History Of Previous Preterm Delivery Research Articles

Maternal Risk Factors Associated with Preterm Birth: A Case Control Study.

Preterm birth is the child birth before 37 completed weeks .Prematurity is one of the leading causes of neonatal morbidity and mortality due to the complications associated with it. The objective of the study was to determine the maternal risk factors associated with all preterm birth in singleton pregnancy at National hospital. Hospital based unmatched case control study was conducted between March 2021 to December 2021 at National hospital, Thimphu, Bhutan. Case to control ratio was 1:2.Data were collected using interviewer -administered structured questionnaires. The collected data were entered into Epi-data and exported into SPSS for analysis. Independent variables with p-valves<0.05 in the univariate analysis were entered to multi variable logistic model to estimate the strength of association .P-valve <0.05 was considered significant. Total of 107 cases and 201 controls participated with a response rate of 95.95%.Multiple logistic regression showed that mothers with ANC follow ≤ four[aOR 9.58(7.36-28.86) ], previous history of preterm delivery [aOR 2.99(1.5-15.77) ], previous caesarean section [aOR 5.72(2.19-14.92)], prelabour rupture of membrane [aOR 8.67(3.78-19.73)], fetal growth restriction [aOR 7.28(2.11-25.11)] , and pre-eclampsia [aOR 10.99(6.75-85.29) were the risk factors positively associated with preterm birth . This study highlights that preeclampsia, number of antenatal care visits ≤ four, prelabour rupture of membrane, fetal growth restriction, previous caesarean section and previous preterm delivery were the risk factors for preterm birth. This show the need of early screening and prevention of preeclampsia, strengthening of antenatal care follow-up, and treatment of infection to prevent prelabour rupture of membrane, reducing primary caesarean section and more attention and care with previous preterm birth .

Role Of Low Dose Aspirin In Preventing Preterm Birth In Patients With Previous History Of Preterm Delivery

Objective: Preterm birth (PTB) occurs between 24-37 weeks of gestation. The important risk factor for PTB is a previous PTB and currently progesterone is used for the management of recurrent spontaneous PTB. Some studies have shown good outcomes but recent studies revealed that the use of vaginal progesterone was not related to a decreased likelihood of PTB or neonatal adverse effects. Thus, the controversy in the literature suggests multiple underlying pathological mechanisms involved in the progression of PTB. This study aims to determine the role of low-dose aspirin in the prevention of preterm birth in patients with a previous history of preterm delivery. Methodology: In this randomized controlled trial, a total of 172 patients fulfilling the inclusion criteria were selected from the inpatient and outpatient departments. Patients were divided randomly into two groups (group A and group B), using random number tables. In Group A, low-dose aspirin (75mg) was given while group B was taken as a control group. Patients were called every 8 weeks in the outpatient department for the assessment of compliance and side effects of the drug. The data were entered and analyzed by using SPSS v25.0. Chi-square was used to compare the two groups for incidence of preterm birth. Relative risk (along with a 95% confidence interval) for the decrease in the incidence of preterm birth with the use of aspirin was calculated. Results: The age of participants included in the study was 18 to 40 years. The mean age of patients in group A was 33.85±5.210 years and in group B was 32.86±4.139 years. The mean fetal birth weight in group A was 2281.1962±363.125 grams and in group B was 2271.4344±374.797 grams. In the low-dose aspirin group, 10(11.6%) had preterm birth and 31(36.0%) in the control group with a p-value of 0.001, which is statistically significant. The risk of having preterm birth with low-dose aspirin was 1.801 times less than controls. Conclusion: aspirin in low dose given before 14 weeks of gestation decrease spontaneous preterm birth as compared to the control group in a woman with a history of previous preterm birth which was spontaneous

Weekly Differences in the Prevalence of a Short Cervix at 18+0 to 23+6 Weeks of Gestation in Pregnant Women with and without a History of Preterm Delivery

