Impact of metabolic acidemia at birth on neonatal outcomes in infants born before 34 weeks’ gestation

Purpose: To examine prematurity-associated neonatal outcomes in early preterm infants with metabolic acidemia compared to those without such acidemia.

Methods: We performed a retrospective cohort analysis to assess the impact of metabolic acidemia on prematurity-associated complications in a large cohort of singleton live-born infants with complete umbilical cord gas analyses delivered between 24 0/7 and 33 6/7 weeks. Metabolic acidemia was defined as an umbilical artery pH less than 7.0 plus a base deficit of 12?mmol/L or greater. Outcomes were adjusted for gestational age using logistic regression.

Results: Between 1 January 1988 and 31 December 2014, 6970 singleton early preterm infants were delivered at our hospital, of which 126 (1.8%) had metabolic acidemia. Neonatal mortality as well as prematurity-associated morbidities were significantly increased in the presence of metabolic acidemia. Included were ventilator requirement (73% versus 36%, p?p?p?=?0.036), and neonatal death (13% versus 4%, p?Conclusion: Metabolic acidemia significantly increases the risks related to prematurity in infants delivered prior to 34 weeks’ gestation.     

Superior vena cava flow and intraventricular haemorrhage in extremely preterm infants

Objective: To evaluate the relationship between superior vena cava flow (SVCF) measurements within the first 24?h of life, and development of intraventricular haemorrhage (IVH) in extremely preterm infants.

Study design: Single centre retrospective cohort study of 108 preterm infants born less than 28 weeks’ gestation. Main outcome measure was degree of IVH at day 7 postnatal age.

Results: The mean GA of the study group was 25.4 weeks. Mean SVCF was lower (75?ml/kg/min) in infants later diagnosed with IVH (n?=?46) compared to infants, who did not develop IVH (87.7?ml/kg/min, p?=?0.055). PDA diameter was inversely associated with SVCF (p?=?0.024) and reversal of flow in the descending aorta (p?=?0.001). Sensitivity analysis did not confirm an independent association of SVCF with development of IVH [OR 0.990 (0.978–1.002), p?=?0.115].

Conclusion: Our study describes early SVCF in extremely preterm infants is associated with the extent of ductal shunting, but insensitive in predicting IVH.     

The use of 17-hydroxy progesterone in women with arrested preterm labor: a randomized clinical trial

Abstract

Background: The use of 17-alpha-hydroxyprogesterone caproate (17?P) has been shown to reduce preterm delivery in women who have had a prior preterm birth. The role of 17?P in women with arrested preterm labor is less certain.

Aims: To compare the preterm birth rate and neonatal outcome in women with arrested preterm labor randomized to receive 17?P or placebo.

Materials and methods: Women with arrested preterm labor were randomized to weekly injections of either 17?P (250?mg) or placebo. Maternal and neonatal outcome were evaluated.

Results: Forty-five singleton pregnancies were randomized after successful tocolysis; 22 received 17?P while 23 got placebo. Gestational age at delivery (p?=?0.067) and the interval from treatment to delivery (p?=?0.233) were not affected by 17?P. Significantly less women in the 17?P group delivered at <34 weeks (14 versus 21, p?=?0.035). There was also a significant reduction in the risk of neonatal sepsis (p?=?0.047) and gr III/IV intraventricular hemorrhage (IVH) (p?=?0.022) in the 17?P group.

Conclusion: In this study, 17?P did not delay the interval to delivery after successful preterm labor, but births <34 weeks as well as neonatal sepsis and IVH were reduced by 17?P treatment.     

Delayed cord clamping and inotrope use in preterm infants

Objective: To evaluate the impact of delayed cord clamping (DCC) on need for inotropic support and mean arterial blood pressure (MABP).

Methods: This is a single-center, prospective case-control study of premature infants, born <32 weeks gestation, who underwent DCC in comparison to a matched control group who underwent immediate cord clamping (ICC). The primary outcomes were the differences in MABP and inotropic medication used over the first week of life. Secondary outcomes included the admission hemoglobin, need for blood transfusion, and rates of intraventricular hemorrhage (IVH). Infants were matched on EGA, birth weight, sex, antenatal corticosteroid and magnesium exposure, and presence of chorioamnionitis.

