Prematurity In Women Research Articles

Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case-Control Study.

Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case-control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66-4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32-49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02-8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09-3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight.

The perinatal outcomes of women treated for Asherman syndrome: a propensity score-matched cohort study.

Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. N/A.

CURRENT APPROACH TO PREGNANT WOMEN WITH THYROID ABNORMALITIES

The course of pregnancy, thyroid status, and hormonal background were studied in 96 women with autoimmune thyroiditis (AIT). It was established that pregnant women have a number of maternal and fetal complications (54.8%); AIT has an adverse effect on the course of pregnancy; a high risk of miscarriage and termination of pregnancy is observed; and the thyroid hormone level is reduced and the TSH level is increased in comparison with that in healthy pregnant women. To prevent gestational complications and prematurity in women with AIT, routine blood TSH testing from early gestation is recommended.

Emergency cerclage following a standardized protocol offers an effective and safe therapeutic option for women with high risk for prematurity – a retrospective monocentric cohort study on 130 pregnancies and 155 neonates

Objective To present emergency cerclage (EC) as a safe and effective therapeutic option for prevention of prematurity in women with advanced cervical dilation in second-trimester pregnancy. It is focused on seemingly futile situations like cervical dilation >5 cm, bulging membranes and multifetal pregnancies. The outcomes of interest are the prolongation of pregnancy, gestational age at delivery and neonatal morbidity and mortality related to distinct risk factors. Study design Retrospective monocentric cohort study involving 130 pregnancies (105 single and 25 twin pregnancies) and 155 neonates by using a standardized protocol. Women between 18 and 28 gestational weeks with cervical shortening of <10 mm + cervical dilation >2 cm and/or bulging membranes were included. Analyses of maternal and neonatal parameters were done by chart review. Results The medium gestational age at delivery was 35 5/7 week with a medium interval from cerclage placement to delivery of 83 days. Overall, 46.5% (72/155) neonates were born beyond 37 weeks, extreme prematurity of less than 28 gestational weeks was observed in 14.8% (23/155), no miscarriage before 22 weeks was documented. The neonatal mortality was 1.9% (3/155). Neonatal deaths and morbidity was related to severe prematurity exclusively. The association of amnion-infection syndromes and failing therapy was significantly with respect to bulging membranes and advanced cervical dilation >5 cm. Conclusions Even in futile cases EC can be an option to save the pregnancy and prevent severe prematurity. However, a standardized protocol is imminent for successful therapy and every indication has to be a case by case decision.

Comparing a Novel Antenatal Program with a Standard in Disadvantaged Women at Psychosocial Risk: A Randomized Controlled Study

Purpose: To evaluate participant’s satisfaction with two models of antenatal childbirth preparation program and effects in women at psychosocial risk. The risk variables included depressive symptoms, stressful events, lack of social support and, low economic level. Design, setting and participants: A blinded randomized controlled and multi-centre trial comparing a novel program intervention to standard program. Women found to be at psychosocial risk were distributed in two groups: an experimental group (EG) or a control group (CG) and evaluated in two times measurement: 1) during pregnancy (<20 weeks) before the routine ultrasound visit and, 2) four weeks after delivery by parcel post. The sample was 184 pregnant women and their partners. Intervention: 10 group sessions in experimental group, focusing on body awareness sensations with humanistic mind-body approach (like mindfulness) in direction to constructing of an individualized childbirth model. Sessions lasted two hours and 15 minutes each during pregnancy, with one individual telephone conversation between sessions. In the control group intervention, the participants were free to choose the standard model of antenatal education: 10 two-hour sessions focused on childbirth preparation and breast feeding, including obstetrical prophylaxis and relaxation. Results: Satisfaction was higher in the experimental group for questions about understanding symptoms of pregnancy: 4 in the CG and 38 in the EG (p=0.05 Pearson Chi-Square and p=0.05 Fisher’s Test); understanding all information received: 3 in the CG and 37 in the EG (p=0.02 Pearson Chi-Square and p=0.02 Fisher’s Test); expressing feelings: 0 in the CG and 18 in the EG (p=0.04 Pearson Chi Square and p=0.03 Fisher’s Test); and communicating with the baby: 3 in the CG and 38 in the EG (p=0.05 in Pearson Chi-Square and p=0.05 Fisher’s Test). The difference in preterm births between groups is significant (P=0.003) with only three premature baby in the experimental group and thirteen in the control group. The weight of the babies was lower in the control group compared to the experimental group (p=0.01). Conclusions: A novel antenatal program that included a psychosomatic approach about all pregnancy sensations (mother and baby) produces higher satisfaction in participants. Program can help to preventing the risk of prematurity in women at psychosocial risk but needs to be studied with a larger sample. Early detection realized on the occasion of the routine ultrasound visit, before 20 weeks pregnancy was an advantage, and suggests effectiveness in the selection of cases at risk.