Objective: The study aimed to estimate weekly differences in the prevalence of a short cervix during the period of 18⁺⁰ to 23⁺⁶ weeks of gestation in pregnant women with and without a history of previous preterm delivery (PTD). Design: An observational study was conducted. Methods: Setting and participants: 20,002 pregnant women, 18,591 without a history of previous PTD (low risk) and 1,411 with at least one previous PTD (high risk), were evaluated at 18⁺⁰ to 23⁺⁶ weeks + days of gestation. Weekly differences in the prevalence of a short cervix (≤25 mm, ≤20 mm, and ≤15 mm) between women with and without previous PTD were estimated. Results: High-risk women had a significantly higher prevalence of a short cervix, defined as either ≤25 mm (4.4% vs. 2.2%; p < 0.0001) or ≤20 mm (2.4% vs. 1.2%; p < 0.0001) but not for ≤15 mm (1.2% vs. 0.9%; p < 0.2) as compared to low-risk pregnant women. The odds ratio for a short cervix ≤25 mm in high-risk as compared to low-risk women was 2.0 (95% CI 1.54–2.61; p < 0.0001). Among low-risk women, those evaluated at 22 or 23 weeks of gestation had a significantly higher prevalence of a short cervix ≤25 mm (3.8% vs. 1.9%; p < 0.0001), ≤20 mm (2.4% vs. 0.98%; p < 0.0001), and ≤15 mm (1.6% vs. 0.7%; p < 0.0001) than low-risk women scanned between 18 and 21 weeks of gestation. Similar results were observed for high-risk women. Limitations: No gestational age at delivery was evaluated. Conclusion: There is higher prevalence of short cervix when pregnant women are evaluated at 22⁺⁰ to 23⁺⁶ than at 18⁺⁰ to 21⁺⁶ weeks of gestation.

Analysis of risk factors progression of preterm delivery using electronic health records

BackgroundPreterm deliveries have many negative health implications on both mother and child. Identifying the population level factors that increase the risk of preterm deliveries is an important step in the direction of mitigating the impact and reducing the frequency of occurrence of preterm deliveries. The purpose of this work is to identify preterm delivery risk factors and their progression throughout the pregnancy from a large collection of Electronic Health Records (EHR).ResultsThe study cohort includes about 60,000 deliveries in the USA with the complete medical history from EHR for diagnoses, medications and procedures. We propose a temporal analysis of risk factors by estimating and comparing risk ratios and variable importance at different time points prior to the delivery event. We selected the following time points before delivery: 0, 12 and 24 week(s) of gestation. We did so by conducting a retrospective cohort study of patient history for a selected set of mothers who delivered preterm and a control group of mothers that delivered full-term. We analyzed the extracted data using logistic regression and random forests models. The results of our analyses showed that the highest risk ratio and variable importance corresponds to history of previous preterm delivery. Other risk factors were identified, some of which are consistent with those that are reported in the literature, others need further investigation.ConclusionsThe comparative analysis of the risk factors at different time points showed that risk factors in the early pregnancy related to patient history and chronic condition, while the risk factors in late pregnancy are specific to the current pregnancy. Our analysis unifies several previously reported studies on preterm risk factors. It also gives important insights on the changes of risk factors in the course of pregnancy. The code used for data analysis will be made available on github.

Reference Range of the Cervical Length Measured by Transvaginal Ultrasound in Twin Pregnancies

Objective: To construct the reference range for cervical length (CL) measured by transvaginal ultrasound (TVS) in twin pregnancies at 16- to 34-weeks’ gestation. Material and Methods: The present study was a retrospective cohort study performed on 123 uncomplicated twin pregnancies delivered at 34-weeks’ gestation or beyond. All twin pregnancy women’s CL at 16- to 34-weeks’ gestation who delivered at Ramathibodi Hospital between February 22, 2016 and March 5, 2019 were examined. The study excluded those who had abortion, history of previous preterm delivery (PTD), monoamniotic twins, single twin demised, history of cervical insufficiency, history of cervical surgery, cervical cerclage, cervical pessary placement, fetal anomaly, fetal chromosome abnormality, fetoscopic surgery or unknown pregnancy outcome. Five hundred seventy-nine CL measurements were analyzed for constructing the mean CL, standard deviation, 95% confidence intervals, and the percentiles of CL. Results: The mean gestational age (GA) at delivery was 36.7 weeks’ gestation. Forty-two percent of women had spontaneous late PTD. The significant negative correlation between CL and GA was demonstrated (r=–0.549) at p&lt;0.01. The mean CL of 579 measurements was 33.2±9.2 mm, while the mean CL captured at 18 to 24 weeks’ gestation was 38.3±5.8 mm. The reference ranges of CL of each GA were established. Conclusion: The mean CL at mid-trimester of twin pregnancies was 38.3 mm The reference range for CL in twin pregnancies between 16- and 34-weeks’ gestation was constructed. Keywords: Cervical length (CL); Transvaginal ultrasound (TVS); Twin pregnancies

