Percentiles of Sonographic Cervical Length

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Ya... I'm below the 10th percentile right now. I'm very glad I have a cerclage!

I just can't respond...

I belong to a message board for women due at the same time as me - September. Earlier this week, unfortunately, a mom gave birth to a little girl at 24 weeks. I can't imagine being in her shoes and my heart really goes out to her, she will have a long/hard road in the NICU and beyond.

I can't respond to the messages of support - I feel badly about not being able to reach out to her but the majority of the other posts are "my cousins friends sisters finance's brother's wife had a little girl at 23 weeks last year - she's 12 months now and TOTALLY PERFECT! No problems at all!" (really, at a year old you can say that?) or "My sister and I were born at 29 weeks 30 years ago and we're totally fine now" (Can you really compare 29 weeks to 24 weeks?), and the most hurtful "Preemie's do so well now - they just need time to grow outside for a while and she'll be just fine!"... ya, that's what my daughter NEEDED... she needed to be outside of me in order to grow.

So how do I respond with "I'm very sorry you are in this position - your NICU rollercoaster will be very hard and you can expect lots of ups and downs. You'll have a big learning curve but don't underestimate how well your daughter can do or even if she falls in with the normal course of a 24 weeker and has trouble for a while. I wish you the best and feel free to email me if you want to talk"... I did and immediately got pelted with all sorts of messages from others saying I was being too negative blah blah blah.

It's amazing how prematurity wears such rose colored glasses to the general public... well, no its not really amazing in a good way.

Seeing pictures of her little girl - with a preemie diaper up to her armpits despite an umbilical line - make me so sad for all preemies. Who's life needs to start being poked, prodded and having a tube shoved down your throat? I cried seeing her pictures. I'm so very scared of putting another baby through that but its practically out of my control and thats even more scary.

Physical Assessment guidelines to establish risk

Hi everyone,

I came across a study on pre-term labor that you will probably find really interesting and encouraging:

http://www.emedicine.com/med/topic3245.htm

Physical assessment guidelines to establish risk

The obstetrician should review previous preterm deliveries, including autopsy reports and medical records, if appropriate and available. Social stressors (including housing and food availability), social support in the family, financial stability, domestic violence, drug abuse involving the patient or her family, and death or serious illness in a close family member should be assessed.

The integrity of the cervix and the extent of any prior injury to the cervix may be assessed by speculum and digital examination. The presence of asymptomatic bacteriuria, STD, and symptomatic BV may be investigated.

In some patients, formal cervical length assessment may be of use in risk assessment.

Cervical length during prenatal care, particularly at 24-28 weeks' gestation, has been demonstrated to be the most sensitive prenatal predictor of preterm birth between both high- and low-risk women. In a mixed high- and low-risk population of singleton pregnancies, transvaginal ultrasound-measured cervical length at 24 weeks was highly correlated with the risk of spontaneous preterm delivery before 35 weeks. The relative risk of preterm delivery among women with a cervix 25 mm or shorter at 24 weeks was 6.2. Furthermore, at 28 weeks, a short cervix (=25 mm) was associated with a 9.6 relative risk of preterm delivery. Cervical length 25 mm or shorter at 28 weeks had a 49% sensitivity for prediction of preterm delivery at less than 35 weeks, a value markedly greater than that of cervical funneling.

