Is an episode of suspected preterm labor that subsequently leads to a term delivery benign?

Asymptomatic short cervix and threatened preterm labor: A comparative study on perinatal outcomes

OBJECTIVE

To determine the rate of delivery within 15 days of admission among patients with an asymptomatic short cervix (ASC) compared to those admitted for threatened preterm labor (TPL).

MATERIAL AND METHODS

This retrospective study conducted in a tertiary maternity hospital, included patients with a singleton pregnancy admitted with a cervical length of less than 25 mm between 24 and 34 weeks. The population was divided into two groups, patients with ASC (i.e., with no contractions at admission) and patients with TPL. The primary outcome was the delivery rate within 15 days of admission. Secondary outcomes included gestational age at delivery, preterm delivery rate before 37°/7 weeks and before 34°/7 weeks, admission to delivery interval, 5 min Apgar score and transfer to neonatal intensive care unit rate. The characteristics of the two groups and the primary and secondary outcomes were compared between the two groups using univariate analysis. Two subgroup analysis were performed, one restricted to patients with a mildly modified CL (15 ≤ CL < 25 mm), and one excluding patients at high risk of preterm birth.

RESULTS

Among the 247 included patients, 136 (55.1 %) had TPL, and 111 (44.9 %) ASC. There were no significant differences in the rate of patient who delivered within 15 days of admission between the groups, 13.2 % in the TPL group vs 8.0 % in the ASC group (p = 0.22). Patients in the TPL group had a significantly higher frequency of delivery before 34 weeks compared to those in the ASC group (19.9 % versus 9.0 %, p = 0.02 This finding persisted in the subgroup analysis excluding patients at high risk of preterm birth (16.5 % in the TPL subgroup vs. 6.9 % in the ASC subgroup, p = 0.04). There were no significant differences in the rates of preterm delivery before 37 weeks, the admission-to-delivery interval, or neonatal outcomes between the two groups or within the subgroup analyses.

CONCLUSION

The frequency of delivery within 15 days of admission was not statistically different between patients with an asymptomatic short cervix and those with TPL. Nevertheless, these asymptomatic patients delivered significantly later and less frequently before 34 weeks, with only one in ten requiring corticosteroids.

Understanding the course of attention deficit hyperactivity disorder in children born after a threatened preterm labor: a 6-year cohort study

BACKGROUND

Recent research suggests that children born after suspected preterm labor may observe a potential cluster with different attention deficit hyperactivity disorder features, depending on the time of birth. However, the evolution of symptoms and their predictors remain unknown in this population.

OBJECTIVE

This study aimed to examine the trajectories of attention deficit hyperactivity disorder symptoms of children born after suspected preterm labor, between ages 2 and 6 years, considering prematurity condition and comparing with controls. In addition, this study aimed to find potential modifiable predictors of evolution to enhance prognosis.

STUDY DESIGN

In this prospective cohort study, 119 mother-child pairs who experienced suspected preterm labor and 60 controls were included. Patients were divided according to prematurity condition in full term (n=27), late preterm (n=55), and very preterm (n=37). Attention deficit hyperactivity disorder symptoms were assessed at ages 2 and 6 years. The association between potential modifying factors (group, time of assessment, sex, birthweight percentile, maternal history of trauma, maternal anxiety at diagnosis, and maternal anxiety during the children's assessments) and disorder trajectories was assessed by adjusting the Bayesian mixed linear models. All analyses were performed in R (version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

An interaction emerged between time and group, with late-preterm neonates born after suspected preterm labor being the only group to improve from ages 2 to 6 years (-2.26 points in Conners scale per percentile decrease and 0.98 probability of effect). Another interaction between time and maternal anxiety at postnatal time assessments intensified over time (0.07 and 0.84). Predictors of symptom severity included lower weight percentile at birth (-0.2 and 0.96), male sex (-2.99 and <0.99), higher maternal anxiety at diagnosis (+0.08 and 0.99), and maternal history of trauma (+0.23 and 0.98).

