Preterm birth accounts to 35 % of deaths in a year. Twin gestation, around 7.2 per 1000 births in the Philippines, is a known risk factor that increases likelihood of preterm birth compared to singletons. Most studies that addresses preterm births are focused on singleton pregnancies. There have been no established recommendations to control preterm labor in twin pregnancies. Pessary insertion is among these recommendations. There are no reported cases of pessary insertion to control preterm birth among twins in the Philippines. This study presents a case of twin gestation in preterm labor and no functional cervix on transvaginal ultrasound. Hodge pessary was inserted at 28 weeks age of gestation. She delivered at 36 weeks to live baby girls, both 2,200 grams and were directly roomed-in. Further studies are recommended to establish stronger evidence supporting pessary use in multiple gestation to improve outcome of neonates.
Pessaries ; Premature Birth ; Obstetric Labor, Premature ; Pregnancy, Twin

BACKGROUND: The consequences of preterm birth not only for the baby but also for the mother has been well documented over the years. Numerous interventions have been tried and tested and yet it is still a significant problem to date. Progesterone has been documented to be an effective prophylactic drug against preterm labor for those considered at high risk for developing the condition. However, little is known its effectiveness when given in oral form as a maintenance tocolysis for those who already suffered from an acute episode or preterm labor.
OBJECTIVE:To evaluate the effectiveness of oral progesterone in the prevention of preterm birth after being diagnosed of preterm labor
DESIGN: Meta-analysis
SUBJECTS: The study population consisted of women with singleton gestation who were diagnosed with preterm labor, defined as having contractions associated with corresponding cervical dilatation, which were treated with oral progesterone as a maintenance tocolytic until delivery.
DATA COLLECTION: Journals were searched in different journal databases. Reviewers independently assessed the eligibility of the articles included in this study. Methodologic quality was reviewed using the Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). Data extracted were analysed using the Review Manager 5.3 Software (Revman 2014) and the Comprehensive Meta-Analysis Software (CMA3 2016).
RESULTS: No statistical difference was noted in terms of latency prolongation, gestational age at birth, occurrence of preterm birth, and on neonatal outcomes such as APGAR Score < 7 at birth, neonatal death between those who received progesterone and those who did not. However, babies in the progesterone group had a mean birthweight higher than their placebo counterparts.
CONCLUSION: The use of oral progesterone as a maintenance tocolysis after arrested preterm labor showed no statistically significant benefit except for higher birthweight in babies upon delivery.

Human ; Female ; Tocolysis ; Tocolytic Agents ; Gestational Age ; Premature Birth ; Progesterone ; Perinatal Death ; Obstetric Labor, Premature ; Birth Weight ; Delivery, Obstetric

Preterm birth (PTB) remains a major cause of neonatal mortality and morbidity, despite improvements in tocolytic treatment and neonatal care. Progesterone (17a-hydroxyprogesterone) produced naturally or synthetically can prevent PTB when applied vaginally and orally. Progesterone use may be a safe and cost-effective option in cases of singleton pregnancy with prior PTB, asymptomatically short cervix and arrested preterm labor.
Cervix Uteri ; Female ; Humans ; Infant ; Infant Mortality ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth ; Progesterone ; Tocolysis

Preterm birth is a major cause of neonatal morbidity and mortality, and occurs in 5% to 15% of all pregnancies. Therefore, its prevention is a major opportunity to reduce medical costs and to promote public health in all countries. Preterm birth is a broad great obstetric syndrome that arises from a wide variety of causes. Although many therapeutic agents are used for premature labor, most of them have serious maternal side effects, and they are ineffective in cases when labor has already begun. Therefore, the authors would like to introduce progesterone, as a treatment to prevent preterm labor. We also investigated whether nifedipine, which is used to treat preterm labor, could prevent preterm labor. We are eager to find more effective and easier-to-use drugs to prevent preterm labor in the future.
Female ; Mortality ; Nifedipine ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth ; Preventive Medicine ; Progesterone ; Public Health

