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PubMed2003

Preterm birth in a French population: the importance of births by medical decision.

This analysis describes the prevalence of preterm birth by medical decision among 50,307 live births from the district of Seine-Saint-Denis in France, using a classification that distinguishes between medically decided preterm births associated with premature rupture of membranes and those for other reasons. Thirty-seven percent of singleton and 28% of twin preterm births result from labour induction or a caesarean section in the absence of labour. One-quarter of singleton indicated preterm births are associated with premature rupture of membranes. Between 28 and 31 weeks of gestation, 40% of all singleton preterm births result from a medical decision not associated with premature rupture of membranes. The high levels of indicated preterm birth must be taken into account in evaluations of preterm birth rates and trends in developed countries.

Cohort Studies↗

PubMed2003

Maternal serum interleukin-6, interleukin-8, tumor necrosis factor-alpha and interferon-gamma in preterm labor.

BACKGROUND: To find out whether preterm labor is associated with raised maternal serum concentrations of interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) and whether the measurement of these cytokines can be used to detect early intrauterine infection in preterm labor. METHODS: Cross-sectional study: 77 women in preterm labor, 47 controls of healthy preterm women not in labor and 19 women in term labor. The serum cytokines levels were measured by enzyme-linked immunosorbent assay (ELISA). The newborns of women who were in labor were followed up for evidence of infection. Differences between groups were tested using analysis of variance, Student's t-test and chi2-test. RESULTS: There was no significant difference in the concentration of all the cytokines measured between the different groups. No statistical difference was found in the concentration of the cytokines between women in preterm labor with ruptured membranes and those with intact membranes. There was also no difference found in the concentration of cytokines between women whose newborns had positive bacterial culture and those with negative culture. There was a positive correlation between the concentrations of IL-6, IL-8 and TNF-alpha. CONCLUSION: Serum levels of interleukin-6, interleukin-8 and tumor necrosis factor-alpha were not increased in preterm labor compared to normal control women. There is doubt regarding the usefulness of maternal serum measurement of these cytokines for the detection of early fetal infection in preterm labor, but this needs further evaluation.

Adolescent↗

PubMed1992

A study of the epidemiology of preterm labor.

A case-control study was designed in order to identify risk factors associated with preterm labor. All cases fulfilling the criteria of eligibility as preterm labor and attending the Ain Shams University Maternity Hospital during the period from January 1991 to June 1991 were included in the study. In the meanwhile, all women delivering after the 37th week of gestation during that period and in the same hospital and matched according to age (+/- 5 years) were included as the control group. Two hundred and thirty four cases and 216 controls were included in the study. An interview was performed to fill an epidemiologic and clinical questionnaire. Results showed that the lower the socioeconomic standard, the more the risk for preterm labor (p < 0.05), smoking whether active or passive is associated with preterm labor (p < 0.001), threatened or induced abortion, unwanted pregnancy, psychological trauma and surgical intervention during current pregnancy are associated with preterm labor (p < 0.001). History of preterm labor is associated with the present condition (p < 0.001). Anemia, hypertension, body weight less than 70 kgm are associated with preterm labor (p < 0.001).

Adult↗

PubMed2005

Hair-relaxer use and risk of preterm birth among African-American women.

PURPOSE: To assess whether hair-relaxer use is associated with an increased risk of preterm birth among African-American women. METHODS: We used data from the Black Women's Health Study. The participants were enrolled in 1995 and provided follow-up information in 1997, 1999, and 2001. Among 6130 singleton births reported by women <45 years of age during follow-up, 497 were preterm (<37 weeks gestation) because of premature rupture of membranes or spontaneous preterm labor for no known reason. In a case-control analysis, we compared the 497 preterm births with the 5633 births of longer gestation, and we used generalized estimation equation models to estimate multivariable odds ratios of preterm birth for users of hair relaxers. RESULTS: With control for confounding factors, the odds ratio for preterm birth among ever users of hair relaxers relative to never users was 1.0 (95% confidence interval, 0.6-1.8). No elevations were seen in risk for use started at a young age or for frequent use for long durations. CONCLUSIONS: These data suggest that hair-relaxer use does not play a role in the etiology of preterm birth in Black women.

Adult↗

PubMed2006

Smaller cerebellar volumes in very preterm infants at term-equivalent age are associated with the presence of supratentorial lesions.

