Resumption of menstruation during lactation after delivery

Twenty-three women in the menstruation resumption during lactation were evaluated. Average period of lactational amenorrhoea was 7 months after delivery. Ovulation before the first menstruation has occurred in 7 breastfeeding women (39%), but only in one case it took place earlier than 6 months after labour. The correlation was established between the resumption of menstruation and entirely period of breastfeeding per day. The Lactational Amenorrhoea Method (LAM) as the family planning procedure was discussed.     

Relaxin in paired samples of serum and milk from women after term and preterm delivery

In a study to determine if relaxin could be measured in milk and if so to correlate concentrations in milk and serum, paired samples of milk and serum were collected from 12 women 3 days after term delivery (term group), from 16 women 3 days after preterm delivery (preterm group), and from some of these patients 6 weeks after delivery (eight term and six preterm). Relaxin was measured by specific human relaxin radioimmunoassay. Relaxin from milk and sera behaved similarly in the relaxin radioimmunoassay and reverse-phase high-performance liquid chromatography. Concentrations of relaxin in sera and milk collected 3 days after delivery did not differ significantly within the term or preterm groups. Neither were there differences in relaxin levels in sera and milk between the term and preterm groups. At 6 weeks postpartum, relaxin was not measured in any sera but was measured in milk from six of eight patients in the term group and five of six patients in the preterm group. Relaxin concentrations in milk were higher in the preterm group. The presence of relaxin in milk at 6 weeks postpartum suggests a nonluteal site of synthesis.     

Histologic placental lesions in women with recurrent preterm delivery

BACKGROUND: The aim of this study was to evaluate whether particular placental histopathology lesions are associated with recurrent preterm birth. METHODS: We analyzed a database of 413 consecutive singleton pregnancies delivered at <32 weeks with past reproductive history available. After the exclusion of nulliparous women, the pregnancies were divided according to the obstetrical history into group 1 (n = 328), women without prior preterm delivery (PTD); group 2 (n = 49), women with one prior preterm childbirth; and group 3 (n = 36), women with > or =2 prior preterm deliveries. Demographic and clinical variables were compared among the three groups by using Kruskal-Wallis test and chi-square test for trend. Finally, the individual placental lesions (i.e. 42 lesions of acute or chronic inflammation, uteroplacental vascular pathology, and intraplacental villous lesions) were correlated with the number of prior preterm deliveries by using regression analysis. A two-tailed P < 0.05 was considered significant. RESULTS: No differences were found among the three groups in demographic or clinical variables. Regression analysis of scored placental lesions corrected for gestational age at delivery showed that the number of prior preterm deliveries was correlated only with chronic marginating choriodeciduitis (correlation coefficient = 0.13; P = 0.01) and acute choriodeciduitis (correlation coefficient = 0.14; P = 0.008). CONCLUSIONS: Among women delivered at <32 weeks, those with prior preterm birth have histologic findings compatible with acute or chronic inflammatory involvement of the uterine cavity, suggesting that a prepregnancy endometrial infection rather than an ascending intrapregnancy pathway may be responsible for some recurrences of PTD.     

S-relaxin as a predictor of preterm delivery in women with symptoms of preterm labour

