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Role of matrix metalloproteinases in preterm labour. Extracellular matrix homeostasis is a key process in the maintenance of the tensile strength of the amniochorion. This tensile strength guarantees the role of the membranes as a physical and functional boundary for the fetus during human pregnancy. Pathological rupture of these structures before 37 completed weeks of gestation is known as preterm prelabour rupture of the membranes (PPROM) and it is a major cause of spontaneous preterm labour (...) and preterm birth. A mechanism involving the activation of matrix metalloproteinases (MMP)-9, a 92-kDa type IV collagenase, as an essential mediator of tissue damage is under investigation. The proposed mechanism involves the abnormal expression and activity of MMP-9 with subsequent connective tissue degradation taking place at a time that does not synchronise with other events of labour. The local physiological signal by amniochorion cells to induce MMP-9 expression is not known, but bacterial products
preterm live-born singletons (33-34 weeks) and 618 unmatched full-term controls (39-40 weeks).Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, prematurerupture of membranes, idiopathic preterm labor and other causes.Odds (...) to very preterm delivery. A history of induced abortion was associated with an increased risk of prematurerupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (< 28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension.Previous induced abortion was associated with an increased risk of very preterm delivery. The strength
controls.Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, prematurerupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms.Odds ratios for very preterm birth for low to moderate (1-9 cigarettes/day) and heavy (>/=10 (...) The complex relationship between smoking in pregnancy and very preterm delivery. Results of the Epipage study. To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth.Case-control study (the French Epipage study).Regionally defined population of births in France.Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term
was increased among moderate and heavy smokers [ORs 1.9 (95% CI 1.0-3.6) and 2.6 (95% CI 1.1-1.6), respectively]. These risks remained essentially unchanged in women without an identifiable cause of preterm labor ('idiopathic preterm labor'). Smoking was also associated with dose-dependent increases in risks of preterm birth due to pretermprematurerupture of membranes and late pregnancy bleedings. There was no association between smoking and risk of very preterm birth caused by hypertensive (...) diseases.Smoking increases the risk of very preterm birth caused by preterm labor (including idiopathic preterm labor), pretermprematurerupture of membranes, and late pregnancy bleedings.
assessed the association between mode of delivery, gestational age (GA), calendar year, maternal condition, and institutional policies on infant mortality outcome.At 23-25 weeks, 38% of infants (range: 34-69%) were delivered by cesarean section (CS), while at 26-27 weeks, 66% (59-80%) were delivered by CS. The CS rate for fetal or maternal indications was 98% in cases of pre-eclampsia/eclampsia, 42% for prematurerupture of membranes (PROM), 68% for hemorrhage, 76% for PROM+hemorrhage, 56% for breech (...) Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis. The aim of this study was to analyse infant mortality among infants born extremely preterm in relation to mode of delivery, maternal diagnosis, and different institutional policies.We conducted a national tertiary health care center study using Swedish Medical Birth Register (MBR) data from 1990 to 2002, to examine the 2,094 live births of infants at 23+0 to 27+6 weeks gestation. We
Risk of preterm delivery in relation to maternal low birth weight. We examined the relationship between maternal low birth weight and preterm delivery risk.Information concerning maternal birth weight was collected during in-person interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Preterm delivery cases were studied in aggregate, in subgroups (spontaneous preterm labor, pretermprematurerupture of membranes, medically induced preterm (...) delivery, moderate preterm delivery [gestational age at delivery 34-36 weeks], and early preterm delivery [gestational age at delivery<34 weeks]).After adjusting for confounders, women weighing<2,500 g at birth had a 1.54-fold increased risk of preterm delivery versus women weighing=2,500 g (95% CI 0.97-2.44). Maternal low birth weight was associated with a 2-fold increased risk of spontaneous preterm delivery (95% CI 1.03-3.89), but weakly associated with pretermprematurerupture of membranes
to preterm birth or prematurerupture of membranes. (...) /-238G/-308G (multivariable odds ratio, 2.4; P = .04), and IL4 -509C/C (multivariable odds ratio, 3.4; P = .02), and the presence of MBL2 codon 54Asp (multivariable odds ratio, 2.3; P = .02) were associated independently with preterm birth at <29 weeks of gestation. Homozygosity for IL10 -1082G/-819C/-592C haplotype (multivariable odds ratio, 1.9; P = .02) was more common in women with pretermprematurerupture of membranes.Polymorphisms in immunoregulatory genes may influence susceptibility
. The risk of pretermprematureruptures of the membranes (PROM), preterm labor, and other reasons for preterm delivery was also assessed.Previous spontaneous abortions and missed abortions were associated with increased risks of preterm delivery, and the risks increased with severity of preterm delivery. Previous pregnancy loss increased the risk of preterm PROM and preterm labor foremost in deliveries before 32 weeks, but was not associated with other reasons of very preterm delivery.Our results (...) Previous pregnancy loss: risks related to severity of preterm delivery. The purpose of this study was to examine the association between previous pregnancy losses and subsequent risk of preterm delivery.A population-based Swedish study including information on all births and women's hospital admissions for pregnancy loss (n = 601,883) in Sweden between 1987 and 2000 was performed. The risk of preterm delivery after a previous pregnancy loss was estimated using logistic regression models
