This study aimed to assess the accuracy of combined maternal serum interleukin-8 and salivary estriol levels in predicting preterm labor in Egyptian pregnant females. The study found that maternal serum interleukin-8 alone had the highest accuracy at a cut-off of 965 pg/ml, with an overall accuracy of 79%, sensitivity of 92.5%, and specificity of 42.5%. Combined interleukin-8 and estriol had an overall accuracy of 68% and salivary estriol alone had an accuracy of 58%. The study concluded that maternal serum interleukin-8 is a more accurate, effective, and relatively non-invasive strategy for predicting preterm labor compared to salivary estriol alone.
1. The document discusses fertility options for women over age 40, what is realistic and not realistic. It provides data from studies on cumulative pregnancy rates, live birth rates, and ovarian response by age.
2. Case studies are presented of women over 40 seeking fertility treatment. For each case, the document recommends counseling and treatment strategies based on the woman's age, ovarian reserve tests, and previous response to treatment. These include tailored stimulation protocols, considering egg donation, or managing expectations.
3. Future potential strategies are discussed, such as accumulating vitrified eggs over time, using androgens or growth hormone to improve response, new stimulation protocols, and alternative sources of eggs if a woman's own eggs are not viable options
- Women with bacterial vaginosis (BV) and abnormal vaginal flora are at higher risk of preterm delivery and late miscarriage. Probiotics containing Lactobacillus species have been shown to reduce the risk of recurrent BV and preterm birth by restoring the normal vaginal microbiome.
- Children born preterm face increased risks of mortality and health and developmental problems. Supplementation of probiotics to pregnant mothers has been associated with reduced risks of preterm birth, preeclampsia, and atopic diseases in infants.
- Studies indicate probiotic intake during pregnancy, especially late pregnancy, can help reduce the incidence of preterm birth and pregnancy complications like preeclampsia.
1) In vitro fertilisation (IVF) is a technique where eggs are fertilised by sperm outside the body in a laboratory. Since the first successful IVF in 1978, millions of babies have been born through IVF worldwide.
2) Advances in IVF include techniques like gamete intrafallopian transfer and polar body diagnosis. Researchers are also exploring in vitro gametogenesis to produce gametes from stem cells for infertility treatment or same-sex couples.
3) While IVF has helped many couples conceive, it also carries risks like multiple births, preterm delivery, and ovarian hyperstimulation syndrome. Success rates have improved over time but depend on factors like a woman's age and the clinic's
1. The document discusses fertility options for women over age 40, outlining what is realistic and not realistic based on medical literature.
2. It reviews factors that affect fertility for older women like ovarian reserve tests, response to ovarian stimulation, embryo quality, and success rates for IVF and cumulative live births from multiple cycles.
3. Options discussed include tailored stimulation protocols, embryo testing, oocyte accumulation, ovarian rejuvenation therapies, and even oocyte donation when a woman's own eggs may not lead to success.
Unexplained infertility refers to the inability to conceive after one year despite routine investigations showing no abnormalities. While the causes are uncertain, treatments aim to increase monthly pregnancy rates and include expectant management, clomiphene citrate, gonadotropins, IUI, IVF, and lifestyle changes. Couples with unexplained infertility have higher risks of obstetric complications and should follow a progressive treatment plan based on factors like duration of infertility and age.
The document discusses unexplained infertility, providing definitions and discussing prevalence, causes, diagnosis, and treatment options. It notes that unexplained infertility affects 10-20% of couples and can cause psychological distress. Potential causes are discussed but many are uncertain and found in fertile couples. Diagnosis involves ruling out known causes through standard investigations. Treatment aims to increase monthly pregnancy rates and options discussed include expectant management, ovulation induction, IUI, IVF, and alternative therapies like letrozole, with success rates provided for each option.
This document discusses the use of letrozole for fertility treatments. It begins with an introduction and outline on polycystic ovary syndrome (PCOS), unexplained infertility, fertility preservation for breast cancer patients, frozen embryo transfer, and decreasing ovarian hyperstimulation syndrome (OHSS). It then goes into more detail on each topic, providing evidence from randomized controlled trials, meta-analyses, and clinical guidelines that letrozole results in higher pregnancy and live birth rates compared to clomiphene citrate for PCOS and unexplained infertility. It also discusses how letrozole can be used during fertility preservation for breast cancer patients to prevent high estrogen levels. The document concludes by stating letrozole may
1. The document discusses fertility options for women over age 40, what is realistic and not realistic. It provides data from studies on cumulative pregnancy rates, live birth rates, and ovarian response by age.
2. Case studies are presented of women over 40 seeking fertility treatment. For each case, the document recommends counseling and treatment strategies based on the woman's age, ovarian reserve tests, and previous response to treatment. These include tailored stimulation protocols, considering egg donation, or managing expectations.
3. Future potential strategies are discussed, such as accumulating vitrified eggs over time, using androgens or growth hormone to improve response, new stimulation protocols, and alternative sources of eggs if a woman's own eggs are not viable options
- Women with bacterial vaginosis (BV) and abnormal vaginal flora are at higher risk of preterm delivery and late miscarriage. Probiotics containing Lactobacillus species have been shown to reduce the risk of recurrent BV and preterm birth by restoring the normal vaginal microbiome.
- Children born preterm face increased risks of mortality and health and developmental problems. Supplementation of probiotics to pregnant mothers has been associated with reduced risks of preterm birth, preeclampsia, and atopic diseases in infants.
- Studies indicate probiotic intake during pregnancy, especially late pregnancy, can help reduce the incidence of preterm birth and pregnancy complications like preeclampsia.
1) In vitro fertilisation (IVF) is a technique where eggs are fertilised by sperm outside the body in a laboratory. Since the first successful IVF in 1978, millions of babies have been born through IVF worldwide.
2) Advances in IVF include techniques like gamete intrafallopian transfer and polar body diagnosis. Researchers are also exploring in vitro gametogenesis to produce gametes from stem cells for infertility treatment or same-sex couples.
3) While IVF has helped many couples conceive, it also carries risks like multiple births, preterm delivery, and ovarian hyperstimulation syndrome. Success rates have improved over time but depend on factors like a woman's age and the clinic's
1. The document discusses fertility options for women over age 40, outlining what is realistic and not realistic based on medical literature.
2. It reviews factors that affect fertility for older women like ovarian reserve tests, response to ovarian stimulation, embryo quality, and success rates for IVF and cumulative live births from multiple cycles.
3. Options discussed include tailored stimulation protocols, embryo testing, oocyte accumulation, ovarian rejuvenation therapies, and even oocyte donation when a woman's own eggs may not lead to success.
