Previous Preterm Delivery Research Articles

Cost-effectiveness of cervical length screening and progesterone treatment to prevent spontaneous preterm delivery in Sweden.

ABSTRACTObjectiveTo estimate the cost‐effectiveness of strategies to prevent spontaneous preterm delivery (PTD) in asymptomatic singleton pregnancies, using prevalence and healthcare cost data from the Swedish healthcare context.MethodsWe designed a decision analytic model based on the Swedish CERVIX study to estimate the cost‐effectiveness of strategies to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy. The model was constructed as a combined decision‐tree model and Markov model with a time horizon of 100 years. Four preventive strategies, namely ‘Universal screening’, ‘High‐risk‐based screening’ (i.e. screening of high‐risk women only), ‘Low‐risk‐based screening’ (i.e. treatment of high‐risk population and screening of remaining women) and ‘Nullipara screening’ (i.e. treatment of high‐risk population and screening of nulliparous women only), included second‐trimester cervical length (CL) screening by transvaginal ultrasound followed by vaginal progesterone treatment in the case of a short cervix. A fifth preventive strategy involved vaginal progesterone treatment of women with previous spontaneous PTD or late miscarriage but no CL screening (‘No screening, treat high‐risk group’). For comparison, we used a sixth strategy implying no specific intervention to prevent spontaneous PTD, reflecting the current situation in Sweden (‘No screening’). Probabilities for a short cervix (CL ≤ 25 mm; base‐case) and for spontaneous PTD at < 33 + 0 weeks and at 33 + 0 to 36 + 6 weeks were derived from the CERVIX study, and probabilities for stillbirth, neonatal mortality and long‐term morbidity (cerebral palsy) from Swedish health data registers. Costs were based on Swedish data, except costs for cerebral palsy, which were based on Danish data. We assumed that vaginal progesterone reduces spontaneous PTD before 33 weeks by 30% and spontaneous PTD at 33–36 weeks by 10% (based on the literature). All analyses were from a societal perspective. We expressed the effectiveness of each strategy as gained quality‐adjusted life years (QALYs) and presented cost‐effectiveness as average (ACER; average cost per gained QALY compared with ‘No screening’) and incremental (ICER; difference in costs divided by the difference in QALYs for each of two strategies being compared) cost‐effectiveness ratios. We performed deterministic and probabilistic sensitivity analysis. The results of the latter are shown as cost‐effectiveness acceptability curves. Willingness‐to‐pay was set at a maximum of 500 000 Swedish krona (56 000 US dollars (USD)), as suggested by the Swedish National Board of Health and Welfare.ResultsAll interventions had better health outcomes than did ‘No screening’, with fewer screening‐year deaths and more lifetime QALYs. The best strategy in terms of improved health outcomes was ‘Low‐risk‐based screening’, irrespective of whether screening was performed at 18 + 0 to 20 + 6 weeks (Cx1) or at 21 + 0 to 23 + 6 weeks (Cx2). ‘Low‐risk‐based screening’ at Cx1 was cost‐effective, while ‘Low‐risk‐based screening’ at Cx2 entailed high costs compared with other alternatives. The ACERs were 2200 USD for ‘Low‐risk‐based screening’ at Cx1 and 36 800 USD for ‘Low‐risk‐based screening’ at Cx2. Cost‐effectiveness was particularly sensitive to progesterone effectiveness and to productivity loss due to sick leave during pregnancy. The probability that ‘Low‐risk‐based screening’ at Cx1 is cost‐effective compared with ‘No screening’ was 71%.ConclusionInterventions to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy, including CL screening with progesterone treatment of cases with a short cervix, may be cost‐effective in Sweden. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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

Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case-control study.

