Objectives Women with a sonographic short cervix in the mid-trimester are at increased risk for preterm delivery. This study was undertaken to determine the ef cacy and safety of using micronized vaginal progesterone gel to reduce the risk of preterm birth and associated neonatal complications in women with a sonographic short cervix. Methods This was a multicenter, randomized, double-blind, placebo-controlled trial that enrolled asymptomatic women with a singleton pregnancy and a sonographic short cervix (10–20 mm) at 19 + 0to23 + 6 weeks of gestation. Women were allocated randomly to receive vaginal progesterone gel or placebo daily starting from 20 to 23 + 6 weeks until 36 + 6 weeks, rupture of membranes or delivery, whichever occurred rst. Randomization sequence was strati ed by center and history of a previous preterm birth. The primary endpoint was preterm birth before 33 weeks of gestation. Analysis was by intention to treat. Results Of 465 women randomized, seven were lost to follow-up and 458 (vaginal progesterone gel, n = 235; placebo, n = 223) were included in the analysis. Women allocated to receive vaginal progesterone had a lower rate of preterm birth before 33 weeks than did those allocated to placebo (8.9% (n = 21) vs 16.1% (n = 36); relative risk (RR), 0.55; 95% CI, 0.33–0.92; P = 0.02). The effect remained signi cant after adjustment for covariables (adjusted RR, 0.52; 95% CI, 0.31–0.91; P = 0.02). Vaginal progesterone was also associated with a signi cant reduction in the rate of preterm birth before 28 weeks(5.1%vs10.3%; RR, 0.50;95%CI, 0.25–0.97; P = 0.04) and 35 weeks (14.5% vs 23.3%; RR, 0.62; 95% CI, 0.42–0.92; P = 0.02), respiratory distress syndrome (3.0% vs 7.6%; RR, 0.39; 95% CI, 0.17–0.92; P = 0.03), any neonatal morbidity or mortality event (7.7% vs 13.5%; RR, 0.57; 95% CI, 0.33–0.99; P = 0.04) and birth weight < 1500 g (6.4% (15/234) vs 13.6% (30/220); RR, 0.47; 95% CI, 0.26–0.85; P = 0.01). There were no differences in the incidence of treatment-related adverse events between the groups. Conclusions The administration of vaginal progesterone gel to women with a sonographic short cervix in the mid-trimester is associated with a 45% reduction in the rate of preterm birth before 33 weeks of gestation and with improved neonatal outcome.

Objective To report mode of delivery and immediate neonatal outcome in women infected with COVID-19. Design Retrospective study. Setting Twelve hospitals in northern Italy. Participants Pregnant women with COVID-19-confirmed infection who delivered. Exposure COVID 19 infection in pregnancy. Conclusions Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.

The relationship between maternal cigarette smoking during pregnancy and obstetric complications is well established. Previous studies suggest a dose-response relationship with increasing risks for complications associated with increased number of cigarettes smoked and duration of smoking during pregnancy. Little data are available for the risks of adverse pregnancy outcomes among nonsmoking women following exposure to environmental tobacco smoke (ETS; secondhand smoke). A number of meta-analyses have found that ETS reduces mean birth weight and may increase the risk of low birth weight but does not seem to affect gestational age or the rate of preterm birth. There is little or no information on other adverse perinatal outcomes.This retrospective cohort study investigated the effects of ETS on perinatal outcomes in a population of nonsmoking women with singleton pregnancies. The participants were identified using the Newfoundland and Labrador Provincial Perinatal Database. Perinatal outcomes were compared between women with self-reported exposure to ETS (n ϭ 1202; 11.1%) and those with no exposure (n ϭ 10,560; 89.9%). Multiple logistic regression models were used to compare outcomes between the 2 groups, adjusting for maternal age, parity, partnered status, work status, level of education, body mass index, alcohol use, illicit drug use, and gestational age at delivery. The primary study outcome measures were birth weight, head circumference, birth length, and stillbirth. Secondary outcomes examined were prelabor rupture of membranes, gestational age at delivery (including preterm birth Ͻ37 weeks and Ͻ34 weeks of gestation), Apgar score, endotracheal intubation for resuscitation, neonatal intensive care unit admission, congenital anomalies, respiratory distress syndrome, intraventricular hemorrhage, necrotising enterocolitis, neonatal bacterial sepsis, jaundice, and neonatal metabolic abnormalities.Independent risk factors associated with exposure to ETS included lower mean birth weight (adjusted odds ratio [aOR], Ϫ53.7 g; 95% confidence interval [CI], Ϫ98.4 to Ϫ8.9 g), smaller head circumference (aOR,Ϫ0.24 cm; 95% CI, Ϫ0.39 to Ϫ0.08 cm), shorter birth length (aOR, Ϫ0.29 cm; 95% CI, Ϫ0.51 to Ϫ0.07 cm), stillbirth (aOR, 3.35; 95% CI, 1.16-9.72), trends toward preterm birth Ͻ34 weeks (aOR,1.87; 95% CI, 1.00-3.53), and neonatal sepsis (aOR, 2.96; 95% CI, 0.99-8.86); all P values were Յ0.05.These findings show an association between exposure of nonsmoking pregnant women to ETS with several adverse perinatal outcomes, including reduced birth weight, smaller head circumferences, stillbirth, and shorter birth length.

