1
|
Nguyen-Hoang L, Dinh LT, Tai AST, Nguyen DA, Pooh RK, Shiozaki A, Zheng M, Hu Y, Li B, Kusuma A, Yapan P, Gosavi A, Kaneko M, Luewan S, Chang TY, Chaiyasit N, Nanthakomon T, Liu H, Shaw SW, Leung WC, Mahdy ZA, Aguilar A, Leung HHY, Lee NMW, Lau SL, Wah IYM, Lu X, Sahota DS, Chong MKC, Poon LC. Implementation of First-Trimester Screening and Prevention of Preeclampsia: A Stepped Wedge Cluster-Randomized Trial in Asia. Circulation 2024; 150:1223-1235. [PMID: 38923439 DOI: 10.1161/circulationaha.124.069907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This trial aimed to assess the efficacy, acceptability, and safety of a first-trimester screen-and-prevent strategy for preterm preeclampsia in Asia. METHODS Between August 1, 2019, and February 28, 2022, this multicenter stepped wedge cluster randomized trial included maternity/diagnostic units from 10 regions in Asia. The trial started with a period where all recruiting centers provided routine antenatal care without study-related intervention. At regular 6-week intervals, one cluster was randomized to transit from nonintervention phase to intervention phase. In the intervention phase, women underwent first-trimester screening for preterm preeclampsia using a Bayes theorem-based triple-test. High-risk women, with adjusted risk for preterm preeclampsia ≥1 in 100, received low-dose aspirin from <16 weeks until 36 weeks. RESULTS Overall, 88.04% (42 897 of 48 725) of women agreed to undergo first-trimester screening for preterm preeclampsia. Among those identified as high-risk in the intervention phase, 82.39% (2919 of 3543) received aspirin prophylaxis. There was no significant difference in the incidence of preterm preeclampsia between the intervention and non-intervention phases (adjusted odds ratio [aOR], 1.59 [95% CI, 0.91-2.77]). However, among high-risk women in the intervention phase, aspirin prophylaxis was significantly associated with a 41% reduction in the incidence of preterm preeclampsia (aOR, 0.59 [95% CI, 0.37-0.92]). In addition, it correlated with 54%, 55%, and 64% reduction in the incidence of preeclampsia with delivery at <34 weeks (aOR, 0.46 [95% CI, 0.23-0.93]), spontaneous preterm birth <34 weeks (aOR, 0.45 [95% CI, 0.22-0.92]), and perinatal death (aOR, 0.34 [95% CI, 0.12-0.91]), respectively. There was no significant between-group difference in the incidence of aspirin-related severe adverse events. CONCLUSIONS The implementation of the screen-and-prevent strategy for preterm preeclampsia is not associated with a significant reduction in the incidence of preterm preeclampsia. However, low-dose aspirin effectively reduces the incidence of preterm preeclampsia by 41% among high-risk women. The screen-and-prevent strategy for preterm preeclampsia is highly accepted by a diverse group of women from various ethnic backgrounds beyond the original population where the strategy was developed. These findings underpin the importance of the widespread implementation of the screen-and-prevent strategy for preterm preeclampsia on a global scale. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03941886.
Collapse
Affiliation(s)
- Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Linh Thuy Dinh
- Center for Prenatal and Neonatal Screening and Diagnosis, Hanoi Obstetrics and Gynecology Hospital, Vietnam (L.T.D., D.-A.N.)
| | - Angela S T Tai
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Duy-Anh Nguyen
- Center for Prenatal and Neonatal Screening and Diagnosis, Hanoi Obstetrics and Gynecology Hospital, Vietnam (L.T.D., D.-A.N.)
| | - Ritsuko K Pooh
- Clinical Research Institute of Fetal Medicine Prenatal Medical Clinic, Osaka, Japan (R.K.P.)
| | - Arihiro Shiozaki
- Department of Obstetrics and Gynecology, Toyama University Hospital, Toyama, Japan (A.S.)
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, China (M.Z., Y.H.)
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, China (M.Z., Y.H.)
| | - Bin Li
- Department of Obstetrics and Gynecology, Kunming Angel Women and Children's Hospital, Teaching Hospital of Kunming University of Science and Technology, China (B.L.)
| | - Aditya Kusuma
- Department of Obstetrics and Gynecology, Harapan Kita Women and Children Hospital, Jakarta, Indonesia (A.K.)
| | - Piengbulan Yapan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand (P.Y.)
| | - Arundhati Gosavi
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore (A.G.)
| | - Mayumi Kaneko
- Department of Obstetrics and Gynecology, Showa University Hospital, Tokyo, Japan (M.K.)
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand (S.L.)
| | - Tung-Yao Chang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan (T.-Y.C.)
| | - Noppadol Chaiyasit
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (N.C.)
| | - Tongta Nanthakomon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand (T.N.)
| | - Huishu Liu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, China (H.L.)
| | - Steven W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taiwan (S.W.S.)
| | - Wing Cheong Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China (W.C.L.)
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia (Z.A.M.)
| | - Angela Aguilar
- Department of Obstetrics and Gynecology, University of the Philippines College of Medicine, Philippine General Hospital, Manila (A.A.)
| | - Hillary H Y Leung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Nikki M W Lee
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - So Ling Lau
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Isabella Y M Wah
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Xiaohong Lu
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| | - Marc K C Chong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine (M.K.C.C.), Chinese University of Hong Kong
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong
| |
Collapse
|
2
|
Feli M, Azimi I, Sarhaddi F, Sharifi-Heris Z, Niela-Vilen H, Liljeberg P, Axelin A, Rahmani AM. Preterm birth risk stratification through longitudinal heart rate and HRV monitoring in daily life. Sci Rep 2024; 14:19896. [PMID: 39191907 DOI: 10.1038/s41598-024-70773-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024] Open
Abstract
Preterm birth (PTB) remains a global health concern, impacting neonatal mortality and lifelong health consequences. Traditional methods for estimating PTB rely on electronic health records or biomedical signals, limited to short-term assessments in clinical settings. Recent studies have leveraged wearable technologies for in-home maternal health monitoring, offering continuous assessment of maternal autonomic nervous system (ANS) activity and facilitating the exploration of PTB risk. In this paper, we conduct a longitudinal study to assess the risk of PTB by examining maternal ANS activity through heart rate (HR) and heart rate variability (HRV). To achieve this, we collect long-term raw photoplethysmogram (PPG) signals from 58 pregnant women (including seven preterm cases) from gestational weeks 12-15 to three months post-delivery using smartwatches in daily life settings. We employ a PPG processing pipeline to accurately extract HR and HRV, and an autoencoder machine learning model with SHAP analysis to generate explainable abnormality scores indicative of PTB risk. Our results reveal distinctive patterns in PTB abnormality scores during the second pregnancy trimester, indicating the potential for early PTB risk estimation. Moreover, we find that HR, average of interbeat intervals (AVNN), SD1SD2 ratio, and standard deviation of interbeat intervals (SDNN) emerge as significant PTB indicators.
Collapse
Affiliation(s)
- Mohammad Feli
- Department of Computing, University of Turku, Turku, Finland.
| | - Iman Azimi
- Department of Computer Science, University of California, Irvine, USA
| | | | | | | | - Pasi Liljeberg
- Department of Computing, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Amir M Rahmani
- Department of Computer Science, University of California, Irvine, USA
- School of Nursing, University of California, Irvine, USA
| |
Collapse
|
3
|
Nguyen-Hoang L, Chaemsaithong P, Ip PN, Guo J, Wang X, Chong MKC, Sahota DS, Chung JP, Poon LC. Biomarkers in the prediction of complications in pregnancy after assisted reproductive technology. Int J Gynaecol Obstet 2024. [PMID: 39016290 DOI: 10.1002/ijgo.15786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/08/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES To compare the temporal changes in mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) across gestation between assisted reproductive technology (ART) pregnancies complicated with great obstetrical syndromes (GOS) or gestational diabetes (GDM) ± large-for-gestational-age (LGA) fetus, and uncomplicated ART pregnancies. METHODS This was a prospective longitudinal study of 143 women with singleton pregnancies who conceived through ART at the Department of Obstetrics and Gynecology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR between December 2017 and January 2020. The participants were followed up at 6-6+3, 11-13+6, 20-24+6, 30-34+6, and 35-37+6 weeks for the measurement of MAP, UtA-PI, PlGF, and sFlt-1. A linear mixed-effects analysis was performed to compare the biomarkers in the GOS, GDM ± LGA, and uncomplicated groups across gestation. RESULTS Thirty-three (23.1%) and fifty-five (31.5%) women were diagnosed with GOS and GDM ± LGA, respectively. The GOS group had higher estimated marginal mean log10 MAP mulitples of the median (MoM) across gestation, compared with the uncomplicated group (0.00771 vs -0.02022; P < 0.001), when adjusting for clinical visits and days of embryo transfer. The absolute mean log10 MAP MoM in the GOS group was found to be significantly higher than that of the uncomplicated group at all clinical visits from 6 weeks onwards. Furthermore, the estimated marginal mean log10 PlGF MoM was significantly lower in the GOS group across gestation, compared with the uncomplicated group (-0.04226 vs 0.05566; P = 0.010). The significant difference in log10 PlGF MoM was observed from 11-13+6 to 30-34+6 week of gestation (P < 0.05). However, no significant differences in the estimated marginal means of log10 UtA-PI MoM and log10 sFlt-1 MoM between GOS and uncomplicated groups were observed. GDM ± LGA group had a lower estimated marginal mean log10 PlGF MoM throughout pregnancy compared with the uncomplicated group (-0.01536 vs 0.05572; P = 0.032). In the individual visit analysis, the significant difference was observed at the 20-24+6 and 35-37+6 weeks visits (P < 0.05). There were no significant differences in estimated marginal mean log10 MoM of MAP, UtA-PI, and sFlt-1 between GDM ± LGA and uncomplicated groups during pregnancy. CONCLUSION Our study has revealed that among pregnancies conceived through ART, GOS is associated with higher MAP and lower PlGF from early gestation until late third trimester, while GDM ± LGA is associated with lower PlGF during the second half of pregnancy. The same degree of differences in MAP and PlGF persists from early until late gestation in the GOS group and these findings highlight the importance of early screening during the first trimester to identify women who are at risk for developing GOS following ART procedures. Lastly, the potential of PlGF in predicting the development of GDM from the second trimester of pregnancy requires further investigation.
Collapse
Affiliation(s)
- Long Nguyen-Hoang
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | - Patricia N Ip
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jun Guo
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital, The Capital Medical University, Beijing, China
| | - Xueqin Wang
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Marc K C Chong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Daljit S Sahota
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jacqueline P Chung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
4
|
Ip PNP, Nguyen-Hoang L, Chaemsaithong P, Guo J, Wang X, Sahota DS, Chung JPW, Poon LCY. Ultrasonographic placental parameters at 11-13+6 weeks' gestation in the prediction of complications in pregnancy after assisted reproductive technology. Taiwan J Obstet Gynecol 2024; 63:341-349. [PMID: 38802197 DOI: 10.1016/j.tjog.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To evaluate the performance of maternal factors, biophysical and biochemical markers at 11-13 + 6 weeks' gestation in the prediction of gestational diabetes mellitus with or without large for gestational age (GDM ± LGA) fetus and great obstetrical syndromes (GOS) among singleton pregnancy following in-vitro fertilisation (IVF)/embryo transfer (ET). MATERIALS AND METHODS A prospective cohort study was conducted between December 2017 and January 2020 including patients who underwent IVF/ET. Maternal mean arterial pressure (MAP), ultrasound markers including placental volume, vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI), mean uterine artery pulsatility index (mUtPI) and biochemical markers including placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 11-13 + 6 weeks' gestation. Logistic regression analysis was performed to determine the significant predictors of complications. RESULTS Among 123 included pregnancies, 38 (30.9%) had GDM ± LGA fetus and 28 (22.8%) had GOS. The median maternal height and body mass index were significantly higher in women with GDM ± LGA fetus. Multivariate logistic regression analysis demonstrated that in the prediction of GDM ± LGA fetus and GOS, there were significant independent contributions from FI MoM (area under curve (AUROC) of 0.610, 95% CI 0.492-0.727; p = 0.062) and MAP MoM (AUROC of 0.645, 95% CI 0.510-0.779; p = 0.026), respectively. CONCLUSION FI and MAP are independent predictors for GDM ± LGA fetus and GOS, respectively. However, they have low predictive value. There is a need to identify more specific novel biomarkers in differentiating IVF/ET pregnancies that are at a higher risk of developing complications.