Outcomes of pregnancies in women with suspected antiphospholipid syndrome

To evaluate maternal and neonatal outcomes in women suspected to have primary antiphospholipid syndrome (PAPS). A cohort from the Nova Scotia Atlee Perinatal Database (n = 211034) was studied. A total of 58 women with antiphospholipid antibodies without a clinical diagnosis of rheumatologic disease were evaluated. We compared them to maternal and neonatal outcomes of women without rheumatologic disease or PAPS who delivered in Nova Scotia 1988-2008. With PAPS, mean maternal age was older; mean gestational age and mean neonatal birth weight were less. With bivariate analysis, maternal colonization and urinary tract infection with group B streptococcus, thromboembolic disease, thrombocytopenia and Caesarean birth were more frequent in the suspected PAPS group compared to the control. Among neonates, hyperbilirubinemia, anemia, apnea, intraventricular hemorrhage grade I and II, retinopathy of prematurity, bronchopulmonary dysplasia, neonatal intensive care unit admission, and assisted ventilation occurred more frequently with PAPS. Babies in PAPS group had a longer hospital stay (8.7 vs 3.9 days). Logistic regression analysis identified that PAPS was only associated with increased risks of preeclampsia (Odds Ratio (OR) 2.2; 95% Confidence Interval (CI) 1.1-4.3; P = 0.016), urinary tract infection (OR 2.2; 95% CI 1.1-4.6; P = 0.02), and prematurity (gestational age ≤37) (OR 2.2; 95% CI, 1.07-4.3, P = 0.03). Positive predictive values for pregnancy induced hypertension, urinary tract infection and prematurity in women who had suspected APS were 24.1%, 17.2% and 45.6% respectively. With suspected PAPS, risks for preeclampsia, urinary tract infection and prematurity are increased. Outcomes for babies are related to prematurity.

Progestogens for Preterm Birth Prevention

We systematically reviewed the effectiveness of progestogens for prevention of preterm birth among women with prior spontaneous preterm birth, multiple gestations, preterm labor, short cervix, or other indications. We searched MEDLINE and EMBASE databases for English language articles published from January 1966 to October 2011. We excluded publications that were not randomized controlled trials or had fewer than 20 participants, identifying 34 publications, of which 19 contained data for Bayesian meta-analysis. Two reviewers independently extracted data and assigned overall quality ratings based on predetermined criteria. Among women with prior preterm birth and a singleton pregnancy (five randomized controlled trials), progestogen treatment decreased the median risk of preterm birth by 22% (relative risk [RR] 0.78, 95% Bayesian credible interval 0.68-0.88) and neonatal death by 42% (RR 0.58, 95% Bayesian credible interval 0.27-0.98). The evidence suggests progestogen treatment does not prevent prematurity (RR 1.02, 95% Bayesian credible interval 0.87-1.17) or neonatal death (RR 1.44, 95% Bayesian credible interval 0.46-3.18) in multiple gestations. Limited evidence suggests progestogen treatment may prevent prematurity in women with preterm labor (RR 0.62, 95% Bayesian credible interval 0.47-0.79) and short cervix (RR 0.52, 95% Bayesian credible interval 0.36-0.70). Across indications, evidence about maternal, fetal, or neonatal health outcomes, other than reducing preterm birth and neonatal mortality, is inconsistent, insufficient, or absent. Progestogens prevent preterm birth when used in singleton pregnancies for women with a prior preterm birth. In contrast, evidence suggests lack of effectiveness for multiple gestations. Evidence supporting all other uses is insufficient to guide clinical care. Overall, clinicians and patients lack longer-term information to understand whether intervention has the ultimately desired outcome of preventing morbidity and promoting normal childhood development.

Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data

There is an ongoing debate as to whether combined antiretroviral treatment (cART) during pregnancy is an independent risk factor for prematurity in HIV-1-infected women. The aim of the study was to examine (1) crude effects of different ART regimens on prematurity, (2) the association between duration of cART and duration of pregnancy, and (3) the role of possibly confounding risk factors for prematurity. We analysed data from 1180 pregnancies prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS). Odds ratios for prematurity in women receiving mono/dual therapy and cART were 1.8 [95% confidence interval (CI) 0.85-3.6] and 2.5 (95% CI 1.4-4.3) compared with women not receiving ART during pregnancy (P=0.004). In a subgroup of 365 pregnancies with comprehensive information on maternal clinical, demographic and lifestyle characteristics, there was no indication that maternal viral load, age, ethnicity or history of injecting drug use affected prematurity rates associated with the use of cART. Duration of cART before delivery was also not associated with duration of pregnancy. Our study indicates that confounding by maternal risk factors or duration of cART exposure is not a likely explanation for the effects of ART on prematurity in HIV-1-infected women.

Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases.

ObjectiveThe purpose of this study is to compare the incidence of congenital defects, spontaneous abortions, number of live births, fetal death and pre-maturity in women with autoimmune diseases taking HCQ during pregnancy.MethodsThe authors searched MEDLINE, Cochrane data base, Ovid-Currents Clinical Medicine, Ovid-Embase:Drugs and Pharmacology, EBSCO, Web of Science, and SCOPUS using the search terms HCQ and/or pregnancy. We attempted to identify all clinical trials from 1980 to 2007 regardless of language or publication status. We also searched Cochrane Central Library and for clinical trials of HCQ and pregnancy. Data were extracted onto standardized forms and were confirmed.ResultsThe odds ratio (OR) of congenital defects in live births of women taking HCQ during pregnancy was 0.66, 95% confidence intervals (CI) 0.25, 1.75. The OR of a live birth for women taking HCQ during pregnancy was 1.05 (95% CI 0.58, 1.93). The OR of spontaneous abortion in women taking HCQ during pregnancy was 0.92 (95% CI 0.49, 1.72). The OR of fetal deaths in women taking HCQ during pregnancy was 0.97 (95% CI 0.14, 6.54). The OR of pre-mature birth defined as birth before 37 weeks in women taking HCQ during pregnancy was 1.10 (95% CI 0.75, 1.61).ConclusionHCQ is not associated with any increased risk of congenital defects, spontaneous abortions, fetal death, pre-maturity and decreased numbers of live births in patients with auto-immune diseases.

Is induced abortion a risk factor in subsequent pregnancy?

To determine whether a history of terminations of pregnancy influences subsequent pregnancies in terms of pregnancy risks, prematurity and neonatal biometrics. Based on the perinatal statistics of eight German federal states, data of 247,593 primiparous women with singleton pregnancies born between 1998 and 2000 were analyzed. The control group consisted of primiparous women without previous induced abortions. Maternal age was adjusted for. There was an overall trend towards an increased rate of preterm delivery at <or=36 weeks' gestation and early preterm delivery at <or=31 weeks' gestation in women who had previous pregnancy terminations. For the cohort of 28-30 years, the observed rates of prematurity in women with one and with >or=2 previous induced abortions were 7.8% and 8.5%, respectively, compared to 6.5% in the control population (P=0.015). Preceding terminations of pregnancy did not alter the rate of small-for-gestational-age newborns. Psychosocial stress and symptoms associated with prematurity such as cervical incompetence and vaginal bleeding before and after 28 weeks of gestation occurred more frequently in women with previous induced abortion compared to the control group (P<0.0001). The rate of preterm births increases with the number of preceding abortions. Similarly, symptoms associated with prematurity are more common. The rate of small-for-gestational-age newborns was not affected by preceding terminations of pregnancy.

707: Does transvaginal ultrasonography of cervical length from 24-30 weeks gestation predict prematurity in women at increased risk of preterm birth?

707: Does transvaginal ultrasonography of cervical length from 24-30 weeks gestation predict prematurity in women at increased risk of preterm birth?

17: Does transvaginal ultrasound measurements of total cervical length or “funneling to the cerclage” predict prematurity in women at increased risk of preterm birth who have a cervical cerclage in situ?

To determine if transvaginal ultrasound (TVUS) measurement of total cervical length (CL) and /or the presence of “funneling to the cerclage” is predictive preterm birth and correlated with adverse perinatal outcome.

