Preterm birth

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0030 ◽

2020 ◽

pp. 374-388

Author(s):

Angharad Care ◽

Zarko Alfirevic

Keyword(s):

Preterm Birth ◽

Individual Risk ◽

Novel Therapies ◽

Spontaneous Preterm Birth ◽

Healthcare Settings ◽

Upper Limit ◽

Environmental Interactions ◽

Prediction And Prevention ◽

Limit Of Viability ◽

Birth Preterm

This chapter discusses the epidemiology, prediction, prevention, and management of spontaneous preterm birth. Preterm birth is usually defined as delivery at any gestation before 37 completed weeks of pregnancy (<37+0 weeks, <259 days). The lower limit of preterm birth and upper limit of late spontaneous miscarriage are blurred as the limit of viability varies with differences in healthcare settings. This condition remains one of the biggest challenges facing obstetricians globally as a result of continuing high rates of morbidity and mortality. Spontaneous preterm birth is caused by a complex collection of pathophysiology with overlapping environmental interactions and behavioural influences that contribute to individual risk. Much debate exists regarding best prevention therapies and there remains a huge need for novel therapies and interventions for both prediction and prevention

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Prediction and Prevention of Spontaneous Preterm Birth in Twin Gestations

Seminars in Perinatology ◽

10.1053/j.semperi.2012.02.003 ◽

2012 ◽

Vol 36 (3) ◽

pp. 190-194 ◽

Cited By ~ 17

Author(s):

Sara G. Brubaker ◽

Cynthia Gyamfi

Keyword(s):

Preterm Birth ◽

Spontaneous Preterm Birth ◽

Prediction And Prevention

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Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality

Journal of Clinical Oncology ◽

10.1200/jco.2016.69.9439 ◽

2017 ◽

Vol 35 (14) ◽

pp. 1522-1529 ◽

Cited By ~ 21

Author(s):

Donghao Lu ◽

Jonas F. Ludvigsson ◽

Karin E. Smedby ◽

Katja Fall ◽

Unnur Valdimarsdóttir ◽

...

Keyword(s):

Preterm Birth ◽

Infant Mortality ◽

Neonatal Mortality ◽

Fetal Growth ◽

Preterm Births ◽

Positive Association ◽

Spontaneous Preterm Birth ◽

Rate Ratios ◽

Birth Preterm ◽

Number Of Births

Purpose To examine whether maternal cancer during pregnancy is associated with increased risks of stillbirth and infant mortality. Methods On the basis of nationwide health registers, we conducted a study of 3,947,215 singleton births in Sweden from 1973 through 2012. Exposure was defined as maternal cancer diagnosed during pregnancy (number of births = 984) or during the year after pregnancy (number of births = 2,723). We calculated incidence rate ratios (IRRs) for stillbirth and infant mortality, comparing exposed births to unexposed births. Small-for-gestational-age (SGA) and preterm births were examined as secondary outcomes. Results Maternal cancer diagnosed during pregnancy was positively associated with stillbirth (IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as SGA (IRR, 4.9; 95% CI, 2.2 to 11.0), and with preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Positive associations of maternal cancer diagnosed during pregnancy or the year after pregnancy were noted for both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality. Conclusion Maternal cancer during pregnancy is associated with increased risks of rare but fatal outcomes, including stillbirth and neonatal mortality. This may be due to conditions associated with fetal growth restriction and iatrogenic preterm birth. Careful monitoring of fetal growth and cautious decision making on preterm delivery should therefore be reinforced.

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