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Sleep Medicine Clinics Dec 2023Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep... (Review)
Review
Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep sufficiently, and pregnant women are at an increased risk for sleep deficiency. Throughout pregnancy, sleep is affected in differing ways. For example, in the first trimester, hormones affect sleep cycles, but by the third trimester, physical complaints such as increasing frequent urination and fetal movement create frequent awakenings. Associations between sleep deficiency and gestational diabetes, hypertensive disorders, depression, and some evidence regarding preterm birth exist. A woman's labor course and perception of delivery are also negatively affected by short sleep duration.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Premature Birth; Sleep; Pregnancy Complications
PubMed: 38501527
DOI: 10.1016/j.jsmc.2023.06.011 -
Frontiers in Immunology 2023Chorioamnionitis, commonly referred to as intrauterine infection or inflammation, is pathologically defined by neutrophil infiltration and inflammation at the... (Review)
Review
Chorioamnionitis, commonly referred to as intrauterine infection or inflammation, is pathologically defined by neutrophil infiltration and inflammation at the maternal-fetal interface. Chorioamnionitis is the common complication during late pregnancy, which lead to a series of serious consequences, such as preterm labor, preterm premature rupture of the fetal membranes, and fetal inflammatory response syndrome. During infection, a large number of neutrophils migrate to the chorio-decidua in response to chemokines. Although neutrophils, a crucial part of innate immune cells, have strong anti-inflammatory properties, over-activating them can harm the body while also eliminating pathogens. This review concentrated on the latest studies on chorioamnionitis-related consequences as well as the function and malfunction of neutrophils. The release of neutrophil extracellular traps, production of reactive oxygen species, and degranulation from neutrophils during intrauterine infection, as well as their pathological roles in complications related to chorioamnionitis, were discussed in detail, offering fresh perspectives on the treatment of chorioamnionitis.
Topics: Female; Infant, Newborn; Pregnancy; Humans; Chorioamnionitis; Neutrophils; Inflammation; Extracellular Traps; Premature Birth
PubMed: 37475854
DOI: 10.3389/fimmu.2023.1198831 -
American Journal of Obstetrics &... Feb 2024This clinical practice guideline on the supply of the omega-3 docosahexaenoic acid and eicosapentaenoic acid in pregnant women for risk reduction of preterm birth and... (Review)
Review
This clinical practice guideline on the supply of the omega-3 docosahexaenoic acid and eicosapentaenoic acid in pregnant women for risk reduction of preterm birth and early preterm birth was developed with support from several medical-scientific organizations, and is based on a review of the available strong evidence from randomized clinical trials and a formal consensus process. We concluded the following. Women of childbearing age should obtain a supply of at least 250 mg/d of docosahexaenoic+eicosapentaenoic acid from diet or supplements, and in pregnancy an additional intake of ≥100 to 200 mg/d of docosahexaenoic acid. Pregnant women with a low docosahexaenoic acid intake and/or low docosahexaenoic acid blood levels have an increased risk of preterm birth and early preterm birth. Thus, they should receive a supply of approximately 600 to 1000 mg/d of docosahexaenoic+eicosapentaenoic acid, or docosahexaenoic acid alone, given that this dosage showed significant reduction of preterm birth and early preterm birth in randomized controlled trials. This additional supply should preferably begin in the second trimester of pregnancy (not later than approximately 20 weeks' gestation) and continue until approximately 37 weeks' gestation or until childbirth if before 37 weeks' gestation. Identification of women with inadequate omega-3 supply is achievable by a set of standardized questions on intake. Docosahexaenoic acid measurement from blood is another option to identify women with low status, but further standardization of laboratory methods and appropriate cutoff values is needed. Information on how to achieve an appropriate intake of docosahexaenoic acid or docosahexaenoic+eicosapentaenoic acid for women of childbearing age and pregnant women should be provided to women and their partners.
Topics: Female; Infant, Newborn; Pregnancy; Humans; Fatty Acids, Omega-3; Docosahexaenoic Acids; Premature Birth; Eicosapentaenoic Acid; Risk Reduction Behavior
PubMed: 38070679
DOI: 10.1016/j.ajogmf.2023.101251 -
Proceedings of the National Academy of... Sep 2023
Topics: Infant, Newborn; Pregnancy; Female; Humans; Serotonin; Premature Birth; Parturition
PubMed: 37651446
DOI: 10.1073/pnas.2312515120 -
BMJ (Clinical Research Ed.) Aug 2023To systematically review the proportions of infants with early exposure to antenatal corticosteroids but born at term or late preterm, and short term and long term... (Meta-Analysis)
Meta-Analysis
The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants.
OBJECTIVE
To systematically review the proportions of infants with early exposure to antenatal corticosteroids but born at term or late preterm, and short term and long term outcomes.
DESIGN
Systematic review and meta-analyses.
