Could the consequences of premature delivery be further attenuated by means of new prenatal strategies? (original) (raw)
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Preterm Birth, Prevention, Prediction, Care
European Journal of Medical and Health Sciences
Preterm delivery is defined by the World Health Organization (WHO) as occurring before 37 weeks of pregnancy or in less than 259 days following the start of a woman's last menstrual cycle The mortality rate for children under the age of five is extremely concerning. Prematurity is the leading cause of death before the age of five around the world, and even when exceptional medical care is provided, children who survive still face long-term physical, developmental, neurological, and cognitive problems. According to the World Health Organization, 15 million babies are born prematurely each year, at least three weeks before their due dates. The top obstetricians, neonatologists, geneticists, microbiologists, immunologists, epidemiologists, health policy specialists, and bioengineers at Stanford are still conducting research to learn the main reason or causes of preterm delivery as well as the science of preterm birth This article reviewed how preterm birth occurs and the risk fact...
Preterm birth: seven-year retrospective study in a single centre population
Italian Journal of Pediatrics
Background: Preterm birth is a health and social problem, considered the leading cause of neonatal mortality worldwide. It is associated with higher rates of neurodevelopmental morbidity, sensorineural impairments and other complications. The aim of the study was to describe the incidence and the major risk factors associated with preterm birth. Methods: We performed a single center, observational and retrospective Cohort study in the Division of Obstetrics and Gynaecology, University Hospital "G. Martino", Messina. Clinical records of all pregnant women who delivered from 1st January 2010 to 31 of December 2016 were collected. Results: In the 7 years considered, a total of 7954 pregnant women were included in our study. The majority of all preterm births were due to infants born late preterm (71.83%), 26.45% were due to preterm and 1.72% to extremely preterm. The preterm cohort had a higher proportion of history of preterm delivery (p < 0.0001), and unmarried (p = 0.003) and underweight or obese patients (p < 0.0001). In addition, prematurity was associated with presence of uterine anomalies (p < 0.0001), vaginal/urinary infections (p = 0.02), poli/oligohydramnios (p < 0.0001), maternal diabetes (p = 0.004), hypertension (p < 0.0001), short cervical length (p < 0.0001). Conclusions: We suggest prompt identification of all risk factors associated with preterm birth to apply immediate and appropriate specific interventions.
Overview. Preterm labour: mechanisms and management
BMC Pregnancy and Childbirth, 2007
Preterm birth remains a major cause of perinatal mortality and long term handicap in surviving infants. This is one of the most important clinical problems in Europe and across the world. While some preterm births are iatrogenic, associated with severe complications of pregnancy (e.g. hypertensive disorders, antepartum haemorrhage, infection), or the result of multiple pregnancies following assisted reproduction, a high
Born Too Soon: Care for the preterm baby
2013
Preterm baby survival and care round the world Each year 15 million babies are born preterm and their survival chances vary dramatically around the world [1]. For the 1.2 million babies born in high income countries, increasing complexity of neonatal intensive care over the last quarter of the 20th century has changed the chances of survival at lower gestational ages. Middle-income and emerging economies have around 3.8 million preterm babies each year, and whilst some countries such as Turkey and Sri Lanka have halved deaths for preterm babies within a decade, other countries have made minimal progress [2]. South Asia and sub-Saharan Africa account for almost two-thirds of the world's preterm babies and over three-quarters of the world's newborn deaths due to preterm birth complications [1]. Worldwide, almost half of preterm babies are born at home, and even for those born in facilities, essential newborn care is often lacking.
A prospective analysis of etiology and outcome of preterm labor
2007
To identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery. METHOD(S) : In this prospective cohort study conducted over a 8 months period (January to August 2005) 416 antenatal women admitted with threatened preterm labor and in preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed. RESULTS : Incidence of preterm labor was 22% and that of preterm deliveries 20.9% Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly high (P<0.0001) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity. RDS was significantly reduced in those who completed steroid cover (P=0.029). CONCLUSION(S) : There is a high incidence of preterm labor and preterm births in our set up, compared to developed countries. Infection is one important modifiable risk factor which can be curtailed. Prolongation of delivery for 48 hours by giving tocolysis for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.
Reproductive Health, 2013
Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies that promote safe motherhood and universal access to care before, during and after pregnancy. The aim of this paper is to present the latest information about available interventions that can be delivered during pregnancy to reduce preterm birth rates and improve the health outcomes of the premature baby, and to identify data gaps. The paper also focuses on promising avenues of research on the pregnancy period that will contribute to a better understanding of the causes of preterm birth and ability to design interventions at the policy, health care system and community levels. At minimum, countries need to ensure equitable access to comprehensive antenatal care, quality childbirth services and emergency obstetric care. Antenatal care services should include screening for and management of women at high risk of preterm birth, screening for and treatment of infections, and nutritional support and counselling. Health workers need to be trained and equipped to provide eff ective and timely clinical management of women in preterm labour to improve the survival chances of the preterm baby. Implementation strategies must be developed to increase the uptake by providers of proven interventions such as antenatal corticosteroids and to reduce harmful practices such as non-medically indicated inductions of labour and caesarean births before 39 weeks of gestation. Behavioural and community-based interventions that can lead to reductions in smoking and violence against women need to be implemented in conjunction with antenatal care models that promote women's empowerment as a strategy for reducing preterm delivery. The global community needs to support more discovery research on normal and abnormal pregnancies to facilitate the development of preventive interventions for universal application. As new evidence is generated, resources need to be allocated to its translation into new and better screening and diagnostic tools, and other interventions aimed at saving maternal and newborn lives that can be brought to scale in all countries. Declaration This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.