Frequency Of Preterm Delivery Research Articles

Effect of Omega 3 Fatty Acids in Reducing Risk of Preterm Labour

Objective: To compare effect of Omega 3 fatty acid supplementation versus no supplementation in high risk pregnant females from 20 weeks gestation in terms of frequency of preterm delivery.Methods: We conducted a prospective randomized controlled clinical trial in department of Obstetrics and Gynecology and, Railway Teaching Hospital Islamic International Medical College Trust, from January 2015 to Jan 2017. Women with a history of prior spontaneous singleton preterm birth and a current singleton gestation were divided into two groups A and B by computer generated random numbers. Omega 3 fatty acid supplementation was given to group A patients from 20 weeks to 36 weeks gestation and patients in group B was received no such treatment. Frequency of preterm delivery was compared among patients of both groups.Results: A total of 500 women with singleton pregnancy with history of one or more preterm deliveries were included, and none was lost to follow up. The mean duration of pregnancy at delivery between the omega3 supplemented and control groups [38.2 (SD, 0.6) weeks and 36.6 (SD, 0.9) weeks, P<0.0001 respectively] was statistically different. The data were also analyzed for birth weight and statistically significant difference of the weights were found in the two groups [3.2 (SD, 0.233) and 2.8 (SD, 0.259) controls P<0.0001].Conclusion: In this study we found that gestational age and birth weight, both are significantly improved with oral administered omeg-3 in high risk pregnancy when compared with controls.

Pregnancy planning in women with diabetes mellitus type 2

The aim of the study: to evaluate the role of pregnancy planning in patients with diabetes mellitus type 2 in improvement of pregnancy and birth outcomes.&#x0D; Material and methods. 80 women with type 2 diabetes mellitus who were referred to the centre “Diabetes mellitus and pregnancy” in Ott’s Research Institute of Obstetrics and Gynecology were examined.&#x0D; Results. In the group of women who underwent pre-pregnancy counseling, the course and outcome of pregnancy were significantly better. Since the frequency of gestosis was lower (60%) than in the group without pregnancy planning (86.7%), there was no gestosis of severe degree in the group of women who underwent pre-pregnancy counseling (in the group without pregnancy planning the rate of gestosis of moderate and severe degree was 25%). Frequency of preterm delivery was lower (15%) in the group of women who underwent pre-pregnancy counseling than in the group without pregnancy planning (38.3%). Also in the group of women who underwent pre-pregnancy counseling there were no fetal congenital malformations, neonatal hypoglycemic events and hypertrophic cardiomyopathy (in the group without pregnancy planning these indicators were respectively - 3.4; 28.8; 3.4%. Also in the group of women who underwent pre-pregnancy counseling there were no perinatal mortality (in the group without pregnancy planning this indicator was 3.4%.&#x0D; Conclusion: pregnancy planning in patients with diabetes mellitus significantly improves the course and outcome of pregnancy.

Clinical characteristics of fetal and neonatal outcomes in twin pregnancy with preeclampsia in a retrospective case-control study: A STROBE-compliant article.

The aim of our study was to compare the clinical characteristics of fetal and neonatal outcomes in twin pregnancies between women with preeclampsia (PE) and those with normotension in a Chinese population.There were 143 preeclamptic women and 367 normotensive women with twin pregnancies included in this retrospective case–control study. The baseline characteristics and perinatal outcomes were collected and compared between the groups. Multiple logistic regression and linear regression were used to assess the correlations between PE and the outcomes.Significant increases were observed in the frequencies of preterm delivery (OR = 2.75, P < 0.001), iatrogenic preterm birth (OR = 3.52, P < 0.001), and IUGR (OR = 2.94, P = 0.001) in the PE group, and the PE group had more than a 2-fold risk of adverse neonatal outcomes. Preeclamptic twin neonates had lower birth weights (β = −147.34, P = 0.005; β = −169.47, P = 0.001). The comparison on the discordance of intertwin weight was not significantly different.Twin pregnancies with PE are associated with worse perinatal outcomes. The adverse outcomes of preeclamptic twin pregnancies may be associated with lower birth weights rather than the discordance of the intertwin weight, which requires further confirmation. The results may provide helpful references for better clinical assessments, evaluations of prognosis, and a deeper understanding of preeclamptic twin pregnancies.

