Proportion Of Preterm Deliveries Research Articles

Elevated antimüllerian hormone levels are not associated with preterm delivery after in vitro fertilization or ovulation induction

To investigate the association between anti-Müllerian hormone and preterm birth risk in a larger cohort of patients who underwent either in vitro fertilization or ovulation induction with intrauterine insemination at a US academic fertility center. Retrospective cohort study SUBJECTS: Live singleton births from patients who underwent in vitro fertilization or ovulation induction between 2016 and 2020 at a single academic fertility center were included in this study. Patients were excluded if they had a missing pre-pregnancy AMH level, a pregnancy using donor oocytes or a gestational carrier, multiple gestations, a delivery prior to 20 weeks gestation, or a cerclage in place. AMH level MAIN OUTCOME MEASURES: The primary outcome was proportion of preterm delivery. Secondary outcomes included rate of pregnancy-induced hypertension, gestational diabetes, and small for gestational age. In the entire cohort (n=875), 8.4% of deliveries were preterm. Mean AMH values were similar between those with term and preterm births (3.9 vs 4.2 ng/mL, p=0.29). Similar proportions of patients with term and preterm deliveries had AMH levels greater than the 75th percentile (25% vs 21%, p=0.4). The odds of preterm birth were similar by AMH quartile after adjusting for history of preterm birth. Similarly, in the PCOS cohort, there was no difference between mean AMH values of term and preterm births (n=139, 9.6 vs 10.0 ng/mL, p=0.9). The proportions of PCOS patients with AMH levels greater than the 75th percentile were similar between those with term and preterm deliveries (25% vs 22%, p=0.9). The odds of preterm birth were similar by AMH quartile after adjusting for history of preterm birth. Elevated AMH levels were not associated with an increased risk of preterm birth in patients who conceived after in vitro fertilization and ovulation induction, including PCOS patients. Although studies suggest that AMH level may help stratify risk of preterm birth in this population, our findings indicate that further studies are needed prior to clinical application.

Impact of trophoectoderm biopsy for preimplantation genetic testing on serum β-hCG levels, time of delivery and birthweight following frozen embryo transfer cycles

Aim: This study investigated whether trophoectoderm (TE) biopsy adversely impacts serum β-human chorionic gonadotropin (hCG) level on the 15th day of embryo transfer (ET), delivery week and birthweight, between biopsied and unbiopsied embryo groups, in a cohort of women who delivered a singleton baby, following frozen–thawed ET. Methods: All women having had a live birth after blastocyst ETs following frozen ET cycles with preimplantation genetic testing (PGT) were included. A control group was selected among women who had a live birth following single frozen blastocyst transfer without PGT-A at the same period in our clinic Results: One hundred fifteen and 173 cycles with- and without-PGT, respectively, were included. Serum β-hCG level on the 15th day after ET was comparable between the groups (p = .336). Average birthweight of the babies born following biopsied embryos were significantly lower (3200 vs. 3380; p = .027). Women who received trophectoderm biopsied embryos had a significantly higher probability of having a baby weighing ≤1500 g and 1500–2500 g (p = .022) or ≤2500 g (p = .008). Proportion of preterm delivery was significantly higher in the biopsy group (p = .023). However, after adjusting for potential covariates, trophectoderm biopsy did not seem to increase the risk of preterm birth (OR 1.525; 95% CI, 0,644–3.611; p = .338) Conclusions: TE biopsy does not seem to impact serum β-hCG level on the 15th day after ET. Average birthweight is lower when a biopsied embryo was transferred. After adjusting for potential covariates, trophectoderm biopsy does not seem to increase the risk of preterm birth

Study of Characteristics of Pregnant Women Who Are Refugees and Aged Under 18 Years.

