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PubMed1992

Listeria monocytogenes. The role of transabdominal amniocentesis in febrile patients with preterm labor.

Two women with preterm labor and intraamniotic infection with Listeria Monocytogenes are presented. In both patients, the prenatal diagnosis of Listeriosis was made by transabdominal amniocentesis. The immediate prominent observation was meconium staining of the amniotic fluid. We propose that an amniocentesis should be performed in women with premature labor and fever. If the amniotic fluid is meconium stained and the Gram stain examination reveals Gram positive rods, Listeria Monocytogenes should be suspected and the patient should be treated accordingly until the culture results are obtained.

Adult↗
PubMed2006

Barusiban, an effective long-term treatment of oxytocin-induced preterm labor in nonhuman primates.

Preterm labor (PTL) affects up to 25% of human pregnancies in developing countries, but there are few therapeutic options. Based on the key role of oxytocin (OXT) in labor and parturition, OXT antagonists are a potentially useful class of drugs for PTL. Barusiban is a new selective, potent, and long-acting OXT receptor antagonist. In this study barusiban was given by continuous i.v. infusion to monkeys during the last 3 wk of pregnancy; the monkeys were also given daily doses of OXT to induce uterine contractions and simulate PTL. Barusiban effectively suppressed OXT-induced PTL-like contractions and prevented early delivery. In contrast, fenoterol (a beta2-adrenoceptor [beta2-AR] agonist used as a comparative control) did not inhibit uterine contractions in this model. Barusiban was particularly effective in maintaining low intrauterine pressure (IUP) near the end of pregnancy, which is when IUP in both OXT controls and fenoterol-treated females increased substantially. Although barusiban delayed the onset of labor, it did not prevent normal delivery. These data demonstrate the safety and efficacy of barusiban in reducing uterine contractility in response to repeated OXT challenge, and suggest that barusiban may be therapeutically effective in long-term treatment of PTL.

Adrenergic beta-Agonists↗
PubMed2001

The diagnosis and management of preterm labor.

Accurate diagnosis of preterm labor remains a problematic issue. New techniques such as transvaginal cervical sonography and fetal fibronectin are increasingly important in diagnosis and intervention planning. Neither test can, at present, be recommended for screening of the general population since there is no effective intervention for a positive test. Future directions in research include development of new tocolytic agents such as COX-2 inhibitors and clarification of the best use of adjunctive therapies such as betamethasone for lung maturity.

Bed Rest↗
PubMed1982

Premature rupture of membranes and spontaneous preterm labor: maternal endometritis risks.

Preterm and term deliveries were analyzed at The Johns Hopkins Hospital from January 1, 1976, through December 31, 1977, to determine maternal infection risks associated with premature rupture of the membranes (PROM). Gravidas who delivered preterm infants demonstrated an increased incidence of endometritis with or without PROM. The risk of endometritis attributable solely to PROM was insignificant compared with the risk attributable to preterm delivery. These findings implicate infection in the mechanism of preterm labor, with or without PROM.

Cesarean Section↗
PubMedDate not supplied

Early detection of preterm labor: ambulatory home monitoring of uterine activity.

Most women who experience preterm labor cannot receive long-term tocolysis mainly because of belated diagnosis. To detect excessive uterine contractions, an ambulatory tocodynamometer was developed. Sixty-two women, at high risk for preterm labor, monitored uterine activity between 20 and 36 weeks' gestation daily for a total of 200 minutes per day. Twenty-nine women (47%) had episodes of preterm labor. All the episodes were diagnosed by the device, and tocolysis was begun. The mean gestational age at which diagnosis was made was 28 +/- 2 (mean +/- SD) weeks, and the mean time gained in utero was 7.5 +/- 2.6 weeks. The data indicate that ambulatory home monitoring may represent a new and effective means for accurate and early diagnosis of preterm labor.

Female↗
PubMed1998

Ambulatory management of preterm labor.

The care of women with preterm labor has focused predominantly on inpatient therapy: tocolysis, antibiotics, and steroid administration. The emphasis is slowly but surely shifting to secondary prevention and outpatient therapy. Our goal should be toward primary prevention of preterm labor in all women. Then and only then will a true reduction in spontaneous prematurity rates be seen.

Ambulatory Care↗
PubMed1996

[Treatment of preterm labor with ritodrine].

