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PubMed2003

Preterm delivery: an overview.

Preterm delivery is the leading factor causing neonatal mortality and morbidity. We have conducted a PubMed literature search to obtain an update on the etiology, diagnostic problems and therapeutic considerations of preterm delivery. Approximately 5-10% of all births are premature. Preterm labor is associated with preterm rupture of membranes, cervical incompetence, polyhydramnion, fetal and uterine anomalies, infections, social factors, stress, smoking, heavy work and other risk factors. The diagnosis is made on the patients presenting symptoms, clinical findings and of progressive effacement and dilatation of the cervix. Biochemical markers of preterm delivery are of minor importance in daily clinical work. Measurement of the cervix, however, is a practical and valuable tool to predict preterm delivery. Cervical cerclage can be useful in selected cases. Antibiotics may help to prevent preterm labor in cases of known etiologic agents (e.g. preterm rupture of membranes and urinary infection). The use of tocolytic agents such as beta-sympathetic receptor stimulators can be advocated for a few days. There is evidence that their long-term use is not beneficial and could even be harmful to the fetus. Calcium channel blockers (nifedipine) and a new selective oxytocin receptor antagonist, atosiban, appear to be as effective as beta-sympathomimetic drugs on uterine contractions with fewer side-effects. Prostaglandin synthetase inhibitors such as indomethacin may prevent uterine contractions and can be used prior to the 32nd week of pregnancy. A single course of corticosteroid treatment in two doses of 12 mg betamethasone or 6 mg of dexamethasone is important for the prevention of respiratory distress between the 24th and 34th weeks of pregnancy. Multiple doses may be harmful and should be avoided. In these cases management should depend on gestation age (fetal maturity). Uterine contractions after 34 weeks' gestation are not an indication for tocolytic treatment.

Female↗

PubMed2001

Fatty acid absorption in preterms on formulas with and without long-chain polyunsaturated fatty acids and in terms on formulas without these added.

BACKGROUND/OBJECTIVE: Long chain polyunsaturated fatty acids have beneficial effects in preterm neurophysiological development and are semi-essential. Their levels and variation in plasma and red cells in term and preterms are better known than their intestinal absorption. In this paper the absorption of supplemented arachidonic acid (AA) and docosahexaenoic acid (DHA) is evaluated in a preterm group. DESIGN: Four newborn randomized groups were studied. Group T comprised 11 terms on regular formula. Preterms: group P (n=9) was on a classic preterm formula. INTERVENTION: groups PA (n=9) and PB (n=13) were on the same formula but PB contained AA and DHA in similar proportion to breast milk. At 20 days a 3 day metabolic balance was taken for Ca, P(i), Mg, total fat and individual fatty acids (C8-C24, saturated unsaturated). RESULTS: Calcium absorption was (mean+/-s.d.) 51+/-13% in terms. In preterms it was respectively 45+/-18, 38+/-11 and 37+/-21%. Total fat absorption was 92.0+/-8.0% in terms, and from 95.0+/-2.0 to 91.0+/-8.0% in preterms. Absorption of 8:0, 10:0 and 12:0 showed a very high and constant rate despite significant intake differences (715-33 mg/kg/day). Linoleic acid and alpha-linolenic acid were absorbed in the three groups at around 94% regardless of a greater LA intake in group P. Details of absorption (mg/kg/day) were: for AA, intake 17+/-7, fecal excretion 5+/-4, net retention 12+/-5 (75.0+/-18%); for DHA, intake 10+/-3, fecal excretion 3+/-2, net retention 6+/-4 (62.3+/-30%). CONCLUSION: Intestinal absorption of fatty acids is high and is comparable in terms and preterms as regards the studied acids. Longer acids were less well absorbed. The supplemented amounts of AA and DHA were less well absorbed and probably not impairing calcium absorption. SPONSORSHIP: University of Alicante, University of Miguel Hernández.

