Frequency Of Preterm Delivery Research Articles

Risk factors for spontaneous preterm deliveries above twenty-eight complete weeks of gestation

Purpose: To identify risk factors for spontaneous preterm delivery (SPD) given that it is associated with high neonatal morbidity and mortality. Material and methods: This case-control study was carried out between 1st February and 31st July 2021. Women who delivered spontaneously between 28 and ˂37 weeks (cases) or at ≥37 weeks (controls) were recruited. The main variables recorded included maternal age and parity, inter-pregnancy interval, if the pregnancy was intended, medical, obstetrical and family past-histories, gestational age at delivery, number of gestation and pathologies during current gestation. Fisher exact test, t-test and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results: Our frequency of preterm delivery was 15.3% (116/759 births), with 9.9% (75/759) being SPD. Significant risk factors for SPD were premature rupture of membranes (aOR 19.96, 95%CI 11.04-45.82), inter-pregnancy interval ˃60 months (aOR 13.02, 95%CI 6.11-33.01), Nulliparity (aOR 10.21, 95%CI 5.72-21.31), 1st degree family history of SPD (aOR 7.73, 95%CI 1.54-11.39), malaria in the 3rd trimester (aOR 6.89, 95%CI 2.15-8.63), multiple pregnancies (aOR 6.43, 95%CI 3.21-9.79), severe anemia (Hb ˂6g/dl) in the 3rd trimester (aOR 5.73, 95%CI 2.04-10.60) and unintended pregnancies (aOR 2.44, 95%CI 1.98-7.88). Conclusion: Women with multiple or unintended pregnancies and those with the pre-gestational risk factors identified above should be well followed up during pregnancy to allow prevention, if not, early diagnosis of SPD. Moreover, prevention of the above-identified pathologies in pregnancy is mandatory if we want to reverse the rate of SPD

Maternal human papillomavirus infection during pregnancy and preterm delivery, a mother-child cohort study in Norway and Sweden.

Human papillomavirus (HPV) infection is common in women of reproductive age. Infection and inflammation are leading causes for preterm delivery (PTD), but the role of HPV infection in PTD and prelabor rupture of membranes (PROM) is unclear. We aimed to explore whether HPV infection during pregnancy in general, and high-risk-HPV (HR-HPV) infection specifically, increased the risk of PTD, preterm prelabor rupture of membranes (PPROM), PROM at term, and/or chorioamnionitis. In pregnant women, who were participating in a prospective multicenter cohort study from a general population in Norway and Sweden (PreventADALL, ClinicalTrials.gov NCT02449850), HPV DNA was analyzed in available urine samples at mid-gestation (16-22 weeks) and at delivery, and in the placenta after delivery with Seegene Anyplex II HPV28 PCR assay. The risk of PTD, PPROM, PROM, and chorioamnionitis was analyzed using unadjusted and adjusted logistic regression analyses for any 28 HPV genotypes, including 12 HR-HPV genotypes, compared with HPV-negative women. Further, subgroups of HPV (low-risk/possibly HR-HPV, HR-HPV-non-16 and HR-HPV-16), persistence of HR-HPV from mid-gestation to delivery, HR-HPV-viral load, and presence of multiple HPV infections were analyzed for the obstetric outcomes. Samples for HPV analyses were available from 950 women with singleton pregnancies (mean age 32 years) at mid-gestation and in 753 also at delivery. At mid-gestation, 40% of women were positive for any HPV and 24% for HR-HPV. Of the 950 included women, 23 had PTD (2.4%), nine had PPROM (0.9%), and six had chorioamnionitis (0.6%). Of the term pregnancies, 25% involved PROM. The frequency of PTD was higher in HR-HPV-positive women (8/231, 3.5%) than in HPV-negative women (13/573, 2.3%) at mid-gestation, but the association was not statistically significant (odds ratio 1.55; 95% confidence interval 0.63-3.78). Neither any HPV nor subgroups of HPV at mid-gestation or delivery, nor persistence of HR-HPV was significantly associated with increased risk for PTD, PPROM, PROM, or chorioamnionitis. No HPV DNA was detected in placentas of women with PTD, PPROM or chorioamnionitis. HPV infection during pregnancy was not significantly associated with increased risk for PTD, PPROM, PROM, or chorioamnionitis among women from a general population with a low incidence of adverse obstetric outcomes.

Ultrasound-Indicated Cerclage in Twin Pregnancies: A Cohort Study.

