News in pathophysiology and management of preterm labour
Authors:
M. Koucký 1; A. Germanová 1,2; Z. Hájek 1; A. Pařízek 1; M. Kalousová 2; P. Kopecký 1
Authors‘ workplace:
Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
1; Ústav klinické biochemie VFN a 1. LF UK, Praha, přednosta prof. MUDr. T. Zima, DrSc.
2
Published in:
Ceska Gynekol 2009; 74(1): 54-63
Overview
Objective:
To summarize available data concerning pathophysiology and management of preterm labour and thein use in clinical practice.
Setting:
Department of Obstetrics and Gynecology od the First Faculty of Medicine, Charles University, and General Teaching Hospital, Prague.
Design:
Review article.
Methods:
Compilation od published data from scientific literature.
Conclusion:
Birth canal infections seem to play a key role in the ethiopathogenesis of premature delivery; the related biochemical changes significantly affect perinatal morbidity and mortality. Other potential causes, particularly hormone metabolism disorders or uteroplacental ischaemia have been intensively studied. The particular pathogenetic process of premature delivery is inflammation. This process is related to both mother and fetus. Fetal inflammatory response (FIRS) – can occur without maternal response – is connected with significant increase in perinatal morbidity. FIRS is characterised by defined laboratory, histological and clinical criteria. Effective primary prevention of premature delivery does not exist at present. The sensitivity and specificity of the laboratory markers having been used so far is low. Thus, the research is focused on finding new inflammation markers to allow early identification of pregnant women at a high risk of premature delivery and fetal inflammation. The screening of women at a high risk by means of new laboratory and ultrasound tests belongs to the most important steps in secondary and tertiary prevention of premature delivery. Intensive research of potential trigger mechanisms has been carried out, including a variety of gene types, which are potentially related to the process of premature delivery. We try to exercise new informations about pathophysiology of preterm labour in prenatal care, firstly about thrombophillias and gestagens. We also use a principles of “evidence based medicine” and revalue importance of steroids, tocolytics and antibiotics.
Key words:
premature labour, premature rupture of membranes, fetal inflammation, markers of inflammation, thrombophillia, gestagens.
Sources
1. Arias, F., Romero, R., Joist, H., Kraus, FT. Thrombophilia: a mechanism of disease in women with adverse pregnancy outcome and thrombotic lesions in the placenta. J Matern Fetal Med, 1998, 7, p. 277 – 286.
2. Asrat, T. Intra-amniotic infecton in patiens with preterm prelabor rupture of membranes. Pathohysiology, detection, and management. Clin Perinatol, 2001, 28, p. 736 – 739.
3. Blois, SM., Ilarregui, JM., Tometten, M., et al. A pivotal role for galectin-1 in fetomaternal tolerance. Nat Med, 2007, 13, p. 1450 – 1457.
4. Buhimschi, IA., Zhao, G., Pettker, CHM., et. al. The receptor for advanced glycation end products (RAGE) system in women with intraamniotic infection and inflammation. Am J Obstet Gynecol, 2007, 196, p. 181.e1 – 181e12.
5. Bukowski, R., Malone, F., Porter, F., et al. Preconceptial folate prevents preterm delivery. Am J Obstet Gynecol, 2007, 197, suppl.1, p.S3.
6. Bytautiene, E., Romero, R., Vedernikov, YP. Induction of premature labor and delivery by alergic reaction and prevention by histamin H1 receptor antagonist. Am J Obstet Gynecol, 2004, 191, p. 1356 – 1361.
7. Carey, JC., Yaffe, SJ., Catz, C. for the VIP Study Group. The vaginal infections and prematurity study: An overview. Clin Obstet Gynecol, 1993, 36, p.809 – 816.
8. Crowther, CA., Harding, JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease. Cochrane Database Syst Rev, 2007,18, Art.No.: CD003935.
9. Czeizel, AE. The primary prevention of birth defects: multivitamins and folic acid. Int J Med Sci, 2004, 1, p. 50 – 61.
10. Da Fonseca, EB., Bittar, RE., Carvalho, MH., Zugaib, M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol, 2003, 188, p. 419 – 424.
11. Da Fonseca, EB., Celik, E, Parra, M., et al. Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med, 2007, 357, p. 462 – 469.
