Special Issue "Pathogenesis, Diagnosis, and Treatment of Preterm Delivery"

A special issue of Medicina (ISSN 1010-660X). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: 1 April 2021.

Special Issue Editors

Prof. Dr. Simone Ferrero
Website
Guest Editor
IRCCS, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
Interests: Angiogenesis; gynecological surgery; intrauterine growth restriction; preterm delivery
Special Issues and Collections in MDPI journals
Dr. Fabio Barra
Website
Co-Guest Editor
IRCCS, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
Interests: endometriosis; inflammation; minimally invasive surgery
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Dr. Carolina Scala
Website
Co-Guest Editor
Ospedale Gaslini, Genova, Italy
Interests: Amniotic fluid; intrauterine growth restriction; obstetrics ultrasonography; prenatal diagnosis; preeclampsia
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Preterm birth is defined as delivery prior to 37 weeks of gestation, and it is still one of the biggest problems in obstetrics. Preterm delivery has remained the major contributor to neonatal morbidity and mortality globally. Although disability-free survival rates have increased over the years, as a result of improved facilities and treatments, preterm birth is still accountable for 75% of all perinatal deaths and >50% of morbidities. Morbidity and mortality are strongly related to gestational age; of those infants born at <30 weeks of gestation, only 25% are free of disabilities at the age of five years.

In most cases, it occurs unexpectedly in women at low risk. Under these circumstances, it requires an elaborate clinical workup; however, it is a time-saving antenatal procedure for caregivers and patients. Preterm delivery is the consequence of four main mechanisms: activation of the maternal–fetal placental interaction with the hypothalamic–pituitary–adrenal axis, inflammation in the amniochorionic–decidual tissue, decidual hemorrhage, and pathological distention of the myometrium.

Historically, risk assessment has been based on digital vaginal examination. The addition of transvaginal sonographic measurement of the cervical length is of value in the prediction of preterm birth within one week. Identification of women at high risk of preterm delivery can be improved by adding fetal fibronectin testing to cervical length measurement. Fetal fibronectin is a protein produced by fetal cells and can be found at the border of the chorion and the decidua. Fetal fibronectin is released into the vagina when a preterm delivery is likely to occur and may be measured using a vaginal swab. The use of cervical length measurement in combination with the fetal fibronectin test is the most accurate and cost-effective way to discriminate between women at high and low risk of delivering within seven days.

Women at high risk of preterm delivery, with a gestational age of between 26+0 and 34+6 weeks, should be treated with a single course of antenatal corticosteroids for 48 h. The glucocorticoids used for antenatal administration are dexamethasone and betamethasone. A single course of antenatal corticosteroids significantly improves short- and long-term outcomes from 26 weeks of gestational age onwards.

Neonatal morbidity and mortality are inversely related to gestational age; therefore, it has been suggested that the prolongation of pregnancy ensures better pregnancy outcomes. Tocolytic therapy has been proven to prolong pregnancy. Its use should be restricted to 48 h in order to transport the patient with a threatened preterm birth to a center with neonatal intensive care unit facilities and to allow for corticosteroids to be administered.

Preterm babies are at high risk of poor neurological outcomes, including periventricular leukomalacia and intraventricular hemorrhage. Cerebral palsy is mostly seen in infants with periventricular leukomalacia but can also be found in infants with intraventricular hemorrhage. Magnesium sulfate improves short-term neurologic outcomes, such as cerebral palsy and gross motor function, and should be administered in women with imminent preterm delivery at <32 weeks of gestation.

Routine prophylactic antibiotic therapy is not recommended in preterm labor with intact membranes. However, pregnancy with premature preterm rupture of membranes (pPROM) should be treated as high risk of intrauterine infection, and therefore, in these pregnancies, antibiotic treatment with erythromycin is recommended.

Prof. Dr. Simone Ferrero
Guest Editor
Dr. Fabio Barra
Dr. Carolina Scala
Co-Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • preterm delivery
  • pregnancy
  • uterine cervix
  • cervical cerclage
  • progesterone
  • fibronectin
  • preterm rupture of membranes

Published Papers

This special issue is now open for submission.
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