To report the pregnancy and neonatal outcomes in patients with twin pregnancies who underwent ultrasound-indicated cerclage (UIC) and to compare them to patients with singleton pregnancies undergoing the same procedures. Patients who underwent UIC between January 2010 and December 2020 at Kangnam Sacred Heart Hospital were reviewed. We compared characteristics, pregnancy, and neonatal outcomes between patients with singleton and twin pregnancies. A total of 94 women (56 singleton and 38 twin pregnancies) underwent UIC were included. The mean gestational age (GA) at cerclage and preoperative cervical length (CL) were not significantly different. Twin pregnancies were more likely to deliver at earlier median gestations than singletons (singleton, 36 + 1 weeks vs twin, 32 + 6 weeks, and p = 0.004). The frequency of preterm delivery <34 weeks in twin group was higher than in singleton group (15 (26.8%) vs 20 (52.6%) and p =0.016). However, the frequency of preterm delivery <32, <28, and <24 weeks was not significantly different between two groups. Although neonatal weights in singleton pregnancies were heavier than twin pregnancies, neonatal mortality and morbidities were not significantly different between two groups. Among various factors contributing to preterm birth, preoperative CL ≤ 15 mm was independently associated with a higher risk of preterm delivery before 34 weeks. Furthermore, pregnancy and neonatal outcomes of twin pregnancies with cervical length ≤ 15 mm are comparable with those of singleton pregnancies (GA at delivery, singleton, 35 + 1 weeks vs twin, 32 + 5 weeks, and p = 0.24; neonatal mortality, singleton, 3.4% vs twin, 4.8%, and p = 0.64). The pregnancy and neonatal outcomes of UIC in twin pregnancies were comparable to those in singleton pregnancies, especially when CL is ≤15 mm. UIC might be considered a safe procedure for twin pregnancies.

Perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary hospital in Ethiopia: A case‐control study

AbstractBackgroundPreeclampsia accounts for 10–15% maternal deaths globally, corresponding to 50,000 annual maternal deaths. Twin pregnancy is a known risk factor for preeclampsia; however, there is inadequate data on the clinical characteristics and perinatal outcomes of twin pregnancies complicated with preeclampsia. This paper studied the perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary hospital in Ethiopia.MethodsA case‐control study was conducted at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia) from September 1, 2016 till August 31, 2018. A total of 173 twin deliveries (63 preeclampsia cases and 110 normotensive controls) were included in the study and the primary outcome was the frequency of preterm delivery. Data were analyzed using SPSS version 23 and statistical test of association was done using chi‐square test for categorical data. Variables with p value of &lt;0.2 on bivariate analysis were entered into multivariable logistic regression analysis. p value &lt;0.05 were considered significant.ResultsThe frequency of preterm birth was 61.9% in the preeclampsia group and 33.6% in the normotensive group, p &lt; 0.001. Preeclampsia group were 2.58 times more likely to have preterm delivery compared to matched normotensive controls [adjusted OR = 2.58, 95% CI (1.24 – 5.35), p = 0.01]. There was no difference in the rate of adverse neonatal outcome (respiratory distress syndrome, early neonatal death, and Low Apgar score) between the groups.ConclusionsIn this study, twin pregnancies complicated with preeclampsia were found to have an increased rate of preterm birth compared to matched controls without hypertension.

O-179 Pregnancy outcomes in women with anorexia nervosa: a North American population-based study

