History Of Preterm Birth Research Articles

Use of Botulinum Toxin A in the Treatment of Intermittent Exotropia: Factors Affecting Treatment Outcome

ABSTRACT Purpose To evaluate the efficiency of botulinum toxin A (BTA) injection in the treatment of intermittent exotropia (IXT) and determine factors affecting treatment outcome. Materials and methods A total of 74 patients diagnosed with any type of IXT were included in the study. BTA injection was administered into both lateral rectus muscles. Gender, refractive error, age, pre- and post-injection measurements of ocular deviation, age at the time of the first BTA injection, number of injections, duration of misalignment, age at the onset of misalignment, presence of amblyopia, presence of anisometropia, preterm birth history, type of delivery, presence of any neurological disorder, follow-up period, postoperative ptosis, and vertical deviation were recorded. The final angle of deviation was used in the statistical analysis. Successful motor alignment was defined as a deviation of ≤10 prism diopters (PD) at distance. The relationship of all factors with treatment success was analyzed using the binary logistic regression analysis. Results A total of 74 patients, 40 female and 34 male, were included in the study. All the patients were followed up for six to 53 months after the first BTA injection, and the mean follow-up was 16.1 ± 11.1 months. Before the first BTA injection of the patients, the mean amount of deviation was measured as 25.7 ± 14.2 (range, 0–60) PD at near and 37.1 ± 10.9 (range, 16–65) PD at distance. According to the most recent examination of the patients, the mean amount of deviation was 10.6 ± 9.8 (range, 0–45) PD at near and 16.4 ± 10.2 (range, 0–45) PD at distance. There was a statistically significant difference between the first and last examinations of the patients in relation to the amount of deviations measured at both near and distance (p < .001). Successful motor alignment (orthotropia within 10 PD for exodeviation) was achieved in 42 patients (56.7%). Thesuccess of treatment increased with the decreased amount of deviation at distance before the BTA injection. Conclusions In patients with IXT, BTA injection into the lateral rectus muscles is an effective procedure, which is also less invasive and taking shorter time than surgery, and it can be considered as an alternative treatment option in those with small-medium angle IXT.

Abstract P138: Post-partum Maternal Vascular Function Is Reduced In Preeclampsia And Preterm Births: A Pilot Study

Introduction: Women with a history of preeclampsia (PreE) or preterm (PreT) birth are at elevated risk of future hypertension, ischemic heart disease, and stroke. Mechanisms for this increased risk are unknown. Flow-mediated dilation of the brachial artery (FMD) is an established surrogate for cardiovascular risk. Hypothesis: In this pilot study, we hypothesize that maternal vascular dysfunction associated with PreE is reversible, and the extent of recovery is predicated on specific maternal characteristics. Methods: In this prospective study, subjects were recruited to three groups: PreE with delivery at 27-34 weeks; PreT delivery at 27-34 weeks without preeclampsia; and healthy controls at 39-40 weeks. Vascular function (FMD), nutrition (validated questionnaire), and physical activity (accelerometers) data were collected at 1-2 days post-partum and 3 months. Results: Fourteen subjects were enrolled (mean age 32±6 years). Systolic blood pressure was higher for PreE subjects (average 131±6) compared to controls (109 ± 9, p=0.004) and PreT (110±8, p=0.008) at visit 1. This difference resolved at visit 2. Though non-significant, FMD (mean±SE) was higher in controls compared to PreE and PreT groups at visit 1 (7.7%±0.8 v. 7.4%±0.7 and 6.9%±1.0, Figure 1). FMD remains depressed at 3 months, but subject follow-up was impacted by the Covid 19 pandemic. Alternate Healthy Eating Index scores were non-significantly higher in the PreT group than PreE and controls. PreT subjects were less sedentary and more physically active (higher moderate-vigorous physical activity, higher total steps). Conclusions: Maternal FMD is reduced immediately post-partum in PreE and PreT births. The PreT group had lower FMD despite better nutrition and physical activity scores. This is a pilot study, and we are not powered for significance. Data from our small cohort support the ability to collect meaningful data in these understudied populations which could inform future studies of long-term cardiovascular risk.

