Progestogen administration in pregnancy may prevent preterm delivery

Article Abstract:

Progesterone is a hormone produced by the corpus luteum (and later by the placenta) which is essential in maintaining pregnancy. Some studies have shown that given early in pregnancy, progesterone can prevent recurrent miscarriage. Most of the controversy surrounding the beneficial effects of progesterone is centered on the type of agent used. The type of progestational agents may vary from study to study. To help clarify this issue, an analysis of all clinical trials using one of the most fully studied progestational agents, 17 alpha-hydroxyprogesterone caproate, is reported. Seven recent controlled trials were found that examined the beneficial effects of hydroxyprogesterone caproate in preventing miscarriage. Six of these studies involved women who were at high risk for miscarriage or preterm birth (delivery before the 37th completed week of pregnancy). There was no evidence that hydroxyprogesterone caproate was useful in preventing miscarriage. However, the rate of preterm birth was reduced, which was reflected by the decreased rate of low-birth-weight infants born to women who took hydroxyprogesterone caproate. There was no significant reduction in the number of infant complications or infant deaths among the women treated with progesterone. Therefore, there is no evidence supporting the beneficial effect of hydroxyprogesterone caproate upon the incidence of miscarriage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Drug therapy, Miscarriage, Progesterone

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Midwifery in the Netherlands. The Wormerveer study; Selection, mode of delivery, perinatal mortality and infant morbidity

Article Abstract:

Midwives are qualified, licenced health practitioners who provide prenatal care and attend childbirth for women with uncomplicated pregnancies. If medical or obstetrical complications arise, the midwife refers the patient to the appropriate obstetrical specialist. In the Netherlands, between 1969 and 1983, 7,980 pregnant women sought prenatal care at midwifery based practices. Total perinatal mortality (infant deaths occurring before, during and after birth, expressed as the number of deaths per 1000 births) was 11.1 per 1000, significantly less than the national perinatal mortality rate of 14.5 per 1000. The perinatal mortality rate was highest, 51.7 per 1000, among infants whose mothers were referred to obstetrical specialists during pregnancy. Perinatal mortality was very low, 2.3 per 1000, in infants assigned to the low risk group during pregnancy. The total cesarean section rate was 1.4 percent and 0.4 percent rate for the low risk group. Only 3.8 percent of the infants cared for by midwives needed hospital admission. Researchers concluded that prenatal and childbirth care provided by midwives, with appropriate patient selection, has very good obstetrical results in the Netherlands.

Case studies, Netherlands, Childbirth at home, Home childbirth, Obstetrical research, Labor, Complicated, Labor complications

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Perinatal mortality in rural Tanzania

Article Abstract:

Death during the perinatal period, between 28 weeks of pregnancy and 28 days after birth, is related to maternal health and adequate prenatal medical care. Factors affecting perinatal death in a rural community in the highlands of Tanzania, Africa were studied. There were 3,054 births between 1971 and 1976, and 1,929 births between 1977 and 1979. Policies aimed at reducing prolonged labor, which contributes to fetal well-being, were incorporated into the obstetrical program of a rural hospital. The perinatal mortality was reduced from 71 to 39 deaths per 1,000 births. Of the 137 stillbirths that occurred, 25 percent could have been avoided. Close perinatal monitoring can help to reduce morbidity and mortality in infants and mothers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Tanzania

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