Abstract Study question What implications does anorexia nervosa (AN) have on pregnancy outcomes in a North American population (NAP)? Summary answer Anorexia nervosa is associated with substantial increased risk of 500% in SGA, 270% in preterm delivery and 335% in placental abruption in a NAP. What is known already While considered by many a contraindication to fertility treatment, many women with AN do conceive with the help of reproductive medicine and spontaneously. This could be either because of lack of proper screening for anorexia nervosa (as studies show), or this being a lifelong disease. Many fertility specialists are faced with the dilemma of treating women who are undernourished, or if by refusing to do so, possibly preventing these patients the joy of parenthood. Most data regarding the consequences of AN on pregnancy complications, comes from Northern Europe and data from North America is lacking. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of AN during pregnancy were identified as part of the study group (n = 214), and the remaining deliveries comprised the reference group (n = 9,096,574). Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups, Chi-squared test or Fisher’s exact test were used when appropriate. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement(2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women diagnosed with AN were more likely to be white, of higher income, to be smokers, have thyroid disease or diagnosed with another psychiatric disorder (p &amp;lt; 0.05 all). No difference was found in the rates of hypertensive diseases of pregnancy, gestational diabetes mellitus, incidence of placenta previa, need for cesarean section, postpartum hemorrhage or chorioamnionitis(P&amp;gt;.05, all). Women with AN had a higher frequency of preterm delivery (aOR 2.70 CI 1.69-4.3, p &amp;lt; 0.001) and placental abruption (aOR 3.35 CI 1.36-8.26, p = 0.009). The incidence of small for gestational age neonates was shockingly higher in the AN group (aOR 5.00 CI 2.93-8.53, p &amp;lt; 0.001). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of AN could not be assessed, nor could compliance with treatment. Wider implications of the findings Women with AN often conceive through ovulation induction. Fertility specialist should be aware of the magnitude of adverse outcomes related to pregnancy in women with AN, with a 500% increase in SGA 500% compared to a control population, and likely contributing to the increase in preterm delivery. Trial registration number not applicable

Outcome of Twin Pregnancies Complicated by a Single Intrauterine Death

ObjectiveSingle intrauterine fetal death (sIUFD) occurs in approximately 6% of twin pregnancies. If it occurs in the second and third trimesters, it places the co-twin at substantial risk, including that of preterm delivery and associated comorbidities of prematurity or neonatal death. The aim of this present study was to determine the outcome of surviving co-twins following spontaneous single intrauterine fetal death.MethodsThis is a retrospective, observational, cohort study that included all twin pregnancies delivered between January 2015 to December 2019 with a gestational age of 24 weeks or more. Maternal data included were: age, medical illnesses, conceivable methods, chorionicity, and complications during pregnancy. Gestational age of intrauterine fetal demise, gestational age of the surviving twin delivery, mode of delivery, and medications used during pregnancy were also recorded. Neonatal data included: gestational age, gender, birth weight, Apgar score, and complications of prematurity.ResultsTwenty-two pregnancies were found to be complicated by sIUFD and included in the present study (group 1), compared to 26 twins with no sIUFD (group 2). The incidence of sIUFD in twin pregnancies after 20 weeks of pregnancy was 4.4%. The gestational age (weeks) in group 1 was 34.5 (29-39) and in group 2 was 32 (26-38). The frequency of preterm delivery 81.8% in group 1 (59% monochorionic) and 69.2% (100% dichorionic) in group 2. No significant statistical differences were found between the two groups in complications of prematurity.ConclusionsWe conclude that delaying delivery in twin pregnancies complicated by single intrauterine demise with regular follow-up may lead to delivering infants with fewer complications of prematurity.

Maternal and Neonatal Outcome of Pregnant Women With SARS-CoV-2 Infection During the First and Second Wave of COVID-19 in a Tertiary Care Institute in Eastern India.

BackgroundThe ongoing coronavirus 2019 (COVID-19) pandemic is the most devastating health care crisis of our times. Pregnant women with COVID-19 infection belong to a vulnerable group with concerns about the effect of the disease on maternal and neonatal health. As we are dealing with a new disease, we must study the changing trend of disease presentation, diagnosis, and treatment to successfully manage such pregnancies.ObjectiveThe purpose of the present study was to evaluate the differences in presenting features, comorbidities, the fetal and maternal outcomes in COVID-19 positive pregnant women in the first and second wave of the pandemic in a tertiary care institute in eastern India.MethodologyThis study was a retrospective observational cohort study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. All COVID-19 positive by reverse transcription-polymerase chain reaction or rapid antigen (RTPCR) test pregnant women (249 women) admitted to the hospital from May 2020 to August 2021 were included in this study. Out of the total, 139 women were admitted during the first wave (May 2020 to February 2021), and 110 women were admitted during the second wave (March 2021 to August 2021) of the pandemic. Data like baseline characteristics, clinical presentation, associated co-morbidities, management modalities, the maternal and neonatal outcomes were analyzed and compared.ResultsThe peak of the first wave of COVID-19 was found during the months of August-October 2020, while the second wave was in April-May 2021. The majority of women had the asymptomatic or mild disease during both waves, but 14 women had moderate to severe disease during the second wave as compared to two women during the first wave. There was a significant increase in maternal deaths in the second wave (3.64%) as compared to the first wave (0.00%). During the second wave, out of 85 women who delivered, 78.8% (n=67) women had a cesarean section which was significantly higher than the first wave (64.6%). Hypertensive disorders (pre-eclampsia, gestational hypertension, and chronic hypertension) were the most common associated comorbidity, followed by diabetes (gestational diabetes, diabetes mellitus type 2) and anemia during both waves of the pandemic. The rate of preterm delivery was 27.78% (n=35) and 24.71% (n=21) during the first and second waves, respectively. Two babies tested positive within 24 hours of delivery during the first wave and one during the second wave. ConclusionA significantly higher number of moderate to severe disease and maternal deaths were reported during the second wave of the pandemic. A higher incidence of severe oligohydramnios and cesarean section was seen during the second wave. The frequency of preterm deliveries and low birth weight remained high during both waves. Neonatal COVID-19 infection was seen during both waves, but the incidence remained low.

