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 .

Temporal Trend in Maternal Morbidity and Comorbidity.

This study aimed to examine the temporal trends of severe maternal morbidity (SMM) in the U.S. population in relation to trends in maternal comorbidity. We performed a repeated cross-sectional analysis of data from individuals at 20 weeks' gestation or greater using U.S. birth certificate data from 2011 to 2021. Our primary outcome was SMM defined as the occurrence of intensive care unit admission, eclampsia, hysterectomy, uterine rupture, and blood product transfusion. We also examined the proportions of maternal comorbidity. Outcomes of the adjusted incidence rate ratio (IRR) with 99% confidence intervals (99% CIs) for 2021 m12 compared with 2011 m1 were calculated using negative binomial regression, controlling for predefined confounders. There were 42,504,125 births included in the analysis. From 2011 m1 to 2021 m12, there was a significant increase in the prevalence of advanced maternal age (35-39 [45%], 40-44 [29%], and ≥45 [43%] years), morbid obesity (body mass index 40-49.9 [66%], 50-59.9 [91%], and 60-69.9 [98%]), previous cesarean delivery (14%), chronic hypertension (104%), pregestational diabetes (64%), pregnancy-associated hypertension (240%), gestational diabetes (74%), and preterm delivery at 34 to 36 weeks (12%). There was a significant decrease in the incidence of multiple gestation (9%), preterm delivery at 22 to 27 weeks (9%), and preterm delivery at 20 to 21 weeks (22%). From 2011 m1 to 2021 m12, the incidence of SMM increased from 0.7 to 1.0% (crude IRR 1.60 [99% CI 1.54-1.66]). However, the trend was no longer statistically significant after controlling for confounders (adjusted IRR 1.01 [95% CI 0.81-1.27]). The main comorbidity that was associated with the increase in SMM was pregnancy-associated hypertension. The rise in the prevalence of comorbidity in pregnancy seems to fuel the rise in SMM. Interventions to prevent SMM should include the management and prevention of pregnancy-associated hypertension. · The rise in maternal mortality is related to morbidity.. · Pregnancy-associated hypertension increases morbidity.. · There were increasing trends in age, body mass index, and medical conditions..

Prevalence and Determinants of Low Birth Weight among the Newborns in Dadra and Nagar Haveli: A Community-based Study.

The world is not on track to meet the World Health Assembly (WHA) global target on Low Birth Weight (LBW). To estimate the prevalence and to identify the associated determinants of LBW among the newborns. We conducted a cross-sectional study among the 364 mothers registered under the all government health facilities of Dadra & Nagar Haveli (DNH) during November 2021 to January 2022. The prevalence of LBW was found to be 39%. On uni-variable logistic regression, live in relationship, caste, weight of mother, Body Mass Index (BMI), weight gain <5 kg in 2nd and 3rd trimester, high-risk pregnancy, complication present in previous pregnancy and preterm delivery, while on multi-variable logistic regression, weight gain <5 kg in 2nd and 3rd trimester (AOR 2, 95% CI 1.007-4.2) and having high-risk pregnancy (AOR 2, 95% CI 1.1-3.0) were found to be the significant predictors of LBW among the newborns. We conclude from the study that the prevalence of low birth weight among the newborn was high. There is a need to address maternal and child health issues like low birth weight, malnutrition and high-risk pregnancy under the RMNCAH+N program through various effective interventions. Future research should evaluate the feasibility of collaborative activities between RMNCAH+N program and the UNICEF in India.

Determinants of preterm premature rupture of membranes and associated perinatal and maternal outcomes at General Justice Gizenga Mpanza Hospital, South Africa.

