Risk factors for spontaneous preterm delivery

Cobo, Teresa; Kacerovský, Marian; Jacobsson, Bo

doi:10.1002/ijgo.13184

Cited by 111 publications

(108 citation statements)

References 95 publications

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“…Thus, the placebo gel reinforced the physiological barrier at the uterine cervix which protects the pregnancy against pathogen invasion and uterine infection. The present results were in accordance with reports on uterine infection due to pathogen invasion from the skin and gastrointestinal microbiome as an ethiology behind 30 − 60% of all early PTB (2). The present results were also in agreement with results from an experimental study showing that the placebo gel exerts anti-in ammatory effects, decreases MMP-13, and delays PTB (18).…”

Section: Discussionsupporting

confidence: 93%

“…Prophylactic treatment with P from the second trimester in asymptomatic women with CL ≤ 25 mm, which is recommended by the International Federation of Gynecology and Obstetrics (FIGO), is effective according to some but not the largest studies (2,12,13).…”

Section: Introductionmentioning

confidence: 99%

“…Extensive screening programmes are needed to evaluate prophylactic strategies since only 1% of asymptomatic women have a CL ≤ 25 mm in the second trimester (14) and only 10 − 20% of women with spontaneous PTB have a previous PTB (2,9). The objective of this study was therefore to investigate the e cacy of maintenance treatment with vaginal P gel or placebo in delaying PTB in women after the onset of preterm labor (PTL).…”

Section: Introductionmentioning

confidence: 99%

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Maintenance Treatment With Vaginal Progesterone or Placebo Delayed Preterm Birth More Efficiently Than Intravenous Tocolysis Alone – A Randomized Controlled Trial

Stjernholm

Marchini

2020

Preprint

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Objective To evaulate the efficacy of maintenance treatment with vaginal progesterone gel compared to placebo in women after the onset of preterm labor.Material and Methods A randomized controlled trial at a university hospital in Sweden in 2009 − 18. Healthy women with singleton pregnancy and early preterm labor were randomized to daily progesterone gel 90 mg (n = 29) or placebo (n = 29) after standard intravenous tocolysis. Women with intravenous tocolysis alone (n = 29) served as a reference group. Results The latency to delivery was 58 ± 34 days with progesterone, 64 ± 51 days with placebo and 2 ± 2 days in the reference group (p < 0.0001 respectively). The rate of preterm birth < 34 weeks was 34% after progesterone, 38% after placebo and 100% in the reference group (progesterone vs reference p = 0.01 and placebo vs reference p = 0.02). The composite neonatal morbidity and length of neonatal intensive care were lower after progesterone and placebo compared to the reference group (p < 0.0001 respectively).Conclusion Maintenance treatment with vaginal progesterone gel or placebo delayed preterm birth more efficiently than intravenous tocolysis alone, suggesting an effect of the placebo gel rather than of progesterone. We conclude, that the placebo gel reinforced the physiological barrier at the uterine cervix which protects the pregnancy from pathogen invasion and uterine infection leading to preterm birth.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maintenance Treatment With Vaginal Progesterone or Placebo Delayed Preterm Birth More Efficiently Than Intravenous Tocolysis Alone – A Randomized Controlled Trial

Stjernholm

Marchini

2020

Preprint

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“…The causes of variations in preterm birth rates among countries and in groups within a country or a region are mainly unknown; however, risk factors associated with preterm birth are discussed in a study by Cobo 10 …”

Section: Prevalencementioning

confidence: 99%

Global burden of preterm birth

Walani

2020

Intl J Gynecology & Obste

574

400

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Preterm birth is a live birth that occurs before 37 completed weeks of pregnancy.Approximately 15 million babies are born preterm annually worldwide, indicating a global preterm birth rate of about 11%. With 1 million children dying due to preterm birth before the age of 5 years, preterm birth is the leading cause of death among children, accounting for 18% of all deaths among children aged under 5 years and as much as 35% of all deaths among newborns (aged <28 days). There are significant variations in preterm birth rates and mortality between countries and within countries. However, the burden of preterm birth is particularly high in low-and middle-income countries, especially those in Southeast Asia and sub-Saharan Africa. Preterm birth rates are rising in many countries. The issue of preterm birth is of paramount significance for achieving United Nations Sustainable Development Goal 3 target #3.2, which aims to end all preventable deaths of newborns and children aged under 5 years by 2030.

