlikely to be helpful in the clinical management of patients in preterm labor.

Objective: To investigate the association between gestational diabetes mellitus (GDM) and preterm birth subtypes. Methods: Based on the cohort of pregnant women in Anqing Prefectural Hospital, the pregnant women who received prenatal screening in the first or second trimesters were recruited into baseline cohorts; and followed up for them was conducted until delivery, and the information about their pregnancy status and outcomes were obtained through electronic medical record system and questionnaire surveys. The log-binomial regression model was used to explore the association between GDM and preterm birth [iatrogenic preterm birth, spontaneous preterm birth (preterm premature rupture of membranes and preterm labor)]. For multiple confounding factors, the propensity score correction model was used to compute the adjusted association. Results: Among the 2 031 pregnant women with a singleton delivery, the incidence of GDM and preterm birth were 10.0% (204 cases) and 4.4% (90 cases) respectively. The proportions of iatrogenic preterm birth and spontaneous preterm birth in the GDM group (n=204) were 1.5% and 5.9% respectively, while the proportions in non-GDM group (n=1 827) were 0.9% and 3.2% respectively, and the difference in the proportion of spontaneous preterm birth between the two groups was significant (P=0.048). Subtypes of spontaneous preterm were further analyzed, and the results showed that the proportions of preterm premature rupture of membranes and preterm labor in the GDM group were 4.9% and 1.0% respectively, while the proportions in the non-GDM group were 2.1% and 1.1% respectively. It showed that the risk of preterm premature rupture of membranes in GDM pregnant women was 2.34 times (aRR=2.34, 95%CI: 1.16-4.69) higher than that in non-GDM pregnant women. Conclusions: Our results showed that GDM might increase the risk of preterm premature rupture of membranes. No significant increase in the proportion of preterm labor in pregnant women with GDM was found.
Infant, Newborn ; Female ; Pregnancy ; Humans ; Premature Birth ; Diabetes, Gestational ; Obstetric Labor, Premature ; Hospitals ; Iatrogenic Disease

OBJECTIVE: To investigate the birth condition of preterm infants and the causes of preterm birth in Henan Province, China, and to provide a basis for the prevention and treatment of preterm birth. METHODS: An epidemiological investigation was conducted for live-birth preterm infants who were born in 53 hospitals in 17 cities of Henan Province from January 1, 2019 to December 31, 2019 to investigate the incidence rate of preterm birth, the distribution of gestational age and birth weight, the use of antenatal glucocorticoids, and the causes of preterm birth. RESULTS: The incidence rate of preterm birth was 5.84% (12 406/212 438) in the 53 hospitals. The proportions of preterm infants with gestational ages of < 28 weeks, 28 - < 32 weeks, 32 - < 34 weeks, and 34 - < 37 weeks were 1.58% (196/12 406), 11.46% (1 422/12 406), 15.18% (1 883/12 406), and 71.78% (8 905/12 406) respectively. The proportions of preterm infants with birth weights of < 1 000 g, 1 000- < 1 500 g, 1 500- < 2 500 g, 2 500- < 4 000 g, and ≥ 4 000 g were 1.95% (240/12 313), 8.54% (1 051/12 313), 49.53% (6 099/12 313), 39.59% (4 875/12 313), and 0.39% (48/12 313) respectively. The infants born by natural labor accounted for 28.76% (3 568/12 406), and those born by cesarean section accounted for 70.38% (8 731/12 406). The rate of use of antenatal glucocorticoids was 52.52% (6 293/11 983) for preterm infants and 68.69% (2 319/3 376) for the preterm infants with a gestational age of < 34 weeks. Iatrogenic preterm labor was the leading cause of preterm birth[40.06% (4 915/12 270)], followed by spontaneous preterm birth[30.16% (3 701/12 270)] and preterm birth due to premature rupture of membranes[29.78% (3 654/12 270)]. The top three causes of iatrogenic preterm birth were hypertensive disorders of pregnancy[47.12% (2 316/4 915)], fetal intrauterine distress[22.85% (1 123/4 915)], and placenta previa/placental abruption[18.07% (888/4 915)]. CONCLUSIONS There is a relatively low incidence rate of preterm birth in Henan Province, and late preterm infants account for a relatively high proportion. Iatrogenic preterm birth is the main cause of preterm birth in Henan Province, and hypertensive disorders of pregnancy and fetal intrauterine distress are the main causes of iatrogenic preterm birth.
Cesarean Section ; China/epidemiology* ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth/etiology*

Preterm birth accounts to 35 % of deaths in a year. Twin gestation, around 7.2 per 1000 births in the Philippines, is a known risk factor that increases likelihood of preterm birth compared to singletons. Most studies that addresses preterm births are focused on singleton pregnancies. There have been no established recommendations to control preterm labor in twin pregnancies. Pessary insertion is among these recommendations. There are no reported cases of pessary insertion to control preterm birth among twins in the Philippines. This study presents a case of twin gestation in preterm labor and no functional cervix on transvaginal ultrasound. Hodge pessary was inserted at 28 weeks age of gestation. She delivered at 36 weeks to live baby girls, both 2,200 grams and were directly roomed-in. Further studies are recommended to establish stronger evidence supporting pessary use in multiple gestation to improve outcome of neonates.
Pessaries ; Premature Birth ; Obstetric Labor, Premature ; Pregnancy, Twin

