Risk Factor For Preterm Delivery Research Articles

#1616 Pregnancy and fetal outcome in women with Alport syndrome

Abstract Background and Aims Pregnancy in patients with CKD is associated with maternal and fetal risks. The data about pregnancy outcome in Alport syndrome (AS) is limited. The aim was to evaluate the fetal and maternal pregnancy outcome in women with AS. Method One center retrospective study included 88 women with AS (86 with COL4A5, 2 with COL4A4 variants). Data at conception (age, arterial hypertension (HP), proteinuria (Pr), GFR), course of pregnancy (HP, Pr, GFR, pre-eclampsia (PE)), delivery (preterm (PD): < 37 weeks; early preterm (EPD): < 34 weeks), fetus characteristics (intrauterine fetal growth restriction (IUGR): L < 2 z-score for gestational age; small for gestational age (SGA): m < 2 z-score (SGA)) were obtained from medical charts and a cross-sectional survey. Results Information of 88 women, 133 term pregnancies (2 in 25 pts, 3 in 2 pts) were analyzed. Only 16 (q = 0,18) from 85 (q = 0,96) women with hematuria had diagnosis of AS before pregnancy; one of them had HP, 13 pts had Pr. HP, Pr, decreased GFR were revealed in 11 (q = 0,13), 27 (q = 0,2) and 9 (q = 0,06) pregnant, respectively. PE occurred in 8 cases (q = 0,06); PD was seen in 24 (q = 0,18) and EPD in 1 (q = 0,01) cases; cesarean section was performed in 8 cases (q = 0,07). IUGR and SGA were recorded in 8 (q = 0,06) and 11 (q = 0,08) neonates, respectively; 6 babies (q = 0,05) required a neonatal intensive care unit stay. Pr was the risk factor for PE (CI 14,86 ± 0,85, p < 0,001), PD (CI 6,267 ± 0,49; p < 0,001), IUGR (CI 14,86 ± 0,85, p < 0,001), SGA (CI 8,93 ± 0,67, p < 0,001). Conclusion The risk of pre-eclampsia and slowing of fetal growth in women with AS and normal kidney function appears comparable to that in the general population. But AS should be considered as a potential risk factor for preterm delivery. Proteinuria is associated with unfavorable pregnancy and fetal outcome in AS.

A Case Control Study to Assess the Risk Factors for Preterm Deliveries among the Mothers Admitted In Shri Vinoba Bhave Civil Hospital, Silvassa, Dadra And Nagar Haveli

BACKGROUND: According to WHO Preterm delivery is defined as a delivery that occurs before 37 weeks of gestation. “Born too Soon” decade of action on preterm birth, produced by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) together with PMNCH-the world’s largest alliance for Women, Children, and adolescents sounds the alarm on a “Silent emergency” of preterm birth, long under recognized in its scale and severity which is impeding progress in improving children’s health and survival. OBJECTIVE: This study aim to determine the risk factors associate with preterm deliveries among the Mothers admitted in Shri Vinoba Bhave Civil Hospital, Silvassa, Dadra and Nagar Haveli. METHODS: The research design adopted for study was Case- control study. The written permission was obtained from the concerned authority of Shri Vinoba Bhave Civil Hospital, Silvassa for conducting the study. During the data collection period, the investigator established a good rapport with Mothers who had participated in the study and taken written consent from each of them. Samples were assigned using consecutive sampling technique. As per the research design & tool, demographic & maternal related data was collected. After collecting data from 200 samples for control group and 50 samples for case group were analysed using descriptive and inferential statistics. RESULT: A family history of PTD (OR:2.1, p value: 0.001, CI: 0.897-6.610), Height (OR: 1.672, p Value: 0.002, CI: 0.127-21.990), weight gain during pregnancy (OR: 13.070, p value: 0.024, CI: 1.413-120.851), , number of health visited during pregnancy (OR:8.411, p value: 0.001, CI:2.485-28.469), danger sign during pregnancy (OR: 2.01, p value: 0.001, CI:0.080-2.375), hypertension (OR:2.41, p value<0.0001, CI: 0.045-8.348), oligohydramnions (OR: 1.652, p value: 0.004, CI: 0.544-5.817)and PROM (OR: 2.319, p value=0.012, CI:0.012-1.280) were all significant associated with PTD. CONCLUSION: The present study assessed the risk factors for preterm deliveries among the mothers admitted at Shri Vinoba Bhave Civil Hospital, Silvassa, DNH. In this study, a family history of preterm birth, weight gain during pregnancy, danger sign during pregnancy, hypertension, oligohydramnions and PROM. Recognizing the most common risk factors for PTD will help to increase the awareness about high-risk pregnancy, improve the preventive measures of preterm risk factors and modify preterm care protocol.

