The prospects for multiple-marker screening for preterm delivery: does transvaginal ultrasound of the cervix have a central role?
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Biomarkers↗
Biomedical subjects
G A Macones
Publications and source records attributed to G A Macones.
Exposure to soy-based formula in infancy and endocrinological and reproductive outcomes in young adulthood.
CONTEXT: A large body of evidence documents the role of phytoestrogens in influencing hormone-dependent states. Infants fed soy formula receive high levels of phytoestrogens, in the form of soy isoflavones, during a stage of development at which permanent effects are theoretically possible. However, a paucity of data exists on the long-term effects of infant soy formulas. OBJECTIVE: To examine the association between infant exposure to soy formula and health in young adulthood, with an emphasis on reproductive health. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study conducted from March to August 1999 among adults aged 20 to 34 years who, as infants, participated during 1965-1978 in controlled feeding studies conducted at the University of Iowa, Iowa City (248 were fed soy formula and 563 were fed cow milk formula during infancy). MAIN OUTCOME MEASURES: Self-reported pubertal maturation, menstrual and reproductive history, height and usual weight, and current health, compared based on type of formula exposure during infancy. RESULTS: No statistically significant differences were observed between groups in either women or men for more than 30 outcomes. However, women who had been fed soy formula reported slightly longer duration of menstrual bleeding (adjusted mean difference, 0.37 days; 95% confidence interval [CI], 0.06-0.68), with no difference in severity of menstrual flow. They also reported greater discomfort with menstruation (unadjusted relative risk for extreme discomfort vs no or mild pain, 1.77; 95% CI, 1.04-3.00). CONCLUSIONS: Exposure to soy formula does not appear to lead to different general health or reproductive outcomes than exposure to cow milk formula. Although the few positive findings should be explored in future studies, our findings are reassuring about the safety of infant soy formula.
Adult↗
Fetal abdominal wall defects and mode of delivery: a systematic review.
OBJECTIVE: To determine whether there is sufficient evidence to support cesarean delivery over vaginal delivery in women carrying a fetus with an abdominal wall defect. DATA SOURCES: An OVID MEDLINE search of English language abstracts using medical subject heading terms "gastroschisis," "omphalocele," and "fetal abdominal wall defects" was performed. The generated list of articles was supplemented by a review of their bibliographies and the bibliographies of obstetric texts. STUDY SELECTION: A total of 27 peer-reviewed observational studies were identified, and 15 were included in the meta-analysis. Our primary inclusion criterion was the reporting of neonatal outcomes for infants with abdominal wall defects who delivered vaginally and who delivered by cesarean section. Studies were excluded if they were a case series or if neonatal outcomes could not be ascertained from the data presented in the manuscript. TABULATION, INTEGRATION, AND RESULTS: Standard meta-analytic techniques were applied to assess the question of whether cesarean delivery improves neonatal outcomes in infants with abdominal wall defects. There was no significant relationship between mode of delivery and the rate of primary fascial repair (random effects model: pooled relative risk [RR] 1.22, 95% confidence interval [CI] 0.99, 1.51), neonatal sepsis (random effects model: pooled RR 0.70, 95% CI 0.30, 1.62), or pediatric mortality (random effects model: pooled RR 1.14, 95% CI 0.59, 2.21). Additionally, there was no significant relationship between mode of delivery and time until enteral feeding or length of hospital stay. CONCLUSION: The available data do not provide evidence to support a policy of cesarean delivery for infants with abdominal wall defects.
Abdominal Muscles↗
Predicting outcomes of trials of labor in women attempting vaginal birth after cesarean delivery: a comparison of multivariate methods with neural networks.