Sonography Cervical Assessment in Twin Pregnancy Correlation with Gestational Age at Delivery

Objective: Observe and correlate the funneling of upper cervical canal by ultrasound and likelihood of cervical incompetence and premature delivery in twin pregnancy. Materials and methods: Retrospective study in twin pregnancies deliveries in 1997, in king Faisal specialist hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin pregnancies underwent routine ultrasound for fetal assessment, when the cervix closed, long; and short, funneling. The time of ultrasound was divided in three groups by gestational age: from 18 to 22 weeks; from 22 to 26 weeks and from 26 to 30 weeks. The gestational age at delivery was our outcome parameter and subdivided the patients in 4 groups, group 1: patients delivered before 24 weeks (n = 4); group 2: delivered between 24 and 34 weeks (n = 16); group 3: delivered between 34 weeks and 36 weeks and 6 days (n = 18); and group 4: delivered with gestational age equal or above 37 weeks (n = 29). The data was analyzed statistically using Pearson chi square method and p value below 0.05 was considered significant. Results: There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy. There was stronger history of mid trimester abortion in patients delivered before 34 weeks of gestational age. Considering the cervical sonographic findings, the diagnosis of funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of gestational age (1 and 2) comparing to other groups (3 and 4) with p value equal to 0.016. The finding in ultrasound justifies the results of higher aggressive management in patients from groups 1 and 2 comparing with groups 3 and 4; admission to hospital (p = 0.007); emergency cerclage (p = 0.04), complete hospital bed rest (p = 0.002). Conclusion: Cervical assessment during routine ultrasound in twins pregnancy seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, especially group 1 (11 = 4), we suggest further study with bigger sample and prospective trial for valued conclusion.

Evaluation of obstetric and perinatal outcome of pregnancy with bad obstetric history

Background: Adverse perinatal outcome has always been a devastating experience for the mother. Advanced maternal age and other risk factors are independent risk factor for perinatal outcome. Therefore, aim of study is to compare the effect of these factor in different study group. Aims and Objectives: Case–control study has been conducted to evaluate obstetrics outcome, maternal morbidity, and perinatal outcome in patients with bad obstetric history. Materials and Methods: A prospective observational case–control study has been conducted in two groups; GROUP A: BOH group (n = 44) and GROUP B: Controls (n = 88) who fulfilled inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical college, Sola during the period of August 2018 to August 2020. Statistical analysis was done by descriptive statistics and qualitative and quantitative method. Results: Incidence of hypertension in Group A was 25%, while in Group B incidence was 6.8%. Incidence of hypertension was 4.5 times higher in Group A than B which was statistically significant (P &lt; 0.05). Incidence of PROM, gestational diabetes mellitus, thyroid dysfunction was higher in Group A than Group B. Higher incidence of preterm delivery found in Group A than in Group B which was statistically significant (P &lt; 0.05). Conclusion: Among all BOH group, cases with previous history of preterm delivery, still birth, recognition of prior learning, and HTD were the major risk factors which could be responsible for adverse obstetric and perinatal outcome.

Prevalence and Risk Factors of Group B Streptococcus Colonization in Pregnant Women: A Pilot Study in Palestine.

