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PubMed1995

Catalase activity as a predictor of amniotic fluid culture results in preterm labor or premature rupture of membranes.

OBJECTIVE: To evaluate catalase activity as a rapid predictor of microbial invasion of amniotic fluid (AF). METHODS: The study population consisted of 74 patients before 36 weeks' gestation with preterm labor or premature rupture of membranes (PROM). Subjects were excluded if there was evidence of clinical chorioamnionitis or fetal distress at admission. Amniocentesis was done within 24 hours of admission, and the AF was cultured for aerobic and anaerobic bacteria and for Mycoplasma species. All AF samples were Gram stained, and slides were examined by microbiology technologists. Amniotic fluid catalase activity was measured immediately after amniocentesis using a commercially available kit. The sensitivity of the Gram stain and catalase activity were compared using McNemar exact test. RESULTS: Amniotic fluid cultures were positive in 12 of 37 (32%) patients presenting with preterm labor and in 21 of 37 (56%) patients with PROM. Catalase activity was significantly more sensitive than Gram stain in detecting positive AF cultures in cases of PROM (P < .001) and preterm labor (P < .04). CONCLUSION: Catalase activity is a simple, rapid test that is useful in identifying subclinical intra-amniotic infection in patients with preterm labor or PROM.

Amniotic Fluid↗
PubMed2005

Cervical assessment in women with threatened preterm labor.

OBJECTIVE: The aim of the study was to examine the clinical value of cervical assessment by transvaginal ultrasonography in women with symptoms of preterm labor. METHODS: We prospectively evaluated 172 women with singleton pregnancies and symptoms of preterm labor. Seventy of them were nulliparas, while 102 were multiparas. Gestational age ranged between 24 and 34 wks. All women underwent cervical assessment with transvaginal ultrasonography and were given intravenous tocolytics. The only parameter evaluated was cervical length. Women with multiple pregnancies, gestational age <24 wks or >34 wks, cervical dilatation >2 cm, placenta praevia, premature rupture of membranes, or cervical cerclage were excluded from the study. The outcome measure was delivery before 34 wks gestation. RESULTS: The preterm delivery rate before 34 wks was 37%. The sensitivity and the specificity of a cervical length of less than 20 mm was 60 and 53.8% and 97.7 and 95.2% for nulliparas and multiparas, respectively. A cervical length <20 mm was also 93.7% predictive of preterm delivery in nulliparas and 87.5% in multiparas, while the corresponding numbers for its negative predictive value (NPV) were 81.4 and 76.9%, respectively. CONCLUSIONS: Cervical assessment in women with symptoms of preterm labor can distinguish those at high risk for preterm delivery. Cervical sonography can be a valuable adjunct to the clinical evaluation of these patients.

Adult↗
PubMed1989

Cachectin/tumor necrosis factor-alpha formation in human decidua. Potential role of cytokines in infection-induced preterm labor.

This study was conducted as part of an investigation to evaluate the hypothesis that bacterial toxins (LPS or lipoteichoic acid), acting on macrophage-like uterine decidua to cause increased formation of cytokines, may be involved in the pathogenesis of infection-associated preterm labor. We found that cachectin/tumor necrosis factor-alpha (TNF-alpha) was synthesized and secreted into the culture medium by human decidual cells and explants in response to treatment with LPS. LPS treatment also caused an increase in PGF2 alpha production by decidual cells and explants. In amnion cells in monolayer culture, TNF-alpha stimulated PGE2 formation, and TNF-alpha was cytostatic (inhibited [3H]thymidine incorporation into DNA) but not cytolytic in amnion cells. TNF-alpha was not detectable (less than 0.34 ng/ml) in the amniotic fluid of normal pregnancies at midtrimester or at term before or after the onset of labor (n = 44); but TNF-alpha was present at concentrations between 2.8 and 22.3 ng/ml in amniotic fluids of 4 of 20 pregnancies with intact membranes complicated by preterm labor (less than 34 wk gestational age). LPS was present in 10 of the 20 amniotic fluids of preterm labor pregnancies, including all four in which TNF-alpha was present. Bacteria were identified in only one of the four LPS-positive, TNF-alpha-positive fluids. Cytokine formation in macrophage-like decidua may serve a fundamental role in the pathogenesis of preterm labor, including increased prostaglandin formation and premature rupture of the membranes.

