早早产的预测

34周以前终止妊娠的早早产是围产儿病率和围产儿死亡的最主要因素，因此预测早早产具有重要的临床意义。该文就近几年来早早产预测指标的研究进展作一综述。     

宫颈粘液中纤连蛋白与早产的关系研究

早产是围产儿发病率和死亡率增加重要原因之一,75%以上的围产儿死亡与早产有关。尽管近年来围产医学有很大发展,但是早产率仍然很高,早期对早产的预测和治疗,是降低早产发生率、改善不良妊娠的关键。近年来研究发现,早产前绒毛膜与蜕膜组织生物活动改变,胎儿纤连蛋白释放到宫颈阴道中,本研究通过检测宫颈粘液中纤连蛋白(FFN)浓度,来分析FFN与早产的关系,预测早产。1资料与方法1.1研究对象2006年9月~2007年2月我院住院先兆早产患者57例作为研究组,平均年龄为(27.1±3.5)岁,平均孕次为(1.7±0.8)次,平均流产次数为(0.7±0.6)次,平均孕周为(…     

影响早产产妇及其围产儿结局相关因素分析

对１９９１年９月～１９９８年３月的早产病例进行分析,以探讨影响早产产妇及其围产儿结局的相关因素, 降低早产发生率,提高早产儿成活率。在上述期间,分娩总数６ １０９例,早产３４１例（３６０例新生儿）,早产发生率５．６％。 ３４１例早产中,新生儿窒息率２６．１％,早产围产儿死亡率８３．３％。早产前５位原因依次为胎膜早破、胎位异常、前置胎盘、 妊高征、多胎妊娠和胎儿宫内窘迫。产前保健的不足对早产的发生有显著性意义。期待治疗可延长胎龄、增加胎儿体重, 对降低早产发生率和早产围产儿死亡率有积极的作用。     

南京市1996—2000年围产儿死亡分析

对南京市 1 996～ 2 0 0 0年 2 671例围产儿死亡个案进行死因分析 ,结果显示南京市 1 996～ 2 0 0 0年围产儿死亡率呈总体下降趋势 ;围产儿死亡主要危险因素为新生儿窒息、出生缺陷、早产、脐带因素、胎盘因素、新生儿肺炎等。建议采取干预措施 ,降低窒息的发生和死亡 ,有效预防早产 ,做好出生缺陷的病因预防和早诊断 ,以进一步降低围产儿死亡率     

334例早产临床分析

目的 分析我院2006年334例早产发生的危险因素,总结提高产科早产预防和医疗水平.方法 比较早产组334例与同期分娩的足月对照组334例,分析早产的临床相关因素及对围产儿的影响.结果 胎膜早破、妊娠高血压综合征、前置胎盘、臀位、多胎妊娠是早产的重要因素.早产使新生儿窒息、围生儿死亡、低体重儿增加.结论 早产使围产儿窒息和死亡率增加.加强早产预测可望降低早产的发生,提高围生医学质量.     

101例早产与围产期保健工作的探讨

目的:为探讨早产的相关因素、围产儿情况与围产期的保健意义。方法:选取了2002年1月～2004年3月在该院分娩的101例早产儿,进行了早产相关因素及围产儿情况分析。结果:胎膜早破、臀位、妊娠高血压综合征、内科合并症占据早产因素的前4位:早产儿低出生评分及死亡率均明显升高。结论:孕期多种因素与早产有关,早产是围产儿死亡的主要原因。提示加强围产期保健,提高孕产妇自我保健意识,对降低早产率有着十分重要的意义。     

101例早产与围产期保健工作的探讨

目的为探讨早产的相关因素、围产儿情况与围产期的保健意义.方法选取了2003年1月～2005年3月在该院分娩的101例早产儿,进行了早产相关因素及围产儿情况分析.结果胎膜早破、臀位、妊娠高血压综合征、内科合并症占据早产因素的前4位早产儿低出生评分及死亡率均明显升高.结论孕期多种因素与早产有关,早产是围产儿死亡的主要原因.提示加强围产期保健,提高孕产妇自我保健意识,对降低早产率有着十分重要的意义.     