Background Maternal Streptococcus agalactiae (Group B Streptococcus (GBS)) colonization is an important cause of complications in mothers and neonates during gestation and after delivery. The data regarding GBS colonization among pregnant women in Palestine is scarce. The aim of this study is to determine the prevalence of GBS colonization, its associated risk factors, and the antibiotic sensitivity patterns in Nablus, West Bank, Palestine. Methods A cross-sectional, single center study conducted at Rafidia Governmental Hospital in Nablus, West Bank, Palestine. Samples were collected between November 2019 and January 2020. Vaginal swabs from 200 pregnant women (≥35 weeks of gestation) attending the labor and delivery department were plated directly on CHROMagarTM StrepB (CHROM agar, France) and placed in an incubator at 35–37°C. After 24 and 48 hours, the plates were checked for growth and classified into three categories: growth of GBS with mauve colonies on chromogenic media, no growth, or other growth. The identification of the mauve colonies was confirmed by the CAMP test. Identified GBS isolates were tested for susceptibility to vancomycin, ampicillin, clindamycin, cefotaxime, erythromycin, and levofloxacin using the disc diffusion method. Clinical and demographic information were collected using a questionnaire. Result The overall prevalence of GBS colonization was 12%. The median age of the study population was 27 years. GBS colonization was significantly associated with age (p=0.013), history of previous preterm delivery (p=0.013), and parity (p=0.015). No association was noted with smoking, previous abortion, previous history of fetal demise, vaginitis, or urinary tract infection. Resistance to ampicillin, vancomycin, cefotaxime, erythromycin, clindamycin, and levofloxacin was found to be 91.7%, 54.2%, 45.8%, 29.2%, 25%, and 8.3%, respectively. Conclusion The prevalence of vaginal GBS in this study was 12% from Nablus, West Bank. Further research is needed to determine the GBS serotypes common in West Bank and the burden they cause on the health system. Moreover, this study also highlights the need to establish a screening program suited to a developing country with low control on the antibiotic's prescription protocols.

Poor weight gain and its predictors among preterm neonates admitted at Muhimbili National Hospital in Dar-es-salaam, Tanzania: a prospective cohort study

BackgroundPreterm delivery is among the major public health problems worldwide and the leading cause of morbidity and mortality among neonates. Postnatal poor weight gain, which can contribute to mortality, can be influenced by feeding practices, medical complications and quality of care that is provided to these high-risk neonates. This study aimed to investigate the proportion and predictors of poor weight gain among preterm neonates at Muhimbili National Hospital (MNH), from September 2018 to February 2019.MethodsA hospital-based prospective cohort study involving preterm neonates with Gestation age (GA) < 37 weeks receiving care at MNH. Eligible preterm, were consecutively recruited at admission and followed up until discharge, death or end of neonatal period. Poor weight gain was defined as weight gain less than 15 g per kg per day. The risk factors associated with poor weight gain were evaluated. Predictors of poor weight gain were evaluated using a multivariate analysis. Results were considered statistically significant if P -value was < 0.05 and 95% confidence interval (CI) did not include 1.ResultsA total of 227 preterm neonates < 37 weeks GA, with male to female ratio of 1:1.2 were enrolled in the study. The overall proportion of preterm with poor weight gain was 197/227 (86.8%). Proportion of poor weight gain among the early and late preterm babies, were 100/113 (88.5%) and 97/114 (85.1%) respectively. Predictors of poor weight gain were low level of maternal education (AOR = 2.58; 95%Cl: 1.02–6.53), cup feeding as the initial method of feeding (AOR = 8.65; 95%Cl: 1.59–16.24) and delayed initiation of the first feed more than 48 h (AOR = 10.06; 95%Cl: 4.14–24.43). A previous history of preterm delivery was protective against poor weight gain (AOR = 0.33; 95% Cl: 0.11–0.79).Conclusion and recommendationPoor weight gain was a significant problem among preterm neonates receiving care at MNH. This can be addressed by emphasizing on early initiation of feed and tube feeding for neonates who are not able to breastfeed. Health education and counselling to mothers focusing on feeding practices as well as close supervision of feeding especially for mothers experiencing difficulties in feeding their preterm will potentially minimize risk of growth failure.

Evaluation of maternal risk factors for preterm delivery in Fatemieh Hospital of Hamadan, Iran, 2019: A case-control study.

