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PubMed2001

Causes and consequences of recent increases in preterm birth among twins.

OBJECTIVE: To examine the causes and consequences of the recent increase in preterm birth among twins. METHODS: We studied all twin births among residents of the province of Nova Scotia, Canada, between 1988 and 1997. Rates of preterm birth, preterm labor induction, preterm cesarean, small-for-gestational age (SGA), respiratory distress syndrome (RDS), stillbirth, perinatal mortality, and infant mortality were compared between past and more recent years. Changes in perinatal mortality were examined using logistic regression to adjust for the effects of other determinants. RESULTS: The study included 2516 twin births (73 stillbirths and 2443 live births). The rate of preterm birth increased from 42.3% in 1988-1992 to 48.2% of twin live births in 1993-1997 (14% increase, P =.04). Twin live births born after preterm labor induction increased from 3.5% in 1988-1989 to 8.6% in 1996-1997 (P for trend =.007). Of live births between 34 and 36 weeks' gestation, the proportion born SGA decreased from 17.5% in 1988-1992 to 9.2% in 1993-1997 (P =.005). Over the same period, rates of prophylactic maternal steroid therapy increased substantially and rates of RDS declined. Perinatal mortality rates among pregnancies reaching 34 weeks decreased from 12.9 per 1000 total births in 1988-1992 to 4.2 per 1000 total births in 1993-1997 (P =.05). CONCLUSION: Increases in preterm labor induction appear to be responsible for the recent increase in preterm birth among twins. These changes have been accompanied by decreases in perinatal morbidity and mortality among twin pregnancies that reach 34 weeks' gestation.

Adult↗

PubMed1997

Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations.

OBJECTIVE: To compare, in singleton and twin pregnancies, the effectiveness of transvaginal ultrasound versus digital examination in predicting preterm delivery in women with suspected preterm labor. METHODS: Transvaginal ultrasound and pelvic examinations were performed on patients admitted with suspected preterm labor between 23 and 33 weeks' gestation. Ultrasound assessment of cervical length and the presence of funneling with fundal pressure were recorded for each patient, and the results were compared with dilatation and effacement as assessed by digital examination for the prediction of preterm delivery in the two groups (singletons and twins). RESULTS: One hundred sixty-two subjects were recruited (136 singletons and 26 twin pregnancies), with no significant demographic differences between the groups. Overall, 33% of the participants delivered preterm (27% of singletons, 62% of twins). Using receiver operating characteristics curves, the best cutoff points were 30 mm for endocervical length at ultrasound, 50% for effacement, and 1.5 cm for dilatation. Of these, the best predictor was endocervical length, which was a better predictor in singleton than in twin pregnancies. Of the potential predictors, including endocervical length, funneling, dilatation, and effacement, only endocervical length was an independent predictor of preterm delivery at less than 34 weeks' gestation for both singletons and twins by multiple logistic regression. When analyzed for delivery at less than 37 weeks' gestation, this relation held true for singletons but not twins. Endocervical length less than 30 mm had a sensitivity of 81% and 75%, specificity of 65% and 30%, positive predictive value of 46% and 63%, and negative predictive value of 90% and 43% for singleton and twin pregnancies, respectively, in predicting spontaneous birth at less than 37 weeks' gestation. CONCLUSION: Between 23 and 33 weeks' gestation, transvaginal ultrasound assessment of endocervical length is superior to funneling and digital examination in predicting preterm delivery in patients who present with suspected preterm labor, and is a better predictor in singletons than in twins.

Adult↗

PubMed1998

Maternal hypertension and spontaneous preterm births among black women.

