Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial

Contains fulltext : 53264.pdf (publisher's version ) (Open Access)BACKGROUND: 15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC) has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery. At present, there are no data on the effectiveness of progesterone in the prevention of preterm birth in multiple pregnancies. METHODS/DESIGN: We aim to investigate the hypothesis that 17OHPC will reduce the incidence of the composite neonatal morbidity of neonates by reducing the early preterm birth rate in multiple pregnancies. Women with a multiple pregnancy at a gestational age between 15 and 20 weeks of gestation will be entered in a placebo-controlled, double blinded randomised study comparing weekly 250 mg 17OHPC intramuscular injections from 16-20 weeks up to 36 weeks of gestation versus placebo. At study entry, cervical length will be measured. The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 15% to 8%. Analysis will be by intention to treat. We will also analyse whether the treatment effect is dependent on cervical length. DISCUSSION: This trial will provide evidence as to whether or not 17OHPC-treatment is an effective means of preventing bad neonatal outcome due to preterm birth in multiple pregnancies. TRIAL REGISTRATION: Current Controlled Trials ISRCTN40512715

Idiopathic polyhydramnios and postnatal findings

Objective. Our objective was to investigate the outcome of neonates with idiopathic polyhydramnios in the first year after birth. Methods. All patients diagnosed in the Erasmus Medical Centre Rotterdam and the University Medical Centre Utrecht between January 2000 and April 2005 with idiopathic polyhydramnios were studied. The outcome variables included mode of delivery, pre-term delivery, birth weight, macrosomia, large-for-gestational-age (weightp90), neonatal or infant mortality and infant morbidity at 1 year after delivery. These were related to antenatal findings, including the onset of polyhydramnios and ultrasonographic evidence of macrosomia (estimated fetal weightp90). Results. Polyhydramnios was diagnosed at a mean gestational age (s.d.) of 31.04.9 weeks. The mean gestational age at birth (s.d.) was 37.93.7 weeks. Macrosomia at birth was present in 25.3% (22/88). Sixty-three of 88 infants were in good health 1 year after birth; 20 infants had an abnormality and 5 children had died. Macrosomia and detection of polyhydramnios in the third trimester was associated significantly with a good outcome. Conclusion. In neonates with idiopathic polyhydramnios, abnormalities were detected during the first year of life in 28.4%. Detection of polyhydramnios in the second trimester and low or normal birth weight are risk factors for associated abnormalities

Serum AFP screening in pregnancy for detection tube defects combined with specific ultrasound. Period january 1980 till january 1984

Zwangeren werden aan serum AFP-screening onderworpen om neuraalbuisdefecten op te sporen. Via gericht echografisch onderzoek bij vrouwen met een verhoogde AFP-concentratie werd het merendeel van de aanwezige congenitale afwijkingen, waaronder alle open neuraalbuisdefecten, gevonden. In dit onderzoek waren geen fout-positieve bevindingen, evenmin als fout-negatieve. Een kind met een gesloten neuraalbuisdefect had een normale AFP-concentratie. Bovendien blijkt een hoge serum AFP-concentratie indicatief voor andere zeer ernstige congenitale afwijkingen. Bij voldoende ervaring met het echografisch onderzoek zal vruchtwateronderzoek aanzienlijk beperkt kunnen blijven. Belangrijke conclusie uit het beschreven onderzoek is dat serum AFP-screening gecombineerd met echografisch onderzoek in een Nederlandse populatie zeer goed uitvoerbaar is mits aan een aantal randvoorwaarden wordt voldaan.GH