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PubMed2000

Predictive value of serum interleukin-6 and -8 levels in preterm labor or rupture of the membranes.

BACKGROUND: The aim of this prospective study was to examine if serum concentrations of cytokines are of value in the identification of patients at risk for preterm delivery. METHODS: Interleukin- 1beta,2,4,6,8 and tumor necrosis factor alpha were determined between 25 and 37 weeks of gestation in the serum of 72 consecutive patients with preterm labor, 38 patients with preterm rupture of the membranes, and 24 healthy pregnant women as a control group. Material was collected within 18 hours after hospitalization and was immediately centrifuged and shock frozen. RESULTS: Significantly increased serum levels were found for interleukin-6 and -8 in patients with preterm labor or preterm rupture of the membranes when compared to the control group (p<0.001 and p<0.005, respectively). In patients with preterm rupture of the membranes and interleukin-6 levels above the median of 4.0 pg/ml the delivery occurred significantly earlier than in patients with lower levels (1 versus 5.5 days; p=0.005). Patients of both pathology groups with detectable (>18 pg/ml). Interleukin-8 levels had a shorter pregnancy duration when compared to other patients (p=0.05 for preterm labor and p=0.04 for preterm rupture of the membranes). Interleukin-1beta,2,4, and tumor necrosis factor alpha were not correlated with clinical outcome. CONCLUSIONS: Increased serum interleukin-6 and -8 levels are associated with a shorter interval between onset of preterm rupture of the membranes and delivery and should therefore be further evaluated for their use in clinical practice.

Adult↗

PubMed2000

[Extremely low birth weight (less than 1000 gram) and early postnatal weight gain in preterm infants].

Improving survival of extremely low birthweight (< 1000 g) preterm infants opens the practical issues of their postnatal nutrition and growth. The authors studied nutrition and weight gain in 16 extremely low birthweight preterm infants (birthweight: 890 +/- 22 g, gestational age: 28.0 +/- 0.2 week, mean +/- SEM) during the first 12 weeks of life. Milk of the mother, or fortified pooled human milk or preterm infant formula was fed. The preterm infants approximated their birthweight by the end of the 3rd week of life (21st day: 866 +/- 29 g). Body weight expressed as per cent of birthweight was 109 +/- 2% at the end of the 4th, 176 +/- 7% at the end of the 8th and 275 +/- 6% at the end of the 12th week of life. Weight gain during the 1st to 8th postnatal weeks was compared to the mean in utero weight gain of foetuses with identical gestational age, gender and weight percentile position. Cumulative weight gain of preterm infants during the first 8 weeks of life was significantly lower than that of the theoretical controls (76 +/- 7% versus 136 +/- 2%, per cent of the initial value, preterm versus control, p < 0.0001). Additional weight gain of preterm infants was lower than that of the controls on the 1st to 5th weeks of life (g/kg/day, 1st week: -14.4 +/- 1.6 versus 16.7 +/- 0.5, p < 0.0001; 5th week: 13.3 +/- 1.2 versus 16.4 +/- 0.3, p < 0.05), there were no differences between the two groups on the 6th and 7th weeks, whereas preterm infants gained significantly more weight on the 8th week of life than the theoretical control value (18.2 +/- 0.9 versus 14.0 +/- 0.2, p < 0.001). These data indicate that the first weeks of life represent an especially important period for the improvement of the nutrition of extremely low birthweight preterm infants.

Gestational Age↗

PubMed2002

Epidemiologic risk factors for preterm delivery.

