Prevalence Of Preterm Delivery Research Articles

Metformin Versus Placebo from First Trimester to Delivery in Polycystic Ovary Syndrome: A Randomized, Controlled Multicenter Study

Metformin is widely prescribed to pregnant women with polycystic ovary syndrome (PCOS) in an attempt to reduce pregnancy complications. Metformin is not approved for this indication, and evidence for this practice is lacking. Our objective was to test the hypothesis that metformin, from first trimester to delivery, reduces pregnancy complications in women with PCOS. We conducted a randomized, placebo-controlled, double-blind, multicenter study at 11 secondary care centers. The participants were 257 women with PCOS, in the first trimester of pregnancy, aged 18-42 yr. We randomly assigned 274 singleton pregnancies (in 257 women) to receive metformin or placebo, from first trimester to delivery. The prevalence of preeclampsia, gestational diabetes mellitus, preterm delivery, and a composite of these three outcomes is reported. Preeclampsia prevalence was 7.4% in the metformin group and 3.7% in the placebo group (3.7%; 95% CI, -1.7-9.2) (P=0.18). Preterm delivery prevalence was 3.7% in the metformin group and 8.2% in the placebo group (-4.4%; 95%, CI, -10.1-1.2) (P=0.12). Gestational diabetes mellitus prevalence was 17.6% in the metformin group and 16.9% in the placebo group (0.8%; 95% CI, -8.6-10.2) (P=0.87). The composite primary endpoint prevalence was 25.9 and 24.4%, respectively (1.5%; 95% CI, -8.9-11.3) (P=0.78). Women in the metformin group gained less weight during pregnancy compared with those in the placebo group. There was no difference in fetal birth weight between the groups. Metformin treatment from first trimester to delivery did not reduce pregnancy complications in PCOS.

Prevalence and determinants of pre-term deliveries in the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

In Nigeria, over 900,000 children under the age of five years die every year. Early neonatal death is responsible for a little over 20% of these deaths. Prematurity remains a significant cause of these early neonatal deaths. In some series, it is reported to be responsible for 60–70% of these deaths. This study aimed to determine the prevalence and determinants of pre-term deliveries at the University of Ilorin Teaching Hospital, Ilorin. This was a prospective cohort study conducted over a 9-month period at the University of Ilorin Teaching Hospital. Records of deliveries and data on maternal socio-biological and antenatal variables were collected during this period in order to determine the prevalence and determinants of pre-term deliveries. Out of the 2,489 deliveries that took place over a 9-month period, there were 293 pre-terms, giving a pre-term delivery rate of 120 per 1,000 deliveries. Of the total deliveries, 1,522 singleton deliveries that satisfied inclusion criteria were recruited; 185 of them were pre-term deliveries giving a case:control ratio of 1:7. Significant determinants of pre-term delivery identified were previous pre-term delivery (P=0.001; OR=3.55; 95% CI=1.71–7.30), antepartum hemorrhage (P=0.000; OR=8.95; 95%CI=4.06–19.78), premature rupture of the membranes (P=0.000; OR=6.48; 95%CI=4.33–9.67), maternal urinary tract infection (P=0.006; OR=5.89; 95%CI=1.16–27.57), pregnancy induced hypertension (P=0.007; OR=3.23; 95%CI=2.09–4.99), type of labor (P=0.000; OR=6.44; 95%CI=4.42–9.38) and booking status (P=0.000; OR=4.67; 95%CI=3.33–6.56). The prevalence of pre-term delivery was 120 per 1,000 live births. Factors significantly associated with pre-term delivery were low socio-economic class, previous pre-term delivery, antepartum hemorrhage, premature rupture of fetal membranes, urinary tract infection, pregnancy induced hypertension, induced labor, and booking elsewhere outside the teaching hospital.