12. De Franco, EA., O’Brien, JM., Adair, CD., et al. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol, 2007, 30, p. 697 – 705.
13. De Heus, R., Mulder, EJ., Derks, JB., Visser, GH. Acute tocolysis for uterine activity reduction in term labor a review. Obstet. Gynecol. Surv, 2008, 63, p. 383 – 388.
14. Dodd, JM., Flenady, VJ., Cincotta, R., Crowther, CA. Progesterone for the prevention of preterm birth: a systematic review. Obstet Gynecol, 2008, 112, p. 127 – 134.
15. Dudley, DJ. Preterm labor: An intrauterine inflammatory response syndrom ? J Reprod Immunol, 1997, 36, p. 93 – 98.
16. Engel, SM., Olshan, AF., Siega-Riz, AM., et al. Polymorphisms in folate metabolizing genes and risk for spontaneous preterm and small-for-gestational age birth. Am J Obstet Gynecol, 2006, 195, p. 1231.e1 – e11.
17. Florio, P., Romero, R., Chaiworapongsa, T., et al. Amniotic fluid and umbilical cord plasma corticotropin-releasing factor (CRF), CRF-binding protein, adrenocorticotropin, and cortisol concentrations in intraamniotic infection and inflammation at term. J Clin Endocrinol Metab, 2008, 93, p. 3604 – 3609.
18. Garfield, RE., Bytautiene, E., Vedernikov, YP., et al. Modulation of rat uterine contractility by mast cells and their mediators. Am J Obstet.Gynecol, 2000, 183, p. 118 – 125.
19. Goldenberg, RL., Hauth, JC., Andrews, WW. Intrauterine infection and preterm delivery. N Engl J Med, 2000, 342, p.1500 – 1507.
20. Gomez, R., Romero, R., Edwin, SS., et.al. Pathogenesis of preterm labor and preterm premature of membranes associated with intra-amniotic infection. Infect Dis Clin North Am, 1997, 11, p. 135 – 142.
21. Gomez, R., Romero, R., Ghezzi, F., et al. The fetal inflammatory response syndrome (FIRS). Am J Obstet Gynecol, 1998, 179, p. 194 – 198.
22. Gotsch, F., Romero, R., Kusanovic, JP., et al. The anti-inflammatory limb of the immune response in preterm labor, intra-amniotic infection/inflammation, and spontaneous parturition at term: a role for interleukin-10. J Matern Fetal Neonatal Med, 2008, 21, p. 529 – 547.
23. Guillard, C., Zidi, I., Marcou, C., et al. Role of HLA-G in innate immunity through direct activation of NF-kappaB in natural killer cells. , 2008, 45, p. 419 – 427.
24. Hájek, Z., Germanová, A., Koucký, M., et al. Detection of fetomaternal infection/inflammation by the soluble receptor for advanced glycation end products (sRAGE): results of a pilot study. J Perinat Med, 2008, 36, p. 399 – 404.
25. Jeffcoat, MK., Geurs, NC., Reddy, MS., et al. Current evidence regarding periodontal disease as a risk factor in preterm birth. Ann Periodontol, 2001,6, p. 183 – 186.
26. Kam, KY., Lamont, RF. Developments in the pharmacotherapeutical managment of spontaneous preterm labor. Expert Opin Pharmacother, 2008, 9, p.1153 – 1168.
27. Keirse, MJ. Progestogen administration in pregnancy may prevent preterm delivery. BJOG, 1990, 97, p. 149 – 154.
28. Kenyon, SL., Pike, K., Jones, D. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial. Lancet, 2008, 372, p. 1276 – 1278.
29. Kenyon, SL., Taylor, DJ., Tarnow-Mordi, W., ORACLE Collaborative Group. Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. ORACLE Collaborative Group. Lancet, 2001, 357, p. 989 – 994.
30. Kenyon, SL., Taylor, DJ., Tarnow-Mordi, W., ORACLE Collaborative Group. Broad--spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet, 2001, 357, p. 979 – 988.
32. Krause, G., Winkler, L., Mueller, SL., et al. Structure and function of claudins. Biochim Biophys Acta, 1778, p.631 – 645.
33. Lee, SE., Romero, R., Park, CW., et al. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. , 2008, 198, p. 633.e1 – e8.
