Association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid and preterm delivery in women / 北京大学学报(医学版)

OBJECTIVE@#To explore the association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid(MMFA) and risk of preterm delivery in women with natural conception, singleton pregnancy and vaginal delivery.@*METHODS@#A retrospective cohort study was performed based on the prenatal health care system and hospital information system of Tongzhou Maternal and Child Health Hospital of Beijing and the women who had their prenatal care in the hospital from January 2015 to December 2018 were included. The information of 16 332 women who conceived naturally, had a singleton pregnancy, and delivered vaginally was collected. Compliance scores were constructed based on the time of initiation and the frequency of taking nutritional supplements. The association between maternal periconceptional micronutrient supplementation, including pure folic acid (FA) pills or MMFA and the rate of preterm delivery was evaluated using Logistic regression models.@*RESULTS@#The preterm delivery rate (gestational week < 37 weeks) of the study population was 3.8%, and the mean (standard deviation) of gestational age was (38.98±1.37) weeks. A total of 6 174 (37.8%) women took FA during the periconceptional period, 8 646 (52.9%) women took MMFA, and 1 512 (9.3%) women did not take any nutritional supplements. The association between periconceptional supplementation of FA or MMFA and risk of preterm delivery in women was not statistically significant [adjusted odds ratio (aOR)=1.01, 95%CI: 0.74-1.37]. The associations with preterm birth were not statistically significant in further analysis by the type of nutritional supplements, time of initiation, and the frequency of supplementation. In addition, the association between the compliance score of taking supplements and the rate of preterm delivery was not statistically significant, either.@*CONCLUSION@#This study did not find an association between the risk of preterm delivery and the use of FA or MMFA during the periconcep-tional period in women with natural conception, singleton pregnancy, and vaginal delivery. In the future, multicenter studies with large-scale prospective cohort or population-based randomized controlled trials are warranted to confirm the association between taking FA or MMFA during the periconceptional period and preterm delivery among women.

Fatores de risco materno-fetais para o nascimento pré-termo em hospital de referência de Minas Gerais / Maternal and fetal risk factors for preterm birth in a reference hospital in Minas Gerais

Introdução. São considerados prematuros, os bebês nascidos antes de completar 37 semanas de gestação e, no Brasil, sua prevalência chega a aproximadamente 10%. A prematuridade pode comprometer a saúde do recém-nascido (RN) e levar a repercussões socioeconômicas. Portanto, é fundamental rastrear gestantes sob risco através de pré-natal adequado, a fim de afastá-las dessas condições ou minimizar suas implicações. Objetivos. Avaliar os principais fatores de risco maternos e fetais associados ao parto pré- termo em um hospital de referência em Barbacena. Métodos. Estudo transversal, retrospectivo, analítico, realizado no Hospital Santa Casa de Misericórdia de Barbacena. Avaliou-se prontuários materno-fetais impressos, disponibilizados de todos os nascimentos pelo Sistema Único de Saúde (SUS), em 2017. Foram analisados dados como: idade, profissão e patologias maternas; exames realizados durante gestação e informações do RN. Resultados. Dentre os 1278 prontuários, foram encontrados 177 prematuros. Verificou-se que diabetes mellitus (DM) ou diabetes mellitus gestacional (DMG), infecções do trato urinário (ITU), síndromes hipertensivas na gravidez, sífilis materna, gemelaridade e parto cesáreo foram estatisticamente relevantes como fatores de risco para prematuridade; e as gestantes trabalhadoras rurais tiveram menos partos prematuros de forma estatisticamente significativa quando comparadas às outras ocupações. Primiparidade e extremos de idade reprodutiva não foram significativos. Quanto aos RN, malformações e peso pequeno para a idade gestacional (PIG) também foram fatores de risco. Conclusões. Os principais fatores de risco maternos e fetais associados ao parto pré-termo na amostra foram DM, ITU, síndromes hipertensivas na gravidez, sífilis materna, gemelaridade, parto cesáreo, malformações fetais e PIG. (AU)

Introduction. Babies born before 37 weeks of gestation are considered premature and, in Brazil, their prevalence reaches approximately 10%. Prematurity can compromise the newborn's health and lead to socioeconomic repercussions. Therefore, it is essential to track pregnant women at risk through an adequate prenatal care, in order to remove them from these conditions or minimize their implications. Objective. To evaluate the main maternal and fetal risk factors associated with preterm birth in a reference hospital in Barbacena. Methods. A retrospective cross-sectional study, non-experimental made in Santa Casa de Misericórdia de Barbacena hospital. This study evaluated print medical records available of all births in Sistema Único de Saúde (SUS) in 2017. Some data were analyzed, such as: age, profession and maternal pathologies; examinations performed during pregnancy and information about the newborn. Results. The sample consisted of 1278 records of births, and there were 177 preterm births. It was checked that previous diabetes or gestational diabetes, urinary tract infections (UTI), pregnancy-induced hypertension, maternal syphilis, twinning and caesarean delivery were statistic relevant factors for prematurity; pregnant women who had a rural occupation had fewer premature deliveries in a statistically significant way than other occupations. First time pregnant women and those at extreme fertile age were not significant. About newborn data, malformations and small for gestational age (SGA) were risk factors for preterm birth. Conclusions. The main maternal and fetal risk factors associated with preterm birth on this study were diabetes, UTI, hypertension syndrome during pregnancy, maternal syphilis, twinning, caesarean delivery, malformations and SGA. (AU)