OBJECTIVE: To investigate the treatment of preterm labor with the beta-adrenergic agonist ritodrine. METHODS: 126 women with preterm labor were randomly assigned to intravenous infusion of ritodrine or magnesium sulfate treatment. Using minimal effective dosage for inhibition of uterine activity, terminating therapy on time, and repeating the i.v. infusion if contraction restarted were the strategy for treatment. RESULTS: Ritodrine was significantly more effective both in the treating period for suppression of contraction (2.33 +/- 0.63 hr for initiation of inhibiting uterine activity, 9.38 +/- 3.88 days of accumulative treating period) and prolongation of gestation (4.81 +/- 2.83 wks) than that of the magnesium sulfate (P < 0.001, 0.005 and 0.01 respectively), and had a term labor of 73.44%. There was no serious cardiac and pulmonary complications in the ritodrine group. CONCLUSION: The present study has shown that ritodrine as a tocolytic agent is highly effective for the management of preterm labor and relative safe for mother and fetus.

Adrenergic beta-Agonists↗
PubMed1993

Gap junction formation in human myometrium: a key to preterm labor?

OBJECTIVE: The purpose of this study was to determine if gap junctions are a necessary component of the human laboring uterus and if their presence in myometrium is a prerequisite for both term and preterm labor. STUDY DESIGN: We obtained 27 human myometrial samples at cesarean section or nongravid hysterectomy. Gap junction formation was analyzed in a blind fashion by freeze fracture and indirect immunofluorescence. Six samples were obtained from term patients with no labor, six from term patients in labor, six from preterm patients with no labor, six from patients in preterm labor, and three from nongravid hysterectomy specimens. RESULTS: Gap junction structures were identified in the human myometrium of patients in term and in preterm labor but not in the other patient samples. In addition, evidence was obtained for the expression of (alpha 1) gap junction ribonucleic acid and (alpha 1) gap junction protein in term samples of human myometrium. CONCLUSION: Gap junctions are a necessary component of the human myometrium during term and preterm labor. The formation of gap junctions may be a final common event for the development of labor, and inhibition of gap junction activity could be a novel approach for the treatment of preterm labor.

Connexins↗
PubMed1990

Relationship of uterine contractility to preterm labor.

An increased uterine contraction rate is associated with preterm labor. The contraction rate in individual patients, however, has not been evaluated critically as to its predictive value in forecasting early labor. In this randomized multicenter study, 105 patients at high risk for preterm delivery monitored their contraction rate at home on a daily basis. An analysis was conducted to determine the association of at least four contractions per hour on a routine strip followed by at least four contractions per hour on a repeat tracing with subsequent preterm labor. Using this threshold, 70% of the patients were correctly classified. This contraction rate resulted in a sensitivity of 57%, a specificity of 80%, a positive predictive value of 72%, and a negative predictive value of 68%. A threshold rate of at least four contractions per hour on a remonitor strip identifies a patient at increased risk for preterm labor (P = .003).

Cardiotocography↗
PubMed1994

Maternal genital Chlamydia trachomatis infection and the risk of preterm labor.

OBJECTIVE: To determine the association between maternal genital Chlamydia trachomatis infection in pregnancy and the risk of preterm labor. The hypothesis tested was that a greater proportion of women experiencing preterm labor would have Chlamydia trachomatis than controls who were not experiencing preterm labor. METHODS: A case-control study in Yaoundé (Cameroon), involving 126 women of gestational age between 28 and 34 weeks, using serology and cervical swab cultures. Data analysis involved simple comparative descriptive statistics as well as univariate and multivariate analysis. RESULTS: The odds of experiencing preterm labor and having genital chlamydial infection were 72.59 (exact 95% C.I. 0.99-7.14); O.R.MH (Mantel-Haenszel) 2.80 (approximate 95% C.I. 1.13-6.97) using serological tests. The proportion of women with positive cervical swab cultures was statistically significantly different between cases and controls (Fisher's exact test, P = 0.02). CONCLUSION: Routine screening and treatment of pregnant women with Chlamydia trachomatis (along with their partners) may be beneficial in reducing the incidence of preterm labor and delivery and hence the perinatal mortality rate.

Case-Control Studies↗
PubMed1993

Possible role of asthma in the risk of preterm labor and delivery.

We assessed the relation between maternal respiratory problems and preterm labor and delivery in a cohort of 3,891 women who delivered a singleton livebirth. Study participants were asked about their medical history in the 12 months before conception; women who reported a history of asthma had a higher risk of preterm labor [relative risk (RR) estimate = 2.33, 95% confidence interval (CI) = 1.03-5.26]. Asthmatic women also had an increased risk of preterm delivery (RR = 1.77, 95% CI = 0.60-5.24). Maternal respiratory problems during pregnancy were also associated with an increased risk of both inhibited preterm labor (RR = 2.14, 95% CI = 1.25-3.66) and preterm delivery (RR = 2.03, 95% CI = 1.08-3.82). Birthweight appeared to be unrelated to maternal history of asthma. Logistic regression models that adjusted for potential confounders did not appreciably alter the results. The adjusted odds ratio (OR) estimate for the odds of preterm labor in asthmatics relative to nonasthmatics is 2.42 (95% CI = 0.90-6.54); the analogous OR estimate for those with respiratory problems during pregnancy is 2.16 (95% CI = 1.14-4.10). The adjusted OR estimate for the odds of preterm delivery in asthmatics is 1.78 (95% CI = 0.53-6.02); for those with respiratory problems during pregnancy, the corresponding estimate is 2.00 (95% CI = 0.92-4.13).

