The management of preterm labor Goldenberg, Robert L
Obstetrics and gynecology (New York. 1953),
2002, Letnik:
100, Številka:
5
Journal Article
Recenzirano
Preterm birth is the leading cause of neonatal mortality and a substantial portion of all birth-related short- and long-term morbidity. Spontaneous preterm labor is responsible for more than half of ...preterm births. Its management is the topic of this review. Although there are many maternal characteristics associated with preterm birth, the etiology in most cases is not clear, although, for the earliest cases, the role of intrauterine infection is assuming greater importance. Most efforts to prevent preterm labor have not proven to be effective, and equally frustrating, most efforts at arresting preterm labor once started have failed. The most important components of management, therefore, are aimed at preventing neonatal complications through the use of corticosteroids and antibiotics to prevent group B streptococcal neonatal sepsis, and avoiding traumatic deliveries. Delivery in a medical center with an experienced resuscitation team and the availability of a newborn intensive care unit will ensure the best possible neonatal outcomes. Obstetric practices for which there is little evidence of effectiveness in preventing or treating preterm labor include the following: bed rest, hydration, sedation, home uterine activity monitoring, oral terbutaline after successful intravenous tocolysis, and tocolysis without the concomitant use of corticosteroids.
Linked article This is a mini commentary on M Richards et al., pp. 722–730 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.16977
Cause of stillbirth reporting Goldenberg, RL
BJOG : an international journal of obstetrics and gynaecology,
January 2018, 2018-01-00, 20180101, Letnik:
125, Številka:
2
Journal Article
Linked article: This is a mini commentary on PE van Beek et al., pp. 529–538 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17010
Objective
To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes.
Design
Prospective cohort study.
Setting
Rural India and Pakistan.
Population
Pregnant women ...residing in the study catchment area.
Methods
We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post‐delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10–10.9 g/dl), moderate (7–9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days.
Results
A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)—normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28‐day neonatal mortality (n/1000)—normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage.
Conclusion
Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered.
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Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle‐income countries.
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Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle‐income countries.
The infectious origins of stillbirth Goldenberg, Robert L; Thompson, Cortney
American Journal of Obstetrics and Gynecology,
09/2003, Letnik:
189, Številka:
3
Book Review, Conference Proceeding, Journal Article
Recenzirano
Our objective was to determine the relationship between various types of perinatal infections and stillbirths.
By use of various textbooks on perinatal infections, multiple MEDLINE searches, and the ...reference list of all appropriate manuscripts, the appropriate English language literature was reviewed to define the relationship between various perinatal infections and stillbirths.
Infection may cause stillbirth by a number of mechanisms, including direct infection, placental damage, and severe maternal illness. A large variety of organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa. In developed countries, between 10% and 25% of stillbirths may be caused by an infection, whereas in developing countries, which often have much higher stillbirth rates, the contribution of infection is much greater. Ascending bacterial infection, both before and after membrane rupture, with organisms such as
Escherichia coli, group B streptococci, and
Ureaplasma urealyticum is usually the most common infectious cause of stillbirth. However, in areas where syphilis is very prevalent, up to half of all stillbirths may be caused by this infection alone. Malaria may be an important cause of stillbirth in women infected for the first time in pregnancy. The two most important viral causes of stillbirth are parvovirus and Coxsackie virus, although a number of other viral infections appear to be causal.
Toxoplasma gondii, leptospirosis,
Listeria monocytogenes, and the organisms that cause leptospirosis, Q fever, and Lyme disease have all been implicated as etiologic for stillbirth.
Because infection-related stillbirth is relatively rare in developed countries, and those that do occur are caused by a wide variety of organisms, reducing this etiologic component of stillbirth much further will be difficult. However, in certain developing countries, the stillbirth rate is so high and the infection-related component so great that achieving a substantial reduction in stillbirth should be possible simply by reducing maternal infections.
Importance of prenatal care in reducing stillbirth Goldenberg, RL; McClure, EM
BJOG : an international journal of obstetrics and gynaecology,
January 2018, 2018-01-00, 20180101, Letnik:
125, Številka:
2
Journal Article
Objective
Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health ...centres in resource‐limited countries.
Design
Cluster randomised trial.
Setting
Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia)
Methods
Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.
Main outcome measures
The primary outcome was a composite of maternal mortality, maternal near‐miss mortality, stillbirth, and neonatal mortality.
Results
During the 24‐month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound‐diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components.
Conclusions
Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced.
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Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
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Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.