Phosphorylated insulin‐like growth factor binding protein‐1 and cervical measurement in women with threatening preterm birth

To assess the efficacy of the cervical phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) in combination with cervical length measurement for the prediction of preterm delivery. Observational prospective study. University Hospital, Spain. A total of 276 women between 24 and 34 weeks gestational age complaining of uterine contractions and intact membranes. Transvaginal scan to assess cervical length and cervical swabs for pIGFBP-1 detection. Prevalence of preterm delivery within 48 hours and 7 days, delivery at < 32, < 34 weeks, admission-to-delivery interval by cervical length and the presence of pIGFBP-1. Results. The prevalence of preterm delivery at < 34 weeks was 14.1% (39/276) and 7.6% (21/276) at < 32 weeks. Cervical pIGFBP-1 was positive in 38.7% (107/276), whereas cervical length < 15 mm was present in 7.2% (20/276) and was > 30 mm for 64.8% (179/276) of the women. The presence of a positive pIGFBP-1 appeared useful for prediction of delivery before 32 (likelihood ratio (LR) = 2.21, confidence interval (CI): 1.63-3.00) and 34 weeks (LR = 1.76, CI: 1.25-2.41), respectively. Receiver operating characteristic curves were significant for cervical length and pIGFBP-1 for prediction of delivery at < 34 weeks, < 32 weeks, < 48 hours and < 7 days. Combining pIGFBP-1 and cervical length had a median interval that was shorter when both were positive as compared to only one positive or both negative, but the CIs overlapped. Both cervical length measurement and pIGFBP-1 are useful for prediction of spontaneous preterm delivery. A pIGFBP-1 positive result associated with cervical length does not improve preterm delivery prediction rates.

Associations of Gestational Weight Gain With Short- and Longer-Term Maternal and Child Health Outcomes

Several studies have reported that changes in maternal gestational weight gain during pregnancy are associated with increased or decreased risk of 5 short- and longer-term adverse maternal or neonatal outcomes: small-for-gestational-age (SGA) birth, large-for-gestational-age (LGA) birth, preterm birth, maternal postpartum weight retention, or child obesity. A few prior studies examined multiple outcomes at the time of birth and reported that the maternal weight gain associated with the lowest-risk may be somewhat lower than current recommendations, especially for obese women. No previous studies, however, have simultaneously investigated both short- and longer-term outcomes, quantitatively summed the predictive prevalence of several outcomes, and examined the effect of different outcome weightings on results. This study examined the relationship between different maternal weight gains during pregnancy and the risk of adverse outcomes including SGA, LGA, preterm delivery, substantial maternal postpartum weight retention, and child obesity in 2,012 mother-child pairs enrolled in Project Viva, a longitudinal pre-birth cohort study. Predicted probabilities were generated for each of the 5 outcomes within each maternal BMI stratum by varying gestational weight gain across the observed range within that stratum. For each BMI category, the maternal weight gain associated with the lowest average predicted probability of the 5 adverse outcomes was determined. Normal weight was defined as a BMI of 18.5 to 24.9 kg/m 2 , overweight as a BMI of 25.0 to 29.9 kg/m 2 , and obesity as a BMI of 30.0 kg/m 2 or greater. Among all women, the mean rate of total gestational weight gain was 0.39 kg/week (standard deviation, 0.14; range: 0.19 to 1.03). The prevalence of SGA and LGA was 6% and 14%, respectively. The prevalence of preterm delivery was 7% and that of substantial postpartum weight retention and child obesity was 16% and 10%, respectively. The lowest predicted prevalence of all 5 adverse outcomes was found among normal-weight women with a gestational gain of 0.28 kg/week, overweight women with a loss of 0.03 kg/week, and obese women with a loss of 0.19 kg/week. Estimates of the maternal weight gain associated with the lowest risk varied modestly for normal-weight and overweight women after adjustment for maternal characteristics and different outcome weights. In contrast, for obese women the maternal weight gain associated with the lowest risk in all models was weight loss. The investigators conclude from these findings that that gestational weight gain recommendations for overweight and obese women should be lowered.