34. Meis, PJ., Klebanoff, M., Tom, E., et al. Prevention of recurrent preterm delivery by 17 -alphahydroxyprogesterone caproate. N Engl J Med, 2003, 348, p. 2379 – 2385.
35. Mercer, BM., Carr, TL., Beazley, DD., et al. Antibiotic use in pregnancy and drug-resistant infant sepsis. Am J Obstet Gynecol, 181, 1999, p. 816 – 821.
36. Ozbek, AN., Atac, BFB., Verdi, BH., et al. Relationship between small-for-gestational age births and maternal thrombophilic mutations. Tromb Res, 2007, 122, p. 175 – 178.
37. Park, CW., Lee, SM., Jun, JK., et al. The antenatal identification of funisitis with a rapid MMP-8 bedside test. Am J Obstet Gynecol, 2007, 197, p. 292 e1 – e5.
38. Raynes-Greenow, CH., Roberts, CL., Bell, JC., et al. Antibiotics for ureaplasma in the vagina in pregnancy (Cochrane review). The Cochrane Library, Issue 4, 2004.
39. Romero, R., Espinoza, J., Erez, O. The role of cervical cerclage in obstetric practice:can the patient who could benefit from this procedure be identified? Am J Obstet Gynecol, 2008, 194, p. 1 – 9.
40. Romero, R., Espinoza, J., Gocalves, LF., et al. The role of inflammation and infection in pretertm birth. Seminars in reproductive medicine, 2007, 25, p. 21 – 39.
41. Romero, R., Espinoza, J., Kusanovic, JP., et al. The preterm parturition syndrome, BJOG, 113, SUPPL.3, 2006, p. 17 – 42.
42. Romero, R., Chaiworapongsa, T., Kuivaniemi, H. Bacterial vaginosis, the inflammatory response and the risk of preterm birth: a role for genetic epidemiology in the prevention of preterm birth. Am J Obstet Gynecol, 2004, 190, p. 1509 – 1519.
43. Romero, R., Mazor, M. Infection and preterm labor. Clin Obstet Gynecol, 1988, 31, p. 553 – 560.
44. Schelonka RL., Waites, KB. Ureaplasma infection and neonatal lung disease. Semin Perinatol, 2007, 31, p. 2 – 9.
45. Schumacher, A., Wafula, PO., Bertoja, AZ., et al. Mechanisms of action of regulatory T cells specific for paternal antigens during pregnancy. Obstet Gynecol, 2007, 110, p. 1137 – 1145.
46. Simcox, R., Sin, WT., Seed, PT., Briley, A., Shennan, AH. Prophylactic anbitiotics for the prevention of preterm birth in women at risk: a meta-analysis. Aust NZ J Obstet Gynaecol, 2007, 47, p. 368 – 377.
47. Szekeres-Bartho, J. Immunological relationship between the mother and the fetus. , 2002, 21, p. 471 – 495.
48. Than, NG., Romero, R., Erez, O., et al. Emergence of hormonal and redox regulation of galectin-1 in placenta mammals: implication in maternal-fetal immune tolerance. Proceedings of the National Academy of Science of the United States of America, 2008, 105, p. 15819 – 15824.
49. Timmons, BC., Mitchell, SM., Gilpin, C., Mahendroo, MS. Dynamic changes in the cervical epithelial tight junction complex and differentiation occur during cervical ripening and parturition. Endocrinology, 2007, p. 1278 – 1287.
50. Tita, AT., Cliver, SP., Goepfert, AR., et al.. Clinical trial of interconceptional antibiotics to prevent preterm birth: subgroup analyses and possible adverse antibiotic-microbial interactio. Am J Obstet Gynecol, 2007, 197, p. 367.e1 – e6.
51. Werler, AS. Periconceptional folic acid exposure and risk of occurent neural tube defects. JAMA, 1993, 269, p. 1257 – 1561.
52. Xu, H., Gonzalez, JM., Ofori, E., Elovitz, MA. Preventing cervical ripening: the primary mechanism by which progestational agents prezent preterm birth? Am J Obstet Gynecol, 2008, 198, 314.e1 - 314.e8.
53. Yoon, BH., Romero, R., Bin Moon, J., et al. Clinical significance of intra-amniotic inflammation in patiens with preterm labor and intact membranes. Am J Obstet Gynecol, 185, 2001, 1130 – 1138.
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2009 Issue 1
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