In the attempt of a trial of labor after a cesarean section approximately one in 200 women experience a complete uterine rupture. As a complete uterine rupture is associated with an adverse perinatal outcome, data regarding subsequent pregnancies are needed to provide proper care and guidance to women with a complete uterine rupture when informing them of future possibilities. The objective of this study was to investigate the fetal and maternal outcomes in subsequent pregnancies after a complete uterine rupture. Retrospective population-based case-control study. Denmark 1997-2017. A total of 175 women with complete uterine rupture during an attempted trial of labor after cesarean (TOLAC) at term (cases) and a corresponding group of 272 women with no uterine rupture during an attempted TOLAC at term (controls) were labeled as index deliveries. Index deliveries were included from January 1, 1997 to December 31, 2008. From the date of the index delivery to December 31, 2017 the information on subsequent pregnancies and deliveries, and on referral to hospital with any obstetric or gynecological diagnosis were retrieved from the Danish Medical Birth Registry and National Patient Registry. Main outcome measures were miscarriage, perinatal death, neonatal morbidity, preterm birth, and recurrence of uterine rupture. Outcome measures were compared between cases and controls. After the index deliveries; there were 109 pregnancies and 70 deliveries after gestational age 22+0 weeks in the population of cases. In the population of controls, there were 183 pregnancies and 126 deliveries after 22+0 weeks. Cases had a significantly higher risk of miscarriage (odds ratio [OR] 3.99; 95% confidence interval [CI] 1.36-13.17). The incidence of uterine rupture was 8.6% among cases and 0.8% among controls (OR 11.7; 95% CI 1.36-543.1). Among cases, 98.6% had live-born infants, and none of these had severe neonatal morbidity. No significant association was found between previous complete uterine rupture and preterm delivery, placenta previa, hysterectomy in relation to subsequent births, diagnosis such as meno/metrorrhagia, dysmenorrhea, or procedures such as hysteroscopy or hysterectomy. In pregnancies following complete uterine rupture continuing after 22+0 weeks, maternal and fetal outcomes are good when managed promptly with cesarean delivery.

Associations between cervical intraepithelial neoplasia during pregnancy, previous excisional treatment, cone-length and preterm delivery: a register-based study from western Sweden

BackgroundExcisional treatment of cervical intraepithelial neoplasia (CIN) has been associated with increased risk of preterm delivery (PTD), although the underlying mechanism is as yet unclear. Studies on formalin-fixed excised tissue indicate that the risk increases with cone-length, but the magnitude of increase is uncertain, especially in case of minor excisions (≤10 mm), as well compared to women with untreated CIN during pregnancy. This study assesses the impact of cone-length at previous treatment for CIN as well as diagnosis of CIN during pregnancy on the risk of PTD.MethodsA register-based cohort study in western Sweden linking cervical cytology, histology, and treatment data from the Swedish National Cervical Screening Registry to data on obstetric outcomes in singleton pregnancies 2008–2016 from the Swedish Medical Birth Registry. These groups were compared for PTD and other obstetric outcomes: (1) women with one excisional treatment (n=3250, including a subgroup (n=2408) with cone-length measured before fixation; (2) women with untreated CIN diagnosed during pregnancy (n=1380); and (3) women with normal cytology (n=42,398). Logistic regression analyses were adjusted for socioeconomic and health-related confounders.ResultsTreated women had increased risk of PTD (adjusted odds ratio (aOR) 1.60, 95% confidence interval (CI) 1.21–2.12), spontaneous PTD (aOR 1.95, 95% CI 1.40–2.72) and preterm prelabor rupture of membranes (pPROM) (aOR 2.74, 95% CI 1.66–4.51) compared to the CIN during pregnancy group. ORs were similar when compared to the normal cytology group. Risks of these outcomes increased with cone-length. Mean cone-length was 9.1 mm. Cone-length ≤10 mm was associated with increased risk of PTD (aOR 1.41, 95% CI 1.02–1.94), spontaneous PTD (aOR 1.73, 95% CI 1.18–2.54), and pPROM (aOR 2.44, 95% CI 1.40–4.28), compared to the CIN during pregnancy group. The PTD risk was similar for cone-lengths 3–10 mm, thereafter increasing by 15% with each additional millimeter.ConclusionsThis study suggests that all excisional treatment, including small cones, are associated with increased risk of PTD and pPROM. Risks increase further with cone-length. In women of reproductive age, clinicians should aim to remove all CIN but minimal healthy cervical tissue.Cone-length should be recorded at treatment, for future prenatal risk estimation.

Patterns of recurrent preterm birth in Western Australia: A 36-year state-wide population-based study.

It is known that a previous preterm birth increases the risk of a subsequent preterm birth, but a limited number of studies have examined this beyond two consecutive pregnancies. This study aimed to assess the risk and patterns of (recurrent) preterm birth up to the fourth pregnancy. We used Western Australian routinely linked population health datasets to identify women who had two or more consecutive singleton births (≥20weeks gestation) from 1980 to 2015. A log-binomial model was used to calculate risk ratios (RRs) and 95% confidence interval (CIs) for preterm birth risk in the third and fourth deliveries by the combined outcomes of previous pregnancies. We analysed 255435 women with 651726 births. About 7% of women had a preterm birth in the first delivery, and the rate of continuous preterm birth recurrence was 22.9% (second), 44.9% (third) and 58.5% (fourth) deliveries. The risk of preterm birth at the third delivery was highest for women with two prior indicated preterm births (RR 12.5, 95% CI: 11.3, 13.9) and for those whose first pregnancy was 32-36weeks gestation, and second pregnancy was less than 32weeks gestation (RR 11.8, 95% CI: 10.3, 13.5). There were similar findings for the second and fourth deliveries. Our findings demonstrate that women with any prior preterm birth were at greater risk of preterm birth in subsequent pregnancies compared with women with only term births, and the risk increased with shorter gestational length, and the number of previous preterm deliveries, especially sequential ones.

