The effectiveness of cervical cerclage in twin pregnancies with a mid-trimester short cervix: A retrospective cohort study.

OBJECTIVE: To analyze the effectiveness of cerclage in twin pregnancies with a short cervix. STUDY DESIGN: Retrospective cohort study performed in two University Institutions in Valencia (Spain) with two different protocols for the management of asymptomatic dichorionic diamniotic twin pregnancies with mid-trimester cervical length ≤ 25 mm: treatment with indomethacin, antibiotics and cerclage (cerclage group) (N = 43) versus expectant management (control group) (N = 37). RESULTS: The initial cervical length was similar in both groups but detection of a short cervix was performed earlier in the cerclage group (21.6 vs 24.1 weeks, p < 0.001). Women with cerclage had a greater pregnancy latency (12.5 vs. 7.7 weeks, p < 0.001); higher gestational age at delivery (34.1 vs. 31.8 weeks, p < 0.04); less spontaneous preterm birth (SPB) < 28 weeks (11.6 % vs 37.8 %, p < 0.009); higher birthweight (2145 vs 1733 g, p < 0.001); lower birthweight < 1500 g (12.5 % vs 40.0 %, p < 0.001); less admissions to the neonatal intensive care unit (NICU) (24.1 % vs 43.3 %, p < 0.03); shorter stay at NICU (25.6 vs 49.4 days, p < 0.02); lower respiratory distress requiring mechanical ventilation (14.9 % vs 36.5 %, p < 0.02); fewer patent ductus arteriosus (8.9 % vs 26.9 %, p < 0.008); and lower composite adverse neonatal outcome (26.6 % vs. 44.8 %, p < 0.03). Cerclage and gestational age at diagnosis were the only independent predictors of SPB < 32 and < 28 weeks by multivariate analysis. The cumulative data in the literature show promising beneficial effects of cerclage. CONCLUSION: Our data suggest that cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.

Understanding the course of attention deficit hyperactivity disorder in children born after a threatened preterm labor: a 6-year cohort study.

BACKGROUND: Recent research suggests that children born after suspected preterm labor may observe a potential cluster with different attention deficit hyperactivity disorder features, depending on the time of birth. However, the evolution of symptoms and their predictors remain unknown in this population. OBJECTIVE: This study aimed to examine the trajectories of attention deficit hyperactivity disorder symptoms of children born after suspected preterm labor, between ages 2 and 6 years, considering prematurity condition and comparing with controls. In addition, this study aimed to find potential modifiable predictors of evolution to enhance prognosis. STUDY DESIGN: In this prospective cohort study, 119 mother-child pairs who experienced suspected preterm labor and 60 controls were included. Patients were divided according to prematurity condition in full term (n=27), late preterm (n=55), and very preterm (n=37). Attention deficit hyperactivity disorder symptoms were assessed at ages 2 and 6 years. The association between potential modifying factors (group, time of assessment, sex, birthweight percentile, maternal history of trauma, maternal anxiety at diagnosis, and maternal anxiety during the children's assessments) and disorder trajectories was assessed by adjusting the Bayesian mixed linear models. All analyses were performed in R (version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria). RESULTS: An interaction emerged between time and group, with late-preterm neonates born after suspected preterm labor being the only group to improve from ages 2 to 6 years (-2.26 points in Conners scale per percentile decrease and 0.98 probability of effect). Another interaction between time and maternal anxiety at postnatal time assessments intensified over time (0.07 and 0.84). Predictors of symptom severity included lower weight percentile at birth (-0.2 and 0.96), male sex (-2.99 and <0.99), higher maternal anxiety at diagnosis (+0.08 and 0.99), and maternal history of trauma (+0.23 and 0.98). CONCLUSION: Unlike very-preterm and full-term children, those born late preterm showed an improvement over time, probably because late-preterm children do not carry the sequelae derived from severe prematurity but benefit from close monitoring. As maternal psychopathology emerged as a determinant modifier of course and severity, it is crucial to develop targeted psychological interventions for pregnant individuals and reevaluate monitoring programs for their offspring, regardless of prematurity.

