Comprehensive Amniotic Fluid Cytokine Profile Evaluation in Women with a Short Cervix: which Cytokine(s) Correlates Best with Outcome?

OBJECTIVE: The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester. STUDY DESIGN: Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length RESULTS: Forty-four amniotic fluid samples were analyzed. After stepwise regression, only monocyte chemotactic protein-1 remained significant and was the most predictive of early delivery. With a cutoff of 1320 pg/mL, monocyte chemotactic protein-1 had a 69% sensitivity, 83% specificity, 36% positive predictive value, and 87% negative predictive value to predict spontaneous preterm birth within 1 week of amniocentesis (P = .015). CONCLUSION: Among 25 cytokines, monocyte chemotactic protein-1 was most predictive of spontaneous preterm birth

Preterm delivery: risks versus benefits of intervention.

The objective of this report is to examine the evidence that supports obstetric intervention to prevent preterm birth and to assess the associated neonatal outcomes. The different causes of preterm birth are identified and reviewed. The evidence to support obstetric intervention is examined, and the current protocols for therapy are listed. An example of institutional data review is outlined and includes common neonatal morbidities with comparison to an international data set. This type of review allows clinicians to establish recommendations for obstetric intervention based on neonatal outcome

Does cerclage prevent preterm birth?

Cerclage procedures can be classified according to timing, (elective, urgent, emergent), and anatomic approach (transvaginal and transabdominal). The most current clinical data and the evidence-based recommendations for each type of cerclage procedure are listed

Pregnancy complicated by sickle hemoglobinopathy.

During the last decade it has been shown that patients with major sickle hemoglobinopathies can experience a normal reproductive outcome. This has been accomplished with early aggressive prenatal care, effective counseling, and appropriate intervention by providers with a high index of suspicion for factors that lead to untoward outcomes in such women. Because controversy surrounds the use of transfusion therapy for pregnant patients with sickle cell disease, individualization should depend on patient circumstances and provider experience because this is a key factor in the management of these women. New therapies for those with major sickle hemoglobinopathy are on the horizon, but their use in pregnancy awaits further evaluation