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6 - Prevention of preterm labour

Published online by Cambridge University Press:  07 August 2009

By
John Morrison  and
Nandini Ravikumar
Edited by
Jane Norman  and
Ian Greer
John Morrison
Affiliation:
National University of Ireland
Nandini Ravikumar
Affiliation:
National University of Ireland
Jane Norman
Affiliation:
University of Glasgow
Ian Greer
Affiliation:
University of Glasgow
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Summary

Introduction

The delivery of infants at preterm periods of gestation is a major factor contributing to perinatal morbidity and mortality in current obstetric practice in developed countries (ACOG Practice Bulletin 2001). It is associated with short- and long-term sequelae and constitutes a significant problem in terms of mortality, disability and cost to healthcare resources and society. Research efforts to address this problem have increased substantially over the last ten years but have failed in their attempts to improve prediction and prevention of preterm delivery.

Preterm delivery results from a series of disorders implicating maternal and fetal disease, some of which are explained and interrelated while many are of unknown aetiology (Iannucci et al. 1996; Burke and Morrison 2000). Epidemiological risk factors for preterm delivery, which are well established (Olsen et al. 1995; Mercer et al. 1996; Kramer et al. 2001), exert a huge influence on its incidence and outcome. In addition, the overall incidence of preterm delivery appears to be increasing in recent years (Goldenberg and Rouse 1998). The reasons for this increase are complex and have been the source of much debate. It has been speculated that there might have been a recent increased tendency to register live birth at very early gestational ages (i.e. 20–22 weeks) in some countries (Joseph et al. 1998).

Type
Chapter
Information
Preterm Labour
Managing Risk in Clinical Practice
 , pp. 153 - 170
Publisher: Cambridge University Press
Print publication year: 2005

