Incidence Of PTB Research Articles

LOW PRETERM BIRTH RATE WITH DECREASING EARLY NEONATAL MORTALITY IN BOSNIA AND HERZEGOVINA DURING 2007-2014.

The aim:of the study was to determine the situation of preterm births and early neonatal mortality during 2007-2014 in Tuzla Canton, Bosnia and Herzegovina.Methods:The study covers a 8-year period and is based on the protocols at the Tuzla Clinic for Gynecology and Obstetrics that covers all birth in Tuzla Canton area. We analyzed the gestational age of all newborns and recorded the number of neonatal deaths in the first week after birth. Demographics, pregnancy and birth characteristics were collected from the maternal records.Results:The total number of births in the period was 32738. Preterm birth was identified in 2401 (7.3%) cases with 12,5% occurring before 32 gestational weeks and 64% in 35-36 gestational weeks. The mothers of the 24-31 gws preterm group were significantly younger that those in the 32-36 group. In the 32-36 group there were significantly greater proportions of mothers with assisted reproductive technology and pre-eclampsia and 16.7% was medical induced preterm births versus 11.4 % in the 24-31 PTB group, p<0.05. The incidence of PTB did no vary significantly during the period, the lowest rate was found in 2010 (6.4%). A total of 221 children died giving a early mortality rate of 6.8 per 1000 live born over the 8 years. The majority 156 dying infants (70.6%) were preterm, only 5.7% died being born in the 35-36 gestational week (5.9 per 1000). Overall the preterm early mortality (7.3 per 1000) has shown a decreasing tendency during the latter years.Conclusion:During the last 8 years there have been no significant decline in preterm birth in the Tuzla region while a decline in early neonatal death has been registered.

Risk factors of preterm birth and low birth weight babies among Roma and non-Roma mothers: a population-based study

In 2009, 8.4% of live births in Hungary were low birth weight (LBW) and 8.7% were preterm (PTB). Roma are disproportionately represented in Northern Hungary where LBW and PTB are highest in the country (10.3% equally). This study evaluates the risk factors for LBW and/or PTB among the Roma and non-Roma populations in two Northern Hungarian counties. We conducted a retrospective cohort study of 5469 non-Roma and 2287 Roma mothers who gave birth in 2009. Women were visited by the Maternal and Child Health Service nurses and completed in-person structured surveys on demographic, socio-economic, cultural and lifestyle factors. These data were combined with biometric data from hospital records. Bivariate statistics and a logistic regression analyses were used to determine risk factors for LBW and PTB. Roma had a higher incidence of PTB and LBW babies compared with non-Roma women (PTB 9.9% vs. 7.1%, LBW 12.2% vs. 6.5% P = 0.001). However, ethnicity was not related to PTB and LBW in multivariable analyses, when controlling for socio-demographic and lifestyle characteristics. Factors associated with LBW and PTB include being underweight, advanced maternal age, and smoking. Strategies that ensure healthy lifestyles must be well integrated in family-based interventions and in the schools, with special consideration for Roma women who have a higher prevalence of deleterious lifestyles and poor birth outcomes. Ensuring a healthy body weight and no smoking has important implications for the mother and foetus.