Rescue doses of antenatal corticosteroids, children's neurodevelopment, and salivary cortisol after a threatened preterm labor: a 30-month follow-up study.

BACKGROUND: Antenatal corticosteroids reduce neonatal complications when administered to women at risk for preterm birth. Moreover, antenatal corticosteroid rescue doses are recommended for women who remain at risk after the initial course. However, there is controversy about the most appropriate frequency and the exact timing of administering additional antenatal corticosteroid doses because there are potential long-term negative effects on infants' neurodevelopment and physiological stress functioning. OBJECTIVE: This study aimed to (1) to assess the long-term neurodevelopmental effects of receiving antenatal corticosteroid rescue doses in comparison with receiving only the initial course; (2) to measure the cortisol levels of infants of mothers who received antenatal corticosteroid rescue doses; (3) to examine a potential dose-response effect of the number of antenatal corticosteroid rescue doses on children's neurodevelopment and salivary cortisol. STUDY DESIGN: This study followed 110 mother-infant pairs who underwent a spontaneous episode of threatened preterm labor until the children were 30 months old, regardless of their gestational age at birth. Among the participants, 61 received only the initial course of corticosteroids (no rescue dose group), and 49 participants required at least one rescue dose of corticosteroids (rescue doses group). The follow-up was carried out at 3 different times, namely at threatened preterm labor diagnosis (T1), when the children were 6 months of age (T2), and when the children were 30 months of corrected age for prematurity (T3). Neurodevelopment was assessed using the Ages & Stages Questionnaires, Third Edition. Saliva samples were collected for cortisol level determination. RESULTS: First, the rescue doses group showed lower problem-solving skills at 30 months of age than the no rescue doses group. Second, the rescue doses group demonstrated higher salivary cortisol levels at 30 months of age. Third, a dose-response effect was found that indicated that the more rescue doses the rescue doses group received, the lower the problem-solving skills and the higher the salivary cortisol levels at 30 months of age. CONCLUSION: Our findings reinforce the hypothesis that additional antenatal corticosteroid doses provided after the initial course may have long-term effects on the neurodevelopment and glucocorticoid metabolism of the offspring. In this regard, the results raise concerns about the negative effects of repeated doses of antenatal corticosteroids in addition to a full course. Further studies are necessary to confirm this hypothesis to help physicians reassess the standard antenatal corticosteroid treatment regimens.

Temperamental and psychomotor predictors of ADHD symptoms in children born after a threatened preterm labour: a 6-year follow-up study.

Children born after threatened preterm labour (TPL), regardless of whether it ends in preterm birth, may represent an undescribed "ADHD cluster". The aim of this cohort study is to identify early temperament and psychomotor manifestations and risk factors of TPL children who present ADHD symptoms. One hundred and seventeen mother-child pairs were followed from TPL diagnosis until the child's 6 years of life. TPL children were divided according to the prematurity status into three groups: full-term TPL (n = 26), late-preterm TPL (n = 53), and very-preterm TPL (n = 38). A non-TPL group (n = 50) served as control. Temperament and psychomotor development at age 6 months and ADHD symptoms at age 6 years were assessed. Perinatal and psychosocial factors were also recorded. All TPL groups showed higher severity of ADHD symptoms compared with non-TPL children (difference in means + 4.19 for the full-term group, + 3.64 for the late-preterm group, and + 4.99 for the very-preterm group, all ps < 0.021). Concretely, very-preterm and late-preterm TPL children showed higher restless/impulsive behaviours, whereas full-term TPL children showed higher emotional lability behaviours. Higher surgency/extraversion and delayed fine motor skills at age 6 months predicted ADHD symptoms at 6 years in TPL children. Male sex, maternal state anxiety symptoms at TPL diagnosis, low parental education, and past maternal experience of traumatic events predicted higher ADHD symptoms in TPL children. Therefore, TPL children may have a higher risk for developing ADHD symptoms, presenting a phenotype that depends on the prematurity status. Moreover, the specific combination of early manifestations and risk factors suggests that TPL children may conform an undescribed group at-risk of ADHD symptoms.