Introduction In recent years, the refugee crisis has become one of the most serious problems. It is well-known that women, individuals aged under 18 years, and pregnant refugees are particularly vulnerable to adverse conditions. In this study, we aimed to determine the characteristics of pregnant refugee women aged under 18 years. Methodology Data for pregnant women were recorded prospectively from 2019 to 2021, and pregnant refugee women aged ≤18 years were enrolled in the study. Sociodemographic characteristics of women, gravidity and parity status, the status of regular antenatal care visits and antenatal care visit any time until birth, type of birth, causes for cesarean section, presence of maternal comorbidities, obstetric complications, and baby-related characteristics were recorded. Results A total of 134 pregnant refugees were enrolled in the study. A total of 31 (23.1%) women had completed primary school, and two (1.5%) women had completedmiddle school or high school. Additionally, only 3.7%of women had a regular job, and 64.2% of the refugees had a total family income below the minimum wage. Also, 10.4% of women lived with more than three people outside the nuclear family. Gravidity numbers were one for 65 (48.5%) women, two for 50 (37.3%) women, and more than two for 19 (14.2%) women, respectively. The proportion of women with regular antenatal care visits was 19.4% (26), and 45.5% (61) had irregular antenatal care visits. Anemia and urinary tract infections were detected in 52 (28.8%) patients and seven (5.2%) patients, respectively. The proportion of preterm delivery was 8.9%, and 10.5% of infants had low birth weight. A total of 16 (11.9%) babies required neonatal intensive care unit support. Conclusions The present study demonstrated that pregnant women who are refugees and aged under 18 years have low education levels, insufficient family income, and often live in crowded families and even as the second wife of a husband. Moreover, although the birth rate was high in pregnant refugees, the rate of regular antenatal follow-up was low. Finally, this study showed that maternal anemia, preterm birth, and low birth weight were common in pregnant refugees.

Pregnancies in Elderly Mothers over 40years: What to Expect from the Rising New Age High-Risk Cohort?

Elderly women are believed to experience many risks associated with pregnancy. Literature fails to provide a clear consensus on the age group in which there is a rise in risk and pathophysiology contributing. 'Pregnancies over forty' are increasing in society, owing to changing lifestyles and sensibilities of youth and the advent of assisted reproductive techniques. In India, studies on elderly pregnant women above 40years of age are lacking. The aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women delivering above 40years. The study group (Group A) comprised of pregnancies in 50 women at age ≥ 40years on the date of delivery. The control group (Group B) had 50 women who delivered subsequent to the study group and age < 40. Various parameters and outcomes including parity, gestational age, number of gestations, co-existing medical illnesses, the incidence of hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), pre-term labor, mode of delivery, birth weight and obstetric and neonatal outcomes were compared. Chi-square test and independent T test were used for statistical analysis. While a good number of patients conceived spontaneously and with basic infertility management, i.e., 84% in the elderly gravid group (Group A) and 96% in the control group (Group B), the number of patients who required ART in Group A were statistically significant (Group A 16% and Group B 4%). Incidence of pre-existing medical diseases like hypertension, diabetes mellitus, thyroid dysfunction, other auto-immune diseases and chronic diseases were noted to be high (26%) in Group A (statistically significant difference). Incidence of HDP, GDM and fetal growth restriction were high in Group A. Tendency to have the presence of fibroid uterus was high in patients in Group A, i.e., 24%, compared to only 8% in the control group; difference was statistically significant. Proportion of pre-term deliveries were high in Group A. Cesarean section rate was high in Group A, though it was not statistically significant. Other perinatal observations and neonatal outcomes were comparable in both groups; differences were not statistically significant. The study reveals an association of a high-risk course of pregnancies in women above the age of 40years. Proportions of IVF pregnancies are higher in elderly women. Interestingly, the proportion of women in elderly group who conceived spontaneously and with basic infertility management including IUI was 84% in the present study. Medical comorbidities and incidence of fibroids were high in elderly women. Obstetric and neonatal outcomes of these pregnancies when managed efficiently are favorable.

