History Of Premature Delivery Research Articles

Associations of air pollution exposures in preconception and pregnancy with birth outcomes and infant neurocognitive development: analysis of the Complex Lipids in Mothers and Babies (CLIMB) prospective cohort in Chongqing, China

ObjectivesTo investigate the associations of traffic-related air pollution exposures in early pregnancy with birth outcomes and infant neurocognitive development.DesignCohort study.SettingEligible women attended six visits in the maternity clinics of two...

Scleral Buckling for Retinopathy of Prematurity: A Case Report

Introduction : Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease that affects premature infants. Patients with advanced ROP require surgery to minimize retinal distortion and prevent total retinal detachment. This case reports the efficacy of scleral buckling (SB) in a patient with stage 4B ROP in both eyes within 3 months.
 Case Illustration : A 4-month-old female baby presented to the Pediatric Ophthalmology Division in Cipto Mangunkusumo Hospital with the chief complaint of no eye contact in both eyes. Her eyes moved by themselves since the age of 3.5 months and sometimes looked crossed. The patient presented to the pediatrician and was referred to the pediatric ophthalmology division for further management. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. Pediatric Ophthalmology Division performed ultrasonography and Retcam and diagnosed ROP stage 4B in both eyes. Scleral buckling was performed by vitreoretinal division in the right and left eyes at 49 and 52 weeks postmenstrual age, respectively.
 Discussion : Vitrectomy and scleral buckling are the surgical options in advanced ROP. Vitrectomy is ideally performed in stage 4A without macular involvement. We considered performing SB because vitrectomy seems to be ineffective in this patient and the patient is more prone to intraocular complications.
 Conclusion : Scleral buckling is effective in preventing further progression of retinal detachment, reducing vitreoretinal traction and preventing ischemia in the retinal detachment. In short-term follow-up, we found no worsening of progression. However, further follow-up is needed to demonstrate the long- term efficacy of SB in advanced ROP.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

A Novel Nomogram for Predicting the Risk of Premature Delivery Based on the Thyroid Function in Pregnant Women.

BackgroundMaternal thyroid dysfunction and autoantibodies were associated with preterm delivery. However, recommendations for cutoff values of thyroperoxidase antibody (TPOAb) positivity and thyroid-stimulating homone (TSH) associated with premature delivery are lacking.ObjectiveTo identify the pregnancy-specific cutoff values for TPOAb positivity and TSH associated with preterm delivery. To develop a nomogram for the risk prediction of premature delivery based on maternal thyroid function in singleton pregnant women without pre-pregnancy complications.MethodsThis study included data from the International Peace Maternity and Child Care Health Hospital (IPMCH) in Shanghai, China, between January 2013 and December 2016. Added data between September 2019 and November 2019 as the test cohort. Youden’s index calculated the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration. Univariate and multivariable logistic regression analysis were used to screen the risk factors of premature delivery. The nomogram was developed according to the regression coefficient of relevant variables. Discrimination and calibration of the model were assessed using the C-index, Hosmer-Lemeshow test, calibration curve and decision curve analysis.Results45,467 pregnant women were divided into the training and validation cohorts according to the ratio of 7: 3. The testing cohort included 727 participants. The pregnancy-specific cutoff values associated with the risk of premature delivery during the first trimester were 5.14 IU/mL for TPOAb positivity and 1.33 mU/L for TSH concentration. Multivariable logistic regression analysis showed that maternal age, history of premature delivery, elevated TSH concentration and TPOAb positivity in the early pregnancy, preeclampsia and gestational diabetes mellitus were risk factors of premature delivery. The C-index was 0.62 of the nomogram. Hosmer-Lemeshow test showed that the Chi-square value was 2.64 (P = 0.955 > 0.05). Decision curve analysis showed a positive net benefit. The calibration curves of three cohorts were shown to be in good agreement.ConclusionsWe identified the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration associated with preterm delivery in singleton pregnant women without pre-pregnancy complications. We developed a nomogram to predict the occurrence of premature delivery based on thyroid function and other risk factors as a clinical decision-making tool.

