MyMedR

Inhibition of preterm labour with a low dose regime of intravenous salbutamol

Chew WC, Lew LC

Family Physician, 1991;3:22-24.

Matched MeSH terms: Obstetric Labor, Premature

Role of Platelet Activating Factor as a Mediator of Inflammatory Diseases and Preterm Delivery

Wahid HH, Anahar FN, Isahak NH, Mohd Zoharodzi J, Mohammad Khoiri SNL, Mohamad Zainal NH, et al.

Am J Pathol, 2024 Jun;194(6):862-878.

PMID: 38403163 DOI: 10.1016/j.ajpath.2024.01.018

Nearly 70% of preterm deliveries occur spontaneously, and the clinical pathways involved include preterm labor and preterm premature rupture of membranes. Prediction of preterm delivery is considered crucial due to the significant effects of preterm birth on health and the economy at both the personal and community levels. Although similar inflammatory processes occur in both term and preterm delivery, the premature activation of these processes or exaggerated inflammatory response triggered by infection or sterile factors leads to preterm delivery. Platelet activating factor (PAF) is a phosphoglycerylether lipid mediator of inflammation that is implicated in infections, cancers, and various chronic diseases and disorders including cardiovascular, renal, cerebrovascular, and central nervous system diseases. In gestational tissues, PAF mediates the inflammatory pathways that stimulate the effector mechanisms of labor, including myometrial contraction, cervical dilation, and fetal membrane rupture. Women with preterm labor and preterm premature rupture of membranes have increased levels of PAF in their amniotic fluid. In mice, the intrauterine or intraperitoneal administration of carbamyl PAF activates inflammation in gestational tissues, thereby eliciting preterm delivery. This review summarizes recent research on PAF as an important inflammatory mediator in preterm delivery and in other inflammatory disorders, highlighting its potential value for prediction, intervention, and prevention of these diseases.

Matched MeSH terms: Obstetric Labor, Premature/metabolism

Dengue infections and pregnancy: caution in interpreting high rates of premature deliveries and maternal mortality

Seneviratne SL, Perera J, Wijeyaratne C

Southeast Asian J. Trop. Med. Public Health, 2007 Jan;38(1):195-6.

PMID: 17539267

Matched MeSH terms: Obstetric Labor, Premature/epidemiology*

Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour

Basri NI, Dasrilsyah RA

BMJ Case Rep, 2024 Feb 06;17(2).

PMID: 38320830 DOI: 10.1136/bcr-2023-258979

Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient's haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.

Matched MeSH terms: Obstetric Labor, Premature*

Automated detection of premature delivery using empirical mode and wavelet packet decomposition techniques with uterine electromyogram signals

Acharya UR, Sudarshan VK, Rong SQ, Tan Z, Lim CM, Koh JE, et al.

Comput Biol Med, 2017 06 01;85:33-42.

PMID: 28433870 DOI: 10.1016/j.compbiomed.2017.04.013

An accurate detection of preterm labor and the risk of preterm delivery before 37 weeks of gestational age is crucial to increase the chance of survival rate for both mother and the infant. Thus, the uterine contractions measured using uterine electromyogram (EMG) or electro hysterogram (EHG) need to have high sensitivity in the detection of true preterm labor signs. However, visual observation and manual interpretation of EHG signals at the time of emergency situation may lead to errors. Therefore, the employment of computer-based approaches can assist in fast and accurate detection during the emergency situation. This work proposes a novel algorithm using empirical mode decomposition (EMD) combined with wavelet packet decomposition (WPD), for automated prediction of pregnant women going to have premature delivery by using uterine EMG signals. The EMD is performed up to 11 levels on the normal and preterm EHG signals to obtain the different intrinsic mode functions (IMFs). These IMFs are further subjected to 6 levels of WPD and from the obtained coefficients, eight different features are extracted. From these extracted features, only the significant features are selected using particle swarm optimization (PSO) method and selected features are ranked by Bhattacharyya technique. All the ranked features are fed to support vector machine (SVM) classifier for automated differentiation and achieved an accuracy of 96.25%, sensitivity of 95.08%, and specificity of 97.33% using only ten EHG signal features. Our proposed algorithm can be used in gynecology departments of hospitals to predict the preterm or normal delivery of pregnant women.