). In the multivariate analysis, an IL-6 level 107.7 pg/mL or greater (determined by receiver operating curve analysis) remained a significant independent risk factor for PVL (OR 30.3, 95% CI 4.5-203.6).Umbilical cord IL-6 levels are higher in preterm infants born after spontaneous preterm labor or prematurerupture of membranes. Elevated IL-6 levels are associated with an increased risk for SIRS, PVL, and NEC in infants born at less than 32 weeks' gestation. (...) Umbilical cord plasma interleukin-6 concentrations in preterm infants and risk of neonatal morbidity. This study was undertaken to evaluate the association between umbilical cord interleukin-6 (IL-6) levels and neonatal morbidity in infants born at less than 32 weeks' gestation.Umbilical cord plasma IL-6 levels and neonatal outcomes were assessed in 309 infants born between 24 weeks and 0 days' and 31 weeks and 6 days' gestation.Mean IL-6 levels were higher in spontaneous (n = 193, 355 +/- 1822
Placental abruption in term and preterm gestations: evidence for heterogeneity in clinical pathways. To estimate the magnitude of associations of acute and chronic processes with abruption in preterm and term gestations.A retrospective cohort study was performed using data on women that delivered singleton live births and stillbirths at 20 or more weeks of gestation in the United States, 1995-2002 (n = 30,378,902). Rates of 1) acute-inflammation-associated clinical conditions (prematurerupture (...) of membranes and intrauterine infection); 2) chronic processes associated with vascular dysfunction or chronic inflammation (chronic and pregnancy-induced hypertension, preexisting or gestational diabetes, small for gestational age, and maternal smoking); and 3) both acute and chronic processes, were examined among women with and without abruption. Rates were examined separately among preterm (< 37 weeks) and term births, with adjustment for confounders. Relative risk (RR) for aforementioned groups
Temporal trends of preterm birth subtypes and neonatal outcomes. To describe temporal trends of preterm birth subtypes, neonatal morbidity, and hospital neonatal mortality.A database of 1.7 million births that occurred in 51 maternity hospitals in Latin America from 1985 to 2003 was studied. Subgroups of preterm births were classified according to the presence or absence of maternal medical or obstetric complications, spontaneous labor, preterm labor after prematurerupture of membranes (...) , induction of labor, or elective cesarean. Outcomes studied, for different periods, were prevalence of small for gestational age, neonatal morbidity, and neonatal mortality.Spontaneous preterm labor without maternal complications was the most frequent subtype of preterm birth (60%), followed by prematurerupture of membranes without maternal complications. Preterm births due to elective induction and delivery by elective cesarean increased markedly in the last 20 years, from 10% in 1985-1990 to 18.5
, and pretermprematurerupture of membranes were the primary outcomes that were examined.Bacterial vaginosis, infection with Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma hominis, Neisseria gonorrhoeae, and group B streptococcal colonization were more common among black women (P < .01) than among comparators. Preterm birth occurred more often among black women with infections that were being studied (20.4%), compared with uninfected black women (9.5%; relative risk, 2.2; 95% CI, 1.1-4.1). Up (...) to 42% of preterm births among black women were attributable to the presence of bacterial vaginosis, T vaginalis, or C trachomatis alone or in combinations. The risk for preterm birth among infected black women who received Centers for Disease Control and Prevention recommended treatment was reduced significantly (relative risk, 0.16; 95% CI, 0.04-0.66).Black women have increased risks of prematurity that are associated with prevalent reproductive tract infections during pregnancy. Preterm birth
-for-gestational-age birth, fetal distress, placental abruption, placenta previa, unexplained vaginal bleeding, pregestational and gestational diabetes, renal disease, Rh sensitization, and congenital malformations. We examined the association between each of the aforementioned conditions and risk of medically indicated preterm birth at less than 35 weeks. Medically indicated preterm birth was defined as a labor induction or a prelabor cesarean in the absence of prematurerupture of membranes at preterm (...) Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth. The objective of the study was to evaluate the extent to which maternal and fetal conditions necessitate medically indicated preterm birth.A population-based, retrospective, cohort study of women who delivered a singleton live birth at 20 weeks or longer in Missouri, 1989 to 1997 was performed (n = 684,711). Maternal-fetal conditions that necessitated iatrogenic preterm birth included preeclampsia, small
Association of maternal IL-1 receptor antagonist intron 2 gene polymorphism and preterm birth. This study was undertaken to determine whether the interleukin-1 receptor antagonist (IL-1RN) variable number tandem repeat polymorphism is associated with preterm birth.A case-control study was performed. Cases (n = 95) delivered before 37 weeks after preterm labor (PTL) or pretermprematurerupture of membranes (PPROM) and controls (n = 105) delivered after 37 weeks. Maternal DNA was genotyped (...) copy of the IL-1RN allele 2 appears to be associated with increased risk of preterm birth.
