Search

The relationship between the intake of artificial sweetener (AS) and adverse pregnancy outcomes is under-researched, and existing studies yield inconsistent conclusions. A Mendelian randomization (MR) approach was employed to investigate the causal relationship between the intake of AS and adverse pregnancy outcomes. Instrumental variables related to the exposure phenotype were selected for analysis. The analysis was conducted using genome-wide association study summary data from public datasets. The inverse variance weighted, MR-Egger, weighted median, simple mode, and weighted mode methods were used to evaluate the causal relationship between exposure and outcomes. Sensitivity analysis and multivariable Mendelian randomization enrolling body mass index, type 2 diabetes mellitus, and fasting glucose were employed to further validate the consistency and robustness of the results. In univariable MR, the intake of AS added to tea was associated with an increased risk of ectopic pregnancy [OR = 1.821 (1.118–2.967), p = 0.016]. In multivariable MR adjusting for body mass index and type 2 diabetes mellitus, the intake of AS added to cereal was linked to a reduced risk of ectopic pregnancy [OR = 0.361 (0.145–0.895), p = 0.028] and premature rupture of membranes [OR = 0.116 (0.019–0.704), p = 0.019], while the intake of artificial sweetener added to coffee was associated with an increased risk of placenta previa [OR = 1.617 (1.042–2.510), p = 0.032]. No causal relationship was identified between the intake of artificial sweetener and other adverse pregnancy outcomes. The consumption of artificial sweetener during pregnancy warrants careful consideration. [ABSTRACT FROM AUTHOR]

Background: Previous study has indicated a potential link between gut microbiota and maternal pregnancy outcomes. However, the causal relationship between gut microbiota and premature rupture of membranes (PROM) remains a topic of ongoing debate. Methods: A two-sample Mendelian Randomization (MR) study was used to investigate the relationship between gut microbiota and PROM. Genetic data on gut microbiota was obtained from the MiBioGen consortium's largest genome-wide association study (GWAS) (n=14,306). Genetic data on PROM (3011 cases and 104247 controls) were sourced from publicly available GWAS data from the Finnish National Biobank FinnGen consortium. Various methods including Inverse variance weighted (IVW), MR-Egger, simple mode, weighted median, and weighted mode were utilized to assess the causal relationship by calculating the odd ratio (OR) value and confidence interval (CI). Sensitivity analyses for quality control were performed using MR-Egger intercept tests, Cochran's Q tests, and leave-one-out analyses. Results: The IVW method revealed that class Mollicutes (IVW, OR=0.773, 95%CI: 0.61-0.981, pval = 0.034), genus Marvinbryantia (IVW, OR=00.736, 95%CI: 0.555-0.977, pval = 0.034), genus Ruminooccaceae UCG003 (IVW, OR=0.734, 95%CI: 0.568-0.947, pval = 0.017) and phylum Tenericutes (IVW, OR=0.773, 95%CI: 0.566-1.067, pval = 0.034) were associated with a reduced risk of PROM, while genus Collinsella (IVW, OR=1.444, 95%CI: 1.028-2.026, pval = 0.034), genus Intestinibacter (IVW, OR=1.304, 95%CI: 1.047-1.623, pval = 0.018) and genus Turicibacter (IVW, OR=1.282, 95%CI: 1.02-1.611, pval = 0.033) increased the risk of PROM. Based on the other four supplementary methods, six gut microbiota may have a potential effect on PROM. Due to the presence of pleiotropy (pval=0.045), genus Lachnoclostridium should be ruled out. No evidence of horizontal pleiotropy or heterogeneity was found in other microbiota (pval >0.05). Conclusions: In this study, we have discovered a causal relationship between the presence of specific probiotics and pathogens in the host and the risk of PROM. The identification of specific gut microbiota associated with PROM through MR studies offers a novel approach to diagnosing and treating this condition, thereby providing a new strategy for clinically preventing PROM. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of oligohydramnios in the mid‐trimester is challenging, because of the high incidence of adverse perinatal outcomes mainly due to bronchopulmonary dysplasia. Antenatal amnioinfusion has been proposed as a possible treatment for oligohydramnios with intact amnions, but there are few relevant studies. This study aimed to evaluate the effectiveness of transabdominal amnioinfusion in the management of oligohydramnios without fetal lethal malformations in the second and early third trimesters. Material and Methods: It is a historical cohort study. A total of 79 patients diagnosed with oligohydramnios at 18–32 weeks gestation were enrolled. In the amnioinfusion group (n = 39), patients received transabdominal amnioinfusion with the assistance of real‐time ultrasound guidance. In the expectant group (n = 41), patients were treated with 3000 mL of intravenous isotonic fluids daily. The perioperative complications and perinatal outcomes were analyzed. Results: Compared with the expectant group, the delivery latency was significantly prolonged, and the rate of cesarean delivery was significantly reduced in the amnioinfusion group (p < 0.05). Although the rate of intrauterine fetal death was significantly reduced, the incidence of spontaneous miscarriage, premature rupture of membranes (PROMs), and threatened preterm labor were significantly higher in the amnioinfusion group than in the expectant group (p < 0.05). There was no significant difference in terms of perinatal mortality (28.9% vs. 41.4%, p > 0.05). Multivariate logistic regression revealed that amnioinfusion (odds ratio [OR] 0.162, 95% confidence interval [CI] 0.04–0.61, p = 0.008) and gestational age at diagnosis (OR 0.185, 95% CI 0.04–0.73, p = 0.016) were independently associated with neonatal adverse outcomes. Further subgrouping showed that amnioinfusion significantly reduced the frequency of bronchopulmonary hypoplasia for patients ≤26 weeks (26.7% vs. 75.0%, p = 0.021). The rates of other neonatal complications were similar in both groups. Conclusions: Amnioinfusion has no significant effect on improving the perinatal mortality of oligohydramnios in the second and early third trimesters. It may lead to a relatively high rate of PROM and spontaneous abortion. However, amnioinfusion may significantly improve the latency period, the rate of cesarean delivery, and neonatal outcomes of oligohydramnios, especially for women ≤26 weeks with high risk of neonatal bronchopulmonary hypoplasia. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the immunohistochemical expression of Aquaporin 3 (AQP3) in placentas of pregnant women with premature rupture of membrane (PROM) and to explore AQP3-related interactors and signaling pathways using in silico approaches. Material and Method: Placental samples from 21 healthy (control) pregnant women and 21 pregnant women diagnosed with PROM were processed for routine histological tissue preparation. Sections were immunostained with AQP3 and analyzed under light microscope via ImageJ software. Protein-protein interaction (PPI) network of AQP3 was constructed with Cytoscape (version 3.10.2). Nodal centrality indexes (degree, closeness and betweenness) were computed through CentiScaPe plugin. The Enrichr tool was utilized to perform pathway enrichment analysis for 15 central genes. Results: AQP3 immune activity was significantly decreased in the plasma membrane of the trophoblastic cell layer of the PROM group compared to control group. According to network centrality analysis, AQP subfamily proteins predominantly play central roles in the AQP3 network; Major Intrinsic Protein of Lens Fiber (MIP), Glycerol-3-Phosphate Dehydrogenase 2 (GPD2), Glyceraldehyde-3- Phosphate Dehydrogenase (GAPDH), Glycerol Kinase 2 (GK2), GK, and Actin Beta (ACTB) with additional central interactors including proteins. Peroxisome proliferator-activated receptors (PPAR) signaling pathway was obtained as the most significantly enriched pathway. Conclusion: Alterations in AQP3 expression level in the PROM group compared with the control group may contribute to disturbances in water transport and cellular homeostasis in placental tissues and in silico potential interaction between AQP3 expression and PPAR signaling suggest the role of AQP3 in cell metabolism in PROM. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aimed to examine prospective associations of different intensity levels and types of physical activity (PA) in early pregnancy with premature rupture of membranes (PROM) among Chinese pregnant women. Methods A total of 6284 pregnant women were included from the Tongji-Shuangliu Birth Cohort. Household/caregiving, occupational, sports/exercise and transportation activities during early pregnancy were investigated by the pregnancy physical activity questionnaire (PPAQ), and the diagnosis of PROM was ascertained during the whole pregnancy. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence interval (CI) for the associations between PA and PROM. Results Among the 6284 pregnant women, 1246 were identified to have PROM (19.8%). Women undertaking the highest level (3 third tertile) of PA during pregnancy appeared to have a lower risk of PROM [OR = 0.68, 95%CI 0.58–0.80) when compared to those at the lowest tertile of PA. Similarly, women with increased levels of light intensity activity, moderate-vigorous intensive, household/caregiving activity and meeting exercise guidelines during pregnancy were associated with reduced risks of PROM (OR = 0.69, 95% CI 0.59–0.81, OR = 0.70, 95% CI 0.60–0.82, OR = 0.62, 95% CI 0.53–0.73 and OR = 0.82, 95% CI 0.70–0.97, respectively). Conclusions High levels of PA of different intensities and PA of household/caregiving activities and meeting exercise guidelines during the first trimester were associated with a lower incidence of PROM. Trial registration The data of human participants in this study were conducted in accordance with the Helsinki Declaration. This study has been approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China ([2017] No. S225). All participants provided written informed consent prior to enrollment. A statement to confirm that all methods were carried out in accordance with relevant guidelines and regulations.