Response to Kourtis et al. ‘Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta-analysis’

Kourtis and colleagues [1] recently reported results from a meta-analysis of published data suggesting that overall the use of antiretroviral therapy (ART) in pregnant HIV-infected women was not associated with a risk of premature delivery. They also reported, however, a significantly increased risk of premature delivery with protease inhibitor (PI)-containing versus non-PI-containing combination therapy [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08–1.70] and with combination therapy initiated before or in the first trimester of pregnancy compared with later in pregnancy (OR 1.71, 95% CI 1.09–2.67). Meta-analysis of published observational studies has been shown to give misleading results when appropriate factors or other types of bias are not adequately controlled for [2]. Kourtis and colleagues [1] found an association between the duration of combination ART and premature delivery among those studies that reported duration and controlled for this, but found no association between prematurity and combination ART when the duration of exposure was ignored. This suggests a possible bias arising from the inability to control for the duration of exposure to combination ART across studies, whereas the inability to allow consistently for other variables including CD4 cell count, illicit drug use and other factors known to be associated with prematurity also biases the results. In addition, findings from a meta-analysis of published data from studies with quite different populations (Europe and the United States) and methodologies could introduce further bias even after accounting for within-study and between-study variances. A pertinent question to have pursued would have been the possible sources of heterogeneity between published studies [3–10]. Recent reports not included have added to the consistent evidence base from Europe regarding an association between HAART and prematurity, including data from the UK and Ireland National Study of HIV in Pregnancy and Childhood [11], which indicated a 50% increased risk of prematurity among women receiving HAART compared with those on mono/dual therapy, and from the Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy [10] indicating a twofold increased risk for women on PI from the second trimester compared with those not receiving PI. Furthermore, this increased risk is biologically plausible. A discussion of the potential mechanisms behind the association between prematurity and exposure to antiretroviral combination therapy in utero is absent from the paper by Kourtis et al. [1]. Preliminary findings from an immunological study in Italy indicate that the increased risk of prematurity in women on HAART may be mediated through changes in the cytokine environment in pregnancy [12]. We agree with Kourtis and colleagues [1] that the results of this meta-analysis should be interpreted with care. As a randomized controlled clinical trial to resolve the question of whether antenatal HAART is associated with adverse pregnancy outcomes is unlikely to take place in the very near future, we suggest that an individual patient data meta-analysis to address this issue should be carried out, utilizing the existing large datasets available from prospective cohort studies in Europe and the United States.

Pregnancy outcome after suicide attempt by drug use: a Danish population-based study.

It is important to study the side-effects of drugs taken during pregnancy, however the findings are difficult to interpret because of a low exposure level, uncertainty of actual drug consumption and confounding by indication. Experience from accidental or intended drug intoxications may bypass some of these methodological shortcomings. Our aim was to examine reproductive failures and child health following a single drug overdose taken prior to or during pregnancy. Women diagnosed with a drug intoxication during pregnancy were identified in the Regional Hospital Discharge Registry of North, Jutland from 1977 to 1999 by linkage of diagnoses for abortion and delivery with diagnoses for intoxication. Hospital medical records were reviewed to obtain data on drug use, dosage, and pregnancy outcome (legally induced abortion/miscarriages/data on birth outcome). The hospitalization history of the children was followed for a mean of 9 years with a maximum of 20 years. Of 122 women studied, 44 wanted an elective abortion, 17 experienced miscarriage, and 61, exposed mainly to weak analgesics and psychotropic drugs, gave birth to 62 infants. We estimated the proportion of miscarriage to be almost doubled, whereas there was no increased risk of congenital abnormalities or prematurity in women exposed to a drug overdose compared with the background population. A drug overdose shortly before or during pregnancy seems to be associated with a substantially increased risk of miscarriage, but there was no increase in fetal pathology at birth among fetuses surviving till birth.

Pregnancy outcome after suicide attempt by drug use: a Danish population-based study

Background. It is important to study the side-effects of drugs taken during pregnancy, however the findings are difficult to interpret because of a low exposure level, uncertainty of actual drug consumption and confounding by indication. Experience from accidental or intended drug intoxications may bypass some of these methodological shortcomings. Our aim was to examine reproductive failures and child health following a single drug overdose taken prior to or during pregnancy. Methods. Women diagnosed with a drug intoxication during pregnancy were identified in the Regional Hospital Discharge Registry of North, Jutland from 1977 to 1999 by linkage of diagnoses for abortion and delivery with diagnoses for intoxication. Hospital medical records were reviewed to obtain data on drug use, dosage, and pregnancy outcome (legally induced abortion/miscarriages/data on birth outcome). The hospitalization history of the children was followed for a mean of 9 years with a maximum of 20 years. Results. Of 122 women studied, 44 wanted an elective abortion, 17 experienced miscarriage, and 61, exposed mainly to weak analgesics and psychotropic drugs, gave birth to 62 infants. We estimated the proportion of miscarriage to be almost doubled, whereas there was no increased risk of congenital abnormalities or prematurity in women exposed to a drug overdose compared with the background population. Conclusions. A drug overdose shortly before or during pregnancy seems to be associated with a substantially increased risk of miscarriage, but there was no increase in fetal pathology at birth among fetuses surviving till birth.

