Uterine compression suture in uterine atony during cesarean section

Objetivo: Determinar si el empleo de la sutura compresiva del útero (técnica de B-Lynch) durante la cesárea en casos de atonía uterina disminuye la pérdida sanguínea y evita la histerectomía posparto. Material y Métodos: Estudio retrospectivo de las cesáreas que cursaron con atonía uterina durante la intervención, desde el 1 de enero de 1990 al 31 de diciembre de 2003, en el Hospital San Bartolomé de Lima. El método estándar de manejo de la atonía uterina en la cesárea consiste en el masaje uterino, el empleo de agentes uterotónicos (ocitocina, prostaglandinas), ligadura de arterias uterinas/ hipogástricas y la histerectomía posparto. Las variables maternas y perinatales obtenidas de las historias clínicas fueron ingresadas a una base de datos computarizado (SPSS versión 10). Resultados: Se identificó 46 casos: en 30 se empleó la técnica B-Lynch y en 16 el método estándar. No hubo diferencias en las características maternas entre ambos grupos. El grupo de B-Lynch presentó subjetivamente menor perdida sanguínea, recibió menor número de unidades de sangre transfundida y presentó significativo menor riesgo de histerectomía posparto comparado con el método estándar (promedio ± DE: 1144,4±311,7 mL vs 1666,9±794,4 mL, p<0,05; 0,36±0,66 vs 2,90±3,64, p<0,05; y OR 0,08, IC95% 0,01-0,45, p<0,01, respectivamente). Conclusiones: La sutura compresiva del útero durante la cesárea en la atonía uterina parece reducir el sangrado vaginal, la transfusión sanguínea y el empleo de la histerectomía comparado con el método estándar.Objetive: To ascertain whether the use of uterine compression suture (B-Lynch technique) during a cesarean section with uterine atony decreases the amount of blood loss and prevents postpartum hysterectomy. Material and Methods: Retrospective study of all the cesarean section deliveries complicated by uterine atony from January 1, 1990 through December 31, 2003 at San Bartolome Hospital in Lima. The standard management of uterine atony included uterine massage, use of uterotonic agents (ocytocin, prostaglandins), uterine/hypogastric artery ligature and, finally, postpartum hysterectomy. Maternal and Infant clinical charts were reviewed and variables were entered into a computer system analysis (SPSS version 10). Results: Forty six cases were identified: B-Lynch technique was used in 30 cases and the standard method in 16 cases. There was no difference in maternal characteristic between both groups. B-Lynch technique group presented subjective lower amount of blood loss, received lower units of blood transfusion and had significant lower risk of postpartum hysterectomy as compared to the standard method group (mean ± SD: 1144,4±311,7 mL vs 1666,9±794,4 mL, p<0,05; 0,36±0,66 vs 2,90±3,64, p<0,05; and OR 0,08, CI95% 0,01-0,45, p<0,01, respectively). Conclusions: Uterine compression sutures during a cesarean section with uterine atony may reduce the amount of blood loss, the number of blood transfusions and the use of hysterectomy as compared to the standard method

Post partum depression: is it associated to gender based violence?

