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Article
The Role of Tumor Necrosis Factor-Alpha (TNF-Α) in The Induction of Preterm Labor

Authors: Taiseer Abdul Ilah AL Hussainy --- Mohammad A. K. Al-Sa’adi --- Mohammad Sabri A. Razzak
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2010 Volume: 3 no.1 Issue: 6 Pages: 779-783
Publisher: Kerbala University جامعة كربلاء

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Abstract

Abstract
Background: Microbial colonization and inflammation in the maternal genital tract has emerged as one of the major risk factors associated with spontaneous preterm birth.
Objectives: this study aimed to demonstrate the role of tumor necrosis alpha(TNF-α)in the induction of preterm labor.
Materials and methods: This study was conducted in Babylon Teaching Hospital of Gynecology and Pediatrics from November 2007 to May 2008. A total of 60 pregnant women with preterm labor admitted to Labor Room and 20 control women (10 of them were pregnant at term with bacterial infection, 5 were pregnant at term without bacterial infection, and 5 were normal females not pregnants and not infected) were included in this study. The ages of patients and controls ranged from (17-40) years. Blood samples were collected from both patients and controls to estimate tumor necrosis factor alpha (TNF-α by EASIA (Enzyme Amplified Sensitivity Immunoassay) method.
Results: The results show there is significantly higher (p<0.05) in the level of TNF- α in patients with preterm labor compared to all control groups.
Conclusion: The results clearly indicate the possible role of TNF-α in the induction of preterm labor.
Keywords: preterm labor, TNF-α

Keywords

preterm labor --- TNF-α


Article
6.EFFECT OF PROGESTERONE IN LOWERING MATERNAL PLASMA CORTICOTROPIN-RELEASING HORMONE IN PATIENTS WITH PRETERM LABOR

Authors: Enas M. Yaseen ايناس محمد ياسين --- Athraa Fadhil Abd ايثار فاضل عبد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2019 Volume: 17 Issue: 1 Pages: 32-42
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Preterm labor is a major obstetrics problem because it associated with high morbidity and mortality to the born baby. Many studies were done to study different aspects of its risk factors, diagnosis and treatment to decrease its incidence, bad sequel to the fetus and recurrence.Objective:To evaluate the role of progesterone in lowering CRH level in plasma of patient with preterm labor.Methods:This study is a case control study. Forty-five pregnant women with preterm labor were included in the study and basal plasma Corticotropin releasing hormone (CRH) level was done for each patient. All patients were given oral tocolytic drug, with an initial bolus of 20 mg Nifedipine followed by 10 mg three times daily. They received betamethasone injection (12 mg) 24 hours after hospitalization. Then after stabilization of each patient with random selection, 25 patients were included in group (1) and were given progesterone injection. Twenty patients were included in group (2) or control group because no progesterone injection was given to them. After 24 hours of admission to the hospital, plasma CRH level was measured for both groups with evaluation of the outcome of each patient with preterm labor.Results:Progesterone is more effective in lowering CRH level in patients with preterm labor. In study of 45 cases of preterm labor, the mean CRH level of group (1) decreased from 33.41 ng/ml to 22.12 ng/ml, while the mean level of it in group (2) increased from 27.44 ng/ml to 28.54 ng/ml. Conclusion:Progesterone treatment is effective in lowering CRH level in patients with preterm labor. This would have a positive effect in prolonging the pregnancy period in these patients.Keywords:Preterm labor, progesterone, CRHCitation;Yaseen EM, Abd AF. Effect of progesterone in lowering maternal plasma corticotropin-releasing hormone in patients with preterm labor. Iraqi JMS. 2019; 17(1): 32-42. doi: 10.22578/IJMS.17.1.6

Keywords

Preterm labor --- progesterone --- CRH


Article
The Benefit of Prophylactic Cervical Cerclage in Twin Pregnancies

Author: Iman Yousif Abdulmalek
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2019 Volume: 16 Issue: 2 Pages: 128-135
Publisher: Babylon University جامعة بابل