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Use of the pessary in the prevention of preterm delivery / Uso do pessário na prevenção de parto pretermo

Abstract Objective The gestational complication most associated with perinatalmortality and morbidity is spontaneous preterm birth with gestational age < 37 weeks. Therefore, it is necessary to identify its risk factors and attempt its prevention. The benefits of the pessary in prematurity are under investigation. Our objective was to analyze the use of the pessary in the prevention of preterm births in published studies, and to compare its efficacy with other methods. Methods Randomized clinical trials published between 2010 and 2018 were selected from electronic databases. Studies on multiple gestations were excluded. Results Two studies were in favor of the pessary as a preventive method, one study was contrary to the method and another two showed no statistically significant difference. Themeta-analysis showed no statistical difference with the use of a cervical pessary in the reduction of births < 37 (odds ratio [OR]: 0.63; confidence interval [95% CI]: 0.38-1.06) and < 34 weeks (OR: 0.74; 95% CI: 0.35-1.57) Conclusion The pooled data available to date seems to show a lack of efficacy of the cervical pessary in the prevention of preterm birth, although the heterogeneity of the studies made comparisons more difficult.

Resumo Objetivo O parto com idade gestacional < 37 semanas é a complicação gestacional mais associada à mortalidade e morbidade perinatal, sendo necessária a identificação de seus fatores de risco e a tentativa de sua prevenção. Os benefícios do pessário na prematuridade estão sendo investigados. Nosso objetivo foi analisar os estudos publicados sobre uso do pessário na prevenção do parto pretermo e comparar sua eficácia perante outros métodos. Métodos Foramselecionados estudos clínicos randomizados publicados entre 2010 e 2018, extraídos de bases eletrônicas de dados. Estudos de gestações múltiplas foram excluídos. Resultados Dois estudos semostraram a favor do pessário comométodo preventivo, um estudo foi contrário ao método, e outros dois não demonstraram diferença estatisticamente significativa. A meta-análise não mostrou diferença significativa no Conclusão Os dados agrupados disponíveis até o momento parecem mostrar uma falta de eficácia do pessário cervical na prevenção do parto pretermo, embora a heterogeneidade dos estudos tenha dificultado as comparações.

The role of three-dimensional ultrasound in pregnancies submitted to cerclage

SUMMARY OBJECTIVE: Cervical cerclage is the standard treatment for cervical incompetence (CI); however, there is still a high risk of preterm birth for women who undergo this treatment. The aim of this study was to longitudinally evaluate findings on two-dimensional transvaginal ultrasonography (2DTVUS) and three-dimensional transvaginal ultrasonography (3DTVUS) that could be related to gestational age at birth. METHODS: A total of 68 pregnant women who were treated with cerclage were evaluated by 2DTVUS and 3DTVUS in the second and third trimesters of pregnancy. Log-rank tests and Cox regression analyses were used to identify significant findings related to gestational age at delivery. RESULTS: A cervical length lower than 281 mm (p= 0.0083), a proximal cervical length lower than 10 mm (p= 0.0151), a cervical volume lower than 18.17 cm3 (p= 0.0152), a vascularization index (VI) under 2.153 (p= 0.0044), and a vascularization-flow index (VFI) under 0.961 (p= 0.0059) in the second trimester were all related to earlier delivery. In the third trimester, a cervical length lower than 20.4 mm (p= 0.0009), a VI over 0.54 (p= 0.0327) and a VFI over 2.275 (p= 0.0479) were all related to earlier delivery. Cervical funnelling in the second and third trimesters and proximal cervical length in the third trimester were not related to gestational age at birth. The COX regression analyses showed that cervical volume in the second trimester; FI and VFI in the third trimester were significantly associated with gestational age at birth. CONCLUSION: In women treated with history-indicated cerclage or ultrasound-indicated cerclage, 2nd trimester cervical volume and 3rd trimester FI and VFI are independent significant sonographic findings associated with time to delivery.