Objective: This study aimed to examine prospective associations of different intensity levels and types of physical activity (PA) in early pregnancy with premature rupture of membranes (PROM) among Chinese pregnant women. Methods: A total of 6284 pregnant women were included from the Tongji-Shuangliu Birth Cohort. Household/caregiving, occupational, sports/exercise and transportation activities during early pregnancy were investigated by the pregnancy physical activity questionnaire (PPAQ), and the diagnosis of PROM was ascertained during the whole pregnancy. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence interval (CI) for the associations between PA and PROM. Results: Among the 6284 pregnant women, 1246 were identified to have PROM (19.8%). Women undertaking the highest level (3 third tertile) of PA during pregnancy appeared to have a lower risk of PROM [OR = 0.68, 95%CI 0.58–0.80) when compared to those at the lowest tertile of PA. Similarly, women with increased levels of light intensity activity, moderate-vigorous intensive, household/caregiving activity and meeting exercise guidelines during pregnancy were associated with reduced risks of PROM (OR = 0.69, 95% CI 0.59–0.81, OR = 0.70, 95% CI 0.60–0.82, OR = 0.62, 95% CI 0.53–0.73 and OR = 0.82, 95% CI 0.70–0.97, respectively). Conclusions: High levels of PA of different intensities and PA of household/caregiving activities and meeting exercise guidelines during the first trimester were associated with a lower incidence of PROM. Trial registration: The data of human participants in this study were conducted in accordance with the Helsinki Declaration. This study has been approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China ([2017] No. S225). All participants provided written informed consent prior to enrollment. A statement to confirm that all methods were carried out in accordance with relevant guidelines and regulations. [ABSTRACT FROM AUTHOR]

Background: Induction of labor (IOL) in nulliparas with premature rupture of membranes (PROM) and an unfavorable cervix at term poses challenges. Our study sought to investigate the impact of prostaglandin E2 (PGE2) compared to oxytocin on the duration of IOL in this specific group of parturients. Methods: This was retrospective matched-case study. All nulliparas with term PROM who underwent induction between January 2006 to April 2023 at Shaare Zedek Medical Center were identified. Cases induced by either PGE2 or oxytocin were matched by the following criteria: (1) time from PROM to IOL; (2) modified Bishop score prior to IOL ≤ 5; (3) newborn birthweight; and (4) vertex position. The primary outcome was time from IOL to delivery. Results: Ninety-five matched cases were identified. All had a modified Bishop score ≤ 5. Maternal age (26 ± 4.7 years old, p = 0.203) and gestational age at delivery (38.6 ± 0.6, p = 0.701) were similar between the groups. Matched factors including time from PROM to IOL (23.5 ± 19.2 versus 24.3 ± 21.4 p = 0.780), birth weight of the newborn (3111 g versus 3101 g, p = 0.842), and occiput anterior position (present on 98% in both groups p = 0.687) were similar. Time from IOL to delivery was significantly shorter by 3 h and 36 min in the group induced with oxytocin than in the group induced with PGE2 (p = 0.025). Within 24 h, 55 (58%) of those induced with PGE2 delivered, compared to 72 (76%) of those induced with oxytocin, (p = 0.033). The cesarean delivery rates [18 (19%) versus 17 (18%)], blood transfusion rates [2 (2%) versus 3 (3%)], and Apgar scores (8.8 versus 8.9) were similar between the groups (PGE2 versus oxytocin, respectively), p ≥ 0.387. Conclusions: Induction with oxytocin, among nulliparas with term PROM and an unfavorable cervix, was associated with a shorter time from IOL to delivery and a higher rate of vaginal delivery within 24 h, with no difference in short-term maternal or neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Introduction: One of the complications of COVID-19 in pregnant women is premature rupture of membranes. SARS-CoV-2 infection activates inflammatory cytokines that contribute to hypercoagulability by activating thrombin which triggers premature rupture of membranes. One of the markers of coagulation that can determine the prognosis of COVID-19 patients is D-dimer levels. Compared to pregnant women who do not experience COVID-19, a higher increase in D-dimer levels is found in pregnant women who experience COVID-19. This study is expected to show whether there is a relationship between D-dimer levels in pregnant women who experience COVID-19 and the incidence of premature rupture of membranes. Methods: The study was conducted through a cross-sectional approach at RSUD Dr. Moewardi, Surakarta with a total of 67 samples recorded in medical records in the period March 2020 to March 2023. After the data was obtained, the analysis was then carried out on SPSS software with the Chi-Square test. Results: Results: The analysis results showed a significant relationship between D-dimer levels and the incidence of PROM in pregnant women with COVID-19 (p=0.014). Pregnant women with PROM had higher D-dimer levels compared to those without PROM. An Odds Ratio of 0.261 indicates that pregnant women with high D-dimer levels have a lower risk of experiencing PROM. Conclusion: There is a significant relationship between D-dimer levels in pregnant women with COVID-19 and the incidence of PROM. Increased D-dimer levels can be a potential indicator to identify pregnant women at risk of experiencing PROM. [ABSTRACT FROM AUTHOR]

Background: Premature rupture of membranes (PROM) is a complication affecting 7–12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (ie <37 weeks gestation) precedes one‐third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis. Aim: To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009 and 2017. Materials and methods: This retrospective population‐based cohort study included all singleton pregnancies from 2009 to 2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: (a) expectant management; (b) induction of labour (IOL); and (c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management. Results: Of 636 590 singleton pregnancies, 52 669 (8.3%) births with PROM at term (42 439; 6.7%) or PPROM (10 230; 1.6%) were identified. Of these, the majority were managed expectantly (n = 22 726; 43.1%), or with IOL (25 931; 49.2%). While elCS represented only 7.6% of these cases (n = 4012), its use rose consistently from 2009 to 2017 for PROM at term and PPROM alike. For women with PPROM at 34–36 weeks the odds of elCS increased by 5% annually (adjusted odds ratio (aOR) 1.05; 95% CI 1.02–1.08) and 2% for IOL (aOR 1.02; 95% CI 1.00–1.05) vs expectant management. Conclusions: The use of elCS and IOL in PPROM is rising in Victoria, particularly between 34 and 36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase. [ABSTRACT FROM AUTHOR]

Background & Objective: Premature rupture of the membranes (PROM) is defined as rupture of the membranes (amniotic sac) before the commencement of the labor and after 37 weeks gestation. Opinions differ whether to induce labor in these parturients or continue to manage conservatively. The purpose of this research was to compare the incidence of unfavorable fetal outcomes in cases of early rupture of the membranes and expectant treatment in the induction of labor. Methodology: This randomized controlled trial was conducted at the Department of Obstetrics & Gynaecology, Lady Reading Hospital, Peshawar, from 1st August 2022 to 31st January 2023. A total of 610 pregnant women with PROM were included in the study. In total, 305 patients were in the expectant management group or Group A, while 305 patients were in induction of labor or Group B. After delivery, fetal outcomes (birth asphyxia, low Apgar score, and sepsis) were noted and compared in both groups. Results: Birth Asphyxia was observed in 69 (22.6%) patients in Group A as compared to 44 (14.4%) patients in Group B (P = 0.009). A low Apgar Score was observed in 27 (8.9%) patients in Group A compared to 10 (3.3%) patients in Group B (P = 0.004). Sepsis was observed in 8 (2.6%) patients in Group A as compared to 1 (0.3%) patient in Group B (P = 0.019). Conclusion: It is concluded that all patients presenting with premature rupture of membranes at term should be actively managed with induction of labor. [ABSTRACT FROM AUTHOR]

Cardiopulmonary and infectious complications are more common in preterm newborns after preterm premature rupture of membranes (pPROM). Fetal echocardiography may be helpful in predicting neonatal condition. Our aim was to assess the cardiovascular changes in fetuses from pregnancies complicated by pPROM and possible utility in predicting the intrauterine or neonatal infection, and neonatal heart failure (HF). It was a prospective study enrolling 46 women with singleton pregnancies complicated by pPROM between 18+0 and 33+6 weeks of gestation and followed until delivery. 46 women with uncomplicated pregnancies served as a control group. Fetal echocardiographic examinations with the assessment of cardiac structure and function (including pulmonary circulation) were performed in all patients. Mean gestational age of pPROM patients was 26 weeks. Parameters suggesting impaired cardiac function in fetuses from pPROM were: higher right ventricle Tei index (0.48 vs. 0.42 p<0.001), lower blood flow velocity in Ao z-score (0.14 vs. 0.84 p=0.005), lower cardiovascular profile score (CVPS), higher rate of tricuspid regurgitation (18.2 % vs. 4.4 % p=0.04) and pericardial effusion (32.6 vs. 0 %). Intrauterine infection was diagnosed in 18 patients (39 %). 4 (8.7 %) newborns met the criteria of early onset sepsis (EOS). HF was diagnosed in 9 newborns. In fetal echocardiographic examination HF group had shorter mitral valve inflow time and higher left ventricle Tei index (0.58 vs. 0.49 p=0.007). Worse cardiac function was observed in fetuses from pPROM compared to fetuses from uncomplicated pregnancies. [ABSTRACT FROM AUTHOR]