Among high-risk women with a history of one or more spontaneous preterm births (excluding those with multiple gestation, uterine anomalies, and prior cervical surgeries), 20% of patients demonstrated a cervical length shorter than 25 mm by transvaginal ultrasonography at 22-25 weeks. Among these patients with a short cervix and one previous preterm birth, 37.5% delivered at less than 35 weeks. In contrast, patients with a cervical length longer than 25 mm had a preterm rate (<35 wk) of only 10.6%. Cervical length has similarly been demonstrated as the optimal predictor of preterm delivery in low-risk women. In an assessment of low-risk women, short cervical length at 24-28 weeks was detected in 8.5% of women.7 These patients demonstrated a relative risk of 6.9 for preterm delivery at less than 35 weeks. As compared with fetal fibronectin or Bishop score, cervical length demonstrated the greatest sensitivity (39%), with a specificity of 92.5% and a negative predictive value of 98%.
Whereas cervical length assessment by digital exam is a semisubjective measurement, a recent study has demonstrated the value of an objective cervico-portio length measurement using Cerivlenz, an intravaginal measuring device.8 These manually obtained cervical length measurements appear to be reproducible, accurate, and predictive of a short cervical length by transvaginal ultrasonography. Therefore, Cerivlenz may represent a low-cost, objective screening tool to identify at-risk patients for preterm delivery.

In addition to the 24-28 week assessment, evidence shows the value of early midtrimester cervical length measurement. Studies of Owen et al from the Maternal Fetal Medicine Units Network demonstrate the value of cervical length measurements between 16 weeks and 23 weeks and 6 days. Serial transvaginal ultrasonographic cervical length measurements in a high-risk population demonstrated that a cervix shorter than 25 mm resulted in a relative risk of 4.5 for spontaneous preterm birth at less than 35 weeks, with a 69% sensitivity, 80% specificity, 55% positive predictive value, and 88% negative predictive value. As the NIH Maternal Fetal Medicine Units Network is initiating a study of progesterone treatment for patients with a short cervix in the early midtrimester, a program of routine cervical length screening may soon be justified.

Among patients with a short cervix, education should be provided concerning the signs and symptoms of preterm labor, especially as the pregnancy approaches potential viability. Prenatal visits/contacts may be scheduled at more frequent intervals to increase patient interaction with the care provider, especially between 20 and 34 weeks' gestation, which may decrease the rate of extreme preterm birth.

Does premature birth run in your family?

Premature birth runs in my family - I was born at 30 weeks, my brother at 34 weeks and my daughter at 28 weeks.

There is a study at Washington University School of Medicine that is recruiting people that have a familial history of preterm birth.

If you have a familial history PLEASE sign up for the study.

There are two parts to participating in the F.E.T.A.L. study:
1) Fill out a detailed questionnaire about the births in your family,
especially the premature births. We will mail you this questionnaire
with a self-addressed, stamped envelope for you to return to us at
your convenience to the address you supplied on the web site. We will
also need to send you consent forms that should be filled out for you
and your child stating that you understand the goals, involvement,
risks, and benefits of the research study, which are outlined in the
consent form and will be explained to you by a member of our research
team after you receive it.
2) The second part of the study includes collecting DNA samples from
you and your child (children) to analyze for specific genes which may
be associated with preterm birth. DNA samples can be obtained from a
saliva collection kit which we would mail to you. You can collect the
saliva samples of members of your family who wish to participate, and
then mail them back to us at the Center for Preterm Birth Research.
Regardless of whether or not you choose to provide DNA samples, we
would appreciate your participation by completing the questionnaire.
The information provided in this form will provide us with valuable
information pertinent to our study.

Please click here to learn more.

I hope you can all agree that it would give all preemie moms great joy to know they helped further the study of why preterm birth occurs and possibly find a cure!

Lack Of Well-Being In A Pregnant Woman May Lead To Premature Delivery

Link to Article

A group of researchers of the University of Modena has investigated the role of psychological well-being in premature delivery. The study is reported in a recent issue of Psychotherapy and Psychosomatics.

The aim of this study was to evaluate how sociodemographic factors, psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor. In a prospective case-control design, 51 consecutive women admitted for threatened preterm labor were enrolled.

The patients received standard care. The day before discharge, once contractions had been stopped, the patients were administered 2 questionnaires: the Prenatal Self-Evaluation Questionnaire of Lederman and the Psychological Well-Being Scales. Controls were enrolled among asymptomatic, healthy women attending routine prenatal care.