Appendectomy during pregnancy: rates, safety, and outcomes over a five-year period. A hospital-based follow-up study

Introduction Appendicitis is the most common acute abdominal complication during pregnancy. If appendix perforation occurs there is an increasing risk of preterm delivery and other pregnancy complications. Objective To assess the outcome of pregnancy after appendectomy, the mode of surgery used, appendectomy rates, and complications. Methods A prospective cohort study of pregnant women with, or without, appendectomy at South Stockholm General Hospital, December 2015 to February 2021 in a setting where pregnant women are prioritized for surgery and laparoscopic surgery was standard of care in first half of pregnancy. Data on preoperative imaging, surgical method, intraoperative findings, microscopic findings, hospital stay, pregnancy, and 30-day complications were prospectively recorded in a local appendectomy register. A non-pregnant control group was gathered comprising women of fertile age in the same study interval. Results During the study period 50 pregnant women, of whom 44 gave birth, underwent appendectomy of 38 199 women giving birth. There were no differences between women with or without appendectomy in proportion of preterm delivery (4.5% vs. 5.6%), small-for-gestational age (2.3% vs. 6.2%), or Cesarean delivery (18.2% vs. 20.4%). The rate of appendix perforation was 19% in non-pregnant control group compared to 12% among pregnancy. There was no case of perforated appendix in the second half of pregnancy. However, women with gestational age > 20 weeks more frequently had an unaffected appendix compared to those operated ≤ 20 gestational weeks (4/11 vs. 2/39, p = .005). Laparoscopic surgery was used in 97% of non-pregnant control group, 92% of appendectomies ≤ 20 weeks gestation, and in 27% >20 weeks. As compared to first half, the appendectomy rate was three times lower during the second half of pregnancy. Pregnant women had priority for surgery < 6 h compared to < 24 h among non-pregnant women, this resulted in a shorter time-to-surgery among pregnant women (p < .001) Conclusion Routine laparoscopic surgery and time priority for pregnant surgery is associated with a low risk of perforation, preterm birth and other complications. However, a low threshold for surgery may increase the risk of a negative exploration.

ARE ADVERSE NEONATAL OUTCOMES MORE FREQUENT IN ADOLESCENT PREGNANCIES?

Adolescent pregnancy is a complex issue since it has been associated to adverse fetal and maternal outcomes. Method: This is a cross-sectional analytical study, having as a data source the medical records of pregnant women at a reference maternity hospital, located in the northeast of Brazil. Data was collected on maternal age, gestational age at delivery, birth weight, type of delivery, 1- and 5-minute Apgar scores less than 7, and fetal deaths. For the analysis of data, two groups were distinguished according to age: 1) girls aged 13-19 years old, and 2) women aged 20-34 years old. Results: A total of 1642 pregnant women’s medical records were included in this study, 28.1% belonged to adolescent mothers, and 71.9% to adult mothers. In the comparison between groups, there were significantly more cesarean deliveries to mothers aged 20-34 years (p&lt;.001); and a significantly higher proportion of preterm deliveries in the group of adolescent mothers (p=.0239). The other study variables did not present statistical significance. Conclusions: Adolescent mothers are at higher odds of preterm birth, and since this factor is associated short- and long-term adverse outcomes for the neonate, there is a need to prioritize this age group in prenatal care.

Efficacy of Vaginal and Oral Progesterone After Tocolytic Therapy in Threatened Preterm Labor: A 3-Arm Parallel- Group Randomized Controlled Trial

