Preterm Delivery In Patients Research Articles

Comparison of the effectiveness of a PAMG-1 test and standard clinical assessment in the prediction of preterm birth and reduction of unnecessary hospital admissions

Purpose: The purpose of this study is to first compare the performance of the PAMG-1 biomarker test to that of standard clinical assessment (SCA) for the risk assessment of spontaneous preterm delivery (sPTD) among women with symptoms of preterm labor (PTL) and then calculate the potential impact on unnecessary admission reduction.Materials and methods: Patients of gestational age 240/7−366/7 with PTL symptoms, cervical dilatation ≤3 cm, no intercourse within 24 h, and clinically intact membranes were recruited consecutively into this prospective observational study. Specificity (SP), sensitivity (SN), positive-predictive value (PPV), and negative-predictive value (NPV) for the PAMG-1 test and SCA, for which a positive result was defined as patient admission, for predicting spontaneous delivery ≤7 and ≤14 d of presentation were calculated.Results: One hundred and forty-eight patients were included in the analysis, 132 of which had both SCA and PAMG-1 results available. For the prediction of sPTD ≤7 d for SCA and PAMG-1, the PPV and NPV were 10% and 100%, and 71% and 98%, respectively. For prediction of sPTD ≤14 d for SCA and PAMG-1, the PPV and NPV were 14% and 100%, and 86% and 96%, respectively. Sixty-one per cent (81/132) of patients were admitted for treatment and/or observation.Conclusion: Our study reinforces the critical role of the PAMG-1 biomarker test to aid in risk assessment of imminent spontaneous preterm delivery in patients with symptoms of PTL. The PAMG-1 test was found to be statistically superior to standard clinical assessment alone, with respect to specificity. Based on our data, the introduction of a PAMG-1 test result into clinical decision making could reduce up to 91% of unnecessary admissions for women presenting with threatened preterm labor.

Neutrophil to lymphocyte ratio & cervical length for prediction of spontaneous preterm delivery in threatened preterm labour

Background: Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies. As inflammation represents a crucial pathogenic process of preterm delivery, the aim of this study is to define the role of serum inflammatory markers in the prediction of spontaneous preterm delivery & to combine these markers with cervical length to increase the diagnostic accuracy.Methods: Eighty pregnant women with threatened preterm labour (group I) were compared with 40 women at term (group II (, subdivided into 2 subgroups (20 of them were not in labour & the other 20 were in labour). Neutrophils to lymphocytes ratio (NLR) & C-reactive protein (CRP) level were measured & compared for all study subjects. For group I, transvaginal cervical length was measured & combined marker (defined as NLR divided by the cervical length) was estimated & they were subdivided into: (group Ia) who delivered before 37 weeks (n=30) & (group Ib) who delivered at term (n=50.)Results: The levels of NLR (P<0.001), CRP (P<0.016) in group Ia were significantly different from those in group Ib & they were also significantly higher in group IIa than in group IIb (P<0.001). The cervix length (P< 0.001) & combined marker (P<0.001) in group Ia were significantly different from those of group Ib. It has been shown that the combined marker has higher sensitivity (65%) & specificity (87%) for prediction of preterm delivery, as compared to cervical length or systemic inflammatory markers each alone .Conclusions Combined marker is useful for identifying women at risk of preterm delivery in patients with threatened preterm labour .

Uterine Leiomyoma Do Not Appear To Be a Risk Factor for Shortened Cervical Length [30L

INTRODUCTION: Several studies report an increased incidence of preterm delivery (PTD) in patients with uterine leiomyoma (UL). A shortened cervical length (CL) is risk factor for PTD, although universal CL screening is not yet advocated nationally. CL studies in pregnancies complicated by UL have suffered from small sample size or lack of accurate CL measurements. Therefore it is not well known whether the risk of PTD in those women with UL can be appropriately screen utilizing CL. Therefore, we reviewed our data on transvaginal (TVS) CL in those patients with UL. METHODS: We performed a retrospective review of patients found to have UL on routine second trimester anatomic survey ultrasounds after establishing a CL screening program. Patient demographics, UL (number and size), TVS-CL and pregnancy outcomes were collected. RESULTS: We obtained data on 224 antepartum patients with UL. Mean age was 34.9 ± 4.9 y, and BMI 29.1 ± 6.6 kg/m2. Prior PTD was noted in 21/224 (9.3%). Multiple UL were noted in 67/224 (29.9 %) with an individual's largest UL diameter of 4.5 ± 2.6 cm. Screening occurred at 21 ± 3.2 wks. Mean TVS-CL was 3.9 ± 0.8 cm. Shortened cervix (less than 2.5 cm) occurred in 2/224 (0.9%). Delivery less than 37 weeks occurred in 38/224 (17%) and before 35 weeks in 18/224 (8%). The cesarean delivery was performed in 85/224 (37.9%). CONCLUSION: TVS-CL in pregnancies complicated by UL do not appear to be significantly shortened. However, the incidence of PTD in patients with UL remains increased compared to national rates.

Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intra-amniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes

Objective: Among patients presenting with preterm labor and intact membranes, those with intra-amniotic inflammation have adverse obstetrical and neonatal outcomes. The diagnosis of intra-amniotic inflammation can easily be made by detecting an elevated concentration of the cytokine interleukin (IL)-6 or the enzyme neutrophil collagenase, also known as matrix metalloproteinase (MMP)-8. The diagnostic performances of MMP-8 and IL-6 enzyme-linked immunosorbent assay tests are similar. Recently, a rapid test has become available for point-of-care determination of either MMP-8 or IL-6. The objectives of this study were to compare the diagnostic indices and predictive values between the rapid MMP-8 and IL-6 tests for the identification of intra-amniotic inflammation in patients with preterm labor and intact membranes.Materials and methods: We performed a retrospective cohort study including 124 women with singleton pregnancies who presented with symptoms of preterm labor and underwent transabdominal amniocentesis for the evaluation of microbial invasion of the amniotic cavity (MIAC). MIAC was defined according to amniotic fluid culture results (aerobic and anaerobic bacteria as well as genital Mycoplasmas). Amniotic fluid white blood cell (WBC) counts were determined using a hemocytometer chamber. An elevated amniotic fluid MMP-8 concentration was assessed using Yoon’s MMP-8 Check® (cutoff: 10 ng/mL). An elevated amniotic fluid IL-6 concentration was scored when there was a positive result for the lateral flow-based immunoassay (cutoff: ≥745 pg/mL and ≥1000 pg/mL). In order to objectively compare rapid MMP-8 and rapid IL-6 tests to identify intra-amniotic inflammation, an amniotic fluid WBC count of ≥50 cells/mm3 was used to define intra-amniotic inflammation.Results: (1) The rapid tests had the same sensitivity for the detection of intra-amniotic inflammation [85.7% (18/21) for all]; (2) the specificity of the rapid MMP-8 test was higher than that of the rapid IL-6 test (cutoff: 745 pg/mL) for the identification of intra-amniotic inflammation [72.8% (75/103) vs. 64.1% (66/103); p < 0.05]; and (3) there were no differences in the sensitivity and specificity between the rapid MMP-8 test and the rapid IL-6 test (cutoff:1000 pg/mL) in the identification of intra-amniotic inflammation. Of 13 patients with discrepant results between the rapid MMP-8 and rapid IL-6 tests, two had a positive MMP-8 but a negative rapid IL-6 test, and both delivered preterm – one within 24 h, and the other within 10 days – and both had acute histologic chorioamnionitis. On the other hand, there were 11 patients with a positive rapid IL-6 but a negative rapid MMP-8 result: 10 delivered preterm, 3 had acute histologic chorioamnionitis and 1 had subacute chorionitis.Conclusion: We conclude that the rapid MMP-8 test has a better specificity than the rapid IL-6 (cutoff: 745 pg/mL) assay for the detection of intra-amniotic infection. Moreover, we observed that among patients who were not identified as having intra-amniotic infection or inflammation by the standard cultivation technique and amniotic fluid WBC count, those who had a positive MMP-8 rapid test delivered preterm and had acute histologic chorioamnionitis.