Unexplained infertility refers to the inability to conceive after one year despite routine investigations showing no abnormalities. While the causes are uncertain, treatments aim to increase monthly pregnancy rates and include expectant management, clomiphene citrate, gonadotropins, IUI, IVF, and lifestyle changes. Couples with unexplained infertility have higher risks of obstetric complications and should follow a progressive treatment plan based on factors like duration of infertility and age.
The document discusses unexplained infertility, providing definitions and discussing prevalence, causes, diagnosis, and treatment options. It notes that unexplained infertility affects 10-20% of couples and can cause psychological distress. Potential causes are discussed but many are uncertain and found in fertile couples. Diagnosis involves ruling out known causes through standard investigations. Treatment aims to increase monthly pregnancy rates and options discussed include expectant management, ovulation induction, IUI, IVF, and alternative therapies like letrozole, with success rates provided for each option.
This document discusses the use of letrozole for fertility treatments. It begins with an introduction and outline on polycystic ovary syndrome (PCOS), unexplained infertility, fertility preservation for breast cancer patients, frozen embryo transfer, and decreasing ovarian hyperstimulation syndrome (OHSS). It then goes into more detail on each topic, providing evidence from randomized controlled trials, meta-analyses, and clinical guidelines that letrozole results in higher pregnancy and live birth rates compared to clomiphene citrate for PCOS and unexplained infertility. It also discusses how letrozole can be used during fertility preservation for breast cancer patients to prevent high estrogen levels. The document concludes by stating letrozole may
Obstetric outcomes associated with second trimester unexplained abnormal mate...Apollo Hospitals
1) To compare the adverse obstetrical outcomes in the patient population with normal blood MoMs.
2) To determine the probability of occurrence of an adverse obstetric event in relation with abnormal maternal blood
analytes.
This document provides evidence-based recommendations for managing unexplained infertility. It discusses various treatment options including expectant management, oral agents with or without IUI, gonadotropins with IUI, and IVF. The key recommendations are that IUI in natural cycles or with oral agents is no more effective than expectant management. Gonadotropins with IUI can be offered but carries a higher risk of multiple pregnancy. IVF demonstrates superior pregnancy rates compared to other options and should be offered after failed ovarian stimulation cycles. Immediate IVF is recommended for women over 38 years old with unexplained infertility.
How to choose between drugs: efficacy / safety and cost effectiveness. In IVF, we have GnRHagonist and antagonists: how to choose based on best available evidence. This talk may help to answer this question
we are in need to describe investigations for our patients but over prescription of these investigations especially if unnecessary could be considered abuse
2021 Gonadotropins for controlled ovarian hyperstimulationHesham Al-Inany
1) The document summarizes key findings from the MEGASET-HR trial which compared the use of HP-hMG versus rFSH alfa in ovarian stimulation for IVF/ICSI among high responders. 2) Key results showed no significant differences in ongoing pregnancy rates per cycle started between the two gonadotropins but HP-hMG was associated with fewer oocytes retrieved and lower estradiol levels. 3) Regarding safety, the rate of OHSS was similar between groups while the rate of early OHSS was slightly higher with HP-hMG.
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
This document summarizes a review of randomized controlled trials (RCTs) and meta-analyses from 1990-2004 on factors affecting the success of embryo transfer (ET). The review identified 2 Cochrane reviews, 5 meta-analyses, and 34 RCTs. Key findings included that pregnancy and implantation rates were increased with trial transfers, ultrasound-guided ET, depositing embryos 2cm below the fundus, and applying gentle pressure to the cervix during and after ET. Soft catheters and exposure to semen around the time of ET also improved outcomes.
This document discusses how evidence-based medicine is changing attitudes in gynecologic practice. It provides an example of a randomized controlled trial comparing two ovarian induction protocols for intrauterine insemination. The trial found that using clomiphene citrate along with human menopausal gonadotropin reduced the rate of premature luteinizing hormone surges compared to human menopausal gonadotropin alone, with no significant differences in clinical pregnancy rates. The document outlines how evidence from randomized trials, prognostic models, economic analyses and other studies can inform clinical decision-making and change practices in gynecology.
This document summarizes a study examining the relationship between endometrial BCL6 expression and IVF success or failure. The study found that women with low endometrial BCL6 expression (<1.4) had a 66% success rate for pregnancy through IVF, while women with high BCL6 expression (≥1.4) only had a 10% success rate. This suggests BCL6 expression may be a biomarker for predicting IVF outcomes and identifying women who may benefit more from treating endometriosis directly rather than undergoing IVF. Future studies are needed to validate these findings in other populations and examine how BCL6 expression changes after treating endometriosis.
- Infertility is considered a disease by the WHO and most countries, so infertility treatment is allowed. Donor gametes and surrogacy are generally not permitted in Islam.
- Assisted reproduction technologies like IVF and PGD are allowed to help couples conceive, but third parties are not acceptable. Embryo research is only permitted using spare IVF embryos.
- While stem cells are being studied for conditions like premature ovarian failure, there is no evidence they can differentiate into eggs. The risks of stem cell therapy for fertility are still unclear. Cryopreservation and some new techniques also have uncertain religious rulings.
The purpose of this study was to investigate any
influence of maternal and/or paternal age, three sperm
parameters (sperm count/ml, motility and morphology) on
pregnancy outcomes in intracytoplasmic sperm injection (ICSI)
cycles. In all, 785 ICSI cases were analyzed retrospectively.
Pregnancy outcome were influenced by the age of the maternal,
paternal partners and sperm count x10⁶. The clinical pregnancy
rate with respect to the age of female partner and male partner
was revealed a significant inverse correlation between them with
(P = <0.001) for each partner. The relationship between clinical
pregnancy rate and sperm count x10⁶/ml was revealed a
significant difference between the groups (P= 0.046). On the other
hand no basic semen parameters (motility and normal
morphology) influence on ICSI pregnancy outcome was found in
the subgroup of patients. We conclude that the influence on
pregnancy outcome after ICSI is related mostly to maternal and
paternal age.
1. The document discusses unsafe abortion, which is defined as a procedure done by untrained people or in unsanitary conditions. It notes that unsafe abortion accounts for 13% of maternal mortality globally.
2. Statistics on the magnitude of unsafe abortion worldwide are provided, with over 20 million unsafe abortions estimated to occur annually. The abortion case fatality rate is highest in Africa at 0.7% and lowest in Europe.
3. The document outlines management of abortion complications, including life support measures, infection prevention, manual vacuum aspiration, counseling and post-abortion family planning. Effective interventions to reduce maternal mortality from unsafe abortion include contraception access and safe abortion services.