Collapse
Affiliation(s)
- Patricia Nga Ping Ip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | - Jun Guo
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, The Capital Medical University, Beijing, China
| | - Xueqin Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liona Chiu Yee Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
5
|
Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, Malamitsi-Puchner A, Kacerovsky M, Modi N, Shennan A, Ayres-de-Campos D, Gliozheni E, Rull K, Braun T, Beke A, Kosińska-Kaczyńska K, Areia AL, Vladareanu S, Sršen TP, Schmitz T, Jacobsson B. European guidelines on perinatal care: corticosteroids for women at risk of preterm birth. J Matern Fetal Neonatal Med 2023; 36:2160628. [PMID: 36689999 DOI: 10.1080/14767058.2022.2160628] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
of recommendationsCorticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids".Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation).Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distress syndrome, and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate quality evidence; Conditional recommendation).Administration in pregnancies beyond 37+0 weeks is not indicated, even for scheduled cesarean delivery, as current evidence does not suggest benefit and the long-term effects remain unknown (Low-quality evidence; Conditional recommendation).Administration should be given in twin pregnancies, with the same indication and doses as for singletons. However, existing evidence suggests that it should be reserved for pregnancies at high-risk of delivering within a 7-day interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus is not a contraindication to the use of antenatal corticosteroids (Moderate quality evidence; Strong recommendation).A single repeat course of corticosteroids can be considered in pregnancies at less than 34+0 weeks gestation, if the previous course was completed more than seven days earlier, and there is a renewed risk of imminent delivery (Low-quality evidence; Conditional recommendation).
Collapse
Affiliation(s)
- George Daskalakis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus-Liebig-University and Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Lung Research Center (DZL), Giessen, Germany
| | - Gian Carlo Di Renzo
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Esin Koç
- Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Králové, Hradec Kralove, Czech Republic
| | - Neena Modi
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Diogo Ayres-de-Campos
- Medical School, Santa Maria University Hospital, Lisbon, Portugal.,European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Elko Gliozheni
- Department of Obstetrics and Gynaecology, Maternity Koco Gliozheni Hospital, Tirana, Albania
| | - Kristiina Rull
- Women's Clinic of Tartu University Hospital, Tartu, Estonia.,Department of Obstetrics and Gynaecology, University of Tartu, Tartu Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Thorsten Braun
- Department of Obstetrics and Division of 'Experimental Obstetrics', Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Katarzyna Kosińska-Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ana Luisa Areia
- Obstetrics Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Centre of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Coimbra, Portugal
| | - Simona Vladareanu
- Neonatology Clinic, Department of Obstetrics and Gynecology, Faculty of General Medicine, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de gynécologie-obstétrique, hôpital Robert-Debré, Université Paris Cité, Paris, France
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| |
Collapse
|
6
|
Otridge J, Meyer JS, Dettmer AM. Amniotic fluid cortisol predicts neonatal and infant development in non-stressed rhesus monkeys: Implications for prenatal stress. Neurotoxicol Teratol 2023; 100:107308. [PMID: 37890675 PMCID: PMC10872548 DOI: 10.1016/j.ntt.2023.107308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
Prenatal stress adversely affects offspring development, with fetal cortisol (CORT) exposure being a primary hypothesized mechanism for stress-induced developmental deficits. Fetal CORT exposure can be assessed via measurements in amniotic fluid. However, in humans, amniocentesis is typically only performed for clinical reasons such as karyotyping; thus, amniotic fluid CORT cannot be obtained from a random sample. To test the hypothesis that fetal CORT exposure predicts neonatal and infant development in healthy primates, we measured amniotic fluid CORT in N = 18 healthy rhesus macaque (Macaca mulatta) dams (50:50 female:male infants) between 80 and 124 days gestation (mean ± SEM = 98.3 ± 2.9 days out of 165 days gestational length; i.e., second trimester). Maternal hair cortisol concentrations (HCCs) were assessed throughout pregnancy and lactation. Offspring were assessed for physical growth, neurological development, cognitive development, and HCCs across postnatal days 30-180. Controlling for gestational age at amniocentesis, higher amniotic fluid CORT significantly predicted slower infant growth rate (g/day) in the first 30 days (β = -0.19; R2 = 0.71, p = .008), poorer sensorimotor scores on the day 30 neonatal assessment (β = -0.28; R2 = 0.76, p = .015), and longer time to complete training (β = 0.48; R2 = 0.54, p = .026), but better performance (β = 0.91; R2 = 0.60, p = .011) on a discrimination cognitive task at 120-180 days. Amniotic fluid CORT was not associated with maternal or infant HCCs. Although these results are correlative, they raise the intriguing possibility that fetal CORT exposure in non-stress-exposed primates, as measured by amniotic fluid CORT, programs multiple aspects of neonatal and infant development. On the other hand, amniotic fluid CORT may not relate to chronic CORT levels in either mothers or infants when assessed by hair sampling.
Collapse
Affiliation(s)
| | - Jerrold S Meyer
- Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Amanda M Dettmer
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
7
|
Telayneh AT, Ketema DB, Mengist B, Yismaw L, Bazezew Y, Birhanu MY, Habtegiorgis SD. Pre-labor rupture of membranes and associated factors among pregnant women admitted to the maternity ward, Northwest Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001702. [PMID: 36963103 PMCID: PMC10022274 DOI: 10.1371/journal.pgph.0001702] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/14/2023] [Indexed: 03/26/2023]
Abstract
Pre-labor rupture of membranes (PROM) is the rupture of fetal membranes before the onset of labor. PROM is found in 3-15% of all pregnancies and 30-40% of preterm labor worldwide. The most serious complications are neonatal and prenatal mortality, which is higher in Africa, including Ethiopia. Despite a paucity of evidence on the magnitude and factors affecting PROM after 28 weeks of gestation but before the onset of labor (including both term and preterm PROM). Hence, the purpose of this study was to determine the magnitude and identify associated factors of the pre-labor rupture of membranes. An institutional-based cross-sectional study was conducted among 315 pregnant women from April 10, 2019 to June 30, 2019 at Debre Markos Referral Hospital. The samples were chosen using a systematic random sampling method among admitted pregnant women. The data were entered using EpiData entry version 4.2 and cleaned and analyzed using Stata/SE version 14.0. In binary logistic regressions, variables with a p-value <0.20 are selected for multivariable analysis. A multivariable logistic regression model with a 95% confidence interval and a p-value <0.05 was used to identify associated factors. In this study, the magnitude of PROM was 19%. Maternal monthly income ≤1000 birr [AOR: 3.33 (95%CI: 1.33, 8.33)], gestational age <37weeks [AOR: 3. 28 (95%CI: 1.53, 7.02)], multiple pregnancy [AOR: 4.14 (95%CI: 1.78, 9.62)], polyhydramnios [AOR: 5.06 (95%CI: 2.28, 11.23)] and history of abnormal vaginal discharge [AOR: 6.65 (95%CI: 2.62, 16.72)] were found significant associated factors. In conclusion, the magnitude of the pre-labor rapture of the membranes was higher than in previous studies. Hence, health professionals should strengthen counseling, early diagnosis, and treatment of infections, as well as focus on women with pregnancy-related risks, to reduce pre-labor rupture of membranes and improve fetal and perinatal health.
Collapse
Affiliation(s)
| | - Daniel Bekele Ketema
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | - Belayneh Mengist
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Lieltework Yismaw
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Yibelu Bazezew
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | | | | |
Collapse
|
8
|
Efficacy of atosiban combined with ritodrine on spontaneous threatened preterm birth and its effect on PAF and fFN levels. Am J Transl Res 2022; 14:7942-7950. [PMID: 36505338 PMCID: PMC9730057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the efficacy of Atosiban combined with Ritodrine treatment on spontaneous threatened preterm birth and its effect on platelet-activating factor (PAF) and fetal fibronectin levels. METHODS Medical records from 120 patients with threatened preterm birth admitted to Baoji Maternal and Child Health Hospital from October 2020 to December 2021 were collected for this retrospective analysis. A total of 56 patients treated with Ritodrine alone were taken as the control group (CG), and the other 64 patients given combined treatment of Atosiban and Ritodrine were seen as the observation group (OG). Indexes of uterine contraction inhibition rate, pregnancy prolongation time, onset time, adverse reactions and pregnancy outcomes were compared between the two groups; in addition, the levels of inflammatory factors as well as PAF and fFN before and after treatment were detected and compared between two groups. RESULTS Compared with the CG, the uterine contraction inhibition rate as well as the pregnancy prolongation time in the OG were evidently higher (all P<0.05); the time of the disappearance of uterine contraction in the OG was significantly shorter (P<0.05); the rate of full-term delivery and neonatal 1-min Apgar score in the OG were obviously higher (P<0.05); and the incidence of total adverse reactions in the OG was markedly lower (P<0.05). However, there was no significant difference observed in the neonatal asphyxia rate and the number of fetuses between the two groups (P>0.05). After treatment, the OG was observed with markedly lower level of inflammatory factors C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) than the CG (P<0.05); levels of PAF and fFN decreased significantly in both two groups (P<0.05), and the levels in the OG were comparatively lower as compared to the CG (P<0.05). The areas under the ROC curve for PAF and fFN to predict pregnancy outcome were 0.766 and 0.757, respectively. CONCLUSION Atosiban combined with Ritodrine evidently improves the therapeutic efficacy in patients with threatened preterm labor, reduces the occurrence of adverse pregnancy outcomes as well as the levels of PAF and fFN.
Collapse
|
9
|
Assessing the Potency of the Novel Tocolytics 2-APB, Glycyl-H-1152, and HC-067047 in Pregnant Human Myometrium. Reprod Sci 2022; 30:203-220. [PMID: 35715551 PMCID: PMC9810572 DOI: 10.1007/s43032-022-01000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
The intracellular signaling pathways that regulate myometrial contractions can be targeted by drugs for tocolysis. The agents, 2-APB, glycyl-H-1152, and HC-067047, have been identified as inhibitors of uterine contractility and may have tocolytic potential. However, the contraction-blocking potency of these novel tocolytics was yet to be comprehensively assessed and compared to agents that have seen greater scrutiny, such as the phosphodiesterase inhibitors, aminophylline and rolipram, or the clinically used tocolytics, nifedipine and indomethacin. We determined the IC50 concentrations (inhibit 50% of baseline contractility) for 2-APB, glycyl-H-1152, HC-067047, aminophylline, rolipram, nifedipine, and indomethacin against spontaneous ex vivo contractions in pregnant human myometrium, and then compared their tocolytic potency. Myometrial strips obtained from term, not-in-labor women, were treated with cumulative concentrations of the contraction-blocking agents. Comprehensive dose-response curves were generated. The IC50 concentrations were 53 µM for 2-APB, 18.2 µM for glycyl-H-1152, 48 µM for HC-067047, 318.5 µM for aminophylline, 4.3 µM for rolipram, 10 nM for nifedipine, and 59.5 µM for indomethacin. A single treatment with each drug at the determined IC50 concentration was confirmed to reduce contraction performance (AUC) by approximately 50%. Of the three novel tocolytics examined, glycyl-H-1152 was the most potent inhibitor. However, of all the drugs examined, the overall order of contraction-blocking potency in decreasing order was nifedipine > rolipram > glycyl-H-1152 > HC-067047 > 2-APB > indomethacin > aminophylline. These data provide greater insight into the contraction-blocking properties of some novel tocolytics, with glycyl-H-1152, in particular, emerging as a potential novel tocolytic for preventing preterm birth.
