-
The Journal of Maternal-fetal &... Dec 2023Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide...
Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide with a great disparity between low, middle and high income countries. It has been estimated that the cost of neonatal care for preterm babies is more than 4 times that of a term neonate admitted into the neonatal care. Furthermore, there are high costs associated with long-term morbidity in those who survive the neonatal period. Interventions to stop delivery once preterm labor starts are largely ineffective hence the best approach to reducing the rate and consequences is prevention. This is either primary (reducing or minimizing factors associated with preterm birth prior to and during pregnancy) or secondary - identification and amelioration (if possible) of factors in pregnancy that are associated with preterm labor. In the first category are optimizing maternal weight, promoting healthy nutrition, smoking cessation, birth spacing, avoidance of adolescent pregnancies and screening for and controlling various medical disorders as well as infections prior to pregnancy. Strategies in pregnancy, include early booking for prenatal care, screening and managing medical disorders and their complications, and identifying predisposing factors to preterm labor such as shortening of the cervix and timely instituting progesterone prophylaxis or cervical cerclage where appropriate. The use of biomarkers such as oncofetal fibronectin, placental alpha-macroglobulin-1 and IGFBP-1 where cervical screening is not available or to diagnosis PPROM would identify those that require close monitoring and allow the institution of antibiotics especially where infection is considered a predisposing factor. Irrespective of the approach to prevention, timing the administration of corticosteroids and where necessary tocolysis and magnesium sulfate are associated with an improved outcome. The role of genetics, infections and probiotics and how these emerging dimensions help in the diagnosis of preterm birth and consequently prevention are exciting and hopefully may identify sub-populations for targeted strategies.
Topics: Adolescent; Female; Humans; Infant, Newborn; Pregnancy; Early Detection of Cancer; Obstetric Labor, Premature; Placenta; Premature Birth; Uterine Cervical Neoplasms
PubMed: 36966809
DOI: 10.1080/14767058.2023.2183756 -
European Journal of Obstetrics,... Jan 2024This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database.
OBJECTIVE
This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database.
METHODS
The ICD-10 coding system was used to identify codes for endometriosis and obstetric outcomes, and data from the NIS (2016-2019) were analyzed. Descriptive statistics were used to summarize variables, while the chi-square test was used to detect significant differences for categorical variables. Univariate and multivariate regression analyses were conducted to assess the association between endometriosis and obstetric outcomes. On multivariate analysis, adjustment was done for age, race, hospital region, smoking status, and alcohol misuse. Forest plots were used to visualize odds ratios and their 95% confidence intervals.
RESULTS
Overall, 2,854,149 women were included in this analysis, of whom 4,006 women had endometriosis. The post-hoc Bonferroni correction was applied to account for multiple comparisons, and our analyses revealed several statistically significant associations (p < 0.004). Specifically, on univariate analysis, significant associations with endometriosis were identified for ruptured uterus, placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, gestational diabetes, preterm labor, and multiple gestation. On multivariate analysis, significant associations with endometriosis were observed for placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, preterm labor, premature rupture of membranes, and multiple gestation.