BACKGROUND: Sometimes general anesthesia is required for dental surgery in pregnant women. Facial bone fractures or neck abscess should be treated immediately. Dental surgery, however, creates a stressful situation that can cause inflammation. Inflammatory responses are a well-known major cause of preterm labor and preterm birth. Here we demonstrate the effects of remifentanil on the factors related to preterm labor and its mechanism of action on amniotic-derived epithelial cells (WISH cells). METHODS: WISH cells were exposed to lipopolysaccharide (LPS) for 24 h and co-treated with various concentrations of remifentanil. MTT assays were performed to measure cell viability. To explain the effects of remifentanil on the factors related to inflammation in WISH cells, activation of nuclear factor kappa B (NF-κB) and p38 and the expression of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, cyclooxygenase (COX)2, and prostaglandin E (PGE)2 were quantified using western blotting and RT-PCR, respectively. RESULTS: Remifentanil did not affect WISH cell viability. In western blot analysis, co-treatment with remifentanil resulted in decreased phosphorylation of NF-κB, and expression of COX2 and PGE2 in LPS-induced inflammation, but the results were statistically significant only at low concentrations. Reduction of IL-1β and TNF-α expression was also observed with RT-PCR. CONCLUSION: Co-treatment with remifentanil does not affect the viability of WISH cells, but reduces the expression of the factors related to inflammation, which can induce uterine contraction and preterm labor. These findings provide evidence that remifentanil may inhibit uterine contraction and preterm labor in clinical settings.
Abscess ; Amnion ; Anesthesia, General ; Blotting, Western ; Cell Survival ; Dinoprostone ; Epithelial Cells ; Facial Bones ; Female ; Humans ; Inflammation ; Interleukins ; Neck ; NF-kappa B ; Obstetric Labor, Premature ; Phosphorylation ; Pregnancy ; Pregnant Women ; Premature Birth ; Prostaglandin-Endoperoxide Synthases ; Tumor Necrosis Factor-alpha ; Uterine Contraction

BACKGROUND: Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. METHODS: This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. RESULTS: The analysis included 672 Korean subjects (mean age, 44 years; range, 11–81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was ‘live infant, no apparent congenital anomaly’ in 195 subjects (92.42%) or ‘lost to follow-up’ in 16 subjects. CONCLUSION: Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01929291
Adolescent ; Adult ; Common Cold ; Constipation ; Diphtheria Toxoid ; Diphtheria ; Dyspepsia ; Female ; Humans ; Immunization ; Incidence ; Infant ; Infant, Newborn ; Korea ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Prospective Studies ; Tetanus Toxoid ; Tetanus ; Vaccination ; Whooping Cough

No abstract available.
Female ; Obstetric Labor, Premature ; Parturition ; Pregnancy

BACKGROUND: Little research based on the artificial neural network (ANN) is done on preterm birth (spontaneous preterm labor and birth) and its major determinants. This study uses an ANN for analyzing preterm birth and its major determinants.
Adenomyosis ; Biopsy ; Body Mass Index ; Conization ; Diabetes Mellitus ; Female ; Forests ; Humans ; Hypertension ; Korea ; Logistic Models ; Machine Learning ; Mass Screening ; Myoma ; Obstetric Labor, Premature ; Parity ; Parturition ; Placenta Previa ; Pregnancy ; Premature Birth ; Seoul

A better understanding of the underlying mechanisms by which signals from the fetus initiate human parturition is required. Our recent findings support the core hypothesis that oxidative stress (OS) and cellular senescence of the fetal membranes (amnion and chorion) trigger human parturition. Fetal membrane cell senescence at term is a natural physiological response to OS that occurs as a result of increased metabolic demands by the maturing fetus. Fetal membrane senescence is affected by the activation of the p38 mitogen activated kinase-mediated pathway. Similarly, various risk factors of preterm labor and premature rupture of the membranes also cause OS-induced senescence. Data suggest that fetal cell senescence causes inflammatory senescence-associated secretory phenotype (SASP) release. Besides SASP, high mobility group box 1 and cell-free fetal telomere fragments translocate from the nucleus to the cytosol in senescent cells, where they represent damage-associated molecular pattern markers (DAMPs). In fetal membranes, both SASPs and DAMPs augment fetal cell senescence and an associated ‘sterile’ inflammatory reaction. In senescent cells, DAMPs are encapsulated in extracellular vesicles, specifically exosomes, which are 30–150 nm particles, and propagated to distant sites. Exosomes traffic from the fetus to the maternal side and cause labor-associated inflammatory changes in maternal uterine tissues. Thus, fetal membrane senescence and the inflammation generated from this process functions as a paracrine signaling system during parturition. A better understanding of the premature activation of these signals can provide insights into the mechanisms by which fetal signals initiate preterm parturition.
Aging ; Cell Aging ; Cytosol ; Exosomes ; Extracellular Vesicles ; Extraembryonic Membranes ; Female ; Fetus ; Humans ; Inflammation ; Membranes ; Obstetric Labor, Premature ; Oxidative Stress ; Paracrine Communication ; Parturition ; Phenotype ; Pregnancy ; Premature Birth ; Risk Factors ; Rupture ; Telomere