BACKGROUND AND PURPOSE: Traditionally cerebellar functions are thought to be related to control of tone, posture, gait, and coordination of skilled motor activity. However, there is an increasing body of evidence implicating the cerebellum in cognition, language, memory, and motor learning. Preterm infants are at increased risk of neurodevelopmental delay, cognitive dysfunction, and behavioral and emotional disturbances. The role of the cerebellum in these adverse outcomes is unclear. OBJECTIVE: The objective of this study was to determine whether absolute cerebellar volumes differ between term-equivalent preterm infants and term-born control infants and to assess whether cerebellar volume is influenced by any possible antenatal, perinatal, and postnatal factors. METHODS: The study compared the MR imaging cerebellar volume by using a manual quantification program of 113 preterm infants at term-equivalent age and 15 term-born control infants. RESULTS: The median cerebellar volume of preterm at term-equivalent age was 25.4 cm3 and that of term-born control infants was 26.9 cm3. On initial analysis, there was a significant median difference of 2.0 cm3 (95% CI, 1.2 cm3 to 2.7 cm3) (2-sided P < .0001). However multiple regression analysis of perinatal variables showed that only infants with supratentorial lesions (P = .003) were significantly associated with the reduction in cerebellar volumes. The median cerebellar volumes were the following: supratentorial lesions, 18.9 cm3; no supratentorial lesions, 26.1 cm3; and term infants, 26.9 cm3 (analysis of variance, P < .0001). Hence, there was no significant difference in cerebellar volumes of preterm infants at term-equivalent age in the absence of supratentorial lesions. The median vermal volumes were 0.7 cm3 and were significantly related to cerebellar volumes both in preterm infants with and without lesions and in term-control infants. CONCLUSION: Premature infants at term-equivalent age have similar total cerebellar and vermal volumes compared with term infants in the presence of normal brain imaging. Reduced cerebellar volume in preterm infants at term-equivalent age is seen in association with supratentorial pathology such as hemorrhagic parenchymal infarction, intraventricular hemorrhage with dilation, and periventricular leukomalacia.

Cerebellum↗

PubMed1992

Primary care physicians' knowledge about diphtheria-tetanus-pertussis immunizations in preterm infants.

Preterm infants often receive their diphtheria-tetanus-pertussis (DTP) immunizations on a delayed schedule or in reduced dosage. Since primary care physicians (PCPs) immunize many preterm infants, the purpose of this study was to describe PCPs' knowledge about the use of DTP immunizations in preterm infants. Among the 479 PCPs who completed the questionnaire, 84% of pediatricians and 60% of family physicians correctly identified chronologic age as a criterion for initiating DTP immunizations in preterm infants. However, nearly 45% of PCPs linked this with other criteria such as a minimum weight requirement. Family physicians' answers differed from the recommendations more often than pediatricians' answers. The answers of pediatricians and family physicians who completed residency greater than 20 years ago differed from the recommendations more often than those who completed training less than or equal to 20 years ago. The answers of PCPs with fewer than five preterm infants in their practices differed from the recommendations more frequently than the answers of those with five or more preterm infants in their practices. Educational interventions are needed to bring PCPs' knowledge and practices into compliance with the American Academy of Pediatrics recommendations concerning DTP immunizations for preterm infants.

Age Factors↗

PubMed1991

Polymorphonuclear leukocyte function in the preterm neonate: effect of chronologic age.

In this study, effect of chronologic age on polymorphonuclear leukocyte (PMN) chemiluminescence and random and chemotactic motility was evaluated in 38 stable preterm neonates of less than 32 weeks' gestation during the first month of life. Chemiluminescence and random and chemotactic motility of PMNs from preterm neonates were first evaluated at mean postnatal age of 9.8 days and then weekly for an ensuing 21-day period. For comparison, one blood sample was obtained for PMN functions from 14 healthy term neonates younger than 72 hours of age and seven normal adults. On day 1 PMN chemiluminescence and random and chemotactic motility values in preterm neonates were significantly lower (P less than .001) compared with those in term neonates and PMN function values of term neonates were significantly lower (P less than .001) than those of adults. Although initial PMN chemiluminescence and random and chemotactic motility values in preterm neonates were depressed, subsequent values on days 7, 14, and 21 increased significantly (P less than .002). On day 21 (mean postnatal age of 30.8 days) no differences existed in chemiluminescent activity and random motility between preterm and term neonates; chemotactic motility in preterm neonates, however, remained impaired. Mean cumulative age (gestational age at birth plus postnatal age) of preterm neonates on day 21 of study was 32.5 weeks, suggesting that chronologic age has more effect on maturational changes in PMN functions than gestational age.

Aging↗

PubMed1990

Uterine activity compared with symptomatology in the detection of preterm labor.