Matched MeSH terms: Obstetric Labor, Premature/diagnosis*; Obstetric Labor, Premature/physiopathology

Observations on obstetric practice in a multicultural setting

TambyRaja RL

Matern Child Health J, 1999 Jun;3(2):111-3.

PMID: 10892419

Singapore provides a rich environment for investigations into ethnic differences in pregnancy outcome, as it is populated by Malays, Indians, and Chinese. Years of clinical practice and obstetric research in this environment have affirmed the observation that many factors interact in determining length of gestation and birth weight, and that these factors have differential affects among these three different ethnic groups. Although technological advances have furthered our understanding of obstetrical outcomes and provided essential tools to promote the survival of premature infants, the persistent use of uniform growth standards hampers our ability to assure positive outcomes for women of different ethnicity. Recognition of ethnic differences has resulted in declines in certain negative pregnancy outcomes for women in Singapore. The development of race-specific uterine growth curves will enhance the provision of perinatal care for all women.

Matched MeSH terms: Obstetric Labor, Premature/ethnology*; Obstetric Labor, Premature/epidemiology

Fulltext Role of mid-trimester transvaginal cervical ultrasound in prediction of preterm delivery

Hebbar S, Samjhana K

Med J Malaysia, 2006 Aug;61(3):307-11.

PMID: 17240581 MyJurnal

Ultrasonographic cervical length assessment is increasingly being utilized clinically to identify women at risk for spontaneous preterm delivery. In a randomised prospective longitudinal study involving 200 women, we measured cervical length and internal os diameter by transvaginal scan at 20 - 24 weeks and analysed their ability to predict preterm birth. The risk of spontaneous preterm delivery increased steeply as cervical length decreased. At cut off value of < or = 2.5cm, the cervical length measurements had sensitivity, specificity, positive predictive value and negative predictive value of 77%, 95%, 56% and 98% respectively. However, internal os diameter lacked sensitivity and specificity. Our data suggests that the duration of pregnancy is directly related to length of the cervix: the shorter the cervix, the greater the chance of preterm delivery.

Matched MeSH terms: Obstetric Labor, Premature/diagnosis*

Fulltext A comparison between the pregnancy outcome of women with gestation diabetes treated with glibenclamide and those treated with insulin

Lim JMH, Tayob Y, O'Brien PM, Shaw RW

Med J Malaysia, 1997 Dec;52(4):377-81.

PMID: 10968114

The pregnancy outcome of 33 women with gestational diabetes who were treated with glibenclamide and changed to insulin if glibenclamide failed, were compared with the pregnancy outcome of 21 women with gestational diabetes treated conventionally with insulin. The pregnancy outcome, with regard to the overall glycaemic control, rates of preterm labour, neonatal hypoglycaemia, fetal macrosomia, perinatal morbidity and mortality, were not statistically different between the two treatment groups. The limited number of women studied, and the non-random allocation of these women to each treatment group however, could have influenced these results. There were a few observed differences in the pregnancy outcome between the two treatment groups, which although were not statistically significant, caused some concern. In particular we noted an increased rate of fetal macrosomia in the glibenclamide treated group, which in theory could have been drug mediated.

Matched MeSH terms: Obstetric Labor, Premature/etiology

Pregnancy and malaria

Menon R

Med J Malaya, 1972 Dec;27(2):115-9.

PMID: 4268036

Matched MeSH terms: Obstetric Labor, Premature/etiology

Role of phIGFBP-1 and ultrasound cervical length in predicting pre-term labour

Azlin MI, Bang HK, An LJ, Mohamad SN, Mansor NA, Yee BS, et al.

J Obstet Gynaecol, 2010;30(5):456-9.

