History Of Preterm Labor Research Articles

Proteína C reactiva plasmática en el segundo trimestre para predicción de parto pretérmino

ObjectiveTo establish the prognostic usefulness of plasma concentrations of C-reactive protein in second trimester for the prediction of preterm delivery. Materials and methodA case-control study was conducted on a sample of 613 pregnant women attending the Dr. Urquinaona Central Hospital, Maracaibo, Venezuela. Group A (n=52) women with preterm birth and group B (n=561) women with term birth, (control group) of pregnant women who had term deliveries. The plasma concentrations of C-reactive protein were compared between the 2 groups. ResultsThe mean gestation age at measurement of plasma concentrations of C-reactive protein was 26.2±1.1 weeks in group A and 25.9±1.1 weeks in group B (P=ns). There were no significant differences in maternal age, body mass index or history of preterm labour. Plasma C-reactive protein concentrations were higher in group A (2.1±0.8) than in group B (1.4±0.6mg/dL (P<.0001). A cut-off value of 1.6mg/dL had a value under curve of 0.71 with a sensitivity of 71.1%, specificity of 54.1%, positive predictive value of 12.5%, and negative predictive value of 95.3%. ConclusionPlasma C-reactive protein concentrations in second trimester are elevated in pregnant women, who later had preterm delivery, but are not useful for predicting this.

Can plateletcrit, an underestimated platelet parameter, be related with preterm labour?

Objective: Noninvasive and simple markers are needed for the prediction of preterm delivery in women at risk for preterm labour. The aim of this study was to determine the value of platelet indices in the prediction of preterm delivery. Design: A retrospective study. Setting: Routine antenatal care in Zonguldak Bülent Ecevit University between 2008 and 2011. Sample: Ninety patients who delivered between 28 and 37 weeks of gestational age and 128 patients who delivered at term. Methods: Plateletcrit and other haematological markers, cervical dilatation and effacement, and the neutrophil-to-lymphocyte ratio as an inflammation marker. Main outcome measure: The role of platelet indices in predicting the preterm delivery. Results: The platelet count, plateletcrit, white blood cell count, red cell distribution width, and neutrophil count were significantly higher in the preterm delivery group. Receiver operating characteristic curve analysis showed that the plateletcrit cut-off value for predicting spontaneous preterm labour was 0.201%, with a sensitivity of 95.6% and specificity of 87.5%; the cut-off value for the platelet count was 234 ? 103/mm3 with a sensitivity of 81.0% and specificity of 71.0%. Conclusion: Plateletcrit is a low-cost, widely available, and noninvasive marker that might be used for the prediction of preterm delivery in patients with a history of preterm labour.

PREGNANCY AND DELIVERY IN WOMEN WITH A HISTORY OF PREECLAMPSIA HYPERHOMOCYSTEINEMIA TREATED WITH BEMIPARIN IN COMBINATION WITH LOW-DOSE ASPIRIN

Preeclampsia is a serious complication of pregnancy and one of the leading causes of maternal mortality. According to modern concepts, the key link in the pathogenesis of preeclampsia is an endothelial dysfunction leadind to persistent prothrombotic hemostasis state. Markers and predictors of preeclampsia considered hypercoagulation, hyperagregation and hyperhomocysteinemia. Women with the history of preterm labor and preeclampsia was treated by antithrombotic correction started on pregravid stage. Pregnancy successfully completed on time delivery without hypertensive complications.

Role of perceived stress in the occurrence of preterm labor and preterm birth among urban women.

This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth. Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix. Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P=.66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P=.05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P=.04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P<.001). Prenatal perceived stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth.

Urogenital infections as a risk factor for preterm labor: a hospital-based case-control study.