The relative contribution of uterine activity obtained by home monitoring with a guard ring tocodynamometer compared with seven specific signs and symptoms reported during patient/nurse contact as an aid in detecting preterm labor has not been studied. In this prospective, multicenter study, patients at risk for developing early labor who were randomized to receive home uterine activity monitoring and perinatal nursing support were assessed. The initiator of provider contact (uterine activity detected on routine transmission, patient-perceived signs and symptoms of preterm labor during perinatal nurse contact, or both) resulting in a diagnosis of preterm labor was recorded. Contraction data were then analyzed for an association with preterm labor. There was a strong association of increased uterine activity (four or more contractions per hour) on a repeat monitoring strip with preterm labor (P less than .001). Among patients diagnosed with preterm labor, 31% had increased uterine activity detected on a routine transmission without patient-reported signs and symptoms, compared with 24% who were diagnosed as the result of patient-reported symptoms without increased uterine activity. Daily objective uterine activity data alone have greater incremental value over and above other signs and symptoms as an aid to the physician in diagnosing preterm labor.

Female↗

PubMed1989

Preterm birth prevention in a rural practice.

A program for the prevention of preterm births was developed for use in small, nonurban communities. In contrast to other programs, increased emphasis was placed on education and reassessment of "low-risk" women. Potentially preventable preterm births were identified and studied. The potentially preventable preterm birth rate decreased from 3.2% in the 3-year control period to 1.3% during the 2-year study period, a 60% reduction. The preterm neonates who were born during the study period were older, had a greater average birth weight, and had fewer admissions to the neonatal intensive care unit. The percentage of women in preterm labor who presented early enough to receive tocolysis increased from 51% to 98%, and those in preterm labor who delivered at term increased from 56% to 96%. Requiring primarily education and increased awareness, this preterm birth prevention program was successful and inexpensive and may be applicable to similar rural primary care practices.

Cost-Benefit Analysis↗

PubMed1989

Umbilical artery acid-base status in the preterm infant.

It is becoming increasingly apparent that Apgar scores are generally lower in otherwise uncomplicated preterm newborns than in term newborns. However, there is little information regarding normal values for umbilical artery blood gas measurements in the preterm infant. The present study included 77 otherwise uncomplicated preterm infants and 1292 uncomplicated term infants. Although preterm infants did have significantly lower 1- and 5-minute Apgar scores, there was no significant difference in the frequency of acidemia (umbilical artery pH below 7.20). The mean pH was 7.29 in preterm infants and 7.28 in term infants. Mean values for pCO2, pO2, HCO3, and base deficit were similar in each group. There were no significant differences in umbilical artery blood gas values in the 77 preterm infants according to birth weight groups. Umbilical cord blood acid-base determination may prove a useful adjunct in assessing the condition of the newborn preterm infant.

Acid-Base Equilibrium↗

PubMed1989

Vaginal pH: a marker of preterm premature rupture of the membranes.

Preterm premature rupture of the membranes (PROM) is a common predecessor of preterm or low birth weight (LBW) birth, yet the risk of preterm PROM is presently unpredictable. Numerous infectious organisms that change the normal vaginal milieu have been associated with preterm PROM. Because these organisms alter vaginal pH, the use of pH was evaluated as a potential marker for women at increased risk for preterm PROM. Among 115 women at high risk for an LBW birth, those with a mean vaginal pH above 4.5 had a threefold increased risk of preterm PROM as compared with those with a mean pH of 4.5 or lower. Vaginal pH may be a useful marker to predict a woman's risk for preterm PROM.

Female↗

PubMed1984

The thyroid-system function in preterm infants of postmenstrual ages of 31 weeks or less: evidence for a "transient lazy thyroid system".

A prospective study was conducted in order to evaluate thyroid function in 20 healthy and 18 sick preterm infants with postmenstrual ages of 31 weeks or less. The clinical condition of both groups was compared using a "Neonatal Special Care Evolution Score". The effect of thyroid hormone treatment, given from D10 on to the sick infants, was also studied. TSH, thyroid hormone levels (TG, T4, T3, rT3, FT4 and FT3) and TBG were measured by radioimmunoassays at D0, D10, D20, D30 and D40. Healthy preterm infants on D0 have a median TSH level of 22 microU/ml and a high TG level of 200 ng/ml; thereafter, median serum levels decrease to 6 microU/ml and 35 ng/ml respectively. During the same period, median serum T4 is maintained at a low level of about 6-8 micrograms/dl, median serum T3 gradually increases from 80 ng/dl on D0 to 150 ng/dl on D40, and median serum rT3 decreases beyond D10 from a plateau of 200 ng/dl to about 100 ng/dl. In the sick preterm infants before treatment, serum TSH is as in the control group but serum T4, T3 and rT3 on D10 are well below the control values (P = 0.005). In all conditions, there is a significant correlation between serum T4 and FT4, and between serum T3 and FT3. Thyroxine, given to the sick preterm infants from D10 on, brings median serum T4 values closely to the ones of the control group whereas serum levels of TSH and TG are unaffected and similar to those of the healthy preterm infants. Furthermore, thyroxine brings serum rT3 within the range of the control group but leaves median serum T3 at a low level of about 50 ng/dl. On T3 treatment, serum T3 normalizes but rT3 and particularly T4 tend to decline further. In the conditions of this study a significant difference in TBG level is not proven. Although an untreated sick group was not enrolled in the study, thyroid hormone treatment brought the "Neonatal Special Care Evolution Score" of the treated sick infants closer to that of the healthy preterm infants. In the sick preterm infant with failure to thrive on D10, there is an impaired thyroid discharge of T4 in spite of serum TSH values not different from those of the control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

