Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
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This achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
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We are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
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Thank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
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\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"9808",leadTitle:null,fullTitle:"Contemporary Topics in Patient Safety - Volume 1",title:"Contemporary Topics in Patient Safety",subtitle:"Volume 1",reviewType:"peer-reviewed",abstract:"As healthcare systems continue to evolve, it is clear that providing safe, high-quality care to patients is an extremely complex process. Ranging from multi-disciplinary teams to bedside care, virtually every aspect of the patient-care experience provides us with an opportunity for doing things better, from improving efficiency, safety, and overall outcomes to reducing costs and promoting team synergy. This book, the fifth in our patient safety series collection, consists of chapters that help explore key concepts related to both the safety and quality of care. In a departure from the vignette-driven format of our earlier books, this installment gravitates toward discussing frameworks, theoretical considerations, team-centric approaches, and a variety of other concepts that are critical to both our understanding and the implementation of safer and better-performing health systems. We also feel that the knowledge presented herein increasingly applies across the world, especially as global health systems evolve and mature over time. It is our goal to improve the recognition of potential opportunities that will highlight various aspects of the delivery of healthcare and thus contribute to better patient experiences, with safety at the forefront. Topics covered in this volume, as well as the previous volumes, highlight the critical importance of identifying and addressing opportunities for improvement, not as one-time events, but rather as continuous, hardwired institutional processes.",isbn:"978-1-83962-404-9",printIsbn:"978-1-83962-403-2",pdfIsbn:"978-1-83962-405-6",doi:"10.5772/intechopen.87616",price:119,priceEur:129,priceUsd:155,slug:"contemporary-topics-in-patient-safety-volume-1",numberOfPages:168,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"fb6371607c2c6c02c6a2af8892765aba",bookSignature:"Stanislaw P. Stawicki and Michael S. Firstenberg",publishedDate:"April 20th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/9808.jpg",numberOfDownloads:3685,numberOfWosCitations:0,numberOfCrossrefCitations:2,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:3,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:5,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 9th 2020",dateEndSecondStepPublish:"December 21st 2020",dateEndThirdStepPublish:"February 25th 2021",dateEndFourthStepPublish:"May 16th 2021",dateEndFifthStepPublish:"July 15th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki",profilePictureURL:"https://mts.intechopen.com/storage/users/181694/images/system/181694.jpeg",biography:"Dr. Stanislaw P. Stawicki is a Professor of Surgery and chair of the Department of Research and Innovation, St. Luke\\'s University Health Network, Bethlehem, Pennsylvania. A specialist in general surgery, surgical critical care, and neurocritical care, he has co-authored more than 650 scholarly works, including more than 20 books. In addition to local, national, and international medical leadership roles, Dr. Stawicki is a member of numerous editorial boards. His areas of expertise are diverse and include health security, medical information security, blockchain technology, patient safety, academic leadership, mentorship and leadership development, traumatology, surgical critical care, and sonography.",institutionString:"St. Luke's University Health Network",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"33",totalChapterViews:"0",totalEditedBooks:"8",institution:{name:"St. Luke's University Health Network",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/64343/images/system/64343.png",biography:"Dr. Michael S. Firstenberg is a thoracic surgeon at the St. Elizabeth Medical Center (Ascension), Appleton, Wisconsin. He attended Case Western Reserve University Medical School, Cleveland, OH, received his general surgery training at University Hospitals in Cleveland, and completed thoracic surgery fellowships at The Ohio State University and the Cleveland Clinic. He is an active member of the Society of Thoracic Surgeons (STS), American Association of Thoracic Surgeons (AATS), American College of Cardiology (ACC), and American College of Academic International Medicine (ACAIM), for which he served as president in 2021–2022. He has authored more than 250 peer-reviewed manuscripts, abstracts, and book chapters and has edited several textbooks and lectured worldwide on topics ranging from medical leadership, COVID-19, endocarditis, and extra-corporeal membrane oxygenation (ECMO).",institutionString:"St. Elizabeth Medical Center",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"26",totalChapterViews:"0",totalEditedBooks:"13",institution:{name:"The Medical Center of Aurora",institutionURL:null,country:{name:"United States of America"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1135",title:"Preventive Healthcare",slug:"preventive-healthcare"}],chapters:[{id:"80888",title:"Introductory Chapter: Patient Safety and Quality of Care - Inextricably Linked and Absolutely Essential Components of Modern Healthcare",doi:"10.5772/intechopen.102952",slug:"introductory-chapter-patient-safety-and-quality-of-care-inextricably-linked-and-absolutely-essential",totalDownloads:40,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"James P. Orlando, Michael S. Firstenberg and Stanislaw P. Stawicki",downloadPdfUrl:"/chapter/pdf-download/80888",previewPdfUrl:"/chapter/pdf-preview/80888",authors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"},{id:"64343",title:"Dr.",name:"Michael S.",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"},{id:"243724",title:"Dr.",name:"James P.",surname:"Orlando",slug:"james-p.-orlando",fullName:"James P. Orlando"}],corrections:null},{id:"79011",title:"Patient Safety: Preventing Patient Harm and Building Capacity for Patient Safety",doi:"10.5772/intechopen.100559",slug:"patient-safety-preventing-patient-harm-and-building-capacity-for-patient-safety",totalDownloads:125,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Patient safety is a global public health concern. It is a health care discipline with ever evolving advancement and complexity resulting in consequential rise in patient harm. Since the pandemic, patient safety has been threatened even more by laying bare the inadequacies of health systems. Many unsafe care practices, risks, and errors contribute to patient harm and overall economic burden. These include medical, diagnostic, and radiation errors, healthcare associated infections, unsafe surgical procedures and transfusion practices, sepsis, venous thromboembolism, and falls. Although patient safety has become an integral part of the healthcare delivery model and resources have been dedicated towards it, much still needs to be achieved. An attitude of inclusivity for all care teams and anyone in contact with the patient, including the patients themselves, would enhance patient safety. Incorporating this attitude from educational infancy will allow for better identification of medical errors and inculcate critical analysis of process improvement. Implementing the ‘Just Culture’ by health care organizations can build the infrastructure to eliminate avoidable harm. To reduce avoidable harm and improve safety, a constant flow of information and knowledge should be available to mitigate the risks. Lastly, proper communication and effective leadership can play an imperative role to engage stakeholders and reduce harm.",signatures:"Gregory Domer, Thomas M. Gallagher, Shekiba Shahabzada, Juliana Sotherland, Elisabeth N. Paul, Kushee-Nidhi Kumar, Bryan Wilson, Shilpa Salpekar and Parampreet Kaur",downloadPdfUrl:"/chapter/pdf-download/79011",previewPdfUrl:"/chapter/pdf-preview/79011",authors:[{id:"188528",title:"Dr.",name:"Elisabeth N.",surname:"Paul",slug:"elisabeth-n.-paul",fullName:"Elisabeth N. Paul"},{id:"265790",title:"Dr.",name:"Parampreet",surname:"Kaur",slug:"parampreet-kaur",fullName:"Parampreet Kaur"},{id:"329788",title:"Dr.",name:"Gregory",surname:"Domer",slug:"gregory-domer",fullName:"Gregory Domer"},{id:"436353",title:"Dr.",name:"Kushee-Nidhi",surname:"Kumar",slug:"kushee-nidhi-kumar",fullName:"Kushee-Nidhi Kumar"},{id:"438190",title:"Dr.",name:"Juliana",surname:"Sotherland",slug:"juliana-sotherland",fullName:"Juliana Sotherland"},{id:"438200",title:"Dr.",name:"Bryan",surname:"Wilson",slug:"bryan-wilson",fullName:"Bryan Wilson"},{id:"439089",title:"Dr.",name:"Thomas M.",surname:"Gallagher",slug:"thomas-m.-gallagher",fullName:"Thomas M. Gallagher"},{id:"440643",title:"Dr.",name:"Shekiba",surname:"Shahabzada",slug:"shekiba-shahabzada",fullName:"Shekiba Shahabzada"},{id:"440645",title:"Dr.",name:"Shilpa",surname:"Salpekar",slug:"shilpa-salpekar",fullName:"Shilpa Salpekar"}],corrections:null},{id:"76041",title:"Calling and Comradeship",doi:"10.5772/intechopen.97065",slug:"calling-and-comradeship",totalDownloads:220,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Patient safety heavily relies on doctors performing to the best of their abilities, delivering high quality of patientcare. However, changing market forces and increasing bureaucracy challenge physicians in their performance. Despite the dynamic conditions they experience, the majority performs on a high level. What exactly drives these doctors? Answering this question will shed light on how to best support doctors to be the engaged healthcare professionals that society wants and needs them to be. So patients are ensured safe and high quality of care. This chapter dips deeper into what primarily drives doctors, thus we turned to doctors themselves for answers. Being interested in their perceptions, feelings, behaviour, relations to, and interactions with, each other, this chapter relies heavily on qualitative research involving around 1000 hospital-based physicians. Conclusively, doctors can only truly blossom in an environment that stimulates their calling and that breathes a comradeship mindset, where sharing is about caring and peer-support is felt. It’s alarming that these essential humanistic and relational values are supressed by today’s more business-like climate in healthcare. Curtailing what primarily inspires doctors will eventually lead to doctors no longer having the