Prevention and treatment of preterm delivery in pregnant women with isthmic-cervical incompetence

Preterm delivery (PD) is a global public health problem, being the leading cause of perinatal morbidity and mortality in many countries. Despite numerous studies on the etiology of this condition, PD incidence has been increasing annually, and about 15 million infants are born prematurely (before the week 37 of gestation) worldwide. One of the main risk factors for PD is isthmic-cervical incompetence (ICI), which leads to microbial invasion of the amniotic cavity, prolapse of the fetal bladder, premature discharge of amniotic fluid and PD. Currently, several methods for ICI prevention and treatment are available: conservative (use of progesterone, obstetric pessary) and surgical (transvaginal cerclage and transabdominal cerclage).

Iron prophylaxis in Pregnancy - Modern and Ayurvedic View

Iron is mandatory for normal fetal development, including the brain. Iron deficiency may have deleterious effects for intelligence and behavioral development. It is important to prevent iron deficiency in the fetus by preventing iron deficiency in the pregnant woman. Iron deficiency anemia during pregnancy is a risk factor for preterm delivery and low birth weight. Ayurveda has recorded some of the complications of pregnancy under the name Garbhopdravas. Garbhini Pandu is the commonest Upadrava among them. Garbhini Pandu is described as a symptom and not as a Vyadhi in Ayurveda classics.

Contributing factors for pregnancy outcomes in women with PCOS after their first FET treatment: a retrospective cohort study

Objective We aim to explore the contributing factors of clinical pregnancy outcomes in PCOS patients undergoing their first FET treatment. Methods A retrospective analysis was conducted on 574 PCOS patients undergoing their first FET treatment at a private fertility center from January 2018 to December 2021. Results During the first FET cycle of PCOS patients, progesterone levels (aOR 0.109, 95% CI 0.018-0.670) and endometrial thickness (EMT) (aOR 1.126, 95% CI 1.043-1.419) on the hCG trigger day were associated with the clinical pregnancy rate. Similarly, progesterone levels (aOR 0.055, 95% CI 0.007-0.420) and EMT (aOR 1.179, 95% CI 1.011-1.376) on the hCG trigger day were associated with the live birth rate. In addition, AFC (aOR 1.179, 95% CI 1.011-1.376) was found to be a risk factor for preterm delivery. Conclusions In women with PCOS undergoing their first FET, lower progesterone levels and higher EMT on hCG trigger day were associated with clinical pregnancy and live birth, and AFC was a risk factor for preterm delivery. During FET treatment, paying attention to the patient’s endocrine indicators and follicle status may have a positive effect on predicting and improving the pregnancy outcome of PCOS patients.

1149 The Impact of Obstetric Risk Factors for Preterm Delivery among Women with Cervical Cerclage

1149 The Impact of Obstetric Risk Factors for Preterm Delivery among Women with Cervical Cerclage

1150 Risk factors for preterm delivery in monochorionic diamniotic pregnancies undergoing selective cord occlusion

1150 Risk factors for preterm delivery in monochorionic diamniotic pregnancies undergoing selective cord occlusion

Recurrent preterm delivery following twin versus singleton preterm delivery: A retrospective cohort.