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Abstract

Background: Despite the progress in modern obstetric practice, preterm labor is second leading cause of death in the 1st month of life and the maincause of perinatal morbidity and mortality; it remains a difficult problem to prevent, delay or even stop. It occurs in 5%–13% of all pregnancies before37 weeks’ gestation but its incidence in twin pregnancies is about 25%. Objectives: This study aimed to determine the effect of prophylactic cervicalcerclage (CC) in comparison to others methods: vaginal progesterone and bed rest in prolongation of gestational age in twin pregnancies to preventpreterm labor. Materials and Methods: A retrospective descriptive study was conducted between January 2012 and September 2018, in a privateobstetric antenatal care clinic in Duhok/Kurdistan Region/Iraq. It involved 150 women with twin pregnancies attending this clinic for follow‑up,they divided into: Group 1 (N‑86): women who received prophylactic CC; Group 2 (N‑44): those who got the vaginal progesterone supplementationof 100 mg from 20 to 34 weeks of gestation; and Group 3 (N‑20): those who asked for advisement of bed rest and restriction of physical activity.Results: Most of the total sample 95.3% had dichorionic placenta, the majority of them 84.7% were the result of assisted reproductive techniques.There was no statistically significant difference between the three groups in relation to maternal age, gravid, and previous preterm delivery, but therewas in relation to the gestational age at delivery. In Group 1, 93% who delivered >37 weeks, whereas 16% and 10% in Group 2 and Group 3 whodelivered at this gestational age, respectively. The overall perinatal survival was 91.3% and 26.6% who admitted to Neonatal Intensive Care Unit.Conclusions: The current study found that the prophylactic CC was an effective method to prolong pregnancy among women with twin pregnancies


Article
Effectiveness and safety of the oxytocin antagonist( atosiban) versus beta-adrenergic agonists (salbutamol) in the treatment of preterm labor.

Authors: Yasamin H. Sharif Al-Shibany ياسمين حمزة شريف --- Saba M. Swadi Al- Thuwainy صبا مطشر الثويني
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 20 Pages: 176-183
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background and Objectives: preterm labor complicates 5-10% of pregnancies and is a leading cause of neonatal morbidity and mortality worldwide and 70-80% of perinatal deaths occur in preterm infants. The aim of this study is to compare the effectiveness, safety and adverse effects of the oxytocin antagonist medication(atosiban) with those of beta-adrenergic agonist (salbutamol) in the treatment of patients with preterm labor.Patients and Methods: one hundred pregnant women with preterm labor were enrolled in this study from the period of( January 2014 – January 2015) at Al-Diwaniya Maternity and Pediatrics Teaching Hospital-Iraq with a gestational age of 24-34 weeks, they were randomly assigned to receive tocolytics either salbutamol (n=50) or atosiban (n=50).Salbutamol was given by(intravenous infusion 10-50 microgram)for up to 48 hour. Atosiban was given by (intravenous bolus dose of 6.75 mg then 300microgram/minute for 3 hour and 100microgram/minute for up to 48hour). Retreatment with the study drugs or alternative tocolytic agents was allowed. Main outcome measures included were tocolytic effectiveness, which was assessed in terms of number of women undelivered after 48hour and 7 days. Tocolytic safety was assessed in terms of maternal and fetal side effects and neonatal morbidity.Results: there were no significant differences between the salbutamol and the atosiban group in prolongation of pregnancy for 48 hour (44% versus67746%;p=0841)and 7 days(20% versus 32%;p=0.171) ,respectively. Maternal adverse events , including tachycardia occurred more frequently in the salbutamol group(22% versus 8%;p=0.050).Neonatal outcomes and complications were comparable between the two study groups(42% versus 32%;p=0.30).Conclusions: the oxytocin antagonist (atosiban) was as effective as beta-agonist(salbutamol) in delaying threatened preterm birth , and found to be better tolerated by both the mother and fetus than salbutamol , with a comparable neonatal safety profil.This study supports the clinical use of atosiban as a first line tocolytic in the treatment of preterm labor

