***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Preterm birth is the leading cause of neonatal mortality and morbidity and long-term disability of non-anomalous infants . Previous studies have identified a prior early spontaneous preterm birth as the risk factor with the highest predictive value for recurrence . Two recent double blind r and omized placebo controlled trials reported lower preterm birth rate with the use of either intramuscular 17 alpha-hydroxyprogesterone caproate ( IM 17OHP-C ) or intravaginal micronized progesterone suppositories in women at risk for preterm delivery . However , it is still unclear which high-risk women would truly benefit from this treatment in a general clinical setting and whether socio-cultural , racial and genetic differences play a role in patient ’s response to supplemental progesterone . In addition the patient ’s acceptance of such recommendation is also in question . More research is still required on identification of at risk group , the optimal gestational age at initiation , mode of administration , dose of progesterone and long-term safety OBJECTIVE : A multicenter , r and omized placebo-controlled trial among women with singleton pregnancies and a history of spontaneous preterm birth found that weekly injections of 17 alpha-hydroxyprogesterone caproate ( 17P ) , initiated between 16 and 20 weeks of gestation , reduced preterm birth by 33 % . The current study estimated both preterm birth recurrence and the potential reduction in the national preterm birth rate . METHODS : Using 2002 national birth certificate data , augmented by vital statistics from 2 states , we estimated the number of singleton births delivered to women eligible for 17P through both a history of spontaneous preterm birth and prenatal care onset within the first 4 months of pregnancy . The number and rate of recurrent spontaneous preterm births were estimated . To predict effect , the reported 33 % reduction in spontaneous preterm birth attributed to 17P therapy was applied to these estimates . RESULTS : In 2002 , approximately 30,000 recurrent preterm births occurred to women eligible for 17P , having had a recurrent preterm birth rate of 22.5 % . If 17P therapy were delivered to these women , nearly 10,000 spontaneous preterm births would have been prevented , thereby reducing the overall United States preterm birth rate by approximately 2 % , from 12.1 % to 11.8 % ( P < .001 ) , with higher reductions in targeted groups of eligible pregnant women . CONCLUSION : Use of 17P could reduce preterm birth  among eligible women , but would likely have a modest effect on the national preterm birth rate . Additional research is urgently needed to identify other population s who might benefit from 17P , evaluate new methods for early detection of women at risk , and develop additional prevention strategies . LEVEL OF EVIDENCE : 11 mg natural progesterone ( P ) was administered to 20 healthy menopausal women by means of a nasal spray or intramuscular injection .  Circulating P levels were calculated at various times after administration . The spray formulation yielded a CMax of 3.75 ng/ml at TMax = 60 min , the area under the curve (AUC)0 - 720 being 1,481.6 + /- 343 . Intramuscular administration yielded a mean CMax of 4.137 ng/ml at TMax = 240 min , the AUC0 - 720 being 2,491.2 + /- 540 . P absorption was faster through the nasal than through the intramuscular route , but intramuscular administration led to high serum levels for a much longer period Progesterone was administered to postmenopausal women in a form of vaginal suppositories containing 100 and 200 mg active substance in Butyrum cacao ( BC ) and Massa estarinum ( ME ) , a base with emulsifying properties . In the case of single doses , blood sample s were taken at 2 , 4 , 6 , 24 , 48 and 72 h. Another group of patients received vaginal suppositories ( 100 mg progesterone ) once a day for a 6 day period , with blood sample s taken 12 h after each administration . The plasma levels of progesterone were evaluated by  radioimmunoassay .  