time, energy and motivation to deliver the best possible patientcare. To restore the balance, we provide recommendations on the individual-, group-, and organizational level.",signatures:"Myra van den Goor and Tanya Bondarouk",downloadPdfUrl:"/chapter/pdf-download/76041",previewPdfUrl:"/chapter/pdf-preview/76041",authors:[{id:"343300",title:"Dr.",name:"Myra",surname:"van den Goor",slug:"myra-van-den-goor",fullName:"Myra van den Goor"},{id:"351542",title:"Prof.",name:"Tanya",surname:"Bondarouk",slug:"tanya-bondarouk",fullName:"Tanya Bondarouk"}],corrections:null},{id:"73581",title:"Digital Health and Healthcare Quality: A Primer on the Evolving 4th Industrial Revolution",doi:"10.5772/intechopen.94054",slug:"digital-health-and-healthcare-quality-a-primer-on-the-evolving-4th-industrial-revolution",totalDownloads:514,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The inefficiencies of the healthcare sector continue to be a barrier to achieving the quadruple aim of healthcare quality improvement. The 4th Industrial Revolution has been characterized by rapid transformations due to information technology, data volume, ubiquity, and increased computer processing power. Despite all the promises and hopes of Digital health tools as a means of attaining healthcare quality, there remains many challenges and hurdles to overcome. This chapter describes the relationship between the 4th Industrial Revolution and healthcare quality as it relates to its impact on healthcare quality, applications, and challenges. Suggestions to stakeholders on ways of navigating these challenges are also discussed.",signatures:"Ahmed Umar Otokiti",downloadPdfUrl:"/chapter/pdf-download/73581",previewPdfUrl:"/chapter/pdf-preview/73581",authors:[{id:"327099",title:"Dr.",name:"Ahmed",surname:"Umar Otokiti",slug:"ahmed-umar-otokiti",fullName:"Ahmed Umar Otokiti"}],corrections:null},{id:"76011",title:"The Role of the Radiation Safety Officer in Patient Safety",doi:"10.5772/intechopen.97058",slug:"the-role-of-the-radiation-safety-officer-in-patient-safety",totalDownloads:529,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The role of the Radiation Safety Officer (RSO) is to prevent unnecessary exposure to ionizing radiation and maintain necessary exposures as low as reasonably achievable (ALARA). The RSO is delegated broad authority throughout the organization by senior management. This authority includes permission to stop unsafe practices and identifying radiation protection problems, initiating, recommending, or providing corrective actions and verifying implementation of these actions. For the most part, these efforts are focused on maintaining radiation doses to employees and the public ALARA. Regulations do not address a role for the RSO in reducing radiation exposure to patients, except when unnecessary exposure is suspected due to equipment malfunction or human error. There is increasing concern about the risks of cancer and other effects from the use of medical imaging procedures. This chapter will discuss the tools and resources available to the RSO to educate members of the medical community and senior management on the need to manage radiation doses to patients so that the physician is able to obtain information necessary to properly diagnose and treat patients while avoiding unnecessary exposure.",signatures:"Thomas L. Morgan and Sandy Konerth",downloadPdfUrl:"/chapter/pdf-download/76011",previewPdfUrl:"/chapter/pdf-preview/76011",authors:[{id:"343320",title:"Dr.",name:"Thomas L.",surname:"Morgan",slug:"thomas-l.-morgan",fullName:"Thomas L. Morgan"},{id:"350479",title:"MSc.",name:"Sandy",surname:"Konerth",slug:"sandy-konerth",fullName:"Sandy Konerth"}],corrections:null},{id:"75074",title:"Safety and Potential Risks with Fecal Microbiota Transplantation",doi:"10.5772/intechopen.95907",slug:"safety-and-potential-risks-with-fecal-microbiota-transplantation",totalDownloads:157,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The therapeutic potential of Fecal Microbiota Transplantation (FMT) is greatly proved worldwide in the recent years. The use of FMT is now an accepted treatment modality and effective standard of care for some patients owing to its success in treating recurrent Clostridium Difficile Infection (rCDI). However, it is still evolving and longer term follow-up data regarding safety are required. Post-FMT serious adverse events (SAEs) have been varied between studies, however have included significant morbidity necessitating hospital admission and mortality in the follow-up period. The follow-up of FMT recipients should be long enough to completely establish efficacy/adverse events. Furthermore, it is recommended that FMT should be offered with caution to immunosuppressed patients, in whom FMT appears efficacious without significant additional adverse effects. In the wake of COVID-19 situation, stringent policies in screening the FMT donors have to be put forth to ensure patient safety. There is a need for high-quality, large, prospective, randomized controlled trials and long-term follow-up investigating screened donors and recipients to evaluate the long term safety and the risk–benefit profile of this promising therapy.",signatures:"Pratyusha Gaonkar",downloadPdfUrl:"/chapter/pdf-download/75074",previewPdfUrl:"/chapter/pdf-preview/75074",authors:[{id:"332490",title:"Dr.",name:"Pratyusha",surname:"Gaonkar",slug:"pratyusha-gaonkar",fullName:"Pratyusha Gaonkar"}],corrections:null},{id:"76640",title:"Control of Clinical Laboratory Errors by FMEA Model",doi:"10.5772/intechopen.97602",slug:"control-of-clinical-laboratory-errors-by-fmea-model",totalDownloads:1208,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Patient safety is an aim for clinical applications and is a fundamental principle of healthcare and quality management. The main global health organizations have incorporated patient safety in their review of work practices. The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",downloadPdfUrl:"/chapter/pdf-download/76640",previewPdfUrl:"/chapter/pdf-preview/76640",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}],corrections:null},{id:"73572",title:"Specialized Training for Nursing in the Surgical Area, a Question of Quality",doi:"10.5772/intechopen.94171",slug:"specialized-training-for-nursing-in-the-surgical-area-a-question-of-quality",totalDownloads:201,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This is an observational, descriptive and cross-sectional study that looks into nursing competencies within the surgical area and analyzes the influence of the variables age, years worked and employment relationship on the dependent variable nursing competencies. The Perceived Perioperative Competence Scale-Revised (PPCS-R) questionnaire was applied to nurses in the surgical area of the General University Hospital of Castellón. The variables were processed using ANOVA tests and Pearson’s correlations. A sample of 50 female nurses with a mean age of 41 ± 7.931 years was evaluated. Age and number of years worked were positively related to 11 items of the questionnaire. Regarding the employment relationship, significant differences were found, with the “permanent” employment relationship obtaining the highest mean score [1.040 (p = .018)]. Education and clinical experience were found to contribute to the development of practice. Patient safety was an essential aspect in managing the associated risk in the operating room (OR).",signatures:"María Desamparados Bernat Adell, María Sánchez Galán, Ana Folch Ayora, Pablo Salas Molina and Eladio Joaquín Collado Boira",downloadPdfUrl:"/chapter/pdf-download/73572",previewPdfUrl:"/chapter/pdf-preview/73572",authors:[{id:"324484",title:"Prof.",name:"María Desamparados",surname:"Bernat Adell",slug:"maria-desamparados-bernat-adell",fullName:"María Desamparados Bernat Adell"},{id:"324489",title:"Prof.",name:"Ana",surname:"Folch Ayora",slug:"ana-folch-ayora",fullName:"Ana Folch Ayora"},{id:"465943",title:"Dr.",name:"María",surname:"Sánchez Galán",slug:"maria-sanchez-galan",fullName:"María Sánchez Galán"},{id:"465945",title:"Dr.",name:"Pablo",surname:"Salas Molina",slug:"pablo-salas-molina",fullName:"Pablo Salas Molina"},{id:"465946",title:"Dr.",name:"Eladio",surname:"Joaquín Collado Boira",slug:"eladio-joaquin-collado-boira",fullName:"Eladio Joaquín Collado Boira"}],corrections:null},{id:"73839",title:"The Use of Virtual Reality Simulations in Nursing Education, and Patient Safety",doi:"10.5772/intechopen.94108",slug:"the-use-of-virtual-reality-simulations-in-nursing-education-and-patient-safety",totalDownloads:692,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Nursing education puts theory into practice. Patient safety is indispensable in nursing education. During clinical practice, nursing students make medication errors and have difficulty deciding on what interventions to perform in unusual situations and communicating with patients or other healthcare professionals. All these problems put patient safety at risk. However, “First, do no harm” is a fundamental human right and an ethical principle, which nurses should always consider when they perform interventions. Nursing students can help develop a culture of patient safety through experience in line with their knowledge, skills, and affective goals. Clinical settings can be equipped with real-life laboratories, mannequins, etc. Virtual reality simulations show nursing students what it is like to be in a real-world clinical setting and what problems and risks they may encounter there, and thus, helps them develop skills, build confidence, and prepare for clinical practice. This section addressed the effect of virtual reality simulations on skill development and patient safety in nursing education.",signatures:"Sule Biyik Bayram and Nurcan Caliskan",downloadPdfUrl:"/chapter/pdf-download/73839",previewPdfUrl:"/chapter/pdf-preview/73839",authors:[{id:"172022",title:"Dr.",name:"Nurcan",surname:"Çalişkan",slug:"nurcan-caliskan",fullName:"Nurcan Çalişkan"},{id:"324114",title:"Assistant Prof.",name:"Sule",surname:"Biyik Bayram",slug:"sule-biyik-bayram",fullName:"Sule Biyik Bayram"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6672",title:"Vignettes in Patient Safety",subtitle:"Volume 3",isOpenForSubmission:!1,hash:"2c8b1831a8cceea8be146cbfbd582b81",slug:"vignettes-in-patient-safety-volume-3",bookSignature:"Stanislaw P. Stawicki and Michael S. 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\r\n\tAll the industrial processes (manufacturing, mechanization, handling…) are changing rapidly as the new technologies evolve. The introduction of Industry 4.0 concepts is changing the classical concept of industry to a new one, more connected, more concentrated in the collaborative work between humans and robots and focused to adopt robotic technologies in the SME.