Are infants born after an episode of suspected preterm labor at risk of attention deficit hyperactivity disorder? A 30-month follow-up study.

BACKGROUND: An episode of suspected preterm labor may be by itself a pathologic event that may alter the normal course of pregnancy and the offspring's neurodevelopment. Certainly, the association between preterm birth and neurodevelopmental disorders can only be partially explained by the immaturity of the nervous system, as evidenced by the increased risk of attention deficit hyperactivity disorder in late-preterm infants without any neurologic alteration. OBJECTIVE: This study aimed to examine whether infants born after suspected preterm labor may be at an increased risk of developing attention deficit hyperactivity disorder. Moreover, potential obstetrical, perinatal, and psychosocial risk factors associated with attention deficit hyperactivity disorder in this population are examined. STUDY DESIGN: A prospective cohort study of 120 mother-infant pairs was conducted from the moment the mothers received a diagnosis of suspected preterm labor until the infants' 30 months of life. Infants were divided according to the prematurity status: full-term infants born after a suspected preterm labor (n=28; born at ≥37 weeks of gestation), late-preterm infants (n=56; born between 32 and <37 weeks of gestation), very-preterm infants (n=36; born before <32 weeks of gestation). At-term infants born without obstetric complications served as a control group (n=46). Infants' attention deficit hyperactivity disorder symptoms were assessed at the age of 30 months. Furthermore, obstetrical, perinatal, and psychosocial risk factors were recorded. RESULTS: All groups of infants born after a suspected preterm labor showed more attention deficit hyperactivity disorder symptoms at the age of 30 months than the control group. Concretely, very-preterm infants showed higher restless or impulsive behaviors, whereas full-term infants born after a suspected preterm labor and late-preterm infants showed higher emotional lability behaviors. Among potential risk factors, male sex and maternal experience of posttraumatic stress symptoms predicted the severity of attention deficit hyperactivity disorder symptoms in infants born after a suspected preterm labor. CONCLUSION: Infants born after a suspected preterm labor had a higher risk of developing attention deficit hyperactivity disorder symptoms, including those born at term. Infants born after a suspected preterm labor showed a distinctive phenotype and shared specific risk factors suggesting that they conform an undescribed population at risk of attention deficit hyperactivity disorder.

Emotional regulation and psychomotor development after threatening preterm labor: a prospective study.

A threatened preterm labor (TPL) represents an adverse prenatal event that may affect fetal neurodevelopment, even in absence of prematurity. Indeed, late-preterm infants, without neurological complications, also exhibit neurodevelopment impairment with psychomotor delay as well as emotional regulation disturbances, considered early manifestations of neuropsychiatric disorders. The aim of this study is to examine the impact of TPL on infant's psychomotor development and temperament. This prospective cohort study recruited mothers who suffered from a TPL and a control group of mothers without TPL and full-term gestation (n = 61). TPL infants were classified into three groups depending on delivery time: Full-Term (n = 37), Late-Preterm (n = 66), and Very-Preterm (n = 38). Neurodevelopmental assessment was performed at 6 months using the Ages & Stages Questionnaires for psychomotor development and the Infant Behaviour Questionnaire-Revised for temperament. After controlling for potential cofounders (multiple pregnancy and in vitro fertilization), Full-Term TPL infants, relative to the control group, exhibited development delay in Communication (p = 0.044) and Personal-social domains (p = 0.005) as well as temperament disturbances with higher Negative Affect (p = 0.013), lower Positive Affect (p = 0.010), and worse Emotional Regulation (p < 0.001) compared to Control. No differences were found between Full-Term and Late-Preterm TPL infants. TPL may represent a risk factor for neurodevelopmental disturbances in the offspring, affecting both psychomotor and emotional infant competences, even when infants were born at term.

