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Minerva Ginecologica Feb 2015The study of preterm labor and prematurity has undergone a major transformation in its approach from an inevitable part of obstetrics with few answers to one in which... (Review)
Review
The study of preterm labor and prematurity has undergone a major transformation in its approach from an inevitable part of obstetrics with few answers to one in which science has led to knowledge and clinical intervention. Despite these advancements, understanding of preterm labor and prevention of prematurity is still limited. In the current review, we begin the discussion with fetal viability, first from a historical perspective and then from the understanding of this issue from a prospective of various professional organizations. We then present the scope of the problem of preterm birth from various countries including the discrepancy between the US and Europe. We continue with updates on extreme prematurity and outcomes with two longitudinal studies from the past 2 years. We further review available interventions for prematurity and discuss the use of antenatal corticosteroids. First, we examine their use in the context of professional recommendations and then examine the trajectory of their continued use in the late preterm period. We focus on a European-based trial with preliminary results and an ongoing American counterpart. The current knowledge of molecular mechanisms behind preterm labor is presented with a focus on the multiple etiologies of preterm labor, both known and presumed, with updates in the basic science realm. Furthermore, we present up-to-date studies on prediction of preterm birth and prematurity-related morbidity.
Topics: Adrenal Cortex Hormones; Animals; Female; Fetal Viability; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications
PubMed: 25300768
DOI: No ID Found -
Fetal and Pediatric Pathology Aug 2022Placental hepatic heterotopia is a benign lesion with unclear histogenesis hypothesized to be of hepatocytic differentiation of yolk sac elements. Of the 14 hepatic...
Placental hepatic heterotopia is a benign lesion with unclear histogenesis hypothesized to be of hepatocytic differentiation of yolk sac elements. Of the 14 hepatic heterotopia cases previously reported, 12 cases occurred in preterm labor. A case of intraplacental hepatic heterotopia in a 27-year-old female with pre-term delivery at 31 + 5 weeks gestational age is described. Histopathological examination revealed a well-demarcated lesion with cohesive, monotonous cells and pale to clear cytoplasm. The differential diagnoses of this lesion included benign, primary and metastatic malignant entities. The lesional cells expressed HepPar-1, CAM 5.2, Glypican-3, and AFP, consistent with cells of hepatic origin. Intraplacental hepatic heterotopia is associated with premature labor. Distinguishing this lesion from maternal and fetal malignancies with similar histopathological presentation has important clinical implications in patient care.
Topics: Adult; Choristoma; Female; Fetus; Humans; Infant, Newborn; Liver; Obstetric Labor, Premature; Placenta; Placenta Diseases; Pregnancy
PubMed: 33399014
DOI: 10.1080/15513815.2020.1865490 -
Clinical Obstetrics and Gynecology Sep 2014Progestogens are a promising treatment in the prevention of spontaneous preterm birth in high-risk women. In women with a prior history of spontaneous preterm delivery... (Review)
Review
Progestogens are a promising treatment in the prevention of spontaneous preterm birth in high-risk women. In women with a prior history of spontaneous preterm delivery and in women with a sonographic shortened cervix, there is considerable evidence supporting a benefit of progestogen therapy in the reduction of preterm delivery. In women with multifetal gestations, progestogen therapy has not been shown to be beneficial. Data are inconclusive in women with arrested preterm labor. Questions remain about the mechanism of progestogen action, the optimal type of progestogen, the best mode of administration, and the ideal dosing regimen.
Topics: Administration, Intravaginal; Administration, Oral; Cervical Length Measurement; Drug Administration Schedule; Female; Humans; Obstetric Labor, Premature; Pregnancy; Pregnancy, High-Risk; Pregnancy, Multiple; Premature Birth; Progesterone; Progestins; Risk Factors
PubMed: 24936913
DOI: 10.1097/GRF.0000000000000039 -
Seminars in Perinatology Dec 2017In the United States, the generally accepted indication for tocolytic therapy centers on suppression of preterm labor. This may be in the form of preventative therapy... (Review)
Review
In the United States, the generally accepted indication for tocolytic therapy centers on suppression of preterm labor. This may be in the form of preventative therapy with progesterone in women with prior spontaneous preterm birth or as an acute intervention to suppress established uterine contractions associated with cervical change occurring at less than 37 weeks gestation. This article seeks to apply this perspective to tocolytic therapy. Here, we provide a review of current tocolytic options and what the last decade of discovery has revealed about the regulation of myometrial excitability and quiescence. Moving forward, we must incorporate the emerging molecular data that is amassing in order to develop novel and effective tocolytic therapeutic options to prevent preterm labor and spontaneous preterm birth (sPTB).
Topics: Adult; Female; Humans; Obstetric Labor, Premature; Pregnancy; Premature Birth; Randomized Controlled Trials as Topic; Tocolysis; Tocolytic Agents; Treatment Outcome
PubMed: 29191291
DOI: 10.1053/j.semperi.2017.08.008 -
Seminars in Immunopathology Aug 2020Preterm birth is the leading cause of mortality in children under the age of five worldwide. Despite major efforts, we still lack the ability to accurately predict and... (Review)
Review
Preterm birth is the leading cause of mortality in children under the age of five worldwide. Despite major efforts, we still lack the ability to accurately predict and effectively prevent preterm birth. While multiple factors contribute to preterm labor, dysregulations of immunological adaptations required for the maintenance of a healthy pregnancy is at its pathophysiological core. Consequently, a precise understanding of these chronologically paced immune adaptations and of the biological pacemakers that synchronize the pregnancy "immune clock" is a critical first step towards identifying deviations that are hallmarks of peterm birth. Here, we will review key elements of the fetal, placental, and maternal pacemakers that program the immune clock of pregnancy. We will then emphasize multiomic studies that enable a more integrated view of pregnancy-related immune adaptations. Such multiomic assessments can strengthen the biological plausibility of immunological findings and increase the power of biological signatures predictive of preterm birth.
