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Infectious Diseases in Obstetrics and... 2017chorioamnionitis is rare but can lead to neonatal infection, high mortality, and neurodevelopmental impairment. We aimed to investigate maternal clinical features and... (Review)
Review
chorioamnionitis is rare but can lead to neonatal infection, high mortality, and neurodevelopmental impairment. We aimed to investigate maternal clinical features and perinatal outcomes and discuss future management strategies. We reviewed the medical records of women with chorioamnionitis at our hospital over a 10-year period ( = 9) and previous published case reports and case series. The most prevalent species was (71.3% of the all cases). The most prevalent predisposing condition was preterm premature rupture of membranes (31/123, 25.2%), followed by pregnancy with a retained intrauterine contraceptive device (26/123, 21.1%) and pregnancy after in vitro fertilization (25/123, 20.3%). Preterm labor was the most common symptom (52/123, 42.3%), and only 13% of cases involved fever. Of the infants, 27% of the singletons and 23.8% of the twins were born before 22 gestational weeks, while 60% of the singletons and 76.2% of the twins were born at 22-36 weeks. The median birth weight of the babies born after 22 weeks was 1230 g. The mortality rates of the singletons and twins born after 22 weeks of gestation in the year 2000 or later were 28.6% and 52.4%, respectively. Antenatal treatment for chorioamnionitis has not been established.
Topics: Adult; Birth Weight; Candida; Candida albicans; Candidiasis; Chorioamnionitis; Female; Humans; Infant, Newborn; Obstetric Labor, Premature; Perinatal Death; Pregnancy; Premature Birth
PubMed: 29180840
DOI: 10.1155/2017/9060138 -
Frontiers in Endocrinology 2023
Topics: Pregnancy; Female; Infant, Newborn; Humans; Premature Birth; Parturition; Obstetric Labor, Premature; Delivery, Obstetric
PubMed: 37082127
DOI: 10.3389/fendo.2023.1179856 -
Obstetrics and Gynecology Dec 2023To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States.
OBJECTIVE
To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States.
METHODS
We carried out a retrospective study of all live births and fetal deaths in the United States, 2015-2021, with data obtained from the natality, fetal death, and linked live birth-infant death files of the National Center for Health Statistics. Analyses were carried out among all singletons; singletons of patients with prepregnancy diabetes, prepregnancy hypertension, and hypertensive disorders of pregnancy; and twins. Outcomes of interest included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, postterm birth, and perinatal death. Interrupted time series analyses were used to estimate changes in the prepandemic period (January 2015-February 2020), at pandemic onset (March 2020), and in the pandemic period (March 2020-December 2021).
RESULTS
The study population included 26,604,392 live births and 155,214 stillbirths. The prepandemic period was characterized by temporal increases in preterm birth and preterm labor induction or cesarean delivery rates and temporal reductions in macrosomia, postterm birth, and perinatal mortality. Pandemic onset was associated with absolute decreases in preterm birth (decrease of 0.322/100 live births, 95% CI 0.506-0.139) and preterm labor induction or cesarean delivery (decrease of 0.190/100 live births, 95% CI 0.334-0.047) and absolute increases in macrosomia (increase of 0.046/100 live births), postterm birth (increase of 0.015/100 live births), and perinatal death (increase of 0.501/1,000 total births, 95% CI 0.220-0.783). These changes were larger in subpopulations at high risk (eg, among singletons of patients with prepregnancy diabetes). Among singletons of patients with prepregnancy diabetes, pandemic onset was associated with a decrease in preterm birth (decrease of 1.634/100 live births) and preterm labor induction or cesarean delivery (decrease of 1.521/100 live births) and increases in macrosomia (increase of 0.328/100 live births) and perinatal death (increase of 9.840/1,000 total births, 95% CI 3.933-15.75). Most changes were reversed in the months after pandemic onset.
CONCLUSION
The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a transient decrease in obstetric intervention (especially preterm labor induction or cesarean delivery) and a transient increase in perinatal mortality.
