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PubMed2000

University hospital based care decreases recurrent preterm deliveries and costs in comparison to no prenatal care(1).

Objective: To compare perinatal outcomes and total health care costs for patients with a previous history of preterm delivery cared for by an inner city university hospital house staff clinic versus patients who have not received any prenatal care.Study Design: We conducted a retrospective review of women with a history of preterm delivery between 1994 and 1996. The inclusion criteria was a history of at least one preterm delivery. Data were obtained on maternal demographics, complete past obstetrical history, and number of prenatal visits.Results: The study groups consisted of 96 house staff patients and 53 patients without prenatal care. The number of prior preterm births, incidence of recurrent preterm delivery, length of neonatal intensive care unit stay, and mother-infant costs were greater in the group without prenatal care. The mean gestational age at time of delivery, and mean birth weight were greater in the house staff group.Conclusion: Our study demonstrates that university hospital-based prenatal care decreases recurrent preterm delivery rates and health care costs when compared to lack of prenatal care. Prenatal care provided at academic centers, with a coordinated multidisciplinary approach, appears to have a positive impact on the problem of preterm deliveries.

Journal Article↗

PubMed2003

Cervical length assessment by ultrasound as a predictor of preterm labour--is there a role for routine screening?

Transvaginal ultrasonography has recently been shown to be an objective, reproducible and reliable method to assess the cervix and predict the risk of preterm delivery in high-risk pregnancies. Assessment of the cervix includes cervical length measurement (CLM) and measurement of dilatation of the internal os in a dynamic functional examination. There is an inverse correlation between cervical length and the frequency of preterm delivery. The high negative predictive value avoids unnecessary interventions such as tocolysis or cerclage in high-risk pregnancies. In contrast, a length of 25 mm or less at 28-30 weeks of gestation is associated with a significantly increased incidence of preterm delivery. Studies in women with high risk for preterm delivery, i.e. contractions, premature rupture of the membranes and history of preterm delivery, have shown a high sensitivity and a high positive predictive value, however in low-risk groups they have failed to show a high sensitivity. From large observational studies in low-risk populations we know that the 50th percentile of the cervical length is 35 mm at 24 weeks of gestation. Advantages of CLM as a screening test include the fact that sonographical assessment of the cervix is a widely accepted and well-standardised method, which requires only a relatively short period of training. Disadvantages of screening are two factors, the first being the low sensitivity of the test and the low prevalence of preterm deliveries in a low-risk population, resulting in cut off values being set at a very low level (i.e. 5th percentile) in order to get acceptable specificity. Secondly, screening is only worthwhile if an effective preventive therapy is available. The debate about tocolysis and cerclage is not yet concluded. Therefore we would not currently recommend cervical length measurement as a screening tool-but as a routine method in high risk gravidas with or without symptoms. Further interest should be focused on scoring systems combining ultrasound with biochemical, endocrinological and maybe molecular cell methods such as the measurement of fetal DNA in maternal blood to prevent preterm deliveries in the general population.

Cervix Uteri↗

PubMed2001

A preterm birth prevention project in Nova Scotia, Canada.

OBJECTIVE: The Halifax County Preterm Birth Prevention Project was designed to evaluate the effectiveness of a population-based preterm birth (PTB) prevention program in Nova Scotia from January 1995 through June 1997 (n = 10,326). METHODS: Preterm birth rates, adjusted for risk status and maternal age, were evaluated over time in Halifax County and compared to non-Halifax County parturients in Nova Scotia. Physician participation was evaluated by means of a mailed survey. RESULTS: There was no appreciable change in the overall (<37 weeks) or early (<34 weeks) PTB rates within or outside Halifax County during the intervention period compared to the preintervention period. Although not significant, the very (<30 weeks) PTB rate in Halifax County decreased by 40% from 0.53 to 0.32%, while outside Halifax County it remained stable (0.43-0.42%). There was a statistically significant decrease in early and very PTB associated with spontaneous labour, as well as an apparent shift in the timing of delivery from very preterm to preterm (> or =30 weeks). Participation among responding physicians was greater for high-risk than low-risk women, but full compliance with project recommendations was low. CONCLUSION: The overall ineffectiveness of the Halifax County Preterm Birth Prevention Project may reflect the reluctance of practitioners to fully incorporate the recommended prevention strategies into their practice. However, such interventions may reduce the risk of spontaneous early preterm birth.