التأثيرات و الاعراض الجانبية لاستتداا عاتاا الاسيستيبا و عتي عاضتد ضلاتاس لووينيتيستيي الب ترعنتا ضنتتابوت الدةيتة قالنااانتة ضتا عاتاا النتالبييساضي وعتي عاضتد ضالتي لننتتابوت البيتتا ت الدةيتة الب تر ةلعوج حالات اليلاسة النبكرة.الطر اة: أجر ت الاااسة ضنت لى اليلاسة و الأطلا التعةين الا يانية العراق , لةلترة ضتي هت ر يتاني -الثان / 4102 و لغا ة ه ر ياني الثان / 4102 ( عةى 011 اضرأة حاضد قعنر 52 01 ستنة( و اسلةتي التى نت -الطتياا ضتا اعتراض لةتيلاسة النبكترة و يانتت تترة الانتد ضتي 52 42 أستبي ( ضتا وجتيس انابالتات لةترح -سنتغرق 51 ثانية قنعا ≤ أاقعة انابالات لو 01 س ياة و يا اسنا عنق الرح ضي 0الى 5 س (و 1التى 5س (لةنياات عا نة اليلاسة وسرعة نبض الجنيي طبيعية , س ساني النر لاات الى ضجنيعتيي: النجنيعة الأولتىو عاسعا 21 ضر لاتة عيلجتت قعاتاا النتالبييساضي عتي طر تق ضاةتي الااتي اليا تا و النجنيعتة الثانيتة 21ضر لاة عيلجت قعاااالاسيسيبا اليا ا ضا ضرا بة هاة الانابالات و الاعراض الجانبية لكد عااا عةى الا والجنيي لغرض سألير اليلاسة النبكرة و ساةيد النلااعلات النر ر ة و الي يات لاى النياليا الداج حا ث اليلاسة.النتتتا: : لتت كتتي عنتتاف التتتو تت ستتألير حتتالات التتيلاسة النبكتترة لنتتاة 21 ستتاعة 22 % ضااقتتد 20 %( و 7أ تا 41 % ضااقتتد 54 %( قتيي النجنيعتتة الأولتى و الثانيتتة عةتى التتتيال و لكتي الاعتتراض الجانبيتة ضثتتد سنتتاانبلاات ةب الا يانت ايثر عنا النجنيعة الأولى الت عيلجت قعاتاا النتالبييساضي 44 % ضااقتد 1%(.لت سكتيعناف التو ات النتا: الإحصا:ية لةنلااعلات النر ر ة لاى النياليا الداج حا ث اليلاسة قيي النجنيعتيي.الاستتنتاج: استتداا عاتاا الاسيستيبا لتا نتتا: ضاااقتة لاستتداا عاتاا النتالبييساضي ت ستألير حتاو التيلاسةالنبكرة و لكي لا أعنية سر ر ة ا لاد ضي النالبييساضي قنب ةة الاعراض الجانبية لاى الا و الجنيي و ننصتقاستتدااضا يتأو لت عوجت لاتالات التيلاسة النبكترة لتاةيتد النلاتاعلات و ننتب الي يتات لتاى الدتاج حتا ثاليلاسة.


Article
4.VAGINAL PROGESTERONE PESSARY FOR PRETERM LABOR PREVENTION IN WOMEN WITH A SHORT CERVIX EARLY IN THE SECOND TRIMESTER

