Outcome of pregnancies with preterm prelabor rupture of membranes before 27 weeks’ gestation: a retrospective cohort study

Objective

Preterm prelabor rupture of membranes (PPROM) before 27 weeks’ gestation is associated with severe perinatal complications, but quantitative estimates are lacking. The aim of this study was to report and predict outcomes of pregnancies complicated by early PPROM and to study antepartum risk factors that might predict perinatal death in future patients.

Study design

We performed a retrospective cohort study of women with PPROM between 13⁺⁰ weeks and 27⁺⁰ weeks’ gestation between 1994 and 2009 in three perinatal centers.

Main outcome measures

Perinatal mortality, composite neonatal morbidity and premature delivery. A model to predict these outcomes was developed from antepartum variables.

Results

We identified 314 women with PPROM before 27 weeks, including 28 multiple pregnancies. Six pregnancies (2%) were terminated before 24 weeks’ gestation, and three were lost to follow up, leaving 305 pregnancies for analysis. Overall, there were 166 perinatal deaths (49%). The perinatal mortality rate decreased with increasing gestational age at PPROM (from 70% in the group PPROM 13–20 weeks to 27% in the group PPROM 24–27 weeks). Of the 170 surviving neonates, 70 suffered from serious morbidity (41%). Early gestational age at PPROM, long interval between PPROM and birth and positive vaginal culture (any bacteria) were associated with perinatal mortality.

Conclusion

Perinatal mortality in PPROM before 27 weeks occurred in half of the cases and among those who survive approximately 40% suffered serious morbidity. Antenatal parameters can be helpful to predict perinatal mortality.     

Risk factors for preterm premature rupture of membranes in Chinese women from urban cities

Objective

To investigate the prevalence of preterm premature rupture of membranes (PPROM) in urban areas in China and examine the associated risk factors.

Methods

A population-based, prospective study was undertaken in 14 cities in China between January 1, 2011, and January 31, 2012. Women were recruited at their first prenatal-care visit, when maternal characteristics were recorded. Risk factors were analyzed by one-way analysis of variance.

Results

Of 112 439 women included in analyses, 3077 (2.7%) had PPROM. Univariate analysis showed an increased risk of PPROM before 28 weeks of pregnancy in migrant women (odds ratio [OR] 2.25; 95% confidence interval [CI] 1.53–3.30; P < 0.001), in those with a history of recurrent induced abortions (OR 2.75; 95% CI 1.66–4.56; P < 0.001), and in those with a history of preterm birth (OR 3.90; 95% CI 0.77–19.61; P < 0.001). The associations were maintained in multivariate analysis (P < 0.001).

Conclusion

Migration as a result of urbanization, high rates of induced abortion, and preterm birth are potential risk factors for PPROM in Chinese women.     

Preterm birth and neonatal mortality in China in 2011

Objective

To determine the incidence of preterm birth, its regional distribution, and associated neonatal mortality in mainland China.

Methods

In a multicenter, hospital-based investigation of preterm birth, 2011 data were obtained from the seven administrative regions of mainland China. Between one and three subcenters were randomly selected for each administrative region, followed by secondary and tertiary hospitals within the chosen subcenters. Data were obtained from women’s medical records, and obstetric and perinatal events were summarized.

Results

Data for 107 905 deliveries were analyzed, which included 7769 (7.1%) preterm births (occurring between 28 and 37 weeks of pregnancy). The incidence varied among regions. Late preterm birth (between 34 and 37 weeks) accounted for 5495 (70.7%) of preterm births. The neonatal mortality rate was 33 deaths per 1000 live preterm births. Of the 254 neonatal deaths, 147 (57.9%) occurred after very preterm birth (between 28 and 32 weeks). Overall, 4519 (58.2%) preterm births occurred by cesarean.

Conclusion

The distribution of preterm birth across China is unbalanced, and neonatal mortality associated with preterm birth is high.     

Inflammatory cytokine mRNA detection by real time PCR in chorioamniotic membranes from pregnant women with preterm premature rupture of membranes

Objective

To quantify the expression of interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor alpha (TNF-α) in chorioamniotic membranes of PPROM pregnant women with chorioamnionits.