Feasibility Studies↗

PubMed2002

New rapid bed-side test to predict preterm delivery: phosphorylated insulin-like growth factor binding protein-1 in cervical secretions.

BACKGROUND: Phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP-1 in cervical secretions by a rapid bed-side test could be used to predict preterm delivery in patients with regular uterine contractions. STUDY DESIGN: In our prospective study, 36 women between 20 and 36 weeks of gestation with regular, persistent contractions (> 10/h) and 18 women between 20 and 36 weeks gestation without symptoms of preterm labor were assessed for the presence of cervical phIGFBP-1. Dacron swabs were applied to the cervix and assayed in 5 min by using immunochromotography, a new rapid bed-side test (actim partus test, Medix Biochemica, Kauniainen, Finland). Data analysis included one-way variance analysis (ANOVA), Student's t-test, chi-square and Fisher's exact test. RESULTS: Of the 36 patients with regular uterine contractions, 18 had a positive actim partus test and 18 had a negative test. Among the 18 patients with a positive test, only one delivered term and the other 17 patients delivered preterm (< 37 weeks). Among the 18 women with a negative test, only two delivered preterm (p < 0.05). Mean gestational age at delivery for patients with a positive and a negative test was 34.4 +/- 3.0 and 37.9 +/- 2.3 weeks, respectively (p < 0.05). Sensitivity, specificity, positive and negative predictive values of the rapid phIGFBP-1 test for preterm delivery was 89.5, 94.1, 94.4 and 88.9%, respectively. For delivery < 37 weeks, positive likelihood ratio was 15.2 (+/- 95% CI; range 2.6-102.5). When cervical phIGBP-1 assay was used to predict delivery within 7 days, sensitivity, specificity, positive and negative predictive values were 93.8, 85%, 83.3 and 94.1%, respectively. Positive likelihood ratio with +/- 95% CI was 6.25 (range 2.2-17.8). When patients were categorized according to cervical dilatation, the positive likelihood ratio of the test when the cervix was closed at 2 cm were 8.3 (1.3-55.3), 13.6 (2-91.4), 15.8 (2.3-106.3) and 1.5 (0.2-11.5), respectively, CONCLUSION: The presence of cervical phIGFBP-1 is predictive of preterm delivery < 37 weeks of gestation. Our study shows that cervical detection of phIGFBP-1 by immunochromotography is a rapid and easily applicable test that highly anticipates preterm delivery in patients at risk.

Adult↗

PubMed2002

Initiation of lactation in women after preterm delivery.

BACKGROUND: Lactogenesis II describes the onset of copious milk secretion, and the success of lactogenesis II has been determined in women by measuring the changes in the composition of mammary secretion in the immediate postpartum period. AIM AND METHODS: Therefore, the aim of this study was to determine the success of lactogenesis II at day 5 postpartum in women expressing milk for their preterm infants (n = 22) by measuring the lactogenesis II markers (milk citrate, lactose, sodium and total protein) and comparing them with women breastfeeding full-term infants (n = 16). RESULTS: There were no significant differences between the means (+/- SD) of the lactogenesis II markers for preterm (4.3 +/- 0.7 mM; 147 +/- 10 mM; 12 +/- 6 mM; 14.0 +/- 1.5 g/l, respectively) and term (3.4 +/- 1.4 mM; 126 +/- 17 mM; 30 +/- 13 mM; 15.3 +/- 2.5 g/l, respectively) women. However, variation about the mean was greater in preterm women (coefficient of variation for citrate, 40%; lactose, 14%; sodium, 42%; and total protein, 17%) compared with term women (17%, 7%, 33%, and 10%, respectively). All lactogenesis II markers were within 3 SD from the means for the term women and thus these women were considered to have successfully initiated their lactation. Only 18% of preterm women had all four lactogenesis II markers within 3 SD from the mean for term women. The remaining 82% of preterm women had at least one of the markers of lactogenesis II at pre-initiation concentrations (36% had 1 marker, 32% had 2 markers, and 14% had 3 markers). Furthermore, these women had significantly lower 24-hr milk production than those preterm women that had all four markers within 3 SD from the mean of the term women. CONCLUSIONS: It was concluded that 82% of preterm women had a compromised initiation of lactation, and this was not uniform in all women.

Biomarkers↗

PubMed2003

Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women in preterm labor.