The clinical significance of eosinophils in the amniotic fluid in preterm labor

Objective. White blood cells are not traditionally considered to be normally present in amniotic fluid. This study was conducted after the observation that a patient with preterm labor and intact membranes had eosinophils as a predominant cell in the amniotic fluid, and had an episode of asthma during the index pregnancy. The goal of this study was to determine whether women presenting with preterm labor with eosinophils in the amniotic fluid had a different outcome than those without eosinophils as the predominant white blood cell in the amniotic cavity.Methods. This retrospective case–control study included women who presented with preterm labor and intact membranes between 24 and 34 weeks of gestation. Patients underwent an amniocentesis shortly after admission for the assessment of the microbiologic status of the amniotic cavity and/or fetal lung maturity. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as genital mycoplasmas. Cytologic studies included amniotic fluid white blood cell count and differential, which was performed on cytocentrifuged specimens. Patients with microbial invasion of the amniotic cavity and/or an amniotic fluid white blood cell count >20 cells/mm3 were excluded from the study. Cases were defined as women in whom the differential contained >20% of eosinophils. Controls were selected among women with an amniotic fluid eosinophil count ≤20% and matched for gestational age at amniocentesis. The analysis was conducted with non-parametric statistics.Results. The study population consisted of 10 cases and 50 controls. Gestational age and cervical dilatation at admission were similar in both groups. Cases had a lower gestational age at delivery than controls [34.6 weeks, inter-quartile range (IQR) 32–37.3 weeks vs. 38.0 weeks, IQR 35–40 weeks, respectively; p = 0.018]. The prevalence of preterm delivery ≤35 weeks was higher among patients who had >20% eosinophils than in the control group [50% (5/10) vs. 18% (9/50), respectively; p = 0.029]. Similar results were observed for delivery at <37 weeks [cases: 70% (7/10) vs. controls: 36% (18/50); p = 0.046].Conclusions. Women with preterm labor and intact membranes who have a large proportion of eosinophils in the amniotic fluid are at an increased risk for spontaneous preterm delivery. These patients may have had an episode of preterm labor related to a type I hypersensitivity reaction.

Pregnancy Outcomes Among HIV-Infected Women Undergoing Antiretroviral Therapy

Background:The use of antiretroviral drugs (ARV) to prevent mother-to-child HIV transmission (PMTCT) promises to be effective. However, limited data on the adverse effects of ARV among pregnant women and pregnancy outcomes have been reported in clinical practice.Objectives:This study aimed to assess adverse effects and outcomes among pregnant HIV-infected women receiving antiretroviral drugs for either antiretroviral therapy (ART) or PMTCT.Study Design:This cohort study was at Chonburi Hospital, Thailand, in 2002-2006.Results:A total of 246 pregnant HIV-infected women with the median age (range) of 27 (16-41) years were included in this study. ART was initiated in 16.3% for treatment during ANC, 66.7% for PMTCT during ANC, and 17.1% for PMTCT in labor. Adverse effects, especially anemia, were significantly associated with continuing combined ART in pregnancy (p<0.001). 88.9% delivered normal-term neonates. The prevalence of pre-term delivery was 10.2%. Overall, 24 adverse events from 21 pregnant women (8.5%) were noted. A significantly higher prevalence of pre-term delivery was noted in the groups continuing combined ART, or initiating of PMTCT during labor rather than ANC (p=0.02). The incidence of low Apgar scores was 3.6%, and these were associated with initiation of PMTCT during labor (p=0.004).Conclusion:Adverse ARV events were more numerous among the pregnant women who needed ART than PMTCT. ANC is beneficial and strongly recommended for all pregnant HIV-infected women for better pregnancy outcomes.

Demographic, clinical and occupational characteristics associated with early onset of delivery: Findings from the duke health and safety surveillance system, 2001–2004

This cross-sectional study explores associations between preterm delivery and demographic, clinical and occupational characteristics of women employed within a university and health system. A comprehensive surveillance system linking individual-level data from Human Resources, medical insurance claims and a job-exposure matrix was used to identify women with a single live birth between 2001 and 2004 and describe maternal characteristics during pregnancy. Preterm delivery occurred in 7.1% (n = 74) of the 1,040 women, a lower preterm delivery prevalence than observed in the general U.S. population. Nearly all (>99.5%) women utilized prenatal care services. Prevalence of preterm delivery was highest for inpatient nurses, nurses' aides and office staff. In multivariate analyses, preterm delivery was positively associated with several clinical conditions: placenta previa, diabetes and cardiovascular disorder/disease. We observed associations between preterm delivery and several previously indicated clinical conditions. Further study of the effect of job characteristics on preterm delivery is warranted.