\r\n
\r\n\tThis book is intended to cover those previous aspects and others related to the new challenges that appear in robotizing the present industry at all levels. Contributions are welcome regarding new robotic morphologies and mechanics to be adopted to new tasks that the collaboration between humans and robots is introducing. This collaboration needs also a lot research that editors expect to collect in the book as well. Control and programming robots to be more efficient and accurate in the tasks also need new research that is expected to be covered in the book. New applications and new robots used in other fields can be now applied into industrial domain. Regarding this point, unmanned aerial robots are deployed more usually for inspections, maintenance, control, surveillance tasks in the industry world. Navigation, map generation and collaboration are also new fields that need research and some papers are expected to be published on these topics in the book. The new applications and the use of new robot structures lead to a review and assessment in terms of ethics and values. Education is still a pending issue that need to be covered at a undergraduated level also, and new educational experiences in this direction are expected as well.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"4a56dacb7c0504f0601f63000d64c1bc",bookSignature:"Prof. Antoni Grau and Dr. Rodrigo Munguia",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10630.jpg",keywords:"New Morphologies, Mechanical Structures, New Control Strategies, Modeling and Identification, Cooperative-Collaborative-Cobots, Human-Robot Interaction, Slam, Robot Communications, Autonomous Cars, UAV and USV, Ethics, Education and Training",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 27th 2020",dateEndSecondStepPublish:"November 24th 2020",dateEndThirdStepPublish:"January 23rd 2021",dateEndFourthStepPublish:"April 13th 2021",dateEndFifthStepPublish:"June 12th 2021",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:1,editedByType:null,kuFlag:!1,biosketch:"Dr. Grau is a robotics academic and researcher with many journal publications, he also edited several books and is a senior IEEE member serving as an associate editor for the IEEE Transactions on Industrial Informatics.",coeditorOneBiosketch:"Dr. Munguia is a researcher in mobile robotics, former head of the Control's Systems and Artificial Intelligence Center of the University of Guadalajara, and author of more than fifty scientific and technical papers among international journals, chapter books, and conference proceedings.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"13038",title:"Prof.",name:"Antoni",middleName:null,surname:"Grau",slug:"antoni-grau",fullName:"Antoni Grau",profilePictureURL:"https://mts.intechopen.com/storage/users/13038/images/system/13038.jfif",biography:"Antoni Grau received his M.S. and Ph.D. degrees in computer science from the Technical University of Catalonia (UPC), Barcelona, in 1990 and 1997, respectively. He is currently a Professor with the Department of Automatic Control, UPC, giving lectures on computer vision, digital signal processing, and robotics at the School of Informatics of Barcelona. His research interests include computer vision, pattern recognition, autonomous mobile robots, factory automation, and education on sustainable development. He has chaired several international conferences. 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He has worked as a software engineer in companies as IBM or Continental Automotive. Currently, he is a titular professor with the Department of Computer Science at the University of Guadalajara, México. His research interests include mobile robotics, unmanned aerial vehicles, navigation systems for autonomous vehicles, automatic control, optimal state estimation, sensor fusion, computer vision, and other related topics. He has more than fifty scientific and technical publications between journal articles, chapter books, and conference proceedings. 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1. Introduction
Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality in both developed and developing countries with European and North American figures ranges between 5–10% of all deliveries. In the UK it represents 7.3% of live births
Extreme preterm birth is defined as preterm birth prior to 28 weeks gestation. It accounts for 5–10% of preterm deliveries. The major concern of extreme preterm birth is the significant risk of neonatal mortality as the survival rates are very low at these gestations (0.4% at 22 weeks, 7% at 24 weeks) while the main concern of preterm births above 28 weeks is the neonatal morbidity as the survival rates are 77% at 28 weeks and 97% at 36 weeks.
2. Aetiology
The aetiology of preterm labour is multifactorial with a common pathway resluting in increased relasee of prostaglandins and cytokines within the cervix, myometrium and fetal membranes. The release of prostaglandins is triggered by infective or inflammatory process [1], uterine overdistension as in cases with polyhydraminons and mutiple preganacy or choriodecudidual haemorrhage as in cases with abruption.
In modern obstetrics, 30–40% of preterm deliveries are iatrogenic. The most common cause of which is severe pre-eclampsia associated with intrauterine growth restriction (IUGR) and antenatal fetal distress. Other common iatrogenic preterm deliveries include, Grade 3 and 4 placenta praevia or placenta abruption with major bleeding, sever IUGR with absent or reversed end-diastolic flow. It is also notable that the increased number of large loop excision of transformation zone (LLETZ) procedures for abnormal cervical cells leads to cervical scarring and iatrogenic cervical incompetence and hence preterm delivery.
3. Prediction of preterm labour
Identifying high risk patients is crucial in managing and preventing preterm labour. Prediction of preterm labour is possble through; risk assessment, uterine activity monitoring, cervical length assessment and fetal fibronectin assessment.
3.1 History taking and risk assessment
Patients with previous preterm labour are at higher risk of having pretem term birth. The risk is 17% after one previous preterm delivery and increases to 28% after two preterm deliveries. Patients with previous preterm premature rupture of membranes (PROM) [2], previous second trimester loss and thoese who are known to have cervical incomptence and congenital uterine anaomalies are at higher risk for preterm birth. Fruther more uterine overdistention as with Polyhydraminos and mutiple pregnancy is associated with preterm delivery. Patient with placental abruption are also known to be at higher risk of preterm labour.
Scoring systems were developed in attempts to achieve accurate and numerical score to help the management of preterm labour. However; the scoring systems proved to have poor sensitivity and poor postive predictive values as more that 50% of preterm labour occurs in the first pregnancy and in womens with no risk factors [3].
3.2 Monitoring uterine activity
It notable that uterine activity increases prior to onset of pretrm labour by 24 hours. However, the use of home uterine contraction monitors or self palpations has not proven to be useful as they had poor postive predictive vlaues and their use did not improve the perinatal outcomes.
3.3 Assessment of cervical length
Clinical assessment of cervical status in terms of dilatation, softening and effacement can predict preterm labour, However it has low sensitivity and repeated vaginal examination in it self may incease the cervical prostaglandins relase and subsquently increase the incidnce of preterm labour.
Utrasound assessment of cervical length is a reliable method and highest predictive value up to 70% is notable with cervical length under 25 mm in womens with risk factors for preterm labour. Serial cervical length assessment is recommended in hight isk group between 16–24 weeks. Cervical length is best measured by transvaginal scan with empty bladder as full bladder may lead to false increase in the cervical length measurments. The risk of preterm labour increases from 1% at cervical length of 25 mm to 4% at 15 mm cervical length. The marked increased risk is notable at 5 mm cervical length with preterm birth risk of 78% [4, 5].
Cervical length assessment is not routine in womens with no risk factors for preterm birth as the positive predictive value is low in this group. Also, preventive interventions as cervical cerclage is not recommended in low risk group as they have shown no improvement in the outcome in this group [4].
The presence of funnelling of the internal os is another helpful finding in predicting the preterm birth, However, it is less accurate compared to cervical length assessment due to inter and intra observer variations [6].
3.4 Fetal fibronectin testing
Fetal fibronectin is normally present in high concentration prior to 21 weeks of gestation in cervical and vaginal secretions prior to membranes fusion. Inflammatory process, uterine overdistension and choriodecidual haemorrhage increase fetal fibronectin secretion after 21 weeks gestation.
Fetal fibronectin testing by swabbing the posterior fornix or ectocervix between 22 and 34 weeks gestation in recommended as postive results in high risk group especially in presence of symptoms warrant admistration of steriods and hospital admission. Fetal fibronectin testing is not recommeded in womens with no risk factors as it has not shown to be effective in improving the outcome despite more than half of preterm birth occurs in this group [7].
Testing for fetal fibronectin is contraindicated before 22 weeks gestation, in presence of preterm premature rupture of membranes, active vaginal bleeding and intercourse in the previous 24 hours.
Other biochemical markers such as Insulin like growth factor binding protein-1, interleukin-6, interleukin-8 and tumour necrosis factor-alpha (TNF-α) were assessed in research setting for use in predicting preterm labour. However, none of those markers is currently used in routine practice [8].
4. Neonatal morbidity and mortality of preterm labour
Preterm birth is associated with significant neonatal morbidities such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, neonatal sepsis, intraventricular haemorrhage and periventricular leucomalacia. Longterm impact of prematurity are mainly cognitive and motor impairement which are more prevelant in extreme preterm births. Prolongation of pregnancy with tocolytic agents and adminstration of antenatal steriods signficantly reduces the neonatal morbidities in preterm births [1, 9].
EPICure data [9] may be useful tool in counselling the parents about fetal prognosis. Neonatal mortality is higher with preterm birth at lower gestational ages with survival rate of 7% at 24 weeks compared to 77% at 28 weeks and 97% at 32 weeks. The survival rates improves 2.2% daily between 24 and 28 weeks gestions. Preterm delivery at 36 weeks is associated with 99% survival rate [1, 9, 10].
5. Prevention of preterm delivery
Mutiple preventive measures were tested for prevention of preterm labour such as treatment of asymptomatic bacteruria and bacterial vaginosis, prophylactic antibiotics in womens with postive fetal fibronectin and reduced cervical length, cervical cerclage, prophlactic tocolysis and hormonal supplements. Some were proved to be effective in reducing preterm deliveries while others shown no significant diffierence in the outcome regarding the incidance of preterm birth and its associated morbidities.
Bacterial vaginosis occurs in 10–22% of pregnant womens with unknown aetiology. Treating the bacterial vagnoisis and hence reducing its associated inflammatory process was proved to reduce the incidance of preterm birth in womens with risk factors for preterm labour especially those with postive fetal fibronectin testing. Asymptomatic bacteruria occurs in 2–9% pregnant womens and its associated inflammtory process can participate in increasing prostagladins levels in cervicovaginal secretions and hence the preterm birth. Treating asymptomatic bacteruria in high risk group reduces the incidence of preterm birth but not in low risk group.