妊娠期肝内胆汁淤积症的围产儿结局探讨

目的探讨妊娠期肝内胆汁淤积症(Intrahepatic cholestasis of Pregnancy,ICP)对围产儿结局的影响及防治措施。方法回顾性分析2005～2010年ICP患者52例的临床资料,随机选取同期分娩的无ICP正常孕产妇67例(对照组)进行对比分析,比较两组围产儿结局。结果观察组胎儿窘迫、新生儿窒息、围产儿死亡及早产发生率均高于对照组,差异有统计学意义(P<0.05)。结论 ICP对围产儿结局影响极大,可引起早产、胎儿窘迫、新生儿窒息、围产儿死亡。早诊断、早治疗,加强孕产期监护,适时终止妊娠是降低其并发症的关键。     

早产预测的临床应用价值评价

早产是我国围产儿不良结局的首要原因,有过自发性早产的妇女是早产再发的高危人群。对于早产相关临床、超声、生化标志物预测的研究旨在识别早产高危孕妇,并提前进行干预,以降低早产发生率,改善围产儿预后。阴道超声宫颈长度测量是预测早产的有效方法,建议对有自发性早产史的单胎妇女常规在孕16~24周进行宫颈长度测量筛查;胎儿纤连蛋白的主要价值在于对有早产临床症状患者有极高的阴性预测值。本文的目的是介绍早产的主要预测方法,并评估其临床运用价值。     

妊娠期肝内胆汁淤积症对围产儿结局的影响

目的:探讨妊娠期肝内胆汁淤积症(ICP)对围产儿结局的影响及防治措施。方法:回顾性分析2001年2月~2009年12月ICP患者81例(观察组)的临床资料,随机选取同期分娩的无ICP正常孕产妇81例(对照组)进行对比分析,比较两组围产儿结局。结果:观察组胎儿窘迫、新生儿窒息、围产儿死亡及早产发生率均高于对照组,差异均有统计学意义(P<0.05)。结论:ICP对围产儿结局影响极大,可引起早产、胎儿窘迫、新生儿窒息、围产儿死亡。早诊断、早治疗、加强孕产期监护,适时终止妊娠是降低其并发症的关键。     

Racial Differences in the Patterns of Singleton Preterm Delivery in the 1988 National Maternal and Infant Health Survey

Objectives: To determine if the association between race and preterm delivery would persist when preterm delivery was partitioned into two etiologic pathways. Methods: We evaluated perinatal and obstetrical data from the 1988 National Maternal and Infant Health Survey and classified preterm delivery as spontaneous or medically indicated. Discrete proportional hazard models were fit to assess the risk of preterm delivery for Black women compared with White women adjusting for potential demographic and behavioral confounding variables. Results: Preterm delivery occurred among 17.4% of Black births and 6.7% of White births with a Black versus White unadjusted hazard ratio (HR) of 2.8 (95% CI = 2.4–3.3). The adjusted HR for a medically indicated preterm delivery showed no racial difference in risk (HR = 1.0, 95% CI = 0.4–2.6). However, for spontaneous preterm delivery between 20 and 28 weeks gestation, the Black versus White adjusted hazard ratio (HR) was 4.9 (95% CI = 3.4–7.1). Conclusions: Although we found an increased unadjusted HR for preterm delivery among Black women compared with White women, the nearly fivefold increase in adjusted HR for the extremely preterm births and the absence of a difference for medically indicated preterm delivery was unexpected. Given the differences in the risks of preterm birth between Black and White women, we recommend to continue examining risk factors for preterm delivery after separating spontaneous from medically indicated preterm birth and subdividing preterm delivery by gestational age to shed light on the reasons for the racial disparity.     

Preterm delivery: detection of risks and preventive treatment]