CONCLUSION

Unlike very-preterm and full-term children, those born late preterm showed an improvement over time, probably because late-preterm children do not carry the sequelae derived from severe prematurity but benefit from close monitoring. As maternal psychopathology emerged as a determinant modifier of course and severity, it is crucial to develop targeted psychological interventions for pregnant individuals and reevaluate monitoring programs for their offspring, regardless of prematurity.

Impact of Suspected Preterm Labor during Pregnancy on Cardiometabolic Profile and Neurodevelopment during Childhood: A Prospective Cohort Study Protocol

Introduction: Suspected preterm labor (SPL), defined as the presence of regular and painful uterine contractions and cervical shortening, represents a prenatal insult with potential long-term consequences. However, despite recent evidence demonstrating suboptimal neurodevelopment at 2 years in this population, it remains underestimated as a significant risk factor for neurodevelopmental disorders or other chronic diseases. The aim of this study is to assess the impact of suspected preterm labor during pregnancy on cardiometabolic profile and neurodevelopment during childhood (6–8 years). Methods and analysis: Prospective cohort study including children whose mothers suffered suspected preterm labour during pregnancy and paired controls. Neurodevelopmental, cardiovascular, and metabolic assessments will be performed at 6–8 years of age. A trained psychologist will carry out the neurodevelopment assessment including intelligence, visual perception, and behavioral assessment. Body composition and physical fitness assessment will be performed by one trained pediatrician and nurse. Finally, cardiovascular evaluation, including echocardiography and blood pressure, will be performed by two pediatric cardiologists. Data regarding perinatal and postnatal characteristics, diet, lifestyle, and weekly screen time of the child will be obtained from medical history and direct interviews with families. Primary outcome measures will include body mass index and adiposity, percentage of fat mass and total and regional lean mass, bone mineral content and density, cardiorespiratory resistance, isometric muscle strength, dynamic lower body strength, systolic and diastolic blood pressure, left ventricle (LV) systolic and diastolic function, general intelligence index, visuospatial working memory span, oculomotor control test, index of emotional, and behavioral problems.

Long-term childhood outcomes for babies born at term who were exposed to antenatal corticosteroids

BACKGROUND

Antenatal corticosteroids improve neonatal outcomes when administered to infants who are at risk of preterm delivery. Many women who receive antenatal corticosteroids for threatened preterm labor proceed to deliver at term. Thus, long-term outcomes should be evaluated for term-born infants who were exposed to antenatal corticosteroids in utero.

OBJECTIVE

This study aimed to compare long-term outcomes between term-born children aged ≥5 years who were born to women who received antenatal corticosteroids for threatened preterm labor and children whose mothers were also evaluated for threatened preterm labor but did not receive antenatal corticosteroids.

STUDY DESIGN

We performed a retrospective cohort study of children born at ≥37 weeks' gestation, aged ≥5 years, and born to mothers diagnosed with threatened preterm labor during pregnancy. The primary exposure of interest was receiving antenatal corticosteroids. Among the collected childhood medical conditions, the primary outcome of interest was a diagnosis of asthma.

RESULTS

Of the 3556 term-born children aged ≥5 years, 629 (17.6%) were exposed to antenatal corticosteroids (all betamethasone), and 2927 (82.3%) were controls whose mothers were evaluated for threatened preterm birth but did not get antenatal corticosteroid injections. Women receiving antenatal corticosteroids had higher rates of maternal comorbidities (diabetes mellitus, hypertension; P≤.01). Antenatal corticosteroid-exposed children had no difference in diagnosis of asthma (12.6% vs 11.6%), attention deficit disorder, or developmental delay (P=.47, .54, and .10, respectively). Controlling for maternal and neonatal characteristics, asthma was not different between those exposed to antenatal corticosteroids and controls (odds ratio, 1.05; 95% confidence interval, 0.79-1.39). The odds of the child's weight percentile being <10% were increased for antenatal corticosteroid-exposed children born at term (odds ratio, 2.00; 95% confidence interval, 1.22-3.25).