Topics: Pregnancy; Female; Humans; Infant, Newborn; United States; Premature Birth; Perinatal Death; Retrospective Studies; Fetal Macrosomia; Pandemics; COVID-19; Pregnancy Outcome; Obstetric Labor, Premature; Fetal Death
PubMed: 37826851
DOI: 10.1097/AOG.0000000000005412 -
Scientific Reports Jun 2021The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm... (Clinical Trial)
Clinical Trial
The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm delivery is unknown. Herein we profiled cell-free RNA in AF samples collected from women who underwent transabdominal amniocentesis after an episode of spontaneous preterm labor and subsequently delivered within 24 h (n = 10) or later (n = 28) in gestation. Expression of known placental single-cell RNA-Seq signatures was quantified in AF cell-free RNA and compared between the groups. Random forest models were applied to predict time-to-delivery after amniocentesis. There were 2385 genes differentially expressed in AF samples of women who delivered within 24 h of amniocentesis compared to gestational age-matched samples from women who delivered after 24 h of amniocentesis. Genes with cell-free RNA changes were associated with immune and inflammatory processes related to the onset of labor, and the expression of placental single-cell RNA-Seq signatures of immune cells was increased with imminent delivery. AF transcriptomic prediction models captured these effects and predicted delivery within 24 h of amniocentesis (AUROC = 0.81). These results may inform the development of biomarkers for spontaneous preterm birth.
Topics: Adult; Amniocentesis; Amniotic Fluid; Cell-Free Nucleic Acids; Cross-Sectional Studies; Female; Gene Expression Regulation; Humans; Obstetric Labor, Premature; Pregnancy; RNA-Seq; Retrospective Studies
PubMed: 34188072
DOI: 10.1038/s41598-021-92439-x -
Disease Markers 2015Preterm labour and birth are a major cause of perinatal morbidity and mortality. Despite modern advances in obstetric and neonatal management, the rate of preterm birth... (Review)
Review
Preterm labour and birth are a major cause of perinatal morbidity and mortality. Despite modern advances in obstetric and neonatal management, the rate of preterm birth in the developed world is increasing. Yet even though numerous risk factors associated with preterm birth have been identified, the ability to accurately predict when labour will occur remains elusive, whether it is at a term or preterm gestation. In the latter case, this is likely due to the multifactorial aetiology of preterm labour wherein women may display different clinical presentations that lead to preterm birth. The discovery of novel biomarkers that could reliably identify women who will subsequently deliver preterm may allow for timely medical intervention and targeted therapeutic treatments aimed at improving maternal and fetal outcomes. Various body fluids including amniotic fluid, urine, saliva, blood (serum/plasma), and cervicovaginal fluid all provide a rich protein source of putative biochemical markers that may be causative or reflective of the various pathophysiological disorders of pregnancy, including preterm labour. This short review will highlight recent advances in the field of biomarker discovery and the utility of single and multiple biomarkers for the prediction of preterm birth in the absence of intra-amniotic infection.
Topics: Biomarkers; Body Fluids; Female; Humans; Obstetric Labor, Premature; Pregnancy; Risk Factors
PubMed: 26160993
DOI: 10.1155/2015/435014 -
Pediatric Research Aug 2023Specific heat shock proteins are associated with pregnancy complications, including spontaneous preterm birth (SPTB). Placental proteomics and whole exome sequencing...
BACKGROUND
Specific heat shock proteins are associated with pregnancy complications, including spontaneous preterm birth (SPTB). Placental proteomics and whole exome sequencing recently suggested an association between heat shock protein HSPA5 and uncomplicated SPTB. In the present study, we investigated the localization of and possible roles for HSPA5 in SPTB.
METHODS
Western blot was performed to validate the result from the previously published proteomic analysis. We used qPCR to assess mRNA expression of genes and immunohistochemistry and immunoelectron microscopy to examine localization of HSPA5 in placental tissue. We silenced the HSPA5 gene in the HTR8/SVneo human trophoblast cell line to investigate possible functions of HSPA5.