RESUMO OBJETIVOS: Determinar quais características ultrassonográficas obtidas por meio da ultrassonografia transvaginal bidimensional (USG TV 2D) e tridimensional (USG TV 3D) associam-se ao parto prematuro em gestantes submetidas à cerclagem profilática e terapêutica. MÉTODOS: Sessenta e seis gestantes com feto único submetidas à cerclagem profilática ou terapêutica e acompanhadas no ambulatório de Aborto Habitual da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da USP, entre 10 de juho de 2012 e 30 de outubro de 2015, foram avaliadas longitudinalmente, por meio das US TV 2D e US TV 3D associadas ao power Doppler para avaliação do VI, FI e VFI, nos três trimestres da gestação. Os resultados foram avaliados em relação ao parto em idade gestacional (IG) menor que 34 semanas e maior ou igual a 34 semanas, assim como em relação à idade do parto como variável contínua. RESULTADOS: O comprimento do colo uterino (CC) e a distância do ponto de cerclagem ao orifício interno do colo uterino (POI) diminuíram de forma significativa entre o segundo e terceiro trimestres da gestação. O CC, o POI e o afunilamento cervical no terceiro trimestre da gestação tiveram relação com a ocorrência de parto em IG<34 semanas. Na análise de regressão de COX, em que a variável de interesse foi o tempo até o parto, o volume do colo uterino no segundo trimestre e o FI e VFI no terceiro trimestre foram significativos. CONCLUSÃO: Foi possível identificar parâmetros ultrassonográficos do colo uterino bi e tridimensionais que se correlacionam com a idade gestacional do parto.

Tocolysis among women with preterm birth: associated factors and outcomes from a Multicenter study in Brazil / Tocólise com parto prematuro: fatores associados e desfechos de um estudo multicêntrico no Brasil

Abstract Objective To evaluate the use of tocolysis in cases of preterm birth due to spontaneous preterm labor in a Brazilian sample. Methods A sample of 1,491 women with preterm birth due to spontaneous preterm labor were assessed, considering treatment with tocolysis or expectant management, according to gestational age at birth (< 34 weeks and 34 to 36 þ 6 weeks) and drugs prescribed. The study took place in 20 Brazilian hospitals from April 2011 to July 2012. Bivariate analyses were conducted to evaluate associations with sociodemographic and obstetric characteristics and odds ratios with their respective 95% confidence intervals were estimated for maternal and neonatal outcomes. Results A total of 1,491 cases of preterm birth were considered. Tocolysis was performed in 342 cases (23%), 233 of which (68.1%) were delivered before 34 weeks. Within the expectant management group, 73% was late preterm and with more advanced labor at the time of admission. The most used drugs were calcium channel blockers (62.3%), followed by betamimetics (33%). Among the subjects in the tocolysis group, there were more neonatal and maternal complications (majority non-severe) and an occurrence of corticosteroid use that was 29 higher than in the expectant management group. Conclusion Tocolysis is favored in cases of earlier labor and also among thosewith less than 34 weeks of gestation, using preferably calcium channel blockers, with success in achieving increased corticosteroid use. Tocolysis, in general, was related to higher maternal and neonatal complication rates, which may be due to the baseline difference between cases at admission. However, these results should raise awareness to tocolysis use.

Resumo Objetivo: Avaliar o uso da tocólise em partos prematuros decorrentes de trabalho de parto espontâneo numa amostra brasileira. Métodos Um total de 1.491 mulheres com parto prematuro decorrente de trabalho de parto espontâneo foram avaliadas, considerando a realização de tocólise ou conduta expectante, de acordo com a idade gestacional ao nascimento (< 34 semanas e 34 a 36 þ 6 semanas) e com as drogas prescritas. O estudo ocorreu em 20 hospitais brasileiros, de abril de 2011a julho de 2012. Análises bivariadas foram realizadas para avaliar associações com características sociodemográficas e obstétricas. Foram calculadas as relações de probabilidade comseus respectivos intervalos de confiança (95%) para os desfechos neonatais e maternos. Resultados Um total de 1.491 casos de partos prematuros foram considerados, e a tocólise foi realizada em 342 (23%) casos, dos quais 233 (68,1%) tiveram partos antes das 34 semanas. No grupo da conduta expectante, 73% forampré-termos tardios e com trabalho de parto mais avançado à admissão. As drogas mais utilizadas foram os bloqueadores do canal de cálcio (62.3%), seguidos pelos betamiméticos (33%). No grupo da tocólise houvemais complicações neonatais ematernas (maioria não grave) e um uso de corticosteroides 29 vezes mais frequente que nos casos de conduta expectante. Conclusão A tocólise foi mais favorável nos casos de trabalho de parto inicial e nos partos realizados antes de 34 semanas de gestação, usando preferencialmente bloqueadores do canal de cálcio, comsucesso em realizar altas taxas de corticoterapia. A tocólise esteve associada a maiores taxas de complicações maternas e neonatais, o que pode ser explicado pela diferença basal dos casos à admissão. Entretanto, esses resultados devem acender um alerta em relação ao uso de tocolíticos.

En mujeres embarazadas con rotura prematura de membranas y edad gestacional entre 34 y 37 semanas: ¿Es la interrupción del embarazo (manejo activo) mejor que el manejo expectante para reducir la sepsis neonatal? / In pregnant women with premature rupture of membranes and gestational age between 34 and 37 weeks: Is termination of pregnancy (active management) better than expectant management to reduce neonatal sepsis?