Associated factors and consequences of late preterm births: results from the 2004 Pelotas birth cohort

Although neonatal and infant mortality rates have fallen in recent decades in Brazil, the prevalence of preterm deliveries has increased in certain regions, especially in the number of late preterm births. This study was planned to investigate: (1) maternal antenatal characteristics associated with late preterm births and (2) the consequences of late preterm birth on infant health in the neonatal period and until age 3 months. A population-based birth cohort was enrolled in Pelotas, Southern Brazil, in 2004. Mothers were interviewed and the gestational age of newborns was estimated through last menstrual period, ultrasound and Dubowitz's method. Preterm births between 34 and 36 completed weeks of gestational age were classified as late preterm births. Only singleton live births from mothers living in the urban area of Pelotas were investigated. Three months after birth, mothers were interviewed at home regarding breast feeding, morbidity and hospital admissions. All deaths occurring in the first year of life were recorded. A total of 447 newborns (10.8%) were late preterms. Associations were observed with maternal age <20 years (prevalence ratio [PR] 1.3 [95% CI 1.1, 1.6]), absence of antenatal care (PR 2.4 [1.4, 4.2]) or less than seven prenatal care visits, arterial hypertension (PR 1.3 [1.0, 1.5]), and preterm labour (PR 1.6 [1.3, 1.9]). Compared with term births, late preterm births showed increased risk of depression at birth (Relative risk [RR] 1.7 [1.3, 2.2]), perinatal morbidity (RR 2.8 [2.3, 3.5]), and absence of breast feeding in the first hours after birth (PR 0.9 [0.8, 0.9]). RRs for neonatal and infant mortality were, respectively, 5.1 [1.7, 14.9] and 2.1 [1.0, 4.6] times higher than that observed among term newborns. In conclusion, in our setting, the prevention of all preterm births must be a priority, regardless of whether early or late.

Elevated third-trimester haemoglobin A 1c predicts preterm delivery in type 1 diabetes

The prevalence of preterm delivery is considerably elevated in women with type 1 diabetes. The aim of the study was to evaluate haemoglobin A 1c (HbA 1c) as a predictor of preterm delivery. Two hundred thirteen consecutive pregnant women with type 1 diabetes and normal urinary albumin excretion were included prospectively. HbA 1c was analyzed at 10, 20 and 28 weeks of gestation. Seventy-one women (33%) delivered pre term and 142 at term. At 10 weeks of gestation, HbA 1c was 7.3% (S.D. 1.0) vs. 6.9% (S.D. 0.9) ( P<.01), at 20 weeks of gestation 6.6% (S.D. 0.7) vs. 6.1% (S.D. 0.7) ( P<.001) and at 28 weeks of gestation 6.7% (S.D. 0.8) vs. 6.1% (S.D. 0.7) ( P<.001). When comparing HbA 1c at 10, 20 and 28 weeks of gestation, HbA 1c at 28 weeks of gestation ( P<.001) was the best predictor of preterm delivery. The adjusted odds ratio per 1% increment in HbA 1c at 28 weeks of gestation was 2.8 (95% CI 1.7–4.4). HbA 1c at 28 weeks of gestation was a clinical significant predictor of preterm delivery in type 1 diabetes.

Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

Expectant mothers require cholesterol for both the hormonal and physical changes of early pregnancy, but it is not clear whether a given pregnancy is at risk if the maternal serum cholesterol falls below a particular level. This pilot study sought to determine whether low maternal serum cholesterol, defined as a total cholesterol (TC) level less than the 10th percentile (159 mg/dL at a mean gestational age of 17.6 weeks), is associated with adverse pregnancy outcomes. Mother-infant pairs were retrospectively chosen from a cohort of 9938 women referred for second-trimester serum screening. Eligible women ranged from 21 to 34 years of age and had no known major risk factors for a poor outcome. All infants were singletons and were born alive. TC values were adjusted for gestational age at screening. The study population included 118 women with low TC and 940 with higher TC levels. Outcomes were assessed using multivariate regression models. The prevalence of preterm delivery was 12.7% in low maternal serum cholesterol mothers and 5.0% in control subjects with mid-range total cholesterol levels. The association between low maternal serum cholesterol and preterm birth was noted only in white mothers. In black women, preterm delivery was associated only with high TC. Term infants of mothers with low maternal serum cholesterol weighed 150 g less on average than those born to control mothers; this was true for both whites and blacks. Low maternal serum cholesterol was not associated with an increased risk of congenital anomalies. There was a trend toward an increased risk of microcephaly in neonates whose mothers had low TC values.

Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

The objective of this study was to assess whether low maternal serum cholesterol during pregnancy is associated with preterm delivery, impaired fetal growth, or congenital anomalies in women without identified major risk factors for adverse pregnancy outcome. Mother-infant pairs were retrospectively ascertained from among a cohort of 9938 women who were referred to South Carolina prenatal clinics for routine second-trimester serum screening. Banked sera were assayed for total cholesterol; <10th percentile of assayed values (159 mg/dL at mean gestational age of 17.6 weeks) defined a "low total cholesterol" prenatal risk category. Eligible women were aged 21 to 34 years and nonsmoking and did not have diabetes; neonates were liveborn after singleton gestations. Total cholesterol values of eligible mothers were adjusted for gestational age at screening before risk group assignment. The study population included 118 women with low total cholesterol and 940 women with higher total cholesterol. Primary analyses used multivariate regression models to compare rates of preterm delivery, fetal growth parameters, and congenital anomalies between women with low total cholesterol and control subjects with mid-total cholesterol values >10th percentile but <90th percentile. Prevalence of preterm delivery among mothers with low total cholesterol was 12.7%, compared with 5.0% among control subjects with mid-total cholesterol. The association of low maternal serum cholesterol with preterm birth was observed only among white mothers. Term infants of mothers with low total cholesterol weighed on average 150 g less than those who were born to control mothers. A trend of increased microcephaly risk among neonates of mothers with low total cholesterol was found. Low maternal serum cholesterol was unassociated with risk for congenital anomalies. Total serum cholesterol <10th population percentile was strongly associated with preterm delivery among otherwise low-risk white mothers in this pilot study population. Term infants of mothers with low total cholesterol weighed less than control infants among both racial groups.

Diagnostic Accuracy of Cervicovaginal Interleukin-6 and Interleukin-6:Albumin Ratio as Markers of Preterm Delivery

Abstract Background: Absence of fetal fibronectin (fFN) in the cervicovaginal fluid (CVF) of women with symptoms of preterm labor is an excellent predictor of women who will not deliver within 2 weeks of testing. Preliminary studies suggest interleukin (IL)-6 performs similarly to fFN. The positive predictive values of both these assays are poor. Inconsistent specimen collection may explain this poor performance. The objective of this study was to validate the clinical utility of cervicovaginal IL-6 and investigate the utility of the IL-6:albumin ratio to predict delivery within 14 days. Methods: We quantified albumin and IL-6 with the DPC Immulite® in 660 CVF specimens collected for physician-ordered fFN analysis. The clinical utility of IL-6 and IL-6:albumin to predict delivery within 14 days of collection was determined. Results: The sensitivity, specificity, and positive and negative likelihood ratios for delivery within 14 days were 65%, 87%, 4.8, and 0.4, respectively, for fFN and 35%, 91%, 3.8, and 0.7 for IL-6, with a 250 ng/L cutoff. With a preterm delivery prevalence of 4.7%, positive and negative predictive values were 19% and 98%, respectively, for fFN and 16% and 97% for IL-6. The areas under the ROC curves were 0.71 and 0.51 for IL-6 and IL-6:albumin, respectively. Odds ratios for delivery within 14 days of collection were 11.8 (P &amp;lt;0.0001), 5.5 (P = 0.0001), and 2.4 (P = 0.06) for fFN, IL-6, and IL-6:albumin, respectively. Conclusions: Cervicovaginal IL-6 may have utility for predicting preterm labor while offering the potential for substantial cost savings. Assay performance characteristics are not improved by normalizing IL-6 to albumin.

Increased Rates of Preterm Delivery Are Associated with the Initiation of Highly Active Antiretrovial Therapy during Pregnancy: A Single‐Center Cohort Study

It remains controversial whether in human immunodeficiency virus (HIV)-positive pregnant women an increased rate of preterm delivery is associated with highly active antiretroviral therapy (HAART). Since 1995 the management and outcome of all HIV-infected pregnant women delivering at St. Mary's Hospital London have been prospectively documented. The prevalence of preterm delivery and the correlation between gestational age and type of antiretroviral therapy were sought: preterm delivery occurred in 14.2% of the 211 deliveries. Initiation of HAART during pregnancy was associated with an increased risk of preterm delivery. This was independent of maternal health and class of antiretroviral therapy.