Determinants of Prematurity at the Centre Hospitalier Universitaire P&amp;#233;diatrique de Bangui (CHUPB)

Objective: The aim of this work was to identify the risk factors for the occurrence of prematurity at CHUPB. Materials and Methods: a case-control study was performed between February and June 2021 at CHUPB. Our study population consisted of premature infants who were matched to full-term newborns on a 1:1 basis. The variables studied were maternal characteristics (age, marital status, education level, and occupation) as well as pregnancy (maternal history, prenatal care), delivery (maternal fever, rupture of membranes), and newborns (gestational age, sex, and weight). The chi2 test with a significance level of p 0.05 and the adjusted odds ratio were used. Results: A total of 609 newborns were hospitalized, 219 of whom were premature (36%), of whom 100 premature infants meeting the inclusion criteria were enrolled. Maternal age 18 years was noted in 20% of cases (adjusted OR = 2.94 [0.86 - 10.06]) versus 5% of controls. Low educational level was noted in 47% (adjusted OR = 4.33 [1.88 - 9.96]) of cases versus 14% of controls. The risk factors identified were previous preterm delivery (adjusted OR = 0.06 [0.00 - 0.80]), maternal fever before labor (adjusted OR = 0.43 [0.20 - 0.90]), and premature rupture of membrane (RPM), (adjusted OR = 0.32 [0.16 - 0.64]). There was no association between marital status and insufficient prenatal visits (ANC) in relation to the occurrence of prematurity. Conclusion: The reduction of preterm births requires improved monitoring of pregnancy, delivery and care of the newborn. But primary prevention lies in improving the living conditions of the population.

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.

Pregnancy-Induced Hypertension and Fetal Outcome Among Patients with PIH

Background: Hypertension is defined as a blood pressure level of 140/90 mmHg measured twice with a 6-h interval between each measurement during pregnancy. The rise in systolic and diastolic blood pressure is critical in determining whether or not someone has pregnancy-induced hypertension (PIH). PIH, also known as toxemia or preeclampsia, is a type of high blood pressure that occurs during pregnancy. Materials and Methods: A total of 67 pregnant women who presented to our hospital with PIH were enrolled using the following inclusion and exclusion criteria. Women with 20 weeks of gestation and those who willing to participate in this study. Results: Pregnancy-induced hypertension was more prevalent among nulliparous (56.7%). Out of 29 women, 13 (44.8%) have past h/o of PIH, 24.1% had previous preterm delivery, and 68.9% had previous lower segment cesarean section. The clinical presentation in mothers with PIH which shows that 47.8% had lower abdominal pain and 19.4% had vomiting/epigastric discomfort followed by headache (11.9%), convulsion (8.95%), and no any complaint (13.43%). Conclusion: Pregnancy-induced hypertension is a frequent medical condition that occurs during pregnancy. We discovered that PIH is more common in children under the age of 18 and in moms who are nulliparous. PIH causes a variety of clinical manifestations, some of which can be used to detect PIH early.

Frequency of Success Rate of Cervical Cerclage in Preventing Preterm Deliveries

Objective: Determination of success rate of cervical cerclage in prevention of preterm deliveries in patients with cervical incompetence. Study Design: Case Series study. Place and Duration of Study: Study was conducted at Khyber Teaching Hospital for a period of six months from 29 March, 2018 to 29 September, 2018. Methodology: 97 pregnant women were recruited who had a history of previous miscarriages or pre-term delivery. Cervical Cerclage was performed on these patients who were then observed till delivery to ascertain the success rate of cervical cerclage in preventing pre-term deliveries in these patients. Results: In this study mean age was 30 years with SD 8.316. 63% patients were nulli para (with previous second trimester losses) and 37% patients were multi para (with previous pre-term deliveries). 78% delivered at term and 22% delivered preterm. 80% of babies delivered with good apgar score and weight greater than 2.5 kg where as 20% of babies delivered with low apgar score and weight less than 2.5kg. Overall success rate of cervical cerclage was 80%. Conclusion: Our study concluded that success rate of cervical cerclage was 80% in preventing pre-term deliveries in patients having cervical incompetence. Keywords: Cervical Cerclage, Pre-term deliveries, Cervical incompetence, Trans-vaginal