OBJECTIVE: Our aim was to assess the utility and effectiveness of a neural network for predicting the likelihood of success of a trial of labor, relative to standard multivariate predictive models. STUDY DESIGN: We identified 100 failed trials of labor and 300 successful trials of labor in women with a prior cesarean delivery performed at our institution. Information was collected on >70 potential predictors of labor outcomes from the medical records, including demographic, historical, and past obstetric information, as well as information from the index pregnancy. Bivariate analyses comparing women in whom a trial of labor failed with those whose trial succeeded were performed. These initial analyses were used to select variables for inclusion into our muitivariate predictive model. From the same data we trained and tested a neural network, using a back-propagation algorithm. The test characteristics of the multivariate predictive model and the neural network were compared. RESULTS: From the bivariate analysis a history of substance abuse (adjusted odds ratio, 0.27; 95% confidence interval, 0.09-0.80), a successful prior vaginal birth after cesarean delivery (adjusted odds ratio, 0.13; 95% confidence interval, 0.05-0.31), cervical dilatation at admission (adjusted odds ratio, 0.53; 95% confidence interval, 0.31-0.88), and the need for labor augmentation (adjusted odds ratio, 2.15; 95% confidence interval, 1.14-4.06) were ultimately discovered to be important in predicting the likelihood of the success or failure of a trial of labor. With these variables in the predictive model the sensitivity of the derived rule for predicting failure was 77%, the specificity was 65%, and the overall accuracy was 69%. We also built a network using the 4 variables that were included in the final multivariate model. We were unable to achieve the same degree of sensitivity and specificity that we observed with the regression-based predictive model (sensitivity and specificity, 59% and 44%). CONCLUSION: In this study a standard multivariate model was better able to predict outcome in women ttempting a trial of labor.
Adult↗
The controversy surrounding indomethacin for tocolysis.
Indomethacin is a prostaglandin synthetase inhibitor sometimes used for tocolysis. Several placebo-controlled trials and trials comparing indomethacin to other potential first-line tocolytic agents support its efficacy for delaying delivery for >48 hours. Recent observational studies, however, have raised concerns about the safety of indomethacin, implicating it with increased rates of intraventricular hemorrhage and necrotizing enterocolitis. Careful analysis of these observational studies suggests that these results should be viewed with caution, because of uncontrolled confounding by indication. A recent decision analysis supports the risk/benefit analysis of indomethacin in this setting. Still, the future of indomethacin in preterm labor should be guided by well-designed prospective clinical trials. Such studies are underway.
Adult↗
Amniotic fluid matrix metalloproteinase-8 indicates intra-amniotic infection.
OBJECTIVE: This study was undertaken to determine whether matrix metalloproteinase-8, which is produced by neutrophils, is a useful marker for the detection of intra-amniotic infection. STUDY DESIGN: We performed a case-control study using enzyme-linked immunosorbent assays to detect matrix metalloproteinase-8 in 77 amniotic fluid specimens that were obtained by amniocentesis from women with preterm contractions or preterm labor and intact fetal membranes (n = 66) and from women with preterm premature rupture of membranes (n = 11). RESULTS: Thirty women had culture-proven intra-amniotic infection (cases), 21 of whom had intact membranes. After constructing receiver operating characteristic curves to establish the optimal threshold concentration of matrix metalloproteinase-8 for a positive test result, we detected matrix metalloproteinase-8 in 27 of 30 women with intra-amniotic infection; only 10 of 47 control specimens contained matrix metalloproteinase-8 (P <.001; odds ratio, 33.3; 95% CI, 8.4, 132.7). Matrix metalloproteinase-8 was present in 20 of 21 women with intact membranes and intra-amniotic infection and in only 10 of 45 control subjects (P <.001; odds ratio, 70.0; 95% CI, 8.3, 587.6). Among women with intact membranes, the sensitivity of the assay was 0.95 and the specificity was 0.78. CONCLUSION: Our results indicate that matrix metalloproteinase-8 is highly correlated with intra-amniotic infection and that enzyme-linked immunosorbent assay for matrix metalloproteinase-8 may be a clinically useful test for the diagnosis of intra-amniotic infection in women with preterm contractions and preterm labor.
Amnion↗
Can antenatal clinical and biochemical markers predict the development of severe preeclampsia?