Antibiotic treatment for prophylactic antibiotics in womens with postive fetal fibronectin and in womens reduced cervical length in absence of infective or inflammatory process is not recommeded due to limited evidence and lack of proven efficacy.
Cervical cerclage proved to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation [4, 11]. Cervical cerclage can be done by transvaginal route (McDonald or Shirodkar techniques) or transadominal route when there is insufficient cervical tissue to hold the suture or when the vaginal approach has failed previously [1, 4]. Counselling prior such procedure is essential to involve the pros and cons. Complications of the procedure can include; bleeding, infection (endometritis), increased frequency of contractions, cervical trauma, preterm premature rupture of membranes, suture displacement, sepsis, cervical scarring. Cervical cerclage is contraindicated in presence of fetal anomaly, intrauterine infection, active bleeding and preterm premature rupture of membranes [1, 6].
Prophylactic tocolysis for high risk women has not proved to reduce the preterm birth rate and is not recommended.
Progesterone supplement via vaginal or intramuscular route on weekly basis till 36 weeks can be considered to promote reduction of uterine activity. Its use is limited to clinical trials in European guidlines [12, 13] while the recent NICE guideline in UK and in North America, progesterone supplementation is recommended for clinical use for reuction of preterm births [1, 14].
Use of cervical pessaries, bed rest and restrticting physical activity and intercourse have no proved evidence of preventing preterm labour [15, 16].
6. Management of preterm labour
The mangement of preterm labour fall into five areas; the use of tocolysis, adminstration of antibiotics, admistration of antenatal steriods, magnisum sulphate for neuroprotection and finally the considerations for the mode of delivery.
7. Tocolysis
It is important to realise that the aim of tocolysis in modern obstertics is limited to gain few days to allow admistration of antenatal steriods which proved to reduce perinatal morbidities in preterm birth and allow in utero transfer (Table 1).
Tocolytics
Mechanism
Dose
Side effects
Contraindications
Ritodrine - b2-agonists Currently not in use
b2-receptor stimulation reduces free intra-cellular Ca+2 via cyclic AMP and hence muscle relaxation
50–100 μ g/min IV then, increase by 50 μ g/min every 10 min. (up to 350 μ g/min)
Maternal; Hyperglycemia hypokalemia Tremors and nervousness Dyspnea and chest pain Palpitations and arrhythmia Hypotension Pulmonary edema Fetal/neonatal; Tachycardia Hypoglycemia Hypocalcemia Hyperbilirubinemia hypotension IVH
Dysrhythmias or other significant cardiac disease Diabetes mellitus Uncontrolled thyroid disease
Calcium channel blockers (CCB) - Nifedipine Currently first line
Inhibit influx of calcium into cell and hence prevent myometrial contraction
20–30 mg, then 10–20 mg every 4–8 hours (max 90 mg/day)
Maternal; Transient hypotension, headache and dizziness, Nausea Flushing Fetal/neonatal; None
Cardiac disease Hypotension Use with magnesium (collapse) Use with caution in renal disease
Atosiban - Oxytocin receptor antagonists Currently second line
Competitively inhibit oxytocin receptors
6.75 mg IV bolus, then 300 μg/min every 3 hours. (max 45 hours)
Maternal; Minimal; Nausea and vomiting Hot flushes Hypotension and dizzness Fetal; None
Inhibition of COX leads to reduced PGs synthesis and hence myometrial relaxation
Indomethacin: 50–100 mg loading dose, then 25–50 mg every 6 hours for max 48 hours Sulindac: 200 mg every 12 hours for max 48 hours.
Maternal; Minimal if used for 48 hours; Less with COX2 inhibitors; Peptic ulcerations Thrombocytopenia Postpartum haemorrhage Allergic reaction. Fetal; Main concern; premature closure of ductus arteriosus Risk of neonatal necrotizing enterocolitis, IVH and renal dysfunction
Renal or hepatic disease Active peptic ulcer Uncontrolled hypertension NSAID-sensitive asthma and thrombocytopenia
Magnesium sulfate (MgSO4) Currently not in use
Intracellular calcium antagonist
Initial: 4–6 g/30 min, then: 2–4 g/h
Maternal; Headache and flushing Lethargy Muscle weakness and diplopia Dry mouth Pulmonary edema Fetal/neonatal; Lethargy Hypotonia Hypocalcemia Respiratory depression
Myasthenia gravis
Table 1.
Tocolytics.
8. B2-agonists
Ritodrine and other b-agonists as terbutaline, salbutamol were used as tocolytic agent but currently not recommeded as first line due to its maternal and neonatal side effects. They act on b2 receptors in myometrial smooth muscles via a cAMP dependent mechanism leading to reduction in the intracellular calcium causing muscular relaxation. Cochrane review on B2-agonists concluded that they decrease the number of preterm births within 48 hours but not within 7 days [1, 17, 18].
Maternal side effects include; palpitations and arrhythmias, chest pain, hypotension, flushing, nausea, headache, pulmonary oedema, hypokalaemia and hyperglycaemia. Neonatal side effects include; tachycardia, hypotension, hypoglycaemia, hypocalcemia and ileus. It is not proved that B2-agnosists are associated with neonatal periventericular haemorrhage [18].
9. Indomethacin
It is a nonsteroidal anti-inflamatory agent which inhibit cyclo-oxygenase enzyme and subsequently reduces myomeytrial prostaglandins concentration which inturn down regulates myometrial cells gap junctions, down regulates oxytocin receptors and reduces intracellular calcium levels. It has better tocolytic effect and better safety profile than b-agonists but its routine use is limited due to the associated fetal side effects [18].
Maternal side effects include; risks of peptic ulcerations, thrombocytopenia and postpartum haemorrhage and allergic reaction. Fetal side effects include; premature closure of ductus arteriosus. There is risk of neonatal necrotizing enterocolitis, intraventericular haemorrhage and renal dysfunction [18].
10. COX (cyclo-oxygenase)-2 inhibitors
It is a nonsteriodal anti-inflammatory agent which act specifically on cycloxgenase-2 enzyme which is upregulated in preterm labour. The mechanism of action is simillar to indomethacin but with better maternal side effect profile. Its routine use is limited due to fetal concerns over premature closure of the ductus and renal idysfunction [18].
11. Atosiban
Atosiban is an oxytocin analogue competitively blocks oxytocin and vasopressin receptors leading to reduced intracelluar calcium and lesser prostagladins production. It is recommended and licenced in preterm labour [1, 18, 19]. Its side effects include; maternal nausea, vomiting, hot flushes, hypotension and dizzness. It has simillar effectivness to B2-agonists and nifidipine but with a safer profile however, it is more expensive and given intravenously [1, 18].
12. Nifedipine
It is a calcium channel blocker that is proved to be effective in reducing preterm birth with lesser side effects compared to B2-agonists. It is admnistered orally and it is considered first line treatment option [1, 18]. The side effects of its use include; headache, dizzness, ankle odema, and constipation.
13. Magnesium sulphate
Cochrane review did not support its use for tocolysis as studies repeorted did not show that magnesium sulphate delayed or prevented preterm birth [18].
14. Antibiotics
The use of antibiotics is recommeded with preterm premature rupture of membranes (PPROM) based on ORACLE trial and chochrane review which proved that they reduce the time to delivery and the incidence of chorioamnionitis. They also decrease the ioccurance of neonatal sepsis and the need for neonatal surfactant and oxygen therapy. On the other hand; the ORACLE trial did not recommed its use in preterm labour without premature rupture of membranes as there was no difference in the neonatal outcomes [1, 20, 21].
It is also concluded that erythromycin is a better choice compared to coamoxiclav in women with preterm labour associated with premature rupture of membranes due to increased risk of necrotizing enetrocoilitis with the use of co-amoxiclav [20, 21].
15. Antenatal steriods
The Royal College of Obstetricians and Gynaecologists (RCOG) recommeded the use of antenatal corticosteriods in women with threating preterm labour as it is proven that their use has significant reduction in neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal death without increase in neonatal sepsis in women who has preterm labour and PPROM.
The use of antenatal steriods is recommeded with threatening preterm labour between 24 weeks and 34 weeks gestations may be considered up to 35 + 6 weeks with the optimal benefit within a window of one to seven days [1, 22].
The agent of choice is betamethasone as it has lesser risk of periventericular leucomalacia compared to the use of dexamethasone [22].
It is recommeded that betamethasone is adminstered intramuscularly in patients with preterm labour as the oral adminstration is associated with higher risk of neonatal sepsis and intraventricular haemorrhage. It is recommended to be used as two doses of 12 mg, 24 hours apart.
The use of mutiple courses of antenatal steriods is not recommeded as per RCOG guidance as it is associated with increassed risks of maternal osteoprosis, infection and imparied glucose tolerance. Multiple courses of steriods is associated with fetal risks including; intrauterine growth restriction, low birth weight, necrotizing enterocolitis, adrenal insufficiency and abnormal neurological development. Compared to a single course, mutiple courses have no benefit of improving neonatal respiratory distress syndrome, chronic lung disease and intraventericular haemorrhage [1, 22].
16. Magnisum sulphate for neuroprotection
Children born to women given magnesium sulphate for seizure prevention in severe pre-eclampsia were noted to have lower rates of cerebral palsy. This is possibly because magnisum decreases extracellular glutamate with hypoxia and hence reduces excitotoxicity. It also limits calcium influx through voltage-gated channels and in turn reduces the activation of apoptosis. Further more it reduces oxidative stress and reduces the production of pro-inflammatory cytokines.
It is use for neuroprotection is recommeded for use in women with established preterm labour or planned to hace elective preterm birth within 24 hours at gestations between 24 and 30 weeks. It is can be considered between 30 and 34 weeks [1, 23].
17. Mode of delivery
Vaginal delivery is considered to be appropriate choice in gestations under 24 weeks as the neonatal survival rate is very low. The challanging decision is the balance of vaginal delivery versus caesarean section in preterm delivery between 24 weeks and 37 weeks gestation [1, 24].