Preterm labor is a leading cause of neonatal morbidity and mortality. Ascending lower genital tract infection leads to preterm labor and adverse pregnancy outcomes. This prospective case-control study was performed to see the association between preterm labor and urogenital infections. A total of 104 women were observed for urogenital infections and their association with preterm labor. Case Group I included 52 women with preterm labor after 26weeks and before 37 completed weeks of gestation with or without rupture of membranes. Control Group II included 52 women at completed or more than 37weeks of gestation with no history of preterm labor, matched to the case group with respect to age and parity. Midstream urine was sent for cytology and culture sensitivity. Samples from posterior fornix of vagina were taken with two sterilized swabs under direct vision using Cusco/Sims speculum before first vaginal examination and were studied for gram stain characteristics and culture sensitivity by standard methods. Microorganisms isolated on culture were noted, and antibiotics were given according to sensitivity. Data collected were analyzed according to the groups by χ(2) test for categorical variables. In our study, urogenital infection was seen in 19 women in Case Group I (36.54%) compared with 9 women in Control Group (17.3%), and the difference was statistically significant (p 0.027). Recognizing and treating the women having urogenital infections at a stage, when it has not become clinically evident, will decrease the percentage of women going into preterm labor and will improve the perinatal outcome.

Vaginal douching by women with vulvovaginitis and relation to reproductive health hazards

BackgroundVaginal douching (VD) is a common practice among married women all over the world specially those in the Middle East. It is used for personal hygiene or for other aesthetic reasons in many countries. The current study investigates the prevalence of VD among patients with vulvovaginitis in Egypt. It also compares the reproductive health hazards among women performing routine VD with those using external hygiene. It also investigates why, and how women practice this douching.MethodsA cross sectional observational study was conducted in a tertiary university affiliated hospital in Assiut, Egypt. An interview administered questionnaire was administered to 620 women by two trained clinic nurses. Women presented to the outpatient clinic and diagnosed to have any type of vaginal infections were approached for participation. The principle outcome was the history of preterm labor in women who routinely performed VD versus those who did not (upon which sample size was estimated). Other outcome measures were the types of vaginal infections, and reproductive implications comprising, ectopic pregnancy, abortion and pelvic inflammatory disease (PID).ResultsThe participants were predominantly multiparas from semi-urban background and middle socioeconomic level. Considering VD as a religious duty and a kind of personal cleanliness were the most common reasons for performing VD in 88.9% and 80.6% of the studied population, respectively. History of preterm labor was reported in 19.2% versus 11.9% (p=0.048), while history of PID in 13.2% versus 6.0% (p=0.008) in women performing VD compared to those not performing this habit, respectively. There were no significant differences between the two groups as regard the history of ectopic pregnancy or the number of previous abortions.ConclusionVaginal douching is a prevalent practice in Egypt and has traditional and religious roots within the community. There are many misbeliefs around this habit in Egypt. Vaginal douching increases certain reproductive health hazards especially preterm labor and PID. Much effort and awareness campaigns are needed to increase women awareness about health hazards of this incorrect practice and to limit its use.

First trimester prediction of early onset preeclampsia using demographic, clinical, and sonographic data: a cohort study

The aim of this research was to evaluate the performance of a predictive model for early onset preeclampsia (PE) during early gestation. Prospective multicenter cohort study was performed in women attending 11-14 weeks ultrasound. Medical history and biometrical variables were recorded and uterine artery Doppler was performed. All patients were followed until postpartum period. Constructed predictive models were compared using the area under the associated receiver operating characteristic curve. Sensitivity, specificity, and likelihood ratios were estimated for each outcome. A total of 627 patients were enrolled. Sixty-five (10.4%) developed gestational hypertension, of which 29 developed PE (4.6% of the total sample) and nine occurred before 34 weeks (1.5% of total sample). Prediction model generated for early onset PE (ePE) with 5% false positive achieve sensitivity of 62.5% and specificity of 95.5%. The positive and negative likelihood ratios for ePE were 13.9 and 0.39, respectively. Development of ePE was significantly associated with history of preterm labor (p = 0.002) and diabetes mellitus (p = 0.02). This study confirms the advantage of combining multiple variables for prediction of ePE.

Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Back groundExposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.AimsThis study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.MethodsA total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.ResultsPregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th–27th week or/and history of preterm labor which occurred within 28th–36th weeks of gestation, demonstrated higher cortisol level (1.0201 ± 0.1855 ng/ml) compared to control group 0.9757 ± 0.2860 ng/ml (P = 0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714 ± 1.7639 ng/ml) than women with miscarriage and preterm births (0.9889 ± 0.5498 ng/ml).ConclusionThe results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.

