Does a preterm labor-assessment algorithm improve preterm labor-related knowledge, clinical practice confidence, and educational satisfaction?: a quasi-experimental study.

PURPOSE: Preterm birth is increasing, and obstetric nurses should have the competency to provide timely care. Therefore, training is necessary in the maternal nursing practicum. This study aimed to investigate the effects of practice education using a preterm-labor assessment algorithm on preterm labor-related knowledge and clinical practice confidence in senior nursing students. METHODS: A pre-post quasi-experimental design with three groups was used for 61 students. The preterm-labor assessment algorithm was modified into three modules from the preterm-labor assessment algorithm by March of Dimes. We evaluated preterm labor-related knowledge, clinical practice confidence, and educational satisfaction. Data were analyzed with the paired t-test and repeated-measures analysis of variance. RESULTS: The practice education using a preterm-labor assessment algorithm significantly improved both preterm labor-related knowledge and clinical practice confidence (paired t=-7.17, p<.001; paired t=-5.51, p<.001, respectively). The effects of the practice education using a preterm-labor assessment algorithm on knowledge lasted until 8 weeks but decreased significantly at 11 and 13 weeks after the program, while the clinical practice confidence significantly decreased at 8 weeks post-program. CONCLUSION: The practice education using a preterm-labor assessment algorithm was effective in improving preterm labor-related knowledge and clinical practice confidence. The findings suggest that follow-up education should be conducted at 8 weeks, or as soon as possible thereafter, to maintain knowledge and clinical confidence, and the effects should be evaluated.

Development and effects of a webtoon education program on preventive self-management related to premature labor for women of childbearing age: a randomized controlled trial.

PURPOSE: The purpose of this study was to develop a webtoon education program on preventive self-management related to premature labor (PSM-PL) for women of childbearing age, to evaluate its effects, and to assess the usability of webtoon education for women of childbearing age. METHODS: The study design was a stratified randomized trial with repeated measures. The participants were Korean women of childbearing age (between the ages of 19 and 49 years), with 49 participants each. The preventive health management self-efficacy related to premature labor (PHMSE-PL) scale, the preventive self-management knowledge related to premature labor (PSMK-PL) scale, and usability of webtoon education were assessed. The intervention group read six episodes of the PSM-PL webtoon within 2 days after clicking an online link. The control group did not receive anything but was given the webtoon after the last measurement. To test the effect of the repeatedly measured variables, a generalized estimating equation model was used. RESULTS: The experimental group had statistically significantly greater increases in PHMSE-PL and PSMK-PL scores from baseline to immediately after and 2 weeks later than the control group. The average score for usability of webtoon education was high (4.52; standard deviation, 0.62) on a scale of 1-5. CONCLUSION: This webtoon education program on PSM-PL was a feasible and acceptable program that increased self-efficacy and knowledge of preventive health management of premature labor in women of childbearing age. Future studies that adopt a webtoon format can be beneficial for childbearing women with other risk factors.

Timing of Antenatal Corticosteroids for Optimal Neonatal Outcomes: A Markov Decision Analysis Model.

OBJECTIVE: Antenatal corticosteroids (ACSs) are administered to pregnant individuals at high risk of preterm delivery to reduce neonatal morbidity and mortality. ACSs have a limited timeframe of effectiveness, and timing of administration can be difficult because of uncertainty surrounding the likelihood of preterm delivery. The objective of the current study was to design a decision analysis model to optimize the timing of ACS administration and identify important model variables that impact administration timing preference. METHODS: We created a Markov decision analysis model with a base case of a patient at 240 weeks gestation with antepartum hemorrhage. Decision strategies included immediate, delayed, and no ACS administration. Outcomes were based on the neonatal perspective and consisted of lifetime quality adjusted life years (QALYs). Data for model inputs were derived from current literature and clinical recommendations. RESULTS: Our base case analysis revealed a preferred strategy of delaying ACSs for 2 weeks, which maximized QALYs (39.18 lifetime discounted), driven by reduced neonatal morbidity at the expense of 0.1% more neonatal deaths, when compared with immediate ACS administration. Sensitivity analyses identified that, if the probability of delivery within the next week was >6.19%, then immediate steroids were preferred. Other important variables included gestational age, ACS effectiveness, and ACS adverse effects. CONCLUSION: ACS timing involves a trade-off between morbidity and mortality, and optimal timing depends on probability of delivery, gestational age, and risks and benefits of ACSs. Clinicians should carefully consider these factors prior to ACS administration.