Diagnostic Accuracy of Cervicovaginal Interleukin-6 and Interleukin-6:Albumin Ratio as Markers of Preterm Delivery

Absence of fetal fibronectin (fFN) in the cervicovaginal fluid (CVF) of women with symptoms of preterm labor is an excellent predictor of women who will not deliver within 2 weeks of testing. Preliminary studies suggest interleukin (IL)-6 performs similarly to fFN. The positive predictive values of both these assays are poor. Inconsistent specimen collection may explain this poor performance. The objective of this study was to validate the clinical utility of cervicovaginal IL-6 and investigate the utility of the IL-6:albumin ratio to predict delivery within 14 days. We quantified albumin and IL-6 with the DPC Immulite in 660 CVF specimens collected for physician-ordered fFN analysis. The clinical utility of IL-6 and IL-6:albumin to predict delivery within 14 days of collection was determined. The sensitivity, specificity, and positive and negative likelihood ratios for delivery within 14 days were 65%, 87%, 4.8, and 0.4, respectively, for fFN and 35%, 91%, 3.8, and 0.7 for IL-6, with a 250 ng/L cutoff. With a preterm delivery prevalence of 4.7%, positive and negative predictive values were 19% and 98%, respectively, for fFN and 16% and 97% for IL-6. The areas under the ROC curves were 0.71 and 0.51 for IL-6 and IL-6:albumin, respectively. Odds ratios for delivery within 14 days of collection were 11.8 (P <0.0001), 5.5 (P = 0.0001), and 2.4 (P = 0.06) for fFN, IL-6, and IL-6:albumin, respectively. Cervicovaginal IL-6 may have utility for predicting preterm labor while offering the potential for substantial cost savings. Assay performance characteristics are not improved by normalizing IL-6 to albumin.

Reduced prevalence of early preterm delivery in women with Type 1 diabetes and microalbuminuria—possible effect of early antihypertensive treatment during pregnancy

In normotensive women with Type 1 diabetes and microalbuminuria we previously found preterm delivery (< 34 weeks) in 23% of the pregnancies. Antihypertensive treatment was initiated in late pregnancy when preeclampsia was diagnosed and diastolic blood pressure > 90 mmHg. From April 2000 our routine was changed and early antihypertensive treatment with methyldopa was initiated if antihypertensive treatment was given prior to pregnancy, if urinary albumin excretion (UAE) was > 2 g/24 h, or blood pressure > 140/90 mmHg. The present study describes the impact of this more aggressive antiypertensive treatment in the prevalence of preterm delivery. The old cohort (1995-1999) consisted of 26 and the new cohort (2000-2003) of 20 pregnant women with Type 1 diabetes and microalbuminuria. All were referred before gestational week 17. The cohorts were comparable with regard to age, diabetes duration, prepregnancy body mass index, HbA1c, blood pressure 121 (13)/71 (8) vs. 121 (14)/73 (8) mmHg [mean (sd)] and early UAE 69 (16-278) vs. 74 (30-287) mg/24 h (geometric mean and range). Antihypertensive treatment was initiated in the old cohort at 29 (20-33) weeks, n = 9, and in the new at 13 (0-34) weeks, n = 10. The prevalence of preterm delivery before 34 weeks was reduced from 23% to zero (P = 0.02), preterm delivery before 37 weeks from 62% to 40% (P = 0.15) and preeclampsia from 42% to 20% (P = 0.11). Perinatal mortality occurred in 4% vs. 0%. Birth weight was 3124 (767) g vs. 3279 (663) g. Introduction of early antihypertensive treatment with methyldopa in normotensive pregnant women with Type 1 diabetes and microalbuminuria resulted in a significant reduction in preterm delivery before gestational week 34.

Fetal thymic involution: A sonographic marker of the fetal inflammatory response syndrome

