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Hubertina C J Scheepers - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of a cervical pessary for women who did not deliver 48 h after threatened preterm Labor assessment of perinatal outcome after specific treatment in Early Labor apostel vi trial
    BMC Pregnancy and Childbirth, 2016
    Co-Authors: Frederik J R Hermans, Martijn A Oudijk, Caroline J Bax, Ewoud Schuit, Brent C Opmeer, Mireille N Bekker, Mallory Woiski, Marieke Sueters, Hubertina C J Scheepers
    Abstract:

    Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm Labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm Labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women. Currently no effective treatment is available. Studies on maintenance tocolysis and progesterone have shown ambiguous results. The pessary has not been evaluated in women with threatened preterm Labor, however studies in asymptomatic women with a short cervix show reduced rates of preterm birth rates as well as perinatal complications. The APOSTEL VI trial aims to assess the effectiveness of a cervical pessary in women who did not deliver within 48 h after an episode of threatened preterm Labor. This is a nationwide multicenter open-label randomized clinical trial. Women with a singleton or twin gestation with intact membranes, who were admitted for threatened preterm Labor, at a gestational age between 24 and 34 weeks, a cervical length between 15 and 30 mm and a positive fibronectin test or a cervical length below 15 mm, who did not deliver after 48 h will be eligible for inclusion. Women will be allocated to a pessary or no intervention (usual care). Primary outcome is preterm delivery < 37 weeks. Secondary outcomes are amongst others a composite of perinatal morbidity and mortality. Sample size is based on an expected 50 % reduction of preterm birth before 37 weeks (two-sided test, α 0.05 and β 0.2). Two hundred women with a singleton pregnancy need to be randomized. Analysis will be done by intention to treat. The APOSTEL VI trial will provide evidence whether a pessary is effective in preventing preterm birth in women who did not deliver 48 h after admission for threatened preterm Labor and who remain at high risk for preterm birth. Trial is registered at the Dutch Trial Register: http://www.trialregister.nl , NTR4210, date of registration: October 16th 2013.

  • Effectiveness of a cervical pessary for women who did not deliver 48 h after threatened preterm Labor (Assessment of perinatal outcome after specific treatment in Early Labor: Apostel VI trial)
    BMC Pregnancy and Childbirth, 2016
    Co-Authors: Frederik J R Hermans, Martijn A Oudijk, Hubertina C J Scheepers, Ewoud Schuit, Brent C Opmeer, Mallory Woiski, Marieke Sueters, Mireille Bekker, Maureen T. M. Franssen, Eva Pajkrt
    Abstract:

    Background Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm Labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm Labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women. Currently no effective treatment is available. Studies on maintenance tocolysis and progesterone have shown ambiguous results. The pessary has not been evaluated in women with threatened preterm Labor, however studies in asymptomatic women with a short cervix show reduced rates of preterm birth rates as well as perinatal complications. The APOSTEL VI trial aims to assess the effectiveness of a cervical pessary in women who did not deliver within 48 h after an episode of threatened preterm Labor. Methods/Design This is a nationwide multicenter open-label randomized clinical trial. Women with a singleton or twin gestation with intact membranes, who were admitted for threatened preterm Labor, at a gestational age between 24 and 34 weeks, a cervical length between 15 and 30 mm and a positive fibronectin test or a cervical length below 15 mm, who did not deliver after 48 h will be eligible for inclusion. Women will be allocated to a pessary or no intervention (usual care). Primary outcome is preterm delivery 

  • 88 nifedipine versus placebo in the treatment of preterm premature rupture of membranes assessment of perinatal outcome by use of tocolysis in Early Labor apostel iv study
    American Journal of Obstetrics and Gynecology, 2016
    Co-Authors: Martijn A Oudijk, Kitty W M Bloemenkamp, Tobias A J Nijman, Elvira O G Van Vliet, Katrien Oude Rengerink, Thomas S De Lange, Caroline J Bax, Jim Van Eyck, Marjolein Kok, Hubertina C J Scheepers
    Abstract:

    36th Annual Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting 01 February 2016 - 06 February 2016

  • cost effectiveness of fibronectin testing in a triage in women with threatened preterm Labor alleviation of pregnancy outcome by suspending tocolysis in Early Labor apostel i trial
    BMC Pregnancy and Childbirth, 2009
    Co-Authors: Jolande Y Vis, Femke F Wilms, Martijn A Oudijk, Martina Porath, Hubertina C J Scheepers, Kitty W M Bloemenkamp, A C Bolte, Jerome Cornette, Jan B Derks, Johannes J Duvekot
    Abstract:

    Background At present, women with threatened preterm Labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm Labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective.

  • Cost-effectiveness of fibronectin testing in a triage in women with threatened preterm Labor: alleviation of pregnancy outcome by suspending tocolysis in Early Labor (APOSTEL-I trial)
    BMC Pregnancy and Childbirth, 2009
    Co-Authors: Femke F Wilms, Martijn A Oudijk, Martina Porath, Hubertina C J Scheepers, Kitty W M Bloemenkamp, A C Bolte, Jerome Cornette, Jan B Derks, Johannes J Duvekot, Jim Van Eyck
    Abstract:

    Background At present, women with threatened preterm Labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm Labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective. Methods/Design We will investigate a prospective cohort of women referred to a perinatal centre for spontaneous threatened preterm Labor between 24 and 34 weeks with intact membranes. All women will be tested for fibronectin and cervical length. Women with a cervical length 30 mm will be managed according to local protocol. Corticosteroids may be given to all women at the discretion of the attending physician. Primary outcome measure will be delivery within 7 days. Secondary outcome measures will be neonatal morbidity and mortality, complications of tocolytics, costs and health related quality of life. The analysis will be according to the intention to treat principle. We anticipate the probability on preterm birth within 7 days in the group of women with a negative fibronectine test to be 5%. Two groups of 110 women will be needed to assure that in case of non-inferiority the difference in the proportion of preterm deliveries < 7 days will be within a prespecified boundary of 7.5% (one sided test, β 0.2, α 0.05). Data obtained from women with a positive and negative fibronectin tests in both the cohort study and the trial will be integrated in a cost-effectiveness analysis that will assess economic consequences of the use of fibronectin. Discussion This study will provide evidence for the use of fibronectin testing as safe and cost-effective method in a triage for threatened preterm Labor. Trial registration Nederlands Trial Register (NTR) number 1857, http://www.trialregister.nl .

Martijn A Oudijk - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of a cervical pessary for women who did not deliver 48 h after threatened preterm Labor assessment of perinatal outcome after specific treatment in Early Labor apostel vi trial
    BMC Pregnancy and Childbirth, 2016
    Co-Authors: Frederik J R Hermans, Martijn A Oudijk, Caroline J Bax, Ewoud Schuit, Brent C Opmeer, Mireille N Bekker, Mallory Woiski, Marieke Sueters, Hubertina C J Scheepers
    Abstract:

    Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm Labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm Labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women. Currently no effective treatment is available. Studies on maintenance tocolysis and progesterone have shown ambiguous results. The pessary has not been evaluated in women with threatened preterm Labor, however studies in asymptomatic women with a short cervix show reduced rates of preterm birth rates as well as perinatal complications. The APOSTEL VI trial aims to assess the effectiveness of a cervical pessary in women who did not deliver within 48 h after an episode of threatened preterm Labor. This is a nationwide multicenter open-label randomized clinical trial. Women with a singleton or twin gestation with intact membranes, who were admitted for threatened preterm Labor, at a gestational age between 24 and 34 weeks, a cervical length between 15 and 30 mm and a positive fibronectin test or a cervical length below 15 mm, who did not deliver after 48 h will be eligible for inclusion. Women will be allocated to a pessary or no intervention (usual care). Primary outcome is preterm delivery < 37 weeks. Secondary outcomes are amongst others a composite of perinatal morbidity and mortality. Sample size is based on an expected 50 % reduction of preterm birth before 37 weeks (two-sided test, α 0.05 and β 0.2). Two hundred women with a singleton pregnancy need to be randomized. Analysis will be done by intention to treat. The APOSTEL VI trial will provide evidence whether a pessary is effective in preventing preterm birth in women who did not deliver 48 h after admission for threatened preterm Labor and who remain at high risk for preterm birth. Trial is registered at the Dutch Trial Register: http://www.trialregister.nl , NTR4210, date of registration: October 16th 2013.