Introducción: La depresión posparto y la violencia basada en género son patologías muy frecuentes en la mujer; la importancia de un diagnóstico y tratamiento oportuno radica en evitar las consecuencias a futuro en la mujer, el recién nacido y la familia en general. Objetivos: Determinar la asociación entre depresión posparto y la violencia basada en género. Diseño: Exploratorio, de corte transversal. Lugar: Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú. Participantes: Mujeres puérperas. Intervenciones: Se aplicó una ficha de datos sociodemográficos y del parto, la escala de Edimburgo, el inventario revisado de factores predictores de depresión posparto y el instrumento de detección de violencia basada en género a 100 mujeres, de 1 a 12 meses de tiempo puerperal. Principales medidas de resultados: Asociación entre depresión posparto y violencia basada en género. Resultados: La tasa de depresión posparto fue 17%, encontrando diferencias estadísticas al compararla con autoestima, depresión previa al embarazo, ansiedad durante la gestación, satisfacción marital y eventos estresantes durante la gestación. El 51% fue víctima de violencia basada en género, siendo la más frecuente la forma psicológica. Se halló diferencias estadísticas entre depresión posparto y violencia basada en género (p=0,001), así como, diferencias estadísticas entre depresión posparto y violencia durante la gestación, encontrando un OR de 5,5 (IC: < 5,5; 16,7>). Conclusiones: Las mujeres víctimas de violencia tienen riesgo elevado de sufrir depresión posparto.Introduction: Post partum depression and gender based violence are very common disorders in women; the importance of early diagnosis and prompt treatment is to avoid future consequences in women, newborns and the family. Objectives: To determine the association between post partum depression and gender based violence. Design: Exploratory cross-sectional. Place: Hospital Nacional Docente Madre Niño San Bartolome, Lima, Peru. Participants: Post partum women. Interventions: We applied a sociodemographic data and delivery card, the Edinburgh scale, revised inventory predictors of post partum depression and an instrument for detection of gender based violence to 100 women 1 to 12 months post partum. Data analysis was conducted using odds ratio tests, Chi-square and Fisher exact test. Main outcome measures: Association between post partum depression and gender based violence. Results: The rate of post partum depression was 17% with statistical difference between the cases of post partum depression and self-esteem, depression before pregnancy, anxiety during pregnancy, marital satisfaction and stressful events during pregnancy. Moreover, 51% of women were victims of gender based violence, mainly psychological and the husband being the principal aggressor. The cases of gender based violence and post partum depression were found significantly different (p=0,001). Also, statistical differences were found between depression post partum y gender based violence during pregnancy, OR 5,5 (CI: <5,5; 16,7>). Conclusions: There is increased risk of depression post partum in women victims of violence

Neonatal ponderal index of healthy fetuses in a population from Lima, Peru

Objetivo: Establecer los valores del índice ponderal (IP) de un grupo de recién nacidos sanos hijos de mujeres peruanas residentes en Lima, que tuvieron embarazos simples sanos. Materiales y Métodos: Estudio retrospectivo, analítico y transversal, en el cual se revisó la base de datos maternas y perinatales SIP del Departamento de Obstetricia y Pediatría del Hospital Nacional Docente Madre-Niño “San Bartolomé”, entre el 1 de enero de 1991 y el 31 de diciembre de 1999. Se seleccionó los embarazos simples de mujeres sanas entre 20 y 30 años, con IMC entre 20 y 25, sin complicaciones obstétricas, con diferencia ± 2 semanas entre la fecha de última regla y edad gestacional por examen físico del neonato vivo y sano. Se definió IP como peso al nacer en gramos x 100/[talla en cm]3 . Resultados: El índice ponderal [percentil 50 (percentil 10- percentil 90)] de 5,443 recién nacidos sanos en Lima para gestaciones de 35,36, 37,38, 39, 40, 41 y 42 semanas fueron 2,55 (2,22-2,84), 2,59 (2,36-3,04), 2,71 (2,42- 3,03), 2,73 (2,44-3,05), 2,72 (2,44-3,05), 2,74 (2,44-3,06), 2,79 (2,45-3,03) y 2,79 (2,42-3,03) g/cm3 , respectivamente. El IP en fetos a término fue mayor en las multíparas que en las nulíparas (p<0,001).No hubo diferencia del IP según sexo. Conclusiones: El feto sano crece en forma simétrica conforme aumenta el tiempo de gestación. El índice ponderal normal varía entre 2,44 y 3,05 g/cm3 . Valores fuera de estos límites nos permiten determinar estados de malnutrición fetal. El índice ponderal del feto sano a término es influenciado por la paridad y el estado nutricional materno y no es influenciado por el sexo.Objetive: To establish values for neonatal ponderal index (PI) in a group of healthy fetuses born from healthy singleton pregnant women at Lima, Peru. Materials and Methods: A retrospective, analytic and transversal study was conducted. Maternal and perinatal data from January 1, 1991 through December 31,1999 was retrieved from the Department of Obstetrics/Gynecology and Pediatrics Database at Hospital Nacional Docente Madre-Niño “San Bartolome”. Healthy singleton pregnant women between 20 and 30 years old, BMI between 20 and 25 kg/m2 , without obstetrical complications, with a difference ± 2 weeks between last menstrual period and gestational age by physical assessment of a live-healthy neonate were selected. PI was defined as birthweight in grams x 100/ [crown-heel length]3 . Results: The PI [50th percentile (10th percentile- 90th percentile)] in 5,443 Lima healthy neonates at 35, 36, 37, 38, 39, 40, 41, and 42 gestational weeks were 2,55 (2,22-2,84), 2,59 (2,36-3,04), 2,71 (2,42- 3,03), 2,73 (2,44-3,05), 2,72 (2,44-3,05), 2,74 (2,44-3,06), 2,79 (2,45-3,03), and 2,79 (2,42-3,03) g/cm3 , respectively. PI of fetuses at term from multiparous women was greater than fetuses from nuliparous women (p<0,001).There was no difference of PI according to gender. Conclusions: Healthy fetuses grow symmetrically during pregnancy. The normal fetal ponderal index is between 2,40 and 3,05 g/ cm3 (10th and 90th percentile). Values out of these limits may diagnose fetal malnutrition. Fetal PI is influenced by parity and maternal nutritional status and not by gender

