Previous Term Delivery Research Articles

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.

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.

A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies.

To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies. A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome. There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery. The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.

Prolonged second stage of labor and risk of subsequent spontaneous preterm birth

Preterm birth is the leading cause of neonatal morbidity and death in the United States. Although many risk factors for spontaneous preterm birth have been elucidated, some women with a previous term delivery experience spontaneous preterm birth in the absence of any identifiable risk factors. Cervical trauma during a prolonged second stage of labor has been postulated as a potential contributor to subsequent spontaneous preterm birth. This study was designed to examine the relationship between the length of the second stage of labor in the first pregnancy and the risk of spontaneous preterm birth in the subsequent pregnancy. This was a retrospective cohort study of all women with 2 consecutive singleton deliveries at a single institution between July 2012 and June 2018, with the first delivery occurring ≥37 weeks of gestation. Multiparous women and those women who did not reach the second stage of labor in the first pregnancy were excluded. Prolonged second stage of labor was defined as ≥4 hours, based on the 75th percentile for this cohort and on recommendations from the National Institute of Child Health and Human Development. Very prolonged second stage of labor was defined as ≥7 hours, based on the 95th percentile for this cohort. The primary outcome was spontaneous preterm birth <37 weeks of gestation in the subsequent pregnancy. The Kruskal-Wallis test compared median values for nonparametric continuous variables; Fisher's exact tests compared proportions for categoric variables, and logistic regression generated odds ratios. A total of 1032 women met criteria for study inclusion, with an overall subsequent spontaneous preterm birth rate of 3.1%. Prolonged second stage of labor of ≥4 hours was identified in 24.4% (252/1032 women) of the cohort, with 70.6% (178/252 women) of this group delivering vaginally. There was no statistically significant difference in rate of spontaneous preterm birth in those with and without prolonged second stage of labor (4.4% [11/252 women] with prolonged labor vs 2.7% [21/780 women] without prolonged labor; P=.21; odds ratio, 1.6; 95% confidence interval, 0.8-3.5). Very prolonged second stage of labor of ≥7 hours was identified in 4.3% (44/1032 women) of the cohort, with 45.4% (20/44 women) of this group delivering vaginally. There was a significantly higher rate of spontaneous preterm birth in those with very prolonged second stage of labor compared with those without prolonged labor (9.1% [4/44 women] with prolonged labor vs 2.8% [28/988 women] without prolonged labor; P=.04; odds ratio, 3.4; 95% confidence interval, 1.1-10.2), although this finding did not persist after we controlled for the mode of first delivery (adjusted odds ratio, 1.55; 95% confidence interval, 0.65-3.73). Spontaneous preterm birth after very prolonged second stage of labor was identified in only 4 patients, all of whom had a cesarean delivery with the first pregnancy. A second stage of labor of ≥4 hours in the first pregnancy was not associated with an increased risk of subsequent spontaneous preterm birth and was associated with a high rate (>70%) of vaginal birth. A second stage of labor of ≥7 hours did not appear to be associated with an increased risk of preterm birth, when we adjusted for mode of first delivery. There was a nonsignificant increase in the risk of preterm birth in those who delivered via cesarean section after a second stage of labor of ≥7 hours.

Pregnancy History Influences the Level of Autophagy in Peripheral Blood Mononuclear Cells From Pregnant Women.

Maternal immune responses are altered during pregnancy and differ between nulliparous and multiparous women. The influence of a prior gestation on autophagy in peripheral blood mononuclear cells (PBMCs) from pregnant women has not been determined and is the subject of this investigation. Peripheral blood mononuclear cells were isolated from 212 pregnant women and immediately lysed in the presence of protease inhibitors, and the extent of autophagy was determined by quantitation of the concentration of p62 (sequestosome-1) in the lysates by enzyme-linked immunosorbent assay (ELISA). In PBMCs, the p62 level is inversely related to the extent of autophagy. The level of the stress-inducible 70-kDa heat shock protein (hsp70), an inhibitor of autophagy, was also measured in the lysates by ELISA. Data were analyzed by the Spearman rank correlation, Mann-Whitney U test, or Kruskal-Wallis test, as appropriate. The p62 concentration in PBMCs increased (autophagy decreased) with the number of previous live ( P = .0322), preterm ( P = .0143), or term ( P = .0418) deliveries. The p62 level was lower (autophagy higher) in women with a prior spontaneous pregnancy loss but no deliveries as compared to women with their first conception ( P = .0087). The intracellular hsp70 concentration correlated with the p62 level ( P < .0001). Multiparity is associated with a reduced level of autophagy in PBMCs. Dysregulated autophagy might be one mechanism leading to spontaneous abortion in nulliparous women.