Every year around the world some 13 million premature children are born. Most of these children are born in developing countries, and they account for the largest share of perinatal morbidity and mortality. This review study analyzed scientifically validated data on interventions to prevent at least some portion of these preterm deliveries and to lessen their impact on neonatal health. The Cochrane and MEDLINE bibliographic databases were consulted. Fifty review pieces and research articles were studied, relating to the following aspects of preterm delivery: risk factors and early detection of the risk of preterm delivery; preventing the risk of preterm delivery; treating preterm delivery once it has begun; and preventing neonatal respiratory distress syndrome. There were few successful approaches to the prediction, prevention, or early detection of the threat of preterm delivery. The only measures that can be recommended for all pregnant women are screening for and treating asymptomatic bacteriuria as a part of prenatal check-ups. Screening for bacterial vaginosis and treating it reduce the incidence of preterm births in pregnant women with a history of premature delivery. In addition, prophylactic cerclage decreases the incidence of premature births in pregnant women who have had more than three preterm births. To treat a delivery that starts early, with or without premature membrane rupture, the interventions that have proved to be effective are administering betamimetics to the parturient woman in order to delay delivery for 48 hours, and using indomethacin for the same purpose, as the second-choice drug. The prenatal administration of corticosteroids to the pregnant woman can induce lung maturation in the fetus and reduce respiratory distress syndrome and ventricular hemorrhage, thus decreasing neonatal mortality. There is a need to continue and support basic and epidemiological research in order to develop new knowledge on the causes and mechanisms of preterm delivery and on preventing the morbidity and mortality that preterm delivery produces.     

Maternal second-trimester serum ferritin concentrations and subsequent risk of preterm delivery

We studied the relationship between maternal second-trimester serum ferritin concentrations and preterm delivery. The 312 preterm delivery cases, studied in aggregate and in subgroups [spontaneous preterm labour, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery (gestational age at delivery 34-36 weeks) and very preterm delivery (gestational age at delivery <34 weeks)] were compared with 424 randomly selected women who delivered at term. Maternal ferritin concentrations, measured in serum collected at 17 weeks gestation on average, was determined using a two-site chemiluminometric immunoassay. Using multiple logistic regression, we derived maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals [CI]. Elevation in maternal second-trimester ferritin was weakly associated with the risk of preterm delivery overall. After adjusting for possible confounding by maternal age, race/ethnicity, parity, Medicaid payment status and smoking during the index pregnancy, the OR for extreme quartiles (>64.5 vs. <26.0 ng/mL) of ferritin was 1.3 [95% CI 0.8, 2.1]. Stratified analyses indicated that elevated maternal serum ferritin was associated with an increased risk of preterm premature rupture of membranes (OR = 2.1; 95% CI 1.1, 4.1), but not with spontaneous preterm labour (OR = 0.9; 95% CI 0.4, 1.7) or medically induced preterm delivery (OR = 1.1; 95% CI 0.6, 2.0). The relationship between elevated maternal second-trimester serum ferritin concentrations and preterm delivery was strongest for spontaneous very preterm deliveries (<34 weeks gestation). Women with ferritin concentrations in the highest decile (>96 ng/mL) experienced a 2.7-fold increased risk of delivering before 34 completed weeks, compared with women with concentrations <26.0 ng/mL. These results are consistent with some previous reports, and further underline the potential for heterogeneity in the aetiology of preterm delivery.     

胎儿纤维连接蛋白联合宫颈长度测量对先兆早产孕妇发生早产的预测价值

目的探讨胎儿纤维连接蛋白联合宫颈长度测量对先兆早产孕妇发生早产的预测价值。方法先兆早产孕妇200例(先兆早产组100例与早产组100例)和足月妊娠正常产妇100例(对照组)采用胎儿纤维连接蛋白联合宫颈长度测量诊断。结果胎儿纤维连接蛋白联合宫颈长度测量对先兆早产孕妇发生早产预测率为88.0%,而对先兆早产的预测为78.0%,同时对照组的阳性比率为9.0%,早产组和先兆早产组的阳性率明显高于对照组(P﹤0.05)。结论胎儿纤维连接蛋白在临产后的表达变化与早产发生有关,为胎儿纤维连接蛋白预测早产提供了一定的理论支持。     

Does evidence of inflammation on Papanicolaou smears of pregnant women predict preterm labor and delivery?