Background: Progesterone has established roles in preventing preterm labor in women with history of spontaneous preterm labor and short cervix, but there is little evidence to support its use to prevent preterm delivery in women with threatened preterm labor. Objective: To evaluate clinical efficacy of oral and vaginal progesterone on prevention of preterm delivery before 34 and 37 weeks in threatened preterm labor. Materials and Methods: The present study was a 3-arm randomized control trial, 231 singleton pregnancies of 28- to 33-weeks-6-days who had threatened preterm labor were recruited and randomized to three groups,1) 200 mg/day vaginal micronized progesterone, 2) 30 mg/day oral dydrogesterone and 3) control group with no progesterone. All groups received identical standard treatment for threatened preterm labor. Comparison of primary outcomes, which is the preterm delivery before 34 and 37 weeks, across groups were performed using chi-square test. Secondary outcomes, which are latency period, cervical change, maternal morbidity, neonatal morbidity, and mortality, were also compared. Results: Proportion of preterm delivery before 34 weeks was not significantly different across the three treatment groups at 16.0%, 12.0%, and 5.2% in control, oral progesterone, and vaginal progesterone groups, respectively (p=0.098). Concerning pairwise comparison, vaginal progesterone was more efficacious in preventing preterm delivery before 34 weeks than the control group (p=0.030), while oral progesterone was similarly effective to the control group (p=0.638). Proportion of preterm delivery before 37 weeks was not significantly different across the three treatment groups at 41.3%, 45.3%, and 31.2% in control, oral, and vaginal progesterone groups, respectively (p=0.182). Latency period differed across three treatment groups with a median latency of 36.5, 42.0, and 43.0 days in control, oral, and vaginal progesterone groups, respectively (p=0.041). Changes in cervical length and Bishop scores were not different across treatment groups. Conclusion: Vaginal progesterone could prevent preterm delivery before 34 weeks and prolong latency period in women with threatened preterm labor. Keywords: Preterm labor, Progesterone efficacy, Threatened preterm labor, After tocolysis

Late preterm versus term external cephalic version: an audit of a single obstetrician experience.

Recent literature evaluating the optimal timing for external cephalic version (ECV) in non-cephalic presentation is limited and hampered by methodological issues. We aimed to compare late preterm ECV [term (36-37weeks of gestation] to term ECV ( > 37weeks). We conducted a retrospective cohort study of prospectively collected data of ECV procedures performed by a single operator during a 6year period. Maternal, ECV procedure, delivery and fetal characteristics were compared between preterm ECV and term ECV. Overall, 547 (91.6%) of ECVs were term ECV while 50 (8.4%) procedures were preterm ECV. Success rate of ECV was 72.0% in the preterm ECV group vs. 71.5% in the term ECV group, p = 0.93. Proportion of preterm delivery was higher among the preterm ECV group (8% vs. 0%, p < 0.001), so does the proportion of early term deliveries (36.0% vs. 22.8%, p = 0.03). The rate of low birth weight was higher among the preterm ECV group (10.0% vs. 3.11%, p = 0.01). Rates of Apgar score at 5min ≤ 8 were higher in the preterm ECV (4.0% vs. 0.5%, p = 0.007). Vaginal delivery and intrapartum cesarean delivery rates did not differ between study groups (72.0% vs. 73.2%, p = 0.83 and 10% vs. 8.4%, p = 0.69). Initiating ECV before term is associated with increased rate of preterm delivery, early term delivery and low birth weight. No effect was found in mode of delivery, intrapartum cesarean delivery, reversion and spontaneous version. We advocate against preterm ECV until future prospective trials will better delineate the effect of preterm ECV on maternal and neonatal outcomes.

Quantifying bias between reported last menstrual period and ultrasonography estimates of gestational age in Lusaka, Zambia.

To quantify differences in assessing preterm delivery when calculating gestational age from last menstrual period (LMP) versus ultrasonography biometry. The Zambian Preterm Birth Prevention Study is an ongoing prospective cohort study that commenced enrolment in August 2015 at Women and Newborn Hospital of University Teaching Hospital in Lusaka, Zambia. Women at less than 20weeks of pregnancy who were enrolled between August 17, 2015, and August 31, 2017, and underwent ultrasonography examination were included in the present analysis. The primary outcome was the difference between ultrasonography- and LMP-based estimated gestational age. Associations between baseline predictors and outcomes were assessed using simple regression. The proportion of preterm deliveries using LMP- and ultrasonography-derived gestational dating was calculated using Kaplan-Meier analysis. The analysis included 942 women. The discrepancy between estimating gestational age using ultrasonography and LMP increased with greater gestational age at presentation and among patients with no history of preterm delivery. In a Kaplan-Meier analysis of 692 deliveries, 140 (20.2%, 95% confidence interval [CI] 17.7-23.0) and 79 (11.4%, 95% CI 9.6-13.6) deliveries were classified as preterm by LMP and ultrasonography estimates, respectively. Taking ultrasonography as a standard, a bias was observed in LMP-based gestational age estimates, which increased with advancing gestation at presentation. This resulted in misclassification of term deliveries as preterm.

