Kamonlapat Wijuckhapan, Patou Tantbirojn and Vorapong Phupong
Pretermlabor is a common obstetric complication that occurs in 11% of all pregnancies [ 1 ]. In King Chulalongkorn Memorial Hospital, a tertiary care hospital in Thailand, the rate of preterm birth had increased from 11.2% in 2007 to 13.9% in 2011. Chorioamnionitis is a common cause of pretermlabor [ 2 ]. Microbiological studies suggest that intrauterine infection might account for 25%-40% of preterm birth [ 3 ]. Histopathology shows that 49.8% of pregnancies with pretermlabor between 23-32 weeks of gestation had histological chorioamnionitis (HCA) [ 4
Gholamreza Jandaghi, Zohreh Khalajinia and Parvaneh Moghadam
obstetrics. 22 st ed. New York: MC Graw-Hill, 2005:855-881.
Sigh U, Singh N, Seth S. A Prospective Analysis of Etiology and Outcome of PretermLabor. J. Obstet Gynecol India. 2007;57(1):48-52.
Coleman AC. Fetal Fibronectin Detection in PretermLabor, Evaluation of Prototype beside Dipstick Technique and Cervical Assessment. Am J Obs Gyn. 1998;179(6):1553-1558.
Morten NH, Kallen K, Hagberg H. et al. Preterm Birth in Sweden 1973-2001. Rate, Subgroups and Effect of Changing Patterns in Multiple
Maternal periodontal infection has been recognizsed as a risk factor for preterm and low birth weight infants. It is hypothesized that pathogens causing periodontal disease might translocate to the amniotic cavity and contribute to triggering an adverse pregnancy outcome. The growing evidence that an infection remote from the foetal-placental unit might have a role in preterm delivery has led to an increased awareness of the potential role of chronic bacterial infections in the body. The aim of this study was to evaluate whether the presence of chronic periodontitis might influence the incidence of preterm labour and preterm birth.
This study was designed as a hospital-based case-control study. Seventy pregnant women aged 18-40 years, with a single live pregnancy were recruited from the Department of Gynaecology and Obstetrics of a general hospital in Sibenik, Croatia, from March 2013 to March 2014.
The case group included: 30 pregnant women who were hospitalized with signs of preterm labour. The control group included 40 normal pregnancy patients, who were analysed for up to 48 h after the delivery of a term baby having a birth weight of more than 1500 g. A full-mouth periodontal examination was performed on all the patients. Information was collected on the demographics, health behaviours, and obstetric and systemic diseases that might have an influence in preterm delivery.
The presence of chronic periodontitis tended to be higher in women with a preterm delivery (the case group), with 20 cases (66%), than in the women in the, control group, in which chronic periodontitis was found in 14 cases (35%); this difference reached statistical significance (p≤0.01). The PTB cases had a significantly worse periodontal status than the controls (p≤0.001). From the PTL group, 18 patients delivered preterm, and chronic periodontitis, found in 15 cases (83%), was more prevalent than in the control group. The risk of women having periodontitis or attachment loss ≥ 4 mm developing PTB showed an OR of 3.7 (95% CI: 1.91 to 4.86; P< 0.001).
The study shows a significant association between periodontal chronic disease and an adverse pregnancy outcome. Periodontal disease represents a strong, independent risk factor for preterm births, and periodontal prevention and therapy should be a part of preventive prenatal care.
Irena Andonova, Vasil Iliev, Nikica Živković, Edita Sušič, Ivana Bego and Vesna Kotevska
Aim: Maternal periodontal infection has been recognized as a risk factor for premature and low birthweight infants. It is suspected that pathogens causing periodontal disease may translocate to the amniotic cavity and so contribute to triggering an adverse pregnancy outcome. The aim of this study was to evaluate whether the presence of specific periodontal pathogens may influence the incidence of preterm labor and premature birth.
Material and Methods: This study was designed as a hospital-based case-control study. A total of 70 pregnant women, aged 18-40 with single live pregnancy were recruited from the Departement of Gynecolgy and Obstetrics at a General hospital in Sibenik, Croatia, between March 2013 to March 2014. The case group: 30 pregnant women who were hospitalised with signs of premature labor. Control group: 40 patients with normal pregnancy post-delivery up to 48 hrs, who had given birth at term, and the baby had a weight of more than 2500 gr. These women had undergone microbiological examination at the time of recruitment, microbial samples, paper point subgingival swabs were obtained in both groups and processed by anaerobic culturing. Standard procedures were used for culture and identification of bacteria. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may have influence the premature delivery.
Results: The levels of periodontal pathogens tended to be higher in the premature (case group) labor compared to the term deliveries (control group). Levels of Porphyromonas gingivalis, Fuscobacterium nucleatum, Actinomyces actinomycetecomitans were statistically significantly higher in premature births as compared to term deliveries, adjusting for baseline levels. The joint effects of red and orange microbial clusters were significantly higher in the premature group compared to the term group.
Conclusions: The study shows a significant association betwen periodontal anaerobic infection and adverse pregnancy outcome. High levels of periodontal pathogens during pregnancy are associated with an increased risk for preterm delivery. Further studies elucidating the role of the microbial load and maternal immune response as related to pregnancy outcome seem merited.
