Explore the vast range of titles available.

It has been hypothesized that oxidative stress may underlie the development of preeclampsia. In this large, multicenter, randomized, double-blind trial involving low-risk, nulliparous women, supplementation with 1000 mg of vitamin C and 400 IU of vitamin E, beginning in the 9th to 16th week of pregnancy, did not reduce the rates of adverse maternal or perinatal outcomes related to pregnancy-associated hypertension. Supplementation with 1000 mg of vitamin C and 400 IU of vitamin E, beginning in the 9th to 16th week of pregnancy, did not reduce the rates of adverse maternal or perinatal outcomes related to pregnancy-associated hypertension. Preeclampsia has been considered to be a two-stage disorder. Abnormal placentation or perfusion results in an increased inflammatory response and endothelial dysfunction, which in turn lead to the characteristic maternal syndrome. 1 Oxidative stress is one of several mechanisms that have been proposed to cause manifestations of the disease; it has been suggested that the generation of free radicals in response to reduced placental perfusion may lead to clinical manifestations. 2 Support for this concept is provided by data showing that there are oxidative modifications of proteins, 3 , 4 lipids, 2 , 5 , 6 and DNA 7 in the blood and tissue of women with preeclampsia . . .

Women with a history of preterm delivery are at high risk for recurrence in subsequent pregnancies, and an effective strategy to reduce this risk has been lacking. In this randomized, placebo-controlled trial, weekly injections of 17 alpha-hydroxyprogesterone caproate reduced the risk of delivery before 37 weeks of gestation by one third among such high-risk women. Injections of 17 alpha-hydroxyprogesterone reduced the risk among high-risk women. Preterm delivery — that is, delivery before 37 completed weeks of gestation — is the major determinant of infant mortality in developed countries. 1 Preterm delivery is more common in the United States than in many other developed countries and is the factor most responsible for the relatively high infant mortality in this country. 1 The rate of preterm delivery in the United States has increased progressively from 9 percent to 12 percent over the past two decades. 2 Despite many trials of reduced activity, tocolytic therapy, antibiotic therapy, and other strategies for prevention, no effective and reproducible method of preventing preterm delivery . . .

Differences in circulating concentrations of antiangiogenic factors sFlt1 and soluble endoglin (sEng) and the pro-angiogenic growth factor PlGF are reported to precede the onset of preeclampsia weeks to months in low-risk pregnant women. The objective of this study was to investigate whether similar changes can be detected in pregnant women at high-risk to develop the syndrome. This study is a secondary analysis of the NICHD MFMU trial of aspirin to prevent preeclampsia in high-risk pregnancies. Serum samples were available from 194 women with pre-existing diabetes, 313 with chronic hypertension, 234 with multifetal gestation, and 252 with a history of preeclampsia in a previous pregnancy. Samples collected across pregnancy were analyzed in a blinded fashion for sFlt1, sEng and PlGF. The odds of developing preeclampsia were significantly increased among women with multiple fetuses for each 2-fold elevation in sFlt1, sEng and the ratio of angiogenic factors (e.g. OR 2.18, 95% CI 1.46-3.32), and significantly decreased for each 2-fold elevation in circulating PlGF (OR 0.50, 95% CI 0.30-0.82) between 7 and 26 weeks' gestation. Cross-sectional analysis of the angiogenic factors across gestation showed significant differences during the third trimester in women who develop preeclampsia compared with appropriate controls in all high-risk groups. However, when data were examined in relation to the gestational week when preeclampsia was diagnosed only sFlt1 was significantly higher 2 to 5 weeks before the clinical onset of preeclampsia and only in women with previous preeclampsia. The pattern of elevated concentrations of sFlt1 and sEng, and low PlGF in high-risk pregnant subjects who develop preeclampsia is similar to that reported in low-risk pregnant women. However, differences in these factors among high-risk women who do and do not develop preeclampsia are modest, and do not appear to be clinically useful predictors in these high-risk pregnant women.

Changes in maternal concentrations of the anti-angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng), and the pro-angiogenic placental growth factor (PlGF) precede the development of preeclampsia in healthy women. The risk of preeclampsia is reduced in women who smoke during pregnancy. The objective of this study was to investigate whether smoking affects concentrations of angiogenic factors (sFlt1, PlGF, and sEng) in women at high risk for developing preeclampsia. We performed a secondary analysis of serum samples from 993 high-risk women (chronic hypertension, diabetes, multifetal gestation, and previous preeclampsia) in a preeclampsia prevention trial. sFlt1, sEng and PlGF were measured in serum samples obtained at study entry, which was prior to initiation of aspirin (median 19.0 weeks' [interquartile range of 16.0-22.6 weeks']). Smoking status was determined by self-report. sFlt1 was not significantly different in smokers from any high-risk groups compared to their nonsmoking counterparts. PlGF was higher among smokers compared to nonsmokers among diabetic women (142.7 [77.4-337.3] vs 95.9 [48.5-180.7] pg/ml, p = 0.005) and women with a history of preeclampsia (252.2 [137.1-486.0] vs 152.2 [73.6-253.7] pg/ml, p = 0.001). sEng was lower in smokers with multifetal gestations (5.8 [4.6-6.5] vs 6.8 [5.5-8.7] ng/ml, p = 0.002) and trended lower among smokers with diabetes (4.9 [3.8-5.6] vs 5.3 [4.3-6.3] ng/ml, p = 0.05). Smoking was not associated with a lower incidence of preeclampsia in any of these groups. In certain high-risk groups, smoking is associated with changes in the concentrations of these factors towards a pro-angiogenic direction during early pregnancy; however, there was no apparent association between smoking and the development of preeclampsia in our cohort.