CONCLUSION

Children born at term who were exposed to antenatal corticosteroids may have increased odds of being in a lower growth percentile than those not exposed. However, rates of diagnoses such as asthma, developmental delay, and attention deficit disorders were not different.

Are infants born after an episode of suspected preterm labor at risk of attention deficit hyperactivity disorder? A 30-month follow-up study

BACKGROUND

An episode of suspected preterm labor may be by itself a pathologic event that may alter the normal course of pregnancy and the offspring's neurodevelopment. Certainly, the association between preterm birth and neurodevelopmental disorders can only be partially explained by the immaturity of the nervous system, as evidenced by the increased risk of attention deficit hyperactivity disorder in late-preterm infants without any neurologic alteration.

OBJECTIVE

This study aimed to examine whether infants born after suspected preterm labor may be at an increased risk of developing attention deficit hyperactivity disorder. Moreover, potential obstetrical, perinatal, and psychosocial risk factors associated with attention deficit hyperactivity disorder in this population are examined.

STUDY DESIGN

A prospective cohort study of 120 mother-infant pairs was conducted from the moment the mothers received a diagnosis of suspected preterm labor until the infants' 30 months of life. Infants were divided according to the prematurity status: full-term infants born after a suspected preterm labor (n=28; born at ≥37 weeks of gestation), late-preterm infants (n=56; born between 32 and <37 weeks of gestation), very-preterm infants (n=36; born before <32 weeks of gestation). At-term infants born without obstetric complications served as a control group (n=46). Infants' attention deficit hyperactivity disorder symptoms were assessed at the age of 30 months. Furthermore, obstetrical, perinatal, and psychosocial risk factors were recorded.

RESULTS

All groups of infants born after a suspected preterm labor showed more attention deficit hyperactivity disorder symptoms at the age of 30 months than the control group. Concretely, very-preterm infants showed higher restless or impulsive behaviors, whereas full-term infants born after a suspected preterm labor and late-preterm infants showed higher emotional lability behaviors. Among potential risk factors, male sex and maternal experience of posttraumatic stress symptoms predicted the severity of attention deficit hyperactivity disorder symptoms in infants born after a suspected preterm labor.

CONCLUSION

Infants born after a suspected preterm labor had a higher risk of developing attention deficit hyperactivity disorder symptoms, including those born at term. Infants born after a suspected preterm labor showed a distinctive phenotype and shared specific risk factors suggesting that they conform an undescribed population at risk of attention deficit hyperactivity disorder.

Biomarkers for Preterm Delivery

Preterm birth occurring before the thirty-seventh gestational week complicates 4.5%-18% of pregnancies worldwide. The pathogenesis of spontaneous preterm delivery is not fully understood. Among the factors held to be responsible for its pathogenesis, the most emphasized is the inflammatory process. Studies in terms of the prediction of preterm delivery are basically divided into 3 categories: 1) Prediction in pregnant women who are asymptomatic and without risk factors, 2) Prediction in pregnant women who are asymptomatic and have risk factors, 3) Prediction in symptomatic pregnant women who have threatened preterm labour. In this chapter, the topic of biomarkers in relation to preterm delivery is discussed. The most commonly used markers in published studies are fetal fibronectin, cervical pIGFBP-1 and cervical length measurement by transvaginal ultrasound. For prediction in symptomatic pregnant women applying to the hospital with threatened preterm labour, the markers used are fetal fibronection, insulin-like growth factors (IGFs) and inflammatory markers. Preterm labour prediction with markers checked in the first and second trimesters are fetal fibronection, insulin-like growth factors (IGFs), micro RNAs, progesterone, circulating microparticles (CMPs), inflammatory markers, matrix metalloproteinases, aneuploidy syndrome screening test parameters and other hormones.

Administration of antenatal corticosteroid is associated with reduced fetal growth velocity: a longitudinal study

OBJECTIVE

To elucidate whether antenatal administration of corticosteroids in pregnancies with threatened preterm labor affects growth velocity.