Author: Enas A.A. Khazaali ايناس عدنان عبد الرسول الخزرجي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 2 Pages: 133-143
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:The prevention of preterm birth is a major health care priority.Objective: To evaluate the efficacy of vaginal progesterone pessary in reducing the rate of preterm delivery and subsequent neonatal morbidity and mortality events in pregnant women with a short cervical length early in the 2nd trimester.Methods: Women with a singleton pregnancy without a history of preterm labor nor a history of second trimester miscarriage, underwent cervical length measurement at 14+0 to 15+6 weeks of gestation. Women found to have a cervical length less than 30 mm received vaginal progesterone pessary (400 mg per pessary) on daily basis, or no treatment. Primary outcome was preterm delivery rate before 37 weeks gestation. Secondary outcome includes neonatal morbidity and mortality events.Results: From the 7725 pregnant women screened between the period from April 2015 to January 2017, 613 were found to have a cervical length less than 30 mm and only 518 pregnant women met the inclusion criteria and agreed to participate in this study. However, only 492 were followed up till the time of delivery. From those 252 women administered 400 mg vaginal progesterone pessary once daily at night and the remaining 240 women did not receive any form of progesterone and served as control. There was a significant reduction in preterm delivery rate less than 37 weeks gestation among women receiving progesterone vaginal pessary compared to the control group 11 (4.4%) vs 38 (15.8%), p value < 0.001. Regarding neonatal outcome, there were significant reduction in the frequency of respiratory distress syndrome, low birth weight neonates and admissions to neonatal intensive care unit in women taking vaginal progesterone pessary compared to the control. While other neonatal morbidity and mortality events, incidence of neonatal congenital anomalies were not significantly different between the two groups.Conclusion: Vaginal progesterone pessaries in women with a cervical length less than 30 mm early in the second trimester are found to be effective in reducing the rate of preterm birth and some of the prematurity related morbidity events. Keywords: preterm labor, vaginal progesterone pessaries, short cervix, premature deliveryCitation: Khazaali EAA. Vaginal progesterone pessary for preterm labor prevention in women with a short cervix early in the second trimester. Iraqi JMS. 2018; 16(2): 133-143. doi: 10.22578/IJMS.16.2.4


Article
The association between abnormal vaginal microbial flora and preterm labor. Does a simple Gram's stain of vaginal swab gives more useful data than culture ?
العلاقة بين المتعضيات المجهرية المهبلية غير الطبيعية و الولادة المسبقة، هل ان الاختبار المباشرمع صبغة غرام يعطي معلومات مفيدة اكثر من اختبار زرع المتعضيات ؟

Author: Haider Al Shamma'a حيدر الشماع
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2014 Volume: 56 Issue: 2 Pages: 147-150
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Preterm labor is the major cause of perinatal mortality and morbidity and it is a challenging obstetrical complication as treatment is marginally effective if ever and no improvement in incidence over the last 5 decades , although may causes were identified the majority are idiopathic and in this category infection seems to be involved as a causative agent Objectives: to evaluate the association of abnormal vaginal flora diagnosed by direct Gram's staining and vaginal culture with preterm labor. Patients, material and methods: 25 women with preterm labor compared with 25 women at full term pregnancy, high vaginal swabs for direct Gram's staining (Spiegel criteria for abnormal vaginal flora) and culture. The results were compared in both group Results: this study showed significant association between preterm labor and abnormal vaginal flora 7 (28%) and 12 (48%) of grade II and III respectively . and a significant association between term pregnancy and normal vaginal flora 16 (64%) of grade I. Also in the presence of abnormal vaginal flora, no significant association with type of pathogenic microorganism and preterm labor as all types may be associated with PTL , and the presence of Lactobacillus spp. (normal grade I flora ) is associated with term pregnancy. Conclusions: Gram's staining of high vaginal swab using Spiegel criteria can be useful simple test to predict preterm laborKey words: preterm labor, vaginal flora grading, vaginal infection.

الخلفية: الولادة المسبقة هي السبب الرئيسي لوفيات و مرضية الاطفال حديثي الولادة وهي من مضاعفات الحمل التي تشكل تحديا حيث ان العلاجات الحالية لوقفها فعالة بصورة هامشية, ولا يوجد تحسن في حدوثها للعقود الخمسة الماضية. وعلى الرغم من وجود اسباب متعددة للولادة المسبقة , تبقى معظم الحالات غير معروفة السبب . و في تلك الحالات يبدو الخمج من الاسباب المحتملة.هدف الدراسة: تقويم علاقة المتعضيات المهبلية غير الطبيعية ( المشخصة بواسطة الاختبار المباشر مع صبغة غرام وبواسطة اختبار زرع المتعضيات ) مع الولادة المسبقة.المرضى و طريقة البحث: خمسة وعشرون سيدة تعاني من علامات ولادة مسبقة, قورنت بخمسة وعشرون سيدة نهاية فترة الحمل , تم اخذ مسحات مهبلية من كل السيدات , تم اجراء الاختبار المباشر مع صبغة غرام و استعمال معايير سبيغل و كذلك اجري اختبار الزرع وقورنت النتائج للمجموعتين.النتائج: وجود ترابط معتبر بين الولادة المسبقة و المتعضيات المجهرية غير الطبيعية من الدرجة الثانية و الثالثة (سبيغل) . كذلك وجود ترابط معتبربين اكمال فترة الحمل و المتعضيات المهبلية الطبيعية نوع لاكتوباسيللوس من الدرجة الاولى (سبيغل). ولا يوجد ترابط معتبربين الولادة المسبقة وانواع المتعضيات المجهرية غير الطبيعية.الاستنتاج: الاختبار المباشرللمسحة المهبلية مع صبغة غرام مفيد للتنبؤ بحصول الولادة المسبقةمفتاح الكلمات: الولادة المسبقة, المتعضيات المهبلية, الخمج المهبلي.