PMID: 20604646 DOI: 10.3109/01443615.2010.489162

This prospective observational study was to evaluate the efficacy of combining phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and transvaginal ultrasound cervical length (CL) compared with either indicator alone in predicting pre-term labour (PTL). Women with singleton pregnancy between 24 and 36 weeks' gestation with evidence of PTL were subjected to phIGFBP-1 and CL tests. Of the 51 women, five were tested positive (phIGFBP-1 positive and CL <2.5 cm) for combination of phIGFBP-1 and CL (four delivered within 1 week), whereas 46 tested negative, of which, only one delivered. A much higher negative predictivity (NP), positive predictivity (PP) and specificity (SP) in the combination test was seen compared with phIGFBP-1 or CL alone (NP: 97.8% vs 97.7% vs 97.1%; PP: 80.0% vs 51.1% and CL 23.5%; SP: 97.8% vs 93.5% vs 71.1%, respectively). The cervical os dilatation of 2 cm with combined positive test (p = 0.001) indicated a higher likelihood of PTL.

Matched MeSH terms: Obstetric Labor, Premature/metabolism; Obstetric Labor, Premature/ultrasonography*

Uterine arteriovenous malformation - Possible association to uterine fibroids?

Gan F, Vikneswaran V, Yu KK

Med J Malaysia, 2021 03;76(2):273-274.

PMID: 33742646

A 32-year-old, gravida 2 para 0+1, was managed in Selayang Hospital, Selangor for uterine fibroids in pregnancy and placenta previa major. The lady went into preterm labour at 33 weeks, requiring emergency Caesarean section. Intraoperatively, we found a thinned-out bulge between the intramural uterine fibroids at the posterior uterine wall, which then perforated and was repaired. Persistent bleeding post operatively led to relaparotomy and hysterectomy. Histology of the uterus reported arteriovenous malformation (AVM). We postulate the possibility of these lesions coexisting with uterine fibroids. Screening for uterine AVMs in patients with fibroids may lead to early detection with option of embolization; deferring the need for hysterectomy.

Matched MeSH terms: Obstetric Labor, Premature

Fulltext Antenatal traumatic brain injury secondary to maternal motor vehicle accident

Shamala N., Faizal, A.H.

Medicine & Health, 2018;13(2):202-207.

MyJurnal

Trauma is thought to complicate 1 in 12 pregnancies. The management of trauma during pregnancy requires special consideration because pregnancy alters maternal physiology and the foetus is a potential collateral victim. The approach of these cases in the setting of the Emergency Department should not only be diagnostic for any foetal injuries but also prognostic for any future undue outcome. Antenatal traumatic brain injury is a rare but real complication of maternal blunt force trauma. Our case involves a 22-year-old primigravida who suffered a motor vehicle accident and on initial assessment revealed normal foetal assessment but subsequently after premature labour revealed a new born with traumatic brain injury. Early ultrasonographic evaluation and observational period with continuous electronic foetal monitoring may improve the detection and emergent treatment in these cases.

Matched MeSH terms: Obstetric Labor, Premature

Hyperthyroidism in pregnancy

Zainuddin Z, Shaker AAH

Family Physician, 2005;13(3):2-4.

MyJurnal

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects

Matched MeSH terms: Obstetric Labor, Premature

Single dose 17 alpha-hydroxyprogesterone caproate in preterm labor: a randomized trial

Tan PC, King AS, Vallikkannu N, Omar SZ

Arch Gynecol Obstet, 2012 Mar;285(3):585-90.

PMID: 21796421 DOI: 10.1007/s00404-011-2026-3

To evaluate the effect of a single 250-mg dose of 17 alpha-hydroxyprogesterone caproate (17-OHPC) intramuscularly as adjunct to nifedipine tocolysis in preterm labor.

Matched MeSH terms: Obstetric Labor, Premature/drug therapy*

Mode of delivery and outcomes in preterm births

Sangkomkamhang U, Pattanittum P, Laopaiboon M, Lumbiganon P

J Med Assoc Thai, 2011 Apr;94(4):415-20.

PMID: 21591525

To compare maternal and neonatal outcomes by mode of delivery in preterm births.

Matched MeSH terms: Obstetric Labor, Premature/epidemiology*

Systemic lupus erythematosus pregnancies: the Sarawak experience and review of lupus pregnancies in Asia

Teh CL, Wong JS, Ngeh NK, Loh WL

Rheumatol Int, 2011 Sep;31(9):1153-7.