Collapse
|
10
|
Maternal Periodontal Disease as a Potential Risk Factor for Preterm Birth and Low Birth Weight. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.2.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
11
|
Spencer RN, Hecher K, Norman G, Marsal K, Deprest J, Flake A, Figueras F, Lees C, Thornton S, Beach K, Powell M, Crispi F, Diemert A, Marlow N, Peebles DM, Westgren M, Gardiner H, Gratacos E, Brodszki J, Batista A, Turier H, Patel M, Power B, Power J, Yaz G, David AL. Development of standard definitions and grading for Maternal and Fetal Adverse Event Terminology. Prenat Diagn 2021; 42:15-26. [PMID: 34550624 DOI: 10.1002/pd.6047] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Adverse event (AE) monitoring is central to assessing therapeutic safety. The lack of a comprehensive framework to define and grade maternal and fetal AEs in pregnancy trials severely limits understanding risks in pregnant women. We created AE terminology to improve safety monitoring for developing pregnancy drugs, devices and interventions. METHOD Existing severity grading for pregnant AEs and definitions/indicators of 'severe' and 'life-threatening' conditions relevant to maternal and fetal clinical trials were identified through a literature search. An international multidisciplinary group identified and filled gaps in definitions and severity grading using Medical Dictionary for Regulatory Activities (MedDRA) terms and severity grading criteria based on Common Terminology Criteria for Adverse Event (CTCAE) generic structure. The draft criteria underwent two rounds of a modified Delphi process with international fetal therapy, obstetric, neonatal, industry experts, patients and patient representatives. RESULTS Fetal AEs were defined as being diagnosable in utero with potential to harm the fetus, and were integrated into MedDRA. AE severity was graded independently for the pregnant woman and her fetus. Maternal (n = 12) and fetal (n = 19) AE definitions and severity grading criteria were developed and ratified by consensus. CONCLUSIONS This Maternal and Fetal AE Terminology version 1.0 allows systematic consistent AE assessment in pregnancy trials to improve safety.
Collapse
Affiliation(s)
- Rebecca N Spencer
- School of Medicine, University of Leeds, Leeds, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gill Norman
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.,Antenatal Results and Choices Charity, UK
| | | | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Alan Flake
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesc Figueras
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain
| | - Christoph Lees
- Queen Charlottes and Chelsea Hospital, Imperial College London, London, UK
| | | | - Kathleen Beach
- Global Health Unit, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Marcy Powell
- Safety and Medical Governance, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Fatima Crispi
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain
| | - Anke Diemert
- Clinic for Obstetrics and Prenatal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Donald M Peebles
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
| | | | - Helena Gardiner
- The Fetal Center, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Eduard Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain.,Center for Biomedical Research on rare Diseases (CIBERER), Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Universitat de Barcelona, Barcelona, Spain
| | | | - Albert Batista
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain
| | | | - Mehali Patel
- Bliss Charity, London, UK.,Sands Charity, London, UK
| | - Beverley Power
- CDH UK: The Congenital Diaphragmatic Hernia Support Charity, King's Lynn, UK
| | - James Power
- CDH UK: The Congenital Diaphragmatic Hernia Support Charity, King's Lynn, UK
| | - Gillian Yaz
- SHINE: Spina bifida, Hydrocephalus, Information, Networking, Equality Charity, Peterborough, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
| |
Collapse
|
12
|
Fitzpatrick A, DiGiacinto D. Comparison of Transabdominal and Transvaginal Sonograms in Evaluation of Cervical Length During Pregnancy. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211012612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: A short cervix during pregnancy indicates a higher risk of preterm delivery. Transvaginal sonography is widely used for the detection of a short cervix. The literature indicates that 21–24 weeks is the most sensitive gestational age to assess transvaginal cervical length (TV CL) of ≤2.5 cm for potential preterm delivery. Pregnancies between 18 and 20 weeks’ gestation are generally performed transabdominally; thus, it could be beneficial to have a recognized correlation between the transabdominal cervical length (TA CL) measurement and the TV CL measurement at this earlier time period. Materials and Methods: An online database search produced 13 research articles to be reviewed. Inclusion criteria consisted of TA CL and TV CL assessment of singleton pregnancies with intact membranes. Results: Findings indicate high diagnostic yield when a TA CL of <2.9 cm or TV CL of <2.5 cm is used for defining a shortened cervix when measured between 18 and 20 weeks’ gestation. Conclusion: This review of the literature indicates a correlation between average TA CL and average TV CL measurements, although the relationship widens as CLs become shorter.
Collapse
Affiliation(s)
| | - Dora DiGiacinto
- Medical Imaging and Radiation Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
13
|
Hujacova A, Sirc J, Pekarkova K, Brozova T, Kostelanska M, Soukup J, Mosko T, Holada K, Stranak Z. Large Platelet and Endothelial Extracellular Vesicles in Cord Blood of Preterm Newborns: Correlation with the Presence of Hemolysis. Diagnostics (Basel) 2021; 11:1316. [PMID: 34441251 PMCID: PMC8394910 DOI: 10.3390/diagnostics11081316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022] Open
Abstract
Different biomarkers are investigated to detect the causes of severe complications in preterm infants. Extracellular vesicles (EVs) are recognized as an important part of cell-to-cell communication, and their increased levels were reported in numerous pathological states. We aimed to increase our knowledge about the incidence of platelet and endothelial EVs in cord blood of preterm newborns using conventional flow cytometry. The presence of platelet (CD36+CD41+), activated platelet (CD41+CD62+), and endothelial (CD31+CD105+) EVs was analyzed. Immune electron microscopy was used to confirm the presence of EVs and the specificity of their labeling. The size of detected extracellular vesicles was in the range 400-2000 nm. The differences in the counts of EVs between the preterm and control group were not significant and no correlation of EVs count with gestation age was recorded. Cord blood plasma samples with free hemoglobin level > 1 mg/mL had more than threefold higher counts of CD36+CD41+ and CD41+CD62+ EVs (p < 0.001), while the count of CD31+CD105+ EVs was only moderately increased (p < 0.05). Further studies utilizing cytometers with improved sensitivity are needed to confirm that the analysis of large platelet and endothelial EVs mirrors the quantitative situation of their whole plasma assemblage.
Collapse
Affiliation(s)
- Andrea Hujacova
- First Faculty of Medicine, Institute of Immunology and Microbiology, Charles University, General University Hospital in Prague, Studnickova 7, 12820 Prague 2, Czech Republic; (A.H.); (K.P.); (M.K.); (J.S.); (T.M.)
| | - Jan Sirc
- Department of Neonatology, Institute for the Care of Mother and Child, Podolske Nabrezí 157/36, 14700 Prague 4, Czech Republic; (J.S.); (T.B.); (Z.S.)
| | - Kristyna Pekarkova
- First Faculty of Medicine, Institute of Immunology and Microbiology, Charles University, General University Hospital in Prague, Studnickova 7, 12820 Prague 2, Czech Republic; (A.H.); (K.P.); (M.K.); (J.S.); (T.M.)
| | - Tereza Brozova
- Department of Neonatology, Institute for the Care of Mother and Child, Podolske Nabrezí 157/36, 14700 Prague 4, Czech Republic; (J.S.); (T.B.); (Z.S.)
| | - Marie Kostelanska
- First Faculty of Medicine, Institute of Immunology and Microbiology, Charles University, General University Hospital in Prague, Studnickova 7, 12820 Prague 2, Czech Republic; (A.H.); (K.P.); (M.K.); (J.S.); (T.M.)
| | - Jakub Soukup
- First Faculty of Medicine, Institute of Immunology and Microbiology, Charles University, General University Hospital in Prague, Studnickova 7, 12820 Prague 2, Czech Republic; (A.H.); (K.P.); (M.K.); (J.S.); (T.M.)
| | - Tibor Mosko
- First Faculty of Medicine, Institute of Immunology and Microbiology, Charles University, General University Hospital in Prague, Studnickova 7, 12820 Prague 2, Czech Republic; (A.H.); (K.P.); (M.K.); (J.S.); (T.M.)
| | - Karel Holada
- First Faculty of Medicine, Institute of Immunology and Microbiology, Charles University, General University Hospital in Prague, Studnickova 7, 12820 Prague 2, Czech Republic; (A.H.); (K.P.); (M.K.); (J.S.); (T.M.)
- Department of Neonatology, Institute for the Care of Mother and Child, Podolske Nabrezí 157/36, 14700 Prague 4, Czech Republic; (J.S.); (T.B.); (Z.S.)
| | - Zbynek Stranak
- Department of Neonatology, Institute for the Care of Mother and Child, Podolske Nabrezí 157/36, 14700 Prague 4, Czech Republic; (J.S.); (T.B.); (Z.S.)
| |
Collapse
|
14
|
İflazoğlu N, Eroğlu H, Tolunay HE, Yücel A. Comparison of the maternal serum endocan levels in preterm premature rupture of membrane and normal pregnancy. J Obstet Gynaecol Res 2021; 47:3151-3158. [PMID: 34109715 DOI: 10.1111/jog.14836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endocan is a novel marker of endothelial inflammation. In this study, we aimed to show whether there was a significant difference between the endocan levels of pregnant women with and without preterm premature rupture of membranes (PPROM and non-PPROM). Also, we aimed to find a relation between endocan levels and the latent period. MATERIAL AND METHODS Pregnant women with PPROM between 28 and 34 weeks of gestation and those without PPROM with similar gestational weeks were included in the study. A total of 88 pregnant women, 44 with PROM and 44 healthy pregnancies, were evaluated. Demographic and obstetric features, leukocyte, and endocan levels of the study and control groups were compared. RESULTS The demographic features and obstetric history of both groups were similar. The mean leukocyte and endocan levels of the study group were higher than in the control group (p < 0.001 and 0.029, respectively). The leukocyte level was the only independent factor predicting PPROM after multivariate logistic regression analysis. CONCLUSION Although the endocan levels were higher in patients with PPROM, multivariate analysis showed that the only independent predictive factor was the leukocyte level.
Collapse
Affiliation(s)
- Nuray İflazoğlu
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Hasan Eroğlu
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Harun Egemen Tolunay
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Aykan Yücel
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| |
Collapse
|
15
|
Chawanpaiboon S, Titapant V, Pooliam J. Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor. ASIAN BIOMED 2021; 15:119-127. [PMID: 37551369 PMCID: PMC10388770 DOI: 10.2478/abm-2021-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery. Objective To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length. Methods We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 200/7 and 366/7 weeks' gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated. Results Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70). Conclusions Cervical length ranging 15-30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice.
Collapse
Affiliation(s)
- Saifon Chawanpaiboon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
| | - Vitaya Titapant
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
| | - Julaporn Pooliam
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
| |
Collapse
|
16
|
Dan K, Lee JE, Han D, Kim SM, Hong S, Kim HJ, Park KH. Proteomic identification of biomarkers in maternal plasma that predict the outcome of rescue cerclage for cervical insufficiency. PLoS One 2021; 16:e0250031. [PMID: 33857242 PMCID: PMC8049309 DOI: 10.1371/journal.pone.0250031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective We sought to identify plasma protein biomarkers that are predictive of the outcome of rescue cerclage in patients with cervical insufficiency. Methods This retrospective cohort study included 39 singleton pregnant women undergoing rescue cerclage for cervical insufficiency (17–25 weeks) who gave plasma samples. Three sets of pooled plasma samples from controls (cerclage success, n = 10) and cases (cerclage failure, n = 10, defined as spontaneous preterm delivery at <33 weeks) were labeled with 6-plex tandem mass tag (TMT) reagents and analyzed by liquid chromatography-tandem mass spectrometry. Differentially expressed proteins between the two groups were selected from the TMT-based quantitative analysis. Multiple reaction monitoring-mass spectrometry (MRM-MS) analysis was further used to verify the candidate proteins of interest in patients with cervical insufficiency in the final cohort (n = 39). Results From MRM-MS analysis of the 40 proteins showing statistically significant changes (P < 0.05) from the TMT-based quantitative analysis, plasma IGFBP-2, PSG4, and PGLYRP2 levels were found to be significantly increased, whereas plasma MET and LXN levels were significantly decreased in women with cerclage failure. Of these, IGFBP-2, PSG4, and LXN levels in plasma were independent of cervical dilatation. A multiple-biomarker panel was developed for the prediction of cerclage failure, using a stepwise regression procedure, which included the plasma IGFBP-2, PSG4, and LXN (area under the curve [AUC] = 0.916). The AUC for this multiple-biomarker panel was significantly greater than the AUC for any single biomarker included in the multi-biomarker model. Conclusions Proteomic analysis identified useful and independent plasma biomarkers (IGFBP-2, PSG4, and LXN; verified by MRM) that predict poor pregnancy outcome following rescue cerclage. Their combined analysis in a multi-biomarker panel significantly improved predictability.