They were matched for parity and gestational age. Gestational age at inclusion ranged from 25 to 34 weeks. Fourteen cases and 4 controls delivered preterm. Cases were less educated than controls, showed a lower acceptance of pregnancy and worse relationship with others, namely with the husband, compared to controls.

They also displayed a reduced environmental mastery. Having a low education, poor relationship with others, including the husband, and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women.

Journal reference: Facchinetti, F. ; Ottolini, F. ; Fazzio, M. ; Rigatelli, M. ; Volpe, A. Psychosocial Factors Associated with Preterm Uterine Contractions. Psychother Psychosom 2007;76:391-394

Ya know what's a bit scary about this? Any woman who is pregnant after a preemie is going to be a NERVOUS wreck (I have yet to talk with one who isn't). Where does that put us according to this study? Even more at risk for preterm birth... ugh!

Home Uterine Monitors Not Useful For Predicting Premature Birth

Link to Article

Portable monitors that detect contractions of the uterus do not appear to be useful for identifying women likely to have a preterm delivery, according to a study by the National Institute of Child Health and Human Development (NICHD).

Although they are widely prescribed for women at risk of giving birth prematurely, the NICHD study confirms earlier findings that the monitors are not useful for predicting or preventing preterm birth. The study also confirmed that several other methods being assessed as ways to predict preterm labor were of little value.

"The study found that while women who gave birth prematurely did have slightly more contractions throughout pregnancy than did women who gave birth at term, there was no detectable pattern that would predict premature birth," said Duane Alexander, M.D., Director of the NICHD.

The study was conducted at the 11 centers participating in the NICHD Network of Maternal-Fetal Medicine Units and appears in the January 25 New England Journal of Medicine. The study was led by Jay Iams, M.D., director of the Division of Maternal-Fetal Medicine at the Ohio State University Medical Center.

The portable, or ambulatory, monitors cost up to $100 a day and may be worn for up to 10 weeks. The monitors relay information to a central monitoring office, where any potential signs of early labor can be passed on to a physician.

The researchers analyzed 34,908 hours of recordings from 306 women. When the women began the study, they were in their 22nd through 24th week of pregnancy. The authors wrote that the women who gave birth before the 35th week of pregnancy had a slightly greater frequency of contractions than did the women who gave birth after the 35th week, but this information did not allow them to predict impending premature labor. A pregnancy is considered full term at 37 weeks.

"…we could identify no threshold frequency that effectively identified women who delivered preterm infants," the study authors wrote in the New England Journal of Medicine article.

The researchers also found little value of some other techniques in predicting preterm labor, including measuring the cervix and collecting a substance known as fetal fibronectin from the cervix.

"Our data indicate that ambulatory monitoring of uterine contractions does not identify women destined to have preterm delivery," the authors wrote.

Preterm birth complicates from 8 to 10 percent of all births, said Catherine Spong, M.D., Chief of NICHD's Pregnancy and Perinatology Branch and coordinator of the Maternal-Fetal Medicine Units. Premature infants are at greater risk for life-threatening infections, for a serious lung condition known as respiratory distress syndrome, and for serious damage to the intestines (necrotizing enterocolitis). Most deaths of premature infants occur among those born before the 32nd week of pregnancy. In addition, the cost of caring for premature infants in the United States exceeds $4 billion each year.

3-D Ultrasound Identifies Women At Risk For Impending Preterm Birth

Link to Article

To help physicians non-invasively identify women at risk for preterm birth, 3-D ultrasound was used to measure the size of fetal adrenal glands, according to an abstract presented by Yale School of Medicine researchers at the Society for Maternal-Fetal Medicine Conference February 8, 2007 in San Francisco.

Preterm birth is a major public health problem with lasting repercussions on families and society. The authors found that the ultrasound measurements could identify a preterm risk of delivery within five days of the measurement.

"Our results suggest that examining the fetal adrenal gland at the time a woman is evaluated for symptoms of preterm labor, may have major beneficial clinical implications," said first author Ozhan Turan, postdoctoral fellow in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. Turan conducted the study with senior author Catalin Buhimschi, M.D., director of Perinatal Research at Yale Ob/Gyn.