INTRODUCCIÓN: La rotura prematura de membranas (RPM) ocurre en un 8 a 10% de las embarazadas, y de ellas, un 20% corresponde a embarazos de pretérmino. El mayor riesgo para el feto luego de una RPM pretérmino son las complicaciones propias de la prematurez. Por debajo de las 34 semanas se favorece el manejo expectante, y el uso de antibióticos y corticoides. Entre las 34 y 37 semanas, sin embargo, las prácticas varían, no habiendo un consenso claro sobre la conducta óptima. OBJETIVO: El objetivo de esta revisión es explorar la evidencia actualmente disponible respecto de la conducta activa versus la expectante en embarazos con RPM entre las 34 y 37 semanas (36 semanas más 6 días). METODOLOGÍA: Se realizó una búsqueda de literatura médica en distintas bases de datos, dentro de las cuales se incluye "PubMed" y "Cochrane", usando los siguientes términos: "Fetal Membranes, Premature Rupture", "Premature Birth", "34 and 37 weeks" y "Clinical Trial". Se limitó la búsqueda a artículos que fueran ensayos clínicos aleatorizados. De un total de 31 trabajos, se seleccionaron 3, a los cuales se les aplicó la pauta de análisis crítico para evaluación de estudios de terapia. RESULTADOS: Se incluyeron 3 estudios que respondían a la pregunta planteada. En el primer estudio se concluyó que en pacientes en que hay interrupción inmediata la incidencia de sepsis neonatal es baja y no es posible demostrar que esta conducta mejore los resultados en comparación con el manejo expectante (2.6% vs. 4.1%). El manejo activo en este estudio se asoció a mayor incidencia de hiperbilirrubinemia, hipoglicemia, y mayor estadía hospitalaria neonatal. En el segundo artículo se planteó que la incidencia de sepsis neonatal sigue siendo baja, lo cual no disminuyó con la inducción del trabajo de parto. Esta tampoco disminuyó el riesgo de otros resultados neonatales o maternos. Finalmente, el tercer estudio concluyó que la interrupción inmediata aumenta las complicaciones neonatales sin disminución de la sepsis neonatal, pero a expensas de mayor frecuencia de fiebre materna y de hemorragia intraparto. CONCLUSIONES: El manejo expectante no es inferior al manejo activo en el contexto de RPM entre las semanas 34 a 37 de edad gestacional.

INTRODUCTION: Premature rupture of membranes (PROM) occur in eight to ten percent of pregnancies, and 20 percent of them occur in preterm pregnancies. Biggest fetal risks after preterm PROM are complications due to prematurity. Before 34 weeks of gestation it is preferred an expectant management, and the use of antibiotics and steroids. Between 34 and 37 weeks, however, practices are variable without a clear consensus about the best management. OBJECTIVE: The objective of this review is to explore the available evidence about active versus expectant management in pregnancies with PROM between 34 and 37 weeks (36 weeks plus 6 days). METHODS: Different databases were searched for medical literature, including 'PubMed' and 'Cochrane', using the following terms: 'Fetal Membranes, Premature Rupture', 'Premature Birth', '34 and 37 weeks' and 'Clinical Trial'. The search was limited to clinical randomized trials. From a total of 31 studies, three were selected, in which critical analysis guidelines for evaluation of therapy studies were applied. RESULTS: Three clinical trials which answered our question were included in this review. The first study concluded that in patients whose pregnancies were interrupted immediately, the incidence of neonatal sepsis was low but is was not able to demonstrate that this action improved outcomes compared to expectant management (2.6% vs 4.1%). Active management in this study was associated to greater incidences of hyperbilirubinemia, hypoglycemia and longer neonatal hospital stay. In the second article the incidence of neonatal sepsis was low and didn't decrease with induction of labor. It also didn't reduce the risk of other maternal nor neonatal outcomes. Finally, the third study concluded that induction of labor increased neonatal complications without reducing neonatal sepsis, but at the expense of increased frequency of intrapartum hemorrhage and maternal fever. CONCLUSION: After analyzing the selected articles, it is possible to conclude that there is enough evidence to say that expectant management is not inferior to active management in relation to PROM between 34 and 37 weeks of gestational age.

Efecto de los glucocorticoides prenatales en neonatos pretérminos tratados con un surfactante natural porcino / Effect of the prenatal steroids in preterm newborn treated with a natural porcine-derived surfactant

Introducción: los glucocorticoides prenatales aumentan los efectos beneficiosos de la terapia con surfactante exógeno. Objetivo: analizar el efecto de los glucocorticoides prenatales en recién nacidos pretérminos tratados con surfactante exógeno. Método: se realizó un estudio descriptivo, longitudinal y prospectivo, no controlado, multicéntrico, desde enero de 2007 hasta diciembre de 2009, en una población de 259 recién nacidos pretérminos, tratados con surfactante exógeno a los que se les evaluó el efecto del uso de los glucocorticoides prenatales. Resultados: los glucocorticoides prenatales fueron utilizados en 59,5 por ciento de las madres, disminuyó el tiempo en ventilación mecánica a los recién nacidos (123/31) p: 0,0068; RR: 1,74 (IC:1,16 - 2,60) y el riesgo de morir p: 0,0003; RR: 2,43 (IC: 1,47 - 4,03). Conclusiones: el uso de glucocorticoides prenatales, en pacientes tratados con surfactante natural porcino, disminuyó la necesidad de soporte ventilatorio y la mortalidad neonatal(AU)