BACKGROUND: Prematurity remains the most significant cause of neonatal morbidity and mortality. Knowing which group of women is at risk for developing preterm labor will define a target population for better prenatal care and prevention modalities. OBJECTIVE: To examine whether preterm delivery rates are associated with ethnicity, age, parity, and style of living. METHODS: We conducted a longitudinal case series examining obstetric and demographic data of 17,493 deliveries that occurred between June 1994 and May 1999. All deliveries were performed in the obstetric department of HaEmek Medical Center (Afula, Israel), which serves as a referral center. The main outcome measures were preterm delivery, as related to the women's ethnicity, age parity, and style of living--namely, town, village, or kibbutz. RESULTS: The overall preterm delivery rate was 8.5%. The preterm delivery rate in non-Jewish women (10.5%) was higher than in Jewish women (7.1%) (P < 0.00001). The preterm delivery rate in women younger than 20 or older than 40 (12.5%) was much higher than in women between the ages of 21 and 40 (8.0%) (P < 0.00001). Grand-multipara women (> 8) had a higher preterm delivery rate (13.8%) than less parous women (8.5%) (P < 0.012). Style of living was also associated with the preterm delivery rate (P < 0.00001): kibbutz 5.5%, Jewish towns 7.8%, non-Jewish towns 8.7%, Jewish villages 6.7%, and non-Jewish villages 11.0%. CONCLUSIONS: Style of living, ethnicity, age and parity are statistically significant risk factors for preterm delivery in our area. These factors provide a more definable target population for better prenatal care.

Adult↗

PubMed2003

Motor, cognitive, and behavioural disorders in children born very preterm.

Children born preterm have been shown to exhibit poor motor function and behaviour that is associated with school failure in the presence of average intelligence. A geographically determined cohort of two-hundred and eighty preterm children (151 males, 129 females) born before 32 weeks' gestation and attending mainstream schools were examined at 7 to 8 years of age together with 210 (112 males, 98 females) age- and sex-matched control participants were tested for motor, cognitive, and behavioural problems. Tests applied were the Movement Assessment Battery for Children (MABC), Clinical Observations of Motor and Postural Skills (COMPS), Developmental Test of Visual-Motor Integration (VMI), Wechsler Intelligence Scale for Children, and Connors' Teacher Rating Scale for attention-deficit-hyperactivity disorder (ADHD). Control children scored significantly better than the preterm group on all motor, cognitive, and behavioural measures. The lowest birthweight and most preterm individuals tended to score the lowest. Motor impairment was diagnosed in 86 (30.7%) of the preterm group and 14 (6.7%) of the control children using the MABC; 97 (42.7%) and 18 (10.2%) using the COMPS; and 68 (24.3%) and 17 (8.1%) respectively using the VMI. Each test of motor function identified different children with disability, although 23 preterm children were identified as having motor disability by all three tests. Preterm children were more likely to have signs of inattention and impulsivity and have a diagnosis of ADHD. Minor motor disabilities persist in survivors of preterm birth despite improvements in care and are not confined to the smallest or most preterm infants. They may exist independently of cognitive and behavioural deficits, although they often co-exist. The condition is heterogeneous and may require more than one test to identify all children with potential learning problems.

Activities of Daily Living↗

PubMed2003

Defining the problem: the epidemiology of preterm birth.

Preterm birth is the major clinical problem associated with perinatal mortality, serious neonatal morbidity and moderate to severe childhood disability in prosperous countries. Its prevalence is affected by the way in which gestational age is assessed, by national differences in the registration of births, associated practices, such as burial costs, or maternity benefits, which encourage or discourage registration, and by the perceived viability of extremely preterm infants. Despite these uncertainties, there is reliable evidence that preterm births are increasing, especially births before 28 weeks gestation. Contributing factors include births following assisted reproductive therapy and ovulation induction, especially multiple births, and the increasing proportion of births among women >34 years. On the other hand, improvements in neonatal care have substantially increased the survival of preterm infants during the last 15 years. There is wider acceptance of the importance of infection as a factor in preterm birth, and increasing recognition that processes leading to preterm birth may be initiated in very early pregnancy (the initiation of pre-eclampsia, major birth defects, premature placental separation), or even prior to pregnancy (prior pregnancy losses). It is unclear whether the familiar clinical presentations of preterm labour and birth reflect different pathophysiological processes. The pathways which link those processes to the consistent pattern of social differences in the probability of preterm birth have prompted new research approaches but in 2002 'the stubborn challenge of preterm birth' remains just that.