Premature birth (PB) is the birth in less than 37 weeks, which can be spontaneous and iatrogenic, its frequency reaches 10% of all births. The pathogenesis of premature labor is based on the inflammatory reaction of the chorion, amnion and decidual membrane, but the origin of the inflammatory reaction is different depending on the gestational age. The objective: to study the prevalence of the inflammatory response in placenta samples from very early preterm, early preterm and term births. Materials and methods. Placenta samples from 203 parturient women who gave birth in the gestational period of 22–27 weeks – very early PB (I group – 101 parturient women with premature rupture of membranes (PROM), II group – 102 parturient women with the onset of labor with intact membranes) and 202 parturient women were examined with deliveries in the period of 28–34 weeks – early PB (III group – 100 women in labor with PROM and IV group – 102 women in labor with the onset of labor with intact fetal membranes) and 60 women in labor with term deliveries. Immunohistochemical detection of CD8, CD3 and CD14 antigens in villi was used to assess the prevalence of the inflammatory process and compare it between groups. Results. In 56.7% of placentas from term deliveries no markers of villousitis were detected, a mild form of villousitis was found in another third of cases. In placentas of woman with the onset of labor between the 28th and 34th weeks with intact fetal membranes there were signs of villousitis in 54.9%, and its mild manifestations in 33.3%. In the case of premature rupture of the membranes, the prevalence of villousitis reached 65%, its severe forms were more often observed. On the other hand, in the groups of very early PB only 14.9 and 15.7% of placentas had no signs of vilouisitis, one in five placentas from these groups had severe focal or diffuse villousitis. In the group of early PB and intact amniotic membranes, one third of the placentas demonstrated an isolated CD3 lymphocyte marker, no antigen was detected in 47.1% of placentas, and only in every tenth placenta antigens of macrophages of fetal origin were determined. A similar distribution was found in placentas from early PB with PROM. In placentas from very early PB the highest frequency of CD14 detection was found – every second placenta contained this marker in isolation and in 22.5% – in combination with maternal lymphocyte markers. In the group of very early PB on the background of PROM placentas with a positive CD14 test dominated – 31.7% isolated and 45.5% in combination with CD3. Conclusions. 1. In placentas from premature births (PB) at 28–34 weeks, villousitis was detected in 54.9% of cases against the background of intact amniotic membranes and in 65.0% – on the background of premature rupture of the membranes, from very early PBs – in 85.1% and 83.3%, respectively. Placentas from deliveries with premature rupture of the fetal membranes more often had signs of severe villousitis – in 21% of cases at 28–34 weeks and in 20.6% at 22–27 weeks. 2. In placentas from early PB, macrophage antigen of fetal origin was detected in 22% of cases in the cases of premature rupture of the fetal membranes and in 21.6% of cases of childbirth with intact membranes; these samples were dominated by infiltration by lymphocytes of maternal origin. On the other hand, placentas from very early PB and ruptured fetal membranes in 77.2% of cases contained antigen of fetal macrophages and in 71.6% of cases of onset of labor with intact membranes. Such results indicate the fetal origin of the inflammatory process in very early PB. [ABSTRACT FROM AUTHOR]

BACKGROUND: Significant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM. METHODS: We conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5 and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined. RESULTS: In total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9-14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5 during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts. CONCLUSION: Using a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.

Yan Lv, Zheren Huang, Yan Ma Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of ChinaCorrespondence: Yan Ma, Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China, Tel +86-0-13813693377, Email mayan19820117@126.comBackground: We aimed to investigate the association between maternal neutrophil ratio and histological chorioamnionitis (HCA) risk in pregnant women with premature rupture of membranes (PROM) in late pregnancy.Methods: A retrospective analysis was conducted on 95 cases of women with PROM in their late pregnancy between March 2018 and August 2021. These women were divided into two groups based on the presence of HCA. General clinical data and laboratory indicators were compared between the two groups. A generalized additive model was used for curve fitting, and a segmented regression model was used to explain further the non-linear relationship between neutrophil ratio and HCA risk.Results: After adjusting for confounding factors, the curve fitting showed a “U”-shaped curve relationship between the neutrophil ratio and the risk of HCA. When the neutrophil ratio was < 76.3%, the risk of HCA exhibited a decreasing trend, but the difference was not statistically significant (adjusted OR = 0.884, 95% CI: 0.781– 1.001, P = 0.053). However, when the neutrophil ratio was > 76.3%, the HCA risk was significantly increased (adjusted OR = 1.339, 95% CI: 1.067– 1.680, P = 0.012). Furthermore, we equally divided the neutrophil ratio into three groups. The risk of HCA was significantly increased in the low-ratio group (OR = 4.292, 95% CI: 1.247– 14.706, P = 0.021) compared with the middle-ratio group, which was used as the reference group. Similarly, the HCA risk of the high-ratio group (OR = 13.145, 95% CI: 1.796– 96.233, P = 0.011) was also significantly enhanced. However, there was no significant difference in HCA risk between the high-ratio and low-ratio groups (OR = 1.182, 95% CI: 0.357– 3.909, P = 0.784).Conclusion: There was a significant “U”-shaped relationship between maternal neutrophil ratio and HCA risk in women with PROM in late pregnancy.Keywords: premature rupture of membranes, late pregnancy, neutrophil ratio, histological chorioamnionitis, non-linear relationship

Objective: Premature rupture of membranes (PROMs) is one of the common causes of preterm birth which has a major contribution to maternal and fetal adverse outcomes. Infection may be contributing to premature rupture of membrane or it may be a consequence. The aim of our study was to assess the common pathogens colonizing the endocervix in women with PROM and pregnancy outcomes. Materials and methods: In this prospective observational study, seventy antenatal women with PROM after 24 weeks of gestation were studied from January 2020 to July 2021. Two swabs were taken from the endocervix. Swabs were subjected to gram staining and culture. The association of endocervical culture positivity with chorioamnionitis, mode of delivery, and neonatal outcome was evaluated. Results: In the study, 24.2% of endocervical cultures were positive. The pathogens isolated were Escherichia coli in 11.4%, Staphylococcus hemolyticus in 2.9%, budding yeast in 2.9%, 1.4% each with Klebsiella pneumoniae and Methicillin-resistant Staphylococcus aureus (MRSA). The culture was positive in 30.3% of subjects with preterm PROM and 18.9% with PROM (p = 0.40). The incidence of chorioamnionitis was higher with endocervical culture-positive cases as compared to culture-negative women (p = 0.05). There was no association of endocervical culture positivity with the neonatal intensive care unit (NICU) admission, duration of membrane rupture, and mode of delivery. Conclusion: In our study, the most common bacteria inhabiting the endocervix in PROM was E. coli. There is a definite influence of bacterial endocervical colonization on pregnancy outcomes but further studies are needed to corroborate the findings. [ABSTRACT FROM AUTHOR]

Background: Observational studies have reported that Helicobacter pylori (H. pylori) infection is associated with a series of pregnancy and neonatal outcomes. However, the results have been inconsistent, and the causal effect is unknown. Methods: A two-sample Mendelian randomization (MR) study was performed using summary-level statistics for anti-H. pylori IgG levels from the Avon Longitudinal Study of Parents and Children Cohort. Outcome data for pregnancy (miscarriage, preeclampsia-eclampsia, gestational diabetes mellitus, placental abruption, premature rupture of membranes, postpartum hemorrhage) and neonates (birthweight, gestational age, and preterm birth) were sourced from genome-wide association meta-analysis as well as the FinnGen and Early Growth Genetics Consortium. Causal estimates were calculated by five methods including inverse variance weighted (IVW). The heterogeneity of instrumental variables was quantified by Cochran's Q test, while sensitivity analyses were performed via MR-Egger, MR-PRESSO, and leave-one-out tests. Results: IVW estimates suggested that genetically predicted anti-H. pylori IgG levels were significantly associated with increased risks of preeclampsiaeclampsia (odds ratio [OR] = 1.12, 95% confidence interval [CI] 1.01-1.24, P = 0.026) and premature rupture of membranes (OR = 1.17, 95% CI 1.05-1.30, P = 0.004). Similar results were obtained for preeclampsia-eclampsia from the MREgger method (OR = 1.32, 95% CI 1.06-1.64, P = 0.027) and for premature rupture of membranes from the weighted median method (OR = 1.22, 95% CI 1.06-1.41, P = 0.006). No significant causal effects were found for other outcomes. There was no obvious heterogeneity and horizontal pleiotropy across the MR analysis. Conclusion: Our two-sample MR study demonstrated a causal relationship of H. pylori infection with preeclampsia-eclampsia and premature rupture of membranes. The findings confirm the epidemiological evidence on the adverse impact of H. pylori in pregnancy. Further studies are needed to elucidate the pathophysiological mechanisms and assess the effectiveness of pre-pregnancy screening and preventive eradication. [ABSTRACT FROM AUTHOR]

