Monitoring Women at Risk for Preterm Labor

Dyson, Donald C.; Danbe, K; Bamber, Judith A.; Crites, Yvonne; Field, D R; Maier, Jeffrey A.; Newman, Lawrence A.; Ray, Deborah A.; Walton, David; Armstrong, Mary Anne

doi:10.1056/nejm199801013380103

Cited by 198 publications

(53 citation statements)

References 14 publications

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“…Although modern approaches to neonatal care have significantly improved preterm neonates' health conditions, preterm delivery is still a major cause of mortality, neurologic complications and disability among neonates, who have no congenital defects and imposes heavy financial burden on healthcare systems (6,7). In 2000, the cost of providing neonatal care in the United States was more than ten billion dollars from which, 60% was related to the neonates, who had a gestational age of less than 37 weeks and 12% to those with a gestational age of 24 to 26 weeks (8,9).…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effects of Continuous and Cyclical Lightings on Weight Gain and Length of Hospital Stay Among Preterm Neonates

Esmaeilizadeh

Shoja

et al. 2016

Mod Care J

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Background: Hospitalization in neonatal intensive care units predisposes preterm neonates to negative stimuli such as continuous 24-hour lighting. Objectives: The present study was done to evaluate the effects of a cyclical lighting model on weight gain and length of hospital stay among preterm neonates. Methods: This clinical trial was performed during year 2012 on 60 preterm neonates, who were hospitalized in the neonatal intensive care unit of Bentolhoda hospital, Bojnord, Iran. The neonates were conveniently recruited and randomly allocated to a control and an experimental group through permuted block randomization. The neonates in these groups were exposed to continuous and cyclical lighting, respectively. Their weight and sleeping time were measured both before and after the intervention. Moreover, the length of their hospital stay was documented. The data were analyzed through doing the independent-sample t and the Mann-Whitney U tests by using the SPSS software (v. 18.0) at a significance level of less than 0.05. Results: Before the study intervention, the groups did not differ significantly regarding the neonates' birth weight, Apgar score, height and sleeping time (P > 0.05). Compared with baseline values, the neonates' weight in the control and the experimental groups increased significantly during the study by 263±52 and 232±48 grams, respectively (P = 0.02). Moreover, the means of hospi-

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Section: Introductionmentioning

confidence: 99%

Comparing the Effects of Continuous and Cyclical Lightings on Weight Gain and Length of Hospital Stay Among Preterm Neonates

Esmaeilizadeh

Shoja

et al. 2016

Mod Care J

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“…[1][2][3][4][5] • Assessment of contraction frequency is not a useful test to predict preterm birth, 6 and its use to detect and arrest initial or recurrent episodes of preterm labor does not affect the rate of preterm birth. [7][8][9] • Antibiotics that eradicate microorganisms associated with preterm birth also do not reliably reduce, and may sometimes increase, the incidence of preterm birth, especially in women with intact membranes. [10][11][12][13][14][15][16][17] • Progestational agents such as 17α-hydroxy-progesterone caproate reduce recurrent preterm birth in some women with a prior preterm birth, 18,19 especially those with early preterm birth 20 and short cervix, 21 but have no effect on preterm birth in multiple gestations.…”

