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CURRENT ISSUES IN PRETERM BIRTH AND PLACENTAL FUNCTION REGULATION

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Prostaglandins and preterm birth
López Bernal Andrés

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Regulation of placental function by insulin-like growth factor (IGF) and IGF-binding proteins
Iwashita Mitsutoshi

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The management of major forms of placenta percreta
Giles Warwick

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Preterm birth and neuropeptides

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Preterm birth and neuropeptides Torricelli Michela

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SCREENING FOR TWIN-TWIN TRANSFUSION SYNDROME AT 11-14 WEEKS OF PREGNANCY: THE KEY ROLE OF DUCTUS VENOSUS BLOOD FLOW ASSESSMENT.

5) Ultrasound Obstet Gynecol. 2010 Feb;35(2):142-8.

Matias A, Montenegro N, Loureiro T, Cunha M, Duarte S, Freitas D, Severo M.

OBJECTIVES: A discrepancy in crown-rump length (CRL) and/or nuchal translucency thickness (NT) between monochorionic twins has been found to be associated with an increased risk of twin-twin transfusion syndrome (TTTS). As one of the most plausible mechanisms for increased NT is hemodynamic imbalance and cardiac dysfunction, indirectly manifested by abnormal blood flow in the ductus venosus (DV), we aimed to clarify the role of DV blood flow assessment in identifying those monochorionic twins more prone to develop TTTS. METHODS: We present 99 cases of monochorionic diamniotic twin pregnancies in which CRL, NT and DV blood flow were evaluated at 11-14 weeks’ gestation. RESULTS: Discrepant values of CRL were not predictive of TTTS development. Intertwin NT discrepancy >or= 0.6 mm had a sensitivity of 50.0% and a specificity of 92.0%. The presence of at least one abnormal blood flow waveform in the DV was associated with a relative risk for developing TTTS of 11.86 (95% CI, 3.05-57.45), with a sensitivity of 75.0% and a specificity of 92.0%. The combination of abnormal DV blood flow with NT discrepancy >or= 0.6 mm yielded a relative risk for the development of TTTS of 21 (95% CI, 5.47-98.33). CONCLUSIONS: Both intertwin discrepancy in NT and abnormal flow in the DV in monochorionic twins may represent early manifestations of hemodynamic imbalance between donor and recipient. In these pregnancies, in addition to NT measurement at 11-14 weeks, the Doppler assessment of DV blood flow significantly increases the performance of screening for those at risk of developing TTTS.

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TRANSVAGINAL CERVICAL LENGTH MEASUREMENT FOR PREDICTION OF PRETERM BIRTH IN WOMEN WITH THREATENED PRETERM LABOR: A META-ANALYSIS.

1) Ultrasound Obstet Gynecol. 2010 Jan;35(1):54-64.

Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G.

OBJECTIVES: To integrate data on the performance of cervical length measurement for the prediction of preterm birth in symptomatic women.

METHODS: MEDLINE, SCOPUS and manual searches for studies with transvaginal ultrasound measurement of the cervical length in symptomatic women were carried out. Random effects models were used for data integration, and pooled test estimates of sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) were calculated along with their 95% CIs.

RESULTS: Twenty-eight studies fulfilled the selection criteria. For birth within 1 week from presentation, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 59.9% (95% CI, 52.7-66.8%), 90.5% (95% CI, 89.0-91.9%), 5.71 (95% CI, 3.77-8.65) and 0.51 (95% CI, 0.33-0.80), respectively. The same estimates for studies with presentation at or before 34 + 0 weeks were 71.0% (95% CI, 60.6-79.9%), 89.8% (95% CI, 87.4-91.9%), 5.19 (95% CI, 2.29-11.74) and 0.38 (95% CI, 0.11-1.34), respectively. For prediction of birth before 34 weeks, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 46.2% (95% CI, 34.8-57.8%), 93.7% (95% CI, 90.7-96.0%), 4.31 (95% CI, 2.73-6.82) and 0.63 (95% CI, 0.38-1.04), respectively. There was considerable heterogeneity across studies in most estimates.

CONCLUSIONS: Measurement of cervical length in symptomatic women can detect a significant proportion of those who will deliver within 1 week and help to rationalize their management. The considerable heterogeneity across studies may be indicative of methodological flaws, which either were not reported at all or were under-reported.

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PRETERM DELIVERY AND RISK OF SUBSEQUENT CARDIOVASCULAR MORBIDITY AND TYPE-II DIABETES IN THE MOTHER.

3) BJOG. 2009 Dec 10.

Lykke JA, Paidas MJ, Damm P, Triche EW, Kuczynski E, Langhoff-Roos J.

Objective Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated.

Design National registry-based retrospective cohort study.

Setting Women delivering in Denmark from 1978 to 2007. Population Women with a first singleton delivery (n = 782 287), and with a first and second singleton delivery (n = 536 419).

Methods Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth.

Main outcome measures Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes.

Results After a first delivery at 32-36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69-2.10) and the risk of thromboembolism increased 1.42-fold (1.24-1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34-1.86) increased risk of type-II diabetes and a 1.18-fold (0.96-1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71-3.10) increased risk of type-II diabetes and a 1.80-fold (1.29-2.50) increased risk of thromboembolism.

Conclusions Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks.

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