Preterm labour: summary of NICE guidance

Sarri, Grammati; Davies, Melanie; Gholitabar, Maryam; Norman, Jane E.

doi:10.1136/bmj.h6283

Cited by 23 publications

(14 citation statements)

References 2 publications

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“…Most of our participants were recruited through the Early Pregnancy Unit, which may constitute a higher‐risk group. However, the incidence of PTB in the UK has been reported to be 8% of all live births, whereas in our population the incidence was 5.7%. During follow‐up, an unavoidable bias common to all observational studies in this field is that some participants received treatment to prevent an adverse outcome as part of their standard clinical care.…”

Section: Discussioncontrasting

confidence: 75%

First‐trimester intrauterine hematoma and pregnancy complications

Al‐Memar

Vaulet

Fourie

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first‐trimester miscarriage and antenatal, delivery and neonatal complications. Methods This was a prospective observational cohort study of women with an intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's and Chelsea Hospital, London, UK, between March 2014 and March 2016. Participants underwent serial ultrasound examinations in the first trimester, and the presence, location, size and persistence of any IUH was evaluated. First‐trimester miscarriage was defined as pregnancy loss before 14 weeks' gestation. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit using validated symptom scores. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis and the chi‐square test were used to assess the association between the presence and features of IUH and the incidence of adverse pregnancy outcome. Odds ratios (OR) were first adjusted for maternal age (aOR) and then further adjusted for the presence of vaginal bleeding or pelvic pain in the first trimester. Results Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07–3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first‐trimester miscarriage (aOR, 0.81 (95% CI, 0.44–1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04). Conclusions Our findings demonstrate that there is no association between the presence of IUH in the first trimester and first‐trimester miscarriage. However, an association with preterm birth, independently of the presence of symptoms of pelvic pain and/or vaginal bleeding, is evident. Women diagnosed with IUH in the first trimester should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during the course of their pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussioncontrasting

confidence: 75%

First‐trimester intrauterine hematoma and pregnancy complications

Al‐Memar

Vaulet

Fourie

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…Most participants were recruited through the Early Pregnancy Unit, which may constitute a higher‐risk group. However, the incidence of PTB in the UK has been reported to be 8% of all live births, whereas in our population, the incidence was 5.7%. During follow‐up, an unavoidable bias prevalent in observational studies in this field is that some participants received intervention to prevent an adverse outcome as part of standard clinical practice.…”

Section: Discussioncontrasting

confidence: 73%

Early‐pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study

Al‐Memar

Vaulet

Fourie

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes. Methods This was a prospective observational cohort study of consecutive women with confirmed intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014 to March 2016. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding during the first trimester. Pregnancies were followed up until the final outcome was known. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis was used to assess the association between first‐trimester symptoms and pregnancy complications by calculating adjusted odds ratios (aOR) with correction for maternal age. Results Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first‐trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow‐up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17–2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89–3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81–1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. Conclusions Our study suggests that there is an increased incidence of antenatal complications in women experiencing pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending early‐pregnancy units. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Nifedipine, a calcium channel blocker (CCB), is a potent cardiovascular drug, registered for the treatment of ischemic heart disease and hypertension. Albeit unlicensed for tocolysis, nifedipine is indicated by international guidelines as a first‐line tocolytic drug for women in threatened preterm labor (TPTL) in order to permit administration of glucocorticosteroids to promote fetal lung maturation . The safety of CCBs in pregnancy has not been rigorously evaluated, and there are some concerns regarding their safety; thus, they remain officially unlicensed for use as tocolytic drugs.…”

Section: Introductionmentioning

confidence: 99%