Reference range of the weekly uterine cervical length at 8 to 38 weeks of gestation in the center of Iran.

Background:There is an inverse relation between the uterine cervical length during pregnancy and the frequency of preterm delivery. The purpose of this study was to construct a chart and evaluate the cervical length at 8 to 38 weeks of normal gestation in the center of Iran.Materials and Methods:Uterine cervical length was measured on 930 asymptomatic pregnant women by abdominal ultrasonographic technique. For statistical evaluation, regression analysis and calculation of percentiles were performed.Results:Our data show a significant decrease in uterine cervical length with increasing gestational age. The mean uterine cervical length exhibits minimal changes from 10 to 24 weeks for most women in this study, although the shortening is more prominent at 33 to 38 weeks’ gestation. The mean shortening of the uterine cervical length between the second and the ninth months was 14.82% (P < 0.05). Also, the cervical length means in trimesters 1, 2 and 3 were 39.30 ± 4.33, 38.28 ± 5.13 and 36.58 ± 4.58 mm, respectively. The third trimester showed a significant reduction (P < 0.05) in cervical length compared to the first and second trimesters (6.92% and 4.44%, respectively). New charts with the 5th, 10th, 50th, 90th, and 95th percentile are presented.Conclusion:Our study provides a new chart and reference values for normal uterine cervical length throughout gestation based on a large sample in the center of Iran. There was a progressive decrease in mean uterine cervical length with increasing gestational age in the population of this study. Our established charts for uterine cervical length throughout gestation might be more useful than a single cut-off value for more efficient prevention and management of preterm birth.

Effect of aspirin in prevention of adverse pregnancy outcome in women with elevated alpha-fetoprotein

Background: To evaluate the effect of low-dose aspirin in prevention of adverse pregnancy outcomes (APO) in women with second trimester alpha-fetoprotein (AFP) >2.5 multiple of median (MOM) and to compare aspirin effect on women with normal and abnormal uterine artery (UtA) Doppler. The primary outcome was the adverse pregnancy outcome.Methods: This randomized controlled trial was conducted in singleton pregnant women, who had unexplained AFP >2.5 MOM and gestational age between 15 and 18 weeks of gestation. They were assigned randomly to receive either aspirin (N = 65) or control (N = 68). UtA Doppler velocimetry studies were performed at the time of targeted ultrasonographic exam.Results: Two groups were comparable regarding the maternal characteristics. The frequency of APO in aspirin and control groups were 26.1% versus 44.1% (p = 0.045), the frequency of preterm delivery before 34 weeks were 3.2% versus 22.0% in aspirin and control group, p = 0.001. Other outcomes were similar in both groups. The frequency of adverse outcomes in women with abnormal UtA Doppler was 39.1% in aspirin and 60.0% in control group, p = 0.556.Conclusion: Low-dose aspirin reduces APO and delivery before 34 weeks of gestation in pregnant women with unexplained elevated AFP.

Pregnancy and fetal outcomes after Glatiramer Acetate exposure in patients with multiple sclerosis: a prospective observational multicentric study

BackgroundOnly few studies have assessed safety of in utero exposure to glatiramer acetate (GA). Following a previous study assessing the safety of interferon beta (IFNB) pregnancy exposure in multiple sclerosis (MS), we aimed to assess pregnancy and fetal outcomes after in utero exposure to GA, using the same dataset, with a specific focus on the risk of spontaneous abortion.Materials and methodsWe recruited MS patients, prospectively followed-up in 21 Italian MS Centres, for whom a pregnancy was recorded in the period 2002–2008. Patients were divided into 2 groups: drug-exposed pregnancies (EP: suspension of the drug less than 4 weeks from conception); non-exposed pregnancies (NEP: suspension of the drug at least 4 weeks from conception or never treated pregnancies). All the patients were administered a structured interview which gathered detailed information on pregnancy course and outcomes, as well as on possible confounders. Multivariate logistic and linear models were used for treatment comparisons.ResultsData on 423 pregnancies were collected, 17 were classified as EP to GA, 88 as EP to IFNB, 318 as NEP. Pregnancies resulted in 16 live births in the GA EP, 75 live births in the IFNB EP, 295 live births in the NEP. GA exposure was not significantly associated with an increased risk of spontaneous abortion (OR = 0.44;95% CI 0.044-4.51;p = 0.49). Mean birth weight and length were not significantly different in pregnancies exposed to GA than in non exposed pregnancies (p = 0.751). The frequency of preterm delivery, observed in 4 subjects exposed to GA (25% of full term deliveries), was not significantly higher in pregnancies exposed to GA than in those non exposed (p > 0.735). These findings were confirmed in the multivariate analysis. There were neither major complications nor malformations after GA exposure.ConclusionsData in our cohort show that mother’s GA exposure is not associated with a higher frequency of spontaneous abortion, neither other negative pregnancy and fetal outcomes. Our findings point to the safety of in utero GA exposure and can support neurologists in the therapeutic counselling of MS women planning a pregnancy.