Contribution of Cervical Plasty in the Management of Cervico-Isthmic Incompetency at the General Hospital of Lamentin in Martinique

Objectives: To evaluate the influence of pre-conception cervical plastic surgery on the prognosis of pregnancy in women with a history of abortive disease through cervical incompetence. Method: Retrospective study over a period of 20 years, from January 1990 to June 2010. We carried out an exhaustive census of the patients with a cervico isthmic gap, who benefited of a pre-pregnancy cervical plasty associated with a systematic cervical cerclage carried out in the first trimester of pregnancy. Results: We identified 10 files that met the inclusion and non-inclusion criteria. The mean age of the patients was 33.8 years. They were multigravida (extremes 2 and 10) and pauciparous (mean parity was low of 1.29). The history of recurrent spontaneous miscarriage was found in all women. The diagnosis of cervico isthmic gap was evoked on the basis of clinical and paraclinical arguments. Seven women got pregnant for a total of nine pregnancies. All pregnancies have reached the age of viability which was 24SA. The prematurity rate was 4/9 pregnancies and the average gestational age for preterm delivery was 31 SA. Five pregnancies evolved to term and the average term for childbirth was 38 SA+6 days. Conclusion: Pre-pregnancy cervical plasty associated with cervical cerclage in the first trimester of pregnancy has yielded interesting results in the prevention of preterm delivery in patients with cervico-isthmic gap. A study on a larger sample is necessary to draw conclusions.

Comparison of PAMG-1 and phIGFBP-1 Tests for the Prediction of Preterm Delivery in Patients with Preterm Labor

Objective: To compare PAMG-1 and phIGFBP-1 tests in predicting impending spontaneous preterm delivery within 7 days upon presentation in pregnant women with symptoms of preterm labor. Study Design: From September 2014 to April 2015 women with singleton gestation, symptoms of preterm labor, GA 22 - 35, participated in this prospective cohort study upon admission. Recruited patients had intact membranes and a minimal cervical dilatation of ≤3 cm. Vaginal swabs for phIGFBP-1 and PAMG-1 were taken in addition to routine treatment. Biochemical test results were blinded and had no effect on management of patients. Results: A total of 96 patients were screened for inclusion into the trial; 57 met the inclusion criteria for final analysis. The PAMG-1 test was positive in 5.7% of patients, while phIGFBP-1 test was positive in 29.8% of patients. The prediction of spontaneous preterm delivery within 7 days of admission in patients with a cervical length < 25 mm (30%), the PAMG-1 test and phIGFBP-1 test showed a SN of 100% and 100%; SP of 83.3% and 50.0%, (p ≤ 0.05); PPV of 71.4% and 45.5%; and NPV of 100% and 100%. 89.5% of women who received corticosteroids and 84.2% of women who received tocolysis did not go into preterm labor within one week. Conclusion: Our study supports the high negative predictability of biochemical tests to rule out spontaneous preterm labor in patients with a short cervix. However, our study strongly suggests that the PAMG-1 test is more accurate for predicting imminent spontaneous preterm delivery as compared to phIGFBP-1. These findings can significantly reduce economic burden caused by unnecessary admission and treatment of patients suspected of preterm labor. Such a reduction in the use of corticosteroids and tocolytics would lead to a reduction in the short and long term health effects associated with the use of therapeutic drugs like corticosteroids, antibiotics and tocolytics.

Effectiveness of Vaginal versus Intramuscular Progesterone for the Prevention of Preterm Delivery

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to compare the effectiveness of vaginal versus intramuscular progesterone to prevent preterm delivery in patients with history of preterm labor in previous pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;It was a Randomized Control Trial carried out in the Gynecology Unit in a Public sector Hospital, Lahore from March to December 2015. A total of 800 patients were enrolled through Antenatal OPD and were randomly divided into two groups by draw method. In Group-A, patients were administered 200mg of vaginal progesterone pessary once daily and in Group-B 250 mg of intramuscular progesterone was injected weekly. Treatment was continued until 37 completed weeks of gestation. The patients were followed up through their contact numbers and on routine follow up. This practice was abandoned if premature rupture of membranes occurred and the fetus was delivered before 37 weeks. All the parameters were recorded by the researcher on proforma. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0. Chi Square test was applied to draw the comparison.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The mean age of patients was 26.16 ± 5.36 years (18 – 35 years). The 296 patients were Para 1, 290 were Para 2, 142 were Para 3, 51 were Para 4 and 21 females were Para 5. In all females, the mean gestational age at time of presentation was 22.00 ± 1.47 weeks, whereas, at time of delivery, mean gestational age was 36.05 ± 2.38 weeks. In vaginal progesterone group, the mean gestational age at time of delivery was 36.67 ± 1.92 weeks while in IM group, mean gestational age at time of delivery was 35.43 ± 2.62 weeks. The difference between both groups was statistically significant (P &amp;lt; 0.05). Effectiveness (delivery ≥ 37 weeks) was achieved in 379 (47%) cases, out of which 228 (57%) cases belonged to vaginal progesterone group and 151 (37.8%) cases belonged to IM progesterone group (P &amp;lt; 0.05). Post stratification with age and parity also showed that vaginal progesterone is more efficacious than IM progesterone (P &amp;lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;We concluded that vaginal progesterone is more effective than intramuscular progesterone for the prevention of preterm labor in patients with history of preterm labor in previous pregnancy.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