Collapse
Affiliation(s)
- Kisoon Dan
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Eun Lee
- Biomedical Research Division, Theragnosis Research Center, Korea Institute of Science and Technology, Seoul, Korea
| | - Dohyun Han
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| |
Collapse
|
17
|
Theis KR, Florova V, Romero R, Borisov AB, Winters AD, Galaz J, Gomez-Lopez N. Sneathia: an emerging pathogen in female reproductive disease and adverse perinatal outcomes. Crit Rev Microbiol 2021; 47:517-542. [PMID: 33823747 DOI: 10.1080/1040841x.2021.1905606] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sneathia is an emerging pathogen implicated in adverse reproductive and perinatal outcomes. Although scarce, recent data suggest that vaginally residing Sneathia becomes pathogenic following its ascension into the upper urogenital tract, amniotic fluid, placenta, and foetal membranes. The role of Sneathia in women's health and disease is generally underappreciated because the cultivation of these bacteria is limited by their complex nutritional requirements, slow growth patterns, and anaerobic nature. For this reason, molecular methods are typically required for the detection and differential diagnosis of Sneathia infections. Here, we review the laboratory methods used for the diagnosis of Sneathia infections, the molecular mechanisms underlying its virulence, and its sensitivity to antibiotics. We further review the evidence of Sneathia's contributions to the pathogenesis of bacterial vaginosis, chorioamnionitis, preterm prelabour rupture of membranes, spontaneous preterm labour, stillbirth, maternal and neonatal sepsis, HIV infection, and cervical cancer. Collectively, growing evidence indicates that Sneathia represents an important yet underappreciated pathogen affecting the development and progression of several adverse clinical conditions diagnosed in pregnant women and their neonates, as well as in non-pregnant women.
Collapse
Affiliation(s)
- Kevin R Theis
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Violetta Florova
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.,Detroit Medical Center, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA
| | - Andrei B Borisov
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Andrew D Winters
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jose Galaz
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, USA.,Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
18
|
Ali A, Christophersen CT, Keelan JA. Vaginal microbial profiling in a preterm birth high-risk cohort using shallow shotgun metagenomics. MICROBIOLOGY AUSTRALIA 2021. [DOI: 10.1071/ma21023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preterm birth (PTB) is a significant health problem globally, with an estimate of 15 million cases annually. Approximately 10% of neonates born early will die prematurely, while a subset will develop severe life-long morbidities. Unfortunately, preterm birth’s syndromic nature has evaded prevention strategies, and it continues to impose a high burden on healthcare systems and families. The role of vaginal bacteria in triggering biomolecular causes of PTB has been recognised for years. However, translating this knowledge to practical diagnostic and therapeutic strategies has remained elusive. New techniques in high-throughput sequencing have improved our understanding of the nature and role of the vaginal microbiome during pregnancy. Several multi-ethnic and multi-geographical studies into the vaginal microbiome have identified five distinct bacterial profiles termed community state types (CSTs), one of which is positively associated with dysbiosis and increased risk of PTB. In a small pilot study of first-trimester vaginal microbial DNA obtained from pregnant women at high-risk of PTB, we compared the CST profiles generated using standard 16S amplicon sequencing with shallow shotgun metagenomics (SSM). Both methods identified the presence of the five CSTs as has been reported previously, although the metagenomic data showed greater taxonomic resolution and more accurate CST assignation. These findings suggest that SSM is a cost-effective and potentially superior alternative to 16S sequencing for vaginal microbiome analysis.
Collapse
|
19
|
Rouholamin S, Razavi M, Rezaeinejad M, Sepidarkish M. A diagnostic profile on the PartoSure test. Expert Rev Mol Diagn 2020; 20:1163-1170. [PMID: 33175636 DOI: 10.1080/14737159.2020.1848549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Preterm birth (PTB) is common, occurring in over 10% of all live births globally, and is increasing worldwide. The limitations of traditional biomarkers of PTB, such as fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as placental alpha macroglobulin-1 (PAMG-1); PartoSure, has the potential to improve disease monitoring and the best interventions. Areas covered: The present expert opinion evaluates the utility and limitations of PAMG-1; PartoSure as a biomarker for PTB in light of the current literature. Expert opinion: Although fFN, phIGFBP-1 and PAMG-1; PartoSure test had similar negative predictive value (NPV) and negative likelihood ratio (LR-), the PAMG-1; PartoSure test had the highest specificity, positive predictive value (PPV), and positive likelihood ratio (LR+) across all at-risk pregnant women. Although findings of this review may be encouraging, the PartoSure test should not be interpreted as absolute evidence for prediction of PTB. The PartoSure test result should always be used in conjunction with information available from the clinical evaluation of the pregnant woman and other diagnostic procedures such as cervical examination, assessment of uterine activity, and evaluation of other risk factors.
Collapse
Affiliation(s)
- Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Maryam Razavi
- Pregnancy Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences , Zahedan, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences , Babol, Iran
| |
Collapse
|
20
|
Azithromycin in the Treatment of Preterm Prelabor Rupture of Membranes Demonstrates a Lower Risk of Chorioamnionitis and Postpartum Endometritis with an Equivalent Latency Period Compared with Erythromycin Antibiotic Regimens. Infect Dis Obstet Gynecol 2020; 2020:2093530. [PMID: 32694907 PMCID: PMC7368187 DOI: 10.1155/2020/2093530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/10/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To determine if antibiotic regimens including azithromycin versus erythromycin has an impact on pregnancy latency and development of clinical chorioamnionitis in the context of preterm prelabor rupture of membranes. Study Design. We conducted a prospective observational cohort study and followed all women receiving antibiotic regimens including either azithromycin or erythromycin in the context of preterm prelabor rupture of membranes. Primary outcomes were the duration of pregnancy latency period and development of chorioamnionitis. Secondary outcomes included neonatal sepsis with positive blood culture, cesarean delivery, postpartum endometritis, and meconium-stained amniotic fluid. Results This study included 310 patients, with 142 receiving the azithromycin regimen and 168 receiving the erythromycin regimen. Patients receiving the azithromycin regimen had a statistically significant advantage in overall rates of clinical chorioamnionitis (13.4% versus 25%, p = 0.010), neonatal sepsis (4.9% versus 14.9%, p = 0.004), and postpartum endometritis (14.8% versus 31%, p = 0.001). In crude and adjusted models, when comparing the azithromycin group with the erythromycin group, a decreased risk was noted for the development of clinical chorioamnionitis, neonatal sepsis, and postpartum endometritis. Pregnancy latency by regimen was not significantly different in crude and adjusted models. Conclusion Our study suggests that latency antibiotic regimens substituting azithromycin for erythromycin have lower rates and decreased risk of clinical chorioamnionitis, neonatal sepsis, and postpartum endometritis with no difference in pregnancy latency.
Collapse
|
21
|
Navolan DB, Stoian DL, Bohiltea RE, Crainiceanu Z, Craina ML, Cretu O, Timar B, Vladareanu R, Terness P, BūRGER F, Nemescu D. Comparison of early pregnancy serum concentration of neopterin, neopterin/creatinine ratio, C-reactive protein, and chitotriosidase, in pregnant women with birth at term and spontaneous preterm birth. Exp Ther Med 2020; 20:2449-2454. [PMID: 32765732 PMCID: PMC7401568 DOI: 10.3892/etm.2020.8784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammatory mechanisms are involved in achieving a normal pregnancy and in the development of certain pregnancy complications. These changes are more intense in pregnant women that suffer of pregnancy complications, such as spontaneous preterm birth (SPB). This study compared the course of inflammatory markers (IM) [neopterin (Neo), neopterin/creatinine ratio (Neo/Cre), C-reactive protein (CRP), and chitotriosidase (Chito)] serum concentration in the early pregnancy of women with birth at term (BT) and preterm birth (PB). IM concentration was measured in 90 sera sampled from 45 pregnancies with BT and 30 sera from 15 pregnancies with PB. Two sera were sampled from each pregnant woman: one in the first trimester and another one in the second trimester. Early pregnancy IM concentration showed a direct correlation with gestational age: Neo (rho=0.262, P=0.004), Neo/Cre (rho=0.372, P<0.001), CRP (rho=0.187, P=0.041), and Chito (rho=0.039, P=0.66). The correlation was present in both categories of patients with BT and PB. Patients with PB before 34 week of pregnancy (wp) and 32 wp showed higher Neo and Neo/Cre concentration than BT patients. A significant association was found between the risk of PB before 34 wp, PB before 32 wp, and Neo concentration (PB <34 wp: odds ratio (OR) =5.13, P=0.035) (PB <32 wp: OR=8.2, P=0.020) and, respectively, Neo/Cre concentration (PB <34 wp: OR=5.29, P=0.015) (PB <32 wp: OR=9.25, P=0.006). No association between CRP or Chito and PB age was found. IM concentration correlates with the gestational age at the time of blood sampling. Increased Neo and Neo/Cre concentration are associated with PB. Further studies are needed to evaluate the usefulness of these markers in clinical practice.
Collapse
Affiliation(s)
- Dan Bogdan Navolan
- Department of Obstetrics and Gynecology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Help Prevent Foundation For Promotion of Prevention and Health, 320036 Resiţa
| | - Dana Liana Stoian
- Department of Endocrinology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Zorin Crainiceanu
- Department of Surgery, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Lucian Craina
- Department of Obstetrics and Gynecology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Octavian Cretu
- Department of Surgery, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Medical Informatics, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Radu Vladareanu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Peter Terness
- 'Otto Meyerhof' Center, Institute of Immunology, 'Ruperto Carola' University of Heidelberg, D-69120 Heidelberg, Germany
| | - Friederike BūRGER
- Metabolic Laboratory, Department of General Pediatrics, University Children's Hospital Heidelberg, D-69120 Heidelberg, Germany
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| |
Collapse
|
22
|
Rezaeean SM, Abedian Z, Latifnejad-Roudsari R, Mazloum SR, Abbasi Z. The Effect of Prenatal Self-Care Based on Orem's Theory on Preterm Birth Occurrence in Women at Risk for Preterm Birth. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:242-248. [PMID: 32724771 PMCID: PMC7299423 DOI: 10.4103/ijnmr.ijnmr_207_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/23/2019] [Accepted: 03/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Preterm birth is increasing as a major cause of perinatal complications and mortality in Iran. The present study aimed to investigate the effect of prenatal self-care based on Orem's theory on preterm birth occurrence in women at risk for preterm birth. MATERIALS AND METHODS The present clinical trial was conducted on 176 pregnant women at 24-26 weeks at risk for preterm birth in Mashhad, Iran, from December 2015 to October 2016. A multistage sampling method was used in this study. The intervention group (88 pregnant women) received individual self-care education but the control group (88 pregnant women) received only common prenatal care. RESULTS There was a statistically significant difference between intervention and control groups in terms of preterm birth occurrence (6.80% vs 20.50%) (χ2 = 6.90, df = 1,p = 0.008). The incidence of preterm birth in the intervention group was approximately three times higher than that in the control group. CONCLUSIONS Given that educational interventions could reduce the incidence of preterm birth, it is suggested that the women at risk for preterm birth are trained for prenatal self-care.