  • Effectiveness of a cervical pessary for women who did not deliver 48 h after threatened preterm Labor (Assessment of perinatal outcome after specific treatment in Early Labor: Apostel VI trial)
    BMC Pregnancy and Childbirth, 2016
    Co-Authors: Frederik J R Hermans, Martijn A Oudijk, Hubertina C J Scheepers, Ewoud Schuit, Brent C Opmeer, Mallory Woiski, Marieke Sueters, Mireille Bekker, Maureen T. M. Franssen, Eva Pajkrt
    Abstract:

    Background Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm Labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm Labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women. Currently no effective treatment is available. Studies on maintenance tocolysis and progesterone have shown ambiguous results. The pessary has not been evaluated in women with threatened preterm Labor, however studies in asymptomatic women with a short cervix show reduced rates of preterm birth rates as well as perinatal complications. The APOSTEL VI trial aims to assess the effectiveness of a cervical pessary in women who did not deliver within 48 h after an episode of threatened preterm Labor. Methods/Design This is a nationwide multicenter open-label randomized clinical trial. Women with a singleton or twin gestation with intact membranes, who were admitted for threatened preterm Labor, at a gestational age between 24 and 34 weeks, a cervical length between 15 and 30 mm and a positive fibronectin test or a cervical length below 15 mm, who did not deliver after 48 h will be eligible for inclusion. Women will be allocated to a pessary or no intervention (usual care). Primary outcome is preterm delivery 

  • 88 nifedipine versus placebo in the treatment of preterm premature rupture of membranes assessment of perinatal outcome by use of tocolysis in Early Labor apostel iv study
    American Journal of Obstetrics and Gynecology, 2016
    Co-Authors: Martijn A Oudijk, Kitty W M Bloemenkamp, Tobias A J Nijman, Elvira O G Van Vliet, Katrien Oude Rengerink, Thomas S De Lange, Caroline J Bax, Jim Van Eyck, Marjolein Kok, Hubertina C J Scheepers
    Abstract:

    36th Annual Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting 01 February 2016 - 06 February 2016

  • cost effectiveness of fibronectin testing in a triage in women with threatened preterm Labor alleviation of pregnancy outcome by suspending tocolysis in Early Labor apostel i trial
    BMC Pregnancy and Childbirth, 2009
    Co-Authors: Jolande Y Vis, Femke F Wilms, Martijn A Oudijk, Martina Porath, Hubertina C J Scheepers, Kitty W M Bloemenkamp, A C Bolte, Jerome Cornette, Jan B Derks, Johannes J Duvekot
    Abstract:

    Background At present, women with threatened preterm Labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm Labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective.