Effects of Interaction Between Gestational Hypertension and History of Preterm Birth on the Risk of Preterm Birth: An Analysis Based on the National Vital Statistics System Database.

BackgroundPremature birth is an unsolved social and public problem. We aimed to explore the independent association and interaction effect between gestational hypertension (GH) and the history of preterm birth (HPB) on the risk of preterm birth.Material/MethodsA case-control study involving participants with complete birth data was conducted using the United States National Vital Statistics System in 2019. Logistic regression analysis of 3 models were performed with odds ratio (OR) and 95% confidence interval (CI). Relative excess risk of interaction (RERI), attributable proportion of interaction (AP), and synergy index (S) were used to evaluate the interaction between GH and HPB on the risk of preterm birth.ResultsA total of 2 822 624 participants were examined, with 10.83% in the known preterm birth group and 89.17% in the control group. Following adjustments for covariates, the association between GH and HPB and preterm birth was significant with ORs of 2.604 (95% CI: 2.573–2.635) and 3.047 (95% CI: 2.997–3.097), respectively. Moreover, there was a significant interaction between GH and HPB on preterm birth risk, with an OR of 6.095 (95% CI: 5.847–6.352), RERI of 1.222 (95% CI: 0.965–1.479), AP of 0.201 (95% CI: 0.167–0.235), and S of 1.317 (95% CI: 1.250–1.387), especially in participants with maternal age 20 to 29, 30 to 34, ≥35 years, and single birth.ConclusionsGH and HPB might be positively associated with preterm birth, and there was an additive interaction between GH and HPB on preterm birth, indicating that obstetricians should pay more attention to prevention in this population.

Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis

ObjectivesTo compare the efficacy of bed rest, cervical cerclage (McDonald, Shirodkar, or unspecified type of cerclage), cervical pessary, fish oils or omega fatty acids, nutritional supplements (zinc), progesterone (intramuscular, oral,...

Intra-breath oscillometry for the evaluation of lung function in children and adolescents with a history of preterm birth.

ABSTRACTObjective:To assess respiratory system impedance (Zrs) and spirometric parameters in children and adolescents with and without a history of preterm birth. Methods:We evaluated a sample of 51 subjects between 11 and 14 years of age: 35 who had a history of preterm birth (preterm group) and 16 who had been born at term (full-term group). Lung function was measured by spirometry, spectral oscillometry, and intra-breath oscillometry. Results:Neither spirometry nor spectral oscillometry revealed any statistically significant differences between the preterm and full-term groups. However, intra-breath oscillometry demonstrated significant differences between the two groups in terms of the change in resistance, reactance at end-inspiration, and the change in reactance (p < 0.05 for all). Conclusions:Our findings suggest that abnormalities in Zrs persist in children and adolescents with a history of preterm birth and that intra-breath oscillometry is more sensitive than is spectral oscillometry. Larger studies are needed in order to validate these findings and to explore the impact that birth weight and gestational age at birth have on Zrs later in life.

Good outcome of newborn septic arthritis with holistic treatment: a case report

Introduction: Septic arthritis (SA) is a serious joint infection associated with significant morbidity that can cause permanent damage with articular cartilage destruction, osteonecrosis, and lifelong deformities. Here we present a good outcome of newborn septic arthritis with prompt treatment.&#x0D; Case Presentation: A one-month-old boy was brought with swelling of both knee joints two weeks before admission. He has a history of preterm birth and was hospitalized in the Neonatal Intensive Care Unit (NICU) because of neonatal pneumonia and sepsis. Several days after treatment, he came with swollen on both knees, both knee joint synovial liquid and sputum culture showed Klebsiella pneumoniae. Magnetic Resonance Imaging (MRI) was found intra articular fluid and erosion of the epiphyseal cartilage suspect infection process. After establishing the diagnosis of SA, we initiated treatment with cloxacillin 60 mg/kgs body weight for 14 days. He underwent debridement and physiotherapist. One year after discharge, the physical examinations showed normal findings and had a normal gait.&#x0D; Conclusion: It can be concluded that prompt diagnosis and treatment of SA on the newborn will have a good outcome with no sequelae. An early diagnosis of SA can guide clinicians to initiate a standardized treatment and improve patient outcomes.