The authors said that understanding the time when a marker becomes positive in relationship to preterm birth is essential for a test with high diagnostic accuracy. "The high accuracy, sensitivity and specificity of the adrenal gland volume in predicting preterm birth within five days from the time of examination proves that 3-dimensional ultrasound evaluation of the fetal adrenal gland has the desired test characteristics to define a population at risk," they said.

The current study creates the basis for further prospective studies to confirm that 3-dimensional ultrasound assessment of the fetal adrenal gland volume can assist clinicians with devising better therapeutic and preventive interventions for preterm birth.

Other authors on the abstract included Sifa Turan, Edmund Funai, Irina Buhimschi and Joshua Copel.

Abstract Title: "Three-dimensional (3D) Ultrasound Measurement of Fetal Adrenal Gland Volume. A Novel Method of Identifying the Patient at Risk for Impending Preterm Birth."

Adapted from materials provided by Yale University.

In Hispanic Women, Genetic Variations Linked To Spontaneous Preterm Birth

Link to Article

Preterm birth is a major cause of illness and death in newborns. A genetic cause of preterm birth was suggested by racial disparity, a tendency to occur within families and a high rate of recurrence, according to Errol Norwitz, M.D., associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale and lead investigator of the study.

Norwitz and his team prepared DNA samples from 102 mothers with a spontaneous unexplained preterm birth and 408 mothers who delivered at term with no complications. They then compared the distribution of 128 well-known genetic variations, known as single nucleotide polymorphisms, in 77 genes between the two groups. The patients in the study were identified from the March of Dimes Perinatal Epidemiology Research Initiative Project at Yale and New York University between January 1989 and June 2005.

"Our analysis demonstrates that, in an Hispanic population, mothers who carried any one of four polymorphisms were significantly more likely to have a spontaneous preterm birth," said Norwitz.

The four polymorphisms included CYP2C9S144, IL6S174, CCR5S1 and ENPP1S121. The risk of preterm birth was highest among women with the ENPP1 variant.

"The strong association of ENPP1 was particularly compelling, but how this variant functions and why it predisposes preterm births still needs to be determined," said Norwitz.

In another abstract using the same study subjects, Norwitz and colleagues explored whether polymorphisms in the gene that encodes the progesterone receptor may identify women at risk for preterm birth. The team found no such association.

"Progesterone supplementation may prevent preterm birth in about 30 to 40 percent of women at high risk by virtue of a prior preterm birth, but exactly how progesterone supplementation works is still unknown," said Norwitz. "While this was a negative finding, it was an important question to answer."

Other authors on both abstracts included Thomas Morgan, Victoria Snegovskikh, Edward Kuczynski, Hee Joong Lee, Frederick Schatz, Se-Te Joseph Huang, Catalin Buhimschi, Edmund Funai, Irina Buhimschi, Antonette Dulay, Guoyang Luo, Sonya Abdel-Razeq and Charles Lockwood.

Abstract #297: "Identification of Single Nucleotide Polymorphisms in Maternal Genes Associated with Spontaneous Preterm Birth."

Abstract # 316: "Single Nucleotide Polymorphisms in the Human Progesterone Receptor (PR) Gene and Spontaneous Preterm Birth."

Adapted from materials provided by Yale University.

Progesterone Injections Do Not Prevent Preterm Birth In Twin Pregnancies, Study Finds

Link to Article

The result came as a surprise to the researchers, who previously discovered that weekly injections of the naturally occurring hormone, called 17 alpha-hydroxyprogesterone or 17-OHPC, reduced additional preterm births by one-third in women whose previous babies were born prematurely.

"Based on the results of the first study, which showed that 17-OHPC reduced preterm birth in the group with the highest risk, we were hopeful that it would also prevent preterm birth in twin pregnancies, which represents an intermediate level of risk," said John Thorp, M.D., a study co-author and professor of obstetrics and gynecology UNC-Chapel Hill. "The mechanisms that lead to preterm birth are complex, and I think our current study shows they may not be amenable to a single solution."