Results: Hundred and fifty-eight infants (DCC n?=?79, ICC n?=?79) were included. Demographic factors were similar between groups. DCC infants had a higher admission hemoglobin (p?p?=?.03), fewer median transfusions (p?=?.03), and were discharged at an earlier post-menstrual age (p?=?.04). When controlling for other factors, DCC was not associated with a reduction in inotrope use (p?=?.22) but was associated with a reduction in high-grade IVH (p?=?.01). There was no difference in MABP between the groups.

Conclusions: DCC is not associated with a reduction in the use of inotropes or a difference in MABP.     

Risk of neonatal and childhood morbidity among preterm infants exposed to marijuana

Background: Limited data exist regarding the neonatal and neurodevelopmental outcomes of infants exposed to marijuana (MJ) in-utero, particularly among preterm infants. We hypothesized that MJ-exposed preterm infants would have worse neonatal and childhood developmental outcomes compared to MJ-unexposed infants.

Methods: Secondary analysis of multicenter randomized-controlled trial of antenatal magnesium sulfate for the prevention of cerebral palsy was conducted. Singleton nonanomalous infants delivered?<35 weeks exposed to MJ in-utero were compared to MJ-unexposed. Primary neonatal outcome was death, grade 3/4 intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or stage II/III necrotizing enterocolitis before discharge. Primary childhood outcome was death, moderate/severe cerebral palsy, or/and Bayley II Scales?<70 at age 2. Backward-stepwise regression used to estimate odds of primary outcomes.

Results: 1867 infants met inclusion criteria; 135(7.2%) were MJ-exposed. There were no differences in neonatal (20% vs. 26%, p?=?0.14) or childhood (26% vs. 21%, p?=?0.21) outcomes in MJ-exposed infants compared to MJ-unexposed infants. In adjusted models, MJ-exposure was not associated with adverse neonatal outcomes (aOR 0.83 95% CI 0.47,1.44) or early childhood outcomes (aOR 1.47, 95% CI 0.97,2.23).

Conclusions: Among infants born?<35 weeks of gestation, MJ-exposure was not associated with adverse neonatal or childhood outcomes. Long-term follow-up studies are needed to assess later childhood neurodevelopmental outcomes following MJ-exposure.     

Preterm preeclampsia: 32 to 37 weeks gestation

Objective: To evaluate neonatal outcomes in late preterm infants delivered due to preeclampsia. Methods: A retrospective cohort of 3580 infants delivered at 32 0/7 to 36 6/7 weeks gestation was examined. Neonatal outcomes of infants delivered due to preeclampsia were compared with outcomes of infants delivered prematurely due to other etiologies. Multivariate logistic regression was used to analyze the association between preeclampsia and the neonatal outcomes. Results: Infants of women with preeclampsia were more likely to be SGA (26.8% vs. 8.4%). They were also more likely to be admitted to the ICN (54.3% versus 39.0%); however, they were less likely to suffer a neonatal death (2.2% vs. 3.4%). Infants born to women with preeclampsia had similar rates of RDS (19.8% vs. 14.2%). Discussion: Neonatal outcomes in late preterm infants born to preeclamptic mothers are significantly different from outcomes in late preterm neonates delivered due to other indications.     

Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation

Abstract

Objective: To investigate the association between exposure to second stage of labor and duration of second stage, and risk of intraventricular hemorrhage (IVH) among infants delivered <30 weeks of gestation.

Methods: We conducted a retrospective cohort study among 158 singleton vertex deliveries (97 vaginal and 61 cesarean). Multivariable logistic regression was used to evaluate the risk of IVH related to second stage.

Results: Infants exposed to second stage as compared to those not exposed to second stage irrespective of their mode of delivery had increased risk of mild IVH (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.15, 6.29) but not of severe IVH (OR 1.14; 95% CI 0.33, 3.84). No relation with risk of mild (OR 0.98; 95% CI 0.95, 1.01) and severe (OR 1.00; 95% CI 0.95, 1.05) IVH was observed for each 1?min increase in duration of second stage. We also observed no significant association between quartiles of duration of second stage and risk of mild (p?=?0.20) and severe (p?=?0.29) IVH. We did not observe any significant interaction by gestational age, chorioamnionitis, birth weight or presenting complaint on admission.

Conclusion: The risk of mild IVH was increased in those exposed to a second stage of labor. However, no clear association was observed between duration of second stage and mild or severe IVH.     

The effect of histological chorioamnionitis on the short-term outcome of preterm infants ≤32 weeks: a single-center study

Abstract

Background and objectives: Chorioamnionitis (CA) is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological CA on the short-term outcome of preterm infants.