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confidence: 99%

Care for Women with Prior Preterm Birth

Iams

2010

Preterm Birth

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Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately. Keywordscerclage; prevention; progesterone; recurrent; preterm birth; risk estimation Efforts to reduce the incidence of preterm birth cannot yet be called successful but have produced sufficient information to justify management suggestions for clinicians, not only for strategies that do not work but also for those that do. The quality and number of clinical trials of interventions intended to reduce the incidence and/or morbidity of preterm birth has risen substantially in recent years, yielding data that can improve care for women at risk.An important advance has been the revision of the traditional model of preterm birth in which painful contractions or preterm membrane rupture were understood as the most common initial steps preceding cervical change. This concept has been challenged by observations from several clinical studies:• Drugs that arrest or inhibit uterine contractions can delay delivery but do not reliably reduce or prevent preterm birth. [1][2][3][4][5] • Assessment of contraction frequency is not a useful test to predict preterm birth, 6 and its use to detect and arrest initial or recurrent episodes of preterm labor does not affect the rate of preterm birth. [7][8][9] • Antibiotics that eradicate microorganisms associated with preterm birth also do not reliably reduce, and may sometimes increase, the incidence of preterm birth, especially in women with intact membranes. [10][11][12][13][14][15][16][17] • Progestational agents such as 17α-hydroxy-progesterone caproate reduce recurrent preterm birth in some women with a prior preterm birth, 18,19 especially those with early preterm birth 20 and short cervix, 21 but have no effect on preterm birth in multiple gestations. 22,23 NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2013 May 09. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript• Cervical cerclage can reduce recurrent preterm birth in women with a prior preterm birth and short cervix 24,25 but increases the risk of preterm birth in women with multiple gestation who also have a short cervix. 24 These findings suggest the following 4 substantive changes in the "contractions change the cervi...

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“…Multiple biochemical and biophysical markers have been tested, but an accurate predictor of early PTB remains elusive. [19][20][21] The measurement of biomarkers in the saliva has the advantages of reflecting biologically active substances, noninvasive testing, and easy collection and storage. It is therefore more suitable for steroid hormone tests.…”

Section: Discussionmentioning

confidence: 99%

Salivary progesterone as a biochemical marker to predict early preterm birth in asymptomatic high‐risk women

Priya

Mustafa

Guleria

et al. 2013

BJOG

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Objective To evaluate salivary progesterone as a predictor of early preterm birth (PTB) and compare it with transvaginal sonographic (TVS) cervical length in asymptomatic high-risk women.Design Prospective study.Setting Departments of Obstetrics and Gynaecology and Biochemistry at UCMS & GTBH, Delhi, India.Sample Ninety pregnant women.Methods The progesterone concentration in saliva of asymptomatic pregnant women at high risk for preterm delivery was estimated by immunoassay, and cervical length was measured by TVS, at the first antenatal visit at 24-28 weeks of gestation, and then repeated 3-4 weeks later.Main outcome measures Early PTB, mean and critical cut-off values of salivary progesterone, and a diagnostic value comparison of salivary progesterone with TVS cervical length.Results The mean value of salivary progesterone was significantly lower in all women who delivered at <37 weeks of gestation (n = 38), compared with the term group (n = 52; P < 0.001). Salivary progesterone decreased significantly from the first to the second visit, with the maximum decrease observed in women who delivered at <34 weeks of gestation (29.6%, 95% CI 17.8-41.4%, P < 0.002). The single predictive critical cut-off value for salivary progesterone was 2575 pg/ml, below which more than 80% of women delivered prematurely before 34 weeks of gestation, with sensitivity, specificity, and positive and negative predictive values of 83% (95% CI 58.6-96.4%), 86% (95% CI 75.9-93.1%), 60% (95% CI 38.6-78.8%) and 95% (95% CI 87.1-99.0%), respectively. The TVS cervical length decreased significantly (P < 0.001) in the women who delivered prematurely.Conclusions Low salivary progesterone concentration can be used for predicting early PTB in asymptomatic high-risk women.

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Monitoring Women at Risk for Preterm Labor

Abstract: Women who have daily contact with a nurse, with or without home monitoring of uterine activity, have no better pregnancy outcomes than women who have weekly contact with a nurse.

Cited by 198 publications

References 14 publications

Comparing the Effects of Continuous and Cyclical Lightings on Weight Gain and Length of Hospital Stay Among Preterm Neonates

Comparing the Effects of Continuous and Cyclical Lightings on Weight Gain and Length of Hospital Stay Among Preterm Neonates

Care for Women with Prior Preterm Birth

Salivary progesterone as a biochemical marker to predict early preterm birth in asymptomatic high‐risk women

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