Placental immune response and its tropism for specific viruses and pathogens affect the outcome of the pregnant woman's susceptibility to and severity of certain infectious diseases. The generalization of pregnancy as a condition of immune suppression or increased risk is misleading and prevents the determination of adequate guidelines for treating pregnant women during pandemics. There is a need to evaluate the interaction of each specific pathogen with the fetal/placental unit and its responses to design the adequate prophylaxis or therapy. The complexity of the immunology of pregnancy and the focus, for many years, on the concept of immunology of pregnancy as an organ transplantation have complicated the field and delayed the development of new guidelines with clinical implications that could help to answer these and other relevant questions. Our challenge as scientists and clinicians interested in the field of reproductive immunology is to evaluate many of the 'classical concepts' to define new approaches for a better understanding of the immunology of pregnancy that will benefit mothers and fetuses in different clinical scenarios.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0897.2010.00836.x

The Immune System in Pregnancy: A Unique Complexity

Late-preterm infants, defined by birth at 340⁄7 through 366⁄7 weeks’ gestation, are less physiologically and metabolically mature than term infants. Thus, they are at higher risk of morbidity and mortality than term infants. The purpose of this report is to define “late preterm,” recommend a change in terminology from “near term” to “late preterm,” present the characteristics of late-preterm infants that predispose them to a higher risk of morbidity and mortality than term infants, and propose guidelines for the evaluation and management of these infants after birth.

“Late-Preterm” Infants: A Population at Risk

The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities.

National Healthcare Disparities Report

http://www.nptinternal.org/productions/chcv2/infant-mortality/pdf/Gestational_Age_study.pdf

Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992 to 2002.

ContextAlthough shortened cervical length has been consistently associated
with spontaneous preterm birth, it is not known when in gestation this risk
factor becomes apparent.ObjectiveTo determine whether sonographic cervical findings between 16 weeks'
and 18 weeks 6 days' gestation predict spontaneous preterm birth and whether
serial evaluations up to 23 weeks 6 days' gestation improve prediction in
high-risk women.Design, Setting, and ParticipantsBlinded observational study performed between March 1997 and November
1999 at 9 university-affiliated medical centers in the United States in 183
women with singleton gestations who previously had experienced a spontaneous
birth before 32 weeks' gestation.ObservationCertified sonologists performed 590 endovaginal sonographic examinations
at 2-week intervals. Cervical length was measured from the external os to
the functional internal os along a closed endocervical canal. Funneling and
dynamic cervical shortening were also recorded.Main Outcome MeasureSpontaneous preterm birth before 35 weeks' gestation, analyzed by selected
cutoff values of cervical length.ResultsForty-eight women (26%) experienced spontaneous preterm birth before
35 weeks' gestation. A cervical length of less than 25 mm at the initial sonographic
examination was associated with a relative risk (RR) for spontaneous preterm
birth of 3.3 (95% confidence interval [CI], 2.1-5.0; sensitivity = 19%; specificity
= 98%; positive predictive value = 75%). After controlling for cervical length,
neither funneling (P = .24) nor dynamic shortening
(P = .054) were significant independent predictors
of spontaneous preterm birth. However, using the shortest ever observed cervical
length on serial evaluations, after any dynamic shortening, the RR of a cervical
length of less than 25 mm for spontaneous preterm birth increased to 4.5 (95%
CI, 2.7-7.6; sensitivity = 69%; specificity = 80%; positive predictive value
= 55%). Compared with a single cervical measurement at 16 weeks' to 18 weeks
6 days' gestation, serial measurements at up to 23 weeks 6 days significantly
improved the prediction of spontaneous preterm birth in a receiver operating
characteristic curve analysis (P = .03).ConclusionsCervical length assessed by endovaginal sonography between 16 weeks'
and 18 weeks 6 days' gestation, augmented by serial evaluations, predicts
spontaneous preterm birth before 35 weeks' gestation in high-risk women.

https://jamanetwork.com/journals/jama/articlepdf/194203/JOC10349.pdf

Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth.

Vasa previa: clinical presentations, outcomes, and implications for management

Matrilysin (matrix metalloproteinase 7) in parturition, premature rupture of membranes, and intrauterine infection

OBJECTIVE: This study compares pyridoxine–metoclopramide combination therapy to prochlorperazine and promethazine monotherapies in the outpatient treatment of nausea and vomiting in pregnancy. STUDY DESIGN: In total, 174 first trimester, singleton pregnancies were evaluated for nausea and vomiting. Patients were prospectively randomized into three treatment groups: pyridoxine–metoclopramide, prochlorperazine, or promethazine. Prior to, and on the third day, patients recorded their subjective responses to the given treatment and their number of emesis episodes. The three treatment groups were compared for therapy response. RESULTS: There were no differences in the number of emesis episodes prior to treatment. Both subjective and objective responses to treatment differed among the three groups when comparing the combination therapy to the monotherapies (p<0.05). CONCLUSION: Combination therapy with pyridoxine and metoclopramide appears to be superior to either monotherapy in the treatment of nausea and vomiting in pregnancy.

Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy.

Delivery of the marginally preterm infant: what are the minor morbidities?

Colonoscopic release of the incarcerated gravid uterus.

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