Objective: To investigate the association between gestational diabetes mellitus (GDM) and preterm birth subtypes. Methods: Based on the cohort of pregnant women in Anqing Prefectural Hospital, the pregnant women who received prenatal screening in the first or second trimesters were recruited into baseline cohorts; and followed up for them was conducted until delivery, and the information about their pregnancy status and outcomes were obtained through electronic medical record system and questionnaire surveys. The log-binomial regression model was used to explore the association between GDM and preterm birth [iatrogenic preterm birth, spontaneous preterm birth (preterm premature rupture of membranes and preterm labor)]. For multiple confounding factors, the propensity score correction model was used to compute the adjusted association. Results: Among the 2 031 pregnant women with a singleton delivery, the incidence of GDM and preterm birth were 10.0% (204 cases) and 4.4% (90 cases) respectively. The proportions of iatrogenic preterm birth and spontaneous preterm birth in the GDM group (n=204) were 1.5% and 5.9% respectively, while the proportions in non-GDM group (n=1 827) were 0.9% and 3.2% respectively, and the difference in the proportion of spontaneous preterm birth between the two groups was significant (P=0.048). Subtypes of spontaneous preterm were further analyzed, and the results showed that the proportions of preterm premature rupture of membranes and preterm labor in the GDM group were 4.9% and 1.0% respectively, while the proportions in the non-GDM group were 2.1% and 1.1% respectively. It showed that the risk of preterm premature rupture of membranes in GDM pregnant women was 2.34 times (aRR=2.34, 95%CI: 1.16-4.69) higher than that in non-GDM pregnant women. Conclusions: Our results showed that GDM might increase the risk of preterm premature rupture of membranes. No significant increase in the proportion of preterm labor in pregnant women with GDM was found.
Infant, Newborn ; Female ; Pregnancy ; Humans ; Premature Birth ; Diabetes, Gestational ; Obstetric Labor, Premature ; Hospitals ; Iatrogenic Disease

A clinical trial was performed to evaluate the tocolytic possibility of nifedipin and to propose a treatment regimen for preterm labor in the National Hospital of Gynecol-Obstet from July 2003 to December 2003. There were 40 cases of preterm labor with gestational age 31 weeks and 3 uterine contractions per minute on average. Patients received a 10 mg sublingual loading dose every 20 minutes (maximum dose 40mg), and followed by 20 mg oral dose every 6- 8 hours. Result: the effectiveness in tocolysis of nifedipin is very fast. It took 60-80 minutes to arrest uterine contraction (70- 80%) (including contractions of high frequency and intensity), especially in urgent tocolysis. The lower the frequency and intensity is, the higher and sooner the effectiveness is. 92.5% of delivery were delayed for 48 hours. 82.85% were postponed until 36 weeks, and the mean time of prolonged pregnacy was 39 days. Side-effects were mild and transient and in normotensive pregnant women blood pressure was almost unaffected. This treatment regimen of nifedipin showed the effectiveness in preterm labor. In brief, nifedipin is an effective, safe, convenient and economic tocolytic agent. It may well represent the best suitable tocolytic alternative currently available and can be used widely in Viet Nam.
Obstetric Labor, Premature, Nifedipine, Tocolysis

Premature birth is the single largest cause of perinatal mortality and morbidity in nonanomalous infants in developing countries. Advances in neonatal care have lead to increased survival and reduced short and long term morbidity for preterm infants. but the rate of preterm birth has actually increased. This review provides recent multifactorial approaches to treatment and prevention of preterm birth.
Developing Countries ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Obstetric Labor, Premature* ; Perinatal Mortality ; Pregnancy ; Premature Birth

