A Comprehensive Integrative Review of the Factors Associated with Spontaneous Preterm Birth, Its Prevention and Prediction, Including Metabolomic Markers / Uma revisão integrativa abrangente dos fatores associados ao parto prematuro espontâneo, sua prevenção e predição, incluindo marcadores metabolômicos

Abstract Pretermbirth is amajormaternal complication that has a great impact on perinatal and neonatal health, with consequences suffered during childhood and adulthood. Little is known about its etiology and development, resulting in poor screening, prediction and preventive methods. The present integrative review discusses the current knowledge regarding some risk factors for preterm birth, the differences between screening and prediction methods, the limitations of some current preventive interventions, the importance of applying standardized concepts for exposures and outcomes, and why it is important to develop more accurate and reproducible methods to predict preterm birth. In addition, the authors introduce the concept of metabolomics and the technology involved in this technique, and discuss about how it has become a promising approach to identify biomarkers for spontaneous preterm birth.

Resumo Parto prematuro é uma complicação obstétrica de grande impacto para saúde perinatal e neonatal, tendo consequências tambémpara a infância e a vida adulta. Pouco se sabe sobre sua etiologia e fatores determinantes, o que limita osmétodos de rastreamento, predição e prevenção. Esta revisão integrativa traz a discussão sobre o conhecimento atual sobre fatores de risco para parto prematuro espontâneo, as diferenças entre métodos de rastreamento e predição, as limitações das atuais intervenções preventivas, a importância de se aplicar conceitos padronizados para exposição e desfecho na investigação de parto prematuro espontâneo, e porque é importante desenvolver métodos precisos e reprodutíveis para predizer o parto prematuro. Por fim, introduzimos o conceito demetabolômica e da tecnologia envolvida nessa técnica, e discutimos como ela tem se mostrado uma abordagem prosmissora para identificar biomarcadores associados ao parto prematuro espontâneo.

Does the use of probiotics in pregnant women with premature rupture of membranes improve the maternal and perinatal outcome? A systematic review / O uso de probióticos em gestantes com rotura prematura de membranas ovulares melhora o desfecho materno e perinatal? Uma revisão sistemática

Introduction: Premature rupture of membranes (PROM) is a condition that affects 8­10% of all pregnancies, and contributes with 20­40% of preterm deliveries. Evidence shows that changes in the vaginal microbiota may also have a favorable impact on the decrease in the prevalence of PROM, and that expectant treatment may be an appropriate approach to reduce morbidity in these cases. Objective: To investigate whether the use of probiotics in pregnant women with premature rupture of ovary membranes improves the maternal and perinatal outcome. Methods: This is a systematic review, developed from articles published between January 2001 and August 2018, which justify the use of probiotics in pregnant women with PROMto improve maternal and perinatal outcome. Results: Some studies have shown a potential role of probiotics in modulating vaginal bacterial communities, reducing rates of cesarean section and PROM, and increasing the latency and weight of newborns in pregnant women with PROM. However, in other studies, there was no confirmation of changes in the vaginal microbiota from the use of oral probiotics. Conclusion: There are benefits in the administration of probiotics to the mother-fetus binomial. However, there are still doubts about routes of administration, choice of strains and period of use. More studies are necessary to settle them.

Introdução: A rotura prematura de membranas ovulares é uma condição que afeta 8­10% de todas as gestações e contribui com 20­40% dos partos prematuros. Evidências mostram que mudanças na microbiota vaginal podem ter impacto favorável na diminuição de sua prevalência, e o tratamento expectante pode ser uma abordagem adequada para reduzir a morbidade nesses casos. Objetivo: Investigar se o uso de probióticos em gestantes com rotura prematura de membranas ovulares melhora o desfecho materno e perinatal. Métodos: Trata-se de uma revisão sistemática desenvolvida com base em artigos publicados no período de janeiro de 2001 a agosto de 2018, que justificam o uso de probióticos em gestantes com rotura prematura de membranas ovulares para melhorar o desfecho materno e perinatal. Resultados: Alguns estudos mostraram potencial atuação dos probióticos em modular comunidades bacterianas vaginais, em reduzir taxas de cesarianas e rotura prematura de membranas ovulares, além de aumentar o período de latência e peso do recém-nascido de gestantes com esse quadro. Porém, em outros trabalhos, não houve confirmação de mudanças na microbiota vaginal pelo uso de probióticos orais. Conclusão: Há benefícios na administração dos probióticos sobre o binômio mãe-feto, contudo ainda há dúvidas sobre vias de administração, sobre escolha das cepas e sobre tempo de uso. Mais estudos precisam ser realizados para dirimi-las.