OBJECTIVE: To examine effects of maternal hypertension on spontaneous preterm birth (birth at less than 37 weeks' gestation) among black women. METHODS: Using hospital discharge summary records from the National Hospital Discharge Survey between 1988 and 1993, we conducted a case-control study to assess the risk of spontaneous preterm birth among black women with chronic hypertension preceding pregnancy and pregnancy-induced hypertension. Logistic regression was used to derive odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Preterm births were almost two times more likely for women with pregnancy-induced hypertension (OR = 1.8; 95% CI, 1.5, 2.2), more than 1.5 times more likely for women with chronic hypertension preceding pregnancy (OR = 1.6; 95% CI, 1.3, 2.1), and more than four times more likely for women with pregnancy-aggravated hypertension (OR = 4.4; 95% CI, 2.9, 6.7) compared with normotensive women. Preterm births also were associated significantly with antepartum hemorrhage, poor fetal growth, marital status, and source of payment. The odds of preterm birth by maternal hypertension were increased among women with chronic hypertension and genitourinary infection, whereas the odds of preterm birth were reduced among women with pregnancy-induced hypertension and genitourinary infection. CONCLUSION: These findings are important in demonstrating the relation between type of hypertension in pregnancy and preterm birth. The relationships between maternal hypertension and preterm birth need to be further investigated to provide some guidelines in the management of hypertension in pregnancy and assessment of prenatal care compliance for black women, particularly when genitourinary infection is present.

Adolescent↗

PubMed1998

Association of sociodemographic variables with risk for very preterm birth in twins.

OBJECTIVE: To assess the influence of maternal race, age, marital status, and education on risk for earlier and later preterm births in twin pregnancies. METHODS: We analyzed 8109 white and 1906 black liveborn twin pregnancies in the Missouri Linked Sibship files for the years 1978-1990, using contingency tables and multiple logistic regression. RESULTS: Black twin gestations had 1.61-fold (95% confidence interval [CI] 1.46, 1.76) greater risk than whites for preterm birth before 34 weeks' gestation. However, there was no race difference after 33 weeks. Among whites, teen age, unmarried status, and education fewer than 12 years were independently associated with risk for delivery before 34 weeks in multivariate analysis (odds ratios [OR] 1.28-1.51, each P < or=.001). These associations were diminished or absent for preterm births after 33 weeks' gestation. White unmarried teen mothers with fewer than 12 years of education had 1.83-fold (95% CI 1.39, 2.40) greater risk for preterm birth before 34 weeks' gestation compared with white married women more than 19 years of age with at least 12 years of education. In blacks, this difference was 1.47-fold (95% CI 1.13, 1.92). In both races, these differences were absent after 33 weeks' gestation. CONCLUSION: Traditional sociodemographic risk factors were present for twin preterm birth, but mainly before 34 weeks' gestation. This, together with previous data from Missouri Linked Sibship files, indicates that dominant pathogenic mechanisms of early preterm birth in twin gestations are likely to be different from those causing later preterm twin birth. Therefore, gestational age should be accounted for in future studies seeking to identify predictive factors or biomechanisms for twin preterm birth.

Adult↗

PubMed1999

Risk scoring, fetal fibronectin, and bacterial vaginosis to predict preterm delivery.

OBJECTIVE: To determine the value of markers for predicting spontaneous preterm birth. METHODS: One hundred forty asymptomatic gravidas were recruited from 20-24 weeks' gestation. Risk score was assessed, vaginal swabs were analyzed for bacterial vaginosis, and cervical and vaginal swab were tested for fetal fibronectin FDC-6, X18A4, and CAF. Univariate analysis was used to determine potential predictors (and combinations of predictors) of outcome. Multiple logistic regression was done to identify independent predictors of spontaneous preterm birth. Sensitivity, specificity, positive and negative predictive values; and odds and likelihood ratios were calculated for significant predictors. RESULTS: Predictors significantly associated with the primary outcome were preterm birth-risk score and vaginal fetal fibronection FDC-6 (logistic regression odds ratio [OR] 16.9 [95% confidence interval (CI) 3.1, 92.8]) and 8.0 ([95% CI 1.6, 38.2], respectively). Bacterial vaginosis, fetal fibronectin X18A4, fibronectin CAF, and cervical fetal fibronectin FDC-6 were not associated with spontaneous preterm birth; however, the statistical power to assess these variables was limited. The combination of positive preterm birth-risk score and vaginal fetal fibronectin FDC-6 had a sensitivity of 44.4%, specificity of 97.7%, positive predictive value of 57.1%, negative predictive value of 96.2%, and a significant likelihood ratio for a positive test of 19.4 (95% CI 5.1, 73.8). CONCLUSION: The combination of preterm birth-risk score and vaginal fetal fibronectin FDC-6 predicted spontaneous preterm birth. Intervention trials are required to determine whether a combination of screening tests will reduce rates of spontaneous preterm birth.