Objective 17-α-hydroxyprogesterone caproate (17-OHP) has been recommended by professional societies for the prevention of recurrent preterm birth, but subsequent clinical studies have reported conflicting efficacy results. This study aimed to contribute to the evidence base regarding the effectiveness of 17-OHP in clinical practice using real-world data. Study Design A total of 4,422 individuals meeting inclusion criteria representing recurrent spontaneous preterm birth (sPTB) were identified in a database of insurance claims, and 568 (12.8%) received 17-OHP. Crude and propensity score-matched recurrence rates and risk ratios (RRs) for the association of receiving 17-OHP on recurrent sPTB were calculated. Results Raw sPTB recurrence rates were higher among those treated versus not treated; after propensity score matching, no association was detected (26.3 vs. 23.8%, RR = 1.1, 95% CI: 0.9–1.4). Conclusion We failed to identify a beneficial effect of 17-OHP for the prevention of spontaneous recurrent preterm birth in our observational, U.S. based cohort. Key Points We observed higher risk for sPTB in the group receiving 17-OHP in the unmatched analysis After propensity-score matching, we still failed to identify a beneficial effect of 17-OHP on sPTB Sensitivity analyses demonstrated robustness to the inclusion criteria and modeling assumptions. [ABSTRACT FROM AUTHOR]

Background: To investigate the clinical value of cervical secretion culture in pregnant women with premature rupture of membranes (PROM) in predicting maternal and fetal outcomes. Methods: We retrospectively reviewed clinical records of pregnant women who underwent obstetric examination and delivered in Fujian Maternal and Child Healthcare from December 2013 to December 2016. Pregnant women with a clear diagnosis of PROM, who underwent cervical secretion culture immediately after hospital admission were selected for the study. The primary outcome was the occurrence of chorioamnionitis. The secondary outcome was neonatal admission to the neonatal intensive care unit (NICU). Correlation between maternal and fetal outcomes and the results of the cervical secretion culture was analyzed by one-way analysis and multifactorial analysis, respectively. The predictive efficacy of cervical secretion culture was evaluated using receiver operating characteristic curve (ROC), area under the curve (AUC) and the integrated discrimination improvement (IDI). Results: A total of 7,727 pregnant women with PROM were included in the study. Of them, 1812 had positive cervical secretion cultures (635 positive for mycoplasma infection, 475 for bacterial, 637 for fungal, and 65 for chlamydial infections). Pregnant women with positive mycoplasma and bacterial cultures had higher rates of developing chorioamnionitis compared to women with negative cervical secretion cultures (9%, 12% vs. 1%, respectively). Similarly, positive mycoplasma and bacterial cultures were associated with higher rate of the preterm (before 34 weeks) labor (3%, 3% vs. 1% in women with negative cultures, respectively), and neonatal admission to the NICU (9%, 11% vs. 7%, respectively). After adjusting for various confounding factors, our analysis demonstrated that a positive cervical secretion culture for mycoplasma or bacterial pathogens remained an independent risk factor for chorioamnionitis. Cervical secretion culture outcome was less effective in predicting chorioamnionitis (AUC 0.569) compared to white blood count (WBC) (AUC 0.626) and C-reactive protein (CRP) levels (AUC 0.605). The IDI of the combined predictive model incorporating WBC, CRP, maternal fever and cervical secretion culture results was 0.0029. Conclusion: Positive cervical secretion cultures, especially for mycoplasma and bacteria, are associated with higher incidence of adverse maternal and fetal outcomes. However, the predictive value of this test is poor, and cannot be efficiently used for predicting chorioamnionitis. [ABSTRACT FROM AUTHOR]

Background: Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required. Aims and Objectives: The study was designed to start induction for an indication that justifies operative delivery in cases of failure. Materials and Methods: A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus. Results: The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby. Conclusion: The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary.

Xinshui Wang,1 Zheren Huang,2 Yan Ma2 1Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China; 2Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of ChinaCorrespondence: Yan Ma, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China, Tel +86-0-13813693377, Email mayan19820117@126.comBackground: This study aimed to develop and validate a model to predict histologic chorioamnionitis (HCA) risk in late preterm and term premature rupture of membranes (PROM) patients using clinical and laboratory parameters.Methods: We conducted a retrospective study on 116 late preterm and term PROM cases, divided into a training (n=81) and a validation set (n=35). A multivariable logistic regression model was developed using the training set. Performance was assessed via the area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI). Decision curve analysis (DCA) evaluated the model’s clinical utility. Additionally, nomograms and a web version of the model were developed.Results: In the training set, the combined model constructed using maternal BMI, gravidity, amniotic fluid characteristics, and prenatal white blood cell (WBC) count showed significantly higher AUC than WBC alone (0.859 vs 0.710, P=0.010), with improved accuracy and sensitivity. In the validation set, the AUC of the combined model remained higher than that of WBC, but the difference was not statistically significant (0.728 vs 0.584, P=0.173). NRI analysis indicated that the combined model improved the correct classification of HCA by 25.0% (P=0.012) compared to that of WBC alone. DCA demonstrated that the combined model had a higher net benefit than WBC in most cases. The nomograms and web version of the model provided convenient tools for clinicians to predict the risk of HCA.Conclusion: This study successfully developed and validated a clinically feasible multivariable model to predict the risk of HCA in women with late preterm and term PROM.Keywords: histologic chorioamnionitis, laboratory indicators, late pregnancy, predictive model, premature rupture of membranes

OBJECTIVE: To evaluate the frequency of gestational diabetes among women who experience premature rupture of membranes METHODOLOGY: This descriptive cross-sectional study was conducted at the Department of Obstetrics & Gynecology, Mohammad Teaching Hospital Peshawar, from October 2021 to February 2022. One hundred fifty-five patients were selected from the Obstetrics and Gynaecology outpatient department. Women presenting with premature membrane rupture, within the reproductive age of 15-45 years, and with a gestational period beyond 37 weeks were included. Women with a history of failed inductions and those with twin pregnancies confirmed by ultrasound were excluded. A consecutive sampling of 155 females with premature rupture of membranes and screening them for gestational diabetes mellitus. The SPSS (version 22.0) was used for statistical analysis. Categorical variables, including gestational diabetes, parity, and gravidity, were summarized using frequencies and percentages. We conducted post-stratification analysis using the chi-square test, with a significance level set at p < 0.05. RESULTS: The average age of the patients was 27.2±5.7 years, with the majority (49.7%) falling within the age range of up to 25 years. The mean parity was 2.49±1.84. Overall, we diagnosed gestational diabetes mellitus in 24.5% of the patients. CONCLUSION: The presence of gestational diabetes mellitus in cases of premature rupture of membranes is familiar in our population. We recommend conducting further studies to identify risk factors and develop preventive strategies before formulating recommendations for its prevention.

Abstract Background The association between uterine malformations and adverse pregnancy outcomes is well recognized. However, studies on adverse pregnancy outcomes based on one kind of anatomical commonality between different uterine anomalies have not been reported. This study aimed to investigate pregnancy outcomes in pregnancies with uterine malformations when the pregnancy is confined to a hemi-uterus. Methods A retrospective observational study of 336 women who gave birth at our hospital from 2015 to 2021 was performed. Women (n = 112) with a unicornuate, complete bicornuate, or didelphic uterus were set as the study group, and women (n = 224) with a normal uterus were set as the reference group. Maternal and neonatal outcomes were evaluated and compared between the two groups using Student’s t-test, one-way ANOVA, Chi-squared test, Yates correction for continuity, or Fisher’s exact test. Modified Poisson regression analyses were used to estimate the relationships between the hemi-uterus pregnancy and preterm birth, preterm premature rupture of membranes, and cesarean section rates by adjusting for potential confounders. A P value

Early rupture of membranes is one of the complicators in pregnancy and childbirth that plays a role in increasing perinatal maternal pain and death that can be caused by infection, where the amniotic membrane that is a barrier to the entry of infection-causing germs is no longer there so that it can be dangerous for the mother and fetus. The purpose of conducting research is to determine the incidence of SC with indications of premature rupture of membranes in Poso area general hospitals—descriptive research method with a Retrospective approach. The study subjects were mothers with SC delivery with hints of KPD selected using purposive sampling techniques. The results of 30 SC mothers with symptoms of Early Rupture of Water (KPD) at the Poso Regional General Hospital were dominated by mothers aged 20-35 years, primiparous parity, gestational age ≥37 weeks, and not working. It can be concluded that it cannot be ascertained that there is a relationship between maternal age and the incidence of KPD because the development or maturity of each woman's reproductive organs is not the same; other causative factors can also be seen from a psychological and financial perspective, such as mothers who experience anxiety in primigravida mothers. Gestational age also influences the older the gestational age will result in the opening of the cervix and stretching of the amniotic membrane, which affects the amniotic membrane so that it is weaker and more accessible to break. Regarding the activities of maternity mothers who work and do not work, it will not affect their health if the mother can still control rest and knows the limits of work. The cause of KPD is multifactor and is usually associated with increased physical stress that causes the amniotic membrane to become weak.

