PTB

Preterm labour and birth are a major cause of perinatal morbidity and mortality. Despite modern advances in obstetric and neonatal management, the rate of preterm birth in the developed world is increasing. Yet even though numerous risk factors associated with preterm birth have been identified, the ability to accurately predict when labour will occur remains elusive, whether it is at a term or preterm gestation. In the latter case, this is likely due to the multifactorial aetiology of preterm labour wherein women may display different clinical presentations that lead to preterm birth...

OBJECTIVE: We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. STUDY DESIGN: Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included...

The management of preterm birth has seen major transformations in the last few decades with increasing interest worldwide, due to the impact of preterm birth on neonatal morbidity and mortality. The prevention strategies currently available for asymptomatic women at risk of preterm birth include progesterone, cervical cerclage and cervical pessary. Each approach has varying effects depending on the patient's prior history of preterm birth, cervical length and the presence of multiple gestations. There is a shift in the focus of antenatal treatment, with the use of prenatal magnesium sulphate and corticosteroids, to reduce neonatal intensive care admissions and longer-term disabilities associated with preterm birth, consequently relieving emotional and economical burden...

OBJECTIVE: PartoSure is a bedside test for the prediction of time-to-spontaneous preterm delivery by the detection of placental alpha microglobulin-1 (PAMG-1). The objectives of this study were to further determine the test's efficacy in predicting delivery within 7 or 14 days from testing, and to compare it with fetal fibronectin (fFN) and cervical length (CL) measurement by transvaginal ultrasound. STUDY DESIGN: The study population consisted of 203 consecutively recruited women with singleton pregnancies between 200/7 and 366/7 weeks of gestation with symptoms of preterm labor, clinically intact membranes, and cervical dilatation of ≤3 cm...

OBJECTIVE: To determine whether the use of vaginal progesterone in twin gestations with a cervical length (CL) of ≤2.5 cm is associated with a reduced risk of preterm delivery. DESIGN: Retrospective cohort study. SETTING: Tertiary-care medical centre in New York City. POPULATION: Women with twin gestations undergoing sonographic cervical length screening. METHODS: Women with twin gestations with a CL of ≤2...

OBJECTIVE: To provide guidelines concerning management after a late fetal pregnancy loss: etiological assessment, follow-up and therapeutic management for subsequent pregnancy. METHODS: French and English publications led to guidelines. RESULTS: In case of a previous late fetal loss, exploration of cavity has to be done (grade C), except hysterosalpingography, which is not recommended (grade A). If uterine anomalies are found, it is recommended to correct them (grade C)...

OBJECTIVE: The objective of the study was to evaluate the efficacy of 17 alpha-hydroxyprogesterone caproate (17OHP-C) in prolonging gestation in patients with a short cervix and other risk factors for preterm delivery, such as previous preterm birth, cervical surgery, uterine anomalies, or prenatal diethylstilbestrol (DES) exposure. STUDY DESIGN: This open-label, multicenter, randomized controlled trial included asymptomatic singleton pregnancies from 20(+0) through 31(+6) weeks of gestation with a cervical length less than 25 mm and a history of preterm delivery or cervical surgery or uterine malformation or prenatal DES exposure...

OBJECTIVE: To determine the prevalence and the clinical significance of amniotic fluid "sludge" (AFS) in asymptomatic patients at low and high risk for spontaneous preterm delivery. METHOD: A prospective cohort study was conducted on 195 singleton pregnancies at low or high risk for preterm birth (PTB) between the 16th and 26th weeks. Cervical length (CL) <25 mm and the presence of AFS were evaluated. The risk for preterm delivery before 28, 32, 35 and 37 weeks were determined according to the presence of AFS, CL < 25 mm and history of high risk for PTB...

Preterm birth is associated with 5 to 18% of pregnancies and is a leading cause of infant morbidity and mortality. Spontaneous preterm labor, a syndrome caused by multiple pathologic processes, leads to 70% of preterm births. The prevention and the treatment of preterm labor have been long-standing challenges. We summarize the current understanding of the mechanisms of disease implicated in this condition and review advances relevant to intra-amniotic infection, decidual senescence, and breakdown of maternal-fetal tolerance...

OBJECTIVE: To determine the effect of the Day of Atonement fast (a 25-hour Jewish fast), on preterm delivery. METHODS: A comprehensive analysis of all deliveries during the Day of Atonement and during the corresponding day a week earlier, between the years 1988 and 2011, was performed. Preterm delivery was defined as delivery before 37 completed weeks of gestation. Data on fasting status was deduced from the ethnicity (as only Jewish parturients fast during the Day of Atonement)...

BACKGROUND: Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. OBJECTIVES: To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. SEARCH STRATEGY: An electronic literature search in OVID MEDLINE and EMBASE, complemented by PubMed, to find recent studies. SELECTION CRITERIA: Studies comparing the risk of spontaneous preterm birth after a previous preterm and previous term pregnancy...

BACKGROUND: Preterm birth is a major contributor to perinatal mortality and morbidity, affecting around 9% of births in high-income countries and an estimated 13% of births in low- and middle-income countries. Tocolytics are drugs used to suppress uterine contractions for women in preterm labour. The most widely used tocolytic are the betamimetics, however, these are associated with a high frequency of unpleasant and sometimes severe maternal side effects. Calcium channel blockers (CCBs) (such as nifedipine) may have similar tocolytic efficacy with less side effects than betamimetics...

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OBJECTIVE: We sought to estimate the association between cervical length (CL) and fetal fibronectin (fFN) and each pathway leading to preterm birth in twin pregnancies. METHODS: Cohort study of 560 patients with twin pregnancies who underwent routine serial CL and fFN screening from 22 to 32 weeks in one maternal fetal medicine practice during 2005-2013. We calculated the association between a short CL (≤20 mm) or positive fFN with overall preterm birth <32 weeks, and then subdivided the analysis into preterm birth <32 weeks from preterm labor, preterm premature rupture of membranes (PPROM) and indicated causes...

BACKGROUND: Findings from studies examining risk of preterm birth associated with elevated prepregnancy body mass index (BMI) have been inconsistent. METHODS: Within a large population-based cohort, we explored associations between prepregnancy BMI and spontaneous preterm birth across a spectrum of BMI, gestational age, and racial/ethnic categories. We analysed data for 989,687 singleton births in California, 2007-09. Preterm birth was grouped as 20-23, 24-27, 28-31, or 32-36 weeks gestation (compared with 37-41 weeks)...