Adult↗

PubMed1999

Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: risk for preterm birth and benefit of treatment.

OBJECTIVE: To examine associations between bacterial vaginosis and other prevalent lower genital tract infections and clinically recognized first-trimester bleeding; possible independent and joint effects of gestational bleeding and bacterial vaginosis or other prevalent infections on preterm birth and premature rupture of membranes; and effects of antimicrobial treatment on reducing risks of preterm birth among these women. METHODS: A secondary analysis was conducted of 1100 pregnant women enrolled in a prospective observational study that examined the effects of standardized diagnosis and treatment of lower genital tract infections to prevent preterm birth. RESULTS: Sixty percent of women with first-trimester bleeding had one or more study infections detected at the initial examination. First-trimester bleeding was associated independently with the presence of bacterial vaginosis (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0, 2.3), Trichomonas vaginalis (OR 2.3, 95% CI 1.3, 4.2), and Chlamydia trachomatis (OR 2.7, 95% CI 1.4, 5.1). Preterm birth was increased among women with first-trimester bleeding and bacterial vaginosis (relative risk [RR] 4.4, 95% CI 2.0, 9.5) and bacterial vaginosis and T vaginalis (RR 3.0, 95% CI 1.0, 8.8). Systemic antimicrobial treatment reduced the rate of preterm birth among women with bacterial vaginosis without first-trimester bleeding (RR 0.37, 95% CI 0.16, 0.88). Treatment of women with both first-trimester bleeding and bacterial vaginosis reduced preterm birth (RR 0.52, 95% CI 0.18, 1.55), but not significantly. CONCLUSION: First-trimester bleeding was increased among women with bacterial vaginosis, T vaginalis, C trachomatis, and combinations of these infections. Women with bacterial vaginosis who also experienced first-trimester bleeding were at heightened risk for preterm birth. Treatment of studied infections reduced significantly the risks of preterm birth among women without first-trimester bleeding.

Adolescent↗

PubMed2000

Preterm birth in two urban areas of Ukraine.

OBJECTIVE: To determine whether the preterm birth rate was elevated in two urban areas of Ukraine, a former eastern bloc country that experienced serious economic, social, and health problems during its transition from a socialist republic. METHODS: We identified every pregnancy in a defined period in two urban sites where a separate study of pregnancy and childhood was being conducted. We obtained gestational age and vital status at delivery for each. Information about onset of labor and conduct of delivery was available for the subgroup enrolled in the collaborating study. RESULTS: Among 17,137 pregnancies, all but 6774 were terminated voluntarily. Among the continuing pregnancies, the preterm birth rate was 6.6% for live-born singletons of 20 or more weeks' gestation. Only 12% of preterm births involved medical intervention, the rest were idiopathic. The preterm birth rate was higher than in Europe (4.0% to 5.4%) and Canada (5.9%) but lower than for whites in the United States (8.4%). CONCLUSION: Live-born preterm birth rates are influenced by whether infants survive to be included in calculations. The high fetal mortality rate in Ukraine causes many preterm births to be excluded, thus lowering the rate. Frequent pregnancy termination and lack of ultrasound dating in Ukraine also might cause the preterm birth rate to be lower. Preterm birth rates, especially among live-born infants, are difficult to interpret and treacherous to compare across nations. Survival of the fetus and its health and development at birth are better indicators of reproductive outcome.

Female↗

PubMedDate not supplied

Immunoreactive 15-hydroxyprostaglandin dehydrogenase (PGDH) is reduced in fetal membranes from patients at preterm delivery in the presence of infection.