  • Cost-effectiveness of fibronectin testing in a triage in women with threatened preterm Labor: alleviation of pregnancy outcome by suspending tocolysis in Early Labor (APOSTEL-I trial)
    BMC Pregnancy and Childbirth, 2009
    Co-Authors: Femke F Wilms, Martijn A Oudijk, Martina Porath, Hubertina C J Scheepers, Kitty W M Bloemenkamp, A C Bolte, Jerome Cornette, Jan B Derks, Johannes J Duvekot, Jim Van Eyck
    Abstract:

    Background At present, women with threatened preterm Labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm Labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective. Methods/Design We will investigate a prospective cohort of women referred to a perinatal centre for spontaneous threatened preterm Labor between 24 and 34 weeks with intact membranes. All women will be tested for fibronectin and cervical length. Women with a cervical length 30 mm will be managed according to local protocol. Corticosteroids may be given to all women at the discretion of the attending physician. Primary outcome measure will be delivery within 7 days. Secondary outcome measures will be neonatal morbidity and mortality, complications of tocolytics, costs and health related quality of life. The analysis will be according to the intention to treat principle. We anticipate the probability on preterm birth within 7 days in the group of women with a negative fibronectine test to be 5%. Two groups of 110 women will be needed to assure that in case of non-inferiority the difference in the proportion of preterm deliveries < 7 days will be within a prespecified boundary of 7.5% (one sided test, β 0.2, α 0.05). Data obtained from women with a positive and negative fibronectin tests in both the cohort study and the trial will be integrated in a cost-effectiveness analysis that will assess economic consequences of the use of fibronectin. Discussion This study will provide evidence for the use of fibronectin testing as safe and cost-effective method in a triage for threatened preterm Labor. Trial registration Nederlands Trial Register (NTR) number 1857, http://www.trialregister.nl .

Kitty W M Bloemenkamp - One of the best experts on this subject based on the ideXlab platform.

  • nifedipine versus placebo in the treatment of preterm preLabor rupture of membranes a randomized controlled trial assessment of perinatal outcome by use of tocolysis in Early Labor apostel iv trial
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
    Co-Authors: Tobias A J Nijman, Kitty W M Bloemenkamp, Elvira O G Van Vliet, Katrien Oude Rengerink, Thomas S De Lange, Caroline J Bax, Jim Van Eyck, Christiana A Naaktgeboren, Marjolein Kok
    Abstract:

    OBJECTIVE: Preterm birth is the most common cause of neonatal morbidity and mortality. Around one third of preterm deliveries starts with preterm preLabor rupture of membranes (PPROM). The aim of this trial was to study the effect of prolonged tocolysis with nifedipine versus placebo in women with PPROM on perinatal outcome and prolongation of pregnancy. STUDY DESIGN: The Apostel IV was a nationwide multicenter randomized placebo controlled trial. We included women with PPROM without contractions between 24(+0) and 33(+6) weeks of gestation. Participants were randomly allocated to daily 80mg nifedipine or placebo, until the start of Labor, with a maximum of 18 days. The primary outcome measure was a composite of poor neonatal outcome, including perinatal death, bronchopulmonary dysplasia, periventricular leukomalacia>grade 1, intraventricular hemorrhage>grade 2, necrotizing enterocolitis>stage 1 and culture proven sepsis. Secondary outcomes were gestational age at delivery and prolongation of pregnancy. Analysis was by intention to treat. To detect a reduction of poor neonatal outcome from 30% to 10%, 120 women needed to be randomized. TRIAL REGISTRY: NTR 3363. RESULTS: Between October 2012 and December 2014 we randomized 25 women to nifedipine and 25 women to placebo. Due to slow recruitment the study was stopped prematurely. The median gestational age at randomization was 29.9 weeks (IQR 27.7-31.3) in the nifedipine group and 27.0 weeks (IQR 24.7-29.9) in the placebo group. Other baseline characteristics were comparable. The adverse perinatal outcome occurred in 9 neonates (33.3%) in the nifedipine group and 9 neonates (32.1%) in the placebo group (RR 1.04, 95% CI 0.49-2.2). Two perinatal deaths occurred, both in the nifedipine group. Bronchopulmonary dysplasia was seen less frequently in the nifedipine group (0% versus 17.9%; p=0.03). Prolongation of pregnancy did not differ between the nifedipine and placebo group (median 11 versus 8 days, HR 1.02; 95% CI 0.58-1.79). CONCLUSION: This randomized trial did not show a beneficial effect of prolonged tocolysis on neonatal outcomes or prolongation of pregnancy in women with PPROM without contractions. However, since results are based on a small sample size, a difference in effectiveness cannot be excluded.

