PRETERM BIRTH - MOTHER AND CHILD Edited by John C. Morrison Preterm Birth - Mother and Child Edited by John C. Morrison Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Anja Filipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published January, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Preterm Birth - Mother and Child, Edited by John C. Morrison p. cm. ISBN 978-953-307-828-1 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Assisted Reproduction and Preterm Birth 1 Offer Erez, Ruth Beer-Weisel, Tal Rafaeli-Yehudai, Idit Erez-Weiss and Moshe Mazor Chapter 2 Environmental Exposures, Genetic Susceptibility and Preterm Birth 47 Regina Grazuleviciene, Jone Vencloviene, Asta Danileviciute, Audrius Dedele and Gediminas Balcius Chapter 3 Clinical Risk Factors for Preterm Birth 73 Ifeoma Offiah, Keelin O’Donoghue and Louise Kenny Chapter 4 Psychobiological Stress and Preterm Birth 95 Curt A. Sandman, Elysia P. Davis and Laura M. Glynn Chapter 5 Oxidative Stress and Antioxidants: Preterm Birth and Preterm Infants 125 Robert A. Knuppel, Mohamed I. Hassan, James J. McDermott, J. Martin Tucker and John C. Morrison Chapter 6 Weakening and Rupture of Human Fetal Membranes – Biochemistry and Biomechanics 151 N. Rangaswamy, D. Kumar, R.M. Moore, B.M. Mercer, J.M. Mansour, R. Redline and J.J. Moore Chapter 7 The Effect of Inflammation on Preterm Birth 183 Grazzia Rey, Silvana Pereyra, Tatiana Velazquez, Daniel Grasso, Justo Alonso, Bernardo Bertoni and Rossana Sapiro Chapter 8 Uterine Contraction Monitoring, Maintenance Tocolysis, and Preterm Birth 201 John C. Morrison, John P. Elliott and Stephen Jones VI Contents Chapter 9 Progestins and Preterm Birth 213 Helen Y. How and Baha M. Sibai Chapter 10 Management of Abnormal Vaginal Flora as a Risk Factor for Preterm Birth 231 Gilbert G.G. Donders and Gert Bellen Chapter 11 Strategies in the Prevention of Preterm Births During and Before Pregnancy 245 Wolf Kirschner and Klaus Friese Chapter 12 Preterm Birth of Extremely Low Birth Weight Infants 263 Jonathan Muraskas, Lisa DeGregoris, Colleen Rusciolelli and Christine Sajous Chapter 13 The Protective Role of Erythropoietin in the Developing Brain 275 Marco Sifringer, Angela M. Kaindl, Stefanie Endesfelder, Clarissa von Haefen, Ivo Bendix and Ursula Felderhoff-Mueser Chapter 14 Preterm Birth and Long-Term Pulmonary Function 301 Indra Narang and Amal Al-Naimi Chapter 15 Cardiovascular Consequences of Preterm Birth in the First Year of Life 319 Karinna Fyfe, Stephanie R. Yiallourou and Rosemary S.C. Horne Chapter 16 The Effect of Preterm Birth on Kidney Development and Kidney Function over Time 341 M.G. Keijzer-Veen and A.J. van der Heijden Preface “…the black of the zebra fish, my past struggles the white, my strengths the blue of my zebra fish, my hope.” Hollidae Robinson, 2011 Clinicians have struggled with the ravages of preterm birth for decades, even centuries, but we have solved many issues through our scientific strengths and there remains considerable hope of reducing the number of preterm births in the future. While there are a multitude studies and books regarding preterm birth, both in the obstetric and the neonatal/pediatric literature, what is missing is the integration of data, from obstetrics through neonatal course, into pediatrics as the neonate transverses childhood. Certainly, pediatricians might wonder why obstetricians cannot keep the baby in utero longer, while obstetricians are rarely apprised of the continued progress of the baby once it is delivered. Obstetricians do not actually know what goes on after the delivery any more than many pediatricians know about what happened during pregnancy, as well as labor, and delivery. This dialogue between specialties is crucial in the battle against preterm birth. While obstetrician looks for causes of preterm birth and strategies for preventing it, the neonatologist searches for treatments for the complications of preterm birth while the pediatrician seeks therapy for long-term morbidity of preterm birth on each organ system of the child. Clearly there needs to be more linkages between the specialties that are divided by birth. This is especially true when confronted with preterm birth because it is certainly problematic for the obstetrician, the neonatologist, and the pediatrician in addition to the hospital, family and society in general. The ultimate goal of this needed dialogue between specialties is to offset the effects or after-effects of preterm birth. In spite of medical advances, preterm birth is still all too common, and it’s ramifications are staggering. Babies that are born preterm, especially before 32 weeks gestation, are associated with the majority of neonatal morbidity and mortality. Preterm delivery before 37 weeks is all too common (i.e., 8-10% of births in X Preface the United States). The reasons for early delivery are varied. For example, fetal disease, such as severe growth restriction, oligohydramnios, or abnormal fetal health assessment tests, may dictate that the infant should be delivered even when it is extremely preterm. Also, maternal factors such as diabetes, preeclampsia, cardiopulmonary disorders, trauma and others may also require early delivery. Similarly, obstetric complications such as preterm labor, preterm premature rupture of the membranes (usually with preterm labor), as well as cervical insufficiency among others, all may lead to birth before 37 weeks. Finally, preterm births may result from iatrogenic causes. Many times, late preterm births (34-37 weeks), occur when the physician deems the baby is near enough to term that attempting preventive treatment should not be undertaken or when the patient refuses treatment (i.e., tocolytics). If the linkages of all these causes of preterm birth are heterogeneous, certainly the etiology of preterm labor also comes in many forms. Preterm labor may occur because of the inflammation, infection, uterine overdistention, cervical insufficiency, illicit drug use, uterine malformations, etc. Complicating matters further; treatment of many causes is usually empiric; since no common etiologic thread is known. Therefore, in women contracting with idiopathic preterm labor, tocolytics are used to stop the contractions rather than using idiologic medications (although none are available) to directly treat the disorder itself, instead of merely treating uterine activity. Lastly, it