European Journal of Molecular & Clinical Medicine

Background: CRP measurement is quick, non-invasive, and risk-free that can be a
useful diagnostic test for evaluating and categorizing the risk levels and also
anticipating the morbidity of both mother and fetus.
Aims: To identify the association between the level of C-Reactive protein (CRP) with
preterm deliveries.
Materials and methods: It is Hospital based Prospective Observational study done for a
period of 2 Years in 95 pregnant women with gestational age between 24 weeks to 36
weeks+6days, who present to emergency /labor room with regular uterine contractions,
at least four in 20 minutes or eight in 60 minutes in presence or absence of cervical
changes.Patients were then followed up till 7 days for preterm delivery. Further
categorization of subjects was done into 2 groups:Group 1: Those who delivered
preterm within 7 days of admission.Group 2: Those who did not deliver within 7 days of
admission.
Results: 95 patients with premature uterine contractions were analysed for CRP levels
and were followed up to find out if they underwent preterm delivery within 7 days of
admission. The mean value of CRP was calculated in the 2 groups and was found to be
higher in those who delivered within 7 days with a statistically significant p value 0.001.
The curve generated cut off for CRP was ≥3.55 mg/l (AUC 0.809, SE 0.046, P <0.001),
indicating a positive association for preterm delivery. With the derived cut off, the
sensitivity, specificity, positive predictive value, negative predictive value of CRP for
predicting preterm delivery was found to be 80.4 %, 75.5%, 80.7% and 75.2%
respectively, with diagnostic accuracy of78.3%.
Conclusions: Prediction of preterm delivery by a simple biomarker like CRP could help
in early intervention and subsequentprevention of preterm birth and its sequelae.

Background: Preterm labour is a pressing public health issue. Currently, nearly one tenth of all the pregnancies are preterm, contributing to ~ 80% of neonatal morbidity and mortality. Although, preterm labour is defined as labour < 37 completed weeks, practically birth after 34 weeks of gestation have better survival outcomes. Tocolytics are the mainstay of reducing preterm deliveries. They cause partial uterine relaxation and hence help in prolonging the pregnancy for at least for 48 - 72 hrs, thus providing sufficient time for corticosteroids to aid in maturation of lungs; thereby preventing respiratory distress syndrome. While there are quite a few tocolytics available, most of them require close fetomaternal monitoring due to their adverse effects. Currently, nifedipine is tocolytic of choice. Nitroglycerine, which is rapidly metabolized in liver has fewer side effects and its transdermal use is beneficial due to its convenience of usage. Since there are very few studies documenting the comparison of the two drugs, our study will be beneficial.
Objectives: To study and compare the effectiveness of transdermal Nitroglycerine patch and oral nifedipine.
Methodology: This study will include a total of 130 women in preterm labour fulfilling the inclusion and exclusion criteria. These study subjects will be divided into two groups A and B randomly using envelope method. One group will be given transdermal nitroglycerine patch and the other will be given oral nifedipine as a tocolytic agent to reduce the preterm contractions. Treatment will be considered successful if contractions stopped and no recurrence of contractions occurred within or after 48 hours. 
Expected results: Transdermal Nitroglycerine patch is more effective than oral nifedipine in management of preterm labour.
Conclusion: Transdermal nitroglycerine patch is more effective in prolonging the pregnancy as compared to oral nifedipine with less adverse effects.