Characterization of pregnant women who gave birth in 2016 at the Hospital de La Samaritana, Bogotá, Colombia / Caracterización de gestantes con atención del parto durante 2016 en el Hospital Universitario de La Samaritana, Bogotá, Colombia

Abstract Introduction: Maternal mortality and severe maternal morbidity are serious public health problems, so it is essential to work on the identification, recognition and situation analysis of patients treated at high-risk pregnancy centers. Objectives: To characterize the pregnant women treated at the Hospital Universitario de la Samaritana (HUS), Bogotá, Colombia, from a demographic, social and clinical point of view in order to identify common factors that may be intervened and, thus, avoid adverse outcomes. Materials and methods: Cross-sectional study. 785 medical records of patients with a gestational age >24 weeks treated at the HUS in 2016 were analyzed. Sociodemographic data were collected, as well as data on the following variables: history of diseases, antenatal care, biopsychosocial risk, and obstetric outcomes. A univariate analysis was performed for each variable; measures of central tendency and dispersion and absolute and relative frequencies were calculated for quantitative and qualitative variables, respectively. Maternal health indicators were also calculated. Results: 47.51% of the pregnant women had a low educational level, 34.39% were single mothers, 32.10% had a previous comorbidity, and 5.85% had insufficient antenatal care. The proportion of preterm births was 23.6 (95%CI: 20.63%-26.69%), the severe maternal morbidity ratio was 157.96/1 000 live births, and the maternal mortality rate was 246/100 000 live births. Conclusions: Pregnant women treated at the HUS are mainly young women from areas where the health system is not easily accessible, and who have insufficient antenatal care and a low schooling level. This population has a high rate of severe maternal morbidity and maternal mortality compared to the national reference value, so they would benefit from educational interventions or risk approaches that prioritize these factors in order to prevent adverse maternal outcomes.

Resumen Introducción. La mortalidad materna y la morbilidad materna extrema son serios problema de salud pública, por lo que es fundamental trabajar en la identificación, reconocimiento y análisis situacional de las pacientes que acuden a los centros de alto riesgo obstétrico. Objetivos. Caracterizar las gestantes atendidas en el Hospital Universitario de la Samaritana (HUS), Bogotá, Colombia, desde el punto de vista demográfico, social y clínico con el fin de identificar factores en común potencialmente intervenibles y, de esta forma, evitar desenlaces adversos. Materiales y métodos. Estudio transversal. Se analizaron 785 historias clínicas de pacientes con edad gestacional >24 semanas atendidas durante 2016 en el HUS. Se recolectaron datos sociodemográficos y sobre las siguientes variables: antecedentes patológicos, controles prenatales, riesgo biopsicosocial y desenlaces obstétricos. Se realizó análisis univariado de cada variable: para las variables cuantitativas se calcularon medidas de tendencia central y de dispersión, mientras que para las cualitativas, frecuencias absolutas y relativas. También se calcularon indicadores de salud materna. Resultados. 47.51% de las gestantes tenían un bajo nivel educativo, 34.39% eran madres solteras, 32.10% tenían comorbilidad previa y 5.85% no asistieron a ningún control prenatal. La proporción de parto pre-término fue de 23.6 (IC95%:20.63%-26.69%), la razón de morbilidad materna extrema fue 157.96/1 000 nacidos vivos y la tasa de mortalidad materna, 246/100 000 nacidos vivos. Conclusiones. Las gestantes atendidas en el HUS son predominantemente mujeres jóvenes, provenientes de áreas con difícil acceso al sistema de salud, con insuficiente atención prenatal y con bajo nivel educativo. Esta población presenta una alta razón de morbilidad materna extrema y mortalidad materna comparada con el valor de referencia nacional y se beneficiaría de intervenciones educativas o enfoques de riesgo que prioricen estos factores con el fin de prevenir desenlaces maternos adversos.

Comparison of the Effect of Nifedipine Alone and the Combination of Nifedipine and Sildenafil in Delaying Preterm Labor: A Randomized Clinical Trial.

Objective: Recently, sildenafil as a drug effective in relaxing smooth muscles can be used as an adjunct to delay the onset of uterine contractions and therefore the occurrence of preterm labor. The aim of this study was to evaluate the effect of nifedipine combination with sildenafil on preterm delivery compared with nifedipine alone. Materials and methods: This randomized double-blinded clinical trial was performed on pregnant women with a gestational age of 26-34 weeks with singleton pregnancy and symptoms of preterm delivery. The mothers were randomly assigned into two groups receiving nifedipine plus sildenafil or those receiving nifedipine alone. The time of delivery, maternal and neonatal complications were compared between the two groups. Results: Mothers who received the combination therapy experienced significantly lower preterm delivery within 72 hours of intervention compared to nifedipine alone (4.5% versus 27.3%, p = 0.002). The rate of delivery during the first 7 days after discharge was 7.6% and 31.8% in nifedipine plus sildenafil and nifedipine alone, respectively (P = 0.001). The prevalence of neonatal respiratory distress syndrome (RDS) as well as mean birth weight was higher in the nifedipine group alone. Treatment protocol with nifedipine and sildenafil compared with nifedipine alone was associated with a significant increase in preterm delivery delay (beta =-5.819, p = 0.001). Conclusion: The use of sildenafil in addition to nifedipine causes more delay in delivery in cases of preterm labor, followed by lower risk for RDS, reduces neonatal intensive care unit (NICU) admission, and preserves neonatal birth weight.

