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Premature Rupture of Membranes

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2761. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial. Full Text available with Trip Pro

-controlled trial, in which women were randomized between 18 + 0 and 22 + 6 weeks of gestation to receive daily treatment with 90 mg of vaginal progesterone gel or placebo. Cervical length was measured with transvaginal ultrasound at enrollment and at 28 weeks of gestation. Treatment continued until either delivery, 37 weeks of gestation or development of preterm rupture of membranes. Maternal and neonatal outcomes were evaluated for the subset of all randomized women with cervical length < 28 mm (...) Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial. To investigate the efficacy of vaginal progesterone to prevent early preterm birth in women with sonographic evidence of a short cervical length in the midtrimester.This was a planned, but modified, secondary analysis of our multinational, multicenter, randomized, placebo

2007 Ultrasound in Obstetrics and Gynecology Controlled trial quality: predicted high

2762. Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized, double-blind, placebo-controlled trial. (Abstract)

of preterm rupture of membranes. The primary outcome was preterm birth at preterm birth at preterm birth: primary results from a randomized, double-blind, placebo-controlled trial. Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. Treatment of preterm labor with tocolysis has not been successful in improving infant outcome. The administration of progesterone and related compounds has been proposed as a strategy to prevent preterm birth. The objective of this trial was to determine whether

2007 Ultrasound in Obstetrics and Gynecology Controlled trial quality: predicted high

2763. Vaginal bleeding during pregnancy and preterm birth. Full Text available with Trip Pro

preterm birth (< or =34 weeks' gestation) (RR = 1.6, 95% CI: 1.1, 2.4) and preterm birth due to preterm premature rupture of the membranes (PPROM) (RR = 1.9, 95% CI: 1.1, 3.3). Bleeding in both trimesters was associated with preterm birth due to preterm labor (RR = 3.6, 95% CI: 1.9, 6.8). Bleeding of multiple episodes, on multiple days, and with more total blood loss was associated with an approximate twofold increased risk of earlier preterm birth, PPROM, and preterm labor. In contrast, bleeding (...) Vaginal bleeding during pregnancy and preterm birth. This study investigated the relation between self-reported vaginal bleeding during pregnancy and preterm birth in a prospective cohort of 2,829 pregnant women enrolled from prenatal clinics between 1995 and 2000 in central North Carolina. The overall association between vaginal bleeding and preterm birth was modest (risk ratio (RR) = 1.3, 95% confidence interval (CI): 1.1, 1.6). Bleeding in the first trimester only was associated with earlier

2004 American Journal of Epidemiology

2764. Invited commentary: disaggregating preterm birth to determine etiology. Full Text available with Trip Pro

' gestation) and divided cases on the basis of proximal causes. Through factor analysis, they found empirical support for dividing preterm cases into 2 groups: intrauterine inflammation (preterm labor, preterm membrane rupture, placental abruption, and cervical insufficiency) and abnormal placentation (preeclampsia and intrauterine growth restriction). Replication of this classification in less extreme preterm births is needed, requiring large numbers of preterm births that have been characterized (...) Invited commentary: disaggregating preterm birth to determine etiology. Identifying the causes of preterm birth has been problematic, in part because of heterogeneous pathways leading to the same event, early delivery. If a risk factor affects only a subset of cases, then studies that address the aggregate outcome will generate diluted measures of association. McElrath et al. (Am J Epidemiol. 2008;168(9):980-989) examined an array of potential influences on very early preterm birth (<28 weeks

2008 American Journal of Epidemiology

2765. A cohort study found that white blood cell count and endocrine markers predicted preterm birth in symptomatic women. (Abstract)

, preeclampsia, intrauterine growth restriction, cervical dilatation > 4 cm, and clinical signs of infection. Analyses used logistic regression.The presence of ruptured membranes was the best predictor of birth within 48 hours. Other important predictors were maternal white blood cell count at 22-27 weeks gestation and maternal adrenocorticotropin and corticotropin-releasing hormone concentrations at 28-36 weeks gestation.Subclinical infection may be an important etiologic factor in preterm births (...) A cohort study found that white blood cell count and endocrine markers predicted preterm birth in symptomatic women. This cohort study investigated potential clinical and biochemical predictors of subsequent preterm birth in women presenting with threatened preterm labor.Subjects were 218 pregnant women admitted to hospital with a diagnosis of threatened preterm labor at 22-36 weeks gestation. Exclusion criteria were multiple pregnancy, fetal anomalies, diabetes mellitus, abruptio placenta