Objective To evaluate whether serum relaxin (S-relaxin) can predict spontaneous delivery before 34 weeks of gestation in high risk pregnancies.
Design A prospective cohort study.
Setting Calculated sample size was reached over a two-year period, during which 9507 women gave birth. Of these, 157 healthy women were eligible for the study as they were admitted with symptoms of delivery before 34 weeks of gestation. Ninety-three women were included. Overall participation rate was 59%.
Population Healthy women with singleton pregnancies with symptoms of delivery before 34 weeks of gestation.
Methods S-relaxin was measured using a standard sandwich ELISA.
Main outcome measures End points were preterm delivery before 34 weeks of gestation and delivery within three days from initiation of symptoms. The best possible prediction of preterm delivery was established using logistic regression for risk factors individually associated with preterm delivery before 34 weeks of gestation. S-relaxin was dichotomised to obtain best possible fit and then entered into the model. The same analyses were done for delivery within three days.
Results Median S-relaxin levels varied significantly in the women with preterm prelabour rupture of membranes (PPROM) (316 pg/mL), contractions (222 pg/mL) or ripe cervices (203 pg/mL) (   P < 0.05  ). S-relaxin above the 80th centile (≥300 pg/mL) was associated with an increased risk of preterm delivery [crude  OR = 4.8; (95% CI: 1.9–12)  ]. Likelihood ratio of a positive test is 2.6 (1.5–4.9) and S-relaxin resulted in a post-test probability of preterm delivery of 0.72, compared with a pre-test probability of 0.49. S-relaxin contributed to the identification of delivery within three days [adj.  OR = 11 (95% CI: 1.8–64)  ].
Conclusion S-relaxin may be a useful predictor in women with symptoms of delivery before 34 weeks of gestation.     

Cervicovaginal HCG and cervical length for prediction of preterm delivery in asymptomatic women at high risk for preterm delivery

Objective  To predict the risk of preterm birth (<37 weeks) or early preterm birth (<34 weeks) by cervicovaginal HCG and cervical length measured between 24–28 weeks of gestation in asymptomatic women at high risk for preterm birth. Methods  This study was conducted in the departments’ of Obstetrics & Gynaecology and Immunopathology of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. In 75 pregnant women at high risk for preterm birth because of prior one on more preterm births due to spontaneous labour or ruptured membranes, cervicovaginal HCG and cervical length (by TVS) were measured between 24–28 weeks of gestation. These parameters were correlated individually and in combination for prediction of preterm birth. Results  Of the 75 women, 20 (26.7%) delivered <37 weeks and 6 (8%) delivered <34 weeks. To predict delivery <37 weeks, cervical length <2.95 cm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 75%, 80.1%, 71.4% and 90.7% respectively, and cervicovaginal HCG >4.75 mIU/ml had a sensitivity, specificity, PPV, and NPV of 70%, 61.81%, 40% and 85% respectively. To predict delivery <34 weeks, cervical length <2.65 cm had a sensitivity, specificity, PPV, and NPV of 50%, 85.50%, 23.08% and 95.16% respectively; and cervicovaginal HCG >14 mIU/ml had a sensitivity, specificity, PPV and NPV of 83.3%, 85.5%, 33.3% and 98.3% respectively. Cervical length was superior to predict delivery <37 weeks, whereas HCG was superior to predict delivery <34 weeks. Their combination was superior to predict preterm birth both <37 weeks or <34 weeks, than either parameter used alone. Conclusion  In high risk asymptomatic women, increased cervicovaginal HCG and reduced cervical length and between 24 to 28 weeks of gestation increased the risk of preterm delivery.     

Preconceptional antibiotic treatment to prevent preterm birth in women with a previous preterm delivery

This article addresses the question of whether the uterine cavity is normally sterile and reviews the difficulties in conducting microbiologic studies of the endometrium, the limitations of conventional microbiologic techniques (cultivation-dependent), and the potential contribution of molecular microbiology to examine microbial diversity and burden of the endometrium. Issues pertaining to the diagnosis of chronic endometritis and the need for information about the prognostic value of this finding in subsequent pregnancies are discussed. The results of a randomized clinical trial of antibiotic administration versus placebo in women with a previous preterm birth are reviewed and commentary is provided. The emerging picture is that microbial-host interactions in the endometrial cavity are important for reproductive success. This is a US government work. There are no restrictions on its use.     

