The impact of funneling shape on the secondary prevention of spontaneous preterm birth in patients treated with either an Arabin pessary, McDonald cerclage or early total cervical occlusion (ETCO)

Objective We sought to determine if the rate of recurrent spontaneous preterm birth (PTB) in women treated with 17-α hydroxyprogesterone caproate (17-OHPC) is modified by maternal body mass index (BMI). Study Design We performed a secondary analysis of the Maternal-Fetal Medicine Units Network omega-3 fatty acid supplementation to prevent recurrent PTB randomized controlled trial. All women received 17-OHPC. Results A total of 708 women were included. Rates of spontaneous PTB did not vary significantly by BMI category. With stratification by obesity class and gestational age at delivery, the unadjusted risk for PTB using earlier gestational cutoffs (< 35, 32, and 28 weeks) demonstrated an association between preterm delivery and increasing severity of obesity. With adjustment for potential confounders, there was no statistically significant relationship between BMI and spontaneous PTB. Conclusion We demonstrated that the risk of PTB in women receiving 250 mg 17-OHPC is not dependent on maternal BMI after adjustment for confounding variables. Pharmacokinetic studies have demonstrated a wide variation in plasma concentration of 17-OHPC across the population with likely considerable overlap in plasma concentrations among the obese and nonobese population. Further studies are needed to evaluate the impact of BMI on efficacy of 17-OHPC prior to any dose adjustment in this population.

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Clinical Pharmacology Aspects of Some Tocolytic Drugs Used in Pregnant Women at Risk of Preterm Birth

The Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products ◽

10.30895/1991-2919-2019-9-3-162-166 ◽

2019 ◽

Vol 9 (3) ◽

pp. 162-166

Author(s):

E. A. Sоkоvа ◽

R. A. Chilova ◽

O. A. Demidova ◽

K. O. Akopov

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Preterm Labour ◽

Plasma Concentrations ◽

Cyclooxygenase Inhibitors ◽

Pharmacokinetic Parameters ◽

Clinical Effects ◽

Spontaneous Preterm Birth ◽

Rational Pharmacotherapy ◽

The Impact

Spontaneous preterm birth is one of the most pressing issues in obstetrics, as it remains one of the leading causes of newborn morbidity and mortality. Pending issues of aetiology, pathogenesis, and absence of medicinal products indicated for the treatment of spontaneous preterm labour pose a challenge for rational pharmacotherapy. The paper presents the results of a scientific literature review on the problem of rational pharmacotherapy of spontaneous preterm labour using tocolytic drugs — calcium channel blockers, cyclooxygenase inhibitors. The paper summarises specific pharmacokinetic parameters of these drugs during pregnancy. It discusses pharmacogenetic aspects of using tocolytic drugs in pregnant women and their potential clinical effects. It was demonstrated that women with threatened miscarriage had high interindividual variability in nifedipine plasma concentrations depending on CYP3A5 genotype. It was shown that certain genetic polymorphisms of CYP2C9 may lead to an increased metabolic rate and an increase in indomethacin clearance resulting in the reduction of its efficacy. Yet, there is minimal research regarding this issue. Therefore, further research is needed to assess the impact of CYP3A5 and CYP2C9 genotypes on the efficacy and safety of nifedipine and indomethacin used as tocolytic drugs in obstetrics.

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Controversies about the Secondary Prevention of Spontaneous Preterm Birth

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-0611-5337 ◽

2018 ◽

Vol 78 (06) ◽

pp. 585-595 ◽

Cited By ~ 7

Author(s):

Ioannis Kyvernitakis ◽

Holger Maul ◽

Franz Bahlmann

Keyword(s):

Preterm Birth ◽

Secondary Prevention ◽

Cervical Ripening ◽

Transvaginal Sonography ◽

Spontaneous Preterm Birth ◽

Long Term Outcome ◽

Meta Analyses ◽

Twin Pregnancies ◽

Singleton Pregnancies

AbstractPreterm birth is one of the major global health problems and part of the Millennium Development goals because of the associated high number of perinatal or neonatal mortality and long-term risks of neurodevelopmental and metabolic diseases. Transvaginal sonography has meanwhile been established as a screening tool for spontaneous preterm birth despite its relatively low sensitivity when considering only the cervical length. Vaginal progesterone has been shown to reduce prematurity rates below 34 weeks in a screening population of singleton pregnancies. Up to now, no positive long-term effect could be demonstrated after 2 years. It seems to have no benefit to prolong pregnancies after a period of preterm contractions and in risk patients without cervical shortening. Meta-analyses still demonstrate conflicting results dependent on quality criteria used for selection. A cerclage is only indicated in singleton pregnancies with previous spontaneous preterm birth and a combined cervical shortening in the current pregnancy. Nevertheless, the short- and long-term outcome has never been evaluated, whereas maternal complications may be increased. There is no evidence for a prophylactic cervical cerclage in twin pregnancies even in cases with cervical shortening. Emergency cerclage remains an indication after individual counseling. The effect of a cervical pessary in singleton pregnancy seems to be more pronounced in studies where a few investigators with increasing experience have treated and followed the patients at risk for preterm birth. Mainly in twin pregnancies, pessary treatment seems to be promising compared to other treatment options of secondary prevention when the therapy is started at early stages of precocious cervical ripening. At present, several international trials with the goal to reduce global rates of prematurity are in progress which will hopefully allow to specify the indications and methods of intervention for certain subgroups. When trials are summarized, prospective meta-analyses carry a lower risk of bias than the meanwhile uncontrolled magnitude of retrospective meta-analyses with conflicting results.