Study design

The study included 25 PPROM women in labor, 15 PPROM without labor, and 25 pregnant women in preterm labor (PTL). Chorioamniotic membranes were collected for histopathological analyses and cytokine mRNA expression quantification by real time PCR. Comparisons were performed using the Mann–Whitney, Kruskal–Wallis, Fisher's exact test or z test with significance set at p < 0.05. The software employed was the SigmaStat version 3.1.

Results

During the study PPROM incidence was 4.6% and chorioamnionits was present in 75% of the samples. IL-1β, IL-6, and IL-8 mRNA expression did not statistically differ among study groups. TNF-α mRNA expression was statistically higher in PTL. No difference in the mRNA concentration of the cytokines studied in the presence of chorioamnionitis was observed.

Conclusion

Chorioamniotic membranes are sources of IL-1β, IL-6, IL-8, and TNF-α and their mRNA concentrations in PPROM are not related to the presence of chorioamnionitis.     

Maternal hyperglycemia and adverse pregnancy outcomes in Dar es Salaam,Tanzania

Objective

To evaluate maternal glucose levels during pregnancy as a predictor of adverse perinatal outcomes in Dar es Salaam, Tanzania.

Methods

Random blood glucose measurements were analyzed from 3383 pregnant women enrolled in a randomized trial to assess the impact of multivitamins on pregnancy outcomes in Dar es Salaam between August 2001 and July 2004. Information on maternal and neonatal morbidity was recorded at monthly study visits, delivery, and 6 weeks postpartum. Binomial regression and generalized estimating equations were used to determine the relationship between elevated glucose (> 7.8 mmol/L) and pregnancy outcomes.

Results

In total, 25 women had elevated glucose (0.7%). Hyperglycemia was associated with an increased risk of delivery before 37 weeks [relative risk (RR), 2.11; 95% confidence interval [CI], 1.07–4.13; P = 0.03), delivery before 34 weeks (RR, 4.15; 95% CI, 1.43–12.03, P = 0.009), incident gestational hypertension (RR, 2.90; 95% CI, 1.24–6.76; P = 0.01), low birth weight (RR, 2.87; 95% CI, 1.18–6.99; P = 0.02), reduced newborn head circumference (mean difference, –1.57; 95% CI, –2.51 to − 0.62; P = 0.001), and fetal loss (RR, 3.38; 95% CI, 1.13–10.08; P = 0.03).

Conclusion

Maternal hyperglycemia is uncommon among pregnant Tanzanian women, but nonetheless seems to increase the risk of several adverse perinatal outcomes.     

The value of serial cervical length measurements for the prediction of threatened preterm labour

Objectives

To assess the predictive performance of cervical length measurement at presentation and 24 h later in women with symptoms of preterm labour.

Study design

Cervical length was measured transvaginally at presentation and 24 hours later in 122 women presenting with threatened preterm labour between 23 and 33 + 6 gestational weeks.

Results

Six women delivered within 1 week of presentation. The sensitivity and specificity of a cervical length <15 mm at admission for delivery within one week was 83.3 and 95.8%, respectively. A reduction of >20% in cervical length 24 h after admission predicted 50% of preterm deliveries within 1 week, with a specificity of 92.7%; in combination with cervical length at presentation it did not improve the prediction. The same was observed for birth before 32 weeks (N = 9) and birth before 35 weeks (N = 15).

Conclusions

Women with threatened preterm labour and a cervical length of <15 mm at presentation are at high risk of delivering preterm. Cervical change in the following 24 hours does not seem to improve the prediction.     

Effect of latency period after premature rupture of membranes on 2 years infant mortality (DOMINOS study)

Objective

To assess the impact of a short latency period after preterm premature rupture of the membranes (PPROM) on infant mortality.

Study design

A prospective cohort study of women with PPROM between 24^0/7 and 33^6/7 weeks’ in singleton gestation was performed in all maternity wards of the Rhône-Alpes Region. Neonatal and infant outcomes were compared according to the latency period (<48 h and ≥48 h). The primary outcome was the mortality rate and the secondary outcome was a composite variable of significant neurological disorders at 2 years of age. Outcomes was stratified according to gestational age at rupture. Univariate and multiple logistic regression analyses were used with SAS statistical software.