Early signs of autism in infants whose mothers suffered from a threatened preterm labour: a 30-month prospective follow-up study.

Infants born after a threatened preterm labour (TPL infants) are at high risk of autism spectrum disorder (ASD). Studying this population may provide insight on the pathophysiological underpinnings of this condition. This study aimed to (i) ascertain the presence and autistic symptom load in TPL infants aged age 30 months relative to non-TPL infants, regardless of preterm birth; (ii) explore the association between early (at 6 months) psychomotor development and temperament features with the autistic symptom load of TPL infants at age 30 months and (iii) examine the association among perinatal risk factors for ASD development with the autistic symptom load of TPL infants at age 30 months. A group of 111 mother-infant pairs recruited at TPL diagnosis and a group of 47 healthy mother-infant controls completed the follow-up. Irrespective of preterm birth, TPL infants showed higher autistic symptom load at age 30 months than non-TPL infants. TPL infants presented poorer communication and problem-solving skills, reduced smiling and laughter, and greater vocal reactivity at age 6 months, predicting higher autistic symptom load at age 30 months. Higher levels of anxiety symptoms in TPL mothers after a TPL diagnosis also predicted higher autistic symptom load for the infants at age 30 months. These results suggest that TPL infants may be an undescribed cluster, with features that differentiate them from other "at-risk" populations. These findings support the need for routine assessment of TPL infants and screening of anxiety symptoms in mothers.

Cumulative life stressors and stress response to threatened preterm labour as birth date predictors.

PURPOSE: Preterm birth represents one of the main causes of neonatal morbimortality and a risk factor for neurodevelopmental disorders. Appropriate predictive methods for preterm birth outcome, which consequently would facilitate prevention programs, are needed. We aim to predict birth date in women with a threatened preterm labour (TPL) based on stress response to TPL diagnosis, cumulative life stressors, and relevant obstetric variables. METHODS: A prospective cohort of 157 pregnant women with TPL diagnosis between 24 and 31 weeks gestation formed the study sample. To estimate the stress response to TPL, maternal salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured. To determine cumulative life stressors, previous traumas, social support, and family functioning were registered. Then, linear regression models were used to examine the effect of potential predictors of birth date. RESULTS: Lower family adaptation, higher Body Mass Index (BMI), higher cortisol levels and TPL diagnosis week were the main predictors of birth date. Gestational week at TPL diagnosis showed a non-linear interaction with cortisol levels: TPL women with middle- and high-cortisol levels before 29 weeks of gestation went into imminent labour. CONCLUSION: A combination of stress response to TPL diagnosis (salivary cortisol) and cumulative life stressors (family adaptation) together with obstetric factors (TPL gestational week and BMI) was the best birth date predictor. Therefore, a psychosocial therapeutic intervention program aimed to increase family adaptation and decrease cortisol levels at TPL diagnosis as well as losing weight, may prevent preterm birth in symptomatic women.

Optimization of Imminent Labor Prediction Systems in Women with Threatened Preterm Labor Based on Electrohysterography.

Preterm birth is the leading cause of death in newborns and the survivors are prone to health complications. Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy. The current methods used in clinical practice to diagnose preterm labor, the Bishop score or cervical length, have high negative predictive values but not positive ones. In this work we analyzed the performance of computationally efficient classification algorithms, based on electrohysterographic recordings (EHG), such as random forest (RF), extreme learning machine (ELM) and K-nearest neighbors (KNN) for imminent labor (<7 days) prediction in women with TPL, using the 50th or 10th-90th percentiles of temporal, spectral and nonlinear EHG parameters with and without obstetric data inputs. Two criteria were assessed for the classifier design: F1-score and sensitivity. RFF1_2 and ELMF1_2 provided the highest F1-score values in the validation dataset, (88.17 ± 8.34% and 90.2 ± 4.43%) with the 50th percentile of EHG and obstetric inputs. ELMF1_2 outperformed RFF1_2 in sensitivity, being similar to those of ELMSens (sensitivity optimization). The 10th-90th percentiles did not provide a significant improvement over the 50th percentile. KNN performance was highly sensitive to the input dataset, with a high generalization capability.