Factores maternos que inciden en amenaza de parto pretérmino en adolescentesgestantes del cantón San Jacinto de Yaguachi / Maternal factors that affect thethreat of preterm delivery in pregnantadolescents of San Jacinto deYaguachi canton

Introducción:La amenaza de parto pre término consiste en la presencia de contracciones regulares después de las 20 y antes de las 37 semanas de gestación Objetivo: Determinar los factores maternos que inciden la amenaza de parto pretérmino en las mujeres gestantes que acuden al Hospital Básico de Yaguachi.Métodos:Sé realizo un Estudio cuantitativo, descriptivo, y transversal en el Hospital Básico "Dr. José Cevallos Ruiz", con una muestra de 20 adolescentes de sexo femenino, con el diagnostico amenaza de parto pretérmino, a las que se les aplicó una encuesta que constó con 5 preguntas entre ellas: Edad, educación, domicilio, controles prenatales y patología asociada a su embarazo.Resultados:Predominó el grupo de adolescentes correspondiente a los 17-19 años con un65%, instrucción secundaria el 55%, el 80% de las gestantes residía en la zona rural. En cuanto a los controles prenatales el 60% de las adolescentes asistieron de 1 a 4 controles, y el 50% de las adolescentes presentaron como factor de riesgo para la amenaza de parto pretérmino, la rotura prematura de membranas como patología asociada a su embarazo. Conclusiones:El factor materno que predominó fue la rotura prematura de membranas, sin embargo la infección de vías urinarias y los trastornos hipertensivosdel embarazo, también se encontraron presentes y por ello, la educación prenatal debe ser tomada en gran consideración

Introduction:The threat of preterm birth consists in the presence of regular contractions after 20 and before 37 weeks of gestation. Objective: To determine the maternal factors that affect the threat of preterm delivery in pregnant women who come to the Basic Hospital of YaguachiMethods:Aquantitative, descriptive, and transversal study in the Basic Hospital "Dr. José Cevallos Ruiz ", with a sample of 20 female adolescents, with the diagnostic threat of preterm delivery, to which a survey was applied that consisted of 5 questions including: Age, education, home, prenatal check-ups and associated pathology to your pregnancy.Results:The group of adolescents corresponding to 17-19 years old predominated with 65%, secondary instruction 55%, 80% of pregnant women resided in the rural area. Regarding the prenatal controls, 60% of the adolescents attended from 1 to 4 controls, and 50% of the adolescents presented as a risk factor for the threat of preterm delivery, the premature rupture of the membranes as a pathology associated with their pregnancy.Conclusions:The maternal factor that predominated was the premature rupture of membranes, nevertheless the infection of urinary tract and the hypertensive disorders of pregnancy, were also present and therefore, prenatal education should be taken into great consideration

An extremely rare case of hand prolapse with preterm premature rupture in the membrane of one twin

The latency in preterm premature rupture of membranes (PPROM) can last for weeks. We describe an extremely rare case of hand prolapse with PPROM that was exposed for 23 days before delivery. The patient had spontaneous PPROM of twin A at 21.4 weeks of gestation with shoulder presentation. The right arm of the fetus eventually protruded out the vagina and the hand was exposed for extended period of time of 23 days until delivery. Daily dressing by applying collagen to dry skin and silicone to keep moisture was done to the protruding hand to prevent dehydration and desquamation of the skin. Prophylactic antibiotics were used and the patient underwent emergent cesarean section due to uncontrolled preterm labor at 25.2 weeks. To the best of our knowledge, this is the first case of hand prolapse of one twin with extended period of latency before delivery.

