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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of neonatal respiratory distress (RD) ranges from 2.2% to 7.6% in developed countries and from 0.7% to 8.3% in India. A study conducted in Pondicherry, India, found the incidence of neonatal RD to be 6.7%. The leading cause of neonatal RD is transient tachypnea (50-60% of RD cases) followed by infections (pneumonia, sepsis, or meningitis), meconium aspiration, and hyaline membrane disease (HMD). Significant predictors of neonatal RD include prematurity, malpresentation, abnormal delivery, premature rupture of membranes, fetal distress, multiple pregnancy, male sex, and low apgar score at birth. The case fatality rate for RD in India is 30-40%. In the Pondicherry study, it was 19%. Case fatality is highest for newborns with HMD (20-40% in developed countries and 50-75% in India). It ranges from 14.3% to 30.37% for meconium aspiration-related RD deaths. RD incidence and subsequent infant mortality can be reduced by improved prenatal care, early detection and referral of high risk pregnancies, closer links between referral hospitals and health centers, close monitoring of labor to detect fetal distress, and early intervention when indicated. In cases of RD, adequate and immediate resuscitation, oxygen supplementation, maintenance of optimal temperature, and time referral if RD lasts beyond two hours will reduce mortality. In cases of HMD and meconium aspiration, adequate ventilatory support and surfactant therapy will reduce mortality.
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PMID:Respiratory distress in newborn. 1232 Mar 81

Despite advances in perinatal medicine in the past decade, the diagnosis and treatment of premature rupture of membranes remain controversial. Premature rupture occurs in 2.7-7.0% of pregnancies and most cases occur spontaneously without apparent cause. The disparity in reported rates of premature rupture is due to differences in the definition and diagnostic criteria for premature rupture and lack of comparability in the populations studied. Mexico's National Institute of Perinatology has adopted the definition of the American COllege of Gynecology and Obstetrics which views premature rupture as that occurring before regular uterine contractions that produce cervical dilation. 8.8% of its patients have premature rupture according to this definition. 20% of cases occur before the 36th week of pregnancy. Treatment of rupture occurring before 37 weeks must balance the threat of amniotic infection with the dangers of premature birth. Infections appear more common in low income patient populations. Chorioamnionitis is a serious complication of pregnancy and is the main argument against conservative treatment of premature rupture. The rate of maternal infection is directly related to the time elapsing between rupture of the membranes and birth. The rate increases after the 1st 24 hours and is at least 10 times higher after 72 hours. But recent studies suggest that there is no considerable increase in infection if vaginal explorations are avoided and careful techniques are used in treating the patient. Those who advise conservative treatment believe that prenatal outcomes are better because respiratory disease syndrome due to prematurity is avoided. Conservative management requires a white cell count at least every 24 hours and measurement of pulse, maternal temperature, and fetal heart rate ideally every 4 hours. Perinatal mortality rates due to premature rupture of membranes range from 2.5-50%. The principal causes are respiratory disease syndrome, infection, asphyxia, and congenital malformations. Neonatal sepsis occurs in about 5% of live births following premature rupture, but the rate triples after 24 hours, especially in premature infants. The rate of neonatal asphyxia also increases considerable after 24 hours. Congenital malformations, prolapse of the cord, and pelvic presentation are positively associated with premature rupture of membranes. If the decision is made to interrupt the pregnancy, it should be done between 12-24 hours after rupture because the risks of infection and respiratory difficulty are most balanced at that point. Vaginal deliveries should be preferred only if conditions are favorable for a prompt delivery. The gestational age, presence of infection, obstetric condition of the mother, and indication for hysterectomy are the most important points to consider i management of premature rupture.
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PMID:[Premature rupture of membranes and chorioamnionitis]. 1234 87

Preterm premature rupture of membranes (PROM) affects over 120,000 pregnancies annually in the United States and is associated with significant maternal, fetal, and neonatal risk. Management of PROM requires an accurate diagnosis as well as evaluation of the risks and benefits of continued pregnancy or expeditious delivery. An understanding of gestational age-dependent neonatal morbidity and mortality is important in determining the potential benefits of conservative management of preterm PROM at any gestation. Where possible, the treatment of pregnancies complicated by PROM remote from term should be directed towards conserving the pregnancy and reducing perinatal morbidity due to prematurity while monitoring closely for evidence of infection, placental abruption, labor, or fetal compromise due to umbilical cord compression. Current evidence suggests aggressive adjunctive antibiotic therapy to reduce gestational age-dependent and infectious infant morbidity. Similarly, review of evaluable data indicates that antenatal corticosteroid administration in this setting enhances neonatal outcome without increasing the risk of perinatal infection. It is not clear that tocolysis in the setting of preterm PROM remote from term reduces infant morbidity. When preterm PROM occurs near term, particularly if fetal pulmonary maturity is evident, the patient is generally best served by expeditious delivery.
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PMID:Preterm premature rupture of the membranes. 1251 65