Risk factors for preterm birth among gravid individuals receiving buprenorphine for opioid use disorder

Opioid use disorder (OUD) has dramatically increased over the last few decades, with 11.5 million American misusing opioids in 2016. Untreated OUD in pregnancy is associated with unique adverse obstetric and perinatal outcomes including insufficient prenatal care, preterm birth (PTB), fetal growth restriction, fetal demise, and placental abruption . The mainstay treatment for OUD management in pregnancy is medication for opioid use disorder (MOUD) including methadone or buprenorphine. The association of PTB and opioid use in pregnancy has been described for over 50 years, and efforts to significantly eliminate this risk are challenged by the many confounding risks described above. When comparing rates of PTB in individuals with OUD on methadone vs buprenorphine. Buprenorphine has been associated with overall lower PTB than Methadone by almost 50 %. Pregnancies complicated by opioid use disorder are at an increased risk for preterm birth, defined as delivery <37 weeks' gestation. Limited literature is available on the prevalence and risk factors for preterm birth in pregnancies complicated by opioid use disorder maintained on buprenorphine. Therefore, we sought to determine the rate of preterm birth and risk factors for preterm birth in this population. We performed a retrospective cohort study of pregnant individuals with singleton gestations receiving buprenorphine for opioid use disorder, who delivered at a tertiary academic medical center between July 1, 2013 and June 30, 2018. Individuals who had at least 3 visits to our colocated clinic were included in the analysis. Patients were divided into 2 groups: the preterm group for patients who delivered at <37 weeks of gestation and the term group for those who delivered at ≥37 weeks of gestation. We defined "supplements to buprenorphine" to include any illicit drugs found on antepartum urine toxicology. Variables evaluated as potential risk factors for preterm birth included medical and infectious comorbidities and illicit polysubstance use. The overall preterm birth rate in this cohort was 22.7% (115/507). There was a nonsignificant trend toward decrease in overall preterm birth and provider-initiated preterm birth rate over the study period. No differences were found between the groups in spontaneous preterm birth rate at <34 weeks of gestation. There were no differences between the groups in the use of tobacco or alcohol, number of prenatal visits, or gestational age when prenatal care started. Individuals with preterm birth in the index pregnancy were more likely to have a history of preterm birth than individuals with term delivery (73% vs 16%; P<.01). No medical or infectious comorbidity or any specific supplement increased the risk of preterm birth. Among individuals using 0, 1, 2, or 3 or more illicit supplements in addition to confirmed buprenorphine for opioid use disorder, the preterm birth rate was 27.4% (reference), 18.0% (P=.09), 18.1% (P=.44), and 15.8% (P=.77), respectively. The preterm birth rate among individuals using buprenorphine for opioid use disorder (22.7%) is higher than the national average but lower than the reported preterm birth rate in individuals using methadone for the treatment of opioid use disorder. No medical or infectious comorbidity or use of additional illicit substances increased the risk of preterm birth.

Evaluation of low-dose aspirin in the prevention of recurrent spontaneous preterm labour (the APRIL study): A multicentre, randomised, double-blinded, placebo-controlled trial.