Healthy neonates birthweight according to gestational age in a Lima population

Objetivo: Establecer los valores del peso al nacer de un grupo de recién nacidos sanos hijos de mujeres residentes en Lima que tuvieron embarazos simples sin complicaciones obstétricas ni neonatales. Materiales y Métodos: Se realizó un estudio retrospectivo, analítico y transversal, en el cual se revisó la base de datos maternas y perinatales del Departamento de Obstetricia y Pediatría del Hospital Nacional Docente Madre-Niño San Bartolomé entre el 1 de enero 1991 y el 31 de diciembre de 1999 (SIP). Se seleccionó los embarazos simples de mujeres entre 20 y 30 años, con IMC entre 20 y 25 kg/mt2 , sin patología materna previa y sin complicaciones obstétricas, con variación ± 2 semanas entre FUR y examen físico del neonato vivo y sano. Resultados: El peso al nacer de 5 443 recién nacidos sanos en Lima [percentil 50 [percentil 10-percentil 90]) a las 35, 36, 37, 38, 39, 40, 41 y 42 semanas fueron 2640 (2346-3356), 2850 (2430-3344), 3100 (2688-3632), 3200 (2770-3700), 3300 (2850- 3770), 3370 (2950-3850), 3450 (3030-3980) , 3512 (3102 – 4000) gramos. Los fetos varones a término sanos pesaron en promedio 108 gramos más que los femeninos (p<0,001). Conclusiones: El peso fetal aumenta con la edad gestacional. Los fetos que nacen antes de la semana 35 están enfermos. Los fetos sanos masculinos a término pesan en promedio 108 gramos más que los fetos femeninos. A diferencia del feto femenino, el feto masculino no gana peso a partir de la semana 41.Objetive: To determine healthy neonates birthweight born from healthy Lima pregnant women without obstetrical complications. Materials and Methods: A retrospective, analytic and transversal study was conducted. Maternal and perinatal data was retrieved from the Department of Obstetrics/Gynecology and Pediatrics Database at Hospital Nacional Docente Madre-Niño San Bartolome from January 1, 1991 through December 31, 1999. Healthy singleton pregnant women 20 to 30 years old, BMI 20 to 25 kg/mt2 , without obstetrical complications, with a difference ± 2 weeks between last menstrual period and gestational age by physical assessment of the healthy living neonate were selected. Results: Birthweights of 5,443 healthy neonates in Lima [50th percentile [10th percentile- 90th percentile]) at 35, 36, 37, 38, 39, 40, 41, and 42 gestational weeks were 2640 (2346-3356), 2850 (2430- 3344), 3100 (2688-3632), 3200 (2770-3700), 3300 (2850- 3770), 3370 (2950-3850), 3450 (3030-3980) , 3512 (3102 – 4000) grams. Male healthy fetuses at term weighted 108 grams more than female fetuses (p<0,001). Conclusions: Fetal weight increases with gestational age. Fetuses born before 35 weeks are sick. Male healthy fetuses at term weighted 108 grams more than female fetuses on average. As compared with female fetuses, healthy male fetuses did not gain weight after 41 weeks