Effects of interpregnancy interval on pregnancy outcomes of subsequent pregnancy: a multicenter retrospective study

Objective: To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy. Methods: A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO's recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics. Results: A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant (P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% (OR=1.42, 95%CI: 1.07-1.88, P=0.015), 46% (OR=1.46, 95%CI: 1.13-1.88, P=0.004), and 64% (OR=1.64, 95%CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study (P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age (OR=2.87, 95%CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 (OR=1.59, 95%CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes (OR=1.58, 95%CI: 1.18-2.13, P=0.002) and premature delivery (OR=1.52, 95%CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM (OR=5.34, 95%CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM (OR=1.44, 95%CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia (OR=4.11, 95%CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia (OR=1.46, 95%CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery (OR=1.47, 95%CI: 1.13-1.92, P=0.004). Conclusions: Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Decrease of premature mothers’ stress levels in the intensive care unit

ObjectiveTo determine the effectiveness of the ‘Creating Opportunities for Parent Empowerment’ (COPE) programme in reducing stress levels in mothers of preterm infants in the neonatal intensive care unit (NICU). MethodsClinical trial performed in Colombia, including mothers of infants younger than 34 weeks of gestation, hospitalized, without a history of premature delivery. The mothers with psychiatric illnesses, language disorders, history of use of psychoactive substances and whose newborns had a congenital malformation were excluded. A group intervened with the COPE programme and a control group with the usual institutional management were formed. Block randomisation and masking was used for mothers and evaluators. The parental stress scale was applied: NICU; Shapiro–Wilk normality test, Wilcoxon test and covariance analysis (ANCOVA) with a significance level of p<.05, 95% CI. Results66 mothers were enrolled. The two groups were similar in their demographic characteristics and in the initial stress level score. The control group increased the final stress score in two categories and the intervention group decreased final values in all categories. The initial and final scores of the overall general stress level showed a significant decrease (p<.01), but when comparing with the ANCOVA analysis there was no significant difference (p=.4). ConclusionsThe COPE programme reduces the level of maternal stress, strengthening aspects during hospitalisation, such as: emotional support, strengthening their role as caregivers and interaction with their babies and the development of a friendly environment in the NICU.

Disminución del nivel de estrés en madres de prematuros en la unidad de cuidados intensivos

ObjectiveTo determine the effectiveness of the ‘Creating Opportunities for Parent Empowerment’ (COPE) programme in reducing stress levels in mothers of preterm infants in the neonatal intensive care unit (NICU). MethodsClinical trial performed in Colombia, including mothers of infants younger than 34 weeks of gestation, hospitalized, without a history of premature delivery. The mothers with psychiatric illnesses, language disorders, history of use of psychoactive substances and whose newborns had a congenital malformation were excluded. A group intervened with the COPE programme and a control group with the usual institutional management were formed. Block randomization and masking was used for mothers and evaluators. The Parental Stress Scale was applied: NICU; Shapiro Wilk normality test, Wilcoxon test and covariance analysis (ANCOVA) with a significance level of p<.05, 95% CI. Results66 mothers were enrolled. The two groups were similar in their demographic characteristics and in the initial stress level score. The control group increased the final stress score in two categories and the intervention group decreased final values in all categories. The initial and final scores of the overall general stress level showed a significant decrease (p<.01), but when comparing with the ANCOVA analysis there was no significant difference (p=.4). ConclusionsThe COPE programme reduces the level of maternal stress, strengthening aspects during hospitalization, such as: emotional support, strengthening their role as caregivers and interaction with their babies and the development of a friendly environment in the NICU.