The effect of educational intervention based on self-efficacy theory on pregnancy anxiety and childbirth outcomes among Iranian primiparous women.

BACKGROUND:Pregnancy anxiety is associated with a diverse birth outcomes. Mothers' education could have a critical role in increasing their self-efficacy to defeat their anxiety and improve pregnancy and child birth outcomes. The study was conducted to examine the effect of intervention based on self-efficacy theory on pregnancy anxiety and child birth outcomes.MATERIALS AND METHODS:The study was conducted as a quasi-experimental design on 60primiparous women (26–28 weeks) in Birjand (East Iranian province) from May to September 2017, who were randomly divided into intervention and control groups. The intervention group received 8 sessions of 90-min educational intervention based on self-efficacy theory strategies besides the routine prenatal care. Vanden Bergh's pregnancy anxiety questionnaire and checklist of pregnancy and delivery outcomes were used for data collection.RESULTS:The level of pregnancy anxiety was similar in both groups before the intervention, but immediately and 1 month after the intervention, the mean score of pregnancy anxiety significantly reduced in the intervention group and significantly increased in the control group (P < 0.001). There was a significant difference in mean neonatal weight (P < 0.001) between the two groups. Emergency and elective cesarean section were significantly lower in the intervention group compared to the control group (P < 0.001), but there were no significant differences in the frequency of preterm delivery between two groups (P < 0.05).CONCLUSION:The results provide support for the effectiveness of intervention based on self-efficacy theory in reducing pregnancy anxiety and enhancing positive pregnancy outcomes. Hence, theory-based educational interventions may serve as a cost-effective and noninvasive approach to reduce pregnancy anxiety in Iran.

Value of HbA1c in Obese Women with Gestational Diabetes

We sought to assess the association of hemoglobin A1c (HbA1c) with adverse perinatal outcomes in obese women with gestational diabetes mellitus (GDM). This was a secondary analysis of a multicenter randomized controlled trial assessing early (14-20 weeks) versus routine (24-28 weeks) screening for GDM in obese women. Women were included if they were diagnosed with GDM at either time during pregnancy and had a HbA1c result available. The primary exposure was HbA1c at 24 to 28 weeks. The primary outcome was a composite of macrosomia, primary cesarean, pregnancy-induced hypertension, shoulder dystocia, neonatal hypoglycemia, or hyperbilirubinemia. Receiver operating characteristics (ROC) curves were used to assess the association of HbA1c with the composite outcome. The Liu method was used to select an optimal HbA1c cutoff, and the incidence of the outcome compared. Of 125 women with GDM, 93 (74%) had a HbA1c at 24 to 28 weeks and 103 (82.4%) had a HbA1c at 14 to 20 weeks. Baseline characteristics were balanced between groups above and below the cutoff. The area under the ROC curve for HbA1c and its association with the adverse perinatal composite outcome was 0.6 (95% confidence interval [CI]: 0.5-0.7). The frequency of the primary outcome was similar among women with low and high HbA1c at 24 to 28 weeks (adjusted relative risk, 1.12, 95% CI: 0.97-1.29). Compared with women with a decreasing HbA1c during pregnancy, women with a stable or increasing HbA1c did not have a significant increase in the primary adverse perinatal composite outcome. However, the frequency of preterm delivery was higher among women with stable or increasing HbA1c compared with those with a decreasing HbA1c (26.1 vs. 6.7%, p = 0.03). A single HbA1c in women with GDM is not associated with a composite perinatal adverse outcome, but a HbA1c that increases or remains stable between 14 to 20 and 24 to 28 weeks is associated with an increase in preterm delivery. · A single HbA1c in GDM is not associated with a composite perinatal adverse outcome.. · HbA1c that increases or remains stable may be associated with an increase in preterm delivery.. · HbA1c at 24 to 28 weeks was not significantly associated with the adverse perinatal composite outcome..