The development of fetal surgery has led to promising therapeutic options for a number of congenital malformations. However, preterm labor (PTL) and premature rupture of membranes continue to be ubiquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access surgical techniques were developed and are increasingly employed. Congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma have already been successfully treated using minimal access fetal surgical procedures. Other life-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. The wider application of minimal access fetal surgery depends on a continued improvement in technology and a better understanding of complications associated with fetal intervention.
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PMID:Minimal access fetal surgery. 1269 62

In two prospective investigations the effectiveness of the self- care program for prematurity prevention, developed by Saling, was investigated. Pregnant women in Erfurt have been offered to perform self-measurements of their vaginal pH by means of test gloves (Careplan VpH) twice a week. The women were instructed to see their physician immediately, if abnormal values (pH > or = 4.7) or other risk factors were present. 73 out of 381 women in the intervention group have been identified as risk cases. 58 of them were treated with a lactobacillus preparation, and 24 with clindamycin cream for bacterial vaginosis, 3 patients refused to have any therapy. In this study the prematurity rate was 8.1 % in the self-measurement/intervention group vs. 12.3 % in the control group (N=2 341, P < 0.05); 0.3 % vs. 3.3 % of the neonates belonged to the group of early prematures with a gestational age of < 32 + 0 weeks (P < 0.01). PROM was registered in 22.8 % vs. 30.8 % (P < 0.001) respectively. Starting March 1, 2000 a similar statewide pH-screening program was initiated in Thuringia. According to the study design a significant decrease of prematurity was hypothetically expected for the second half of the year 2000. In Erfurt an overall decrease of prematurity from 7.68 to 6.81 % and a reduction of cases < 32 + 0 weeks from 3.22 to 2.39 % was observed (N=1,600). Data from 16,276 women are available for the state of Thuringia. On this basis a significant reduction of early prematurity from 1.58 to 0.99 % was seen respectively (P < 0.001). Comparing low birthweights a significant reduction of cases was achieved as well in all groups. On the basis of the data obtained we recommend the extension of the campaign in the whole of Germany.
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PMID:[Current aspects of the Thuringia prematurity prevention campaign 2000]. 1296 Nov 2

Current guidelines for dialysis in pregnant women have been developed in response to occasional dialysis patients who unexpectedly become pregnant. These include prolonged dialysis times, generally 20 or more hours per week. The increased dialysis time requires careful monitoring of phosphorus and potassium which may be removed in excessive amounts. Target serum bicarbonate for a pregnant woman is 18-20 mEq/L. Patients require increased supplementation of water soluble vitamins particularly folate. Increased doses of erythropoietin are needed to meet the demands for increased red cell production occasioned by pregnancy. Hypertension is the greatest danger to the mother and extreme vigilance is required up to six weeks postpartum. Volume status is difficult to predict and can only be determined by repeated clinical assessment. Only 50% of pregnancies result in a surviving infant and in the best subgroups, no more than 75% of pregnancies are successful. Over 80% of live born infants are premature, often severely premature. The key to improving the outcome of pregnancy in dialysis patients lies in decreasing premature labor and premature rupture of membranes in the late second and early third trimester. To this end, it is important for obstetricians to recognize that the risk of prematurity in pregnant dialysis patients is as higher or higher than in any other group and that any intervention, including such measures as progesterone and oxytocin antagonists, used to prevent premature labor in other groups should be considered in dialysis patients.
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PMID:Pregnancy in dialysis patients: where do we go from here? 1296 89

In two prospective investigations, the effectiveness of the self care programme for prematurity prevention, developed by Saling, was investigated. Pregnant women in Erfurt have been offered to perform self measurements of their vaginal pH by means of test gloves twice a week in order to screen for any disturbances in the vaginal milieu. The women were instructed to see their physician immediately, if abnormal pH > or = 4.7 or other risk factors were present, in order to get them confirmed and to start lactobacillus acidophilus therapy or in case of bacterial vaginosis to treat with clindamycin cream i. vag. Patients who were not interested in the programme served as a control group. Seventy-three out of 381 women in the intervention group have been identified as risk cases. Fifty-eight of them were treated with a lactobacillus preparation, and 24 with clindamycin cream, three patients refused to have any therapy. In this study, the prematurity rate was 8.1% in the self measurement/intervention group versus 12.3% in the control group (P < 0.05, n = 2341). 0.3% versus 3.3% of the neonates belonged to the group of very early prematures with a gestational age of <32 + 0 (P < 0.01). PROM was registered in 22.8% versus 30.8% (P < 0.001), respectively. Starting 1 March 2000, a similar statewide pH screening programme was initiated in order to reduce prematurity in the State of Thuringia. According to the study design, a significant decrease of prematurity was hypothetically expected for the second half of 2000. In Erfurt, an overall decrease of prematurity from 7.68 to 6.81% and a reduction of cases < or = 32 weeks from 3.22 to 2.39% was observed. Premature rupture of membranes was seen in 19 versus 0 pregnancies with early prematurity (n = 1600). Data from 16,276 women are available for the state of Thuringia. On this basis, a significant reduction of early prematurity from 1.58 to 0.99% was seen, respectively (P < 0.001). Comparing low birthweights a significant reduction of cases was achieved as well in all groups. On the basis of the data obtained we recommend the extension of the campaign in whole of Germany.
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PMID:Efficient prematurity prevention is possible by pH-self measurement and immediate therapy of threatening ascending infection. 1632 82