Risk of coronary artery disease in women with history of pregnancies complicated by preeclampsia and LBW

Women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction and low infant birth weight looks at a higher risk for subsequent ischemic heart disease. Objective: To determine the relationship between pregnancy complications and maternal coronary artery disease (CAD) in the future. Materials and method: We performed a case-control study on 690 patients (345 patients in each group) referred to Tehran Heart Center. Women with CAD were in the case group and women without CAD were in the control group. The history of pregnancy complications (including preeclampsia, low birth weight [LBW] delivery, preterm labor and gestational hypertension) was evaluated in the two groups. Results: 12.5% of the patients in the case group had a history of preeclampsia, compared with the control group (1.7%). (p < 0. 0001). Seven percent of the patients in the case group and 0.9% of the patients in the control group had history of LBW delivery. The difference was significant (p < 0.0001). A history of preterm labor was recorded in 11% of cases and 3.2% of controls. Performing multivariate analysis showed that there is a strong association between preeclampsia and CAD (OR: 16.92; 95% CI; p < 0.0001), LBW delivery and CAD (OR: 6.52; 95% CI; p: 0.0038), and also between high parity and CAD. (OR: 1.135; 95% CI; p: 0.0479). Conclusion: Our results suggest preeclampsia, LBW delivery and high parity of the mother as independent risk factors for CAD in the future.

Recurrent preterm birth in women treated with 17 α-hydroxyprogesterone caproate: the contribution of risk factors in the penultimate pregnancy

Objective: Examine rates of recurrent, spontaneous preterm birth (PTB) in women treated prophylactically with 17 α-hydroxyprogesterone caproate (17P) when the penultimate PTB was due to preterm labor (PTL) or preterm premature rupture of the membranes (pPROM). Methods: Retrospective, descriptive, database study of 1183 singleton gestations that initiated prophylactic 17P at <21 weeks with a penultimate PTB. Primary outcomes examined were rates of recurrent PTB at <37 and <32 weeks’ gestation in the PTL (n = 939) and pPROM (n = 244) cohorts. Results: Recurrent PTB <37 weeks occurred in 38% versus 28.3% of the PTL and pPROM cohorts, respectively (p <0.005). Rates of recurrent PTB <32 weeks were similar. Logistic regression revealed three risk factors increased the odds of recurrent PTB: >1 previous PTB (OR 1.8 [95% CI: 1.33–2.44]); penultimate birth at 28–33.9 weeks’ gestation (OR 1.61 [95% CI: 1.22–2.13]); and, PTL as the indication for delivery in the penultimate PTB (OR 1.66 [95% CI: 1.16–2.37]). Conclusion: Several historical factors increase the risk for recurrent PTB in women receiving 17P. Contrary to earlier studies of PTL and pPROM recurrence, women receiving prophylactic 17P with a penultimate PTB due to pPROM are at lower risk of recurrent PTB than those with a history of PTL.

Imaging of Müllerian Duct Anomalies

Müllerian duct anomalies (MDAs) are relatively common disorders that are particularly relevant in patients with infertility, recurrent pregnancy loss, or a history of preterm labor. Accurate characterization of MDAs is crucial to the implementation of appropriate treatment. Various imaging modalities have been used in the evaluation of MDAs, including hysterosalpingography, ultrasound, and magnetic resonance imaging (MRI). Although hysterosalpingography and ultrasound may suggest a Müllerian duct anomaly, further evaluation by MRI is often required. MRI is the best imaging method available because of its superior ability to reliably visualize complex uterovaginal anatomy.

Effect of aspirin treatment on TNFα production by women with a history of preterm birth

Lipopolysaccharide (LPS)-stimulated TNFα production is reported to be greater for whole blood (WB) cultures prepared from patients with a history of preterm birth than cultures obtained from women with a history of term birth. The objectives of this study were (1) to determine if there is a similar differential responsiveness for peripheral blood mononuclear leukocytes (PBML) and (2) to determine if treatment with aspirin influences LPS-stimulated TNFα production in these patients. WB and PBML were obtained from women with a history of preterm delivery before 32 weeks (cases; n = 5) and age- and race-matched controls ( n = 5) with a history of uncomplicated term delivery. WB and PBML were cultured and stimulated with LPS. All participants then took aspirin daily for 1 week and responsiveness of PBML and WB cultures to LPS was retested. The history of preterm labor was found to have no effect on LPS-stimulated TNFα production in cultures of WB or PBML. Aspirin treatment enhanced LPS-stimulated TNFα production by PBML from controls but not cases. We conclude that endotoxin responsiveness of women with a history of preterm birth is similar to that of women with a history of term birth in terms of in vitro TNFα production. Aspirin increases TNFα production by PBML in control women but not in women with a history of preterm birth. The divergent responses to aspirin treatment in patients with and without prior preterm labor may reflect differential regulation of cytokine production by prostaglandins in women with preterm labor associated with infection or inflammation.