Preterm Premature Rupture of Membranes (PPROM) is defined as the rupture of fetal membranes prior to the onset of labor, before 37 weeks gestation and remains a significant obstetric complication of pregnancy with high rates of perinatal morbidity and mortality worldwide. The aim of our study was to establish the determinants of PPROM <34 weeks at this GJG MRH hospital which has a high incidence of PPROM. It was a descriptive , retrospective chart review of women diagnosed with PPROM over a 1 year period from 1st of January 2018 to 31st of December 2018. Detailed clinical and demographic information was recorded. Statistical analysis was carried out using SPSS (Version 28.0 IBM, Armonk, New York, USA) of 7071 singleton deliveries, 428 were diagnosed with PPROM. Majority (69%) were between the age groups of 21 to 30 years. Women belonging to age groups of <20 years and >=30 years, including women who attend antenatal clinics >=4 times were less likely to experience PPROM. History of abortions, previous preterm delivery, previous PPROM and women who had infectious components were determinants of PPROM. Among the neonates delivered by women who had PPROM, 56.3% had an unfavorable outcome.

Істміко-цервікальна недостатність після вчасних пологів - що пішло не так?

Premature birth is a serious global medical problem. About 15 million premature babies are born annually in the world, of which 1 million dies. Spontaneous premature birth is a cause of 40-45% of all premature births. Cervical insufficiency (CI) is a significant risk factor for spontaneous premature birth. Purpose - to identify the risk factors for the development of CI in patients with a history of full-term pregnancies to draw attention to the problem of underdiagnosis of hidden obstetric injuries. Materials and methods. During 2021 – June 2023, a retrospective cohort study was conducted in the municipal non-profit enterprise “Kyiv Perinatal Center”, within which 140 patients were analyzed. The study group includes 70 patients who have a history of at least one full-term pregnancy, and who had a diagnosis of CI during the last pregnancy. The control group consisted of patients who had 2 or more pregnancies, during which they were not diagnosed with CI. Results. The odds of developing CI during the next pregnancy increased compared with the control group in the presence of the following: rapid delivery - up to ≈4:1; prolonged second stage of labour - up to ≈6.5:1; cervical surgery with cervical dilatation - up to ≈4.7:1; cervical surgery without cervical dilatation - up to ≈4.1:1. Previous spontaneous preterm delivery was not found to be a predictor of CI development at subsequent pregnancies. Conclusions. The results show that patients with precipitous delivery and surgical manipulations on the cervix in history have at least 4 times higher the risk of CI development after timely childbirth, and with a prolonged second period of childbirth - have 6.5 times higher risk. It should be noted that statistically significant differences were not found in patients who had spontaneous preterm delivery. We also postulate that such data indicate two possible phenotypes of the CI: one is of traumatic genesis, and the second is of congenital tendency of the cervix to weakness, which can first manifest in the form of precipitous childbirth, and subsequently manifest in the form of CI. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.

Exploring the association of parity and its interaction with history of preterm delivery on gestational duration

PurposePreterm delivery is a major cause of child mortality. While the relationship between parity and preterm delivery is known, its association with gestational duration and variability remains underexplored. Differences in variance may suggest interaction with other well-established risk factors. MethodsWith 1.1 million spontaneous deliveries (1990–2012) from the Swedish Medical Birth Register, we assessed while accounting for potential confounders the effects of parity on the mean and variance of gestational duration, and its possible interactions with history of preterm delivery. Pedigrees allowed to account for nonobserved, shared confounders using linear mixed models. ResultsParity has a modest association with mean gestational duration, but a large effect on its variance. For example, the first pregnancy had the shortest mean gestational duration, 0.29 days shorter (95% CI: −0.33, −0.25) than the second, and the largest variance (σ2 = 135 days2). Accounting for shared unobserved confounders highlighted a group effect bias, likely linked to the mothers’ total number of offspring. Parity interacts with other risk factors, including previous preterm delivery where the magnitude of its effect increases with parity (up to 4.6 days effect difference). ConclusionsNonshared factors across a mother's pregnancies highlight parity's importance to gain insight into the mechanisms governing the timing of delivery.

