Impact of Obstetric History on the Risk of Spontaneous Preterm Birth in Singleton and Multiple Pregnancies

Objective We aimed to assess the relationship between obstetric history and incidence of short cervical length (CL) at <24 weeks gestational age (GA) in women with a prior spontaneous preterm birth (PTB). Study Design Women with a singleton gestation and a history of spontaneous PTB on progesterone who received prenatal care at a single center from 2011 to 2016 were included. Those who did not undergo screening or had a history-indicated cerclage were excluded. The associations between short CL (<25 mm) before 24 weeks and obstetrical factors including: number of prior PTBs, history of term birth, and GA of earliest spontaneous PTB were estimated through modified Poisson regression, adjusting for confounding factors. Multiple pregnancies for the same woman were accounted for through robust sandwich standard error estimation. Results Among 773 pregnancies, 29% (n = 224) had a CL <25 mm before 24 weeks. The number of prior PTBs was not associated with short CL, but a prior full-term delivery conferred a lower risk of short CL (absolute risk reduction or aRR 0.79, 95% CI 0.63–1.00). Earliest GA of prior spontaneous PTB was associated with short CL. The strongest association was observed in women with a prior PTB at 160/7 to 236/7weeks (aRR 1.98, 95% CI: 1.46–2.70), compared with those with deliveries at 340/7 to 366/7 weeks. Yet, even women whose earliest PTB was 340/7 to 366/7 weeks remained at risk for a short CL, as 21% had a CL <25 mm. The number of prior PTBs did not modify the effect of GA of the earliest prior PTB (interaction test: p = 0.70). Conclusion GA of earliest spontaneous PTB, but not the number of prior PTBs, is associated with short CL. Nevertheless, women with a history of later PTBs remain at sufficiently high risk of having a short CL at <24 weeks gestation that we cannot recommend modifications to existing CL screening guidelines in this group of women. Key Points

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Obstetric History and Likelihood of Preterm Birth of Twins

American Journal of Perinatology ◽

10.1055/s-0037-1617758 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1023-1030

Author(s):

Sarah Little ◽

Julian Robinson ◽

Hector Mendez-Figueroa ◽

Suneet Chauhan ◽

Sarah Easter

Keyword(s):

Preterm Birth ◽

Twin Pregnancy ◽

Reference Group ◽

Controlled Trial ◽

Secondary Analysis ◽

Neonatal Morbidity ◽

Spontaneous Preterm Birth ◽

Term Birth ◽

Obstetric History ◽

Term Delivery

Objective The objective of this study was to investigate the relationship between preterm birth in a prior pregnancy and preterm birth in a twin pregnancy. Study Design We performed a secondary analysis of a randomized controlled trial evaluating 17-α-hydroxyprogesterone caproate in twins. Women were classified as nulliparous, multiparous with a prior term birth, or multiparous with a prior preterm birth. We used logistic regression to examine the odds of spontaneous preterm birth of twins before 35 weeks according to past obstetric history. Results Of the 653 women analyzed, 294 were nulliparas, 310 had a prior term birth, and 49 had a prior preterm birth. Prior preterm birth increased the likelihood of spontaneous delivery before 35 weeks (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.28–4.66), whereas prior term delivery decreased these odds (aOR: 0.55, 95% CI: 0.38–0.78) in the current twin pregnancy compared with the nulliparous reference group. This translated into a lower odds of composite neonatal morbidity (aOR: 0.38, 95% CI: 0.27–0.53) for women with a prior term delivery. Conclusion For women carrying twins, a history of preterm birth increases the odds of spontaneous preterm birth, whereas a prior term birth decreases odds of spontaneous preterm birth and neonatal morbidity for the current twin pregnancy. These results offer risk stratification and reassurance for clinicians.

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PF.02 The Role of Quantitative Fetal Fibronectin and Cervical Length in Predicting Spontaneous Preterm Birth in Multiple Pregnancies

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2013-303966.014 ◽

2013 ◽

Vol 98 (Suppl 1) ◽

pp. A5.1-A5 ◽

Cited By ~ 1

Author(s):

R Mapara ◽

DS Abbott ◽

NL Hezelgrave ◽

AH Shennan

Keyword(s):

Preterm Birth ◽

Cervical Length ◽

Multiple Pregnancies ◽

Spontaneous Preterm Birth ◽

Fetal Fibronectin

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“Relaxin-dependent” way of implementing spontaneous preterm labor in multiple pregnancies: The involvement of placental relaxin 2

Journal of obstetrics and women s diseases ◽

10.17816/jowd60946 ◽

2021 ◽

Vol 70 (2) ◽

pp. 27-36

Author(s):

Olga V. Pachuliya ◽

Olesya N. Bespalova ◽

Mariya G. Butenko ◽

Yulia P. Milyutina ◽

Tatyana G. Tral ◽

...