Imaging of Müllerian Duct Anomalies

Müllerian duct anomalies (MDAs) are relatively common disorders that are particularly relevant in patients with infertility, recurrent pregnancy loss, or a history of preterm labor. Accurate characterization of MDAs is crucial to the implementation of appropriate treatment. Various imaging modalities have been used in the evaluation of MDAs, including hysterosalpingography, ultrasound, and magnetic resonance imaging (MRI). Although hysterosalpingography and ultrasound may suggest a Müllerian duct anomaly, further evaluation by MRI is often required. MRI is the best imaging method available because of its superior ability to reliably visualize complex uterovaginal anatomy.

Preterm Labor: A Review

ABSTRACT Introduction Preterm labor (PTL) is one of the leading causes of perinatal morbidity and mortality. It is one of the major public health problems, especially with reference to mortality, disability and health care expenses. Incidence The overall incidence of PTL is around 10-15% (6-15% Range)3 (The incidence of PTL in our institute (JNMC) was 10.2% during 2006-2007. Out of all PTL 50% occur spontaneously, 25% following preterm prelabor rupture of membranes (PPROM) and another 25% iatrogenic (Induced due to maternal and/or fetal risks). Risk factors Previous history of preterm labor is one of the important risk factor(risk of PTL in subsequent pregnancies is 14.3% and 28% after one and two preterm births. Others include multiple pregnancy, uterine over distension (polyhydramnios, macrosomia and fibroids), uterine anomalies, cervical incompetence, bacterial vaginosis, bleeding in early pregnancy, poor socioeconomic status, elderly and adolescent age group and tobacco use. Predictors Cervical length assessment by USG, fetal fibronectin, vaginal pH are being used. Prevention Progesterone and clindamycin (abnormal vaginal flora) antibiotic is being used with reasonable evidence. Treatment Corticosteroids and antibiotics help in reducing neonatal morbidity and mortality and tocolytics (nifedepine and atosiban are recommended) helps in allowing the steroids to act. Newer developments New predictors like higher vaginal pH (&gt; 4.5) and Gram stain score of 9 to 10 with Nugent criteria in early pregnancy is increasingly associated with preterm labor. Search for selective and safe tocolytic is also under consideration, specially the prostaglandin synthetase inhibitors and the role of potassium channels in myometrium. Conclusion Successful prediction, prevention and treatment of preterm labor has significant influence on the perinatal outcome, health care expenditure and quality of life. As the cause for preterm labor is still an enigma, it is difficult to predict, prevent and treat PTL successfully. At present the treatment of PTL is mainly antibiotics, tocolytics and corticosteroids with varied success.

501: The use of protease inhibitors (PI) during pregnancy and the risk for intrauterine growth restriction in human immunodeficiency virus (HIV) positive women