Is variation in copy number of the human beta defensin gene cluster associated with preterm birth?

BackgroundIncreased expression of antimicrobial peptides including human beta defensins (HBD) has been reported in the amniotic fluid and vaginal secretions of women who deliver preterm. We have previously shown that these women have increased first trimester serum HBD2. The gene encoding HBD2, DEFB4A, is part of a defensin beta (DEFB) cluster on chromosome 8 that is variable in copy number. Increased serum HBD2 is associated with increased DEFB copy number. We aimed to test the hypothesis that variation in DEFB copy number is associated with preterm birth. MethodsIn a retrospective, case-control study, genomic DNA and serum were extracted from blood collected from white European women at 11–13 weeks' gestation attending King's College Hospital between March 1, 2006, and Sept 30, 2010. DEFB copy number was determined by paralogue ratio test. Serum HBD2 concentration was measured by ELISA. Data were analysed with Pearson correlation (Excel, version 2010) and binary logistic regression (SPSS, version 20). FindingsCases were 102 women who either delivered preterm in the index pregnancy or had a history of preterm delivery. Controls were 152 women who had had at least one previous term delivery and delivered at term in the index pregnancy; they had no history of preterm birth. Modal copy number was 4 (range 2–7). Serum was available from 140 women (30 cases, 54 controls, 56 not included in the genetic association study). Median HBD2 concentration was 761·5 pg/mL (IQR 449·6–1232·0). There was no association between DEFB copy number and preterm birth, nor was there a correlation between copy number and serum HBD2 concentration. InterpretationAlthough variation in HBD2 protein expression in the first trimester might be useful to predict risk of preterm birth, we found no association between DEFB copy number and preterm birth. Nor did we find a correlation between DEFB copy number and serum HBD2 expression in the first trimester of pregnancy; this might be due to variation in regulatory sequences—some of which are progesterone and oestrogen sensitive—between individual copies. FundingWellcome Trust, Wellbeing of Women.

382: Is cervical length screening necessary in women with previous term deliveries?

382: Is cervical length screening necessary in women with previous term deliveries?

The risk of preterm birth associated with uterine anomalies, and the clinical utility of serial measurement of cervical length

ObjectiveTo determine the risk of preterm birth associated with uterine anomalies, and the clinical utility of serial measurement of cervical length.Study design and resultsWe carried out a retrospective cohort study...

17-alphahydroxyprogesterone caproate in women with previous spontaneous preterm delivery: does a previous term delivery affect the rate of recurrence?

The purpose of this study was to determine the role of previous term delivery on the rate of recurrent preterm birth in women with previous spontaneous preterm delivery (SPTD) who receive 17-alphahydroxyprogesterone caproate (17P) therapy. Women with singleton gestations who were receiving 17P therapy were studied. Rates of recurrent SPTD were compared for 1 or ≥2 SPTD with and without a previous term delivery. Five thousand one hundred two women had 1 previous SPTD, and 2217 women had ≥2 SPTDs. In women with 1 previous SPTD, a previous term delivery had lower rates of SPTD at <35 weeks (8.4% vs 11.2%; P = .002) and preterm delivery at <32 weeks (4.7% vs 6.2%; P = .027) compared with those women with no such history. No differences were found for SPTD at <35 weeks with ≥2 SPTDs. In patients who received 17P therapy with 1 previous SPTD, a previous term delivery confers a reduction in risk of preterm delivery at <37, <35, and <32 weeks' gestation; such reduction is not evident with ≥2 previous SPTDs.

27: 17 alpha-hydroxyprogesterone caproate in women with previous preterm delivery: does a previous term delivery influence effectiveness?

27: 17 alpha-hydroxyprogesterone caproate in women with previous preterm delivery: does a previous term delivery influence effectiveness?

Preeclampsia in the Second Pregnancy: Does Previous Outcome Matter?