CONCLUSION
The present findings provide important insights into the potential relationship between endometriosis and various adverse obstetric outcomes and may help inform clinical practice and future research. Further studies that use more detailed clinical data and longitudinal designs are needed to solidify the presented conclusions.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Endometriosis; Placenta Previa; Abruptio Placentae; Postpartum Hemorrhage; Pre-Eclampsia; Inpatients; Placenta; Pregnancy Complications; Premature Birth; Obstetric Labor, Premature; Pregnancy Outcome
PubMed: 37976766
DOI: 10.1016/j.ejogrb.2023.11.009 -
Seminars in Fetal & Neonatal Medicine Aug 2020The fetal inflammatory response syndrome (FIRS) is a condition whereby the fetus mounts an inflammatory response to intrauterine infection/inflammation. Clinical... (Review)
Review
The fetal inflammatory response syndrome (FIRS) is a condition whereby the fetus mounts an inflammatory response to intrauterine infection/inflammation. Clinical consequences include preterm premature rupture of membranes (PPROM), spontaneous preterm delivery, neonatal sepsis, bronchopulmonary dysplasia, and brain and other organ injury. Mechanisms leading to brain injury in FIRS have been investigated in animal and human studies. We review the neuroimaging findings of brain injury in FIRS, which overlap those of hypoxic-ischemic injury, and clinical correlation is necessary for a correct diagnosis. FIRS should be considered the primary diagnosis when neuroimaging findings such as periventricular leukomalacia are identified in preterm children born as a consequence of PPROM and spontaneous preterm labor. Additionally, FIRS should be considered in term infants who do not have the most common features of HIE (e.g. a sentinel event). Systematic histopathologic examination of the placenta and umbilical cord and/or detection of characteristic inflammatory markers in such cases are needed to establish the correct diagnosis.
Topics: Brain Injuries; Child; Chorioamnionitis; Female; Fetal Blood; Humans; Infant; Infant, Newborn; Neuroimaging; Obstetric Labor, Premature; Placenta; Pregnancy; Premature Birth; Systemic Inflammatory Response Syndrome
PubMed: 32800654
DOI: 10.1016/j.siny.2020.101143 -
NeoReviews Feb 2023Most patients with congenital anomalies do not require prenatal intervention. Furthermore, many congenital anomalies requiring surgical intervention are treated... (Review)
Review
Most patients with congenital anomalies do not require prenatal intervention. Furthermore, many congenital anomalies requiring surgical intervention are treated adequately after birth. However, there is a subset of patients with congenital anomalies who will die before birth, shortly after birth, or experience severe postnatal complications without fetal surgery. Fetal surgery is unique in that an operation is performed on the fetus as well as the pregnant woman who does not receive any direct benefit from the surgery but rather lends herself to risks, such as hemorrhage, abruption, and preterm labor. The maternal risks involved with fetal surgery have limited the extent to which fetal interventions may be performed but have, in turn, led to technical innovations that have significantly advanced the field. This review will examine congenital abnormalities that can be treated with minimally invasive fetal surgery and introduce the next frontier of prenatal management of fetal surgical pathology.
Topics: Female; Pregnancy; Infant, Newborn; Humans; Fetus; Prenatal Care; Obstetric Labor, Premature
PubMed: 36720693
DOI: 10.1542/neo.24-2-e67 -
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 -
Endocrinology, Diabetes & Metabolism Apr 2021The neurosteroid allopregnanolone modulates oxytocin expression in the brain, and its effects arise from its action on the GABA receptor. Whether neurosteroid levels and...
INTRODUCTION
The neurosteroid allopregnanolone modulates oxytocin expression in the brain, and its effects arise from its action on the GABA receptor. Whether neurosteroid levels and the function of the GABA receptor are involved in the risk of preterm labour in pregnant women is unknown.
METHODS
Pregnant women with ( = 16) or without ( = 20) threatened preterm labour (TPL) in gestational week 33 + 6 days to 37 + 0 days were studied prospectively with procedures including foetal heart rate monitoring, vaginal examination, ultrasound examination and blood tests to determine allopregnanolone, progesterone and oxytocin levels. The GABA receptor function in both groups was measured with a saccadic eye velocity test (SEVT).
RESULTS
Plasma oxytocin levels were higher in the TPL group than in the control group (41.5 vs. 37.0 pmol/L, respectively, = .021). Although the allopregnanolone and progesterone levels in both groups did not differ, there was a negative association between blood oxytocin and allopregnanolone (as predictor) levels in the TPL group (B: -3.2, 95% confidence interval (CI): -5.5 to -0.9, = .012). As a predictor of TPL, progesterone was associated with cervix maturity (odds ratio: 1.02, 95% CI: 1.00-1.04, = .038). SEVT showed that the women in both groups had similar GABA receptor functions. In both groups, body mass index correlated with peak saccadic eye velocity ( = .34, = .044) and negatively with allopregnanolone ( = -.41, = .013).
