Percentiles of Sonographic Cervical Length

Please click the picture to see the bigger version

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

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.

Tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks of gestation: a randomized controlled pilot study

Link to article

OBJECTIVE: The purpose of this study was to determine whether intravenous magnesium sulfate (MgSO(4)) followed by oral nifidepine tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks' gestation reduces neonatal hospital stay.

STUDY DESIGN: Fifty-four women between 32 0/7 and 34 6/7 weeks with preterm labor were randomized to receive either MgSO(4) and oral nifidepine (n = 24) or no tocolysis (n = 30). All women received betamethasone and prophylactic antibiotics. The primary outcome was total neonatal hospital stay. Data were analyzed using Chi-square and Mann Whitney U test.

RESULTS: The 2 groups had similar mean cervical dilation and gestational age at enrollment. There were no statistically significant differences in total neonatal hospital stay (5.8 +/- 7.2 days; median of 3 days in the no tocolysis vs. 7.5 +/- 8.6 days; median of 3 days in the tocolysis group), rate of preterm delivery (57% vs. 75%) or need for oxygen supplementation (7% vs. 21%, p < 0.23). The neonatal complications were similar in each group.

CONCLUSION: Tocolysis after 32 weeks gestation does not reduce neonatal hospital stay.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I am very disheartened to read this. I wouldn't be surprised to learn that some women have not been offered tocolysis because 'it won't do any good anyway'.

Very sad.

Dehydration

This pregnancy is very different from my first in a variety of ways. First was the morning sickness (aka all day sickness) - I didn't get it with Arianna at all. I had/have it very bad with this one but its getting much better - instead of all day nausea nothing tastes good.

Second has been my lack of 'thinking about it'. With Arianna I thought about being pregnant every day - looking up all sorts of baby/parenting information and obsessing over my pregnancy. This time I generally don't think about it much at all - I'm actually hoping I can start 'bonding with this pregnancy' a bit more after the cerclage surgery.

Thirdly its my dehydration. I'm naturally NOT a thirsty person - never have been. I probably live the majority of my life in a mildly dehydrated state. Last weekend I don't think I drank much at all - we were busy, out and about so I didn't take the time I needed to drink many decaf fluids.

Monday morning I came into work and my lips were dry/cracked. My legs were itchy from being dry and my hands were cracking. Hmm... I should probably drink something. So I brought in a pitcher and some decaf iced tea sweetened with sugar - the only thing I can drink unlimited amounts of. I'm not kidding when I tell you I drank 2.5 Liters of tea at work and only used the bathroom 3 times.

HOLY DEHYDRATED BATMAN!

It's now Thursday and I've been drinking about 3 liters a day and not really using the bathroom all that much - its obvious my body really needs all this fluid. But its horrible that its sugary iced tea! So today I went to the store and got some decaf iced tea sweetened with splenda which my OB told me is a much better alternative, so as soon as the original container of iced tea mix is gone I'll switch to the no sugar kind.

Being dehydrated can trigger pre-term labor and it makes me wonder if that's what happened with Arianna. The day I went into labor I was working the cat show at the convention center and on my feet all day. I can't really recall drinking anything that day. I met my mom for lunch and drank 2 big glasses of seltzer water that day but in the bathroom I had lost my plug (not knowing that was what it was). I was in active labor 5 hours later.

Well... you can rest assured I won't make the same mistake this time - I'm drinking tons of fluids and staying hydrated. Just finished my 2 liter pitcher and its only 1:45 PM!

Women Successfully Treated to Prevent Preterm Labor at Low Risk for Recurrent Episode

Link to article

ROCHESTER, Minn. — Mayo Clinic and Medical University of South Carolina researchers have found that the large majority of expectant mothers treated to prevent preterm labor will deliver at or near term.

"We found that if you stopped labor once, only one out of nine women would come back with a repeat episode, which is about a baseline risk for preterm delivery," says Brian Brost, M.D., Mayo Clinic high-risk pregnancy specialist and study co-author. "Most babies will do just fine — they are delivered near term or at term."

While expectant mothers treated with magnesium for preterm labor commonly feel queasy or flushed, serious side effects are rare, according to Dr. Brost, and they usually result from improper dosage or monitoring of the patient following treatment.

The investigators also studied whether the expectant mothers whose preterm labor did recur would be candidates for a steroid treatment in addition to the magnesium. The goal of steroid treatment is to promote accelerated development of the baby's lungs and other body systems. In order for the steroid to be delivered and absorbed into the baby's system, the repeat magnesium treatment to inhibit uterine contractions would need to delay labor for at least 24 to 48 hours. In this study, the researchers found that the magnesium could delay labor long enough for the steroid to work in about half the cases.

This study was conducted retrospectively by analyzing delivery records for consecutive preterm labor patients at Mayo Clinic. In 154 expectant mothers treated for preterm labor who were still undelivered one week later, 87.7 percent (135 women) delivered their babies at greater than 34 weeks. After 34 weeks, standard procedure is to deliver the baby rather than treat the mother again if she went into labor, according to the study's researchers.

In 19 women, or 12.3 percent, preterm labor recurred. Repeat magnesium treatment to inhibit uterine contractions delayed labor for at least 24 to 48 hours in 11 women, offering the possibility for steroid therapy. The other eight women with repeat preterm labor delivered within 24 hours of readmission to the hospital, which did not allow enough time for the physicians to consider giving the steroid treatment.

No measures have been shown to definitively prevent preterm labor, according to Dr. Brost. At the same time, he says, rates of preterm labor have been slowly but steadily rising in the last several decades in the United States.

Newborns are considered to be full-term when delivered about 40 weeks after the first day of their mother's last menstrual period.

To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.