  • 88 nifedipine versus placebo in the treatment of preterm premature rupture of membranes assessment of perinatal outcome by use of tocolysis in Early Labor apostel iv study
    American Journal of Obstetrics and Gynecology, 2016
    Co-Authors: Martijn A Oudijk, Kitty W M Bloemenkamp, Tobias A J Nijman, Elvira O G Van Vliet, Katrien Oude Rengerink, Thomas S De Lange, Caroline J Bax, Jim Van Eyck, Marjolein Kok, Hubertina C J Scheepers
    Abstract:

    36th Annual Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting 01 February 2016 - 06 February 2016

  • cost effectiveness of fibronectin testing in a triage in women with threatened preterm Labor alleviation of pregnancy outcome by suspending tocolysis in Early Labor apostel i trial
    BMC Pregnancy and Childbirth, 2009
    Co-Authors: Jolande Y Vis, Femke F Wilms, Martijn A Oudijk, Martina Porath, Hubertina C J Scheepers, Kitty W M Bloemenkamp, A C Bolte, Jerome Cornette, Jan B Derks, Johannes J Duvekot
    Abstract:

    Background At present, women with threatened preterm Labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm Labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective.

  • Cost-effectiveness of fibronectin testing in a triage in women with threatened preterm Labor: alleviation of pregnancy outcome by suspending tocolysis in Early Labor (APOSTEL-I trial)
    BMC Pregnancy and Childbirth, 2009
    Co-Authors: Femke F Wilms, Martijn A Oudijk, Martina Porath, Hubertina C J Scheepers, Kitty W M Bloemenkamp, A C Bolte, Jerome Cornette, Jan B Derks, Johannes J Duvekot, Jim Van Eyck
    Abstract:

    Background At present, women with threatened preterm Labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm Labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective. Methods/Design We will investigate a prospective cohort of women referred to a perinatal centre for spontaneous threatened preterm Labor between 24 and 34 weeks with intact membranes. All women will be tested for fibronectin and cervical length. Women with a cervical length 30 mm will be managed according to local protocol. Corticosteroids may be given to all women at the discretion of the attending physician. Primary outcome measure will be delivery within 7 days. Secondary outcome measures will be neonatal morbidity and mortality, complications of tocolytics, costs and health related quality of life. The analysis will be according to the intention to treat principle. We anticipate the probability on preterm birth within 7 days in the group of women with a negative fibronectine test to be 5%. Two groups of 110 women will be needed to assure that in case of non-inferiority the difference in the proportion of preterm deliveries < 7 days will be within a prespecified boundary of 7.5% (one sided test, β 0.2, α 0.05). Data obtained from women with a positive and negative fibronectin tests in both the cohort study and the trial will be integrated in a cost-effectiveness analysis that will assess economic consequences of the use of fibronectin. Discussion This study will provide evidence for the use of fibronectin testing as safe and cost-effective method in a triage for threatened preterm Labor. Trial registration Nederlands Trial Register (NTR) number 1857, http://www.trialregister.nl .

Eric Maurin - One of the best experts on this subject based on the ideXlab platform.

  • demand for education and Labor market outcomes lessons from the abolition of compulsory conscription in france
    Journal of Human Resources, 2007
    Co-Authors: Eric Maurin, Theodora Xenogiani
    Abstract:

    Before 1997, education was a way for young French men to avoid military service in the army. After the abolition of compulsory conscription in 1997, this incentive to stay on in education disappeared. We show that the decrease in the benefit of pursuing education for men was followed by a fall in their educational achievement relative to women and by a decrease in their relative entry wages. These results suggest that high school dropout rates could be reduced by policies increasing the immediate benefits of pursuing education and that it would yield a substantial improvement in Early Labor market outcomes.