Introduction: The antenatal corticosteroids increase the beneficial effects of the therapy with exogenous surfactant. Objective: To find out the effect of the antenatal corticosteroids in preterm newborns treated with exogenous surfactant. Methods: A multicenter, uncontrolled, prospective, longitudinal and descriptive study was carried from January 2007 to December 2009 in a population of 259 preterm newborns treated with exogenous surfactant to evaluate the effect of the use of antenatal corticosteroids. Results: The antenatal corticosteroids were used in 59,5 percent of mothers; the length of assisted ventilation in newborns as well as the risk of death were reduced (123/31) p: 0.0068; RR: 1.74 (IC:1.16 - 2.60) and p: 0.0003; RR: 2.43 (IC: 1.47 - 4.03), respectively. Conclusions: The use of antenatal corticosteroids in patients treated with natural porcine-derived surfactant reduced the assisted ventilation support requirement and the neonatal mortality(AU)

Impacto do monitoramento telefônico de gestantes na prevalência da prematuridade e análise dos fatores de risco associados em Piracicaba, São Paulo, Brasil / Telephone monitoring service for pregnant women and impact on prevalence of prematurity and associated risk factors in Piracicaba, São Paulo State, Brazil / Impacto del monitoreo telefónico de mujeres embarazadas en la prevalencia de partos prematuros y análisis de factores de riesgo asociados en Piracicaba, São Paulo, Brasil

Resumo: Objetivou-se verificar o impacto do monitoramento telefônico na prevalência da prematuridade e identificar os fatores de risco associados ao parto prematuro através de estudo transversal, de universo de gestantes monitoradas nos anos de 2010, 2011 e 2012 (n = 2.739). Utilizou-se estimação de modelos de regressão logística múltipla hierarquizada, considerando permanência no modelo p ≤ 0,05. A prevalência de prematuridade foi de 8,34% nas gestantes monitoradas e de 10,18% nas não monitoradas (p = 0,0058), sendo inversamente proporcional ao número de monitoramentos (p < 0,0001). As variáveis associadas foram: idade materna menor que 19 anos, antecedentes de dois ou mais filhos mortos, gestação múltipla, diabetes e hipertensão arterial, menor número de monitoramentos telefônicos, atividades laborais em pé e/ou carga de peso, fumo, número de consultas pré-natal, sem ultrassonografia, diabetes gestacional, gravidez múltipla e anomalia fetal. Com custos baixos, a estratégia demonstrou ser efetiva na redução da ocorrência do parto prematuro.

Abstract: This study aims to assess the impact of a telephone monitoring service on prevalence of prematurity and to analyze associated risk factors using data on 2,739 pregnant women. Estimation was based on hierarchical multiple logistic regression, with p ≤ 0.05 for variables to remain in the model. Prevalence of preterm birth was 8.34% in monitored pregnant women and 10.18% in unmonitored women (p = 0.0058). Prevalence of preterm birth was inversely proportional to the number of monitoring calls (p < 0.0001). Variables associated with prematurity were maternal age < 19 years, history of death of two or more children, multiple pregnancy, diabetes, hypertension, fewer monitoring calls, extended standing or lifting heavy weights at work, smoking, fewer prenatal visits, no ultrasound examination, gestational diabetes, multiple pregnancy, and fetal abnormality. This low-cost strategy proved effective for reducing the preterm birth rate.

Resumen: Este estudio tuvo como objetivo evaluar el impacto de monitoreo telefónico en la prevalencia de los partos prematuros y de los factores de riesgo asociados con el parto prematuro a través de un estudio transversal con datos de 2.739 mujeres embarazadas en Piracicaba, São Paulo, Brasil. Se utilizó la estimación de modelos de regresión logística múltiple jerárquica, considerando permanecer en el modelo de p ≤ 0,05. La prevalencia de parto prematuro era 8,34% en las mujeres embarazadas monitoreadas y 10,18% en sin control (p = 0,00058), siendo inversamente proporcional al número de monitoreo (p < 0,0001). Las variables asociadas fueron: edad materna de 19 años, una historia de dos o más niños muertos, embarazo múltiple, diabetes e hipertensión, menos monitoreo telefónico, actividades industriales a pie y/o con peso/carga, tabaquismo, menos visitas prenatales, sin ultrasonido, diabetes gestacional, embarazo múltiple y anormalidad fetal. Con menores costes, la estrategia resultó una medida eficaz para reducir la incidencia de parto prematuro.