Addition of Cervical Elastosonography to Cervical Length to Predict Preterm Birth in Pregnancy Women with Prior Preterm Birth: A preliminary prospective study.

To investigate the characteristics of cervical elastosonography in pregnancies and establish an ultrasound-based combing predictor for improving the prediction in pregnant women with prior-preterm birth who might ultimately undergo preterm birth (PTB). 169 singleton pregnancies with prior-preterm birth were examined by cervical elastography from January to November of 2021. According to the ultrasound image and result of the following-up, the patients were separated into preterm groups and full-term groups with or without cerclage. There were five elastographic parameters: Elasticity Contrast Index (ECI), Cervical hard tissue Elasticity Ratio (CHR), External Cervical os Strain rate (ES), Closed Internal Cervical os Strain rate (CIS), CIS/ES ratio and CLmin. Multivariable logistic regression was used to screen out the most significant predictors. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the ability of prediction. The PTB group without cerclage showed significantly softer cervix stiffness, while those with cerclage showed significantly harder. CHRmin with P < 0.05 in the univariate logistic regression analysis was screened as a more valuable cervical elastosonography parameter than other ones. The combination of CLmin and CHRmin in un-cerclage and integrating CHRmin, maternal age and pre-pregnancy BMI in cerclage presented good predictive value. The results of AUC were higher than CLmin, respectively (0.775 vs 0.734, 0.729 vs 0.548). The addition of cervical elastography parameters (such as CHRmin) might improve the ability to predict preterm birth in pregnant women with previous preterm delivery, which was better than using CL alone.

The association between indications for cesarean delivery and surgery time.

We aimed to determine risk factors for prolonged surgery time of cesarean delivery (CD). We conducted a retrospective cohort study in a single tertiary university-affiliated medical center (2011-2022). The study group consisted of all women who underwent CD that lasted >90 min (representing the 95th percentile of CD length in our cohort). Data were compared with CDs with an operation time of <90 min. Demographic, obstetric, and surgical characteristics, as well as indications for surgery and urgency (in labor vs. elective surgery), were compared. Overall, during the study period, 31 660 CDs were performed in our center. Of them, 1397 (4.4%) lasted >90 min. After applying a multivariate analysis, abnormal placentation (relative risk [RR] 1.5 [95% confidence interval (CI), 1.3-1.8]), previous uterine scar (RR, 2.15 [95% CI, 1.5-3.0]), general anesthesia (RR, 3.5 [95% CI, 2.9-4.4]) and preterm delivery (RR, 2.06 [95% CI, 1.78-2.4]) were found to be associated with prolonged surgical time. CD due to malpresentation (RR, 0.57 [95% CI, 0.46-0.7]), multiple gestations (RR, 0.72 [95% CI, 0.6-0.9]), and patient request (RR, 0.56 [95% CI, 0.38-0.84]) were found to be protective factors. The main risk factors associated with additional surgery time in CD are general anesthesia, abnormal placentation, previous uterine scar, and preterm delivery.

Amniotic Sludge and Prematurity: Systematic Review and Meta-analysis.

To perform a systematic review and meta-analysis of studies on maternal, fetal, and neonatal outcomes of women with singleton pregnancies, after spontaneous conception, and with the diagnosis of amniotic sludge before 37 weeks of gestational age. We conducted a search on the PubMed, Cochrane, Bireme, and Theses databases until June 2022. Using the keywords intra-amniotic sludge or fluid sludge or echogenic particles, we found 263 articles, 132 of which were duplicates, and 70 were discarded because they did not meet the inclusion criteria. The articles retrieved were analyzed by 2 reviewers; 61 were selected for full-text analysis, 18 were included for a qualitative analysis, and 14, for a quantitative analysis. Among the maternal outcomes analyzed, there was an increased risk of preterm labor (95% confidence interval [95%CI]: 1.45-2.03), premature rupture of ovular membranes (95%CI: 1.99-3.79), and clinical (95%CI: 1.41-6.19) and histological chorioamnionitis (95%CI: 1.75-3.12). Regarding the fetal outcomes, there was a significant increase in the risk of morbidity (95%CI: 1.80-3.17), mortality (95%CI: 1.14-18.57), admission to the Neonatal Intensive Care Unit (NICU; 95%CI: 1.17-1.95), and neonatal sepsis (95%CI: 2.29-7.55). The results of the present study indicate that the presence of amniotic sludge is a risk marker for preterm delivery. Despite the heterogeneity of the studies analyzed, even in patients with other risk factors for prematurity, such as short cervix and previous preterm delivery, the presence of amniotic sludge increases the risk of premature labor. Moreover, antibiotic therapy seems to be a treatment for amniotic sludge, and it may prolong pregnancy.