The main risk factor for preterm delivery (PTD; <37 gestational weeks) is having a history of PTD. The aim of this research was to compare the risk for recurrent PTD following twin versus singleton gestation PTD. A retrospective population-based cohort study was performed, including all women who had two consecutive pregnancies, the first of which ended with PTD. The incidence of PTD recurrence was compared between women with PTD in twin versus singleton gestation. Multivariable logistic models were used to study the association between twinning status and PTD recurrence, and specifically by gestational age of the first PTD, inter-pregnancy interval (IPI), and mode of conception. The study population included 15 590 women, of whom 1680 (10.8%) had twins in their index pregnancy and 13 910 (89.2%) had singletons. The incidence of recurrent PTD was 10.5% (n = 177) following twin PTD versus 21.9% (n = 3044) following singleton PTD (adjusted odds ratio = 0.50, 95% confidence interval 0.32-0.76, while controlling for confounding variables). The results were consistent while stratifying by IPI, gestational age of the first PTD, or mode of conception. Women with PTD in twin gestations are at lower risk for recurrent PTD compared with women with singleton PTD.

Assessing the Clinical Significance of Third-Trimester Post-Coital Bleeding.

This study aimed to evaluate the impact of third-trimester post-coital bleeding (PCB) on pregnancy outcomes. A retrospective cohort study was conducted at two tertiary medical centers, including all pregnant women between 24 and 34 weeks of gestation referred due to vaginal bleeding over an 11-year period. The study population includes all singleton deliveries; within this population, women were further classified into three groups: those admitted due to vaginal bleeding related to PCB, those admitted due to vaginal bleeding not related to PCB, and those who did not report vaginal bleeding. The primary outcome measure was delivery prior to 37 weeks of gestation, while secondary outcome measures included maternal and neonatal complications. Baseline characteristics of the two groups were compared. During the study period, there were a total of 51,698 deliveries. Among these, 230 cases involved bleeding between 24 and 34 weeks of gestation, 34 (14.8%) were identified as PCB, and 196 as bleeding unrelated to intercourse. In addition, 51,468 pregnancies without bleeding were analyzed as the general population for comparison. The incidence of preterm labor before 37 weeks of gestation was notably higher in both women with PCB (14.7%) and those with bleeding unrelated to coitus (20.9%) compared to the general population (5.6%); however, there was no statistically significant difference between the two bleeding groups (p = 0.403) while both were significantly different from the general population (p &lt; 0.001). The odds ratio for preterm birth before 37 weeks of gestation after PCB was 3.29 (95% CI: 1.26-8.56, p = 0.0149). There were no significant differences between the PCB and bleeding unrelated to intercourse groups in terms of maternal and neonatal complications. This study found that third-trimester PCB is a risk factor for preterm delivery, with rates similar to other causes of third-trimester bleeding but significantly higher than the general population without bleeding. These findings challenge the assumption that PCB is benign.

Ingenuity pathway analysis of gingival epithelial cells stimulated with estradiol and progesterone

ObjectivePeriodontal disease is a risk factor for preterm delivery, and elevated female hormone levels during pregnancy promote hormone-dependent periodontopathogenic bacterial growth and gingivitis. Although the saliva of pregnant women contains female hormones at elevated levels, their effects on the gingiva are poorly understood. Therefore, in this study, we investigated the effects of estradiol and progesterone stimulation on gingival epithelial cells via ingenuity pathway analysis. MethodsHuman gingival epithelial progenitors were cultured in a CnT-Prime medium; 17β-estradiol (E2) and progesterone (P4) were used as the reagents. Cells treated with dimethyl sulfoxide alone were used as the control group. Cells in the control and experimental groups were incubated for 12 h. RNA was extracted from the cultured cells, RNA-Seq was performed, and pathway analysis was conducted. ResultsDifferentially expressed genes were detected for 699 (over 2-fold increase) and 348 (decrease) genes in group E2 and for 1448 (increase) and 924 (decrease) genes in group P4 compared with those in the control group (FDR <0.05, n = 4). The z-scores of the pathways suggest that E2 and P4 increased the activity of the wound healing signaling pathway. The activation of this pathway was higher in the E2 and P4 groups than that in the control group. ConclusionsThe results of this study suggest that estradiol and progesterone may affect gingival homeostasis and wound healing.