EP18.02: Comparison of partosure (PAMG‐1) and actim partus (phlGFBP‐1) for the prediction of preterm delivery in patients with preterm labour and a short cervix

EP18.02: Comparison of partosure (<scp>PAMG</scp>‐1) and actim partus (<scp>phlGFBP</scp>‐1) for the prediction of preterm delivery in patients with preterm labour and a short cervix

An elevated amniotic fluid prostaglandin F2α concentration is associated with intra-amniotic inflammation/infection, and clinical and histologic chorioamnionitis, as well as impending preterm delivery in patients with preterm labor and intact membranes

Objective: To determine whether an elevated amniotic fluid concentration of prostaglandin F2α (PGF2α) is associated with intra-amniotic inflammation/infection and adverse pregnancy outcomes in patients with preterm labor and intact membranes.Materials and methods: The retrospective cohort study included 132 patients who had singleton pregnancies with preterm labor (< 35 weeks of gestation) and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as for genital mycoplasmas. Intra-amniotic inflammation was defined by an elevated amniotic fluid matrix metalloproteinase-8 (MMP-8) concentration (>23 ng/mL). PGF2α was measured with a sensitive and specific immunoassay. The amniotic fluid PGF2α concentration was considered elevated when it was above the 95th percentile among pregnant women at 15–36 weeks of gestation who were not in labor (≥170 pg/mL).Results: (1) The prevalence of an elevated amniotic fluid PGF2α concentration was 40.2% (53/132) in patients with preterm labor and intact membranes; (2) patients with an elevated amniotic fluid PGF2α concentration had a significantly higher rate of positive amniotic fluid culture [19% (10/53) versus 5% (4/79); p = 0.019], intra-amniotic inflammation/infection [49% (26/53) versus 20% (16/79); p = 0.001], spontaneous preterm delivery, clinical and histologic chorioamnionitis, and funisitis, as well as a higher median amniotic fluid MMP-8 concentration and amniotic fluid white blood cell count and a shorter amniocentesis-to-delivery interval than those without an elevated concentration of amniotic fluid PGF2α (p < 0.05 for each); and (3) an elevated amniotic fluid PGF2α concentration was associated with a shorter amniocentesis-to-delivery interval after adjustment for the presence of intra-amniotic inflammation/infection [hazard ratio 2.1, 95% confidence interval (CI) 1.4–3.1; p = 0.001].Conclusion: The concentration of PGF2α was elevated in the amniotic fluid of 40.2% of patients with preterm labor and intact membranes and is an independent risk factor for intra-amniotic inflammation/infection, impending preterm delivery, chorioamnionitis, and funisitis.

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.

Identification of a gene in Mycoplasma hominis associated with preterm birth and microbial burden in intraamniotic infection

Microbial invasion of the amniotic cavity is associated with spontaneous preterm labor and adverse pregnancy outcome, and Mycoplasma hominis often is present. However, the pathogenic process by which M hominis invades the amniotic cavity and gestational tissues, often resulting in chorioamnionitis and preterm birth, remains unknown. We hypothesized that strains of M hominis vary genetically with regards to their potential to invade and colonize the amniotic cavity and placenta. We sequenced the entire genomes of 2 amniotic fluid isolates and a placental isolate of M hominis from pregnancies that resulted in preterm births and compared them with the previously sequenced genome of the type strain PG21. We identified genes that were specific to the amniotic fluid/placental isolates. We then determined the microbial burden and the presence of these genes in another set of subjects from whom samples of amniotic fluid had been collected and were positive for M hominis. We identified 2 genes that encode surface-located membrane proteins (Lmp1 and Lmp-like) in the sequenced amniotic fluid/placental isolates that were truncated severely in PG21. We also identified, for the first time, a microbial gene of unknown function that is referred to in this study as gene of interest C that was associated significantly with bacterial burden in amniotic fluid and the risk of preterm delivery in patients with preterm labor. A gene in M hominis was identified that is associated significantly with colonization and/or infection of the upper reproductive tract during pregnancy and with preterm birth.