Introduction Intra-amniotic inflammation is traditionally defined as an elevation of amniotic fluid interleukin (IL)-6. Previous case control studies have suggested an association between an elevated midtrimester amniotic fluid IL-6 and preterm delivery, although such an association has been recently challenged. Intra-amniotic inflammation can also be defined by an elevation of the T-cell chemokine, Interferongamma-inducible protein (IP)-10. An elevation in amniotic fluid IP-10 has been associated with chronic chorioamnionitis, a lesion frequently found in late spontaneous preterm birth and fetal death. In contrast, an elevation in amniotic fluid IL-6 is typically associated with acute chorioamnionitis and funisitis. This study was conducted to examine the relationship between an elevation in amniotic fluid IL-6 in the midtrimester and preterm delivery at or before 32 weeks of gestation, and the amniotic fluid concentration of IP-10 and preterm delivery after 32 weeks of gestation. Materials and methods This cohort study included 847 consecutive women undergoing genetic midtrimester amniocentesis; in 796 cases, amniotic fluid and pregnancy outcome was available for study after exclusion of abnormal karyotype and/or fetal congenital anomalies. Spontaneous preterm delivery was defined as early (≤ 32 weeks) or late (after 32 completed weeks of pregnancy). The amniotic fluid and maternal blood concentrations of IL-6 and IP-10 were measured by specific immunoassays. Results 1) The prevalence of preterm delivery was 8.3% (66/796), while those of early and late spontaneous preterm delivery were 1.5% (n = 12), and 4.5% (n = 36), respectively; 2) patients who had a spontaneous preterm delivery after 32 weeks of gestation had a higher median amniotic fluid IP-10 concentration than those who delivered at term [median 713 pg/mL, inter-quartile range (IQR) 509 – 1427 pg/mL vs. median 589 pg/mL, IQR 402 – 953 pg/mL; P = 0.006] and an elevation of amniotic fluid IP-10 concentration above 502 pg/mL (derived from an ROC curve) was associated with late spontaneous preterm delivery [odds ratio 3.9 (95% CI 1.6 – 9.9)]; 3) patients who had a spontaneous preterm delivery ≤ 32 weeks of gestation had a higher median amniotic fluid IL-6 concentration than those who delivered at term [median 2052 pg/mL, IQR 435 – 3015 pg/mL vs. median 414 pg/mL, IQR 209 – 930 pg/mL; P = 0.006], and an elevated amniotic fluid IL-6 concentration above 1740 pg/mL (derived from an ROC curve) was associated with early spontaneous preterm delivery [odds ratio 9.5 (95% CI 2.9 – 31.1)]; 4) subclinical intra-amniotic inflammation, defined as an elevation of IL-6 (≥ 2.9 ng/mL) or IP-10 (≥ 2.2 ng/mL) concentration above the 95th percentile of patients who had uncomplicated term delivery (n = 652 for IL-6 and n = 633 for IP-10), was observed in 6.3% (50/796) and 5.8% (45/770) of cases, respectively. Although each type of inflammation is a risk factor for spontaneous preterm delivery, many patients had a term delivery without complication; 5) the amniotic fluid ...

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Recent molecular studies concluded that the endometrium has a resident microbiota dominated by Lactobacillus spp. and is therefore similar to that of the vagina. These findings were largely derived from endometrial samples obtained through a transcervical catheter and thus prone to contamination. Herein, we investigated the molecular microbial profiles of mid-endometrial samples obtained through hysterectomy and compared them with those of the cervix, vagina, rectum, oral cavity, and controls for background DNA contamination. Microbial profiles were examined through 16S rRNA gene qPCR and sequencing. Universal bacterial qPCR of total 16S rDNA revealed a bacterial load exceeding that of background DNA controls in the endometrium of 60% (15/25) of the study subjects. Bacterial profiles of the endometrium differed from those of the oral cavity, rectum, vagina, and background DNA controls, but not of the cervix. The bacterial profiles of the endometrium and cervix were dominated by Acinetobacter , Pseudomonas , Cloacibacterium , and Comamonadaceae. Both 16S rRNA gene sequencing and Lactobacillus species-specific ( L . iners & L crispatus ) qPCR showed that Lactobacillus was rare in the endometrium. In conclusion, if there is a microbiota in the middle endometrium, it is not dominated by Lactobacillus as was previously concluded, yet further investigation using culture and microscopy is necessary.

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Women with endometriosis at first pregnancy have an increased risk of impaired obstetric outcome, while a reduced number of complications occur in the successive gestation. Therefore, it is worthy for obstetricians to increase the surveillance in nulliparous women with endometriosis during pregnancy.