Preterm birth is the leading cause of neonatal morbidity and mortality. The recurrence rate of spontaneous preterm birth is high, and additional preventive measures are required. Our objective was to assess the effectiveness of low-dose aspirin compared to placebo in the prevention of preterm birth in women with a previous spontaneous preterm birth. We performed a parallel multicentre, randomised, double-blinded, placebo-controlled trial (the APRIL study). The study was performed in 8 tertiary and 26 secondary care hospitals in the Netherlands. We included women with a singleton pregnancy and a history of spontaneous preterm birth of a singleton between 22 and 37 weeks. Participants were randomly assigned to aspirin 80 mg daily or placebo initiated between 8 and 16 weeks of gestation and continued until 36 weeks or delivery. Randomisation was computer generated, with allocation concealment by using sequentially numbered medication containers. Participants, their healthcare providers, and researchers were blinded for treatment allocation. The primary outcome was preterm birth <37 weeks of gestation. Secondary outcomes included a composite of poor neonatal outcome (bronchopulmonary dysplasia, periventricular leukomalacia > grade 1, intraventricular hemorrhage > grade 2, necrotising enterocolitis > stage 1, retinopathy of prematurity, culture proven sepsis, or perinatal death). Analyses were performed by intention to treat. From May 31, 2016 to June 13, 2019, 406 women were randomised to aspirin (n = 204) or placebo (n = 202). A total of 387 women (81.1% of white ethnic origin, mean age 32.5 ± SD 3.8) were included in the final analysis: 194 women were allocated to aspirin and 193 to placebo. Preterm birth <37 weeks occurred in 41 (21.2%) women in the aspirin group and 49 (25.4%) in the placebo group (relative risk (RR) 0.83, 95% confidence interval (CI) 0.58 to 1.20, p = 0.32). In women with ≥80% medication adherence, preterm birth occurred in 24 (19.2%) versus 30 (24.8%) women (RR 0.77, 95% CI 0.48 to 1.25, p = 0.29). The rate of the composite of poor neonatal outcome was 4.6% (n = 9) versus 2.6% (n = 5) (RR 1.79, 95% CI 0.61 to 5.25, p = 0.29). Among all randomised women, serious adverse events occurred in 11 out of 204 (5.4%) women allocated to aspirin and 11 out of 202 (5.4%) women allocated to placebo. None of these serious adverse events was considered to be associated with treatment allocation. The main study limitation is the underpowered sample size due to the lower than expected preterm birth rates. In this study, we observed that low-dose aspirin did not significantly reduce the preterm birth rate in women with a previous spontaneous preterm birth. However, a modest reduction of preterm birth with aspirin cannot be ruled out. Further research is required to determine a possible beneficial effect of low-dose aspirin for women with a previous spontaneous preterm birth. Dutch Trial Register (NL5553, NTR5675) https://www.trialregister.nl/trial/5553.

Cervicovaginal microbiome in twin vs singleton gestations

The vaginal microbiome diversity profile varies by race and ethnicity and changes considerably from the nonpregnant state to the pregnant state, specifically with a shift to Lactobacillus predominance in singleton gestations. There is a paucity of data that evaluate the cervicovaginal microbiome in women with twin gestations as a distinct population from those with singleton gestations. We sought to characterize the cervicovaginal microbiome diversity profiles among twin gestations in the second trimester of pregnancy. In this prospective cross-sectional cohort study, women with twin gestations were matched to singleton controls without a history of a short cervix or preterm birth by gestational age ±2 weeks and race. Cervicovaginal lavage samples were collected from 14 to 24 weeks of gestation during prenatal visits followed by a cervical length measurement. Cervicovaginal microbiota were analyzed with 16S RNA gene sequencing and classified into community state types based on Lactobacillus species predominance. Microbiome alpha and beta diversities were compared between twin and singleton gestations. A total of 19 twin gestations and 19 singleton gestations underwent second-trimester cervicovaginal microbiome analysis. The groups were similar in gestational age at sample collection, maternal age, parity, body mass index, preterm birth history, and comorbidity. The cohort was predominantly of Black race (79%). Of twin gestations, 79% were dichorionic and diamniotic and 21% monochorionic and diamniotic. Of note, 3 twin gestations and 1 singleton gestation were complicated by a short cervix (P=.6). The vaginal microbiome of twin gestations had decreased alpha and beta diversities compared with singleton gestations. Twin gestations had lower taxon abundance and decreased variability in taxon abundance than singleton gestations. Overall, there was decreased diversity of community state type groups among twin gestations compared with singleton gestations. Community state types I and III were more prevalent among twin gestations, whereas community state types II and IV were similar among these 2 groups. Community state type IV, which is defined by a lack of Lactobacillus species and the presence of diverse strict anaerobes, was the predominant type among microbiota profiles of twin gestations (55%) and singleton gestations (64%). Community state type V was more prevalent in singleton gestations. When stratified by race, we found similar alpha diversity in Black and non-Black patients with twin gestations. In our predominantly Black population of pregnant women, the second-trimester vaginal microbiome in twin gestations showed decreased alpha and beta diversities compared with singleton controls. Our findings increased the understanding of the content of microbial communities in the second trimester of pregnancy in twin gestations and suggested a potential mechanism for preterm birth in twin gestations.

