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PubMed1993

[Term birth of a twin after the rupture of the uterine horn at 15 weeks gestational age].

Having treated a case which resulted in the delivery at term of an intrauterine twin when the other twin had been lost after the rupture of a uterine cornu which itself followed a salpingectomy without removal of the interstitial portion of the tube brings the authors to discuss the physiopathology and the symptomatology of such cases. They also discuss the value of resecting the interstitial portion of the tube and what management should be when there is a live intrauterine pregnancy.

Adult↗
PubMed2006

Epidemiology of late preterm (near-term) births.

The preterm birth rate (births before 37 completed weeks of gestation) has been increasing in the United States, largely driven by an increase in infants delivered between 34 and 36 weeks, often called near-term, but referred to as late preterm in this article. In 2004, the preterm birth rate was 12.5%, the highest rate since the National Center for Health Statistics began tracking such data. This article reviews the epidemiology of late preterm births and proposes a research agenda.

Age Distribution↗
PubMedDate not supplied

Neonatal size of low socio-economic status Black and White term births in Albany County, NYS.

Birth weight has long been a focus of study by epidemiologists and human biologists, because it reflects the quality of the intrauterine environment and may be used as a predictor of future growth and development. Comparisons of Black and White neonates in the USA have consistently shown differences in birth weight. Confounding variables are a major problem in any such investigation, especially socio-economic status which is highly correlated with race in the USA. This study was distinctive in the sampling of one socio-economic stratum (low income), and the use of five anthropometric measures in addition to birth weight. The goals of this study were as follows: to determine if there were differences in body size and body composition at birth in Black and White neonates of low socio-economic status (SES), and to investigate what variables might account for any observed variability. The sample consisted of full term Black and White neonates of low SES (n = 323) born in Albany, NY (1986-1997). Birth weight, length, head and arm circumference, and subscapular and triceps skinfolds were compared. Race was determined through maternal self-identification. White neonates were significantly larger than Black neonates in birth weight, length and head circumference. Among female neonates none of the anthropometric dimensions differed between Blacks and Whites. Among male neonates, Whites were significantly larger than Blacks in birth weight, length, head and arm circumferences. Principal components analysis reduced the six anthropometric dimensions to two summary measures: body size and composition. When controlling for social and biological variables, race and sex were significant predictors of body composition, but not body size. Interpretation of results and possible causal relationships are discussed.

Adolescent↗
PubMed2006

Predicting term birth weight using ultrasound and maternal characteristics.

OBJECTIVES: The aim of the study was to compare an ultrasound-based prediction formula of Shepard, Hadlock, our new equation and equation of Nahum based on maternal characteristics. STUDY DESIGN: Two groups of 125 (group A) and 130 (group B) healthy term pregnant women were sampled. Standard ultrasonographic measurements were performed and maternal characteristics recorded. A new birth weight equation was developed by multiple stepwise regression analysis from the group A data and then compared to the different birth weight prediction equations of Hadlock, Shepard and Nahum on group B. RESULTS: New prediction equation: log(10) EFW=0.64041xBPD-0.03257xBPD(2)+0.00154xACxFL. Our new (Halaska) and Hadlock's ultrasound estimations are comparable. Both equations are superior to Shepard and Nahum's equations. The Nahum equation is comparable to the Shepard estimation. Halaska equation tends to have the highest overall accuracy, Hadlock's estimation predicts better fetuses over 4000g, but this needs to be further validated. CONCLUSIONS: The Halaska and Hadlock's estimations are comparable to one another; the Nahum equation is comparable to Shepard's and can be used as simple, inexpensive and approximative estimate.

Adult↗
PubMed1980

Perinatal mortality in term and post-term births.

The hospital records were reviewed of 64 infants born at or after 37 weeks of amenorrhea who suffered perinatal mortality during a 3-year period at Boston Hospital for Women. The most frequent cause of death of a term or post-term infant was extrinsic perinatal hypoxia, and the second most common was lethal malformation. Half the deaths of term infants occurred ante partum. Further reduction in perinatal mortality for this group may require extension of antepartum fetal monitoring techniques to all pregnancies. Intrapartum loss was rare, occurring at a rate of 0.43 per 1000 for infants delivered at term, and not at all among post-term infants. Massive aspiration of amniotic sac content was found frequently in antepartum and intrapartum death, and death from meconium aspiration occurred in neonates despite intrapartum monitoring and early suctioning of the pharynx and trachea. Asphyxiated term and post-term infants consistently pass meconium. Prevention of all deaths from meconium aspiration, thus, will require the prevention of asphyxia. A goal for obstetric care is that no fetus alive in utero at 37 weeks of amenorrhea should subsequently die in the perinatal period, provided no lethal malformation is present.

Female↗
PubMed2006

Preeclampsia as a cause of preterm and late preterm (near-term) births.