BACKGROUND: Previous studies indicate an association between intra-amniotic microbial invasion and/or inflammation and spontaneous preterm birth, but there is a limited amount of data available from Europe. The aim of this study was to investigate the occurrence of intra-amniotic microorganisms and cytokines (interleukin-6 and interleukin-8) in a Swedish population of women in preterm labor and their correlation with preterm birth. METHODS: Amniotic fluid was retrieved transabdominally from 61 patients in preterm labor before 34 weeks of gestation. Polymerase chain reaction analyses for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. Interleukin-6 and interleukin-8 were analyzed with enzyme-linked immunosorbent assay. RESULTS: Microorganisms in amniotic fluid were detected in 10 patients (16%). Patients with detected bacteria in the amniotic fluid had significantly higher levels of interleukin-6 and interleukin-8. There was also an association between interleukin-6/-8, the amniocentesis-delivery interval ( or= 1.5 ng/mL or interleukin-8 >or= 1.3 ng/mL was associated with an increased risk of delivery within 7 days (interleukin-6: relative risk 7.3; 95% confidence interval: 2.8-19; sensitivity 83%, specificity 87%; interleukin-8: relative risk 14, 95% confidence interval: 3.6-55, sensitivity 91%, specificity 87%). CONCLUSIONS: The occurrence of intra-amniotic microbial invasion and inflammation in this population of Swedish women in preterm labor was similar to data reported from populations with a higher incidence of preterm delivery. Amniotic interleukin-6 and interleukin-8 correlated with the presence of microorganisms and with preterm birth.

Adult↗

PubMed2003

Serial serum ferritin estimation in pregnant women at risk of preterm labor.

BACKGROUND: To estimate serial serum ferritin (SF) concentrations after 20 weeks of pregnancy in women at risk of having a preterm labor and to correlate them with the outcome of pregnancy. METHODS: Venous blood samples were drawn serially at 26, 30 and 34 weeks of gestation in one hundred pregnant women who were at risk of having a preterm delivery. Samples were analyzed for hemoglobin (Hb), leukocyte count, hemotocrit serum iron (SI), total iron-binding capacity (TIBC), SF and transferrin saturation. Seventy-six subjects delivered at term and 24 subjects delivered before 37 weeks. The various parameters were compared between the term and the preterm groups. RESULTS: Mean SF at different gestations in the term and the preterm group was not statistically different. Serial SF levels in subjects in the term group showed a declining trend with advancing gestation as seen in normal pregnancies. However, in the preterm group, a rising trend was observed. Further, SF levels of > 30 micro g/dl at 26 weeks and > 40 micro g/dl at 34 weeks were found to have a reasonable sensitivity and specificity for predicting preterm delivery. CONCLUSION: A SF concentration of > 40 micro g/dl and a rise in SF concentration with increasing gestation should alert the clinician regarding the possibility of preterm delivery.

Anemia, Iron-Deficiency↗

PubMed2002

Factors affecting the introduction of complementary foods in the preterm infant.

OBJECTIVES: The aim of the study was to identify current infant feeding practices among carers of preterm infants. DESIGN: Structured interviews on milk and complementary feeding practices were conducted with mothers of preterm infants at intervals until infants were 12 months corrected age. SETTING: Recruitment took place in three local Surrey hospitals over a 2 y period. SUBJECTS: Two-hundred and fifty-three preterm infants (139 male, 114 female) including 33 sets of twins and three sets of triplets were recruited. RESULTS: Forty-nine percent of the preterm infant group received first solid foods (the commencement of 'weaning') before the current Department of Health (DoH) guideline. The mean+/-s.e.m. weaning age from birth was 17.1+/-0.23 weeks. Ninety-five percent of the infants were weaned before the DoH guideline when the data was examined from term (mean 11.5+/-s.e.m. 0.21 weeks). Twenty-one percent were weaned before the DoH guideline for preterm infants which is that 'the infant weighs at least 5 kg' (mean 5.61+/-s.e.m. 0.01 kg). Human milk-fed infants were significantly lighter at weaning than combined milk-fed infants (5.32+/-0.12 vs 5.72+/-0.01 kg; P<0.05) even though they were weaned at a similar age. Infant formula-fed infants (mean weaning age from term 10.2+/-0.47 weeks) were weaned significantly earlier than both human milk-fed (11.9+/-0.49 weeks; P<0.05) and combined milk-fed (11.9+/-0.25 weeks; P<0.005) infants. CONCLUSIONS: The introduction of complementary foods varied widely between carers of preterm infants and compliance with DoH guidelines was poor. Further studies on preterm infants are necessary to see if weaning practices affect long-term growth and morbidity and to provide a basis for the development of appropriate recommendations. SPONSORSHIP: This work was funded by the MAFF Food Intolerance Programme.