Female↗

PubMed2003

Obstetric, neonatal and anesthetic considerations for preterm labor and delivery.

Preterm birth is a continuing obstetric problem that contributes significantly to the incidence of perinatal death and long-term handicap. In this context, various studies have shown preterm births account for between 69% and 83% of neonatal deaths. Despite this, the incidence of preterm birth has remained static for many years. One explanation for this is that the management of preterm labor has altered very little in the past 30 years. Strategies aimed at reducing the incidence of preterm birth include the identification of risk factors that increase the likelihood of preterm delivery. Treatment is then designed to target those risk factors and limit their effect. Although perinatal mortality has declined, mostly due to the improved management of very low birthweight babies rather than prevention of preterm labor, efforts to prevent preterm birth have been largely unsuccessful so far and preterm birth still represents a major health care problem to both developed and developing countries.

Anesthesia, Obstetrical↗

PubMed2004

[Economical impact of preterm delivery management based on fetal fibronectin results].

BACKGROUND: Preterm labor continues to be the first cause (after congenital malformations) of morbidity and mortality during the perinatal period. One of the markers showing the highest sensitivity to predict preterm labor seems to be fetal fibronectin (fFN) determined in the cervicovaginal secretion. OBJECTIVES: To identify patients at risk of preterm labor based on the presence of fFN in cervicovaginal secretions and to analyze the cost-benefit of medical attention and hospital stay depending on the fFN results. MATERIAL AND METHODS: Four hundred and sixty two patients were admitted in a 6 month period to the Maternal-Fetal Medicine Department. All of them had symptoms of preterm labor. Their gestational ages were between 24 and 34 weeks, the fFN analyses were taken from cervical vaginal secretion. One hundred and fifty eight were fFN positive and 304 were negative. Patients with positive fFN were hospitalized and received specific treatment for preterm labor. The patients with negative fFN were sent home with no medical treatment. In order to calculate the economic impact of the hospital's medical attention we considered the total cost in pesos which included patient's hospital care when admitted with preterm labor symptoms, hospital stay, and neonatal attention. The total costs were compared and analyzed in the two groups. RESULTS: The average cost generated for fFN positive and negative patients was 23,059 and 7,859 pesos, respectively. Approximately 15,200 pesos were saved per patient in this group. Multiplying this amount among patients with negative fFN (n=304), we would have saved 4,620,000 pesos in a 6 month period. Our established medical management did not affect negatively maternal-fetal well being. For statistical purposes of variables the Mann Whitney U, chi square and McNemar's tests were calculated. CONCLUSION: By determining fFN for the diagnosis of preterm labor, we obtained savings of 4,620,000 pesos in a 6 month period avoiding unnecessary treatments and hospital stay in patients with negative fFN. Determination of fFN in cervical vaginal secretion in patients with symptoms of preterm labor showed to have high sensitivity and specificity in predicting preterm labor between 24-34 weeks of gestation, permitting a more rational use of medical management and resources and avoiding unnecessary treatments. The treatment instituted on the basis of an opportune diagnosis in patients with positive fFN showed to prolong weeks of gestation. Although a persistence of morbidity and mortality of prematurity has been reported, these have diminished in comparison with studies previously done in the institution.

Body Fluids↗

PubMed2006

[Analysis of the concentration of plasma copper and collagen in fetal membrane of the preterm's mothers].

