Background Preterm birth (PTB) accounts for 65% neonatal deaths and 50% neurological disability in children. Prior spontaneous PTB is the highest risk factor for subsequent PTB and is usually associated with sub-clinical infection, possibly due to genetic polymorphisms of proinflammatory cytokines. Bacterial vaginosis (BV) has been implicated in PTB and early treatment may reduce it but less attention has been paid to other infections. We assessed the infective and obstetric complications in a group of pregnant women at high risk of PTB and the interventions to reduce PTB.
Methods Study group: Pregnant women at high risk of PTB Interventions: Microbiological screening for infections from beginning of second trimester then 4-weekly until 28 weeks gestation with treatment of infections found; 2-weekly ultrasound assessment of cervical length during second trimester with cerclage and progesterone injections if needed. Outcome: Gestational age at delivery.
Results We have managed 104 pregnancies in 95 multiparous women who had at least one previous mid-trimester miscarriage (MTM), PTB or stillbirth due to chorioamnionitis. 21% had two previous MTM and/or PTB; 5% had three; 4% had four and 1% had five MTM/PTB. 75% were of white ethnicity, 7% asian, 18% black. One or more infection was identified in 51 (49%) of the pregnancies; Group B streptococcal infection (GBS) in 21%, BV in 16%, S aureus in 3%, heavy growth vaginal or urinary coliforms in 16%. Prevalence of infections was more frequent in black (68%), than white (48%), than asian (14%) women. Pregnancy outcome: Exact gestational age unknown in 4 due to transfer to different hospital when >28/40 gestation so outcomes for 100 pregnancies. Four resulted in MTM leaving 96 viable pregnancies. Gestational age at delivery: 24–27/40 in 3%; 28–31/40 in 3%; 32–37/40 in 13%, term in 81%. There was no association with treated infection and pregnancy outcome, infections had been identified and treated in 39% of PTBs and 50% of term births.
Conclusions In this group of women with high risk pregnancies, 49% had infections known to be associated with PTB which were treated in the second trimester. The overall PTB rate was 19% with 6% extremely or very preterm. There was no association between treated infection in pregnancy and PTB. Although the PTB rates are higher than the normal obstetric population they are significantly lower than would be predicted for such high risk pregnancies.
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