The relationship between the intake of artificial sweetener (AS) and adverse pregnancy outcomes is under-researched, and existing studies yield inconsistent conclusions. A Mendelian randomization (MR) approach was employed to investigate the causal relationship between the intake of AS and adverse pregnancy outcomes. Instrumental variables related to the exposure phenotype were selected for analysis. The analysis was conducted using genome-wide association study summary data from public datasets. The inverse variance weighted, MR-Egger, weighted median, simple mode, and weighted mode methods were used to evaluate the causal relationship between exposure and outcomes. Sensitivity analysis and multivariable Mendelian randomization enrolling body mass index, type 2 diabetes mellitus, and fasting glucose were employed to further validate the consistency and robustness of the results. In univariable MR, the intake of AS added to tea was associated with an increased risk of ectopic pregnancy [OR = 1.821 (1.118–2.967), p = 0.016]. In multivariable MR adjusting for body mass index and type 2 diabetes mellitus, the intake of AS added to cereal was linked to a reduced risk of ectopic pregnancy [OR = 0.361 (0.145–0.895), p = 0.028] and premature rupture of membranes [OR = 0.116 (0.019–0.704), p = 0.019], while the intake of artificial sweetener added to coffee was associated with an increased risk of placenta previa [OR = 1.617 (1.042–2.510), p = 0.032]. No causal relationship was identified between the intake of artificial sweetener and other adverse pregnancy outcomes. The consumption of artificial sweetener during pregnancy warrants careful consideration.

Purpose: This study aims to explore the association of maternal preconceptional folic acid (FA) supplementation with gestational age and preterm birth in twin pregnancies, and whether the association varies by chorionicity or conception mode. Methods: From November 2018 to December 2021, the information of FA supplementation and pregnancy outcomes were collected in twin pregnant women. The linear regression models and the logistic regression were used to test the association of preconceptional FA supplementation with gestational age at delivery and preterm birth and premature rupture of membranes (PROM). Results: A total of 416 twin pregnancies were included. Compared with no use in twins, maternal preconceptional FA use was associated with a 0.385-week longer gestational age (95% CI 0.019–0.751) and lower risk of preterm birth < 36 weeks (adjusted OR 0.519; 95% CI 0.301–0.895) and PROM (adjusted OR 0.426; 95% CI 0.215–0.845). The protective effect on preterm birth < 36 weeks and PROM is similar whether taking FA supplements alone or multivitamins. However, the associations varied by chorionicity and conception mode of twins or compliance with supplementation. The positive associations between preconceptional FA use and gestational age only remained significant among twins via assisted reproductive technology or dichorionic diamniotic twins. Significant protective effects on preterm birth < 36 weeks and PROM were only found among women who took FA at least 4 times a week before conception. Conclusion: Maternal preconceptional FA supplementation was associated with longer gestation duration and lower risk of preterm birth < 36 weeks and PROM in twin pregnancies. To improve the success of their pregnancies, reproductive women should start taking FA supplements well before conception and with good compliance. [ABSTRACT FROM AUTHOR]

Problem: We aimed to investigate the predictive value of delta neutrophil index (DNI) for histological choriomanionitis (HCAM) and the effect of maternal inflammatory markers on neonatal outcomes and fetal inflammatory parameters. Method of Study: In this retrospective cross‐sectional study, 68 pregnant women without HCAM (group 1) and 46 pregnant women diagnosed with HCAM (group 2) were divided into two groups. Demographic stories of the groups; maternal hematological parameters; maternal DNI and systemic inflammatory index (SII) values; outcomes of newborns; fetal inflammatory markers were recorded and compared between groups. Results: Maternal DNI, and SII levels were significantly higher in group 2 (p value <.05 for all). Admission to the neonatal unit (NICU) was higher in group 2 than in group 1 (p =.0001). We found that fetal inflammatory markers were significantly higher in group 2 (p values.001 for CRP,.0001 for DNI, and.002 for leukocyte). Maternal DNI was determined to be significantly diagnostic at a value of ≥1.3 in HCAM (p =.001). We observed that SII had a significant predictive value of 953036.6 (p =.019) for NICU admission. There is also a positive correlation between fetal inflammatory markers and maternal inflammatory markers. Conclusions: We found that maternal inflammatory markers are high in HCAM, maternal DNI can predict patients who will develop HCAM, maternal SII value can predict NICU admission, fetal inflammatory markers are high in HCAM, and these markers are affected by maternal inflammatory markers. [ABSTRACT FROM AUTHOR]

Background: Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required. Aims and Objectives: The study was designed to start induction for an indication that justifies operative delivery in cases of failure. Materials and Methods: A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus. Results: The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby. Conclusion: The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary. [ABSTRACT FROM AUTHOR]

Introduction: Mycoplasma hominis (M. hominis) is one of the smallest free-living prokaryotes and it is one of the most famous pathogenic Mycoplasmas of the human reproductive system which causes miscarriage, vaginosis, infertility, premature birth with low weight, meningitis, and pneumonia. This research aimed to study the prevalence of premature rupture of membranes (PROM) of pregnant mothers due to M. hominis in women's hospitals of Ardabil province with two techniques of PCR and culture. Methods and Materials: This case-control study was conducted on 100 pregnant women with PROM and 50 healthy women without symptoms (control) referring to women's hospitals in Ardabil province. After sampling by cervical swap, the samples were evaluated for the presence of M. hominis by culture and PCR methods. Results: In the case group of 100 studied patients, 39 samples (39%) were recognized positive for M. hominis by culture method and 51 samples (51%) were recognized positive by PCR method. Furthermore, in the control group, out of 50 examined samples, 7 samples (14%) were diagnosed as positive for M. hominis by culture method and 9 samples (18%) were recognized positive by PCR method. There were statistically significant relationship among age group, history of abortion, vaginal infection before pregnancy and spontaneous rupture of membranes in pregnant women with the risk of contracting M. hominis followed by PROM in pregnant women (p<0.05). Discussion and Conclusion: PROM of pregnant mothers due to contamination with M. hominis is high and it is more common. Compared to the culture method, the PCR method is more suitable and specific for identifying positive cases of M. hominis in pregnant women who have PROM. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the association between altered maternal serum amino acids (AAs) levels and premature rupture of membranes (pPROM) in pregnant women. We conducted a case-control study involving 60 pregnant women diagnosed with pPROM and 60 healthy pregnant women as controls. Amino acid levels were quantified using high-performance liquid chromatography. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive capability of specific AAs for pPROM. Our findings revealed that lysine, glycine, and glutamic acid levels were significantly elevated in the pPROM group compared with the control group. Lysine, with a threshold value exceeding 137.90 μmol/L, exhibited the highest predictive accuracy, with an area under the curve (AUC) of 0.796 (p < 0.001), sensitivity of 66.7 %, and specificity of 80.0 %. Glycine, with a cut-off value of >242.48 μmol/L, had an AUC of 0.789 (p < 0.001), sensitivity of 83.3 %, and specificity of 65.0 %. Glutamic acid, at a threshold of 111.40 μmol/L, demonstrated an AUC of 0.787 (p < 0.001), sensitivity of 88.3 %, and specificity of 65.0 %. These AAs could effectively predict the occurrence of pPROM. Elevated blood levels of lysine, glycine, and glutamic acid were found to be associated with pPROM. These AAs serve as potential predictive biomarkers for pPROM, with lysine showing the highest AUC and sensitivity. Identifying such biomarkers may contribute to the development of non-invasive diagnostic tools for pPROM risk assessment, enabling timely interventions and improved maternal and fetal outcomes. • Maternal serum amino acid levels (lysine, glycine, glutamic acid) were significantly elevated in pPROM group. • Lysine showed the highest predictive accuracy for pPROM with an AUC of 0.796. • Glycine had an AUC of 0.789, and glutamic acid had an AUC of 0.787 for pPROM prediction. • Elevated amino acid levels in maternal serum can serve as potential predictive biomarkers for pPROM. [ABSTRACT FROM AUTHOR]

Background: The association between uterine malformations and adverse pregnancy outcomes is well recognized. However, studies on adverse pregnancy outcomes based on one kind of anatomical commonality between different uterine anomalies have not been reported. This study aimed to investigate pregnancy outcomes in pregnancies with uterine malformations when the pregnancy is confined to a hemi-uterus. Methods: A retrospective observational study of 336 women who gave birth at our hospital from 2015 to 2021 was performed. Women (n = 112) with a unicornuate, complete bicornuate, or didelphic uterus were set as the study group, and women (n = 224) with a normal uterus were set as the reference group. Maternal and neonatal outcomes were evaluated and compared between the two groups using Student's t-test, one-way ANOVA, Chi-squared test, Yates correction for continuity, or Fisher's exact test. Modified Poisson regression analyses were used to estimate the relationships between the hemi-uterus pregnancy and preterm birth, preterm premature rupture of membranes, and cesarean section rates by adjusting for potential confounders. A P value < 0.05 was considered significant. Results: Women in the study group had a higher history of spontaneous abortion (24.1% vs. 10.7%, P = 0.002) and intrauterine fetal death (5.4% vs. 0.4, P = 0.006). Compared with the reference group, the study group had significantly higher rates of assisted reproductive technology (9.4% vs. 2.2%, P = 0.001) and cord-around-the neck (54.5% vs. 29.9%, P = 0.000). Modified Poisson regression analyses showed that the study group was at higher risk for preterm birth (aRR, 6.8; 95% CI 2.7–16.7), preterm premature rupture of membranes (aRR, 14.1; 95% CI 3.2–62.5), malpresentation (aRR, 13.2; 95% CI 6.3–27.7), and cesarean section (aRR, 4.4; 95% CI 3.3–5.7). Conclusion: Women with a unicornuate, didelphic, or complete bicornuate uterus are at higher risk for some adverse pregnancy outcomes than those with a normal uterus. [ABSTRACT FROM AUTHOR]