OBJECTIVE: The purpose of the study is to determine primarily the concentration of plasma copper and collagen in fetal membrane of the preterm's mothers, and explore the relation of copper status and fetal membrane collagen of preterm's mothers. METHODS: The general situations were collected both in neonatos and their mothers. The plasma copper concentrations of mother venous blood and cord blood were analyzed by ICP-OES. Sirius Red dyeing was first used in fetal membrane to detect the thickness and collagen in preterm's and full-term's mothers. RESULTS: The prevalence of premature rupture of membrane (PROM) was 40.00% in preterm's mothers, and 9.09% in the full-term's mothers. The mothers' preconceptual weight, infant body length and body weight at birth were lower in preterm group than those of the full-term group. The cord blood plasma copper was significantly lower in preterms than in full-terms. Both the thickness and the concentration of collagen I and II of non-split fetal membrane of preterm's mothers were significantly less than those of the full-term's mothers. CONCLUSION: Both the concentration of plasma copper and fetal membrane collagen of preterm's mothers were lower than that of the full-term's. It can confer that the deficient copper status could lead to immature collagen in fetal membrane which induce PROM and have preterm birth finally. More work need to be done in this field.

Adult↗

PubMed1990

Histologic chorioamnionitis and preterm delivery in different patient populations.

The placentas of 1843 deliveries were examined for the presence of histologic chorioamnionitis, which was classified as mild, moderate, or severe. Chorioamnionitis was present in 7.5% of patients who underwent cesarean before labor and in 18 and 32% of those delivering at term and preterm, respectively. Chorioamnionitis was severe in 74% of preterm but in only 15% of term deliveries. Premature rupture of membranes (PROM) was more frequent with preterm than with term delivery, with chorioamnionitis present in 42 and 15% of patients, respectively. Although chorioamnionitis was equally frequent in women with intact membranes delivering preterm and term, chorioamnionitis was severe in 63% of preterm and 14% of term deliveries (P less than .001). The frequency and severity of chorioamnionitis were related inversely to gestational age at preterm birth. Preterm delivery was more frequent in black than in white patients (19 versus 9%) and in indigent clinic versus private patients (13 versus 7.5%). However, there was no significant difference in frequency and severity of chorioamnionitis between black and white or between indigent clinic and private patients who delivered preterm. Among term births, chorioamnionitis was more often severe in black than in white patients. Chorioamnionitis in term deliveries was more frequent in clinic than in private patients; however, this was not true when only severe chorioamnionitis was considered. There were no differences in PROM between these patient populations. Thus, higher preterm birth rates in black and indigent clinic populations are not due to the more frequent occurrence of chorioamnionitis.

Black People↗

PubMed1989

Controlled trial of a Preterm Labor Detection program: efficacy and costs.

Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.

Clinical Trials as Topic↗

PubMed1986

Health care of preterm infants in the first year of life.

The home environment of preterm infants and their use of health services after discharge from hospital were investigated. Of the mothers of preterm infants studied 49% were not educated beyond primary school level, 38% were unmarried and 20% of these families had marked social problems, and 56% lived in grossly overcrowded conditions. Only the extent of unmarried motherhood and marked social problems were greater in preterm infants than in a control group of term infants. Attendance at primary care services for illness was no different for the preterm and term groups, although hospital admissions were most frequent in the preterm infants. Three preterm infants died in the first year. Only 65% of preterm infants and 55% of controls had completed weight charts on their preschool record card at 12 months of age. Three preterm and 2 control infants had not been fully immunized. In spite of poor social circumstances, the use of health services by the mothers of preterm infants was most encouraging.

Educational Status↗

PubMed1980

Effects of prematurity and early intervention on responsivity to tactual stimuli: a comparison of preterm and full-term infants.