METHODS

A cohort of 262 pregnancies exposed to antenatal corticosteroids longitudinally studied and delivered from 36 weeks (cases) were compared to an unexposed group of 270 women (controls).

METHODS

Fetal growth was assessed analyzing the growth velocity of head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). Growth velocity (GV) was calculated as the difference in the Z-score between the biometric measurements recorded at the time of steroids administration and at 36 week of gestation, divided by the time interval (expressed in days) between the two scans and multiplied by 100. Similarly, changes in the Pulsatility Index (PI) of uterine, umbilical (UA), middle cerebral (MCA) arteries and cerebroplacental ratio (CPR) during the same time interval were also computed.

RESULTS

Median gestational age at steroid administration (30.2 weeks vs 30.4) and follow-up ultrasound (36.4 weeks vs 36.4) were similar between cases and controls. In pregnancies exposed to antenatal corticosteroids, growth velocity in the HC (-0.61 vs. 0.12; p ≤ 0.001), AC (-0.55 vs. -0.04; p ≤ 0.001) and EFW (-0.89 vs. 0.06; p ≤ 0.001) were lower when compared to pregnancies not exposed to steroid therapy, while there was no difference in the growth velocity of FL (-0.05 vs 0.19; p = .06) or in any of the Doppler parameters explored.

CONCLUSION

In pregnancies exposed to antenatal steroid therapy, there is a significant reduction in fetal growth velocity not otherwise associated with changes in cerebroplacental Dopplers.

Antenatal corticosteroids and neurodevelopmental outcomes in late preterm births

OBJECTIVES

Antenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 34^0/7-36^6/7 weeks of gestation), when the benefits of ACS are subtle.

DESIGN

Population-based, retrospective cohort.

SETTING

Ontario, Canada, between 2006 and 2011.

PATIENTS

All live singleton infants born during the LPT period with a minimum 5-year follow-up.

INTERVENTIONS

Exposure to ACS prior to 34^0/7 weeks of gestation.

MAIN OUTCOME MEASURES

Suspected neurocognitive disorder, audiometry testing or visual testing.

RESULTS

Overall, 25 668 infants were eligible for analysis, of whom 2689 (10.5%) received ACS. Infants in the ACS group had lower mean birth weight and higher rates of birth weight <10th percentile, neonatal resuscitation and neonatal intensive care unit admission. At 5 years of age, ACS exposure was associated with an increased risk of suspected neurocognitive disorder (adjusted HR (aHR) 1.12, 95% CI 1.05 to 1.20), audiometry testing (aHR 1.20, 95% CI 1.10 to 1.31) and visual testing (aHR 1.06, 95% CI 1.01 to 1.11).

CONCLUSION

In children born during the LPT period, exposure to ACS prior to 34^0/7 weeks of gestation is associated with an increased utilisation of the healthcare system related to audiometry and visual testing and suspected neurocognitive disorders by 5 years of age.

Hospital antenatal admissions for threatened preterm labor: how long should we be "observing"?

PURPOSE

We sought to describe temporal trends in hospital admissions for threatened preterm labor (TPTL) and to examine hospital admission duration among women delivered or discharged undelivered.

METHODS

We carried out a cohort study on all TPTL admissions among pregnancies with a live singleton fetus and intact membranes between 1999 and 2015 using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. ICD-9 codes were used to identify women with TPTL. Duration of antenatal admission length of stay was calculated in days following admission to hospital until delivery ("Delivery Admission") or undelivered discharge ("Observation Admission"). Analyses included evaluating trends of birth admissions over total admissions, identifying predictors of delivery using logistic regression, and measuring risk for delivery with increasing duration of antepartum hospitalization.

RESULTS

Of 15,335,288 pregnancy admissions, 1,089,987 admissions were for TPTL, with 61.8% being 'Delivery Admissions". During the 16-year study period, overall rates of TPTL admissions declined with a rising proportion of admissions being "Delivery Admissions". "Delivery Admissions" were more common among patients who were older, non-Caucasian, obese, or who had placental abruption. "Observation Admissions" were more common among admissions for antepartum hemorrhage or antepartum spotting. Among all "Delivery Admissions" for TPTL, 89% had delivered within 2 days, 7% delivered within 3-6 days, and 5% delivered beyond 6 days.