Frequency of Postpartum Depression (PPD) in Rawalpindi and its determinants

Background: Postpartum Depression (PPD) is a common complication after childbirth. It has serious impact on mental health of mother as well as behavioral and cognitive development of infant. Objective: To determine frequency of PPD in a metropolitan area of Pakistan and its associated factors. Methods: A cross sectional study was conducted at Gynecology and Obstetrics Department of Fauji Foundation Hospital, Rawalpindi over a period of six months from January to June 2022. A total of 252 female patients fulfilling the inclusion criteria were included. Patients Health Questionnaire (PHQ 9) was used for screening of PPD in the test subjects. Patients were categorized into two major groups: PPD (PHQ 9 ≥ 5) and No PPD (PHQ 9 ≤ 4). Odds ratio (OR) with 95% confidence interval was used to determine the association of various factors with PPD. Results: Out of 252 patients, 87 (34.5%) had PPD while 165 (65.5%) had no PPD. The major determinants were Age &gt; 35 years (OR 5.00, CI 1.286-19.440), BMI &gt; 30 (OR 3.333, CI 0.77-14.43), Gestational Age ≤35 weeks (OR 6.354, CI 2.65-10.678), Parity &gt;4 (OR 2.364, CI 0.548-10.19), number of female children &gt;4 (OR 7.670, CI 3.458-9.650), Low birth weight baby (OR 2.529, CI 1.109-5.766), COVID-19 in pregnancy (OR 2.371, CI 1.162-4.838), family history of depression (OR 4.425, CI 2.119-9.242), past history of PPD (OR 3.793, CI 1.780-8.085), no social support from husband (OR 11.379, CI 3.447-37.5) and family (OR 6.322, CI 3.145- 12.707). Conclusion: The major determinants of PPD in this study were lack of social support from husband and family members, previous female children and preterm deliveries. Other risk factors included age, obesity, multiparity, low birth weight, COVID-19 in pregnancy, family history of depression and stressful event during pregnancy, sleep deprivation, bottle feeding practice, and neonatal admission in NICU.

Bacterial Vaginosis: A Review of Pathophysiology, Epidemiology, Complications, Diagnosis, and Treatment

Bacterial vaginosis (BV) is the most-common cause of abnormal vaginal discharge among women of reproductive age, though many are asymptomatic. It is caused by the replacement of normal vaginal Lactobacillus with Gram-negative and anaerobic organisms. BV has assumed increasing public health importance through associations with numerous adverse outcomes in both gravid and non-gravid women. Risk factors for BV include smoking, non-White race, prior BV, current other sexually transmitted diseases (STDs), inserting items in the vagina (e.g., sex, douching), and menses. Symptomatic BV has been associated with pelvic inflammatory disease (PID), miscarriage, premature rupture of membranes, chorioamnionitis, premature labor and delivery, postpartum endometritis, and post-hysterectomy vaginal cuff cellulitis. Anaerobic Gram-negative rods common to BV have also been independently associated with endometritis or PID, even in the absence of clinical BV. BV has also been independently associated with an increased risk of acquiring STDs, including acquiring and transmitting HIV. BV is not an STD, though recent sexual intercourse and multiple sexpartners are risk factors. BV causes a malodorous, white or gray vaginal discharge and is diagnosed through Amsel’s criteria. Treatment with metronidazole or clindamycin is important for symptom relief and to prevent adverse obstetric consequences, particularly among high-risk women who have had a previous preterm delivery or have a pre-pregnancy weight &lt;50 kg.