Effects of nonpharmacological interventions on the psychological health of high-risk pregnant women: a systematic review and meta-analysis.

Purpose: This study aimed to summarize the current evidence on the effects of nonpharmacological interventions on psychological health outcomes for women with high-risk pregnancies due to conditions such as preeclampsia, gestational diabetes, or preterm labor. Methods: The following databases were searched from January 2000 to December 2020: PubMed, Ovid Embase, CINAHL, Web of Science, DBpia, RISS, and KISS. Two investigators independently reviewed and selected articles according to the inclusion/exclusion criteria. RoB 2 and the ROBINS-I checklist were used to evaluate study quality. Results: Twenty-nine studies with a combined total of 1,806 pregnant women were included in the systematic review and meta-analysis. Psychological health improvements were found in women with preeclampsia (Hedges' g=-0.67; 95% confidence interval [CI], -0.91 to -0.44), gestational diabetes (Hedges' g=-0.38; 95% CI, -0.54 to -0.12), and preterm labor (Hedges' g=-0.73; 95% CI, -1.00 to -0.46). The funnel plot was slightly asymmetrical, but the fail-safe N value and the trim-and-fill method showed no publication bias. Conclusion: Nonpharmacological interventions for women with high-risk pregnancies due to conditions such as preeclampsia, gestational diabetes, and preterm labor can improve psychological parameters such as anxiety, stress, and depression. Nurses can play a pivotal role in the nursing management of pregnant women with high-risk conditions and apply various types of nonpharmacological interventions to meet their needs in uncertain and anxious times during pregnancy.

Experiences of hospitalization among pregnant women with preterm labor in Korea: a phenomenological study.

Purpose: The purpose of this study was to describe pregnant women's lived experiences of hospitalization due to preterm labor in Korea. Methods: This qualitative study adopted a phenomenological approach. Individual in-depth interviews were conducted with nine participants, over the age of 20 years, who had been hospitalized for more than 1 week after being diagnosed with preterm labor. All interviews were audio-taped and verbatim transcripts were made for analysis. The data were analyzed following Colaizzi's phenomenological method. Results: The participants' ages ranged from 26 to 36 years, and all were married women. They were hospitalized for 13.1 days on average. Five thematic clusters emerged from the analysis. 'Withstanding hospitalization for the fetus's well-being' describes women's feelings during preterm labor and their endurance during their prolonged hospitalization, rooted in their conviction that the fetus comes first. 'Endless frustration in the hospital' encompasses women's emotions while lying in bed and quietly thinking to themselves. 'Unmet physiological needs' describes participants' awareness of their inability to independently handle human physiological needs given the need for careful and limited movement. 'Gratitude for the support around oneself' reflects the support from family and medical staff. 'Shifting perceptions and accepting one's circumstances' describes accepting hospitalization and making efforts to spend their remaining time in the hospital in a meaningful way. Conclusion: The findings in this study provide a deeper understanding and insights into the experiences of Korean women with preterm labor during hospitalization, underscoring the need to develop interventions for these patients.

Ruptura uterina em primípara: relato de caso / Uterine rupture in primiparous: case report

Introdução: A ruptura uterina é uma complicação grave, devido ao risco de morte materna e perinatal. Em países desenvolvidos, essa complicação obstétrica afeta 3,5/1.000 mulheres com cesárea anterior e 6/10.000 grávidas sem antecedentes da operação, sendo a incisão cesariana prévia a etiologia principal. Relato de Caso: Gestante, 38 anos, G1P0A0, com idade gestacional de 35 semanas e 5 dias, deu entrada na maternidade em trabalho de parto prematuro. Ao exame físico apresentando 3 metrossístoles em 10min/30" 30" 35", colo uterino amolecido e fino, com dilatação de 3 cm, exame especular com presença de líquido amniótico claro, bolsa rota há 6 horas e pequeno sangramento há 20 minutos. Foi indicado parto cesáreo devido ao histórico de luxação de quadril. O diagnóstico de ruptura uterina foi realizado durante o parto operatório, com visualização de partes fetais. O caso teve evolução benigna para a m ãe e o recém-nascido, sem a ocorrência de complicações ou sequelas, ambos tiveram alta hospitalar em perfeitas condições de saúde. Discussão: Configurou-se uma ruptura uterina completa espontânea no terceiro trimestre gestacional, sem quaisquer fatores de risco subjacentes identificáveis, exceto pela idade materna avançada (maior que 35 anos). Conclusão: Este relato contribui para um número limitado de ocorrências descritas que envolvem ruptura espontânea de um útero sem cicatriz prévia em uma paciente primigesta.