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“…Walani 6 provides a global perspective on rates, including recent WHO data 7 . Cobo, Kacerovsky, and Jacobsson provide an overview of risk factors, including the microbiome 8 . Martin, Jayaram, and Collier review opportunities for reduction in preterm birth related to early identification and treatment of pre‐eclampsia 9 .…”

mentioning

confidence: 99%

Preterm birth: A clinical enigma and a worldwide public health concern

Jacobsson

Simpson

2020

Intl J Gynecology & Obste

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Delivery before 37 weeks of gestation is a major worldwide public health concern, occurring in 10% of all births globally. This problem exists both in low-and middle-income countries (LMIC) and in high-income countries. In a 2012 report by WHO, March of Dimes, Save the Children, and The Partnership for Maternal, Newborn and Child Health-'Born Too Soon'-it was stated that in 2010, 15 million babies were born preterm, namely before 37 weeks of gestation. 1 Over 1 million of these preterm babies died. Surviving infants had an increased risk of learning disabilities, as well as visual and auditory problems. The magnitude of the problems is inversely related to gestational age at birth. For example, a linear decline in the need for special education can be shown for births from gestational week 24 to week 41. 2 At the time of the 'Born Too Soon' report, 1 only a few interventions were generally accepted: elimination of early elective deliveries; progesterone or progestational agents if a prior preterm birth had occurred; single embryo transfer in Assisted Reproductive Technologies (ART); cerclage for cervical insufficiency; cessation of smoking. If all of these guidelines were followed, however, the reduction in preterm birth was only a modest 9.6%-9.1%. 3As a result of these realities, the FIGO Working Group on Preterm Birth was initiated in 2014, a collaborative agreement between FIGO and the March of Dimes, both Non-State Actors (NSA) in official relations with WHO. Terms of reference included identification of risk factors, strategies to communicate clinical significance, and preparation of enduring educational material for use by member societies and for presentation at international FIGO meetings and elsewhere. These included FIGO World Congresses in Vancouver in 2015 and in Rio de Janeiro in 2018. Site-specific workshops and presentations were held elsewhere, in particular South America (Costa Rica, Uruguay). The success of these and other ventures have resulted in extension of the activities of Working Group. In 2016 the Working Group completed an exhaustive individual patient data meta-analysis encompassing 4.1 million births in California and four countries (Czech Republic, Sweden, New Zealand, Slovenia). 4 Of preterm birth pregnancies, 2/3 lacked a known biological basis. As result, attention expanded to elucidate the biological basis (etiology) of preterm birth. Enthusiasm for exploring the potential beneficial treatment with vaginal progesterone and 17-alpha OH progesterone caproate continued. Perturbations of the vaginal microbiome as a predisposing factor in preterm birth are perhaps one explanation for the markedly higher risk in African-Americans. Heritable factors have long been known to exist, and in 2017 a genomewide association study of 43 568 women discovered six genes of significance. 5 Work continues in other related fields-regulatory genes, glycobiology, maternal stress, sleep disturbance, and anatomic changes in the cervix and vagina. In this special section of IJGO, Preterm Birth Working Gro...

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Risk factors for spontaneous preterm delivery

Cited by 111 publications

References 95 publications

Maintenance Treatment With Vaginal Progesterone or Placebo Delayed Preterm Birth More Efficiently Than Intravenous Tocolysis Alone – A Randomized Controlled Trial

Maintenance Treatment With Vaginal Progesterone or Placebo Delayed Preterm Birth More Efficiently Than Intravenous Tocolysis Alone – A Randomized Controlled Trial

Global burden of preterm birth

Preterm birth: A clinical enigma and a worldwide public health concern

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