Porphyromonas gingivalis outer membrane vesicles shape trophoblast cell metabolism impairing functions associated to adverse pregnancy outcome.

Periodontitis is proposed as a risk factor for preterm delivery, fetal growth restriction, and preeclampsia with severe consequences for maternal and neonatal health, but the biological mechanisms involved are elusive. Porphyromonas gingivalis gain access to the placental bed and impair trophoblast cell function, as assessed in murine and human pregnancy, suggesting a pathogenic role in adverse pregnancy and neonatal outcomes. P. gingivalis releases outer membrane vesicles (P. gingivalis OMV) during growth that spread to distant tissues and are internalized in host cells as described in metabolic, neurological, and vascular systemic diseases. Here we tested the hypothesis that P. gingivalis OMV internalized in trophoblast cells disrupt their metabolism leading to trophoblast and placenta dysfunction and adverse pregnancy outcomes. An in vitro design with human trophoblast cells incubated with P. gingivalis OMV was used together with ex vivo and in vivo approaches in pregnant mice treated with P. gingivalis OMV. P. gingivalis OMV modulated human trophoblast cell metabolism by reducing glycolytic pathways and decreasing total reactive oxygen species with sustained mitochondrial activity. Metabolic changes induced by P. gingivalis OMV did not compromise cell viability; instead, it turned trophoblast cells into a metabolic resting state where central functions such as migration and invasion were reduced. The effects of P. gingivalis OMV on human trophoblast cells were corroborated ex vivo in mouse whole placenta and in vivo in pregnant mice: P. gingivalis OMV reduced glycolytic pathways in the placenta and led to lower placental and fetal weight gain in vivo with reduced placental expression of the glucose transporter GLUT1. The present results point to OMV as a key component of P. gingivalis involved in adverse pregnancy outcomes, and even more, unveil a metabolic cue in the deleterious effect of P. gingivalis OMV on trophoblast cells and mouse pregnancy, providing new clues to understand pathogenic mechanisms in pregnancy complications and other systemic diseases.

Spontaneous Preterm Birth: a Fetal-Maternal Metabolic Imbalance

Abstract Preterm delivery is a major global health problem associated with increased neonatal morbidity and mortality. To develop effective strategies to reduce preterm birth, it is important to address the causes of and risk factors for this condition. Maternal metabolism plays a crucial role in pregnancy outcomes, as it affects the availability of nutrients, energy, and other essential factors required for fetal development and growth. Several aspects of maternal metabolism can potentially contribute to the risk of preterm delivery. Severe energy deficiency as observed in women suffering from eating disorders can affect the hypothalamic-pituitary-gonadal axis resulting in amenorrhea and infertility, suggesting that maintaining a minimum maternal weight is essential to uphold a functional reproductive system, thus ensuring a successful pregnancy. Maternal undernutrition as observed in past famine and observations and animal studies may affect fetal growth and trigger an early activation of the parturition pathway leading to preterm delivery. A correlation exists between maternal size and gestation duration. Obesity is associated with a higher likelihood of medically indicated preterm birth. Low maternal body mass index and low gestational weight gain during pregnancy have been associated with preterm birth, potentially due to fetal-maternal metabolic imbalance; however, the exact mechanism remains to be determined, thus emphasizing the importance of appropriate weight management before and during pregnancy. Addressing metabolic-related risk factors for preterm delivery requires a comprehensive approach to reduce the burden of preterm delivery and improve neonatal outcomes. This review aims to explore various aspects of fetal-maternal metabolic imbalance that could potentially contribute to preterm birth. By doing so, we suggest a novel and comprehensive approach that sheds light on the intricate connection between fetal-maternal imbalance and the susceptibility to preterm birth.