Evaluation of Cases with Neonatal Cholestasis

Amaç: Çalışmanın amacı, neonatal kolestaz nedeniyle takip edilen çocuk hastaların etiyoloji, tanı yöntemleri, laboratuvar bulguları, tedavi şekilleri ve uzun dönem prognozları açısından geriye dönük olarak incelenmesi amaçlandı. Gereç ve Yöntem: Yaşamın ilk üç ayında kolestazı olan hastalar çalışmaya alınmıştır. Hastalar ekstrahepatik kolestaz ve intrahepatik kolestaz olarak gruplandırılmıştır. Ekstrahepatik kolestaz grubu içerisine biliyer atrezi, koyulaşmış safra sendromu ve koledok kisti dâhil edilmiştir. Bunların dışında kalan hastalar intrahepatik kolestaz grubu içerisinde değerlendirilmiştir. Hastaların tanıları, yakınmaları, klinik seyirleri, laboratuvar bulguları ve tedaviye yanıtları incelenerek geriye dönük olarak prognozları değerlendirilmiştir. Bulgular: Çalışma grubu kolestaz tanısı alan hastalar 43’ü kız (%41), 62’si erkek (%59) cinsiyete sahip olmak üzere toplam 105 hastadan oluştu. Vakaların 46’sı (%43.8) prematüre doğmuştu. Otuz altı hasta (%34.3) 30-37 haftalar arasında; 10 hasta (%9.5) 30 haftanın altında olup, 39’unda ise (%37.1) düşük doğum ağırlığı mevcuttu. Hastaların %81’inde intrahepatik, %19’unda ekstrahepatik nedenlere bağlı kolestaz geliştiği saptandı. Akolik dışkı ekstrahepatik kolestaz vakaların %90’ında (18 vaka), intrahepatik vakaların %15.3’ünde (13 vaka) olmak üzere toplam 31 vakada görülmüştür. İntrahepatik kolestaz vakalarında doğum ağırlığının ekstrahepatik kolestaz vakalarına göre daha düşük olduğu saptandı. Klinik seyirlerinde intrahepatik kolestaz hastası 38 vaka (%44.7), ekstrahepatik kolestaz hastası 7 vaka (%35) düzeldi. Sonuç: Çalışmamızda, hastaların literatür oranlarından daha geç tanı aldığı görülmüştür. Bu gecikme özellikle biliyer atrezi vakalarının erken cerrahi müdahale şansını azaltmaktadır. Ultasonografik görüntülemede “triangular cord sign” belirtisinin literatürden farklı olarak hiç görülmemesi bu konuda eğitim ve tecrübe eksikliğinin olduğunu düşündürmüştür. Bunun dışında, GGT yüksekliği, spenomegali, doğum ağırlığı, akolik dışkılama gibi karaciğer hastalığı için anlamlı olacak bulguların gözden kaçması, tanı için hızlı davranılamaması çocuk hekimlerinin farkındalığını artırılması gerektiğine işaret etmektedir.

Low birth weight at term and its determinants in a tertiary hospital of Nepal: a case-control study.

Birth weight of a child is an important indicator of its vulnerability for childhood illness and chances of survival. A large number of infant deaths can be averted by appropriate management of low birth weight babies and prevention of factors associated with low birth weight. The prevalence of low birth weight babies in Nepal is estimated to be about 12-32%.Our study aimed at identifying major determinants of low birth weight among term babies in Nepal. A hospital-based retrospective case control study was conducted in maternity ward of Tribhuvan University Teaching Hospital from February to July 2011. A total of 155 LBW babies and 310 controls were included in the study. Mothers admitted to maternity ward during the study period were interviewed, medical records were assessed and anthropometric measurements were done. Risk factors, broadly classified into proximal and distal factors, were assessed for any association with birth of low-birth weight babies. Regression analysis revealed that a history of premature delivery (adjusted odds ratio; aOR5.24, CI 1.05-26.28), hard physical work during pregnancy (aOR1.48, CI 0.97-2.26), younger age of mother (aOR1.98, CI 1.15-3.41), mothers with haemoglobin level less than 11gm/dl (aOR0.51, CI0.24-1.07) and lack of consumption of nutritious food during pregnancy (aOR1.99, CI 1.28-3.10) were significantly associated with the birth of LBW babies. These factors should be addressed with appropriate measures so as to decrease the prevalence of low birth weight among term babies in Nepal.

Predição do parto prematuro: avaliação sequencial do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile

To investigate the usefulness of the measurement of cervical length and of the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) performed sequentially in the prediction of preterm birth and the correlation between tests. We analyzed data from 101 asymptomatic pregnant women with a history of premature delivery. The ultrasound measurement of cervical length and phIGFBP-1 test were performed in parallel every three weeks, between 24 and 34 week. The best cutoff value for each cervical evaluation was established by the ROC curve, and the two tests were compared using nonparametric tests. We determined the sensitivity, specificity and predictive values of each test and of the association of the exams for the occurrence of delivery before the 37th weeks. There were 25 preterm births (24.8%). The cervix length showed the highest sensitivity and was able to predict preterm birth in all evaluations, with similar accuracy at different gestational ages. The test for phIGFBP-1 was not helpful at 24 weeks, but was able to predict prematurity when performed at 27, 30 and 33 weeks. The combination of tests increased the sensitivity (81.8%) and negative predictive value (93.7%) when compared to the separate use of each test. The mean cervical length was lower in women with a positive test. Both cervical length and the test for phIGFBP-1 were able to predict premature delivery, and sequential combination of both tests showed a high sensitivity and high negative predictive value.