The study results are published in the Aug. 2 issue of The New England Journal of Medicine. The lead author is Dwight J. Rouse, M.D., of the University of Alabama at Birmingham. The study was conducted for the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development, which provided grant funding. It took place at 14 sites across the United States, including UNC-Chapel Hill, WakeMed and the Wake County Health Department.

For the study, 655 healthy women with twin pregnancies and no prior preterm births received weekly injections of either 17-OHPC or placebo, starting at 16 to 20 weeks into their pregnancies and ending at 35 weeks. The results showed no meaningful difference between the 17-OHPC and placebo groups. Birth or miscarriage before 35 weeks gestation occurred in 41.5 percent of the 17-OHPC group and in 37.3 percent of the placebo group.

The researchers concluded that treatment with 17-OHPC did not reduce the rate of preterm birth in women with twins.

"Why 17-OHPC is effective in reducing the rate of preterm birth in women with a prior spontaneous preterm birth, but not in women carrying twins is a question that will be answered only when the mechanisms underlying preterm birth and the actions of 17-OHPC are better understood," they wrote, adding that additional research is needed to see whether 17-OHPC is effective in other conditions in which the risk of preterm birth is increased.

Thorp said the same research network is currently working on two other 17-OHPC studies. One involves women with triplets while the other focuses on women with a short cervix. Both groups are considered to have an intermediate risk of preterm birth.

Another question for future research, Thorp said, is whether or not injections are the best method for administering 17-OHPC. It's worth investigating whether other methods, such as daily vaginal suppositories, might be more effective, he said.

A commercial formulation of the drug, marketed under the name Gestiva, has been granted orphan drug status by the Food and Drug Administration and an application for full FDA approval is pending.

Metronidazole to Prevent Preterm Delivery in Pregnant Women with Asymptomatic Bacterial Vaginosis

Original Article

Background Bacterial vaginosis has been associated with preterm birth. In clinical trials, the treatment of bacterial vaginosis in pregnant women who previously had a preterm delivery reduced the risk of recurrence.

Methods To determine whether treating women in a general obstetrical population who have asymptomatic bacterial vaginosis (as diagnosed on the basis of vaginal Gram's staining and pH) prevents preterm delivery, we randomly assigned 1953 women who were 16 to less than 24 weeks pregnant to receive two 2-g doses of metronidazole or placebo. The diagnostic studies were repeated and a second treatment was administered to all the women at 24 to less than 30 weeks' gestation. The primary outcome was the rate of delivery before 37 weeks' gestation.

Results Bacterial vaginosis resolved in 657 of 845 women who had follow-up Gram's staining in the metronidazole group (77.8 percent) and 321 of 859 women in the placebo group (37.4 percent). Data on the time and characteristics of delivery were available for 953 women in the metronidazole group and 966 in the placebo group. Preterm delivery occurred in 116 women in the metronidazole group (12.2 percent) and 121 women in the placebo group (12.5 percent) (relative risk, 1.0; 95 percent confidence interval, 0.8 to 1.2). Treatment did not prevent preterm deliveries that resulted from spontaneous labor (5.1 percent in the metronidazole group vs. 5.7 percent in the placebo group) or spontaneous rupture of the membranes (4.2 percent vs. 3.7 percent), nor did it prevent delivery before 32 weeks (2.3 percent vs. 2.7 percent). Treatment with metronidazole did not reduce the occurrence of preterm labor, intraamniotic or postpartum infections, neonatal sepsis, or admission of the infant to the neonatal intensive care unit.

Conclusions The treatment of asymptomatic bacterial vaginosis in pregnant women does not reduce the occurrence of preterm delivery or other adverse perinatal outcomes.