RESULTS
HSPA5 was upregulated in placentas from SPTBs compared to spontaneous term births. We did not observe upregulation of HSPA5 mRNA in placental samples. The protein was localized in placental trophoblast in both spontaneous preterm and term placentas. Gene silencing of HSPA5 in human trophoblast cell culture affected the inflammatory response and decreased the expression of several proinflammatory genes.
CONCLUSIONS
We suggest that upregulation of HSPA5 in the placenta is associated with spontaneous preterm labor. HSPA5 may promote the inflammatory response and alter the anti-inflammatory state of the placenta which could eventually lead to premature labor.
IMPACT
We validated upregulation of HSPA5 in placentas from spontaneous preterm birth. HSPA5 was not upregulated at transcriptional level which suggests that it may be regulated post-translationally. Silencing HSPA5 in a human trophoblast-derived cell line suggested that HSPA5 promotes expression of proinflammatory cytokines. The emerging inflammation could lead to spontaneous preterm labor. Identifying inflammatory pathways and factors associated with spontaneous preterm birth increases knowledge of the molecular mechanisms of premature labor. This could provide cues to predict imminent premature labor and lead to information about how to safely maintain pregnancies.
Topics: Humans; Pregnancy; Infant, Newborn; Female; Premature Birth; Placenta; Endoplasmic Reticulum Chaperone BiP; Proteomics; Obstetric Labor, Premature; RNA, Messenger
PubMed: 36788289
DOI: 10.1038/s41390-023-02501-9 -
American Journal of Obstetrics and... Jan 2022The onset of the term human parturition involves myometrial gene expression changes to transform the uterus from a quiescent to a contractile phenotype. It is uncertain...
BACKGROUND
The onset of the term human parturition involves myometrial gene expression changes to transform the uterus from a quiescent to a contractile phenotype. It is uncertain whether the same changes occur in the uterus during preterm labor.
OBJECTIVE
This study aimed to compare the myometrial gene expression between term and preterm labor and to determine whether the presence of acute clinical chorioamnionitis or twin gestation affects these signatures.
STUDY DESIGN
Myometrial specimens were collected during cesarean delivery from the following 7 different groups of patients: term not in labor (n=31), term labor (n=13), preterm not in labor (n=21), preterm labor with acute clinical chorioamnionitis (n=6), preterm labor with no acute clinical chorioamnionitis (n=9), twin preterm not in labor (n=8), and twin preterm labor with no acute clinical chorioamnionitis (n=5). RNA was extracted, reverse transcribed and quantitative polymerase chain reactions were performed on 44 candidate genes (with evidence for differential expression in human term labor) using the Fluidigm platform. Computational analysis was performed using 2-class unpaired Wilcoxon tests and principal component analysis.
RESULTS
Computational analysis revealed that gene expression in the preterm myometrium, irrespective of whether in labor or not in labor, clustered tightly and is clearly different from the term labor and term not-in-labor groups. This was true for both singleton and twin pregnancies. Principal component analysis showed that 57% of the variation was explained by 3 principal components. These 44 genes interact in themes of prostaglandin activity and inflammatory signaling known to be important during term labor, but are not a full representation of the myometrium transcriptional activity.
CONCLUSION
The myometrial contractions associated with preterm labor are associated with a pattern of gene expression that is distinct from term labor. Therefore, preterm labor may be initiated by a different myometrial process or processes outside the myometrium.
Topics: Adult; Computer Simulation; Female; Gene Expression; Gestational Age; Humans; Labor, Obstetric; Myometrium; Obstetric Labor, Premature; Pregnancy; Pregnancy, Twin; Uterine Contraction
PubMed: 34245680
DOI: 10.1016/j.ajog.2021.07.002 -
Ginekologia Polska 2018Our aim is to evaluate the laboratory results and proteinuria levels of preeclamptic women and their relation-ships to maternal and fetal outcomes.
OBJECTIVES
Our aim is to evaluate the laboratory results and proteinuria levels of preeclamptic women and their relation-ships to maternal and fetal outcomes.