Arachidonic Acid↗

PubMed2003

Development of a scoring system for predicting the risk of preterm birth in women receiving cervical cerclage.

OBJECTIVE: To develop a model for identifying women receiving cervical cerclage at risk for spontaneous preterm birth <32 weeks. STUDY DESIGN: Retrospective cohort study of high-risk patients based on past obstetric history. Our inclusion criteria involved all patients with singleton gestation who received cerclage between 10 and 24 weeks. They were evaluated for the risk factors associated with preterm birth <32 weeks. Risk factors evaluated include: indication for cerclage, gestational age at cerclage placement, cervical length prior to cerclage, timing of cerclage (emergency or elective) and route of cerclage (abdominal or vaginal). Univariable and multivariable analyses were used to determine the risk factors associated with preterm birth. A risk-scoring model was developed for the prediction of preterm birth <32 weeks in women receiving cerclage. RESULTS: We identified 256 women receiving cerclage that met our inclusion criteria. Preterm births <32 weeks occurred in 51 (20%). Multivariable analysis revealed a cervical length <25 mm, a history of cone biopsy and emergency cerclage to be significant risk factors associated with preterm birth <32 weeks. The sensitivity, specificity, positive and negative predictive values of the best model for predicting spontaneous preterm birth <32 weeks in women with cerclage are 80%; 96%; 82% and 95%, respectively. CONCLUSION: The presence of a short cervical length, a history of cone biopsy and emergency cerclage were associated with preterm birth <32 weeks. Our model had a high sensitivity for identifying women who may benefit from a closer surveillance.

Adult↗

PubMed2005

Low birth weight and preterm neonates: can they be managed at home by mother and a trained village health worker?

OBJECTIVE: Observations on a cohort of neonates in the preintervention year of the field trial of home-based neonatal care (HBNC) in rural Gadchiroli, India, showed that preterm birth and low birth weight (LBW), <2500 g, constituted the most important risk factors. Owing to a limited access to hospital care, most neonates were managed at home in the subsequent intervention years. The objective of this paper is to evaluate the feasibility and effectiveness of managing LBW and preterm neonates in home setting. DESIGN: We retrospectively analyzed data from the intervention arm (39 villages) in the HBNC trial. Feasibility was assessed by coverage and by quality (19 indicators) of care. Effectiveness was evaluated by change in case fatality (CF) and in the incidence of comorbidities in LBW or preterm neonates by comparing the preintervention year (1995 to 1996) with the intervention years (1996 to 2003). RESULTS: During 1996 to 2003, total 5919 live births occurred in the intervention villages, out of whom 5510 (93%) received HBNC. These included 2015 LBW neonates and 533 preterm neonates, out of whom 97% received only home-based care. The coverage and quality of interventions assessed on 19 indicators was 80.5%. The CF in LBW neonates declined by 58% (from 11.3 to 4.7%, p<0.001), and in preterm neonates, by 69.5% (from 33.3 to 10.2%, p<0.0001). Incidence of the major comorbidities, viz., sepsis, asphyxia, hypothermia and feeding problems, declined significantly. Preterm-LBW neonates without sepsis (270) received only supportive care -- CF in them decreased from 28.2 to 11.5% (p<0.01), and those with sepsis (53) received supportive care and antibiotics -- CF in them decreased from 61 to 13.2% (p<0.005). Supportive care contributed 75% and treatment with antibiotics 25% in the total averted deaths in preterm-LBW neonates. The intrauterine growth restriction (IUGR)-LBW neonates without sepsis (1409) received only supportive care -- the CF was unchanged, and 181 with sepsis received supportive care and antibiotics -- the CF decreased from 18.4 to 8.8% (p<0.05). Treatment with antibiotics explained entire reduction in mortality in IUGR neonates. In total, 55 deaths in LBW neonates were averted by supportive care and 35 by the treatment with antibiotics. CONCLUSIONS: Home-based management of LBW and the preterm neonates is feasible and effective. It remarkably improved survival by preventing comorbidities, by supportive care, and by treating infections.