Avaliação da ministração de corticosteroides em situações de suspeita de parto pré-termo iminente: um estudo de coorte retrospectivo em um centro terciário / Evaluation of corticosteroid administration in situations of suspected imminent preterm delivery: a retrospective cohort study in a tertiary centre

ResumoOBJETIVOA ministração antenatal de um ciclo único de corticoterapia está recomendada a mulheres grávidas entre a 24 e a 34 semanas com risco de parto prematuro. O efeito máximo é atingido quando os corticosteroides ministrados entre 24 horas e 7 dias antes do parto. O objetivo deste estudo foi avaliar a ocorrência de parto nos sete dias após corticoterapia nas principais situações obstétricas com risco de parto pré-termoMÉTODOSEstudo de coorte retrospectivo incluindo 209 grávidas internadas em risco de parto pré-termo submetidas a tratamento com corticosteroides para maturação pulmonar fetal. O estudo foi realizado entre janeiro de 2012 e março de 2014 e um hospital universitário. O desfecho principal avaliado foi o número de mulheres que tiveram parto no prazo de 7 dias após a ministração antenatal de corticosteroides. Foram definidos dois grupos de acordo com o motivo para iniciar corticosteroides: ameaça de parto pré-termo (Grupo APPT) e outras indicações para corticoterapia (Grupo RPPT). Foi efetuada uma análise de sobrevivência de Kaplan-Meier e um valor p<0,05 foi considerado estatisticamente significativoRESULTADOS46,4% (n=97) das mulheres grávidas tiveram parto nos 7 dias após a ministração de corticosteroides. Parto em 7 dias ocorreu mais frequentemente no grupo RPPT, em comparação com o grupo APPT (57,3 versus 42,4%, p=0,001). Foi detectada uma diferença estatisticamente significativa entre a curva de sobrevivência para os grupos APPT e RPPT, com um hazard ratio para parto até 7 dias 1,71 vezes maior para o grupo RPPT (IC95% 1,23-2,37; p<0,001)CONCLUSÃOPode-se concluir que a probabilidade de um evento (nascimento dentro de 7 dias após corticoterapia) é menor no grupo de grávidas internadas no contexto de ameaça de parto pré-termo do que por outras indicações. A utilização de corticosteroides em grávidas internadas por suspeita de trabalho parto pré-termo deverá ser alvo de uma rigorosa avaliação clínica.

AbstractPURPOSEThe administration of a single-course antenatal corticosteroid treatment is recommended for pregnant women between 24 and 34 weeks with risk of premature birth. The maximum effect is achieved when antenatal corticosteroids are administered between 24h and 7 days before delivery. The objective of this study was to evaluate the occurrence of birth within seven days of corticosteroid therapy in major obstetric situations with risk of preterm birthMETHODSRetrospective cohort study including 209 pregnant women hospitalized in risk of preterm delivery, submitted to corticosteroid therapy for fetal lung maturation. The study was carried out between January 2012 and March 2014 at a university hospital. Main outcome measure was the number of women who delivered within 7 da ys after antenatal corticosteroid administration. Two groups were defined according to the reason for starting corticosteroids: threatened preterm labour (Group APPT) and other indications for corticosteroid therapy (Group RPPT). A Kaplan-Meier survival analysis was performed and a p value <0.05 was considered statistically significant.RESULTS46.4% (n=97) of pregnant women gave birth in the seven days following corticosteroid administration. Delivery within 7 days occurred more frequently on group 2 in comparison to group 1 (57.3 versus42.4%; p=0.001). There is a statistically significant difference between the survival curve for groups 1 and 2, with a hazard ratio for delivery within 7 days 1.71 times higher for group 2 (95%CI 1.23-2.37; p<0.001)CONCLUSIONIt can be concluded that the probability of an event (birth within 7 days after corticosteroids) is smaller in the group of pregnant women admitted in the context of threatened preterm labor than for other indications. The use of corticosteroids in pregnant women admitted for suspected preterm labor should be subject to rigorous clinical evaluation.

Correlação entre o uso de corticoterapia antenatal, a reanimação e a mortalidade de recém-nascidos prematuros de muito baixo peso / Correlation between antenatal corticosteroid therapy, resuscitation and mortality in very low birth weight infants

OBJETIVO: Avaliar a correlação entre o uso de corticoterapia antenatal (CAN), a frequência de reanimação em sala de parto e a evolução ao óbito de recém-nascidos menores de 1.500 g e idade gestacional menor ou igual a 34 semanas. MÉTODOS: Estudo de coorte no qual foram acompanhados, desde a internação até a idade gestacional corrigida de 34 semanas, todos os recém-nascidos admitidos na UTI neonatal de janeiro de 2006 a dezembro de 2011. Foram excluídos os recém-nascidos que apresentaram malformações, síndromes genéticas, infecções congênitas e os transferidos de ou para outras instituições. Os recém-nascidos foram separados em 2 grupos: os que receberam (n=182) e os que não receberam (n=38) corticosteroide antenatal. Os principais desfechos estudados foram a necessidade de reanimação neonatal, a presença das principais morbidades neonatais e a evolução ao óbito durante a internação. As médias das variáveis foram comparadas utilizando-se o teste t de Student ou teste não paramétrico e as frequências foram comparadas pelo teste do χ2, com correção de Fisher. Todas as variáveis que se apresentaram diferentes entre os grupos foram avaliadas por regressão logística. Foi utilizado o pacote estatístico Statistical Package for the Social Sciences (SPSS) 16.0 e a significância foi considerada 0,05. RESULTADOS: Foram avaliados 220 pacientes. Não houve diferença entre os grupos quanto ao peso de nascimento, à idade gestacional e à presença das principais patologias neonatais. O grupo de recém-nascidos que recebeu CAN apresentou mortalidade 3 vezes menor (IC95% 1,4-6,5) e necessitou 2,4 vezes menos de reanimação (IC95% 1,1-5,0). Além disso, houve diminuição ...