Introduction: Uterine rupture is a serious complication, due to the risk of maternal and perinatal death. In developed countries, this obstetric complication affects 3.5/1,000 women with previous cesarean section and 6/10,000 pregnant women with no story of the operation, with the previous cesarean section being the main etiology. Case Report: Pregnant woman, 38 years old, G1P0A0, with a gestational age of 35 weeks and 5 days, was admitted to the maternity ward in premature labor. At the physical examination reinforced 3 metrosystoles in 10min/30" 30" 35", soft and thin cervix, with 3cm dilation, specular examination with the presence of clear liquid with lumps, broken bag for 6 hours and minor bleeding for 20 minutes. Cesarean delivery is indicated due to a story of hip dislocation. The diagnosis of uterine rupture was performed during operative delivery, with visualization of fetal parts. The case had a benign evolution for the mother and the newborn, without the occurrence of complications or sequelae, both were discharged from hospital in perfect health conditions. Discussion: A complete spontaneous uterine rupture occurred in the third trimester of pregnancy, without any identifiable underlying risk factors, except for advanced maternal age (over 35 years). Conclusion: This report contributes to a limited number of previous events that involve spontaneous rupture of a uterus without previous scarring in a primigravid patient.

[Visualization of unstructured personal narratives of perterm birth using text network analysis]. / í ìŠ¤íŠ¸ 네트워크 분석을 이용한 조산 경험 이야기의 시각화.

Purpose: This study aimed to identify the components of preterm birth (PTB) through women's personal narratives and to visualize clinical symptom expressions (CSEs). Methods: The participants were 11 women who gave birth before 37 weeks of gestational age. Personal narratives were collected by interactive unstructured storytelling via individual interviews, from August 8 to December 4, 2019 after receiving approval of the Institutional Review Board. The textual data were converted to PDF and analyzed using the MAXQDA program (VERBI Software). Results: The participants' mean age was 34.6 (±2.98) years, and five participants had a spontaneous vaginal birth. The following nine components of PTB were identified: obstetric condition, emotional condition, physical condition, medical condition, hospital environment, life-related stress, pregnancy-related stress, spousal support, and informational support. The top three codes were preterm labor, personal characteristics, and premature rupture of membrane, and the codes found for more than half of the participants were short cervix, fear of PTB, concern about fetal well-being, sleep difficulty, insufficient spousal and informational support, and physical difficulties. The top six CSEs were stress, hydramnios, false labor, concern about fetal wellbeing, true labor pain, and uterine contraction. "Stress" was ranked first in terms of frequency and "uterine contraction" had individual attributes. Conclusion: The text network analysis of narratives from women who gave birth preterm yielded nine PTB components and six CSEs. These nine components should be included for developing a reliable and valid scale for PTB risk and stress. The CSEs can be applied for assessing preterm labor, as well as considered as strategies for students in women's health nursing practicum.

Factores pronóstico asociados a parto prematuro en mujeres a quienes se les practicó apendicectomía durante el embarazo en un país de medianos ingresos / Prognosis factors associated with premature delivery in women undergoing appendectomy during pregnancy in a middle-income country