PubMedDate not supplied

Employment-related stress and preterm delivery: a contextual examination.

Studies of employment-related stress as a risk factor for preterm delivery suggest that contextual factors unrelated to occupation, as well as work-related characteristics, must be examined in assessing this relationship. In this study, the relationship of work and contextual characteristics--assessed at midpregnancy and including scores on an occupational fatigue index--to preterm delivery was examined among 943 black and 425 white low-income multiparous women who were at risk for a poor pregnancy outcome. At 24 to 26 weeks gestational age, a 77-item questionnaire was self-administered to obtain detailed information on sociodemographic and contextual characteristics, home physical activities, and occupational characteristics. Questions in the occupational section of the questionnaire included most of those previously used by Mamelle and coworkers in 1984 and 1987 to construct an occupational fatigue index. The overall preterm delivery rate for black women was 14.0 percent and for white women, 9.6 percent. No relationships were observed between age, education, or marital status and preterm delivery, or between work status, hours per week, transportation, travel time, reliability of child care, or home physical activity and preterm delivery for either black women or white women. Black (but not white) women who continued to work at midpregnancy and who reported being able to take rest breaks when they felt tired had a lower preterm delivery rate (10.4 percent versus 21.9 percent; P = 0.031) compared with those who could or did not. Generally, scores for individual sources and levels of occupational fatigue, as well as total occupational fatigue index scores, were unrelated to preterm delivery in this relatively homogeneous group of low income high-risk women.

Adult↗

PubMedDate not supplied

Recognition of maternal identity in preterm and fullterm mothers.

The purpose of this exploratory and descriptive study was to investigate the maternal role attainment process of the preterm mother by comparing the endpoint of the process--maternal identity--in preterm and fullterm mothers. Forty-two first-time mothers, 21 preterm mothers and 21 fullterm mothers, were interviewed once at approximately one year post-birth. Qualitative and quantitative phenomena were examined. Qualitative data were collected via semi-structured interviews. Quantitative data were collected with instruments that measured maternal role attainment variables. Content analysis of the maternal identity recognition event revealed eight commonly discussed themes. Analysis of the quantitative data revealed no statistically significant relationships between length of gestation and any of the maternal role attainment variables. Also, no difference was found between preterm and fullterm mothers in the mean timing of the recognition of maternal identity. However, a 10-week difference in the median timing of maternal identity recognition was found. Sixty-two percent of the fullterm mothers recognized a maternal identity by two weeks after delivery, whereas only 24% of the preterm mothers experienced maternal identity recognition within this time frame. A statistically significant relationship was found between the timing of maternal identity recognition and maternal affective perception of the infant. The more positive the maternal affective perception of the infant, the earlier was the timing of maternal identity recognition. The study concluded that preterm mothers experienced a maternal role attainment process similar to fullterm mothers except that identity recognition was relatively delayed. The themes described by the preterm mothers tended to be qualitatively different and focused on denied maternal role experiences, especially denied contact with the infants and denied rights in relation to the infants.

Adult↗

PubMed1994

A prospective evaluation of the signs and symptoms of preterm labor.

OBJECTIVE: To describe the time relation between symptoms, contractions, and the clinical diagnosis of preterm labor. METHODS: We analyzed the records from 57 women who were enrolled in a previously reported trial of home uterine monitoring and who developed preterm labor while using the monitor. In a post hoc descriptive study of signs and symptoms during the 7 days preceding a diagnosis of preterm labor, we reviewed uterine contraction records and study records of the responses to a standard list of questions about potential symptoms of preterm labor. RESULTS: Monitored contraction frequency increased on the day of preterm labor diagnosis, from an average of fewer than three per hour to five per hour, but was not increased on any of the days before the day of diagnosis. Neither symptoms nor contraction monitoring strips indicated any significant changes more than 24 hours before the clinical diagnosis was made. Self-palpated and monitored contractions were the most common symptoms of preterm labor. CONCLUSION: A clinical diagnosis of preterm labor is preceded by an increase in self-palpated and monitored contractions and other symptoms for less than 24 hours.