Comparison of the frequency of preterm births in patients treated with oral versus intramuscular progesterone with history of previous preterm birth

Background: Globally, it has proven that preterm birth is associated with perinatal mortality to the extent of &gt;75%, and &gt;50% of perinatal and long term morbidity. Oral progesterone are easy to take but are less effective because of first pass hepatic metabolism leading to variable plasma levels while intramuscular progesterone carries the risk of swelling and bruising at injection site. The aim was to find out frequency of preterm birth in patients treated with oral versus intramuscular progesterone.Methods: Randomized controlled trial conducted in the department of obstetrics and gynecology, Sir Ganga Ram hospital Lahore, Pakistan conducted from 5 October 2017 to 4 April 2018. This study involved 530 pregnant women with history of at least 1 previous preterm delivery presenting in antenatal clinic between 16-20 weeks of gestation. Group I received oral progesterone 10 mg tablet duphaston BD from 20 weeks till 37 weeks. Group II received intramuscular progesterone injection proluton depot 250 mg IM weekly from 16-20 weeks till 37 weeks.Results: The mean age of the patients was 27.52±4.57 years while the mean gestational age was 17.39±1.38 weeks. 47.5% of the patients were para 2 followed by para 3 (32.3%) and para 1 (20.2%). The mean gestational age at delivery was significantly higher among intramuscular group (36.14±2.23 versus 35.07±2.97 weeks; p=0.000). The frequency of preterm delivery was significantly lower in intramuscular group (24.9% versus 39.6%; p=0.000) as compared to oral group.Conclusions: Frequency of preterm delivery was significantly lower in patients treated with intramuscular progesterone (24.9% versus 39.6%; p=0.000) as compared to oral progesterone.

Physical Activity Patterns of Women with a Twin Pregnancy—A Cross-Sectional Study

Background: No specific physical activity guidelines are available for women in multiple pregnancy. Aim of the study was to assess the knowledge and experience of women regarding physical activity during their latest twin pregnancy. Methods: A cross-sectional study including women after a twin delivery was conducted in Poland. A questionnaire was distributed in 2018 via web pages and Facebook groups designed for pregnant women. Results: 652 women filled out the questionnaire completely. Only 25% of women performed any physical exercises during twin gestation. The frequency of preterm delivery was similar in physically active and non-active participants. 35% of the respondents claimed to have gained information on proper activity from obstetricians during antenatal counselling while 11% claimed to be unable to identify the reliable sources of information. 7% of women admitted to feel discriminated by social opinion on exercising during a twin pregnancy. Conclusions: The population of women with a twin gestation is not sufficiently physically active and is often discouraged from performing exercises during gestation. Therefore, it is crucial to inform obstetricians to recommend active lifestyle during a twin gestation and to provide reliable information on physical activity to pregnant women. Further research on this topic is necessary in order for obstetric providers to counsel women on appropriate exercise with a twin pregnancy.

901 Maternal weight gain and readmission rates amongst women with hypertensive disorders of pregnancy

Mobilization of extracellular fluid postpartum has been implicated in hypertensive crisis leading to postpartum hypertensive readmission amongst women with hypertensive disorders of pregnancy (HDP). We sought to determine how weight gain during pregnancy which reflects increased extracellular fluid differed between women who were readmitted versus those who were not amongst women with HDP. This was a retrospective case-control study of all women admitted with HDP (identified by ICD10 codes) between Jan. 1st, 2016 - Dec. 31st, 2019. Subjects were divided into those who were readmitted due to hypertension complications versus those who were not. The primary exposure was maternal weight gain during pregnancy. Bivariate analyses of baseline characteristics by exposure were conducted. Logistic regression modeling was used to adjust for confounders. Of the 2,131 subjects, 62 (2.90%) were readmitted due to hypertension complications. Women who were readmitted verses those who were not differed in terms of age, race, and incidence of A2GDM, preterm delivery, and specific types of hypertensive disorders of pregnancies (Table 1). Average weight gain during pregnancy differed between those who were readmitted versus those who were not (24.7 lbs. ±29.1 v. 32.8 lbs. ±24.7, p<0.05) (Table 1). However, when adjusting for age, race, and frequency of preterm delivery, the difference in weight gain was no longer significant (OR 0.99, 95% CI: 0.99-1.00, p=0.10) (Table 2). In this cohort of women with HDP, maternal weight gain during pregnancy was not related to risk of readmission due to hypertension complications once other maternal characteristics and diseases severity was controlled for.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