DATA SOURCES
Eight databases searched from 1 January 2000 to 1 February 2023, reflecting recent perinatal care, and references of screened articles.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials and population based cohort studies with data on infants with early exposure to antenatal corticosteroids (<34 weeks) but born at term (≥37 weeks), late preterm (34-36 weeks), or term/late preterm combined.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened titles, abstracts, and full text articles and assessed risk of bias (Cochrane risk of bias tool for randomised controlled trials and Newcastle-Ottawa scale for population based studies). Reviewers extracted data on populations, exposure to antenatal corticosteroids, and outcomes. The authors analysed randomised and cohort data separately, using random effects meta-analyses.
MAIN OUTCOME MEASURES
The primary outcome was the proportion of infants with early exposure to antenatal corticosteroids but born at term. Secondary outcomes included the proportions of infants born late preterm or term/late preterm combined after early exposure to antenatal corticosteroids and short term and long term outcomes versus non-exposure for the three gestational time points (term, late preterm, term/late preterm combined).
RESULTS
Of 14 799 records, the reviewers screened 8815 non-duplicate titles and abstracts and assessed 713 full text articles. Seven randomised controlled trials and 10 population based cohort studies (1.6 million infants total) were included. In randomised controlled trials and population based data, ∼40% of infants with early exposure to antenatal corticosteroids were born at term (low or very low certainty). Among children born at term, early exposure to antenatal corticosteroids versus no exposure was associated with increased risks of admission to neonatal intensive care (adjusted odds ratio 1.49, 95% confidence interval 1.19 to 1.86, one study, 5330 infants, very low certainty; unadjusted relative risk 1.69, 95% confidence interval 1.51 to 1.89, three studies, 1 176 022 infants, I=58%, τ=0.01, low certainty), intubation (unadjusted relative risk 2.59, 1.39 to 4.81, absolute effect 7 more per 1000, 95% confidence interval from 2 more to 16 more, one study, 8076 infants, very low certainty, one study, 8076 infants, very low certainty), reduced head circumference (adjusted mean difference -0.21, 95% confidence interval -0.29 to -0.13, one study, 183 325 infants, low certainty), and any long term neurodevelopmental or behavioural disorder in population based studies (eg, any neurodevelopmental or behavioural disorder in children born at term, adjusted hazard ratio 1.47, 95% confidence interval 1.36 to 1.60, one study, 641 487 children, low certainty).
CONCLUSIONS
About 40% of infants exposed to early antenatal corticosteroids were born at term, with associated adverse short term and long term outcomes (low or very low certainty), highlighting the need for caution when considering antenatal corticosteroids.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42022360079.
Topics: Child; Infant, Newborn; Infant; Humans; Female; Pregnancy; Premature Birth; Infant, Premature; Adrenal Cortex Hormones; Glucocorticoids; Parturition
PubMed: 37532269
DOI: 10.1136/bmj-2023-076035 -
American Journal of Obstetrics and... Mar 2024Induction of labor is a widely used practice. From 2016 to 2019, >1 in 3 women giving birth in the United States did so after undergoing labor induction. The obvious... (Review)
Review
Induction of labor is a widely used practice. From 2016 to 2019, >1 in 3 women giving birth in the United States did so after undergoing labor induction. The obvious goal of labor induction is vaginal birth with minimal maternal or neonatal morbidity. To achieve this goal, criteria for failed labor induction are needed. Herein, we provide an evidence-based approach to safely prevent unnecessary cesarean deliveries for failed induction. Although there are no randomized trials comparing failed labor induction criteria, the observational data have been consistent: if the status of the mother and the fetus permits, at least 12 to 18 hours of oxytocin should be administered after membrane rupture before deeming an induction of labor to have failed because of nonprogression to the active phase of labor.
Topics: Infant, Newborn; Pregnancy; Female; Humans; United States; Labor, Induced; Oxytocin; Labor, Obstetric; Cesarean Section; Fetal Membranes, Premature Rupture
PubMed: 36848041
DOI: 10.1016/j.ajog.2021.06.103 -
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 -
Clinics in Perinatology Jun 2024
Topics: Humans; Premature Birth; Infant, Newborn; Pregnancy; Female; Infant, Premature
PubMed: 38705656
DOI: 10.1016/j.clp.2024.03.003 -
The Journal of Obstetrics and... Jul 2023Transperineal ultrasound (TPUS) has become an increasingly popular tool in obstetrics due to its objective, non-invasive, and real-time imaging capabilities. (Review)
Review
BACKGROUND
Transperineal ultrasound (TPUS) has become an increasingly popular tool in obstetrics due to its objective, non-invasive, and real-time imaging capabilities.
AIM
This review aims to describe the basic approaches, current utilization, and potential future applications of TPUS.
MATERIALS & METHOD
A comprehensive literature review on TPUS was conducted. In addition, discussions at academic meetings and congress focused on TPUS were also considered.