Background:The present study aimed to evaluate maternal risk factors of preterm delivery in Fatemieh Hospital in Hamadan, Iran, 2019.Methods:In this case-control study, 7,478 hospital files of live-born neonates and their mothers in Hamadan Fatemieh Hospital in 2019 were examined. According to statistical estimates, 261 preterm deliveries and 736 term deliveries were studied. Information files of neonates and mothers were used to complete the study questionnaire. The data were compared in two separate groups and logistic regression was performed to estimate the crude relationship between demographic and clinical characteristics of term and preterm delivery.Results:The mean age of women was 27.89 ± 6.48 years. Analysis of data revealed that academic education (OR: 2.02, P = 0.014), age group 25-34 years (OR: 1.5, P = 0.016), age of 35 years and above (OR: 1.66, P = 0.018), previous history of preterm delivery (OR: 5.3, P < 0.001), history of abortion (OR: 1.67, P = 0.004), history of surgery (OR: 1.54, P = 0.007), history of infertility (P = 0.016), and a history of cesarean (OR: 2.11, P < 0.001) were potentially associated with a higher odds of preterm delivery (P < 0.2).Conclusion:Based on the results, it is important to identify potential risk factors of preterm delivery in mothers and corrective interventions in strengthening consultation and education of pregnant women during pregnancy. Such a measure helps select the type of delivery and strengthen prenatal care in identifying mothers in high-risk groups and performing timely interventions.

Preterm birth prevention.

Preterm birth (PTB), which occurs in about 12% of pregnancies worldwide, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids and antibiotics has improved neonatal outcomes but has not reduced the incidence of PTB. Evidence suggests that the rate of PTB may be reduced by the prophylactic use of progesterone in women with a previous history of preterm delivery and in those with a short cervical length identified by routine transvaginal ultrasound. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of PTB.

OUTCOME OF ORAL PROGESTERONE THERAPY IN PREVENTION OF PRETERM LABOR.

Objectives; To determine the outcome of oral progesterone therapy in prevention of preterm labor at a tertiary care hospital. Material and methods; All women (345) with previous history of preterm delivery, aged less than 45 years of age having their gestational ages 15 – 20 weeks were included from January 2018 to May 2019 at Department of Gynecology and Obstetrics, Nishtar Hospital Multan. These study cases were given 400 mg oral progesterone every day till delivery and were followed till delivery to record prevention of preterm birth (efficacy; birth of a baby with more than 37 weeks gestational age assessed on LMP treated with oral progesterone). Data were analyzed by using SPSS Version 20. Results; Mean age of our study cases was 30.12 ± 4. 83 years. Mean parity of our study cases was 4.52 ± 1.19. Mean gravidity of our study cases was 5.66 ± 1.18. Mean gestational age of our study cases was 37.51 ± 1.34 weeks at the time of delivery. Mean body mass index of our study cases was 23.39 ± 2.87 kg/m 2 . Our study results have indicated that obesity was present in 83 (24.1%) study cases. Of these 345 study cases, 180 (52.2%) belonged to urban areas, 328 (95.1%) had singleton pregnancy and previous no. of preterm births ranging from 1 – 2 was noted in 240 (69.57%). Treatment with oral progesterone prevented preterm labor in 231 (67%) of the study cases. Conclusion; Our study results support the use of oral progesterone as use of oral progesterone was successful in preventing preterm labor in our study. Its use was found to be safe and reliable, hence can be given to the women with previous history of preterm birth without any adverse side effect. The prevention of preterm birth was significantly associated with age, parity, gravidity, no. of previous preterm births, order of pregnancy and residential status. Keywords; Oral Progesterone, Prevention, Preterm birth. DOI : 10.7176/JMPB/55-08 Publication date :May 31 st 2019

Women with threatened preterm labour followed by term delivery have an increased risk of spontaneous preterm birth in subsequent pregnancies: a population-based cohort study.