Background and Objectives: Urinary tract infections (UTIs) are an important cause of perinatal and maternal morbidity and mortality. The aim of this study was to describe and compare the main pregnancy outcomes among pregnant patients with complicated and uncomplicated UTIs; Materials and Methods: This retrospective study included 183 pregnant patients who were evaluated for uncomplicated UTIs and urosepsis in the Urology Department of 'C.I. Parhon' University Hospital, and who were followed up at a tertiary maternity hospital—'Cuza-voda' from Romania between January 2014 and October 2023. The control group (183 patients) was randomly selected from the patient's cohort who gave birth in the same time frame at the maternity hospital without urinary pathology. Clinical and paraclinical data were examined. Descriptive statistics and a conditional logistic regression model were used to analyze our data. Results: Our results indicated that patients with urosepsis had increased risk of premature rupture of membranes (aOR: 5.59, 95%CI: 2.02–15.40, p < 0.001) and preterm birth (aOR: 2.47, 95%CI: 1.15–5.33, p = 0.02). We could not demonstrate a statistically significant association between intrauterine growth restriction and pre-eclampsia with the studied urological pathologies. Conclusions: Careful UTI screening during pregnancy is needed for preventing maternal–fetal complications. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify the associated risk factors of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). Methods: This retrospective case-control study was conducted at Firooz-abadi Hospital between 2019 and 2021. The study included 90 pregnant women diagnosed with PROM or PPROM (case group), compared with 90 women without this complication (control group) who presented to the hospital during the specified period. Demographic and clinical information of the case group was collected and compared with data from 90 pregnant women in the control group, matched for gestational age and other relevant factors. Statistical analysis was performed to assess the differences between the groups. Results: Maternal age and weight were found to be significantly lower in the case group compared to the control group (P=0.02, P

Background and objective: Pregnancy associated Group B streptococcal infection is a well-established cause of significant neonatal morbidity and mortality. A cross-sectional study was conducted to determine the prevalence of Group B streptococcal infection among women presenting in labor at different ages and gestational ages and its correlation with different risk factors. Methods: Vaginal swab and urine sample for culture from 150 women having risk factors and being in labor and having risk of developing Group B streptococcal infection from 2nd of November 2020 to 2nd of December 2021. Results: The prevalence of Group B streptococcal infection among risky group women during labor in Maternity Teaching Hospital was 8%. The rate of agreement between the vaginal swab results and urine culture results was 92%. There was no significant association between urine culture results with age, parity and prolonged rupture of membrane. A significant high rate of infected urine in culture was found among women with a very extreme preterm gestational age (p value 0.049), and it was also significant among women with pyrexia (p value 0.001). Conclusion: The prevalence of Group B streptococcal infection among high-risk group of women during labor in Maternity Teaching Hospital of Erbil city was 8%.

Background Sepsis is one of the main causes of neonatal mortality. The morbidity and mortality rates due to neonatal sepsis are as high as 9-20%. Premature rupture of membranes (PROM) and preterm gestational age are among the risk factors of neonatal sepsis. Objective To evaluate for potential associations between PROM as well as preterm gestational age to neonatal sepsis by meta-analysis and systematic review. Methods A meta-analysis and systematic review were performed using literature sourced from PubMed, Cochrane, and Google Scholar according to PRISMA guidelines. We calculated the incidence of sepsis in neonates with and without PROM and premature gestational age. Journal quality was assessed according to the Newcastle-Ottawa Scale (NOS) criteria. Results From the literature search for PROM, 21 case-control studies met the inclusion criteria. Neonatal sepsis was more common in neonates who had a maternal history of PROM than in those without [OR 2.69 (95%CI 1.56 to 4.65); P

Vitamin C (ascorbic acid) is an essential water-soluble micronutrient involved in the antioxidant defense mechanisms and synthesis of collagen [1]. It has been suggested that vitamin C could be effective in preventing premature rupture of membranes (PROM) and preterm birth, but previous systematic reviews and meta-analyses had inconsistent results [1-4]. Some found that women supplemented with vitamin C had reduced risk of preterm PROM (PPROM) [1] and term PROM (TPROM) [1], while other found that vitamin C supplementation was not effective in reducing risk of PPROM [3, 4] or preterm birth [1, 3] or, conversely, that it was associated with an increased risk of preterm birth [2]. Considering previous inconsistencies, we aimed to conduct a systematic review and meta-analysis to determine if vitamin C supplements could be effective in preventing PROM or preterm birth. We registered our protocol in PROSPERO (CRD42022371644). PubMed/MEDLINE, Scopus and Web of Science were searched up to December 21, 2022. Backward and forward citation searching was also performed. We included randomized controlled clinical studies evaluating the efficacy of vitamin C supplementation alone in prevention of PROM or preterm birth in pregnant women in comparison with control group who received placebo or no vitamin C supplementation, and excluded studies in which information needed for calculation of combined effect sizes could not be extracted, calculated or obtained, studies with unavailable full text, conference abstracts, non-randomized clinical studies and studies in which efficacy of vitamin C in combination with other supplements was evaluated (if both groups received same supplements such study was not excluded). Cochrane Risk of Bias 2 (RoB 2) tool was used to assess risk of bias. Data analysis was performed using Meta-Essentials: Workbooks for meta-analysis (Version 1.5) [5]. Random effects model was used with inverse variance weighting method, while combined effects sizes were estimated using risk ratio (RR) and considered significant only if both 95% confidence interval (CI) did not include 1 and p<0.05. Four main outcomes were evaluated: PROM (regardless of being preterm or term), PPROM, TPROM and preterm birth. Cochran's Q test and I² statistic were used to evaluate statistical heterogeneity. In case of significant heterogeneity (p<0.10 and I²>50%), subgroup and moderator analyses were used to explore potential sources of heterogeneity. Sensitivity analysis was carried out by excluding individual studies one at a time and recalculating the combined effect size estimates for the remaining studies. We planned to assess publication bias, but because of the small number of studies (less than 10) we did not. A total of 9 studies (10 reports) met eligibility criteria. Total daily dose of vitamin C supplementation varied from 100 to 1000 mg. The overall risk of bias according to RoB 2 tool was judged as "high" and "some concerns" for 4 (44.4%) and 5 (55.6%) of 9 studies, respectively. Vitamin C supplementation was associated with a significantly reduced risk of PROM (7 studies, 1590 participants, RR=0.57, 95% CI from 0.39 to 0.81, Z=-3.82, p<0.001, Q=6.83, p=0.337, I²=12.17%, robust in sensitivity analysis) and PPROM (4 studies, 457 participants, RR=0.67, 95% CI from 0.45 to 0.99, Z=-3.25, p=0.001, Q=1.27, p=0.737, I²=0.00%, not robust in sensitivity analysis) without significant between-study heterogeneity. No significant differences were seen between women supplemented with vitamin C and controls in risk of TPROM (3 studies, 397 participants, RR=0.44, 95% CI from 0.13 to 1.49, Z=-2.89, p=0.004, Q=2.29, p=0.319, I²=12.50%, robust in sensitivity analysis) without significant between-study heterogeneity and preterm birth (5 studies, 1643 participants, RR=0.94, 95% CI from 0.57 to 1.55, Z=-0.34, p=0.730, Q=8.02, p=0.091, I²=50.13%, robust in sensitivity analysis) but with significant between-study heterogeneity, so we explored its potential sources in subgroup and moderator analyses with available data. Subgroups of studies in Africa and continents other than Africa had an acceptable level of heterogeneity (I²=43.86% and I²=0.00%, respectively) and combined effect sizes were not significant (RR=1.10, 95% CI from 0.56 to 2.18 and RR=0.52, 95% CI from 0.17 to 1.59, respectively). Also, subgroup of studies with high risk of bias was without any heterogeneity (I²=0.00%) and with nonsignificant combined effect size (RR=0.77, 95% CI from 0.03 to 22.90). In conclusion, our results indicate that vitamin C supplementation could be effective in reducing risk of PROM and PPROM, but not TPROM and preterm birth. Considering that membrane rupture may be associated with increased oxidative stress and abnormalities in collagen formation and structure [6], vitamin C could be effective in preventing PROM and PPROM because of its antioxidant effects and role in the synthesis of collagen. However, the total number of studies included in some of the analyses was relatively small, so these results should be interpreted cautiously as some analyses could have been underpowered. Also, considering significant heterogeneity and lack of robustness in some of the analyses, additional high-quality studies with low risk of bias, larger and more homogenous samples are needed to confirm these findings. Acknowledgements: This work was supported by the Centre for Scientific Research Work of the Serbian Academy of Sciences and Arts and the University of Kragujevac (Project title: Vitamin C level in pregnant women and efficacy of vitamin C supplements in the prevention of premature rupture of membranes and preterm birth; Acronym: VitCePrev). [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify the associated risk factors of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). Methods: This retrospective case-control study was conducted at Firooz-abadi Hospital between 2019 and 2021. The study included 90 pregnant women diagnosed with PROM or PPROM (case group), compared with 90 women without this complication (control group) who presented to the hospital during the specified period. Demographic and clinical information of the case group was collected and compared with data from 90 pregnant women in the control group, matched for gestational age and other relevant factors. Statistical analysis was performed to assess the differences between the groups. Results: Maternal age and weight were found to be significantly lower in the case group compared to the control group (P=0.02, P<0.001, respectively). This suggests that younger age and lower maternal weight may be risk factors for PROM and PPROM. Furthermore, the number of women with a history of PROM or PPROM was significantly higher in the Case group (P<0.001), indicating that a previous occurrence of membrane rupture increases the risk of subsequent incident. In addition, the study findings showed a significantly higher rate of smoking among pregnant women in the case group compared to the control group (P=0.04). Moreover, the occurrence of urinary tract infections during pregnancy and chorioamnionitis was significantly higher in the case group (P<0.001), suggesting that these infections may contribute to membrane rupture. Conclusion: In conclusion, our study provides valuable insights into the risk factors associated with PROM and PPROM. It highlights that lower maternal age and weight, a history of PROM or PPROM, lower gestational age, a history of gestational diabetes mellitus and first-trimester bleeding, smoking, and urinary tract infections during pregnancy are significantly associated with an increased risk of PROM and PPROM. These findings emphasize the importance of early identification and management of these risk factors in order to prevent or mitigate the occurrence of PROM and PPROM, ultimately improving maternal and neonatal outcomes. Further research and public health initiatives are warranted to raise awareness and promote preventive measures targeting these identified risk factors. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the frequency of gestational diabetes among women who experience premature rupture of membranes. METHODOLOGY: This descriptive cross-sectional study was conducted at the Department of Obstetrics & Gynecology, Mohammad Teaching Hospital Peshawar, from October 2021 to February 2022. One hundred fifty-five patients were selected from the Obstetrics and Gynaecology outpatient department. Women presenting with premature membrane rupture, within the reproductive age of 15-45 years, and with a gestational period beyond 37 weeks were included. Women with a history of failed inductions and those with twin pregnancies confirmed by ultrasound were excluded. A consecutive sampling of 155 females with premature rupture of membranes and screening them for gestational diabetes mellitus. The SPSS (version 22.0) was used for statistical analysis. Categorical variables, including gestational diabetes, parity, and gravidity, were summarized using frequencies and percentages. We conducted post-stratification analysis using the chi-square test, with a significance level set at p < 0.05. RESULTS: The average age of the patients was 27.2±5.7 years, with the majority (49.7%) falling within the age range of up to 25 years. The mean parity was 2.49±1.84. Overall, we diagnosed gestational diabetes mellitus in 24.5% of the patients. CONCLUSION: The presence of gestational diabetes mellitus in cases of premature rupture of membranes is familiar in our population. We recommend conducting further studies to identify risk factors and develop preventive strategies before formulating recommendations for its prevention. [ABSTRACT FROM AUTHOR]