Adult↗

PubMed1994

[Increased risk of preterm delivery in women with earlier conization].

The object of the study was to determine the relation between cervical conization and preterm birth. All Danish women with singleton pregnancies who gave birth to their first infant in 1982 and second infant in 1982-1987 were included in a register-based cohort study. Information on pregnancy outcome and cervical conization in 1977-1987 was obtained from the Medical Birth Register and the National Register of Hospital Discharges. It was found that in a cohort of 14.233 women, 170 had had cervical conization. Thirty-four had had cervical conization before the first delivery, 62 between the first and the second, and 74 after the second delivery. Women with cervical conization had a significantly higher risk of preterm birth. Also, women with subsequent cervical conization had a higher risk of preterm birth in previous pregnancies. However, the risk of preterm birth was higher in women with previous than with subsequent cervical conization. It is concluded that cervical conization is correlated with preterm birth. Since women with subsequent cervical conization are at increased risk of preterm birth in preceding pregnancies, other factors than the surgical intervention may contribute to the significantly increased risk of preterm birth.

Adult↗

PubMed1993

Characteristics of women in preterm labor associated with elevated C-reactive protein levels.

OBJECTIVE: To evaluate clinical, microbiologic, and histologic findings associated with elevated C-reactive protein levels among women in preterm labor or with preterm premature rupture of the membranes (PROM). METHODS: Obstetric data, serum C-reactive protein levels, and amniotic fluid (AF) and chorioamniotic membrane cultures and histology were obtained on 203 women presenting between 22-34 weeks' gestation in preterm labor or with PROM. RESULTS: Women with C-reactive protein greater than 1.5 mg/dL were more likely to deliver within 7 days of enrollment (54 of 68, 79%) than were women with normal C-reactive protein levels (45 of 135, 33%) (P < .001). The median C-reactive protein levels and association with rapid delivery did not differ between women with intact versus ruptured membranes. Elevated C-reactive protein levels were associated with a positive AF culture among women in preterm labor with intact membranes. To control for confounding by a long interval to delivery, only the group delivering within 7 days was considered for evaluation of C-reactive protein levels and placental and infant outcome. Among women delivering within 7 days, elevated C-reactive protein was associated with the development of clinical chorioamnionitis and with infant death before hospital discharge, but not with a positive membrane culture or histologic chorioamnionitis. CONCLUSIONS: Elevated C-reactive protein appears to be associated with AF infection, delivery within 7 days of admission, and infant death among women delivering preterm, but not with membrane infection or inflammation. Elevated C-reactive protein may be helpful in determining the need for AF culture and in targeting studies of antibiotic therapy among women in preterm labor or with preterm PROM.

Amniotic Fluid↗

PubMed1993

Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae.

Electrographically confirmed seizures in preterm and term neonates were compared with respect to clinical correlates, incidence, associated brain lesions, and risk for neurologic sequelae. Over a 4-year period, 92 neonates from a neonatal intensive care unit population of 4020 admissions at a large obstetric hospital with 40,845 livebirths had electrographically confirmed seizures. Sixty-two neonates were preterm and 30 were full-term for gestational age. Chi-square calculations were used to compare the two groups. While the incidence of seizures for all neonates admitted to a neonatal intensive care unit was 2.3%, outborn neonates were more likely to have seizures than inborn neonates. Preterm neonates of < or = 30 weeks gestational age had a seizure frequency of 3.9%, which was significantly higher than that of older preterm neonates and full-term neonates. Clinical criteria contemporaneous with electrographic seizures were noted in only 28 (45%) of 62 preterm, and 16 (53%) of 30 full-term neonates. Subtle seizures coincident with electrographically confirmed seizures were the most predominant clinical type for both term and preterm neonates (71% and 68%, respectively). The distribution of clonic, myoclonic, and tonic seizures was also similar for both groups. Autonomic signs coincident with electrographically confirmed seizures (ie, blood pressure, heart rate, oxygenation, respiration changes) were more frequently observed in preterm than full-term neonates with subtle seizures; 7 (37%) of 19 compared with 1 (6%) of 16. Electrical seizures without clinical correlates were noted more frequently than electroclinical seizures for both populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticonvulsants↗