A Blood Test to Predict Preterm Birth: Don’t Mess with Maternal-Fetal Stress

The timely onset of labor and birth is a critical determinant of perinatal outcome. The mean duration of human pregnancy is 40 wk (280 d) from the first day of the last normal menstrual period. Both preterm birth (PTB; defined as delivery before 37 wk gestation) and postterm pregnancy (delivery after 42 wk) are associated with adverse perinatal outcome. In developed countries, PTB complicates 7–12% of all deliveries but accounts for over 70% of perinatal morbidity and mortality (1). Although the incidence of PTB has continued to rise every year for the past three decades, perinatal survival and intact survival have increased steadily during this same time period due in large part to the appropriate and timely use of antenatal corticosteroids and to improvements in neonatal resuscitation and infant care. For these reasons, early and accurate identification of women at risk of PTB is critical to optimize perinatal outcome. Early identification of women at risk will become even more important if recent reports on the use of progesterone supplementation to prevent PTB can be replicated (2–4). Obstetric care providers have traditionally relied on clinical symptoms (regular uterine contractions, pelvic pressure) to identify women at risk of spontaneous PTB. Numerous studies have now shown that reliance on clinical symptoms alone is inaccurate and unreliable. Such an approach will fail to identify the majority of womenwhodeliverpreterm(5), and, contrary topopularbelief, the presence of symptoms is not associated with an increased risk of spontaneous PTB (6, 7). For these reasons, extensive efforts have been made to develop objective tests to identify women at risk of PTB. Two such tests are currently recommended by the American College of Obstetricians and Gynecologists (ACOG) for the prediction of PTB, namely cervicovaginal fetal fibronectin (fFN) and measurement of cervical length by transvaginal ultrasound (8). A number of other predictive tests are under investigation, the most promising of which are measurements of steroid and stress hormones in the maternal circulation. The biological plausibility behind the use of maternal serum stress and sex steroid hormone levels to predict PTB is well established. Considerable evidence suggests that the hormonal milieu of the fetoplacental unit is in control of the timing of labor, although maternal and genetic factors are also involved (9–11). It is likely that a “parturition cascade” exists at term that is responsible for the removal of mechanisms maintaining uterine quiescence and the recruitment of factors acting to promote uterine activity. Although a detailed review of the proposed cascade is beyond the scope of this editorial, it is clear that endocrine factors are involved. As in other mammalian viviparous species, the final common pathway toward parturition in the human appears to be maturation and activation of the fetal hypothalamic-pituitary-adrenal (HPA) axis, with an increase in the major adrenal glucocorticoid product in the fetal circulation in late gestation (cortisol in the sheep and human; corticosterone in the rat and mouse). The cellular and molecular factors responsible for the maturation of the fetal HPA axis are incompletely understood, but are associated with the gestational age-dependent up-regulation of a number of critical genes, most importantly fetoplacental CRH. Levels of CRH in the maternal circulation increase from 10–100 pg/ml in nonpregnant women to 500–3,000 pg/ml in the third trimester of pregnancy (12). The source of this excess CRH is the placenta. Shortly before the onset of labor, both at term and preterm, CRH levels increase and hepatic-derived CRH-binding protein levels decrease, resulting in a marked increase in free (biologically active) CRH (13). CRH, in turn, acts via specific nuclear receptors in the myometrium, placenta, and fetal membranes to differentially regulate target genes. Among its effects on term uterine tissues, CRH promotes myometrial contractility by stimulating prostaglandin production from the decidua and fetal membranes (14) and potentiates the contractile effects of oxytocin and prostaglandins on the myometrium (15). At term, CRH also directly stimulates the production of the C-19 steroid, dehydroepiandrostenedione sulfate, from the intermediate (fetal) zone of the fetal adrenal glands (16, 17). Dehydroepiandrostenedione sulfate is then 16-hydroxylated in the fetal liver and converted to estriol

Long-term follow-up of infants of women with normal glucose tolerance (NGT) and gestational diabetes (GDM): Risk factors for obesity and components of the metabolic syndrome in childhood

INFECTED AFRICAN POPULATION ROBERT GOLDENBERG, TAHA TAHA, IRVING HOFFMAN, WAFAIE FAWZI, ANTHONY MWATHA, University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, Alabama, Johns Hopkins University, Baltimore, Maryland, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Harvard University, Boston, Massachusetts, Fred Hutchinson Cancer Research Center, Statistical Center for HIV/ AIDS Research Prevention, Seattle, Washington OBJECTIVE: The use of antibiotics to prevent PTB has achieved mixed results. Our goal in this study was to determine if antibiotics given prenatally and during labor reduced the incidence of PTB and histologic chorioamnionitis (HCA). STUDY DESIGN: A double blind randomized placebo – controlled trial of antibiotics to reduce PTB and perinatal transmission of HIV was conducted in 4 African sites. Women were given antibiotics at 20-24 weeks (metronidazole 250 mg and erythromycin 250 mg t.i.d. orally for 7 days) and during labor (metronidazole 250 mg and ampicillin 500 mg q 4 hours) or identically appearing placebos. Endpoints available in 2098 HIV-infected and 335 HIVuninfected women included gestational age (GA) determined by both obstetric and pediatric criteria and birthweight (BWT). Preand post-treatment rates of various STIs were determined and placentas were evaluated for HCA. RESULTS: Comparing antibiotic versus placebo treated women, there were no differences in mean GA at delivery (38.7 vs 38.6 wks p=NS), the percent of PTB (25.3 vs 24.6 p=NS), the time between randomization and delivery (17.1 vs 17.1wks p=NS),meanBWT(2965 vs 2974gp=NS), BWT!1500g (1.6 vs 1.7% p=NS), or !2500g (12.4 vs 13.7% p=NS). Four weeks after the 24-week antibiotic/placebo course, BV was reduced from 44.5 to 23.8% in the antibiotic groups vs 43.3 to 37.5% in the placebo group for an OR of 0.50 (0.41-0.60, p!0.0001). Trichomoniasis decreased from 19.0 to 6.0% in the antibiotic group vs 16.3 to 12.3% in the placebo group for an OR of 0.41 (0.031-0.56%, p!0.0001). However, the placentas showed no difference in the rate of HCA (36.3 vs 35.8% p=NS). CONCLUSION: Despite reducing the rate of vaginal infections, the antibiotic regimen used in this study did not reduce the rate of PTB or low birthweight, increase the time to delivery, or increase mean GA or BWT. Failure of this regimen to reduce the rate of HCA likely explains the reason the antibiotics SMFM Abstracts S3