Article
MATERNAL PLACENTAL VASCULOPATHY AND INFECTION IN PATIENTS WITH PRETERM DELIVERY
الاعتلال الوعائي السخدي الامي والإصابة الجرثومية بين حالات الولادة المبكرة

Author: Liqaa R. Al Khuzaee لقاء رياض الخزاعي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2008 Volume: 6 Issue: 1 Pages: 114-120
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Premature delivery remains the most important cause of neonatal mortality and there is considerable amount of information in the literature indicating a strong association between maternal placental vasculopathy and chorioamnionitis with preterm delivery.Objective: To outline the association between maternal placental vasculopathy and chorioamnionitis with preterm labor and premature rupture of membranes.Patients & Methods: We performed a case control study conducted on 54 patients who were delivered preterm 37 patients because of preterm labor and 17 because of premature rupture of membranes, and 54 patients who were delivered at term after uncomplicated pregnancy for the period from January 2004 to July 2005. We studied the clinical information’s obtained include demographic data, gestational age, obstetric history, route of delivery, infants birth weight and placental histopathological features. All the patients were seen at Gynecology & Obstetrics department at Al-Kadhimiya Teaching Hospital in Baghdad.Results: Maternal placental vascular lesions were present in 13 (35.1%) patients with preterm labor, and six (35.3%) patients, with premature rupture of membranes while only 6 (11.1) of control patients. Histopathological features suggestive of Infection of the placenta were found in 14 (37.8%) patients with preterm delivery and 6 (35.3%) patients with premature rupture of membranes and eight (14.8%) of control patients. Conclusion: It is possible to identify two subgroups of patients among those who are delivered preterm because of preterm labor or premature rupture of membrane, one with infection of the product of conception and another with maternal placental vasculopathy.

خلفية الدراسة: تعد الولادة المبكرة من أهم أسباب الوفاة بين الأطفال ألحديثي الولادة و هناك كمية ضخمة من المعلومات في النشرات المطبوعة تشير إلى وجود صلة قوية بين الاعتلال الوعائي السخدي الامي و التلوث وحالات الولادة المبكرة. هدف الدراسة:.إثبات التلازم بين الاعتلال الوعائي السخدي الامي والتهابات الأغشية و المخاض المبكر وتمزق الأغشية المشيمية السلوية المبكر . طريقة العمل: لقد قمنا بدراسة 54 حالة ولادة مبكرة ناتجة عن 37 حالة مخاض مبكر و 17 حالة تمزق الأغشية قبل الأوان و مقارنتها مع 54 حالة ولادة تمت عند اكتمال مدة الحمل بدون مضاعفات في الفترة من كانون الثاني 2004 إلى تموز 2005 .تمت معالجة جميع الحالات في قسم النسائية و التوليد في مستشفى الكاظمية التعليمي في بغداد. النتائــج: الاعتلال الوعائي السخدي الامي كان موجودا في 13 حالة (%35.1) من حالات المخاض المبكر و 6 حالات (35.3%) من حالات تمزق الأغشية قبل الأوان و 6 حالات (%11.1) من حالات الضبط .تلوث الأغشية كان موجودا في 14 حالة (37.8%) من حالات المخاض المبكر و 6 حالات(35.3%) من حالات تمزق الأغشية قبل الأوان و8 حالات(14.8%) من حالات الضبط..الاستنتاج: إن من الممكن تمييز مجموعتين من المرضى في حالات الولادة المبكرة الناتجة عن المخاض المبكر و تمزق الأغشية قبل الأوان الأولى هي مجموعة تلوث الأغشية و الثانية هي مجموعة الاعتلال الوعائي السخدي الامي.