OBJECTIVE: This study was undertaken to develop a multivariable clinical predictive rule for severe preeclampsia using second-trimester clinical factors and biochemical markers. STUDY DESIGN: We performed a retrospective cohort study of all pregnant patients with single gestations from 1995 through 1997 for whom we had complete follow-up data. Through medical record review we determined whether patients had severe preeclampsia develop according to American College of Obstetricians and Gynecologists criteria. Case patients with severe preeclampsia were compared with control subjects with respect to clinical data and multiple-marker screening test results. With potential predictive factors identified in the bivariate and stratified analyses both an explanatory logistic regression model and a clinical prediction rule were created. Patients were assigned a predictive score according to the presence or absence of predictive factors, and receiver operating characteristic analysis was used to determine the optimal score cutoff point for prediction of severe preeclampsia with maximal sensitivity. RESULTS: Among the 1998 patients we found 49 patients with severe preeclampsia (prevalence, 2.5%). After we controlled for confounding variables, case patients and control subjects had similar human chorionic gonadotropin and alpha-fetoprotein levels, and the only variables that remained significantly associated with severe preeclampsia were nulliparity (relative risk, 3.8; 95% confidence interval, 1.7-8.3), history of preeclampsia (relative risk, 5.0; 95% confidence interval, 1.7-17.2), elevated screening mean arterial pressure (relative risk, 3.5; 95% confidence interval, 1.7-7.2), and low unconjugated estriol concentration (relative risk, 1.7; 95% confidence interval, 0.9-3.4). Our predictive model for severe preeclampsia, which included only these 4 variables, had a sensitivity of 76% and a specificity of 46%. CONCLUSION: Even after incorporation of the strongest risk factors, our predictive model had only modest sensitivity and specificity for discrimination of patients at risk for development of severe preeclampsia. The addition of the human chorionic gonadotropin and alpha-fetoprotein biochemical markers did not enhance the model's predictive value for severe preeclampsia.
Adult↗
Genetic influences on premature parturition in an Australian twin sample.
We investigated possible genetic influences on women's liability to preterm birth, using data from a large sample of Australian female twin pairs. In a 1988-90 questionnaire survey, both members of 905 parous twin pairs (579 monozygotic and 326 dizygotic) reported on whether deliveries had been more than two weeks preterm. Tetrachoric twin pair correlations for first birth were rMZ = 0.20+/-0.11 and rDZ = -0.03+/-0.14, and for any birth were rMZ = 0.30+/-0.08 and rDZ = 0.03+/-0.11. Best-fitting models to data contained only additive genetic influences and individual environmental effects. Heritability was 17% for preterm delivery in first pregnancy, and 27% for preterm delivery in any pregnancy. In the former case, however, we could not reject a model without genetic influences. Although our data did not allow for differentiation of the varying aetiologies of premature parturition, results from this exploratory analysis suggest that further investigation of genetic influences on specific reasons for preterm birth is warranted.
Adult↗
Ultrasonographic prediction of fetal macrosomia. Association with cesarean delivery.
OBJECTIVE: To investigate whether the incorrect ultrasonographic prediction of macrosomia affects the cesarean delivery rate among nonmacrosomic neonates. STUDY DESIGN: For this retrospective, cohort study, comprehensive ultrasonographic records were reviewed at two centers. Patients with singleton, nonanomalous gestations whose ultrasonography predicted an estimated fetal weight > or = 4,000 g composed one cohort (n = 135), while the other cohort (n = 129) consisted of patients whose ultrasonography predicted an estimated fetal weight between 3,000 and 3,999 g. We compared the cesarean delivery rate in neonates falsely diagnosed with macrosomia (false positives) with the rate in those correctly diagnosed as nonmacrosomic (true negatives). RESULTS: The rate of cesarean delivery was significantly higher among those falsely diagnosed by ultrasonography with a macrosomic fetus as compared to those with a fetus truly diagnosed as nonmacrosomic (42.3% vs. 24.3%, relative risk = 1.74, 95% confidence interval 1.09-2.78). Subgroup analyses excluding diabetic mothers and multiparous women and comparing false positives with true negatives with neonatal birth weights between 3,500 and 4,000 g (birth weights similar to false positives) demonstrated significantly increased cesarean delivery rates among false positives. CONCLUSION: Even in nonmacrosomic neonates, the antenatal ultrasonographic diagnosis of suspected macrosomia is associated with a significant increase in cesarean delivery rates.
Adult↗
Prediction of delivery among women with early preterm labor by means of clinical characteristics alone.