Avaliação da qualidade da atenção pré-natal dentre gestantes com e sem história de prematuridade no Sistema Único de Saúde no Rio de Janeiro, Brasil

OBJETIVOS: avaliar adequação, acompanhamento pré-natal, satisfação e riscos gestacionais das gestantes com história de prematuridade. MÉTODOS: estudo seccional com 1239 gestantes, 259 com história de prematuridade no Sistema Único de Saúde (SUS) do RJ em 2007/2008. Informações demográficas, socio-econômicas, história obstétrica, adequação pré-natal e satisfação foram coletadas através de entrevistas e do cartão pré-natal. Utilizou-se teste χ² para comparar o grupo com história de prematuridade com os grupos de baixo risco e sem história de prematuridade. RESULTADOS: não houve diferenças na adequação e no cuidado pré-natal entre as gestantes com história de prematuridade comparadas às de baixo risco gestacional. Houve insatisfação com tempo de espera pelas consultas, horário de funcionamento das unidades de saúde e explicações dos profissionais de saúde. CONCLUSÕES: a presença de história de prematuridade não influenciou para que essas gestantes tivessem um pré-natal de melhor qualidade. As unidades de saúde apresentaram problemas, segundo a percepção das gestantes, em relação ao modo de funcionamento. As explicações dos profissionais de saúde sobre risco da prematuridade não atenderam às expectativas das gestantes.

Bilateral temporal lobe agenesis with bilateral arachnoid cysts – a rare congenital anomaly

Bilateral temporal lobe agenesis/hypogenesis along with middle cranial fossa arachnoid cysts (ACs) is extremely rare, and very few cases have been reported in the literature. We present the case of 2-year-old female presenting with chief complaints of headache, vomiting, and fever. There was a history of premature delivery in the seventh month and up-rolling of eyes since birth. Magnetic resonance imaging findings revealed bilateral temporal lobe agenesis with bilateral ACs, along with encephalomalacia in both parietal lobes. Ultrasound abdomen findings and biochemical tests revealed renal parenchymal disease. The lipid profile analysis revealed highly elevated triglyceride levels to 457.4 mg% and also enhanced very-low-density lipoprotein levels to 91.5 mg%. Presently, the patient is being treated on conservative lines. To our knowledge, this is the first report of an unusual association between bilateral temporal lobe agenesis associated with renal parenchymal disease and dyslipidaemia.

Prediction and prevention of spontaneous preterm birth

Incidence of preterm delivery ranges from 7-12% of all gestations and premature birth is one of the main causes for newborn morbimortality. It is responsible for over three quarters of neonatal deaths, minus congenital malformations. Several strategies can be adopted to reduce premature delivery rates, including risk factor identification and prophylactic use of progesterone. Among the main actions of progesterone is its relaxing effect upon uterine muscles, the ability to block the effects of cytokin, and its antiinflammatory and immunosuppresive effects. The use of exogenous progesterone reduces the rates of prematurity for patients under risk of premature delivery, such as those with a history of premature deliveries, and short cervix as revealed by transvaginal ultrasound in the second quarter of pregnancy. This review aims to highlight important aspects to be considered in the outpatient clinic and describe the main predictive and preventive actions of premature birth available in obstetric care.

A randomised controlled trial of probiotics for the prevention of spontaneous preterm delivery associated with bacterial vaginosis: preliminary results.

