Article References & Abstracts
PRETERM LABOUR

1. Author Scott
   Title Danforth's Obstetrics & Gynecology
   Source 7th ed., Copyright c 1994 Lippincott-Raven Publishers p297-300
   
   
2. Title Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage.
   Source Br J Obstet Gynaecol 1993 Jun;100(6): p516-23
   ISSN 0306-5456
   Abstract OBJECTIVE: To assess whether cervical cerclage in women deemed to be at increased risk of cervical incompetence prolongs pregnancy and thereby improves fetal and neonatal outcome. DESIGN: Multicentre randomised controlled trial. SETTING: Hospitals in the United Kingdom, France, Hungary, Norway, Italy, Belgium, Zimbabwe, South Africa, Iceland, Ireland, the Netherlands and Canada. SUBJECTS: One thousand two hundred and ninety-two pregnant women whose obstetricians were uncertain whether to recommend cervical cerclage, most of whom had a history of early delivery or cervical surgery. INTERVENTIONS: Cervical cerclage was compared with a policy of withholding the operation unless it was considered to be clearly indicated. MAIN OUTCOME MEASURES: Delivery before 33 completed weeks, preterm delivery (< 37 weeks), and vital status of the baby after completion of the pregnancy. RESULTS: The overall preterm delivery rate was 28%. There were fewer deliveries before 33 weeks in the cerclage group (83 (13%) compared with 110 (17%), P = 0.03) and this difference reflected deliveries characterised by features of cervical incompetence (painless cervical dilatation and prelabour rupture of the membranes). There was a corresponding difference in very low birthweight deliveries (63 (10%) compared with 86 (13%), P = 0.05). The difference in the overall rate of miscarriage, stillbirth or neonatal death (55 (9%) compared with 68 (11%)) was less marked and was not statistically significant. The use of cervical cerclage was associated with increased medical intervention and a doubling of the risk of puerperal pyrexia. CONCLUSIONS: These results suggest that the operation had an important beneficial effect in 1 in 25 cases in the trial (95% confidence interval (CI) 1 in 12 to 1 in 300 sutures). Its use is associated with increased medical intervention and puerperal pyrexia. Nevertheless, this trial suggests that, on balance, cervical cerclage should be offered to women at high risk, such as those with a history of three or more pregnancies ending before 37 weeks gestation.
   
   
3. Author Sawdy RJ; Bennett PR
   Institution The Institute of Obstetrics and Gynaecology, Division of Paediatrics, Obstetrics and Gynaecology, Imperial College of Science and Medicine, Queen Charlotte's Hospital, London, UK.
   Title Recent advances in the therapeutic management of preterm labour.
   Source Curr Opin Obstet Gynecol 1999 Apr;11(2): p131-9
   ISSN 1040-872X
   Abstract Preterm labour and delivery pose an increasing problem to the obstetrician. Improvements in tocolysis with the recent introduction of new therapeutic targeting strategies, and a reappraisal of the safety and relative efficacy of some older compounds, have led to a tendency away from prescribing beta-sympathomimetic agents. Infection prophylaxis and promotion of fetal lung maturity are deemed advantageous, but treatment protocols have not been clarified. This review examines the important publications of the past year in these areas.
   
   
4. Author Brocklehurst P, Hannah M, McDonald H
   Title Interventions for treating bacterial vaginosis in pregnancy
   Source Cochrane Collection of Systematic Reviews: A substantive amendment to this systematic review was last made on 29 July 1998. Cochrane reviews are regularly checked and updated if necessary.
   Abstract Background and objectives: Bacterial vaginosis has been associated with poor perinatal outcome. Since the infections are amenable to treatment, identification during pregnancy and treatment may reduce the risk of preterm birth and its consequences. The objective of this review was to assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Selection criteria: Randomised trials comparing one antibiotic regimen with placebo or no treatment, or which compare two or more alternative antibiotic regimens in pregnant women with bacterial vaginosis. Data collection and analysis: Trial quality assessments and data extraction were done independently by three reviewers. Study authors were contacted for additional information. Main results: Five trials involving 1504 women were included. These trials were of good quality. Antibiotic therapy was highly effective at eradicating infection during pregnancy as judged by 'test-of-cure' following therapy (odds ratio 0.22, 95% confidence interval 0.17 to 0.27). The effect of treating bacterial vaginosis during pregnancy showed a trend to less births before 37 weeks gestation (odds ratio 0.78, 95% confidence interval 0.60 to 1.02). The prevention of preterm birth less than 37 weeks gestation was most marked in the subgroup of women with a previous preterm birth (odds ratio 0.37, 95% confidence interval 0.23 to 0.60). Reviewers' conclusions: The current evidence does not support screening and treating all pregnant women for bacterial vaginosis to prevent preterm birth and its consequences. For women with a history of a previous preterm birth there is some suggestion that detection and treatment of bacterial vaginosis early in pregnancy may prevent a proportion of these women having a further preterm birth. It is not known whether this is associated with an improvement in neonatal well-being.
   