OBJECTIVE: This study was undertaken to assess whether individual clinical factors or combinations thereof could be used to accurately predict the risk of delivery within 1 week of admission among women with preterm labor and minimal cervical dilatation. STUDY DESIGN: We performed a case-control study of patients admitted to our institution with preterm labor and minimal cervical dilatation. A case patient was a patient who sought treatment with uterine contractions between 24 and 34 weeks' gestation with cervical dilatation </=2 cm, who received tocolysis with magnesium sulfate, and who was delivered within 7 days of admission. Control subjects were those who had the same presentation with preterm labor but were not delivered within the first 7 days after admission. The medical records of case patients and control subjects were then abstracted, and information on >70 potential predictors was recorded. Statistical analysis consisted of bivariate and multivariable methods. We also generated a multivariable clinical predictive model with the purpose of detecting a proportion as high as possible of those destined to be delivered within 1 week (high sensitivity). We estimated that we would need 50 case patients and 150 control subjects to detect an odds ratio of 2.5 for risk factors with a prevalence of 20%, an alpha error of.05, a beta error of.20, and a control subject/case patient ratio of 3:1. RESULTS: Three variables were eligible for inclusion in our logistic models according to the bivariate analyses-bleeding on admission, substance abuse, and admission white blood cell count >/=14,000 cells/microL. The simplest and most favorable model included only 2 variables, bleeding and substance abuse, and yielded a sensitivity of 46% and a specificity of 76%. The full 3-variable model had similar test characteristics. For no model were we able to achieve a sensitivity >/=50%. CONCLUSION: The results of this case-control study suggest that combinations of clinical factors do not yield an adequate level of discrimination to be used alone for predicting the likelihood of delivery within 1 week among patients with minimal degrees of cervical dilatation.
Adult↗
Association of polymorphism within the promoter of the tumor necrosis factor alpha gene with increased risk of preterm premature rupture of the fetal membranes.
OBJECTIVE: The rarer allele of a polymorphism within the promoter region at position -308 of the gene for tumor necrosis factor alpha is associated with increased gene transcription. In this study we tested the hypothesis that this rarer allele is associated with spontaneous preterm birth. STUDY DESIGN: We conducted a case-control study of women admitted to our labor and delivery unit. To assess data from a single racial group with a high incidence of preterm birth we restricted our analysis to African American women, who contributed 73.6% of the samples collected during the study period. Case patients (n = 55) were defined as women who were delivered before 37 weeks' gestation after idiopathic preterm labor or preterm premature rupture of membranes. Control subjects (n = 110) included women who were delivered after 37 weeks' gestation and had no history of preterm delivery. We also performed subgroup analyses of women with idiopathic preterm labor and delivery (n = 29) and women who were delivered preterm after preterm premature rupture of the fetal membranes (n = 26). RESULTS: Although carriers (homozygotes plus heterozygotes) of the rarer allele of the polymorphism at position -308 in the gene for tumor necrosis factor alpha were not significantly more common among women who were delivered preterm (n = 24/55, 44%) than among control subjects (n = 33/110, 30%, P =.08, odds ratio 1.81, 95% confidence interval 0.92-3.54), carriers of the rarer allele were more common among women who were delivered preterm after preterm premature rupture of membranes (n = 15/26, 58%) than among control subjects (P =.008, odds ratio 3.18, 95% confidence interval 1.33-7.83). CONCLUSIONS: Our results demonstrate an association between allelic variants of the polymorphism at position -308 in the gene for tumor necrosis factor alpha and preterm birth after preterm premature rupture of the fetal membranes. We hypothesize that host susceptibility to environmental factors, such as hyperresponsiveness of the gene for tumor necrosis factor alpha to genital tract infection, may promote preterm premature rupture of the fetal membranes and subsequent preterm delivery.
Adolescent↗
Predicting delivery within 48 hours in women treated with parenteral tocolysis.
OBJECTIVE: To develop a prediction rule using clinical admission characteristics for women treated with parenteral tocolysis for preterm labor who are at highest risk of delivery within 48 hours. METHODS: We performed a case-control study of patients treated with magnesium sulfate for idiopathic preterm labor. A case was defined as a patient who received magnesium sulfate tocolysis and delivered within 48 hours of admission. We selected a 48-hour delay to delivery as a clinically relevant endpoint for the maximization of steroid benefit. Controls were patients who received magnesium sulfate tocolysis and remained undelivered 48 hours after admission. Cases and controls were identified by merging a pharmacy billing database with International Classification of Disease codes for premature labor. Medical records were reviewed and risk factor information was obtained. We focused on risk factors within the first hour of admission, because our goal was to identify patients at high risk of delivery early in their hospital course. Backward stepwise logistic regression was used to develop explanatory and predictive models. The focus of the predictive model was to maximize the test's sensitivity and negative predictive value. RESULTS: We identified 50 cases and 150 controls. The following six variables were included in the initial multivariable models based on bivariate analyses: white blood cell count at least 14.0 (1000/microL), cervical dilation at least 2 cm, bleeding, substance abuse, parity, and previous abortion. A two-variable model containing cervical dilation and bleeding had an overall accuracy of 73%, sensitivity of 62%, and specificity of 76%, and it was as sensitive and specific as more complex models. CONCLUSION: Cervical dilation of at least 2 cm and bleeding on admission had an overall accuracy of 73% in predicting the likelihood of delivery within 48 hours in women receiving magnesium sulfate.
