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Incidence of preterm delivery in patients with previous preterm delivery and/or abortion.

Patients with a history of two or more pregnancies which ended spontaneously before 37 weeks' gestation had an increased risk of spontaneous labour and delivery in subsequent pregnancies. This risk was correlated with previous second trimester abortion and spontaneous preterm delivery but not with previous first trimester abortions. Patients with one or more pregnancies ending in spontaneous second trimester abortion or with preterm labour and delivery had a 38--43% risk of again delivering before term.

Abortion, Spontaneous

Contribution of preterm delivery to perinatal mortality.

A detailed retrospective analysis was made of the records of 486 preterm infants, who accounted for 5-1% of all births during 1973 and 1974. Whereas preterm delivery did not contribute to perinatal mortality in terms of stillbirth, it outweighed all other causes in terms of early neonatal deaths. Preterm birth was responsible for 85% of the early neonatal deaths not due to lethal congenital deformities. Early neonatal mortality rates were closely linked both to gestational age and birth weight and to the reason for preterm birth. Early neonatal mortality was high (97 per 1000) when preterm labour was spontaneous, whether or not associated with material or fetal disease or with multiple pregnancy, but low (27 per 1000) when preterm delivery was elective. Preventing spontaneous preterm labour would considerably reduce neonatal mortality in our community.

England

Disturbance in parent-child relationship following preterm delivery.

Increasing concern is expressed that the psychosocial development of preterm infants may be hindered by a disturbance of parental attitudes following the initial period of specialised care. Attitudes of parents of 17 preterm infants were compared with those of parents of 17 full-term infants at a single semi-structured interview six to 20 months after the birth. The groups of parents were matched for parity and did not differ in their social, ethnic and educational backgrounds. There was evidence of some disturbance in parent-child relationships in the preterm group, consisting of delays in maternal attachment to the child, negative maternal perception of the child compared with expectation of an 'average' baby, and persistent parental anxiety about leaving the child with a baby-sitter. In addition, two preterm children had been abused or neglected. Parental reaction to a preterm birth is discussed and the need for adequate support to be given to parents in the early period following the birth is stressed.

Anxiety

Clinical estimation of gestational age: rules for avoiding preterm delivery.

Reliable knowledge of the duration of pregnancy prior to birth is often of crucial importance in making obstetric care decisions. Laboratory methods for estimating fetal maturity have received considerable attention, but the usefulness of historical information has only rarely been addressed. In order to examine the value of clinical estimators of fetal gestational age (GA) in 690 pregnancies, the correlations of menstrual history (LMP), first unamplified audible fetal heart tones (FFH), and quickening (Q), with GA, based on the modified Dubowitz examination at birth, were examined. Evaluation of each of the data sets used alone reveals that in order to be 90% certain that an infant will be mature at delivery (greater than or equal to 38 weeks), a reliable LMP must have been noted for 42 weeks prior to birth, the FFH heard for 21 weeks, and Q felt for 25 weeks. These findings suggest that carefully obtained historical and physical examination information remains a cornerstone of appropriate obstetric care.

Delivery, Obstetric

A study of complications in preterm deliveries after prolonged premature rupture of the membranes.

The risk of infection for mother and baby after spontaneous rupture of the membranes was evaluated in a prospective study of 24 patients with ruptured membranes before the 36th week of pregnancy. The mean length of pregnancy after rupture was 10 days and 2 hours. Only patients harboring Group B streptococci or E. coli in the urogenital tract were treated with antibiotics (during delivery). With the exception of 1 woman, all patients harbored one or more pathogens in the urogenital tract. Four mothers were infected but all recovered. One of 26 infants died from infection. The study did not confirm any association between prolonged rupture of the membranes and the frequency of idiopathic respiratory distress syndrome, nor did it contradict attempts to actively prolong pregnancy after rupture of the membranes.

Bacterial Infections

[Epidemiological aspects of idiopathic early birth (author's transl)].

Epidemiological data of 338 preterm deliveries (excluding multiple gestations) were compared with the same number of term deliveries. Both groups were matched for age and parity. In one third of the cases only, possible organic factors could be attented to preterm delivery. In the remaining patients the etiology was unknown e.g. "idiopathic". These results confirm the difficulty to identify the patient at risk for preterm delivery, especially in the nullipara.

Body Height

Perinatal mortality and one-year infant morbidity.

Perinatal mortality in Southampton and South-west Hampshire Health District fell from 20.8 per 1000 total births in 1970 to 11.3 per 1000 in 1976. This was atributable mainly to a fall in the stillbirth rate, but also to a recent fall in the neonatal death rate in the first week. All infants born in 1975 who had any problems in the perinatal period were followed up for one year. Of the 12 children identified at one year as having a major handicap, eight suffered from problems of prenatal origin, two from problems associated with preterm delivery, and two from other conditions acquired during the perinatal period. As two-thirds of the major handicaps arose from congenital abnormalities, preterm delivery and low birth weight were not the main causes of major handicap.

Congenital Abnormalities

Fetal lung maturation. III. The amniotic fluid cortisol/cortisone ratio in preterm human delivery and the risk of respiratory distress syndrome.