Maternal profile according to Mediterranean diet adherence and small for gestational age and preterm newborn outcomes.

OBJECTIVE: The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics. DESIGN: The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case-control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index. SETTING: Obstetrics ward of the La Fe Hospital in Valencia. PARTICIPANTS: All mother-child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent. RESULTS: 14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA. CONCLUSIONS: Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.

Trajectories of stress biomarkers and anxious-depressive symptoms from pregnancy to postpartum period in women with a trauma history.

Background: Cross-sectional studies have found that a trauma history can be associated with anxious-depressive symptomatology and physiological stress dysregulation in pregnant women. Methods: This prospective study examines the trajectories of both anxiety and depressive symptoms and salivary cortisol and α-amylase biomarkers from women with (n = 42) and without (n = 59) a trauma history at (i) 38th week of gestation (T1), (ii) 48 hours after birth (T2), and (iii) three months after birth (T3). Results: The quantile regression model showed that trauma history was associated with higher cortisol levels at T1 and this difference was sustained along T2 and T3. Conversely, there were no significant differences in α-amylase levels between groups across the three time points and both groups showed an increase in α-amylase levels from T2 to T3. The ordinal mixed model showed that trauma history was associated with higher anxiety symptoms at T1 and this remained constant from T1 to T2 but was reversed from T2 to T3. In contrast, both groups showed similar depressive symptoms across the three time points. Conclusions: Whereas physiological stress dysregulation (in terms of higher cortisol levels) was maintained from pregnancy to postpartum period, pregnancy and childbirth were the most vulnerable stages for developing anxious symptoms in mothers with trauma history.

Antecedentes: Los estudios transversales han encontrado que una historia de trauma puede estar asociada con sintomatología ansioso-depresiva y una desregulación del estrés fisiológico en mujeres embarazadas.Métodos: Este estudio prospectivo examina las trayectorias de los síntomas de ansiedad y depresión y los biomarcadores de estrés en saliva (cortisol y α-amilasa) de mujeres con (n = 42) y sin (n = 59) una historia de trauma a las (i) 38 semanas de gestación (T1), (ii) 48 horas después del nacimiento (T2), y (iii) tres meses después del nacimiento (T3).Resultados: El modelo de regresión por cuantiles mostró que la historia de trauma se asoció con niveles más altos de cortisol en T1 y esta diferencia se mantuvo a lo largo de T2 y T3. A la inversa, no hubo diferencias significativas en los niveles de α-amilasa entre los grupos en los tres tiempos y ambos grupos mostraron un aumento en los niveles de α-amilasa de T2 a T3. El modelo mixto ordinal mostró que la historia de trauma se asoció con más síntomas de ansiedad en T1 y esta diferencia se mantuvo constante de T1 a T2, pero se invirtió de T2 a T3. En contraste, ambos grupos mostraron síntomas depresivos similares en los tres tiempos.Conclusiones: Mientras que la desregulación del estrés fisiológico (en términos de niveles más altos de cortisol) se mantuvo desde el embarazo hasta el posparto, el embarazo y el parto fueron las etapas más vulnerables para el desarrollo de síntomas ansiosos en madres con historia de trauma.

Anxiety and depressive symptoms, and stress biomarkers in pregnant women after in vitro fertilization: a prospective cohort study.