Collapse
Affiliation(s)
| | - Zahra Abedian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad-Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed-Reza Mazloum
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zohreh Abbasi
- Department of Midwifery, Medical Faculty, North Khorasan University of Medical Sciences, Bojnurd, Iran
| |
Collapse
|
23
|
Hong S, Park KH, Kim YM, Lee YE, Park Y, Lee JE. A Protein Microarray Analysis of Plasma Proteins for the Prediction of Spontaneous Preterm Delivery in Women with Preterm Labor. Reprod Sci 2020; 27:1187-1196. [PMID: 32046457 DOI: 10.1007/s43032-019-00114-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
We aimed to identify novel biomarkers in maternal plasma that predict spontaneous preterm delivery (SPTD) in women with preterm labor (PTL) using an antibody microarray and to develop the best prediction model for SPTD based on these biomarkers in combination with clinical and ultrasound factors. This retrospective cohort study included 215 women with singleton pregnancies and PTL (23-33 weeks) who gave plasma samples. In a nested case-control study design, plasma proteomes from SPTD (case subjects, n = 15) and term delivery (control subjects, n = 15) groups were differentially profiled using a membrane-based antibody microarray. Six candidate biomarkers of interest were validated by enzyme-linked immunosorbent assay (ELISA) in the total cohort (n = 215). Cervical lengths were also measured. The primary outcome measure was SPTD within 48 h after sampling. Twenty of the molecules studied displayed significant intergroup differences. Validation by ELISA confirmed significantly higher levels of plasma endostatin and lipopolysaccharide binding protein (LBP) in women who had SPTD within 48 h than in those delivering after 48 h. However, plasma macrophage inflammatory protein (MIP)-1α levels were significantly lower in women who delivered within 48 h. A combined model was developed to predict SPTD within 48 h using a stepwise regression procedure, which included plasma endostatin and LBP levels, nulliparity, and cervical length (area under the curve = 0.920). Plasma LBP, endostatin, and MIP-1α are potential new biomarkers for predicting imminent SPTD and a combined noninvasive model based on these biomarkers and clinical and ultrasound factors can accurately predict imminent SPTD in women with PTL.
Collapse
Affiliation(s)
- Subeen Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea.
| | - Yu Mi Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Young Eun Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Yehyon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Ji Eun Lee
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, South Korea
| |
Collapse
|
24
|
Determinants of preterm birth among mothers who gave birth at public hospitals in the Amhara region, Ethiopia: A case-control study. PLoS One 2019; 14:e0225060. [PMID: 31710645 PMCID: PMC6844458 DOI: 10.1371/journal.pone.0225060] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background Preterm birth (PTB) is a public health issue worldwide. In developing nations, like Ethiopia, PTB is under reported and underestimated. However, it is the leading cause of neonatal and under-five mortality in Ethiopia. Besides, limited and non-comparative research studies to date has been conducted in the country to address the prevalence of PTB. Therefore, this study aims to determine predictors of PTB. Methods Hospital-based unmatched case control study was employed on a sample of 139 cases and 278 controls from October 2017 to December 2017 in the Amhara region, Ethiopia. The cases and controls were proportionally allocated in each hospital based on the last one-year case flows. As soon as a case was identified, the respective two controls were enrolled until the required sample size was satisfied. The outcome variable was measured by using either last menstrual period (LMP), early ultrasound result, or Ballard maturity examination. Face-to-face interviews were conducted using a standardized, structured, and pre-tested questionnaire to collect data. The collected data was entered into Epi-data and exported into SPSS for analysis. Independent variables with p-values < 0.25 in the bivariate analysis were entered into multivariable logistic regression models with forward logistic regressions method to control the influence of covariates. Ethical clearance was ensured. Results A total of 134 cases and 268 controls participated with a response rate of 96.4%. After adjusting for covariates, the following variables were associated with PTB: residing in rural areas [AOR = 2.99: 95% CI 1.19, 7.48], low maternal age [AOR = 3.47: 95% CI 1.11, 10.83], being illiterate [AOR = 4.56: 95% CI 1.11,8.62], short birth spacing [AOR = 2.48: 95% CI 1.07, 5.75], no antenatal care visits for this index pregnancy [AOR = 10.78: 95% CI 4.43, 26.25], having a history of previous adverse birth outcomes [AOR = 3.47: 95% CI 1.51, 8.02], and exposure to medical problems during pregnancy [AOR = 13.94: 95% CI 4.39, 24.27]. Conclusion The study revealed maternal sociodemographic factors, short birth space, lack of antenatal care, exposure to previous adverse birth outcomes and facing medical illnesses during pregnancy were the predictors of PTB. Therefore, inclusive preventive and control interventions should be developed at regional, zonal and district levels to reduce the burden of PTB among women resided in rural areas such as integrating antenatal care services into the existing health extension packages. Study results suggest increasing the awareness of PTB, contraceptive utilization and counseling to enhance birth spacing, antenatal care visits, and accessibility to services among women in Ethiopia should be given due attention. Health care providers should focus on mothers with previous adverse birth outcomes and those exposed to medical problems during pregnancy. Additional community based longitudinal studies supplemented with qualitative methods are recommended.
Collapse
|
25
|
Souza RT, McKenzie EJ, Jones B, de Seymour JV, Thomas MM, Zarate E, Han TL, McCowan L, Sulek K, Villas-Boas S, Kenny LC, Cecatti JG, Baker PN. Trace biomarkers associated with spontaneous preterm birth from the maternal serum metabolome of asymptomatic nulliparous women - parallel case-control studies from the SCOPE cohort. Sci Rep 2019; 9:13701. [PMID: 31548567 PMCID: PMC6757051 DOI: 10.1038/s41598-019-50252-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023] Open
Abstract
Prediction of spontaneous preterm birth (sPTB) in asymptomatic women remains a great challenge; accurate and reproducible screening tools are still not available in clinical practice. We aimed to investigate whether the maternal serum metabolome together with clinical factors could be used to identify asymptomatic women at risk of sPTB. We conducted two case-control studies using gas chromatography-mass spectrometry to analyse maternal serum samples collected at 15- and 20-weeks' gestation from 164 nulliparous women from Cork, and 157 from Auckland. Smoking and vaginal bleeding before 15 weeks were the only significant clinical predictors of sPTB for Auckland and Cork subsets, respectively. Decane, undecane, and dodecane were significantly associated with sPTB (FDR < 0.05) in the Cork subset. An odds ratio of 1.9 was associated with a one standard deviation increase in log (undecane) in a multiple logistic regression which also included vaginal bleeding as a predictor. In summary, elevated serum levels of the alkanes decane, undecane, and dodecane were associated with sPTB in asymptomatic nulliparous women from Cork, but not in the Auckland cohort. The association is not strong enough to be a useful clinical predictor, but suggests that further investigation of the association between oxidative stress processes and sPTB risk is warranted.
Collapse
Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
| | | | | | | | | | - Erica Zarate
- The University of Auckland, Auckland, New Zealand
| | - Ting Li Han
- The University of Auckland, Auckland, New Zealand
| | | | | | | | - Louise C Kenny
- The Department of Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - José G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Philip N Baker
- The University of Auckland, Auckland, New Zealand
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
26
|
Barinov SV, Artymuk NV, Novikova ON, Shamina IV, Tirskaya YI, Belinina AA, Lazareva OV, Kadcyna TV, Borisova AV, Stepanov SS, Di Renzo GC. Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth. J Matern Fetal Neonatal Med 2019; 34:2071-2079. [PMID: 31409178 DOI: 10.1080/14767058.2019.1656195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin's pessary with cervical cerclage in women at a high risk of pregnancy loss. MATERIALS AND METHODS This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin's pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. RESULTS Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p = .448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p = .011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin's pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. CONCLUSIONS Women with a high risk of pregnancy loss treated with Arabin's pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.
Collapse
Affiliation(s)
- S V Barinov
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - N V Artymuk
- Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia
| | - O N Novikova
- Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia
| | - I V Shamina
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - Y I Tirskaya
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - A A Belinina
- Altai State Clinical Perinatal Centre, Barnaul, Russia
| | - O V Lazareva
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - T V Kadcyna
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - A V Borisova
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.,Peoples Friendship University of Russia (RUDN) Moscow, Russian Federation
| | - S S Stepanov
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - G C Di Renzo
- Department of Obstetrics and Gynecology and Centre for Reproductive and Perinatal Medicine, The University of Perugia, Perugia, Italy
| |
Collapse
|
27
|
Barooti E, Darvish S, Kariman N, Yazdanpanah G. Comparison of Human Chorionic Gonadotropin Test and Amnisure Test for Diagnosis of Premature Rapture of Membrane. MEDICAL LABORATORY JOURNAL 2019. [DOI: 10.29252/mlj.13.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
28
|
Woraboot W, Wanitpongpan P, Phaophan A. Correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women. J Chin Med Assoc 2019; 82:50-54. [PMID: 30839404 DOI: 10.1016/j.jcma.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm labor is one of major obstetric challenges and can be predicted by cervical length at mid-trimester. In some settings, transvaginal ultrasound is not available and the screening and prevention of preterm labor will be suboptimal. We hope to find a correlation between other marker i.e. lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women during 16-32 weeks of gestation. METHODS This study was a cross-sectional study. 166 singleton pregnant women were invited to participate in the study between June 2015 and December 2015. Transabdominal ultrasonography was performed to measure the lower uterine wall thickness and transvaginal ultrasonography was performed to measure the cervical length. The Spearman's rank correlation was used to evaluate the correlation between the two parameters. The inter-observer variation was assessed by using Bland-Altman plot. The outcomes of all pregnancies were followed and only those who delivered at term were included for the calculation of normal value of lower uterine wall thickness. RESULTS There was a highly positive correlation between lower uterine wall thickness and cervical length (rs = 0.767, n = 166, p < 0.001). For those who had short cervical length (defined as less than 30 mm) at GA 16-24 weeks (n = 10), the mean corresponding lower uterine wall thickness was 4.4 mm (SD 0.50). The inter-observer variation of the measurement of lower uterine wall thickness and cervical length were small. The lower uterine wall thickness tended to be slightly thinner when the gestation advanced. (mean 5.4 mm at 16-20 weeks and 5.1 mm at 28-32 weeks). CONCLUSION There was a highly positive correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women.
Collapse
Affiliation(s)
- Wanitchar Woraboot
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | |
Collapse
|
29
|
Di Renzo GC, Cabero Roura L, Facchinetti F, Helmer H, Hubinont C, Jacobsson B, Jørgensen JS, Lamont RF, Mikhailov A, Papantoniou N, Radzinsky V, Shennan A, Ville Y, Wielgos M, Visser GHA. Preterm Labor and Birth Management: Recommendations from the European Association of Perinatal Medicine. J Matern Fetal Neonatal Med 2018; 30:2011-2030. [PMID: 28482713 DOI: 10.1080/14767058.2017.1323860] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- G C Di Renzo
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - L Cabero Roura
- b Department of Obstetrics and Gynecology , Hospital Vall D'Hebron , Barcelona , Spain
| | - F Facchinetti
- c Mother-Infant Department, School of Midwifery , University of Modena and Reggio Emilia , Italy
| | - H Helmer
- d Department of Obstetrics and Gynaecology , General Hospital, University of Vienna , Vienna , Austria
| | - C Hubinont
- e Department of Obstetrics , Saint Luc University Hospital, Université de Louvain , Brussels , Belgium
| | - B Jacobsson
- f Department of Obstetrics and Gynecology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - J S Jørgensen
- g Department of Obstetrics and Gynaecology , Odense University Hospital , Odense , Denmark
| | - R F Lamont
- h Department of Gynaecology and Obstetrics , University of Southern Denmark, Odense University Hospital , Odense , Denmark.,i Division of Surgery , University College London, Northwick Park Institute of Medical Research Campus , London , UK
| | - A Mikhailov
- j Department of Obstetrics and Gynecology , 1st Maternity Hospital, State University of St. Petersburg , Russia
| | - N Papantoniou
- k Department of Obstetrics and Gynaecology , Athens University School of Medicine , Athens , Greece
| | - V Radzinsky
- l Department of Medicine , Peoples' Friendship University of Russia , Moscow , Russia
| | - A Shennan
- m St. Thomas Hospital, Kings College London , UK
| | - Y Ville
- n Service d'Obstétrique et de Médecine Foetale , Hôpital Necker Enfants Malades , Paris , France
| | - M Wielgos
- p Department of Obstetrics and Gynecology , Medical University of Warsaw , Warsaw , Poland
| | - G H A Visser
- o Department of Obstetrics , University Medical Center , Utrecht , The Netherlands
| |
Collapse
|
30
|
Cerovac A, Gordana G, Ljuca D. Mode of Delivery in Preterm Births - Bosnian and Herzegovinian Experience. Mater Sociomed 2018; 30:290-293. [PMID: 30936795 PMCID: PMC6377931 DOI: 10.5455/msm.2018.30.290-293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/14/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The method of carrying out PTB is one of the most controversial topics of modern perinatology, because there are no clear and undeniable works and studies that would in any case support vaginal delivery (VD) or delivery to the cesarean section (CS). AIM To determine more frequent mode of delivery in different groups of birth weights and degrees of prematurity from single and twin pregnancies. To determine the degree of vitality of premature born vaginal delivery (VD) in relation to the cesarean section (CS) in different degrees of prematurity from single and twin pregnancies. PATIENTS AND METHODS Research has retrospective cohort character. Data were collected from the databases of University Clinic of Gynecology and Obstetrics Tuzla for the period of five years (January 1st, 2012-December 31st, 2016). The study included newborns of both genders, gestational age from 24 to 37 weeks of gestation (WG) in singleton and twin pregnancies. RESULTS Out of 19506 births, 1350 (6.92%) were preterm birth (PTB). Singleton PTB was 1180 (87.40%), and the twins were 170 (12.59%). Vaginal delivery (VD) was born 788 (58.37%). Cesarean section (CS) was born 562 (41.63%). There was statistically significant association between the mode of delivery (MD) in singleton and twins pregnancy in all three subgroups of birth weight (BW) 1000-1499, 2000-2499 and >2500 grams in 33-37 WG. In this group was more frequent VD than CS mode of singleton delivery, and CS than VD mode of twins delivery. In contrast to newborn with BW 1500-1999 grams (chi-square = 23.16, P <0.0001) in same gestational period where was more frequent CS than VD (OR: 2.56, 95% CI: 1.71-3,85). Apgar score (AS) at first and five minute 5-7 and 8-10 in the period 28-32 and 33-37 was a statistically significant frequent in VD and singletons in contrast to CS and twins. CONCLUSION VD was more frequent in the higher WG, as well as the higher AS in singletons in contrast to twins delivery.