Cortisol and cortisone have been measured in amniotic fluid samples obtained within 24 hours of deliver of 50 premature infants. When expressed as cortisol/cortisone ratios, the ratio tends to rise with advancing gestational age, although statistical significance is not attained. Both cortisol concentration and the cortisol/cortisone ratio are significantly lower in the amniotic fluid of infants who develop respiratory distress syndrome than in those with mature lung function (cortisol ratio: 19.2 +/- 10.3 ng/ml vs 26.1 +/- 9.4, P less than .02; cortisol/cortisone ratio: 1.2 +/- 0.6 vs 2.0 +/- 0.8, P less than .001). These findings also hold in the subgroup of infants less than 32 weeks' gestation but not in those infants at or beyond the 32nd week. The amniotic fluid cortisone concentration is significantly lower in infants born after spontaneous labor beginning with rupture of the membranes as opposed to after contractions or bleeding (13.2 +/- 3.6 ng/ml vs 16.3 +/- 6.1, P less than .05), although the cortisol concentrations and the cortisol/cortisone ratios are not significantly different.

Amniotic Fluid

[Results and consequences using Prechtl's concept of optimal conditions. Obstetrical and Postnatal complications (author's transl)].

An extended list of Prechtl's list of optimal obstetric conditions was used to describe the history of 200 newborns, randomly chosen from a defined population born in 1972. Differences between the population from Groningen (Prechtl's) and Tübingen, and different definitions of the items used in the list are discussed. Reduced optimal conditions in the history of the mother effectively reduced the optimal conditions in the newborn aswell. This was particularly so in case of: Preterm deliveries and miscarriages, bleedings in the first trimester, preterm onset of labour, operative deliveries, less than 38 weeks of gestational age, and an Apgar score below 7.

Abortion, Spontaneous

Trends in perinatal mortality in Cape Town, 1967--1977.

Perinatal deaths and perinatal mortality rates in Cape Town for the period 1967--1977 have been analysed, and large differences were found between the various ethnic groups. In non-Whites stillbirths accounted for more than two-thirds of perinatal deaths in 1977, and in at least 75% of these fetal death preceded labour. Perinatal mortality rates must be considered together with the number of perinatal deaths if the true magnitude of the problem with regard to the various obstetric complications and procedures is to be appreciated. The main perinatal problems as they affect the infant were (i) during pregnancy--antepartum haemorrhage (especially abruptio placentae), intra-uterine growth retardaton, multiple pregnancy, proteinuric hypertension and unbooked status; (ii) during labour and delivery--preterm labour, stillbirths (especially before labour) and vaginal breech delivery; (iii) in the early neonatnal period--immaturity and respiratory distress and neonatal infection.

Black or African American

Contemporary management and conduct of preterm labor and delivery: a review.

Current concepts in the conduct of preterm labor and management of delivery of the premature infant are reviewed. Pharmacologic modalities available for inhibiting preterm labor are discussed as well as the efficacy, indications and contraindications for these agents. An analysis of the role of corticosteroids in achieving fetal pulmonary maturity in the preterm infant is reviewed, and based on the existent literature the intrapartum management of the small fetus is outlined. The mode of delivery, vaginal or via cesarean section, for these infants is likewise discussed.

Adrenal Cortex Hormones

Effects on the child of alcohol abuse during pregnancy. Retrospective and prospective studies.

Retrospective and prospective investigations of children to alcoholic women gave an incidence of fetal alcohol lesion of one per 300 deliveries of whom half had the complete fetal alcohol syndrome. Perinatal and infant mortalities were increased seven to tenfold and low birth weight (less than or equal to 2 500 g), preterm deliveries (less than 37 weeks) and smallness for gestational age (less than -2 S.D.) were increased eightfold, threefold and twelvefold, respectively. Small size at birth correlated with reduced mental performance later in life, 58% had IQ below 85 and 19% below 70.8% had cerebral palsy. The incidence of cerebral palsy associated with maternal inebriety was 1/5 000 deliveries, i.e. every sixth case of cerebral palsy. Tracing of alcoholic women during pregnancy and treatment gave favourable effect on intrauterine growth when sobriety could be induced early in pregnancy but could not protect from functional brain disturbance measured by neurological performance and be evoked response electroencephalography. Damage to the fetus by alcohol is now the largest known health hazard by a noxious agent that is preventable.

Alcoholism

Causes of the excessive rates of perinatal mortality and prematurity in pregnancies complicated by maternal urinary-tract infections.

The study was undertaken to determine the causes of the more frequent pre-term deliveries, fetal and neonatal deaths associated with maternal urinary-tract infections during pregnancy. The combined perinatal mortality rate for eight common placental and fetal disorders was 42 per thousand births in the infected vs. 21 per thousand in the noninfected, owing to a greater mortality from noninfectious placental and fetal disorders in the gestations with the urinary-tract infections (P less than 0.001). All the mortality excess took place when the urinary-tract infections occurred within 15 days of delivery. Death rates were highest when the urinary-tract infections coexisted with maternal hypertension and acetonuria.Hydramnios, amniotic-fluid bacterial infections and abruptio placentae were responsible for two thirds of the more frequent preterm deliveries in the pregnancies complicated by urinary-tract infections.

Abruptio Placentae