The decision for caesarean section is recommended to be for the obstetric reasons such as malpresentations and intrapartum fetal distress. Cochrane review for elective caesarean section in women with threating preterm labour between 24 and 37 weeks gestation has not shown statistically significant difference in the neonatal outcomes with regard the incidence of respiratory distress syndrome and neonatal seizures.
There is no evidence to support routine prophylactic outlet forceps or episiotomy when considering vaginal delivery between 24 and 37 weeks gestations. It is advisable to leave the fetal membranes intact till late in labour to reduce the risk of cord prolapse. The fetal scalp electrode and fetal blood sampling use is contraindicated prior to 34 weeks gestation and hence any suspicious fetal monitoring trace should be considered as indication for caesarean section. Their use is considered between 34 and 36 weeks gestation. It is also important to note that ventouse delivery is contraindicated prior to 34 weeks gestation. Consideration should be taken for caesarean section in preterm delivery with breech presentation [1, 24].
Delayed cord clamping for at least 30 seconds but no longer than three minutes is advisable in preterm deliveries to allow auto transfusion of the baby. Senior obstetrician should be consulted in planning the delivery and the decision-making throughout the labour [1, 24].
Parents should have discussion with joint obstetric and neonatal team prior embarking onto labour is helpful to ensure their understanding of challenges for the preterm baby such as ability to maintain stable core body temperature, ability to breath spontaneously and feeding difficulties. The expected postnatal care for the preterm baby should be planned as detailed as possible with the parents and ensure the availability of the facilities.
\n',keywords:"definition, maternal morbidity, feral morbidity, risk factors, tocolysis, antenatal steroids",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75219.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75219.xml",downloadPdfUrl:"/chapter/pdf-download/75219",previewPdfUrl:"/chapter/pdf-preview/75219",totalDownloads:205,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:26,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"October 19th 2020",dateReviewed:"January 16th 2021",datePrePublished:"May 12th 2021",datePublished:"November 3rd 2021",dateFinished:"February 12th 2021",readingETA:"0",abstract:"Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality and accounts for 5–10% of all deliveries. Cervical length assessment between 16–24 weeks and positive fetal fibronectin beyond 21 weeks gestation are proved to useful tools in prediction of preterm labour. Treating asymptomatic bacteruia and bacterial vaginosis in high-risk women reduces the incidence of preterm labour. Cervical cerclage is recommended to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation. Atosiban and nifidipine are currently the agents of choice in tocolysis. Antenal steriods in womens with threating preterm labour reduces the perinatal morbidties. Magnisum sulphate role is established for neuroprotection especially in extreme gestations between 24–30 weeks. Vaginal delivery is mode of choice for delivery with consideration to avoid fetal blood sampling, fetal scalp electrodes and ventouse prior to 34 weeks gestations. Caesarean section is considered for obstetric reasons that guide labour management at term.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75219",risUrl:"/chapter/ris/75219",book:{id:"8557",slug:"empowering-midwives-and-obstetric-nurses"},signatures:"Maged Shendy, Hend Hendawy, Amr Salem, Ibrahim Alatwi and Abdurahman Alatawi",authors:[{id:"49200",title:"Mr.",name:"Maged",middleName:null,surname:"Shendy",fullName:"Maged Shendy",slug:"maged-shendy",email:"mego_marmar@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Liverpool Women's Hospital",institutionURL:null,country:{name:"United Kingdom"}}},{id:"337197",title:"Dr.",name:"Hend",middleName:null,surname:"Hindawy",fullName:"Hend Hindawy",slug:"hend-hindawy",email:"dr.hendhindawy@hotmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Basildon and Thurrock University Hospitals NHS Foundation Trust",institutionURL:null,country:{name:"United Kingdom"}}},{id:"337200",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Alatwi",fullName:"Ibrahim Alatwi",slug:"ibrahim-alatwi",email:"ialatwi@moh.gov.sa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Tabuk",institutionURL:null,country:{name:"Saudi Arabia"}}},{id:"337201",title:"Dr.",name:"Abdurhman",middleName:null,surname:"Alatwi",fullName:"Abdurhman Alatwi",slug:"abdurhman-alatwi",email:"Abdurhmansa@moh.gov.sa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Tabuk",institutionURL:null,country:{name:"Saudi Arabia"}}},{id:"337461",title:"Dr.",name:"Amr",middleName:null,surname:"Salem",fullName:"Amr Salem",slug:"amr-salem",email:"amr_salem79@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Basildon and Thurrock University Hospitals NHS Foundation Trust",institutionURL:null,country:{name:"United Kingdom"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Aetiology",level:"1"},{id:"sec_3",title:"3. Prediction of preterm labour",level:"1"},{id:"sec_3_2",title:"3.1 History taking and risk assessment",level:"2"},{id:"sec_4_2",title:"3.2 Monitoring uterine activity",level:"2"},{id:"sec_5_2",title:"3.3 Assessment of cervical length",level:"2"},{id:"sec_6_2",title:"3.4 Fetal fibronectin testing",level:"2"},{id:"sec_8",title:"4. Neonatal morbidity and mortality of preterm labour",level:"1"},{id:"sec_9",title:"5. Prevention of preterm delivery",level:"1"},{id:"sec_10",title:"6. Management of preterm labour",level:"1"},{id:"sec_11",title:"7. Tocolysis",level:"1"},{id:"sec_12",title:"8. B2-agonists",level:"1"},{id:"sec_13",title:"9. Indomethacin",level:"1"},{id:"sec_14",title:"10. COX (cyclo-oxygenase)-2 inhibitors",level:"1"},{id:"sec_15",title:"11. Atosiban",level:"1"},{id:"sec_16",title:"12. Nifedipine",level:"1"},{id:"sec_17",title:"13. Magnesium sulphate",level:"1"},{id:"sec_18",title:"14. Antibiotics",level:"1"},{id:"sec_19",title:"15. Antenatal steriods",level:"1"},{id:"sec_20",title:"16. Magnisum sulphate for neuroprotection",level:"1"},{id:"sec_21",title:"17. Mode of delivery",level:"1"}],chapterReferences:[{id:"B1",body:'NICE guideline Preterm labour and birth [NG25] Published date: 20 November 2015 Last updated: 02 August 2019'},{id:"B2",body:'Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2013; (1): CD000262'},{id:"B3",body:'Sangkomkamhang US, Lumbiganon P, Prasertcharoensuk W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery.Cochrane Database Syst Rev 2015; (5): CD006178'},{id:"B4",body:'Royal College of Obstetricians and Gynaecologists. Cervical Cerclage. Green-top Guideline No. 60. London: RCOG, 2011'},{id:"B5",body:'Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 2010; 35: 54-64'},{id:"B6",body:'Alfirevic Z, Stampalija T, Roberts D, Jorgensen AL. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 2012; (4): CD008991'},{id:"B7",body:'Deshpande SN, van Asselt AD, Tomini F, et al. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis. Health Technol Assess 2013; 17: 1-138'},{id:"B8",body:'Menon R, Torloni MR, Voltolini C, et al. Biomarkers of spontaneous preterm birth: an overview of the literature in the last four decades. Reprod Sci 2011; 18: 1046-70'},{id:"B9",body:'Moore T, Hennessy EM, Myles J, et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961'},{id:"B10",body:'Royal College of Obstetricians and Gynaecologists. Perinatal Management of Pregnant Women at the Threshold of Infant Viability: the Obstetric Perspective. Scientific Impact Paper No. 41. London: RCOG, 2014'},{id:"B11",body:'Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a metaanalysis.Obstet Gynecol 2011; 117: 663-71'},{id:"B12",body:'Di Renzo GC, Roura LC, Facchinetti F, et al. Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth. J Matern Fetal Neonatal Med 2011; 24: 659-67'},{id:"B13",body:'Royal College of Obstetricians and Gynaecologists. The Use of Progesterone to Prevent Preterm Delivery. 2015'},{id:"B14",body:'Dodd J, Jones L, Flenady V, Cincotta R, Crowther C. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane. Database Syst Rev 2013; (7): CD004947'},{id:"B15",body:'Goya M, Pratcorona L, Merced C, et al.; Pesario Cervical para Evitar Prematuridad (PECEP) Trial Group. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 2012; 379: 1800-6'},{id:"B16",body:'Sosa CG, Althabe F, Belizan JM, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev 2015; (3): CD003581'},{id:"B17",body:'Flenady V, Wojcieszek AM, Papatsonis DN, et al. Calcium channel blockers for inhibiting preterm labour and birth. Cochrane Database Syst Rev 2014; (6): CD002255'},{id:"B18",body:'Royal College of Obstetricians and Gynaecologists. Tocolysis for Women in Preterm Labour. Green-top Guideline No. 1b. London: RCOG, February 2011'},{id:"B19",body:'Flenady V, Reinebrant HE, Liley HG, Tambimuttu EG, Papatsonis DN. Oxytocin receptor antagonists for inhibiting preterm labour. Cochrane Database Syst Rev 2014; (6): CD004452'},{id:"B20",body:'Kenyon SL, Taylor DJ, Tarnow-Mordi W; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomized trial. Lancet 2001; 357: 979-88'},{id:"B21",body:'Royal College of Obstetricians and Gynaecologists. Preterm Prelabour Rupture of Membranes. Green-top Guideline No. 44. London: RCOG, October 2010'},{id:"B22",body:'Royal College of Obstetricians and Gynaecologists. Antenatal Corticosteroids to Reduce Neonatal Morbidity. Green-top Guideline No. 7. London: RCOG, October 2010'},{id:"B23",body:'Royal College of Obstetricians and Gynaecologists. Magnesium Sulphate to Prevent Cerebral Palsy Following Preterm Birth. Scientific Impact Paper No. 29. London: RCOG, 2011'},{id:"B24",body:'Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2013; (9): CD000078'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Maged Shendy",address:"mego_marmar@yahoo.com",affiliation:'
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1. Introduction
Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality in both developed and developing countries with European and North American figures ranges between 5–10% of all deliveries. In the UK it represents 7.3% of live births
Extreme preterm birth is defined as preterm birth prior to 28 weeks gestation. It accounts for 5–10% of preterm deliveries. The major concern of extreme preterm birth is the significant risk of neonatal mortality as the survival rates are very low at these gestations (0.4% at 22 weeks, 7% at 24 weeks) while the main concern of preterm births above 28 weeks is the neonatal morbidity as the survival rates are 77% at 28 weeks and 97% at 36 weeks.