PURPOSE: To evaluate the correlation between the use of antenatal corticosteroid therapy (AC), the frequency of resuscitation in delivery room and mortality of newborn infants under 1,500 g and gestational age less than or equal to 34 weeks. METHODS: A cohort study was conducted on all newborn infants under 1,500 g and with a gestational age less than or equal to 34 weeks admitted at the neonatal ICU between January 2006 and December 2011. Newborns who had congenital anomalies, genetic syndromes, congenital infections and those who were transferred to or came from other institutions were excluded. The studied infants were divided into 2 groups: those who received (n=182) and those who did not receive (n=38) AC. The main outcomes studied were the necessity of neonatal resuscitation, the presence of the main neonatal diseases and mortality during hospitalization. The means of the variables were compared using Student's t-test or non-parametric test and frequencies were compared by χ2test with Fisher's correction. The variables that presented difference between groups were assessed by logistic regression. The Statistical Package for the Social Sciences (SPSS) 16.0 was used and the significance level was set at 0.05. RESULTS: In this study, 220 patients were evaluated. The groups were similar concerning birth weight, gestational age and the presence of the main neonatal morbidity during hospitalization. The infants who received antenatal corticosteroids showed lower mortality (OR=3.0; 95%CI 1.4-6.5) and required less resuscitation (OR=2.4; 95%CI 1.1-5.0). Besides, they required less advanced resuscitation procedures, such as tracheal cannula (OR=3.7; 95%CI 1.7-7.6), cardiac massage (OR=5.7; 95%CI 2.0-16.5) and medications (OR=8.9; 95%CI 2.0-39.4). CONCLUSIONS: The use of antenatal corticosteroids reduced the need for resuscitation in delivery room, especially advanced procedures, and reduced the mortality in the studied groups. .

Risk factors of preterm labour and the use of progesterone in prevention of preterm birth

To find out the risk factors of preterm labour and to study the use of progesterone for the prevention of preterm birth. An interventional study was conducted for a period of one year on patients admitted with threatened preterm labour. The outcome measures included preterm birth at less than 37 completed weeks of gestation, fetal and neonatal outcome. The patients were started on two injections of250 mg hydroxyprogesterone daily for the first 3 days. They were discharged on two injections [250 mg each] at three days interval for 2 weeks and were invited for a follow-up visit in antenatal clinics. Out of 4670 pregnant women with singleton pregnancy, 567 [12.14%]presented with confirmed preterm labour. Risk factors for spontaneous preterm labour included maternal age less than 25 years [n=367, 64.67%],history of preterm birth [n=236, 41.62%], uterine anomalies [n=23, 4.06%] and cervical anomalies [n=4, 0.71%]. Injectable Progesterone was associated with arrest of early labour pains and prolongation of pregnancy. Neonatal outcome including respiratory distress syndrome [n=23, 4.06%], necrotizing enter colitis [n=4, 0.71%] and admission to neonatal Intensive Care Unit [n=6, 1.06%]were noted. Due to beneficial effects of Injectable progesterone, the pregnancy was observed to be prolonged by 4 or more than 4 weeks [n=405, 71.43%]. Preterm birth can be prevented if risk factors of preterm labour are fully assessed and managed properly. Progesterone is associated with beneficial effects in prolonging pregnancy and preventing preterm delivery

Cervical cerclage for preventing preterm birth in twin pregnancies. A systematic review and meta-analysis

To evaluate the effect of cervical cerclage on preventing preterm birth in twin pregnancies. We searched Cochrane Central Register of Controlled Trials [CENTRAL], MEDLINE, EMBASE, Current Controlled Trials, China Biology Medicine [CBM], Chinese National Knowlegde Infrastructure [CNKI] and VIP Chinese Journal database [VIP] from April to August 2012. All available randomized trials comparing the effects of cervical cerclage for preventing preterm birth in twin pregnancies with no cerclage were included. The study took place in the First Affiliated Hospital of ChongQing Medical University, Chongqing, People's Republic of China. Five eligible studies with a total of 310 participants were finally included. No statistically significant differences were found between patients who received cervical cerclage and those who did not receive cervical cerclage, in terms of preterm birth [RR 0.91, 95% CI 0.78-1.18], live births [RR 0.93, 95% CI 0.87-1.01] and mode of delivery [RR 1.34, 95% CI 0.61-2.98] per randomized woman. These results of preterm birth, premature rupture of membrane, model of delivery did not change before and after sensitivity analysis. No significant difference was observed between cervical cerclage group and no cerclage group in twin pregnancies and large scale randomized controlled trials are needed to strengthen clinical usage of cervical cerclage