The effect of maternal fasting during Ramadan on preterm delivery: a prospective cohort study

Please cite this paper as: Awwad J, Usta I, Succar J, Musallam K, Ghazeeri G, Nassar A. The effect of maternal fasting during Ramadan on preterm delivery: a prospective cohort study. BJOG 2012;119:1379–1386.Objective To determine the effect of fasting during the month of Ramadan on the rate of preterm delivery (PTD).Design A prospective cohort study of women with singleton pregnancies who elected to fast and matched controls.Setting Four medical centres in Beirut, Lebanon.Population Women presenting for prenatal care (20–34 weeks of gestation) during the month of Ramadan, September 2008.Methods Data were collected prospectively. The frequency of PTD was evaluated in relation to the duration of fasting and the stage of gestation at the time of fasting.Main outcome measures The primary endpoint was the percentage of pregnant women who had PTD, defined as delivery before 37 completed weeks of gestation.Results A total of 468 women were approached, of whom 402 were included in the study. There were no differences in smoking history and employment. There was no difference in the proportion of women who had PTD at &lt;37 weeks (10.4% versus 10.4%) or PTD at &lt;32 weeks (1.5% versus 0.5%) in the Ramadan‐fasted group and the controls, respectively. The PTD rate was also similar in those who fasted before or during the third trimester. The mean birthweight was lower (3094 ± 467 g versus 3202 ± 473 g, P = 0.024) and the rate of ketosis and ketonuria was higher in the Ramadan‐fasted women. On multivariate stepwise logistic regression analysis, fasting was not associated with an increased risk of PTD (odds ratio 0.72; 95% confidence interval 0.34–1.54; P = 0.397). The only factor that had a significant effect on the PTD rate was body mass index (odds ratio 0.43; 95% confidence interval 0.20–0.93; P = 0.033).Conclusions Fasting during the month of Ramadan does not seem to increase the baseline risk of preterm delivery in pregnant women regardless of the gestational age during which this practice is observed.

Pregnancy risk in female kidney and liver recipients: a retrospective comparative study

Objective: To determine and compare maternal, neonatal and graft outcomes in pregnant women after kidney or liver transplantation, who had delivered from 1 January 2005 to 1 February 2010. Methods: A retrospective, single-center study provided in Warsaw, Poland. Results: Complete data were collected in 38 deliveries in 37 women. Preexisting hypertension was present in 15 of 19 (79%) pregnant kidney recipients and in 2 of 19 (10.5%) women after liver transplantation (p < 0.000). The incidence of preeclampsia was also more often in pregnant kidney recipients (p = 0.04). Mean gestational age at labor was lower in the kidney group (34.9 ± 3.56 vs. 37.5 ± 1.62, p = 0.000). A similar relation was observed in the frequency of preterm deliveries before 37 weeks of gestation (42% vs. 11%, respectively, p = 0.02) and neonates small for gestational age (47% vs. 11%, respectively, p = 0.008). Cesarean sections were performed in approximately 79% (15/19) and 95% (18/19) liver and kidney posttransplant pregnancies, respectively. Four of 38 infants presented structural malformations. Conclusions: Pregnancies after kidney transplantation are complicated with a higher prevalence of prematurity and worse neonatal prognosis, which depends mainly on the underlying condition.