Both perinatal disease and preterm birth correspond to a multifactorial syndrome: participation of vascular disease inheritance, vaginal microbial flora and nutritional state

Objetivos: 1) Conocer las características maternas y la asociación de la flora microbiana vaginal (FMV) en gestantes con riesgo alto de prematuridad (GAP); y, 2) Determinar la asociación de la FMV y el resultado maternoperinatal en dichas gestantes. Diseño: Estudio caso-control, desde enero 1994 hasta diciembre 1995. Material y métodos: El grupo de casos incluyó 238 madres con gestaciones simples, internadas por amenaza de parto pretérmino, fluido vaginal aumentado, pielonefritis aguda e hipertensión arterial, a quienes se realizó estudio directo en lámina de la FMV. El grupo control consistió en 3 850 gestantes con feto único que tuvieron parto a término en el mismo período. Las gestantes del grupo de casos fueron separadas en aquellas que presentaron vaginitis bacteriana (n=136), vaginosis bacteriana (VB, n=57) y trichomonas vaginalis (TV, n=45). Resultados: Las gestantes con TV y aquellas con VB tenían una pareja sexual. Los casos presentaron mayor riesgo de malnutrición materna, peso materno bajo, un familiar diabético/hipertenso crónico, prediabetes, anemia crónica, amenaza de aborto, cicatriz uterina, fiebre puerperal y endometritis. Los neonatos de los casos presentaron mayor riesgo de hiperbilirrubinemia, sepsis neonatal, prematuridad, dificultad respiratoria, morbilidad neonatal, infante pequeño y grande para la edad de gestación. Conclusiones: La herencia y el medio ambiente determinan el estado de nutrición, el tipo de flora microbiana vaginal y la respuesta inflamatoria del huésped (madre/feto). La respuesta del huésped a varios factores estresores sería la responsable del síndrome del parto pretérmino, la prematuridad y la morbilidad neonatal.Objectives: 1) To determine the association between maternal characteristics and the microbial flora of the vagina in pregnancies with high risk of prematurity; and, 2) To determine the association between the microbial flora of the vagina and the maternal and perinatal outcome in pregnancies with high risk of prematurity. DESIGN: Case-control study, between January 1994 and December 1995. Material and methods: Case group comprised 238 singleton-pregnant women who were admitted because of preterm premature contractions, preterm labor, increased vaginal fluid, acute pylonephritis and arterial hypertension. All cases underwent a wet preparation to establish the microbial flora. The control group included 3 850 singleton pregnant women who delivered a term neonate at the same institution. Case group was further divided into women with bacterial vaginitis (n=136), bacterial vaginosis (BV, n=57) and trichomonas vaginalis (TV, n=45). Results: Women with TV and BV had a single sexual partner. Case group had increased risk of maternal malnutrition, low maternal weight, a diabetic/ hypertensive direct relative, prediabetes, chronic anemia, threatened abortion, uterine scar, puerperal fever, and endometritis. Case-group neonates had increased risk of hyperbilirrubinemia, neonatal sepsis, prematurity, respiratory distress syndrome, neonatal morbidity, small and large-for-gestational age infant. Conclusions: Both inheritance and environment determine nutritional status, vaginal microbial flora and the inflammatory response of the maternal-fetal unit. The maternal-fetal response to various factors would establish the pathogenic pathway for preterm labor syndrome, prematurity and neonatal morbidity