Relaxation Techniques during pregnancy

Relaxing during pregnancy is important. Research has shown that stress can increase the likelihood that you will have a premature birth. Personally I try to have some amount of time during the day that is dedicated to stress relief. This is something I did not do in my first pregnancy.

Pregnancy can be a stressful time. Your body is going through major changes you’re supporting a tiny growing baby inside you and you’re thwarted by all sorts of pregnancy side-effects, like morning sickness and aching legs. If you’re trying to cope with working, looking after the rest of your family and keeping up with your usual routine, it can all get too much at times.

But it’s important to take time out for yourself and relax and both you and your baby will benefit. Research shows that if you’re regularly stressed, anxious and tense during your pregnancy, you’ve got a greater chance of having a baby that also suffers from stress and anxiety. So if you need some inspiration as to how to relax, here are some helpful tips!

1. Put your feet up. Aching legs and ankles are a common problem in pregnancy, especially in the third trimester, so give yourself regular breaks and take the pressure of your feet. Sit in a comfy chair with your feet on a footstool or propped up on cushions, lie on the sofa or lie on your bed – whatever is comfortable for you. If your ankles are swelling, stack several cushions together to raise your feet up higher, as this helps reduce swelling.

2. Listen to calming music. Take time out from the madness of life and whisk yourself away to a calmer place, with the help of some relaxing music. Choose one of your favourites or treat yourself to a special pregnancy relaxation CD. Sit back, close your eyes and let the music wash over and relax you.

3. Have a massage. Massage is great for easing tension and relaxing the muscles. Rope your partner in to give you a massage or book a treatment with a specialist (many places offer special treatments for pregnant women).

4. Try a reflexology treatment. Reflexology is a natural therapy that believes your feet are in a sense a ‘map of your body.’ A reflexologist will clear blockages and ease ailments by putting a small amount of pressure on your feet – it’s a bit like a foot massage. It can be very relaxing, can relieve tension and help any pregnancy ailments you’re suffering from. (but get someone who is trained in this and has pregnancy experience as some reflexology can actual start labor in a more advanced pregnancy)

5. Have a go at antenatal yoga. Yoga designed for pregnancy can help tone up your body, but most classes also teach special relaxation tips too. These can help relieve any stress you’re experiencing during pregnancy, as well as ease worry about the birth itself. Ask you midwife for antenatal yoga class recommendations.

6. Try meditation or visualisation. Relaxing your mind is just as important as relaxing your body, but it can be hard to do. Meditation or visualisation could help and there are lots of CDs and classes available that teach it especially with pregnancy in mind.

7. Have a laugh. Laughter is a great form of natural – and free – therapy. Meet up with your friends, or watch your favourite comedy or film and have a good laugh. Your baby will pick up on the feel-good factor too.

8. Get some fresh air and sunshine. It’s good to get fresh air and sunshine when you can and can be a good pick-me-up if you’ve been inside all day. Have a stroll around your neighbourhood, walk to the park or even walk around the shops, breathe in the fresh air and relax.

9. Enjoy a night out with your partner. Spend some time unwinding and relaxing together – especially if it’s your first baby, as life will change when it arrives. Have a lovely meal, go to the theatre or indulge in your favourite pastime.

10. Enjoy water. Water is another form of natural healer. Swimming is ideal during pregnancy, as the water is supportive, and it’s not too exhausting. If you fancy a class, most places offer antenatal swimming sessions, but if a swimming pool isn’t your cup of tea, enjoy a nice long soak in the bath instead.

And finally, enjoy the course of your pregnancy. The nine months will fly by and a new baby will soon be part of your life.