Previously we reported that the proportion of trophoblast cells that were immunopositive for 15-OH prostaglandin dehydrogenase (PGDH) in the chorionic membranes was reduced in women in preterm labour without infection, compared with women at term, but was not altered in preterm labour patients with an underlying infective process. Subsequently, we found that PGDH activity and PGDH mRNA were significantly lower in membranes of this latter group of patients than in women at preterm labour without infection or at term. To resolve this issue we used immunohistochemistry to examine the distribution and frequency of immunoreactive (ir)-PGDH positive cells in full-thickness fetal membranes in patients at preterm labour in the presence or absence of infection. Trophoblast and decidual stromal cells were identified using antibodies against cytokeratin and vimentin, respectively. There was considerable variation in the number of chorionic trophoblast cells that were positive for ir-PGDH, but in some patients there was little or no ir-PGDH staining, and this was associated with loss of trophoblast cells from the tissue. The mean intensity and number of ir-PGDH positive cells was significantly lower in membranes from patients in preterm labour with infection than in idiopathic preterm labour at which the diagnosis of infection was not made. We conclude that in the setting of preterm labour with infection there may be loss of trophoblast cells from membranes, with corresponding reduction in the number of ir-PGDH positive cells. Loss of PGDH activity removes the initial step in activating primary prostaglandins, which are then able to pass unmetabolized to the decidua and myometrium, and contribute to the stimulus to preterm birth.

Chorion↗

PubMed2003

What we have learned about the predictors of preterm birth.

The Preterm Prediction Study conducted by the Maternal Fetal Medicine Network between 1993 and 1996 studied a large number of risk factors for preterm birth in more than 3,000 women at 10 centers. The goals of the study were to better understand the strength of one risk factor versus another and to explore interactions among the predictors looking for combinations of factors that were more predictive of preterm birth than any single factor used alone. The most potent factors that were associated with spontaneous preterm birth at < 32 weeks were a positive cervical-vaginal fetal fibronectin test (odds ratio, 32.7) and < l0th percentile cervical length (odds ratio, 5.8), and in serum, > 90th percentiles of alpha-fetoprotein (odds ratio, 8.3) and alkaline phosphatase (odds ratio, 6.8), and > 75th percentile of granulocyte colony-stimulating factor (odds ratio, 5.5). Results for spontaneous preterm birth at < 35 weeks were generally similar but not as strong. The overlap among the strongest biologic markers for predicting spontaneous preterm birth was small. This suggests that the use of tests such as maternal alpha-fetoprotein, alkaline phosphatase, and granulocyte colony-stimulating factor as a group or adding their results to fetal fibronectin and cervical length test results may enhance our ability to predict spontaneous preterm birth and that the development of a multiple-marker test for spontaneous preterm birth is feasible.

Alkaline Phosphatase↗

PubMed1997

Gestational diabetes and preterm labour: is glycaemic control a contributing factor?.

OBJECTIVES: (1) to evaluate the incidence of preterm delivery in patients with gestational diabetes mellitus; (2) to determine the association between glycaemic control and preterm delivery in these patients. STUDY DESIGN: (1) The incidence of spontaneous preterm singleton deliveries was determined in 550 intensively-treated patients with gestational diabetes mellitus. A total of 14 552 consecutive patients without gestational diabetes mellitus who delivered during the same interval served as a control population; (2) Glycaemic profiles (i.e., mean blood glucose, percent of hypoglycaemic [ < 60 mg/dl] and hyperglycaemic [ > 120 mg/dl] episodes) were compared in 34 patients with gestational diabetes mellitus who delivered preterm, and 68 matched controls with gestational diabetes mellitus who delivered at term. RESULTS: (1) The incidence of preterm delivery in gestational diabetics was similar to that found in the non-diabetic population (6.2% vs. 6.5%, respectively, P = 0.82; confidence limits: 0.65, 1.36); (2) women with gestational diabetes mellitus who delivered at term, or preterm had similar glycaemic profiles for both the entire treatment period and the week preceding delivery. CONCLUSIONS: (1) There is no increased risk for preterm delivery in intensively-treated gestational diabetes mellitus patients; (2) In a population such as this women with gestational diabetes mellitus who deliver preterm cannot be characterised by their glycaemic profile.

Adult↗

PubMed2000

Transvaginal ultrasonography examination of the uterine cervix in hospitalised women undergoing preterm labour.