2. Aetiology
The aetiology of preterm labour is multifactorial with a common pathway resluting in increased relasee of prostaglandins and cytokines within the cervix, myometrium and fetal membranes. The release of prostaglandins is triggered by infective or inflammatory process [1], uterine overdistension as in cases with polyhydraminons and mutiple preganacy or choriodecudidual haemorrhage as in cases with abruption.
In modern obstetrics, 30–40% of preterm deliveries are iatrogenic. The most common cause of which is severe pre-eclampsia associated with intrauterine growth restriction (IUGR) and antenatal fetal distress. Other common iatrogenic preterm deliveries include, Grade 3 and 4 placenta praevia or placenta abruption with major bleeding, sever IUGR with absent or reversed end-diastolic flow. It is also notable that the increased number of large loop excision of transformation zone (LLETZ) procedures for abnormal cervical cells leads to cervical scarring and iatrogenic cervical incompetence and hence preterm delivery.
3. Prediction of preterm labour
Identifying high risk patients is crucial in managing and preventing preterm labour. Prediction of preterm labour is possble through; risk assessment, uterine activity monitoring, cervical length assessment and fetal fibronectin assessment.
3.1 History taking and risk assessment
Patients with previous preterm labour are at higher risk of having pretem term birth. The risk is 17% after one previous preterm delivery and increases to 28% after two preterm deliveries. Patients with previous preterm premature rupture of membranes (PROM) [2], previous second trimester loss and thoese who are known to have cervical incomptence and congenital uterine anaomalies are at higher risk for preterm birth. Fruther more uterine overdistention as with Polyhydraminos and mutiple pregnancy is associated with preterm delivery. Patient with placental abruption are also known to be at higher risk of preterm labour.
Scoring systems were developed in attempts to achieve accurate and numerical score to help the management of preterm labour. However; the scoring systems proved to have poor sensitivity and poor postive predictive values as more that 50% of preterm labour occurs in the first pregnancy and in womens with no risk factors [3].
3.2 Monitoring uterine activity
It notable that uterine activity increases prior to onset of pretrm labour by 24 hours. However, the use of home uterine contraction monitors or self palpations has not proven to be useful as they had poor postive predictive vlaues and their use did not improve the perinatal outcomes.
3.3 Assessment of cervical length
Clinical assessment of cervical status in terms of dilatation, softening and effacement can predict preterm labour, However it has low sensitivity and repeated vaginal examination in it self may incease the cervical prostaglandins relase and subsquently increase the incidnce of preterm labour.
Utrasound assessment of cervical length is a reliable method and highest predictive value up to 70% is notable with cervical length under 25 mm in womens with risk factors for preterm labour. Serial cervical length assessment is recommended in hight isk group between 16–24 weeks. Cervical length is best measured by transvaginal scan with empty bladder as full bladder may lead to false increase in the cervical length measurments. The risk of preterm labour increases from 1% at cervical length of 25 mm to 4% at 15 mm cervical length. The marked increased risk is notable at 5 mm cervical length with preterm birth risk of 78% [4, 5].
Cervical length assessment is not routine in womens with no risk factors for preterm birth as the positive predictive value is low in this group. Also, preventive interventions as cervical cerclage is not recommended in low risk group as they have shown no improvement in the outcome in this group [4].
The presence of funnelling of the internal os is another helpful finding in predicting the preterm birth, However, it is less accurate compared to cervical length assessment due to inter and intra observer variations [6].
3.4 Fetal fibronectin testing
Fetal fibronectin is normally present in high concentration prior to 21 weeks of gestation in cervical and vaginal secretions prior to membranes fusion. Inflammatory process, uterine overdistension and choriodecidual haemorrhage increase fetal fibronectin secretion after 21 weeks gestation.
Fetal fibronectin testing by swabbing the posterior fornix or ectocervix between 22 and 34 weeks gestation in recommended as postive results in high risk group especially in presence of symptoms warrant admistration of steriods and hospital admission. Fetal fibronectin testing is not recommeded in womens with no risk factors as it has not shown to be effective in improving the outcome despite more than half of preterm birth occurs in this group [7].
Testing for fetal fibronectin is contraindicated before 22 weeks gestation, in presence of preterm premature rupture of membranes, active vaginal bleeding and intercourse in the previous 24 hours.
Other biochemical markers such as Insulin like growth factor binding protein-1, interleukin-6, interleukin-8 and tumour necrosis factor-alpha (TNF-α) were assessed in research setting for use in predicting preterm labour. However, none of those markers is currently used in routine practice [8].
4. Neonatal morbidity and mortality of preterm labour
Preterm birth is associated with significant neonatal morbidities such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, neonatal sepsis, intraventricular haemorrhage and periventricular leucomalacia. Longterm impact of prematurity are mainly cognitive and motor impairement which are more prevelant in extreme preterm births. Prolongation of pregnancy with tocolytic agents and adminstration of antenatal steriods signficantly reduces the neonatal morbidities in preterm births [1, 9].
EPICure data [9] may be useful tool in counselling the parents about fetal prognosis. Neonatal mortality is higher with preterm birth at lower gestational ages with survival rate of 7% at 24 weeks compared to 77% at 28 weeks and 97% at 32 weeks. The survival rates improves 2.2% daily between 24 and 28 weeks gestions. Preterm delivery at 36 weeks is associated with 99% survival rate [1, 9, 10].
5. Prevention of preterm delivery
Mutiple preventive measures were tested for prevention of preterm labour such as treatment of asymptomatic bacteruria and bacterial vaginosis, prophylactic antibiotics in womens with postive fetal fibronectin and reduced cervical length, cervical cerclage, prophlactic tocolysis and hormonal supplements. Some were proved to be effective in reducing preterm deliveries while others shown no significant diffierence in the outcome regarding the incidance of preterm birth and its associated morbidities.
Bacterial vaginosis occurs in 10–22% of pregnant womens with unknown aetiology. Treating the bacterial vagnoisis and hence reducing its associated inflammatory process was proved to reduce the incidance of preterm birth in womens with risk factors for preterm labour especially those with postive fetal fibronectin testing. Asymptomatic bacteruria occurs in 2–9% pregnant womens and its associated inflammtory process can participate in increasing prostagladins levels in cervicovaginal secretions and hence the preterm birth. Treating asymptomatic bacteruria in high risk group reduces the incidence of preterm birth but not in low risk group.
Antibiotic treatment for prophylactic antibiotics in womens with postive fetal fibronectin and in womens reduced cervical length in absence of infective or inflammatory process is not recommeded due to limited evidence and lack of proven efficacy.
Cervical cerclage proved to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation [4, 11]. Cervical cerclage can be done by transvaginal route (McDonald or Shirodkar techniques) or transadominal route when there is insufficient cervical tissue to hold the suture or when the vaginal approach has failed previously [1, 4]. Counselling prior such procedure is essential to involve the pros and cons. Complications of the procedure can include; bleeding, infection (endometritis), increased frequency of contractions, cervical trauma, preterm premature rupture of membranes, suture displacement, sepsis, cervical scarring. Cervical cerclage is contraindicated in presence of fetal anomaly, intrauterine infection, active bleeding and preterm premature rupture of membranes [1, 6].
Prophylactic tocolysis for high risk women has not proved to reduce the preterm birth rate and is not recommended.
Progesterone supplement via vaginal or intramuscular route on weekly basis till 36 weeks can be considered to promote reduction of uterine activity. Its use is limited to clinical trials in European guidlines [12, 13] while the recent NICE guideline in UK and in North America, progesterone supplementation is recommended for clinical use for reuction of preterm births [1, 14].
Use of cervical pessaries, bed rest and restrticting physical activity and intercourse have no proved evidence of preventing preterm labour [15, 16].
6. Management of preterm labour
The mangement of preterm labour fall into five areas; the use of tocolysis, adminstration of antibiotics, admistration of antenatal steriods, magnisum sulphate for neuroprotection and finally the considerations for the mode of delivery.
7. Tocolysis
It is important to realise that the aim of tocolysis in modern obstertics is limited to gain few days to allow admistration of antenatal steriods which proved to reduce perinatal morbidities in preterm birth and allow in utero transfer (Table 1).
