Etiologies of preterm birth in an indigent population: Is prevention a logical expectation?

Article Abstract:

Preterm births occur when fewer than 37 of the 40 weeks of pregnancy have elapsed, and can be caused by spontaneous preterm labor, spontaneous premature rupture of membranes, or a medical decision to induce delivery due to a maternal or fetal complication. Information regarding the incidence of preterm birth and its causes was collected from medical records to determine what proportion of preterm births could have been prevented with proper obstetrical care. Preterm births accounted for 11 percent (1,445 of 13,119) of singleton (single infant) births in a large, poor community (70 percent of patients were black) from 1982 to 1986. Of these 1,445 preterm births, 46, 28 and 26 percent were due to spontaneous preterm labor, spontaneous premature rupture of membranes (PROM), and indicated preterm labor (induced because of maternal or fetal complications), respectively. The percentages of preterm births according to gestational age were 44 percent between 35 and 36 weeks, 32 percent between 31 and 34 weeks, and 24 percent before 30 weeks. Collectively, almost 77 percent of these preterm births (1,109 of 1,445) occurred in cases in which obstetricians would not attempt to prevent labor (either between 35 and 36 weeks or after spontaneous PROM) or when maternal or fetal complications made it necessary to induce delivery. Therefore, only 23 percent of the preterm births in this study were potentially preventable, which, these authors conclude, is a respectable rate given the current maternal screening process available in poor communities. It is concluded that reducing the rate of preterm birth below the level found in this study would be difficult. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Demographic aspects, Pregnant women, Premature birth, Pregnancy, Complications of, Pregnancy complications

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Is indicated or spontaneous preterm delivery more advantageous for the fetus?

Article Abstract:

Infants born prematurely have a high incidence of respiratory distress syndrome (serious impairment of breathing), primarily as a result of the immaturity of their lungs. However, research results suggest that pregnancies with complications are associated with a faster rate of maturation of the fetal lung, possibly because of the manufacture of certain hormones by the 'stressed' fetus. To determine whether, in fact, intrauterine stress confers an advantage upon fetuses born before term (before 37 weeks' gestation), 337 newborns born prematurely because of pregnancy complications (the cases) were compared with newborns delivered by spontaneous preterm labor without rupture of membranes (the membranes that surround the fetus), and with infants delivered prematurely after premature rupture of membranes, or PROM (the two control groups). Each subject in the case group (with an indicated preterm delivery) was matched for age, race, and fetal sex with either a woman in the spontaneous preterm labor control group or a woman in the PROM control group. Several variables related to maternal outcome, delivery, and neonatal outcome were evaluated. Results showed no advantage in terms of survival or complications for infants born after complicated pregnancies. However, this group had a lower rate of necrotizing enterocolitis (a serious disease of the gastrointestinal tract, which can be fatal) than either control group, and the PROM group had more neonatal sepsis (systemic infection) than its matched indicated preterm delivery group. Overall, the results do not support the contention that 'stressed' pregnancies are advantageous for the preterm infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Complications and side effects, Diseases, Infants (Premature), Premature infants, Infant mortality, Premature labor

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Maternal serum thromboxane B2 reduction versus pregnancy outcome in a low-dose aspirin trial

Article Abstract:

Pregnant women with less thromboxane in their blood appear to have better outcomes and fewer complications. Thromboxane A2 constricts blood vessels. Aspirin inhibits its production. A total of 558 healthy women expecting a first baby were randomly assigned to take low doses of aspirin or a placebo beginning at 24 weeks gestation. Blood levels of thromboxane were measured periodically. Among the 283 women taking aspirin, 223 had greater than a twofold reduction in levels of thromboxane between 24 and 29 weeks gestation compared with 91 of 275 women taking the placebo. Conversely, 184 women taking the placebo had an increase in thromboxane compared with 60 aspirin takers. Women with greater than a twofold reduction in thromboxane were less likely to have a small-for-gestational-age baby, had fewer preterm births and were less likely to develop preeclampsia than women with less than a twofold reduction in thromboxane.

Physiological aspects, Childbirth, Delivery (Childbirth), Thromboxanes, Aspirin

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