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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From August 1992 to August 1993 we used the Prematurity Prevention Programme at 50 Pat. (23 + 1 to 34 + 0 pregnancy week) with premature labour or with a premature rupture of membranes. The results tally for the most part with the results in the literature. The combination of a positive bacteriological cut, of a positive identification of fibronectin and of a CRP-value > or = 2.0 mg/dl indicate and advanced degree of symptoms of premature birth through infection. With the examinations of the Prematurity Prevention Programme we have a simple technical and systematic programme for assessment symptoms of premature birth. The clinical use of this programme is a good help at the medical care of high risk patients.
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PMID:[Results and experiences with the premature labor prevention program]. 816 38

Researchers evaluated the comparative effectiveness of measuring fetal fibronectin concentrations in cervical secretions by either a rapid immunoassay or an enzyme-linked immunosorbent assay as a tool for the screening of premature delivery in otherwise asymptomatic pregnant women at high risk for prematurity. Cervical secretion samples from the ectocervix were taken every two weeks between the 24th and the 34th week of pregnancy from 102 pregnant women at high risk for premature delivery. The samples were obtained with two swabs. One sample was used for the immediate-reading membrane test while the other was used for the immunoenzyme test. There was a 37.25% rate of preterm birth. Membrane tests yielded a 73.68% sensitivity and a 92.18% specificity, with a positive predictive value of 84.84% and a negative predictive value of 85.50%. The enzyme-linked immunosorbent assays were 78.94% sensitive and 85.93% specific, with a positive predictive value of 76.92% and a negative predictive value of 87.30%. The two tests were concordant with each other. There was a mean of 2.9 weeks between the last sampling and the occurrence of preterm birth. The rapid result membrane test is comparable to the standard fetal fibronectin enzyme-linked immunosorbent assays for the detection of fetal fibronectin in cervical secretions between the 24th and the 34th weeks of pregnancy.
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PMID:Cervical fetal fibronectin in patients at increased risk for preterm delivery. 869 47

The congenital nephrotic syndrome of the Finnish type (CNF) is a rare autosomal recessive disease with proteinuria starting already in utero, prematurity and nephrotic syndrome developing within the first weeks of life. The basic defect of this disease is unknown but has been suggested to be restricted to the kidney glomeruli and especially to the glomerular basement membrane (GBM). The location of the major matrix components in the glomeruli of CNF patient kidneys has previously been reported. Using indirect immunofluorescence microscopy we here describe the more recently characterized components of the glomerular extracellular matrix, including nidogen, tenascin, vitronectin and chondroitin sulfate proteoglycan in CNF and control kidney glomeruli. The accumulation of tenascin and chondroitin sulfate in the renal interstitium as well as a more granular deposition pattern of vitronectin in the mesangium of CNF glomeruli as compared to the control kidneys were observed. These changes were considered secondary to the massive proteinuria, reflected also by the presence of glomerular sclerosis and interstitial fibrosis in the CNF kidney samples. Additionally, analysis of GBM components by immunoblotting revealed either increased or decreased proportionate amounts of fibronectin and laminin in the GBM of CNF kidneys, respectively. Interestingly, different proportionate amounts of proteolytic fragments of nidogen were found in CNF glomeruli as compared to controls. Equal levels of nidogen mRNA were found in the cortical tissue of CNF and control glomeruli. Since nidogen is crucial for the supramolecular organization of basement membranes, these results suggest that an unusual fragmentation of nidogen, due to abnormal assembly, degradation or reorganization of glomerular extracellular matrix, may be associated with the basic defect of CNF.
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PMID:Noncollagenous matrix components of glomeruli in congenital nephrotic syndrome of the Finnish type: evidence of abnormal splitting of nidogen? 893 84