Introducción. El objetivo del estudio fue estimar los factores pronóstico asociados con el parto prematuro y otros resultados clínicos en mujeres embarazadas sometidas a apendicectomía en Colombia.Métodos. Se llevó a cabo un estudio retrospectivo de cohorte a partir de las bases de datos administrativos, que incluyó mujeres embarazadas afiliadas al sistema de salud contributivo en Colombia y sometidas a apendicectomía, entre enero de 2013 y noviembre de 2016. Se estimaron la tasa de parto prematuro, la tasa de mortalidad a los 30 días, el ingreso materno a la unidad de cuidados intensivos a 30 días, el reingreso de la madre a los 30 días y el bajo peso al nacer. Se utilizaron regresiones logísticas multivariadas para identificar estos tres factores pronóstico. Resultados. Se incluyeron 1.589 mujeres en el estudio. La edad media fue de 26,43 ± 5,79 años, el 17,94 % de las apendicectomías se practicaron en el tercer trimestre, el 6,10 % fueron apendicectomías laparoscópicas y el 22,03 % requirió drenaje por peritonitis. Las tasas de parto prematuro, mortalidad a 30 días, ingreso a la unidad de cuidados intensivos a 30 días, reingreso a los 30 días y bajo peso al nacer, fueron 12,08 %, 0,13 %, 9,75 %, 16,93 % y 3,34 %, respectivamente. La edad menor de 18 años, la apendicectomía en el tercer trimestre y el drenaje por peritonitis se asociaron con un mayor riesgo de parto prematuro. El índice de comorbilidad de Charlson, la apendicectomía en el tercer trimestre y el drenaje por peritonitis, se asociaron con un mayor ingreso materno a la unidad de cuidados intensivos.Conclusiones. La apendicectomía en el tercer trimestre y la apendicitis complicada, son factores pronóstico asociados a parto prematuro en mujeres colombianas embarazadas sometidas a apendicectomía

Introduction: The objective of the study was to estimate the prognostic factors associated with premature delivery and other clinical outcomes in pregnant women undergoing appendectomy in Colombia.Methods: A retrospective cohort study was conducted from the administrative healthcare records, which inclu-ded pregnant women affiliated with the contributory health system in Colombia and undergoing appendectomy, between January 2013 and November 2016. The birth rate was estimated, premature delivery rate, the 30-day mortality rate, 30-day maternal admission to Intensive Care Unit (30-ICU), 30-day readmission (30-R-Adm), and low birth weight (LBW). Multivariate logistic regressions were used to identify these three prognostic factors.Results: 1589 women were included in the study. Mean age was 26.43 ± 5.79, 17.94% of the appendectomies were performed in the third trimester, 6.10% were laparoscopic appendectomies and 22% required peritonitis drainage. The Rates of premature delivery, 30-day mortality, 30-ICU, 30-R-Adm and LBW were 12%, 0.13%, 9.75%, 16.93% and 3.34%, respectively. Age under 18 years, appendectomy in the third trimester and peritonitis drainage were associated with an increased risk of premature delivery. Comorbidity Charlson Index, appendectomy in the third trimester and peritonitis drainage were associated with an increased maternal admission to ICU.Conclusions: Appendectomy in the third trimester and complicated appendicitis are prognostic factors associated with premature delivery in Colombian pregnant women undergoing to appendectomy

Riesgos maternos asociados a la prematuridad / Maternal risks associated with prematurity / Riscos maternos associados à prematuridade

RESUMEN Introducción: se realizó una revisión bibliográfica sobre los riesgos maternos asociados a la prematuridad en el servicio de Neonatología del Hospital General Provincial Carlos M. de Céspedes, en Bayamo, Granma, en el periodo comprendido de los años 2016 al 2018. Objetivo: determinar los factores maternos de riesgo de neonatos prematuros que tuvieron un parto antes de las 37 semanas. Método: se utilizaron libros de texto específicos de Medicina y se realizó la recopilación de artículos de Internet a través de buscadores como el Servicio de la Editorial Elsevier, Secretaría de Ciencia y Técnica de la Nación, LILACS, MEDLINE con la asistencia del buscador específico PUBMED, IMBIOMED, La Biblioteca Cochrane, SciELO. Resultados: analizar si factores maternos como: edad materna, paridad, nivel de escolaridad, nivel socioeconómico hábitos tóxicos y enfermedades maternas, infecciones genitourinarias, embarazos múltiples, abortos previos, ruptura prematura de membranas y placenta previa, así como el hábito de fumar están relacionadas con la prematuridad, como las causas principales de prematuridad. Conclusiones: los hijos de madres con hábitos tóxicos, el embarazo en la adolescencia, las enfermedades maternas asociadas al embarazo (anemia, hipertensión arterial, infección cervicovaginal), embarazos múltiples, abortos previos e infección del tracto urinario, tienen más probabilidades del nacimiento antes del término de la gestación; y constituyeron factores maternos de riesgo de nacimientos prematuros.

ABSTRACT Introduction: a bibliographic review was carried out on the maternal risks associated with prematurity in the Neonatology service of the Carlos M. de Céspedes Provincial General Hospital, in Bayamo, Granma, in the period from 2016 to 2018. Objective: to determine the maternal risk factors of premature infants who had a delivery before 37 weeks. Method: Medicine-specific textbooks were used and Internet articles were compiled through search engines such as the Elsevier Publishing Service, the National Secretariat of Science and Technology, LILACS, MEDLINE with the assistance of the specific PUBMED search engine, IMBIOMED, ​​The Cochrane Library, SciELO. Results: analyze whether maternal factors such as: maternal age, parity, educational level, socioeconomic level toxic habits and maternal diseases, genitourinary infections, multiple pregnancies, previous abortions, premature rupture of membranes and placenta previa, as well as smoking are related with prematurity, as the main causes of prematurity. Conclusions: children of mothers with toxic habits, teenage pregnancy, maternal diseases associated with pregnancy (anemia, high blood pressure, cervicovaginal infection), multiple pregnancies, previous abortions and urinary tract infection, are more likely to be born before birth term of pregnancy; and constituted maternal risk factors for premature births.