ObjectiveTo assess if the use of a PI is associated with an increased risk of adverse fetal outcome, particularly, the development of intrauterine fetal growth restriction (IUGR).Study DesignAn IRB-approved, chart review was performed from 01/2001-7/2008. Data abstracted included maternal age, race, CD4 count at the time of delivery, a history of preterm labor, presence of hypertension (HTN) and/or diabetes (DM), birth weight, Apgar scores, presence of abnormal Doppler studies, presence of oligohydramnios, gestational age at delivery and findings consistent with abruption. Fetal exposure to tobacco, alcohol and illicit drugs were also documented. The classes and times of initiation of antiretroviral agents used were evaluated. Categorical data were analyzed using the chi square test (or Fisher′s exact test where appropriate). Continuous variables were analyzed using the Student t test. A multinomial regression analysis was performed to assess for interactions between CD4 count, tobacco use, alcohol use, illicit drug use, class of antiretroviral drug used, race, and presence of HTN (using STATA 8.2, College Station, TX).Results102 patients were identified. 21 were on no therapy or a regimen that did not include a PI. 81 patients were on combination therapy that included a PI and 18 of them developed IUGR. Of those not on a PI, none developed IUGR (22% vs. 0%, p=0.02). Alcohol, tobacco or illicit drug use did not differ between the groups. No differences were noted between groups with respect to demographic characteristics or other obstetric outcome. After adjusting for confounders, the development of IUGR was still significantly associated with the use of a PI.ConclusionTabled 1ORP95% CITobacco2.4<0.0011.6-3.6PI2.00.0011.3-3.1Illicit drugs0.80.320.5-1.3Race1.10.670.8-1.6HTN0.60.410.2-1.9CD41.30.051.0-1.7 Open table in a new tab ObjectiveTo assess if the use of a PI is associated with an increased risk of adverse fetal outcome, particularly, the development of intrauterine fetal growth restriction (IUGR). To assess if the use of a PI is associated with an increased risk of adverse fetal outcome, particularly, the development of intrauterine fetal growth restriction (IUGR). Study DesignAn IRB-approved, chart review was performed from 01/2001-7/2008. Data abstracted included maternal age, race, CD4 count at the time of delivery, a history of preterm labor, presence of hypertension (HTN) and/or diabetes (DM), birth weight, Apgar scores, presence of abnormal Doppler studies, presence of oligohydramnios, gestational age at delivery and findings consistent with abruption. Fetal exposure to tobacco, alcohol and illicit drugs were also documented. The classes and times of initiation of antiretroviral agents used were evaluated. Categorical data were analyzed using the chi square test (or Fisher′s exact test where appropriate). Continuous variables were analyzed using the Student t test. A multinomial regression analysis was performed to assess for interactions between CD4 count, tobacco use, alcohol use, illicit drug use, class of antiretroviral drug used, race, and presence of HTN (using STATA 8.2, College Station, TX). An IRB-approved, chart review was performed from 01/2001-7/2008. Data abstracted included maternal age, race, CD4 count at the time of delivery, a history of preterm labor, presence of hypertension (HTN) and/or diabetes (DM), birth weight, Apgar scores, presence of abnormal Doppler studies, presence of oligohydramnios, gestational age at delivery and findings consistent with abruption. Fetal exposure to tobacco, alcohol and illicit drugs were also documented. The classes and times of initiation of antiretroviral agents used were evaluated. Categorical data were analyzed using the chi square test (or Fisher′s exact test where appropriate). Continuous variables were analyzed using the Student t test. A multinomial regression analysis was performed to assess for interactions between CD4 count, tobacco use, alcohol use, illicit drug use, class of antiretroviral drug used, race, and presence of HTN (using STATA 8.2, College Station, TX). Results102 patients were identified. 21 were on no therapy or a regimen that did not include a PI. 81 patients were on combination therapy that included a PI and 18 of them developed IUGR. Of those not on a PI, none developed IUGR (22% vs. 0%, p=0.02). Alcohol, tobacco or illicit drug use did not differ between the groups. No differences were noted between groups with respect to demographic characteristics or other obstetric outcome. After adjusting for confounders, the development of IUGR was still significantly associated with the use of a PI. 102 patients were identified. 21 were on no therapy or a regimen that did not include a PI. 81 patients were on combination therapy that included a PI and 18 of them developed IUGR. Of those not on a PI, none developed IUGR (22% vs. 0%, p=0.02). Alcohol, tobacco or illicit drug use did not differ between the groups. No differences were noted between groups with respect to demographic characteristics or other obstetric outcome. After adjusting for confounders, the development of IUGR was still significantly associated with the use of a PI. ConclusionTabled 1ORP95% CITobacco2.4<0.0011.6-3.6PI2.00.0011.3-3.1Illicit drugs0.80.320.5-1.3Race1.10.670.8-1.6HTN0.60.410.2-1.9CD41.30.051.0-1.7 Open table in a new tab