Results

Out of 471 women recruited in the study at a mean gestational age of 30.5 ± 0.2 weeks, 170 (37%) presented with a <48-h latency period, and 301 (63%), a ≥48-h latency period. While prior to 30 weeks’ gestation, the mortality rate was higher in neonates with a short latency period (16.3% versus 7.3%, p < 0.01) with pulmonary disease being the major cause of death, a short latency period was associated with a lower mortality rate after 30 weeks’ gestation (0% versus 3.7%, p = 0.02). After adjusting for confounding factors, a <48-h latency period remained an independent factor associated with infant mortality prior to 30 week's gestation (odds ratio 3.8, 95% confidence interval 1.3–11.7). Significant neurological disorders were not modified by the length of the latency period.

Conclusion

For PPROM that occur before 30 weeks’ gestation, a short latency period was associated with a higher infant mortality rate. Inversely, it was associated with a lower mortality rate after 30 weeks’. There is an urgent need for a thorough evaluation of expectant management of PPROM after 30 weeks’ gestation.     

Maintenance tocolysis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor

Objective

To evaluate the efficacy of maintenance therapy with oral micronized progesterone (OMP) for prolongation of pregnancy in cases of arrested preterm labor.

Methods

Ninety women at 24–34 weeks of singleton pregnancy with intact membranes and arrested preterm labor were randomly allocated to receive OMP (n = 45) or placebo (n = 45) daily until 37 weeks or delivery, whichever was earlier. Outcome parameters were compared using Student t test, χ² test, Fisher exact test, and log-rank χ² test.

Results

OMP significantly prolonged the latency period (33.29 ± 22.16 vs 23.07 ± 15.42 days; P = 0.013). Log-rank analysis revealed a significant difference in mean time to delivery between the 2 groups (P = 0.014). There were significantly fewer preterm births (33% vs 58%; P = 0.034) and low birth weight neonates (37% vs 64%; P = 0.017), and significantly higher mean birth weight (2.44 ± 0.58 vs 2.14 ± 0.47 kg; P = 0.009) in the OMP group. Perinatal outcomes and adverse effects were similar in the 2 groups.

Conclusion

Maintenance tocolysis with OMP significantly prolonged pregnancy and decreased the number of preterm births.Clinical Trial Registry of India: CTRI/2011/10/002043.     

The use of cervical length and change in cervical length for prediction of spontaneous preterm birth in asymptomatic twin pregnancies

Objective

To assess the association between cervical length (CL) and change of CL over two measurements and preterm birth (PTB) at <32 weeks in asymptomatic twin pregnancies.

Study design

This study was undertaken in the multiple pregnancy antenatal clinic at the Security Forces Hospital (SFH), a tertiary care hospital in Riyadh, Saudi Arabia, between November 2005 and October 2010. This study involved 420 women with asymptomatic twin gestations, but only 209 unselected patients completed the study and met the inclusion criteria. All patients had a CL measurement by transvaginal ultrasound at 20–23 weeks, and a second CL measurement was done within 3–5 weeks of the initial measurement. Patients were classified into two groups, group A with significant shortening of CL, and group B without significant shortening of CL. Comparisons between the groups were performed using a chi-square test or a Fisher exact test for categorical variables, whereas Student's t-test or Wilcoxon's rank-sum test was used for continuous variables. We employed ROC curves to compare the diagnostic accuracy of actual cervical length and percent change in cervical length in predicting preterm birth events. All analyses were performed using the SAS/STAT software.

Results

There were 35 (16.7%) patients whose CL shortened by ≥25% (group A), and 174 (83.3%) whose CLs either did not shorten or shortened by <25% (group B). Preterm birth at <28, <30, <32, and <34 weeks gestation was higher in group A than in group B even if the CL was >25 mm. The use of CL shortening was superior, but not statistically significantly, to the use of CL for the prediction of PTB at <32 (P = 0.0524) and <34 weeks (P = 0.281), but CL was preferred for the prediction of PTB at <28 (P = 0.037) and <30 weeks (P = 0.0457).

Conclusion

The test of two CL measurements, the first between 20 and 23 weeks gestation and another CL measurement 3–5 weeks later, with a difference of ≥25%, is a good predictor for preterm birth in asymptomatic twin pregnancies, even if the CL is >25 mm.     

