Are Uterine Natural Killer Cells Involved in the Initiation of Preterm Labor ?
Condition: Preterm Labour
MeSH terms: Premature Birth; Obstetric Labor, Premature
Study type: Observational [Patient Registry]

Summary: 
      Research question:

      Population of study: women diagnosed as term pregnancy in labor (control) and the other group
      diagnosed as preterm labor (cases).

      Intervention: measuring uterine natural killer cells . Outcome: uterine natural killer cells
      has a role in initiation of preterm labor.

      Research hypothesis:

      • Are uterine Natural Killer cells involved in the initiation of preterm labor ?

      Medical Application:

      • Possibility of prediction of preterm labor by assessment of Natural killer cells as well as
      preventing preterm labor by suppressing their activity .
    

Detailed description: 
      Type of the Study:

      This is a case control study .

      Study Settings:

      This clinical trial will be conducted at Ain Shams University Maternity Hospital and the
      laboratory work will be done at Ain Shams University histopathology Laboratory , in the
      period between August 2012 to August 2014 .

      Study Population:

      The patients will be recruited from women attending casualty at Ain Shams University
      Maternity Hospital.

      The included patients will be

      Divided into two groups:

        -  Group 1: Patients who has threatened preterm labor and will receive tocolysis and these
           patients will either not respond to tocolysis and delivered preterm or will respond to
           tocolysis and will deliver at term .

        -  Group 2: Patient delivered vaginally at term with no history of having tocolysis for
           preterm labor at the current pregnancy .

      Intervention:

      After taking informed written consent, the recruited patients will be subjected to the
      following:

      - History taking, with particular emphasis on: Past medical history (no diabetes mellitus, no
      hypertension, etc..) Past obstetric history (history of preterm labor). Menstrual history(to
      be sure of her LMP( last menstrual period) and this date is reliable).

        -  Having earlier ultrasound to document gestational age.

        -  History of labor pains which is becoming regular and frequent.

        -  No suggestive history of preterm prelabor rupture of membranes

        -  General examination with particular emphasis on blood pressure, weight and height.

        -  Abdominal examination with particular emphasis on uterine activity.

        -  Obstetric ultrasound (transabdominal) to document viability of pregnancy and to ensure
           the gestational age.

        -  Included patients will receive tocolysis (according to Ain Shams University Maternity
           hospital protocol which is recommending usage of calcium channel blocker (Nifedipine)
           Initially 10mg orally every 15 minutes, up to 4 doses of Nifedipine to stop
           contractions. After this slow release nifedipine. It has been found that an 8 hourly
           dosage of 40mg - 20mg - 40mg calcium channel blocker is suitable for most women. This is
           in addition to use of steroids to enhance lung maturity (dexamethasone, 6 mg
           intramuscular /12 hrs for 48 hrs)

        -  Patients will be traced by fetal monitor and uterine tocodynamometer (Oxford Sonicaid
           Team ®)to monitor uterine contractions and if the treatment was successful or not.

        -  After delivery a placental sample will be taken either the patient delivered preterm or
           at term (term patients will be either control term group or patients with successful
           treatment of preterm labor). The placental sample taken should have part of the decidua
           and then the sample will be fixed in 10% neutral-buffered formalin for 24-48 h,
           routinely processed, embedded in paraffin wax, sectioned at 3 μm thickness, and mounted
           on 3-aminopropyl-triethoxysilane -coated slides. Serial sections will be immunostained
           for CD 16 and CD56 . immunohistochemistry study will be done at Ain Shams Maternity
           Hospital Histopathology department.
    

Intervention name(s): immunohistochemistry study
Intervention type(s): Other
Intervention description(s): After taking informed written consent,a placental sample will be taken either the patient delivered preterm or at term (term patients will be either control term group or patients with successful treatment of preterm labor). The placental sample taken should have part of the decidua and then the sample will be fixed in 10% neutral-buffered formalin for 24-48 h, routinely processed, embedded in paraffin wax, sectioned at 3 μm thickness, and mounted on 3-aminopropyl-triethoxysilane -coated slides. Serial sections will be immunostained for CD 16 and CD56 . immunohistochemistry study will be done at Ain Shams Maternity Hospital Histopathology department.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        The patients will be recruited from women attending casualty at Ain Shams University
        Maternity Hospital.
      
Biospecimen description: 
      a placental sample will be taken either the patient delivered preterm or at term (term
      patients will be either control term group or patients with successful treatment of preterm
      labor). The placental sample taken should have part of the decidua and then the sample will
      be fixed in 10% neutral-buffered formalin for 24-48 h, routinely processed, embedded in
      paraffin wax, sectioned at 3 μm thickness, and mounted on 3-aminopropyl-triethoxysilane
      -coated slides. Serial sections will be immunostained for CD 16 and CD56 .
      Immunohisto-chemistery study will be done at Ain Shams Maternity Hospital Histopathology
      department.
    
Keywords: uterine natural killer cells; CD16; CD56; Preterm labour