Investigating the predictive role of uterocervical angle in predicting preterm labor in singleton pregnancies: a meta-analysis.

In this meta-analysis, we aimedto demonstrate the relationship between uterocervical angle and preterm labor in singleton pregnancies more clearly and reliablywith this meta-analysis. In this study, we use keywords such as "uterocervical angle," "cervical angle," "angle," "cervix," "cervical," "preterm," and "preterm labour." We searched various databases, including PubMed, MEDLINE, ClinicalKey, Scopus, ScienceDirect, Web of Science, and Google Scholar. The search encompassed the period from January 1, 2010, to December 27, 2020. As a result of the literature review, a total of 585 articles were identified. After the screening and selection process, six studies met the inclusion criteria and were included in the analysis. These six studies were deemed relevant and provided valuable information on the research topic. When the Egger test (p = 0.020) and Begg test (p = 0.188) were performed, no significant publication bias was found in the studies examined. These statistical tests assess publication bias, and the resulting p-values indicate a low probability of bias in the included studies. Cochran's Q test revealed the presence of heterogeneity among the included studies. Heterogeneity indicates variability in the results beyond what would be expected by chance alone. This finding suggests that the studies may differ in methodologies, populations, or other factors, which could impact the overall results and require further investigation. There was a significant difference between the patient and control groups (p < 0.001). This result provides strong evidence to support the importance of the difference between the two groups compared. Based on the findings of this study, a wider uterocervical angle appeared to be significantly associated with an increased risk of preterm delivery in overall effect. It concluded that a wide uterocervical angle may be a potential risk factor for preterm delivery. Moreover, the study revealed a significant association between wider uterocervical angles and an elevated risk of preterm labour in singleton pregnancies. In this study, the definition of preterm birth accepts as birth before 37 weeks of gestation. These results highlight the potential significance of evaluating the uterocervical angle as a meaningful predictor for identifying the propensity of preterm labour in singleton pregnancies.

Effect of spousal military deployment during pregnancy on neonatal birth outcomes: a systematic review

IntroductionStress experienced during pregnancy is associated with adverse birth outcomes including preterm delivery (PTD) and low birth weight (LBW). Pregnant spouses and partners of deployed military personnel can experience heightened...

Prevalence and risk factors for preterm delivery in UNIOSUN Teaching Hospital, Osogbo - A 5 year retrospective review

Introduction: Preterm delivery is the leading cause of death in the neonatal period. It causes 28% of perinatal mortality. In Nigeria, it is responsible for 40-60% of perinatal morbidity. According to a U.S. research, preterm births have surged globally. In 2016, 16.8% of singleton live births in Lagos, Nigeria, were preterm.Methods: It was a retrospective review of patients with singleton preterm delivery in UNIOSUN Teaching Hospital, Osogbo from July 2013 to June 2018. Case records of mothers/patients with preterm deliveries were retrieved. Information on the patients' age, parity, educational status, weight, body mass index, number of antenatal visits, identifiable causes of preterm delivery and others were all extracted.Result: During the research period, 2,234 babies were born, including 210 preterm singletons out of which 147 were reviewed. Singleton preterm birth prevalence was 9.4%.Of the 147 mothers, n (20.4) had premature rupture of membrane (PROM), hypertensive disorders in pregnancy occurred in n(17.0%), Urinary Tract Infection (10.8%) and malaria in pregnancy (6.1%).Conclusion: Preterm birth rates were low compared to recent rates in the country. PROM, malaria in pregnancy, UTI in pregnancy, hypertensive disorders in pregnancy and previous history of spontaneous miscarriage were important causes/risk factors for preterm delivery.

Perioperative risk factors of preterm delivery after fetoscopic laser photocoagulation for twin-twin transfusion syndrome.