Subjects and methods: The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus (PDA) requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (IVH; grade III–IV) were analyzed.

Results: Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological CA (n?=?145) and without histological CA (n?=?136). Mean gestational age was 28.8?±?2.6 weeks and 29.1?±?2.5 weeks, and mean birth weight was 1138?±?350?g and 1210?±?299?g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological CA was associated with early onset sepsis (p?=?0.007), PDA (p?=?0.003), IVH (p?=?0.03), and death (p?=?0.04).

Conclusion: Maternal histological CA is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, IVH, PDA and increased mortality.     

Cervical assessment in women with hysteroscopic uterine septum resection: a retrospective cohort study

Objective: To estimate whether cervical length measured by transvaginal ultrasonography in women with a history of hysteroscopic uterine septum resection predicts spontaneous preterm birth <35 weeks’ gestation.

Methods: This retrospective cohort study compared women who had undergone hysteroscopic metroplasty, and were subsequently pregnant with singleton gestations delivered January 2003 to December 2012, to a low-risk control group. Transvaginal ultrasonographic cervical lengths were measured 16–30 weeks’ gestation. The primary outcome was spontaneous preterm birth <35 weeks’ gestation and the primary exposure variable of interest was cervical length.

Results: Women with a uterine septum resected (N?=?24) had a shorter cervical length (2.90?cm) than the low-risk control group (N?=?141, 4.31?cm, p?p?p?p?p?=?0.003). Women with septum resected were more likely to receive corticosteroids (33.3% versus 11.3%, p?=?0.010), but were not more likely to have a spontaneous preterm birth <35 weeks (4.2% versus 0.7%, p?=?0.27). There were no differences noted in secondary outcomes including neonatal morbidity.

Conclusion: Pregnant women with a history of a hysteroscopic uterine septum resection have shorter cervical lengths than low-risk controls but may not be at a higher risk of spontaneous preterm birth <35 weeks’ gestation. Further research with a larger sample size is needed to evaluate this group of women to determine if transvaginal ultrasonographic cervical length assessment is of benefit.     

Early-onset preeclampsia and neonatal outcomes

Objective.?To evaluate the neonatal outcomes of infants delivered to mothers with early-onset preeclampsia.

Study design.?This is a retrospective cohort of 1709 infants delivered at 24 0/7 to 29 6/7 weeks gestation was examined. Neonatal outcomes of 235 infants delivered prematurely because of preeclampsia were compared with 1474 infants delivered preterm because of other etiologies. Primary outcomes examined included: small for gestational age (SGA), respiratory distress syndrome (RDS), and neonatal death (NND). Multivariable logistic regression was used to analyze the association between preeclampsia and the neonatal outcomes, controlling for potential confounders.

Results.?Infants of women with preeclampsia were more likely to be SGA (17.8% vs. 5.6%, AOR 3.9, CI 2.5–6.2) and have RDS (70.6% vs. 60.7%, AOR 1.5, 95% CI 1.1–2.2); however, they were less likely to suffer a NND (11.1% vs. 18.1%, AOR 0.6, 95% CI 0.4–0.9).

Conclusion.?Compared with neonates delivered prematurely because of other etiologies, neonates born to preeclamptic mothers were more likely to be SGA and have RDS, but had a decrease in mortality. This may be a reflection of the differences in the underlying pathophysiology behind indicated preterm birth due to preeclampsia.     

Risk factors associated with respiratory disorders in late preterm infants

Objective: Late preterm infants are still high risk for respiratory problems. The aim of this study was to identify risk factors associated with respiratory problems in Japanese late preterm infants.

Methods: In this retrospective multicenter study, we included singleton late preterm deliveries at 34+^0/7–36+^6/7 weeks of gestation. We excluded cases with congenital anomalies. We defined neonatal respiratory disorders (NRD) as the combination of the need for mechanical ventilation or the use of nasal continuous positive airway pressure. We examined the perinatal risk factors associated with NRD.

Results: We included 683 late preterm infants. We found that 13.7%, 6.8% and 2.6% of the infants with NRD were born at 34, 35 and 36 weeks of gestation, respectively. In a multivariate logistic regression analysis adjusting for confounders, the gestational age (GA) at birth (adjusted odds ratio 0.40 per week [95% confidence interval, 0.25–0.61]), cesarean birth (4.18 [2.11–8.84]), and a low Apgar score (33.3 [9.93–121.3]) were independent risk factors associated with NRD.