Prevalence and determinants of preterm delivery in an inner city referral hospital, Greater Accra Region, Ghana-2016

Introduction : globally, preterm delivery contributes about 30% to 40% of neonatal mortality and 20% to 30% of infant and under-five mortality. The world’s preterm birth rate has been on the rise since the last two decades; with an increase of 20% since 1990 in high-income countries. Accurate data on prevalence and determinants of preterm delivery from low-income countries are not readily available. We assessed prevalence and determinants of preterm delivery in an inner city referral hospital in Ghana. Methods : a descriptive study followed by 12 unmatched case-control study was conducted from October 2015 to May 2016. A case of preterm was a baby in the hospital delivered during the study period at a gestational age between 28 and 36 weeks and a control was a baby delivered after 37 completed weeks of gestation. We interviewed mothers of cases and controls and reviewed maternal and fetal health records. Univariable analysis of categorical variables was expressed as frequencies and relative frequencies. At 95% confidence level, bivariable analysis and multiple logistic regression were done to determine associations between selected independent variables and preterm delivery. Results : of 5,215 deliveries, 796(15.3%) were preterm with 361(45.4%) of preterm babies being males. Mean gestational age was 32(+/-2.4) weeks. Determinants of preterm delivery were hypertensive complications in pregnancy [Odds ratio (OR)= 2.1, 95%CI 1.1-4.5], antepartum hemorrhage in index pregnancy (OR = 2.1, 95%CI 1.1-4.5), premature rupture of membranes (OR = 1.7, 95%CI 1.1-2.6) and Caesarean section delivery (OR = 1.4, 95%CI 1.2-4.6). Compared to controls, preterm babies were less likely to be delivered by mothers who had more than four antenatal clinics (ANC) attendance (OR = 0.2, 95%CI 0.0-0.1) and those with partner support (OR = 0.4, 95%CI 0.2-0.9) Conclusion : the proportion of preterm delivery was high, more likely in complicated pregnancies and less likely in ANC attendees and women with partner support. We educated mothers on need for ANC attendance and partner support.

Long-term outcome of infants born late preterm.

Late preterm infants are defined as those born between 34(0/0) and 36(6/7) weeks of gestation. This population represents a growing proportion of preterm deliveries and traditionally has been neglected as thought to behave similarly to term infants. However, studies in the last decade have shown that they are vulnerable not only during the first few weeks of life but also later on in infancy and childhood. The aim of this review is to summarize the published literature in the field of the long-term outcomes of the late preterm delivery. The main areas that are affected are the respiratory function and the neurodevelopment of these babies due to the early arrest in the lung and brain development, respectively. Moreover, the overall general health of this population is affected in the long-term and ongoing follow up studies are required to provide a better understanding in the field. Continuous efforts should also be made so that the needs of these infants are recognized and managed in a timely appropriate manner.

Paternal therapy with disease modifying drugs in multiple sclerosis and pregnancy outcomes: a prospective observational multicentric study

BackgroundMost of Multiple Sclerosis (MS) patients undergo disease modifying drug (DMD) therapy at childbearing age. The objective of this prospective, collaborative study, was to assess outcomes of pregnancies fathered by MS patients undergoing DMD.MethodsStructured interviews on pregnancies fathered by MS patients gathered in the Italian Pregnancy Dataset were collected; pregnancies were divided according to father exposure or unexposure to DMD at time of procreation. Treatment were compared with multivariable logistic and linear models.ResultsSeventy-eight pregnancies fathered by MS patients were tracked. Forty-five patients were taking DMD at time of conception (39 beta-interferons, 6 glatiramer acetate), while 33 pregnancies were unexposed to DMD. Seventy-five pregnancies ended in live-births, 44 in the exposed and 31 in the unexposed group. No significant differences between the two groups were found in the risk of spontaneous abortion or malformations (p > 0.454), mean gestational age (p = 0.513), frequency of cesarean delivery (p = 0.644), birth weight (p = 0.821) and birth length (p = 0.649). In comparison with data of the Italian general population, the proportion of spontaneous abortion and caesarean delivery in exposed pregnancies fell within the estimates, while the proportion of pre-term delivery in the exposed group was higher than expected.ConclusionsOur data indicate no association between paternal DMD exposure at time of conception and risk of spontaneous abortion, adverse fetal outcomes and congenital malformations. Further studies clarifying the role of DMD fathers intake prior and during pregnancy are desirable, to supply guidelines for clinical practice.