Preterm delivery is the chief problem in obstetrics today, accounting for 70 percent of perinatal mortality and nearly half of long-term neurologic morbidity. 1 , 2 Approximately 10 percent of all births are preterm, but most of the serious illness and death is concentrated in the 1 to 2 percent of infants who are born at less than 32 weeks of gestation and who weigh less than 1500 g. Approximately 20 percent of preterm births are the result of a physician's decision to bring about delivery for maternal or fetal indications, and the remainder follow the spontaneous onset of labor or rupture . . .

In this multicenter, four-year observational study of women with a history of cesarean section and a singleton gestation, a trial of labor was associated with a higher risk of symptomatic uterine rupture in the mother and hypoxic–ischemic encephalopathy in the infant than was elective cesarean delivery, although the absolute risks of these complications were low. The findings from this study should help inform women about their choices regarding the type of delivery after a prior cesarean section. The findings from this study should help inform women about their choices regarding the type of delivery after a prior cesarean section. The overall rate of cesarean delivery in the United States has risen dramatically, from 5 percent of all deliveries in 1970 to a high of 26 percent in 2002. 1 Efforts to reduce the number of cesarean births, although initially successful, failed to achieve the U.S. Public Health Service goals, set in 1990. These goals included achieving an overall rate of cesarean delivery of 15 percent, and a rate of vaginal birth after previous cesarean section of 35 percent of deliveries after previous cesarean sections, by the year 2000. 2 The Healthy People 2010 report published in 2000 proposes a target rate . . .

Preterm birth is a common cause of neonatal morbidity and mortality. An extensive body of evidence indicates that infection is associated with preterm delivery and with low birth weight of the infant. 1 Chorioamnionitis is strongly correlated with preterm delivery 2 , 3 and the failure of tocolytic-drug therapy. 4 Evidence of infection, manifested by the presence of organisms or inflammatory cytokines in the amniotic fluid or chorioamniotic membranes, 3 – 5 commonly accompanies preterm labor and preterm premature rupture of membranes, particularly at the earliest gestational ages. Most microorganisms found in the amniotic fluid and placenta are thought to come from the vagina, especially among . . .

Infection with Trichomonas vaginalis has been associated with an increase in adverse outcomes of pregnancy. In the Vaginal Infections and Prematurity Study, pregnant women colonized with T. vaginalis had a 30 percent higher risk of delivering an infant with low birth weight or delivering before term, a 40 percent higher risk of giving birth to an infant who was both preterm and of low birth weight, and nearly twice the risk of stillbirth or neonatal death, as compared with women without T. vaginalis colonization. 1 Eleven percent of preterm deliveries among African-American women have been considered potentially attributable to trichomoniasis. 1 Trichomoniasis . . .

Background. Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations studied limit acceptance of the data. Methods. We randomly assigned 4589 healthy nulliparous women who were 13 to 21 weeks pregnant to receive daily treatment with either 2 g of elemental calcium or placebo for the remainder of their pregnancies. Surveillance for preeclampsia was conducted by personnel unaware of treatment-group assignments, using standardized measurements of blood pressure and urinary protein excretion at uniformly scheduled prenatal visits, protocols for monitoring these measurements during the hospitalization for delivery, and reviews of medical records of unscheduled outpatient visits and all hospitalizations. Results. Calcium supplementation did not significantly reduce the incidence or severity of preeclampsia or delay its onset. Preeclampsia occurred in 158 of the 2295 women in the calcium group (6.9 percent) and 168 of the 2294 women in the placebo group (7.3 percent) (relative risk, 0.94; 95 percent confidence interval, 0.76 to 116). There were no significant differences between the two groups in the prevalence of pregnancy-associated hypertension without preeclampsia (15.3 percent vs. 17.3 percent) or of all hypertensive disorders (22.2 percent vs. 24.6 percent). The mean systolic and diastolic blood pressures during pregnancy were similar in both groups. Calcium did not reduce the numbers of preterm deliveries, small-for-gestational-age births, or fetal and neonatal deaths; nor did it increase urolithiasis during pregnancy. Conclusions. Calcium supplementation during pregnancy did not prevent preeclampsia, pregnancy-associated hypertension, or adverse perinatal outcomes in healthy nulliparous women.

Preterm delivery is the primary cause of perinatal mortality in the United States. To date, no effective means of preventing spontaneous preterm delivery has been identified. At least in some cases, however, microbial colonization of the fetal membranes or the amniotic fluid, or alterations in the vaginal flora such as are seen in patients with bacterial vaginosis, have been associated with spontaneous labor and preterm delivery. 1 – 10 We undertook a prospective, double-blind trial to address three questions. First, does antimicrobial therapy reduce the incidence of preterm delivery in women at risk for preterm delivery? Second, does antimicrobial therapy reduce the . . .