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Where does most preterm birth occur in the world?
- More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries.
Premature effacement of the cervix, or short cervix, in the midtrimester of pregnancy currently represents the strongest predictor of spontaneous preterm birth. Numerous studies have examined the relationship between short cervix and preterm birth, and although differences in sensitivity and predict …
- Joan Slager, Sandra Lynne
- Clinical Context
- Study Synopsis and Perspective
- Clinical Implications
Spontaneous preterm birth (SPTB) is one of the most common complications of pregnancy, affecting 11% to 12% of births in the United States. The authors of the current study note that, other than a history of cervical surgery, there are few established risk factors for preterm birth among nulliparous women with a singleton pregnancy. Maternal history alone fails to account for more than half of women at risk for preterm birth. The presence of vaginal fetal fibronectin can indicate a higher risk for preterm birth, but positive test results are meaningful only after 22 weeks' gestation and may not be evident until only shortly before preterm labor. Therefore, the goal of the current study by Dekker and colleagues was to evaluate risk factors for preterm birth, particularly among nulliparous women.
Clinical characteristics are a poor predictor of SPTB in nulliparous women, according to the results of a new study. In addition, the trial suggests, the risk factors for SPTB with intact membranes (SPTB-IM) differ from the risk factors for SPTB after prelabor rupture of the membranes (SPTB-PPROM). This suggests that there are different pathophysiological pathways underlying these distinct phenotypes. Gustaaf Albert Dekker, MD, PhD, from the University of Adelaide's Robinson Institute in South Australia, and colleagues published the results of a multicenter international study in the July issue of PLoS ONE. The study included a prospective cohort of low-risk nulliparous pregnant women. Of the 3234 women included in the study, the researchers documented 156 cases of SPTB. Smoking was more common in the SPTB-IM group (22.9% vs 10.6% in term births; P< .001). "Not feeling well" was also a risk factor for SPTB-IM, as was marijuana use before pregnancy. The presence of mild hypertension...SPTB affects 11% to 12% of deliveries in the United States. Maternal history alone fails to account for more than half of women at risk for preterm birth. The presence of vaginal fetal fibronectin...The current study by Dekker and colleagues demonstrates that clinical data are only modestly useful in predicting the risk for preterm birth in nulliparous women. Only shortened cervical length was...
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Jul 01, 2006 · A cheap, easy and practical method of predicting preterm delivery may be the clinical cervical examination, but trials provide evidences that it has low predictive value for preterm birth. Laboratory methods, especially the measurement of fetal fibronectin, are very important predictors of preterm birth , .
- F.G. Krupa, D. Faltin, J.G. Cecatti, F.G.C. Surita, J.P. Souza
The Preterm Prediction Study: sequential cervical length and fetal fibronectin testing for the prediction of spontaneous preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
- Robert L. Goldenberg, Jay D. Iams, Anita Das, Brian M. Mercer, Paul J. Meis, Atef H. Moawad, Menache...
- The Problem
- The Solution
- Why Does Preterm Birth Happen?
- Where and When Does Preterm Birth Happen?
- Who Response
An estimated 15 million babies are born too early every year. That is more than 1 in 10 babies. Approximately 1 million children die each year due to complications of preterm birth (1). Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems. Globally, prematurity is the leading cause of death in children under the age of 5 years. And in almost all countries with reliable data, preterm birth rates are increasing. Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive. Suboptimal use of technology in middle-income settings is causing an increased burden of disability among preterm babies who survive the neonatal period.
More than three quarters of premature babies can be saved with feasible, cost-effective care, such as essential care during child birth and in the postnatal period for every mother and baby, provision of antenatal steroid injections (given to pregnant women at risk of preterm labour and under set criteria to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections. For example, continuity of midwifery-led care in settings where there are effective midwifery services has been shown to reduce the risk of prematurity by around 24%. Preventing deaths and complications from preterm birth starts with a healthy pregnancy. Quality care before, between and during pregnancies will ensure all women have a positive pregnancy experience. WHO’s antenatal care guidelines include key interventions to help prevent preterm birth, such as counselling on healthy diet and optim...
Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labour or caesarean birth, whether for medical or non-medical reasons. Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.
More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk. The 10 countries with the greatest number of preterm births(2): 1. India: 3 519 100 2. China: 1 172 300 3. Nigeria: 773 600 4. Pakistan: 748 100 5. Indonesia: 675 700 6. United States of America: 517 400 7. Bangladesh: 424 100 8. Philippines: 348 900 9. Democratic Republic of the Congo: 341 400 10. Brazil: 279 300 The 10 countries with the highest rates of preterm birth per 100 live births (2): 1. Malawi: 18.1 preterm births per 100 births 2. Comoros: 16.7 3. Congo: 16.7 4. Zimbabwe: 16.6 5. Equatorial Guinea: 16.5 6. Mozambique: 16.4 7. Gabon: 16.3 8. Pakistan: 15.8 9. Indonesia: 15.5 10. Mauritania: 15.4 Of 65 countries with reliable trend data, all but three show an increase in preterm birth rates ove...
In 2012, WHO and partners published a report Born too soon: the global action report on preterm birththat included the first-ever estimates of preterm birth by country. WHO is committed to reducing the health problems and lives lost as a result of preterm birth: 1. Working with Member States and partners to implement Every newborn: An action plan to end preventable deaths adopted in May 2014 in the framework of the UN Secretary-General’s Global strategy for women’s and children’s health; 2. Working with Member States to strengthen the availability and quality of data on preterm births; 3. Providing updated analyses of global preterm birth levels and trends every 3 to 5 years; 4. Working with partners around the world to conduct research into the causes of preterm birth, and test effectiveness and delivery approaches for interventions to prevent preterm birth and treat babies that are born preterm; 5. Regularly updating clinical guidelines for the management of pregnancy and mothers...
May 01, 2020 · The detection rate for preterm stillbirth was especially low for Karmer (54.3%) compared with Hadlock and WHO (70.4%, and 71.6%, respectively). Conclusions Although the diagnosis of SGA using IG21 has the strongest association with stillbirth, IG21 under detects SGA and stillbirth compared with the Hadlock and WHO charts.