Amniotic Fluid↗
PubMed1997

The diagnostic value of interleukin-8 and fetal fibronectin concentrations in cervical secretions in patients with preterm labor and intact membranes.

The objectives of this study were 1) to evaluate interleukin-8 concentrations in cervical secretions in predicting preterm delivery, microbial invasion of the amniotic cavity and histologic chorioamnionitis in patients with preterm labor and intact membranes and 2) to compare the diagnostic value of interleukin-8 with fetal fibronectin determinations in predicting preterm delivery, microbial invasion of the amniotic cavity and histologic chorioamnionitis in patients with preterm labor and intact membranes. Interleukin-8 and fetal fibronectin were assayed in cervical secretions in 106 patients with singleton pregnancies and intact membranes admitted for preterm labor. Amniotic fluid obtained by amniocentesis was cultured and placentas (No = 43) analyzed for the presence of chorioamnionitis. The prevalence of pregnancies delivered preterm was 46.2% (49/106) and 15.09% (16/106) of amniotic fluid cultures were positive. Interleukin-8 levels in cervical secretions were significantly increased in patients who delivered preterm (p < or = 0.0001), in presence of positive amniotic fluid culture (p = 0.0016) and histological chorioamnionitis (p = 0.008) than in patients with negative findings. Receiver-operator characteristics curve analysis showed that an interleukin-8 value > 450 pg/ml is comparable to that of a fetal fibronectin value > 50 ng/ml in predicting preterm delivery (p = 0.247). Among patients who delivered preterm interleukin-8 concentrations > 860 pg/ml predicted a positive amniotic fluid culture with a sensitivity of 81.2% and a specificity 66.6%. Further, in patients who delivered preterm and had a negative amniotic fluid culture, IL-8 concentrations > 480 pg/ml predicted histological chorioamnionitis with a sensitivity 78.5% and specificity 61.5%. A positive fetal fibronectin > 50 ng/ml was not predictve of either a positive amniotic fluid culture or the presence of histological chorioamnionitis. In conclusion, increased concentrations of interleukin-8 and fetal fibronectin are associated with impending delivery and their diagnostic value seems comparable. However, interleukin-8 concentrations identify patients at risk of a positive amniotic fluid culture and the presence of histological chorioamnionitis. Measurement of interleukin-8 in cervical secretion is a non-invasive method to identify patients at risk for both preterm delivery and intrauterine infection.

Adult↗
PubMed1994

Parenteral nutrition during pregnancy. Lack of association with idiopathic preterm labor or preeclampsia.

We reviewed published cases of lipid-containing parenteral nutrition during pregnancy to determine the incidence of idiopathic preterm labor and preeclampsia. Seventy-three reported cases of lipid-containing parenteral nutrition during pregnancy were identified. Idiopathic preterm labor occurred in 2 of 11 (18%) cases that delivered prior to term. Most patients who had preterm delivery while receiving parenteral nutrition had underlying medical conditions and/or coexistent obstetric problems that are associated with preterm delivery. Total parenteral nutrition during pregnancy was not associated with an increased risk of preterm delivery from idiopathic preterm labor. Preeclampsia was not reported in patients receiving lipid-containing parenteral nutrition. The lack of association of preeclampsia in patients receiving parenteral nutrition deserves further study.

Adult↗
PubMed1979

Contemporary management and conduct of preterm labor and delivery: a review.

Current concepts in the conduct of preterm labor and management of delivery of the premature infant are reviewed. Pharmacologic modalities available for inhibiting preterm labor are discussed as well as the efficacy, indications and contraindications for these agents. An analysis of the role of corticosteroids in achieving fetal pulmonary maturity in the preterm infant is reviewed, and based on the existent literature the intrapartum management of the small fetus is outlined. The mode of delivery, vaginal or via cesarean section, for these infants is likewise discussed.

Adrenal Cortex Hormones↗
PubMed2004

Prospective randomized controlled trial of fetal fibronectin on preterm labor management in a tertiary care center.

