Analysis of preterm deliveries below 35 weeks' gestation in a tertiary referral hospital in the UK. A case-control survey

<p>Abstract</p> <p>Background</p> <p>Preterm birth remains a major public health problem and its incidence worldwide is increasing. Epidemiological risk factors have been investigated in the past, but there is a need for a better understanding of the causes of preterm birth in well defined obstetric populations in tertiary referral centres; it is important to repeat surveillance and identify possible changes in clinical and socioeconomic factors associated with preterm delivery. The aim of this study was to identify current risk factors associated with preterm delivery and highlight areas for further research.</p> <p>Findings</p> <p>We studied women with singleton deliveries at St Michael's Hospital, Bristol during 2002 and 2003. 274 deliveries between 23-35 weeks' gestation (preterm group), were compared to 559 randomly selected control deliveries at term (37-42 weeks) using standard statistical procedures. Both groups were >80% Caucasian. Previous preterm deliveries, high maternal age (> 39 years), socioeconomic problems, smoking during pregnancy, hypertension, psychiatric disorders and uterine abnormalities were significantly associated with preterm deliveries. Both lean and obese mothers were more common in the preterm group. Women with depression/psychiatric disease were significantly more likely to have social problems, to have smoked during pregnancy and to have had previous preterm deliveries; when adjustments for these three factors were made the relationship between psychiatric disease and pregnancy outcome was no longer significant. 53% of preterm deliveries were spontaneous, and were strongly associated with episodes of threatened preterm labour. Medically indicated preterm deliveries were associated with hypertension and fetal growth restriction. Preterm premature rupture of the membranes, vaginal bleeding, anaemia and oligohydramnios were significantly increased in both spontaneous and indicated preterm deliveries compared to term controls.</p> <p>Conclusions</p> <p>More than 50% of preterm births are potentially preventable, but remain associated with risk factors such as increased uterine contractility, preterm premature rupture of the membranes and uterine bleeding whose aetiology is unknown. Despite remarkable advances in perinatal care, preterm birth continues to cause neonatal deaths and long-term morbidity. Significant breakthroughs in the management of preterm birth are likely to come from research into the mechanisms of human parturition and the pathophysiology of preterm labour using multidisciplinary clinical and laboratory approaches.</p

Is adenomyosis the neglected phenotype of an endomyometrial dysfunction syndrome?

Since the dissociation between adenomyoma and endometriosis in the 1920s and the laparoscopic progress in the diagnosis and surgery of endometriosis, the literature has been greatly focused on the disease endometriosis. The study of adenomyosis, on the other hand, has been neglected as the diagnosis remained based on hysterectomy specimens. However, since the introduction of magnetic resonance and sonographic imaging techniques in the 1980s, the myometrial junctional zone has been identified as a third uterine zone and interest in adenomyosis was renewed. This has also been the start for the interest in the role of the myometrial junctional zone dysfunction and adenomyosis in reproductive and obstetrical disorders

Accuracy and use of WHO hemoglobin color scale for diagnosis of anemia among pregnant women by health care providers in periurban settings in Karachi, Pakistan

The study assessed the diagnostic accuracy of the Hemoglobin Color Scale (HCS), comparing clinical signs assessment technique (CSAT) of health care providers against the gold standard of laboratory hemoglobinometry. A cross-sectional validation study was conducted among 194 pregnant women located in 2 towns of periurban settings in Karachi, from June 2012 to February 2013. Anemia was assessed by HCS and CSAT by health care providers and compared with laboratory hemoglobinometry. The sensitivity and specificity of HCS were 70.9% (95% CI = 62.7-78.3) and 49.1% (95% CI = 35.1-63.2); for CSAT they were 95.7% (95% CI = 91.0-98.4) and 5.7% (95% CI = 1.2-15.7), respectively. The area under the curve for HCS for diagnosis of anemia was 0.60 (95% CI = 0.52-0.66), compared with 0.50 (95% CI = 0.43-0.57) for CSAT (P = .01). The accuracy of HCS is better than CSAT for assessing anemia by health care providers among pregnant women

Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial

OBJECTIVE: To compare oral iron to intravenous iron administration to women in late pregnancy and/or after labor to correct iron deficiency. METHODS: 271 anemic women (148 pregnant women and 123 women post lower segment caesarean section) with hemoglobin (Hb) levels below 110 g/L were enrolled over a two-year period and randomized to receive either two tablets FGF (ferrous sulfate with folic acid) or 400mg of intravenous iron sucrose plus folic acid 600 mg. Treatment effectiveness was assessed by measuring Hb and ferritin postpartum on day 1, day 14 and day 42. Transfusions of red blood cells and adverse drug reactions were recorded. RESULTS: Data of 214 women were available for analysis. Both forms of iron replacement therapy led to increased hemoglobin and ferritin levels over the testing period. Ferritin was significantly higher in the i.v. iron treatment group compared to the oral iron treatment group (p¼0.004) two weeks after delivery, while Hb values did not differ between the groups. No serious adverse drug reactions were observed. Red blood cell transfusion rate was low (1.9%), with equal rates observed in both treatment groups. CONCLUSION: Intravenous and oral irons were both effective in correcting peripartum anemia, although intravenous iron restored stores faster than oral iron.Bernd Froessler, Carmel Cocchiaro, Khaschayar Saadat-Gilani, Nicolette Hodyl and Gustaaf Dekke