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Spontaneous Preterm Labour (spontaneous + preterm_labour)
Selected AbstractsMid-trimester amniotic fluid C-reactive protein, ferritin and lactate dehydrogenase concentrations and subsequent risk of spontaneous preterm labourAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Sedigheh BORNA Background: Preterm delivery is a serious problem in obstetrics. A pre-existing inflammation in the first half of gestation has been proposed as a possible condition that leads to preterm delivery. Aim: Our aim was to compare C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) concentrations in mid-trimester amniotic fluid of patients with preterm and term deliveries and to found out their predictive values for preterm delivery. Methods: The study was conducted on 90 pregnant women who underwent genetic amniocentesis between the 15th and the 20th weeks of gestation. The samples were carried immediately to the laboratory for cytogenetic and biochemical examination. Non-parametric tests and receiver-operating characteristic curve analysis were used for statistical purpose. Results: This study showed women with preterm delivery at < 37 weeks (n = 17) had a higher median of amniotic fluid LDH concentration than those women who delivered at term (n = 73) (P = 0.003). Amniotic fluid LDH concentration of > 120 IU/L had a sensitivity of 59% and a specificity of 81% in the prediction of spontaneous preterm delivery at < 37 weeks. Maternal serum alpha-fetoprotein levels were higher in patients delivered preterm compared with term deliveries (P = 0.036). Conclusion: Mid-trimester LDH is found to be quite effective in the prediction of preterm delivery. Pre-existing intrauterine inflammatory process early in gestation may be an important risk factor for preterm delivery. [source] Has publication of the results of the ORACLE Children Study changed practice in the UK?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2010S Kenyon Please cite this paper as: Kenyon S, Pike K, Jones D, Brocklehurst P, Marlow N, Salt A, Taylor D. Has publication of the results of the ORACLE Children Study changed practice in the UK? BJOG 2010;117:1344,1349. Objective, To investigate whether publication of the results of the ORACLE Children's Study, a 7-year follow-up of the ORACLE trial, changed practice with regard to the routine prescription of antibiotics to women with preterm rupture of membranes or spontaneous preterm labour (intact membranes). Design, A comparative questionnaire survey of clinical practice in November 2007 (before publication) and March 2009 (after publication). Population, Lead obstetricians for labour wards of all maternity units in the UK. Methods, Self-administered questionnaires requested information about the routine prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour (intact membranes). Main outcome measures, Change in practice for prescription of antibiotics. Results, The response rate was 166/214 (78%) in 2007 and 158/209 (76%) in 2009. In total, 120 maternity units responded on both occasions. For women with preterm rupture of membranes, 162/214 (98%) in 2007 and 151/158 (96%) in 2009 maternity units reported that they prescribed antibiotics, with the majority using erythromycin (98%). For women with spontaneous preterm labour (intact membranes), 35/166 (21%) in 2007 and 25/158 (16%) in 2009 maternity units reported that they routinely prescribed antibiotics. The findings from units who responded on both occasions are similar. Conclusions, There has been little change in the reported prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour following publication of the ORACLE Children's Study. This suggests that current practice may require updated guidance. [source] Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005Caroline Moreau Objectives To evaluate the risk of very preterm birth (22,32 weeks of gestation) associated with previous induced abortion according to the complications leading to very preterm delivery in singletons. Design Multicentre, case-control study (the French EPIPAGE study). Setting Regionally defined population of births in France. Sample The sample consisted of 1943 very preterm live-born singletons (<33 weeks of gestation), 276 moderate preterm live-born singletons (33,34 weeks) and 618 unmatched full-term controls (39,40 weeks). Methods Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, premature rupture of membranes, idiopathic preterm labor and other causes. Main outcome measures Odds ratios for very preterm birth by gestational age and by pregnancy complications leading to preterm delivery associated with a history of induced abortion. Results Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1,2.0); the risk was even higher for extremely preterm deliveries (<28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (<28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension. Conclusion Previous induced abortion was associated with an increased risk of very preterm delivery. The strength of the association increased with decreasing gestational age. [source] Primary predictors of preterm labourBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2005François Goffinet Spontaneous preterm birth accounts for 60% of all preterm births in developed countries. With the increase in multiple pregnancies, induced preterm birth and the progress in neonatal care for extremely preterm neonates, spontaneous preterm birth for singleton pregnancies in developed countries has probably decreased over the past 30 years. This decrease is likely to be related to better prenatal care for all pregnant women because the recognition of primary risk factors in early or late pregnancy remains a basic part of prenatal care. The failure to distinguish between induced and spontaneous preterm labour in most population-based studies makes it difficult to interpret results with respect to the primary predictors of preterm labour. Many such primary predictors of preterm labour have been used over the past 20,30 years. These include individual factors, socio-economic factors, working conditions and obstetric and gynaecological history. Risk scores have been proposed in order to produce these data. Unfortunately, the predictive value of these scores, especially their specificity, is poor, mainly because all of these factors are indirect. We still cannot identify the mechanisms that lead to preterm labour and birth. New markers more directly related to preterm labour have recently been proposed, some of which relate to direct causes of preterm labour such as cervical ultrasound measurement, fetal fibronectin (FFN), salivary estriol, serum CRH and bacterial vaginosis. Several of these have predictive values, which are potentially useful for clinical practice. Nonetheless, pregnant women in developed countries are already closely monitored throughout pregnancy. Before proposing new screening tests to be applied systematically to all pregnant women, their advantages and drawbacks must be fully evaluated. [source] The complex relationship between smoking in pregnancy and very preterm deliveryBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2004Results of the Epipage study Objective To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth. Design Case,control study (the French Epipage study). Setting Regionally defined population of births in France. Population Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls. Methods Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms. Main outcome measures Odds ratios for very preterm birth for low to moderate (1,9 cigarettes/day) and heavy (,10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth. Results Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3,2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3,1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8). Conclusion These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women. [source] | ||||||||||