Prevention of recurrent preterm delivery by 17 Alpha-Hydroxyprogesterone Caproate

Learn more about 17p shots here: http://www.hydroxyprogesterone.com/

New England Journal of Medicine Abstract

Volume 348:2379-2385
June 12, 2003
Number 24

Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate

Paul J. Meis, M.D., Mark Klebanoff, M.D., Elizabeth Thom, Ph.D., Mitchell P. Dombrowski, M.D., Baha Sibai, M.D., Atef H. Moawad, M.D., Catherine Y. Spong, M.D., John C. Hauth, M.D., Menachem Miodovnik, M.D., Michael W. Varner, M.D., Kenneth J. Leveno, M.D., Steve N. Caritis, M.D., Jay D. Iams, M.D., Ronald J. Wapner, M.D., Deborah Conway, M.D., Mary J. O'Sullivan, M.D., Marshall Carpenter, M.D., Brian Mercer, M.D., Susan M. Ramin, M.D., John M. Thorp, M.D., Alan M. Peaceman, M.D., for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network

Background:
Women who have had a spontaneous preterm delivery are at greatly increased risk for preterm delivery in subsequent pregnancies. The results of several small trials have suggested that 17 alpha-hydroxyprogesterone caproate (17P) may reduce the risk of preterm delivery.

Methods:
We conducted a double-blind, placebo-controlled trial involving pregnant women with a documented history of spontaneous preterm delivery. Women were enrolled at 19 clinical centers at 16 to 20 weeks of gestation and randomly assigned by a central data center, in a 2:1 ratio, to receive either weekly injections of 250 mg of 17P or weekly injections of an inert oil placebo; injections were continued until delivery or to 36 weeks of gestation. The primary outcome was preterm delivery before 37 weeks of gestation. Analysis was performed according to the intention-to-treat principle.

Results:
Base-line characteristics of the 310 women in the progesterone group and the 153 women in the placebo group were similar. Treatment with 17P significantly reduced the risk of delivery at less than 37 weeks of gestation (incidence, 36.3 percent in the progesterone group vs. 54.9 percent in the placebo group; relative risk, 0.66 [95 percent confidence interval, 0.54 to 0.81]), delivery at less than 35 weeks of gestation (incidence, 20.6 percent vs. 30.7 percent; relative risk, 0.67 [95 percent confidence interval, 0.48 to 0.93]), and delivery at less than 32 weeks of gestation (11.4 percent vs. 19.6 percent; relative risk, 0.58 [95 percent confidence interval, 0.37 to 0.91]). Infants of women treated with 17P had significantly lower rates of necrotizing enterocolitis, intraventricular hemorrhage, and need for supplemental oxygen.

Conclusions:
Weekly injections of 17P resulted in a substantial reduction in the rate of recurrent preterm delivery among women who were at particularly high risk for preterm delivery and reduced the likelihood of several complications in their infants.

Preterm delivery — that is, delivery before 37 completed weeks of gestation — is the major determinant of infant mortality in developed countries.1 Preterm delivery is more common in the United States than in many other developed countries and is the factor most responsible for the relatively high infant mortality in this country.1 The rate of preterm delivery in the United States has increased progressively from 9 percent to 12 percent over the past two decades.2 Despite many trials of reduced activity, tocolytic therapy, antibiotic therapy, and other strategies for prevention, no effective and reproducible method of preventing preterm delivery has been demonstrated.3

One treatment that showed promise in small trials was prophylactic treatment with progestational compounds.4,5,6,7 Not all trials reported positive results.8,9 One meta-analysis found no evidence of effectiveness of progestational compounds in the prevention of preterm delivery or the prevention of recurrent miscarriage.10 Another meta-analysis, restricted to trials of 17 alpha-hydroxyprogesterone caproate (17P), a natural metabolite of progesterone, showed, in composite, a significant reduction in the rate of preterm delivery.11 We therefore chose this pharmacologic agent as the active drug for our study.

Women who have had a preterm delivery are at especially high risk for preterm delivery in a subsequent pregnancy.12 We therefore conducted a multicenter trial to test the effectiveness of 17P as compared with placebo in the prevention of recurrent preterm delivery in this group of women.

STUDY: Diet influence preterm delivery?

Diet influences preterm delivery?

Issue 23: 14 Nov 2005
Source: American Journal of Obstetrics & Gynecology 2005; 193: 1292-301

Adopting a cholesterol-lowering diet could reduce the risk of preterm delivery in low-risk pregnancies, according to the findings of a new study.