Timing of antenatal corticosteroids in relation to clinical indication

This study aimed at determining the proportion of women who receive antenatal corticosteroids (ACS) within the optimal time window before birth based on the indication for ACS, and to explore in more detail indications that are associated with suboptimal timing. A retrospective cohort study of all women who received ACS in a single tertiary center between 2014 and 2017. The primary outcome was an ACS-to-birth interval ≤ 7days. Secondary outcomes were ACS-to-birth interval of ≤ 14days, and the proportion women who received ACS but ultimately gave birth at term (≥ 370/7weeks). The study outcomes were stratified by the clinical indication for ACS. A total of 1261 women met the study criteria, of whom 401 (31.8%) and 569 (45.1%) received ACS within ≤ 7days and ≤ 14days before birth, respectively, and 203 (16.1%) ultimately gave birth at term. The proportion of women who received ACS within 7days before birth was highest for women with preeclampsia (50.4%), and was lowest for women with an incidental finding of a short cervix (8.4%). In the subgroup of women with an incidental finding of a short cervix, the likelihood of optimal timing was not related to the magnitude of cervical shortening, history of preterm birth, multifetal gestation, presence of cervical funneling, or the presence of cervical cerclage. Over two-thirds of infants who are exposed to ACS do not get the maximal benefit from this intervention. The current study identified clinical indications for ACS that are associated with suboptimal timing of ACS where more research is needed to develop quantitative, indication-specific prediction models to guide the timing of ACS.

The retrospective study for effectiveness of cervical cerclage in preventing recurrent preterm birth

ObjectiveThis study aimed to clarify the effectiveness of cervical cerclage in preventing recurrent preterm births. Materials and methodsA retrospective study was conducted using the perinatal registration database of the Japan Society of Obstetrics and Gynecology for the Perinatal Center from 2014 to 2016. The efficacies of history-indicated, ultrasound-indicated, and physical examination-indicated cerclage as preventive treatments for women with a history of preterm birth were evaluated by comparing cerclage and non-cerclage cases. Fisher's exact test was performed to evaluate any significant differences in patient backgrounds. Prior to the evaluation, propensity score matching was performed for history-indicated and ultrasound-indicated cerclage patients. ResultsFor this study, 6060 multiparous women with a history of preterm birth were reviewed. After excluding 17 patients with unknown indications for cervical cerclage, 6043 patients were included in the study. History-indicated and ultrasound-indicated cerclage did not reduce the risk of preterm birth in subsequent pregnancies for any of the pregnancy periods (p = 0.413, p = 1.000). In contrast, physical examination-indicated cerclage significantly reduced the risk of subsequent preterm births for all pregnancy periods (p < 0.001). ConclusionSubsequent preterm births were effectively prevented only in physical examination-indicated cerclage cases. For history- or ultrasound-indicated cerclage, statistically significant differences in subsequent preterm births were not evident.

Effect of Breastfeeding and Preterm Births on the Severity of Lower Respiratory Tract Infections and Associated Risk of Hospitalization in Infants and Toddlers.

We studied the effect of duration of breastfeeding and history of prematurity on the duration of hospitalization in infants with lower respiratory tract infections (LRTI) because these may reflect the severity of illness as well as sizable direct and indirect healthcare costs. One hundred twenty-five patients (49 girls, 76 boys; aged 1-24 months) were hospitalized for LRTI during a period of 102 days and studied prospectively. We found a significant difference (P = .045) between the durations of hospitalization of the 92 patients breastfed for at least six months, compared to the other group of 33 patients who were breastfed for less than six months. The durations of hospitalization among the groups with and without a history of prematurity were not statistically different (P = .78). A history of breastfeeding for more than six months had significant effect on the duration of hospitalization, but this was not true for children with a history of preterm birth.

Transvaginal Sonographic Assessment Following Cervical Pessary Placement for Preterm Birth Prevention.