Tocolytics
Mechanism
Dose
Side effects
Contraindications
Ritodrine - b2-agonists Currently not in use
b2-receptor stimulation reduces free intra-cellular Ca+2 via cyclic AMP and hence muscle relaxation
50–100 μ g/min IV then, increase by 50 μ g/min every 10 min. (up to 350 μ g/min)
Maternal; Hyperglycemia hypokalemia Tremors and nervousness Dyspnea and chest pain Palpitations and arrhythmia Hypotension Pulmonary edema Fetal/neonatal; Tachycardia Hypoglycemia Hypocalcemia Hyperbilirubinemia hypotension IVH
Dysrhythmias or other significant cardiac disease Diabetes mellitus Uncontrolled thyroid disease
Calcium channel blockers (CCB) - Nifedipine Currently first line
Inhibit influx of calcium into cell and hence prevent myometrial contraction
20–30 mg, then 10–20 mg every 4–8 hours (max 90 mg/day)
Maternal; Transient hypotension, headache and dizziness, Nausea Flushing Fetal/neonatal; None
Cardiac disease Hypotension Use with magnesium (collapse) Use with caution in renal disease
Atosiban - Oxytocin receptor antagonists Currently second line
Competitively inhibit oxytocin receptors
6.75 mg IV bolus, then 300 μg/min every 3 hours. (max 45 hours)
Maternal; Minimal; Nausea and vomiting Hot flushes Hypotension and dizzness Fetal; None
Inhibition of COX leads to reduced PGs synthesis and hence myometrial relaxation
Indomethacin: 50–100 mg loading dose, then 25–50 mg every 6 hours for max 48 hours Sulindac: 200 mg every 12 hours for max 48 hours.
Maternal; Minimal if used for 48 hours; Less with COX2 inhibitors; Peptic ulcerations Thrombocytopenia Postpartum haemorrhage Allergic reaction. Fetal; Main concern; premature closure of ductus arteriosus Risk of neonatal necrotizing enterocolitis, IVH and renal dysfunction
Renal or hepatic disease Active peptic ulcer Uncontrolled hypertension NSAID-sensitive asthma and thrombocytopenia
Magnesium sulfate (MgSO4) Currently not in use
Intracellular calcium antagonist
Initial: 4–6 g/30 min, then: 2–4 g/h
Maternal; Headache and flushing Lethargy Muscle weakness and diplopia Dry mouth Pulmonary edema Fetal/neonatal; Lethargy Hypotonia Hypocalcemia Respiratory depression
Myasthenia gravis
Table 1.
Tocolytics.
8. B2-agonists
Ritodrine and other b-agonists as terbutaline, salbutamol were used as tocolytic agent but currently not recommeded as first line due to its maternal and neonatal side effects. They act on b2 receptors in myometrial smooth muscles via a cAMP dependent mechanism leading to reduction in the intracellular calcium causing muscular relaxation. Cochrane review on B2-agonists concluded that they decrease the number of preterm births within 48 hours but not within 7 days [1, 17, 18].
Maternal side effects include; palpitations and arrhythmias, chest pain, hypotension, flushing, nausea, headache, pulmonary oedema, hypokalaemia and hyperglycaemia. Neonatal side effects include; tachycardia, hypotension, hypoglycaemia, hypocalcemia and ileus. It is not proved that B2-agnosists are associated with neonatal periventericular haemorrhage [18].
9. Indomethacin
It is a nonsteroidal anti-inflamatory agent which inhibit cyclo-oxygenase enzyme and subsequently reduces myomeytrial prostaglandins concentration which inturn down regulates myometrial cells gap junctions, down regulates oxytocin receptors and reduces intracellular calcium levels. It has better tocolytic effect and better safety profile than b-agonists but its routine use is limited due to the associated fetal side effects [18].
Maternal side effects include; risks of peptic ulcerations, thrombocytopenia and postpartum haemorrhage and allergic reaction. Fetal side effects include; premature closure of ductus arteriosus. There is risk of neonatal necrotizing enterocolitis, intraventericular haemorrhage and renal dysfunction [18].
10. COX (cyclo-oxygenase)-2 inhibitors
It is a nonsteriodal anti-inflammatory agent which act specifically on cycloxgenase-2 enzyme which is upregulated in preterm labour. The mechanism of action is simillar to indomethacin but with better maternal side effect profile. Its routine use is limited due to fetal concerns over premature closure of the ductus and renal idysfunction [18].
11. Atosiban
Atosiban is an oxytocin analogue competitively blocks oxytocin and vasopressin receptors leading to reduced intracelluar calcium and lesser prostagladins production. It is recommended and licenced in preterm labour [1, 18, 19]. Its side effects include; maternal nausea, vomiting, hot flushes, hypotension and dizzness. It has simillar effectivness to B2-agonists and nifidipine but with a safer profile however, it is more expensive and given intravenously [1, 18].
12. Nifedipine
It is a calcium channel blocker that is proved to be effective in reducing preterm birth with lesser side effects compared to B2-agonists. It is admnistered orally and it is considered first line treatment option [1, 18]. The side effects of its use include; headache, dizzness, ankle odema, and constipation.
13. Magnesium sulphate
Cochrane review did not support its use for tocolysis as studies repeorted did not show that magnesium sulphate delayed or prevented preterm birth [18].
14. Antibiotics
The use of antibiotics is recommeded with preterm premature rupture of membranes (PPROM) based on ORACLE trial and chochrane review which proved that they reduce the time to delivery and the incidence of chorioamnionitis. They also decrease the ioccurance of neonatal sepsis and the need for neonatal surfactant and oxygen therapy. On the other hand; the ORACLE trial did not recommed its use in preterm labour without premature rupture of membranes as there was no difference in the neonatal outcomes [1, 20, 21].
It is also concluded that erythromycin is a better choice compared to coamoxiclav in women with preterm labour associated with premature rupture of membranes due to increased risk of necrotizing enetrocoilitis with the use of co-amoxiclav [20, 21].
15. Antenatal steriods
The Royal College of Obstetricians and Gynaecologists (RCOG) recommeded the use of antenatal corticosteriods in women with threating preterm labour as it is proven that their use has significant reduction in neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal death without increase in neonatal sepsis in women who has preterm labour and PPROM.
The use of antenatal steriods is recommeded with threatening preterm labour between 24 weeks and 34 weeks gestations may be considered up to 35 + 6 weeks with the optimal benefit within a window of one to seven days [1, 22].
The agent of choice is betamethasone as it has lesser risk of periventericular leucomalacia compared to the use of dexamethasone [22].
It is recommeded that betamethasone is adminstered intramuscularly in patients with preterm labour as the oral adminstration is associated with higher risk of neonatal sepsis and intraventricular haemorrhage. It is recommended to be used as two doses of 12 mg, 24 hours apart.
The use of mutiple courses of antenatal steriods is not recommeded as per RCOG guidance as it is associated with increassed risks of maternal osteoprosis, infection and imparied glucose tolerance. Multiple courses of steriods is associated with fetal risks including; intrauterine growth restriction, low birth weight, necrotizing enterocolitis, adrenal insufficiency and abnormal neurological development. Compared to a single course, mutiple courses have no benefit of improving neonatal respiratory distress syndrome, chronic lung disease and intraventericular haemorrhage [1, 22].
16. Magnisum sulphate for neuroprotection
Children born to women given magnesium sulphate for seizure prevention in severe pre-eclampsia were noted to have lower rates of cerebral palsy. This is possibly because magnisum decreases extracellular glutamate with hypoxia and hence reduces excitotoxicity. It also limits calcium influx through voltage-gated channels and in turn reduces the activation of apoptosis. Further more it reduces oxidative stress and reduces the production of pro-inflammatory cytokines.
It is use for neuroprotection is recommeded for use in women with established preterm labour or planned to hace elective preterm birth within 24 hours at gestations between 24 and 30 weeks. It is can be considered between 30 and 34 weeks [1, 23].
17. Mode of delivery
Vaginal delivery is considered to be appropriate choice in gestations under 24 weeks as the neonatal survival rate is very low. The challanging decision is the balance of vaginal delivery versus caesarean section in preterm delivery between 24 weeks and 37 weeks gestation [1, 24].
The decision for caesarean section is recommended to be for the obstetric reasons such as malpresentations and intrapartum fetal distress. Cochrane review for elective caesarean section in women with threating preterm labour between 24 and 37 weeks gestation has not shown statistically significant difference in the neonatal outcomes with regard the incidence of respiratory distress syndrome and neonatal seizures.
There is no evidence to support routine prophylactic outlet forceps or episiotomy when considering vaginal delivery between 24 and 37 weeks gestations. It is advisable to leave the fetal membranes intact till late in labour to reduce the risk of cord prolapse. The fetal scalp electrode and fetal blood sampling use is contraindicated prior to 34 weeks gestation and hence any suspicious fetal monitoring trace should be considered as indication for caesarean section. Their use is considered between 34 and 36 weeks gestation. It is also important to note that ventouse delivery is contraindicated prior to 34 weeks gestation. Consideration should be taken for caesarean section in preterm delivery with breech presentation [1, 24].
Delayed cord clamping for at least 30 seconds but no longer than three minutes is advisable in preterm deliveries to allow auto transfusion of the baby. Senior obstetrician should be consulted in planning the delivery and the decision-making throughout the labour [1, 24].
Parents should have discussion with joint obstetric and neonatal team prior embarking onto labour is helpful to ensure their understanding of challenges for the preterm baby such as ability to maintain stable core body temperature, ability to breath spontaneously and feeding difficulties. The expected postnatal care for the preterm baby should be planned as detailed as possible with the parents and ensure the availability of the facilities.