To evaluate the association of a history of threatened preterm labour (TPL) followed by term delivery with the risk of spontaneous preterm delivery (PTD) in subsequent pregnancy. Population-based cohort study. Data of the National Health Insurance Claims Database and a national health-screening programme for infants and children in South Korea. Women who had their first singleton delivery in 2010 and a subsequent second singleton delivery between 2011 and 2015. Multivariable analysis adjusting for maternal age and interval between first and second deliveries was used to assess the risk of PTD based on PTD, TPL followed by term delivery, and term delivery in the first pregnancy. The risk of PTD during the second pregnancy. This study included 115629 women with two consecutive deliveries during the study period. Spontaneous PTD rates in the second pregnancy were 7.71, 2.22 and 1.02% in women with PTD, TPL followed by term delivery, and term delivery in the first pregnancy, respectively. Threatened preterm labour followed by term delivery in the first pregnancy was associated with increased risk of PTD in the subsequent pregnancy after adjustment for potential confounding factors (adjusted odds ratio 2.21; 95% CI 1.76-2.78). Although women with a history of TPL followed byterm delivery had a lower risk of PTD during a subsequentpregnancy compared with those with history of previous PTD, they still had a significantly increased risk ofPTD compared with those who delivered at term without TPL. The history of threatened preterm labour followed by term delivery is related to increased risk of subsequent spontaneous preterm delivery.

Parto pré-termo

Mais de 70% da morbidade e mortalidade neonatal e infantil é secundária à prematuridade. O parto pré-termo espontâneo é uma síndrome na qual o processo da parturição pode ser iniciado por um ou mais caminhos que levam às alterações do colo uterino, ativação decidual, contrações uterinas e rotura das membranas ovulares. Os principais fatores de risco para o parto pré-termo são a história prévia de parto pré-termo e a gestação gemelar, mas a maioria das mulheres que têm filhos prematuros não apresentam fatores de riscos aparentes. Toda gravidez potencialmente possui risco. A suplementação com progesterona reduz o risco de parto pré-termo em aproximadamente 40%, em mulheres com feto único e que tiveram um parto pré-termo com feto único e em mulheres com colo curto detectado pela ultrassonografia transvaginal na gravidez atual. Outras intervenções obstétricas que reduzem a morbidade neonatal tais como, a corticoterapia antenatal, a tocólise e a antibioticoterapia profilática para o estreptococo do grupo B, são terapêuticas terciárias eficazes mas não reduzem a incidência de parto pré-termo.

A study on maternal and perinatal risk factors of cerebral palsy among children attending a cerebral palsy clinic in Visakhapatnam

Background: Cerebral palsy (CP) is a disorder of movement and posture, defined as an “umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development”. Risk factors for CP include maternal infection, placental insufficiency, gestational diabetes, pregnancy induced hypertension, instrumental delivery, low birth weight, hypoxic ischemic injury, hyperbilirubinemia, metabolic abnormalities (hypoglycemia). The families are affected psychologically, financially and socially. It also imposes burden on national health system. The objective of the study was to study the distribution of maternal and perinatal risk factors of cerebral palsy among children attending a cerebral palsy clinic in Visakhapatnam.Methods: A retrospective cohort study was conducted by eliciting history from the mothers of 90 cerebral palsy children who were treated in cerebral palsy clinic, Visakhapatnam, Andhra Pradesh, India for a period of 6 months in 2016. After taking consent, data was collected using a pretested questionnaire. Detailed history was taken from the mothers of 90 cerebral palsy children regarding the period of gestation at which the child was born (preterm or full term), any previous history of pre-term delivery or abortions and neonatal complications was obtained from the care givers. Data was entered into MS-excel sheet and analysed by using SPSS Trial Version 20.Results: Total numbers of study subjects were 90, out of which 58 were boys and 32 were girls. Around 38% of study subjects were born out of consanguineous marriage. As per the records available, only 7% of mothers had gestational diabetes. It was found that 13% study subjects were preterm, 22% had low birth weight, 24% had perinatal hypoglycaemia, 33% had neonatal jaundice and 33% had birth asphyxia.Conclusions: Consanguinity, birth asphyxia, neonatal jaundice are found to be the important risk factors for Cerebral Palsy in our study which can be avoided by improving maternal and paediatric health services.