Qualitative Determination of Human Chorionic Gonadotropin in Vaginal Washings for the Early Diagnosis of Premature Rupture of Fetal Membranes / Determinação qualitativa de gonadotrofina coriônica humana no lavado vaginal para o diagnóstico precoce de ruptura prematura de membranas fetais

Abstract Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25). Results The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

Resumo Objetivo Este estudo objetivou validar o exame qualitativo da subunidade β da gonadotrofina coriônica humana (β-hCG) em lavado vaginal de gestantes com ruptura prematura de membranas (RPM) fetais. Métodos Estudo transversal de gestantes com 24 a 39 semanas atendidas em um hospital de Maringá divididas em 2 grupos: grupo A (clinicamente diagnosticadas com RPM) e grupo B (gestantes sem perda de liquido amniótico). As pacientes foram submetidas a lavado vaginal com 3 mL de soro fisiológico, que logo em seguida foi aspirado de volta na mesma seringa e imediatamente enviado ao laboratório para a realização do exame de β-hCG vaginal com pontos de corte de 10 mIU/mL (β-hCG-10) e/ ou 25 mIU/mL (β-hCG-25). Resultados O teste de β-hCG-10 na secreção vaginal foi realizado em 128 casos, e o teste do qui-quadrado com correção de Yates mostrou diferença significante entre os dois grupos (p = 0,0225). Os parâmetros de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram respectivamente 77,1%; 43,6%; 52,3%; 70,4%; e 58,6%. O teste de β-hCG-25 na secreção vaginal foi realizado em 49 casos, e a análise pelo teste exato de Fisher mostrou diferença significativa entre os grupos (p = 0,0175). Os parâmetros de sensibilidade, especificidade, VPP, VPN e acurácia foram respectivamente 44,4%; 87,1%; 66,6%; 72,9%; e 71,4%. Conclusões O β-hCG-25 apresentou melhor acurácia para o diagnóstico de RPM, e pode corroborar o diagnóstico precoce de RPM por se tratar de um exame simples e rápido.

Delivery modes and their influencing factors of pregnant women with previous cesarean section: a retrospective study of 474 gravidas / 中华围产医学杂志

Objective To investigate the safety of vaginal delivery in gravidas with previous cesarean section and its influencing factors.Methods Four hundred and seventy-four full-term gravidas who received cesarean section at the Department of Obstetrics and Gynecology of Peking University First Hospital from January 1,2012 to August 31,2014 were enrolled in this study.Among those subjects,38 who underwent successful vaginal delivery were grouped into vaginal birth after cesarean (VBAC) group,and the other 436 accepting repeated cesarean section were grouped into cesarean group.Delivery outcomes and maternal/neonatal complications of the two groups were retrospectively analyzed with two-sample t-test and Chi-square test.Results Among the 45 patients (9.5％) who attempted VBAC,seven underwent cesarean section for suspected fetal distress and the other 38 (84.4％) succeeded in vaginal birth without uterine rupture.The amount of postpartum hemorrhage in patients of cesarean group was more than that of VBAC group [(330.8±94.8) vs (257.7± 199.7) ml,t=2.021,P＜0.01] after exclusion of three patients with dangerous placenta previa,and the postpartum hospital stay was shorter than that of cesarean group [(2.5± 1.4) vs (4.5± 1.3) d,t=7.952,P＜0.01].There were three newborns with neonatal asphyxia,twelve with neonatal infections and forty transferred to the Pediatrics Department following cesarean section.Besides,complications of headache and urinary retention occurred in 20 and 32 mothers after cesarean section,respectively.However,no complication occurred in VBAC group.Sixty-three cesarean sections were indicated as thin lower uterine segment and among them,fourteen (22.2％) had muscular rupture.Among the six patients who complained of tenderness in lower uterine segment,three were found having muscular rupture during cesarean section.Conclusion VBAC is an option for gravidas with history of cesarean section only if they meet the criteria for VBAC attempt.VBAC could lower the cesarean section rate without increase the incidence of complications.The rate of trial of labor after cesarean was low,patients education should be strengthened to increase it.

Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes / Avaliação dos resultados perinatais em gestantes com rotura prematura das membranas pré-termo

SUMMARY Objective: To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM). Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion: The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.

RESUMO Objetivo: determinar a associação do índice de líquido amniótico (ILA) com os resultados perinatais na rotura prematura das membranas pré-termo (RPMPT). Método: realizou-se um estudo de coorte retrospectivo, de 2008 a 2012. Foram incluídas 86 gestantes, com diagnóstico de RPMPT e idade gestacional entre a 24ª e 35ª semanas. Foram excluídas gestantes que apresentavam síndromes hipertensivas, diabetes, fetos com malformações fetais e infecção na admissão. Para determinar a associação entre ILA e desfechos perinatais, foram utilizados os testes qui-quadrado e exato de Fisher, quando pertinentes, além da razão de risco (RR) e seu intervalo de confiança a 95% (IC95%). A correlação entre ILA e desfechos perinatais foi determinada por regressão linear simples, e a evolução do ILA durante a gestação foi analisada pelo teste Z. Resultados: quando comparados os recém-nascidos que apresentavam ultrassonografia com ILA<5 cm e ILA>5 cm, observou-se maior frequência de mortalidade perinatal nos casos de ILA<5 cm. Quando o oligo-hidrâmnio, porém, era diagnosticado como grave (ILA<3 cm), observava-se maior frequência de escore de Apgar <7 no 1º minuto, sepse neonatal e mortalidade neonatal precoce em relação aos que apresentavam ILA>3 cm. Observou-se uma correlação positiva entre ILA e idade gestacional no parto, peso ao nascer e escore de Apgar no 1º e 5º minutos, além de diminuição do volume do líquido amniótico com o avançar da idade gestacional. Conclusão: a presença de oligo-hidrâmnio grave após a RPMPT contribuiu para uma maior frequência de complicações e mortalidade perinatal.

Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections / Ruptura prematura das membranas fetais pré-termo: associação com fatores sociodemográficos e infecções geniturinárias maternas

OBJECTIVE: tthis study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. METHODS: this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight > 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. RESULTS: of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94), with lower level of schooling (PR = 2.43), age > 29 years (PR = 2.49), and smokers (PR = 2.04). It was also associated with threatened miscarriage (PR = 1.68) and preterm labor, (PR = 3.40). There was no association with maternal urinary tract infection or presence of genital discharge. CONCLUSIONS: the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. .

OBJETIVO: o objetivo deste estudo foi verificar a ocorrência da ruptura prematura das membranas fetais pré-termo em gestações únicas e sua associação com fatores sociodemográficos maternos e infecções geniturinárias autorreferidas. MÉTODOS: estudo transversal de base populacional onde foram incluídas todas as mães dos recém-nascidos dos partos únicos ocorridos no ano de 2010, com peso ao nascer igual ou superior a 500 gramas, residentes no município. As puérperas foram entrevistadas nas duas maternidades da cidade. Foram considerados casos as gestantes que perderam líquido amniótico antes da internação hospitalar e cujo tempo de gestação fosse inferior a 37 semanas. Foi realizada análise estatística por níveis, para controle de fatores de confusão por meio da regressão de Poisson. RESULTADOS: das 2.244 mulheres elegíveis para o estudo, 3,1% apresentaram ruptura prematura das membranas fetais pré-termo, a qual foi mais frequente, após ajuste, nas mulheres de menor nível econômico, razão de prevalência (RP) de 1,94, menor escolaridade, RP de 2,43, com idade superior a 29 anos, RP de 2,49 e tabagistas, RP de 2,04. Também esteve relacionada com ameaça de aborto, RP de 1,68, e de trabalho de parto pré-termo, RP de 3,40. Não houve associação com infecção urinária materna ou presença de corrimento genital. CONCLUSÕES: o desfecho foi mais frequente nas puérperas com menor escolaridade, mais pobres, mais velhas e tabagistas, assim como naquelas com histórico de ameaça de abortamento e trabalho de parto prematuro. Estes fatores devem ser considerados na sua abordagem preventiva, diagnóstica e terapêutica. .