Comparison of the frequency of preterm births in patients treated with oral versus intramuscular progesterone with history of previous preterm birth

Background: Globally, it has proven that preterm birth is associated with perinatal mortality to the extent of &gt;75%, and &gt;50% of perinatal and long term morbidity. Oral progesterone are easy to take but are less effective because of first pass hepatic metabolism leading to variable plasma levels while intramuscular progesterone carries the risk of swelling and bruising at injection site. The aim was to find out frequency of preterm birth in patients treated with oral versus intramuscular progesterone.Methods: Randomized controlled trial conducted in the department of obstetrics and gynecology, Sir Ganga Ram hospital Lahore, Pakistan conducted from 5 October 2017 to 4 April 2018. This study involved 530 pregnant women with history of at least 1 previous preterm delivery presenting in antenatal clinic between 16-20 weeks of gestation. Group I received oral progesterone 10 mg tablet duphaston BD from 20 weeks till 37 weeks. Group II received intramuscular progesterone injection proluton depot 250 mg IM weekly from 16-20 weeks till 37 weeks.Results: The mean age of the patients was 27.52±4.57 years while the mean gestational age was 17.39±1.38 weeks. 47.5% of the patients were para 2 followed by para 3 (32.3%) and para 1 (20.2%). The mean gestational age at delivery was significantly higher among intramuscular group (36.14±2.23 versus 35.07±2.97 weeks; p=0.000). The frequency of preterm delivery was significantly lower in intramuscular group (24.9% versus 39.6%; p=0.000) as compared to oral group.Conclusions: Frequency of preterm delivery was significantly lower in patients treated with intramuscular progesterone (24.9% versus 39.6%; p=0.000) as compared to oral progesterone.

Effect of second‐trimester sonographic cervical length on the risk of spontaneous preterm delivery in different risk groups: A prospective observational multicenter study

The aim of the study is to compare the effect of cervical length measured with transvaginal ultrasound in the second trimester on the risk of spontaneous preterm delivery (PTD) between different risk groups of asymptomatic women with a singleton pregnancy. This is a pre-planned exploratory analysis of the CERVIX study, a prospective blinded multicenter diagnostic accuracy study. Asymptomatic women with a singleton pregnancy were consecutively recruited at their second-trimester routine ultrasound examination at seven Swedish ultrasound centers. Cervical length was measured with transvaginal ultrasound at 18-20weeks (Cx1; n=11072) and 21-23weeks (Cx2, optional; n=6288). The effect of cervical length on the risk of spontaneous PTD and its discriminative ability was compared between women with: (i) previous spontaneous PTD, late miscarriage or cervical conization (high-risk group; n=1045); (ii) nulliparae without risk factors (n=5173); (iii) parae without risk factors (n=4740). Women with previous indicated PTD were excluded (n=114). Main outcome measures were: effect of cervical length on the risk of spontaneous PTD expressed as odds ratio per 5-mm decrease in cervical length with interaction analysis using logistic regression to test whether the effect differed between groups, area under the receiver operating characteristic curve (AUC), sensitivity, specificity, number needed to screen to detect one spontaneous PTD. The effect of cervical length at Cx2 on the risk of spontaneous PTD <33weeks was similar in all groups (odds ratios 2.26-2.58, interaction p value 0.91). The discriminative ability at Cx2 was superior to that at Cx1 and was similar in all groups (AUC 0.69-0.76). Cervical length ≤25mm at Cx2 identified 57% of spontaneous preterm deliveries <33weeks in the high-risk group with number needed to screen 161. The number needed to screen for groups (ii) and (iii) were 1018 and 843. The effect of cervical length at 21-23weeks on the risk of spontaneous PTD <33 weeks is similar in high- and low-risk pregnancies. The differences in number needed to screen should be considered before implementing a screening program.

Assessment of Prevalence of Hypertension in pregnant women with its Complications: A Cross Sectional Study