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References

Abdalla, H. I., Billett, A., Kan, A. K.et al. (1998) Obstetric outcome in 232 ovum donation pregnancies. Br. J. Obstet. Gynaecol. 105, 332–7.CrossRefGoogle ScholarPubMed
Abramov, Y., Nadjari, M., Weinstein, D.et al. (2000) Indomethacin for preterm labor: a randomised comparison of vaginal and rectal-oral routes. Obstet. Gynecol. 95, 482–6.Google Scholar
Althuisius, S. M., Dekker, G. A., Hummel, P., Bekedam, D. J. and Geijn, H. P. (2001) Final results of the Cervical Incompetence Prevention Randomized Prevention Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone. Am. J. Obstet. Gynecol. 185, 1106–12.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin (2001) Clinical Management Guidelines for Obstetrician-Gynecologists Number 31, October 2001. Assessment of risk factors for preterm birth. Obstet. Gynecol. 98, 709–16.
Ananth, C. V., Misra, D. P., Demissie, K. and Smulian, J. C. (2001) Rates of preterm delivery among Black women and White women in the United States over two decades: an age-period-cohort analysis. Am. J. Epidemiol. 154, 657–65.CrossRefGoogle ScholarPubMed
Anderson, B. and Nielsen, T. F. (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet. Gynecol. Scand. 78, 758–62.CrossRefGoogle Scholar
Bernasko, J., Lynch, L., Lapinski, R. and Berkowitz, R. L. (1997) Twin pregnancies conceived by assisted reproductive techniques; maternal and neonatal outcomes. Obstet. Gynecol. 89, 368–72.CrossRefGoogle ScholarPubMed
Boer, K., Smit, B. J., Huis, A. M. and Hogerzeil, H. V. (1994) Substance use in pregnancy: do we care? Acta Paediatr. Suppl. 404, 65–71.CrossRefGoogle ScholarPubMed
Burke, C. and Morrison, J. J. (2000) Perinatal factors and preterm delivery in an Irish obstetric population. J. Perinat. Med. 28, 49–53.CrossRefGoogle Scholar
Cherukuri, R., Minkoff, H., Feldman, J., Parekh, A. and Glass, L. (1988) A cohort study of alkaloidal cocaine (“crack”) in pregnancy. Obstet. Gynecol. 72, 147–51.Google ScholarPubMed
Crowther, C. A. and Moore, V. (2002) Magnesium for preventing preterm birth after threatened preterm labour (Cochrane Review). In The Cochrane Library, Issue 3. Oxford: Update SoftwareGoogle Scholar
Dennedy, M. C., Friel, A. M., Houlihan, D. D., Smith, T. and Morrison, J. J. (2002) Cannabinoids and the human uterus during pregnancy. J. Soc. Gynecol. Invest. 9, 52A.Google Scholar
Devane, W. A., Hanus, L., Breuer, A.et al. (1992) Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 258, 1946–9.CrossRefGoogle ScholarPubMed
Dinsmoor, M. J., Irons, S. J. and Christmas, J. T. (1994) Premature rupture of the membranes associated with recent cocaine use. Am. J. Obstet. Gynecol. 171, 305–8.CrossRefGoogle ScholarPubMed
El-Metwally, D., Vohr, B. and Tucker, R. (2000) Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J. Pediatr. 137, 616–22.CrossRefGoogle ScholarPubMed
Fan, Y. D., Pastorek, J. G., Miller, J. M. and Mulvey, J. (1987) Acute pyelonephritis in pregnancy. Am. J. Perinatol. 4, 324–6.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Horwood, J. L. and Northstone, K. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. (2002) Maternal use of cannabis and pregnancy outcome. BJOG 109, 21–7CrossRefGoogle ScholarPubMed
Fisch, B., Harel, L., Kaplan, B.et al. (1997) Neonatal assessment of babies conceived by in vitro fertilization. J. Perinatol. 17, 473–98.Google ScholarPubMed
Fried, P. A., Watkinson, B. and Willan, A. (1984) Marijuana use during pregnancy and decreased length of gestation. Am. J. Obstet. Gynecol. 150, 23–7.CrossRefGoogle ScholarPubMed
Goldenberg, R. L. and Rouse, D. J. (1998) Prevention of premature birth. N. Engl. J. Med. 339, 313–20.CrossRefGoogle ScholarPubMed
Goldenberg, R. L., Mayberry, S. K., Copper, R. L., Dubard, M. B. and Hauth, J. C. (1993) Pregnancy outcome following a second-trimester loss. Obstet. Gynecol. 81, 444–6.Google ScholarPubMed
Golding, J. (1995) Reproduction and caffeine consumption – a literature review. Early Hum. Dev. 43, 1–14.CrossRefGoogle ScholarPubMed
Guise, J. M., Mahon, S. M.Aickin, M.et al. (2001) Screening for bacterial vaginosis in pregnancy. Am. J. Prev. Med. 20, S62–72.CrossRefGoogle ScholarPubMed
Gunter, L. M. (1963) Psychopathology and stress in the life experience of mothers of premature infants. Am. J. Obstet. Gynaecol. 86, 405–20.CrossRefGoogle ScholarPubMed
