UMA ANÁLISE INTEGRAL DO TRABALHO DE PARTO PREMATURO

A prematuridade é um dos mais significativos desafios da obstetrícia, constituindo a principal causa de morbimortalidade neonatal. A presença de fatores de risco, tanto maternos quanto fetais, geram maior vigilância durante o decorrer da gestação, entretanto cada gravidez ocorre de forma singular e seus fatores devem ser analisados individualmente, motivo que nos leva ao estudo profundo e integral de cada um deles. O diagnóstico do trabalho de parto prematuro é eminentemente clínico e, muitas vezes, de difícil estabelecimento precoce. Para auxiliar na obtenção de um diagnóstico em estágio inicial, tem-se empregado métodos complementares, como o ultrassom transvaginal e a fibronectina fetal. Existem várias opções de tratamento com suas particularidades para a indicação, porém a escolha deve ser feita prontamente a fim de prolongar a gestação, evitando os desfechos desfavoráveis do parto prematuro. Palavras-chave: trabalho de parto prematuro; diagnóstico precoce; tratamento adequado ABSTRACT Prematurity is one of the most significant challenges of obstetrics, being the main cause of neonatal morbidity and mortality. The presence of risk factors, both maternal and fetal, generate greater vigilance during the course of gestation, however each pregnancy occurs in a singular way and its factors must be analyzed individually, reason that leads us to the deep and integral study of each one of them. The diagnosis of preterm labor is eminently clinical and often difficult to establish early. To assist in obtaining an early diagnosis, complementary methods have been employed, such as transvaginal ultrasound and fetal fibronectin. There are several treatment options with their particularities for the indication, but the choice must be made promptly in order to prolong the gestation, avoiding the unfavorable outcomes of the preterm birth. Keywords: preterm labor; early diagnosis; appropriate treatment.

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The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25–34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03951-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohammed H. Ibrahim ◽

Tahani Elfaki ◽

Elhassan M. Elhassan ◽

Somia K. Abdelrahiem ◽

Ishag Adam

Keyword(s):

Clinical Trial ◽

Preterm Birth ◽

Combination Therapy ◽

Preterm Labor ◽

Neonatal Morbidity ◽

Trial Registration ◽

Morbidity And Mortality ◽

Secondary Outcome ◽

Type I ◽

First Choice

Abstract Background Preterm birth is the most common cause of neonatal morbidity and mortality. Tocolytics are considered a standard treatment for women with threatened preterm delivery to allow time for maternal steroid administration and transfer to referral centers with neonatal intensive care units. However, there is controversy about the best tocolytic therapy to be considered as the first choice. The aim of this study is to compare the tocolytic effectiveness and tolerability of combination therapy with nifedipine and indomethacin versus nifedipine monotherapy among Sudanese women with preterm labor (PTL) as well as to compare the possible neonatal outcomes associated with each drug. Methods/design This is a randomized controlled clinical trial to be conducted in the Medani Maternity Hospital, Sudan. Women aged 18–40 years that are diagnosed with preterm labor and have a gestational age between 25 and 34 weeks will be eligible to participate in this trial. The diagnosis of threatened PTL is defined as persistent uterine contractions “(four contractions every 20 min or eight contractions every 60 min)” with cervical changes “(cervical effacement ≤80% or cervical dilatation >two cm)”. Patients will be eligible regardless of the presentation of the fetus. It will be randomly decided whether participants receive nifedipine/indomethacin combination therapy or nifedipine monotherapy. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). The secondary outcome is an estimated association with neonatal morbidity and mortality. The sample size will be 117 subjects in each arm of the study, according to a type I error of 0.05 and a study power of 80%. Discussion We expect higher effectiveness of the combination indomethacin/nifedipine tocolytic therapy compared with nifedipine monotherapy. We plan to suggest this combination therapy as the best option for postponing PTL. Trial registration Clinical trial registration: PACTR202004681537890, date of registration: March 8, 2020.

