Threatened Preterm Labor Research Articles

Change in cervical length in cases resulting in threatened preterm labor.

To determine the predisposing changes in cervical length (CL) and the critical range of CL in which significant uterine contractions emerge resulting in threatened preterm labor (TPL). Sixty-eight uncomplicated singleton pregnancies where the CL was <25mm before 31weeks were divided into cases with TPL (n=23) or without (n=45). CL and uterine contractions were monitored sequentially starting between 16 and 20weeks. The gestational ages when a CL of <25 or <15mm was first observed, the interval between these two measurements, and the CL value at TPL diagnosis were analyzed retrospectively. (1) The gestational ages when a CL of <25 and <15mm was first detected were lower in the TPL group (25 (median); 18-30 (range) and 28; 25-33weeks, respectively) than in the non-TPL group (27; 20-30 and 33; 26-35weeks; P=0.030 and P<0.001). (2) The interval between the two measurements was shorter in the TPL group (2.5; 0-15weeks) than in the non-TPL group (5.5; 0-13weeks, P=0.034). (3) The CL value at TPL diagnosis was 13mm (median), ranging from 7 to 18mm. Cases with early onset and subsequent rapid CL shortening before 31weeks resulted in TPL when CL decreased below the range 7-18mm.

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino

Objective To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound. Material and methods We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n = 112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits. Results Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group. Conclusions Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient.

Transformed Alpha-Fetoprotein (t-AFP) Levels in Women with Threatened Preterm Labor

Background/Aims: To evaluate maternal serum transformed α-fetoprotein (MSt-AFP) levels, a new molecular conformation of AFP was used in cases of threatened preterm labor (TPL). Methods: Prospective case-control study. Maternal serum levels of classical AFP and transformed AFP (t-AFP) were compared between 2 groups matched by gestational age: 25 women with TPL and 25 healthy pregnant women as controls. Results: There was no significant difference in classical maternal serum AFP (MSAFP) levels between the 2 groups. In contrast, MSt-AFP levels were significantly lower in cases of TPL than in the control group [7.64 (1.78–29.06) vs. 33.38 (13.80–190.50) ng/ml; p = 0.006]. Similarly, the t-AFP:AFP ratio was also decreased in the TPL group [0.04 (0.004–0.12) vs. 0.16 (0.05–0.80); p = 0.008]. There was no significant correlation between MSAFP and MSt-AFP levels. Conclusions: MSt-AFP levels are decreased in women with TPL.

Preterm labour. Premature rupture of membranes. Chorioamnionitis

The lower the gestational age at birth, the greater the risk of perinatal morbidity and mortality and maternal morbidity (increase in the number of caesareans, postnatal metritis). It is important for there to be a timely diagnosis of threatened preterm labour (TPL) in order to begin tocolytic treatment and to obtain efficient foetal pulmonary maturity. It is also necessary to distinguish between a true and a false TPL. There is a high tendency of overdiagnosis and overtreatment and prolonged hospitalisation is frequent. With cervical alteration and uterine dynamics tests it is possible to establish an accurate diagnosis that will result in suitable management. Early identification and primary prevention are not as developed as the therapeutic attitude, but it is important to bear in mind mechanisms for identifying high risk patients. They include antecedents of preterm labour, signs and symptoms, cervical alteration, etc. Premature rupture of membranes and chorioamnionitis involve the risk of preterm labour if they occur in early gestational ages.

Amenaza de parto prematuro: Rotura prematura de membranas. Corioamnionitis

The lower the gestational age at birth, the greater the risk of perinatal morbidity and mortality and maternal morbidity (increase in the number of caesareans, postnatal metritis). It is important for there to be a timely diagnosis of threatened preterm labour (TPL) in order to begin tocolytic treatment and to obtain efficient foetal pulmonary maturity. It is also necessary to distinguish between a true and a false TPL. There is a high tendency of overdiagnosis and overtreatment and prolonged hospitalisation is frequent. With cervical alteration and uterine dynamics tests it is possible to establish an accurate diagnosis that will result in suitable management. Early identification and primary prevention are not as developed as the therapeutic attitude, but it is important to bear in mind mechanisms for identifying high risk patients. They include antecedents of preterm labour, signs and symptoms, cervical alteration, etc. Premature rupture of membranes and chorioamnionitis involve the risk of preterm labour if they occur in early gestational ages.

Prediction of Preterm Delivery Based on Maternal Plasma Urocortin

Preterm birth still remains a significant management problem, and a large number of markers of the disease have been investigated. We measured plasma levels of urocortin, a neuropeptide expressed by gestational tissues, in women with threatened preterm labor (TPTL) to evaluate whether the measurement may predict preterm delivery (PTD). We studied patients as part of an open observational study. The study was conducted at a tertiary referral center for obstetric care. Eighty-five women with singleton pregnancies between 28 and 34 completed gestational weeks with TPTL participated in the study. Interventions included clinical examination and urocortin measurement. Pregnancy outcome and evaluation of sensitivity, specificity, and predictive values of urocortin as diagnostic test for PTD were measured. Thirty of 85 patients (35.3%) had PTD: 23 of 30 delivered within 7 d from admission (delivery time interval: 2.91 +/- 1.62 d; gestational weeks at delivery: 32.12 +/- 1.7); the remaining delivered later (delivery time interval: 11.71 +/- 4.27 d; gestational weeks at delivery: 33.5 +/- 2.18). Urocortin was significantly higher in women who delivered preterm (median 131.2 pg/ml, interquartile interval 115.1-139.4 pg/ml) than in those who progressed to term delivery [95.4 (69.9-101.3) pg/ml, P < 0.0001] and still higher in those delivering within 7 d from admission [137.7 (124.8-141.2) pg/ml]. Receiver operating characteristic curve analysis revealed that urocortin at the cutoff of 113.9 pg/ml had sensitivity of 80%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 90% as a marker for PTD. Maternal plasma urocortin concentration is increased in patients with TPTL who have PTD, and its measurement may be a promising new biochemical marker of PTD.