OBJECTIVE: The purpose of this study was to investigate the effect of the rapid fetal fibronectin on the length of hospital stay and the use of preterm labor interventions in a tertiary care center. STUDY DESIGN: Women who were seen in the Labor and Delivery Unit with symptoms of preterm labor were assigned randomly to receive fetal fibronectin (n=46 women) or to preterm labor management without fetal fibronectin (n=51 women). Physicians were not blinded to the result; groups were compared. RESULTS: There was no difference between groups in demographic or obstetric characteristics, the hours spent in labor and delivery, the number of women who were admitted to the antepartum service, the length of stay, or medical interventions. When the results for women with a negative fetal fibronectin test were compared to women with a positive fetal fibronectin test, a significant difference was found in admissions to the antepartum service (P=.032) and the length of stay (P=.008). CONCLUSIONS: A negative fetal fibronectin test was associated with fewer admissions to the antepartum ward and a shorter length of stay.

Adult↗
PubMed2000

An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescue.

OBJECTIVES: This study was designed to evaluate the efficacy and safety of the oxytocin receptor antagonist atosiban in the treatment of preterm labor. STUDY DESIGN: A multicenter, double-blind, placebo-controlled trial with tocolytic rescue was designed. Five hundred thirty-one patients were randomized to receive, and 501 received, either intravenous atosiban (n = 246) or placebo (n = 255), followed by subcutaneous maintenance with the assigned agent. Standard tocolytics as rescue tocolysis were permitted after 1 hour of either placebo or atosiban if preterm labor continued. The primary end point was the time from the start of study drug to delivery or therapeutic failure. Secondary end points were the proportion of patients who remained undelivered and did not receive an alternate tocolytic at 24 hours, 48 hours, and 7 days. RESULTS: No significant difference was found in the time from start of treatment to delivery or therapeutic failure between atosiban and placebo (median, 25.6 days vs 21.0 days, respectively; P =.6). The percentages of patients remaining undelivered and not requiring an alternate tocolytic at 24 hours, 48 hours, and 7 days were significantly higher in the atosiban group than in the control group (all P < or =.008). A significant treatment-by-gestational age interaction existed for the 48-hour and 7-day end points. Atosiban was consistently superior to placebo at a gestational age of > or =28 weeks. Fourteen atosiban-treated patients and 5 placebo-treated patients were randomized at <24 weeks; the incidence of fetal-infant deaths was higher for the atosiban group at <24 weeks. Maternal-fetal adverse events were similar except for injection-site reactions, which occurred more often with atosiban. CONCLUSIONS: In this trial the treatment of patients in preterm labor with atosiban resulted in prolongation of pregnancy for up to 7 days for those at a gestational age > or =28 weeks, and this occurred with a low rate of maternal-fetal adverse effects. In addition, at a gestational age > or =28 weeks, the infant morbidity and mortality of atosiban-initiated standard care were similar to those with placebo-initiated standard care. Given that all patients in this study were eligible for tocolysis and that, in practice, nearly all patients who are eligible for a tocolytic receive one, the benefit of using atosiban is the placebo-like maternal-fetal side effect profile. These observations support the use of this oxytocin receptor antagonist in the treatment of patients in preterm labor with intact membranes. Efficacy and infant outcome data at <28 weeks are inconclusive.

Double-Blind Method↗
PubMed2004

[Ultrasonographic measurement of cervical length in twin pregnancies with preterm labor: comparison with singleton pregnancies].

OBJECTIVE: Our purpose was to assess the utility of ultrasonographic measurement of cervical length for predicting preterm delivery in pregnant women with twin pregnancy and preterm labor. PATIENTS AND METHOD: Prospective study in 192 singleton and 66 twin pregnancies with preterm labor before 34 weeks. Vaginal sonography for measurement of cervical length, and screening for fetal fibronectin in vaginal smears were performed at admission. The incidence of delivery before 34 weeks was compared with cervical length and the presence of fetal fibronectin. RESULTS: In singleton pregnancies, delivery before 34 weeks was significantly more frequent in women with a cervical length <30 mm (26.6 vs. 2.0%; P = 0.0004), or presence of fetal fibronectin (27.5 vs. 6.0%; P = 0.001). The corresponding negative predictive values (NPV) were 98% and 94%, respectively. In twin pregnancies, receiver characteristic curve analysis showed that a cervical length of 20 mm had the highest diagnostic performance in predicting preterm delivery. The corresponding NPV was 63%. In this group, delivery before 34 weeks showed no significant difference in women with a cervical length < 30 mm (43.7 vs. 38.8%), cervical length < 20 mm (52.0 vs. 36.6%, P = 0.219), or presence of fetal fibronectin (47.6 vs. 21.7%, P = 0.0705). DISCUSSION AND CONCLUSION: Ultrasonographic measurement of cervical length does not predict preterm delivery in twin pregnancies with preterm labor.