Association of Polymicrobial Growth from Urine Culture with Adverse Pregnancy Outcomes

We sought to determine if pyelonephritis and preterm delivery occur more frequently among pregnant women with polymicrobial growth from screening urine culture than among women with negative urine culture. A retrospective cohort study was performed. Three hundred eighty pregnant women with greater than 100,000 colony-forming units per milliliter of polymicrobial growth from urine culture performed at less than 20 weeks of pregnancy were compared with 375 women with negative urine culture. Admissions for pyelonephritis were identified from discharge records. Gestational age at delivery was determined from a research registry. Frequency of pyelonephritis and preterm delivery did not differ between the two groups. Frequencies of pyelonephritis were 0.3% and 0% in women with polymicrobial and negative urine culture, respectively ( P=0.32). Frequencies of preterm delivery were 16.8% and 16% ( P=0.76). Among those with repeat urine cultures, 4.6% in the polymicrobial group and 2.4% of those in the negative initial urine culture group had a positive culture later in the pregnancy ( P=0.21). There is no association between polymicrobial growth from screening urine culture and pyelonephritis or preterm delivery.

Antidepressant Use During Pregnancy and the Risk of Preterm Delivery and Fetal Growth Restriction

The associations between prenatal exposure to antidepressants and preterm delivery and fetal growth restriction are controversial and poorly understood. We studied the relation between antidepressant use and these outcomes. Analysis included women with nonmalformed infants interviewed in the Slone Epidemiology Center Birth Defects Study between 1998 and 2008. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for premature and small-for-gestational age (SGA) offsprings, adjusting for sociodemographic, lifestyle, medical, and reproductive factors. The frequencies of preterm delivery were 7.3% among the 5710 nonusers (reference), 8.9% among the 192 selective serotonin reuptake inhibitor (SSRI) users (OR, 1.1; 95% CI, 0.6-2.0), and 15.3% among the 59 non-SSRI antidepressant users (OR, 2.2; 95% CI, 1.0-4.9); the respective frequencies of delivering an SGA offspring were 7.2%, 10.9% (OR, 1.7; 95% CI, 1.0-2.7), and 13.6% (OR, 2.2; 95% CI, 1.0-4.9). Compared with nonusers, the frequencies of preterm delivery (7.6%) and SGA offspring (5.7%) were not increased among the 106 women who discontinued SSRIs before the end of the first trimester. Among women who continued SSRIs beyond the first trimester, 10.5% delivered a preterm infant (OR, 1.3; 95% CI, 0.6-2.8) and 17.4% had an SGA offspring (OR, 3.0; 95% CI, 1.7-5.5). Women treated with SSRIs late in pregnancy had a higher frequency of delivering SGA infants, and women receiving non-SSRI antidepressants were more likely to deliver premature and SGA offsprings. The findings suggest an effect of underlying mood disorder or an effect common to both drug classes. In any case, prenatal antidepressant use may help identify women at elevated risks of delivering preterm and SGA infants.

Risk of low birth weight and preterm delivery in singleton pregnancies conceived by women with and without a history of infertility

OBJECTIVE: To determine predictors and risk of low birth weight (LBW) and preterm delivery (PTD) in singleton pregnancies conceived by women with a history of infertility. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study was conducted at 11 infertility clinics in Northern California. Data were collected on 983 women who carried singleton pregnancies to ≥ 20 weeks gestation between 1994 and 1998. These women either conceived naturally following a history of infertility or they conceived using infertility treatment. The fertile comparison group (n= 1008) was identified through California Vital Statistics records and matched on singleton status, maternal age, and county of delivery. RESULTS: There was a significant difference in the frequency of LBW between the three groups of women (chi-square 9.12, p=.01). There were more women in the infertile with treatment group compared to the fertile comparison group who delivered a LBW infant. There was no significant difference (chi-square 1.23, p= .541) in the frequency of PTD between the three groups of women. Women with a history of infertility who gave birth to a LBW infant were 1.55 (95% CI 1.03, 2.34) times more likely to have undergone infertility treatment to conceive their pregnancy than those women with a history of infertility who conceived a pregnancy without treatment, controlling for maternal age, parity, gestational diabetes, and obesity. Nulliparity was a significant predictor of LBW; women who gave birth to a LBW infant were 1.51 times (95% CI 1.07, 2.14) more likely to be nulliparous controlling for maternal age, gestational diabetes and obesity, regardless of fertility status. CONCLUSIONS: Women with a history of infertility who undergo infertility treatment and conceive a singleton pregnancy may be at increased risk for giving birth to a LBW infant, but there does not appear to be an increased risk for preterm delivery.