Adult↗

PubMed1998

Decreased selenium concentration in maternal and cord blood in preterm compared with term delivery.

The Se concentration in maternal and cord whole blood and plasma was determined spectrofluorimetrically in: (1) 42 women at term and (2) 46 at preterm parturients, and in the placenta. The glutathione peroxidase (GSH-Px) activity was measured in red cells and plasma in maternal and cord blood of both groups. The Se concentrations and GSH-Px activities of the above-mentioned groups were compared with those of non-pregnant women. Whole blood and plasma Se concentration of parturients at term did not differ significantly from those of non-pregnant women (72.3 versus 80.3 ng ml-1 whole blood and 48.7 versus 56.2 ng ml-1 plasma). In preterm parturients, however, Se concentrations were significantly lower (61.1 ng ml-1 whole blood and 39.2 ng ml-1 plasma) when compared with term parturients. The Se levels in cord blood and plasma were similar to their mothers' Se concentrations. No difference was observed in placenta Se levels (130 ng g-1 wet weight in both groups). The same was true for glutathione (GSH): the concentration in maternal and cord blood of term and preterm parturients did not differ and varied from 2.43 to 2.50 mmol l-1 red cells. Red cell GSH-Px activities were similar in maternal and cord blood of both term and preterm groups and ranged from 14.3 to 15.7 U g-1 Hb. The plasma enzyme activity in the maternal blood of preterm parturients was significantly (p < 0.05) lower than that of mothers at term delivery. The GSH-Px activity in the plasma of cord blood was significantly (p < 0.001) lower in the preterm than in the term group. It is suggested that low Se levels in the blood of women at preterm delivery, as shown here, may be one of the causes of retinopathy and respiratory distress syndrome in preterm infants.

Adolescent↗

PubMed1997

The effects of housing on the health of preterm infants.

Using a prospective study based on cases and controls selected from a geographical population, we have investigated the effects of housing on the health of very preterm infants (< or = 32 weeks' gestation) during the first year of life. Information on health morbidity of the 117 preterm and 226 term babies was collected using a parent-held record, and housing data by a validated self-completion questionnaire. The most common health problems in the first year-upper (UR) and lower (LR) respiratory tract infection, otitis media (OM) and diarrhoea and vomiting (DV)-were all more frequent in the preterm group, There were no significant differences in the housing conditions to which preterm and control infants were exposed. Relative risks (RR) and 95% confidence intervals (CI) associated with each housing factor were calculated for preterm and control infants separately. Significant (P < 0.05) interaction effects were found for overcrowding and gas cooking. Overcrowding was associated with an increased incidence of LR [RR = 1.53; CI 0.96-2.42] and DV [RR = 1.57; CI 0.92-2.67] in the preterm, but with a decreased incidence of LR [RR = 0.28; CI 0.04-1.86] and DV [RR = 0.85; CI 0.30-2.38] in the term controls. The use of gas ovens was found to be associated in preterm infants with an increase in LR [RR = 1.48; CI 0.96-2.28] and DV [RR = 2.24; CI 1.28-3.93] but the controls did not show this effect for LR [RR = 0.67; CI 0.40-1.09] or DV [RR = 0.93; CI 0.56-1.56]. These associations are robust-even after allowing for confounding social factors-but causality has not been proved. This work suggests that preterm infants may be vulnerable to specific adverse housing factors, and further studies are now indicated to clarify potential mechanisms and interactive effects behind these associations.

Case-Control Studies↗

PubMed1998

Intergenerational influences affecting birth outcome. II. Preterm delivery and gestational age in the children of the 1958 British birth cohort.