To identify risk factors for preterm delivery (PTD) in patients who received fetoscopic laser photocoagulation (FLP) of placental anastomoses for twin-twin transfusion syndrome (TTTS). This retrospective cohort study prospectively analyzed and recorded perioperative data in a cohort of patients who had FLP for TTTS, identifying perioperative risk factors for PTD using a Cox proportional hazard regression model. Of 304 patients included, 26 (8.6%) delivered within 4weeks of FLP. Independent predictors of delivery within 4weeks of FLP were a history of PTD (hazard ratio [HR]: 5.91, 95% confidence interval [CI]:1.21-28.82, p=0.03), vaginal bleeding in the second trimester (HR: 6.62, 95% CI: 1.76-24.90, p<0.01), and amnioreduction ≥1715mL (HR: 3.16, 95% CI: 1.11-9.05, p<0.03). Patients with a history of PTD, preoperative vaginal bleeding, and amnioreduction ≥1715mL were more likely to deliver prematurely.

Beberapa Faktor Risiko Kejadian Persalinan Prematur (Studi Persalinan Prematur di RSUD Hj. Anna Lasmanah Kabupaten Banjarnegara)

Preterm delivery occurs before 37 weeks gestation. One of the causes of high infant mortality rate in Banjarnegara district in 2013 due to preterm birth (36,53%). The purpose of this study was to analyze the risk factors associated with the incidence of preterm delivery. The method used was a quantitative method with case control design. This study consisted of 69 cases and 69 controls. Samples were taken by simple random sampling. Data analysis used chi square test with α= 95%. The results showed correlation between age (OR=2,412 (1,188-4,900)), hemoglobin concentration (OR=3,514 (1,631-7,571)), mid upper arm circumference (OR=2,605 (1,200-5,656)), gestational weight gain (OR= 10,384 (4,524-23,833)), history of preterm delivery (OR=9,750 (2,790-34,071), family income (OR=6,535 (3,100-13,776)), and antenatal care (OR=7,708 (3,310-17,952)) with preterm delivery. There were no correlation between parity, body mass index pre-pregnancy, status of cigaretee smoke exposure and presence concomitant diseases. Advice for Health Service by Midwife to have a personal blood test tool to measure hemoglobin levels of pregrant women, so Midwife can check and monitor status of anemic pregnant women directly and actively provide information about the risk factors for preterm delivery, partiulary weight gain according to the recommendation from Institute of Medicine. To pregnant women should be routine to do antenatal care, so the risk factor of preterm delivery can be known as soon as possible.

Mode of Delivery and Neonatal Outcome in Adolescent Pregnancy (13-16 Years Old) Associated with Anemia.

Background: Adolescent pregnancy represents an important public-health problem due to its maternal and fetal outcomes. Adolescent patients are predisposed to multiple obstetrical complications, including anemia and preterm birth which has a higher incidence among this population; withal, in the specialty literature, anemia is considered to be a risk factor for preterm delivery; furthermore, multiple studies have demonstrated that a very young age is an independent risk factor for preterm birth. Objectives: The study aims to reveal if anemia during adolescent pregnancy has a negative impact on the time and mode of delivery and newborns’ outcomes. Patients and methods: We performed a retrospective multicentric study on adolescent pregnancy. We analyzed 172 patients aged between 13 and 16 years who delivered in two large tertiary hospitals between 1 October 2018 and 15 April 2022. We divided the patients into two groups—a study group (n = 64) with anemia and a control group (n = 108) without anemia. We evaluated the modes of delivery, the times of birth, and the neonatal outcomes by 1-min newborn’s Apgar score, neonatal intensive-care unit (NICU) admission, and the newborns’ weights. Results: The rate of cesarean section was higher in patients with anemia than in the control group (45.31% vs. 38.88%, p < 0.001). We found that patients between 13 and 16 years diagnosed with anemia have a higher risk of preterm birth than those without anemia (35.93% vs. 21.29%, p < 0.001); however, an increased rate of LBW neonates was observed in the anemic adolescent group ≤14 years (p < 0.001). Regarding the newborns’ 1-min Apgar score, NICU admission, no statistically significant differences were recorded between the two groups according to the severity of anemia. In the anemic patients’ group, prenatal screening was identified in 9.37% of cases, while in the control group, in 16.67% (p = 0.034), which represents negative predictive factors, along with a low socio-economic status for the presence of anemia in young adolescent patients. Conclusions: Anemia is a risk factor for preterm birth, LBW, and cesarean section in young adolescent pregnancy. The association of lack of prenatal care and low socio-economic status worsens maternal and neonatal outcomes.