CONCLUSION

Overall admissions for TPTL declined over the study period with increasing proportions being "Delivery Admissions". Protocols taking into consideration declining risk of preterm birth among patients undelivered after 2 days may be helpful in reducing unnecessary prolonged observation admissions.

The association between threatened preterm labour and perinatal outcomes at term: a population-based cohort study

OBJECTIVE

To estimate the association between threatened preterm labour (TPTL) and perinatal outcomes of infants born at term.

DESIGN

A population-based cohort study of perinatal outcomes following TPTL <37 weeks of gestation with delivery at term.

SETTING

Nova Scotia, Canada.

POPULATION

All non-anomalous, singleton pregnancies ≥37 weeks of gestation without antepartum haemorrhage from 1988 to 2019.

METHODS

Using data from the Nova Scotia Atlee Perinatal Database, TPTL was defined as pregnancies with a hospital admission between 20 and 37 weeks of gestation, with a diagnosis code denoting TPTL with administration of antenatal corticosteroids, or with administration of any tocolysis. Poisson regression models were used to estimate the risk ratios (RR) with 95% CI of maternal and perinatal outcomes in women who had an episode of TPTL relative to those who did not.

MAIN OUTCOME MEASURES

Birthweight for gestational age below the tenth centile and a composite of perinatal mortality or severe perinatal morbidity.

RESULTS

Of 256 599 term deliveries meeting the inclusion criteria, 2278 (0.9%) involved TPTL. The risks of the primary outcomes were higher among those with TPTL relative to those without: birthweight for gestational age below the tenth centile (RR 1.24, 95% CI 1.11-1.39) and the composite of perinatal mortality/severe perinatal morbidity (RR 1.33, 95% CI 1.15-1.54).

CONCLUSIONS

Although the prevalence of TPTL in term deliveries is low, affected pregnancies are at increased risk for adverse perinatal outcomes. Increased fetal surveillance should be considered in the management of pregnancies affected by TPTL.

Altered DNA methylation in human placenta after (suspected) preterm labor

Aim: The aim of this study was to determine if alterations in DNA methylation in the human placenta would support suspected preterm labor as a pathologic insult associated with diminished placental health. Methods: We evaluated placental DNA methylation at seven loci differentially methylated in placental pathologies using targeted bisulfite sequencing, in placentas associated with preterm labor (term birth after suspected preterm labor [n = 15] and preterm birth [n = 15]), and controls (n = 15). Results: DNA methylation levels at the NCAM1 and PLAGL1 loci in placentas associated with preterm labor did differ significantly (p < 0.05) from controls. Discussion: Specific alterations in methylation patterns indicative of an unfavourable placental environment are associated with preterm labor per se and not restricted to preterm birth.

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour

BACKGROUND

The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders.

METHODS

A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis.

RESULTS

SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms.

CONCLUSION

This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.

Increased risk of morbidities and health-care utilisation in children born following preterm labour compared with full-term labour: A population-based study

AIM

Recent evidence is emerging indicating long-term effects in infants born after an episode of preterm labour (PTL), even if birth is at term. This population-based study compared long-term rates of outcomes and health-care utilisation (HCU) in children born following spontaneous preterm labour, irrespective of gestational age at delivery or of an uncomplicated pregnancy (SPTLu), with children born following full-term labour (FTL), overall stratified by comorbidity status and assessed using a composite morbidity measure (CM).

METHODS

Retrospective data on mother-neonate pairs were collected from a patient-linked dataset from the Netherlands Perinatal Registry and the PHARMO Database Network. Children born between 2000 and 2010 were followed until 2012.