Adult↗
PubMed1990

Digoxin-like immunoreactive substance and preterm labor.

An endogenous digoxin-like substance (DLIS) that may be related to preterm labor has been studied. Using a commercially available radioimmunoassay kit. DLIS levels were determined in 110 women, of whom 33 were in preterm labor, 27 were in labor at term, 26 had normally ongoing pregnancies before term and were not in labor, and finally 24 were at term but not in labor. Mean DLIS levels of women in preterm labor was found to be significantly high (greater than 0.2 ng/ml, p less than 0.05). Whether this finding points to a causative role for DLIS in preterm labor remains to be further investigated.

Adult↗
PubMed1994

Magnesium sulfate loading: preeclampsia vs preterm labor (a clinical pearl).

OBJECTIVE: To measure the apparent volume of distribution (AVOD) for magnesium (Mg) in preeclampsia and preterm labor and determine if a standard 4 gm loading dose of magnesium sulfate (MgSO4) is sufficient to attain therapeutic levels. METHODS: Twenty-five patients with preeclampsia and 25 with preterm labor received 4 g of MgSO4 intravenously over 15 minutes. Serum Mg levels were determined before and one minute after loading and the AVOD for Mg was calculated. Stepwise linear regression with AVOD as the dependent variable was performed and comparisons between the groups were made. RESULTS: Preeclamptics were heavier, had greater surface areas, and presented at a later stage of pregnancy than did patients with preterm labor. Despite these differences AVOD did not differ between the groups. Predose magnesium levels were slightly higher in the preeclamptic group (p = .04). Post-loading levels were nearly identical due to similar AVOD's and, because of the lower levels required for seizure prevention as opposed to tocolysis, were therapeutic 88% of the time in preeclampsia but only 12% of the time in preterm labor (p < .001). Multivariate analysis revealed that only ideal body weight, degree of underweight, and current therapy with betamimetics were significantly related to AVOD. CONCLUSION: AVOD was found to be similar in preeclamptic and preterm labor patients. A 4 g loading dose of MgSO4 is usually adequate to achieve therapeutic levels in preeclampsia but not in preterm labor.

Female↗
PubMed1989

Infection and labor. IV. Cachectin-tumor necrosis factor in the amniotic fluid of women with intraamniotic infection and preterm labor.

A growing body of evidence supports a causal link between subclinical intrauterine infection and preterm labor. The mechanisms responsible for the onset of parturition in this setting have not been elucidated. The conventional view has been that bacterial products increase prostaglandin biosynthesis by intrauterine tissues and this, in turn, leads to the onset of labor. An alternative or complementary mechanism is that microbial products activate the host monocyte-macrophage system and that cytokines released during this process signal the initiation of parturition by stimulating prostaglandin biosynthesis by intrauterine tissues. This study was conducted to determine if cachectin-tumor necrosis factor is present in the amniotic fluid of women with intraamniotic infection and whether this cytokine can alter the rate of prostaglandin biosynthesis by intrauterine tissues. Amniotic fluid from 54 women was assayed for tumor necrosis factor. Tumor necrosis factor was not detectable in the amniotic fluid of women without intraamniotic infection regardless of the presence or absence of term or preterm labor. On the other hand, the amniotic fluid of 11 of 15 women with preterm labor and intraamniotic infection had measurable tumor necrosis factor. This cytokine stimulated prostaglandin E2 biosynthesis by amnion cells in monolayer culture in a dose-dependent fashion. These data support the concept that macrophage activation is involved in the onset of human parturition in the setting of infection. We propose that the host (fetus and/or mother) signals the onset of parturition through the secretion of inflammatory cytokines released in response to bacterial invasion.

Amnion↗
PubMed1980

Diagnosis of preterm labor.

The obvious means by which one can make the diagnosis of preterm birth, namely preterm delivery, is not satisfactory if we are to optimize outcome of pregnancy. However, the indiscriminate use of drugs to inhibit questionable preterm labor is also not desirable. There is a pressing need for an improved method of diagnosis. If some biochemical means were available to diagnose preterm labor, the short-term use of tocolytic therapy (until the result of the testing procedure was known) would be indicated in questionable cases of preterm labor. Until such time that improved methods of diagnosis are available, it would seem preferable to err on the side of overdiagnosis, particularly in very early preterm labor where neonatal morbidity and mortality are excessively high.