ROLE OF VAGINAL PROGESTERONE IN THE PREVENTION OF PRETERM DELIVERY

BACKGROUND&#x0D; Preterm Birth is the main cause of Perinatal morbidity and Mortality. Progesterone has been used for preventing Preterm Labour and is being advocated for it. Its use in women presenting with Preterm labor pains has diverse results.The administration of Progesterone has been shown to lower not only the number of the episodes of preterm Uterine contractions but it also decrease the incidence of preterm delivery in the high risk women for Preterm delivery. &#x0D; OBJECTIVE&#x0D; To compare the frequency of Spontaneous Preterm Birth , in the woman having a prior history of one spontaneous Preterm Delivery, who are treated by 100mg of vaginal progesterone pessary daily versus controls.&#x0D; STUDY DESIGN&#x0D; A Randomized controlled trial was carried out at the Obstetrics &amp; Gynaecology Department of Lahore General Hospital (a tertiary care hospital) of 6 months duration from 1-09-2018 To 28-02-2019. Two groups of Patients were made. Patients in Group-A were instructed to use a vaginal pessary containing 100mg natural progesterone daily before going to sleep every night, starting from the time of enrollment to 36 weeks of pregnancy or until occurrence of preterm labor or premature rupture of membranes. Patients in Group-B did not receive progesterone pessary and acted as control.All the patient were followed up until the delivery.&#x0D; RESULTS&#x0D; In Group :A and in Group:B mean age of the women was 27.71±3.31 and 27.81±3.57 years. There were total 60(30%) neonates who were delivered premature. In Group-A, the frequency of preterm delivery was 21%(21/100), while in Group-B it was 39%. The frequency of the Preterm delivery was quite significantly less in the women who were on progesterone as compared to the women who were not given progesterone. i.e. (p-value=0.005)&#x0D; CONCLUSION&#x0D; It is thus concluded that vaginal progesterone resulted in Significant reduction of the Preterm delivery rate in the women with a prior history of 1 spontaneous Preterm birth i.e. 21% in treatment group A vs. 39% in non-treatment group B.

The relation between prepregnancy maternal body mass index and total gestational weight gain with the characteristics of the newborns

Aims To evaluate the relationship between the maternal body mass index (BMI) and total gestational weight gain (GWG) with the characteristics of newborns, taking into consideration the birth weight (BW), weight for age score (WfA), length for age (LfA), and weight for length (WfL), APGAR score, and premature delivery. Methods We conducted a study, from March 2015 to 2016. We included a number of 1218 pregnant women who delivered single babies, from three different hospitals that serve the entire Mures County and who met our inclusion criteria. Results We did not find significant differences regarding weight, length at birth, and gestational age, between girls and boys, neither between total GWG during pregnancy and the measured anthropometric parameters of the newborns, or between maternal GWG and gestational age of the newborns. We found a positive correlation between the mothers’ BMI and the BW of the newborns (p =.03, r = 0.06, 95% CI = 0.0036–0.1169), but not between BMI and the birth length and nor with APGAR score. The statistical analysis showed a positive correlation between BMI and LfA (p = .01, r = 0.07, 95%CI = 0.0141–0.1269), but not with WfA and WfL. Women with higher BMI before getting pregnant showed significantly higher frequency of preterm delivery (p = .0078). We found a statistically significant correlation between GWG and BW (p<.0001). Excessive GWG correlates statistically significant with BW (p < .0001). Conclusions We found a positive correlation between the mothers’ BMI and excessive GWG and the BW of their newborns in women delivering a single baby. Women with higher BMI showed significantly higher frequency of preterm delivery.

