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Objectives: Current international guidelines recommend tocolytic treatment by at least 48 h to complete fetal lung maturation and to ensure in-utero transfer to a perinatal center before 34 weeks of gestation in patients with threatened preterm birth. According to the results of former surveys, significant differences between daily clinical practice patterns and evidence-based guideline recommendations regarding tocolytic treatment have been demonstrated. We compared data from a nation-wide survey on the practice of initial tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth"., Study Design: 632 obstetric units in Germany received a link to an online questionnaire between January 20th and March 31st 2020, which was developed according to national and international recommendations and guidelines. Collected data was descriptively analyzed by performing measures of frequency., Results: The response rate was 19%; 51 (42.5%) of the respondents consider CTG tracing with ≥ 4 contractions within 20 min, 49 (40.8%) cervical length measurement of ≤ 25 mm and 13 (10.9%) subjective contractions as the most significant decision-making criteria for tocolysis; 47 (39.2%) of obstetric units initiate tocolysis earliest at 23 + 0, 34 (28.3%) at 22 + 0, 26 (21.7%) at 23 + 5 and 13 (10.8%) at 24 + 0 weeks of gestation; 104 (86.7%) stop tocolysis latest at the 34 + 0 weeks of gestation, 42 (35.0%) obstetric units administer antenatal corticosteroids at 23 + 5, 16 (13.3%) at 22 + 0, and 13 (10.8%) at 24 + 0 weeks of gestation. Calcium channel blockers are the first-line tocolytic drug used by 59 (49.1%) of the obstetric units, followed by intravenous betamimetics as bolus (n = 26, 21.7%) and atosiban (n = 20, 16.7%). Severe side-effects were observed by 105 (70%) of the respondents in association with the use of betamimetics, 14 (9.3%) with the use of nifedipine and 30 (20.0%) with nitroglycerine patches. The German guideline was considered the most important decision-making support by 78 (65%) of the obstetric units, followed by hospital specific SOPs/algorithms (n = 31, 25.8%)., Conclusion: Our survey highlights a considerable discrepancy between evidence-based guideline recommendations and daily clinical practice., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

At present, there is no effective treatment for preterm labor. The most obvious reason for this anomaly is that there is no objective manner in which to evaluate the progression of pregnancy through steps leading to labor, either at term or preterm. Understanding the physiology of the uterus during term and preterm parturition is important for developing methods to control uterine function and is essential to solving clinical problems related to labor. Several techniques have been adopted to monitor and/or to diagnose labor. Unfortunately they are either subjective or indirect and do not provide an accurate prediction especially for preterm labor. Uterine electromyography (EMG) may provide more objective, highly accurate, and clinically useful information. This may be especially important in clinical scenarios such as prediction of preterm labor, differentiation between true and false labor, and management of labor augmentation, labor induction or tocolysis. Thereby EMG would enable clinicians to apply much better treatment for pregnant patients.

To understand cervical ripening and especially the pathophysiology of cervical insufficiency, it is important to know the cervical composition: the cervix is dominated by fibrous connective tissue, consisting predominantly of Type I collagen (70%). Despite many studies of the cervix, we still rely upon relatively crude methods for clinical evaluation of the cervix. If the amount of cervical collagen plays a role in cervical insufficiency and in success of or length of induction of labor, then measurements of cervical collagen may provide an objective means of establishing the diagnosis or prognosis. We have established and reported a non-invasive means, called Collascope, to measure collagen cross-linking using light-induced fluorescence (LIF), and which is specifically designed to assess cervical ripening, and functions by measuring the natural fluorescence of non-soluble collagen in the cervix. Studies conducted in animals and humans in a variety of settings indicate that cervical function can be successfully monitored using the Collascope during pregnancy: LIF correlates negatively with gestational age and positively with time-to-delivery interval, and is predictive of delivery within 24h. Additionally LIF is significantly lower in women with cervical insufficiency. We suggest that the Collascope might be useful to better define management in cases of spontaneous preterm or induced term cervical ripening. From our studies and others, it is clear that in forecasting (pre-)term cervical ripening, the capability of the technologies and bioassays that have been generally accepted into clinical practice are limited. Any devices shown to be superior to the clinically accepted tests currently used should be quite useful for clinicians. The Collascope offers an objective measurement of both the function and state of the cervix, by directly measuring collagen cross-linking using LIF.