Age Factors↗

PubMed2003

Moderate alcohol drinking and risk of preterm birth.

OBJECTIVE: We have analysed the association between alcohol drinking before and during the three trimesters of pregnancy and risk of preterm birth of babies with normal weight for gestational age or with low weight for gestational age (SGA). DESIGN: Case-control study. SETTING: General and university hospitals in Italy. SUBJECTS: Cases were 502 women who delivered preterm births <37 weeks gestation. The controls included 1966 women who gave birth at term (>/=37 weeks of gestation) to healthy infants of normal weight (ie between 10th and 90th centile according to the Italian standard) on randomly selected days at the hospitals where cases had been identified. INTERVENTIONS: Interview. RESULTS: No increased risk of preterm birth was observed in women drinking one or two drinks/die in pregnancy, but three or more drinks/die increased the risk (multivariate odds ratios (OR) 2.0 for >/=3 drinks during the first trimester, 1.8 during the second and 1.9 during the third). When the analysis was conducted separately for preterm births with normal weight or SGA, the increased risk was observed in preterm SGA only (multivariate OR for >/=3 drinks/die during the first trimester=3.6, 95% confidence interval (CI) 1.3-11.1); the estimated multivariate OR for >/=3 drinks/die during the first trimester of preterm babies with normal weight for gestational age was only slightly above unity and not statistically significant (multivariate OR 1.4, 95% CI 0.5-3.7). CONCLUSIONS: The study shows an increased risk in mothers who drink >/=3 die units alcohol in pregnancy of preterm births.

Adult↗

PubMedDate not supplied

Cigarette smoking, low birth weight, and preterm births in low-income African American women.

OBJECTIVE: To examine effects of light and heavy cigarette smoking on the incidence of low birth weight (LBW) and preterm births in African American women. DESIGN: A total of 1146 low-income African American women participated in a randomized trial to test the effectiveness of nursing intervention in the reduction of preterm and LBW births. This secondary analysis focused on the effects of cigarette smoking on LBW (< 2500 gm) and preterm (< 37 weeks' gestation) births. RESULTS: Cigarette smoking had a significant effect on both LBW and preterm births. When light smokers were compared with nonsmokers, odds ratios were 1.89 (confidence interval (CI) 1.15, 3.13; p = 0.0127) for LBW births and 1.74 (CI 1.00; 3.02; p = 0.0499) for preterm births. When heavy smokers were compared with nonsmokers, odds ratios were 3.03 (CI 1.90, 4.86; p = 0.001) for LBW births and 2.60 (CI 1.55, 4.35; p = 0.0003) for preterm births. CONCLUSION: Cigarette smoking was associated with significantly higher rates of both LBW and preterm births in this sample of African American women.

Adult↗

PubMed2005

A randomized multicenter study to determine the efficacy of activity restriction for preterm labor management in patients testing negative for fetal fibronectin.

OBJECTIVE: To assess the impact of activity restriction (AR) on the incidence of preterm birth in women treated for preterm labor testing negative for fetal fibronectin (fFN). STUDY DESIGN: Women who were diagnosed with preterm labor and tocolyzed with magnesium sulfate were concurrently screened with fFN for the purpose of subsequent management. Included were consenting patients with negative fFN, gestational age 23 0/7-33 6/7 weeks, cervical dilation < or =3 cm, and minimal vaginal bleeding. Patients were randomized to AR or no AR. Primary study outcome was incidence of preterm delivery and interval from randomization to delivery. RESULTS: A total of 73 women with negative fFN were randomized (36 with AR, 37 without AR). The overall preterm birth rate was 40%, with 44.4% of patients with AR and 35.1% of patients without AR delivering preterm, p=0.478. CONCLUSION: Maternal AR did not impact pregnancy outcome. The incidence of preterm birth in symptomatic women testing fFN negative was higher than previously reported.

Adult↗

PubMed2000

Maternal age and preterm births in a black population.