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672: The impact of parity on spontaneous preterm birth in women with a twin gestation

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2007.10.700 ◽

2007 ◽

Vol 197 (6) ◽

pp. S193

Author(s):

Danielle Castagnola ◽

Matthew Hoffman ◽

Khanh-Ha Nguyen ◽

Anthony Sciscione

Keyword(s):

Preterm Birth ◽

Spontaneous Preterm Birth ◽

The Impact

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The Impact of Medically Indicated and Spontaneous Preterm Birth among Hypertensive Women

American Journal of Perinatology ◽

10.1055/s-0033-1333676 ◽

2013 ◽

Vol 30 (10) ◽

pp. 843-848 ◽

Cited By ~ 7

Author(s):

Carlos Carreno ◽

Sean Blackwell ◽

Baha Sibai ◽

Benjamin Kase

Keyword(s):

Preterm Birth ◽

Spontaneous Preterm Birth ◽

The Impact

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The impact of high body mass index on the prediction of spontaneous preterm birth by ultrasonographic cervical length

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2005.10.169 ◽

2005 ◽

Vol 193 (6) ◽

pp. S54

Author(s):

Israel Hendler (F)

Keyword(s):

Body Mass Index ◽

Preterm Birth ◽

Body Mass ◽

High Body Mass Index ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

High Body ◽

The Impact

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Ethnic differences in the impact of male fetal gender on the risk of spontaneous preterm birth

Journal of Perinatology ◽

10.1038/s41372-021-01024-7 ◽

2021 ◽

Author(s):

Myrthe J. C. S. Peelen ◽

Brenda M. Kazemier ◽

Anita C. J. Ravelli ◽

Christianne J. M. de Groot ◽

Joris A. M. van der Post ◽

...

Keyword(s):

Preterm Birth ◽

Ethnic Differences ◽

Spontaneous Preterm Birth ◽

Fetal Gender ◽

The Impact

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The Impact of Previous Obstetric History on the Risk of Spontaneous Preterm Birth in Women with a Sonographic Short Cervix

American Journal of Perinatology ◽

10.1055/s-0040-1705169 ◽

2020 ◽

Vol 37 (12) ◽

pp. 1189-1194

Author(s):

Carolynn M. Dude ◽

Lisa D. Levine ◽

Nadav Schwartz

Keyword(s):

Preterm Birth ◽

Full Term ◽

Secondary Outcome ◽

Spontaneous Preterm Birth ◽

Short Cervix ◽

Term Birth ◽

Obstetric History ◽

Nulliparous Women ◽

History Of ◽

The Impact

Abstract Objective The natural history of women with a short cervix and a low-risk obstetric history remains poorly defined. In our study, we sought to better characterize the impact of previous obstetric history on the delivery outcomes in women diagnosed with a mid-trimester sonographic short cervix. Study Design We performed a retrospective cohort study of women with singleton gestations who underwent transvaginal cervical length screening between 16 and 24 weeks at two urban hospitals in Philadelphia between January 2013 and March 2018 and were found to have a short cervix (defined as ≤2 cm). Women were excluded from the cohort if there were major fetal anomalies noted or if delivery outcome information was not available. The cohort was then divided into three groups based on obstetric history: nulliparous, history of full-term birth only, or history of spontaneous preterm birth (sPTB). The primary outcome was sPTB <37 weeks, while the secondary outcome was sPTB <34 weeks. Results Our cohort included a total of 384 singleton pregnancies that were diagnosed with a sonographic short cervix: 165 women were nulliparous, 119 women had a history of full-term birth, and 100 women with a history of sPTB. We found that women with a short sonographic cervix had a sPTB rate of 39.6% with no differences found between the three groups. Only two-thirds of nulliparous women and women with a history of full-term birth received the recommended preventative treatment, compared with almost 100% of women with a history of sPTB. Conclusion Women with and without a history of sPTB are at comparable risk of sPTB in the presence of a sonographically short cervix. Preventative therapies should be recommended to both nulliparous women and women with a history of full-term birth since uptake in this population are not as high.

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