ABSTRACT
OBJECTIVE: To evaluate a new a cut off level of fetal fibronectin as a predictor of birth in women with threatened preterm labour. DESIGN: A retrospective cohort study performed at Ipswich hospital, Ipswich, Queensland, Australia, in women with threatened preterm labour with intact membranes between 23 weeks to 34 + 6 week gestation. STUDY DESIGN: A quantitative fetal fibronectin (fFN) was performed. Maternal demographics and birth outcome data were extracted from the routinely collected perinatal data held by the hospital. The odds of preterm birth were estimated for each cut off value of fFN (10, 50 and 200 ng ml-1) using logistic regression and accounting for multiple presentations by the same woman. RESULTS: Among the 447 presentations and 376 pregnancies, rates of preterm birth <34 weeks were 2.9%, 9.2%, 3.3%, 19.6%, 4.2% and 35.3% for each category of values respectively (fFN <10, ≥10, <50, ≥50, <200 and ≥200 ng ml-1). Birth rates within 7 d of testing were 1.1%, 7.5%, 1.8%, 16.1%, 2.1% and 41.2% respectively. Comparing fFN level of <10 to a level of 10-199 ng ml-1 there was no significant increase in odds of preterm birth < 34 weeks or birth within the next 7 d (OR 2.28, 95% CI 0.84-6.17 and OR 3.61, 95% CI 0.89-14.7 respectively. CONCLUSION: In women presenting with TPL, those with levels of <200 ng ml-1 have a low risk of birthing within 7 d or before 34 weeks gestation. This allows a personalised decision making and probable discharge home without need for steroid loading.
ABSTRACT
BACKGROUND: Concerns have been expressed in relation to a possible negative effect of fentanyl epidural analgesia on breastfeeding rates. A 2016 systematic review was inconclusive and suggested cohort studies be performed with control groups to allow for other potential confounding factors. AIMS: To assess the effect of fentanyl epidural analgesia in labour on breastfeeding practices. MATERIAL AND METHODS: A prospective cohort study, conducted at a metropolitan hospital, Ipswich, Queensland. Eligible women were first-time mothers, wishing to breastfeed after a vaginal birth at term. Women who had fentanyl epidural only (107) were compared with women who had subcutaneous morphine only (90), and women who had neither subcutaneous morphine nor epidural (107). RESULTS: Fewer women in the fentanyl epidural analgesia group were fully breastfeeding when leaving hospital (54.2% compared to 69.2% in the no analgesia group and 77.8% in the subcutaneous morphine group; P < 0.05). At 6 weeks postpartum, there was no evidence of difference between the groups (43% for fentanyl epidural analgesia, 52.3% for no analgesia group and 48.9% for subcutaneous morphine group; P = 0.63). Rates of induction of labour, instrumental birth and admission to special care nursery differed significantly between groups and when controlled for these, there was no association between fentanyl epidural analgesia and breastfeeding at discharge (adjusted odds ratio (OR) 0.74; 95% CI 0.39-1.41) or at 6 weeks postpartum (OR 0.75; 95% CI 0.41-1.38). CONCLUSION: Our study did not find an association between fentanyl epidural analgesia in labour and rates of fully breastfeeding at discharge and at 6 weeks postpartum.