Magnesium Sulfate More Effective Than Nifedipine in Preventing Preterm Delivery

Link to article

June 29, 2007 — Magnesium sulfate is more effective than nifedipine in preventing preterm delivery for 48 hours, but nifedipine is linked with fewer maternal adverse events, according to the results of a randomized controlled trial published in the July issue of Obstetrics & Gynecology.

"Magnesium sulfate is the most commonly used first-line tocolytic in North America although it has not been demonstrated to be superior to saline infusion, and its use has been a source of controversy," write Deirdre J. Lyell, MD, from Stanford University Medical Center and Lucile S. Packard Children's Hospital in California, and colleagues. "Magnesium sulfate requires intravenous administration, has potential for overmedication with serious maternal adverse effects and may be associated with adverse neonatal effects.... Nifedipine may be more easily tolerated, is administered orally, and appears to have few adverse effects."

The objective of this multicenter randomized study was to compare the efficacy and adverse effects of intravenous magnesium with those of oral nifedipine for acute tocolysis of preterm labor in 192 patients in active preterm labor who were at 24 to 33 weeks and 6 days of gestation. The main endpoint was arrest of preterm labor, defined as prevention of delivery for 48 hours with uterine quiescence.

Compared with women treated with nifedipine, more women treated with magnesium sulfate achieved the main endpoint (87% vs 72%; P = .01). Both groups were similar in delivery within 48 hours (7.6% magnesium sulfate vs 8.0% nifedipine; P = .92), gestational age at delivery (35.8 vs 36.0 weeks; P = .61), birth before 37 and 32 weeks (57% vs 57%; P = .97 and 11% vs 8%; P = .39, respectively), and episodes of recurrent preterm labor.

In the magnesium sulfate group, mild and severe maternal adverse effects were significantly more frequent than in the nifedipine group. Although average birth weight, birth weight less than 2500 g, and neonatal morbidities were similar in both groups, newborns of mothers in the magnesium sulfate group spent longer in the neonatal intensive care unit (8.8 ± 17.7 vs 4.2 ± 8.2 days; P = .007).

Study limitations include lack of double-blinding or placebo control and failure to establish the optimal doses of magnesium sulfate and nifedipine.

"Patients who received magnesium sulfate achieved the primary outcome more frequently," the authors write. "However, delay of delivery, gestational age at delivery, and neonatal outcomes were similar between groups. Nifedipine was associated with fewer maternal adverse effects."

The Division of Maternal–Fetal Medicine at Stanford University and the Department of Obstetrics and Gynecology at Santa Clara Valley Medical Center supported this study. The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2007;110:61-67.

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.

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.

Terbutaline: Can it prevent preterm labor?

Can beta-mimetic therapy help prevent preterm labor?

There is no evidence that beta-mimetic drugs, such as terbutaline and ritodrine, prevent preterm birth. However, beta-mimetics are effective in temporarily reducing or stopping contractions in women who are having preterm labor.

Beta-mimetics are best used to delay delivery long enough — usually 24 to 48 hours — to allow treatment with corticosteroids to speed fetal lung development. Beyond that use, it isn't clear that the benefits of beta-mimetics outweigh the potential risks for the mother. Adverse effects from beta-mimetic drugs may include fluid in the lungs (pulmonary edema) and abnormal heart rhythms (arrhythmias).

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.

Causes of preterm birth

Some causes of preterm birth

Although the cause is often unknown, a variety of factors play a role in preterm birth:

• Certain genital tract infections, such as chlamydia, bacterial vaginosis (BV), and trichomoniasis, are associated with preterm delivery.

Substances produced by bacteria can weaken the membranes around the amniotic sac and cause it to rupture early. Even when the membranes remain intact, bacteria can cause preterm labor if they get into the amniotic fluid or sac.

You may have been checked for chlamydia and gonorrhea at your first prenatal visit, and you would have been treated immediately if you'd tested positive for either of these sexually transmitted infections.

If you've had a previous preterm birth, you may also have been screened for bacterial vaginosis. Although some studies show that treating BV in the second and third trimesters reduces the risk of preterm labor in women with a history of preterm birth, other research has found that it makes no difference. So experts don't agree on whether it's worthwhile to test pregnant women who don't have symptoms. (If you have symptoms of bacterial vaginosis, you'll be tested and treated with antibiotics, if needed.)

You probably won't be tested for trichomoniasis unless you have symptoms. Some research suggests that treating women for trichomoniasis during pregnancy actually increases the risk of preterm birth.

• Having a problem with the placenta, such as placenta previa or placental abruption.

• Having structural abnormalities of the uterus or cervix, such as a cervix that's shorter than 25 millimeters and that effaces or dilates without contractions (cervical insufficiency).

• Having an excessively large uterus, which is often the case when you're pregnant with multiples or have too much amniotic fluid.

• Certain chronic maternal illnesses may be related to preterm labor, such as diabetes, sickle cell anemia, severe asthma, lupus, inflammatory bowel disease, and chronic active hepatitis. Other conditions to watch for include non-uterine infections, such as a kidney infection or pneumonia; abdominal surgery, such as having your appendix taken out; trauma to the abdomen; and periodontitis (a gum infection that goes into the bone and other tissues that support your teeth).

Preeclampsia

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.

Typically, preeclampsia occurs after 20 weeks gestation (in the late 2nd or 3rd trimesters or middle to late pregnancy), though it can occur earlier. Proper prenatal care is essential to diagnose and manage preeclampsia. Preeclampsia, Pregnancy Induced Hypertension (PIH) and toxemia are closely related conditions. HELLP Syndrome and eclampsia are other manifestations of the same syndrome. It is important to note that research shows that more women die from preeclampsia than eclampsia and one is not necessarily more serious than the other.

Preeclampsia and other hypertensive disorders of pregnancy are a leading global cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 deaths each year.