Introduction: World Health Organization has reported that pregnancy induced hypertension is one of the main causes for mortality and morbidity in maternal and fetal deaths. About 60% of deaths accounted of eclampsia. Aims and Objectives: To diagnose for hypertension in pregnant women. To evaluate the knowledge of pregnancy induced hypertension among the pregnant women. To investigate the complications reported in Pregnancy induced hypertension (PIH) women, during and after labor. Study area and period: The present study was conducted in Chittoor government hospital, Chittoor, during the period of Jan 2016 and Dec 2017. The information and materials required for the study have been collected from the gynecology and obstetrics departments of the respective hospital. Results: During the study period of Jan 2016 and Dec 2017, about 2234 number of pregnant women have visited the obstetrics and gynecology department. All the 2234 pregnant women were tested for blood pressure. Among which 198 women were found to have hypertension, which may be of early onset PIH or chronic hypertension (HTN). Different variables of the study population like period of gestation [&lt;20 weeks, ≥20 weeks], previous cesarean section if present, previous preterm delivery if present, hypertension in previous pregnancy, history of paternal hypertension, history of abortions if have been, history of any still births, family history of PIH have been noted and reported in table 2. More than 8% of women were found to been falling in &lt;20 weeks of gestational age (GA). Conclusion: The study included 2234 pregnant women, in which 198 women were diagnosed with hypertension. Thus, prior investigation and identification hypertension in pregnant women helps in better management of PIH and to overcome the complications that are reported due to PIH during and after labor. Better knowledge and treatment is required for managing hypertension in maternal women in gynecology and obstetrics department for maternal and fetal care.

Prevalence, Risk Factors and Outcome of Preterm Births at University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Nigeria: A 2-year Case-Control Study

Background: Preterm birth (PTB) is an important cause of perinatal morbidity and mortality in developing societies like Nigeria. It poses huge long-term medical and financial burdens for the affected children, their families, the health care system and society at large. Objective: The objective of this study was to determine the prevalence, risk factors and birth outcome of PTB at UMTH, Nigeria. Methodology: A two-year case-control study of cases of preterm births at the UMTH, from 1st January, 2016 to 31st December, 2017 was undertaken. For each PTB, the next term delivery was taken as control. Information on socio-demographic characteristics, risk factors, gestational ages at presentation and delivery, and birth outcome were obtained from the women’s case files with proforma and compared with that of the control. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software Version 23. The statistical significance was set at P&lt;0.05. Results: During the period under review, there were 6,171 deliveries and preterm births constituted 291 births giving a prevalence rate of 4.7% or 47 per 1000 deliveries. The mean ages for the cases and controls were similar 26.4± 6.1 vs 26.5± 5.3 with (F=0.15, P=0.7) while the mean parity were 3.0±2.6 and 3.2±2.5 with (F=4.6, P=0.03). Nulliparity was commoner among the cases 61(24.6%) compared to the controls 34(13..7%) with X2 = 9.69, P=0.001. Similarly, 96(38.7%) of the cases were unbooked compared to 44(17.7%) among the conrols X2 = 26.9, P=0.000. About 20% of the cases had no formal education compared to 13% of the control. Preterm birth was associated with unbooking status (OR=1.82, CI: 1.40-2.36), nulliparity (OR = 2.05, CI: 1.29-3.26), previous preterm delivery (OR = 95.2, CI: 13.10-691.99) and pregnancy induced hypertension (OR = 25.45, CI: 9.13-70.92). Antepartum haemorrhage (OR = 13.89, CI: 4.92-39.25), twin gestation (OR = 18.18, CI: 2.40-137.68), Polyhydramnios (OR = 2.02, CI: 1.85-2.22) and PROM (OR = 5.39, CI: 2.87-10.15) were other risk factors independently associated with PTB. The perinatal mortality in PTB was 43(16.2%). Conclusion: The prevalence rate of PTB at the UMTH is 4.7% and is associated with previous PTB, unbooked status, twin gestation, polyhydramnious, APH and PIH. Efforts should be intensified on educating women of reproductive age group on the benefits of antenatal booking in pregnancy and quality antenatal care as this would provide ample opportunity for early detection and proper management of women at risk. Keywords: Preterm birth, Risk factors, Neonatal outcome, Maiduguri.

Burden and risk factors of preterm birth in Nasarawa State, North Central, Nigeria: A five-year case review

Background: Preterm birth has been on the increase globally and accounting for morbidities and mortalities. Preterm delivery referred to the birth of a newborn prior to thirty seven completed gestational weeks. There is dearth of knowledge on the burden of preterm birth in this state. This study therefore determined the burden of preterm deliveries in Nasarawa State, evaluate the risk factors and identify the outcome of such deliveries. Methods: A descriptive cross-sectional study of all preterm delivered from the 1st of January 2014 to the 31st of December 2013 at the Dalhatu Araf Specialist Hospital (DASH) Lafia, General Hospital Akwanga and Medical Centre Mararaba Gurku in the Southern, Northern and Western senatorial zones of Nasarawa State respectively. Data was analyzed using SPSS version 20. Results: The mean age of mothers of preterm in this study is 26.5±5.7 years. More than three-quarter of preterm birth in Nasarawa State were at the DASH Lafia. The prevalence of preterm birth and admissions were 1.5% and 10.8% respectively. One in four of the preterm were either late preterm or extreme preterm. Singleton gestation accounted for 82.1% of the preterm births while 75.6% of such deliveries where through the vaginal mode of deliveries. Risk factors for preterm deliveries were multiple gestation, antepartum haemorrhage (placenta previa), premature rupture of membrane and previous preterm delivery. Deaths among the preterm was 11% in this study. Conclusion: The burden of preterm births in this study is comparable to other centre in same region. Half of the preterm were either late or extreme preterm. Risk factors for preterm deliveries were placenta previa, premature rupture of membrane, multiple gestation and previous preterm child birth. Death was recorded in one out of every nine preterm

'Mycoplasma hominis does not share common risk factors with other genital pathogens': Findings from a South African pregnant cohort.