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Preterm Labour

10.5772/intechopen.96049 ◽

2021 ◽

Author(s):

Maged Shendy ◽

Hend Hendawy ◽

Amr Salem ◽

Ibrahim Alatwi ◽

Abdurahman Alatawi

Keyword(s):

Preterm Birth ◽

Preterm Labour ◽

Transvaginal Ultrasound ◽

Neonatal Morbidity ◽

Cervical Length ◽

Fetal Blood ◽

Fetal Fibronectin ◽

High Risk Women ◽

Fetal Blood Sampling ◽

Fetal Scalp

Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality and accounts for 5–10% of all deliveries. Cervical length assessment between 16–24 weeks and positive fetal fibronectin beyond 21 weeks gestation are proved to useful tools in prediction of preterm labour. Treating asymptomatic bacteruia and bacterial vaginosis in high-risk women reduces the incidence of preterm labour. Cervical cerclage is recommended to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation. Atosiban and nifidipine are currently the agents of choice in tocolysis. Antenal steriods in womens with threating preterm labour reduces the perinatal morbidties. Magnisum sulphate role is established for neuroprotection especially in extreme gestations between 24–30 weeks. Vaginal delivery is mode of choice for delivery with consideration to avoid fetal blood sampling, fetal scalp electrodes and ventouse prior to 34 weeks gestations. Caesarean section is considered for obstetric reasons that guide labour management at term.

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Faculty Opinions recommendation of Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727188470.793534026 ◽

2017 ◽

Author(s):

Jeff Keelan

Keyword(s):

Preterm Birth ◽

Individual Patient Data ◽

Meta Analysis ◽

Neonatal Morbidity ◽

Patient Data ◽

Morbidity And Mortality ◽

Short Cervix ◽

Vaginal Progesterone

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A comparative study between nifedipine and isoxsuprine in the suppression of preterm labor pain

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202727 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2886

Author(s):

Susheela Khoiwal ◽

Vandana Patidar ◽

Radha Rastogi ◽

Bharat Tailor

Keyword(s):

Preterm Labor ◽

Preterm Labour ◽

Neonatal Morbidity ◽

Labour Pain ◽

Labor Pain ◽

Morbidity And Mortality ◽

Medical College ◽

Uterine Contractions ◽

High Incidence ◽

A Prospective Study

Background: A prospective study was conducted to compare the effectiveness of Nifedipine and Isoxsuprine in suppression of preterm labour pain as tocolytics drug. As preterm labour pain is major contributor for perinatal morbidity and mortality. The aims of this study were to assess the effect of nifedipine and isoxsuprine in threatened preterm labour with the aim of preventing preterm birth and its sequelae.Methods: This study was conducted on 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical College, Udaipur and attending OPD and IPD with complain of uterine contractions between 28-36 weeks of gestation.Results: Nifedipine was more effective than isoxsuprine hydrochloride as tocolytic agent.Conclusions: There is high incidence of preterm labour in India which leads to neonatal morbidity and mortality. Nifedipine is a better tocolytic drug compared to isoxsuprine hydrochloride.

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Fetal fibronectin, endotoxin, bacterial vaginosis and cervical length as predictors of preterm birth and neonatal morbidity in twin pregnancies

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.1997.tb11010.x ◽

1997 ◽

Vol 104 (12) ◽

pp. 1398-1404 ◽

Cited By ~ 74

Author(s):

U.-B. Wennerholm ◽

B. Holm ◽

I. Mattsby-Baltzer ◽

T. Nielsen ◽

J. Platz-Christensen ◽

...

Keyword(s):

Preterm Birth ◽

Bacterial Vaginosis ◽

Neonatal Morbidity ◽

Cervical Length ◽

Fetal Fibronectin ◽

Twin Pregnancies

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Screening for spontaneous preterm birth and resultant therapies to reduce neonatal morbidity and mortality: A review

Seminars in Fetal and Neonatal Medicine ◽

10.1016/j.siny.2017.11.007 ◽

2018 ◽

Vol 23 (2) ◽

pp. 126-132 ◽

Cited By ~ 11

Author(s):

Angelica V. Glover ◽

Tracy A. Manuck

Keyword(s):

Preterm Birth ◽

Neonatal Morbidity ◽

Morbidity And Mortality ◽

Spontaneous Preterm Birth

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17-Alpha-Hydroxyprogesterone vs. Placebo for Preventing of Recurrent Preterm Birth: A Systematic Review and Meta-Analysis of Randomized Trials

Frontiers in Medicine ◽

10.3389/fmed.2021.764855 ◽

2021 ◽

Vol 8 ◽

Author(s):

Abdulaali R. Almutairi ◽

Hadir I. Aljohani ◽

Nouf S. Al-fadel

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Meta Analysis ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Morbidity And Mortality ◽