Adult↗
PubMed1987

Preterm labor: stimulation of arachidonic acid metabolism in human amnion cells by bacterial products.

There is a strong association between preterm labor and infection. Some potentially pathogenic bacteria have phospholipase activity, and it has been suggested that release of phospholipase from these organisms may increase prostaglandin E2 synthesis in amnion cells and hence initiate preterm labor. In this study we established monolayer amnion cell cultures from tissue collected at elective cesarean section at term before labor. Cells were prelabeled with tritiated arachidonic acid and then further incubated after addition of 2%, 5%, or 10% (vol/vol) filtered medium in which either group B beta-hemolytic streptococcus, Streptococcus viridans, Escherichia coli, Bacteroides fragilis, or Lactobacillus had been growing. Tritiated arachidonic acid and its metabolites released by the amnion cells in these or control incubates were extracted from culture medium and separated by high-performance liquid chromatography. Addition of conditioned medium from each of the organisms with the exception of Lactobacillus caused an increase in overall arachidonic acid metabolism. There was an increase in the ratio of cyclooxygenase to lipoxgenase metabolism and in prostaglandin E2 production in particular when compared to controls. The profile of arachidonic acid metabolism in amnion cells following addition of filtered bacterial medium resembled that obtained from amnion cells cultured following spontaneous labor. We suggest that abnormal bacterial colonization of the genital tract may lead to an increase in arachidonic acid metabolism in amnion cells with an increase in prostaglandin E2 production and the consequent initiation of preterm labor.

Amnion↗
PubMed1996

The nursing management of women experiencing preterm labor: clinical guidelines and why they are needed.

Nursing care is a critical component of therapy for women experiencing preterm labor. Diversity exists, however, in the level of comprehensiveness and consistency in guidelines for clinical practice. Nonstandardized care interferes with the ability to achieve consistent, positive patient care outcomes. This article is intended for nurses who seek to organize and standardize their care for women experiencing preterm labor. This article presents a review of the applicable practice and research literature. Clinical guidelines for the nursing management of women experiencing preterm labor are presented in the appendix.

Female↗
PubMed2001

The oxytocin antagonist atosiban versus the beta-agonist terbutaline in the treatment of preterm labor. A randomized, double-blind, controlled study.

OBJECTIVE: To compare the efficacy and safety of atosiban and terbutaline for the inhibition of preterm labor. METHODS: Two hundred and forty-nine women diagnosed with preterm labor at 23-33 weeks of gestation were enrolled of whom 245 women received treatment, 116 with atosiban and 129 with terbutaline. At randomization, women were stratified by gestational age (< or =28 weeks and >28 weeks). Atosiban (iv bolus dose of 6.75 mg, then 300 microg/min for 3 h and 100 microg/min thereafter) and terbutaline (5-20 microg/min) were administered by iv infusion for 13-18 h. Re-treatment with study drug or an alternative tocolytic agent was allowed. Tocolytic effectiveness was assessed in terms of the number of women undelivered after 48 hours and 7 days and efficacy and tolerability in terms of the number of women remaining undelivered and not requiring alternative tocolytic therapy after 48 hours and 7 days of starting therapy. Safety was assessed in terms of maternal side effects and neonatal morbidity. RESULTS: Tocolytic effectiveness at 48 hours was 86.1% vs 85.3%; p=0.783, and after 7 days it was 76.5% vs 67.4%; p=0.067, in the atosiban and terbutaline groups, respectively. Tocolytic efficacy and tolerability after 48 hours was 72.2% vs 68.2%; p=0.51 and after 7 days was 55.6% vs 43.4%; p=0.08 in the atosiban and terbutaline groups, respectively. Overall, there were fewer clinically important adverse events with atosiban than with terbutaline. CONCLUSIONS: The efficacy of atosiban in the inhibition of preterm labor was shown to be comparable to terbutaline. Atosiban had a superior safety profile compared with terbutaline in terms of maternal and fetal adverse events, and comparable infant outcomes.