The 1958 British cohort study has data to investigate intergenerational effects on preterm delivery and on gestational age in non-preterm births, allowing for many confounders that may differ in the more pathological preterm babies. Previous results for all gestational ages-have been inconsistent. The strongest and only likely independent intergenerational effect on non-preterm gestational age found is parental gestational age (adjusted regression coefficient = 0.067 weeks per week in mothers and 0.045 in fathers). The preterm analysis has low power; however, reported history of hypertension in mothers (any), in fathers and in the maternal grandmother (measured in the 1958 pregnancy) all significantly and independently increased the risk of preterm birth [OR = 1.7, 2.0, 1.5 respectively]. The absolute risk was particularly high in hypertensive mothers who had been preterm themselves (21%). Other possible intergenerational influences of height, weight, fetal growth and gestation were not significant enough and/or consistent enough between parents to speculate whether they are truly intergenerational or confounded by other factors acting during the pregnancy. Excepting mother's weight for height, no genetic or environmental influence studied affects both gestational age and fetal growth in term births. However, many maternal factors that reduce either fetal growth or gestation in term births are associated with increased risk of preterm birth.

Adolescent↗

PubMed2000

Maternal sociodemographic characteristics as risk factors for preterm birth in twins versus singletons.

Many studies have examined associations between sociodemographic variables and preterm birth in singletons. However, almost no research has been published on whether variables such as maternal age, race, ethnicity, level of education and smoking are associated with preterm birth among twins in the same way. The purpose of this study was to examine such associations in twins and singletons comparatively. The study population consisted of all 567796 twins and 23297909 singleton births recorded in the US birth records for 1990-95. Gestational age data were rigorously 'cleaned' to solve the problem of biologically implausible birthweight/gestation combinations in vital records. Preterm birth was defined as gestational age < 35 weeks. Some 25.8% of twins and 3.2% of singletons were preterm by this definition. Crude and adjusted relative risks (RR) were estimated using a modified Mantel-Haenszel procedure. We found several characteristics associated with preterm birth in both twins and singletons, e.g. for twins: race (black adjusted RR = 1.30 compared with white non-Hispanic); marital status (unmarried adjusted RR = 1.15 compared with married); and age (< or = 17 years adjusted RR = 1.39 compared with 20-29 years). A similar analysis of singletons revealed stronger associations between the same characteristics and preterm birth, e.g. the adjusted RR for black race was 2.3. These differences in RRs suggest that sociodemographic characteristics have weaker effects on preterm birth among twins than among singletons. Care must be taken in interpreting differences in preterm birth in twins and singletons, as their gestational age distributions differ so markedly.

Adolescent↗

PubMed2000

Defining preterm delivery--the epidemiology of clinical presentation.

It is possible that preterm delivery is not a single entity but a cluster of conditions with different aetiologies that ultimately result in the delivery of an infant before 37 completed weeks of gestation. Whereas some researchers have reported aetiological heterogeneity, others have found no differences between subtypes or have disputed the desirability and utility of classifying preterm birth into subtypes. This study explores the relationship of maternal risk factors to type of preterm delivery in a cohort of over 7000 black and white women delivering singleton infants at the University of California, San Francisco's Moffitt Hospital between 1980 and 1990. Although the magnitude of the effect of individual risk factors differed between preterm delivery subtypes, the set of risk factors significantly associated with both categories of spontaneous preterm delivery was identical, while that associated with medically indicated preterm births was different. This study indicates that whereas the distinction between spontaneous preterm deliveries and those that are medically indicated seems valid, distinguishing between types of spontaneous preterm births may not lead to useful aetiological inferences.

Adolescent↗

PubMed2000

Morphology assessed by transvaginal ultrasonography differs in patients in preterm labor with vs. without bacterial vaginosis.