Cochrane Library ◽

Relative Risk Ratio ◽

Analysis Model ◽

Clinical Trial Registries

Background: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality.Objective: To estimate the effect of 17-alpha-hydroxyprogesterone caproate (17-OHPC) compared to placebo in singleton gestations for reducing the risk of recurrent PTB and neonatal morbidity and mortality.Work Design: Systematic review and meta-analysis.Search Strategy: Searching MEDLINE, Embase, Web of Science, SCOPUS, Cochrane Library, and clinical trial registries.Selection Criteria: Randomized controlled trials of singleton gestations with a history of PTB and treated with a weekly intramuscular injection of 17-OHPC or placebo.Data Collection and Analysis: A random meta-analysis model was performed for the PTB outcomes (<32, <35, and <37 weeks) and neonatal outcomes (neonatal death, grade 3 or 4 intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis). Effect estimates were measured by relative risk ratio (RR) with a 95% confidence interval (CI).Main Results: Six works were included. There were no statistically significant reductions in the PTB risk following the use of 17-OHPC at <32 weeks (RR = 0.61, 95% CI: 0.13–2.77, and I2 = 39%), <35weeks (RR = 0.60, 95% CI: 0.10–3.67, and I2 = 51%), and <37 weeks (RR = 0.68, 95% CI: 0.46–1, and I2 = 75%). Furthermore, all the neonatal outcomes were statistically similar between the two groups.Conclusion: Treatment with 17-OHPC is not associated with reducing the risk of PTB or neonatal outcomes compared to placebo.

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PROLONG Clinical Study Protocol: Hydroxyprogesterone Caproate to Reduce Recurrent Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0038-1642062 ◽

2018 ◽

Vol 35 (12) ◽

pp. 1228-1234 ◽

Cited By ~ 4

Author(s):

Cynthia Gyamfi-Bannerman ◽

Joseph Biggio ◽

Suneet Chauhan ◽

Brenna Hughes ◽

Judette Louis ◽

...

Keyword(s):

Preterm Birth ◽

Sample Size ◽

Neonatal Morbidity ◽

Total Sample ◽

Morbidity And Mortality ◽

Safety And Efficacy ◽

Mortality Index ◽

Hydroxyprogesterone Caproate ◽

Secondary Outcomes

AbstractThe objective of this commentary is to describe the background, rationale, and methods of the PROLONG (Progestin's Role in Optimizing Neonatal Gestation) trial, which is a multicenter, multinational, placebo-controlled, randomized clinical trial (RCT) designed to assess the safety and efficacy of Makena (hydroxyprogesterone caproate injection, 250 mg/mL) in reducing the risk of preterm birth (PTB) and neonatal morbidity/mortality in women pregnant with a singleton gestation who had a previous singleton spontaneous PTB. The total sample size of the RCT will include 1,707 women. The trial has two coprimary outcomes: PTB less than 35 weeks and a composite neonatal morbidity and mortality index. This study sample size will provide 90% power to assess for a 35% reduction in neonatal morbidity and mortality. Secondary outcomes will include 2-year follow-up of infants. The trial is ongoing and targeted to complete recruitment in 2018.

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Study of renal profile in septicemic neonates

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180533 ◽

2018 ◽

Vol 5 (2) ◽

pp. 448

Author(s):

Sharwari J. Bhutada ◽

Chandrakant M. Bokade

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Neonatal Sepsis ◽

Age Of Onset ◽

Tertiary Care ◽

Neonatal Morbidity ◽

Morbidity And Mortality ◽

P Value ◽

Etiological Agents

Background: Neonatal sepsis can cause multiorgan involvement causing neonatal morbidity and mortality. The kidneys are an important organ affected in septicemic newborns. In this study we evaluated the renal functions and its association with various risk factors along with outcome in septicemic neonates.Methods: This study was a prospective observational study conducted in a tertiary care teaching hospital. The sample size was 276 cases of septicemic new-borns and study duration was 2 years. The profile of acute renal failure (ARF) and various risk factors were studied in a sample of 276 septicemic neonates. Detailed clinical examination and investigations were done to confirm the diagnosis of neonatal sepsis and the occurrence of ARF was studied among these septicemic newborns. Risk factors like birth weight, gestational age, shock, etiological agents, DIC were studied for the occurrence of ARF and mortality in ARF patients among septicemic neonates.Results: 30.07% of septicemic neonates developed ARF. DIC (p value=0.014), shock (p value=<0.0001), gestational age (p value=0.005), birth weight (p value=0.003), were found to be analytically significant for the occurrence of ARF. Birth weight (p value=0.006), age of onset of sepsis (p value=0.019), shock (p value =<0.0001), oliguria (p value =<0.0001), and DIC (p value=0.015) were significant predictors of mortality in ARF among septicemic neonates.Conclusions: Awareness and early identification of various risk factors and ARF in septicemic neonates can prevent morbidity and mortality among neonates.

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