Living With the Threat of Preterm Labor: Women’s Work of Keeping the Baby In

To explore the social organization of women's preterm labor experiences. Institutional ethnography investigated how the woman's experience is socially organized and for patterns of how something is organized to recur. Eight women who experienced preterm labor while living in one city in Western Canada volunteered to participate. Institutional ethnographic methodology guided the analysis of audiotaped transcribed interviews to understand the work these women do and the complexities of their everyday lives. Women spoke about their fear of going home and feeling alone with the responsibility for their work of "keeping the baby in." Overall, preterm labor was experienced as a profound sense of personal responsibility for preventing preterm birth and was practiced as being "careful." The assumption that the family is privately responsible for care work in the home results in the lack of assessment of resources for managing the medical plan on discharge and the lack of resources available or offered to assist families. The work of keeping the baby in conflicts with family care work responsibilities and can cause significant hardships for some women and families.

EEG Features in Women with a Complicated Pregnancy

Clinical and EEG spectral analysis was carried out in 14 pregnant women (five women at risk of preterm labor and four with miscarriage). It was shown that the baseline EEG pattern of women with the persistent threat of preterm labor was characterized by the high spectral power of the α-rhythm and its predisposition to hypersynchronization. In the miscarriage group, virtually a complete absence of the α-rhythm and the predominance of generalized both high-frequency and slow low-amplitude rhythms are noted in most pregnant women. The data obtained allow a risk group characterized by either a hypersynchronous unstable α-rhythm or its absence to be identified among pregnant women.

The prediction of spontaneous preterm birth in women with threatened preterm labor using transvaginal ultrasound of the cervix

Purpose: This study was to determine if cervical parameters, as assessed by transvaginal ultrasound, were predictive of spontaneous preterm birth in women following an episode of threatened preterm labor (TPL).Methods: Women with a singleton pregnancy (20–34 weeks gestation) and intact membranes were enrolled following admission for TPL. The transvaginal ultrasound assessment of the cervix was performed when uterine activity had ceased. Only the ultrasound relating to the episode of suspected preterm labor is reported.Results: Sixty women had a transvaginal scan performed at a gestation of 27.7 ± 3.7 weeks (mean ± SD) (range 20.1–33.7 weeks). Cervical parameters were significantly different in women who delivered preterm (shorter closed endocervical canal length –P &lt; 0.0001; increased internal os dilatation –P &lt; 0.0001) to the women who delivered at term. Twenty‐five women had an abnormal cervix (closed endocervical canal length &lt;30 mm + internal os dilatation &gt;5 mm). Of these, 16 (64%) delivered preterm (&lt;37 weeks). In contrast, only one woman with a normal cervix delivered preterm (P &lt; 0.0001; RR 22.4, 95% CI 3.17–158.1). Five women (20%) delivered within 1 day of their abnormal cervical ultrasound, seven (28%) in &lt;7 days, and 10 (40%) in &lt;14 days whereas no woman with a normal cervical ultrasound delivered within 14 days (sensitivity 100%; negative predictive value 100%). In a linear regression model with gestational age at delivery as the dependent variable, endocervical canal length had an R2 of 59.3% (P &lt; 0.0001) which was not improved by the addition of any of the other parameter variables.Conclusions: Transvaginal ultrasound of the cervix can identify those women with an abnormal cervix following an episode of TPL who are at increased risk of preterm birth. It also identifies the women with normal cervices and therefore at low‐risk of preterm birth which potentially could reduce unnecessary interventions.

Fetal Fibronectin in the Cervicovaginal Fluid of Women with Threatened Preterm Labour as a Predictor of Delivery Before 34 Weeks' Gestation

Fetal fibronectin (fFN) is an extracellular matrix protein found at the junction between fetal and maternal tissue. It has been hypothesized that fFN is released into cervicovaginal fluid prior to the onset of preterm labour and during episodes of threatened preterm labour (TPL). In the present study fFN was present in the cervicovaginal fluid of 31% (11/36) of patients with TPL. The presence of fFN was found to be predictive of delivery prior to 34 weeks' gestation in 36 patients presenting with TPL and intact membranes (sensitivity 100%, specificity 81%). Eleven patients had a positive fFN assay and 5 delivered before 34 weeks (positive predictive value (PPV) 46%). Twenty-five patients had a negative fFN result and none were delivered before 34 weeks (negative predictive value (NPV) 100%). Patients presenting with TPL who are fFN positive would be ideal candidates for intervention trials of tocolytics. It may be possible to delay or avoid immediate tocolysis and interhospital transfer in patients with a negative fFN immunoassay.