\n',keywords:"definition, maternal morbidity, feral morbidity, risk factors, tocolysis, antenatal steroids",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75219.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75219.xml",downloadPdfUrl:"/chapter/pdf-download/75219",previewPdfUrl:"/chapter/pdf-preview/75219",totalDownloads:205,totalViews:0,totalCrossrefCites:0,dateSubmitted:"October 19th 2020",dateReviewed:"January 16th 2021",datePrePublished:"May 12th 2021",datePublished:"November 3rd 2021",dateFinished:"February 12th 2021",readingETA:"0",abstract:"Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality and accounts for 5–10% of all deliveries. Cervical length assessment between 16–24 weeks and positive fetal fibronectin beyond 21 weeks gestation are proved to useful tools in prediction of preterm labour. Treating asymptomatic bacteruia and bacterial vaginosis in high-risk women reduces the incidence of preterm labour. Cervical cerclage is recommended to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation. Atosiban and nifidipine are currently the agents of choice in tocolysis. Antenal steriods in womens with threating preterm labour reduces the perinatal morbidties. Magnisum sulphate role is established for neuroprotection especially in extreme gestations between 24–30 weeks. Vaginal delivery is mode of choice for delivery with consideration to avoid fetal blood sampling, fetal scalp electrodes and ventouse prior to 34 weeks gestations. Caesarean section is considered for obstetric reasons that guide labour management at term.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75219",risUrl:"/chapter/ris/75219",signatures:"Maged Shendy, Hend Hendawy, Amr Salem, Ibrahim Alatwi and Abdurahman Alatawi",book:{id:"8557",type:"book",title:"Empowering Midwives and Obstetric Nurses",subtitle:null,fullTitle:"Empowering Midwives and Obstetric Nurses",slug:"empowering-midwives-and-obstetric-nurses",publishedDate:"November 3rd 2021",bookSignature:"Amita Ray",coverURL:"https://cdn.intechopen.com/books/images_new/8557.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-066-2",printIsbn:"978-1-83969-065-5",pdfIsbn:"978-1-83969-067-9",isAvailableForWebshopOrdering:!0,editors:[{id:"251100",title:"Prof.",name:"Amita",middleName:null,surname:"Ray",slug:"amita-ray",fullName:"Amita Ray"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"49200",title:"Mr.",name:"Maged",middleName:null,surname:"Shendy",fullName:"Maged Shendy",slug:"maged-shendy",email:"mego_marmar@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Liverpool Women's Hospital",institutionURL:null,country:{name:"United Kingdom"}}},{id:"337197",title:"Dr.",name:"Hend",middleName:null,surname:"Hindawy",fullName:"Hend Hindawy",slug:"hend-hindawy",email:"dr.hendhindawy@hotmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Basildon and Thurrock University Hospitals NHS Foundation Trust",institutionURL:null,country:{name:"United Kingdom"}}},{id:"337200",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Alatwi",fullName:"Ibrahim Alatwi",slug:"ibrahim-alatwi",email:"ialatwi@moh.gov.sa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Tabuk",institutionURL:null,country:{name:"Saudi Arabia"}}},{id:"337201",title:"Dr.",name:"Abdurhman",middleName:null,surname:"Alatwi",fullName:"Abdurhman Alatwi",slug:"abdurhman-alatwi",email:"Abdurhmansa@moh.gov.sa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Tabuk",institutionURL:null,country:{name:"Saudi Arabia"}}},{id:"337461",title:"Dr.",name:"Amr",middleName:null,surname:"Salem",fullName:"Amr Salem",slug:"amr-salem",email:"amr_salem79@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Basildon and Thurrock University Hospitals NHS Foundation Trust",institutionURL:null,country:{name:"United Kingdom"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Aetiology",level:"1"},{id:"sec_3",title:"3. Prediction of preterm labour",level:"1"},{id:"sec_3_2",title:"3.1 History taking and risk assessment",level:"2"},{id:"sec_4_2",title:"3.2 Monitoring uterine activity",level:"2"},{id:"sec_5_2",title:"3.3 Assessment of cervical length",level:"2"},{id:"sec_6_2",title:"3.4 Fetal fibronectin testing",level:"2"},{id:"sec_8",title:"4. Neonatal morbidity and mortality of preterm labour",level:"1"},{id:"sec_9",title:"5. Prevention of preterm delivery",level:"1"},{id:"sec_10",title:"6. Management of preterm labour",level:"1"},{id:"sec_11",title:"7. Tocolysis",level:"1"},{id:"sec_12",title:"8. B2-agonists",level:"1"},{id:"sec_13",title:"9. Indomethacin",level:"1"},{id:"sec_14",title:"10. COX (cyclo-oxygenase)-2 inhibitors",level:"1"},{id:"sec_15",title:"11. Atosiban",level:"1"},{id:"sec_16",title:"12. Nifedipine",level:"1"},{id:"sec_17",title:"13. Magnesium sulphate",level:"1"},{id:"sec_18",title:"14. Antibiotics",level:"1"},{id:"sec_19",title:"15. Antenatal steriods",level:"1"},{id:"sec_20",title:"16. Magnisum sulphate for neuroprotection",level:"1"},{id:"sec_21",title:"17. Mode of delivery",level:"1"}],chapterReferences:[{id:"B1",body:'NICE guideline Preterm labour and birth [NG25] Published date: 20 November 2015 Last updated: 02 August 2019'},{id:"B2",body:'Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2013; (1): CD000262'},{id:"B3",body:'Sangkomkamhang US, Lumbiganon P, Prasertcharoensuk W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery.Cochrane Database Syst Rev 2015; (5): CD006178'},{id:"B4",body:'Royal College of Obstetricians and Gynaecologists. Cervical Cerclage. Green-top Guideline No. 60. London: RCOG, 2011'},{id:"B5",body:'Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 2010; 35: 54-64'},{id:"B6",body:'Alfirevic Z, Stampalija T, Roberts D, Jorgensen AL. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 2012; (4): CD008991'},{id:"B7",body:'Deshpande SN, van Asselt AD, Tomini F, et al. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis. Health Technol Assess 2013; 17: 1-138'},{id:"B8",body:'Menon R, Torloni MR, Voltolini C, et al. Biomarkers of spontaneous preterm birth: an overview of the literature in the last four decades. Reprod Sci 2011; 18: 1046-70'},{id:"B9",body:'Moore T, Hennessy EM, Myles J, et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961'},{id:"B10",body:'Royal College of Obstetricians and Gynaecologists. Perinatal Management of Pregnant Women at the Threshold of Infant Viability: the Obstetric Perspective. Scientific Impact Paper No. 41. London: RCOG, 2014'},{id:"B11",body:'Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a metaanalysis.Obstet Gynecol 2011; 117: 663-71'},{id:"B12",body:'Di Renzo GC, Roura LC, Facchinetti F, et al. Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth. J Matern Fetal Neonatal Med 2011; 24: 659-67'},{id:"B13",body:'Royal College of Obstetricians and Gynaecologists. The Use of Progesterone to Prevent Preterm Delivery. 2015'},{id:"B14",body:'Dodd J, Jones L, Flenady V, Cincotta R, Crowther C. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane. Database Syst Rev 2013; (7): CD004947'},{id:"B15",body:'Goya M, Pratcorona L, Merced C, et al.; Pesario Cervical para Evitar Prematuridad (PECEP) Trial Group. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 2012; 379: 1800-6'},{id:"B16",body:'Sosa CG, Althabe F, Belizan JM, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev 2015; (3): CD003581'},{id:"B17",body:'Flenady V, Wojcieszek AM, Papatsonis DN, et al. Calcium channel blockers for inhibiting preterm labour and birth. Cochrane Database Syst Rev 2014; (6): CD002255'},{id:"B18",body:'Royal College of Obstetricians and Gynaecologists. Tocolysis for Women in Preterm Labour. Green-top Guideline No. 1b. London: RCOG, February 2011'},{id:"B19",body:'Flenady V, Reinebrant HE, Liley HG, Tambimuttu EG, Papatsonis DN. Oxytocin receptor antagonists for inhibiting preterm labour. Cochrane Database Syst Rev 2014; (6): CD004452'},{id:"B20",body:'Kenyon SL, Taylor DJ, Tarnow-Mordi W; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomized trial. Lancet 2001; 357: 979-88'},{id:"B21",body:'Royal College of Obstetricians and Gynaecologists. Preterm Prelabour Rupture of Membranes. Green-top Guideline No. 44. London: RCOG, October 2010'},{id:"B22",body:'Royal College of Obstetricians and Gynaecologists. Antenatal Corticosteroids to Reduce Neonatal Morbidity. Green-top Guideline No. 7. London: RCOG, October 2010'},{id:"B23",body:'Royal College of Obstetricians and Gynaecologists. Magnesium Sulphate to Prevent Cerebral Palsy Following Preterm Birth. Scientific Impact Paper No. 29. London: RCOG, 2011'},{id:"B24",body:'Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2013; (9): CD000078'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Maged Shendy",address:"mego_marmar@yahoo.com",affiliation:'
Pharmaceutical Care Adminsteration, Tabuk Region, Kingdom of Saudi Arabia
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\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
\r\n
\r\n\t
\r\n
\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
\r\n
\r\n\t
\r\n
\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
\r\n
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
\r\n
\r\n\t
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
\r\n
\r\n\t
\r\n
\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
\r\n
\r\n\t
\r\n
\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\t
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
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He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"4",type:"subseries",title:"Fungal Infectious Diseases",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment",scope:"Fungi are ubiquitous and there are almost no non-pathogenic fungi. Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",hasOnlineFirst:!0,hasPublishedBooks:!1,annualVolume:11400,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). 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The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",annualVolume:11423,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"275140",title:"Dr.",name:"Dinh Hoa",middleName:null,surname:"Nguyen",fullName:"Dinh Hoa Nguyen",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRbnKQAS/Profile_Picture_1622204093453",institutionString:null,institution:{name:"Kyushu University",institutionURL:null,country:{name:"Japan"}}},{id:"20259",title:"Dr.",name:"Hongbin",middleName:null,surname:"Ma",fullName:"Hongbin Ma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRhDJQA0/Profile_Picture_2022-05-02T08:25:21.jpg",institutionString:null,institution:{name:"Beijing Institute of Technology",institutionURL:null,country:{name:"China"}}},{id:"28640",title:"Prof.",name:"Yasushi",middleName:null,surname:"Kambayashi",fullName:"Yasushi Kambayashi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYOQxQAO/Profile_Picture_1625660525470",institutionString:null,institution:{name:"Nippon Institute of Technology",institutionURL:null,country:{name:"Japan"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/89535",hash:"",query:{},params:{id:"89535"},fullPath:"/profiles/89535",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()