Controlled trial of a preterm labor detection program: Efficacy and costs

Main, Denise M.; Richardson, D.K.; Hadley, Carolyn B.; Gabbe, S.G.

doi:10.1016/0020-7292(90)90398-5

Cited by 22 publications

(51 citation statements)

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“…[91][92][93] • Supplemental calcium has not been studied specifically in women with a prior preterm delivery. Its use in other populations has not reduced preterm birth.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Care for Women with Prior Preterm Birth

Iams

2010

Preterm Birth

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Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately. Keywordscerclage; prevention; progesterone; recurrent; preterm birth; risk estimation Efforts to reduce the incidence of preterm birth cannot yet be called successful but have produced sufficient information to justify management suggestions for clinicians, not only for strategies that do not work but also for those that do. The quality and number of clinical trials of interventions intended to reduce the incidence and/or morbidity of preterm birth has risen substantially in recent years, yielding data that can improve care for women at risk.An important advance has been the revision of the traditional model of preterm birth in which painful contractions or preterm membrane rupture were understood as the most common initial steps preceding cervical change. This concept has been challenged by observations from several clinical studies:• Drugs that arrest or inhibit uterine contractions can delay delivery but do not reliably reduce or prevent preterm birth. [1][2][3][4][5] • Assessment of contraction frequency is not a useful test to predict preterm birth, 6 and its use to detect and arrest initial or recurrent episodes of preterm labor does not affect the rate of preterm birth. [7][8][9] • Antibiotics that eradicate microorganisms associated with preterm birth also do not reliably reduce, and may sometimes increase, the incidence of preterm birth, especially in women with intact membranes. [10][11][12][13][14][15][16][17] • Progestational agents such as 17α-hydroxy-progesterone caproate reduce recurrent preterm birth in some women with a prior preterm birth, 18,19 especially those with early preterm birth 20 and short cervix, 21 but have no effect on preterm birth in multiple gestations. 22,23 NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2013 May 09. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript• Cervical cerclage can reduce recurrent preterm birth in women with a prior preterm birth and short cervix 24,25 but increases the risk of preterm birth in women with multiple gestation who also have a short cervix. 24 These findings suggest the following 4 substantive changes in the "contractions change the cervi...

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“…[91][92][93] • Supplemental calcium has not been studied specifically in women with a prior preterm delivery. Its use in other populations has not reduced preterm birth.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Care for Women with Prior Preterm Birth

Iams

2010

Preterm Birth

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“…In a study in Ohio (Iams 1989), women attended clinics and had cervical examinations weekly between 20 and 36 weeks' gestation and were advised on the signs and symptoms of labour onset. In the Pennsylvania trial (Main 1989), women attended weekly or twice-weekly clinics from 22 weeks' gestation; and again women were educated on the early signs of labour and had cervical assessment. In the West Los Angeles 1994 trial, clinics rather than women were randomised (five experimental clinics and three control).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Incomplete outcome data-Rates of attrition and exclusion in the control and experimental groups were not clearly set out in two studies (Iams 1989;Main 1989). In the Main 1989 study, there appeared to be little loss to follow-up for the primary outcome (preterm birth), although there were relatively high levels of missing data for neonatal outcomes as approximately 20% of infant case-notes were not reviewed.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…Perinatal death (defined as stillbirth after trial entry, or death of a liveborn infant up to seven days of age): Perinatal death was reported in one of the included studies with outcome data for 302 infants (Main 1989). There was no evidence of a significant difference between groups; overall, there were 13 deaths, seven in the treatment group and six in the control group (risk ratio (RR) 1.25, 95% confidence interval (CI) 0.43 to 3.62).…”

Section: Primary Outcomesmentioning

confidence: 99%

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Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes

Whitworth¹,

Quenby

2007

Cochrane Database of Systematic Reviews

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“…In one unpublished study, only 20% of preterm births and only 2% of births were identified (Orleans, Leff, and Haverkamp, personal communication). Elsewhere, Main et al (57) reported that only 1% of high-risk women delivered before 34 weeks gestation solely because of preterm labor. Second, the effectiveness of monitoring uterine activity cannot be separated from the effectiveness of tocolysis.…”

Section: Monitoring Of Uterine Activitymentioning

confidence: 99%

Preventing and Managing Prematurity

Lumley

1991

Int J Technol Assess Health Care

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In the past decade the prevention and management of prematurity have begun to be addressed with more appropriate designs. A few strategies-very few-can now be recommended. A few, some widely implemented, can be abandoned. The risks and benefits of most interventions still require clarification.It is commonly agreed among clinicians, researchers, and health policy makers in industrialized countries that the crucial perinatal problem is prematurity. One response to this recognition has been an emphasis on the need for a better understanding of the pathophysiology of prematurity as the key to prevention. Eastman's (19) classic comments-"only when the factors causing prematurity are clearly understood can any intelligent attempt at prevention be made"-is still quoted by those who hold this view, and it could still be regarded as largely true.In contrast, several recent articles call for a greater sense of urgency, exhorting clinicians to stop worrying about causes and to implement preventive programs instead (32;33;36). It is tempting, in the face of stable prematurity rates and the insatiable demand for more neonatal intensive care facilities, to respond enthusiastically to the call. The only trouble with this advice is its lack of clarity about preventive programs: What is the scope of prevention and what components of which programs actually work?First, the scope for prevention is limited by the fact that more than 60% of preterm deaths occur before labor or in infants with lethal malformations (86;87). Even when the infant is alive and not malformed at the onset of labor, some preterm deliveries are elective and others are complicated by factors that contraindicate delaying the delivery (e.g., bleeding). The remaining cases of preterm birth involving spontaneous uncomplicated preterm labor or preterm premature rupture of the membranes (PPROM) with a healthy fetus offer the widest scope for prevention; in some cases, however, delivery is already inevitable at the time of hospital admission. Potential preventive efforts in the uncomplicated group include true primary prevention, early identification of preterm labor or its premonitory signs, and inhibition of preterm labor.Though it is often blurred in practice, the distinction between prevention and inhibition of preterm labor is an important one because the potential for net negative outcomes is even greater with prophylactic interventions. These interventions are used in women at risk, rather than in ones with an established problem, and are used for a greater proportion of the pregnancy.

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Controlled trial of a preterm labor detection program: Efficacy and costs

Cited by 22 publications

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Care for Women with Prior Preterm Birth

Care for Women with Prior Preterm Birth

Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes

Preventing and Managing Prematurity

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