OBJECTIVE: To determine whether cervical morphology in preterm labor patients differs in the presence or absence of bacterial vaginosis. DESIGN: Observational study. SUBJECTS: One hundred and twelve consecutive patients with objectively confirmed preterm labor admitted to a tertiary care centre were included in the study. Patients with placenta previa, active uterine bleeding or indication for an immediate delivery (e.g. severe pre-eclampsia or suspected fetal asphyxia), or severe fetal anomalies were excluded. METHODS: Transvaginal ultrasonography was used to measure cervical length and internal os width. Bacterial vaginosis was diagnosed by Gram stain of a vaginal smear. RESULTS: A total of 36 patients (32%) had bacterial vaginosis. Cervical length in this group was shorter than in patients with normal flora (mean 20.4 +/- 7.2 mm vs. 26.4 +/- 6.7 mm; P = 0.0002), and more patients with bacterial vaginosis had a dilated internal cervical os > or = 5 mm (67% vs. 30%, P = 0.001). There were no significant differences, however, in preterm delivery rate and birth weight between the two groups; the overall preterm delivery rate was 40%. A cervical length < 25 mm was predictive of preterm delivery (P = 0.001, RR 4.2, 95% CI 1.8-9.7). CONCLUSIONS: These data suggest that cervical change in preterm labor is more pronounced in patients with bacterial vaginosis but without a concomitant increase in the risk for preterm delivery. Despite this association, the cervical length measured by transvaginal ultrasonography alone is a useful predictor of preterm delivery, independent of the presence or absence of bacterial vaginosis.

Adult↗

PubMed2000

Infection and preterm birth.

Preterm birth complicates 11% of all pregnancies in the United States and remains a leading cause of infant mortality and long-term neurological handicap. The majority of this morbidity and mortality is concentrated among the small subset of infants born before 32 weeks' gestational age and that have birth weights < 1500 g. Although the survival of these preterm infants has improved over the last 20 years, the rate of long-term handicap has not. Despite widespread use of preventive strategies, the rate of preterm birth is increasing. Therefore, the prevalence of long-term handicap attributed to preterm birth also is increasing. Considerable data implicate a clinically silent upper genital tract infection as a key component of the pathophysiology of a majority of early spontaneous preterm births, but a minority of preterm births that occur near term. This report reviews the current status of our understanding of the relationship between genital tract microbial infection and spontaneous preterm birth, the availability and usefulness of markers to identify women with such infections, and the results of recent prospective randomized clinical trials of antibiotic therapy to prevent preterm birth. Strengths and limitations of the trials are reviewed in relationship to their value for guidance in clinical management strategies and directions for future research are discussed.

Female↗

PubMed2005

Insulin-like growth factor binding protein-1 detection in preterm labor: evaluation of a bedside test.

Phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) is secreted by decidual cells and may leak into cervical secretions during detachment of the fetal membrane. The aim of this study was to determine whether a rapid bedside test for phIGFBP-1 predicts preterm birth in women with preterm uterine contractions. This was a prospective study of pregnant women who sought medical care for symptoms of preterm labor. Cervical swabs were assayed for the presence of phIGFBP-1 by a rapid bedside test. Sixty-four patients were enrolled. Eleven of them (17%) delivered preterm (< 35 weeks). phIGFBP-1 in cervical secretions predicted preterm birth with a sensitivity of 72.7%, a specificity of 83.0%, a positive predictive value of 47.0%, and negative predictive value of 93.6%. Positive phIGFBP-1 bedside test in women with preterm uterine contractions may indicate a significant risk for subsequent preterm birth. The absence of phIGBP-1 is a reassuring sign that the likelihood of preterm birth is low.

Adult↗

PubMed1993

Risk factors and deliveries associated with preterm, severely small for gestational age fetuses.

Maternal and fetal risk factors and deliveries associated with 153 singleton, preterm, severely small for gestational age (SGA) fetuses were compared to the corresponding data of 153 next-born preterm appropriate for gestational age (AGA) fetuses matched for gestational age. Maternal history of previous delivery of an infant of SGA status, pre-eclampsia, hypertension without proteinuria, oligohydramnios, and fetal congenital anomalies were identified as risk factors for preterm, severely SGA deliveries. In the preterm, severely SGA group the rate for abdominal deliveries was 82%. Of these operations, 40% were emergency cesarean sections, many of which involved pre-eclampsia cases. If congenital malformations were excluded, perinatal mortality rate was 7% in the preterm SGA group and 4.6% in the preterm AGA group. Preterm, severely SGA fetuses constitute a perinatal risk group, which cannot be avoided. However, awareness of and familiarity with the risk factors associated with preterm, severely SGA cases can better equip the attending physician to consider appropriate perinatal care options.