Current tocolytic protocols rely largely on the use of beta-mimetics to induce myometrial quiescence and delay delivery. Unfortunately, the rapid transplacental passage and poor receptor specificity of the commonly used beta-mimetics results in widespread activation of intrauterine and extrauterine beta 1 and beta 2 receptors. The use of beta-mimetics is associated with a range of well-recognized and potentially dangerous side effects for mother and fetus. The value of continued use of beta-agonists after obtaining uterine quiescence also has been the subject of recent debate. In this article we have attempted to explore the biochemical and molecular rationale for the use of alternative therapeutic modalities in the treatment and prevention of PTL. In the light of the current view that the term "preterm labor" covers a considerable diversity of causes, we propose that a range of treatment regimes should be chosen on the basis of the diagnosis and classification of the patient according to the their particular condition. Although the measurement of several biochemical parameters have been suggested to be of use in predicting PTL, we believe that a panel of diagnostic indicators (e.g., free or total CRH, IL-6, extracellular matrix proteases, fetal fibronectin) is more likely to provide useful diagnostic information on which appropriate treatment modalities can be selected (Table 1). Because of the complex and interactive nature of the mechanisms operating within the intrauterine environment to regulate myometrial activation and uterotonin production, we speculate that a combination of tocolytics, anti-inflammatory agents, uterotonic antagonists, and receptor blockers is likely to be more effective than a monotherapeutic approach, which focuses on only one facet of the process of uterine activation for pharmacologic intervention. For example, the use of antibiotics, PGHS inhibitors, and/or beta-mimetics might be an appropriate first line of treatment for infection-associated PTL in extreme prematurity. If it is successful, this treatment might be followed by longer term use of a progestagen and/or NO donor to maintain myometrial quiescence until closer to term. Alternatively, use of progesterone or oxytocin antagonists may be effective in augmenting the actions of beta-mimetics while reducing their side effects, whereas other combinations may be useful as long-term prophylactics in women with a high risk of developing PTL. Improvements continue in our diagnostic ability to correctly identify the different causes of preterm labor. We anticipate that careful selection of differing combinations of therapeutic options will result in significant reductions in the morbidity, mortality, and healthcare costs associated with preterm birth.
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PMID:The molecular mechanisms of term and preterm labor: recent progress and clinical implications. 932 26

Preterm births account for 5.9% of all deliveries in France, a proportion that has not changed noticeably over the past 30 years. Neither risk scores nor systematic digital vaginal examinations at prenatal consultations have helped to diminish the incidence of prematurity. Because an indispensable prerequisite to reducing this incidence is better identification of the patients at risk, new approaches towards this end have been proposed in recent years. Various studies have shown that fetal fibronectin in cervico-vaginal secretions between 23 and 36 weeks' gestation can be used to identify, among patients with uterine contractions and clinically observable modifications of the cervix, a subgroup of women at very high risk of preterm delivery. Systematic assays for fetal fibronectin among low-risk women are not, however, valuable, because of both the low prevalence of preterm delivery in such a population and the poor positive predictive value. Transvaginal ultrasound of the cervix furnishes an objective and noninvasive method for ascertaining cervical status. Various studies have shown that, among patients presenting signs of preterm labor, the risk of preterm birth is higher when the cervical length, measured with ultrasound, is less than a given cut-off point (the good predictive values of which have been ascertained). Transvaginal ultrasound is also useful among the general population. Measurement of cervical length thus ought to be incorporated into the routine ultrasound performed in this population. Moreover, in addition to cervical shortening, other abnormal ultrasound findings independently associated with an increased risk of preterm delivery include the following: dilatation of the internal os, wedging, funneling (protrusion of amniotic membranes into the cervix), dynamic changes in the degree of dilation of the cervical canal (opening of the internal os or protrusion of membranes) observed, either spontaneously during contractions or after pressure on the fundus. Because fibronectin assays and cervical ultrasound allow patients at risk of true preterm labor to be identified earlier and more accurately, they should improve the chances that tocolytic treatment will succeed. They also ought to reduce the iatrogenic disorders related to prevention of preterm birth (excessive tocolysis and extended hospitalizations) without raising the incidence of such births.
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PMID:[New markers of the risk of preterm delivery]. 991 40

The objective of this article is to correlate a new biochemical method called fetal fibronectin (fFN) found in cervico-vaginal secretions (CVS) in pregnant woman with the presence or not of preterm labor. In this paper the patients studied had pregnancies of 24 up to 37 weeks of pregnancy. The were free of symptoms and without risk factors for preterm labor. The cervico-vaginal specimen was taken with special equipment designed for this purpose (Adeza Biomedical Collection Kit). The laboratory processed this for immunoassay. A positive fFN was considered above 0.05 microgram/dl. There were 263 patients enrolled for this study. Of these 232 had fFN negative (89%) and 31 were positive (12%). The weeks of gestation at birth were 38.6 for the negative group and 34.4 for the positive group (p < 0.0001). Only 5 neonates from the negative group were born before 37 weeks of gestation (2.2%) and in the positive fFN group this occurred in 22 case (71%) (p < 0.0001). The average weight at birth for the negative fibronectin group was 3152 g. for the positive group (p < 0.0001). The neonatal morbidity was more frequent and respiratory distress syndrome was more severe in the positive fibronectin group in comparison with the negative fFN with a significant p. The same tendency was observe with the Apgar score < 7 at 1 and 5 minutes (more frequent in the positive group) (p < 0.0001). The was one neonatal death in the negative group (0.43%) and 5 in the positive group (16%) p = 0.0001. The sensibility and positive predicitive value of positive fFN for the prediction of preterm labor was 81.4 and 71 respectively and the specificity and negative predictive value for negative fFN was 96.1 and 97.8. Finally the RR for prematurity when the fFN was positive on SCV was 32.9. The presence fFN in cervical-vaginal secretion between 24 and 37 weeks of gestation seems to be a good indicator of preterm labor. In this study positive results correlate with less weeks of pregnancy and lees weight at birth. Also with higher with more morbidity and mortality. These findings give the obstetrician a better chance of an opportune diagnosis with adequate treatment and improve perinatal results.
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PMID:[Presence of fetal fibronectin in cervico-vaginal secretion as predictor of premature labor]. 1008 6