BackgroundBacterial vaginosis increases the risk of spontaneous preterm delivery at less than 34 weeks of gestation.ObjectiveThe purpose of this study was to evaluate the efficacy of the early administration of selected lactobacilli strains (probiotics) to pregnant women with asymptomatic bacterial vaginosis/intermediate-degree infections to prevent spontaneous premature delivery and associated neonatal morbidity.Methods/DesignAsymptomatic pregnant women at less than 20 weeks of gestation, with no indication of elective preterm delivery, with a vaginal pH ≥ 4.5 and Nugent score > 3 were randomly assigned to the placebo or intervention group (oral administration of selected lactobacilli up to the 24th to 26th week of gestation). The randomisation was stratified for the history of premature delivery (HPD) and blocked. The allocation was concealed, and the participating health professionals and patients were blinded. The primary outcome was preterm delivery (<34 to <32 weeks), and the secondary outcomes were associated neonatal complications.ResultsIn total, 4,204 pregnant women were screened; 320 and 324 individuals were respectively randomly assigned to the placebo and intervention groups, and 62% finished the trial. None of the randomised patients were lost to follow-up. For the non-HPD stratum, the intent-to-treat relative risks of spontaneous premature birth at < 34 and < 37 weeks' gestation were 0.33 (0.03, 3.16) and 0.49 (0.17, 1.44), respectively, and they were non-significant (ns) with p = 0.31 and 0.14. The corresponding actual treatment figures were zero and 0.32 (0.09, 1.19), which were ns with p = 0.12 and 0.06. The intent-to-treat relative risk of spontaneous premature birth at < 37 weeks of gestation for the trial as a whole, including HPD and non-HPD participants, was 0.69 (0.26, 1.78), p = 0.30 (ns). The neonatal complications under evaluation occurred in only one infant (< 34 weeks; placebo group) who presented with respiratory distress syndrome and suspected early neonatal sepsis. The recorded adverse events were minor and relatively non-specific.ConclusionsThe efficacy of the tested probiotics to prevent preterm delivery among women without a history of preterm delivery was not determined because the study sample was insufficient to estimate statistically significant intent-to-treat effects; additional studies are needed to evaluate this intervention among these women.Trial registrationTrial registration at NIH register: NCT00303082. Sources of funding: the Brazilian Health Ministry and the State of Rio de Janeiro Research Foundation.

Assessment of Immunoglobulin IgG protective antibody level to Rubella virus in Pregnant women attending the Yaoundé gynecology, Obstetric and Pediatric Hospital (HGOPY) in Cameroon

Rubella virus belongs to the genus Rubivirus of the Togavirus family. The infection is usually mild with infants and adults. However, it can cause devastating problems when it infects the fetus, and when infection occurs during the first few weeks of pregnancy this could sometimes lead to the death of the fetus About 5 to 25% of women worldwide of child-bearing age lack rubella antibodies and aretherefore susceptible to primary infection. This study was conducted to assess immunoglobulin IgG antibody protective levels and the relationship between the antibodies titre levels maternal age,history of premature delivery, and previous abortion, in pregnant women visiting the Yaoundé Gynecological, Obstetric and Pediatric Hospital(HGOPY). This study was conducted as a step towards producing findings that could contribute towards formulating control strategies for the Rubella virus in Cameroon, a low resource sub-saharan African Country. 211 pregnant women attending the prenatal consultation of mean age 27±5.99 years were randomly selected and screened for rubella IgG antibodies. 39.3% of them were in their third trimester of pregnancy while 25.6% and 35.1% were in their first and second trimester of pregnancy respectively. 11.73% of the women had a history of premature delivery and 40.3% had a history of at least one abortion. Spearman's correlation was calculated between antibody titre and age. 88.6% of pregnant women were seropositive while 9% (susceptible) were sero-negative and 2.4% had equivocal results. Themost susceptible women to rubella infection were in the age group 26-30 years while women in the age group 21-25 years band were the most seropositive. nactTirounth=rrmteeir0rb ebe.ol2e aadw4rnt y6iadoo s fn.t ia aptbr grseeeetstvr w oio((enrrueg==sn c00 ato..h5b0re4o9r e9r2plt 6raioe)tp,ign

Clinical studies on seroprevalence of rubella virus in pregnant women of Cameroon regions.

A study was conducted to investigate the seroprevalence of the rubella virus amongst pregnant women and the relationship it has with the duration of pregnancy, premature delivery, and past history of abortion in pregnant women visiting the Yaoundé Gynecological, Obstetric and Pediatric Hospital (HGOPY). 211 pregnant women attending the prenatal consultation of mean age 27±5.99 years were randomly selected and screened for rubella IgG antibodies. 39.3% of them were in their third trimester of pregnancy while 25.6% and 35.1% were in their first and second trimester of pregnancy respectively. 11.73% of the women had a history of premature delivery and 40.3% had a history of at least one abortion. Spearman's correlation was calculated between antibody titre and age. 88.6% of pregnant women were seropositive while 9% (susceptible) were seronagative and 2.4% had equivocal results. The most susceptible women to rubella infection were in the age group 26-30 years while women in the age group 21-25 years band were the most seropositive. There was a strong correlation between the antibody titre and age (r=0.549 p

Effectiveness of Double Cervical Cerclage in Women With at Least One Previous Pregnancy Loss in the Second Trimester: A Randomized Controlled Trial