Gestational hypertension-preeclampsia is the most common medical disorder of pregnancy. It is also a major cause of maternal and perinatal morbidities. The majority of adverse pregnancy outcomes occur in patients who develop severe hypertension or severe preeclampsia, and in those who develop the clinical manifestations before 34 weeks' gestation. There is some concern regarding neonatal morbidity in the late preterm (near term) infant (34 0/7 through 36 6/7 weeks' gestation) as a result of gestational hypertension and preeclampsia. A review of the available data suggests that most deliveries of the late preterm infant in such women are justified because of the concerns about maternal and fetal safety with continued gestation. In addition, the rate of preterm delivery at 34 to 36 weeks' gestation in women with gestational hypertension or preeclampsia is low. Indeed, most admissions to Neonatal Intensive Care Unit in such pregnancies occur in those at > or =37 weeks' gestation. There is urgent need for research to assess the reasons behind preterm delivery at 34 to 36 weeks' gestation in women with hypertension and preeclampsia. In addition, there is need for research to assess the reasons for admission to the NICU in term infants born of mothers with varying severities of hypertension and preeclampsia. In this paper, the phrase "late-preterm" has been used instead of "near term," as the former was considered more appropriate to reflect this subgroup of preterm infants in a workshop on this topic held in July 2005, organized by the National Institute of Child Health and Human Development.

Female↗
PubMed2003

Pre-term birth and severe pre-eclampsia are not associated with altered expression of HLA on human trophoblasts.

PROBLEM: The unusual pattern of human leukocyte antigen (HLA) expression on human trophoblasts could play an important role in successful pregnancy outcome. To determine whether alterations in HLA expression are associated with pregnancy abnormalities we have investigated expression of these antigens on chorionic and extravillous cytotrophoblasts. METHODS: Frozen tissue sections of placenta and fetal membranes were collected after pre-term spontaneous delivery, severe pre-eclampsia pre-term Caesarean section, normal term delivery and term Caesarean section. HLA expression was analyzed by immunohistochemistry. RESULTS: We did not observe differences in the expression of HLA on chorionic and extravillous cytotrophoblasts in pregnancy abnormalities. However, we noted higher expression levels of HLA class Ia molecules in amnion epithelial cells in pre-term deliveries. Furthermore, in severe pre-eclampsia the number of extravillous cytotrophoblast islands were elevated when compared with pre-term deliveries. CONCLUSIONS: No alterations in expression of HLA class Ia, HLA-G and HLA class II on human trophoblasts in pregnancy abnormalities were seen.

Amnion↗
PubMed2006

Atosiban vs ritodrine used prophylactically with cerclage in ICSI pregnancies to prevent pre-term birth in women identified as being at high risk on the basis of transvaginal ultrasound scan.

Our objective was to compare the effectiveness and safety of atosiban and ritodrine, in pregnancies obtained by intracytoplasmic sperm injection (ICSI) undergoing cervical cerclage. Data from a prospective study were compared with those from a retrospective study. Sixteen ICSI pregnant women, 20-24 weeks' gestation and maternal age >18 years, received atosiban (bolus dose 6.75 mg i.v., followed by 300 microg/min i.v. for 3 h and 100 microg/min i.v. for 45 h). Cervical cerclage was performed 3 h after starting atosiban. The control group (group B) of 16 ICSI pregnant women were matched and received ritodrine hydrochloride (100-350 microg/min) for 48 h. Cervical cerclage was performed after 24 h. Pre-term rupture of membranes occurred within 48 h of cervical cerclage in one woman receiving atosiban and in four women receiving ritodrine. There was no significant difference in terms of pregnancies not delivered at 48 h (short-term tocolysis) and at 7 days (long-term tocolysis). However, there was a significantly higher incidence of maternal tachycardia with ritodrine compared with atosiban (p < 0.001). The mean gestational age at delivery was significantly higher for atosiban compared with ritodrine (36 vs 33 weeks; p < 0.001). The neonatal outcome was poorer for ritodrine than atosiban, as there were very low birth weight infants (p = 0.008), resulting in lower Apgar scores (p = 0.005) and there were more neonates requiring a long stay in the neonatal intensive care unit (p = 0.005). We conclude that atosiban is associated with a significantly lower incidence of maternal tachycardia and improved neonatal outcome compared with ritodrine.

Adult↗
PubMed1998

Preterm and term births of small for gestational age infants: a population-based study of risk factors among nulliparous women.