BackgroundThe role of Mycoplasma hominis (M. hominis) as a genital tract pathogen was still debatable. This study identified the risk factors associated with the prevalence of M. hominis in South African pregnant women.MethodsThis was a cross-sectional analysis of n = 221 prenatal patients attending a Durban hospital during November 2017 to April 2018. M. hominis was detected from urine samples using the quantitative polymerase chain reaction. The population characteristics were described using frequencies stratified by the infection status of M. hominis. In addition, a univariate analysis was used to assess the relationship between each risk factor and infection status. The analysis further considered logistic regression to assess the influence of these risk factors univariately and in the presence of other factors. The coinfection rate between M. hominis and bacterial vaginosis (BV), Trichomonas vaginalis (T. vaginalis), Mycoplasma genitalium (M. genitalium) and Candida species was also determined. All the tests were conducted at 5% level of significance.ResultsThe prevalence of M. hominis in this study population was 48% (106/221). In the univariate analysis, factors significantly associated with M. hominis positivity included having past abnormal vaginal discharge (p = 0.037), having current abnormal vaginal discharge (p = 0.010) and a borderline significance (p = 0.052), which were noted for previous pre-term delivery. However, none of these factors were sustained in the multivariate analysis. There was a statistically significant association between M. hominis and BV positivity (p < 0.001). Similarly, M. hominis and M. genitalium positivity was significant (p = 0.006).ConclusionThis study showed that M. hominis does not share common risk factors with known genital tract pathogens in a population of pregnant women and therefore cannot be considered a genital tract pathogen.

Investigating the efficacy and safety of metronidazole during pregnancy; A systematic review and meta-analysis.

ObjectiveWe aimed to review and analyze studies focusing on the efficacy of metronidazole in reducing the risk of preterm birth and the safety of metronidazole taking into account the different doses, duration of treatment and routes of administration.Study designsEmbase, Cochrane Library and PubMed were searched up to 29 July 2019 to identify studies assessing metronidazole exposure during pregnancy. Additional studies were identified from reference lists of retrieved papers. Measured outcomes were preterm births (<37 weeks of gestation) and associated delivery outcomes such as spontaneous abortions (≤ 20 weeks of gestation), stillbirths (≥20 weeks of gestation) and low birth weight (<2500 g) irrespective of the period of exposure and major malformations after first-trimester exposure. Overall effect estimates for RCTs and observational studies were calculated using the random-effects model and pooled using Risk Ratios (RR) and Odds Ratios (OR) respectively. ROB-2 and ROBINS-I tool were used to assess Risk of Bias for RCTs and observational studies, respectively.ResultsTwenty-four studies (17 observational studies and 7 RCTs) were selected. Pooled RR was 1.10 (95 % CI 0.78–1.55; n = 7; I2 = 72 %) for preterm birth. Subgroup analysis found RR 1.67; 95 % CI 1.07–2.62; n = 3; I² = 32 %) for treatment duration of ≤3 days among women with a previous preterm delivery. Pooled OR for spontaneous abortion was 1.72 (95 % CI 1.40–2.12; n = 5; I2 = 72 %) and 1.15 (95 % CI 0.98–1.34; n = 12; I2 = 25 %) for major malformations. After exclusion of studies with critical risk of bias, pooled OR were 1.7 (1.42–2.04; n = 3; I2 = 19 %) and 1.13 (0.93–1.36; n = 9; I2 = 28 %) respectively. Among several specific malformations analyzed, only congenital hydrocephaly was significantly increased at 4.06 (95 % CI 1.75–9.42; n = 2; I² = 0%).ConclusionsData do not confirm the efficacy of metronidazole in reducing the risk of preterm birth and associated delivery outcomes. Further research is required to confirm the effect of high dose and short duration of metronidazole treatment on preterm birth among the high-risk group. Regarding the increased odds of spontaneous abortion, RCTs are required to assess the role of the underlying infection. The need for further studies to confirm the risk of congenital hydrocephaly is paramount.

Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study

The objective of this retrospective, nationwide Finnish population-based cohort study was to determine whether there is an association between preterm caesarean breech delivery in the first pregnancy and maternal and neonatal morbidity in the subsequent pregnancy and delivery. We identified all singleton preterm breech birth in Finland from 2000 to 2017 (n = 1259) and constructed a data set of the first two deliveries for these women. We compared outcomes of the following pregnancy and delivery among women with a previous preterm caesarean breech section with the outcomes of women with one previous vaginal preterm breech birth. p Value, odds ratio, and adjusted odds ratio were calculated. Neonates of women with a previous caesarean preterm breech delivery had an increased risk for arterial umbilical cord pH below seven (1.2% versus 0%; p value .024) and a higher rate of neonatal intensive care unit admission [22.9% versus 15% adjusted OR 1.57 (1.13–2.18); p value <.001]. The women with a previous caesarean section had a higher rate of uterine rupture (2.3% versus 0%; p value .001). They were also more likely in the subsequent pregnancy to have a planned caesarean section [19.9% versus 4% adjusted OR 8.55 (4.58–15.95), an emergency caesarean section [21.5% versus 9.7% adjusted OR 2.16 (1.28–2.18)], or an instrumental vaginal delivery [9.3% versus 3.8% adjusted OR 2.38 (1.08–5.23)]. IMPACT STATEMENT What is already known on this subject? Vaginal birth after caesarean section is generally known to be associated with a higher risk of maternal and neonatal morbidity. What do the results of this study add? The following birth after previous caesarean preterm breech section is associated with a higher rate of uterine rupture and with a higher rate neonatal admission to the neonatal intensive care unit and more often an arterial umbilical cord pH below seven regardless of the mode of the following delivery, compared to women with a subsequent delivery after a previous vaginal preterm breech birth. What are the implications of these findings for clinical practice and/or further research? Our results must be considered when counselling patients regarding their first preterm breech delivery, as the selected method of delivery also affects the outcomes of subsequent pregnancies and deliveries.

Late preterm births and associated neonatal outcomes in a tertiary care center-A prospective observational study.

Background: Prematurity is one of the leading causes of morbidity and mortality among newborns. The incidence of preterm deliveries especially the late preterm births have unfortunately gone up in the last decade. Late preterm births are associated with increased neonatal complications compared to term births. This study makes an effort to find out the relevant maternal and fetal factors associated with late preterm births. This study also assesses the maternal and neonatal outcomes associated with late preterm births. Methods: This prospective observational study was conducted at Maternal and Child Health Unit of Shri B M Patil Medical College Hospital Vijayapur, Karnataka over a period of 1 year. 200 late preterm births and 200 term births were enrolled in the study. During the study period, all neonates delivered in the hospital were divided into two groups as late preterm group and term group. Maternal and neonatal data was collected in predefined structured proforma. Results: The mother's mean age in the late preterm group was 24.34 ± 4.07 years, and among the term group was 25.24 ± 4.54 years, which was not statistically significant (P=0.857). The obstetric risk factors observed for late preterm births were inadequate antenatal care (39%), premature rupture of membranes (31%), hypertensive disease of pregnancy (24.5%), previous preterm delivery (21%), and maternal anemia (13%). When two or more factors were found, late preterm labor incidence was 32.6% in this study. 14.5% late preterm's needed resuscitation (P=0.003), 45% late preterm neonates had difficulty establishing feeding at birth (P<0.001), 34% late preterm’s had respiratory distress at birth (P<0.001), 12% had hypoxic-ischemic encephalopathy (Stage2/3) (0.003), 35% had early-onset sepsis (P<0.001), 28% had jaundice (P<0.001), 24% had hypoglycemia (P<0.001), 41% had hypothermia (P<0.001), 13.5% had HSPDA (P<0.006). The duration of hospital stay was significantly more in late preterm neonates (8.7 ± 1.6 days) as compared to term neonates (3.9 ± 1.1 days) with a pvalue of <0.05. Most important is the mortality, which was significantly more among late preterm neonates (18%) than term neonates (6%) with a p-value of 0.011. Conclusion: Maternal risk factors such as preterm premature rupture of membrane, inadequate antenatal care, hypertensive disorders of pregnancy, and maternal anemia were associated with late preterm births. Since late preterm birth is an independent risk factor for neonatal morbidity and mortality compared to term neonates, knowing maternal and perinatal risk factors is essential. Early identification and management of these risk factors reduces the neonatal morbidities and mortalities.

Factors associated with risk of preterm delivery in Tanzania: A case-control study at Muhimbili National Hospital.