   
5. Author Smaill F
   Title Antibiotics for asymptomatic bacteriuria in pregnancy
   Source Cochrane Collection of Systematic Reviews: A substantive amendment to this systematic review was last made on 10 October 1996. Cochrane reviews are regularly checked and updated if necessary.
   Abstract Background and objectives: Up to 30% of mothers develop acute pyelonephritis if asymptomatic bacteriuria is untreated. Asymptomatic bacteriuria may have a role in preterm birth, or it may be a marker for low socioeconomic status and thus, low birthweight. The objective of this review was to assess the effect of antibiotic treatment for asymptomatic bacteriuria on persistent bacteriuria during pregnancy, the risk of preterm delivery and the development of pyelonephritis after delivery. Search strategy: I searched the Cochrane Pregnancy and Childbirth Group trials register. Selection criteria: Randomised trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Data collection and analysis: Trial quality was assessed. Main results: Thirteen studies were included. Overall the study quality was not strong. Antibiotic treatment compared to placebo or no treatment was effective in clearing asymptomatic bacteriuria (odds ratio 0.07, 95% confidence interval 0.05 to 0.10). The incidence of pyelonephritis was reduced (odds ratio 0.25, 95% confidence interval 0.19 to 0.32). Antibiotic treatment was also associated with a reduction in the incidence of preterm delivery or low birthweight babies (odds ratio 0.60, 95% confidence interval 0.45 to 0.80). Reviewers' conclusions: Antibiotic treatment appears to be effective in reducing the risk of pyelonephritis in pregnancy. An apparent reduction in preterm delivery is consistent with current theories about the role of infection in preterm birth, but this association should be interpreted with caution.
   
   
6. Title Preterm labor.
   Source Criteria Set, The American College of Obstetricians and Gynecologists, June 1998.
   
   
7. Author Macones GA; Sehdev HM; Berlin M; Morgan MA; Berlin JA
   Institution Department of Obstetrics and Gynecology, University of Pennsylvania, School of Medicine, Philadelphia, USA.
   Title Evidence for magnesium sulfate as a tocolytic agent.
   Source Obstet Gynecol Surv 1997 Oct;52(10): p652-8
   ISSN 0029-7828
   Abstract The objective of our study is to quantitatively examine the available evidence regarding the efficacy and side effects of magnesium sulfate for acute tocolysis (from randomized trials) compared with placebo and beta-agonist agents. Randomized trials comparing magnesium sulfate with placebo or beta-agonists for tocolysis were identified with a MEDLINE-based search and was supplemented by a search of obstetrical textbooks and bibliographies. Trials underwent quality evaluation and data abstraction by two independent, blinded investigators. Outcomes evaluated included delivery delay of various durations as well as the frequency of major and minor side effects. Summary odds ratios and 95 percent confidence intervals for dichotomous outcomes were calculated using a random effects model. Interstudy heterogeneity for these outcomes was assessed with a Q statistic. We identified 12 randomized controlled trials of magnesium sulfate for acute tocolysis. Four studies were excluded because of either lack of comparison of magnesium sulfate to either placebo or beta-agonists or lack of reporting clinical outcomes of interest. The eight remaining randomized trials comparing magnesium sulfate with placebo or beta-agonists were included in this analysis. There was no significant difference between MgSO4 and placebo for any of the measured outcomes for delay in delivery. Comparing magnesium sulfate to ritodrine or beta-agonists did not demonstrate any differences between the agents in achieving clinically significant tocolysis. There was a significant difference between MgSO4 and beta-agonists in the frequency of medication discontinuation because of side effects, but not in the frequency of major adverse drug events. There are few data comparing magnesium sulfate with a placebo for acute tocolysis. Magnesium sulfate seems to be comparable to ritodrine and beta-agonists, although the available data are not sufficient for a rational choice between these agents.
   
   
8. Title Magnesium sulphate for preventing preterm birth in threatened preterm labour [protocol]
   Source The Cochrane Database of Systematic Reviews: http://www.updateusa.com/clibpw/clib.htm
   
   
9. Author Crowley PA
   Institution Department of Obstetrics and Gynaecology, Trinity College Dublin, Coombe Women's Hospital, Dublin, Ireland.
   Title Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994 [see comments]
   Source Am J Obstet Gynecol 1995 Jul;173(1): p322-35
   ISSN 0002-9378

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