Babies born to teenagers aged 15-19 years have a substantial risk of dying within the first year of life. Although associated socio-demographic factors may account for an increase in the risk of adverse reproductive outcomes for teenagers, there is a concern that young maternal age may also be a biological risk factor. We examined the effects of maternal age of primiparous black women on the incidence of preterm births using data from 6,072 black women delivering between 1989 and 1995 at an urban perinatal network of 17 hospitals and health centres serving residents in a well-defined geographical area. Maternal age was grouped as: < or = 15, 16-17, 18-19, 20-24, 25-29 or > or = 30 years age groups. The 20-24 age group with the highest number of births and lowest preterm rate was used as the reference age. Preterm birth was defined as delivery < 37 completed weeks of gestation. Of the 6,072 infants born to the cohort, 1,170 (19.3%) were preterm. The unadjusted odds for a preterm birth for the < or = 15-year-olds (odds ratio [OR] = 0.97; 95% confidence interval [CI], 0.69,1.36), for the 16- to 17-year-olds (OR=1.21; CI=0.94, 1.57) and for the 18- to 19-year olds (OR=1.15, CI = 0.92, 1.43) were not significantly different from that for the reference group. The risk for the 25-to 29-year-old mothers was 1.26 times [CI = 1.05, 1.50] and for the > 30-year-old mothers 1.28 times [CI = 1.07, 1.52] that for the reference group. Adjustments using logistic regression analysis for the effects of maternal smoking, drug abuse during pregnancy, insurance status, having prenatal care and median family income from census tract of residence did not result in a significantly increased risk for preterm birth or low birthweight for the teenage groups compared with the reference group. We conclude that primiparous teenage black mothers do not have an inherent biologically increased risk for preterm births.

Adolescent↗

PubMed2000

Prediction of preterm birth by second trimester cervical sonography in twin pregnancies.

OBJECTIVES: To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation. METHODS: Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation. RESULTS: Sixty-five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length < or = 25 mm and < or = 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0-10.3 and R.R. 3.6, C.I. 1.6-7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02-0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix < or = 30 mm and any funneling were strongly predictive of PTD. CONCLUSIONS: Both cervical length < or = 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth.

Cervix Uteri↗

PubMed2001

Modulation of calcium oxalate monohydrate crystallization kinetics by urine of preterm neonates.

Preterm neonates frequently develop nephrocalcinosis (NC). However, the cause has not yet been elucidated. This study focuses on the effects of urine from preterm neonates on crystallization kinetics. Urine samples were collected and renal ultrasound examinations of preterm neonates (gestational age < 32 weeks) were performed during the first weeks of life, at term, and ages 6, 12, and 24 months. The effect of urine on crystallization was determined using a seeded crystal growth system, which measures the square root of solubility product ( radicalLc), percentage of growth inhibition (GI), and agglomeration inhibition ([tm]) of calcium oxalate crystals. Data for preterm neonates in the first weeks of life (n = 19) were compared with those for full-term neonates (n = 17) and healthy adults. Moreover, the correlation between [tm] and urinary (U)citrate level was studied. Mean radicalLc (0.27 +/- 0.1 versus 0.36 +/- 0.08 mmol/L) and mean [tm] (81 +/- 32 versus 143 +/- 97 minutes) were lower and mean Ucalcium-creatinine (2.20 +/- 1.74 versus 0.46 +/- 0.73 mol/mol) and Uoxalate-creatinine ratios (0.39 +/- 0.21 versus 0.16 +/- 0.09 mol/mol) were greater in preterm neonates in the first weeks of life compared with full-term neonates (p < 0.05). Furthermore, [tm] was less than the lower limit for healthy adults for all but one preterm neonate; [tm] increased and Ucalcium-creatinine and Uoxalate-creatinine ratios decreased with age (p < 0.005). There was a correlation between [tm] and citrate excretion (coefficient of 38; P < 0.001). Patients with and without NC at term did not differ statistically in mean radicalLc, percentage of GI, or [tm]. In conclusion, urine from preterm neonates in the first weeks of life is highly supersaturated and has a defective ability to inhibit calcium oxalate crystal agglomeration. This ability improves with age and is citrate mediated. We suggest that both the high level of supersaturation and defective ability to inhibit calcium oxalate crystal agglomeration contribute to the high incidence of NC.

Adult↗

PubMed2006

Kernicterus in late preterm infants cared for as term healthy infants.