PMID: 20349069 DOI: 10.1007/s00296-010-1435-0

We performed a cross-sessional study of all systemic lupus erythematosus (SLE) pregnancies during a 4-year period (2006-2009) to describe the clinical features, maternal and foetal outcomes in our centre. There were 48 pregnancies in 44 women with SLE. Our patients have a mean age of 30.0 years (SD 6.36) and a mean disease duration of 40.67 months (SD 48.23). Our patients have complicated pregnancies: 32.7% have SLE flares, 17.3% have preeclampsia and 48.9% needed caesarean sections. There were 20.0% foetal losses and 17.8% preterm deliveries in our patients. SLE flares contributed to 60.0% of foetal losses in our patients. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable to developed countries in Asia. The low incidence of APS, the high usage of hydroxychloroquine and the high SLE remission rate in our patients prior to conceptions contributed to the good outcome.

Matched MeSH terms: Obstetric Labor, Premature/epidemiology

Salbutamol in premature labour--a preliminary report

Ken DK, Ng KH

Med J Malaysia, 1974 Mar;28(3):191-3.

PMID: 4278259

Matched MeSH terms: Obstetric Labor, Premature/drug therapy*

Prevention of respiratory distress syndrome

Yu, Victor Y.H.

Malaysian Journal of Child Health, 1993;5(1):3-8.

MyJurnal

ANTENATAL CORTICOSTEROID THERAPY. Benefits. In 1969, the first study was published which showed that prematurely delivered lambs exposed prenatally to corticosteroids survived longer than placebo-treated control animals.' A randomised clinical trial (RCT) followed which demonstrated that antenatal corticosteroid therapy significantly reduced the incidence of respiratory distress syndrome (RDS) in infants born before 2 weeks gestation and reduced mortality in those born before 37 weeks.2 A meta-analysis has been published on 12 RCTs involving over 3000 women in preterm labour, using primarily 24mg of betamethasone or dexamethasone given in 2-6 divided doses over a 48-hour period.' It showed that antenatal corticosteroid therapy is associated with a significant reduction in the risk of RDS (a) if the infant is born > 24 hours or < 7 days of the treatment, (b) in both male and female infants and (c) even in infants < 31 weeks gestation. It also significantly reduces mortality rate and morbidity such as intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC), shortens the duration of hospitalisation and reduces treatment costs. The improvement in survival rate in infants born

Matched MeSH terms: Obstetric Labor, Premature

Fulltext Antenatal profile and obstetric outcome of adolescent pregnancy in a Malaysian semi-rural clinic

Kwa SK, Lu AIC, Zairul Azwan MA, Aman Fuad Y, Siti Aishah A

Family Physician, 2001;11(3):7-10.

Adolescent pregnancy is associated with long term medical and sociological problems. For intervention, it is important to have information on their profile and obstetric outcome. A study was conducted in 1999 on teenage mothers compared to mothers in the 20-34 year age group. Antenatal records of all these mothers registered in a Malaysian semi-rural Health Clinic in 1998 were reviewed and the relevant information was analysed using descriptive statistics and chi-square for comparison in SPSS 7.5. Only 402 (80.9%) of the 497 antenatal records could be included. There were 40 (9.95%) adolescent pregnancies and 362 (90.05%) pregnancies in mothers aged 20-34 years. Pregnant adolescents were more likely to be Malays (85% versus 66%), unmarried (65% versus 5.5%) and less educated (32.5% versus 12.1%). They have a significantly lower rate of contraceptive usage (2.5% versus 20.2%) and tend to come late for their first antenatal visit (55% versus 18.5%). Their pregnancy complications of anaemia and pregnancy induced hypertension were no worse. But they had a significantly higher preterm delivery rate (37.5% versus 21.8%) and their babies were more likely to have low birth weight (32.5% versus 9.9%). Based on this preliminary finding, further investigations should be carried out and polices should include programmes targeted for this group.

Matched MeSH terms: Obstetric Labor, Premature

Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study

Voon HY, Leong MS, Li CW, Bujang A, Suharjono H

Med J Malaysia, 2017 10;72(5):259-263.

PMID: 29197879 MyJurnal

BACKGROUND: In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies.

METHODS: Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone.

RESULTS: The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours.

CONCLUSION: In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.

Matched MeSH terms: Obstetric Labor, Premature

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