RESULTS

Of pregnancies in 134 006 mother-neonate pairs, 122 894 (92%) pregnancies resulted in FTL, and 11 112 (8%) resulted in PTL. Of the PTL pregnancies, 6599 (59%) were SPTLu. Mean follow-up after birth was 6.6-6.7 years. Children from SPTLu pregnancies were at increased risk of neurodevelopmental and respiratory conditions compared with those from FTL pregnancies. In children from SPTLu pregnancies, the presence of the CM was associated with an increased risk of respiratory conditions and failure to thrive. Post-natal hospitalisations (incidence rate (IR) per 100 patient-years: 18.1 vs. 11.7) and specialist referrals (IR per 1000 patient-years: 290.6 vs. 184.5) occurred significantly more frequently in children from SPTLu versus FTL pregnancies.

CONCLUSION

The increased risk of morbidities and HCU in children born following SPTLu pregnancy in this population-based setting reinforces the need for safe interventions that can effectively halt labour and lead to an improvement in childhood outcomes.

Antenatal corticosteroids: an assessment of anticipated benefits and potential risks

Antenatal corticosteroids are standard of care for pregnancies at risk of preterm delivery between 24-34 weeks' gestational age. Recent trials demonstrate modest benefits from antenatal corticosteroids for late preterm and elective cesarean deliveries, and antenatal corticosteroids for periviable deliveries should be considered with family discussion. However, many women with threatened preterm deliveries receive antenatal corticosteroids but do not deliver until >34 weeks or at term. The net effect is that a substantial fraction of the delivery population will be exposed to antenatal corticosteroids. There are gaps in accurate assessments of benefits of antenatal corticosteroids because the randomized controlled trials were performed prior to about 1990 in pregnancies generally >28 weeks. The care practices for the mother and infant survival were different than today. The randomized controlled trial data also do not strongly support the optimal interval from antenatal corticosteroid treatment to delivery of 1-7 days. Epidemiology-based studies using large cohorts with >85% of at-risk pregnancies treated with antenatal corticosteroids probably overestimate the benefits of antenatal corticosteroids. Although most of the prematurity-associated mortality is in low-resource environments, the efficacy and safety of antenatal corticosteroids in those environments remain to be evaluated. The short-term benefits of antenatal corticosteroids for high-risk pregnancies in high-resource environments certainly justify antenatal corticosteroids as few risks have been identified over many years. However, cardiovascular and metabolic abnormalities have been identified in large animal models and cohorts of children exposed to antenatal corticosteroids that are consistent with fetal programming for adult diseases. These late effects of antenatal corticosteroids suggest caution for the expanded use of antenatal corticosteroids beyond at-risk pregnancies at 24-34 weeks. A way forward is to develop noninvasive fetal assessments to identify pregnancies across a wider gestational age that could benefit from antenatal corticosteroids.

Controversies about the Secondary Prevention of Spontaneous Preterm Birth

Preterm birth is one of the major global health problems and part of the Millennium Development goals because of the associated high number of perinatal or neonatal mortality and long-term risks of neurodevelopmental and metabolic diseases. Transvaginal sonography has meanwhile been established as a screening tool for spontaneous preterm birth despite its relatively low sensitivity when considering only the cervical length. Vaginal progesterone has been shown to reduce prematurity rates below 34 weeks in a screening population of singleton pregnancies. Up to now, no positive long-term effect could be demonstrated after 2 years. It seems to have no benefit to prolong pregnancies after a period of preterm contractions and in risk patients without cervical shortening. Meta-analyses still demonstrate conflicting results dependent on quality criteria used for selection. A cerclage is only indicated in singleton pregnancies with previous spontaneous preterm birth and a combined cervical shortening in the current pregnancy. Nevertheless, the short- and long-term outcome has never been evaluated, whereas maternal complications may be increased. There is no evidence for a prophylactic cervical cerclage in twin pregnancies even in cases with cervical shortening. Emergency cerclage remains an indication after individual counseling. The effect of a cervical pessary in singleton pregnancy seems to be more pronounced in studies where a few investigators with increasing experience have treated and followed the patients at risk for preterm birth. Mainly in twin pregnancies, pessary treatment seems to be promising compared to other treatment options of secondary prevention when the therapy is started at early stages of precocious cervical ripening. At present, several international trials with the goal to reduce global rates of prematurity are in progress which will hopefully allow to specify the indications and methods of intervention for certain subgroups. When trials are summarized, prospective meta-analyses carry a lower risk of bias than the meanwhile uncontrolled magnitude of retrospective meta-analyses with conflicting results.