Cervical cerclage is widely used to prevent preterm birth in women at moderate or high risk of prematurity due to a history of preterm birth in the second trimester. Several studies reported, however, that cerclage is not effective; one study found no difference in the risk of preterm birth between cerclage and bed rest alone. Many of these studies, however, can be criticized because of deficiencies in design. A number of authors believe that placement of the suture close to the internal os may improve perinatal outcomes. Most studies investigating cerclage have used a single purse-string cerclage suture. The investigators in the present study suggest that use of a single suture is inadequate, no matter where it is placed in the cervix. This prospective randomized controlled pilot study compared the effect of double cervical cerclage with traditional single cervical cerclage on the frequency of preterm birth, perinatal outcomes, and maternal side effects in 51 singleton women with a history of pregnancy loss in the second trimester and suspected cervical incompetence. The participants were randomized into 2 groups: double cervical cerclage (n = 17) and traditional single cervical cerclage (n = 34). The effect of using double or single cervical sutures on a number of outcomes was compared. Outcomes examined included the duration of pregnancy, perinatal outcomes, maternal hospital stay, neonatal death, and neonatal admission to the intensive care unit. At less than 34 weeks of gestation, there was a nonsignificant difference in the rate of preterm delivery between the 2 groups favoring double cerclage, 12% versus 41%. At less than 28 weeks of gestation, the incidence of preterm delivery was lower (but not significantly) in the double cervical cerclage group compared to the single cerclage group, 6% versus 29%. The mean birth weight in the double cerclage group was higher (double suture: 2696 ± 911 vs. single suture: 2242 ± 1119 g, P = 0.048). The rates of neonatal survival and admission to the intensive care unit were not significantly different in the 2 groups. Few neonatal complications and no intraoperative maternal complications were associated with use of double cervical cerclage. The findings of this pilot study suggest that double cervical cerclage is effective and may be more effective than traditional single cervical cerclage in preventing preterm delivery and improving perinatal outcome among women with a prior history of premature delivery in the second trimester.

Estrategias para Mejorar la Sobrevida del Prematuro Extremo

Introduction: Biomedical advances have not decreased the number of premature deliveries. Newborns under 32 weeks constitute the most significant portion of infant mortality in developed countries. Objective: a literature review that identifies risk factors associated to premature labor and highlight strategies that increase survival. Results: Prenatal factor associated to early delivery include Black descent, maternal age, history of premature delivery, socioeconomic stratus, multiple deliveries and infections. Mortality is increased with earlier gestational age and lower fetal weight. Factors associated to increased survival include area of residence and place of birth, uterine transfer, variable levels of neonatal care, use of prenatal corticosteroids to accelerate pulmonary maturation, proactive management during childbirth, use of artificial surfactant and avoid use of steroids after delivery. Neonatal networks improve survival by potentiating best practices. Conclusions: Survival among these patients is enhanced by identification of risk factors for early delivery, knowing strategies that improve survival and planning for delivery in sites where best practices are offered.

Thrombophilic polymorphisms in preterm delivery

Single nucleotide polymorphisms tumor necrosis factor (TNF) G-308A, coagulation factors V G1691A and II G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, as well as the angiotensin-converting enzyme (ACE) insertion/deletion polymorphism were investigated in 86 women with a history of premature delivery (PD) and compared with those of a control group of adults from Guadalajara, Mexico (a minimum of 162 individuals were typed for each polymorphism). Significant differences in the frequency of these polymorphisms were found for MTHFR C677T (increased), and the ACE deletion (increased) among women who had a history of preterm delivery compared with controls. These polymorphisms therefore might be associated with PD.

Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data.

Accumulating evidence has associated bacterial vaginosis (BV) with serious medical complications such as premature delivery. The present article synthesizes available data on the treatment of nonpregnant and pregnant women with BV to prevent preterm delivery. A literature search identified articles published since 1976 that evaluated treatment of BV. An intention-to-treat sensitivity analysis was performed, to better compare studies. Studies that evaluated therapy efficacy varied with regard to diagnostic criteria, patient characteristics, clinicians, and laboratories. Therapies varied in efficacy for cure 4 or more weeks after therapy, from 48% to 85%. Intervention studies to reduce BV-related adverse outcomes of pregnancy differed in populations studied, medication used, type of therapy (oral or intravaginal), and timing of treatment. The benefit of treating women at high risk with oral metronidazole has been shown in several studies; however, the effect of treating women without a history of premature delivery is unclear. The use of intravaginal clindamycin therapy, especially during the latter half of the second trimester and thereafter, appears to increase infections during the neonatal period.