Multifetal pregnancies, especially those of higher order multiples, pose significant risks to both mother and fetuses. These risks include maternal complications such as preeclampsia and gestational diabetes as well as fetal complications like premature birth, low birth weight, and developmental impairments. Multifetal pregnancy reduction (MFPR) aims to reduce these risks by terminating one or more fetuses, leaving the remaining fetuses with improved health outcomes. While controversial, MFPR is generally considered ethically acceptable for reducing high order multiples and may provide benefits for triplet pregnancies. The procedure involves using ultrasound guidance to transvaginally inject a needle into the selected fetus between 7-12 weeks gestation.
1) Laparoscopic ablation of minimal or mild endometriosis in women with subfertility aims to increase pregnancy rates but evidence from randomized trials is limited and inconclusive.
2) Two randomized trials found slightly higher pregnancy rates with ablation but the number needed to treat was high at 8 women to achieve one additional pregnancy.
3) A prospective cohort study found no significant difference in fecundity rates between women with minimal/mild endometriosis and unexplained infertility.
There is a recent and strong trend in western countries to advocate single embryo transfer (eSET). The rational behind this trend is to avoid complications of multiple pregnancy after IVF. However, we would urgue that twin pregnancy is totally different from high order multiple pregnancy and the long term economic analysis of twin pregnancy has never been explored before. We tried to calculate the risks and benefits of twin pregnancy from a society perspectives. Based on our model, it seems that double embryo transfer (DET) is still a valid option.
Methods: The current case-control study was conducted at Ain Shams University Maternity Hospital. The study included two groups of women: group A, including pregnant women with a history of unexplained recurrent miscarriage; and group B, including control pregnant women with no prior miscarriage. Women included in either group were at their first trimester of pregnancy (6-13 weeks of gestation). For all included women, 3-hour oral glucose test was performed. Serum insulin levels were measured at the same times. Markers of insulin resistance, including HOMA-IR, HOMA-B, AUCG and AUCI were calculated.
Hospital based study on perinatal mortality in RIMS,Manipuriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document analyzes histomorphologic changes in placentas from pregnancies complicated by hypertension. Placentas from 50 normal pregnancies and 50 pregnancies with hypertension were examined. Microscopic analysis found significantly increased villous abnormalities in placentas from pregnancies with hypertension, including higher rates of syncytial knots, decreased vasculo-syncytial membranes, more fibrinoid necrosis, thicker basement membranes, and more villous stromal fibrosis. These findings suggest reduced blood flow in the placenta among pregnancies with hypertension, which can impact fetal and maternal health.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
Obstetric outcomes associated with second trimester unexplained abnormal mate...Apollo Hospitals
1) To compare the adverse obstetrical outcomes in the patient population with normal blood MoMs.
2) To determine the probability of occurrence of an adverse obstetric event in relation with abnormal maternal blood
analytes.
This document provides evidence-based recommendations for managing unexplained infertility. It discusses various treatment options including expectant management, oral agents with or without IUI, gonadotropins with IUI, and IVF. The key recommendations are that IUI in natural cycles or with oral agents is no more effective than expectant management. Gonadotropins with IUI can be offered but carries a higher risk of multiple pregnancy. IVF demonstrates superior pregnancy rates compared to other options and should be offered after failed ovarian stimulation cycles. Immediate IVF is recommended for women over 38 years old with unexplained infertility.
How to choose between drugs: efficacy / safety and cost effectiveness. In IVF, we have GnRHagonist and antagonists: how to choose based on best available evidence. This talk may help to answer this question
we are in need to describe investigations for our patients but over prescription of these investigations especially if unnecessary could be considered abuse
2021 Gonadotropins for controlled ovarian hyperstimulationHesham Al-Inany
1) The document summarizes key findings from the MEGASET-HR trial which compared the use of HP-hMG versus rFSH alfa in ovarian stimulation for IVF/ICSI among high responders. 2) Key results showed no significant differences in ongoing pregnancy rates per cycle started between the two gonadotropins but HP-hMG was associated with fewer oocytes retrieved and lower estradiol levels. 3) Regarding safety, the rate of OHSS was similar between groups while the rate of early OHSS was slightly higher with HP-hMG.
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
This document summarizes a review of randomized controlled trials (RCTs) and meta-analyses from 1990-2004 on factors affecting the success of embryo transfer (ET). The review identified 2 Cochrane reviews, 5 meta-analyses, and 34 RCTs. Key findings included that pregnancy and implantation rates were increased with trial transfers, ultrasound-guided ET, depositing embryos 2cm below the fundus, and applying gentle pressure to the cervix during and after ET. Soft catheters and exposure to semen around the time of ET also improved outcomes.
This document discusses how evidence-based medicine is changing attitudes in gynecologic practice. It provides an example of a randomized controlled trial comparing two ovarian induction protocols for intrauterine insemination. The trial found that using clomiphene citrate along with human menopausal gonadotropin reduced the rate of premature luteinizing hormone surges compared to human menopausal gonadotropin alone, with no significant differences in clinical pregnancy rates. The document outlines how evidence from randomized trials, prognostic models, economic analyses and other studies can inform clinical decision-making and change practices in gynecology.
This document summarizes a study examining the relationship between endometrial BCL6 expression and IVF success or failure. The study found that women with low endometrial BCL6 expression (<1.4) had a 66% success rate for pregnancy through IVF, while women with high BCL6 expression (≥1.4) only had a 10% success rate. This suggests BCL6 expression may be a biomarker for predicting IVF outcomes and identifying women who may benefit more from treating endometriosis directly rather than undergoing IVF. Future studies are needed to validate these findings in other populations and examine how BCL6 expression changes after treating endometriosis.
- Infertility is considered a disease by the WHO and most countries, so infertility treatment is allowed. Donor gametes and surrogacy are generally not permitted in Islam.
- Assisted reproduction technologies like IVF and PGD are allowed to help couples conceive, but third parties are not acceptable. Embryo research is only permitted using spare IVF embryos.
- While stem cells are being studied for conditions like premature ovarian failure, there is no evidence they can differentiate into eggs. The risks of stem cell therapy for fertility are still unclear. Cryopreservation and some new techniques also have uncertain religious rulings.
The purpose of this study was to investigate any
influence of maternal and/or paternal age, three sperm
parameters (sperm count/ml, motility and morphology) on
pregnancy outcomes in intracytoplasmic sperm injection (ICSI)
cycles. In all, 785 ICSI cases were analyzed retrospectively.
