Computer modeling tools to understand the causes of preterm birth
The mechanical integrity of the soft tissue structures supporting the fetus may play a role in maintaining a healthy pregnancy and triggering the onset of labor. Currently, the level of mechanical loading on the uterus, cervix, and fetal membranes during pregnancy is unknown, and it is hypothesized that the over-stretch of these tissues contributes to the premature onset of contractility, tissue remodeling, and membrane rupture, leading to preterm birth. The purpose of this review article is to introduce and discuss engineering analysis tools to evaluate and predict the mechanical loads on the uterus, cervix, and fetal mem...
Source: Seminars in Perinatology - September 25, 2017 Category: Perinatology & Neonatology Authors: Andrea R. Westervelt, Kristin M. Myers Source Type: research
17-alpha hydroxyprogesterone caproate for preterm birth prevention: Where have we been, how did we get here, and where are we going?
Prematurity is a major public health problem in the United States and worldwide. Women with a history of a previous preterm birth are at high risk for recurrence. Progesterone is a key hormone involved in pregnancy maintenance. In general, progesterone is thought to maintain pregnancy through several closely linked mechanisms: (1) promotion of uterine quiescence, (2) inhibition of pro-inflammatory cells, and (3) immunosuppressive action. 17-Alpha hydroxyprogesterone caproate is currently the only medication approved to prevent recurrent preterm birth. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 22, 2017 Category: Perinatology & Neonatology Authors: Tracy A. Manuck Source Type: research
Maintaining and repeating tocolysis: A reflection on evidence
It is inherent to human logic that both doctors and patients want to suppress uterine contractions when a woman presents in threatened preterm labor. Tocolysis is widely applied in women with threatened preterm labor with a variety of drugs. According to literature, tocolysis is indicated to enable transfer to a tertiary center as well as to ensure the administration of corticosteroids for fetal maturation. There is international discrepancy in the content and the implementation of guidelines on preterm labor. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 21, 2017 Category: Perinatology & Neonatology Authors: Isabelle Dehaene, Lina Bergman, Paula Turtiainen, Alexandra Ridout, Ben Willem Mol, Elsa Lorthe, from the International Spontaneous Preterm birth Young Investigators group (I-SPY) Source Type: research
Racial and ethnic differences in preterm birth: A complex, multifactorial problem
Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates, and is a major public health problem. Non-Hispanic black women have a 2-fold greater risk for preterm birth compared with non-Hispanic white race. The reasons for this disparity are poorly understood and cannot be explained solely by sociodemographic factors. Underlying factors including a complex interaction between maternal, paternal, and fetal genetics, epigenetics, the microbiome, and these sociodemographic risk factors likely underlies the differences between racial groups, but these relationships are currently poorly under...
Source: Seminars in Perinatology - September 20, 2017 Category: Perinatology & Neonatology Authors: Tracy A. Manuck Source Type: research
Predicting preterm birth: Cervical length and fetal fibronectin
Spontaneous preterm birth remains the leading cause of neonatal morbidity and mortality worldwide, and accounts for a significant global health burden. Several obstetric strategies to screen for spontaneous preterm delivery, such as cervical length and fetal fibronectin measurement, have emerged. However, the effectiveness of these strategies relies on their ability to accurately predict those pregnancies at increased risk for spontaneous preterm birth (SPTB). Transvaginal cervical shortening is predictive of preterm birth and when coupled with appropriate preterm birth prevention strategies, has been associated with reduc...
Source: Seminars in Perinatology - September 18, 2017 Category: Perinatology & Neonatology Authors: Moeun Son, Emily S. Miller Source Type: research
Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs
The quality of maternity care in the United States is variable, and access to care is tenuous for rural residents, low-income individuals, and people of color. Without accessible, timely, and high-quality care, certain clinical and sociodemographic characteristics of individuals may render them more vulnerable to poor birth outcomes. However, risk factors for poor birth outcomes do not occur in a vaccum; rather, health care financing, delivery, and organization as well as the policy environment shape the context in which patients seek and receive maternity care. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 7, 2017 Category: Perinatology & Neonatology Authors: Katy B. Kozhimannil, Rachel R. Hardeman, Carrie Henning-Smith Source Type: research
Pathophysiology of preterm labor with intact membranes
Preterm labor with intact membranes is a major cause of spontaneous preterm birth (sPTB). To prevent sPTB a clear understanding is needed of the hormonal interactions that initiate labor. The steroid hormone progesterone acting via its nuclear progesterone receptors (PRs) in uterine cells is essential for the establishment and maintenance of pregnancy and disruption of PR signaling (i.e., functional progesterone/PR withdrawal) is key trigger for labor. The process of parturition is also associated with inflammation within the uterine tissues and it is now generally accepted that inflammatory stimuli from multiple extrinsic...