Adrenergic beta-Agonists↗
PubMed1999

Maintenance oral nifedipine for preterm labor: a randomized clinical trial.

OBJECTIVE: This study was undertaken to evaluate the efficacy of maintenance oral nifedipine in patients initially treated with intravenous magnesium sulfate for preterm labor. STUDY DESIGN: Patients with a diagnosis of preterm labor between 24 and 33.9 weeks' gestation were randomly assigned to receive either maintenance tocolytic therapy with oral nifedipine (20 mg every 4-6 hours) or no treatment (control) after discontinuation of magnesium tocolysis. Pregnancy and neonatal outcomes were evaluated. A sample size of 50 patients was required to detect a 10-day difference in mean time gained (beta =.2, alpha =.05). Statistical analyses were based on intent to treat. The t, chi(2), and Fisher exact tests were performed. RESULTS: Seventy-four patients were randomly assigned to receive either oral nifedipine (n = 37) or no treatment (n = 37). There were no statistically significant differences in age, race, parity, preterm delivery risk factors, enrollment gestational age, results of cervical examination, delivery gestational age, time gained, or neonatal complications between the groups. Delivery gestational age (mean +/- SD) was 35.4 +/- 3.2 weeks for patients randomly assigned to receive nifedipine and 35.3 +/- 3.2 weeks for patients who received no treatment (P =.9). Time gained during pregnancy was 37 +/- 23.9 days in the nifedipine group and 32.8 +/- 20.4 days in the control group (P =.4). CONCLUSION: Maintenance therapy with oral nifedipine does not significantly prolong pregnancy in patients initially treated with intravenous magnesium sulfate for preterm labor.

Adult↗
PubMed2001

Amniotic fluid matrix metalloproteinase-8 in preterm labor with intact membranes.

OBJECTIVE: Intra-amniotic inflammation is a major determinant of maternal and neonatal outcome in patients with preterm labor. Matrix metalloproteinase-8 is a sensitive marker of inflammation in body fluids. This study was conducted to examine the value of amniotic fluid matrix metalloproteinase-8 determinations in patients with preterm labor and intact membranes. STUDY DESIGN: Amniotic fluid was obtained by transabdominal amniocentesis from 371 patients with preterm labor. Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas. Amniotic fluid analysis included Gram stain examination, white blood cell count, and matrix metalloproteinase-8 (enzyme-linked immunosorbent assay) determination. Nonparametric statistics were used for analysis. RESULTS: The rate of preterm delivery was 54% (200/371) and that of intra-amniotic infection was 9.2% (34/371). The median amniotic fluid matrix metalloproteinase-8 concentration was more than 50-fold higher in patients with intra-amniotic infection than in patients with no intra-amniotic infection (median, 605.6 ng/mL; range, 0.65-15,000 ng/mL vs median, 10.6 ng/mL; range, <0.06-16,600 ng/mL, respectively; P <.0001). The matrix metalloproteinase-8 amniotic fluid concentrations were significantly higher in patients who delivered preterm than in patients who delivered at term (median, 19.5 ng/mL; range, <0.06-16,600 ng/mL vs median, 2.1 ng/mL; range, <0.06-500 ng/mL, respectively; P <.001). After exclusion of patients with intra-amniotic infection, patients who delivered preterm had a significantly higher median amniotic fluid matrix metalloproteinase-8 than patients who delivered at term (P <.05). An amniotic fluid matrix metalloproteinase-8 level of >30 ng/mL was an independent predictor for the occurrence of neonatal morbidity (odds ratio, 3.4; 95% CI, 1.9-5.8; P <.01). CONCLUSION: Increased amniotic fluid matrix metalloproteinase-8 concentrations identify patients at risk for intra-amniotic infection, impending preterm delivery, and adverse neonatal outcome.

Amniocentesis↗
PubMed1993

Alterations in maternal-fetal Doppler flow velocity waveforms in preterm labor patients undergoing magnesium sulfate tocolysis.

