Predicting Preterm Birth Using Cell-Free Ribonucleic Acid.

Spontaneous preterm birth (sPTB) is a complex and clinically heterogeneous condition that remains incompletely understood, leading to insufficient interventions to effectively prevent it from occurring. Cell-free ribonucleic acid signatures in the maternal circulation have the potential to identify biologically relevant subtypes of sPTB. These could one day be used to predict and prevent sPTB in asymptomatic individuals, and to aid in prognosis and management for individuals presenting with threatened preterm labor and preterm prelabor rupture of membranes.

Impact of early preeclampsia prediction on medication adherence and behavior change: a survey of pregnant and recently-delivered individuals.

BACKGROUND: Behavior change and medication adherence represent potential barriers to optimal prevention of pregnancy complications including preeclampsia. We sought to evaluate baseline sentiments on pregnancy care and medication amenability, and how these measures would be impacted by early predictive testing for preeclampsia. METHODS: We developed a digital survey to query participants' baseline sentiments on pregnancy care, knowledge about pregnancy complications, and views on a hypothetical test to predict preeclampsia. The survey was administered online to pregnant and recently-delivered individuals in the United States. Survey data were analyzed using pooled two-sample proportion z-tests with adjustment for multiple comparisons. RESULTS: One thousand and twenty-two people completed the survey. 84% reported they were satisfied with their pregnancy care. Self-assessed knowledge about preeclampsia was high, with 75% of respondents reporting they have a "good understanding" of preeclampsia, but measured knowledge was low, with only 10% able to identify five common signs/symptoms of preeclampsia. Notably, 40% of participants with prior preeclampsia believed they were at average or below-average risk for recurrence. 91% of participants desired early pregnancy predictive testing for preeclampsia. If found to be at high risk for preeclampsia, 88% reported they would be more motivated to follow their provider's medication recommendations and 94% reported they would desire home blood pressure monitoring. Increased motivation to follow clinicians' medication and monitoring recommendations was observed across the full spectrum of medication amenability. Individuals who are more medication-hesitant still reported high rates of motivation to change behavior and adhere to medication recommendations if predictive testing showed a high risk of preeclampsia. Importantly, a high proportion of medication-hesitant individuals reported that if a predictive test demonstrated they were at high risk of preeclampsia, they would feel more motivated to take medications (83.0%) and aspirin (75.9%) if recommended. CONCLUSION: While satisfaction with care is high, participants desire more information about their pregnancy health, would value predictive testing for preeclampsia, and report they would act on this information. Improved detection of at-risk individuals through objective testing combined with increased adherence to their recommended care plan may be an important step to remedy the growing gap in prevention.

Subsequent pregnancy outcome after B-lynch suture placement.

OBJECTIVE: To evaluate whether use of the B-Lynch suture is associated with subsequent adverse pregnancy outcomes. METHODS: This is a cohort study of women who experienced postpartum hemorrhage between January 2000 and June 2010 and had a subsequent pregnancy at a single university hospital. Women who had postpartum hemorrhage and B-Lynch suture were compared with those complicated by postpartum hemorrhage but no B-Lynch suture placement. The primary outcome was a composite adverse outcome related to placentation abnormalities and included placenta previa, placenta accreta, preeclampsia, preterm birth, or a small-for-gestational-age neonate. The study was powered to detect a twofold difference in the frequency of the composite outcome. RESULTS: Two hundred fifty-two patients met inclusion criteria, 63 of whom had a prior B-Lynch suture. Women with a prior B-Lynch had a higher mean estimated blood loss (1,800 mL compared with 1,200 mL, P<.001) and were more likely to have received a blood transfusion (29.2% compared with 13.3%, P=.01) in the index pregnancy. The composite outcome was not different between the groups (14.3% compared with 13.8%, P=.92). A logistic regression controlling for potential confounding factors did not show any association between exposure to a B-Lynch suture and adverse pregnancy outcome in a subsequent pregnancy (adjusted odds ratio 0.88, 95% confidence interval 0.34-2.28. CONCLUSION: Placement of a B-Lynch suture is not associated with an increased risk of future adverse pregnancy outcomes related to abnormal placentation. LEVEL OF EVIDENCE: II.