Preventing preterm birth

Article Abstract:

Premature birth accounts for an increasing share of mortality in newborns as other causes of death decline. One-fourth of preterm births occur because of threats to the mother or fetus, and these cases are very different from spontaneous preterm labor or rupture of the membranes. For a time, beta blockers seemed to be effective in delaying labor in spontaneous premature labor, but they were shown to have no effect on mortality or serious complications associated with prematurity. The dilemma facing clinicians is diagnosing and treating women at risk for premature labor, while at the same time, avoiding the administration of potentially dangerous drugs to women who do not need them. There are no reliable preventive measures, and even the common approach of bed rest in pregnancies with twins has been found to be of little value. Charles J. Lockwood and his colleagues, in an article in the September 5, 1991 issue of The New England Journal of Medicine, reported that fetal fibronectin (proteins found in amniotic fluid and fetal tissues) can be used to identify women at high risk for premature labor. The issue of prediction in the presence of ruptured membranes, or suspected ruptured membranes, is difficult because 94 percent of these women tested positive, but once the membranes have ruptured, labor is usually not intentionally delayed. In any case, a woman with ruptured membranes and contractions will rarely reach full term no matter what treatment is tried. A more specific marker for diagnosing ruptured membranes will be needed in these cases. The value of fetal fibronectin as a predictor of preterm labor remains to be established. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery

Article Abstract:

Although premature birth is the primary cause of death among newborn infants, no specific, objective test to identify women at increased risk of delivering before term is available. In addition, treatment is often begun too late, and there is no reliable way to distinguish between normal contractions that occur in late pregnancy and actual premature labor. Fibronectins, proteins found in amniotic fluid and placental tissue, may indicate damage to fetal membranes if found in the cervix and vagina in the second or third trimester, and may be an indication that labor is imminent. Sixty-five women whose membranes (''bag of waters'') had ruptured prematurely and 117 women with preterm contractions and intact membranes entered the study and were compared with 163 pregnant women without complications. As expected, fetal fibronectin was found in patients whose membranes had ruptured, because high levels of the protein are found in amniotic fluid and would be present in the samples. Among patients with contractions and intact membranes, fetal fibronectin did distinguish between those with irrelevant contractions and those who were at risk for premature labor. The means by which fetal fibronectin can reach the cervix and vagina are discussed, and it is suggested that it be used as a marker for labor, whether premature or not. The results demonstrate that fetal fibronectin can be used to distinguish between women with symptoms of premature labor who will actually go on to deliver prematurely and those who will not. However, identification of these patients will not necessarily lead to better outcomes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infants (Newborn), Newborn infants

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Pregnancy loss in the antiphospholipid-antibody syndrome - a possible thrombogenic mechanism

Article Abstract:

Antiphospholipid antibodies appear to reduce levels of a natural anticoagulant called annexin V. This could explain why women with these antibodies have blood clotting disorders and recurrent miscarriages. Researchers took blood samples from three patients with antiphospholipid antibodies and isolated the antibodies. The antibodies were cultured with placental trophoblast cells and umbilical vein cells. Cells exposed to the antibodies had lower annexin V levels and blood in the cell cultures clotted much faster compared to cells exposed to normal plasma.

Measurement, Antiphospholipid syndrome, Antiphospholipid antibodies, Circulating anticoagulants

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