Pregnancy outcome were influenced by the age of the maternal,
paternal partners and sperm count x10⁶. The clinical pregnancy
rate with respect to the age of female partner and male partner
was revealed a significant inverse correlation between them with
(P = <0.001) for each partner. The relationship between clinical
pregnancy rate and sperm count x10⁶/ml was revealed a
significant difference between the groups (P= 0.046). On the other
hand no basic semen parameters (motility and normal
morphology) influence on ICSI pregnancy outcome was found in
the subgroup of patients. We conclude that the influence on
pregnancy outcome after ICSI is related mostly to maternal and
paternal age.
1. The document discusses unsafe abortion, which is defined as a procedure done by untrained people or in unsanitary conditions. It notes that unsafe abortion accounts for 13% of maternal mortality globally.
2. Statistics on the magnitude of unsafe abortion worldwide are provided, with over 20 million unsafe abortions estimated to occur annually. The abortion case fatality rate is highest in Africa at 0.7% and lowest in Europe.
3. The document outlines management of abortion complications, including life support measures, infection prevention, manual vacuum aspiration, counseling and post-abortion family planning. Effective interventions to reduce maternal mortality from unsafe abortion include contraception access and safe abortion services.
Multifetal pregnancies, especially those of higher order multiples, pose significant risks to both mother and fetuses. These risks include maternal complications such as preeclampsia and gestational diabetes as well as fetal complications like premature birth, low birth weight, and developmental impairments. Multifetal pregnancy reduction (MFPR) aims to reduce these risks by terminating one or more fetuses, leaving the remaining fetuses with improved health outcomes. While controversial, MFPR is generally considered ethically acceptable for reducing high order multiples and may provide benefits for triplet pregnancies. The procedure involves using ultrasound guidance to transvaginally inject a needle into the selected fetus between 7-12 weeks gestation.
1) Laparoscopic ablation of minimal or mild endometriosis in women with subfertility aims to increase pregnancy rates but evidence from randomized trials is limited and inconclusive.
2) Two randomized trials found slightly higher pregnancy rates with ablation but the number needed to treat was high at 8 women to achieve one additional pregnancy.
3) A prospective cohort study found no significant difference in fecundity rates between women with minimal/mild endometriosis and unexplained infertility.
There is a recent and strong trend in western countries to advocate single embryo transfer (eSET). The rational behind this trend is to avoid complications of multiple pregnancy after IVF. However, we would urgue that twin pregnancy is totally different from high order multiple pregnancy and the long term economic analysis of twin pregnancy has never been explored before. We tried to calculate the risks and benefits of twin pregnancy from a society perspectives. Based on our model, it seems that double embryo transfer (DET) is still a valid option.
Methods: The current case-control study was conducted at Ain Shams University Maternity Hospital. The study included two groups of women: group A, including pregnant women with a history of unexplained recurrent miscarriage; and group B, including control pregnant women with no prior miscarriage. Women included in either group were at their first trimester of pregnancy (6-13 weeks of gestation). For all included women, 3-hour oral glucose test was performed. Serum insulin levels were measured at the same times. Markers of insulin resistance, including HOMA-IR, HOMA-B, AUCG and AUCI were calculated.
Hospital based study on perinatal mortality in RIMS,Manipuriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document analyzes histomorphologic changes in placentas from pregnancies complicated by hypertension. Placentas from 50 normal pregnancies and 50 pregnancies with hypertension were examined. Microscopic analysis found significantly increased villous abnormalities in placentas from pregnancies with hypertension, including higher rates of syncytial knots, decreased vasculo-syncytial membranes, more fibrinoid necrosis, thicker basement membranes, and more villous stromal fibrosis. These findings suggest reduced blood flow in the placenta among pregnancies with hypertension, which can impact fetal and maternal health.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
This research article examines alterations in reproductive hormones during pregnancy and the risk of preeclampsia. The study followed 79 preeclamptic women and 80 healthy pregnant controls longitudinally from the third trimester through 6 weeks postpartum. Blood samples were taken at each visit and analyzed for beta-hCG, oestriol, progesterone and prolactin levels. Results showed beta-hCG and oestriol levels were significantly altered in the preeclamptic group compared to controls in the first and third trimesters respectively, indicating these hormones may help identify risk of preeclampsia earlier in pregnancy. The study aims to determine the gestational age at which hormonal changes occur that are associated with developing preecl
“A Study on Coagulation Profile in Pregnancy Induced Hypertension Cases”iosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
Studies show that about 20% of all recognized clinical pregnancies end in spontaneous abortion, mainly in the first trimester. Risk factors associated with the occurrence of a sporadic miscarriage have been established, with genetic factors being the most prevalent. As a problem that affects many couples, it is important to increase the quality of prognosis and diagnosis.
The document summarizes a study on women's awareness of initiating and continuing breastfeeding after cesarean section in Baghdad, Iraq. The study involved surveying 30 women who had cesarean sections using a questionnaire. The results showed that 43.3% initiated breastfeeding within 24 hours of their c-section. 76.7% continued breastfeeding, though only 26% practiced exclusive breastfeeding. The study aimed to identify factors influencing breastfeeding initiation and continuation after c-sections. It recommended promoting breastfeeding through baby-friendly hospital initiatives and counseling women during pregnancy and after birth.
Current Point of View in Preterm Labor Management in AlbaniaRustem Celami
The document discusses a study conducted in Albania on the use of maintenance tocolysis therapy to prevent preterm labor. The study included 325 pregnant women between 28-32 weeks gestation hospitalized for preterm labor. Women received tocolysis therapy for over one month. Those between 28-30 weeks gestation saw more prolonged pregnancies compared to the 30-32 weeks group. The study concluded that maintenance tocolysis therapy can considerably benefit women diagnosed with preterm labor and help prolong their singleton pregnancies when medical intervention is not urgently needed. However, more research is still required.
Study of Incidence and Etiology of Prolapse at Rural Based Teaching Hospitaltheijes
In our country as large number of woman deliver at home, usually conducted by untrained dias, incidence of prolapse is higher. The etiology of prolapse was discussed by ARETAEUS, a Greek physician who believed procedentiato be result of weakness of ligaments of the uterus. There are multiple etiological factors in the developed of prolapse. Diagnosis of prolapse at the earliest will help to reduce the complications of prolapse as well as continue child bearing function of the young woman.
Characterization and the Kinetics of drying at the drying oven and with micro...Open Access Research Paper
The objective of this work is to contribute to valorization de Nephelium lappaceum by the characterization of kinetics of drying of seeds of Nephelium lappaceum. The seeds were dehydrated until a constant mass respectively in a drying oven and a microwawe oven. The temperatures and the powers of drying are respectively: 50, 60 and 70°C and 140, 280 and 420 W. The results show that the curves of drying of seeds of Nephelium lappaceum do not present a phase of constant kinetics. The coefficients of diffusion vary between 2.09.10-8 to 2.98. 10-8m-2/s in the interval of 50°C at 70°C and between 4.83×10-07 at 9.04×10-07 m-8/s for the powers going of 140 W with 420 W the relation between Arrhenius and a value of energy of activation of 16.49 kJ. mol-1 expressed the effect of the temperature on effective diffusivity.