Gyetvai, K., Hannah, M. E., Hodnett, E. D. and Ohlsson, A. (1999) Tocolytics for preterm labor: a systematic review. Obstet. Gynecol. 94, 869–77.Google ScholarPubMed
Handler, A., Kistin, N., Davis, F. and Ferre, C. (1991) Cocaine use during pregnancy: perinatal outcomes. Am. J. Epidemiol. 133, 818–21.CrossRefGoogle ScholarPubMed
Hannah, M., Amankwah, K., Barret, J.et al. (1995) The Canadian consensus on the use of tocolytics for preterm labour. J SOGC 17, 1089–115.Google Scholar
Hatch, E. E. and Bracken, M. B. (1986) Effect of marijuana use in pregnancy on fetal growth. Am. J. Epidemiol. 124, 986–93.CrossRefGoogle ScholarPubMed
Hedegaard, M., Brink Henriksen, T., Sabroe, S. and Secher, N. J. (1993) Psychological distress in pregnancy and preterm delivery. Br. Med. J. 307, 234–9.CrossRefGoogle ScholarPubMed
Higby, K. and Suiter, C. R. (1999) A risk-benefit assessment of therapies for premature labour. Drug Saf. 21, 35–56.CrossRefGoogle ScholarPubMed
Hoffman, S. and Hatch, M. C. (1996) Stress, social support and pregnancy outcome: a reassessment based on recent research. Paediatr. Perinatal Epidemiol. 10, 380–405.CrossRefGoogle ScholarPubMed
Hogue, C. J., Hofmann, S. and Hatch, M. C. (2001) Stress and preterm delivery: a conceptual framework. Paediatr. Perinatal Epidemiol. 15, 30–40.CrossRefGoogle ScholarPubMed
How, H. Y., Hughes, S. A., Vogel, R. L., Gall, S. A. and Spinnato, J. A (1995) Oral terbutaline in the out patient management of preterm labor. Am. J. Obstet. Gynecol. 173, 1518–22.CrossRefGoogle ScholarPubMed
Ianucci, T. A., Tomich, P. G. and Gianopoulos, J. G. (1996) Aetiology and outcome of extremely low-birth-weight infants. Am. J. Obstet. Gynecol. 174, 1896–902.CrossRefGoogle Scholar
Iizuka, K., Yoshii, A., Samizo, K.et al. (1999) A major role for the Rho-associated coiled coil forming protein kinase in G-protein-mediated Ca2 + sensitisation through inhibition of myosin phosphatase in rabbit trachea. Br. J. Pharmacol. 128, 925–33.CrossRefGoogle Scholar
Joseph, K. S., Kramer, M. S., Maecoux, S.et al. (1998) Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994. N. Engl. J. Med. 339, 1434–9.CrossRefGoogle ScholarPubMed
Kekki, M., Kurki, T., Pelkonen, J., Kurkinen-Raty, M. and Cacciatore, B. J. (2001) Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomised controlled trial. Obstet. Gynecol. 97, 643–8.Google Scholar
Kenyon, S. and Boulvain, M. (2002) Antibiotics for preterm premature rupture of the membranes. In: Cochrane Library, issue 3.
Kenyon, S. L., Taylor, D. J. and Tarnow-Mordi, W.; ORACLE Collaborative Group. (2001a) Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. Lancet 357, 989–94.CrossRefGoogle Scholar
Kenyon, S. L., Taylor, D. J. and Tarno-Mordi, W.; ORACLE Collaborative Group. (2001b) Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet 357, 979–88.CrossRefGoogle Scholar
King, J. and Flenady, V. (2002) Antibiotics for preterm labour with intact membranes. In The Cochrane Library, Issue 3. Oxford: Update Software.Google Scholar
Klerman, L. V., Ramsey, S. L., Goldenberg, R. L.et al. (2001) A randomized controlled trial of augmented prenatal care for multiple-risk Medicaid eligible African American women. Am. J. Public Health 91, 105–11.Google ScholarPubMed
Koupilova, I., Vagero, D., Leon, D. A.et al. (1998) Social variation in size at birth and preterm delivery in the Czech Republic and Sweden, 1981–1991. Paediatr. Perinatal Epidemiol. 12, 7–24.CrossRefGoogle Scholar
Kramer, M. S. (1996) Attributable causes of low birthweight. In Battaglia, F., Falkner, F., and Garza, C.et al., eds. Maternal and Extra-uterine Nutritional Factors: their Influence on Fetal and Infant Growth. Madrid: Ediciones Ergon, pp. 349–57.Google Scholar
Kramer, M. S., Goulet, L., Lydon, J.et al. (2001) socioeconomic disparities in preterm birth: casual pathways and mechanisms. Paediatr. Perinatal Epidemiol. 15, 104–23.CrossRefGoogle Scholar
Kurkinen-Raty, M., Vuopala, S., Koskela, M.et al. (2000) A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 107, 1427–32.CrossRefGoogle ScholarPubMed
Kurtzman, J. T., Spinnato, J. A., Goldsmith, L. J.et al. (1999) Human chorionic gonadotrophin exhibits potent inhibition of preterm delivery in a small animal model. Am. J. Obstet. Gynecol. 181, 853–7.CrossRefGoogle Scholar
Lees, C. C., Lojacono, A., Thompson, C.et al. (1999) Glyceryl trinitrate and ritodrine in tocolysis: an international multicenter randomized study. GTN Preterm Labour Investigation Group. Obstet. Gynecol. 94, 403–8.Google ScholarPubMed
