Medical therapy in the management of preterm birth.

Preterm birth is still the major cause of neonatal mortality and morbidity despite major improvements in neonatal care in the developed countries. Among survivors, the risk of severe consequences is inversely related to the gestational age at delivery. Appropriate antenatal intervention should delay delivery long enough to reduce perinatal consequences related to prematurity. Efficacy of tocolysis varies with gestational age and by the underlying cause of the preterm labour. In this paper we evaluate the use of not steroid anti-inflammatory drugs (NSAIDs) and other tocolytic agents in premature labor as optimal acute first-line treatment. We'll then discuss the use of medical therapy in order to delay delivery beyond 48 hours in selected cases. In a ongoing prospectic randomised trial we consider the association Atosiban - Progesterone to treat spontaneous preterm labor. Our preliminary data suggest that vaginal administration of Progesterone after arrest of uterine activity by atosiban administration could be able to prolong pregnancy in subjects with short cervix.

The influence of maternal insulin-dependent diabetes on fetal nuchal translucency thickness and first-trimester maternal serum biochemical markers of aneuploidy.

OBJECTIVE: To evaluate the influence of maternal insulin dependent diabetes mellitus (IDDM) on maternal serum free beta-hCG, PAPP-A and fetal nuchal translucency (NT), thickness at 11 to 13(+6) weeks of gestation in a large cohort of women screened prospectively for chromosomal anomalies. METHODS: Information on maternal IDDM status, maternal serum biochemical marker levels and fetal NT were collected from the prenatal screening computer records in two first-trimester screening centres. In total the control group included 33 301 pregnancies of which 16 366 had NT and maternal serum biochemistry results and 16 305 with NT only. The IDDM group included 195 pregnancies of which 79 had NT and maternal serum biochemistry results and 127 with NT only. The median maternal weight corrected free beta-hCG and PAPP-A, expressed as multiple of the median (MoM), and fetal NT, expressed as delta values, in the IDDM and non-IDDM groups were compared. RESULTS: There were no significant differences between the IDDM and non-IDDM groups in median maternal weight corrected free beta-hCG (IDDM 0.87 MoM, 95% Confidence Interval 0.75 to 1.16 MoM, non-IDDM 1.00 MoM), median maternal weight corrected PAPP-A (IDDM 1.02 MoM, 95% Confidence Interval 0.83 to 1.05 MoM, non-IDDM 1.01 MoM), or mean delta NT (IDDM 0.0358 mm, non-IDDM 0.0002 mm). CONCLUSIONS: In pregnancies with maternal IDDM, first-trimester screening for chromosomal defects does not require adjustments for the measured fetal NT. However, more data are required before the possible reduction in maternal serum free beta-hCG and the reduction of PAPP-A suggested by the published world series can be considered sufficiently important to take into account in the calculation of risks for chromosomal defects.