Accuracy of cervico vaginal fetal fibronectin test in predicting risk of spon...Open Access Research Paper
Preterm delivery is the leading cause of neonatal mortality. One of the best predictors to assess the risk of preterm labour (PTB) is by measuring fetal fibronectin (fFN) in cervico vaginal secretion after 26 weeks of pregnancy. The aim is to evaluate the diagnostic accuracy of qualitative cervico vaginal fFN in symptomatic women and asymptomatic high risk women during antenatal care. Prospective study which was conducted in Basrah Maternity and Child Hospital. It included 106 pregnant women at gestational age more than 26 weeks who had uterine contraction with or without pervious risk factors for PTB. Cervico vaginal fluid sampling was undertaken from all women included in the study after the age of 26 weeks of gestation and qualitative fFN assessment was done with 50ng/ml is the cut off point for positivity. As regard qualitative fFN assessment for predicting of PTB sensitivity, specificity, PPV, NPV, were 71%, 87%, 40.50%, 94% respectively in symptomatic women. While in asymptomatic women with previous high risk had 26% sensitivity, 84% specificity, 32% PPV, and 87% NPV. Qualitative assessment of fFN in cervico vaginal fluid is good predictive marker in detecting of PTB.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
This document summarizes evidence on the use of progesterone to prevent preterm birth. It finds that progesterone reduces the risk of preterm birth before 37 weeks in women with a prior preterm delivery or short cervix. Progesterone may also reduce complications for infants born preterm to mothers receiving it. However, progesterone does not prevent early preterm birth in twin or triplet pregnancies. No long-term harms were seen in children exposed to progesterone prenatally.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
This study examined 73 pregnant patients in Pakistan who presented with signs of liver disease. Laboratory testing found that 50 (68.5%) patients had acute hepatitis E virus (HEV) infection. The study aimed to evaluate maternal and fetal outcomes. It found that acute HEV during pregnancy predicted poor outcomes. 10% of HEV-infected mothers developed fulminant hepatic failure and did not survive. There were also high rates of fetal complications, including 8% intrauterine death, 10% neonatal death, and 12% preterm delivery due to maternal or fetal distress. The study concludes that acute HEV infection during pregnancy carries significant health risks for both mother and baby.
Risk Factors and Pregnancy Outcome of Preterm Laboriosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
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Accuracy of Combined Maternal Serum Interleukin-8 and Salivary Estriol in Prediction of Preterm Labor
1. _____________________________________________________________________________________________________
*Corresponding author: Email: wgrrs@yahoo.com;
British Journal of Medicine & Medical Research
6(10): 978-986, 2015, Article no.BJMMR.2015.274
ISSN: 2231-0614
SCIENCEDOMAIN international
www.sciencedomain.org
Accuracy of Combined Maternal Serum Interleukin-8
and Salivary Estriol in Prediction of Preterm Labor
Gihan M. Shehata1*
, Gihane I. Khalil2
, Hesham Abd Elfatah3
and Samir Elsayd3
1
Department of Biomedical informatics and Medical Statistics, Medical Research Institute,
Alexandria University, Egypt.
2
Department of Chemical Pathology, Medical Research Institute, Alexandria University, Egypt.
3
Department of Gynecology and Obstetrics, Faculty of Medicine, Alexandria University, Egypt.
Authors’ contributions
This work was carried out in collaboration between all authors. Author GMS designed the study, wrote
the protocol, and wrote the first draft of the manuscript, does the statistical analysis. Author GIK
managed the literature searches, chemical analyses of the samples, authors HAE and SE managed
the clinical examination of the patients with sampling the specimens. All authors read and approved
the final manuscript.
Article Information
DOI: 10.9734/BJMMR/2015/15146
Editor(s):
(1) Jimmy T. Efird, Department of Public Health, Director of Epidemiology and Outcomes Research East Carolina Heart
Institute, Brody School of Medicine, Greenville, North Carolina, USA.
Reviewers:
(1) Ronald Wang, Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.
(2) Anonymous, USA.
(3) David Krantz, PerkinElmer Labs/NTD, 80 Ruland Road, Suite 1, Melville, NY 11747, USA.
Complete Peer review History: http://www.sciencedomain.org/review-history.php?iid=909&id=12&aid=7774
Received 10
th
November 2014
Accepted 18th
December 2014
Published 14th
January 2015
ABSTRACT
Aim: To assess the accuracy of combined maternal serum interleukin and maternal salivary estriol
levels in prediction of preterm labor in Egyptian pregnant females.
Study Design: Case control study.
Place and Duration of Study: It was conducted in El-Shatby University Hospital of Gynecology
and Obstetrics, Alexandria, Egypt between 1st
Jan to 30th
September in the year 2012.
Methodology: We included 80 pregnant females of gestational age 28-36 weeks (40 females with
preterm labor and 40 pregnant not in labor). Both groups were matched for the women's age and
the gestational age. A questionnaire was completed; abdominal and vaginal examinations were
done. Maternal serum and saliva were collected for measuring the serum interleukin-8 and salivary
estriol levels using ELISA technique.
Original Research Article
2. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
979
Results: Using ROC curve analysis, the overall diagnostic accuracy of Salivary Estriol alone at cut
off point 200 pg/ml in prediction of preterm labor was 58% (0.46-0.71). Sensitivity and specificity
were 82.5% and 32.5% respectively. The diagnostic accuracy of combined Salivary Estriol and
serum interleukin-8 in prediction of preterm labor was 68% (0.56-0.79). Sensitivity and specificity
were 75%% and 60% respectively. Lastly, the maternal serum interleukin-8 had the following
accuracy measures for prediction of preterm labor at cut off point 965 pg/ml. (Overall accuracy:
79% (0.69-0.89), sensitivity 92.5% and specificity 42.5%).
Conclusion: The maternal serum interleukin-8 is an effective and relatively non invasive and more
accurate strategy for prediction of preterm labor at cut off point 965 pg/ml than salivary estriol.
(Overall accuracy: 79%, sensitivity 92.5% and specificity 42.5%).
Keywords: Preterm labor; interleukin-8; salivary estriol; prediction.
1. INTRODUCTION
Preterm labor is defined as labor occurring
before the completion of 37 weeks gestation
(<259 days), It is a leading cause of neonatal
morbidity [1,2]. Preterm birth includes preterm
labor with intact membranes (PTL; ±40%),
preterm premature rupture of membranes
(PPROM; ± 40%), and indicated delivery
because of deteriorating maternal or fetal health
(± 20%) [3].