The moulded baby syndrome: incidence and risk factors regarding 1,001 neonates

Postural deformities are frequent in neonates. The moulded baby syndrome (MBS) comprises one or more of the following disorders: plagiocephaly, torticollis, congenital scoliosis, pelvic obliquity, adduction contracture of a hip and/or malpositions of the knees or feet. We analysed the incidence of MBS in healthy neonates and identified the risk factors of its composing elements. One thousand and one healthy neonates were examined on the second or third day of life by the same paediatrician. Familial, obstetrical, perinatal history and putative risk factors for postural deformities were collected. Families of newborns with a torticollis or plagiocephaly were given positioning advice and the outcome was evaluated by a phone survey 2 months later. MBS was detected in 107 neonates (10.7%): 97 plagiocephalies or torticollis, 25 congenital scoliosis or pelvic obliquities, and 13 malpositions of the knees or feet. We identified risk factors related to the mother (age: OR=1.39, parity: OR=0.643), to the obstetrical history (preterm labour: OR=1.65, oligoamnios: OR=10.179, breech presentation: OR=2.746, pregnancy toxaemia: OR=3.773, instrumental delivery: OR=6.028) and to the newborn (male gender: OR=1.982, birth length: OR=1.196). The initial plagiocephaly or torticollis improved in 77% of infants after 2 months of stimulation and positioning measures. Paediatricians should be alert regarding the frequent but subtle MBS postural deformities and give positioning advice to the parents. A neonate of male gender or greater birth length, with an older primiparous mother, a history of preterm labour, oligoamnios or pregnancy toxaemia, a breech presentation or an assisted delivery is more likely to have MBS.

Correlates of low birth weight in term pregnancies: a retrospective study from Iran.

BackgroundLow birth weight (LBW) is considered as a major multifaceted public health concern. Seventy-two percent of LBW infants are born in Asia. An estimation of 8% LBW infants has been reported for Eastern Mediterranean region including Iran. This study investigated contributory factors of LBW in singleton term births in Tehran, Iran. Tehran is a multicultural metropolitan area and a sample from the general population in Tehran could be regarded as a representative sample of urban population in Iran.MethodsThis was a retrospective study using data from 15 university maternity hospitals in Tehran, Iran. Data on all singleton term births in these hospitals were extracted from case records during a one calendar year. Study variables included: maternal age, maternal educational level, history of LBW deliveries, history of preterm labor, cigarette smoking during pregnancy, number of parities, chronic diseases and residential area (Tehran versus suburbs of Tehran). In order to examine the relationship between LBW and demographic and reproductive variables the adjusted logistic regression analysis was performed.ResultsIn all, data for 3734 term pregnancies were extracted. The mean age of women was 25.7 (SD = 5.3) years and 5.2% of term births were LBW. In addition to association between LBW and maternal age, significant risk factors for LBW were: history of LBW deliveries [adjusted odds ratio (OR) = 2.53, 95% confidence interval (CI) = 1.06–6.03], smoking during pregnancy (OR = 4.64, 95% CI = 1.97–10.95) and chronic diseases (OR for hypertension = 3.70, 95% CI = 2.25–6.06, OR for others = 2.04, 95% CI = 1.09–3.83).ConclusionThe findings indicate that in addition to maternal age, history of LBW deliveries; smoking during pregnancy and chronic diseases are significant determinants of LBW in this population. This is consistent with national and international findings indicating that maternal variables and risk behaviors during pregnancy play important roles on LBW.

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

Indomethacin prophylaxis or expectant treatment are common strategies for the prevention or management of symptomatic patent ductus arteriosus (sPDA). To compare the clinical responses of extremely low birth weight (ELBW) infants to indomethacin prophylaxis with that of other infants who were managed expectantly by being treated with indomethacin or surgically only after an sPDA was detected. Retrospective cohort investigation of 167 ELBW infants who received indomethacin prophylaxis (study) and 167 ELBW infants (control) treated expectantly who were matched by year of birth (1999 to 2006), birth weight, gestational age (GA) and gender. Mothers of the two groups of infants were comparable demographically and on the history of preterm labor, pre-eclampsia, antepartum steroids and cesarean delivery. Study and control infants were similar in birth weight, GA, low 5 min Apgar scores, surfactant administration, the need for arterial blood pressure control, bronchopulmonary dysplasia and neonatal mortality. Necrotizing enterocolitis, spontaneous intestinal perforations, intraventricular hemorrhage grade III to IV, periventricular leukomalacia and stage 3 to 5 retinopathy of prematurity occurred also with similar frequency in both groups of infants. In the indomethacin prophylaxis group, 29% of the infants developed sPDA, and of them 38% responded to indomethacin treatment. In the expectantly treated group, 37% developed sPDA, and of them 59% responded to indomethacin treatment. Overall, surgical ligation rate for sPDA was similar between both groups of patients. In our experience, indomethacin prophylaxis does not show any advantages over expectant early treatment on the management of sPDA in ELBW infants. Although no deleterious effects were observed, prophylaxis exposed a significant number of infants who may have never developed sPDA, to potential indomethacin-related complications.