Conclusions: An earlier GA, cesarean delivery, and a low Apgar score are independent risk factors associated with NRD in singleton late preterm infants. Patients with late preterm deliveries exhibiting these risk factors should be managed in the intensive delivery setting.     

Neurodevelopmental outcomes of premature infants with severe intraventricular hemorrhage

Objective: Our objective was to determine the neurodevelopmental outcome at 18–24 months’ of corrected age (CA) in preterm infants with severe intraventricular hemorrhage (IVH).

Methods: This was a retrospective cohort study of all preterm infants who were <37 weeks’ gestation, had Grade 3–4 IVH, were admitted between January 2009 and December 2010 and discharged. The cohort was divided into three groups. Group 1 was defined as infants born with a birth weight (BW) less than 1000?g, group 2 was defined as infants born with a BW between 1000 and 1500?g and group 3 was defined as infants born with a BW between 1501 and 2500?g. Severe IVH was defined as the presence of grade 3–4 IVH on cranial ultrasound. Cranial ultrasound was performed in the first week of life and subsequently at weekly intervals by a radiologist. A comprehensive assessment including hearing, vision, neurological and developmental evaluation with Bayley Scales of Infant Development, Second edition was performed by the experienced researchers at 18–24 months’ CA. Neurodevelopmental impairment (NDI) was defined as at the presence of one or more of the following: cerebral palsy; Mental Developmental Index score lower than 70; Psychomotor Developmental Index score lower than 70; bilateral hearing impairment; or bilateral blindness.

Results: From January 2009 to December 2010, a total of 138 infants were diagnosed as severe IVH (grade 3–4). Of them, 74 (71.1%) infants (group 1?=?31, group 2?=?29 and group 3?=?14 infants) completed the follow-up visit and evaluated at 18–24 months’ CA. Median Apgar score (p?p?p?p?p?p?p?=?0.014, respectively). The duration of hospitalization and mortality rates consistent with the degree of prematurity were significantly higher in group 1 compared to groups 2 and 3 (p?=?0.03 and p?=?0.01). Among the long-term outcomes, the rates of CP and NDI did not differ between the groups (p?=?0.68 and p?=?0.068).

Conclusion: Our results demonstrated that long-term outcomes of preterm infants did not differ between the groups classified according to the BW at two years of age. This has leaded to the conclusion that severe IVH is alone represents a significant risk factor for poor neurodevelopmental outcome in this already high-risk population.     

Cord blood erythropoietin and interleukin-6 for prediction of intraventricular hemorrhage in the preterm neonate

Objective.?To evaluate cord blood erythropoietin (EPO) and interleukin-6 (IL-6) levels to predict preterm infants at risk of developing intraventricular hemorrhage (IVH).

Methods.?Levels of umbilical cord EPO, acid–base status and IL-6 were analyzed in 116 consecutive, preterm newborns (GA at delivery: 29 [23–34 ] weeks) born to mothers who had a clinically indicated amniocentesis to rule out infection. Early-onset neonatal sepsis (EONS) was diagnosed using symptoms, hematological criteria and blood cultures.

Results.?IVH was diagnosed by cranial ultrasounds. The prevalence of IVH in our population was 25% (29/116). There was a direct relationship between cord blood EPO and cord blood IL-6 concentration (r?=?0.225, p?=?0.014), independent of GA at birth. Elevated cord blood EPO levels (r?=?0.182, p?=?0.016) and GA at birth (r?=??0.236, p?=?0.004) remained significant independent factors associated with the risk of IVH, when evaluated with stepwise logistic regression analyses. Cord blood IL-6, pH, and EONS were not associated with IVH. These relationships remained following correction for GA at birth (p?=?0.027).

Conclusions.?Our results suggest that elevation in cord blood EPO may predict newborns at risk for IVH, independent of fetal inflammatory status. Further studies are warranted to confirm this association.     

Homocysteine levels and its association with intraventricular hemorrhage in preterm infants born to preeclamptic mothers

Abstract

Objective: To investigate the relation between serum homocysteine levels and intraventricular hemorrhage (IVH) in preterm infants born to preeclamptic mothers.