Case-Control Studies↗
Selection of delivery method in pregnancies complicated by autoimmune thrombocytopenia: a decision analysis.
OBJECTIVE: To compare three common strategies for selecting delivery methods in term pregnancies complicated by immune thrombocytopenia by contrasting their effects on the number of severely thrombocytopenic neonates delivered vaginally and total cesarean rates. METHODS: We used decision analysis to compare three strategies to select delivery method in women with autoimmune thrombocytopenia, funipuncture at term, intrapartum fetal scalp platelet sampling with delivery mode decisions based on platelet count in the first two strategies, and no testing of fetal platelets with delivery mode determined by standard obstetric criteria. We assumed that the goal of each strategy was to minimize the number of severely thrombocytopenic neonates delivered vaginally while maintaining an acceptable cesarean rate. Severe thrombocytopenia was defined as under 50,000 platelets per microL. Probabilities with ranges (used in sensitivity analyses) were derived from the medical literature. RESULTS: Of the two testing strategies, funipuncture was clearly preferable. Funipuncture resulted in zero cases of severely thrombocytopenic neonates delivered vaginally (as did scalp sampling), with a lower overall cesarean rate compared with fetal scalp sampling (36.6% versus 69.1%). Compared with the no-testing strategy, the funipuncture strategy reduced the number of severely thrombocytopenic neonates delivered vaginally (0 versus 82 per 1000) with a modest increase in the cesarean rate (1.9 cesareans to prevent vaginal delivery of one severely thrombocytopenic neonate). CONCLUSION: Fetal scalp sampling should be abandoned in favor of funipuncture when testing for thrombocytopenia.
Autoimmune Diseases↗
Cost-effectiveness analysis: an introductory guide for clinicians.
UNLABELLED: Economic analyses are becoming increasingly prevalent in the obstetrics and gynecology literature, and it is essential that clinicians have a basic comprehension of this research methodology. The purpose of this article is to provide an introduction to economic analysis, in particular cost-effectiveness analysis, and to summarize the basic principles and recently proposed standards for studies using these analytic methods. The fundamental principle of economic analysis is that choices will have to be made between alternative use of resources because there are not unlimited resources to provide all the medical care possible to each individual. These analyses can illustrate the tradeoffs involved in choosing among a variety of clinical interventions to improve health care, and ultimately inform decision making. With a basic understanding of the key concepts of economic analyses, clinicians and health service researchers will be better prepared to critically review these analyses and incorporate them into daily practice. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to provide an introduction to economic analysis and to summarize the various types of economic analyses, to understand the principle assumption of each analysis and their limitations and to be aware of the various principles of conducting cost-effective analyses.
Cost-Benefit Analysis↗
The utility of clinical tests of eligibility for a trial of labour following a caesarean section: a decision analysis.
OBJECTIVE: There is evidence to suggest that women who have a failed trial of labour following caesarean section are at the highest risk of major morbid events, compared with those who have a successful trial of labour or elective repeat caesarean section. Attempts are being made to predict, either by radiological or ultrasonic measurements or clinical factors, who should attempt a trial of labour after a prior caesarean section and who should not, in the hopes of reducing the number of failed trials of labour with their associated morbidity. The goal of this study was to determine the necessary sensitivity and specificity for such a test to be clinically useful in this setting. METHODS: A decision analytic approach was used which compared two strategies for treating women with a prior caesarean section: trial of labour for all or application of a hypothetical test, the results of which would determine whether a woman would be offered a trial of labour. It was assumed that the goal of the strategies was to minimise the number of major maternal morbid events (hysterectomy, uterine rupture, operative injury) with an acceptable caesarean section rate. Probability estimates for these outcomes were obtained from the existing literature. We evaluated several combinations of sensitivity and specificity to determine the impact of these characteristics on the number of major complications and the number of caesarean sections, compared with the strategy of trial of labour for all women. The results are reported per 1000 women with a previous caesarean section. RESULTS: Under baseline assumptions, a clinical test for determining eligibility for a trial of labour must have both a sensitivity and specificity in excess of 75% to obtain a reasonable trade-off between reduction in morbidity and the total rate of caesarean sections. In women with a low empiric likelihood of a successful trial of labour, tests with lesser degrees of both sensitivity and specificity are reasonable. In women with a high empiric likelihood of a successful trial of labour, much higher sensitivities and specificities are required. CONCLUSIONS: In developing tests to determine to whom to offer a trial of labour, investigators and clinicians must realise that in most cases, a highly sensitive and specific test is needed, although this is dependent on the empiric likelihood of the success of a trial of labour.