2005 Journal of Clinical Epidemiology

2766. The Randomized Nitric Oxide Tocolysis Trial (RNOTT) for the treatment of preterm labor. (Abstract)

The Randomized Nitric Oxide Tocolysis Trial (RNOTT) for the treatment of preterm labor. This study was undertaken to assess the effectiveness of glyceryl trinitrate (GTN) patches in comparison with beta2 sympathomimetics (beta2) for the treatment of preterm labor.A multicenter, multinational, randomized controlled trial was conducted in tertiary referral teaching hospitals. Women in threatened preterm labor with positive fetal fibronectin or ruptured membranes between 24 and 35 weeks' gestation

2004 American journal of obstetrics and gynecology Controlled trial quality: predicted high

2767. Heterogeneity of perinatal outcomes in the preterm delivery syndrome. (Abstract)

of labor, either with or without maternal obstetric and medical complications; preterm deliveries after prelabor spontaneous rupture of amniotic membranes (PROM), either with or without obstetric and medical complications; and medically indicated preterm deliveries with maternal obstetric and medical complications. Severe neonatal morbidity and neonatal mortality were the primary outcomes.Fifty-six percent of all preterm deliveries were spontaneous, without maternal complications. Small for gestational (...) Heterogeneity of perinatal outcomes in the preterm delivery syndrome. Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery.This analysis included 38,319 singleton pregnancies, of which 3,304 (8.6%) were preterm deliveries (less than 37 completed weeks) enrolled in the World Health Organization randomized trial of a new antenatal care model. We classified them as preterm deliveries after spontaneous initiation

2004 Obstetrics and Gynecology Controlled trial quality: uncertain

2768. The placenta in preterm birth. Full Text available with Trip Pro

The placenta in preterm birth. Rates of preterm birth range from 5% to 13% of deliveries in developed countries. About two-thirds of preterm deliveries are due to spontaneous onset of preterm labour or preterm premature rupture of membranes. Approximately one-third follow induction of labour or caesarean section performed for maternal or fetal indications such as preeclampsia, haemorrhage, non-reassuring fetal heart rate or intrauterine growth restriction. Thus, pathologists are frequently (...) called on to evaluate preterm placentas, to determine the cause of the spontaneous preterm birth and/or correlate placental findings with the clinical history. This review provides pathologists with an overview of the recent clinical research in the pathogenesis of preterm birth and relates these to the correlative placental pathologies of the major causes of spontaneous preterm birth. A brief summary of the placental gross and histopathological findings in indicated preterm birth is also included.

2008 Journal of Clinical Pathology

2769. Management of threatened preterm delivery in France: a national practice survey (the EVAPRIMA study). (Abstract)

-sectional national practice survey.Of the 734 admissions for TPD, 12.1% involved premature rupture of membranes and 12.9% were in utero transfers. Women admitted for TPD accounted for roughly 6% of all annual deliveries, regardless of the unit's level of care, and 42.4% of these women delivered preterm: none delivered before 32 weeks in level 1 maternity units, 11.6% in level 2 and 88.4% in level 3. Transvaginal cervical ultrasound was performed for 54.5% of the women with intact membranes. Tocolysis (...) Management of threatened preterm delivery in France: a national practice survey (the EVAPRIMA study). To describe the management of threatened preterm delivery (TPD) in France 3 years after publication of the French guidelines and to analyse the factors of variation of the practices observed.Population-based study.Representative sample of French maternity units. The study included 107 hospitals, accounting for 20% of all French maternity units.Women hospitalised for TPD during May 2005.Cross

2008 BJOG

2770. EPICure: facts and figures: why preterm labour should be treated. (Abstract)

head scan findings. In this population, abnormal head scan findings are independent predictors of reduced, severe motor disability at 2.5 years. Using step-wise logistic regression analysis, postnatal transfer was associated with severe motor disability; prolonged membrane rupture with reduced Mental Development Index (MDI) and antenatal steroid with increased MDI. It is clear that factors around the time of birth are critical in determining outcome, irrespective of later complications during (...) EPICure: facts and figures: why preterm labour should be treated. The principal objective of the EPICure studies was to determine both short- and long-term outcomes of extremely preterm birth. Data were collected for all births before 26 completed weeks of gestation in the UK and Republic of Ireland for 10 months in 1995. Of 811 infants admitted to neonatal units, 314 (39%) survived. Of these, 283 (92%) were assessed at 2.5 years and 241 (78%) at 6 years, together with a comparator group

2006 BJOG

2771. Pre-pregnancy body mass index and weight gain during pregnancy in relation to preterm delivery subtypes. (Abstract)