The time of maximum concentration ( tmax ) was 4 h in most cases , and 6 h in the others . The plasma levels were not dose-proportional . Peak plasma concentrations were in the range of 10 - 15 ng/ml with a mean of 10.5 ng/ml for the 100 mg and 12 ng/ml for the 200 mg doses . The ratio of the mean area under the curve ( AUC ) for 200 mg and the mean AUC for the 100 mg dose was found to be 1.37 . Replacing BC with ME result ed in the lowering of cmax and AUC , and an increase in tmax following a reducing in the rate and extent of adsorption . In the case of ME suppositories , the variability in AUC , cmax and tmax was greater compared to that observed with the BC suppositories . Elimination half-time was in the range of 9 - 10 h for BC and 14 h for ME suppositories . In vitro assessment of the release kinetics from a hydrophobic and an emulsion type base confirmed previous findings : the latter base assured better pharmaceutical availability . The repeated doses did not seem to produce an accumulation of progesterone in the plasma . On the contrary , a small decrease in plasma levels over time appeared during the 6 day period . Numerical analysis revealed an excellent goodness of fit for the in vivo experimental data via biexponential curves , i.e. a pseudomonocompartmental model Whilst only about a third of all cerebral palsy occurs in children who had been of low birthweight , recent increases in the survival of low and very low birthweight infants have coincided with significant increases in the numbers of cerebral palsy children amongst them . This paper analyses data from the Western Australian Cerebral Palsy Register and from the Maternal and Child Health Research Data Base for stillbirths , neonatal deaths and survivors to address the issues of increased survival , cerebral palsy and timing of brain damage . The analysis is inconclusive but suggestive that both antenatal and postnatal complications are important in the increases in cerebral palsy in low birthweight infants . The good news is that this means that a certain proportion of postnatally damaged low birthweight survivors could possibly be prevented by better neonatal care . The bad news is that the remaining proportion have probably received their damage well before delivery and the possibilities for prevention are still remote . Further studies of low birthweight infants with cerebral palsy are urgently required . They should include antenatal factors , investigating the various aetiological pathways to preterm birth , r and omised controlled trials of neonatal interventions and search ing for better neonatal predictors of brain damage OBJECTIVE This study was undertaken to determine whether progestational agents can prevent inflammation-induced preterm parturition and fetal demise . STUDY DESIGN The activation of contractile and inflammatory pathways in response to localized intrauterine inflammation was investigated by using quantitative polymerase chain reaction ( PCR ) . Serum progesterone ( P4 ) levels and alterations in progesterone receptor-B ( PR-B ) were determined with radioimmunoassay and quantitative PCR , respectively . With our in vivo model of intrauterine inflammation , animals were r and omly assigned to pretreatment with P4 or medroxyprogesterone acetate ( MPA ) before intrauterine lipopolysaccharide ( LPS ) . Animals were observed for preterm delivery . The number of live pups 48 hours after intrauterine LPS was recorded for each treatment group . The ability of MPA to alter signal transduction pathways leading to preterm parturition were investigated by quantitative PCR and histochemical studies . RESULTS Intrauterine inflammation is associated with decreased serum progesterone levels and decreased transcription of PR-B. Preterm delivery rates were 100 % for LPS alone , 63 % for LPS+P4 , and 0 % for LPS+MPA . No live pups remained at 48 hours in the LPS or LPS+P4 groups . Pretreatment with MPA significantly preserved fetal viability .  MPA suppressed activation of contraction-associated genes and inflammatory mediators and prevented cervical ripening in response to intrauterine inflammation . CONCLUSION MPA , with its progestational and anti-inflammatory properties , prevented inflammation-induced preterm parturition and significantly preserved fetal viability OBJECTIVE Our purpose was to determine gestational age-specific outcomes of infants born in a period of surfactant use . STUDY DESIGN All 465 consecutive births between 23 and 28 weeks ' gestation in a tertiary center from 1987 to 1992 were analyzed prospect ively . At 18 months ' corrected age , 217 of 254 ( 85 % ) survivors were evaluated . RESULTS From 1987 and 1988 to 1991 and 1992 there was an increase in survival for infants born at 24 weeks ( from 0 % to 33 % p = 0.17 ) , 