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Threatened Preterm Labour (threatened + preterm_labour)
Selected AbstractsClinical predictive factors for preterm birth in women with threatened preterm labour or preterm premature ruptured membranes?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009Keiichiro YONEYAMA Background: Independent predictive factors of preterm delivery were evaluated using clinical data at hospitalisation by multivariate analysis. Aim: The aim of this study was to clarify independent predictive factors related to preterm delivery by multivariate analysis of clinical data at hospitalisation of patients with threatened preterm delivery or premature rupture of membranes (PROM), and to realise the early and highly reliable prediction of preterm delivery in pregnant women at risk. Methods: The subjects were 200 patients, which diagnosed with threatened preterm delivery or PROM and admitted at gestational ages of 22,35 weeks. Univariate and multivariate analyses were performed; 20 factors were evaluated concerning clinical data, and we extracted prognostic factors using logistic regression analysis. Results: The mean age of the patients was 30.5 years, and the mean gestational age at admission was 30.0 weeks. Preterm delivery was observed in 55 (27.5%), and term delivery in 145 (72.5%). On multivariate analysis, haemorrhage, prepregnancy body mass index, fetal fibronectin and cervical length were extracted as independent predictive factors related to preterm delivery. Conclusions: If the reliable and reproducible prediction of preterm delivery becomes possible using the four factors extracted in this study, further evaluation of these factors may lead to clarification of the mechanism of preterm delivery. [source] Progesterone for maintenance tocolytic therapy after threatened preterm labour: A randomised controlled trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2008Sedigheh BORNA Background: Women with preterm labour that is arrested with tocolytic therapy are at increased risk of recurrent preterm labour. The efficacy of maintenance tocolytic therapy after successful arrest of preterm labour remains controversial. Aim: The purpose of this study was to determine whether supplementation of vaginal progesterone after inhibition of preterm labour is associated with an increased latency period and a decreased recurrent of preterm labour. Methods: This trial was conducted in 70 women who presented with symptoms of threatened preterm labour, who after arrest of uterine activity were then randomised to progesterone therapy or no treatment. Treatment group received progesterone suppository (400 mg) daily until delivery and control group received no treatment. Results: Longer mean latency until delivery (36/11 ± 17/9 vs 24/52 ± 27/2) (mean + standard deviation) days; respiratory distress syndrome 4 (10.8%) vs 12 (36.4%) P = 0.021; low birthweight 10 (27%) vs 17 (51.5%) P = 0.04; and birthweight (3101.54 ± 587.9 g vs r 2609.39 ± 662.9 g, P = 0.002), were significantly different between the two groups. No significant differences were found between recurrent preterm labour 13 (35.1%) vs 19 (57.6%), P = 0.092; admission to intensive care unit 9 (24.3%) vs 13 (39.4%), P= 0.205 ; and neonatal sepsis 2 (5.4%) vs 6 (18.2%) P = 0.136, for the progesterone and control groups, respectively. Conclusion: The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of readmission for preterm labour. [source] The case for tocolysis in threatened preterm labourBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2003Nicholas M. Fisk The failure of tocolytics to improve neonatal outcomes in placebo-controlled trials has wrongly been interpreted as evidence that they do not work. While delivery is unequivocally prolonged by 24 hours, 48 hours and 7 days, the time gained was not exploited to optimise neonatal outcome. These trials typically studied women at relatively advanced gestational ages with predictably good outcomes, enrolled them in tertiary centres where they could not benefit from in-utero transfer, and had low levels of corticosteroid administration. No study has been powered to detect clinically meaningful differences that might be expected to accrue from 1,7 days prolongation of gestation. Despite this, Bayesian interpretation suggests that tocolytics do improve neonatal outcome. The largest placebo-controlled study showed clear trends towards better survival in fetuses <28 weeks, lower rates of cerebral palsy and higher Bayley mental scores. Meta-analysis of neonatal morbidity in the beta-agonist trials suggests a near-significant reduction in respiratory distress syndrome (RDS), together with trends towards reduced intraventricular haemorrhage, necrotising enterocolitis, and patent ductus arteriosus. Finally, there is the Orwellian analogy that tocolytics don't work, but some work better than others. Although calcium antagonists have not been evaluated against placebo, meta-analysis of comparative trials with beta-agonists demonstrate a significantly lower incidence of RDS and neonatal jaundice, presumably mediated through the reduced chance of delivery within 48 hours and 7 days. Development of tocolytics that are safe for mother and baby should facilitate adequately-powered placebo-controlled studies, which both focus on women most likely to benefit and capitalise on the 1,7 days gained. [source] | ||||||||||