Background Transvaginal sonographic cervical length assessment identifies pregnant women at risk for preterm birth, and the subsequent placement of a cervical pessary may reduce this risk. The mechanism of action remains uncertain, and postplacement transvaginal sonography may provide further insight into the controversial efficacy of this therapy. Objective To identify any pre- or postplacement sonographic findings associated with preterm delivery following cervical pessary insertion among at-risk women. Materials and Methods This retrospective cohort study utilized electronic medical record and imaging review of all women identified within a large tertiary care health system having undergone cervical pessary placement for preterm birth risk reduction and subsequently delivered between January 2013 (the adoption of this therapeutic option in our system) and March 2017. Indications for cervical pessary placement were guided by maternal–fetal medicine consultation and required a functional cervical length measurement on transvaginal sonography of 25 mm or less. Criteria for initial transvaginal cervical assessment included obstetric history, multiple gestation, and current concern on transabdominal imaging for cervical shortening. All pre- and postplacement transvaginal sonographic measurements were determined for study purposes by re-review of each patient's images by a single author blinded to outcome. Results A total of 88 women were identified as having undergone cervical pessary placement for preterm birth prevention, and 52 yielded complete delivery and imaging data for inclusion. As expected, this was a high-risk population with 51.9% carrying multiple gestations, 32.7% with a history of prior preterm birth, and 11.6% with a history of cervical conization. Although previously hypothesized to represent the mechanism of action, neither the change in uterocervical or intracervical angle was associated with gestational age at delivery. Alternatively, preplacement imaging measurements of cervical funneling, anterior cervical length, and cervical diameter were significantly associated with appropriate pessary placement and decreased preterm birth. Forty-two subjects (80.8%) demonstrated both the anterior and posterior aspects of the cervix within the pessary (appropriate placement) and 95.2% of these subjects demonstrated cervical funneling on initial imaging compared with 25% of those with inappropriate placement ( p = 0.002). Anterior cervical length less than 20 mm and cervical diameter less than 33 mm were associated with preterm delivery less than 28 weeks (16.7 vs. 0%, p = 0.039), and anterior cervical length less than 20 mm was associated with preterm delivery less than 32 weeks (41.7 vs. 10.7%, p = 0.025). Cervical diameter less than 33 mm correlated with an “inappropriately placed” pessary among 83.3% in comparison to 48.7% ( p = 0.048) of women with a cervical diameter less than 33 mm. Significant associations were noted between postplacement functional cervical length measurements and preplacement anterior cervical length ( p = 0.001) and cervical diameter ( p = 0.012). Conclusion Contrary to current thinking, no significant changes in uterocervical and intracervical angle following cervical pessary placement were identified. However, preplacement sonographic measurement of funneling, anterior cervical length, and cervical diameter are predictive of appropriate pessary placement and extreme preterm birth. These may represent markers for candidacy of cervical pessary placement. Postplacement transvaginal sonography represents an important tool to assess potential efficacy of this therapeutic modality, and further investigation of these factors is warranted.

Prognosis and Prognostic Factors of Patients with Emergent Cerclage: A Japanese Single-Center Study.

Objectives The aims of this study were to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation. Materials and Methods This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in our institute. Results Emergent cerclage was performed in 123 patients (median age: 34, interquartile range: 31–36). Primiparous patients numbered 44 (36%). A history of spontaneous preterm birth (SPTB) was present in 30 (24%). The median presurgical cervical length (CL) was 16 (8–21) mm at surgery. Of the 123, 20 (16%) were delivered at 33 + 6 weeks or less (<34 weeks). We conducted logistic regression analysis of the risk factors of SPTBs <34 weeks after cerclage. Three risk factors were identified that increased the risk of SPTB <34 weeks: presurgical CL 0 mm (odds ratio (OR): 5.30; 95% confidence interval (CI): 1.58–17.7), a history of SPTB (OR: 4.65; 95% CI: 1.38–15.7), and the presence of sludge (OR: 4.14; 95% CI: 1.20–14.3). Conclusion Three risk factors predicted SPTB <34 weeks after emergency cerclage without progesterone administration: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB <34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data with progesterone.