MATERIAL AND METHODS
One hundred preeclamptic pregnant women who gave birth in our clinic between 2013 and 2015 were included in our study retrospectively. The data collected from the patients included gestational week, age, gravidity, parity, abortus history, blood pressure, biochemical parameters, delivery method, maternal hospitalization time, cesarean indication, complications, blood products required, plasmapheresis use and dialysis need. The details about the newborns were recorded retrospectively. The relationships between preeclampsia signs and maternal and neonatal out-comes were analyzed. The protein amounts were analyzed via 24-hour collected urine analyses and spot urine analyses.
RESULTS
A statistically significant positive correlation was observed between neonatal intensive care unit needs and pro-teinuria levels. Fetal growth restriction, respiratory distress syndrome and sepsis were observed as the level of proteinuria increased, but the result was not statistically significant. Eclampsia was observed only in patients with massive proteinuria, and it was statistically significant. An increase in cesarean sections, placental abruptions, antihypertensive drug needs and blood product replacement rates was observed as the amount of proteinuria increased in preeclamptic women, but the results were not statistically significant.
CONCLUSIONS
The severity of preeclampsia cannot be determined by the level of proteinuria. However, when massive proteinuria is detected, the clinician should be more cautious about maternal and fetal complications.
Topics: Adult; Female; Humans; Infant, Newborn; Infant, Premature; Intensive Care, Neonatal; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Proteinuria; Retrospective Studies; Severity of Illness Index; Young Adult
PubMed: 30084477
DOI: 10.5603/GP.a2018.0044 -
BMC Medical Informatics and Decision... Jan 2022In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options....
BACKGROUND
In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor.
METHODS
This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15).
RESULTS
The final version includes information, probabilities and figures depending on users' preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery.
CONCLUSION
A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor.
Topics: Counseling; Decision Making; Decision Support Techniques; Female; Gestational Age; Humans; Infant, Newborn; Obstetric Labor, Premature; Pregnancy
PubMed: 34991580
DOI: 10.1186/s12911-021-01735-z -
Frontiers in Endocrinology 2022Survivors of preterm birth struggle with multitudes of disabilities due to improper programming of various tissues and organ systems contributing to adult-onset... (Review)
Review
Survivors of preterm birth struggle with multitudes of disabilities due to improper programming of various tissues and organ systems contributing to adult-onset diseases at a very early stage of their lives. Therefore, the persistent rates of low birth weight (birth weight < 2,500 grams), as well as rates of neonatal and maternal morbidities and mortalities, need to be addressed. Active research throughout the years has provided us with multiple theories regarding the risk factors, initiators, biomarkers, and clinical manifestations of spontaneous preterm birth. Fetal organs, like the placenta and fetal membranes, and maternal tissues and organs, like the decidua, myometrium, and cervix, have all been shown to uniquely respond to specific exogenous or endogenous risk factors. These uniquely contribute to dynamic changes at the molecular and cellular levels to effect preterm labor pathways leading to delivery. Multiple intervention targets in these different tissues and organs have been successfully tested in preclinical trials to reduce the individual impacts on promoting preterm birth. However, these preclinical trial data have not been effectively translated into developing biomarkers of high-risk individuals for an early diagnosis of the disease. This becomes more evident when examining the current global rate of preterm birth, which remains staggeringly high despite years of research. We postulate that studying each tissue and organ in silos, as how the majority of research has been conducted in the past years, is unlikely to address the network interaction between various systems leading to a synchronized activity during either term or preterm labor and delivery. To address current limitations, this review proposes an integrated approach to studying various tissues and organs involved in the maintenance of normal pregnancy, promotion of normal parturition, and more importantly, contributions towards preterm birth. We also stress the need for biological models that allows for concomitant observation and analysis of interactions, rather than focusing on these tissues and organ in silos.
Topics: Pregnancy; Adult; Female; Infant, Newborn; Humans; Premature Birth; Obstetric Labor, Premature; Placenta; Myometrium; Biomarkers
PubMed: 36313741
DOI: 10.3389/fendo.2022.1015622