Maternal and obstetrical factors associated with short cervical length at midtrimester in women with no history of preterm delivery

Aim To evaluate associations between maternal characteristics and a short cervix in patients without history of preterm delivery, and to determine if these characteristics can predict the presence of a short cervix. Materials and methods This is a retrospective cohort study that included 18,592 women with singleton pregnancies without history of previous preterm deliveries who underwent universal transvaginal cervical length (TVCL) screening between 18 + 0 and 23 + 6 weeks/days of gestation. A short cervix was defined as a cervical length (CL) ≤25 mm, ≤20 mm, and ≤15 mm. Associations between maternal age, weight, height, body mass index (BMI), previous term deliveries, and history of previous miscarriages, with a short cervix were evaluated using logistic regression models. Results The prevalence of a short cervix in our population was: CL ≤25 mm, 2.2% (n = 403); CL ≤20 mm, 1.2% (n = 224); and CL ≤15 mm, 0.9% (n = 161). Women with BMI >30 and/or previous abortions constituted 45.5% of the total population (8463/18,582). Significant associations with short cervix were observed for women with BMI ≥30, and for women with at least one previous abortion (p < .001). Parous women had a significantly lower association with a short cervix than nulliparous women (p < .001). Maternal age or height were not associated with a short cervix. Prediction of short cervix based on presence of any of the following: BMI ≥ 30 or previous abortions showed sensitivities of 55.8% (≤25 mm), 61.6% (≤20 mm), and 63.4% (≤15 mm) with similar specificity (50.1–54.6%) and likelihood ratio positive (1.2–1.5); and prediction based on BMI ≥ 30 and previous abortions showed sensitivities of 11.1% (≤25 mm), 14.7% (≤20 mm), and 16.7% (≤15 mm) with specificity 93%. Conclusions Among low risk women for spontaneous preterm delivery, those with a BMI ≥30 and/or previous miscarriages had a significantly increased risk for a short cervix at 18 + 0 and 23 + 6 weeks/days of gestation. Despite these significant associations, screening by maternal risk factors in a low risk population of pregnant women should not be an alternative to mid-trimester universal CL measurement.

Prediction of preterm delivery based on thyroid peroxidase antibody levels and other identified risk factors

ObjectiveThyroid dysfunction and TPOAb positivity during pregnancy are associated with adverse pregnancy outcomes such as preterm delivery. The aim of this study was to predict preterm delivery based on identified risk factors, especially TPOAb levels. Study designA secondary analysis was run on data collected in the Tehran Thyroid and Pregnancy study (TTPs). We used the data of 1515 pregnant women with singletons. The association between risk factors and preterm birth (delivery before 37 completed weeks of gestation) was investigated in univariate analysis. Multivariate logistic regression analysis was performed to identify independent risk factors, and a stepwise backward elimination method was used to determine the helpful combination of risk factors. The nomogram was developed based on a multivariate logistic regression model. The performance of the nomogram was evaluated using a concordance index and calibration plots with bootstrap samples. Statistical analysis was performed using STATA software package; the significance level was set at P < 0.05. ResultsBased on multivariate logistic regression analysis, a combination of previous preterm delivery [OR: 5.25; 95 %CI: (2.13–12.90), p < 0.01], TPOAb [OR: 1.01; 95 %CI: (1.01–1.02), and T4 [OR: 0.90; 95 %CI: (0.83–0.97); p = 0.04] as independent risk factors that most precisely predicted preterm birth. The area under the curve (AUC) was 0.66 (95% CI: 0.61–0.72). The calibration plot suggests that the fit of the nomogram is reasonable. ConclusionA combination of T4, TPOAb, and previous preterm delivery was identified as independent risk factors that accurately predicted preterm delivery. The total score obtained based on the nomogram designed based on risk factors can predict the risk of preterm delivery.