The objective is to specify epidemiological profile of pre term labour birth and evaluate the efficiency of the tocolysis protocol of Dakar University Teaching Hospital. It's a retrospective study which included 155 cases of spontaneous premature birth registered from January 1st 2000 to December 31 2002 in obstetrician clinic. The incidence is 15 per 1000 childbirth. The epidemiological profiles on a pauciparous woman (mean age: 25 years), of low economic and social level (90%), admitted with a bad antenatal follow-up and a pathology associated with pregnancy dominated by arterial hypertension (25%). The mean age of gestation is 30 weeks; severe forms are prevalent and tocolysis score of Baumgarten is equal or higher than 4 in 71.6%. The three principal etiologists are toxaemia, premature rupture of membranes and infections. An association Salbutamol-Phloroglucinol is carried out in 28 cases (18%) or with Phloroglucinol in 25 cases (16.1%). In summary, 138 patients (89%) were finally confined by low way after 5 hours a median time. Perinatal mortality was 347.2 per 1000; it's related to the large premature ones particularly having a weight of birth less than or equal to 1300 grams (78%). The threats of pre term labour are often diagnosed tardily. The access to the tocolysis in emergency is limited and it's effectiveness practises very weak. Use of calcic inhibitors and the systematisation of corticotherapy should improve the forecast of prematurity.
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PMID:[Threatened preterm labour: assessment of its management at the Dakar University Teaching Hospital]. 1577 Aug 6

Worldwide, Chlamydia trachomatis (CT) is the most common sexually transmitted bacteria. The improved understanding of CT pathophysiology in recent years became possible through DNA amplification technique and genome cloning. This paper updates informations on chlamydial infection in pregnant women, its pathophysiology, diagnostic methods, prevention and treatment. There is increasing evidence that Chlamydia trachomatis infection may result in a number of adverse pregnancy outcomes, including early and late abortion, infection of the foetus, stillbirth, premature rupture of membranes, prematurity and postpartum endometritis. Ectopic pregnancy is often associated with a previous tubal chlamydial infection. C. trachomatis infection in newborns may be acquired during pregnancy or during vaginal delivery, and it may result in neonatal conjunctivitis and/or pneumonia. We discuss benefits of early treatment of chlamydial infections in pregnant women and present guidelines for treatment. Screening should lead to early detection and treatment of men and women with chlamydial infection and thereby reduce the incidence of pelvic inflammatory disease, tubal infertility and ectopic pregnancy.
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PMID:Is it justifiable to perform screening tests for Chlamydia trachomatis in pregnant women? 1608 73

With the aim of collecting evidence on repetition of low birth weight, intra-uterine growth retardation (IUGR), and prematurity in successive pregnancies, a systematic review was conducted on MEDLINE, LILACS, PAHO, and MedCarib from 1965 to 2004, using as descriptors: "low birth weight and recurrence, repetition or previous", "risk factors and repetition, recurrence or previous LBW", "IUGR and recurrence, repetition or previous", "risk factors and repetition, recurrence or previous IUGR", "prematurity and recurrence, repetition or previous", and "risk factors and repetition, recurrence or previous prematurity". Of 24 studies, 18 were excluded due to inconsistency between the title and the actual subject investigated (obstetric history as a risk factor rather than a selection criterion). The most important risk factors associated with repetition of low birth weight were maternal age > 30 years, smoking, short inter-gestational interval, and black skin color; those associated with IUGR were maternal age < 20 or > 35 years, low maternal education, high blood pressure, drug addiction, and non-technical/non-professional paternal occupation; and with preterm birth, premature rupture of membranes, chorioamnionitis, preeclampsia, preterm labor, and inter-gestational interval less than 12 months.
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PMID:[Risk factors for repetition of low birth weight, intrauterine growth retardation, and prematurity in subsequent pregnancies: a systematic review]. 1675 52


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