Method: This study included 84 preterm infants (42 born to preeclamptic mothers and 42 born to normotensive healthy mothers) who were admitted to Izmir Tepecik Training and Research Hospital Neonatology Clinic on the postnatal first day. The measurement of homocysteine levels in all samples were performed with an Immulite 2000 analyzer, using the chemiluminescence method. Cranial ultrasounds were performed on the fourth day and in the 1 month of age.

Results: The mean plasma levels of homocysteine in infants born to preeclamptic mothers and in the control group were 8.2?±?5.9?μmol/L and 5.3?±?2.7?μmol/L, respectively. The plasma levels of homocysteine were significantly higher in the study group (p?=?0.006). There was no association between the plasma homocysteine levels and IVH or other neonatal complications including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and mortality.

Conclusion: Our data suggest that plasma levels of homocysteine are higher among infants born to preeclamptic mothers, but these high levels are not associated with IVH and other neonatal complications in preterm infants.     

Male disadvantage for neonatal complications of term infants,especially in small-for-gestational age neonates

Abstract

Objective: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications.

Methods: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates.

Results: 37?342 singleton neonates were born ≥37 weeks’ gestation. 19?112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA’s, low 5-min apgar scores (<7) at 39–40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia.

Conclusions: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.     

Reduction of twin pregnancy to singleton: does it improve pregnancy outcome?

Objective.?To compare pregnancy complications, obstetrical and neonatal outcome of twin pregnancies reduced to singleton, with both non-reduced twin pregnancies and singleton pregnancies.

Methods.?A retrospective case–control study was performed at the Obstetrics and Gynecology Ultrasound unit of a tertiary referral medical center. Patient's population included 32 bi-chorionic bi-amniotic twin pregnancies reduced to singleton and 35 non-reduced twin pregnancies. Thirty-six patients with singleton pregnancies comprised the second control group. Main outcome measures were rates of pregnancy complications, preterm delivery (both before 37 weeks of gestation and before 34 weeks of gestation), late abortions, intra-uterine growth retardation, cesarean section, mean birth weights, and mean gestational age at delivery.

Results.?The reduced twin pregnancies group had similar rates of total pregnancy complications, preterm deliveries, and cesarean section as non-reduced twins. Gestational age at delivery and mean birth weight were also similar to non-reduced twins and significantly different compared with singletons. Preterm delivery and late abortion incidences were significantly higher when reduction was beyond 15 weeks gestation.

Conclusions.?Reduction of twin pregnancy to singleton does not change significantly pregnancy course and outcome. Favorable obstetrical and neonatal outcomes could be achieved by performing early, first trimester reductions.     

Obstetrical and neonatal outcomes of triplet births – spontaneous versus assisted reproductive technology conception

Objective: To determine the average gestational age at birth and to compare obstetrical and neonatal outcomes of triplet births conceived spontaneously versus via assisted reproductive technology (ART).

Methods: A retrospective chart review of triplet pregnancies that resulted in three live babies was conducted at Mount Sinai Hospital (Toronto, Canada) from January 2000 to June 2013.

Results: A total of 230 women and 690 fetuses were identified. The mean gestational age at birth was 32.0?±?3.8 weeks. Obstetrical outcomes included preterm premature rupture of the membranes in 29%, preterm labor in 26%, preeclampsia or HELLP syndrome in 19% and gestational diabetes in 10%. The mean birth weight of infants born after 24 weeks was 1655?±?550?g and the rate of small for gestational age was 28%. The neonatal mortality rate prior to discharge was 7%. Aside from respiratory distress syndrome (30.6 versus 46.6%; p?=?0.02), there were no differences in gestational age at birth, obstetrical or neonatal outcomes between spontaneous versus ART triplet conception. Monochorionicity carried a higher risk of small for gestational age, congenital anomalies and neonatal mortality compared to trichorionicity.

Conclusion: Rates of preterm birth and related complications remain high in triplet gestation. However, obstetrical and neonatal outcomes were similar for triplets conceived spontaneously versus via ART.     

Decidual polyps are associated with preterm delivery in cases of attempted uterine cervical polypectomy during the first and second trimester

Objective: To clarify which types of cervical polyp removed during the first and second trimester are associated with the risk of spontaneous abortion and preterm delivery.

Methods: Pregnant females who underwent attempted polypectomy of cervical polyps during pregnancy and delivered singleton infants between 2005 and 2011 were evaluated. The clinical courses and outcomes of preterm delivery after polypectomy stratified according to the pathologic diagnosis of the polyps were retrospectively reviewed. The removed polyps were classified into decidual polyps and endocervical polyps.