Interleukin-1 beta gene polymorphisms and preterm birth

Objective

To investigate the association between two genetic variations in the Interleukin-1 beta (IL1B) gene and preterm birth.

Study design

In this case-control study we tested the allelic distribution of two of its common polymorphisms (IL1B +3953C>T [rs1143634], IL1B −511C>T [rs16944]) in one hundred women with preterm birth and one hundred healthy women with at least one uncomplicated full term pregnancy and no history of preterm birth.

Results

A significant association was found between the presence of the IL1B +3953C>T polymorphism and preterm birth (p = 0.049, OR 0.6 [0.3–1.0]). No significant association was found between the IL1B −511C>T polymorphism and preterm birth (p = 0.471, OR 1.3 [0.7–2.3]).

Conclusion

Our findings suggest that the IL1B +3953C>T polymorphism is associated with a risk reduction for preterm birth in Caucasian women, possibly by altering the inflammatory response during pregnancy.     

Neonatal and two-year outcomes after rupture of membranes before 25 weeks of gestation

Objective

To assess the impact of extreme preterm premature rupture of membranes (PPROM) <25 weeks of gestation on preterm child outcome.

Study design

Retrospective study comparing the neonatal and 2-year outcomes of infants exposed to extremely PPROM <25 weeks with a non-exposed group of neonates in a tertiary care referral centre located in Paris, France, between 2003 and 2007. All women with singleton pregnancy and PPROM between 15^0/7 and 24^6/7 weeks of gestation were recruited. For each infant born alive, the next inborn neonate matched for gestational age and sex was selected as a control among neonates born alive after spontaneous preterm labour with intact membranes. The main outcome measures were neonatal outcome assessed by a combined criterion of adverse neonatal outcomes and the two-year neurodevelopmental outcome assessed by developmental Brunet–Lézine tests and neurological examinations.

Results

In 78 cases of extremely PPROM, 22 live births occurred at a mean gestational age of 26^5/7 weeks. The percentage of neonates with adverse neonatal outcomes was significantly higher among PPROM than non-exposed cases (68.2 versus 27.3%). At 2 years of age, children from the PPROM group were more likely to have delayed acquisitions (64.3 versus 15.8%) and behavioural disorders (57.1 versus 15.8%). Mean Brunet–Lézine language score was significantly lower among those infants (78.9 versus 96.8).

Conclusion

PPROM <25 weeks is associated with increased neonatal mortality and morbidity and with increased risks of delayed acquisitions, behavioural disorders and lower language performance scores at 2 years in comparison with matched preterm neonates born after spontaneous preterm labour with intact membranes.     

Intrauterine factors and risk of nonepithelial ovarian cancers

Objective

The majority of ovarian tumors in girls and young women are nonepithelial in origin. The etiology of nonepithelial ovarian tumors remains largely unknown, and intrauterine exposures may play an important role. We examined the association of perinatal factors with risk of nonepithelial ovarian tumors in girls and young women.

Methods

National cohort study of 1,536,057 women born in Sweden during 1973–2004 and followed for diagnoses of nonepithelial ovarian tumors through 2009 (attained ages 5–37 years). Perinatal and maternal characteristics and cancer diagnoses were ascertained using nationwide health registry data.

Results

147 women were diagnosed with nonepithelial ovarian tumors in 31.6 million person-years of follow-up, including 94 with germ cell tumors and 53 with sex-cord stromal tumors. Women born preterm (< 37 weeks of gestation) had a significantly increased risk of developing nonepithelial ovarian tumors (adjusted hazard ratio 1.86, 95% CI 1.03–3.37; p = 0.04). Histological subgroup analyses showed that preterm birth was associated with increased risk of sex-cord stromal tumors (4.39, 2.12–9.10; p < 0.001), but not germ cell tumors (0.68, 0.21–2.15; p = 0.51). No significant associations were found with fetal growth, birth order, and maternal age at birth.

Conclusions

This large cohort study provides the first evidence that preterm birth is a risk factor for developing sex cord-stromal tumors. Ovarian hyperstimulation in response to high gonadotropin levels in preterm girls could mediate disease risk through the proliferative and steroidogenic effects of FSH and LH on granulosa and theca cells, from which most sex-cord stromal tumors are derived.     