Efficacy of intramuscular progesterone in prevention of preterm birth in patients with history of preterm birth

Background: Preterm birth is associated with many adverse outcomes and is defined as birth of a baby before 37 weeks of gestation. Around 15 million babies born preterm around the world with survival rates at different gestational like less 23 week, 23 weeks, 24 weeks and 25 weeks are 0%, 15%, 55% and 80% respectively. Progesterone has shown to reduce the incidence of preterm birth. Objective of the study was to find out frequency of preterm birth in patients (with previous history of preterm birth) treated with intramuscular progesterone.Methods: It was randomized controlled trial conducted in the department of Obstetrics and Gynecology, Unit-I, Sir Ganga Ram Hospital Lahore, Pakistan conducted from October 2017 to April 2018. It included 530 pregnant women with history of at least 1 previous preterm delivery presenting in antenatal clinic between 16-20 weeks of gestation. The lottery method was employed to segregate patients in two groups. Patients received intramuscular progesterone injection proluton depot 250 mg intramuscular weekly from 16-20 weeks till 37 weeks and other group received placebo drug.Results: Mean age was 27.52±4.57 years while the mean gestational age was 17.39±1.38 weeks. The mean gestational age at delivery was significantly higher among intramuscular group (36.14±2.23 versus 35.07±2.97 weeks; p=0.000). The frequency of preterm delivery was significantly lower in intramuscular group (24.9% versus 39.6%; p=0.000) as compared to placebo group.Conclusions: Frequency of preterm delivery was significantly lower in patients treated with intramuscular progesterone (24.9% versus 39.6%; p=0.000) irrespective of patients age, parity, BMI and number of previous preterm deliveries.

Subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis in women with spontaneous preterm delivery.

ObjectiveTo compare subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis (HCA) in women with spontaneous preterm delivery (SPTD).MethodsAmong 1,706 women who gave birth twice or more at our institution, 138 women delivered spontaneously at preterm (<37.0 weeks). Subsequent deliveries occurred at our institution and placental biopsy results were available. The study population was categorized into 2 groups based on the presence of acute HCA at the time of SPTD: HCA group (n=52) and non-HCA group (n=86). The primary outcome measures were gestational age at delivery, birthweight, and frequency of preterm delivery in subsequent pregnancies.ResultsThe median gestational age at the time of SPTD was 34.0 weeks (interquartile range [IQR], 28.9–35.3 weeks), and the frequency of acute HCA was 52/138 (38%). There were no differences in gestational age at delivery, birthweight, and frequency of preterm delivery between the HCA group and non-HCA group (median gestational age at delivery, 38.0 weeks (IQR, 36.7–38.8 weeks) in the HCA group vs. 37.9 weeks (IQR, 35.7–39.0 weeks) in the non-HCA group; frequency of preterm delivery, 14/52 (27%) in the HCA group vs. 33/86 (38%) in the non-HCA group; and median birthweight, 3.14 kg (IQR, 2.64–3.45 kg) in the HCA group vs. 2.95 kg (IQR, 2.44–3.36 kg) in the non-HCA group; P>0.1 for all.ConclusionThe presence of acute HCA in women at prior SPTD did not significantly affect their subsequent pregnancy outcomes.

Efficacy of daily rectal micronized progesterone for prevention of preterm delivery: a randomized clinical trial

Introduction Preterm delivery is the leading cause of neonatal morbidity and mortality and its prevention is always under serious concern. Objective The aim of the present study was to determine the efficacy of rectal progesterone as a maintenance tocolytic after arresting preterm labor, for increasing the duration of pregnancy, and postponing preterm birth. Method The study was performed as a double blind randomized clinical trial on women with preterm labor in whom contractions have been stopped. The eligible women were randomly divided into two groups. In the intervention group (progesterone group), progesterone was administered rectally as a dose of 200 mg daily until 36+6 weeks or spontaneous delivery before that time, whichever came first; and in the placebo group, placebo was administered in a similar manner. Primary outcomes were number of deliveries before 37 weeks of gestation and time to delivery interval in two groups. Secondary outcomes were neonatal Apgar score and weight, and need for NICU admission. Results 160 women finished the study (80 women in each group). The women of the two groups did not have significant difference according to the baseline characteristics. Frequency of preterm labor (earlier than 37 weeks) and mean gestational age at the time of delivery did not show significant difference in two groups. Also, neonatal outcome including Apgar score, birth weight, NICU admission and neonatal complications were not different between the two groups. The pregnancy length was longer in progesterone group (28.84 ± 3.36 VS 21.19 ± 4.62 days), [p = .001, CI 95%: 3.71–4.83]. The time-to-event (delivery) analysis showed a hazard ratio of 1.02 (95% CI 0.36–2.77). Conclusion Rectal progesterone at a daily dose of 200 mg as a maintenance tocolytic agent, cannot lower the frequency of preterm delivery but was suggested to prolong pregnancy length.