STUDY QUESTION: Does in vitro fertilization (IVF) affect the course of anxiety and depressive symptoms as well as physiological stress from pregnancy to postpartum period? SUMMARY ANSWER: IVF mothers have more anxiety symptoms and higher stress biomarker levels but fewer depression symptoms than natural conception mothers at the third trimester of pregnancy, but these differences are negligible during postpartum period. WHAT IS KNOWN ALREADY: Cross-sectional studies have found an association between IVF and high stress levels during the prenatal period. There is, however, no follow-up study about the IVF effect on the mental health status from pregnancy to postpartum, adopting simultaneous measurement of self-reported symptoms and stress biomarkers. STUDY DESIGN, SIZE, DURATION: This is a prospective cohort study. A total of 243 eligible women were recruited during the third trimester of pregnancy (60 women after successful IVF and 183 who conceived naturally). The recruitment was performed during a 12-month period, and the follow-up was carried out until 3 months after delivery. PARTICIPANTS/MATERIALS, SETTING, METHODS: This study was performed in the Division of Obstetrics in a regional referral center. The State scale of the State-Trait Anxiety Inventory (STAI-S) and the Beck Depression Inventory-Sort Form (BDI/SF) were used as anxiety and depression indicators, respectively; salivary cortisol and α-amylase levels as stress biomarkers. Anxiety, depression and stress biomarkers were measured at the third trimester of pregnancy (T1), at 48 h after birth (T2) and at 3 months after birth (T3). Associations with IVF were assessed using ordinal mixed models for anxiety and depressive symptoms and linear quantile models for stress biomarkers. MAIN RESULTS AND THE ROLE OF CHANCE: Relative to natural conception mothers, IVF mothers had higher STAI-S scores at T1 (P = 0.016, odds ratio (OR) = 2.46), and this difference remained steady from T1 to T2 (P = 0.37, OR = 0.70) and from T2 to T3 (P = 0.36, OR = 0.69). In the case of depressive symptoms, the IVF group obtained lower BDI/SF scores at T1 (P < 0.001, OR = 0.192). This difference was apparently reduced from T1 to T2 (P = 0.072, OR = 2.21) and remained constant from T2 to T3 (P = 0.107, OR = 2.09). It is important to note that whereas the mean BDI/SF score was not clinically significant for any group (it was lower than the cut-off 4), the mean STAI-S score of the IVF group at T1 was so (it was higher than the cut-off 19). As for stress biomarkers, IVF mothers had higher cortisol levels at T1 (P = 0.043, Δlog(cortisol) = 0.88) compared to natural conceptions. From T1 to T2 cortisol levels of both groups increased at the relatively same rate (P = 0.81, Δlog(cortisol) = -0.16). However, the progressions tended to be different from T2 to T3, with IVF mothers exhibiting a sharp decrease in cortisol levels (P = 0.059, Δlog(cortisol) = -0.94), while natural conceptions value remained steady. In the case of α-amylase, there were no statistically significant differences between both groups at T1 (P = 0.7, Δlog(α-amylase) = -0.095). On the contrary, while IVF mothers showed sustained α-amylase levels across the time, the progression was different in the natural conception group, who showed a decrease in α-amylase levels from T1 to T2 (P = 0.049, Δlog(α-amylase) = 0.596) and a non-significant increase from T2 to T3 (P = 0.53, Δlog(α-amylase) = -0.283). LIMITATIONS REASON FOR CAUTION: Since this follow-up study has been carried out from the third trimester of pregnancy, the findings cannot be generalized to extremely preterm births. WIDER IMPLICATIONS OF THE FINDINGS: IVF women may have lower depressive symptoms for being pregnant. However, due to the potential pregnancy complications associated with IVF, they may have higher physiological stress and clinically significant anxiety at the third trimester of pregnancy but not during postpartum. Taking into account that both prenatal high maternal cortisol levels and prenatal clinically significant anxiety increase the risk of disturbance in the fetal neurodevelopment, psychological therapy should be extended during pregnancy in IVF women. STUDY FUNDING/COMPETING INTEREST(S): MV funded by FIS PI17/0131 grant from the Instituto de Salud Carlos III (ISCIII) and RETICS funded by the PN 2018-2011, and the European Regional Development Fund, reference RD16/0022/0001; AG-B funded by a 'Juan Rodés' Grant (JR17/00003) from the ISCIII. CC-P funded by a 'Miguel Servet I' Grant (CP16/00082) from the ISCIII. Authors declare no competing interests.

