Prophylactic oral nifedipine to reduce preterm delivery: a randomized controlled trial in women at high risk.

OBJECTIVE: To establish the efficacy of prophylactic nifedipine vs. placebo in reducing spontaneous preterm delivery in asymptomatic women at high risk for preterm delivery. DESIGN: Prospective multicentric randomized double-blind study. SETTING: Tertiary care centre, University Hospitals of Brescia and Torino, Italy. POPULATION: Eighty-seven singleton pregnancies without uterine contractions and ultrasonographic cervical length of ≤25 mm at 24-32 weeks, at risk for preterm delivery, with longitudinal follow up in our Preterm Prevention Clinic. METHODS: Selection was done on the basis of ultrasonographic cervical length; 43 women were randomized to receive placebo and 44 to receive nifedipine. MAIN OUTCOME MEASURES: Primary end point: spontaneous preterm delivery <37 weeks in nifedipine vs. placebo. SECONDARY OUTCOMES: delivery <32 weeks, maternal side effects, neonatal complications, admissions to the Neonatal Intensive Care Unit and randomization/delivery time in nifedipine vs. placebo. RESULTS: There was no trend towards a lower risk of spontaneous preterm delivery, neither at <37 weeks of nifedipine vs. placebo (11.4% vs. 19.0%; p = 0.320), or <32 weeks (2.3% vs. 2.4%; p = 0.973). Nifedipine reduced spontaneous preterm delivery <37 weeks (p = 0.015) in the multiparous women by stratified analysis for parity. SECONDARY OUTCOMES between the groups did not differ except for a higher percentage of maternal side-effects in the nifedipine group (31.8%) vs. placebo (11.9%) (p < 0.05). Subgroup analysis showed a borderline (p = 0.047) lower percentage of spontaneous preterm delivery in women with a ultrasonographic cervical length of <20 mm in the nifedipine group. CONCLUSIONS: Prophylactic nifedipine in asymptomatic women at high risk for preterm delivery had a positive effect on the rate of spontaneous preterm delivery <37 weeks in multiparous women.

Operative vaginal delivery: all you should know.

Over the last three decades, the decrease in operative vaginal delivery (OVD) has lead to an increase in the rate of cesarean sections, giving rise to intense debate amongst healthcare providers. As the use of vacuum and forceps requires personnel be adequately trained so as to become familiar with the correct use of instruments, the lack of skilled and experienced instructors may well lead to this technique being discarded in the near future. The aim of this study was to review the literature, compare the recommendations from international OVD guidelines and to illustrate the correct technique of obstetrical vacuum and forceps application to promote OVD among clinicians as a safe way of delivery.

[New methods for preterm birth prediction: the PAMG-1 test].

BACKGROUND: The aim of this study was to assess the efficacy of PAMG-1 test (placental alpha microglobulin-1) in cervicovaginal secretions collected immediately following transvaginal ultrasound (TVUS) of women with signs and symptoms of preterm labor (PTL), clinically intact membranes and cervical length between 15 and 30 mm for the prediction of imminent spontaneous delivery (within 7 days of testing), as well as delivery <34 weeks of gestation. METHODS: Performing PAMG-1 test in 79 women with singleton pregnancy (240/7 -336/7 weeks' gestation) reporting signs and symptoms indicative of PTL and cervical length <30 mm. RESULTS: For PTB prediction risk within 7 days of testing in pregnant women with cervicale length between 15-30 mm sensitivity is 100% and specificity is 94%. Positive predictive value (PPV) is 77% and negative predictive value (NPV) is 100%. For delivery prediction <34 weeks of gestation sensitivity decreased from 100% to 67% and specificity from 94% to 89%, PPV is 55% and NPV 93%. CONCLUSIONS: The inaccuracy of traditional methods, including biophysical tests, biochemical markers, or the combination of both, for assessing the risk of spontaneous preterm birth in patients presenting with symptoms of PTL often leads to unnecessary admission and administration of corticosteroids and tocolytics. The PAMG-1 test demonstrated high efficacy in identifying women at risk of imminent PTL within 7 days of testing, despite being performed immediately after TVUS. High NPV can prevent improper admission and unnecessary therapies for mother and fetus.