Single fetal demise in multiple pregnancy

Single intrauterine fetal demise (sIUFD) in multiple pregnancy occurs with frequency from 3.7 up to 6.8 % and is associated with an risk of premature birth, death of cotwin and high morbidity and mortality rates in newborns. The time of sIUFD and type of twin gestation would determine perinatal outcomes. The rate of prenatal death of the co-twin is different and depend on the type of multiple pregnancy, accounting 4 % for dichorionic and 12 % in monochorionic pregnancies. However, the correlation between the type of chorionicity, delivery time and the frequency of preterm delivery is not clearly established. The risk of neurological complications in newborns after sIUFD fluctuate significantly in case of the type of chorionicity and could achieve 18 % in monochorionic twins and only 1 % in dichorionic twins. The paper was discussed the main reasons for sIUFD in multiple pregnancy, rather pathophysiological aspects of perinatal morbidity and mortality for cotwin was also discussed. The management of complications, methods of their correction, optimal methods and time of delivery in case of sIUDF in multiple pregnancies was presented.

Twin pregnancies treated with emergency or ultrasound-indicated cerclage to prevent preterm births

Introduction: Multiple gestations are high-risk pregnancies associated with an increased risk of neonatal morbidity and mortality, mainly due to preterm births. Numerous interventions have been attempted in order to delay the time of delivery and subsequently, prevent preterm births in twin gestations. To date, no really effective intervention has been found. Use of cerclage in twin pregnancies has been controversial. Recently, however, small retrospective cohort studies have shown a potentially positive effect with the use of cerclage in twin pregnancies. The aim of this study was to evaluate pregnancies and neonatal outcomes in twin gestations with a short cervix treated with cervical cerclage at a single University Hospital.Methods: This retrospective cohort study included all women – with twin gestation and a short cervix – who had an ultrasound indicated or emergency cervical cerclage at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark between January 1999 and May 2017. Cervical cerclage was offered to women before 26 weeks of gestation if: (1) the cervix at ultrasound was ≤20 mm without cervical dilatation (ultrasound-indicated cerclage), or (2) the cervix at ultrasound was ≤20 mm with cervical dilatation (emergency cerclage). Women with history-indicated cerclage placement or multifetal embryo reduction were excluded. A total of 65 women participated in the study.Results: The median gestational age at cerclage placement was 22.6 weeks with a median cervical length of 10 mm (range 0–20 mm). The frequency of preterm delivery before 32 weeks of gestation was 41.5% and 27.7% before 28 weeks. Median pregnancy latency was 77 days (range 4–148) and the median gestational age at delivery was 33.0 weeks. Gestational age at delivery was significantly lower among women with cervical dilatation and visible membranes than among women with a short cervix only (27.7 versus 33.6 weeks, p < .01) and so was the median pregnancy latency (48 versus 81 days, p < .05). Overall, neonatal survival was 91.5%.Conclusion: Cervical cerclage in twin pregnancies may prolong pregnancy even when placed on a very short or dilated cervix. In our study, the procedure was safe and without any serious complications. The overall neonatal survival rate was high.

Prevalence of Anemia and Iron Deficiency among Palestinian Pregnant Women and Its Association with Pregnancy Outcome.

Background Anemia is a public health problem especially among pregnant women. This study aimed to investigate the prevalence of anemia and iron deficiency among pregnant women and its association with pregnancy outcome in Hebron Governorate in southern Palestine. Methods This is a cross-sectional study that included 300 pregnant women in their first trimester and 163 babies. Maternal anthropometric and socioeconomic and newborns' data were collected. Complete blood count for study subjects and maternal serum ferritin were measured. Results The prevalence of iron deficiency anemia among pregnant women was 25.7% and 52% of them had depleted iron stores. When pregnant women were grouped into three hemoglobin (Hb) tertile groups, a significant difference was observed between maternal Hb and newborns' birth weight (P= 0.009), height (P= 0.022), head circumference (P= 0.017), and gestational age (P= 0.012). There was a significant association between maternal serum ferritin and frequency of low birth weight (P= 0.001) and frequency of preterm delivery (P= 0.003). No significant association was observed between maternal anthropometric measures or the socioeconomic status and pregnancy outcomes. Conclusion Iron deficiency is a moderate public health problem among the study subjects. Maternal Hb and serum ferritin significantly affect pregnancy outcomes.