Background: We aimed to explore the association of the number, order, gestational age and type of prior PTB and the risk of preterm birth (PTB) in the third delivery in women who had three consecutive singleton deliveries. Methods: A retrospective cohort study of all women who had three consecutive singleton births at a single medical center over a 20-year period (1994–2013). The primary outcome was PTB (<37 weeks) in the third delivery. Results: 4472 women met inclusion criteria. The rate of PTB in the third delivery was 4.9%. In the adjusted analysis, the risk of PTB was 3.5% in women with no prior PTBs; 10.9% in women with prior one PTB only in the first pregnancy; 16.2% in women with prior one PTB only in the second pregnancy; and 56.5% in women with prior two PTBs. A similar trend was observed when the outcome of interest was spontaneous PTB and when the exposure was limited to prior spontaneous or indicated PTB. Conclusions: In women with a history of PTB, the risk of recurrent PTB in subsequent pregnancies is related to the number and order of prior PTBs. These factors should be taken into account when stratifying the risk of PTB.
During the study period, 55 women met inclusion criteria, and 17 had an early PTB (31%). Women with an early PTB despite vaginal progesterone therapy had similar demographic/obstetric history as those who delivered !34 weeks. Women with an early PTB had a lower mean CL at diagnosis (12.2AE4.0 vs 15.8AE4.4mm, p¼.006). ROCC demonstrated that CL was associated with early PTB (AUC 0.75 (0.61-0.88, p¼.004), and CL<15mm was best predictive of early PTB with a sensitivity of 77% and specificity of 76% (Figure A). CL<15mm was associated with an early PTB with an OR of 10.5 (2.7-40.3, p¼.001) and survival curve log rank p<.001 (Figure B). CL<15mm was associated with a lower mean GA of delivery (30.0AE6.9 vs 36.4AE4.5, p<.001), lower mean birth weight (1683AE1089 vs 2772AE906g, p<.001), increased incidence of NICU admission (50% vs 24%, p¼.04) and composite perinatal morbidity/ mortality (53% vs 12%, p¼.008). CONCLUSION: A CL<15mm is associated with an increased risk of early PTB in women with short cervix, despite vaginal progesterone therapy, and is associated with increased perinatal morbidity/mortality. Further studies should be done on whether additional measures such as cerclage would benefit this subgroup of women.
Interventions: Patient was taken to the OR for diagnostic laparoscopy and video from this surgery is presented here. The majority of the case is spent on adhesiolysis and restoration of anatomy. Necrotic tissue is resected and the abdomen and pelvis are irrigated. An intraperitoneal drain is placed under direct visualization. Measurements/Results: The patient improved clinically post-operatively. Conclusions: Laparoscopic management of tubo-ovarian abscess can be technically difficult but offers patients enhanced post-operative recovery and decreased risk of complication compared to laparotomy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.