Specialists from centers in Oslo, Norway, randomly assigned 290 women aged 21-38 years to, from 17-20 weeks’ gestation onwards, either continue their usual diet or to adopt a diet with a high intake of fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables, and legumes.

The women in the dietary intervention group met with a dietician at the start of the study and at weeks 24, 30, and 36 of their pregnancy. The diet (described in detail in the published paper) included limiting the intake of cholesterol to 150 mg/day, reducing saturated fat to 8% of total energy intake, and aiming at a weight gain of 8-14 kg from pre-pregnancy levels.

All of the women in the study were non-smoking, white, with singleton pregnancies, and had no previous pregnancy-related complications. About two-thirds were nulliparous.

Lipids lowered
Writing in the latest issue of the American Journal of Obstetrics & Gynecology, the researchers report that maternal levels of total cholesterol and low-density lipoprotein were significantly lower in the intervention group than in the control group. There were no differences between the two groups in levels of cord and neonatal lipids.

Overall, one of the 141 women in the dietary intervention group had a preterm delivery (defined as a live delivery before 37 completed weeks of gestation), compared with 11 of the 149 women in the control group. This was a statistically significant difference. There were no differences between the groups in the incidence of other pregnancy complications.

The researchers write: “In conclusion, a diet that was reduced in saturated fat and cholesterol, and enriched in a number of micronutrients, modified maternal cholesterol levels, but not cord and neonatal lipids. It was associated with a lower incidence of preterm delivery in low-risk pregnancies and had no adverse effects.”

They say the findings warrant replicating the study in a larger population of pregnant women, involving both low-risk and high-risk pregnancies: “The marked observed effect of this diet on the reduction of preterm delivery in low-risk pregnancies should encourage future larger studies to clarify the role of such a diet in the prevention of preterm birth.”

STUDY: Prior Miscarriage Raises Risk for Low-Birthweight Infant

Prior Miscarriage Raises Risk for Low-Birthweight Infant

THURSDAY, Dec. 20 (HealthDay News) -- Women who've had a miscarriage or an abortion are much more likely than women who haven't to experience a low-birthweight or premature baby in the future, new research shows.

A team at Virginia Commonwealth University looked at data on more than 45,500 mother-and-child pairs enrolled in the United States Collaborative Perinatal Project.

About 40 percent of the mothers had one or two children, and almost two-thirds of the mothers were between ages 20-29. The researchers found that rates of low-birthweight (under 2,500 grams or 5.5 pounds) and premature babies (less than 37 weeks gestation) were highest among women who were black, young or old, poorly educated, and unmarried.

The study also found that women who'd had one, two, or three or more miscarriages or abortions in the past were almost three, five and nine times, respectively, more likely than normal to have an underweight baby.

Women who'd had one miscarriage or abortion were 67 percent more likely to have a premature baby, while women who'd had three or more miscarriages or abortions were more than three times as likely to have a premature baby, compared to women who hadn't had a miscarriage or an abortion.

The study is published in the Journal of Epidemiology and Community Health.

The researchers noted that previous studies have been inconclusive, with some reporting no increased risk and others identifying a significantly increased risk of low-birthweight or premature babies among women who've had a miscarriage or abortion. Despite the conflicting evidence, women and doctors need to be aware of the potential risks, the authors concluded.

-- Robert Preidt

I always have to chuckle at these studies...

"The researchers found that rates of low-birthweight (under 2,500 grams or 5.5 pounds) and premature babies (less than 37 weeks gestation) were highest among women who were black, young or old, poorly educated, and unmarried."

Hmm... so where do I fit? I had a micro-preemie, I'm white, 27 (is that old or young?), am college educated and married... also had extra prenatal care. Where does that put me?

That puts me in the "we don't know why and don't know how to prevent..." category. Just where I longed to be! (that was sarcastic if you didn't catch that)