Interleukin 6 and fetal fibronectin as a predictors of preterm delivery in symptomatic patients

Preterm delivery is the leading cause of neonatal mortality and morbidity. The rate of preterm births has been estimated to be about 15 million, which accounts for 11.1% of all live births worldwide. The purpose of this study was to evaluate the cervico-vaginal (CVF) cytokine IL-6 and fetal fibronectin (fFN) status as predictors of preterm delivery in patients with symptoms of preterm labor. Patients with symptoms suggestive of preterm labor were recruited from September 2013 to March 2014. Vaginal swabs were taken for fetal fibronectin test (fFN) and CVF IL-6. Antibiotics, steroids and tocolytics were administered, where appropriate. The outcome was measured by the occurrence of preterm delivery within 14 days from the day of hospital admission. Cut-off value of 1305 pg/mL for the concentration of IL-6 in the CVF was the best predictor of preterm delivery, with the sensitivity of 69.4% and specificity of 68.2%. Patients with positive fFN test had the OR of 6.429 (95%CI 1.991-20.758) to deliver prematurely. The multivariate analysis of combined fFN and CVF IL-6 tests resulted in risk of 86.7% to deliver prematurely, if both tests were positive. The combination of both tests performed better than the individual tests and decreased the false positive rate, which in turn reduced the chances for inappropriate patient treatment, bringing down the costs.

Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation: a prospective observational study.

The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD). This prospective observational study included 109 patients with cervical length of ≤ 25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity specificity negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally ROC curves were constructed for elastography and cervical length for predicting PTDs. Forty-five cases of PTDs (< 37 weeks of pregnancy) were found in the studied population. The number of PTDs was significantly higher in the red group, than in the blue and purple groups. The sensitivity specificity NPV and PPV for the assessment of both, red and yellow internal os for predicting preterm delivery were 82.2%, 75.0%, 84.0% and 72.5% respectively The cut-off value for elastography suggested inclusion of both, red and yellow (warm) colors as predictors of PTD. Elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length may be useful in predicting PTD.

Evaluation of the correlation between IL-1β, IL-8, IFN-γ cytokine concentration in cervico-vaginal fluid and the risk of preterm delivery

The aim of the study was to evaluate IL-1β, II-8, IFN-γ cytokine concentrations in cervico-vaginal fluid in patients with threatening preterm delivery. The study group included 84 patients between 27 and 34 weeks of pregnancy admitted with symptoms of threatened preterm delivery. The cervico-vaginal fluid was taken from each patient qualified for the study and IL-1β, II-8, IFN-γ concentration was analyzed by enzyme-linked immunosorbent assay (ELISA). The following factors were analyzed: maternal age and parity gestational age at admission for the examination and at delivery, sex of the newborn, Apgar evaluation at 1 and 5 minutes of life, umbilical blood pH, history of miscarriage or preterm delivery pre-pregnancy body mass index, and smoking. Their influence on the concentration of biochemical markers tested in patients at risk of preterm delivery was investigated. In the study group, patients who delivered preterm had significantly higher concentrations of IL-1β and II-8 as compared to patients who delivered at term. Patients who delivered preterm more often had a history of a miscarriage and their newborns had lower birth weight, lower Apgar score, and lower pH of the umbilical blood. As far as factors significantly influencing cytokine concentrations are concerned, the level of IL-1β and II-8 concentration is an independent predictor of preterm delivery in patients with threatened preterm labor. In the study group, the IFN-γ concentration did not significantly diversify patients who delivered preterm and at term.