The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study.

To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24+0 and 33+6 weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05-0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44-4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.

Association among Cases of Women with first degree Family History of Diabetes Mellitus, Previous Macrosomia and Preterm Births, and Pregnancy Weight Gain at Mama Lucy Kibaki Hospital, Nairobi City

Background: Weight gain during pregnancy is of great concern for most women and obstetricians because of its possible consequences. This concern exists because gestational weight gain that exceeds what is recommended by the Institute of Medicine is associated with many maternal and fetal complications. While excessive gestational weight gain (GWG) is associated with modifiable risk factors for Gestational Diabetes Mellitus (GDM) notably, obesity and overweight conditions, there is a paucity of information on the association of cases of excessive GWG with non-modifiable risk factors (NMRF) for GDM namely history of diabetes mellitus in the first-degree family members as well as previous macrosomia and preterm deliveries. Method: The study prospectively monitored GWG in 337 women with a history of diabetes mellitus in first-degree family members as well as previous macrosomia and preterm deliveries. Data collected was analysed through bivariate regression to determine the odds of excessive GWG in the presence and absence of each of the three non-modifiable risk factors. Results: The non-modifiable risk factors of women of all BMIs were not found to be significantly associated with excessive GWG. For instance, a family history of DM in obese women was not associated with excessive GWG (P = 0.254; AOR = 0.715; 95%CI: 0.401-1.272). History of macrosomia in obese women was also not statistically significant (P = 0.973; AOR = 1.015; 95% CI: 0.429-2.402). Similarly, history of preterm births in obese women was not significantly associated with excessive GWG (P = 0.778; AOR = 0.902; 95%CI: 0.441-1.847). Conclusion: History of macrosomia and preterm births as well as family history of Diabetes mellitus cannot serve as predictors for excessive GWG because there is no association among them and excessive GWG by women of all BMIs

Unsuspected placenta accreta spectrum at vaginal delivery: assessment of incidence, characteristics, and maternal morbidity

Placenta accreta spectrum refers to morbidly adherent trophoblastic tissue invading into the gravid uterus and is associated with significant maternal morbidity. Most cases of placenta accreta spectrum are suspected antenatally, and most patients undergo planned, late-preterm cesarean hysterectomy to reduce the risk of morbidity. Rarely, however, placenta accreta spectrum is incidentally diagnosed at vaginal delivery, but there is a scarcity of data regarding these events. This study aimed to examine the incidence, characteristics, and outcomes of pregnant individuals with incidentally diagnosed placenta accreta spectrum at term vaginal delivery. This was a retrospective cohort study investigating the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 8,694,669 term vaginal deliveries from January 2016 to December 2019. Exclusion criteria included previous uterine scar, placenta previa, and preterm delivery. Exposure was assigned by the diagnosis of placenta accreta spectrum. The main outcomes were: (1) incidence rate, (2) clinical and pregnancy characteristics, and (3) maternal morbidity related to unsuspected placenta accreta spectrum at vaginal delivery. Multivariable binary logistic regression analysis and inverse probability of treatment weighting were fitted for statistical analysis. Unsuspected placenta accreta spectrum was reported in 1 in 3797 vaginal deliveries. In a multivariable analysis, the following were associated with increased likelihood of unsuspected placenta accreta spectrum (all, P<.05): (1) patient factor with older age, (2) uterine factors such as uterine anomaly and uterine myoma, (3) pregnancy factors including early-term delivery and previous recurrent pregnancy losses, and (4) fetal factors of in utero growth restriction and demise. Of those, uterine anomaly had the greatest association with unsuspected placenta accreta spectrum (adjusted odds ratio, 6.23; 95% confidence interval, 4.20-9.26). In a propensity score-weighted model, patients in the unsuspected placenta accreta spectrum group were more likely to have hemorrhage (65.2% vs 4.1%), blood product transfusion (21.3% vs 0.6%), hysterectomy (14.9% vs <0.1%), coagulopathy (2.9% vs 0.1%), and shock (2.9% vs <0.1%) compared with those without placenta accreta spectrum. Patients in the unsuspected placenta accreta spectrum group were also more likely to receive manual removal of the placenta compared with those in the non-placenta accreta spectrum group (25.1% vs 0.6%). This study suggests that although unsuspected placenta accreta spectrum among patients undergoing term vaginal delivery is rare, it is associated with significant morbidity. The observed association between uterine anomalies and placenta accreta spectrum warrants further investigation.