Collapse
Affiliation(s)
- Anis Cerovac
- Department of Gynecology and Obstetrics, General hospital Tesanj, Tesanj, Bosnia and Herzegovina
| | - Grgic Gordana
- Clinic for Gynecology and Obstetrics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dzenita Ljuca
- Clinic for Gynecology and Obstetrics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| |
Collapse
|
31
|
Duncan JR, Tobiasz AM, Dorsett KM, Aziz MM, Thompson RE, Bursac Z, Talati AJ, Mari G, Schenone MH. Fetal pulmonary artery acceleration/ejection time prognostic accuracy for respiratory complications in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2018; 33:2054-2058. [PMID: 30318947 DOI: 10.1080/14767058.2018.1536744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To determine the prognostic accuracy of the fetal pulmonary artery acceleration time/ejection time (PATET) for the prediction of neonatal respiratory complications (NRCs) in pregnancies with preterm premature rupture of membranes (PPROM).Methods: This is a prospective cohort of singleton pregnancies complicated by PPROM managed in our institution from October 2015 to April 2018. Inclusion criteria included mothers from 13 to 46 years of age and singleton pregnancies with PATET measurements <7 days prior to delivery. PATET was obtained by placing the Doppler caliper in the main pulmonary artery proximal to the bifurcation of this vessel. NRC was defined as: need for ventilatory support, respiratory distress syndrome (RDS), or lung hypoplasia. Logistic regression models and area under the receiver operating characteristic curves (ROC) were utilized to determine the prognostic accuracy of PATET and gestational age for NRC and RDS.Results: Of 95 patients included, 46 had NRC (RDS = 33). PATET was a significant predictor of NRC (AUC 0.74; 95%CI: 0.61-0.83; p < .001) and RDS (AUC 0.69; 95%CI: 0.57-0.80; p = .021) in PPROM. Gestational age at delivery and gestational age at PPROM were also significantly associated with NRC and RDS. Their predictive accuracy for NRC was 0.87 and 0.84, and for RDS 0.85 and 0.86, respectively.Conclusions: PATET is a statistically significant predictor for NRC in pregnancies with PPROM; however, its clinical use may be limited as gestational age is a better predictor of these outcomes.Rationale: NRCs are common in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). We aim to determine the prognostic accuracy of the fetal PATET for the prediction of neonatal NRC in these pregnancies. Our results indicate that PATET is a statistically significant predictor for NRC in pregnancies with PPROM; however, its clinical use may be limited, as gestational age is a better predictor of these outcomes.
Collapse
Affiliation(s)
- Jose R Duncan
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Ana M Tobiasz
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetric and Gynecology, University of North Dakota, Bismarck, ND, USA
| | - Katherine M Dorsett
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael M Aziz
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca E Thompson
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Ajay J Talati
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Neonatology Division, Memphis, TN, USA
| | - Giancarlo Mari
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mauro H Schenone
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
32
|
Hu CY, Li FL, Hua XG, Jiang W, Zhang XJ. Longitudinal trajectory of vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis during pregnancy as well as the impact on pregnancy outcomes: a preliminary study. J Matern Fetal Neonatal Med 2018; 32:3612-3617. [PMID: 29685081 DOI: 10.1080/14767058.2018.1469125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives: The aims of this study were to describe the course of vulvovaginal candidiasis (VVC), trichomoniasis, and bacterial vaginosis (BV) in pregnancy and to explore the association between these longitudinal changes and pregnancy outcomes. Methods: A total of 793 pregnant women were enrolled at the first trimester of pregnancy and were followed prospectively twice at the second and third trimester. VVC, trichomoniasis, and BV were evaluated at each trimester of pregnancy. Results were evaluated for trends of these three diseases and the association between these changes of trends and pregnancy outcomes. Results: The trend of negative at all three time points was dominant for all three diseases compared with trend of positive throughout pregnancy was the most rare. In addition, for VVC, a trend toward positive can't be ignored (7.5%). However, for BV, the distribution of other three trends (trend negative, trend positive, status random) were basically the same. Different trends of these three diseases were not associated with adverse pregnancy outcomes, with the exception of women who had a trend of BV positive throughout pregnancy were more likely to suffer from amniotic fluid infection (AFI) compared with women who were negative at all three time points (p = .016, OR: 17.29, 95% CI: 1.70-175.54). Conclusions: In this population, the trend of negative throughout pregnancy was dominant for all three diseases compared with few women were positive across their pregnancy. BV may be associated with AFI during pregnancy.
Collapse
Affiliation(s)
- Cheng-Yang Hu
- a Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , People's Republic of China
| | - Feng-Li Li
- a Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , People's Republic of China
| | - Xiao-Guo Hua
- a Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , People's Republic of China
| | - Wen Jiang
- a Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , People's Republic of China
| | - Xiu-Jun Zhang
- a Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , People's Republic of China
| |
Collapse
|
33
|
Eldaly A, Omran E, Youssef MA, Abdallah A, Metwally A, Haggag H, Elkaffas R. Use of beta subunit of human chorionic gonadotropin assay as a diagnostic tool for prelabor rupture of membranes. J Matern Fetal Neonatal Med 2018; 32:1965-1970. [PMID: 29295662 DOI: 10.1080/14767058.2017.1422712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The study aimed at assessment of the accuracy of the β-hCG test in vaginal washing fluid for diagnosis of prelabor rupture of membranes (PROM). PATIENTS AND METHODS Two groups of pregnant women from 17 to 38 weeks of gestation were recruited. The first group (PROM group) included 50 pregnant women with unequivocal PROM. The other group included 50 pregnant women with intact membranes. A sterile speculum examination was performed. If less than 5 cc was collected or no fluid found, 10 cc sterile saline was sprinkled on the vaginal wall and 5 cc were recollected in a sterile syringe. Two drops of collected fluid were used for qualitative testing of β-hCG. The remaining fluid was used for quantitative assessment of β-hCG. RESULTS The quantitative β-hCG test results were significantly higher in PROM group (median and range: 138.5 (23-475) versus 13 (1-55); the difference in medians and 95% CI: 105 (91-166); p value: <.001). The qualitative β-hCG test was positive in 42/50 (84%) of the PROM group, while it was negative in 50/50 (100%) of the intact membranes group. Areas under receiver operating characteristics (AUC) for both the quantitative and qualitative β-hCG tests were high (0.97, 95% CI: 0.91-0.99, p value: <.001 and .92, 95% CI: 0.84-0.96, p value: <.001, respectively). The suggested cut-off of β-hCG for the quantitative test was 32 mIU/ml. The sensitivity of quantitative and qualitative tests are: 94, 95% CI: 83.5-98.7% and 84, 95% CI: 70.9-92.8%, respectively. The specificity of quantitative and qualitative tests are: 94, 95% CI: 83.5-98.7% and 100, 95% CI: 92.9-100%, respectively. CONCLUSION β-hCG test (either quantitative or qualitative) in vaginal washing fluid can be used in the diagnosis of PROM in both preterm and term cases.
Collapse
Affiliation(s)
- Ashraf Eldaly
- a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - Eman Omran
- a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - Mohamed A Youssef
- a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - Ahmed Abdallah
- a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - Ahmed Metwally
- a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - Hisham Haggag
- a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.,b Department of Obstetrics and Gynecology , University of Würzburg , Würzburg , Germany
| | - Rasha Elkaffas
- c Department of Chemical Pathology , Cairo University , Cairo , Egypt
| |
Collapse
|
34
|
Lotfi G, Faraz S, Nasir R, Somini S, Abdeldayem RM, Koratkar R, Alsawalhi N, Ammar A. Comparison of the effectiveness of a PAMG-1 test and standard clinical assessment in the prediction of preterm birth and reduction of unnecessary hospital admissions. J Matern Fetal Neonatal Med 2017; 32:793-797. [DOI: 10.1080/14767058.2017.1391782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ghassan Lotfi
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Saima Faraz
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Razan Nasir
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Sreenisha Somini
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Rasha M. Abdeldayem
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Raghunandini Koratkar
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Nadia Alsawalhi
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| | - Abeer Ammar
- Department of Obstetrics and Gynecology, Latifa Hospital Dubai Health Authority, Dubai, United Arab Emirates
| |
Collapse
|
35
|
Bolotskikh V, Borisova V. Combined value of placental alpha microglobulin-1 detection and cervical length via transvaginal ultrasound in the diagnosis of preterm labor in symptomatic patients. J Obstet Gynaecol Res 2017; 43:1263-1269. [PMID: 28613021 PMCID: PMC5575556 DOI: 10.1111/jog.13366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 12/02/2022]
Abstract
AIM We aimed to evaluate the combined value of placental alpha microglobulin-1 (PAMG-1) and cervical length (CL) via transvaginal ultrasound for assessing risk of imminent spontaneous preterm delivery in patients presenting with threatened preterm labor (PTL). METHODS Clinical exam, PAMG-1 test, cardiotocography, and CL measurement via transvaginal ultrasound were performed on all patients meeting inclusion criteria. Ninety-nine patients at 22+0 -36+6 gestational weeks with the symptoms of PTL were included. The interval between sample collection and delivery was measured for each method. RESULTS Performance metrics were calculated for PAMG-1 test, CL < 25 mm, and contractions ≥ 8/h. The sensitivity, specificity, positive predictive value, and negative predictive value for the PAMG-1 test were 100%, 95%, 75%, 100% and 100%, 98%, 88%, 100% for 7 and 14 days, respectively; the respective values for CL < 25 mm were 83%, 59%, 22%, 96% and 79%, 59%, 24%, 94% for 7 and 14 days; and those for contractions ≥ 8/h were 42%, 38%, 8%, 83% and 43%, 38%, 10%, 80% for 7 and 14 days. Specificity for the PAMG-1 test was statistically significant (P < 0.001) in pairwise comparisons for all other methods. Patients were divided into four groups for analysis of PAMG-1 test performance as follows: CL < 15 mm (100%, 100%, 100%, 100% and 100%, 100%, 100%, 100% for 7 and 14 days, respectively); CL < 25 mm (100%, 94%, 83%, 100% and 100%, 97%, 92%, 100% for 7 and 14 days, respectively); CL of 15-30 mm (100%, 95%, 64%, 100% and 100%, 97%, 82%, 100% for 7 and 14 days, respectively); and CL ≥ 30 mm (100%, 100%, 100%, 100% and 100%, 100%, 100%, 100% for 7 and 14 days, respectively). CONCLUSION The use of the PAMG-1 test in patients with a CL of 15-30 mm is highly predictive of imminent spontaneous preterm delivery in women presenting with threatened PTL and could save hospital resources.