Small uterine septum is an important risk variable for preterm birth

Objective(s)

To evaluate whether a uterus with a small septum (arcuate uterus or class VI according to the American Fertility Society (AFS) classification) behaves similarly to a uterus with a larger septum (septate or subseptate uterus or AFS class V).

Study design

Observational study included 826 singleton deliveries to 730 women with a history of hysteroscopic resection of the uterine septum. Data on deliveries were obtained from the National Perinatal Registry of Slovenia (NPIS). Multiple gestations were excluded. We analysed and compared perinatal outcomes before and after hysteroscopic resection in two groups of women: in women with a small uterine septum (Group A) and in those with a larger uterine septum (Group B). Data on the septum length were obtained during hysteroscopic resection by comparing the length of the 1.4-cm long yellow tip of the electric knife to the length of the resected septum. A small uterine septum was defined as having a length of 1.3–1.5 cm.

Results

The preterm birth rate in Group A (n = 420) was 33.9% before and 7.2% after hysteroscopic resection (P < 0.001); the preterm birth rate in Group B (n = 406) was 36.5% before and 8.0% after hysteroscopic resection (P < 0.001). The very preterm birth rate in Group A was 12.5% before and 3.1% after hysteroscopic resection (P < 0.001); the very preterm birth rate in Group B was 15.0% before and 2.9% after hysteroscopic resection (P < 0.001). After surgery, we registered a decreased need for neonatal intensive care, as well as a significant decrease in stillbirth and neonatal death rates in both groups of patients.

Conclusion(s)

Similarly to a large uterine septum, a small uterine septum or arcuate uterus is an important hysteroscopically preventable risk variable for preterm birth.     

Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study

Objective

To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies.

Study design

A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n = 320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women's hospital (n = 170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared.

Results

Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group.

Conclusions

The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group.     

Development of a prognostic model for predicting spontaneous singleton preterm birth

Objective

To develop and validate a prognostic model for prediction of spontaneous preterm birth.

Study design

Prospective cohort study using data of the nationwide perinatal registry in The Netherlands. We studied 1,524,058 singleton pregnancies between 1999 and 2007. We developed a multiple logistic regression model to estimate the risk of spontaneous preterm birth based on maternal and pregnancy characteristics. We used bootstrapping techniques to internally validate our model. Discrimination (AUC), accuracy (Brier score) and calibration (calibration graphs and Hosmer-Lemeshow C-statistic) were used to assess the model's predictive performance. Our primary outcome measure was spontaneous preterm birth at <37 completed weeks.

Results

Spontaneous preterm birth occurred in 57,796 (3.8%) pregnancies. The final model included 13 variables for predicting preterm birth. The predicted probabilities ranged from 0.01 to 0.71 (IQR 0.02–0.04). The model had an area under the receiver operator characteristic curve (AUC) of 0.63 (95% CI 0.63–0.63), the Brier score was 0.04 (95% CI 0.04–0.04) and the Hosmer Lemeshow C-statistic was significant (p < 0.0001). The calibration graph showed overprediction at higher values of predicted probability. The positive predictive value was 26% (95% CI 20–33%) for the 0.4 probability cut-off point.

Conclusions

The model's discrimination was fair and it had modest calibration. Previous preterm birth, drug abuse and vaginal bleeding in the first half of pregnancy were the most important predictors for spontaneous preterm birth. Although not applicable in clinical practice yet, this model is a next step towards early prediction of spontaneous preterm birth that enables caregivers to start preventive therapy in women at higher risk.     

Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting

Objective

To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource-limited settings.

Methods

A prospective cross-sectional study was undertaken involving women with (n = 105) and without (n = 105) a confirmed diagnosis of PPROM admitted to Nnamdi Azikiwe University Teaching Hospital, southeast Nigeria, between January 1, 2011, and April 30, 2013. Endocervical swabs were collected from all participants and examined microbiologically. Antibiotic sensitivity testing was performed using Kirby–Bauer disk diffusion.

Results

Streptococcus spp., Staphylococcus aureus, and Escherichia coli were significantly more prevalent among women with PPROM than among those without PPROM (P < 0.01). Among the antibiotics considered safe to use during pregnancy, the bacteria were most sensitive to ampicillin-sulbactam, cefixime, cefuroxime, and erythromycin.