Cesarean Section↗

PubMed1989

Effectiveness of patient education to reduce preterm delivery among ordinary risk patients.

Patient education is an important component of all preterm birth prevention programs, but studies of these programs have not examined the independent contribution of patient education to preterm birth prevention. The Program to Reduce Obstetrical Problems and Prematurity in the Bronx, New York, is a multifaceted preterm birth prevention program that includes a half hour combined videotape and nurse discussion session, which was offered to all patients. In evaluating the outcome of pregnancies in patients not at high risk for preterm delivery (ordinary risk patients) we found that patients who received instruction to recognize early signs of preterm labor had babies with a higher birthweight (3255 +/- 548 gm) than patients who were not so instructed (3200 +/- 599 gm, p = 0.03). Average length of gestation in the instructed and noninstructed patients was 276 +/- 15 days and 275 +/- 18 days (p = 0.12), respectively. The preterm delivery rate among patients receiving the instruction was 9.5% compared with 11.5% among those who did not receive it. We conclude that specific prenatal education about early warning signs of preterm labor is an important component of preterm birth prevention programs that can be demonstrated to have an independent contribution to prenatal care.

Adult↗

PubMed1987

Evaluation of the weekly cervical examination in a preterm birth prevention program.

The efficacy of regular cervical examinations in detecting preterm labor, as well as possible risks, was studied for 133 preterm labor patients who had received regular cervical examinations as part of a preterm birth prevention program. When compared to all other patients experiencing preterm labor during the study period, the rates of preterm premature rupture of the membranes, chorioamnionitis, and postpartum endomyometritis were not increased. For 95 patients with preterm labor within 7 days of a routine cervical examination, labor onset was not temporally associated with the preceding examination. Preterm labor was diagnosed in 18 asymptomatic patients (18.2%) when the weekly examination revealed cervical change. Routine cervical exams, therefore, did not increase morbidity, and for some patients identified preterm labor before symptoms appeared.

Cervix Uteri↗

PubMed1983

Growth and biochemical response of preterm infants fed human milk or modified infant formula.

My colleagues and I compared the biochemical status and rates of growth of three groups of preterm infants: one group was fed milk obtained early from mothers of preterm infants; one group received milk produced during the mature stage of lactation by mothers of term infants; and one group received a whey-based infant formula. Sixty healthy preterm infants with birth weights of 1600 g or less were randomly assigned to one of the three feedings groups. The 20 infants in each group were followed until they reached a weight of 1800 g. The mean (+/- S.E.M.) number of days required to regain birth weight was similar for infants receiving the formula (10.3 +/- 0.8) and those receiving milk from mothers of preterm infants (11.4 +/- 0.8); both were significantly less than the number (18.8 +/- 1.7) for infants receiving milk from mothers of term infants (P less than 0.001). Subsequent rates of weight gain were greater for the groups receiving formula (27.0 +/- 0.8 g per day) and milk from mothers of preterm infants (23.7 +/- 1.1) than for the group receiving milk from mothers of term infants (15.8 +/- 0.8) (P less than 0.001). Similarly, the average increments in crown-to-heel length and in the head circumference were significantly greater for the groups given formula and milk from mothers of preterm infants (P less than 0.005 and P less than 0.001, respectively). These data indicate that feeding with either milk from mothers of preterm infants or a whey-based infant formula results in more appropriate growth in preterm infants than feeding with milk from mothers of term infants.

Acid-Base Equilibrium↗

PubMed2000

Maintenance treatment of preterm labor with the oxytocin antagonist atosiban. The Atosiban PTL-098 Study Group.