Animals↗
PubMed2000

Predictive value of serum interleukin-6 and -8 levels in preterm labor or rupture of the membranes.

BACKGROUND: The aim of this prospective study was to examine if serum concentrations of cytokines are of value in the identification of patients at risk for preterm delivery. METHODS: Interleukin- 1beta,2,4,6,8 and tumor necrosis factor alpha were determined between 25 and 37 weeks of gestation in the serum of 72 consecutive patients with preterm labor, 38 patients with preterm rupture of the membranes, and 24 healthy pregnant women as a control group. Material was collected within 18 hours after hospitalization and was immediately centrifuged and shock frozen. RESULTS: Significantly increased serum levels were found for interleukin-6 and -8 in patients with preterm labor or preterm rupture of the membranes when compared to the control group (p<0.001 and p<0.005, respectively). In patients with preterm rupture of the membranes and interleukin-6 levels above the median of 4.0 pg/ml the delivery occurred significantly earlier than in patients with lower levels (1 versus 5.5 days; p=0.005). Patients of both pathology groups with detectable (>18 pg/ml). Interleukin-8 levels had a shorter pregnancy duration when compared to other patients (p=0.05 for preterm labor and p=0.04 for preterm rupture of the membranes). Interleukin-1beta,2,4, and tumor necrosis factor alpha were not correlated with clinical outcome. CONCLUSIONS: Increased serum interleukin-6 and -8 levels are associated with a shorter interval between onset of preterm rupture of the membranes and delivery and should therefore be further evaluated for their use in clinical practice.

Adult↗
PubMed1990

Uterine activity compared with symptomatology in the detection of preterm labor.

The relative contribution of uterine activity obtained by home monitoring with a guard ring tocodynamometer compared with seven specific signs and symptoms reported during patient/nurse contact as an aid in detecting preterm labor has not been studied. In this prospective, multicenter study, patients at risk for developing early labor who were randomized to receive home uterine activity monitoring and perinatal nursing support were assessed. The initiator of provider contact (uterine activity detected on routine transmission, patient-perceived signs and symptoms of preterm labor during perinatal nurse contact, or both) resulting in a diagnosis of preterm labor was recorded. Contraction data were then analyzed for an association with preterm labor. There was a strong association of increased uterine activity (four or more contractions per hour) on a repeat monitoring strip with preterm labor (P less than .001). Among patients diagnosed with preterm labor, 31% had increased uterine activity detected on a routine transmission without patient-reported signs and symptoms, compared with 24% who were diagnosed as the result of patient-reported symptoms without increased uterine activity. Daily objective uterine activity data alone have greater incremental value over and above other signs and symptoms as an aid to the physician in diagnosing preterm labor.

Female↗
PubMed1999

Oral nicardipine versus intravenous magnesium sulfate for the treatment of preterm labor.

OBJECTIVE: The aim of this study was to compare the efficacy and safety of oral nicardipine in acute therapy for preterm labor with those of parenteral magnesium sulfate. STUDY DESIGN: Patients between 24 and 34 weeks' gestation with documented preterm labor were randomly assigned to receive oral nicardipine (n = 57) or intravenous magnesium sulfate (n = 65) as initial tocolytic therapy. Patients in the nicardipine group received a 40-mg loading dose and then 20 mg every 2 hours as needed to stop contractions (total 80 mg). Patients in the magnesium sulfate group received a 6-g bolus followed by 2 to 4 g/h to provide uterine quiescence. Patients could be switched to another tocolytic regimen if they continued to have contractions after 6 hours of therapy. The main outcome variables examined were time to uterine quiescence, time gained in utero, recurrence of preterm labor, failure of tocolysis, and pertinent maternal and neonatal outcomes. RESULTS: There were no significant differences in maternal demographic characteristics between the groups. Among patients who responded with uterine quiescence within 6 hours, there was a significant decrease in the time to uterine quiescence in the nicardipine group (P <.01). Patients in the magnesium sulfate group were more likely to have recurrence of preterm labor necessitating further tocolytic attempts (P =.048). The patients in the magnesium sulfate group had more adverse side effects, mainly nausea and vomiting (P =.004). There were no differences in birth weight, estimated gestational age at delivery, or neonatal complications between the 2 groups. CONCLUSIONS: Oral nicardipine is an effective, safe, and well-tolerated tocolytic agent. In this prospective clinical trial patients randomly assigned to receive oral nicardipine had arrest of preterm labor more rapidly than did those randomly assigned to receive parenteral magnesium sulfate. Patients who received magnesium sulfate were more likely to have adverse medication effects and recurrent preterm labor.

Administration, Oral↗