Results: The pathological diagnoses included 41 decidual polyps and 42 endocervical polyps. No malignant polyps were found. The removal of decidual polyps during pregnancy carried a higher risk of spontaneous abortion (12.2% versus 0%, p?=?0.026) and preterm delivery (34.2% versus 4.8%, p?=?0.001) than that of endocervical polyps. According to the multivariate logistic regression analysis, risk factors for preterm delivery before 37 weeks’ gestation were the presence of decidual polyps and a history of preterm delivery.

Conclusions: The risk of abortion and preterm delivery associated with polypectomy during pregnancy is greater in patients with decidual polyps. It might be safer not to remove cervical polyps during pregnancy, except in cases in which the polyps are suspected to be malignant.     

Pregnancy outcomes associated with intrauterine growth restriction

OBJECTIVE: This study was undertaken to examine the incidence of intrauterine growth restriction (IUGR) and neonatal outcomes of pregnancies delivered from 26 to 41 weeks' gestation. STUDY DESIGN: A retrospective review of a linked database of all deliveries in California in 1994 through 1996 that were reported to the Office of Statewide Health and Planning Development. MATERIAL AND METHODS: A database of maternal and neonatal discharge summaries linked to birth and death certificates were examined for gestational age at delivery, diagnosis of IUGR, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), length of stay, and hospital charges (CHA). More than 1.4 million singleton deliveries were examined by week of gestation and separated into the presence or absence of IUGR and then examined for adverse neonatal outcomes. RESULTS: The frequency of IUGR was increased in the preterm newborn infants compared with those at 40 weeks' gestation (26 = 8.9%, 27 = 7.7%, 28 = 9.8%, 29 = 10.5%, 30 = 12.3%, 31 = 9.1%, 32 = 7.5%, 33 = 6.6%, 34 = 5.6%, 35 = 5.0%, 36 = 4.4%, 37 = 3.7%, 38 = 2.3%, 39 = 1.5%, 40 = 1.1%). Up to 28 weeks' gestation, the incidence of RDS was higher for infants without IUGR compared with infants with IUGR (not significant). Starting at 29 weeks' gestation, RDS was higher for infants with IUGR. Initially not significant, this difference was statistically significant starting from 34 weeks. The findings were similar for IVH, NEC, and length of stay. The threshold at which the relationship between the presence of IUGR and the outcome flipped was 30, 28, and 29 weeks, whereas significance was observed at 34, 35, and 30 weeks, respectively. CHA were always higher for those patients with IUGR but became significantly higher after 29 weeks. CONCLUSION: IUGR was increased with prematurity and may represent an important risk factor to check for in women who present with preterm labor. Prematurity associated with adverse neonatal outcomes (RDS, IVH, NEC, CHA) were largely unaffected by IUGR until the third trimester. From then on, all adverse outcomes were increased compared with normally grown premature infants, suggesting a need for closer surveillance for IUGR in the third trimester.     

Success rate of terbutaline in inhibiting preterm labor for 48 h

Objective: To determine terbutaline success rate in postponing preterm labor for 48?h and to identify factors associated with its efficacy, side effects, maternal and neonatal outcomes.

Methods: A retrospective study analyzing data from pregnant women suffering from preterm labor who had received terbutaline for inhibition of labor from January 2007 to December 2013.

Results: A total of 385 cases were analyzed; there were 321 cases (83.4%) delivered ≥48?h and 64 cases (16.6%) delivered before 48?h. The factors that affect the success rate of terbutaline administration in singleton pregnancy were cervical dilatation (ORs 0.37; 95% CI 0.18–0.79) and cervical effacement (ORs 0.36; 95% CI 0.17–0.75). The most common side effect of terbutaline was tachycardia (95.1%), but there were no serious cardiovascular events and maternal death. Mean neonatal birth weight was 2.294.3?±?638.4?g. Neonatal complications included respiratory distress syndrome (RDS) 16.2%, intraventricular hemorrhage (IVH) 1.4%, necrotizing enterocolitis (NEC) 0.7%, sepsis 5.3%, and neonatal death 0.9%.

Conclusions: The success rate of terbutaline in treatment of preterm labor was high whereas side effects were tolerable. Neonatal outcome was good. The factors that significantly affect the success rate of terbutaline administration in singleton pregnancy were cervical dilatation and cervical effacement. Thus, terbutaline can be used safely for short-term treatment of preterm labor.