1.1 Burden of Disease due to Preterm
Birth
Preterm birth is one of the most important issues
in reproductive medicine. It complicates 10-15%
of all pregnancies [4,5]. Its incidence has
increased during the last decade. Main reasons
are: (1) a higher incidence of multiple births due
to fertility-enhancing drugs and procedures; (2) a
tendency toward early (including preterm)
induction or Cesarean section for pathological
pregnancies; (3) an increase in registration of
births near the borderline of viability; and (4) a
more accurate estimated gestational age by the
increasing use of early ultrasound [6]. It is among
the top causes of death in infants worldwide.
1.2 Etiology of Preterm Birth
Preterm birth is a heterogeneous condition where
up to 30 - 40% of all cases of preterm birth are
due to elective delivery for a maternal or a fetal
complication e.g. hypertension, diabetes, intra-
uterine growth restriction [1]. The remaining 60 –
70% of preterm birth is likely due to covert or
sub-clinical infective/inflammatory processes,
cervical dysfunction, idiopathic (unknown),
multiple gestations and possible social,
nutritional, and environmental interactions [2].
The cause for preterm birth is in many situations
elusive and unknown; many factors appear to be
associated with the development of preterm birth,
making the reduction of preterm birth a
challenging proposition.
Spontaneous preterm birth (SPB), includes PTL
and PPROM. The strategies to prevent or reduce
SPB have not been effective until now. SPB is a
syndrome produced by a wide variety of disease
conditions operating through different pathogenic
pathways and mechanisms [7]. With the recent
advances in understanding the pathogenesis of
SPB, a number of techniques have been
proposed to predict SPB [7]. It is of clinical
relevance to be able to predict SPB, if an
intervention is available that is likely to improve
outcome. Another reason to identify women at
risk for a preterm birth is to allow appropriate
maternal transport to a tertiary care center for the
optimal care to be provided for the newborn.
The failure of traditional approaches to predict
SPB is likely to be an inadequate understanding
of the underlying heterogeneous pathogeneses
of SPB, so the understanding of the
pathogenesis has substantially improved the
detection of the factors that help in predicting
preterm labor. New biochemical fluid markers
(cytokines, hormones and enzymes) might be
relevant in the etiology of SPB.
1.3 Pathogenesis of Spontaneous
Preterm Birth (SPB)
Cases of SPB result from four primary
pathogenic processes that may occur either in
isolation or in combination [8]. While each
process follows a unique biochemical cascade,
they share a common final biological pathway,
involving the release of prostaglandins which
generate uterine contractions and an increased
expression of genital tract proteases which
3. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
980
promote cervical change and rupture of
membranes (Fig. 1). To ascertain patients at risk,
given these heterogeneous biochemical and
biophysical pathways, a combination of
pathogenic-specific markers will be needed.
Initial studies employing longitudinal sampling
have demonstrated a rise in both plasma and
salivary E3 two to five weeks before the onset of
labor whether occurring at term deliveries or
preterm. This increase in E3 may be used to
diagnose threatened preterm labor in women at
high-risk for spontaneous Preterm Birth [7,8].
The cytokines IL-1β,-6, -8 can be measured in
maternal serum and cervical secretions. They
play a role in inflammation-based spontaneous
Preterm Birth. Lower genital tract IL-6 and IL-8
concentrations appear to be related to
subsequent SPB. However, presently there are
no consistent results regarding the usefulness in
predicting spontaneous preterm birth.
1.4 Rational of the Study
In our community there were studies concerning
the estriol, IL1 and IL6 only but no sufficient
studies about IL8 or the combination of both of
estriol and IL8. While both were involved in the
pathogenesis pathway of preterm labor so estriol
and IL-8 were assessed in our paper.
1.5 Research Hypothesis
The combination of maternal salivary estriol and
serum interleukin-8 will be better predictor than
either of them alone.
1.6 Limitations of the Study
The difficulty in following up pregnant cases till
developing preterm labor causes limitation in
doing follow up study design. We used case
control study to evaluate the role of both factors
in identifying cases of preterm labor, so we could
use these markers in prediction of it.
Also, On sampling from the patients , the cases
had symptoms of preterm labor like leucorrhea,
abdominal pain but really not entered in true
labor except after many days of admission; not
the same day of collection of the specimens.
Fig. 1. Pathways of Preterm Birth (PTB) due to preterm Premature Rupture of the Membranes
(PPROM) and/or Preterm Labor (PTL)
Activation of
maternal/fetal HPA axis
caused by:
- Maternal fetal stress
- Premature onset of
physiologic initiators
Inflammation
caused by:
Infection of the:
- Chorion
- Decidua
- Systemic
Decidual
Hemorrhage:
-Placental
abruption
Pathological uterine
distension:
-Multifetal pregnancy
-Polyhydramnios
-Uterine anomaly
- Chorion
- Decidua
-Cervical change
-Rupture of membrane
PTB
-Uterine contractions
protease
uterotonins
-hCG
-MSAFP
-CRH
-E1-E3
-IL-1 TNF
-IL-6 -Thrombin -Mechanical stretch
-Gap junction
-PG synthase
-IL-8
4. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
981
The other limitation was relatively small sample
size which is limited due to the expensive price of
the kits of both estriol and interleukin-8 (funded
by the authors only) so we are in need for further
research to establish these screenings as
reliable, and limited specificity with large fund for
larger sample size.
2. MATERIALS AND METHODS
2.1 Setting
The present study was conducted in El Shatby
University Hospital of Gynecology and Obstetrics
in Alexandria. It is the largest hospital of its kind
in Alexandria, a tertiary care facility and a center
of expertise in a maternity care and management
of gynecological problems. It serves population
of Alexandria city and nearby governorates
(Matrouh and El-Beheira) with considerably high
case load that warrants the accumulation of a
sufficient number of cases during a reasonable
period of time.
2.2 Study Design
Case Control study.
2.3 Study population
The Study population was pregnant females of
gestational age 28-36 weeks (gestational age will
be determined by dating from last menstrual
period, fundal level and ultrasound) attending
El-Shatby University Hospital of Gynecology and
Obstetrics in Alexandria in the year 2012. The
study population was classified into two groups
the first group was healthy women not in labor
(control) and the second group was women
suffering from preterm labor (cases). Both groups
were matched for the women's age and the
gestational age.
2.4 Inclusion Criteria
All Pregnant females in gestational age between
28-36 weeks.