Objective: To study if spontaneous contractions augmented by proteinase-activated receptor-2 (PAR-2)-activating peptide serine-leucine-isoleucine-glycine-arginine-leucine (SLIGRL) involve coactivation of membrane chemoceptors and are associated with expression of PAR-2 mRNA in non-pregnant and pregnant rat myometrium., Materials and Methods: Non-pregnant, mid-pregnant, and late pregnant rat uterine horn and small intestine segments were snap-frozen in liquid nitrogen to determine PAR-2 mRNA levels by real time polymerase chain reaction (PCR). Uterine rings were used for isometric tension recording. Effect of SLIGRL (0.1 mM) on spontaneous contractions before and after exposure to ibuprofen (cyclooxygenase inhibitor, 1.0 microM), SQ-29548 (thromboxane A(2) receptor inhibitor, 1.0 microM), ketotifen (histamine 1 receptor inhibitor, 10 microM), WEB-2170BS (platelet-activating factor (PAF) receptor inhibitor, 10 microM), atropine (muscarinic receptor inhibitor, 0.1 microM), or ketanserin (serotonin receptor inhibitor, 10 microM) were compared. Paired t-test and one-way ANOVA followed by Dunnett's or Newman-Keuls post hoc tests were used for statistical analysis when appropriate., Significance: P<0.05., Results: The agents did not significantly affect time-associated decay in spontaneous contractile activity in any group of the tissues. Activation of spontaneous contractions induced by SLIGRL in non-pregnant rat myometrium did not involve coactivation of membrane chemoceptors, while in mid-pregnant rat myometrium coactivation of prostanoid, histamine, and serotonin receptors and in late pregnant rat myometrium coactivation of thromboxane receptors was noted. Expression of PAR-2 mRNA was similar in non-pregnant, mid-pregnant, and late pregnant rat myometrium., Conclusions: Expression of PAR-2 in rat myometrium is not dependent on gestational age. Stimulation of PAR-2 is associated with production/release of cyclooxygenase pathway product(s) activating thromboxane/prostaglandin H2 receptors, partial involvement of histamine H1 receptors and serotonin receptors in midpregnancy and thromboxane A2/prostaglandin H2 receptors in late pregnancy.

Objective: To define the changes in cervical light-induced fluorescence (LIF), an index of cross-linked collagen, after the use of locally applied prostaglandin preparations for labor induction at term and the correlation between LIF and Bishop-Score., Study Design: The characteristic LIF of cervical collagen was measured from the surface of the cervix using a specially designed instrument (collascope) in 41 gravidas undergoing labor induction at term by prostaglandins. LIF and Bishop-Score were obtained directly before and 4h after the administration of prostaglandin. Paired Student's t-test, Wilcoxon Signed Rank test, Linear Regression, Spearman correlation and Fisher Exact test were used as appropriate., Results: Cervical LIF decreased significantly after prostaglandin application (0.982+/-0.04 [before] to 0.885+/-0.037 [after], p=0.025). The decrease in LIF correlated with the initial LIF before PG-application (r=0.61). The Bishop-Score increased in all 41 patients. No correlation was found between LIF versus Bishop-Score., Conclusions: Cervical application of prostaglandins decreases the amount of cross-linked collagen as measured by LIF. This effect was observed only in patients with a prior high cross-linked collagen.

Objective: To investigate the content of tumor necrosis factor alpha, interleukin-1 beta, interleukin-6 and interleukin-8 messenger ribonucleic acid (mRNA) in the lower uterine segment during term parturition., Study Design: mRNA extracts from the lower uterine segment obtained from 53 women undergoing non-elective caesarean section at term were analyzed by semi-quantitative reverse transcriptase polymerase chain reaction. The patients were grouped according to cervical dilatation (less than 2 cm, n=18; 2 to less than 4 cm, n=13; 4-6 cm, n=7; more than 6 cm, n=15) at the time of caesarean section., Results: Interleukin-1 beta and interleukin-8 mRNA-contents at more than 6 cm cervical dilation were significantly higher than at less than 2 cm. The levels of interleukin-6 were already significantly increased in the 4-6 cm group, while the tumor necrosis factor alpha ribonucleic acid content did not change during parturition., Conclusion: The process of cervical dilatation during parturition at term is associated with an increased expression of interleukin-1 beta, interleukin-6 and interleukin-8 mRNA in the lower uterine segment. These findings support the theory that the activation of the inflammatory network plays an important role in the progress of cervical dilatation.