ABSTRACT Although it has been observed that the incidence of preeclampsia is lower among women having their second pregnancy than among women having their first, it is unclear whether protection against preeclampsia results from parity or gravidity. For example, 1 previous study reported a protective effect in the second pregnancy of a late miscarriage in the first pregnancy, whereas other studies have found that only deliveries >37 completed weeks have a protective effect. Another study showed that a previous abortion, either spontaneous or therapeutic, was protective, irrespective of gestational age. This retrospective observational study was designed to determine whether the reduced risk of preeclampsia in the second pregnancy is dependent or independent of the first pregnancy's outcome, including the gestational age at delivery. Data from 24,500 women with first and second pregnancies between 1986 and 2006 were obtained from the Aberdeen Maternity and Neonatal Databank in Scotland. The treatment group included all women who developed preeclampsia in their second pregnancy, whereas the control group included all women with normotensive second pregnancies. Potential independent risk factors for the development of preeclampsia in the second pregnancy were evaluated, and crude and adjusted odds ratios (OR) were estimated using binary logistic regression. A total of 903 (3.7%) of the 24,500 women in the study population had preeclampsia in the second pregnancy. Of these, 167 had a previous history of preeclampsia, for a recurrence rate of 14.2%. The incidence of preeclampsia was increased in women with interpregnancy intervals of 6 years or more (19.3% vs. 14.7%) and in those with an increase in BMI (70.8% vs. 63.2%), whereas a change of partner appeared to have a protective effect (3.5% vs. 5.6%). Compared to women who were normotensive in the first pregnancy, women with a history of preeclampsia in the previous pregnancy had an adjusted odds ratio of 5.12 (95% confidence interval [CI] of 4.42–6.48) for developing preeclampsia in the second pregnancy. Using a model that included only live births, and after controlling for maternal age, BMI, smoking, change of partner, interpregnancy interval, and previous history of preeclampsia or gestational hypertension, the risk of preeclampsia in the second pregnancy appeared to decrease with increasing gestational age at delivery of the first pregnancy. Compared to women who had a previous term delivery, the odds ratio for developing preeclampsia in the second pregnancy was 4.22 (95% CI, 2.54–7.03) for women whose previous pregnancy ended in the second trimester, 2.32 (95% CI, 1.62–3.32) for women who had a previous preterm birth at 25 to 32 weeks', and 1.62 (95% CI, 1.46–1.72) for those with a previous preterm birth at 33 to 36 weeks'. The effect of a previous fetal death was evaluated using a second model that included all study patients whose previous pregnancy extended beyond 20 weeks. After adjusting for the same variables listed above, the risk of preeclampsia was the same for women with a previous history of stillbirth as for those with a previous live birth. Only first deliveries beyond 37 weeks were protective against preeclampsia, independent of outcome, in the second pregnancy. These findings suggest that the protective effect of a previous pregnancy against preeclampsia in the second pregnancy is dependent on the gestational age at delivery of the first pregnancy but not on that pregnancy's outcome.

Prediction of failed labor induction in parous women at term: Role of previous obstetric history, digital examination and sonographic measurement of cervical length

To examine the predictive value of previous obstetric history, Bishop score, and sonographic measurement of cervical length for predicting failed induction of labor in parous women at term. This prospective observational study enrolled 110 consecutive parous women at term with singleton gestations scheduled for the induction of labor. Transvaginal ultrasound for measurement of cervical length was performed and the Bishop score was assessed using digital examination. Univariate and multivariate analyses were used for statistical analysis. Labor induction failed in 15 women (14%). In terms of previous obstetric history, women with only previous mid-trimester loss or preterm delivery had a significantly higher risk of failed labor induction than those with at least one previous term delivery. Logistic regression demonstrated that previous obstetric history and the Bishop score, but not cervical length, were found to be significant and independent contributing factors for failed labor induction. In the receiver operating characteristic curves, the best cut-off value of the Bishop score for the prediction of failed labor induction was 3, with a sensitivity of 73% and a specificity of 44%. The previous obstetric history (i.e., only previous mid-trimester loss or preterm delivery) and the Bishop score independently predicted the failure of labor induction in parous women; however sonographic measurement of the cervical length appeared to have a poor predictive value for the risk of failed induction.