Lobel, M. (1994) Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes. J. Behav. Med. 17, 225–72.CrossRefGoogle ScholarPubMed
Lobel, M., Dunkel-Schetter, C. and Scrimshaw, S. C. M. (1992) Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women. Health Psychol. 11, 32–40.CrossRefGoogle ScholarPubMed
Lumley, J. (1993) The epidemiology of preterm birth. Baillieres Clin. Obstet. Gynaecol. 7, 477–98.CrossRefGoogle ScholarPubMed
McDonald, H., Brocklehurst, P., Parsons, J. and Vigneswaran, R. (2003) Antibiotics for treating bacterial vaginosis in pregnancy. In The Cochrane Library, Issue 4. Oxford: Update Software.Google Scholar
MacFarlane, A., Cole, S., Johnson, A. and Botting, B. (1988) Epidemiology of birth before 28 weeks of gestation. Br. Med. Bull. 44, 861–91.CrossRefGoogle ScholarPubMed
McGrady, G. A., Sung, J. F., Rowley, D. L. and Hogue, C. J. (1992) Preterm delivery and low birthweight among first-born infants of black and white college graduates. Am. J. Epidemiol. 136, 266–76.CrossRefGoogle ScholarPubMed
Macones, G. A., Berlin, M. and Berlin, J. A. (1995) Efficacy of oral beta-agonist maintenance therapy in preterm labour: a meta-analysis. Obstet. Gynecol. 85, 313–17.CrossRefGoogle ScholarPubMed
Madinger, N. E., Greenspoon, J. S. and Ellrodt, A. G. (1989) Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome? Am. J. Obstet. Gynecol. 161, 657–62.CrossRefGoogle ScholarPubMed
Matsuda, L. A., Lolait, S. J., Brownstein, M. J., Toung, A. C. and Bonner, T. I. (1990) Structure of a cannabinoid receptor and functional experssion of the cloned cDNA. Nature 346, 561–4.CrossRefGoogle Scholar
Mattison, D. R., Damus, K., Fiore, E., Petrini, J. and Alter, C. (2001) Preterm delivery: a public health perspective. Paediatr. Perinatal Epidemiol. 15, 7–16.CrossRefGoogle ScholarPubMed
Medical Research Council/Royal College of Obstetricians and Gynaecologists (MRC/RCOG) Working Party on Cervical Cerclage. (1993) Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists Multicentre Randomized Trial of Cervical Cerclage. BJOG 100, 516–23.CrossRef
Mercer, B. M., Goldenberg, R. L., Das, A.et al. (1996) The preterm prediction study: A clinical risk assessment system. Am. J. Obstet. Gynecol. 174, 1885–95.CrossRefGoogle ScholarPubMed
Miller, J. M. and Boudreaux, M. C. (1999) A study of antenatal cocaine use – chaos in action. Am. J. Obstet. Gynecol. 180, 1427–31.CrossRefGoogle ScholarPubMed
Moran, C. J, Friel, A. M., Smith, T. J., Cairns, M. and Morrison, J. J. (2002) Expression and modulation of Rho kinase in human pregnant myometrium. Mol. Hum. Rep. 8, 196–200.CrossRefGoogle ScholarPubMed
Morrison, J. J. and Rennie, J. M. (1997) Clinical, scientific and ethical aspects of fetal and neonatal care at extreme preterm periods of gestation. BJOG 104, 1341–50.CrossRefGoogle Scholar
Moutquin, J. M., Sherman, D., Cohen, H. (2000) Double blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety study. Am. J. Obstet. Gynecol. 182, 1191–9.CrossRefGoogle ScholarPubMed
Munro, S., Thomas, K. L. and Abu Shaar, M. (1993) Molecular characterization of a peripheral receptor for cannabinoids. Nature 365, 61–5.CrossRefGoogle ScholarPubMed
Neerhof, M. G., MacGregor, S. N., Retzky, S. S. and Sullivan, T. P. (1989) Cocaine abuse during pregnancy: peripartum prevalence and perinatal outcome. Am. J. Obstet. Gynecol. 161, 633–8.CrossRefGoogle ScholarPubMed
Offidani, C., Pomini, F., Caruso, A.et al. (1995) Cocaine during pregnancy: a critical review of the literature. Minerva Ginecol. 47, 381–90.Google ScholarPubMed
Olsen, P., Laara, E., Rantakillio, P.et al. (1995) Epidemiology of preterm delivery in two birth cohorts with an interval of 20 years. Am. J. Epidemiol. 142, 1184–93.CrossRefGoogle ScholarPubMed
Perri, T., Chen, R., Yoeli, R.et al. (2001) Are singleton assisted reproductive technology pregnancies at risk of prematurity. J. Assist. Reprod. Genet. 18, 245–9.CrossRefGoogle Scholar
Peruzzi, L., Gianoglio, B., Porcellini, M. G. and Coppo, R. (1999) Neonatal end-stage renal failure associated with maternal ingestion of cyclo-oxygenase-type-1 selective inhibitor nimesulide as tocolytic. Lancet 354, 1615.CrossRefGoogle ScholarPubMed
Pritchard, C. W. and Teo, P. Y. (1994) Preterm birth, low birthweight and stressfulness of the household role for the pregnant woman. Soc. Sci. Med. 38, 89–96.CrossRefGoogle Scholar
