What Interventions Are Being Used to Prevent Preterm Birth and When?

OBJECTIVE: This study sought to determine the proportions of women at risk of preterm birth who received progesterone, elective and rescue cerclage, or pessary to prevent preterm birth, by using medical records. The authors also sought to determine whether these proportions differed among primary-, secondary-, and tertiary-level centres. METHODS: The authors conducted a retrospective cohort study and extracted data from consecutive medical charts of women with an estimated date of confinement over 3 months in primary-, secondary-, and tertiary-level centres in Southern Ontario. The study identified women with a previous spontaneous preterm birth or a short cervix and determined whether they were offered and whether they received a preventive intervention for preterm birth. Descriptive statistics and Fisher exact tests were calculated. RESULTS: The authors reviewed 1024 consecutive charts at primary, secondary, and tertiary centres and identified 31 women with a previous spontaneous preterm birth or a short cervix. Of these women, less than one half (42%) received progesterone or cerclage for prevention of preterm birth, and none received pessary. One in four women (26%) were not referred to an obstetrician or maternal-fetal medicine specialist in time for an intervention, and among those referred before 24 weeks of gestation, an intervention was offered to 57% of the women. CONCLUSION: Less than half of women at risk of spontaneous preterm birth received progesterone, cerclage, or pessary, attesting to the importance of improving knowledge translation methods to encourage timely referral and use of progesterone for the prevention of preterm birth.

Arrest of descent in second stage of labour secondary to macrosomia: a case report.

BACKGROUND: Fetal macrosomia, defined as birth weight greater than 4000 g, complicates 10% of pregnancies and is a well-documented cause of prolonged second stage of labour, as well as of arrest of descent of the fetal presenting part. CASE: A multigravida woman with gestational diabetes mellitus was admitted in labour at term, and progressed to full dilatation. The fetal vertex failed to descend beyond -3 station. An emergency Caesarean section was performed and a 6452 g male infant was delivered. CONCLUSION: Physicians should be aware of the possibility of macrosomia as the cause of failure of descent in the second stage. A heightened state of suspicion should be maintained, particularly in a multigravida woman with a prior macrosomic baby and the presence of other predisposing factors such as gestational diabetes mellitus.

Alpha-fetoprotein values in amniotic fluid obtained during early amniocentesis (11-13 weeks).

OBJECTIVES: To determine the normal values of alpha-fetoprotein (AFP) in amniotic fluid between the gestational ages of 11 and 13 weeks and compare these with previously published values. METHODS: Amniotic fluid AFP was analyzed in 149 patients who had undergone amniocentesis between 11 +/- 0 and 13 +/- 6 weeks gestation as part of the pilot study of the Canadian Early and Mid-Trimester Amniocentesis Trial. Analysis was done using the Abbott IMX System (Abbott Laboratories Diagnostic Division, Abbott Park, Ill.). These values were then compared with previously published values. RESULTS: There is a progressive and linear rise in the amniotic fluid AFP concentration from 11 to 13 weeks gestation. The differences between each of the three gestational ages were statistically significant at the 0.05 level. The values differed significantly from those obtained by Crandall et al. [Am J Obstet Gynecol 1989;160:1204-1206], which were also consistently higher. CONCLUSION: Although reference points for 11, 12 and 13 weeks have been established, there are limitations to their clinical application.