premature Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(1):53-58
The gestational complication most associated with perinatalmortality and morbidity is spontaneous preterm birth with gestational age < 37 weeks. Therefore, it is necessary to identify its risk factors and attempt its prevention. The benefits of the pessary in prematurity are under investigation. Our objective was to analyze the use of the pessary in the prevention of preterm births in published studies, and to compare its efficacy with other methods.
Randomized clinical trials published between 2010 and 2018 were selected from electronic databases. Studies on multiple gestations were excluded.
Two studies were in favor of the pessary as a preventive method, one study was contrary to the method and another two showed no statistically significant difference. Themeta-analysis showed no statistical difference with the use of a cervical pessary in the reduction of births < 37 (odds ratio [OR]: 0.63; confidence interval [95% CI]: 0.38-1.06) and < 34 weeks (OR: 0.74; 95% CI: 0.35-1.57)
The pooled data available to date seems to show a lack of efficacy of the cervical pessary in the prevention of preterm birth, although the heterogeneity of the studies made comparisons more difficult.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(1):53-58
The gestational complication most associated with perinatalmortality and morbidity is spontaneous preterm birth with gestational age < 37 weeks. Therefore, it is necessary to identify its risk factors and attempt its prevention. The benefits of the pessary in prematurity are under investigation. Our objective was to analyze the use of the pessary in the prevention of preterm births in published studies, and to compare its efficacy with other methods.
Randomized clinical trials published between 2010 and 2018 were selected from electronic databases. Studies on multiple gestations were excluded.
Two studies were in favor of the pessary as a preventive method, one study was contrary to the method and another two showed no statistically significant difference. Themeta-analysis showed no statistical difference with the use of a cervical pessary in the reduction of births < 37 (odds ratio [OR]: 0.63; confidence interval [95% CI]: 0.38-1.06) and < 34 weeks (OR: 0.74; 95% CI: 0.35-1.57)
The pooled data available to date seems to show a lack of efficacy of the cervical pessary in the prevention of preterm birth, although the heterogeneity of the studies made comparisons more difficult.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):235-242
DOI 10.1590/S0100-72032012000500008
PURPOSE: To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1st, 2009 and October 31st, 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14, 95%CI 2.23-7.68 and RR=2.84, 95%CI: 1.41-5.74). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight >700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and >700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extreme preterm infants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):235-242
DOI 10.1590/S0100-72032012000500008
PURPOSE: To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1st, 2009 and October 31st, 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14, 95%CI 2.23-7.68 and RR=2.84, 95%CI: 1.41-5.74). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight >700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and >700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extreme preterm infants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(11):354-360
DOI 10.1590/S0100-72032011001100006
PURPOSE: To analyze the association of pregnancy in adolescence and prematurity. METHODS: The study included all the patients who delivered at a teaching hospital in Maranhão State, from July to December 2006. The patients were divided into two groups: adolescents (10 to 19 years old) and adults (20 to 34 years old). The variables studied were: educational level, marital status, number of prenatal visits, gestational age at the onset of prenatal care, duration of gestation, delivery route and birth weight. Statistical analysis was performed using the Epi-Info software, version 3.4.1, and the associations between variables were analyzed by the odds ratio (OR), with a 95% confidence interval (CI). Models of logistic regression were also used. The level of significance adopted was 0.05. RESULTS: The study evaluated 1,978 patients. The frequency of deliveries in adolescents was 25.4%. This group presented low educational level, no mates, low number of prenatal visits, late onset of prenatal care, low birth weight and prematurity. In the analysis of prematurity as the outcome variable, there was a clear association with low number of prenatal visits (OR 3.0; 95%CI 2.2-4.0) and late onset of prenatal care (OR 1.9; 95%CI 1.3-2.6) and low educational level (OR 1.9; 95%CI 1.4-2.5) related to adolescence (OR 1.5; 95%CI 1.1-1.9). The incidence of caesarean delivery was significantly lower among adolescents (33.3%) than among adults (49.4%), with a lower association with pre-eclampsia and cephalo-pelvic disproportion. CONCLUSIONS: Pregnancy in adolescence was associated with late onset of prenatal care and low number of visits, as well as low educational level, low birth weight, prematurity and a lower incidence of cephalo-pelvic disproportion and pre-eclampsia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(11):354-360
DOI 10.1590/S0100-72032011001100006