RESUMO Introdução: foi realizada uma revisão bibliográfica sobre os riscos maternos associados à prematuridade no serviço de Neonatologia do Hospital Geral Provincial Carlos M. de Céspedes, em Bayamo, Granma, no período de 2016 a 2018. Objetivo: determinar os fatores de risco maternos de prematuros. que tiveram um parto antes de 37 semanas. Método: foram utilizados livros didáticos específicos para medicina e artigos da Internet foram compilados por meio de mecanismos de pesquisa, como o Elsevier Publishing Service, Secretaria Nacional de Ciência e Tecnologia, LILACS, MEDLINE, com a assistência do mecanismo de pesquisa PUBMED específico , IMBIOMED, ​​Biblioteca Cochrane, SciELO. Resultados: analisar se fatores relacionados à idade materna, paridade, escolaridade, nível socioeconômico de hábitos tóxicos e doenças maternas, infecções genito-urinárias, gestações múltiplas, abortos anteriores, ruptura prematura de membranas e placenta prévia e tabagismo estão relacionados prematuridade, como as principais causas da prematuridade. Conclusões: filhos de mães com hábitos tóxicos, gravidez na adolescência, doenças maternas associadas à gravidez (anemia, pressão alta, infecção cervicovaginal), gestações múltiplas, abortos anteriores e infecção do trato urinário têm maior probabilidade de nascer antes do nascimento. termo da gravidez; e constituiu fatores de risco materno para partos prematuros.

Geographical differences in preterm delivery rates in Sweden: A population-based cohort study.

INTRODUCTION: Preterm delivery is a major global public health challenge. The objective of this study was to determine how preterm delivery rates differ in a country with a very high human development index and to explore rural vs urban environmental and socioeconomic factors that may be responsible for this variation. MATERIAL AND METHODS: A population-based study was performed using data from the Swedish Medical Birth Register from 1998 to 2013. Sweden was chosen as a model because of its validated, routinely collected data and availability of individual social data. The total population comprised 1 335 802 singleton births. A multiple linear regression was used to adjust gestational age for known risk factors (maternal smoking, ethnicity, maternal education, maternal age, height, fetal sex, maternal diabetes, maternal hypertension, and parity). A second and a third model were subsequently fitted allowing separate intercepts for each municipality (as fixed or random effects). Adjusted gestational ages were converted to preterm delivery rates and mapped onto maternal residential municipalities. Additionally, the effects of six rural vs urban environmental and socioeconomic factors on gestational age were tested using a simple weighted linear regression. RESULTS: The study population preterm delivery rate was 4.12%. Marked differences from the overall preterm delivery rate were observed (rate estimates ranged from 1.73% to 6.31%). The statistical significance of this heterogeneity across municipalities was confirmed by a chi-squared test (P < 0.001). Around 20% of the gestational age variance explained by the full model (after adjustment for known variables described above) could be attributed to municipality-level effects. In addition, gestational age was found to be longer in areas with a higher fraction of built-upon land and other urban features. CONCLUSIONS: After adjusting for known risk factors, large geographical differences in rates of preterm delivery remain. Additional analyses to look at the effect of environmental and socioeconomic factors on gestational age found an increased gestational age in urban areas. Future research strategies could focus on investigating the urbanity effect to try to explain preterm delivery variation across countries with a very high human development index.

Leiomyomatous uterus and preterm birth: an exposed/unexposed monocentric cohort study.