Expression of epithelial-mesenchymal transition-related factors in placenta accreta

The purpose of this article is to review the risks and benefits of scheduled preterm delivery in patients with placenta accreta, increta, and percreta and to provide guidance regarding timing of delivery in such cases. Relevant documents for this opinion were identified through a search of the English literature for publications, including one or more of the keywords “accreta” or “increta” or “percreta” and “preterm” and “delivery time” by the use of PubMed (U.S. National Library Of Medicine, January 1990-January 2010), with results limited to studies involving humans. Additional information was obtained from references identified from within selected articles, from additional review articles, and from guidelines by organizations, including the American College of Obstetricians & Gynecologists. Each included article was evaluated according to study design and quality in accordance with scheme outlined by the U.S. Preventative Services Task Force, and final recommendations are provided based on the level of published evidence. On the basis of this search, we found that abnormal placentation, encompassing placenta accreta, increta, and percreta, is increasingly common. We also found that randomized controlled trials and well-controlled observational studies that can be used to define best practice in delivery time are lacking. Optimal delivery time must be determined from available case series, retrospective reviews and decision analysis studies. Given the best-available evidence, optimal time for delivery is believed to be between 34 and 35 weeks in most cases.

Therapy side-effects and predictive factors for preterm delivery in patients undergoing tocolysis with atosiban or ritodrine for threatened preterm labour

The objective of this study was to compare the safety and efficacy of atosiban and ritodrine in the treatment of threatened preterm labour (TPL) and to analyse the predictive factors of preterm delivery. We retrospectively sampled data on 380 women hospitalised for TPL (24–35 weeks’ gestation), in our clinic between 2004 and 2007. All were subjected to tocolysis with ritodrine and/or atosiban. Data were analysed using R (version 2.12.1), considering p < 0.05 as significant. We had 69 women treated with atosiban, 242 treated with ritodrine and 69 treated with ritodrine changed for atosiban, if adverse effects occurred. In the multivariate logistic regression, the use of atosiban vs ritodrine does not play any role in delaying delivery after 48 h or 7 days, whereas the cervical change at the digital examination, high contractions pre/post-therapy ratio, pPROM, cervical length and fibronectin result as predictive factors for both delivery before 48 h or 7 days. Maternal adverse drug effects were significantly more frequent in patients treated with ritodrine, and one single case of pulmonary oedema was observed. We found fewer side-effects in the atosiban than in the ritodrine group and no difference in efficacy. Moreover, the most predictive factors for preterm delivery were fibronectin test, pPROM, digital vaginal examination and uterine contraction persistence. We believe that predictive capacity of these tests could give the opportunity for targeting therapy and limiting drug side-effects and cost.

Pregnancy Outcomes after Late Second Trimester Amniocentesis for Prenatal Diagnosis

Objective: To compare the rate of preterm delivery in patients who had an amniocentesis before and after 20 weeks gestation. Study Design: This is a single-center retrospective cohort study of patients referred for specialized sonogram between January 1, 2007 and December 31, 2009. Outcomes of patients who underwent amniocentesis at less than 20 0/7 weeks were compared to those who had amniocentesis on or after 20 0/7 weeks. Results: 1041 patients met the inclusion criteria, and 290 (27.9%) underwent amniocentesis. Women were younger in the late amniocentesis group and were more likely to be African-American. Gestational age at delivery, rate of preterm birth,, and birth weight did not differ between the two groups. In a multivariate analysis, gestational age at amniocentesis was not a significant factor for gestational age at delivery. Conclusion: Amniocentesis performed after 20 weeks gestation appears to be safe. This study provides reassuring information regarding late amniocentesis.

OC09.06: A novel method to predict preterm delivery in patients with preterm uterine contractions and intact membranes

OC09.06: A novel method to predict preterm delivery in patients with preterm uterine contractions and intact membranes

Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization

To assess the impact of elevated peak serum E(2) levels (EPE(2); defined as levels >90th percentile) on the day of hCG administration during controlled ovarian hyperstimulation (COH) for IVF on the likelihood for small for gestational age (SGA), preeclampsia (PreE), and preterm delivery (PTD) in singleton pregnancies. Retrospective cohort study. Tertiary-care academic medical center. Singleton live-birth pregnancies conceived after fresh IVF-ET. None. The delivery rate of SGA infants and the development of PreE and PTD in patients with and without EPE(2). Patients with EPE(2) during COH were more likely to deliver SGA infants (7 [26.9%] vs. 10 [3.8%]; odds ratio [OR], 95% confidence interval [CI] {9.40, 3.22-27.46}) and develop PreE (5 [18.5%] vs. 12 [4.5%]; adjusted OR, 95% CI {4.79, 1.55-14.84}). No association was found between EPE(2) and the likelihood for delivery before 37 weeks, 35 weeks, or 32 weeks of gestation. Receiver operating characteristic analysis revealed that EPE(2) level predicted adverse obstetrical outcome (SGA + PreE) with 38.5% and 91.7% sensitivity and specificity, respectively. Using a serum peak E(2) cutoff value of 3,450 pg/mL (>90th percentile level), the positive predictive value was 37%, while the negative predictive value was 92%. EPE(2) level (>3,450 pg/mL) on the day of hCG administration during COH is associated with greater odds of developing PreE and delivery of an SGA infant in singleton pregnancies resulting from IVF cycles.

102: Prior term birth decreases the risk of preterm delivery in a subsequent twin pregnancy

ObjectiveTo determine if prior term birth alters the risk of preterm delivery in patients with twin gestations.Study DesignWe used the 2008 United States Natality Live Birth dataset to examine the risk of preterm births among twin gestations. All twin births between 24 weeks 0 days and 36 weeks 6 days gestational age were included. Women were categorized into: nulliparas, multiparas without a history of preterm delivery, and multiparas with a history of preterm delivery. Risk of preterm birth was compared using chi-square test and multivariable logistic regression to control for potential confounding factors.Results19,383 nulliparous and 39,288 multiparous women were included in the study. Of the multiparous women, 4413 (11%) had a history of a prior preterm delivery. The risk of preterm delivery was increased among multiparous women with prior preterm deliveries compared to their counterparts. Multiparous women with a history of a prior term birth had a decreased risk of delivery less than 34 weeks compared to both nulliparas and those with a prior preterm birth (Table 1).Tabled 1ConclusionA prior term delivery confers a decreased risk of preterm birth less than 34 weeks in a subsequent twin gestation compared to nulliparous women and women with a prior preterm birth. This information can be used to guide surveillance protocols and counsel patients. ObjectiveTo determine if prior term birth alters the risk of preterm delivery in patients with twin gestations. To determine if prior term birth alters the risk of preterm delivery in patients with twin gestations. Study DesignWe used the 2008 United States Natality Live Birth dataset to examine the risk of preterm births among twin gestations. All twin births between 24 weeks 0 days and 36 weeks 6 days gestational age were included. Women were categorized into: nulliparas, multiparas without a history of preterm delivery, and multiparas with a history of preterm delivery. Risk of preterm birth was compared using chi-square test and multivariable logistic regression to control for potential confounding factors. We used the 2008 United States Natality Live Birth dataset to examine the risk of preterm births among twin gestations. All twin births between 24 weeks 0 days and 36 weeks 6 days gestational age were included. Women were categorized into: nulliparas, multiparas without a history of preterm delivery, and multiparas with a history of preterm delivery. Risk of preterm birth was compared using chi-square test and multivariable logistic regression to control for potential confounding factors. Results19,383 nulliparous and 39,288 multiparous women were included in the study. Of the multiparous women, 4413 (11%) had a history of a prior preterm delivery. The risk of preterm delivery was increased among multiparous women with prior preterm deliveries compared to their counterparts. Multiparous women with a history of a prior term birth had a decreased risk of delivery less than 34 weeks compared to both nulliparas and those with a prior preterm birth (Table 1).Tabled 1 19,383 nulliparous and 39,288 multiparous women were included in the study. Of the multiparous women, 4413 (11%) had a history of a prior preterm delivery. The risk of preterm delivery was increased among multiparous women with prior preterm deliveries compared to their counterparts. Multiparous women with a history of a prior term birth had a decreased risk of delivery less than 34 weeks compared to both nulliparas and those with a prior preterm birth (Table 1). ConclusionA prior term delivery confers a decreased risk of preterm birth less than 34 weeks in a subsequent twin gestation compared to nulliparous women and women with a prior preterm birth. This information can be used to guide surveillance protocols and counsel patients. A prior term delivery confers a decreased risk of preterm birth less than 34 weeks in a subsequent twin gestation compared to nulliparous women and women with a prior preterm birth. This information can be used to guide surveillance protocols and counsel patients.