SUBSTANCE ABUSE IS A SIGNIFICANT MARKER FOR PERINATAL MORBIDITY IN A POPULATION OF WOMEN WITH POOR PRENATAL CARE IN WASHINGTON † 1560

Poor prenatal care (PNC) is an important risk factor for perinatal morbidity. This study defines the additive risk of substance abuse (SA) during pregnancy in a population of 480 D.C. residents with no/poor PNC. Poor PNC was identified if care was initiated after 24 weeks, or less than 5 visits. 35% of these post partum women showed evidence of substance abuse during pregnancy by history and/or urine testing. The two groups are compared below (results expressed as mean ±S.E.M.) The relative risk (RR) for prematurity in women with SA and no/poor PNC was 2.7, (95% C.I. = 1.6-3.8, p<0.0001). The attributable risk fraction (ARF) for LBW associated with SA in this population was 31%. The RR for LBW in women with SA and no/poor PNC was 2.6 (95% C.I. = 1.5-3.63, p<0.0001). The ARF for prematurity associated with SA in this population was 32%. We conclude that women with no/poor PNC who abuse substances during pregnancy are at exquisitely high risk for poor outcomes and deserve to be targeted specifically in programs designed to reduce perinatal/neonatal morbidity and mortality. Table

Untreated cervical infections, chorioamnionitis and prematurity

Objective: To examine the relationship of endocervical pathogens and cervicitis with the development of chorioamnionitis, premature rupture of membranes (PROM) and prematurity. Methods: Three groups of pregnant women were included in the study: group A, controls with no evidence of cervicitis; group B, women with cervicitis due to pathogenic bacteria, who had been treated; and group C, women with untreated cervicitis who had not followed the prescribed therapy. Endocervical samples were cultured and aerobic and anaerobic bacteria isolated to examine the correlation of cervicitis with chorioamnionitis, PROM and prematurity. Results: There was a significantly higher incidence of prematurity in women with untreated cervicitis (group C). Mixed endocervical pathogens were most often involved (36.3%). A significantly higher number of endocervical pathogens were isolated in cases of chorioamnionitis ( P < 0.001). Prematurity was seen in 39.6% of cases of chorioamnionitis. Prematurity was also more common in women with PROM (42.1%) than in those with intact membranes (11.8%). Conclusion: It is concluded that untreated endocervical infections are an etiological factor of chorioamnionitis, PROM and prematurity.

Association of maternal hematocrit with premature labor

An examination of the association of maternal hematocrit with the occurrence of premature birth revealed a continuous relationship between these two factors with an increasing rate of prematurity occurring with decreasing maternal hematocrit. The lowest risk of premature birth was found when maternal hematocrit was between 41% and 44%. Statistically significant increases in prematurity were noted at all hematocrit levels of ≤38%. A woman with a hematocrit of 37% had twice the risk of having a premature birth as a woman whose hematocrit was between 41% and 44% (p < 0.01). In a logistic regression analysis with premature birth as the dependent variable and hematocrit as the only predictor variable, it was noted that decreasing the hematocrit by a single point was associated with a 24% increase in the risk of prematurity (odds ratio = 1.24) while a five-point decrease in hematocrit was associated with a tripling in the risk of prematurity (odds ratio = 2.98). In a multivariable logistic regression analysis hematocrit was noted to explain more of the variation in prematurity than any of the other risk factors included in the model. An investigation of this association in specific groups at high risk of having premature births revealed that 46% of the increased risk of prematurity in black women and 49% of the increased risk of prematurity in women receiving welfare was related to hematocrit or some factor associated with hematocrit.

Maternal urinary tract infection and adverse fetal outcomes.

The relationship of acute urinary tract infection occurring during pregnancy and the incidence of adverse fetal outcomes was examined with the use of birth certificate data from Washington state for the years 1980 and 1981. The two-year fetal mortality rate among urinary tract infection-associated pregnancies was found to be 17.9 per thousand livebirths, 2.4 times the rate for the state as a whole. Low birth weight newborns and small for gestational age newborns were, respectively, 2.04 and 1.57 times more frequent in urinary tract infection-associated pregnancies compared to controls. These estimates of risk were unchanged when adjusted for maternal age, race, and past obstetric history. The risk of prematurity in women with urinary tract infection and no history of fetal loss was 2.4 times the control risk. Sepsis was rare in both the urinary tract infection and control groups. These results add to the evidence implicating maternal urinary tract infection as a threat to fetal well-being.