Article

The epidemiology of preterm labour--why have advances not equated to reduced incidence?

Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Faculty of Medicine, Imperial College London, London, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.76). 01/2007; 113 Suppl 3:1-3. DOI: 10.1111/j.1471-0528.2006.01116.x
Source: PubMed

ABSTRACT The major burden of preterm birth is in the developing world, where most of the increasing death and morbidity is secondary to infectious diseases such as malaria, HIV, tuberculosis, bacterial vaginosis and intestinal parasites. In some developing countries, the growth of medical care has outstripped the growth of preventive public health, with an associated increase in iatrogenic preterm births. In developed countries, more than one-third of preterm births are medically indicated because of conditions such as fulminating pre-eclampsia or severe intrauterine growth restriction. Neither of these conditions is currently preventable. One in five preterm births is associated with multiple pregnancy, and these have been greatly increased by assisted reproduction techniques. The use of tocolytics has proved disappointing perhaps because inflammation rather than spontaneous uterine activity is increasingly recognised as the final common pathway. Inappropriate antibiotics used late in pregnancy are ineffective and may have adverse effects. Currently, the most promising interventions are public health related and include reducing the transmission of communicable diseases, improvements in the management of diabetes and reduction in harmful behaviours such as smoking and drug abuse.

0 Bookmarks
 · 
60 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to identify rates, associated morbidities, and preventable causes of late preterm birth (LPB) in a defined population. We conducted a retrospective cross-sectional analysis using deidentified delivery data for all who delivered in San Antonio/Bexar County, Texas between 2000 and 2008 (N  = 259,576). LPB was defined as a live birth from 34(0/7) to 36(6/7) weeks. Variables analyzed included age, race/ethnicity, weight gain, hypertensive disease, diabetes, and preterm labor including premature rupture of membranes. From 2000 to 2006, the LPB rate in San Antonio/Bexar County, Texas, was slightly higher than the national average, 9% versus 8.7% (P  < 0.01). From 2000 to 2008, 23,312 LPBs occurred in San Antonio/Bexar County and 53% experienced at least one studied comorbidity. Using logistic regression comparing LPB to term, variables associated with an increased risk of LPB were black race, age < 17, age ≥ 35, gestational hypertension, eclampsia, chronic hypertension, and diabetes. LPB was higher than the national average in our population, and preventable causes of LPB (extremes of age, hypertensive disease, and diabetes) were commonly associated with LPB. We speculate that teenage pregnancy prevention, counseling regarding risks associated with advanced maternal age, and improved management and prevention of hypertensive disease and diabetes should prove beneficial in decreasing the LPB rate.
    American Journal of Perinatology 06/2011; 28(9):703-7. · 1.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical proteomics has been applied to the identification of biomarkers of obstetric and neonatal disease. We will discuss a number of encouraging studies that have led to potentially valid biomarkers in the context of Down's syndrome, preterm birth, amniotic infections, preeclampsia, intrauterine growth restriction and obstructive uropathies. Obtaining noninvasive biomarkers (e.g., from the maternal circulation, urine or cervicovaginal fluid) may be more feasible for obstetric diseases than for diseases of the fetus, for which invasive methods are required (e.g., amniotic fluid, fetal urine). However, studies providing validated proteomics-identified biomarkers are limited. Efforts should be made to save well-characterized samples of these invasive body fluids so that many valid biomarkers of pregnancy-related diseases will be identified in the coming years using proteomics based analysis upon adoption of 'clinical proteomics guidelines'.
    Expert Review of Proteomics 01/2014; · 3.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Our objective was to assess the effectiveness, safety and efficiency of a protocol combining fetal fibronectin diagnostic testing and atosiban tocolysis for the management of pre-term labour, using a combination of narrative review and economic modelling. We compared the proposed protocol to alternatives using nifedipine with or without fetal fibronectin. We have found that the proposed protocol may be safer and more acceptable by women than the alternatives, and its use can result in significant cost-savings.
    Journal of Obstetrics and Gynaecology 09/2009; 29(6):507-11. · 0.55 Impact Factor

Full-text

View
0 Downloads