[What is a "true" threatened premature labor?]

[Preterm birth: evolution 1994 to 2006]

OBJECTIVE

Evaluate the incidence of births before 33 weeks of amenorrhea over a 12-year period and the place of prematurity induced among them. Determine the evolution of various causes of birth prior to that and draw up a detailed inventory.

PATIENTS AND METHODS

This is a retrospective study from 1994 to 2006, concerning mothers who gave birth in the Network Users Association of computerized records in Pediatrics, Obstetrics and Gynecology (AUDIPOG) between 22 and 32+6 days of maternity. A total of 3781 deliveries were included. The statistical significance of links between the degree of prematurity (high prematurity/extreme prematurity) and the type of prematurity (induced/spontaneous) or mode of early work in the event of induced prematurity (trigger/prior cesarean work) was determined. The evolution of different etiologies was also studied with a complete inventory in 2006.

RESULTS

We observed a significant increase in the rate of births before 33 SA: it was multiplied by 3 in 12 years and stood at 1.7% of births in 2006. No increase in prematurity induced was observed, but in case of preterm labor induced the number of births by caesarean section increased significantly. Concerning the evolution of etiologies, vaginal and urinary infections decreased the most, followed by fetal malformations. Only multiple pregnancies increased significantly. The principle cause of preterm birth was hypertension. Prior to 28 SA, premature births were caused by metrorrhagia and infections at greater levels than 28-32 SA.

DISCUSSION AND CONCLUSION

The growing number of births before 33 SA is a serious phenomenon that must be monitored as they are increasingly common in France.

Tocolyse par la nifédipine. Utilisation en pratique courante

OBJECTIVES

To assess tocolysis with nifedipine in preterm labour during actual clinical practice in terms of efficacy and safety.

PATIENTS AND METHODS

Retrospective observational study during two years including preterm labour between 26 and 33+6 weeks of amenorrhea. Preterm labour was defined by the presence of three or more uterine contractions in 10 minutes associated to cervical modifications diagnosed by vaginal sonography (length<or=25 mm). Patients were excluded if they had more than two fetuses or other gestational pathologies. Tocolysis resulted in oral taking of 30 mg of nifedipine (3x10 mg) with continuous follow-up of blood pressure. Tocolysis was modified when contractions did not disappear. Success was defined when delivery was delayed more than 48 hours. Failure was defined either by a delivery occurring in the first two days of tocolysis or when a modification of treatment was required.

RESULTS

Fifty-eight patients were included, 10 of whom having a twin pregnancy. Success was obtained in 84% of patients (49/58). All of these women did not deliver during the first seven days after introduction of tocolysis. Five patients delivered in the first two days after tocolysis and four others required a change in tocolysis. Mean gestational age at delivery was 37+5 weeks and 35 weeks for single and twin pregnancies, respectively. No maternal or fetal side effects were described.

DISCUSSION AND CONCLUSION

Nifedipine could be prescribed for tocolysis in actual clinical practice because it seems to have safety and excellent tolerance.