Collapse
Affiliation(s)
- Vyacheslav Bolotskikh
- North-Western Branch, Russian Academy of Medical Sciences, D.O. Ott Research Institute of Obstetrics and Gynecology, Saint Petersburg, Russia
| | - Vera Borisova
- North-Western Branch, Russian Academy of Medical Sciences, D.O. Ott Research Institute of Obstetrics and Gynecology, Saint Petersburg, Russia
| |
Collapse
|
36
|
Igbinosa I, Moore FA, Johnson C, Block JE. Comparison of rapid immunoassays for rupture of fetal membranes. BMC Pregnancy Childbirth 2017; 17:128. [PMID: 28446135 PMCID: PMC5406884 DOI: 10.1186/s12884-017-1311-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background Rupture of membranes (ROM) before the onset of uterine contractions, particularly in pregnancies less than 37 weeks gestational age, is a common diagnostic problem in obstetrical practice. Timely detection of ROM is vital to support gestational age-specific interventions to optimize perinatal outcomes and minimize the risk of serious complications such as preterm delivery, fetal distress and maternal/fetal infections. Rapid bedside immunoassay tests designed to detect amniotic fluid proteins in cervicovaginal fluids have emerged as valuable clinical tools to provide timely ROM diagnosis. Methods In this prospective observational study, two commercially-available immunoassay tests (ROM Plus®, AmniSure®) were evaluated concurrently in 111 pregnant women who presented with the chief complaint of ROM. Immunoassay results were compared to clinical parameters for determining ROM via comprehensive, retrospective clinical chart review. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Overall, diagnostic performance characteristics were robust and similar between ROM Plus® and AmniSure®, respectively: sensitivity (96.4 and 89.3%), specificity (98.8 and 100%), PPV (96.4 and 100%), NPV (98.8% and 96.5) and accuracy (98.2 and 97.3%). For term patients (≥37 weeks gestation), the sensitivities were 93.8 and 81.3% and specificities were 97.1 and 100% for ROM Plus® and AmniSure®, respectively. For preterm patients (<37 weeks gestation), both immunoassay tests provided exact concordance with clinical confirmation of ROM resulting in 100% diagnostic accuracy. Conclusions Both rapid immunoassay tests provided similarly excellent diagnostic accuracy for the rapid detection of ROM with only two discrepant results for ROM Plus® and three discrepant results for AmniSure® compared to clinical confirmation. The findings from this study recommend these tests for pregnant women presenting with suspected ROM to guide correct clinical management decisions to improve obstetrical and neonatal outcomes. Trial registration ClinicalTrials.gov, NCT02208011 (1 August 2014).
Collapse
Affiliation(s)
- Irogue Igbinosa
- Department of Obstetrics & Gynecology, Woman's Hospital, Louisiana State University Health Sciences, 500 Rue de la vie, Suite 414, Baton Rouge, LA, 70817, USA
| | - Ferney A Moore
- Department of Obstetrics & Gynecology, Woman's Hospital, Louisiana State University Health Sciences, 500 Rue de la vie, Suite 414, Baton Rouge, LA, 70817, USA
| | - Cheri Johnson
- Woman's Hospital, 100 Woman's Way, Baton Rouge, LA, 70817, USA
| | - Jon E Block
- , 2210 Jackson Street, Suite 401, San Francisco, CA, 94115, USA.
| |
Collapse
|
37
|
Eleje GU, Ezugwu EC, Eke AC, Ikechebelu JI, Ezeama CO, Ezebialu IU, Ojiegbe NO, Obiora CC, Okafor CI, Udigwe GO, Nwosu BO, Ezugwu FO. Accuracy and response time of dual biomarker model of insulin-like growth factor binding protein-1/ alpha fetoprotein (Amnioquick duo+) in comparison to placental alpha-microglobulin-1 test in diagnosis of premature rupture of membranes. J Obstet Gynaecol Res 2017; 43:825-833. [DOI: 10.1111/jog.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/04/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- George Uchenna Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynecology; University of Nigeria Teaching Hospital; Ituku-Ozalla Enugu Nigeria
| | - Ahizechukwu Chigoziem Eke
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Joseph Ifeanyichukwu Ikechebelu
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Chukwuemeka Okwudili Ezeama
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | | | | | | | | | - Gerald Okanandu Udigwe
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Betrand Obi Nwosu
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Frank O. Ezugwu
- Department of Obstetrics and Gynecology; ESUT Teaching Hospital; Parklane Enugu Nigeria
| |
Collapse
|
38
|
Di Renzo GC, Giardina I, Clerici G, Brillo E, Gerli S. Progesterone in normal and pathological pregnancy. Horm Mol Biol Clin Investig 2017; 27:35-48. [PMID: 27662646 DOI: 10.1515/hmbci-2016-0038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Abstract
Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. It has been proposed and extensively used in the treatment of different gynecological pathologies as well as in assisted reproductive technologies and in the maintenance of pregnancy. Called "the pregnancy hormone", natural progesterone is essential before pregnancy and has a crucial role in its maintenance based on different mechanisms such as: modulation of maternal immune response and suppression of inflammatory response (the presence of progesterone and its interaction with progesterone receptors at the decidua level appears to play a major role in the maternal defense strategy), reduction of uterine contractility (adequate progesterone concentrations in myometrium are able to counteract prostaglandin stimulatory activity as well as oxytocin), improvement of utero-placental circulation and luteal phase support (it has been demonstrated that progesterone may promote the invasion of extravillous trophoblasts to the decidua by inhibiting apoptosis of extravillous trophoblasts). Once the therapeutic need of progesterone is established, the key factor is the decision of the best route to administer the hormone and the optimal dosage determination. Progesterone can be administered by many different routes, but the most utilized are oral, the vaginal and intramuscular administration. The main uses of progesterone are represented by: threatened miscarriage, recurrent miscarriage and preterm birth (in the prevention strategy, as a tocolytic agent and also in the maintenance of uterine quiescence).
Collapse
|
39
|
Eleje GU, Ezugwu EC, Eke AC, Ikechebelu JI, Obiora CC, Ojiegbe NO, Ezebialu IU, Ezeama CO, Nwosu BO, Udigwe GO, Okafor CI, Ezugwu FO. Comparison of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) and traditional clinical assessment for diagnosing premature rupture of fetal membranes. J Perinat Med 2017; 45:105-112. [PMID: 27855117 DOI: 10.1515/jpm-2016-0204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) compared with traditional clinical assessment (TCA) of nitrazine, ferning and pooling for the diagnosis of prelabor rupture of membranes (PROM). METHODS A double-blinded, multicenter clinical study was conducted between February 2015 and August 2015 among pregnant women presenting with symptoms or features suggestive of PROM between 24 and 42 weeks gestation. Confirmation of PROM was done after delivery based on the presence of any two of these criteria: delivery within 48 h to 7 days, evidence of chorioamnionitis, membranes explicitly ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Sensitivity, specificity and accuracy were outcome measures assessed. RESULTS Two hundred and thirty-six women were recruited. Three women were excluded from the final analysis due to lack of follow-up data and failure to meet inclusion criteria. Two hundred and thirty-three women had complete data for analysis. The specificity and sensitivity values for TCA were 76.2% and 85.2%, which were lower than those of Amnioquick duo+, which were 97.6% and 97.9%, respectively. The accuracy of Amnioquick duo+ was statistically higher (97.9% vs. 83.7%; RR=1.17; 95%CI=1.10-1.24; P<0.001). In equivocal cases (pooling=negative), the accuracy of Amnioquick duo+ vs. TCA was 98.4% vs. 69.4% (RR=1.42; 95%CI=1.20-1.68; P<0.001) at ≥34 weeks gestation and 100.0% vs. 71.4% (RR=1.40; 95%CI=1.07-1.83; P=0.021) at <34 weeks gestation. CONCLUSION The performance matrix of Amnioquick duo+® was superior to that of TCA for diagnosing PROM even in equivocal cases.
Collapse
|
40
|
Hadzi-Lega M, Maier JT, Helmer H, Hellmeyer L, Markova AD, Poposka A. Comparison of PAMG-1 and phIGFBP-1 Tests for the Prediction of Preterm Delivery in Patients with Preterm Labor. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojog.2017.73037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
41
|
Abstract
Cervical-vaginal fluid (CVF) is a complex biological fluid that hydrates the mucosa of the lower female reproductive system. In-depth proteomic and biochemical studies on CVF have revealed that it contains large amounts of endogenous proteases and protease inhibitors, including an abundance of several members of the tissue kallikrein-related peptidase (KLK) family. Despite their ubiquitous presence in human tissues and fluids, KLK expression levels vary considerably, with maximum expression observed in reproduction-related tissues and fluids. The roles of KLKs in the lower female reproductive system are not fully understood. The activation of KLKs in CVF is dependent on pH and various modes of KLK regulation in the vagina exist. KLKs have been postulated to have roles in physiological functions related to antimicrobial processes, vaginal and cervical epithelial desquamation, sperm transport, and the processing of fetal membranes as observed in preterm premature rupture of membranes. Increased understanding of the functional roles of KLKs in the lower female reproductive system could lead to new diagnostic and therapeutic modalities for conditions such as vaginal infections and vaginal atrophy.
Collapse
|
42
|
A Sanitary Pad for Self-Assessment of Rupture of Membranes. Obstet Gynecol 2016; 128:331-336. [PMID: 27400003 DOI: 10.1097/aog.0000000000001515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multistep immunoassay kits for the diagnosis of rupture of membranes are relatively complex and are not designed to be used by pregnant women themselves. These kits require procedural steps of specimen extraction and preparation. We evaluated the ability of a sanitary pad containing a qualitative immunoassay for alpha-fetoprotein (AFP) to serve as a one-step self-test to detect amniotic fluid leakage. TECHNIQUE Four sets of pads were evaluated. The pads in the study set were worn by 288 pregnant women with confirmed rupture of membranes. Three controls were evaluated: 1) pads worn by 93 pregnant women with intact membranes, 2) additional pads instilled with urine specimens obtained from the 381 women described previously (study set plus control set 1), and 3) pads instilled with semen collected from 40 men. EXPERIENCE All 288 pads that absorbed amniotic fluid had positive results. Approximately half of the pads absorbed with normal vaginal discharge had a sufficient amount to yield valid results, which were all negative. All 381 pads with instilled urine and all 40 pads with instilled semen had negative results. CONCLUSION An immunoassay for AFP, embedded in a pad, appears to be a feasible and reproducible self-test for the detection of rupture of membranes.
Collapse
|
43
|
McQuivey RW, Block JE. ROM Plus(®): accurate point-of-care detection of ruptured fetal membranes. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:69-74. [PMID: 27274316 PMCID: PMC4869842 DOI: 10.2147/mder.s106106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Accurate and timely diagnosis of rupture of fetal membranes is imperative to inform and guide gestational age-specific interventions to optimize perinatal outcomes and reduce the risk of serious complications, including preterm delivery and infections. The ROM Plus is a rapid, point-of-care, qualitative immunochromatographic diagnostic test that uses a unique monoclonal/polyclonal antibody approach to detect two different proteins found in amniotic fluid at high concentrations: alpha-fetoprotein and insulin-like growth factor binding protein-1. Clinical study results have uniformly demonstrated high diagnostic accuracy and performance characteristics with this point-of-care test that exceeds conventional clinical testing with external laboratory evaluation. The description, indications for use, procedural steps, and laboratory and clinical characterization of this assay are presented in this article.