BACKGROUND: Preterm delivery is the most common cause of neonatal morbidity and mortality in the United States. There is evidence that cervicovaginal infection could predispose to preterm labor. This study explored a possible association of evidence of inflammation on an otherwise normal Papanicolaou smear obtained during pregnancy with subsequent preterm labor and preterm delivery. METHODS: Using a retrospective matched cohort design, we studied women who gave birth to live singleton infants at the University of Missouri Hospital and Clinics during a 21-month period. Papanicolaou smears were obtained from 1 to 8 months before delivery and were interpreted in the same cytopathology laboratory. Data pertaining to outcome variables and potential confounding variables were collected from hospital charts. RESULTS: Incidence rates were 14.4 percent for labor < 37 weeks' gestation (preterm labor), 12.3 percent for hospitalization for preterm labor, 9.9 percent for delivery < 37 weeks (preterm delivery), 2.6 percent for delivery < 34 weeks, and 7.5 percent for birth weight < 2500 g. On univariate and multivariate analyses, there were no significant differences in any outcome between the 293 women with inflammation and the 284 women without inflammation on Papanicolaou smear. Results were unchanged when the analysis was limited to the 412 women who received no antibiotics during pregnancy. Among the 38 women with a history of preterm labor or preterm delivery, those with cervical inflammation had a higher rate of preterm labor than those without inflammation. CONCLUSIONS: In the sample as a whole, there was little evidence that findings of inflammation on Papanicolaou smear constituted a risk factor for preterm labor or preterm delivery. The data suggest that inflammation could be associated with an increased risk in a subgroup of women at higher risk by virtue of their obstetric history.     

Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking

STUDY OBJECTIVE: Research shows that neighbourhood socioeconomic factors are associated with preterm delivery. This study examined whether cigarette smoking and individual socioeconomic factors modify the effects of neighbourhood factors on preterm delivery. DESIGN: Case-control study. SETTING: Moffit Hospital in San Francisco, California. PARTICIPANTS: 417 African American and 1244 white women, including all preterm and a random selection of term deliveries 1980-1990, excluding non-singleton pregnancies, congenital anomolies, induced deliveries, and women transported for special care. US census data from 1980 and 1990 were used to characterise the women's neighbourhoods, defined as census tracts. RESULTS: Cigarette smoking increased the risk of preterm delivery among both African American (OR=1.77, 95% confidence intervals (CI) (1.12 to 2.79)) and white women (OR=1.25, 95% CI (1.01 to 1.55)). However, cigarette smoking did not attenuate or modify the association of neighbourhood factors with preterm delivery. Among African American women, having public insurance modified the relation between neighbourhood unemployment and preterm delivery; among women without public insurance, the risk of preterm delivery was low in areas with low unemployment and high in areas with high unemployment, while among women with public insurance the risk of preterm delivery was highest at low levels of neighbourhood unemployment. CONCLUSIONS: Cigarette smoking was associated with preterm delivery, especially among African Americans. Adverse neighbourhood conditions had an influence on preterm delivery beyond that of cigarette smoking. The effects of some neighbourhood characteristics were different depending on individual socioeconomic status. Examining socioeconomic and behavioural/biological risk factors together may increase understanding of the complex causes of preterm delivery.     

Familial patterns of preterm delivery: maternal and fetal contributions

Women who deliver preterm (<37 completed weeks' gestation) are at high risk for recurrence. This has prompted exploration of candidate genes (both maternal and fetal) associated with preterm delivery. Epidemiologists can use recurrence patterns of preterm delivery across generations to assess the relative contributions of maternal and fetal genes. The authors used data from the Medical Birth Registry of Norway (1967-2004) to identify 191,282 mothers and 127,830 fathers who subsequently had at least one singleton offspring. The authors stratified parents according to whether or not they had been born preterm and calculated the risk of preterm delivery among their firstborn. Mothers born preterm had a relative risk for preterm delivery of 1.54 (95% confidence interval (CI): 1.42, 1.67). This association was weaker for fathers born preterm (relative risk (RR) = 1.12, 95% CI: 1.01, 1.25). Among early preterm births (<35 weeks), the effect became stronger for mothers (RR = 1.85, 95% CI: 1.52, 2.27) and weaker for fathers (RR = 1.06, 95% CI: 0.77, 1.44). These data suggest that paternal genes have little, if any, effect on preterm delivery risk. This argues against major contributions of fetal genes inherited from either parent. The increased risk of preterm delivery among mothers born preterm is consistent with heritable maternal phenotypes that confer a propensity to deliver preterm.     