Preterm Delivery: Associated Risk Factors And Neonatal Outcomes in Duhok Hospital for Obstetrics And Gynecology

Objectives: To identify the risk factors and evaluate the early neonatal outcomes of premature infants in Duhok Hospital for Obstetrics and Gynecology, a tertiary center in Kurdistan Region - Iraq. Methods: This cross sectional study was carried out from September 1/2021 to December 31/2021. Four hundred participants were recruited, 200 were preterm and 200 were term. The participants were examined and followed till delivery. Multivariable logistic regression analysis was used to identify the risk factors for preterm delivery. Results: The risks factors for preterm delivery were maternal age ≥ 35 years (AOR 3.32; 95 % CI 1.12-9.86), nulliparity (AOR 2.14; 95 % CI 1.25-3.67), history of preterm birth (AOR 6.51; 95 % CI 1.99-21.28,), no ANC (AOR 3.01; 95 % CI 1.32-6.87), &lt; 4 ANC visits (AOR 1.92; 95 % CI 1.12-3.30), PROM (AOR 4.71; 95 % CI 2.71-8.16), antepartum hemorrhage (AOR 9.25; 95 % CI 1.81-47.39), hypertensive disorders in pregnancy (AOR 2.30; 95 % CI 1.12-4.71) and anemia (AOR 3.51; 95 % CI 1.86-6.63). Preterm delivery is linked to poor early neonatal outcomes. Conclusions: Early identification of women at risk for preterm delivery by health care providers is essential to prevent preterm delivery

Risk Factors of Preterm Birth in Women After Local Treatment of Cervical Intraepithelial Neoplasia - a Retrospective Cohort Study.

Purpose A previous cervical intraepithelial neoplasia is associated with an increased obstetrical risk. It was the aim of the study to identify risk factors of preterm birth in patients with cervical intraepithelial neoplasia in dependence of the treatment modality (excisional vs. ablative). Methods Women with treated cervical intraepithelial neoplasia and subsequent pregnancy (n=155) were included in this retrospective study. Methods of treatment were either conization by large loop excision of the transformation zone (LLETZ) or ablative laser vaporization. Results Of the total population 60.6% (n=94) had a conization and 39.4% (n=61) a laser vaporization alone. The frequency of preterm birth <37 weeks was 9.7% (n=15) without differences between conization and laser (11.7 vs. 6.7%, p=0.407) with an odds ratio (OR) of 1.9 (95% confidence interval [CI] 0.6-6.2). Preterm birth <34 weeks was found in 2.6% (n=4), of which all had a conization (4.3 vs. 0%, p=0.157). Risk factors for preterm birth were repeated cervical intervention (OR 4.7 [95%CI 1.5-14.3]), especially a combination of conization and laser ablation (OR 14.9 [95%CI 4.0-55.6]), age at intervention <30 years (OR 6.0 [95%CI 1.3-27.4]), a history of preterm birth (OR 4.7 [95%CI 1.3-17.6]) and age at delivery <28 years (OR 4.7 [95%CI 1.5-14.3]). Conclusion The large loop excision of the transformation zone as a modern, less invasive ablative treatment did not obviously increase the risk of preterm birth compared to laser vaporization. The most important risk factor for preterm delivery was the need of a repeated intervention, especially at younger age. We assume that the persistence or recurrence of the cervical intraepithelial neoplasia following a high-risk human papillomavirus infection is mainly responsible for the observed effect.