RESULTS
TPUS was initially used in prostate biopsies and is currently applied to evaluating fetal head descent in labor, with the angle of progression being the most widely used parameter. It is more tolerated than conventional invasive or expensive methods, such as digital vaginal examinations or MRIs. Additionally, TPUS can assess the internal rotation of the fetal head in the birth canal.
DISCUSSION
Compared to other imaging modalities like MRI and CT scans, TPUS is easier to perform and more cost-effective. It also provides real-time imaging, allowing for quick and accurate assessments. It also help clinicians make critical decisions regarding the mode of delivery and identify patients at high risk for fecal incontinence postpartum. With its many benefits, TPUS has the potential to become a standard tool in urogynecology and obstetrics.
CONCLUSIONS
Transperineal ultrasound is a non-invasive imaging modality that is well-tolerated and easy to understand for patients and their family and help medical staff support the patients. Transperineal ultrasound can be applied in real-time monitoring of labor progress, helping predict the possibility of vaginal delivery during labor, and further research in this area is warranted.
Topics: Female; Humans; Male; Pregnancy; Delivery, Obstetric; Labor, Obstetric; Parturition; Postpartum Period; Ultrasonography; Perineum; Perinatal Care; Fecal Incontinence
PubMed: 37138387
DOI: 10.1111/jog.15645 -
The Journal of Maternal-fetal &... Dec 2023Intra-amniotic inflammation (IAI), associated with either microbe (infection) or danger signals (sterile), plays a major role in the pathophysiology of preterm labor and...
OBJECTIVE
Intra-amniotic inflammation (IAI), associated with either microbe (infection) or danger signals (sterile), plays a major role in the pathophysiology of preterm labor and delivery. Coiled-Coil-Helix-Coiled-Coil-Helix Domain Containing 2 (CHCHD2) [also known as Mitochondrial Nuclear Retrograde Regulator 1 (MNRR1)], a mitochondrial protein involved in oxidative phosphorylation and cell survival, is capable of sensing tissue hypoxia and inflammatory signaling. The ability to maintain an appropriate energy balance at the cellular level while adapting to environmental stress is essential for the survival of an organism. Mitochondrial dysfunction has been observed in acute systemic inflammatory conditions, such as sepsis, and is proposed to be involved in sepsis-induced multi-organ failure. The purpose of this study was to determine the amniotic fluid concentrations of CHCHD2/MNRR1 in pregnant women, women at term in labor, and those in preterm labor (PTL) with and without IAI.
METHODS
This cross-sectional study comprised patients allocated to the following groups: (1) mid-trimester ( = 16); (2) term in labor ( = 37); (3) term not in labor ( = 22); (4) PTL without IAI who delivered at term ( = 25); (5) PTL without IAI who delivered preterm ( = 47); and (6) PTL with IAI who delivered preterm ( = 53). Diagnosis of IAI (amniotic fluid interleukin-6 concentration ≥2.6 ng/mL) included cases associated with microbial invasion of the amniotic cavity and those of sterile nature (absence of detectable bacteria, using culture and molecular microbiology techniques). Amniotic fluid and maternal plasma CHCHD2/MNRR1 concentrations were determined with a validated and sensitive immunoassay.
RESULTS
(1) CHCHD2/MNRR1 was detectable in all amniotic fluid samples and women at term without labor had a higher amniotic fluid CHCHD2/MNRR1 concentration than those in the mid-trimester ( = 0.003); (2) the amniotic fluid concentration of CHCHD2/MNRR1 in women at term in labor was higher than that in women at term without labor ( = 0.01); (3) women with PTL and IAI had a higher amniotic fluid CHCHD2/MNRR1 concentration than those without IAI, either with preterm ( < 0.001) or term delivery ( = 0.01); (4) women with microbial-associated IAI had a higher amniotic fluid CHCHD2/MNRR1 concentration than those with sterile IAI ( < 0.001); (5) among women with PTL and IAI, the amniotic fluid concentration of CHCHD2/MNRR1 correlated with that of interleukin-6 (Spearman's Rho = 0.7; < 0.001); and (6) no correlation was observed between amniotic fluid and maternal plasma CHCHD2/MNRR1 concentrations among women with PTL.
CONCLUSION
CHCHD2/MNRR1 is a physiological constituent of human amniotic fluid in normal pregnancy, and the amniotic concentration of this mitochondrial protein increases during pregnancy, labor at term, and preterm labor with intra-amniotic infection. Hence, CHCHD2/MNRR1 may be released into the amniotic cavity by dysfunctional mitochondria during microbial-associated IAI.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Interleukin-6; Cross-Sectional Studies; Mitochondrial Proteins; Chorioamnionitis; Obstetric Labor, Premature; Inflammation; Amniotic Fluid; Sepsis; Gestational Age; Fetal Membranes, Premature Rupture; DNA-Binding Proteins; Transcription Factors
PubMed: 36941246
DOI: 10.1080/14767058.2023.2183088