M D Mitchell - One of the best experts on this subject based on the ideXlab platform.

  • The relationship between spontaneous rupture of membranes, Labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of prostaglandins and thromboxane B2 in term pregnancy.
    American journal of obstetrics and gynecology, 1993
    Co-Authors: R Romero, P Baumann, R Gomez, C Salafia, L Rittenhouse, D Barberio, E Behnke, D B Cotton, M D Mitchell
    Abstract:

    The purpose of this study was to examine the relationship between rupture of membranes, Labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of eicosanoids in patients with spontaneous rupture of membranes at term. Amniotic fluid was retrieved by transabdominal amniocentesis from patients with rupture of membranes and patients with intact membranes at term. Studies to determine the microbial state of the amniotic cavity included culture for bacteria and mycoplasmas, Gram stain, amniotic fluid white blood cell count, and Limulus amebocyte lysate. Eicosanoids (prostaglandin E2, prostaglandin F2 alpha and its stable metabolite, 6-keto-prostaglandin F1 alpha, and thromboxane B2) were determined with sensitive and specific radioimmunoassays validated for human amniotic fluid. Statistical inference was conducted with analysis of variance and linear contrast. (1) Spontaneous rupture of membranes at term was associated with a significant increase in amniotic fluid concentrations of all eicosanoids measured in this study except 6-keto-prostaglandin F1 alpha. (2) Early Labor in patients with rupture of membranes was associated with a significant increase in the amniotic fluid concentration of all eicosanoids. (3) A significant increase in amniotic fluid eicosanoids in women with microbial invasion of the amniotic cavity could not be documented. Whereas preterm Labor in the absence of microbial invasion of the amniotic cavity is not associated with a significant increase in amniotic fluid concentrations of prostaglandins, a clear increase was documented in women with Early Labor after spontaneous rupture of membranes. These observations suggest that there are fundamental differences in the biochemistry of term and preterm parturition.

  • The relationship between spontaneous rupture of membranes, Labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of prostaglandins and thromboxane B2 in term pregnancy.
    American Journal of Obstetrics and Gynecology, 1993
    Co-Authors: R Romero, P Baumann, R Gomez, C Salafia, L Rittenhouse, D Barberio, E Behnke, D B Cotton, M D Mitchell
    Abstract:

    Objective: The purpose of this study was to examine the relationship between rupture of membranes, Labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of eicosanoids in patients with spontaneous rupture of membranes at term. Study Design: Amniotic fluid was retrieved by transabdominal amniocentesis from patients with rupture of membranes and patients with intact membranes at term. Studies to determine the microbial state of the amniotic cavity included culture for bacteria and mycoplasmas, Gram stain, amniotic fluid white blood cell count, and Limulus amebocyte lysate. Eicosanoids (prostaglandin E 2 , prostaglandin F 2α and its stable metabolite, 6-keto-prostaglandin F 1α , and thromboxane B 2 ) were determined with sensitive and specific radioimmunoassays validated for human amniotic fluid. Statistical inference was conducted with analysis of variance and linear contrast. Results: (1) Spontaneous rupture of membranes at term was associated with a significant increase in amniotic fluid concentrations of all eicosanoids measured in this study except 6-keto-prostaglandin F 2α (2) Early Labor in patients with rupture of membranes was associated with a significant increase in the amniotic fluid concentration of all eicosanoids. (3) A significant increase in amniotic fluid eicosanoids in women with microbial invasion of the amniotic cavity could not be documented. Conclusions: Whereas preterm Labor in the absence of microbial invasion of the amniotic cavity is not associated with a significant increase in amniotic fluid concentrations of prostaglandins, a clear increase was documented in women with Early Labor after spontaneous rupture of membranes. These observations suggest that there are fundamental differences in the biochemistry of term and preterm parturition.