, spontaneous PTD after preterm premature rupture of membranes (PPROM), and indicated PTD.Each 5 kg/m(2) BMI increase was associated with indicated PTD (adjusted odds ratio [OR] 1.71, 95% confidence interval [CI] 1.40-2.06). The association weakened somewhat after adjustment for hypertension and diabetes before and/or during pregnancy (5 kg/m(2) adjusted OR, 1.40; 95% CI, 1.12-1.75). Associations with spontaneous PTD and PPROM were weaker (5 kg/m(2) adjusted ORs, 0.90 and 1.14, respectively). Weight gain (...) Pre-pregnancy body mass index and weight gain during pregnancy in relation to preterm delivery subtypes. Associations between preterm delivery (PTD) and pre-pregnancy body mass index (BMI) and pregnancy weight gain may differ across outcome subtypes.The authors analyzed data from 2,468 cohort participants in western Washington State, USA (1996-2005) and examined pre-pregnancy BMI and weight gain rate from pre-pregnancy to 18-22 weeks' gestation in relation to spontaneous PTD after preterm labor

2008 Acta Obstetricia et Gynecologica Scandinavica

2772. Early preterm breech delivery: is a policy of planned vaginal delivery associated with increased risk of neonatal death? (Abstract)

or PCD according to the center's management policy.The study included 84 women in the PVD group and 85 women in the PCD group. Incidence of neonatal death was similar in both (10.7% vs 7.1%; P = .40). Head entrapment (adjusted odds ratio, 7.2; 95% CI, 1.7-29.8), preterm premature rupture of membranes at <24 weeks of gestation (adjusted odds ratio, 13.3; 95% CI, 2.8-63.0), and gestational age between 26 weeks and 27 weeks 6 days of gestation (adjusted odds ratio, 4.7; 95% CI, 1.2-18.5) were associated (...) Early preterm breech delivery: is a policy of planned vaginal delivery associated with increased risk of neonatal death? The purpose of this study was to compare neonatal death rates in preterm singleton breech deliveries from 26 weeks to 29 weeks 6 days of gestation in centers with either a policy of planned vaginal delivery (PVD) or planned cesarean delivery (PCD).Women with preterm singleton breech deliveries were identified from the databases of 3 perinatal centers and classified as PVD

2008 American Journal of Obstetrics and Gynecology

2773. Neonatal mortality and morbidity rates in late preterm births compared with births at term. (Abstract)

, respectively, compared with 0.2 at 39 weeks (P<.001). Neonatal morbidity was significantly increased at 34, 35, and 36 weeks, including ventilator-treated respiratory distress, transient tachypnea, grades 1 or 2 intraventricular hemorrhage, sepsis work-ups, culture-proven sepsis, phototherapy for hyperbilirubinemia, and intubation in the delivery room. Approximately 80% of late preterm births were attributed to idiopathic preterm labor or ruptured membranes and 20% to obstetric complications.Late preterm (...) Neonatal mortality and morbidity rates in late preterm births compared with births at term. To analyze neonatal mortality and morbidity rates at 34, 35, and 36 weeks of gestation compared with births at term over the past 18 years at our hospital and to estimate the magnitude of increased risk associated with late preterm births compared with births later in gestation.We performed a retrospective cohort study of births at our hospital over the past 18 years. The study included all liveborn

2008 Obstetrics and Gynecology

2774. Extreme preterm birth: onset of delivery and its effect on infant survival and morbidity. (Abstract)

preterm labor, preterm premature rupture of membranes (PROM), or iatrogenic preterm delivery. These groups were compared for survival and survival without major morbidity (intraventricular hemorrhage grade 3-4, periventricular leukomalacia, retinopathy of prematurity grade 3-4, bronchopulmonary dysplasia, or necrotizing enterocolitis) at discharge.The cause of the preterm birth was preterm labor in 154 of 288 (53%), preterm PROM 83 of 288 (29%), and iatrogenic preterm delivery 51 of 288 (18 (...) Extreme preterm birth: onset of delivery and its effect on infant survival and morbidity. To investigate whether correlations could be found between the onset of preterm delivery and infant outcome, that is, survival and major morbidity.The study was a retrospective, hospital-based cohort study. All women with a live fetus on admission, giving birth at 22(+0) to 27(+6) weeks of gestation between 1998 and 2003 were included. The deliveries were subdivided into those that began with either

2008 Obstetrics and Gynecology

2775. Maternal obesity and neonatal mortality according to subtypes of preterm birth. (Abstract)

infants (n=3,934, 136 deaths), neonatal mortality in infants born after preterm premature rupture of membranes (PROM) was significantly increased if they were born to an overweight or obese mother (adjusted hazard ratios 3.5, CI 1.4-8.7, and 5.7, CI 2.2-14.8). There were no associations between high BMI and neonatal mortality in infants born after spontaneous preterm birth without preterm PROM or in infants born after induced preterm delivery.High maternal weight seems to increase the risk of neonatal (...) Maternal obesity and neonatal mortality according to subtypes of preterm birth. To examine the association between prepregnancy body mass index (BMI) and neonatal mortality while accounting for the timing of delivery and subtypes of preterm birth.The study population included 85,375 liveborn singletons of mothers in the Danish National Birth Cohort (1996-2002) who were interviewed during the second trimester. Information about pregnancy outcomes and neonatal deaths (n=230) was obtained from

