Effect of urinary trypsin inhibitor on preterm labor with high granulocyte elastase concentration in cervical secretions.
OBJECTIVE
To explore whether intravaginal treatment with urinary trypsin inhibitor (UTI) prevents preterm delivery in patients in preterm labor with increased levels of granulocyte elastase in cervical secretions.


METHODS
The subjects were patients in preterm labor with increased levels of granulocyte elastase in cervical secretions from 16 to 33 weeks gestation. Maternal and neonatal outcomes were compared between patients receiving UTI treatment (UTI group; n=33) and those not receiving UTI treatment (control group; n=40).


RESULTS
In patients receiving UTI, the mean gestational age at delivery was greater than that in the control group (37.8 vs. 35.6 weeks, p=0.003), and the rates of premature delivery before 34 and 37 weeks gestation were lower (3% vs. 20%, p=0.028; and 18% vs. 47%, p=0.008, respectively). The percentage of neonates weighing more than 2,500 g was significantly higher in the UTI group, with no neonates weighing less than 1,500 g. The neonatal hospitalization rate was lower in the UTI group (9% vs. 42%, p=0.001).


CONCLUSIONS
In patients in preterm labor with a high elastase concentration in cervical secretions, treatment with UTI reduced the risk of preterm delivery and improved neonatal outcomes.
Hayashi
Masako
M
Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School. yamaguchi1126@yahoo.co.jp
Oya
Atsuko
A
Miyake
Hidehiko
H
Nakai
Akihito
A
Takeshita
Toshiyuki
T
D000282:Administration, Intravaginal; D000328:Adult; D001034:Apgar Score; D016022:Case-Control Studies; D002582:Cervix Mucus / Q000201:enzymology*; D005260:Female; D005865:Gestational Age; D006023:Glycoproteins / Q000008:administration & dosage*; D006760:Hospitalization; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D053208:Kaplan-Meier Estimate; D019272:Leukocyte Elastase / Q000378:metabolism*; D007752:Obstetric Labor, Premature / Q000188:drug therapy* / Q000201:enzymology; D011247:Pregnancy; D047928:Premature Birth / Q000201:enzymology / Q000517:prevention & control*; D015149:Tocolytic Agents / Q000627:therapeutic use; D016896:Treatment Outcome; D015854:Up-Regulation
D006023:Glycoproteins; D015149:Tocolytic Agents; D019272:Leukocyte Elastase; C028665:urinastatin