Improved Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria or Diabetic Nephropathy

OBJECTIVE—To describe pregnancy outcome in type 1 diabetic women with normoalbuminuria, microalbuminuria, or diabetic nephropathy after implementation of an intensified antihypertensive therapeutic strategy.RESEARCH DESIGN AND METHODS—Prospective study of 117 pregnant women with type 1 diabetes. Antihypertensive therapy, mainly methyldopa, was given to obtain blood pressure <135/85 mmHg and urinary albumin excretion <300 mg/24 h. Blood pressure and A1C were recorded during pregnancy. The pregnancy outcome was compared with recently published studies of pregnant women with microalbuminuria or diabetic nephropathy.RESULTS—Antihypertensive therapy was given in 14 of 100 women with normoalbuminuria, 5 of 10 women with microalbuminuria, and all 7 women with diabetic nephropathy. Mean systolic blood pressure during pregnancy was 120 mmHg (range 101–147), 122 mmHg (116–135), and 135 mmHg (111–145) in women with normoalbuminuria, microalbuminuria, and diabetic nephropathy, respectively (P = 0.0095). No differences in mean diastolic blood pressure or A1C were detected between the groups. No women with microalbuminuria developed preeclampsia. The frequency of preterm delivery was 20% in women with normoalbuminuria and microalbuminuria in contrast to 71% in women with diabetic nephropathy (P < 0.01) where the median gestational age was 258 days (220–260). Compared with previous studies using less stringent antihypertensive therapeutic strategy and less strict metabolic control, gestational age was longer and birth weight was larger in our study.CONCLUSIONS—With intensified antihypertensive therapy and strict metabolic control, comparable pregnancy outcome was seen in type 1 diabetic women with microalbuminuria and normoalbuminuria. Although less severe than in previous studies, diabetic nephropathy was associated with more adverse pregnancy outcome.

Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment

Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment

Caesarean Delivery Rates and Pregnancy Outcomes: The 2005 WHO Global Survey on Maternal and Perinatal Health in Latin America

Rates of cesarean section continue to increase throughout the world. The authors analyzed data from the 2005 World Health Organization global survey on maternal and perinatal health in an attempt to clarify the association between operative delivery and pregnancy outcome at the institutional level. The database consisted of a multistage stratified sample of 24 geographic regions in 8 Latin American countries. Data were collected for all women admitted to 120 institutions (randomly chosen from 410 hospitals) who were admitted for delivery over a 3-month period. Data were obtained for 97,095 of 106,546 deliveries—a coverage rate of 91%. The median rate of cesarean delivery was 33%. Factors that helped to determine operative delivery rates included primiparity, previous operative delivery, and institutional complexity. Private hospitals consistently had higher rates than did public institutions. After adjusting for risk factors, cesarean rates correlated positively with postpartum antibiotic treatment as well as with severe maternal morbidity and mortality. The most common indication for cesarean delivery was the spectrum of cephalopelvic disproportion/dystocia/failure to progress. Next most common in public hospitals was fetal distress and at private centers, previous cesarean delivery without complications. On multiple linear regression analysis, the only factors independently associated with cesarean delivery were primiparity, previous cesarean delivery, and institutional complexity. Only primiparity and previous cesarean delivery remained significant for elective operative deliveries. After adjusting for preterm delivery, an increased rate of cesarean delivery correlated with increased fetal mortality and more frequent admission of infants to intensive care for 1 week or longer. The frequency of preterm delivery and neonatal mortality increased when rates of cesarean delivery reached 10% to 20%. These findings indicate that a high cesarean delivery rate does not necessarily indicate good-quality care. Perinatal outcomes should be closely scrutinized at institutions where high operative delivery rates prevail.