OP22.03: Prediction of failed labor induction in multiparous women at term: role of previous obstetric history, digital examination, and sonographic measurement of cervical length

The purpose of this study was to examine the predictive value of previous obstetric history, Bishop score, and sonographic measurement of cervical length for predicting failed labor induction in multiparous women at term. This prospective observational study enrolled 110 consecutive multiparous women with singleton gestations scheduled for labor induction at term. Transvaginal ultrasound for measurement of cervical length was performed and the Bishop score was assessed by digital examination. Receiver operating characteristic (ROC) curves and logistic regression were used for statistical analysis. Labor induction failed in 15 women (14%). In terms of previous obstetric history, women with only previous mid-trimester loss or preterm delivery had a significantly higher risk of failed labor induction than those with at least one previous term delivery. Logistic regression demonstrated that both previous obstetric history and the Bishop score were found to be significant and independent contributing factors for failed labor induction. Further examination of the different components of the Bishop score showed that only previous obstetric history provided a significant contribution to the prediction of failed labor induction. To predict the failure of labor induction, the best cut-off value of Bishop score was 3, with a sensitivity of 73% and a specificity of 44%. The previous obstetric history and the Bishop score independently predicted the failure of labor induction in multiparous women. However, sonographic measurement of cervical length appeared to have poor predictive value for the risk of failed induction.

294: Outcome of Pregnancy with Metformin on Patient with Recurrent Spontaneous Abortion who Have Abnormal Carbohydrate Metabolism

To determine the incidence of abnormal glucose tolerance test (GTT) in recurrent spontaneous aborters including PCO and non-PCO patients, and also whether metformin would safety reduce the rate of first trimester spontaneous abortions without teratogenisity in patients with abnormal GTT. Prospective pilot study. University related clinic. One hundred sixty-two patients with history of recurrent spontaneous abortions and 74 patients with previous term deliveries as control. Performing GTT on all patients administering metformin 1500 mg/day in patients with abnormal GTT. Continuation of pregnancy above first trimester. Out of 162 patients with previous abortions 29 (17.9%) and out of 74 women in control group, 4 (5.4%) patients had abnormal GTT respectively (p=0.017). Also 7 (24.1%) women in abnormal GTT group and 8 (6.1%) in normal GTT group were PCO. Among 29 patients with abnormal GTT, 17 patients were given metformin and 12 women receive nothing during pregnancy. Pregnancy outcome: Three of 17 (17.64%) patients in metformin group and 8 of 12 (66.6%) patients group II (non metformin group) aborted before 13 weeks respectively (p=0.04). No anomaly was seen in newborn of patients when delivered at term. It was shown that there is association between abnormal GTT and history of recurrent abortion including PCO and non PCO patients. Also improved outcome of pregnancy was seen with metformin therapy among those with abnormal GTT.

Periviable birth at 20 to 26 weeks of gestation: Proximate causes, previous obstetric history and recurrence risk

Early preterm birth at 20 to 26 weeks of gestation (periviable birth) carries extreme risks of infant death and morbidities. Prevention of periviable birth could improve infant outcomes significantly. We sought to characterize the causes of periviable birth and to determine whether periviable birth can be predicted by previous pregnancy outcome. We evaluated 104,921 pregnancies (1974-2004) and assessed the frequency and causes of periviable birth. Women who were delivered of both their first and second pregnancies at >20 weeks of gestation at our institution were identified. Predictive values of the first pregnancy outcomes for second pregnancy outcomes were determined. Periviable birth complicated 1981 deliveries (1.9%). Seventy-nine percent of the women with periviable births had no history of periviable births; 44% of the women had no previous deliveries, and 35% of the women had previous term deliveries only. Causes of periviable birth were labor (36%), premature rupture of membranes (34%), bleeding (10%), and preeclampsia (4%). Four percent of the gestations were multiple gestations. Among 7970 pregnancies at >20 weeks of gestation, periviable birth in the first pregnancy was associated with preterm birth and periviable birth in the second pregnancy (35.6%, 6.9%; relative risk, 3.3 and 8.6; P < .0001). Periviable birth and preterm birth in the first pregnancy were insensitive for periviable birth in the second pregnancy (8.8%, 36.8%, respectively). Although periviable birth is associated with subsequent periviable birth and preterm birth, preterm birth and periviable birth are insensitive markers for recurrences in the next pregnancy. Early pregnancy or preconceptional markers for prediction of periviable birth are needed.

