Title Participants Abstract "Prevention and not merely prediction of preterm labor and delivery" "Yves Jacquemyn" "Different methods have been proposed to screen for preterm labor and delivery; most of these aim to predict the risk that preterm delivery is going to take place. However, interesting though this knowledge might be, knowing the future is of no use when no changes can be made. Recent publications have suggested new and exciting modalities to actually diminish the frequency of preterm birth in patients selected by transvaginal cervical length measurement; these modalities include vaginal progesterone and vaginal pessaries. Although promising, many questions remain to be answered; not least about the long term outcome for both neonates and mothers, but also on the eventual introduction of such strategies to the general obstetric population. One of the main problems that urgently needs clarification is how we are going to offer this best of medicine to those needing it most: deprived and socially isolated women who have the highest risk for preterm labor and delivery, probably not due to any congenital cervical problems, but to a combination of environmental, microbiological and social factors, including transgenerational poverty and deprivation." "Economic analysis comparing induction of labor and expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial)" "Sylvia M.C. Vijgen, David P. van der Ham, Denise Bijlenga, Antonius Mulder, et al." "Objective To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM). Design Economic analysis based on a randomized clinical trial. Setting Obstetric departments of eight academic and 52 non‐academic hospitals in the Netherlands. Population Women with PPROM near term who were not in labor 24 h after PPROM. Methods A cost‐minimization analysis was done from a health care provider perspective, using a bottom‐up approach to estimate resource utilization, valued with unit‐costs reflecting actual costs. Main outcome measures Primary health outcome was the incidence of neonatal sepsis. Direct medical costs were estimated from start of randomization to hospital discharge of mother and child. Results Induction of labor did not significantly reduce the probability of neonatal sepsis [2.6% vs. 4.1%, relative risk 0.64 (95% confidence interval 0.251.6)]. Mean costs per woman were 8094 for induction and 7340 for expectant management (difference 754; 95% confidence interval −335 to 1802). This difference predominantly originated in the postpartum period, where the mean costs were 5669 for induction vs. 4801 for expectant management. Delivery costs were higher in women allocated to induction than in women allocated to expectant management (1777 vs. 1153 per woman). Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. Conclusions In women with pregnancies complicated by PPROM near term, induction of labor does not reduce neonatal sepsis, whereas costs associated with this strategy are probably higher." "Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks" "David P. van der Ham, Sylvia M.C. Vijgen, Jan G. Nijhuis, Antonius Mulder, et al." "Background At present, there is insufficient evidence to guide appropriate management of women with preterm prelabor rupture of membranes (PPROM) near term. Methods and Findings We conducted an open-label randomized controlled trial in 60 hospitals in The Netherlands, which included non-laboring women with >24 h of PPROM between 34+0 and 37+0 wk of gestation. Participants were randomly allocated in a 1∶1 ratio to induction of labor (IoL) or expectant management (EM) using block randomization. The main outcome was neonatal sepsis. Secondary outcomes included mode of delivery, respiratory distress syndrome (RDS), and chorioamnionitis. Patients and caregivers were not blinded to randomization status. We updated a prior meta-analysis on the effect of both interventions on neonatal sepsis, RDS, and cesarean section rate. From 1 January 2007 to 9 September 2009, 776 patients in 60 hospitals were eligible for the study, of which 536 patients were randomized. Four patients were excluded after randomization. We allocated 266 women (268 neonates) to IoL and 266 women (270 neonates) to EM. Neonatal sepsis occurred in seven (2.6%) newborns of women in the IoL group and in 11 (4.1%) neonates in the EM group (relative risk [RR] 0.64; 95% confidence interval [CI] 0.25 to 1.6). RDS was seen in 21 (7.8%, IoL) versus 17 neonates (6.3%, EM) (RR 1.3; 95% CI 0.67 to 2.3), and a cesarean section was performed in 36 (13%, IoL) versus 37 (14%, EM) women (RR 0.98; 95% CI 0.64 to 1.50). The risk for chorioamnionitis was reduced in the IoL group. No serious adverse events were reported. Updating an existing meta-analysis with our trial results (the only eligible trial for the update) indicated RRs of 1.06 (95% CI 0.64 to 1.76) for neonatal sepsis (eight trials, 1,230 neonates) and 1.27 (95% CI 0.98 to 1.65) for cesarean section (eight trials, 1,222 women) for IoL compared with EM. Conclusions In women whose pregnancy is complicated by late PPROM, neither our trial nor the updated meta-analysis indicates that IoL substantially improves pregnancy outcomes compared with EM." "Optimizing the strategy of antenatal corticosteroids in threatened preterm labor" "Christoph Lees" "Imbalances between matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) in maternal serum during preterm labor" "Ivo Kroes, Gabriële Holtappels, Bruno Verhasselt, Mario Vaneechoutte, Rita Verhelst" "Non-cardiogenic lung edema in a woman treated with atosiban for preterm labor" "Myriam Hanssens" "No Abstract available." "Elevated soluble triggering receptor expressed on myeloid cells (sTREM)-1 levels in maternal serum during term and preterm labor" "Bart Saerens, Bruno Verhasselt, Mario Vaneechoutte, Rita Verhelst" "Inflammatory response in maternal serum during preterm labour" "Inge Tency, Marleen Temmerman, Mario Vaneechoutte" "Preterm birth (PTB), defined as a delivery before 37 weeks of gestation, is the leading cause of perinatal morbidity and mortality worldwide. Diagnosis of preterm labour as well as accurate prediction of PTB is notoriously difficult. Preterm birth is initiated by multiple mechanisms including infection or inflammation which is the only pathological process for which a firm causal link with PTB has been established. Intrauterine infection evokes an immune response that involves the release of cytokines and chemokines, prostaglandins and matrix-degrading enzymes. These substances trigger uterine contractions, membrane rupture and cervical ripening. Most intrauterine infections are chronic and