Social and emotional deprivation in the mother is associated with anatomical and functional alterations in the fetus and newborn

Objetivo: Demostrar que la privación social y afectiva en la madre se asocia a restricción del crecimiento fetal, muerte fetal, parto pretérmino, alteraciones anatómicas y funcionales en el feto y recién nacido. Materiales y Métodos: Estudio retrospectivo en el que se analizó la base de datos materno-perinatal del Hospital San Bartolomé. Se examinó tres grupos de gestantes con privación social y afectiva: 1) madres solteras (n=6561), 2) gestantes adolescentes con ausencia de control prenatal (n=2131) y 3) primigestas con talla menor de 160 cm (n=35722). Se comparó las complicaciones maternas y perinatales con las gestantes : 1) madres con unión estable (n=40629), 2) gestantes adolescentes con control prenatal (n=7644) y 3) primigestas con talla mayor de 159 cm (n=5264). Se empleó el odds ratio (OR) y el intervalo de confianza al 95% (IC). Resultados: Las madres solteras presentaron mayor riesgo de falla en la función placentaria (OR 1,92, IC95% 1,51-2,44), restricción del crecimiento fetal (OR 2,02, IC95% 1,45-2,82), rotura prematura de membranas fetales (OR 1,28, IC95% 1,00-1,63) comparadas con las madres con unión de pareja estable. Las gestantes adolescentes con ausencia de control prenatal presentaron mayor riesgo de muerte fetal (OR 2,89, CI95% 1,85-4,50), rotura prematura de membranas fetales (OR 1,38, CI95% 1,18-1,62), parto pretérmino (OR 1,63, CI95% 1,39- 1,91), neonato pequeño para la edad (OR 1,25, IC95% 1,08-1,44), morbilidad neonatal (OR 1,23, IC95% 1,07-1,41), asfixia perinatal (OR 2,73, IC95% 1,33-5,58), neonato con Ápgar bajo en minuto 1 (OR 1,26, IC95% 1,05-1,52), dificultad respiratoria (OR 1,51, IC95% 1,10- 2,06), sepsis neonatal (OR 1,54, IC95% 1,19-1,99), prematuridad (OR 1,50, IC95% 1,27- 1,78), muerte neonatal (OR 2,56, IC95% 1,88-3,48) y muerte perinatal (OR 3,02, IC95% 2,24- 4,07) comparadas con las gestantes adolescentes con control prenatal. Las primigestas con talla menor de 160 cm presentaron mayor riesgo de ausencia de control prenatal (OR 1,22, IC95% 1,13-1,32), parto pretérmino (OR 1,12, IC95% 1,00-1,26), desproporción fetopélvica (OR 1,49, IC95% 1,11-2,02), parto por cesárea (OR 1,28, IC95% 1,19-1,38), Ápgar bajo en minuto 1 (OR 1,20, IC95% 1,07-1,35), recién nacido pequeño para la edad (OR 1,29, IC95% 1,17-1,42) y recién nacido prematuro (OR 1,12, IC95% 1,00-1,26) comparadas con la primigesta con talla mayor de 159 cm. Conclusiones: Las mujeres con falta de apoyo social y afectivo, como son las madres solteras, las mujeres adolescentes sin cuidado prenatal y las mujeres de talla baja, presentan riesgo aumentado en la salud materna y perinatal. Estos resultados sugieren que la privación social y/o afectiva en la madre repercute negativamente en el resultado perinatal, generando alteraciones anatómicas y funcionales en el feto y recién nacido.Objective: To ascertain that social and emotional deprivation of the mother is associated with fetal growth restriction, fetal death, preterm birth and congenital defects. Materials and Methods: We retrieved the maternal and perinatal outcome from the Informatic Perinatal System of all pregnancies with antenatal care whose delivery occurred between January 1, 1992 and December 31, 2001. Three groups of patients with social and emotional deprivation were included: 1) single women (n=1285), 2) teenage women with absent prenatal care (APC), (n=2131), and 3) primigravid with stature lower than 160 cm (n=35722). Maternal and perinatal outcome were compared with: 1) women living with sexual partner (n=5550), 2) teenage women with prenatal care (n=7644), and 3) primigravids taller than 159 cm (n=5264). Odds ratio and 95% confidence interval (CI) were calculated. Results: Single women presented greater risk of placental failure (OR 1,92, 95%CI 1,51-2,44), fetal growth restriction (OR 2,02, 95%CI 1,45-2,82), and premature rupture of fetal membrane (OR 1,28, 95%CI 1,00-1,63) as compared with women living with sexual partners. Teenagers presented greater risk of fetal death (OR 2,89, 95%CI 1,85- 4,50), premature rupture of fetal membranes (OR 1,38, 95%CI 1,18-1,62), preterm labor (OR 1,63, 95%CI 1,39- 1,91), small for gestational age infant (OR 1,25, 95%CI 1,08-1,44), neonatal morbidity (OR 1,23, IC95% 1,07- 1,41), perinatal asphyxia (OR 2,73, 95%CI 1,33-5,58), low one minute Apgar score (OR 1,26, 95%CI 1,05-1,52), respiratory distress syndrome (OR 1,51, 95%CI 1,10-2,06), neonatal sepsis (OR 1,54, 95%CI 1,19-1,99), prematurity (OR 1,50, 95%CI 1,27-1,78), neonatal death (OR 2,56, 95%CI 1,88-3,48), and perinatal death (OR 3,02, 95%CI 2,24-4,07) as compared with teen-age women without absent prenatal care. Primigravids shorter than 160 cm presented greater risk of absent prenatal care (OR 1,22, 95%CI 1,13- 1,32), preterm labor (OR 1,12, 95%CI 1,00-1,26), fetopelvic disproportion (OR 1,49, 95%CI 1,11-2,02), cesarean section delivery (OR 1,28, 95%CI 1,19-1,38), low one minute Apgar score (OR 1,20, 95%CI 1,07-1,35), small for gestational age infant (OR 1,29, 95%CI 1,17-1,42), and preterm neonate (OR 1,12, 95%CI 1,00-1,26) as compared to primigravids with taller than 159 cm. Conclusions: Women with social and/or emotional privation, such as single pregnant women, teenage pregnant women with no prenatal care and women with low stature, are at increased perinatal risk of anatomical and functional alterations in the fetus and newborn