Can stress biomarkers predict preterm birth in women with threatened preterm labor?

BACKGROUND: Preterm birth is a major paediatric challenge difficult to prevent and with major adverse outcomes. Prenatal stress plays an important role on preterm birth; however, there are few stress-related models to predict preterm birth in women with Threatened Preterm Labor (TPL). OBJECTIVE: The aim of this work is to study the influence of stress biomarkers on time until birth in TPL women. METHODS: Eligible participants were pregnant women between 24 and 31 gestational weeks admitted to the hospital with TPL diagnosis (n=166). Stress-related biomarkers (α-amylase and cortisol) were determined in saliva samples after TPL diagnosis. Participants were followed-up until labor. A parametric survival model was constructed based on α-amylase, cortisol), TPL gestational week, age, parity, and multiple pregnancy. The model was adjusted using a logistic distribution and it was implemented as a nomogram to predict the labor probability at 7- and 14-day term. RESULTS: The time until labor was associated with cortisol (p=0.001), gestational week at TPL diagnosis (p=0.004), and age (p=0.02). Importantly, high cortisol levels at TPL diagnosis were predictive of latency to labor. Validation of the model yielded an optimum corrected AUC value of 0.63. CONCLUSIONS: High cortisol levels at TPL diagnosis may have an important role in the preterm birth prediction. Our statistical model implemented as a nomogram provided accurate predictions of individual prognosis of pregnant women.

Colorectal surgery and surgical site infection: is a change of attitude necessary?

INTRODUCTION: Surgical site infection (SSI) can be as high as 30% in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality. The aim of this study is to evaluate the impact of a set of simple preventive measures that have resulted in a reduction in surgical site infection in colorectal surgery. APPLIED METHOD: Prospective study with two groups of patients treated in the colorectal unit of the "Clinico Universitario Lozano Blesa" hospital in Zaragoza. One group was subject to our measures from February to May 2015. The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented. RESULTS: One hundred forty-nine patients underwent a major colorectal surgical procedure. Seventy (47%) belonged to the control group and were compared to the remaining 79 patients (53% of the total), who were subject to our treatment bundle in the period tested. Comparing the two groups revealed that our set of measures led to a general reduction in SSI (31.4 vs. 13.6%, p = 0.010) and in superficial site infection (17.1 vs. 2.5%, p = 0.002). As a consequence, the postoperative hospital stay was shortened (10.0 vs. 8.0 days, p = 0.048). However, it did not, the number of readmissions nor the re-operation rate. SSI was clearly related to open surgery. CONCLUSIONS: The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.

A preliminary study to assess the impact of maternal age on stress-related variables in healthy nulliparous women.

PURPOSE: Childbearing age has progressively increased in industrialized countries. The impact of this delay on motherhood, however, requires further research. METHODS: The study sample included a prospective cohort of healthy nulliparous pregnant women aged between 18 and 40 years (n=148) assessed at 38 weeks gestation (Time#1, T1), 48h after birth (Time#2, T2), and 3 months after birth (Time#3, T3). The effect of age on psychological, biological, and social variables was evaluated. Maternal psychological symptoms in terms of depression and anxiety were assessed at T1-T3; and parenting stress at T3. Stress biomarkers (cortisol, α-amylase) were determined in mothers at T1-T3. Questionnaires addressing social functioning (i.e., family functioning, maternal attitudes, and social support) were conducted at T3. Bayesian additive models were used to analyze the data. RESULTS: Depressive symptoms showed a steep increase starting from 35 years of age at T1 and an U-shaped relationship with a minimum around 30 years old at T3. The same results were observed for parenting stress. Cortisol levels increased sharply from 30 years of age at T3. Family functioning, maternal attitudes, and social support improved moderately from 30 years of age. CONCLUSIONS: Prenatal depressive symptoms were higher in older women, but postpartum depressive symptoms and parenting stress increased in both younger and older women. Nevertheless, cortisol levels just increased in older ages at postpartum. In contrast, social functioning (family functioning, maternal attitudes, and social support) improved with age. We conclude that these social advantages may compensate for other disadvantages of delayed childbearing (i.e., depressive symptoms, parenting stress, and high cortisol level).