OBJECTIVES: Patients admitted with an acute episode of preterm labor who respond to early intravenously administered tocolysis remain at risk of having subsequent episodes of preterm labor and preterm delivery. Several pharmacologic agents have been used in an attempt to reduce subsequent episodes of preterm labor, and all are associated with significant side effects. Atosiban, an oxytocin receptor antagonist, is effective in the treatment of an acute episode of preterm labor. This study was designed to compare the efficacy and safety of atosiban with those of placebo maintenance therapy in women with preterm labor who achieved uterine quiescence with intravenous atosiban. STUDY DESIGN: A multicenter, double-blind, placebo-controlled trial was designed for patients in preterm labor who responded to early intravenous treatment with atosiban. Five hundred thirteen patients were randomly assigned to receive maintenance therapy, 252 to receive atosiban, and 251 to receive matching placebo. Maintenance therapy was administered as a continuous subcutaneous infusion, via pump, of 30 microg/min to the end of 36 weeks' gestation. The primary end point was the number of days from the start of maintenance therapy until the first recurrence of labor. A secondary end point was the percentage of patients receiving subsequent intravenous atosiban therapy. RESULTS: The time (median) from the start of maintenance treatment to the first recurrence of labor was 32.6 days with atosiban and 27.6 days with placebo (P =.02). At least one subsequent intravenous atosiban treatment was needed by 61 atosiban patients (23%) and 77 placebo patients (31%). Except for injection site reactions, adverse event profiles of atosiban and placebo were comparable. There were 4 neonatal deaths reported in the atosiban group and 5 in the placebo group after the start of maintenance therapy. Infant outcomes (including birth weight) were comparable between maintenance and treatment groups. CONCLUSIONS: Maintenance therapy with the oxytocin receptor antagonist atosiban can prolong uterine quiescence after successful treatment of an acute episode of preterm labor with atosiban. Treatment was well tolerated.

Adult↗

PubMed2000

Intrauterine infection and preterm delivery: evidence for activation of the fetal hypothalamic-pituitary-adrenal axis.

OBJECTIVE: We studied pregnant women in preterm labor with and without intrauterine infection to determine whether fetal hypothalamic-pituitary-adrenal axis activation occurs in the setting of infection-induced preterm parturition. STUDY DESIGN: Amniotic fluid collected by amniocentesis and maternal blood from patients in preterm labor with intact membranes at 24 to 34 weeks' gestation were analyzed by radioimmunoassay for the steroid hormones estrone, estradiol, progesterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and cortisol. Amniotic fluid was also obtained for microbial culture and for interleukin 6 measurements by enzyme immunoassay. RESULTS: Patients with intrauterine infection (n = 11) had significantly higher amniotic fluid concentrations of dehydroepiandrosterone (539 +/- 79 pg/mL) and of cortisol (5.28 +/- 1.0 microg/dL) than did patients with preterm labor and preterm delivery without infection (n = 11; 273 +/- 82 pg/mL and 1.61 +/- 1.05 microg/dL, respectively) or patients with preterm labor and subsequent term delivery (n = 11; 202 +/- 79 pg/mL and 1.82 +/- 1.0 microg/dL, respectively). Furthermore those patients who were delivered within 7 days after enrollment (who were also more likely to have intrauterine infection) had higher amniotic fluid concentrations than did those who were not delivered within 7 days of both estrone (586 +/- 101 pg/mL vs 314 +/- 98 pg/mL) and estradiol (238 +/- 44 pg/mL vs 91 +/- 43 pg/mL). CONCLUSION: Intrauterine infection was associated with increased fetal adrenal androgen and cortisol biosynthesis, and delivery within 7 days after the onset of preterm labor was associated with increased placental estrogen synthesis. These data are consistent with fetal hypothalamic-pituitary-adrenal axis activation in the setting of infection-associated preterm delivery.

Adult↗