Preterm birth is a leading cause of peripheral morbidity and mortality. The national rate of prematurity approaches 11%. In spite of widespread tocolytic use, the preterm birth rate has actually increased over the past 30 years in the United States. Preterm birth appears to have a multifactorial etiology. Leading theories include infectious, inflammatory or ischemic insult to the uteroplacental barrier, activation of the fetal hypothalamic-pituitary pathway, decreased cervical competence, and pathologic uterine distention. Multiple biochemical and biophysical markers have been studied for their potential to correctly identify women at risk of preterm delivery. Of these, fetal fibronectin and endovaginal ultrasound examination of the cervix have proven effective in predicting which symptomatic women are actually at low risk of preterm birth. Salivary estriol is being studied as a marker for preterm labor and delivery and it too will likely be found to be a reliable risk identifier in a high risk population. However, home uterine activity monitoring has not been shown to decrease the frequency of preterm birth or its neonatal complications.
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PMID:Preterm birth risk assessment. 1156 9

Proliferative retinopathies, such as those complicating prematurity and diabetes, are major causes of blindness. A prominent feature of these retinopathies is excessive neovascularization, which is orchestrated by the hypoxia-induced vascular endothelial growth factor (VEGF) stimulating endothelial cells and the integrin-mediated adhesive interactions of endothelial cells with extracellular matrix components such as fibronectin (FN). Recently, we demonstrated that alpha-defensins interfere with alpha5beta1-FN interactions and dependent endothelial cell functions. Here, alpha-defensins were studied in hypoxia-induced proliferative retinopathy. In vitro, alpha-defensins specifically inhibited alpha5beta1-integrin-dependent migration of bovine retinal endothelial cells (BRECs) to FN, attenuated the VEGF-stimulated increase in endothelial permeability, and blocked BREC proliferation and capillary sprout formation in 3-dimensional fibrin-matrices. An up-regulation of beta1-integrin and FN was observed in the retinal vessels in the mouse model of hypoxia-induced retinal angiogenesis. Systemic and local administration of alpha-defensins reduced retinal neovascularization by 45% and 60%, respectively, and this effect was comparable to the inhibitory effect of alpha5beta1-blocking antibody. alpha-Defensins were detected in human diabetic retinas associated with normal retinal vessels but were absent from proliferative lesions. Together, these data show that alpha-defensins inhibit pathologic retinal neovascularization in vivo and may provide a clinically efficient strategy against proliferative retinopathies.
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PMID:Inhibition of pathologic retinal neovascularization by alpha-defensins. 1612 22

Prematurity continues to be the leading cause of neonatal death and developmental disability, highlighting the importance of identifying potential predictors of prematurity as well as interventions that can be linked to the predictors. This review covers recent research on potential psychological, physiological, and biochemical predictors. Among the psychological stressors are depression, anxiety, difficult relationships, and lack of social support. Biochemical predictors include corticotropin-releasing hormone, cortisol, and fetal fibronectin. A program of research that links an intervention for prematurity with a predictor for prematurity, that is, massage therapy to reduce cortisol and, in turn, reduce prematurity, is then presented.
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PMID:Prematurity and potential predictors. 1820 83

Moderate and late preterm births account for the majority of preterm babies. The common perception that birth at 32-36 weeks' gestation carries few risks is now being challenged, as these babies have increased risk of neonatal mortality and morbidity. However, spontaneous labour at this gestation frequently has no specific, easily identifiable precursor, although preterm birth per se has a number of epidemiological and clinical associations. Prediction and prevention of preterm birth is currently largely aimed at identifying women at high risk such as those with previous preterm birth, and targeting intervention at this group. Both cervical length assessment and fibronectin testing permit some modification of the likelihood of preterm birth in this group. Progesterone treatment for the prevention of preterm birth is currently being researched widely, and appears a potentially promising strategy. Babies born at 32-36 weeks' gestation need careful monitoring in labour, with modification of intervention in labour due to their prematurity.
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PMID:Obstetric management of moderate and late preterm labour. 2241 Feb 56


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