Predictive Value of Cervical Length Measurement on Transvaginal Ultrasonography in Determination of Preterm Delivery in a Nigerian South Western Tertiary Hospital

Introduction: There has been an upsurge in the prevalence of preterm delivery globally and short cervix has been strongly associated with it. However, studies have shown that when it is detected early in mid-second trimester, preventive measures could be taken to forestall pregnancy loss. Materials and Methods: This prospective cohort study was conducted among pregnant women who presented for mid-trimester anomaly ultrasound scan between 18 and 24 weeks at the University College Hospital (UCH), Ibadan. The cervical length was measured with ultrasound machine through the transvaginal route and the patients were subsequently followed up till delivery. Results: One hundred and seventy-seven pregnant women with an age range between 21 and 44 years were recruited for the study. The incidence rate of mid-pregnancy short cervical length among the patients was 7.9%. The preterm delivery rate was 14.1%, and the association between it and short cervical length was statistically significant. The positive predictive value for preterm delivery when the &lt;2.5 cm cervical length cut-off was used was 44%, the negative predictive value was 97.3%. Conclusion: The incidence of preterm delivery due to ultrasonographically detected short cervical length was significant among the women attending antenatal clinic in UCH, and there was a significant association with some of the risk factors such as previous preterm delivery and previous preterm premature rupture of membranes.

The risk factors and causes of spontaneous preterm birth in women with previous term delivery

Previous spontaneous preterm delivery is the most important risk factor of preterm birth, whereas term delivery without obstetric complication is a reassuring evidence for the subsequent pregnancy. However, we sometimes experience spontaneous preterm birth after uncomplicated term delivery. This study was performed to evaluate the risk factors and causes of spontaneous preterm birth after previous term delivery(sPAT). Retrospective cohort study was performed. Singleton pregnant women with spontaneous preterm birth whose previous pregnancy outcomes had been uncomplicated term deliveries were enrolled. We analyzed their causes of preterm birth and compared clinical characteristics and perinatal outcomes to controls with two consecutive term deliveries during the same period. The optimal interpregnancy interval(OPI) was defined between 18-59 months. Preterm birth with maternal-fetal indication, stillbirth, or congenital anomaly were excluded. A total 196 pregnant women met the inclusion criteria and 463 women were selected as controls. The mean gestational age at delivery was 33+3 weeks of gestation in sPAT group. Preterm premature rupture of membrane(PPROM) was the most common cause of spontaneous preterm birth, followed by preterm labor with intact membrane, and cervical insufficiency. The cervical lengths at midtrimester in the sPAT group were above 2.5cm in most cases. Women with sPAT had less total weight gain and average weight gain per week during pregnancy compared to controls. The proportion of women with OPI was significantly lower in women with sPAT than in controls. The cesarean delivery(CD) rate of the index term pregnancy was similar between the two groups, but the CD rate of the subsequent pregnancy was significantly higher in sPAT group than controls. Unlike the general spontaneous preterm birth, PPROM is the cause of preterm birth in more than half of the women with sPAT. Lower weight gain during pregnancy and inadequate interpregnancy interval were associated with preterm birth even in women with a previous term delivery.

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.