Source: Seminars in Perinatology - September 7, 2017 Category: Perinatology & Neonatology Authors: Asha N. Talati, David N. Hackney, Sam Mesiano Source Type: research
Genetics, hormonal influences, and preterm birth
Prematurity is a devastating disease with high neonatal morbidity and mortality based on gestational age at birth. Genetic and hormonal signals impact directly on the maternal predisposition to preterm birth or sudden onset of myometrial contractility. Candidate gene or genome-wide approaches are beginning to identify potential variants for women at risk for premature delivery or increased responsiveness to hormonal signals including progesterone. However, a majority of these studies have not yielded definitive results to allow for at this stage for development of personalized therapy. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 5, 2017 Category: Perinatology & Neonatology Authors: Kara M. Rood, Catalin S. Buhimschi Source Type: research
Genetics, hormonal influences, and pretertm birth
Prematurity is a devastating disease with high neonatal morbidity and mortality based on gestational age at birth. Genetic and hormonal signals impact directly on the maternal predisposition to preterm birth or sudden onset of myometrial contractility. Candidate gene or genome-wide approaches are beginning to identify potential variants for women at risk for premature delivery or increased responsiveness to hormonal signals including progesterone. However, a majority of these studies have not yielded definitive results to allow for at this stage for development of personalized therapy. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 5, 2017 Category: Perinatology & Neonatology Authors: Kara M. Rood, Catalin S. Buhimschi Source Type: research
Epidemiology of preterm birth
Preterm birth is a worldwide epidemic with a global incidence of 15 million per year. Though rates of preterm birth in the United States have declined over the last decade, nearly 1 in 10 babies is still born preterm. The incidence, gestational age, and underlying etiology of preterm birth is highly variable across different racial and ethnic groups and geographic boundaries. In this article, we review the epidemiology of preterm birth in the United States and globally, with a focus on temporal trends and racial, ethnic, and geographic disparities. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - August 30, 2017 Category: Perinatology & Neonatology Authors: Stephanie E. Purisch, Cynthia Gyamfi-Bannerman Source Type: research
Racial disparity in infant mortality
In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women ’s long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other like...
Source: Seminars in Perinatology - August 29, 2017 Category: Perinatology & Neonatology Authors: Nana Matoba, James W. Collins Source Type: research
Perinatal legislative policies and health outcomes
Perinatal epidemiology examines the variation and determinants of pregnancy outcomes from a maternal and neonatal perspective. However, improving public and population health also requires the translation of this evidence base into substantive public policies. Assessing the impact of such public policies requires sufficient data to include potential confounding factors in the analysis, such as coexisting medical conditions and socioeconomic status, and appropriate statistical and epidemiological techniques. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - August 28, 2017 Category: Perinatology & Neonatology Authors: Scott A. Lorch Source Type: research
Understanding pregnancy outcomes using epidemiology and health services research
Scott A. Lorch, MD, MSCE(Guest editor) (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - August 28, 2017 Category: Perinatology & Neonatology Authors: Scott A. Lorch Source Type: research
The pathophysiology of human premature cervical remodeling resulting in spontaneous preterm birth: Where are we now?
Approximately one in ten (approximately 500,000) pregnancies results in preterm birth (PTB) annually in the United States. Although we have seen a slight decrease in the U.S. PTB rate between 2007 and 2014, data from 2014 to 2015 shows the preterm birth rate has slightly increased. It is even more intriguing to note that the rate of PTB has not significantly decreased since the 1980s. In order to decrease the rate of spontaneous preterm birth (sPTB), it is imperative that we improve our understanding of normal and abnormal reproductive tissue structure and function and how these tissues interact with each other at a cellul...
Source: Seminars in Perinatology - August 18, 2017 Category: Perinatology & Neonatology Authors: Joy Vink, Mirella Mourad Source Type: research
Epidemiology of maternal morbidity and mortality
We describe current local and national initiatives in place to reduce maternal morbidity and mortality and offer suggestions for future research. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - August 17, 2017 Category: Perinatology & Neonatology Authors: Adi Hirshberg, Sindhu K. Srinivas Source Type: research