Genome-wide and candidate gene association studies of placental abruption

Placental abruption (PA), a pregnancy-related vascular disorder, is a leading cause of maternal and perinatal morbidity and mortality. The success of identifying genetic susceptibility loci for PA, a multi-factorial heritable disorder, has been limited. We conducted a genome-wide association study (GWAS) and candidate gene association study using 470 PA cases and 473 controls from Lima, Peru. Genotyping for common genetic variations (single nucleotide polymorphisms, SNPs) was conducted using the Illumina Cardio-Metabo Chip platform. Common variations in 35 genes that participate in mitochondrial biogenesis (MB) and oxidative phosphorylation (OS) were selected for the candidate gene study. Regression models were fit to examine associations of each SNP with risk of PA. In pathway analyses, we examined functions and functional relationships of genes represented by the top GWAS hits. Genetic risk scores (GRS), based on top hits of the GWAS and candidate gene analyses, respectively, were computed using the risk allele counting method. The top hit in the GWAS analyses was rs1238566 (empirical P-value=1.04e-4 and FDR-adjusted P-value=5.65E-04) in FLI-1 gene, a megakaryocyte-specific transcription factor. Networks of genes involved in lipid metabolism and cell signaling were significantly enriched by the 51 genes whose SNPs were among the top 200 GWAS hits. SNPs known to regulate MB (e.g. CAMK2B, NR1H3, PPARG, PRKCA, and THRB) and OP (e.g., COX5A, and NDUF family of genes) were associated with PA risk. GRS was significantly associated with PA risk. Our study suggests that integrating multiple analytical strategies in genetic association studies can provide opportunities for identifying genetic risk factors and novel molecular mechanisms that underlie PA