Cabergoline versus bromocriptine in suppression of lactation after cesarean delivery

We evaluated the efficacy of cabergoline, a new ergoline derivative, in blocking puerperal lactation in a group of women delivered by cesarean section. In a single-blind controlled trial 36 women were randomly allocated to treatment with cabergoline 1 mg in a single dose p.o. (n = 18) or bromocriptine 5 mg/day p.o. for 14 days (n = 18). Treatment was started about 50 h after delivery. Clinical assessment of breast signs and determination of serum prolactin were performed just before treatment and at 3, 5, 7 and 14 days. In the cabergoline-treated group milk secretion was inhibited in 17 women (94.4%). Maximum decrease of serum prolactin was -89.7% at 5 days, and the prolactin-lowering effect of cabergoline was still present at 14 days. In the bromocriptine group milk secretion was inhibited in 16 women (88.9%). Maximum prolactin decrease (-86.9%) was reached at 3 days. Persistent side effects were comparable in the two groups. This study demonstrates that a single oral dose of 1 mg cabergoline is as effective in suppressing puerperal lactation as a full treatment with bromocriptine, even in women delivered by cesarean section.     

Neonatal outcome after preterm delivery for preeclampsia

Objective: Our purpose was to determine whether maternal preeclampsia per se has a beneficial effect on neonatal outcome after delivery before 35 weeks.Study design: A matched cohort study design was used. Two hundred twenty-three infants of strictly defined preeclampsia women were matched for gestational age, race, gender, and mode of delivery with infants of normotensive women with preterm labor and delivery. Pregnancies with multiple gestation, premature rupture of membranes, known fetal anomalies, diabetes, or maternal medical disease were excluded. Information was obtained by review of maternal and neonatal charts. Paired categoric and continuous data were compared by McNemar's test and the Wilcoxon signed-rank test, respectively.Results: There was no difference in the incidence of neonatal death (4.5% vs 4.5%, p = 0.82), respiratory distress syndrome (22.0% vs 22.0%, p = 0.88), grades 3 and 4 intraventricular hemorrhage (2.2% vs 2.2%, p = 0.72), grades 2 and 3 necrotizing enterocolitis (5.8% vs 4.0%, p = 0.48), and culture-proved sepsis (9.0% vs 9.0%, p = 0.85). Results were similar when analysis was limited to infants born at ≤ 32 weeks, infants born to mothers with severe preeclampsia, and infants with intrauterine growth restriction.Conclusion: Maternal preeclampsia per se does not have a beneficial effect on the postnatal course] of infants born at 24 to 35 weeks' gestation.     

The risk of preterm delivery in women from different ethnic groups

Objective To examine whether routinely measured variables explained the increased risk of preterm delivery in some UK ethnic groups.
Design Cross sectional study of deliveries recorded in the Child Health Record System.
Setting North Birmingham, UK.
Population All North Birmingham women delivering singletons, 1994–1997 inclusive.
Method Logistic regression.
Main outcome measures Odds ratio (OR) and 95% confidence interval (CI) for preterm delivery, defined as less than 37 weeks, less than 34 weeks and less than 28 weeks, unadjusted and adjusted for maternal age, an area-based socio-economic status measure, and marital status, year of birth, fetal sex and past obstetric history.
Results For Afro-Caribbean women, the ORs (95% CIs) were: for delivery less than 37 weeks, 1.44 (1.26–1.64) unadjusted and 1.22 (1.07–1.41) adjusted; for delivery less than 34 weeks, 1.55 (1.25–1.92) unadjusted and 1.29 (1.02–1.61) adjusted; for delivery less than 28 weeks, 1.66 (1.08–2.55) unadjusted and 1.32 (0.84–2.06) adjusted. For African women, the risk of delivery less than 37 weeks was not significantly raised; for delivery less than 34 weeks, the OR (95% CI) was 1.88 (0.99–3.58) unadjusted and 1.78 (0.93–3.40) adjusted; for delivery less than 28 weeks, the OR (95% CI) was 4.02 (1.60–10.12) unadjusted and 4.10 (1.66–10.16) adjusted. In Afro-Caribbeans, deprivation and marital status explained the differences between the unadjusted and adjusted ORs. There was a linear relation between deprivation and preterm delivery for all ethnic groups, except for Asians.
Conclusions Factors associated with deprivation and marital status explain about half of the excess of preterm births in Afro-Caribbeans, but not Africans. The risk of preterm delivery might not be related to deprivation in Asians.     