The cost of preterm labor and preterm birth for mothers with uncomplicated pregnancies and their infants in Italy: a retrospective cohort study

BACKGROUND

Preterm labor (PTL)/preterm birth (PTB) impose significant burden on health-care systems. Women with uncomplicated pregnancies at risk of PTL/PTB have not been widely investigated, and published evidence on the costs of these women and their infants in Italy is absent. We aimed to describe women with uncomplicated pregnancies and associated costs for these women and their infants.

METHODS

Data on women aged 12-44 years with uncomplicated pregnancies who delivered between 1 September 2009 and 31 December 2014 with PTL diagnosis alone or PTL and PTB were included from four Italian databases. Costs were examined during pregnancy, delivery, and 3 years after delivery for mothers and infants, overall and by gestational age (GA).

RESULTS

A total of 3058 mothers linked to 3333 infants were included. Costs during pregnancy were €1777. Costs during delivery for PTL/PTB mothers and their infants ranged from €3174 (GA ≥37) to €21007 (GA <28). Combined maternal and infant costs appeared higher for births with lower GAs (<37) in the three-year follow-up.

CONCLUSIONS

In Italy, PTL/PTB mothers with uncomplicated pregnancies with infants at lower GAs appeared to incur higher medical costs compared to mothers with infants at higher GAs in all three time periods, with particularly marked differences found when considering mother and infant combined costs.

Efficacy of serum procalcitonin to predict spontaneous preterm birth in women with threatened preterm labour: a prospective observational study

Background

A hypothesis of preterm parturition is that the pathogenesis of spontaneous preterm birth (sPTB) may be associated with an inflammatory process. Based on this theory, we have hypothesized that an inflammatory biomarker, procalcitonin (PCT), may be a good predictive marker of sPTB at the admission for threatened preterm labour (TPL). The present study was aimed to investigate the association between serum PCT and sPTB in women with TPL and to evaluate whether PCT levels may predict sPTB in women with TPL within 7 or 14 days.

Methods

In a prospective observational laboratory-based study, women with singleton pregnancies, TPL between 24 and 36 weeks and intact membranes, were enrolled between January 2014 and June 2016. Participants received routine medical management of TPL (tocolysis with atosiban, antenatal corticosteroids, and biological tests at admission (C-reactive protein, white blood cell count, and PCT measured on electrochemiluminescence immunoassay)). The primary endpoint was sPTB before 37 weeks of gestation. The value of serum PCT levels to predict sPTB within 7 or 14 days were evaluated using receiver-operating curves (ROC) analysis.

Results

A total of 124 women were included in our study. PCT levels did not statistically differ between women with sPTB (n = 30, 24.2%) and controls (n = 94) (median in ng/mL [interquartile range]: 0.043 [0.02–0.07] compared to 0.042 [0.02–0.13], respectively; P = 0.56). PCT levels did not also statistically differ between women with sPTB within 7 days (n = 7, 5.6%) or 14 days (n = 12, 9.7%) after testing and controls. Moreover, subgroup analysis revealed no difference among PCT levels at admission between 24 and 28 weeks, between 28 and 32 weeks and over 32 weeks, and controls. On the basis of the receiver-operating characteristic curve, the highest sensitivity and specificity corresponded to a PCT concentration of 0.038 ng/mL, with poor predictive values for sPTB within 7 or 14 days.

Conclusion

Serum PCT was not relevant to predict sPTB within 7 or 14 days in women admitted with TPL between 24 and 36 weeks, and thus it is not a suitable biological marker to confirm the hypothesis of an inflammatory process associated with preterm parturition.

Trial registration

Clinicaltrials.gov (NCT01977079), Registered 24 October 2013.