Collapse
Affiliation(s)
- Ross W McQuivey
- Clinical Affairs, Clinical Innovations, Salt Lake City, UT, USA
| | - Jon E Block
- Independent Clinical Consultant, San Francisco, CA, USA
| |
Collapse
|
44
|
Lamont CD, Jørgensen JS, Lamont RF. The safety of tocolytics used for the inhibition of preterm labour. Expert Opin Drug Saf 2016; 15:1163-73. [DOI: 10.1080/14740338.2016.1187128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Callum D. Lamont
- Department of Medical Education, Lincoln County Hospital, Lincoln, UK
| | - Jan Stener Jørgensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Ronald F. Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
| |
Collapse
|
45
|
Rogers LC, Scott L, Block JE. Accurate Point-of-Care Detection of Ruptured Fetal Membranes: Improved Diagnostic Performance Characteristics with a Monoclonal/Polyclonal Immunoassay. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2016; 10:15-8. [PMID: 27199579 PMCID: PMC4862745 DOI: 10.4137/cmrh.s38386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Accurate and timely diagnosis of rupture of membranes (ROM) is imperative to allow for gestational age-specific interventions. This study compared the diagnostic performance characteristics between two methods used for the detection of ROM as measured in the same patient. METHODS Vaginal secretions were evaluated using the conventional fern test as well as a point-of-care monoclonal/polyclonal immunoassay test (ROM Plus®) in 75 pregnant patients who presented to labor and delivery with complaints of leaking amniotic fluid. Both tests were compared to analytical confirmation of ROM using three external laboratory tests. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS Diagnostic performance characteristics uniformly favored ROM detection using the immunoassay test compared to the fern test: sensitivity (100% vs. 77.8%), specificity (94.8% vs. 79.3%), PPV (75% vs. 36.8%), NPV (100% vs. 95.8%), and accuracy (95.5% vs. 79.1%). CONCLUSIONS The point-of-care immunoassay test provides improved diagnostic accuracy for the detection of ROM compared to fern testing. It has the potential of improving patient management decisions, thereby minimizing serious complications and perinatal morbidity.
Collapse
Affiliation(s)
| | | | - Jon E Block
- Independent Clinical Consultant, San Francisco, CA, USA
| |
Collapse
|
46
|
Barišić T, Mandić V, Tomić V, Zovko A, Novaković G. Antibiotic prophylaxis for premature rupture of membranes and perinatal outcome. J Matern Fetal Neonatal Med 2016; 30:580-584. [PMID: 27109595 DOI: 10.1080/14767058.2016.1178228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the perinatal outcomes of newborns after premature rupture of membranes (PROM) at the term according to the timing of initial antibiotic administration. MATERIAL AND METHODS This is a retrospective, cohort study investigating perinatal outcomes of newborns in pregnant women with PROM at the term who were treated with ampicillin within or after 6 h from the PROM. Statistical analysis was performed using Student's t-test for continuous variables test and chi-square or for categorical data. RESULTS The study involved 144 pregnant women with PROM and their newborns, a lower number received antibiotics after birth were in the group who received antibiotics within 6 h of PROM (26.4% versus 73.6%), the mediane values of C-reactive protein were lower (3.0 ± 2.9 mg/l versus 6.1 ± 7.3 mg/l; p < 0.001), their newborns remained shorter in hospital after birth (4.13 versus 4.94; p =0.023) and time between PROM and delivery was shorter (p < 0.001). In group who received prophylactic antibiotics after 6 h of the PROM had significantly higher frequency of infection in newborns (45.3% versus 15.4%), and higher number of chorioamnionitis (9.72% versus 3,47%) compared to group who received antibiotics within 6h. CONCLUSION Timely usage of antibiotic prophylaxis and shorter time between PROM and delivery improve perinatal outcomes.
Collapse
Affiliation(s)
- Tatjana Barišić
- a Department of Obstetrics and Gynecology University Clinical Hospital Mostar , Mostar , Bosnia and Herzegovina
| | - Vjekoslav Mandić
- a Department of Obstetrics and Gynecology University Clinical Hospital Mostar , Mostar , Bosnia and Herzegovina
| | - Vajdana Tomić
- a Department of Obstetrics and Gynecology University Clinical Hospital Mostar , Mostar , Bosnia and Herzegovina
| | - Ana Zovko
- c Health Centre Mostar , Mostar , Bosnia and Herzegovina
| | - Gorjana Novaković
- b Departmant of Neonatology University Clinical Hospital Mostar , Mostar , Bosnia and Herzegovina , and
| |
Collapse
|
47
|
Lemos AP, Feitosa FEDL, Araujo Júnior E, Feitosa HN, Pereira JGD, Mota RMS, Carvalho FHC. Delivery prediction in pregnant women with spontaneous preterm birth using fetal adrenal gland biometry. J Matern Fetal Neonatal Med 2016; 29:3756-61. [PMID: 26820835 DOI: 10.3109/14767058.2016.1147556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the prediction of delivery within 7 days in pregnant women who showed symptoms of spontaneous preterm birth (PB) by means of fetal adrenal gland biometry and to compare these predictions with the cervical length (CL) measurement. METHODS We performed a prospective cross-sectional study with 53 pregnant women between 24 and 36 weeks of gestation. An ultrasound exam was performed for each participant to obtain the CL measurement (transvaginal route) and fetal adrenal gland biometry on day 1 of their hospital admission because of symptoms of spontaneous PB. The main outcome measure was the time between the ultrasound exam and delivery, which was classified into two groups: delivery ≤7 days and delivery >7 days. A receiver operating characteristics (ROC) curve was performed to define the cutoffs for sensitivity and specificity. RESULTS The prevalence of delivery within 7 days was 35.8%, which showed a statistically significant difference from the depth of the central zone of the fetal adrenal gland (p = 0.036). The cutoff for the depth of the central zone of the fetal adrenal gland was 7.2 mm (sensitivity 66.7%, specificity 61.8% and accuracy 63.5%). These values were not significantly different than the cutoffs for cervical length measurement: 20 mm (p = 0.267) and 9 mm (p = 0.118). CONCLUSION The biometry for the central zone of the fetal adrenal gland predicted delivery within 7 days in pregnant women with spontaneous PB and had a predictive accuracy similar to that of CL measurement.
Collapse
Affiliation(s)
- Aline Pinto Lemos
- a Fetal Medicine Service - Maternidade-Escola Assis Chateaubriand, Federal University of Ceará (UFC) , Fortaleza - CE , Brazil and
| | | | - Edward Araujo Júnior
- b Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo - SP , Brazil
| | - Helvécio Neves Feitosa
- a Fetal Medicine Service - Maternidade-Escola Assis Chateaubriand, Federal University of Ceará (UFC) , Fortaleza - CE , Brazil and
| | - João Gabriel Damasceno Pereira
- a Fetal Medicine Service - Maternidade-Escola Assis Chateaubriand, Federal University of Ceará (UFC) , Fortaleza - CE , Brazil and
| | - Rosa Maria Salani Mota
- a Fetal Medicine Service - Maternidade-Escola Assis Chateaubriand, Federal University of Ceará (UFC) , Fortaleza - CE , Brazil and
| | | |
Collapse
|
48
|
Amabebe E, Reynolds S, Stern VL, Parker JL, Stafford GP, Paley MN, Anumba DOC. Identifying metabolite markers for preterm birth in cervicovaginal fluid by magnetic resonance spectroscopy. Metabolomics 2016; 12:67. [PMID: 27065760 PMCID: PMC4783437 DOI: 10.1007/s11306-016-0985-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/17/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Preterm birth (PTB) may be preceded by changes in the vaginal microflora and metabolite profiles. OBJECTIVES We sought to characterise the metabolite profile of cervicovaginal fluid (CVF) of pregnant women by 1H NMR spectroscopy, and assess their predictive value for PTB. METHODS A pair of high-vaginal swabs was obtained from pregnant women with no evidence of clinical infection and grouped as follows: asymptomatic low risk (ALR) women with no previous history of PTB, assessed at 20-22 gestational weeks, g.w., n = 83; asymptomatic high risk (AHR) women with a previous history of PTB, assessed at both 20-22 g.w., n = 71, and 26-28 g.w., n = 58; and women presenting with symptoms of preterm labor (PTL) (SYM), assessed at 24-36 g.w., n = 65. Vaginal secretions were dissolved in phosphate buffered saline and scanned with a 9.4 T NMR spectrometer. RESULTS Six metabolites (lactate, alanine, acetate, glutamine/glutamate, succinate and glucose) were analysed. In all study cohorts vaginal pH correlated with lactate integral (r = -0.62, p < 0.0001). Lactate integrals were higher in the term ALR compared to the AHR (20-22 g.w.) women (p = 0.003). Acetate integrals were higher in the preterm versus term women for the AHR (20-22 g.w.) (p = 0.048) and SYM (p = 0.003) groups; and was predictive of PTB < 37 g.w. (AUC 0.78; 95 % CI 0.61-0.95), and delivery within 2 weeks of the index assessment (AUC 0.84; 95 % CI 0.64-1) in the SYM women, whilst other metabolites were not. CONCLUSION High CVF acetate integral of women with symptoms of PTL appears predictive of preterm delivery, as well as delivery within 2 weeks of presentation.
Collapse
Affiliation(s)
- Emmanuel Amabebe
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, South Yorkshire UK
| | - Steven Reynolds
- Academic Unit of Radiology, Department of Cardiovascular Science, University of Sheffield, Sheffield, South Yorkshire UK
| | - Victoria L. Stern
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, South Yorkshire UK
| | - Jennifer L. Parker
- Integrated BioSciences, School of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire UK
| | - Graham P. Stafford
- Integrated BioSciences, School of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire UK
| | - Martyn N. Paley
- Academic Unit of Radiology, Department of Cardiovascular Science, University of Sheffield, Sheffield, South Yorkshire UK
| | - Dilly O. C. Anumba
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, South Yorkshire UK
- Academic Unit of Reproductive and Developmental Medicine-Obstetrics and Gynecology, Department of Human Metabolism, University of Sheffield, 4th Floor, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF UK
| |
Collapse
|
49
|
Lee J, Romero R, Kim SM, Chaemsaithong P, Yoon BH. A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM. J Matern Fetal Neonatal Med 2015; 29:2727-37. [PMID: 26441216 DOI: 10.3109/14767058.2015.1103729] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine whether a new antibiotic regimen could reduce the frequency of intra-amniotic inflammation/infection in patients with preterm PROM. STUDY DESIGN This retrospective cohort study was conducted to evaluate the effect of antibiotics on the frequency of intra-amniotic inflammation/infection based on the results of follow-up transabdominal amniocenteses from 89 patients diagnosed with preterm PROM who underwent serial amniocenteses. From 1993-2003, ampicillin and/or cephalosporins or a combination was used ("regimen 1"). A new regimen (ceftriaxone, clarithromycin and metronidazole) was used from 2003-2012 ("regimen 2"). Amniotic fluid was cultured and matrix metalloproteinase-8 (MMP-8) concentrations were measured. RESULTS (1) The rates of intra-amniotic inflammation and intra-amniotic inflammation/infection in patients who received regimen 2 decreased during treatment from 68.8% to 52.1% and from 75% to 54.2%, respectively. In contrast, in patients who received regimen 1, the frequency of intra-amniotic inflammation and infection/inflammation increased during treatment (31.7% to 55% and 34.1% to 58.5%, respectively); and (2) intra-amniotic inflammation/infection was eradicated in 33.3% of patients who received regimen 2, but in none who received regimen 1. CONCLUSION The administration of ceftriaxone, clarithromycin and metronidazole was associated with a more successful eradication of intra-amniotic inflammation/infection and prevented secondary intra-amniotic inflammation/infection more frequently than an antibiotic regimen which included ampicillin and/or cephalosporins in patients with preterm PROM.
Collapse
Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .,f Department of Obstetrics and Gynecology , Seoul Metropolitan Government --Seoul National University Boramae Medical Center , Seoul , Republic of Korea , and
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
| |
Collapse
|
50
|
Lecerf M, Vardon D, Morello R, Lamendour N, Dreyfus M. Comparaison des performances diagnostiques de deux tests de rupture prématurée des membranes (IGFBP-1/PAMG-1) en pratique clinique. ACTA ACUST UNITED AC 2015; 44:832-9. [DOI: 10.1016/j.jgyn.2014.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 09/28/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
|