Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subs...Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20- 27.9, 28- 33.9 vs 34- 36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17- OHP caproate versus placebo. Effectiveness of 17- OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20- 27.9, 28- 33.9, and 34- 36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17- OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17- OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver < 37 weeks (42% vs 63% , P = .026 and 34% vs 56% , P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17- OHP caproate or control. Conclusion: 17- OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at < 34 weeks.展开更多
目的探讨未足月胎膜早破(PPROM)产妇分娩孕周、分娩时机对母婴结局的影响。方法选取南阳医学高等专科学校第一附属医院收治的PPROM产妇217例(孕28~36周),另选取足月妊娠产妇100例(孕37~41周)。收集并比较不同分娩孕周、分娩时机产妇和...目的探讨未足月胎膜早破(PPROM)产妇分娩孕周、分娩时机对母婴结局的影响。方法选取南阳医学高等专科学校第一附属医院收治的PPROM产妇217例(孕28~36周),另选取足月妊娠产妇100例(孕37~41周)。收集并比较不同分娩孕周、分娩时机产妇和新生儿的临床资料,包括分娩孕周、分娩时机、分娩方式、母亲并发症、新生儿结局。结果不同分娩孕周产妇分娩方式,母亲羊膜腔感染、产后出血、产褥感染发生率,新生儿窒息、NRDS、HIE、死亡发生率及产后1、5 min Apgar评分比较,差异有统计学意义(P<0.05)。不同分娩时机产妇母亲羊膜腔感染、产后出血、产褥感染发生率比较,差异有统计学意义(P<0.05);新生儿窒息、NRDS、HIE、死亡发生率及产后1、5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论 PPROM可引起不良分娩结局和剖宫产率的上升,胎膜早破至分娩时间越长母体发生产期并发症的风险越高。展开更多
OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that ...OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium- stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.展开更多
文摘Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20- 27.9, 28- 33.9 vs 34- 36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17- OHP caproate versus placebo. Effectiveness of 17- OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20- 27.9, 28- 33.9, and 34- 36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17- OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17- OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver < 37 weeks (42% vs 63% , P = .026 and 34% vs 56% , P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17- OHP caproate or control. Conclusion: 17- OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at < 34 weeks.
文摘目的探讨未足月胎膜早破(PPROM)产妇分娩孕周、分娩时机对母婴结局的影响。方法选取南阳医学高等专科学校第一附属医院收治的PPROM产妇217例(孕28~36周),另选取足月妊娠产妇100例(孕37~41周)。收集并比较不同分娩孕周、分娩时机产妇和新生儿的临床资料,包括分娩孕周、分娩时机、分娩方式、母亲并发症、新生儿结局。结果不同分娩孕周产妇分娩方式,母亲羊膜腔感染、产后出血、产褥感染发生率,新生儿窒息、NRDS、HIE、死亡发生率及产后1、5 min Apgar评分比较,差异有统计学意义(P<0.05)。不同分娩时机产妇母亲羊膜腔感染、产后出血、产褥感染发生率比较,差异有统计学意义(P<0.05);新生儿窒息、NRDS、HIE、死亡发生率及产后1、5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论 PPROM可引起不良分娩结局和剖宫产率的上升,胎膜早破至分娩时间越长母体发生产期并发症的风险越高。
文摘OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium- stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.