Sonographic measurement of cervical length in threatened preterm labor with intact membranes

LABOR WITH INTACT MEMBRANES JORGE CARRILLO, PABLO TORRES, JUAN ROJAS, KATYA ASTUDILLO, IRIS DELGADO, ALVARO INSUNZA, Hospital Padre Hurtado-Clinica Alemana-Universidad del Desarrollo, Santiago, Chile, Universidad del Desarrollo Clinica Alemana, Santiago, Chile OBJECTIVE: We sought to determine whether sonographic measurement of cervical length (CL) could predict delivery within 7 days of presentation and before 35 weeks’ gestation in women with threatened preterm labor. STUDY DESIGN: Sonographic measurement of CL was done in 852 women with singleton pregnancies presenting with painful uterine contractions. Women in labor, with ruptured membranes or those with cervical cerclage were excluded. Clinical management was determined without considering cervical length. Primary outcome was delivery within 7 days of admission; secondary outcome was delivery at or before 35 weeks’ gestation. RESULTS: Median gestation at presentation was 31.5 (range, 24.0-34.9) weeks and median cervical length was 31.5 (range, 3-61) mm. Delivery within 7 days occurred in 14 (1.6%) and delivery at or before 35 weeks, in 61 (7.2%) cases. Logistic regression analysis demonstrated that significant independent predictors of delivery within 7 days were cervical length (odds ratio (OR), (OR, 5.92; 95% CI 2.02-17.31) and vaginal bleeding (OR, 5.90; 95% CI 1.24-27.9); for delivery at or before 35 weeks, significant independent predictors were vaginal bleeding (OR 6.87; 95% CI 2.83-16.65), cervical length (OR 3.31; 96% CI 1.92-5.70) and a history of preterm labor (OR 2.03; 95% CI 1.06-3.89). No significant independent contribution to any of the outcome measures was added with other sociodemographic variables as well aas with gestational age at presentation, parity or cigarette smoking. ROC curve analysis showed that a cervical length shorter than 19.5 mm was the best cutoff value for predicting a delivery within 7 days of presentation (p = 0.05) and at or before 35 weeks’ gestation (p ! 0.05). CONCLUSION: Sonographic measurement of cervical length helps to recognize patients at risk of preterm birth within 7 days of admission for threatened preterm labor. A cervical length shorter than 19.5 mm seems to be the best cutoff value to distinguish between true and false labor in this population.

Vaginal Douching Practices of Women in Eight Florida Panhandle Counties

To document knowledge, beliefs, douching practices, prevalence of bacterial vaginosis, and preterm births in women who douche. Descriptive, cross-sectional nonexperimental design. Six private midwifery/nurse practitioner offices and eight county health departments in the Florida panhandle. Four hundred eighty-three English- or Spanish-speaking women aged 14 to 45 years. Self-administered questionnaire about douching; medical record review. Prevalence of douching, history of preterm labor, preterm births, and prevalence of bacterial vaginosis. Of 483 women, 76% had douched, 43% douched at least once per month, and 36% were unaware they should not douche. As determined by odds ratio, women who douched monthly were 2.5 times more likely to have a history of bacterial vaginosis than women who did not douche (p < .001), and women who douched weekly were 2.75 times more likely to have bacterial vaginosis (p = .004). Of 409 clients with medical records available, 32 had preterm births of which 69% had a history of bacterial vaginosis (x2 = 4.5, df = 1, p = .034). Among women with preterm births who douched regularly prior to pregnancy (n = 14), 87% had a history of bacterial vaginosis (x2 = 7.14, df = 1, p = .008). Associations of douching with bacterial vaginosis and bacterial vaginosis with preterm labor were significant. Health care professionals should initiate discussions to discourage douching.