Romero, R., Sibai, B. M., Sanchez-Ramos, L.et al. (2000) An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a radomized, double blind, placebo-controlled trial with tocolytic rescue. Am. J. Obstet. Gynecol. 182, 1173–83.CrossRefGoogle Scholar
Rust, O. A., Atlas, R. O., Jones, K. J., Benham, B. N. and Balducci, J. (2000) A randomised trial of cerclage versus no cerclage among patients with ultrasonographically detected second trimester prefers dilation of the internal os. Am. J. Obstet. Gynecol. 183, 830–5.CrossRefGoogle Scholar
Rust, O. A., Atlas, R. O., Reed, J., Gaalen, J. and Balducci, J. (2001) Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help. Am. J. Obstet. Gynecol. 185, 1098–105.CrossRefGoogle Scholar
Rutter, D. R. and Quine, L. (1990) Inequalities in pregnancy outcome: review of psychosocial and behavioural mediators. Soc. Sci. Med. 30, 553–68.CrossRefGoogle ScholarPubMed
Sanchez-Ramos, L., Kaunitz, A. M., Gaudier, F. L. and Delke, I. (1999) Efficacy of maintenance therapy after acute tocolysis: A meta-analysis. Am. J. Obstet. Gynecol. 181, 484–90.CrossRefGoogle ScholarPubMed
Sawdy, R. J. and Bennett, P. R. (1999) Recent advances in the therapeutic management of preterm labour. Curr. Opin. Obstet. Gynecol. 11, 131–9.CrossRefGoogle ScholarPubMed
Schieve, L. A. and Handler, A. (1996) Preterm delivery and perinatal death among black and white infants in a Chicago-area perinatal registry. Obstet. Gynecol. 88, 356–63.CrossRefGoogle Scholar
Shiono, P. H., Klebanoff, M. A., Nugent, R. P.et al. (1995) The impact of cocaine and marijuana use on low birthweight and preterm birth: a multicenter study. Am. J. Obstet. Gynecol. 172, 19–27.CrossRefGoogle ScholarPubMed
Slattery, M. M. and Morrison, J. J. (2002) Preterm Delivery. Lancet 360, 1485–97.CrossRefGoogle ScholarPubMed
Soderstrom-Anttila, V., Sajaniemi, N., Tiitinen, A. and Hovatta, O. (1998) Health and development of children born after oocyte donation compared with that of those born after in vitro fertilization, and parents' attitudes regarding secrecy. Hum. Reprod. 13, 2009–15.CrossRefGoogle ScholarPubMed
Spencer, B., Thomas, H. and Morris, J. (1989) A randomized controlled trial of the provision of a social support service during pregnancy; the South Manchester Family Worker project. BJOG 96, 281–8.CrossRefGoogle ScholarPubMed
Tambyrajia, R. L. and Mongelli, M. (2000) Sociobiological variables and pregnancy outcome. Int. J. Gynaecol. Obstet. 70, 105–12.CrossRefGoogle ScholarPubMed
The Canadian Preterm Labor Investigators Group. (1992) Treatment of preterm labor with the beta adrenergic agonist ritodrine. The Canadian Preterm Labor Investigators Group. N. Engl. J. Med. 327, 308–12.CrossRef
Tsatsaris, V., Papatsonis, D., Goffinet, F., Dekker, G. and Carbonne, B. (2001) Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis. Obstet. Gynecol. 97, 840–7.Google ScholarPubMed
Uehata, M., Ishizaki, T., Satoh, H.et al. (1997) Calcium sensitisation of smooth muscle mediated by a Rho-associated protein kinase in hypertension. Nature 389, 990–4.CrossRefGoogle Scholar
Vermeulen, G. M., Zwet, A. A. and Bruinse, H. W. (2001) Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous prefer birth. BJOG 108, 697–700.Google Scholar
Wenstrom, K. D., Weiner, C. P., Merrill, D. and Niebyl, J. (1997) A placebo controlled randomized trial of the terbutaline pump for prevention of preterm delivery. Am. J. Perinatal. 14, 87–91.CrossRefGoogle ScholarPubMed
Williams, D. R. (1990) Socioeconomic differentials in health: a review and redirection. Soc. Psychol. Quart. 53, 81–99.CrossRefGoogle Scholar
Wood, N. S., Marlow, N., Costeloe, K., Gibson, A. T. and Wilkinson, A. R. EPICure study group (2000) Neurological and developmental disability after extremely preterm birth. N. Engl. J. Med. 343, 378–84.CrossRefGoogle Scholar
Worldwide Atosiban versus Beta-agonists Study Group. (2001) Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. The Worldwide Atosiban versus Beta-agonists Study Group. BJOG 108, 133–42.
Wray, S. (1993) Uterine contraction and physiological mechanisms of modulation. Am. J. Physiol. 264, C1–18.CrossRefGoogle ScholarPubMed
Zhou, W., Sorensen, H. T. and Olsen, J. (1999) Induced abortion and subsequent pregnancy duration. Obstet. Gynecol. 94, 948–53.Google ScholarPubMed

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