OBJECTIVE: To study risk factors for small for gestational age (SGA) infants by gestational age among nulliparous women and to estimate mortality rates among SGA and appropriate-for-gestational-age (AGA) infants by gestational age. DESIGN: A population-based study from the Swedish Medical Birth Register. Setting Sweden 1992 1993. POPULATION: Liveborn singleton infants to nulliparous women (n = 96,662). MAIN OUTCOME MEASURES: Crude and adjusted odds ratios of risk factors for SGA by gestational age. Rates of neonatal and postneonatal mortality. RESULTS: Older maternal age (> or = 30 years) was foremost associated with increased risks of very and moderately preterm SGA (> or = 32 weeks and 33-36 weeks, respectively), but also with term SGA (> or = 37 weeks). Risks of SGA increased with decreasing maternal height at all gestational ages. Smoking increased the risks of moderately preterm and term SGA. Short maternal education increased the risk of preterm SGA and low pre-pregnancy body mass index slightly increased the risk of term SGA. Pre-eclampsia and essential hypertension foremost increased the risk of very preterm SGA (OR = 40.5 and 32.4, respectively) and moderately preterm SGA (OR = 17.4 and 10.6, respectively), but also increased the risk of term SGA. Neonatal and postneonatal mortality rates of SGA infants were substantially influenced by gestational age, and mortality rates were consistently higher among preterm SGA infants compared with AGA infants. CONCLUSIONS: Risk factors for SGA and mortality rates among SGA infants vary by gestational age. A subdivision of risk factors by gestational age adds knowledge, particularly about risks of preterm SGA, where the highest rates of mortality were observed.

Adolescent↗
PubMed1992

Term birth after midtrimester hysterotomy and selective delivery of an acardiac twin.

OBJECTIVE: Our aim was to determine whether hysterotomy and selective removal of an acardiac twin could improve the outcome of the "pump" twin. STUDY DESIGN: A literature and case review of the outcome of the acardiac twin malformation was performed. When an acardiac malformation was diagnosed at 19 weeks' gestation the patient was monitored with weekly ultrasonographic examinations. At 23 weeks' gestation, no blood flow could be demonstrated to the acardiac twin and it was thought that the continued presence of the acardiac twin posed a risk to the "pump" twin. A midtrimester hysterotomy was performed and the acardiac twin was delivered. RESULTS: After the midtrimester hysterotomy, the pregnancy progressed to term and a healthy female infant was delivered by elective cesarean section at 37 weeks' gestation. CONCLUSION: Midtrimester hysterotomy may be a useful intervention in cases of twinning when one fetus is a threat to the health of the other.

Adult↗
PubMed1993

Very pre-term birth and visual impairment. A retrospective investigation of 411 infants of gestational age 30 weeks or less, 1983-89 Rigshospitalet, Copenhagen.

In a group of infants and children of very preterm delivery (gestational age 30 weeks or less, n = 411, Rigshospitalet Copenhagen 1983-89) 13 got blind due to retinopathy of prematurity (3.2%) while another 13 with sequelae retained useful vision of at least one eye. One child later acquired bilateral retinoblastoma, with a free interval of one year from a protracted course of ROP stage 2-3 eventually to regress. The 411 surviving subjects being recruited from a total of 515 of a similarly low gestational age, the survival rate in the 7-year period under study was just below 80%. No doubt, the high survival rate in this very pre-term group is of importance for the risk of developing retinopathy of prematurity, but the role of the ophthalmologist in controlling the infants is also emphasized. Generally, stricter observation schemes are recommended. Probably, the ROP frequency in the sample of 23.6% is an underestimate.

Blindness↗
PubMed2006

The impact of multiple gestations on late preterm (near-term) births.

Multiple pregnancies currently account for 3% of all births in the United States but are disproportionately responsible for larger rates of prematurity and significant neonatal morbidity. The mean birth age for most multi-fetal pregnancies occurs during the late preterm period when both spontaneous preterm labor and iatrogenic premature birth because of obstetrical or maternal complications are common. Multiples pose numerous unique challenges, emphasizing the significant impact of plurality on late preterm births.

Female↗
PubMed2005

Does angiotensin-1 converting enzyme genotype influence motor or cognitive development after pre-term birth?

ABSTRACT : BACKGROUND : Raised activity of the renin-angiotensin system (RAS) may both amplify inflammatory and free radical responses and decrease tissue metabolic efficiency and thus enhance cerebral injury in the preterm infant. The angiotensin-converting enzyme (ACE) DD genotype is associated with raised ACE and RAS activity as well as potentially adverse stimuli such as inflammation. The DD genotype has been associated with neurological impairments in the elderly, and thus may be also associated with poorer motor or cognitive development amongst children born preterm prematurely. METHODS : The association of DD genotype with developmental progress amongst 176 Caucasian children born at less than 33 weeks gestation (median birthweight 1475 g, range 645-2480 g; gestation 30 weeks, range 22-32; 108 male) was examined at 2 and 5 1/2 years of age. Measured neuro-cognitive outcomes were cranial ultrasound abnormalities, cerebral palsy, disability, Griffiths Developmental Quotient [DQ] at 2 yrs, and General Cognitive Ability [British Ability Scales-11] and motor performance [ABC Movement], both performed at 5 1/2 yrs. All outcomes were correlated with ACE genotype. RESULTS : The DD genotype was not associated with lower developmental quotients even after accounting for important social variables. CONCLUSION : These data do not support either a role for ACE in the development of cognitive or motor function in surviving infants born preterm or inhibition of ACE as a neuroprotective therapy.

Journal Article↗