α+‐Thalassaemia and pregnancy in a malaria endemic region of Papua New Guinea

The effect of maternal alpha+ -thalassaemia on pregnancy was assessed in the north coastal region of Papua New Guinea (PNG), where malaria is hyperendemic and alpha+ -thalassaemia is extremely common. In a prospective study of 987 singleton hospital deliveries, we correlated maternal alpha-globin genotype with markers of reproductive fitness (age in primigravidae, gravidity, pregnancy interval and the number of miscarriages and stillbirths), Plasmodium falciparum(P. falciparum) infection of the mother and placenta, maternal haemoglobin, preterm delivery and birthweight. The frequency of the -alpha genotype in mothers was 0.61. Markers of reproductive fitness were similar in women with and without alpha+ -thalassaemia. Median haemoglobin concentration during pregnancy and after delivery was about 1.0 g/dl lower in homozygous alpha+ -thalassaemia than in women with a normal alpha- globin genotype (P < or = 0.001). The frequency of placental P. falciparum infection and systemic malaria infection after delivery showed no consistent relationship to alpha-globin genotype. The frequency of preterm delivery and low birthweight did not vary significantly according to maternal alpha-globin genotype. Maternal alpha+ -thalassaemia does not affect reproductive fitness or susceptibility to malaria during pregnancy. Although median haemoglobin concentration was significantly lower in mothers homozygous for alpha+ -thalassaemia than those with a normal alpha-globin genotype, this did not result in an adverse outcome of pregnancy.

Complete versus incomplete placenta previa and obstetric outcome

Objective: To compare obstetric outcome in women with complete versus incomplete placenta previa (PP). Methods: A 10-year retrospective case–control study was conducted between 1992 and 2001. A 202 singleton pregnancies with PP were analyzed. Results: The incidence of PP was 0.4%. Complete PP comprised 32.7% and incomplete PP 67.3% of cases. No difference was observed in the frequency of antepartum hemorrhage. Women with complete PP had significantly higher requirement for antepartum and postpartum transfusions, higher frequency of postpartum hemorrhage and postpartum hysterectomy. The risk for placenta accreta was increased in complete PP group even after controlling for confounding factors (adjusted OR = 3.75, 95% CI = 1.11–12.68, p < 0.05). No difference in the frequency of preterm delivery was found between the groups. Term infants of mothers with complete PP had significantly lower birth weight (3205 vs. 3360, p = 0.04). Conclusion: Complete PP is a high-risk subgroup of PP associated with higher maternal morbidity in comparison to incomplete PP.

Preterm delivery rates in North Carolina: are they really declining among non-Hispanic African Americans?

The preterm delivery rate in North Carolina is consistently higher than the national average. However, recent reports suggest that singleton preterm delivery rates for non-Hispanic Whites are increasing while those for non-Hispanic African Americans are decreasing. To study this pattern further, the authors examined data on singleton non-Hispanic White and non-Hispanic African-American births in 1989 and 1999 by using North Carolina vital statistics data. They found that the frequency of preterm delivery rose 1.1% (8.5% to 9.6%) among non-Hispanic Whites but declined 1.4% (17.9% to 16.5%) among non-Hispanic African Americans over the same time period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28-31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1989 than in 1999. To reduce the potential for bias due to misclassification of infant gestational age, frequencies of preterm delivery of infants who weighed less than 2,500 g were calculated. Unlike the original analysis, this calculation showed that preterm delivery increased for both subgroups. A number of non-Hispanic African-American births classified as preterm were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1989 than in 1999, inflating 1989 preterm delivery rates.

Treatment of asymptomatic bacterial vaginosis to prevent pre-term delivery: a randomised trial

Objectives: To evaluate the efficacy of clindamycin vaginal cream 2% once daily for 7 days in prolonging pregnancy. Study design: Randomised clinical trial of 112 women between 14 and 25 weeks of gestation with diagnosis of asymptomatic bacterial vaginosis were enrolled in a multicenter randomised trial and assigned to active or no treatment. A total of 55 women were assigned to clindamycin and 57 to no treatment. Main outcome measure: frequency of pre-term delivery. Results: The rates of pre-term delivery was 12.2% in the clindamycin group and 15.7% in the no treatment group ( P=0.78). Birth weight was <2500 g in three and seven babies, respectively, in the two groups ( P=0.32). Mean gestational ages at birth were 38.9 and 39.2 ( P=0.52), respectively, in the clindamycin and no treatment groups. Conclusions: The results of this study suggest that treating asymptomatic bacterial vaginosis does neither markedly prolong pregnancy nor increase birthweight.

