Recent Advances and Challenges in the Early Diagnosis and Treatment of Preterm Labor

Gondane, Prashil; Kumbhakarn, Sakshi; Maity, Pritiprasanna; Kapat, Kausik

doi:10.3390/bioengineering11020161

Bioengineering

2024

DOI: 10.3390/bioengineering11020161

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Recent Advances and Challenges in the Early Diagnosis and Treatment of Preterm Labor

Prashil Gondane,

Sakshi Kumbhakarn,

Pritiprasanna Maity

et al.

Abstract: Preterm birth (PTB) is the primary cause of neonatal mortality and long-term disabilities. The unknown mechanism behind PTB makes diagnosis difficult, yet early detection is necessary for controlling and averting related consequences. The primary focus of this work is to provide an overview of the known risk factors associated with preterm labor and the conventional and advanced procedures for early detection of PTB, including multi-omics and artificial intelligence/machine learning (AI/ML)- based approaches. … Show more

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Role of isoxsuprine in acute and maintenance tocolysis

Mane,

Singh

2024

Int J Reprod Contracept Obstet Gynecol

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Preterm birth (PTB) continues to be a significant global health issue, with India reporting 3.02 million PTBs, accounting for nearly 23% of all PTBs worldwide. Over the past decade, the PTB rate has remained unchanged at 13 per 100 live births. Preterm labor (PTL), a leading cause of pregnancy-related hospitalizations, poses significant challenges for healthcare providers. Effective management is essential to mitigate the complications associated with PTB, which places a considerable burden on the healthcare system. Managing PTL is particularly challenging due to the difficulty in predicting its onset, as approximately 50% of PTB cases occur without identifiable risk factors. The current PTB detection methods, such as the transvaginal ultrasound (TVUS) examination, the fibronectin test, etc., fail to detect PTB accurately, which makes PTB a complicated condition. The primary goal of PTL management is to prolong pregnancy with tocolytics which provides an opportunity to administer antenatal corticosteroids and magnesium sulfate, if needed, as well as in utero transfer to higher care facilities, when necessary. This review delves into recommendation shared by expert gynecologists on the role of effective tocolysis in management of PTL. The experts shared insights that in India, isoxsuprine is preferred over other tocolytic agents in acute PTL management, allowing sufficient time for corticosteroids to act. However, they opined that there is a possibility of spontaneous recurrence of PTL after the cessation of active labour therapy, highlighting the importance of maintenance tocolysis. The use of oral isoxsuprine as maintenance tocolysis has been associated with improved perinatal outcomes, including lesser incidence of NICU admission, improved birth weight outcomes, and extended latency periods. Maintenance tocolysis can be given to patients of cervical cerclage, active and threatened PTL. In conclusion, while PTL remains a significant challenge, isoxsuprine use in both acute and maintenance phases of therapy can positively impact maternal and perinatal outcomes.

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Role of isoxsuprine in acute and maintenance tocolysis

Mane,

Singh

2024

Int J Reprod Contracept Obstet Gynecol

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Cervicovaginal foetal fibronectin in predicting success of induced labour among nulliparous women: a systematic review

Inayat,

Tariq,

Bashir

et al. 2024

Asia Pac J Surg Exp & Pathol

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Background The global rates of labor induction continue to exhibit a surge, attributed to a range of medical, obstetric, and non-medical factors. Although the Bishop score is often used to assess cervical preparation, its ability to accurately predict outcomes, particularly in nulliparous women with an unfavorable cervix, is still unknown. Method A complete review of the literature was undertaken, including PubMed, EMBASE, Cochrane Library, and Google Scholar databases, with the search period extending until April 2023. The studies included in this analysis focused on investigating the predictive value of fFN concerning induced labor outcomes in nulliparous women. The process of data extraction primarily concentrated on the features of the study, interventions, controls, criteria for inclusion and exclusion, and the outcomes that were evaluated. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results The review synthesized findings from five studies, revealing varied predictive values of fFN. Sciscione et al. (2005) reported no significant difference in vaginal delivery rates between positive and negative fFN groups (Positive fFN: 55.8% vs. Negative fFN: 53.3%; P > .70). Uygur et al. (2016) found a higher cesarean section rate in patients with negative fFN results (P = 0.002). Reis et al. (2003) highlighted that higher parity and Bishop scores were more predictive than fFN alone (P = .021 for funneling; P = .157 for fFN presence). Grab et al. (2022) and Khalaf et al. (2023) further corroborated fFN's role in predicting labor outcomes, with the latter study demonstrating high sensitivity (85%), specificity (80%), and accuracy (82.6%) in predicting successful labor induction (P < .05 for Bishop score relation with fFN; P = 0.029 for positive vs. negative fFN). Conclusion This systematic review validated that fFN is a significant biomarker for predicting labor induction outcomes, especially in nulliparous women. The combination of additional clinical factors with fFN has been shown to boost its prediction accuracy, indicating the need for a personalized strategy to labor induction.

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Recent Advances and Challenges in the Early Diagnosis and Treatment of Preterm Labor

Cited by 2 publications

References 144 publications

Role of isoxsuprine in acute and maintenance tocolysis

Role of isoxsuprine in acute and maintenance tocolysis

Cervicovaginal foetal fibronectin in predicting success of induced labour among nulliparous women: a systematic review

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