Conclusion

For the first 48 hours, women with PPROM should receive an intravenous dose combining ampicillin-sulbactam, cefixime, cefuroxime, or erythromycin with metronidazole followed by oral administration of the chosen antibiotic combination to complete a 7-day course.     

Factors associated with the use of prenatal corticosteroids in the management of preterm delivery in Chinese hospitals

Objective

To assess the prevalence of the use of prenatal corticosteroids (PCS) in the management of preterm delivery and the factors associated with PCS administration.

Methods

A secondary analysis was performed of a cross-sectional study conducted in 21 Chinese healthcare facilities between November 2010 and January 2011. The medical records of women who delivered preterm were reviewed. Associations between PCS administration and individual and organizational-level factors were determined.

Results

The study population comprised 659 women who delivered at 20 facilities. PCS were given to 158 (68.1%) of 232 women delivering after 27–34 weeks of pregnancy and 119 (27.9%) of 427 delivering after 35–36 weeks. Teenaged girls were less likely to receive PCS after 27–34 weeks than were women aged 20–35 years (odds ratio [OR] 0.22; 95% confidence interval [CI] 0.07–0.70). Among women who delivered after 35–36 weeks, the odds of receiving PCS were lower in urban hospitals than in periurban or rural hospitals (OR 0.04; 95% CI 0.00–0.44), and there was significant hospital-level variance with regard to the administration of PCS (P < 0.05).

Conclusion

Generally, PCS were underprescribed to women at risk of preterm delivery and many women received the treatment after 35–36 weeks of pregnancy, when it might not have been effective.     

Pregnancy outcomes of expectant management of stable mild to moderate chronic hypertension as compared with planned delivery

Objective

To compare outcomes between elective delivery at 37 weeks of pregnancy and expectant management among pregnant women with mild to moderate chronic hypertension.

Methods

In a two-center study, 76 women with mild to moderate chronic hypertension were randomly allocated to planned delivery at 37 completed weeks (group A) or expectant management for spontaneous onset of labor or reaching 41 weeks (group B) between April 2012 and October 2013. Differences were compared by t test, χ² test, or Fisher exact test. Odds ratios (ORs) with 95% confidence interval (CIs) were determined.

Results

There were no differences in superimposed pre-eclampsia (SPE), severe hypertension, preterm delivery, placental abruption, oligohydramnios, intrauterine growth restriction, or perinatal mortality between the groups. Group B had higher gestational age at delivery (P = 0.001) and birth weight (P = 0.01), but lower cesarean (OR 3.4; 95% CI, 1.2–10.3; P = 0.03) and neonatal care unit admission (OR 5.4; 95% CI, 1.4–21.0; P = 0.01) rates. More women with SPE were diagnosed before than after 37 weeks in group B (P = 0.01). Overall, patients who developed SPE had more adverse pregnancy outcomes than those who did not.

Conclusion

Mild to moderate chronic hypertension could be managed expectantly up to 41 weeks if SPE did not develop.     

Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight

Objective

To evaluate the association between exposure to life-threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).

Methods

The present retrospective cohort study compared the outcomes of 1851 births by women exposed to rocket attacks and 2979 births by unexposed women. The timing, frequency, and intensity of exposure were calculated for each trimester and for the entire pregnancy period. Demographic and medical data were abstracted from the patients’ records.

Results

The rates of PTB and LBW were higher among exposed than unexposed women (PTB: 9.1% versus 6.8%, P = 0.004; LBW: 7.6% versus 5.8%, P = 0.02). The rate of infants who were small for gestational age did not differ between the groups. After controlling for potential confounders, the risks for PTB and LBW remained significantly higher in the exposed group (PTB: adjusted odds ratio 1.3 [95% confidence interval, 1.1–1.7]; LBW: adjusted odds ratio 1.3 [95% confidence interval, 1.03–1.7]). There was no linear association between the intensity of exposure and the risk of PTB or LBW.

Conclusion

Maternal exposure to intermittent but repeated life-threatening rocket attacks for a prolonged period might be associated with increased risks of PTB and LBW.