Preterm birth: a puzzle worth solving

Article Abstract:

Preterm birth, the delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Despite improvements in perinatal medicine, preterm delivery is responsible for 60 percent of illness and death in the neonatal period. In fact, the incidence of preterm births has increased in recent years. About 20 percent of the preterm deliveries are initiated to remove the fetus from a hostile environment created by a disease in the mother, while the rest are spontaneous. The medical, social and economic implications of preterm birth are the consequences of a poor understanding of the mechanism of preterm labor and the failure of drugs (tocolytic agents) to effectively arrest labor once it has started. At present, preterm prevention programs focus on early diagnosis (before the cervix dilates and flattens) and delay of labor. The earlier preterm labor is confirmed, the more likely labor can be arrested with tocolytic agents. First, the clinician must identify patients at risk for preterm labor. Risk factors include a previous history of preterm labor and delivery, more than one fetus, fibroid tumors (myoma), abnormal uterus, multiple abortions, incompetent cervix, exposure to diethylstilbestrol (DES) and dilation of the cervix (without labor). Secondly, patients should be taught the signs and symptoms of preterm labor such as low back pain, abdominal cramps, contractions, increased vaginal discharge, a heavy feeling in the pelvic area, diarrhea and menstrual-like cramping. Thirdly, intermittent gentle examination of the cervix is required to check for dilatation and thinning (effacement) of the cervix. The outcomes of prevention programs vary. Inconsistencies arise because physicians differ in their medical management and attitudes towards low birth weight, and the accuracy of contraction monitoring varies from study to study. Recently, a home monitoring system has been developed to measure the frequency and type of uterine contractions. The addition of home monitoring devices to preterm prevention programs has improved early diagnosis of preterm labor. The diagnosis of preterm labor in identified high-risk patients should include home monitoring, analysis of patient-perceived signs and symptoms (through patient education), daily nursing assessments and intermittent physical examinations. (Consumer Summary produced by Reliance Medical Information, Inc.)

---

Preventing preterm birth in twin gestation: home uterine activity monitoring and perinatal nursing support

Article Abstract:

Preterm birth, delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Preterm deliveries are more common in women carrying twins. Programs aimed at reducing the incidence of preterm delivery focus on identifying pregnancies at risk for early labor. A new home monitoring system measures, records and transmits patterns of uterine contractions via the telephone, which nursing specialists then assess for signs and symptoms of labor. The sooner preterm labor is detected, the more possible it is to arrest it with tocolytic drugs. The signs and symptoms of preterm labor include dilation of the cervix accompanied by regular uterine contractions. To see if home monitoring and daily nursing support helps detect preterm labor early, 45 women experiencing an initial episode of preterm labor while carrying twins were studied. Women were assigned to receive either home monitoring plus perinatal nursing support (19 patients) or a regular program of education regarding the signs and symptoms of labor (26 patients). Uterine patterns were transmitted to the perinatal nursing service twice a day, and nurses were available 24 hours a day. All the patients had a physical exam at least every two weeks. Preterm labor developed in 16 (62 percent) of the women who received the standard patient education protocol and 14 (74 percent) of the women in the home monitoring and nursing support program; this difference was not statistically significant, however. Cervical dilation was detected early (while it was less than three centimeters) in all of the monitored women experiencing preterm labor and in 10 of the women receiving the education protocol. The average dilation in the monitored group was 1.6 centimeters, compared with 2.9 centimeters in the education group (delivery occurs when the dilation of the cervix reaches about 10 centimeters). More of the patients receiving education alone delivered prematurely (81 percent) than women receiving home monitoring plus nursing support (50 percent). Home monitoring and nursing support was able to diagnose labor earlier and lower the preterm delivery rate by one third in women carrying twins. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Premature birth

---

Home uterine activity monitoring is associated with a reduction in preterm birth

Article Abstract:

Preterm birth, the delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Despite advances in perinatal medicine, preterm delivery continues to be a leading cause of illness and death during the delivery and neonatal period. Preterm birth prevention involves identifying women at risk for preterm delivery, diagnosing preterm labor as early as possible and arresting labor with tocolytic drugs so that pregnancy can be effectively prolonged. Programs designed to teach women the signs and symptoms of preterm labor have yielded mixed results. It is thought that these programs are lacking information regarding the frequency and validity of uterine contractions. A new home monitoring system measures, records and transmits patterns of uterine contractions via the telephone, which are then interpreted by nursing specialists available 24 hours a day. The value of home monitoring was evaluated in women at risk for early delivery. Women were assigned to receive home monitoring plus daily nursing support (155 women) or a standard program of care involving intensive education and frequent prenatal visits (144 women). The patients receiving home monitoring combined with daily nursing contact were diagnosed with preterm labor earlier (when the cervix was less than two centimeters dilated), had more successful tocolysis (pharmacological arrest of preterm delivery), and could carry the pregnancy to term more often than the women receiving standard prenatal care. The diagnosis of preterm labor was made more often in the monitored group (31 percent) than in the group relying on patient-perceived signs and symptoms. It is concluded that detection of preterm labor can be achieved earlier if a home monitoring system combined with nursing support is added to preterm prevention programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Similar abstracts:

• Abstracts: Yersinia enterocolitica O:33 infections in infants and children, associated with the household preparation of chitterlings
• Abstracts: Maintenance treatment of duodenal ulceration: ranitidine 300 mg at night is better than 150 mg in cigarette smokers
• Abstracts: Why do physicians stop practicing obstetrics? The impact of malpractice claims. Characteristics of physicians with obstetric malpractice claims experience
• Abstracts: The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy
• Abstracts: Pearly penile papules: absence of human papillomavirus DNA by the polymerase chain reaction

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.