OBJECTIVE: To evaluate the effects of magnesium on fetal hemodynamics in mothers treated with magnesium sulfate for preterm labor. METHODS: Twenty women who presented to the Carolinas Medical Center in preterm labor between 24-35 weeks' gestation were enrolled in the study. Pulsed-wave Doppler measurements were made from the fetal middle cerebral artery, the fetal umbilical artery, and the maternal uterine arteries before the initiation of magnesium sulfate tocolysis and during its intravenous administration. Baseline measurements were compared with intra-therapy measurements using paired t tests. RESULTS: During the administration of magnesium sulfate, the fetal middle cerebral artery diastolic blood flow velocity decreased significantly (P = .05) and the maternal uterine artery diastolic blood flow velocity increased significantly (P = .01). There were no significant changes in the umbilical artery diastolic blood flow measurements. These findings remained the same after adjusting for gestational age, estimated fetal weight, frequency of contractions, serum magnesium level at the time of the intra-therapy Doppler study, and maternal blood pressure. CONCLUSION: The alterations in fetal hemodynamics during magnesium sulfate administration suggest a physiologic normalization process related to the stressed preterm infant and the preterm labor process itself.

Adult↗
PubMed1992

A woman's attitude toward pregnancy. Can it predispose her to preterm labor?

A prospective study was designed to assess the relationship between a woman's attitude toward pregnancy, sociomedical factors and preterm labor among 434 consecutive pregnant women who filled out a self-reporting, multiple choice questionnaire at 24-28 weeks' gestation. The score on "poor investment in pregnancy," evaluating the maternal attitude toward pregnancy and the antepartum fetomaternal relationship, was the best predictor of preterm labor, followed by the risk score based upon sociomedical factors. Psychologic factors could play a significant role in the onset of preterm labor.

Adult↗
PubMed2003

Biochemical predictors of preterm labor: fetal fibronectin and salivary estriol.

Preterm birth is a major complication of pregnancy and remains a leading cause of neonatal morbidity and mortality worldwide. Improvements in the authors' understanding of the pathophysiology of preterm labor have led to the development of novel diagnostic tools of use to identify women at greatest risk for preterm birth. Currently two FDA-approved biochemical tests are available in the United States: (1) fetal fibronectin and (2) salivary estriol. The presence of a positive fetal fibronectin test in the midtrimester of pregnancy is strongly associated with early spontaneous preterm birth. In contrast, a positive salivary estriol test is associated with late preterm birth, thus limiting its clinical use. Both tests have low test sensitivity and are currently used clinically for their negative predictive values. That is, women who screen negative are at very low risk for preterm birth and, thus, no interventions are indicated to prevent preterm birth. Women with a positive test are at increased risk and would be candidates for intervention. One of the main limitations of fetal fibronectin and salivary estriol, and an array of other proposed markers, is the fact that while these markers may aid in identification of women at increased risk for preterm birth, the authors currently have no clearly effective obstetric interventions for preterm-birth prevention in these high-risk women. Use of tocolytics, antimicrobials, or progesterone therapy currently has limited or unproven benefit in the management of women deemed at increased risk using these markers. Thus, until effective targeted obstetric interventions are available, the use of biochemical markers to identify women at increase risk for preterm birth remains largely research tools.

Biomarkers↗
PubMed2002

Antibiotic therapy for the treatment of preterm labor: a review of the evidence.

OBJECTIVE: The purpose of this study was to evaluate the evidence regarding antibiotics for the treatment of preterm labor. STUDY DESIGN: Through dual review, we abstracted study design and masking, definitions of preterm labor and pregnancy outcome, patient inclusion/exclusion characteristics, patient demographic characteristics, drug and cointerventions, and numerous birth, maternal, and neonatal outcome measures. We graded the quality of the individual articles and the strength of the evidence for antibiotic benefit. RESULTS: We abstracted data from 14 randomized trials and 1 observational study. Of these studies, 13 trials met the requirements for a meta-analysis. The meta-analysis demonstrated a mixed outcome pattern with small improvements in pregnancy prolongation, estimated gestational age at birth, and birth weight. Data were insufficient to show a beneficial effect on neonatal morbidity or mortality rates. CONCLUSION: Treatment of preterm labor with antibiotic therapy can prolong gestation. The benefits of antibiotics are small, and there is considerable uncertainty about the optimal agent, route, dosage, and duration of therapy.

Anti-Bacterial Agents↗