Inflammasome activation during spontaneous preterm labor with intraâ amniotic infection or sterile intraâ amniotic inflammation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146295/1/aji13049.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146295/2/aji13049_am.pd

Human βâ defensinâ 1: A natural antimicrobial peptide present in amniotic fluid that is increased in spontaneous preterm labor with intraâ amniotic infection

ProblemHuman βâ defensins (HBDs) are antimicrobial peptides that participate in the soluble innate immune mechanisms against infection. Herein, we determined whether HBDâ 1 was present in amniotic fluid during normal pregnancy and whether its concentrations change with intraâ amniotic inflammation and/or infection.Method of StudyAmniotic fluid was collected from 219 women in the following groups: (a) midtrimester who delivered at term (n = 35); (b) term with (n = 33) or without (n = 17) labor; (c) preterm labor with intact membranes who delivered at term (n = 29) or who delivered preterm with (n = 19) and without (n = 29) intraâ amniotic inflammation and infection or with intraâ amniotic inflammation but without infection (n = 21); and (d) preterm prelabor rupture of membranes (pPROM) with (n = 19) and without (n = 17) intraâ amniotic inflammation/infection. Amniotic fluid HBDâ 1 concentrations were determined using a sensitive and specific ELISA kit.Results(a) HBDâ 1 was detectable in all amniotic fluid samples; (b) amniotic fluid concentrations of HBDâ 1 were changed with gestational age (midtrimester vs term no labor), being higher in midtrimester; (c) amniotic fluid concentrations of HBDâ 1 were similar between women with and without spontaneous labor at term; (d) among patients with spontaneous preterm labor, amniotic fluid concentrations of HBDâ 1 in women with intraâ amniotic inflammation/infection and in those with intraâ amniotic inflammation without infection were greater than in women without intraâ amniotic inflammation or infection who delivered preterm or at term; and (e) the presence of intraâ amniotic inflammation and infection in patients with pPROM did not change amniotic fluid concentrations of HBDâ 1.ConclusionHBDâ 1 is a physiological constituent of amniotic fluid that is increased in midtrimester during normal pregnancy and in the presence of culturable microorganisms in the amniotic cavity. These findings provide insight into the soluble host defense mechanisms against intraâ amniotic infection.Amniotic fluid concentrations of human beta defensinâ 1 (HBDâ 1) in women with spontaneous preterm labor and intact membranes. Red lines indicate medians with interquartile ranges.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146360/1/aji13031.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146360/2/aji13031_am.pd

The amniotic fluid cell-free transcriptome in spontaneous preterm labor

The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm delivery is unknown. Herein we profiled cell-free RNA in AF samples collected from women who underwent transabdominal amniocentesis after an episode of spontaneous preterm labor and subsequently delivered within 24 h (n = 10) or later (n = 28) in gestation. Expression of known placental single-cell RNA-Seq signatures was quantified in AF cell-free RNA and compared between the groups. Random forest models were applied to predict time-to-delivery after amniocentesis. There were 2385 genes differentially expressed in AF samples of women who delivered within 24 h of amniocentesis compared to gestational age-matched samples from women who delivered after 24 h of amniocentesis. Genes with cell-free RNA changes were associated with immune and inflammatory processes related to the onset of labor, and the expression of placental single-cell RNA-Seq signatures of immune cells was increased with imminent delivery. AF transcriptomic prediction models captured these effects and predicted delivery within 24 h of amniocentesis (AUROC = 0.81). These results may inform the development of biomarkers for spontaneous preterm birth