Blanka Borowiec, Tomasz Hadada and Magdalena Kosińska
1. Barfield WD. Public Health Implications of Very Preterm Birth. Clin Perinatol. 2018;45:565–77; DOI:10.1016/j.clp.2018.05.007.
2. Mikulski A. Ekologiczne znaczenie efektu matczynego. Wiadomości Ekol 49 97-113. 2003.
3. Terzidou V, Bennett PR. Pretermlabour. Curr Opin Obstet Gynecol. 2002;14:105–13.
4. Behrman RE, Butler AS, Institute of Medicine (U.S.). Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm birth : causes, consequences, and prevention. National Academies Press; 2007.
Aishah Alamrani, Saeed Mahmoud and Mohammed Alotaibi
during term and pretermlabor: evidence that decidual inflammation precedes labor Biol Reprod 2012 86 39
76 Romero R, Gomez R, Chaiworapongsa T, Conoscenti G, Cheol_Kim J, Mee Kim Y. The role of infection in pretermlabour and delivery. Paediatr Perinatal Epidemiol. 2001; 15:41-56. 10.1046/j.1365-3016.2001.00007.x
Romero R Gomez R Chaiworapongsa T Conoscenti G Cheol_Kim J Mee Kim Y The role of infection in pretermlabour and delivery Paediatr Perinatal Epidemiol 2001 15 41 56
77 Keelan JA, Blumenstein M, Helliwell RJA, Sato TA, Marvin KW, Mitchell MD
Simona Korenčan, Bojana Pinter, Mojca Grebenc and Ivan Verdenik
applied where appropriate. Statistical significance was set at p<0.05.
The Course of Pregnancy
Gestational diabetes and bleeding during pregnancy were less common in the study group of adolescents aged ≤19 years, while anaemia was more common only in the younger subgroup of adolescents aged ≤17 years. In addition, unknown estimated date of delivery, threatened pretermlabour and pretermlabour were more common in adolescents. It was more common for adolescents to have a low and appropriate gestational weight gain compared to women in the control
1. GOLDENBERG RL, CULHANE JF, IAMS JD, ROMERO R. Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606):75-84.
2. VAKILIAN K, RANJBARAN M, KHORSANDI M, SHARAFKHANI N, KHODADOST M. Prevalence of pretermlabor in Iran: A systematic review and meta-analysis. Int J Reprod BioMed. 2015; 13(12):743-8.
3. SILBERGELD EK, PATRICK TE. Environmental exposures, toxicologic mechanisms, and adverse pregnancy outcomes. American journal of obstetrics and gynecology. 2005; 192(5 Suppl):S11
Marta Borowska, Ewelina Brzozowska and Edward Oczeretko
Prevention and early diagnosis of forthcoming preterm labor is of vital importance in preventing child mortality. To date, our understanding of the coordination of uterine contractions is incomplete. Among the many methods of recording uterine contractility, electrohysterography (EHG) – the recording of changes in electrical potential associated with contraction of the uterine muscle, seems to be the most important from a diagnostic point of view. There is some controversy regarding whether EHG may identify patients with a high risk of preterm delivery. There is a need to check various digital signal processing techniques to describe the recorded signals. The study of synchronization of multivariate signals is important from both a theoretical and a practical point of view. Application of the Hilbert transformation seems very promising.
Hassan Boskabadi, Gholamali Maamouri and Shahin Mafinejad
Neonatal Complications Related with Prolonged Rupture of Membranes
Background. Prolonged rupture of membranes (PROM) is a common and significant cause of preterm labor and has a major impact on neonatal morbidity and mortality. The aim of this study was to determine maternal risk factors and the prevalence rate of neonatal complications following PROM. This study also detected the role of maternal antimicrobial treatment on neonatal complications.
Methods: This cross-sectional study was performed at Ghaem hospital, Mashhad, Iran; from March 2008 to April 2010 to evaluate newborns' outcome that were born from mothers with prolonged premature rupture of membranes (PROM> 18 hours). Maternal risk factors, antibiotic administration and its influences on neonatal complications were evaluated. Eligible infants were categorized into group I (symptomatic infants), II (mother with chorioamnionitis) and III (asymptomatic infants).
Results. 150 infants were included in the study. 12 (7.7%) infants had definitive infections (meningitis, sepsis, pneumonia), 101(67%) infants were premature and 88(58.6%) infants had mothers with a history of antibiotic intake. Maternal risk factors were reported in the following order: previous PROM (10%), addiction (8%), high urinary tract infection (5/3%), diabetes (4.7%), placenta abruption (4.7%), preeclampsia (3/3%) and cercelage (2%). Neonatal complications related with PROM were prematurity (67.3%), respiratory distress syndrome (22.6%), asphyxia (8.6%), meningitis (5.2%), sepsis (4%), pneumonia (1.3%) and death (4.6%). History of antibiotic administration to mothers with PROM was negative in four babies with sepsis and one with meningitis.
Conclusion. The most common complication of PROM was prematurity and its side effects, but infection is the most important modifiable complication. Although antimicrobial treatment of women with a history of PROM improves neonatal outcome through reducing neonatal sepsis and respiratory distress syndrome (RDS), but the incidence rate of meningitis and pneumonia may be increased.