Infecção genital e marcadores preditivos do parto prematuro / Genital infection and preterm birth predictive markers

Apesar dos avanços na área da Obstetrícia, a prematuridade ainda é a principal causa de morbidade e mortalidade neonatal. Esforços continuam sendo feitos na busca de marcadores que possam predizer tal evento e, assim, evitar o parto prematuro. A presente revisão abordou a relação da infecção genital com a prematuridade e sua influência nos resultados dos principais indicadores preditivos do parto prematuro, bem como a eficácia da antibioticoterapia. Os estudos revisados sugerem que o tratamento da vaginose bacteriana relaciona-se a resultados satisfatórios para a prevenção da prematuridade somente se realizado na primeira metade da gestação. A alteração dos testes preditivos não indica, por si só, o uso de antibióticos.

Despite advances in the field of Obstetrics, prematurity is still responsible for the leading cause of neonatal morbidity and mortality. Efforts are still being made in the search for markers that can predict such an event and thus prevent premature delivery. This review explores the relationship of genital infection with preterm birth and its influence on the results of the main preterm birth predictive markers, as well as the effectiveness of antibiotics. The revised studies suggest that treatment of bacterial vaginosis relates to satisfactory results for the prevention of preterm performed only if the first half of pregnancy. The change of predictive tests not indicates, by itself, the use of antibiotics.

Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis / Tratamento de doença periodontal e risco de parto prematuro: revisão sistemática e metanálise

The events leading to preterm birth are still not completely understood. A quantitative systematic review was performed to estimate the effects of periodontal care during pregnancy on preventing preterm birth and low birth weight. The meta-analysis included randomized trials with pregnant women with a diagnosis of periodontal disease before 20 weeks of gestation. Relative risk (RR) with 95% confidence intervals (95%CI) was calculated. We evaluated the reduction in preterm and low birth weight. Thirteen trials were included, comparing 3,576 women in intervention groups with 3,412 women receiving usual care. The meta-analysis of the effects of periodontal disease treatment during pregnancy indicated a non-significant reduction in preterm births (RR = 0.90; 95%CI: 0.68-1.19) and low birth weights (RR = 0.92; 95%CI: 0.71-1.20). The creation and examination of a funnel plot revealed clear evidence of publication bias. In summary, primary periodontal care during pregnancy cannot be considered an efficient way of reducing the incidence of preterm birth.

Os eventos que levam à prematuridade ainda não são completamente compreendidos. Foi realizada uma revisão sistemática quantitativa para avaliar os efeitos do tratamento de doença periodontal durante a gravidez para prevenir o nascimento prematuro e baixo peso ao nascer. A metanálise incluiu estudos randomizados de grávidas com diagnóstico de doença periodontal antes de 20 semanas de gestação. O risco relativo (RR) com intervalos de 95% de confiança (IC95%) foi calculado. Avaliou-se os desfechos prematuridade e baixo peso ao nascer. Foram incluídos 13 estudos, comparando 3.576 mulheres em grupos de intervenção com 3.412 mulheres que receberam tratamento habitual. A metanálise mostrou uma redução não significativa nos partos prematuros (RR = 0,90; IC95%: 0,68-1,19) e baixo peso ao nascer (RR = 0,92; IC95%: 0,71-1,20). O gráfico de funil revelou clara evidência de viés de publicação. Em resumo, o tratamento periodontal em mulheres grávidas não pode ser considerado uma forma eficiente de reduzir a incidência de parto prematuro ou baixo peso ao nascer.

Progesterona para prevenção do parto prematuro / Progesterone for prevention of preterm delivery

Esta revisão, baseada em evidências, pretendeu analisar a utilização da progesterona na prevenção do parto prematuro. Foram apresentados os principais ensaios clínicos randomizados em gestações únicas ou gemelares que utilizaram a progesterona sintética por via intramuscular ou a progesterona natural pela via vaginal ou oral em gestações de risco para a prematuridade espontânea. Concluímos que há benefícios quanto ao uso da progesterona sintética e natural para prevenir o parto prematuro em gestações únicas com antecedente de prematuridade espontânea e no colo curto.

This review, based on evidence, aimed to examine the use of progesterone to preventing premature labor and presented the major randomized clinical trials in singleton or twin gestations using the synthetic progesterone by intramuscular and natural progesterone by vaginal or oral in high risk pregnancies for spontaneous prematurity. We concluded that there are benefits about the use of the synthetic progesterone and natural progesterone to prevent premature labor in single pregnancies with a history of spontaneous prematurity and in short cervix.