is difficult to study the treatment modalities, as they last for months. For example, if a patient is treated for acute preterm labor at 26 weeks with intravenous tocolytics, and the contractions are successfully stopped, the effect of that treatment is over within a few hours as the medicine exits the maternal circulation quickly. Continuous tocolytic medications given orally have the problems of patient compliance, and if no treatment is given the risk of recurrent preterm labor and early delivery is high. Unfortunately, the highly successful treatment for prolonging pregnancy with low dose terbutaline administered by continuous infusion pump is no longer available in the U.S. Another problem with preterm birth is the data itself. Some material in articles and practically all the data in books offer information that, while new when written, becomes old in the 1-2 years it takes to publish the results of the latest findings and getting it in the hands of the reader. This is where electronic publishing can be so helpful, as a bridge between researchers and practitioners. The goals for this book on preterm birth are several. First, the subject of preterm birth should be covered from the obstetric, neonatal, and pediatric perspective. Second, the data should be cutting edge, well referenced, and always related to clinical circumstances for the practitioner. Thirdly, via electronic publishing, the data on this subject should be online within a few months of acceptance of each chapter rather than a year or more it takes with traditional publishing. Fourthly, this methodology also should enable the authors to continually update the chapters electronically as new findings become available. Instead of sending off for reprints, obtaining interlibrary loans for references, buying a new textbook, or subscribing to new journals, the data on preterm birth is here reading all at the right price – and it is free. [...]... United States exceeded $26.2 billion in 2005 (Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes, 2007) Preterm birth is associated with short and long term maternal and fetal sequel The 10 Preterm Birth - Mother and Child mothers are at risk of recurrent preterm birth and cardiovascular disease later in life (Nardi, Zureik et al., 2006; Smith, Pell et al.,... multiple gestations and the increased risk for preterm delivery, has become a focus of attention, and the institute of Medicine in the USA has concluded that "Fertility treatments are a significant contributor to preterm birth among both multiple and singleton pregnancies." (Institute of 2 Preterm Birth - Mother and Child Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy... the mother and/ or fetus in both term and preterm labor The fundamental difference between term and preterm parturition is that the former results from physiological activation of the common pathway, while preterm labor arises from pathological processes that extemporaneously activate one or more of the components of the common pathway of parturition 16 Preterm Birth - Mother and Child Preterm labor... multiple gestations and the increased risk for preterm delivery, has become a focus of attention Indeed, the institute of Medicine in the USA has concluded that "Fertility Assisted Reproduction and Preterm Birth 11 treatments are a significant contributor to preterm birth among both multiple and singleton pregnancies." (Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy... a recovery (Atkinson and Marlier, 2010) For example, in Finland the rate of women giving birth after the age of 35 increased from 16.7%in 1997 to 19.2% in 2007 (Lampinen, Vehvilainen-Julkunen et al., 2009) The corresponding mean maternal age in Japan between 1970 and 2000 increased from 25.6 to 28.0 years (Mathews and Hamilton, 2002) 6 Preterm Birth - Mother and Child Delaying childbearing may be attributed... neonates among patients with preterm labor and intact membranes as well as those with preterm PROM, and the higher prevalence of low birthweight in ART pregnancies Decidual bleeding is thought to play a role in the pathogenesis of preterm labor and preterm PROM leading to preterm birth Indeed, hemosiderin deposition, that are regarded as a marker for bleeding are found in the decidua and retro-chorionic hematoma... patients who deliver preterm after PROM between 22 and 32 weeks of gestation, and 36% of patients with preterm delivery and intact membranes (Salafia, LopezZeno et al., 1995) In contrast these lesions are found only in 0.8% of placentas of those who deliver at term 20 Preterm Birth - Mother and Child The effect of decidual bleeding on the activation of premature uterine contractions and/ or rupture of... birth The prevention of preterm birth is one of the major objectives of modern obstetrics In the US there is an initiative to reduce the rate of preterm birth to 6.1% by 2010, and the March of Dimes has made this topic its main field of interest In spite of all efforts, at present there is Assisted Reproduction and Preterm Birth 23 no specific treatment for spontaneous preterm birth and this is attributed... 2001); 2) thrombin and activated coagulation factor X can induce pro inflammatory cytokines production (IL-6 and IL-1) that may leads to prostaglandins generation and premature myometrial activation and contractions (Lockwood, Toti et al., 2005); and 3) thrombin Assisted Reproduction and Preterm Birth 21 activates matrix degrading enzymes such as matrix metalloproteneinases (MMPs) 1, 3 and 9 that can degrade... treatments and preterm birth Indeed, ART are independently associated with preterm birth in singleton as well as in twin gestation 5 The association between preterm birth and assisted reproduction Preterm delivery is the leading cause for perinatal morbidity and mortality worldwide (Goldenberg, Culhane et al., 2008) The annual societal economic burden associated with preterm birth in the United States . PRETERM BIRTH - MOTHER AND CHILD Edited by John C. Morrison Preterm Birth - Mother and Child Edited by John C. Morrison Published. birth among both multiple and singleton pregnancies." (Institute of Preterm Birth - Mother and Child 2 Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes,. Maintenance Tocolysis, and Preterm Birth 201 John C. Morrison, John P. Elliott and Stephen Jones VI Contents Chapter 9 Progestins and Preterm Birth 213 Helen Y. How and Baha M. Sibai Chapter