Preterm births in a resource constrained setting: sociobiologic risk factors and perinatal outcomes

Background : To determine maternal risk factors and perinatal outcomes of preterm births in south-western Nigeria. Methods : A retrospective study of preterm and term deliveries in a tertiary hospital in Nigeria. The delivery records were reviewed and case files of preterm births were identified and retrieved. Perinatal outcomes were determined by review of the postnatal and special care baby unit records. Multivariate logistic regression was carried out to determine factors independently associated with preterm births. Adjusted odds ratios and confidence intervals were determined. Results : The preterm birth rate was 5.7%. Prelabour rupture of membranes was the leading cause of preterm birth, while a third of them were unexplainable. Age >35yrs (AOR 2.16(1.36-3.42)), the unbooked status (AOR 2.52(1.76-3.61)), Previous history of preterm delivery (AOR 6.41(2.48-16.60)), pre-labour rupture of membranes (AOR 11.08(6.01-18.56)), antepartum haemorrhage (AOR 10.91(4.94-24.09)), multiple gestations (AOR 32.23(13.07-79.50)) and hypertension in pregnancy(AOR6.42(3.79-10.88)) were independently associated with preterm delivery. Low birthweight, asphyxia, neonatal intensive care unit admission and perinatal mortality were common among preterm births. The perinatal mortality rate among the preterm neonates was 14.5%. Conclusion : Preterm birth remains a significant cause of perinatal deaths. Strategies addressing potentially modifiable risk factors will reduce the incidence and improve the perinatal outcomes associated with preterm births. Keywords : preterm delivery, prematurity, perinatal mortality, Nigeria.

FETAL FIBRONECTIN AND PHOSPHORILATED INSULIN- LIKE GROWTH FACTOR BINDING PROTEIN-1 AS PREDICTORS OF SPONTANEUS PRETERM DELIVERY

The aim of the paper was to assess the combined use of cervical length, fetal fibronectin and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women in the following 14 days. Cervical length was prospectively measured in 58 consecutive singleton pregnancies with intact membranes and regular contractions at 24–36 weeks; fetal fibronectin and phIGFBP-1 were also assessed. Demographic data was evaluated (history of previous preterm delivery, history of spontaneous abortion, parity, BMI, maternal age, Islamic or Orthodox religion). Values of all variables were evaluated (demographic data, cervical length and values of phIGFBP1 and fetal fibronectin) alone and in combination with cervical length of ≤ 15mm and more than 15 mm. PhIGFPB was positive in 30 patients (22 of them gave birth in 14 days). In women with cervical length less than 15 mm phIGFBP-1, it was positive in 9 pregnant women who were delivered in 14 days. In women with cervical length less than 25 mm phIGFBP-1 was positive in 26 patients (2 of them gave birth in 14 days). In patients with cervical length more than 25 mm phIGFBP-1 was positive in 4 patients (2 of them gave birth in 14 days). Using logistic regression we confirmed that with OR 0.117 and CI 95% (0.046-0.295) and p<0.01 odds for preterm birth among patients with negative test results, phIGFBP-1 was by 0.117 lower than the odds for preterm birth among patients with positive test results. Using the same test, we confirmed that with OR=14,722 (CI 95% 5.27-41.1), (p<0.01) cervical length less than 25 mm was a good predictor of preterm delivery in symptomatic patients. Probability for delivery in the following 14 days in patients with positive phIGFBP-1 and cervical length≤15 mm is 0.88 or probability for not delivering in those patients is 0.12. Eighty-eight percents of patients with positive phIGFBP-1 and cervical length ≤15 mm will give birth in the following 14 days. In symptomatic women phIGFBP-1 may significantly improve the risk assessment for preterm delivery with cervical length and help to plan subsequent pregnancy management. Acta Medica Medianae 2014;53(3):11-18.

Cervical length and phosphorilated insulin like growth factor binding protein-1 as the predictors of spontaneus preterm delivery in symptomatic women