Background: Amniotic fluid plays multiple important roles in pregnancy like homeostasis, protection from trauma, infection, and also facilitates cervical dilation in labour. Therefore, if the fetal membranes are ruptured before time, the consequences that follow can be detrimental to the fetus as well as the mother. The etiology of premature rupture of membranes (PROM) is still largely unclear and the complications are manifold. However prompt diagnosis and early management can help limit the adverse consequences and ensure a safe delivery. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, in a tertiary care hospital in Tezpur, Assam, over a period of 1 year (2021-2022). Out of all the patients who attended the OPD or emergency labour room, 94 cases were included in the study as per the inclusion and exclusion criteria. The data of these women was entered into a proforma and the study was done after due ethical clearance. Results: Hospital incidence was 1.3%, with more women being primigravidae. Majority of cases had unknown etiology but women from lower socioeconomic class showed more chances of PROM. Caesarean section was the mode of delivery in 68% cases. Most common maternal morbidity factor was fever at 7.4%. Most babies had a good APGAR score. 20.2% of babies required admission to NICU. No maternal or perinatal mortality was seen. Conclusion: PROM is an enigmatic condition associated with high risk of maternal and perinatal morbidity and mortality, even in the absence of other obstetric complications. Timely management and appropriate intervention can greatly improve both outcomes. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the levels of interleukin‐1β (IL‐1β), IL‐18, and the NOD‐like receptor pyrin domain‐containing 3 (NLRP3) inflammasome in patients with premature rupture of membranes (PROMs). Methods: We selected 60 pregnant women at the Fourth Hospital of Baotou between January 2019 and July 2021. These women were divided into three distinct groups: the preterm PROM group with 20 cases, term PROM (TPROM) group with 20 cases, and a control group with 20 cases consisting of normal full‐term pregnancies without PROM. Peripheral blood was collected from all participants. Using enzyme‐linked immunosorbent assay, the levels of IL‐1 and IL‐18 in the plasma were assessed. Additionally, the proportions of NLRP3, apoptosis‐associated speck‐like protein (ASC), and caspase‐1‐positive macrophages were also evaluated. Results: The ratios of NLRP3, ASC, IL‐1β, and IL‐18 concentrations, along with the presence of caspase‐1‐positive macrophages, were notably greater in the PROM groups in comparison with the control group (p <.05). In the TPROM group and control group, the proportions of IL‐1β and IL‐18 levels were found to be lower than NLRP3, ASC, and caspase‐1‐positive macrophages levels (p <.05). Conclusion: The concentrations of IL‐1β and IL‐18, as well as the ratios of NLRP3, ASC, and caspase‐1‐positive macrophages, were elevated in patients with PROM compared to the control group. This suggests a potential correlation between the excessive activation of NLRP3 and the development of PROM. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the influence of pre-pregnancy body mass index (BMI) on the incidence of premature rupture of membranes (PROM) among Chinese women. Methods: This was a hospital-based retrospective cohort study of 75,760 Chinese women who had live singleton births between 2016 and 2020. In this study, we utilized logistic regression analysis to estimate the association between pre-pregnancy BMI and PROM based on gestational age. Results: Prior to pregnancy, being overweight or obese was found to be significantly associated with an increased risk of preterm premature rupture of membranes (PPROM), as evidenced by adjusted odds ratios and 95 % confidence intervals of 1.336 (1.173–1.522) and 1.411 (1.064–1.872), respectively. Those with PPROM were divided into three groups according to gestational age: 22–27, 28–31, and 32–36 weeks. Women who were overweight or obese prior to pregnancy had a higher likelihood of experiencing PROM between 22 and 27 weeks of gestation. This finding remained consistent even after controlling for potential confounding factors, such as gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, hydramnios, cervical abnormalities, and a history of preterm birth. Conclusion: Our research findings indicate that being overweight or obese before pregnancy is linked to a higher likelihood of experiencing PPROM. Therefore, achieving optimal weight before pregnancy is important to prevent PPROM and its associated complications.

Abstract Objective In this study, we investigated the levels of interleukin‐1β (IL‐1β), IL‐18, and the NOD‐like receptor pyrin domain‐containing 3 (NLRP3) inflammasome in patients with premature rupture of membranes (PROMs). Methods We selected 60 pregnant women at the Fourth Hospital of Baotou between January 2019 and July 2021. These women were divided into three distinct groups: the preterm PROM group with 20 cases, term PROM (TPROM) group with 20 cases, and a control group with 20 cases consisting of normal full‐term pregnancies without PROM. Peripheral blood was collected from all participants. Using enzyme‐linked immunosorbent assay, the levels of IL‐1 and IL‐18 in the plasma were assessed. Additionally, the proportions of NLRP3, apoptosis‐associated speck‐like protein (ASC), and caspase‐1‐positive macrophages were also evaluated. Results The ratios of NLRP3, ASC, IL‐1β, and IL‐18 concentrations, along with the presence of caspase‐1‐positive macrophages, were notably greater in the PROM groups in comparison with the control group (p

Objective: Several studies have identified risk factors for neonatal sepsis, but they are limited to specific geographical areas with results that may not be generalizable to other populations. Hence, the objective of this study was to determine the contributing factors, representative at a national level, that influence the occurrence of neonatal sepsis in neonates receiving hospital care in Ethiopia. Methods and materials: A thorough search was conducted across PubMed/Medline, Hinari, Cochrane Library, and Google Scholar to identify relevant studies. The pooled odds ratio was estimated using the random effect model. The heterogeneity among the included studies was evaluated using the I2 and Cochrane Q-statistics tests. Egger's tests used to assess publication bias. Results: A total of 19 studies comprising 6190 study participants were included. Neonatal sepsis was positively associated with several factors, namely: prolonged premature rupture of membrane (OR: 3.85, 95% CI: 2.31–6.42), low first minute APGAR score (OR: 3.74, 95% CI: 1.29–10.81), low fifth minute APGAR score (OR: 4.17, 95% CI: 1.76–9.91), delayed initiation of breastfeeding (OR: 3.41, 95% CI: 2.18–5.36), and infection of the maternal urinary tract (OR: 3.17, 95% CI: 1.87–5.35). Conclusion: Duration of rupture of membrane, APGAR score, time of initiation of breastfeeding, and urinary tract infection have a role in the development of neonatal sepsis.