OBJECTIVE: Our purpose was to assess the accuracy of cervical mensuration (length, wedging) by transvaginal ultrasonography in the prediction of preterm birth among hospitalised women undergoing preterm labour. METHOD: Evidence was extracted from articles through a MEDLINE search from 1987 to 1997, followed up by examining the references at the end of pertinent articles. The key words were: pregnancy, cervix, ultrasonography, preterm labour, preterm delivery, cervical length, cervical wedging or funnelling. Final criteria for the selection of the studies were cervical length and/or wedging at internal os in hospitalised women undergoing preterm labour without restriction on the study design. RESULTS: Nine articles from 12 publications were analysed and incorporated in a discussion. Study design and selection criteria vary among publications. Preterm delivery was the principal outcome, but its definition is not the same according to the authors. The best cut-off for cervical length varies from 18 to 30 mm. The size of the samples is limited. The sensitivity for predicting preterm birth ranges from 68 to 100%, and the specificity ranges from 30 to 78%. Cervical wedging has a sensitivity varying from 23 to 100%, and a specificity ranging from 54 to 90%. CONCLUSION: Ultrasonography of the cervix is an interesting technology as it is cheap and easy to use. However this technique remains to be assessed before implementing it in daily clinical practice. Finally, studies incorporating transvaginal ultrasonography into interventional trials are needed to determine the efficacy of measuring cervical length in the prevention of preterm birth.

Cervix Uteri↗

PubMed2002

Brainstem auditory-evoked potentials of 8-year-old preterm children in relation to their psycholinguistic abilities and MRI findings.

BACKGROUND: Brainstem auditory potential (BAEP) has been used to demonstrate brainstem damage and to provide prognosis for the outcome for newborn children. There are contradictory results of its power to predict problems in language development or problems at school. It is well known that preterm children experience an excess of these problems. AIM: To study if BAEP findings of 8-year-old preterm children differ from those of the full-term born control children and whether there is correlation to their linguistic problems or to the findings in magnetic resonance imaging (MRI). STUDY DESIGN: Population-based cohort study. SUBJECTS: Forty-two preterm children aged 8 years born with birth weight <1750 g and their matched full-term control children with birth weight >2500 g, 24 of whom had BAEP recordings and MRI. OUTCOME MEASURES: Differences in BAEPs between the preterm and the control children. Correlation of BAEPs with linguistic problems and with MRI findings. RESULTS: No differences were found in the absolute latencies nor in the interpeak intervals and in the I/V amplitude ratio. Nor did the results differ even when cerebral palsy disabled preterm children, preterm children with mild neurodevelopmental dysfunction or healthy preterm children were compared to each other or to the control children. No correlation to the linguistic problems or to the findings of periventricular leukomalacia (PVL) in MRI or to the different measurements of the brainstem were found. CONCLUSION: If hearing impairment does not exist, BAEP does not give further information on neurodevelopmental nor linguistic problems of the preterm children.

Brain↗

PubMed2006

Occupational working conditions as risk factors for preterm birth in Benin, West Africa.

BACKGROUND: Although many studies from developed countries have established a relationship between various occupational working conditions during pregnancy and preterm birth, there is little data available in developing countries where both maternal physical labor during pregnancy and preterm birth are common. The aim of this study was to examine the association between difficult occupational working conditions of pregnant women and premature births in the Republic of Benin in West Africa. METHOD: The case-control study included 99 women with preterm babies and 104 women with full-term babies. The participants were residents of the Republic of Benin who delivered between May 1, 2000 and April 30, 2002. Preterm delivery was defined as delivery prior to 37 completed weeks of gestation. The study sample was selected randomly from birth records. Data were collected both reviewing birth records and conducting semi-structured personal interviews with mothers. Logistic regression models were adjusted for mother's age, mother's education, health problems during pregnancy, and twin birth. RESULTS: Although working state of mother during pregnancy did not increase the risk for preterm delivery, carrying heavy loads more than 5 days per week was significantly associated with having a preterm baby (adjusted OR: 5.0; 95% CI: 1.38-18.8; P=0.018). Carrying heavy loads and having worked a lot more than 5 days per week was also significantly associated with preterm birth (adjusted OR: 6.88; 95% CI: 1.45-32.2; P=0.015). CONCLUSION: Reducing heavy loads carrying during pregnancy may also prevent preterm delivery in developing countries. Though replication of these data using a prospective design is needed, our results suggest that educating women about the risks associated with heavy labor during pregnancy is indicated.