Objective: To assess the combined use of cervical length and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women in next 14 days. Methods: Cervical length was prospectively measured in 58 consecutive singleton pregnancies with intact membranes and regular contractions at 24-36 weeks, and phIGFBP-1 was assessed. Demographic data was evaluated(history of previous preterm delivery, history of spontaneous abortion, parity, BMI, maternal age, Orthodox or Muslims). Results: Values of all variables were evaluated (demographic data, cervical length and values ofphIGFBP-1) alone and in combination with cervical length of ≤ 15 mm and more than 15 mm. In women with cervical length less than 15 mm/ /phIGFPB-1 was positive in 30 patients(22 of them delivered in 14 days). In women with cervical length less than 15 mm/phIGFBP-1was positive in 9 of delivered pregnant women in 14 days. In women with cervical length less than 25 mm/phIGFBP-1was positive in 26 patients (2 of them delivered in 14 days). In patients with cervical length more than 25 mm/ph IGFBP-1 was positive in 4 patients (2 of them delivered in 14 days). With logistic regression we confirmed that with OR 0.117 and CI 95% (0.046-0.295) and p < 0.01 odds for preterm birth among patients with negative phIGFBP-1 is 0.117 lower than the odds for preterm birth among patients with positive test results. With same test for p = 0.009 (p < 0.01) we confirmed with OR and CI 95% (0.06 to 0.671) that cervical length less than 25 mm is good predictor of preterm delivery with symptomatic patients. Probability for delivery in the following 14 days with patients with positive phIGFBP-1 and cervical length ≤ 15 mm is 0.88 or probability for not delivering in those patients is 0.12. In 88% patients with positive phIGFBP-1 and cervical length ≤ 15 mm will deliver in the following 14 days. Conclusions: In symptomatic women phIGFBP-1 may significantly improve the risk assessment for preterm delivery with cervical length and help to plan sub-sequent pregnancy management.

Increased Incidence of Gestational Diabetes in Women Receiving Prophylactic 17α-Hydroxyprogesterone Caproate for Prevention of Recurrent Preterm Delivery

Meta-analysis of both older and current studies supports the use of 17α-hydroxyprogsterone caproate (17P) for preventing preterm birth. At the same time, progesterone is known to be diabetogenic. This study was planned to evaluate whether weekly prophylaxis with 17P alters the incidence of gestational diabetes mellitus (GDM). Women with singleton gestations who had a history of preterm delivery were enrolled for outpatient management before 27 weeks' gestation and delivered after 28 weeks' gestation. None of those participating had preexisting diabetes. The treatment group included 557 women who, starting at 16-21 weeks' gestation, received weekly intramuscular injections of 250 mg of 17P. The control group numbered 1524 parturients who also had a history of at least 1 preterm delivery. The 2 groups were similar with respect to maternal age and body mass index. Women given 17P had a significantly higher incidence of GDM than did control women (12.9% vs. 4.9%). The odds ratio (OR) was 2.9, and the 95% confidence interval, 2.1-4.1. Gestational age at the time of delivery was similar in the 2 groups, as were rates of spontaneous recurrent preterm delivery at less than 35 weeks' gestation (12.4% in the treatment group and 9.6% in the control group). Overweight and obese women had the highest risk of developing GDM, but 17P prophylaxis remained positively and independently associated with GDM in a logistic regression analysis that controlled for maternal weight, smoking, use of betamimetic drugs, and gestational age at the first outpatient visit. The overall adjusted OR was 3.09. These findings support the practice of screening for GDM early in gestation in women with a previous history of preterm delivery who receive 17P in an attempt to avoid another preterm birth.

Association of smoking during pregnancy and fetal growth restriction: Subgroups of higher susceptibility

Objective To analyze the association between maternal smoking and fetal growth restriction, defined as a failure to achieve the growth potential, and to define subgroups of higher susceptibility for this association. Study design A definition of growth restriction by customized birthweight standards applied to 13,661 non-malformed singleton deliveries. Customization was performed by maternal ethnic origin, height, booking weight, parity, gestational age at delivery and fetal gender. The adjusted risk of smoking for customized smallness-for-gestational age and the identification of subgroups with higher susceptibility were assessed by logistic regression. Results Overall, the adjusted odds ratio of smoking (all levels of exposure grouped) for the occurrence of growth restriction was 1.9 (95% confidence interval: 1.69–2.13). Smoking was etiologically responsible for 13.9% (95% confidence interval: 11.2–16.5) of the cases of growth restriction occurring in the population. Smoking resulted in an increasingly greater risk of growth restriction with progressive levels of cigarette consumption. The risk of smoking for fetal growth restriction was significantly greater in older women and those with a previous history of spontaneous preterm delivery. Conclusions Smoking is associated with a higher risk for growth restriction. In addition, older pregnant women and those with a previous history of preterm delivery have an increased susceptibility.