The Relationship of Socioeconomic Status to Preterm Contractions and Preterm Delivery

Spontaneous preterm labor precedes approximately 50% of preterm births. One to 10% of pregnant women are hospitalized for preterm labor. This study examines the relationship of socioeconomic indicators, family income, education and type of insurance, with preterm contractions and subsequent preterm delivery. Data were from the pregnancy risk assessment monitoring system on 107,926 women who had singleton births during 2000?C2002. Data on preterm contractions, family income, and type of insurance during pregnancy were from the maternal questionnaire. Maternal education and gestational age were derived from birth certificate data. Predicted marginal probabilities from logistic regression models were used to calculate the adjusted cumulative incidence and cumulative risk ratio of preterm contractions and preterm delivery. Median annual household income was approximately $30,000. More than one-fourth (28.1 95% CI: 27.7, 28.6) of women experienced preterm contractions, and these women were 3 times as likely (18 vs. 5%) to deliver preterm as women without preterm contractions. Only 58% of women who delivered preterm reported contractions. Lower income and Medicaid-paid care were independently associated with an increased risk of preterm contractions but not with preterm delivery. The association of lower income and Medicaid enrollment with preterm contractions but not preterm delivery suggests that SES is associated with the initiation of the pathway to spontaneous preterm delivery rather than access to or the success of interventions to prevent delivery following the onset of contractions.     

History of fetal loss and other adverse pregnancy outcomes in relation to subsequent risk of preterm delivery

Objective: To evaluate the association between maternal reproductive history and preterm delivery. Methods: The 312 preterm delivery cases, studied in aggregate, and in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34–36 weeks], and very preterm delivery [gestational age at delivery <34 weeks]), were compared with 424 randomly selected women who delivered at term. Maternal medical records provided information on maternal reproductive history, pregnancy outcome, as well as sociodemographic characteristics. Using multivariate logistic regression, we derived maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: A history of 2+ miscarriages was ( OR = 2.2; 95% CI 1.2–3.9), but a history of 2+ prior induced abortions (OR = 1.2; 95% CI 0.7–2.0) was not, associated with preterm delivery in the index pregnancy. Analyses of preterm delivery subgroups indicated that a history of 2+ miscarriages was associated with an increasedrisk of spontaneous preterm labor (OR = 2.6; 95% CI 1.2–2.8), preterm premature rupture of membrane (OR = 1.8; 95% 0.7–4.4), and medically induced preterm delivery (OR = 1.9; 95% CI 0.8–4.2), though only the former approached statistical significance. Excess risk of preterm delivery was associated with maternal prior history of delivering a stillborn infant (OR = 10.7), a prior history of delivering a newborn that later died during the neonatal period (OR = 3.2), and a prior history of having a pregnancy complicated by spontaneous preterm delivery (OR = 6.0). Generally these associations were evident for each subgroup of preterm delivery, though inferences were often hindered by our relatively small sample size. Conclusions: These results support the hypothesis that maternal adverse reproductive history is associated with an increased risk of preterm labor and delivery.     

华南汉族女性TNF-α基因多态与早产的相关研究

目的:研究肿瘤坏死因子(tum or necrosis facor,TNF)-α基因-308、+488位点单核酸多态性(single nucleotide polym orphism,SNP)与华南地区汉族女性早产的相关性,并探讨其与早产相关危险因素的交互作用。方法:应用病例对照研究方法,选取116例正常足月产妇及110例早产产妇为研究对象,采用聚合酶链反应-高分辨率熔解曲线(PCR-HRM)技术结合测序法检测其TNF-α基因-308、+488位点多态性分布,运用多因素Logistic回归等方法分析基因型和早产的关系以及与相关危险因素的交互作用。结果:①检测到对照组和早产组的TNF-α基因-308位点基因型GG、GA、AA频率分布均为84.5%、15.5%和0%,+488位点基因型GG、GA、AA频率分别为78.5%、19.8%、1.7%和69.1%、28.2%、2.7%,两组基因型分布频率和等位基因频率比较差异无统计学意义(P0.05)。②TNF-α基因产妇有家族早产史、孕期阴道炎、胎膜早破为早产的危险因素,TNF-α基因-308位点GA基因型对家族早产史、孕期阴道炎、胎膜早破的暴露效应有放大作用,+488位点GA+AA基因型对胎膜早破、家族早产史的暴露效应也有放大作用,交互作用系数(r)均1,均为超相乘交互模型。结论:TNF-α基因+488位点GA+AA基因型和-308位点GA基因型与华南汉族女性早产的危险性相关,且与胎膜早破、家族早产史存在一定的交互作用。