2.5 Exclusion Criteria
1- General maternal systemic diseases either
medical or obstetrical
2- Local causes initiating preterm labor such
as uterine myomas or uterine anomalies
(bi-cornuate uterus or septate uterus), if
any local cause is discovered postpartum,
this case will be excluded.
3- Evidence of congenital anomalies
4- Intrauterine growth retardation
2.6 Sample Size Calculation
A minimum sample size of 38 for each group was
calculated to achieve 80% power and to detect
difference of 184 between the mean serum
interleukin-8 levels of the null hypothesis (148±5)
and the alternative hypothesis of (332±389) with
a significance level of 0.05 [9].
2.7 Tools of Data Collection
After having approval from the ethical committee,
Medical Research Institute, signed informed
consents were obtained from all patients who
agree to participate in the study.
Three tools were used to obtain relevant
information: Interviewing questionnaire, clinical
examination and investigations.
2.7.1 Interviewing questionnaire
An interview schedule was designed to collect
relevant information from all eligible women
enrolled in this study. The schedule included the
following items: Personal history, menstrual
History, obstetric History, Medical history and
Present complaint
2.7.2 Examination
Complete clinical examination was done for the
study subjects. General, abdominal and vaginal
examination
2.7.3 Investigations
a- Abdominal sonography:
b- Biochemical analysis: for measuring the
following:
1-Salivary estriol level by ELISA Technique
(DiaMetra company, Italy).: Saliva sample was
collected at any time of the day taking into
cosideration the following Specific instructions:
No teeth brushing before collection, At least
1hour was left after any food or drink before
collecting the sample, Good clear sample shoyld
be received (no contamination with food, lipstick
or blood as in bleeding gums).
5. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
982
2- Serum interleukin-8 level by ELISA Technique
(eBioscience company, North America): Blood
samples were collected at any time of the day in
a gel foam tubes for autoseparation and the
sample was centrifuged for 15 minutes at 3000
rpm.
3. RESULTS
The study included 80 pregnant females
presented to El-Shatby Maternity University
Hospital, 40 healthy females (control) and 40
females with preterm labor (cases). The age of
females ranged between a minimum of 18 years
to a maximum of 35 years with a mean of
25.9±4.18 years. Both groups were matched for
the female's age and the gestational age.
Table 1 shows the association between the
groups of cases and the socio-demographic
characteristics. As regards female age, about
22.5% of the cases has age more than 30 years
compared to 2.5% of the control. So, increased
women's age was associated with a significant
increased risk of preterm labor relative to those
with younger age groups. (OR=5.6, CI= 1.34-
23.5, p=0.024). Regarding the education, most of
the cases (70%) were low educated (less than 12
years) versus 50% of the controls. This
difference was not statistically significant.
(OR=2.33, CI=0.94-5.7, p=0.06). Concerning the
occupation, all the entire cases was not working
(100%) compared to 97.5% of the control. This
difference was not statistically significant.
(OR=0.32, CI= 0.21-2.62, p=0.314).
Assessment of the diagnostic accuracy of
Salivary Estriol alone, Serum interleukin-8 alone
or the combination of both was done for
prediction of preterm labor. We choose the cut
off points of salivary estriol or interleukin-8
according to the highest sensitivity and highest
specificity, It revealed the following results:
The role of salivary estriol in predicting preterm
labor was presented in Table 2. It was shown
that 82.5% of cases had salivary estriol more
than 200 pg/ml compared to 67.5% of the
controls. The risk of preterm labor was nearly two
times among those with high salivary estriol
levels more than 200 pg/ml than those with
salivary estriol level less than or equal 200 pg/ml,
but this was not statistically significant (OR =2.2,
CI= 0.79-6.48, p=>0.05).
The role of interleukin-8 in predicting preterm
labor was also demonstrated in Table 3, where
92.5% of cases had serum interleukin-8 more
than 965 pg/ml compared to 57.5% of the
controls. The risk of preterm labor was nearly
nine times among those with high serum
interleukin-8 levels more than 965 pg/ml than
those with serum interleukin-8 levels less than or
equal 965 pg/ml, this association was statistically
significant (OR =9.11, CI= 2.4-34.57, p<0.05).
The role of combined salivary estriol at cut off
200 pg/ml and interleukin-8 at cut off 965 pg/ml
in predicting preterm labor were shown in the
same (Table 3). It clarified that 75% of cases had
both tests positive versus 40% of the controls.
The risk of preterm labor was nearly five times
among those with positive tests than those with
negative tests. This was statistically significant
(OR =4.5, CI= (1.73-11.69), p<0.05).
Table 1. shows association between the groups of cases and the socio-demographic
characteristics
Socio-demographic
characteristics
Preterm labor X2
test
(P)
OR
(95% CI)No (control) Yes (cases)
No % No %
Age:
< 25 years®
25-30 years
> 30 years
X ± SD years
Range
16
23
1
25.5±3.4
19-35
40
57.5
2.5
14
17
9
26.2±4.8
18-35
35
42.5
22.5
7.433
(0.024)*
0.84 (0.32-2.18)
5.63 (1.34-23.5)*
Education:
< 12 years education ®
≥ 12 years education
20
20
50
50
28
12
70
30
3.33
(0.06)
2.33
(0.94-5.7)
Occupation:
Non worker
Worker
39
1
97.5
2.5
40
0
100
0
1.03
(0.314)
0.32
(0.21-2.62)
® is the reference group, *P is statistically significant (<0.05)
6. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
983
Table 2. Salivary Estriol, serum interleukin-8 and combined both tests as predictors of
preterm labor
Salivary estriol level ** Positive
preterm labor
by clinical
examination
Negative preterm
labor by clinical
examination
Total
no
OR
(95% confidence
interval))
No % No %
Salivary Estriol > 200 pg/ml 33 82.5 27 67.5 60 2.2
(0.79-6.48)Salivary Estriol ≤ 200 pg/ml 7 17.5 13 32.5 20
Total 40 100 40 100 80
Serum Interleukin-8 level ***
Interleukin-8 > 965 pg/ml 37 92.5 23 57.5 60
9.11
(2.4-34.57)*
Interleukin-8 ≤ 965 pg/ml 3 7.5 17 42.5 20
Total 40 100 40 100 80
Combined salivary estriol and serum interleukin-8
Both Tests are Positive 30 75 16 40 46
4.5
(1.73-11.69)*
One or Both tests negative 10 25 24 60 34
Total 40 100 40 100 80
* P value is statistically significant (<0.05)
** Cut off point of salivary estriol 200pg/ml at highest sensitivity=83% and specificity=33%
*** Cut off point of interleukin-8 965pg/ml at highest sensitivity=93% and specificity=43%
Table 3. Diagnostic accuracy of Salivary Estriol alone, serum interleukin-8 alone and
combinations of both tests in prediction of preterm labor
Parameters of diagnostic
accuracy in predicting
preterm labor
Value for the
salivary estriol
at cut off point
200 pg/ml
Value for serum
interleukin-8 at
cut off point
965 pg/ml
Value for combined
salivary estriol at cut off
point 200pg/ml
& interleukin-8 at cut off
point 965 pg/ml
Overall accuracy (95% C.I.) 58% (0.46-0.71) 79% (0.69-0.89) 68% (0.56-0.79)
P value 0.19 (0.00)* (0.007)*
Sensitivity 82.5% 92.5% 75%
Specificity 32.5% 42.5% 60%
* P value is statistically significant (<0.05)
Concerning the diagnostic accuracy of salivary
estriol, serum interleukin-8 or both together in
predicting preterm labor, (Table 3. and Fig. 2)
illustrate the different parameters of diagnostic
accuracy of at a cut off point 200 pg/ml for the
salivary estriol (the cut off point of highest
sensitivity (82.5%) and specificity (32.5%)), while
the cut off for the serum interleukin-8 was 965
pg/ml (the cut off point of highest sensitivity
(92.5%) and specificity (42.5%)). The overall
accuracy of Salivary estriol in predicting preterm
labor, was 58% (CI=0.48-0.71) which was not
statistically significant (p=0.19). While it was 79%
(CI=0.69-0.89) and 68% (0.56-0.79) for serum
interleukin-8 and combined tests respectively
which were statistically significant (p=0.00 and
0.007 respectively). It was shown that the overall
accuracy of serum interleukin-8 were higher than
the overall accuracy of salivary estriol alone or
both combined, so serum interleukin-8 alone had
high prediction rate of preterm labor (79%) than
salivary estriol alone or both combined (58% and
68% respectively).