OBJECTIVE: To compare the clinical profile and health care experiences related to management of newborn jaundice and hyperbilirubinemia in preterm infants (<37(0/7) weeks gestation) who are cared for as term infants (> or =37(0/7) weeks) and develop acute and/or chronic posticteric sequelae. METHODS: Retrospective study of a convenient sample of term and near term infants voluntarily reported to the Pilot Kernicterus Registry (1992-2003). Study infants were required to meet the clinical definitions for acute bilirubin encephalopathy (moderate or advanced severity) and/or the classical signs of kernicterus. Main outcome measures were the comparison of etiology, severity and duration of extreme hyperbilirubinemia (TSB levels >20 mg/dL), response to interventions of intensive phototherapy and exchange transfusion, and health care delivery experiences in preterm as compared with term infants. RESULTS: No targeted attention was accorded to preterm infants during their neonatal health care experiences as related to predischarge risk assessment, feeding, discharge follow-up instructions, or breastfeeding, regardless of the known vulnerability of preterm infants to safely transition during the first week after birth. The TSB levels, age at re-hospitalization, and birth weight distribution were similar for late preterm and term infants. Large for gestational age and late preterm infants disproportionately developed kernicterus as compared with those who were appropriate for gestational age and term. Clinical management of extreme of hyperbilirubinemia, by the attending clinical providers, was not impacted or influenced by the gestational age, clinical signs, or risk assessment. This resulted in severe posticteric sequelae which was more severe and frequent in late preterm infants. CONCLUSIONS: Late prematurity (34(0/7) to 36(6/7) weeks) of healthy infants was not recognized as a risk factor for hazardous hyperbilirubinemia by clinical practitioners. Unsuccessful lactation experience was the most frequent experience; being large for gestational age as well as the other known biologic risk factors for hyperbilirubinemia and bilirubin neurotoxicity were not identified by the clinical care providers either before discharge or at immediate postdischarge follow up.

Birth Weight↗

PubMed2001

Preterm birth risk assessment.

Preterm birth is a leading cause of peripheral morbidity and mortality. The national rate of prematurity approaches 11%. In spite of widespread tocolytic use, the preterm birth rate has actually increased over the past 30 years in the United States. Preterm birth appears to have a multifactorial etiology. Leading theories include infectious, inflammatory or ischemic insult to the uteroplacental barrier, activation of the fetal hypothalamic-pituitary pathway, decreased cervical competence, and pathologic uterine distention. Multiple biochemical and biophysical markers have been studied for their potential to correctly identify women at risk of preterm delivery. Of these, fetal fibronectin and endovaginal ultrasound examination of the cervix have proven effective in predicting which symptomatic women are actually at low risk of preterm birth. Salivary estriol is being studied as a marker for preterm labor and delivery and it too will likely be found to be a reliable risk identifier in a high risk population. However, home uterine activity monitoring has not been shown to decrease the frequency of preterm birth or its neonatal complications.

Cervix Uteri↗

PubMed2000

Neonatal outcome in growth-restricted versus appropriately grown preterm infants.

The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.

Fetal Growth Retardation↗

PubMedDate not supplied

[Psychosocial stress as a risk factor for preterm birth--first results of the BabyCare project].

Psychosocial stress is and has been under study in a plenty of epidemiological research done to further detect the mechanisms between risk factors and preterm birth, but the role of these possible risk factors is up to now not approved neither theoretically nor empirically. Associations calculated between those risk factors and preterm birth are highly inconsistent and with exceptions only moderate. Based on the data given by the BabyCare programme in a first analysis for the group of primiparae it will be analysed, which psychosocial risk factors are correlated with preterm birth and which of these can be judged as independent risk factors, as far as this can be ruled out by the sample-size given. The descriptive data analysis shows, that the frequency of psychosocial risk factors is varying as it can be expected by age and social stratification. The analytical analysis shows by the given sample-size that the variable "strong stress in the last 12 months before pregnancy" has the highest ODDS-Ratio, which is also almost significant. Unexpectedly there is no correlation between preterm birth and the frequency and characteristics of life-events in the last 12 months, nor between the stress index, nor between the frequency of psychosocial complaints. Weaker associations--further to be approved--are given with respect to work load and occupation, problems in partnership and emotional or social support as well as to unplanned pregnancy and "low social status". The risk-ratios of the psychosocial variables are altogether much lower than the ratios of the medical or behavioural risk factors. The analysis of preterm birth rates reveals, that "strong stress in the last 12 months before pregnancy" will especially raise the preterm birth rates of smokers by an additional factor of 1.5. The associations found have to be approved by raising sample-size by stratified analytical methods and additional research by follow-up or retrospective studies to finally find out the factors which arise in the subsequent time of pregnancy and might explain the higher risk of preterm birth in the group of women with "strong stress in the last 12 months before pregnancy".

Female↗