To determine factors associated with risk of preterm delivery among pregnant women delivering at Muhimbili National Hospital in Tanzania. A 1:1 case-control study was conducted to assess maternal sociodemographic, lifestyle, and current and previous obstetric factors associated with risk of preterm delivery. Mothers of preterm infants were regarded as cases and those of term infants were controls. Chi-square test and logistic regression were used to assess association between the factors and risk of preterm delivery. A total of 222 case-control pairs were studied. Maternal type of employment (P=0.039), previous preterm delivery (P=0.002), previous spontaneous abortion (P=0.004), uterine scar (P<0.001), parity (P=0.034), number of prenatal care visits (P=0.032), premature rupture of membranes (PROM) (P<0.001), placenta previa (P=0.002), bleeding during second trimester (P=0.004), pre-eclampsia (P<0.001), and maternal anemia (P=0.033) were associated with risk of preterm delivery. The main risk factors associated with preterm delivery included previous preterm delivery (odds ratio [OR] 13.23, 95% confidence interval [CI] 1.72-101.95), placenta previa (OR 12.63, 95% CI 1.63-97.98), and PROM (OR 8.77, 95% CI 1.33-4.60). Close monitoring of pregnant women who present any of the risk factors is important to prevent or reduce the risk of preterm delivery in Tanzania.

A chronicle of the 17-alpha hydroxyprogesterone caproate story to prevent recurrent preterm birth

Preterm birth is a substantial public health concern. In 2019, the US preterm birth rate was 10.23%, which is the fifth straight year of increase in this rate. Moreover, preterm birth accounts for approximately 1 in 6 infant deaths, and surviving children often suffer developmental delay or long-term neurologic impairment. Although the burden of preterm birth is clear, identifying strategies to reduce preterm birth has been challenging. On October 29, 2019, a US Food and Drug Administration advisory committee voted 9 vs 7 to withdraw interim accelerated approval of 17-alpha hydroxyprogesterone caproate for preventing recurrent preterm birth because the called for a confirmatory trial, known as the Prevention of Preterm Birth in Women With a Previous Singleton Spontaneous Preterm Delivery trial, was not confirmatory. The Prevention of Preterm Birth in Women With a Previous Singleton Spontaneous Preterm Delivery trial included subjects enrolled in the United States and Canada to ensure that at least 10% of patients would be from North America; however, this trial took 9 years to complete and did not demonstrate significant treatment effects in the 2 primary outcomes of interest. Delivery before 35 weeks' gestation occurred in 122 of 1130 women (11%) given 17-alpha hydroxyprogesterone caproate compared with 66 of 578 women (11.5%) given placebo (relative risk, 0.95; 95% confidence interval, 0.71-1.26; P=.72). Similarly, the coprimary outcome neonatal composite index occurred in 61 of 1093 women (5.6%) given 17-alpha hydroxyprogesterone caproate compared with 28 of 559 women (5.0%) given placebo (relative risk, 1.12; 95% confidence interval, 0.68-1.61; P=.73). There was also a lack of efficacy for 17-alpha hydroxyprogesterone caproate treatment in the analysis of a variety of secondary outcomes. Like the Maternal-Fetal Medicine Units Network trial, the Prevention of Preterm Birth in Women With a Previous Singleton Spontaneous Preterm Delivery trial was also flawed. Importantly, the Maternal-Fetal Medicine Unit Network trial was the sole justification for treating women in the United States with 17-alpha hydroxyprogesterone caproate for nearly 2 decades. Currently, despite more than half a century, 17-alpha hydroxyprogesterone caproate still has not been found to be clearly effective. In this context, how does the advising physician dependent on scientific evidence advise a patient that 17-alpha hydroxyprogesterone caproate is effective when the evidence to support this advice has repeatedly been found to be inadequate? This clinical opinion is a critical appraisal of the 2 randomized trials examining the efficacy of 17-alpha hydroxyprogesterone caproate to prevent recurrent preterm birth and a chronicle of events in the regulatory process of drug approval to help answer this question. With this examination, these events illustrate the complexity of pharmaceutical regulations in the era of accelerated Food and Drug Administration approval and characterize the financial impact and influence in medicine. In this report, we also emphasize the value of observational studies in contemporary practice and identify other examples in medicine where accelerated Food and Drug Administration approval has been withdrawn. Importantly, the themes of the 17-alpha hydroxyprogesterone caproate story are not limited to obstetrics. It can also serve as a microcosm of issues within the US healthcare system, which ultimately contributes to the high cost of healthcare. In our opinion, the answer to the question is clear-the facts speak for themselves-and we believe 17-alpha hydroxyprogesterone caproate should not be endorsed for use to prevent recurrent preterm birth in the United States.