Presentation to delivery interval in women with early preterm delivery presenting with preterm labor: the effect of gestational age

Background: To evaluate the association between gestational age at presentation and interval to delivery in women with early spontaneous preterm delivery (PTD).

Methods: A retrospective cohort study of women who presented with threatened preterm labor (tPTL) and intact membranes and had a spontaneous PTD <34 weeks in a university-affiliated hospital (2009–2015). The interval from presentation to delivery was compared between different gestational age subgroups.

Results: Of 67 550 deliveries during the study period, 252 met inclusion criteria. This cohort was divided to three gestational age subgroups at presentation: 24–28^6/7 weeks (n?=?83), 29–31^6/7 weeks (n?=?61) and 32–33^6/7 weeks (n?=?108). Median time from presentation to delivery was 24.5?h. An inverse relation was observed between gestational age at presentation and admission–delivery interval (group A: 74.7?h, group B: 21.0?h, group C: 14.0?h, p?Conclusion: Gestational age at presentation is inversely related to admission–delivery interval in women with tPTL and intact membranes.     

Risk of preterm delivery in non-diabetic women with polycystic ovarian syndrome

Objective:To examine the risk and etiology of preterm delivery in women with polycystic ovary syndrome (PCOS).Study Design:Retrospective cohort study comparing preterm delivery rate among non-diabetic PCOS and non-PCOS women with singleton pregnancy. Multivariable logistic regression was used to identify predictors of preterm delivery among PCOS women.Result:Among 908 PCOS women with singleton pregnancy, 12.9% delivered preterm compared with 7.4% among non-PCOS women (P<0.01). Causes of preterm delivery among PCOS women included preterm labor (41%), cervical insufficiency (11%), hypertensive complications (20%), preterm premature rupture of membranes (15%), fetal-placental concerns (9%) and intrauterine fetal demise (5%). Maternal age, race/ethnicity and nulliparity were significant predictors of preterm delivery in PCOS, whereas body mass index and fertility medications were not.Conclusion:A higher proportion of PCOS women delivered preterm (12.9%) compared with non-PCOS women, with the majority of cases due to spontaneous preterm birth. Future studies should explore etiologies and strategies to improve pregnancy outcomes in PCOS.     

Use of fetal fibronectin in women at risk for preterm delivery

Fetal fibronectin, a large molecular weight glycoprotein produced in the chorion, is expressed in cervical and vaginal secretions in women with disruption of the choriodecidual [table: see text] junction by labor or by inflammation. The presence of FFN in vaginal or cervical secretions before 35 weeks is a moderately good predictor of preterm delivery. The absence of FFN is a strong predictor that preterm delivery is unlikely within the next 7 to 14 days, with NPVs exceeding 99% in some studies. The predictive power of FFN is stronger at earlier gestation ages (24-28 wks) than it is later [table: see text] in pregnancy and is stronger for short-term prediction (7-14 d) than for predicting overall outcome (however, it remains statistically significant for predicting delivery < 37 wks). Although use of FFN in the clinical setting may require some changes to common protocols (e.g., performing sterile speculum examination before digital cervical examination), the use of FFN in patients with suspected preterm labor appears to have significant utility in reducing unnecessary interventions in women with symptoms suggestive of preterm labor. In women without symptoms, the use of FFN may be most beneficial in providing reassurance to some women thought to be at high-risk for preterm delivery because of past obstetric history. Screening women without symptoms at low-risk with FFN is not yet recommended because effective interventions are not demonstrated for patients found to be positive.