2007 Obstetrics and Gynecology

2776. Monocyte Major Histocompatibility Complex Class II Expression in Term and Preterm Labor. (Abstract)

elective cesarean delivery or in spontaneous labor, in premature labor, or with preterm premature rupture of the membranes (PROM) at less than 32 weeks, and gestation-matched reference group. Monocyte MHC Class II expression was measured by flow cytometry using a dual-staining technique. Plasma cytokine levels were assayed using a cytometric bead array system. In vitro whole blood stimulation with LPS was also performed, and cytokine production was measured.Term labor was associated with a fall (...) Monocyte Major Histocompatibility Complex Class II Expression in Term and Preterm Labor. To investigate how term and preterm labor (PTL) influence the balance between maternal proinflammatory and antiinflammatory responses as measured by expression of major histocompatibility complex (MHC) Class II on maternal monocytes and tumor necrosis factor-alpha (TNF-alpha) production by in vitro stimulation of whole blood by lipopolysaccharide (LPS).Blood was taken from the following women (n=118): term

2007 Obstetrics and Gynecology

2777. Are deaths due to prematurity avoidable in developing countries? (Abstract)

518 perinatal deaths (17%) whose primary obstetric cause of death was due to spontaneous preterm labour (PNMR 7.48/1000 births). The most common avoidable factors were delay in seeking help during labour (14.7%), lack of neonatal facilities (10.0%), lack of transport (7.3%) and inappropriate response to the presence of premature rupture membranes (4.6%). Few perinatal deaths could be ascribed to poor antenatal or intrapartum management of spontaneous preterm labour. The vast majority (...) Are deaths due to prematurity avoidable in developing countries? Our aim was to assess the potential for reducing the perinatal mortality rate (PNMR) related to spontaneous preterm delivery. Data from 44 Perinatal Problem Identification Program sentinel sites around South Africa were used. In each perinatal death the primary cause as well as missed opportunities and substandard care were discussed and allocated. 3045 perinatal deaths in 78,343 births of > or = 1000 g were analysed. There were

2004 Tropical Doctor

2778. Clinical significance of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery. Full Text available with Trip Pro

% (20/43) vs. 5.8% (9/154); P < 0.001), < 32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and < 35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001 (...) Clinical significance of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery. To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' among asymptomatic patients at high risk for spontaneous preterm delivery.This retrospective case-control study included 281 patients with (n = 66) or without (n = 215) AF 'sludge', who underwent transvaginal ultrasound examination between 13 and 29 completed weeks

2007 Ultrasound in Obstetrics and Gynecology

2779. Teenage antenatal clinics may reduce the rate of preterm birth: a prospective study. (Abstract)

% CI 0.29-0.68), preterm, prelabour, prolonged rupture of membranes (OR 0.34; 95% CI 0.18-0.63) or deliver preterm (OR 0.40; 95% CI 0.25-0.62) compared with those from general clinics. However, there was no independent effect of clinic care upon newborn biometry outcomes. Clinic care did not significantly alter rates of initiation of breastfeeding in hospital. However, significantly more of the teenage antenatal clinic mothers were discharged on contraception (OR 1.58; 95% CI 1.07-2.25).Teenage (...) Teenage antenatal clinics may reduce the rate of preterm birth: a prospective study. To examine whether teenage antenatal clinics reduce the incidence of preterm birth.A multicentre prospective study was performed.Three Australian hospitals with maternity services.Consecutive teenage patients (N= 731) were approached at their first or second antenatal visit.Cases were women attending multidisciplinary teenage antenatal clinics and controls attended general hospital-based antenatal clinics

2004 BJOG

2780. Role of cytokines in preterm labour and brain injury. (Abstract)

characterised. The rate of preterm birth in Sweden is lower, and the rate of chorioamnionitis, bacterial vaginosis (BV), neonatal sepsis, and urinary tract infections during pregnancy is lower compared with the USA. In a Swedish population of women with preterm labour or preterm premature rupture of the membranes (PPROM) <34 weeks of gestation, microorganisms were detected in the amniotic fluid in 25% of women with PPROM and in 16% of those in preterm labour. Nearly half of these women had intra-amniotic (...) Role of cytokines in preterm labour and brain injury. Intrauterine infection induces an intra-amniotic inflammatory response involving the activation of a number of cytokines and chemokines which, in turn, may trigger preterm contractions, cervical ripening and rupture of the membranes. Infection and cytokine-mediated inflammation appear to play a prominent role in preterm birth at early gestations (<30 weeks). The role of infection/inflammation in preterm birth in Europe has been incompletely

2005 BJOG

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