Adult↗

PubMed1995

Prevention of preterm birth.

Preterm labour and delivery remain a major cause of perinatal morbidity, mortality and long-term adverse neurodevelopmental outcome. An effective primary prevention strategy is desirable, but current approaches appear largely ineffective at present. Understanding the aetiology of the onset of preterm labour continues to improve with the recognition of the role played by subclinical infection in a significant proportion of cases. The investigation of hormonal influences in the aetiology of preterm labour is at an early stage, but there appears to be a relationship between raised serum relaxin concentrations and preterm delivery (Petersen et al, 1992). The naturally occurring phospholipase A2-inhibitor gravidin, believed to be important in pregnancy maintenance, is found in a reduced concentration in women delivering preterm (Wilson, 1993). The relationship between hormonal levels, socio-economic influences, subclinical infection and actual preterm labour and delivery remains to be established. Secondary prevention with tocolysis remains unsatisfactory, owing to the low therapeutic index of currently available agents and their varied maternal and neonatal adverse effects. The investigation of newer tocolytic agents remains a worthwhile pursuit, whilst the underlying aetiology of preterm labour and effective prevention remains to be elucidated. The widespread recognition of the benefits of antenatal corticosteroid administration and subsequent adoption into clinical practice has reduced, and will continue to reduce, the morbidity associated with preterm birth while newer methods of accelerating fetal maturation are explored and applied in clinical practice.

Adrenal Cortex Hormones↗

PubMed1998

Term delivery after hospitalization for preterm labor: incidence and costs in california.

Objective: To determine the incidence and costs for cases of idiopathic preterm labor followed by term delivery.Study Design: Patients hospitalized with preterm labor (N = 28,845) were identified in a dataset linking antepartum and delivery discharge abstracts of all women in California (N = 404,466) with a delivery related diagnosis from 1/1/93 to 11/19/93. Patients with multiple gestations, PROM, abruption, placenta previa, uterine anomalies, and other morbidities were excluded, leaving 19,897 study subjects. Birth outcomes were classified as term or preterm (<37 weeks). The incidence, hospital costs, and risk factors for hospitalization for preterm labor followed by term delivery were then determined using a retrospective nested case control design. Indirect costs of subsequent bedrest were estimated using data from the California Disability Insurance Fund.Results: Thirty-four percent of patients hospitalized with idiopathic preterm labor had term deliveries accounting for 2% of the pregnant population. Eighty-one percent of patients who were discharged undelivered after hospitalization delivered at term. These patients were significantly more likely to be Caucasian, privately insured, and older than patients who delivered preterm. A minimum of 45% of cases were estimated to be false diagnoses based on the relative risk of post-dates pregnancy between patients hospitalized with preterm labor and term controls. Costs totalled $4,995 per case with $2,335 in hospital costs and $2,497 in indirect costs from an average of 4 weeks of bedrest. Statewide costs for California were estimated to range from 24 to 48 million dollars annually for these potentially avertible hospitalizations.Conclusions: Hospitalization for idiopathic preterm labor with delivery at term is common, costly, and probably due to false diagnosis in a significant proportion of cases.

Journal Article↗

PubMed2003

Impact of participation in the Halifax County Preterm Birth Prevention Project.