Low vitamin D (VitD) level is a risk factor for preterm birth (PTB), but the results of previous studies remained inconsistent, which may be influenced by the confounding factors and different types of PTB. We performed Mendelian randomization (MR) to uncover the association of 25-hydroxyvitamin D (25(OH)D) with PTB, premature rupture of membranes (PROM), and preterm premature rupture of membranes (PPROM). This study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from August 2011 to March 2022. Plasma 25(OH)D levels in three trimesters of pregnancy were measured. We conducted an MR analysis utilizing a genetic risk score (GRS) approach, which was based on VitD-associated single-nucleotide polymorphisms. The prospective cohort study included 3923 pregnant women. The prevalence of PTB, PROM, and PPROM were 6.09%, 13.18%, and 1.33%, respectively. Compared to those without vitamin D deficiency (VDD), only vaginally delivering pregnant women with VDD had a 2.69 (1.08–6.68) times risk of PTB. However, MR analysis did not support the association. One-unit higher GRS was not associated with an increased risk of PTB, regardless of the trimesters (OR [95% CI]: 1.01 [0.93–1.10], 1.06 [0.96–1.18], and 0.95 [0.82–1.10], respectively). When further taking PROM and PPROM as the outcomes, the MR analysis also showed no consistent evidence of a causal effect of VitD levels on the risk of them. Our MR analyses did not support a causal effect of 25(OH)D concentrations in the three trimesters on PTB, PROM, and PPROM. [ABSTRACT FROM AUTHOR]

Background: Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the fetal membranes before the completion of 37 weeks of pregnancy. PPROM is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. PPROM occurs in 3% of pregnancies. Aims and objectives: The present study was done to identify risk factors associated with PPROM and feto-maternal outcome in PPROM. Methods: The present study was single centered prospective comparative study. A total of 100 patients in each group that is GROUP A - 28 to less than 34 weeks of gestation and GROUP B-34 to 37 weeks of gestation were selected for the study. Study was conducted from April 2019 to March 2020 in the Department of obstetrics and Gynecology, Nil Ratan Sircar medical college and hospitals, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: PPROM is mainly seen is in primigravida patients compared to multigravida. My study had 60% primigravida in Group A and 52% in Group B. There were no risk factors found in 74% patient in 28 to less than 34 weeks of gestation and 76% in 34-37 weeks of gestation. Most common risk factors in both groups was history of PPROM in previous pregnancy followed by malpresentation like Breech. Perinatal mortality includes stillbirth and early neonatal death which was 12% in Group A and 2% in Group B. Maternal morbidity was less in both groups. There was no maternal mortality. Chorioamnionitis was seen in 3 patients in Group A. Conclusion: Perinatal morbidity was mainly due to respiratory distress syndrome and prematurity in less than 34 weeks of gestation. Maternal morbidity was also increased mainly in lower gestational age group. [ABSTRACT FROM AUTHOR]

Introduction: Mycoplasma hominis (M. hominis) is one of the smallest free-living prokaryotes and it is one of the most famous pathogenic Mycoplasmas of the human reproductive system which causes miscarriage, vaginosis, infertility, premature birth with low weight, meningitis, and pneumonia. This research aimed to study the prevalence of premature rupture of membranes (PROM) of pregnant mothers due to M. hominis in women's hospitals of Ardabil province with two techniques of PCR and culture. Methods and Materials: This case-control study was conducted on 100 pregnant women with PROM and 50 healthy women without symptoms (control) referring to women's hospitals in Ardabil province. After sampling by cervical swap, the samples were evaluated for the presence of M. hominis by culture and PCR methods. Results: In the case group of 100 studied patients, 39 samples (39%) were recognized positive for M. hominis by culture method and 51 samples (51%) were recognized positive by PCR method. Furthermore, in the control group, out of 50 examined samples, 7 samples (14%) were diagnosed as positive for M. hominis by culture method and 9 samples (18%) were recognized positive by PCR method. There were statistically significant relationship among age group, history of abortion, vaginal infection before pregnancy and spontaneous rupture of membranes in pregnant women with the risk of contracting M. hominis followed by PROM in pregnant women (p<0.05). Discussion and Conclusion: PROM of pregnant mothers due to contamination with M. hominis is high and it is more common. Compared to the culture method, the PCR method is more suitable and specific for identifying positive cases of M. hominis in pregnant women who have PROM. [ABSTRACT FROM AUTHOR]

Disruption of fetal membranes before the onset of labor is referred to as premature rupture of membranes (PROM). Lack of maternal folic acid (FA) supplementation reportedly leads to PROM. However, there is a lack of information on the location of FA receptors in the amniotic tissue. Additionally, the regulatory role and potential molecular targets of FA in PROM in vitro have rarely been investigated. The three FA receptors (folate receptor α isoform [FRα], transporter of reduced folate [RFC], and proton-coupled folate transporter [PCFT]) in human amniotic epithelial stem cells (hAESCs) and amniotic tissue were localized using immunohistochemistry and immunocytochemistry staining. Effect and mechanism analyses of FA were performed in hAESCs and amniotic pore culture technique (APCT) models. An integrated pharmacological-bioinformatics approach was utilized to explore the potential targets of FA for the treatment of PROM. The three FA receptors were widely expressed in human amniotic tissue, especially in the hAESC cytoplasm. FA stimulated the amnion regeneration in the in vitro APCT model. This mimics the PROM status, in which cystathionine-β-synthase, an FA metabolite enzyme, may play an important role. The top ten hub targets (STAT1, mTOR, PIK3R1, PTPN11, PDGFRB, ABL1, CXCR4, NFKB1, HDAC1, and HDAC2) of FA for preventing PROM were identified using an integrated pharmacological–bioinformatic approach. FRα, RFC, and PCFT are widely expressed in human amniotic tissue and hAESCs. FA aids the healing of ruptured membrane. • FA receptors are widely expressed in human amnions. • FA stimulate healing of the Amnion Pore Culture Technique (APCT) model in vitro. • The top 10 hub targets of FA were selected by an integrated bioinformatic approach. [ABSTRACT FROM AUTHOR]

The article presents the results of a study amniotic glucose concentration as a potential early indicator of the inflammatory process in the fetal membranes. The main focus was on the analysis of the features of pregnancy and labor in women with premature rupture of membranes (PROM) during full-term and preterm labor according to amniotic fluid glucose levels. Currently, the expectant approach in cases of PROM is widely practiced throughout the world. The objective: to estimate the glucose level in the amniotic fluid as a preclinical marker of chorioamnionitis. Materials and methods. Depending on the glucose concentration in the amniotic fluid at the time of rupture of membranes and the term of rupture of membranes, 97 pregnant women were divided into 4 groups. I and II groups consisted of women with PROM between 24 and 36 weeks and 6 days. In the I group there were 34 pregnant women with a glucose concentration in the amniotic fluid of more than 0.5 mmol/l, and in the II group – 15 pregnant women with the indicator of less than 0.5 mmol/l. III and IV groups included pregnant women with PROM at full-term pregnancy (after 37 weeks). In the III group there were 34 patients with an amniotic glucose concentration of more than 0.5 mmol/l, and in the IV – 14 pregnant women with the indicator of less than 0.5 mmol/l. In all groups, the further course of pregnancy, the time period from the rupture of membranes to the beginning of labor, the need for induction of labor, hyperthermia before the beginning of labor, deviations from the normal course of labor were analyzed (hyperthermia, fetal distress in labor, uterine weakness) and the frequency of operative delivery. Results. The study determined that women with an amniotic glucose concentration below 0.5 mmol/l at the time of hospitalization were more likely to have hyperthermia before and during childbirth. Hyperthermia was most often observed during the first 12 hours after membrane rupture. In addition, these women were more prone to serious birth complications, such as fetal distress, weak labor, and a greater likelihood of needing an operative delivery. Conclusions. 1. A decreased amniotic glucose level less than 0.5 mmol/l is associated with more frequent clinical manifestations of amniotic infection (20% in preterm pregnancies and 14.8% – in full-term pregnancies) than in groups with a glucose content of more than 0.5 mmol/l (8.8% in preterm pregnancies and 5.9% – in full-term pregnancies, p≤0.05). 2. Among patients with a glucose content in amniotic fluid less than 0.5 mmol/l, laboratory manifestations of intra-amniotic infection were detected more often (40% in preterm pregnancies and 42.5% in full-term pregnancies) than among pregnant women with a glucose content of more than 0.5 mmol/l (20% in both full-term and preterm pregnancies, p≤0.05). 3. Determination of the glucose level in amniotic fluid can be considered as an available method of preclinical diagnosis of chorioamnionitis for the individual choice of management tactics in case of premature rupture of the amniotic membranes, which is especially important in premature pregnancy. [ABSTRACT FROM AUTHOR]