Ureaplasma and Mycoplasma screening in women at high risk for preterm birth

To examine the association of positive Ureaplasma and Mycoplasma (U & M) with preterm birth and the rates of recurrence in a high-risk pregnant population. This was a retrospective study of all pregnant women who had U & M cervical culture at a tertiary care center. At our institution, it is our protocol to perform U & M cervical culture for women with high risk factors of preterm birth (history of preterm birth, recurrent pregnancy loss, multiple gestation, and cerclage) and treat women and partners. Test-of-cure is performed after the treatment. We examined rates of recurrence after the treatment. For the analysis of preterm birth (less than 37 weeks), we limited analyses to women who had cervical culture at less than 16 weeks, singleton gestation, and the indication for culture being a history of preterm birth or recurrent pregnancy loss. Adjusted odds ratios (aOR) with 95% confidence interval (95%CI) were calculated, controlling confounders. Of 510 women, 311 (61%) and 95 (19%) had Ureaplasma and Mycoplasma, respectively. Of 178 who had Ureaplasma treated and had test-of cure, 137 (77%) had recurrence. Of 41 who had Mycoplasma treated and had test-of-cure, 10 (24%) had recurrence. There was no difference in preterm birth between women who had negative Ureaplasma, those who had Ureaplasma and treated, and those who had Ureaplasma but were not treated (38% vs. 33% [aOR 0.81; 95%CI 0.43-1.54]) vs. 54% [aOR 1.91; 95%CI 0.58-6.27], respectively). Similarly, there was no difference in preterm birth between women who had negative Mycoplasma, those who had Mycoplasma and treated, and those who had Mycoplasma but were not treated (38% vs. 27% [aOR 0.64; 95%CI 0.24-1.75] vs. 40% [aOR 1.05; 95%CI 0.28-3.91], respectively). Ureaplasma is prevalent and the recurrence rate after treatment is high. Women who had positive Ureaplasma or Mycoplasma and were treated did not have increased odds of preterm birth compared to those who did not have Ureaplasma or Mycoplasma. Our findings question the clinical utility of screening for U & M in pregnancies at high risk for preterm birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ultrasound indicated cerclage in women with previous late preterm birth

It is unclear whether women with a history of late preterm birth (34 to 36+6 weeks’ gestation) should undergo serial transvaginal cervical length screening. We sought to compare the rates of ultrasound indicated cerclage between women with a history of preterm birth prior to 34 weeks and those with previous late preterm birth.

Cerclage for the Management of Cervical Insufficiency: A Review

Cervical insufficiency (CI) is classically characterized as painless dilation of the uterine cervix in the second trimester that results in delivery of the pregnancy, typically prior to 24 weeks’ gestation. Treatment of the condition has centered on prevention of recurrence in women with a history of CI or early preterm birth. Universal screening tools for CI in women without a history of prior PTB are lacking. Cervical change that is painless may occur with minimal symptoms such as increasing of vaginal discharge/mucous, vaginal pressure or fullness; many women and their providers can dismiss pathologic symptoms that would otherwise be benign in women without CI. The management of CI is categorized as surgical vs. nonsurgical. The cornerstone of surgical management is composed of cervical cerclage, and may be placed by a transvaginal or transabdominal approach depending on the obstetric history. Nonsurgical management includes pessary or activity restriction. For women who have experienced a midtrimester loss due to suspected cervical insufficiency, postnatal or preconception consultation is essential to identify modifiable risk factors, collect medical records of the delivery, and review pathology results if available.

Antenatal Corticosteroids Decrease the Risk of Composite Neonatal Respiratory Morbidity in Planned Early Term Cesarean Deliveries.

While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2-13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5-89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks. Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. · Steroids administered prior to scheduled cesarean lead to decreased neonatal respiratory morbidity.. · Steroid administration was not associated with increased adverse neonatal outcomes.. · Steroid administration was most beneficial between 37 and 38 weeks..

Vaginal Progesterone versus Cerclage for Preventing Preterm Birth in Asymptomatic Singleton Pregnant Women with a History of Preterm Birth

Vaginal Progesterone versus Cerclage for Preventing Preterm Birth in Asymptomatic Singleton Pregnant Women with a History of Preterm Birth

Risk factors associated with preterm birth in the Dominican Republic: a case-control study

ObjectivesThis study aimed to identify the risk factors associated with preterm birth, and to determine the prevalence of preterm births in the Dominican Republic.DesignCase-control study.SettingsSeven National Reference Hospitals from different...