Reference ranges for cortisol and α-amylase in mother and newborn saliva samples at different perinatal and postnatal periods.

This paper describes a reliable analytical method based on Ultra High-Performance Liquid Chromatography coupled to tandem mass spectrometry to determine cortisol in saliva samples from healthy mothers (n=87) and newborns (n=65) at different time points: (i) 38 weeks of gestation, (ii) in the immediate postnatal period (48h) after a term delivery and, (iii) 3 months after delivery. The procedure is characterized by a simple sample treatment employing a sample volume of 25µL. In addition to this, salivary α-amylase was determined using a commercial kit. We have proposed potential reference ranges in saliva for cortisol (0.7-35nmolL(-1)) and α-amylase (2-500UmL(-1)) in mothers, and for cortisol (0.1-56nmolL(-1)) and α-amylase (0.1-500UmL(-1)) in newborn infants. In addition, statistical differences between the two sensitive population groups (mothers and newborns) at the perinatal and postnatal periods were studied. A lower concentration for maternal cortisol was found at 38 weeks of gestation than at 48h (p=0.048) or 3 months after delivery (p=0.021). Similar results were found for the α-amylase determinations. Hence, higher concentrations than could be expected from a chronic stress marker were found at 3 months after delivery than at 38 weeks of gestation (p<0.001) or 48h after delivery (p<0.001). We conclude that this analytical method could be applied to further clinical research on perinatal and postnatal stress, such as threatened preterm labor and/or parenting stress, respectively.

Delayed interval delivery of the second twin: obstetric management, neonatal outcomes, and 2-year follow-up.

OBJECTIVES: To evaluate the obstetric management and neonatal outcomes in twin pregnancies with delayed delivery of the second twin, including follow-up. METHODS: This study is a review of four cases of delayed delivery of the second twin in our hospital from 2009 to 2012. The obstetric management of the cases from the expulsion of the first twin to the delivery of the second twin is analyzed. The neonatal outcomes including follow-up for 2 years were reviewed. RESULTS: The first twins were delivered between 15 and 25 weeks (average 21 weeks) and the second twins were delivered between 25 and 31 weeks (average 27 weeks). One first twin (25 %) survived, while three (75 %) second twins survived. Two out of the three second twins delivered after 28 weeks were in satisfactory condition. CONCLUSIONS: The delayed delivery of the second twins which occurred in the third trimester is associated with favorable outcome, however, the risks should not be ignored.

The negative predictive value of cervical interleukin-6 for the risk assessment of preterm birth.

OBJECTIVE: To determine the potential clinical use of cervical interleukin-6 (IL-6) as a negative predictor of preterm birth in symptomatic women. STUDY DESIGN: Observational prospective study carried out in a tertiary hospital. PATIENTS AND METHODS: We studied 100 singleton pregnant women with threatened preterm delivery and intact membranes, between 24 and 34 weeks, recruited during the period 2006-2008. A cervical swab for IL-6 detection was taken and a transvaginal ultrasound scan was performed for measuring the cervical length. RESULTS: Five women delivered within 2 d and six women within 7 d. A high cervical IL-6 concentration was found in these women. The area under the ROC curve for cervical IL-6 was 0.97 for deliveries within 2 d after the test, and 0.85 for deliveries within 7 d. The optimal cut-off point was a cervical IL-6 concentration of 210 pg/ml. The negative predictive value (NPV) was 100% for deliveries within 2 d, and 98.5% for deliveries within 7 d (when considering a prevalence of preterm birth of 8%). Cervical IL-6 and sonographic measurement of cervical length showed similar NPV. CONCLUSION: A low-cervical IL-6 concentration can accurately identify symptomatic women with a very low chance to progress to preterm birth within 2-7 d.