BACKGROUND: The risk of preterm birth may increase in the presence of uterine leiomyomas during pregnancy. Whether myomectomy abrogates this risk has never been studied. OBJECTIVE: Our aim was to evaluate the association between the presence of uterine leiomyomas during pregnancy and preterm birth and, if an association exists, to evaluate its persistence in case of a history of myomectomy. STUDY DESIGN: This exposed/unexposed monocentric retrospective cohort study included all women with singleton pregnancies delivering >22 weeks in a tertiary university hospital maternity unit from January 2011 through September 2015. Women with a leiomyomatous uterus were compared to women with no myomas. Women in the leiomyomatous uterus group were women with uterine leiomyoma(s) during pregnancy (≥1 leiomyoma, measuring ≥20 mm or multiple leiomyomas whatever the size) seen on at least 1 obstetric ultrasound without history of myomectomy, or women with a history of myomectomy (removal of ≥1 leiomyoma, measuring ≥20 mm or multiple leiomyomas whatever the size) by hysteroscopy, laparoscopy, or laparotomy with or without persistent leiomyomas. The association between leiomyomatous uterus and preterm birth was assessed through univariate and multivariable logistic regression. RESULTS: Among the 19,866 women in the cohort, 301 (1.5%) had a leiomyomatous uterus (154 unoperated women and 147 operated women). The rate of premature delivery was 12.0% in the leiomyomatous uterus group and 8.4% in the nonleiomyomatous uterus group. After adjusting for the risk factors for preterm birth, leiomyomatous uterus was significantly associated with preterm birth (adjusted odds ratio, 2.5; 95% confidence interval, 1.7-3.7). This association was significant for unoperated women (adjusted odds ratio, 2.7; 95% confidence interval, 1.6-4.6) as well as operated women (adjusted odds ratio, 2.3; 95% confidence interval, 1.3-3.9) when compared to the nonleiomyomatous uterus group. CONCLUSION: Uterine leiomyomas are associated with preterm birth and this association persists after myomectomy.

Cystatin C as a novel predictor of preterm labor in severe preeclampsia.

BACKGROUND: The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes. METHODS: Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes. RESULTS: Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity. CONCLUSION: GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Risk Factors for Premature Birth among Premature Obstetric Labor Women: A Prospective Cohort Study.

PURPOSE: To identify risk factors for premature birth among premature obstetric labor women. METHODS: Participants were 129 hospitalized women who were diagnosed with potential premature obstetric labor with 20 weeks to 37 weeks of gestation. Data were analyzed using descriptive statistics, χ2 test, t-test, and binary logistic regression. RESULTS: Of 129 women, 78(60.5%) gave premature birth and 51 (39.5%) gave full-term birth. Risk factors for premature birth were education level (≤bachelor's degree), abnormal bowel condition (constipation or diarrhea), time firstly diagnosed with a premature obstetric labor (below 28 weeks of pregnancy), and multiple pregnancy. There were also increased risks of premature birth for participants with high level of anxiety and high level of prenatal stress. In social support, there was an increased risk of premature birth for participants with low level of social support. CONCLUSION: Prenatal nursing programs should consider not only psychosocial factors such as anxiety, prenatal stress, and social support, but also some general and obstetric factors such as education level, abnormal bowel condition, time firstly diagnosed with a premature obstetric labor, and multiple pregnancy to increase maternal and child health.

Risk Factors for Premature Birth among Premature Obstetric Labor Women: A Prospective Cohort Study

PURPOSE: To identify risk factors for premature birth among premature obstetric labor women. METHODS: Participants were 129 hospitalized women who were diagnosed with potential premature obstetric labor with 20 weeks to 37 weeks of gestation. Data were analyzed using descriptive statistics, χ2 test, t-test, and binary logistic regression. RESULTS: Of 129 women, 78(60.5%) gave premature birth and 51 (39.5%) gave full-term birth. Risk factors for premature birth were education level (≤bachelor's degree), abnormal bowel condition (constipation or diarrhea), time firstly diagnosed with a premature obstetric labor (below 28 weeks of pregnancy), and multiple pregnancy. There were also increased risks of premature birth for participants with high level of anxiety and high level of prenatal stress. In social support, there was an increased risk of premature birth for participants with low level of social support. CONCLUSION: Prenatal nursing programs should consider not only psychosocial factors such as anxiety, prenatal stress, and social support, but also some general and obstetric factors such as education level, abnormal bowel condition, time firstly diagnosed with a premature obstetric labor, and multiple pregnancy to increase maternal and child health.

Cystatin C as a novel predictor of preterm labor in severe preeclampsia

BACKGROUND: The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes. METHODS: Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes. RESULTS: Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity. CONCLUSION: GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Maternal-Fetal Medicine physicians' practice patterns for 22-week delivery management.

OBJECTIVE: To describe Maternal-Fetal Medicine (MFM) physicians' practice patterns for 22-week delivery management. MEHODS: Surveyed 750 randomly-sampled members of the Society of Maternal-Fetal Medicine, querying MFMs' practices and policies guiding 22-week delivery management. RESULTS: Three hundred and twenty-five (43%) MFMs responded. Nearly all (87%) would offer induction. Twenty-eight percent would order steroids, and 12% would perform cesarean for a patient desiring resuscitation. Offering induction differed significantly based on the provider's practice setting, region, religious service attendance and political affiliation. In multivariable analyses, political affiliation remained a significant predictor of offering induction (p = 0.03). CONCLUSIONS: Most MFMs offer induction for PPROM at 22 weeks. A noteworthy proportion is willing to order steroids and perform cesarean. Personal beliefs and practice characteristics may contribute to these decisions. While little is known about the efficacy of these interventions at 22 weeks, some MFMs will offer obstetrical intervention if resuscitation is intended.