CONCLUSIONS
Neurosteroid levels were unchanged in the peripheral blood of women with TPL, despite the increase in available oxytocin. Although the function of the GABA receptor was unchanged in women with TPL, to ensure reliable results, saccadic eye velocity should be investigated during a challenge test with a GABA receptor agonist.
Topics: Adolescent; Adult; Biomarkers; Body Mass Index; Brain; Female; Humans; Male; Obstetric Labor, Premature; Oxytocin; Pregnancy; Pregnanolone; Progesterone; Receptors, GABA-A; Risk; Saccades; Young Adult
PubMed: 33855217
DOI: 10.1002/edm2.216 -
Seminars in Perinatology Aug 2019Antenatal corticosteroids (ACS) are sporadically used in low and middle income countries (LMIC), although their use is considered by the World Health Organization (WHO)... (Review)
Review
Antenatal corticosteroids (ACS) are sporadically used in low and middle income countries (LMIC), although their use is considered by the World Health Organization (WHO) as essential for decreasing infant mortality. Presently the WHO recommends the use of ACS only when gestational age is known, delivery is imminent, and the delivery will be in a facility that can provide care for the mother and the infant. We review uncertainties about ACS in high income countries that are underappreciated for anticipating their effectiveness in LMIC. We discuss the implications of a large RCT that evaluated the use of ACS in LMIC and found no benefit for presumed preterm infants and increased mortality in larger infants. The treatment schedules for ACS have not been optimized and more is now known about how to improve treatment strategies to hopefully decrease risks such as neonatal hypoglycemia in LMIC. The benefits from ACS may depend on the patient populations and health care environment in which the therapy is used. Further trials are needed to evaluate the safety and efficacy of ACS in LMIC.
Topics: Adrenal Cortex Hormones; Adult; Developing Countries; Drug Administration Schedule; Female; Gestational Age; Guidelines as Topic; Humans; Infant; Infant Mortality; Infant, Premature; Infant, Premature, Diseases; Obstetric Labor, Premature; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; World Health Organization
PubMed: 30979597
DOI: 10.1053/j.semperi.2019.03.012 -
Advances in Experimental Medicine and... 2020Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be... (Review)
Review
Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.
Topics: Anesthesia; Anesthetics; Breast; Breast Neoplasms; Female; Fetus; Humans; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications
PubMed: 32816269
DOI: 10.1007/978-3-030-41596-9_14 -
Ceska Gynekologie 2020To summarize current knowledge regarding Lactobacillus crispatus-dominated vaginal microbiota in pregnancy, as well as an association between the presence of... (Review)
Review
OBJECTIVE
To summarize current knowledge regarding Lactobacillus crispatus-dominated vaginal microbiota in pregnancy, as well as an association between the presence of Lactobacillus crispatus-dominated vaginal microbiota and pregnancy complications.
DESIGN
Review.
SETTING
Department of Obstetrics and Gynecology, University Hospital Hradec Kralove.
MATERIAL AND METHODOLOGY
In this review, the results from literature available about the presence of L. crispatus-dominated microbiota in pregnancy are summarized.
RESULTS
Pregnant women with Lactobacillus crispatus-dominated vaginal microbiota is very common in pregnancy and it is associated with a lower risk of preterm delivery.
CONCLUSION
Lactobacillus crispatus-dominated vaginal microbiota represents an optimal vaginal microbiota in pregnancy.
Topics: Female; Humans; Infant, Newborn; Lactobacillus crispatus; Microbiota; Obstetric Labor, Premature; Pregnancy; Premature Birth; Vagina
PubMed: 32414287
DOI: No ID Found -
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