Decision Support Techniques↗
Risk factors for rapid repeat pregnancy among adolescent mothers: a review of the literature.
STUDY OBJECTIVE: To review risk factors for rapid repeat pregnancy that have been studied among adolescents, and to determine which of these factors serve as useful predictors for second pregnancy. DESIGN: A Medline search of journal articles from 1966 to 1997 identified English language articles addressing repeat pregnancy among adolescents. All relevant citations within these articles were also included. MAIN OUTCOME MEASURES: Risk factors that were correlated with rapid repeat pregnancy in studies using rigorous statistical analysis were considered to be significant. RESULTS: Significant predictors of rapid repeat pregnancy included younger age, low socioeconomic status, low education of teen's mother or head of household, marriage, intended or desired first pregnancy, and use of a contraceptive method other than Norplant postpartum. CONCLUSIONS: There is little consensus as to which risk factors are the most important predictors of recidivism. With as many as half of teenage mothers conceiving again within two years, the identification of "high-risk" teens may be less important than the development of intervention strategies for all these young women.
Adolescent↗
Antiphospholipid antibodies in chronic hypertension: the value of screening during pregnancy.
To determine if screening for antiphospholipid antibodies in gravid chronic hypertension patients is warranted, we performed a retrospective cohort study to test the association between antiphospholipid antibodies and perinatal outcome in this group of women. The primary outcome we compared was adverse perinatal outcome, defined as delivery <37 weeks' gestation secondary to maternal or fetal indications, intrauterine or neonatal death, birth weight <10th percentile for gestational age, early-onset severe preeclampsia, or placental abruption. Our sample size allowed for the detection of a 60% reduction in the relative risk of adverse perinatal outcome in patients who were antiphospholipid antibody screen negative (80% power, P = 0.05). No increased risk of adverse perinatal outcome was demonstrated among patients with positive serum antiphospholipid antibodies (33.3%, 5/15) versus patients with negative screening (40.0%, 22/55) in our cohort (RR 0.88, 95% Cl 0.38-1.83). Furthermore, antiphospholipid antibody status was not associated with adverse perinatal outcome after controlling for classic indications for antibody screening (RRMH 0.63, 95% Cl 0.30-1.33). In conclusion, chronic hypertension patients with positive antiphospholipid antibody screening are not at increased risk for adverse perinatal outcome compared to those with negative screening. Therefore, screening for antiphospholipid antibodies in chronic hypertension patients without classic indications for screening is not warranted.
Adult↗
Optimising maternal-fetal outcomes in preterm labour: a decision analysis.
OBJECTIVE: To compare, using decision analytic techniques, maternal and fetal risk and benefits of three strategies for the management of preterm labour after 32 weeks. These strategies are empiric tocolysis, no tocolysis, or amniocentesis for fetal maturity testing. DATA SOURCES: Published medical literature provided the probabilities, including those for tocolysis efficacy, maternal and neonatal outcomes, and steroid efficacy. DATA: Synthesis Separate decision trees were created for hypothetical cohorts of patients presenting with preterm labour at 32, 34, and 36 weeks of gestation to compare strategies. The primary outcome was the total number of expected adverse maternal and neonatal events for each strategy at each gestational age. RESULTS: At 32 weeks tocolysis yielded the lowest total number of adverse maternal and neonatal events. At 34 weeks, both tocolysis and no tocolysis yielded similar overall outcomes. At 36 weeks most clinical outcomes were good regardless of strategy. CONCLUSIONS: This analysis supports the empiric use of tocolytics at 32 weeks. At 34 weeks, either tocolysis or no tocolysis appear to be reasonable alternatives. At 36 weeks no tocolysis is probably preferred. This analysis also suggests that amniocentesis should not be employed in the management of preterm labour at these gestational ages.
Amniocentesis↗