Cardiac and behavioral responses to a tactual stimulus were evaluated during the first sleep cycle for 3 groups of infants: 30 full terms, 30 nonintervened preterms, and 30 intervened preterms. Prior to testing, the latter group had received a regimen of multimodal sensory stimulation, which emphasized the tactual and vestibular modalities. The results showed that the intervention altered the preterms' sensory functioning mainly during active sleep. In this state, the full terms and the intervened preterms exhibited a significant cardiac acceleration to the stimulus, while the nonintervened preterms failed to do so. Similarly, the behavioral response of the intervened preterm more closely approximated that of the full terms. During quiet sleep the intervention did not affect either the cardiac or the behavioral response. In this sleep state, the full terms' cardiac response was that of monophasic acceleration, whereas both groups of preterms exhibited a biphasic response with a smaller initial acceleration which was followed by a deceleration below baseline. Behaviorally, the preterms responded less frequently and gave smaller responses than the full terms. Thus there were marked differences between preterms and full terms, and the intervention seemed to narrow this gap to some extent.

Female↗

PubMed1995

Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence.

OBJECTIVE: We assessed the effectiveness of individualized developmental support in the special care nursery for low-risk preterm infants. SETTING: A university-affiliated teaching hospital. PARTICIPANTS: Twelve healthy full-term infants, and 24 low-risk preterm infants randomly assigned to a control or an experimental group. DESIGN: The preterm control group received standard care and the preterm experimental group received individualized developmental care at the same special care nursery. OUTCOME MEASURES: Medical, behavioral (Assessment of Preterm Infants' Behavior and Prechtl's Neurological Examination of the Full-Term Newborn Infant), and electrophysiologic outcome (using quantitative electroencephalography with topographic mapping) of all three groups was assessed 2 weeks after the expected due date. RESULTS: No between- or among-group medical differences were seen for this low-risk, healthy sample. The preterm experimental group showed behavioral and electrophysiologic performances comparable to those of the full-term group, whereas the preterm control group performed significantly less well. Behavioral measures suggested significantly poorer attentional functioning for the preterm control group. Electrophysiologic results implicated the frontal lobe. CONCLUSIONS: Individualized developmental intervention supports neurobehavioral functioning as measured at 2 weeks post-term. It appears to prevent frontal lobe and attentional difficulties in the newborn period, the possible causes of behavioral and scholastic disabilities often seen in low-risk preterm infants at later ages.

Child Development↗

PubMed1995

Total body bone mineral content in small-for-gestational -age, appropriate-for-gestational -age, large-for-gestational -age term infants and appropriate-for-gestational -age preterm infants.

BACKGROUND: Metabolic bone disease is a recognized complication in very low birth weight infants. Inadequate postnatal intake of calcium and phosphorus is probably important in the pathogenesis of bone disease in the newborn. A few studies have shown lower bone mineral content at birth in small for gestational age (SGA) than in appropriate for gestational age (AGA) infants. The present study was designed to compare total body bone mineral (TBBM) content in AGA, SGA, and large for gestational age (LGA) term infants. Also, it was designed to evaluate extrauterine changes in TBBM in preterm infants. METHODS: Ten SGA [mean +/- S.D. birth weight (B.W.) was 1.7 +/- 0.2 Kg, gestational age (G.A.), 39.0 +/- 0.8 weeks], ten AGA (B.W.; 3.3 +/- 0.4 Kg; G.A.: 39.3 +/- 1.4 weeks), ten LGA (B.W.: 4.4 +/- 0.3 Kg; G.A.: 40.4 +/- 0.9 weeks) term infants and ten AGA preterm infants (B.W.: 1.6 +/- 0.3 Kg; G.A.: 31.9 +/- 1.9 weeks) were enrolled in this study. TBBM content was measured using dual-photon-absorptiometry at 1 week postnatally in SGA, AGA, LGA term infants and in preterm infants at 1, 6, 12 weeks postnatally. Serum total calcium, phosphorus, magnesium, alkaline phosphatase activity (alk-p), parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OHD) and urinary calcium, phosphorus, creatinine were measured at 1 week postnatally in all studied infants and 6, 12 weeks, postnatally in preterm infants. Preterm and SGA term infants received premature formula enriched with calcium, phosphorus and vitamin D. RESULTS: There was no significant difference (p > 0.05) in serum calcium, phosphorus, magnesium, alk-p, PTH, 25-OHD and urinary calcium, phosphorus, creatinine values among SGA, AGA and LGA term infants at one week of age. Also, there was no significant difference in serum biochemical values in preterm infants at 1, 6, 12 weeks postnatally. Significantly lower (p < 0.05) urinary phosphorus values were found in preterm than in term infants. TBBM content was lower (p < 0.05) in SGA term infants than in AGA and LGA term infants. Premature infants had lower (p < 0.01) TBBM values than term AGA infants; however, TBBM values increase with postnatal age in preterm infants. CONCLUSIONS: Biochemical or marked radiological evidence of metabolic bone disease did not develop in any of the studied preterm infants. It appears that feeding permature infants with formula enriched with phosphorus, calcium and vitamin D may provide sufficient mineral for bone mineralization.