PURPOSE: To analyze the association of pregnancy in adolescence and prematurity. METHODS: The study included all the patients who delivered at a teaching hospital in Maranhão State, from July to December 2006. The patients were divided into two groups: adolescents (10 to 19 years old) and adults (20 to 34 years old). The variables studied were: educational level, marital status, number of prenatal visits, gestational age at the onset of prenatal care, duration of gestation, delivery route and birth weight. Statistical analysis was performed using the Epi-Info software, version 3.4.1, and the associations between variables were analyzed by the odds ratio (OR), with a 95% confidence interval (CI). Models of logistic regression were also used. The level of significance adopted was 0.05. RESULTS: The study evaluated 1,978 patients. The frequency of deliveries in adolescents was 25.4%. This group presented low educational level, no mates, low number of prenatal visits, late onset of prenatal care, low birth weight and prematurity. In the analysis of prematurity as the outcome variable, there was a clear association with low number of prenatal visits (OR 3.0; 95%CI 2.2-4.0) and late onset of prenatal care (OR 1.9; 95%CI 1.3-2.6) and low educational level (OR 1.9; 95%CI 1.4-2.5) related to adolescence (OR 1.5; 95%CI 1.1-1.9). The incidence of caesarean delivery was significantly lower among adolescents (33.3%) than among adults (49.4%), with a lower association with pre-eclampsia and cephalo-pelvic disproportion. CONCLUSIONS: Pregnancy in adolescence was associated with late onset of prenatal care and low number of visits, as well as low educational level, low birth weight, prematurity and a lower incidence of cephalo-pelvic disproportion and pre-eclampsia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(10):286-291
DOI 10.1590/S0100-72032011001000003
PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(10):286-291
DOI 10.1590/S0100-72032011001000003
PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):552-558
DOI 10.1590/S0100-72032009001100005
PURPOSE: to compare the effectiveness of transdermal nitroglycerin with oral nifedipine in the inhibition of preterm delivery. METHODS: a clinical essay has been performed with 50 women in preterm delivery, randomly divided into two groups, 24 receiving oral nifedipine (20 mg), and 26, transdermal nitroglycerin (10 mg patch). Patients with a single gestation, between the 24th and the 34th weeks and diagnosis of preterm delivery were selected. Women with fetal malformation and clinical or obstetric diseases were excluded. The variables analyzed were: effective tocolysis, time needed for tocolysis, recurrence frequency, progression to preterm delivery, and side effects. RESULTS: tocolysis efficacy in the first 12 hours was similar between the groups (nitroglycerin: 84.6% versus nifedipine: 87.5%; p=0.50). The time average time needed for tocolysis was also similar (6.6 versus 5.8 hours; p=0.30). There was no difference between the groups, concerning the recurrence of preterm delivery (26.9 versus 16.7%; p=0.30), and neither in the rate of preterm delivery within 48 hours (15.4 versus 12.5%; p=0.50). Nevertheless, the cephalea rate was significantly higher in the Nitroglycerin Group (30.8 versus 8.3%; p=0.04). CONCLUSIONS: transdermal nitroglycerin has presented similar effectiveness to oral nifedipine to inhibit preterm delivery in the first 48 hours, however with higher cephalea frequency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):552-558
DOI 10.1590/S0100-72032009001100005
PURPOSE: to compare the effectiveness of transdermal nitroglycerin with oral nifedipine in the inhibition of preterm delivery. METHODS: a clinical essay has been performed with 50 women in preterm delivery, randomly divided into two groups, 24 receiving oral nifedipine (20 mg), and 26, transdermal nitroglycerin (10 mg patch). Patients with a single gestation, between the 24th and the 34th weeks and diagnosis of preterm delivery were selected. Women with fetal malformation and clinical or obstetric diseases were excluded. The variables analyzed were: effective tocolysis, time needed for tocolysis, recurrence frequency, progression to preterm delivery, and side effects. RESULTS: tocolysis efficacy in the first 12 hours was similar between the groups (nitroglycerin: 84.6% versus nifedipine: 87.5%; p=0.50). The time average time needed for tocolysis was also similar (6.6 versus 5.8 hours; p=0.30). There was no difference between the groups, concerning the recurrence of preterm delivery (26.9 versus 16.7%; p=0.30), and neither in the rate of preterm delivery within 48 hours (15.4 versus 12.5%; p=0.50). Nevertheless, the cephalea rate was significantly higher in the Nitroglycerin Group (30.8 versus 8.3%; p=0.04). CONCLUSIONS: transdermal nitroglycerin has presented similar effectiveness to oral nifedipine to inhibit preterm delivery in the first 48 hours, however with higher cephalea frequency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):561-566
DOI 10.1590/S0100-72032005000900010
Preterm delivery is the most common cause of neonatal morbidity and mortality. About 75% of preterm births follow preterm labor. The pathogenesis of spontaneous preterm birth is complex and its clinical management is based on a careful assessment of the risks for mother and infant and on continuing the pregnancy versus delivery. The goal of the present article is to review the diagnosis of preterm labor, the tocolytic treatment, glucocorticoid therapy, antimicrobial treatment, and management of progressive preterm labor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):561-566
DOI 10.1590/S0100-72032005000900010
Preterm delivery is the most common cause of neonatal morbidity and mortality. About 75% of preterm births follow preterm labor. The pathogenesis of spontaneous preterm birth is complex and its clinical management is based on a careful assessment of the risks for mother and infant and on continuing the pregnancy versus delivery. The goal of the present article is to review the diagnosis of preterm labor, the tocolytic treatment, glucocorticoid therapy, antimicrobial treatment, and management of progressive preterm labor.