La edad materna avanzada como elemento favorecedor de complicaciones obstétricas y del nacimiento / Advanced maternal age as a conducive element in obstetric complications and birth

Introducción: el aumento actual del embarazo en mujeres añosas provoca un riesgo superior para la mujer y su feto. Objetivo: evaluar la edad materna avanzada como factor de complicaciones obstétricas y del nacimiento. Material y método: se efectuó una investigación observacional, retrospectiva, transversal y analítica en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río entre 2012 y 2013. El universo de estudio fueron la totalidad de gestantes que ingresaron en el período estudiado. La muestra se formó con gestantes añosas (grupo estudio 360 pacientes) y un grupo control (720 pacientes) con embarazadas entre 25 y 30 años; ambos se escogieron por muestreo intencionado. Se resumieron las variables cualitativas mediante frecuencias absolutas y relativas porcentuales. Se utilizaron las pruebas de ji cuadrado, Odd Ratio. El intervalo de confianza para el Odd Ratio al 95%. Resultados: hubo un predominio de la embarazada con partos anteriores (92.8%), la normopeso (68.9%), el 34.4% padecían alguna enfermedad crónica, siendo la principal la hipertensión arterial; la anemia durante el embarazo estuvo presente en el 34.4%, el 88.3% parieron a término, de modo espontáneo; además preponderó la cesárea con un (52.2%). La morbilidad intraparto se manifestó en el 13.1%, mientras la puerperal en el 26.7%. Hubo una elevada asociación del embarazo prolongado con la enfermedad hipertensiva, el oligoamnios y la anemia (p < 0,001), también con la inducción del parto (p < 0,001) y la cesárea (p < 0,001), así como con la morbilidad puerperal (p < 0,001). Conclusiones: la edad materna avanzada es un factor de riesgo a tener en cuenta durante el proceso de la gestación y el nacimiento.

Introduction: the current increase in age for pregnant women provokes a higher risk for both woman and fetus. Objective: to evaluate the advanced maternal age as a risk factor for obstetric complications and birth. Methods: an observational, retrospective, cross sectional and analytical research was conducted at Abel Santamaria Cuadrado University Hospital in Pinar del Rio between 2012 and 2013. The study group was comprised of the total of pregnant women admitted during this period. The sample included pregnant women with advanced maternal-aged (360 patients the study group) and the control group (720 the control group), and ages between 25 and 30 years; both were chosen by intentional sampling. Qualitative variables were summarized by absolute and relative percentage frequencies. Chi-square tests, Odd Ratio and the confidence interval for OR 95% were used. Results: There was a predominance of pregnant women with previous deliveries (92.8%), normal weight (68.9%), 34.4% of them suffered from any chronic disease, hypertension was the most important; anemia during pregnancy was present in 34.4%, out of them 88.3% delivered at term spontaneously; with a prevalence of cesarean sections (52.2%). Intrapartum morbidity appeared in 13.1%, while in postpartum was 26.7%. There was a strong association between pregnancy and hypertension, oligoamnios and anemia (p <0.001), labor induction (p <0.001) and cesarean section (p <0.001), as well as puerperal morbidity (p <0.001). Conclusions: advanced maternal age is a risk factor to be considered during pregnancy and birth.

Fratura de mandíbula em paciente pediátrico no momento do parto: relato de caso / Mandibular fracture in a pediatric patient at the time of delivery: a case report

Dentro do grupo dos pacientes pediátricos, as fraturas de ossos faciais no recém-nascido são pouco relatadas na literatura. É um acontecimento raro, quando ocorre no momento do parto. A mandíbula é o osso da face mais envolvido, sendo sua incidência aumentada com o passar da idade. O presente artigo relata um caso de fratura de mandíbula ocorrida no momento de um parto prematuro, tratada de forma conservadora, com acompanhamento pós-operatório de 5 anos.

Within the group of pediatric patients, facial bone fractures in the newborn are rarely reported in the literature. They are of rare occurrence at the time of delivery. The mandible is the facial bone most involved in fractures, the incidence of which tends to increase with age. This article reports a case of mandibular fracture that occurred at the time of premature obstetric labor, which was treated conservatively and followed up for 5 years.