Fetal interleukin-1 receptor antagonist gene polymorphism, intra-amniotic interleukin-1β levels, and history of spontaneous abortion

The purpose of this study was to determine whether fetal carriage of specific alleles of the polymorphic interleukin-1 receptor antagonist gene is associated with variations in intra-amniotic cytokine levels and previous pregnancy outcomes. Fetal cells in midtrimester amniotic fluid from 189 women were tested for interleukin-1 receptor antagonist intron 2 length polymorphisms. Concentrations of cytokines in amniotic fluid were tested by enzyme-linked immunosorbent assay. Pregnancy history data were obtained subsequently. Homozygosity for interleukin-1 receptor antagonist allele 1 was detected in 13 of 17 fetuses (76.5%) from women whose previous pregnancies all ended in spontaneous abortions, as compared with 33 of 74 fetuses (44.6%) from women with at least 1 previous term birth ( P = .02). Fetal carriage of interleukin-1 receptor antagonist allele 2 was associated with only 1 (5.9%) previous spontaneous abortion, as opposed to 31 pregnancies (41.9%) that were associated with a previous term delivery ( P = .004). A similar relationship between interleukin-1 receptor antagonist allele 1 and spontaneous abortions was observed when pregnancies of white women only were analyzed. Median mid trimester amniotic fluid interleukin-1beta concentrations were higher in women whose previous pregnancies ended in term deliveries (15.7 pg/mL), as opposed to women with 1 to 2 (6.4 pg/mL; P = .04) or > or =3 (4.1 pg/mL; P = .007) previous spontaneous abortions. Fetal carriage of interleukin-1 receptor antagonist allele 2 was associated with elevated intra-amniotic interleukin-1beta levels (16.2 pg/mL), as compared with interleukin-1 receptor antagonist allele 1 homozygotes (10.8 pg/mL; P = .03). Fetal carriage of interleukin-1 receptor antagonist allele 1 is associated with reduced intra-amniotic interleukin-1beta concentrations and an increased occurrence of spontaneous abortions in previous pregnancies.

Recurrence Risk of Preterm Birth due to Preeclampsia

There may be an increased risk of preterm birth due to preeclampsia among women whose previous pregnancies ended in preterm birth due to preeclampsia. We studied 1,130 women who delivered 2 successive singleton infants in our hospital, excluding women who delivered an abnormally formed infant during the study period. We reviewed the gestational week at delivery in these 2,260 pregnancies and found a total of 182 preterm deliveries (8.1%) by 156 women. The causes of preterm birth were reviewed. Failed tocolysis, including premature rupture of membranes and clinical chorioamnionitis, and preeclampsia accounted for 135 (74.2%) and 30 (16.5%) of the 182 preterm deliveries, respectively. Women whose 1st delivery was preterm had a 3.26 times (95% CI 2.21–4.79) higher risk of a subsequent preterm delivery than women whose 1st delivery was term (26/96 vs. 60/1,034). The risk of preeclampsia-related preterm delivery was 54.4 times (17.2 to 172.5) higher in women with a previous preeclampsia-related preterm delivery than in women with a previous term delivery (5/19 vs. 5/1034). Women who had a history of preeclampsia-related preterm birth had a greater risk of preeclampsia-related preterm birth in a subsequent pregnancy as compared with women with a previous term birth.

Increased tumor necrosis factor-α production after lipopolysaccharide stimulation of whole blood in patients with previous preterm delivery complicated by intra-amniotic infection or inflammation

Objective: To compare cytokine production after lipopolysaccharide stimulation of whole blood from women who were delivered of infants at term compared with women who were delivered of preterm infants with intra-amniotic evidence of infection or inflammation. Study Design: Whole blood samples from 12 women who were not pregnant and who had previously had preterm deliveries before 32 weeks complicated by intra-amniotic infection or inflammation and samples from 12 age- and race-matched control subjects were stimulated with Escherichia coli lipopolysaccharide. Tumor necrosis factor-α and interleukin-6 levels were quantified at 6 hours and interleukin-10 at 24 hours by enzyme immunoassay. Results were compared with use of the Wilcoxon rank sum test. Results: Tumor necrosis factor-α production was significantly higher in whole blood from women with histories of a preterm birth and intra-amniotic infection or inflammation (11,243 ± 1030 pg/mL [mean ± SEM]) compared with control subjects (3649 ± 349 pg/mL) at a lipopolysaccharide concentration of 1 μg/mL (P =.002). There were no significant differences in interleukin-6 or interleukin-10 production. Conclusion: Women with previous early preterm deliveries who had evidence of intra-amniotic infection or inflammation had significantly higher tumor necrosis factor-α production after lipopolysaccharide stimulation of whole blood compared with women with previous term deliveries. (Am J Obstet Gynecol 2001;185:1064-7.)