Article
The Use of Vitamin D Supplement in Prevention of Preterm Labor

Author: Suha J.Witwit
Journal: Journal of University of Babylon مجلة جامعة بابل ISSN: 19920652 23128135 Year: 2017 Volume: 25 Issue: 2 Pages: 651-661
Publisher: Babylon University جامعة بابل

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Abstract

In modern obstetrics, preterm labor remain a major problem . Infection during pregnancy is the commonest cause. Since that vitamin D has been shown to act as an anti-inflammatory& immune modulator in the placenta so it could be used for preterm labor prevention. In pregnant ladies ,higher levels of vitamin D were considerably associated with a lower risk of infection, preterm labor & preterm birth. Vitamin D supplementation during pregnancy has long been a matter of concern, but updated researches showed that even a high dose supplementation in healthy pregnant ladies was safe & effective. The aim of the study 1.Determine the relationship between maternal 25-hydroxyvitamin D & the risk of spontaneous preterm birth before 37 completed weeks.2.Determine whether 4000 IU/day of vitamin D supplement prevent preterm birth in those with threatened preterm labor (premature uterine contraction)& those with early preterm labor(in the latent phase) . the study was carried : 1. at Babylon Teaching hospital for Maternity& pediatric in the obstetrical word. 2.out patient clinic. A randomized clinical trial was done on (109) patients from 1st of June 2014 to 1st of Jan 2015. Their gestational age was of (24-<37completed weeks), Blood samples were taken from all of them for measurement of vitamin D level. Those patients then divided into 2 groups: 1. study group consist of 69 pregnant women who were presented with either threatened preterm labor or early preterm labor ( at the latent phase) were given a supplement of vitamin D (4000IU) daily till term & follow them for their progress of labor& 2. Control group of 40 pregnant women at the same gestational age of the study group but without preterm labor.(just assess vitamin D level). There was a significant association between low vitamin D level & preterm labor as preterm labor was inversely associated with pre delivery level. The study found that (61.1%) of patients with threatened preterm labor & (75.8%) of patients with early preterm labor are presented with low vitamin D level , while (62.5%) of control group presented with sufficient vitamin D level. There was (36.4%) reduction in proportion of early preterm labor as well as (83.3%) reduction in proportion of threatened preterm labor(premature uterine contraction) after vitamin D supplementation.Conclusion: vitamin D supplement has a role in prevention of preterm labor especially in those with low pre delivery serum level & those with threatened preterm labor.

دراسة سريرية اجريت في مستشفى بابل للنسائية والاطفال خلال الفترة من حزيران 2014-كانون الثاني 2015.تضمنت الدراسة 109 امرأة حامل ما بين (24-37 اسبوع) حيث تم قياس نسبة فيتامين د من خلال اخذ عينة دم من كل امرأة ثم تم تقسيمهم الى مجموعتين: المجموعة الاولى(69) امرأة حامل واللواتي لديهن تقلصات رحمية مبكرة او علامات ولادة مبكرة والمجموعة الثانية وهي مجموعة السيطرة اشتملت على(40) امرأة حامل بدون تقلصات رحمية ومن ثم تم اعطاء 4000 وحدة من فيتامين د(حبة واحدة يوميا) لكل امرأة لديها تقلصات رحمية او ولادة مبكرة( المجموعة الاولى) ومن ثم متابعة المريضات لمعرفة فيما اذا توقفت التقلصات اوالولادة المبكرة ام لا.البيانات المأخوذة لكلا المجموعتين تتضمن العمر ,عدد الولادات الكلي لدى المريضة ,عمر(فترة) الحمل ,نسبة فيتامين د في الجسم, معدل وزن المريضة ,حالة التدخين, المستوى المهني.

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