Cervical length assessment by ultrasound as a predictor of preterm labour—is there a role for routine screening?

Transvaginal ultrasonography has recently been shown to be an objective, reproducible and reliable method to assess the cervix and predict the risk of preterm delivery in high‐risk pregnancies. Assessment of the cervix includes cervical length measurement (CLM) and measurement of dilatation of the internal os in a dynamic functional examination. There is an inverse correlation between cervical length and the frequency of preterm delivery. The high negative predictive value avoids unnecessary interventions such as tocolysis or cerclage in high‐risk pregnancies. In contrast, a length of 25 mm or less at 28–30 weeks of gestation is associated with a significantly increased incidence of preterm delivery. Studies in women with high risk for preterm delivery, i.e. contractions, premature rupture of the membranes and history of preterm delivery, have shown a high sensitivity and a high positive predictive value, however in low‐risk groups they have failed to show a high sensitivity. From large observational studies in low‐risk populations we know that the 50th percentile of the cervical length is 35 mm at 24 weeks of gestation3. Advantages of CLM as a screening test include the fact that sonographical assessment of the cervix is a widely accepted and well‐standardised method, which requires only a relatively short period of training. Disadvantages of screening are two factors, the first being the low sensitivity of the test and the low prevalence of preterm deliveries in a low‐risk population, resulting in cut off values being set at a very low level (i.e. 5th percentile) in order to get acceptable specificity. Secondly, screening is only worthwhile if an effective preventive therapy is available. The debate about tocolysis and cerclage is not yet concluded. Therefore we would not currently recommend cervical length measurement as a screening tool—but as a routine method in high risk gravidas with or without symptoms. Further interest should be focused on scoring systems combining ultrasound with biochemical, endocrinological and maybe molecular cell methods such as the measurement of fetal DNA in maternal blood to prevent preterm deliveries in the general population.

Cervical length assessment by ultrasound as a predictor of preterm labour—is there a role for routine screening?

Transvaginal ultrasonography has recently been shown to be an objective, reproducible and reliable method to assess the cervix and predict the risk of preterm delivery in high-risk pregnancies. Assessment of the cervix includes cervical length measurement (CLM) and measurement of dilatation of the internal os in a dynamic functional examination. There is an inverse correlation between cervical length and the frequency of preterm delivery. The high negative predictive value avoids unnecessary interventions such as tocolysis or cerclage in high-risk pregnancies. In contrast, a length of 25 mm or less at 28–30 weeks of gestation is associated with a significantly increased incidence of preterm delivery. Studies in women with high risk for preterm delivery, i.e. contractions, premature rupture of the membranes and history of preterm delivery, have shown a high sensitivity and a high positive predictive value, however in low-risk groups they have failed to show a high sensitivity. From large observational studies in low-risk populations we know that the 50th percentile of the cervical length is 35 mm at 24 weeks of gestation 3 . Advantages of CLM as a screening test include the fact that sonographical assessment of the cervix is a widely accepted and well-standardised method, which requires only a relatively short period of training. Disadvantages of screening are two factors, the first being the low sensitivity of the test and the low prevalence of preterm deliveries in a low-risk population, resulting in cut off values being set at a very low level (i.e. 5th percentile) in order to get acceptable specificity. Secondly, screening is only worthwhile if an effective preventive therapy is available. The debate about tocolysis and cerclage is not yet concluded. Therefore we would not currently recommend cervical length measurement as a screening tool—but as a routine method in high risk gravidas with or without symptoms. Further interest should be focused on scoring systems combining ultrasound with biochemical, endocrinological and maybe molecular cell methods such as the measurement of fetal DNA in maternal blood to prevent preterm deliveries in the general population.