Birth Weight↗

PubMed1994

Cervical sonography in preterm labor.

OBJECTIVE: To improve the accuracy of the diagnosis of preterm labor by comparing transvaginal sonography to digital examination of the cervix. METHODS: We performed transvaginal sonography in women with preterm labor who had completed a course of parenteral tocolysis. Cervical length was measured according to criteria reported previously. Cervical sonographic findings were not used in diagnosis or management. Sonographic cervical length was compared to digital assessment of dilation and effacement to assess the risk of preterm birth after treatment for preterm labor. RESULTS: Forty-eight singleton and 12 twin gestations were studied. Thirty women were nulliparous and 30 were parous. The mean (+/- standard deviation) gestational age was 31.1 +/- 2.7 weeks (range 24-35) at the examination and 35.6 +/- 2.9 weeks (range 26-43) at delivery. Twenty-four subjects delivered before 36 weeks' gestation and 36 delivered at or after 36 weeks. Cervical sonography was distinctly superior to digital assessment of dilation and effacement as a test for delivery before 36 weeks, when compared using receiver operating characteristic curves. This analysis indicated a cervical length of 30 mm as the best cutoff to maximize sensitivity and specificity. All 24 subjects who delivered preterm had cervical lengths less than 30 mm. Cervical sonography was especially useful in selecting women with preterm labor who would not deliver prematurely, ie, a high negative predictive value. None of 15 women whose cervical length was 30 mm or more delivered spontaneously before 36 weeks. CONCLUSION. Among women treated for preterm labor, a cervical length of at least 30 mm predicted a low likelihood of preterm birth. Cervical sonography may improve the accuracy of diagnosis in women treated for preterm labor.

Adult↗

PubMed1997

[Multivariate analysis of the significance of vaginal bacterial colonization in the occurrence of a preterm birth with various risk parameters].

Using a discriminance analysis we investigated the interactions between parameters of the vaginal flora and subclinical infection regarding preterm birth. The prospective study includes 222 single pregnancies, 114 of them with preterm labour or premature rupture of the membranes (PROM). The analysis includes information of a vaginal/ cervical smear (total number of pathogenic germs, species and groups of pathogenic germs), vaginal pH, maternal white blood cell count (WBC), C-reactive protein (CRP) and temperature. A normal vaginal flora was found in only 19%. Pregnancies with preterm labour have a higher quantity of pathogenic germs, whereas there is no difference of the germ group distribution. Moreover, pregnancies with preterm labour and 2 or 3 pathogenic germs have a higher rate of preterm birth. The discriminance analysis shows that only the affiliation the risk group with preterm labour and the parameters CRP and WBC have a significant selectivity for consequent preterm birth, but not the parameters containing information of the vaginal flora. The same is valid for the group with preterm labour, where only the parameters PROM and WBC are able to select significantly for preterm birth.

Adult↗

PubMed2006

Guidelines for the management of spontaneous preterm labor.