The influence of gestational age and smoking habits on the risk of subsequent preterm deliveries.

Previous preterm delivery and maternal smoking are associated with increased risks of preterm delivery. It is not known whether gestational age at the time of a preterm delivery is correlated with gestational age in successive preterm deliveries and whether changes in smoking habits influence the subsequent risk of preterm delivery. We studied the associations among smoking habits, previous very preterm or moderately preterm delivery (before 32 weeks and at 32 to 36 weeks, respectively), and the risk of a subsequent very preterm or moderately preterm delivery in a population-based cohort of 243,858 women in Sweden between 1983 and 1993. The results were adjusted for covariates known to be associated with preterm delivery. The odds ratios for very or moderately preterm delivery in a subsequent pregnancy among women with a previous very preterm delivery, as compared with women who had a previous term delivery, were 12.4 (95 percent confidence interval, 9.1 to 17.0) and 7.1 (95 percent confidence interval, 6.0 to 8.4), respectively. Among women with a previous moderately preterm delivery, the corresponding odds ratios were 2.3 (95 percent confidence interval, 1.9 to 3.0) and 5.9 (95 percent confidence interval, 5.5 to 6.3), respectively. The odds ratios for a very preterm second delivery among the women who smoked 1 to 9 cigarettes per day and those who smoked 10 or more cigarettes per day, as compared with nonsmokers, were 1.4 (95 percent confidence interval, 1.1 to 1.7) and 1.6 (95 percent confidence interval, 1.3 to 2.0), respectively. The corresponding odds ratios for moderate preterm delivery were 1.3 (95% confidence interval, 1.2 to 1.4) and 1.5 (95 percent confidence interval, 1.4 to 1.6). The women who quit smoking between pregnancies were not at increased risk for very or moderately preterm delivery, whereas the women who started to smoke in the second pregnancy had the same risk as those who continued to smoke. The risk of a very preterm delivery in successive pregnancies is increased primarily among women with a previous very preterm delivery. Changes in smoking habits influence the risk of preterm delivery as well.

Monitoring of fetus with osteogenesis imperfecta and severe anemia

The patient was a 27-year-old woman, gravida 3, para 2, with two previous normal term deliveries. The blood was type 0, Rh positive, with no abnormal antibodies. The prenatal course was unremarkable until 26 weeks of gestation when she complained of spotting. Examination revealed the cervix to be 80 per cent effaced and 1 cm. dilated. A cerclage was placed on the cervix and she was treated with bed rest. At 36 weeks of gestation spontaneous contractions ensued and the cerclage was removed. Fetal monitoring revealed a base-line heart rate of 160 b.p.m. with a beat-to-beat variability of up to 12 b.p.m. Contractions registered every three and a half minutes and the peak of each contraction was followed by a typical late deceleration. The severity of bradycardia varied from 10 to 50 b.p.m. and its duration ranged from 80 to 200 seconds. In addition to the uniform patterns of late fetal bradycardia there were wide and erratic shifts of the base-line from 160 down to 65 b.p.m. for three to five minutes unassociated with contractions. To confirm the presence of a congenital malformation, an abdominal roentgenogram was obtained and it revealed the characteristic skeletal hypomineralization and the multiple intrauterine fractures of osteogenesis imperfecta. A female infant, weighing four pounds and nine ounces, was delivered by cesarean section. The newborn infant had severe deformities due to the fractures and marked hydrops and died 15 minutes after birth. Cord blood evaluation revealed: hemoglobin, 8.4 Gm.; hematocrit, 27.5 per cent: reticulocytes, 14.7 per cent; a negative direct Coombs test was 100 per cent hemoglobin F on electrophoresis.