Keyword(s):

Preterm Birth ◽

Histological Examination ◽

Preterm Labor ◽

Multiple Pregnancy ◽

Chorionic Villus ◽

Multiple Pregnancies ◽

Spontaneous Preterm Birth ◽

Wide Range ◽

Relaxin 2 ◽

Term Labor

BACKGROUND: Despite numerous studies, the etiopathogenesis of preterm birth in multiple pregnancy remains unclear, which determines the low effectiveness of measures for the prevention of preterm birth. This fact makes it necessary to study possible ways of implementing preterm birth in multiple pregnancies and to search for new biomarkers of their pathogenetic links. Experimental and clinical studies have demonstrated the contribution of the pleiotropic hormone relaxin to the regulation of a wide range of physiological processes and its role in the implementation of the pathogenetic mechanisms of pregnancy complications, primarily premature birth. The proven autocrine / paracrine mechanism of placental relaxin action, which implements important local effects, determines the prospects for studying the contribution of its dysregulation to the implementation of spontaneous preterm labor in multiple pregnancies. MATERIALS AND METHODS: A morphological examination of 92 placentas from 46 deliveries of dichorionic diamniotic twins was performed: 24 of them were spontaneous premature births and 22 spontaneous term births. Histological examination of placentas along with immunohistochemical verification of relaxin 2 expression in the chorionic villus of the dichorial twins placentas were carried out. RESULTS: Histological examination of the dichorionic twins placentas revealed that those from spontaneous preterm birth were characterized by a higher frequency of chronic placental insufficiency with reduced compensatory and adaptive mechanisms and more pronounced circulatory disorders in the circulatory bed of the villous tree, when compared to placentas from spontaneous term labor. The first verification of relaxin 2 expression in the chorionic villi of the dichorionic twins placenta showed the role of the peptide in the initiation of spontaneous preterm birth. The relative area of relaxin 2 expression in spontaneous preterm labor was significantly higher (p 0.05) compared to that in spontaneous term labor. CONCLUSIONS: The data obtained confirm the hypothesis put forward about the involvement of placental relaxin in the pathogenesis of spontaneous preterm labor in multiple pregnancies. The authors were the first to propose the definition of a relaxin-dependent way of implementing spontaneous preterm labor. To help define new preventive strategies, the prospects for further studies of the role and significance of relaxin in the implementation of pathogenic processes involved in spontaneous preterm birth in multiple pregnancies have been outlined.

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The effect of early administration of rectal progesterone in IVF/ICSI twin pregnancies on the preterm birth rate: A randomized trial

10.21203/rs.2.13317/v2 ◽

2020 ◽

Author(s):

Mona Aboulghar ◽

Yahia El-Faissal ◽

Ahmed Kamel ◽

Ragaa Mansour ◽

Gamal Aboulserour ◽

...

Keyword(s):

Preterm Birth ◽

Birth Rate ◽

Previous History ◽

Secondary Outcome ◽

Base Line ◽

Multiple Pregnancies ◽

Spontaneous Preterm Birth ◽

Preterm Birth Rate ◽

Twin Pregnancies ◽

Natural Progesterone

Abstract Background: The rate of multiple pregnancies in IVF/ICSI ranges from 20-30% . The incidence of preterm birth in multiple pregnancies is as high as 60% and is even higher in pregnancies conceived after IVF & ICSI. The effect of progesterone on prevention of preterm birth in twins is controversial . Our group has proven a positive effect in reduction of preterm birth ,by starting progesterone from the mid-trimester ,in exclusively IVF/ICSI singleton pregnancies but not twins. The purpose of our current study was to explore the effect of earlier administration of natural progesterone, in IVF/ICSI twin pregnancies starting at 11-14 weeks for prevention of preterm birth. Methods: This is a double-blind, placebo controlled, single center, randomized clinical trial. Women with dichorionic twin gestations, following an IVF/ICSI trial were randomized to receive natural rectal progesterone (800 mg daily ) vs placebo, starting early from 11-14 weeks. They were randomized regardless of cervical length and had no previous history of preterm birth or known Mullerian anomalies. The primary outcome was, spontaneous preterm birth rate <37 weeks. The secondary Outcome was; spontaneous preterm birth <34,32,28 weeks and neonatal outcome. Results: A total of 203 women were randomized to both groups, final analysis included 199 women as 4 were lost to follow up. The base line characteristics as well as gestational age at delivery were not significantly different between the study and the placebo group (34.7±3.6 vs 34.5±4.5, P=0.626). Progesterone administration was not associated with a significant decrease in the spontaneous preterm birth rates <37 weeks (73.5% vs 68%, P = 0.551), <34 (20.6% vs 21.6%, P = 0.649), <32 (8.8% vs 12.4%, P = 0.46) & <28 (4.9 % vs 3.1 %, P = 0.555). Conclusions: Rectal natural progesterone starting from the first trimester in IVF/ICSI twin pregnancies did not reduce spontaneous preterm birth.The trial was registered on 31 January 2014 at www.ISRCTN.com, 69810120.

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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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