Topics: Child; Female; Fetus; Humans; Infant, Newborn; Obstetric Labor, Premature; Placenta; Pregnancy; Premature Birth
PubMed: 32020337
DOI: 10.1007/s00281-019-00772-1 -
Journal of Perinatal Medicine Feb 2019Uterine tachysystole (TS) is a potentially significant intrapartum complication seen most commonly in induced or augmented labors but may also occur in women with... (Review)
Review
Uterine tachysystole (TS) is a potentially significant intrapartum complication seen most commonly in induced or augmented labors but may also occur in women with spontaneous labor. When it occurs, maternal and perinatal complications can arise if not identified and managed promptly by obstetric care providers. Over recent years, new definitions of the condition have facilitated further research into the field, which has been synthesized to inform clinical management guidelines and protocols. We propose a set of recommendations pertaining to TS in line with contemporary evidence and obstetric practice.
Topics: Cardiotocography; Female; Humans; Obstetric Labor Complications; Obstetric Labor, Premature; Pregnancy; Tocolysis; Uterine Contraction; Uterine Monitoring
PubMed: 30352043
DOI: 10.1515/jpm-2018-0175 -
Nederlands Tijdschrift Voor... Feb 2015Pre-eclampsia or toxaemia of pregnancy is a multi-organ disorder in the second half of pregnancy. Approximately 1-3% of all pregnancies in the Netherlands are... (Review)
Review
Pre-eclampsia or toxaemia of pregnancy is a multi-organ disorder in the second half of pregnancy. Approximately 1-3% of all pregnancies in the Netherlands are complicated by this condition. The disease is characterised by vascular damage resulting in hypertension and proteinuria with high morbidity for both mother and child. The underlying cause is a poorly developed placenta. To date the only real treatment comprises medicinal protection against complications and the disorder can be cured only through termination of pregnancy. Complications range from severe hypertension to maternal mortality due to cerebral haemorrhage. Long-term consequences can be severe for both mother and child. For instance, the risk of cardiovascular disease in mothers in later life is significantly increased. Many risk factors have been identified, including diabetes, BMI and an age of above 40. The association between periodontal disease and pre-eclampsia emphasises the importance of good oral hygiene in the periconceptional period.
Topics: Adult; Female; Humans; Maternal Age; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Prognosis; Proteinuria; Risk Factors
PubMed: 26193106
DOI: 10.5177/ntvt.2015.02.14162 -
Clinics in Perinatology Jun 2024This review examines the complexities of preterm birth (PTB), emphasizes the pivotal role of inflammation in the pathogenesis of preterm labor, and assesses current... (Review)
Review
This review examines the complexities of preterm birth (PTB), emphasizes the pivotal role of inflammation in the pathogenesis of preterm labor, and assesses current available interventions. Antibiotics, progesterone analogs, mechanical approaches, nonsteroidal anti-inflammatory drugs, and nutritional supplementation demonstrate a limited efficacy. Tocolytic agents, targeting uterine activity and contractility, inadequately prevent PTB by neglecting to act on uteroplacental inflammation. Emerging therapies targeting toll-like receptors, chemokines, and interleukin receptors exhibit promise in mitigating inflammation and preventing PTB.
Topics: Humans; Pregnancy; Female; Premature Birth; Tocolytic Agents; Infant, Newborn; Inflammation; Obstetric Labor, Premature
PubMed: 38705654
DOI: 10.1016/j.clp.2024.02.006 -
Ceska Gynekologie 2021To provide a comprehensive overview of the available information on the maternal microbio-me and its effect on pregnancy and preterm birth.
OBJECTIVE
To provide a comprehensive overview of the available information on the maternal microbio-me and its effect on pregnancy and preterm birth.
METHODS
Systematic review of available literature on the topic was done using the PubMed database.
CONCLUSION
Etiology of preterm labor is multifactorial. Individual setting of humoral and cellular immune response is key; however, lately the focus has shifted to the role of the microbio-me, especially the vaginal one. The role of additional microbio-mes and the relationship between different compartments are the focus of intensive research. Mainly the differences in the maternal and neonatal microbio-me depend on the method of delivery and administration of different antibio-tics during pregnancy and labor. The uterine cavity is no longer thought to be without colonization and the formation of the fetal microbio-me begins early in pregnancy.
Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Labor, Obstetric; Microbiota; Obstetric Labor, Premature; Pregnancy; Premature Birth
PubMed: 35038883
DOI: 10.48095/cccg2021422 -
JNMA; Journal of the Nepal Medical... 2017Chorioangioma of placenta is the commonest benign tumour of the placenta. It consists of a benign angioma arising from chorionic tissue. We report a case of placental...
Chorioangioma of placenta is the commonest benign tumour of the placenta. It consists of a benign angioma arising from chorionic tissue. We report a case of placental chorioangioma which was diagnosed in the post partum period in a patient with polyhydramnios who went into preterm labor and delivered a premature baby.
Topics: Adult; Female; Hemangioma; Humans; Obstetric Labor, Premature; Placenta; Placenta Diseases; Polyhydramnios; Pregnancy; Pregnancy Complications, Neoplastic; Premature Birth
PubMed: 29453483
DOI: No ID Found