intraventricular hemorrhage, periventricular leukomalacia (PVL), and combined poor short-term outcomes (death, severe intraventricular hemorrhage, and PVL).Of the 397 infants who met enrollment criteria, 44% were born vaginally and 56% by cesarean delivery. The proportion of multiparous, breech presentation and prolonged rupture of membranes was significantly different between groups. For infants weighing less than 751 g, the risks of severe intraventricular hemorrhage (41% versus 22%; odds ratio [OR] 2.79, 95 (...) The impact of vaginal delivery in premature infants weighing less than 1,251 grams. To evaluate whether mode of delivery is a predictor of poor short-term outcome at different birth weight categories in very low birth weight infants.This study examined a cohort of infants weighing less than 1,251 g born at 2 perinatal centers from January 1, 2000, to December 31, 2003. Outborn infants or those with major anomalies were excluded from the study. Outcome variables included death, severe
and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out for singletons and generalized estimating equation models used for twins.The proportion of cerebral palsy was 8% in singletons and 9% in twins. For singletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-6.7), pretermprematurerupture of membranes (PPROM) with short latency (adjusted OR 4.9, 95% CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7 (...) Prenatal risk factors for cerebral palsy in very preterm singletons and twins. To identify the main prenatal risk factors for cerebral palsy in very preterm singletons and twins.The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83% of the surviving children). The risk factors studied were pregnancy complications
Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Despite the recent increase in preterm birth in the United States, trends in preterm birth subtypes have not been adequately examined. We examined trends in preterm birth among singletons following rupturedmembranes, medical indications, and spontaneous preterm birth and evaluated the impact of these trends on perinatal mortality.A population-based, retrospective cohort study comprising (...) % confidence interval 14-16%) among blacks from 18.5% to 16.2% between 1989 and 2000. Among whites, preterm birth following rupturedmembranes declined by 23%, medically indicated preterm birth increased by 55%, and spontaneous preterm birth increased by 3%. Among blacks, preterm birth following rupturedmembranes declined by 37%, medically indicated preterm birth increased by 32%, and spontaneous preterm birth decreased by 27%. The largest decline in perinatal mortality among whites was associated
in selected patients, but has been proven to be ineffective for vaginal colonization with organisms such as Ureaplasma urealyticum and group B streptococcus. Large well-designed trials have shown that the routine administration of antibiotics to women with preterm labor and intact membranes is not beneficial; however, antibiotic regimens including macrolides are recommended for pretermprematurerupture of the membranes.Large well-designed trials have shown that the routine administration of antibiotics (...) to women with preterm labor and intact membranes is not beneficial; however, antibiotic regimens that include macrolides are recommended for pretermprematurerupture of the membranes.
A polymorphism in the promoter region of TNF and bacterial vaginosis: preliminary evidence of gene-environment interaction in the etiology of spontaneous preterm birth. The rarer of 2 alleles of a polymorphism in the promoter of the tumor necrosis factor alpha gene (TNF) has been associated with spontaneous preterm birth following pretermprematurerupture of the fetal membranes in some populations. The aim of this study was to assess if the presence of symptomatic bacterial vaginosis amplifies (...) the risk of spontaneous preterm birth in those with a "susceptible" TNF genotype.A case-control study was performed at our institution. Cases (n=125) were defined as women who delivered before 37 weeks as a result of rupturedmembranes or preterm labor, while control subjects (n=250) were defined as women who delivered after 37 weeks. DNA was collected from maternal blood and analyzed for the TNF genotype. Information on symptomatic bacterial vaginosis and other risk factors for preterm birth
delivery after idiopathic preterm labour, pretermprematurerupture of membranes and ante-partum haemorrhage, but not preterm delivery after maternal hypertension. The strength of the association increased with decreasing gestational age at birth.Identifying subgroups of preterm births on the basis of the complications involved in delivery increases our understanding of the mechanisms by which previous induced abortion affects subsequent pregnancy outcomes. (...) History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey. The objective of this study was to investigate the relationship between history of induced abortion and preterm delivery in various parts of Europe, and according to the main cause of preterm birth.We used data from a case-control survey, the EUROPOP study; 2938 preterm births and 4781 controls at term from ten European countries were included. Based on national statistics, we