subclinical in nature and consequently hard to diagnose before labour or rupture of the membranes. The best studied site of infection is amniotic fluid, but this requires an invasive procedure. A non-invasive approach seems to be more relevant to clinical practice. However, few studies have investigated the maternal inflammatory response during preterm labour. Therefore, the overall objective of this study was to determine several inflammatory markers in maternal serum from pregnant women in labour (either term or preterm) vs. non-labouring controls. We completed a nested case control study in which singleton pregnancies were recruited at Ghent University Hospital and divided into groups according to gestational age and labour status. Multiple proteins were evaluated in maternal serum using enzyme-linked or multiplex bead immunoassays including soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), matrix metalloproteinases (MMP)-9 and MMP-3, tissue inhibitor of metalloproteinases (TIMP)-1, TIMP-2, TIMP-3 and TIMP-4 and a panel of 30 cytokines, chemokines and growth factors." "Management of preterm labor: Clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation" "Karel Allegaert" "This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the management of preterm labor. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of examinations with the aim to improve the accuracy in diagnosing preterm labor and allow timely and appropriate administration of tocolytics, antenatal corticosteroids and magnesium sulphate and avoid unnecessary or excessive interventions. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world in the light of scientific literature and serves as a guideline for use in clinical practice." "Inflammatory response in maternal serum during preterm labour" "Inge Tency" "Preterm birth (PTB), defined as a delivery at less than 37 weeks of gestation, is the leading cause of perinatal morbidity and mortality worldwide. The serious effects of PTB on parents, infant and society make PTB an important issue to public health. Despite significant advances in perinatal care and advancing knowledge of risk factors and mechanisms associated with PTB, there has been little progress in reducing the PTB rate. Diagnosis of preterm labour as well as accurate prediction of PTB is notoriously difficult, because of the heterogeneity of the condition. PTB is a syndrome initiated by multiple mechanisms including infection or inflammation which is the only pathological process for which both a firm causal link with PTB has been established and a molecular pathophysiology defined. Intrauterine infection evokes an immune response that involves the release of cytokines and chemokines, prostaglandins and matrix-degrading enzymes. These substances trigger uterine contractions, membrane rupture and cervical ripening. Most intra-uterine infections are chronic and subclinical in nature and consequently hard to diagnose before labour or rupture of the membranes. A tremendous amount of efforts has been expended to identify markers to predict PTB and to improve our understanding of the mechanisms and pathways leading to PTB. The best studied site of infection is amniotic fluid, but obtaining this sample requires an invasive and sometimes risky procedure (e.g. amniocentesis). A non-invasive approach seems to be more relevant to clinical practice because of the feasibility and accessibility. However, few studies have investigated the maternal inflammatory response during preterm labour. Therefore, the overall objective of this study was to determine several inflammatory markers in maternal serum from pregnant women in labour (either term or preterm) vs. non-labouring controls. We completed a nested case control study in which singleton pregnancies were recruited at the obstetric department of Ghent University Hospital and divided into groups according to gestational age and labour status. Multiple proteins were evaluated in maternal serum using enzyme-linked or multiplex bead immunoassays including soluble triggering receptor expressed on myeloid cells-1 (sTRE M-1), matrix metalloproteinases (MMP)-9 and MMP-3, tissue inhibitor of metalloproteinases (TIMP)-1, TIMP-2, TIMP-3 and TIMP-4 and a panel of 30 cytokines, chemokines and growth factors. Our study showed that serum levels of sTRE M-1 were elevated during spontaneous term and preterm labour vs. non-labouring women. sTRE M-1 concentrations were significantly higher in preterm vs. term labour. In line with previous studies, MMP-9 concentrations were elevated during preterm labour. TIMP-1 and TIMP-2 were lower in preterm gestation, irrespective of labour, while TIMP-4 concentrations were raised in labour. One of the most intriguing findings of our study is that MMP-9:TIMP-1 and MMP-9:TIMP-2 balances in maternal serum were tilting in favour of matrix degradation (gelatinolysis) in women with preterm labour. This observation suggests that aberrant serum expression of MMP:TIMP ratios may provide a far less invasive method to determine enzymes essential in the degradation of extracellular matrix (EC M) during pregnancy and parturition. Among the 30 inflammatory serum markers, only hepatocyte growth factor (HGF) was increased in women with PTB, while interleukin (IL)-12 serum levels were lower in labouring women and interferon gamma induced protein (IP)-10 serum levels were higher in women at term gestation. This may indicate that the inflammatory response in serum of women with term and preterm labour is rather weak. Until present, few biomarkers have shown clinical usefulness, because they are nonspecific or become positive too late. Among the biomarkers evaluated to date, the most powerful and consistent predictors of PTB are the presence of foetal fibronectin in cervicovaginal fluid and a short cervix on transvaginal ultrasound examination. The clinical value of both tests primarily lies in their negative predictive value thereby guiding clinicians in decision-making and avoiding unnecessary interventions. During the last decades, it has become clear that single or universal biomarkers will not be capable to predict PTB accurately in all populations. Future research should focus on multiple biomarkers in different PTB subtypes to allow differentiation depending on the underlying causes. The future development of an accurate, minimally invasive multiple marker test is necessary to permit incorporation into clinical practice. The availability of new technologies capable of probing the genome offers exciting possibilities to gain new insights into the mechanisms leading to PTB and to develop targeted therapies."