25 to 26 weeks ( 38 % to 71 % , p < 0.005 ) , and 27 to 28 weeks ( 66 % to 84 % , p < 0.05 ) . At each weekly interval from 24 to 28 weeks of gestation the respective incidence of normality was 44 % , 71 % , 57 % , 76 % and 72 % ( not significant ) and the respective mean developmental quotient was 91 + /- 17 , 89 + /- 25 , 90 + /- 24 , 96 + /- 15 and 96 + /- 14 ( not significant ) . CONCLUSIONS Gestational age was strongly associated with outcome in terms of survival . Overall , 70 % of children followed up were developing within the normal range A prior report suggested that active-duty pregnant women are at increased risk for low-birth weight infants and a higher perinatal mortality rate . The present double-blind investigation was design ed to prospect ively evaluate that risk and to test the efficacy of 17 alpha-hydroxyprogesterone caproate to prevent reported complications . Three groups of active-duty women were studied , beginning between 16 and 20 weeks ' gestation . They were similar for parity , previous abortion , race , cigarette smoking , and marital status . Of these , 80 were given 17 alpha-hydroxyprogesterone caproate , 88 received placebo , and 78 declined to participate in the protocol . There was no significant differences in the three groups when comparisons were made for low-birth weight infants and for perinatal mortality . However , when comparison was made to a military dependent population , they had a significantly worse outcome with regard to both perinatal mortality ( p = 0.001 ) and infants with a birth weight less than 2,500 gm ( p = 0.01 ) . We concluded that pregnant military personnel were at increased risk for adverse pregnancy outcome , but that this risk was not altered by therapy with 17 alpha-hydroxyprogesterone caproate OBJECTIVE On the basis of the recent Maternal Fetal Medicine Unit Networks clinical trial , the American College of Obstetricians and Gynecologists supports the administration of 17-alpha hydroxyprogesterone caproate to high-risk patients . Because inflammation/infection is believed to be a contributing factor in many cases of preterm birth , it is imperative to underst and the effect of 17-alpha hydroxyprogesterone caproate treatment in this clinical situation . STUDY DESIGN Using a mouse model of localized intrauterine inflammation , we investigated the ability of progestational agents to prevent preterm birth .  On gestational day 15 ( E15 ) , dams were assigned r and omly to treatment with 17-alpha hydroxyprogesterone caproate , medroxyprogesterone acetate , or vehicle before intrauterine infusion of lipopolysaccharide . All dams were monitored for morbidity and preterm birth . Three separate sets of experiments were performed to assess different outcomes at 6 , 24 , and 96 hours . At 6 and 24 hours , C-reactive protein , interleukin-6 , and interleukin-10 levels were measured in maternal serum by enzyme-linked immunosorbent assay . RESULTS Pretreatment with 17-alpha hydroxyprogesterone caproate or medroxyprogesterone acetate before intrauterine lipopolysaccharide treatment significantly decreased the preterm birth rate , compared with lipopolysaccharide treatment alone . Medroxyprogesterone acetate treatment was more effective than 17-alpha hydroxyprogesterone caproate treatment in the prevention of preterm birth and result ed in live pups at term . Treatment with 17-alpha hydroxyprogesterone caproate was associated with significant maternal morbidity . CONCLUSION In the setting of intrauterine inflammation , progestational agents decrease the preterm birth rate but can result in maternal morbidity . 17-Alpha hydroxyprogesterone caproate should not be used in patients who are suspected of having sub clinical infection and /or acute preterm labor . The mechanisms by which progestational agents inhibit preterm birth warrants further investigations so that the use of this drug to appropriate population s could be pursued without undue fetal or maternal harm OBJECTIVE The purpose of this study was to evaluate whether 17-alpha-hydroxyprogesterone caproate ( 17 
    Output:
    
While there is a potential beneficial effect in the use of progesterone for some women considered to be at increased risk of preterm birth , primarily in the reduction in the risk of preterm birth before 34 weeks gestation , it remains unclear if the observed prolongation of pregnancy translates into improved health outcomes for the infant