Preterm birth is defined as delivery at <37 completed weeks of pregnancy (World Health Organization). Spontaneous preterm birth (SPB) includes preterm labor, preterm spontaneous rupture of membranes, preterm premature rupture of membranes (PPROM) and cervical weakness; it does not include indicated preterm delivery for maternal or fetal conditions. Early SPB (<32 weeks' gestation) is associated with an increased higher perinatal mortality rate, inversely proportional to gestational age. The pathophysiologic events that trigger SPB are largely unknown but include decidual hemorrhage (abruption), mechanical factors (uterine overdistention or cervical incompetence), and hormonal changes (perhaps mediated by fetal or maternal stress). In addition, several cervicovaginal infections have been associated with preterm labor. SPB is also the leading cause of long-term morbidity, including neurodevelopmental handicap, cerebral palsy, seizure disorders, blindness, deafness and non-neurological disorders, such as bronchopulmonary dysplasia and retinopathy of prematurity. Delaying delivery may reduce the rate of long-term morbidity by facilitating the maturation of developing organs and systems. The benefits of administration of antepartum glucocorticosteroids to reduce the incidence and severity of respiratory distress syndrome may be exploited by delay. Delay may also permit transfer of the fetus in utero to a center with neonatal intensive care unit facilities. There is considerable variation in the way that spontaneous preterm labor (SPTL) is diagnosed, managed and treated internationally. The development of clinical guidelines requires an evidence-based approach to improve outcome and allow more efficient use of resources. With recent advances in our understanding of the etiology and mechanisms of SPTL and the availability of safer, more specific tocolytics, it was felt that guidelines should be developed to achieve, if possible, an European consensus in patient diagnosis, management and treatment.

Anti-Bacterial Agents↗

PubMedDate not supplied

Rates of and factors associated with recurrence of preterm delivery.

CONTEXT: Information about risk of recurrent preterm delivery is useful to clinicians, researchers, and policy makers for counseling, generating etiologic leads, and measuring the related public health burden. OBJECTIVES: To identify the rate of recurrence of preterm delivery in second pregnancies, factors associated with recurrence, and the percentage of preterm deliveries in women with a history of preterm delivery. DESIGN AND SETTING: Population-based cohort study of data from birth and fetal death certificates from the state of Georgia between 1980 and 1995. SUBJECTS: A total of 122 722 white and 56174 black women with first and second singleton deliveries at 20 to 44 weeks' gestation. MAIN OUTCOME MEASURE: Length of gestation (categorized as 20-31, 32-36, or > or =37 weeks) at second delivery compared with length of gestation at first delivery, by age and race. RESULTS: Most women whose first delivery was preterm subsequently had term deliveries. Of 1023 white women whose first delivery occurred at 20 to 31 weeks, 8.2% (95% confidence interval [CI], 6.6%-10.1%) delivered their second birth at 20 to 31 weeks and 20.1% (95% CI, 17.7%-22.8%) at 32 to 36 weeks. Of 1084 comparable black women, 13.4% (95 % CI, 11.4%-15.6%) delivered at 20 to 31 weeks and 23.4% (95% CI, 20.9%-26.1%) delivered at 32 to 36 weeks. Among women whose first delivery occurred at 32 to 36 weeks, all corresponding rates were lower than those whose first birth was at 20 to 31 weeks; the rates of second birth at 20 to 31 weeks were substantially lower (for white women, 1.9% [95% CI, 1.7%-2.2%]; for black women, 3.8% [95% CI, 3.4%-4.2%]). Compared with women aged 20 to 49 years at their second delivery, women younger than 18 years had twice the risk of recurrence of delivery at 20 to 31 weeks. Of all second deliveries at 20 to 31 weeks, 29.4% for white women and 37.8% for black women were preceded by a preterm delivery. CONCLUSIONS: Our data suggest that recurrence of preterm delivery contributes a notable portion of all preterm deliveries, especially at the shortest gestations.

Adolescent↗