Time to focus on the public health aspects of preterm delivery

Preterm delivery is a leading cause of child death and results in substantial emotional and economic costs for both the involved family and for society. It increases later disease risk in both the mother and in her preterm delivered child. The proportion of preterm delivery is increasing in several populations. Public health interventions have so far been the only beneficial initiative in prevention and treatment of preterm delivery and there is a need for both larger research studies and an approach that centers more on this complicated condition as a public health problem. The public health and population focus is an important fundament for proper use of new molecular biology techniques that in the future may increase our understanding of the pathophysiological pathways of preterm delivery and result in causal treatment modalities that are applicable to the clinical setting.

Cost-effectiveness of fibronectin testing in a triage in women with threatened preterm labor: alleviation of pregnancy outcome by suspending tocolysis in early labor (APOSTEL-I trial)

BackgroundAt present, women with threatened preterm labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm labor. We will assess whether triage of these women with fibronectin testing, cervical length or their combination is cost-effective.Methods/DesignWe will investigate a prospective cohort of women referred to a perinatal centre for spontaneous threatened preterm labor between 24 and 34 weeks with intact membranes. All women will be tested for fibronectin and cervical length. Women with a cervical length <10 mm and women with a cervical length between 10-30 mm in combination with a positive fibronectin test will be treated with tocolytics according to local protocol. Women with a cervical length between 10-30 mm in combination with a negative fibronectin test will be randomised between treatment with nifedipine (intervention) and placebo (control) for 48 hours. Women with a cervical length > 30 mm will be managed according to local protocol. Corticosteroids may be given to all women at the discretion of the attending physician. Primary outcome measure will be delivery within 7 days. Secondary outcome measures will be neonatal morbidity and mortality, complications of tocolytics, costs and health related quality of life. The analysis will be according to the intention to treat principle. We anticipate the probability on preterm birth within 7 days in the group of women with a negative fibronectine test to be 5%. Two groups of 110 women will be needed to assure that in case of non-inferiority the difference in the proportion of preterm deliveries < 7 days will be within a prespecified boundary of 7.5% (one sided test, β 0.2, α 0.05). Data obtained from women with a positive and negative fibronectin tests in both the cohort study and the trial will be integrated in a cost-effectiveness analysis that will assess economic consequences of the use of fibronectin.DiscussionThis study will provide evidence for the use of fibronectin testing as safe and cost-effective method in a triage for threatened preterm labor.Trial registrationNederlands Trial Register (NTR) number 1857, .

Iron-deficiency anemia increases risk of preterm delivery.

In an inner-city sample of pregnant women, iron-deficiency anemia was associated with a higher risk of preterm delivery and low birth weight but not with small-for-gestational-age births. However, the prevalence of iron-deficiency anemia (3.5%) explained only a small proportion of preterm deliveries.

Pregnancy Outcome in Women Before and After Cervical Conisation: Population-Based Cohort Study

Objectives To examine the consequences of cervical conisation in terms of adverse outcome in subsequent pregnancies. Design Population based cohort study. Data sources Data on cervical conisation derived from the Cancer Registry of Norway and on pregnancy outcome from the Medical Birth Registry of Norway, 1967-2003. 15 108 births occurred in women who had previously undergone cervical conisation and 57 136 who subsequently underwent cervical conisation. In the same period there were 2 164 006 births to women who had not undergone relevant treatment (control). Results The proportion of preterm delivery was 17.2% in women who gave birth after cervical conisation versus 6.7% in women who gave birth before cervical conisation and 6.2% in women who had not undergone cervical conisation. The relative risk of a late abortion ( Conclusion Cervical conisation influences outcome in subsequent pregnancies in terms of an increased risk of preterm delivery, especially in the early gestational age groups in which the clinical significance is highest. A careful clinical approach should be taken in the selection of women for cervical conisation and in the clinical care of pregnancies after a cervical conisation.

Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome

The goal was to study the effects of social support during pregnancy on maternal depressive symptoms, quality of life and pregnancy outcomes. Eight hundred ninety-six women were prospectively studied in the first trimester of pregnancy and following completion of the pregnancy. The sample was divided into quartiles yielding groups of low, medium and high social support based on perceived social support. Pregnant women with low support reported increased depressive symptoms and reduced quality of life. The effects of social support on pregnancy outcomes were particularly pronounced in women who had smoked during pregnancy, with significant main effects of social support in a two-way analysis of variance (smoking status and social support) for child body length (F = 4.26, P = 0.04; 50.43 +/- 2.81 cm with low support versus 51.76 +/- 2.31 cm with high support) and birthweight (F = 11.35, P = 0.001; 3175 +/- 453 g with low support versus 3571 +/- 409 g with high support). In smokers, pregnancy complications occurred more frequently when given low support {34 versus 10.3% with high support, chi(2) = 5.49, P = 0.019; relative risk (RR) = 3.3 [95% confidence interval (95% CI) = 1.1-10.2]}, and the proportion of preterm deliveries was greater given low support (10.0 versus 0% with high support, chi(2) = 3.84, P = 0.05, odds ratio = 8.1). Lack of social support constitutes an important risk factor for maternal well-being during pregnancy and has adverse effects on pregnancy outcomes.

Cervical cerclage for prevention of preterm delivery in woman with short cervix:randomised controlled trial

Cervical cerclage has been widely used in the past 50 years to prevent early preterm birth and its associated neonatal mortality and morbidity. Results of randomised trials have not generally lent support to this practice, but this absence of benefit may be due to suboptimum patient selection, which was essentially based on obstetric history. A more effective way of identifying the high-risk group for early preterm delivery might be by transvaginal sonographic measurement of cervical length. We undertook a multicentre randomised controlled trial to investigate whether, in women with a short cervix identified by routine transvaginal scanning at 22-24 weeks' gestation, the insertion of a Shirodkar suture reduces early preterm delivery. Cervical length was measured in 47?123 women. The cervix was 15 mm or less in 470, and 253 (54%) of these women participated in the study and were randomised to cervical cerclage (127) or to expectant management (126). Primary outcome was the frequency of delivery before 33 completed weeks (231 days) of pregnancy. The proportion of preterm delivery before 33 weeks was similar in both groups, 22% (28 of 127) in the cerclage group versus 26% (33 of 126) in the control group (relative risk=0.84, 95% CI 0.54-1.31, p=0.44), with no significant differences in perinatal or maternal morbidity or mortality. The insertion of a Shirodkar suture in women with a short cervix does not substantially reduce the risk of early preterm delivery. Routine sonographic measurement of cervical length at 22-24 weeks identifies a group at high risk of early preterm birth.

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

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

Effect of ethnic origin of mother on fetal outcome.

The outcome of 11046 infants, from 20 weeks' gestation, born to mothers of different ethnic origins within one London borough has been analysed. There was no difference in perinatal death rates between the Asian and white infants. Among those with mothers from Africa and the West Indies there were overall significantly more intrauterine deaths (26.8/1000 and 20.0/1000) and neonatal deaths (8.6/1000 and 9.6/1000) than for the white mothers (intrauterine deaths 8.3/1000; neonatal deaths 3.7/1000). At less than 28 weeks', gestation specific death rates were similar in all groups and the overall higher death rates were due to an increase in the proportion of preterm deliveries among the black mothers. From 28 to 36 weeks' gestation, black infants born alive had lower neonatal death rates (7.7/1000) than the white infants (19/1000). The cause of the increased incidence of preterm labour among the black mothers is uncertain, though differences in intrauterine infection rates may be an important factor.