OBJECTIVES: (1). To determine if participation in the Halifax County Preterm Birth Prevention Project (HCPBPP) reduced the risk of preterm birth; (2). to evaluate the degree to which specific components of the HCPBPP contributed to preterm-birth risk reduction. METHODS: A nested case-control study was conducted among women residing in Halifax County who gave birth at the IWK Grace Health Centre during the final year of the HCPBPP. Cases, defined as women who delivered preterm (<37 weeks), and controls, defined as women who delivered at full term, were recruited to complete interviewer-administered questionnaires. Three controls per case were sequentially selected. The exposures of interest were overall participation and compliance with specific components of the program. Univariate and multivariate statistical methods were employed to evaluate the effect of exposure to the preterm-birth prevention program. RESULTS: Seventy cases and 210 controls were enrolled in the study. Although 82% of subjects participated in some aspect of the HCPBPP, only 8% of high-risk and 6% of low-risk women complied fully with program recommendations. Exposure to project educational strategies or pelvic examinations provided no protective benefit for preterm birth in low-risk or high-risk women. However, compliance with prenatal care providers recommendations to restrict activity or monitor for uterine contractions by self-palpation was associated with a marked reduction in the risk of preterm birth among low-risk women (odds ratio, 0.20; 95% confidence interval, 0.08 0.50). CONCLUSION: Although full participation in the HCPBPP protocol was limited, the findings of this case-control study suggest that activity restriction and uterine activity monitoring by self-palpation may reduce the likelihood of preterm birth in women with no identifiable risk factors for prematurity.

Bed Rest↗

PubMed2005

Does availability of fetal firbonectin testing in the management of threatened preterm labour affect the utilization of hospital resources?

OBJECTIVES: To examine how the availability of fetal fibronectin testing affects the utilization of hospital resources. METHODS: A comparison of the rates, duration, and costs of hospitalization for a prospective cohort of women who presented with preterm labour after fetal fibronectin (Ffn) testing became available, and a historical baseline cohort who presented with preterm labour before fetal fibronectin testing was available. The study included singleton pregnancies presenting between 24 and 34 weeks' gestation with signs and symptoms of preterm labour. The women in each study cohort presented during a designated 20-week period. RESULTS: We examined the records of 116 subjects with comparable gestational age distributions in each 20-week period. During the study period when Ffn testing was available, 51 tests were performed. Four tests were invalid, and 12 subjects who were tested did not meeting the inclusion criteria. Admissions for preterm labour in the study period were significantly less than in the baseline cohort (12.1% vs. 24.1%, P = 0.03), with no difference in preterm births (8.6% vs. 7.8%). The mean length of stay per patient with preterm labour declined from 5.2 days to 0.6 days (P < 0.0001), and the mean cost per patient with preterm labour declined from $3666 to $581 (P < 0.0001). In the 20-week study period, there was a reduction in total length of hospital stay from 145 to 28 days, with an overall reduction in total cost from $102 660 to $26 169. CONCLUSION: The availability of Ffn testing was associated with a reduction in hospital admissions, length of hospital stay, and overall hospital costs in the management of threatened preterm labour.

Adult↗

PubMed2003

Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes.

BACKGROUND: Previous studies have shown an association between intra-amniotic microbial invasion and/or inflammation and spontaneous preterm birth. The aim of this study was to investigate the occurrence of intra-amniotic microorganisms and cytokines [interleukin (IL)-6 and IL-8] in a Swedish population, with low incidence of preterm birth, of women with preterm prelabor rupture of membranes and their correlation to preterm birth. METHODS: Amniotic fluid was retrieved transabdominally from 58 patients with preterm prelabor rupture of membranes before 34 weeks of gestation. Polymerase chain reaction (PCR) analyses for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. IL-6 and IL-8 were analyzed with enzyme-linked immunosorbent assay (ELISA). RESULTS: Microorganisms in amniotic fluid were detected in 13 patients (25%). Patients with bacteria detected in the amniotic fluid had significantly higher levels of IL-6 and IL-8. An amniotic fluid concentration of IL-6 >/= 0.80 ng/ml [relative risk 1.93, 95% confidence interval (CI) 1.13-3.29, sensitivity 63%, specificity 75%] was associated with an increased risk of delivery within 7 days. There was also an association between IL-8 and preterm birth (< 34 weeks). CONCLUSIONS: Intra-amniotic microbial invasion and inflammation in this population of Swedish women with preterm prelabor rupture of membranes were similar to data reported from populations with a higher incidence of preterm delivery. Amniotic IL-6 correlated to the presence of microorganisms and delivery within 7 days and IL-8 to delivery before 34 weeks.

Adult↗