The purpose of this study was to evaluate whether there is a relationship between the sonographic fetal thymus size and the presence of an intrauterine infection in patients with preterm labor. Thirty-one women who had been admitted with preterm labor and intact membranes between 24 and 32 weeks of gestation were included. Fetal thymus perimeter was measured sonographically, and amniocentesis for the microbiologic assessment of the amniotic cavity was performed. Placentas and umbilical cords were examined for the presence of chorioamnionitis/funisitis. The prevalence of preterm delivery and intra-amniotic infection was 51.6% (16/31 women) and 32.3% (10/31 women), respectively. In all cases with intrauterine infection and in 23.8% of cases without intrauterine infection, the fetal thymus perimeter was below the 5th percentile for gestational age (10/10 women vs 5/21 women; P < .01). Isolated histologic chorioamnionitis and funisitis were found in 22.6% and 25.8% of fetuses, respectively. The fetal thymus was below the 5th percentile for gestational age in 100%, 71.4%, and 12.5% of patients with histologic signs of funisitis and isolated chorioamnionitis and without histologic signs of infection, respectively. Fetal thymus involution in preterm labor patients is strongly associated with funisitis, which is the histologic manifestation of the fetal inflammatory response syndrome.

Cervicovaginal fibronectin improves the prediction of preterm delivery based on sonographic cervical length in patients with preterm uterine contractions and intact membranes

The purpose of this study was to examine the diagnostic performance of ultrasonographic measurement of the cervical length and vaginal fetal fibronectin determination in the prediction of preterm delivery in patients with preterm uterine contractions and intact membranes. Ultrasound examination of the cervical length and fetal fibronectin determination in vaginal secretions were performed in 215 patients admitted with preterm uterine contractions (22-35 weeks) and cervical dilatation of </=3 cm. Outcome variables were the occurrence of preterm delivery within 48 hours, 7 days, and 14 days of admission, delivery </=32 and </=35 weeks, as well as the admission-to-delivery interval. Statistical analysis included chi-square test, receiver-operator characteristic (ROC) curve analysis, logistic regression, and survival analysis. The overall prevalence of preterm delivery </=35 weeks was 20% (43/215). The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days of admission, and delivery </=32 and </=35 weeks were 7.9% (17/215), 13.0% (28/215), 15.8% (34/215), 8.9% (9/101), and 15.8% (34/215), respectively. ROC curve analysis and contingency tables showed a significant relationship between the occurrence of preterm delivery and both cervical length and fetal fibronectin results ( P < .01 for each). Both tests performed comparably in the prediction of spontaneous preterm delivery. However, when fetal fibronectin results were added to those of cervical length (<30 mm), a significant improvement in the prediction of preterm delivery was achieved. Fetal fibronectin adds prognostic information to that provided by sonographic measurement of the cervical length in patients with preterm uterine contractions and intact membranes.

Is amniotic fluid interleukin-6 determination of value before the placement of a “rescue cerclage”?

Is amniotic fluid interleukin-6 determination of value before the placement of a “rescue cerclage”?

Hysteroscopic Metroplasty Improves Gestational Outcome in Women with Recurrent Spontaneous Abortion

Study Objective To compare the reproductive outcome in women with recurrent spontaneous abortion (RSA) associated with septate uterus after hysteroscopic metroplasty compared with patients who did not undergo surgery. Design Longitudinal evaluation (Canadian Task Force classification II-2). Setting University of Rome, Tor Vergata-affiliated endoscopic unit. Patients Forty-eight consecutive women with septate uterus and RSA were enrolled in the study. Interventions Hysteroscopic metroplasty. Measurements and Main Results Reproductive outcome in terms of term pregnancy was significantly improved after hysteroscopic metroplasty compared with controls (76% vs. 20%). No differences were found in the prevalence of preterm delivery between groups (4% vs. 5%). Conclusion Our data suggest that hysteroscopic septum incision can improve pregnancy outcome in patients with RSA associated with septate uterus.

The prevalence of preterm deliveries in Berlin has not changed over 7 years: the impact of multiple births.

The problem of preterm deliveries has worsened in developed countries over the past decade. To evaluate whether multiple deliveries had an impact on this development, we analyzed the data of the Berlin Perinatal Survey from 1993-1999 for 206,308 deliveries. The prevalence of preterm deliveries was fairly constant during this period, and the proportion of preterm deliveries in the case of multiples remained constant. But the prevalence of preterm neonates increased significantly in Berlin due to an increased prevalence of multiple births. There was a significant increase of mothers aged over 30, of German nationality, and with preceding infertility treatment, while the prevalence rates of nearly all other risk factors for prematurity decreased over time. The risk of infertility treatments resulting in multiple deliveries increased in these years. On average, infertility treatment led to an about 10 times higher risk of producing multiples than singletons OR (95% CI) of 9.6 (8.6-10.6).