4. DISCUSSION
Preterm labor is a common serious clinical
problem. It is a major determinant of neonatal
mortality and morbidity and has long-term
adverse consequences for health [10-12]. The
highest rates occurred in Africa and North
America, where 11.9% and 10.6%, respectively,
of the births were preterm. Europe, where 6.2%
of the births were preterm, had the lowest rate.
[13].
Preterm birth rates available from some
developed countries, such as the United
7. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
984
Kingdom, the United States and the
Scandinavian countries, show a dramatic rise
over the past 20 years [14,15]. Factors possibly
contributing to but not completely explaining this
upward trend include increasing rates of multiple
births, greater use of assisted reproduction
techniques. In developing countries, accurate
and complete population data and medical
records usually do not exist.
The current study was conducted in El-Shatby
Hospital of Gynecology and Obstetric, a
university hospital and a tertiary care facility
providing health services to middle and low
socioeconomic group of population of Alexandria
and nearby areas. The study focused on the
estimation of the accuracy estimates of the
combined maternal serum interleukin-8 and
Salivary estriol in predicting preterm labor among
women presented with symptoms of preterm
labor with or without premature rupture of
membrane in comparison to the control group
who were coming for antenatal care. Both groups
were matched for the women's age and the
gestational age. They had age ranged from 18-
35 years with mean age of 25.9±4.18.
The study markers (Salivary estriol and Serum
interleukin-8) were measured in the study sample
with mean of salivary estriol (pg/ml) in the cases
and controls 738.1±106.7 and 525.1±103.8
respectively. While the mean of serum
interleukin-8 (pg/ml) in the cases and controls
was 1136.1±126.8 and 986.7±118.8 respectively.
Although this figure was obtained based on the
study that occurred in only one hospital, yet this
hospital provides health services to a large group
of population of Alexandria and nearby areas, so
the prevalence detected can reflect a large
proportion of the population. This was consistent
with Lockwood et al. [7] in his study in England.
Fig. 2. ROC curve of maternal salivary estriol, serum interleukin- 8 and combined both tests in
predicting preterm labor (accuracy 58%, 79% and 68% respectively)
8. Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274
985
Concerning the assessment of the diagnostic
accuracy of the maternal Salivary Estriol/Serum
interleukin-8 in prediction of preterm labor, they
were used as a screening method for Pregnant
women to detect the risk of preterm labor. The
highest the maternal salivary estriol and or the
highest maternal serum interleukin-8, the
increased the risk of preterm labor. Although
estriol or interleukin-8 obtains an actual
measurement level, test results are typically
reported simply as ‘positive’ or ‘negative’
depending on whether the level of the predictor is
above or below a specified threshold. For
diagnostic tests providing a positive or negative
result, performance across the study group is
usually summarized in terms of sensitivity and
specificity. Sensitivity is the probability of testing
positive if the disease is truly present. Specificity
is the probability of testing negative if the disease
is truly absent.
Controversies do exist regarding the cut off point
at which the salivary estriol or serum interleukin-
8 levels are said to be negative or positive. The
present study found that the overall accuracy of
maternal salivary estriol to predict preterm labor
at cut off point 200 pg/ml was 58%. The
sensitivity and specificity were 82.5% and 32.5%
respectively. Combinations of maternal salivary
estriol and Maternal serum interleukin-8 had
overall accuracy, sensitivity and specificity 68%,
75% and 60% respectively. The highest overall
accuracy and sensitivity were for the maternal
serum interleukin-8 alone 79% and 92.5%
respectively. In accordance with the present
finding is that of Castracane in Australia 2000
who discovered an increased risk of preterm
labor among women who had high salivary
estriol level and reported a sensitivity and
specificity of 85% and 38% respectively with
overall accuracy 57% [16]. Other recent studies
[17,18] revealed overall accuracy 60%% with
accompanying sensitivity and specificity of 87%
and 35% respectively at cut off point 200pg/ml.
While Goodwin was in disagreement with this
findings as he found that the sensitivity of
salivary estriol in prediction of preterm labor was
low (56%) at the same cut off point [19].
Concerning the role of maternal serum
inreleukin-8 in prediction of preterm labor, many
recently published studies were in agreement
with the results of our study as they support that
the role of interleukin-8 in prediction of preterm
labor is superior to the combination of salivary
estriol and serum interleukin-8 [20-24]. This is in
disagreement with Romero (2003) and Osmers
(2005) where they found that the combinations of
salivary estriol and interleukin-8 were better than
each alone [25,26].
5. CONCLUSION
The overall accuracy of serum interleukin-8 alone
in prediction of preterm labor (79%) with 95% CI
(69%-89%) was higher than accuracy of salivary
estriol alone (58%) or the combination of both
(68%).
ETHICAL APPROVAL
Authors have obtained all necessary ethical
approval from the ethical committee, Medical
Research Institute El-Shatby university hospital
of gynecology and obstetrics.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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