Objective To investigate the changes in preterm birth rate,its gestational age distribution,and possible contributors in Peking Union Medical College Hospital (PUMCH) over the last 25-year period. Methods The clinical data of premature deliveries,both singleton and twins,in PUMCH from January 1,1990 to December 31,2014 were retrospectively analyzed. We counted the number of premature fetuses and assessed the changes of preterm birth rate and its gestational age distribution (including extremely preterm birth,early preterm birth,and late preterm birth) over time. The etiologies (including spontaneous and iatrogenic) of preterm birth were also surveyed. Results The overall preterm birth rate was 7.8% in PUMCH,showing a slightly up-trend in both singletons and twins. Twin prematurity accounted for 23.8% of total preterm births,increased from 15.1% to 28.5%. Preterm births subgrouped by gestational age included 26 cases (0.7%) of extreme prematurity (<28 weeks),1199 cases (33.9%) of early preterm birth (28- 33weeks),and 2310 cases (65.3%) of late preterm birth (34- 36weeks). The gestational age distribution in singletons and twins showed no significant difference(z=0.844,P=0.398). Changes in the proportion of preterm birth before 28 weeks was little,gradually increased in the 28- 33weeks group (from 23.8% to 36.1%) and gradually decreased in the 34- 36weeks group (from 75.5% to 63.3%). Trends of gestational age distribution of singleton and twins were similar to that of the total. Spontaneous preterm labor,preterm premature rupture of membrane,and medically indicated (iatrogenic) preterm birth accounted for 20.2%,38.9%,and 40.9% respectively. There was no difference in singletons and twins(χ=1.071,P=0.301).The proportion of iatrogenic preterm was increased. Common reasons for iatrogenic preterm birth included gestational hypertension,fetal indications (including fetal distress,fetal growth restriction),placenta previa,and pregnancy complicated by heart disease. Conclusions The overall preterm birth rate shows an upward trend in the general hospital as a result of more multifetal gestations and more medically indicated preterm births. Reducing multifetal gestations and effective control of pregnancy complications should be the priorieties in preterm birth intervention.
Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth ; Retrospective Studies ; Twins

OBJECTIVE: To investigate the birth condition of preterm infants and the causes of preterm birth in Henan Province, China, and to provide a basis for the prevention and treatment of preterm birth. METHODS: An epidemiological investigation was conducted for live-birth preterm infants who were born in 53 hospitals in 17 cities of Henan Province from January 1, 2019 to December 31, 2019 to investigate the incidence rate of preterm birth, the distribution of gestational age and birth weight, the use of antenatal glucocorticoids, and the causes of preterm birth. RESULTS: The incidence rate of preterm birth was 5.84% (12 406/212 438) in the 53 hospitals. The proportions of preterm infants with gestational ages of < 28 weeks, 28 - < 32 weeks, 32 - < 34 weeks, and 34 - < 37 weeks were 1.58% (196/12 406), 11.46% (1 422/12 406), 15.18% (1 883/12 406), and 71.78% (8 905/12 406) respectively. The proportions of preterm infants with birth weights of < 1 000 g, 1 000- < 1 500 g, 1 500- < 2 500 g, 2 500- < 4 000 g, and ≥ 4 000 g were 1.95% (240/12 313), 8.54% (1 051/12 313), 49.53% (6 099/12 313), 39.59% (4 875/12 313), and 0.39% (48/12 313) respectively. The infants born by natural labor accounted for 28.76% (3 568/12 406), and those born by cesarean section accounted for 70.38% (8 731/12 406). The rate of use of antenatal glucocorticoids was 52.52% (6 293/11 983) for preterm infants and 68.69% (2 319/3 376) for the preterm infants with a gestational age of < 34 weeks. Iatrogenic preterm labor was the leading cause of preterm birth[40.06% (4 915/12 270)], followed by spontaneous preterm birth[30.16% (3 701/12 270)] and preterm birth due to premature rupture of membranes[29.78% (3 654/12 270)]. The top three causes of iatrogenic preterm birth were hypertensive disorders of pregnancy[47.12% (2 316/4 915)], fetal intrauterine distress[22.85% (1 123/4 915)], and placenta previa/placental abruption[18.07% (888/4 915)]. CONCLUSIONS There is a relatively low incidence rate of preterm birth in Henan Province, and late preterm infants account for a relatively high proportion. Iatrogenic preterm birth is the main cause of preterm birth in Henan Province, and hypertensive disorders of pregnancy and fetal intrauterine distress are the main causes of iatrogenic preterm birth.
Cesarean Section ; China/epidemiology* ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth/etiology*

Uterine didelphys with unilateral hematometra, hemicolpos, and ipsilateral renal agenesis is a rare m01lerian duct malformation. Uterine didelphys with an obstructed hemivagina is frequently associated with renal agenesis, mostly ipsilateral to the blind vaginal pouch. Accurate early diagnosis and septal resection elevate pregnancy rate and birth rate but it is difficult to find these malfomations until the complication associated with pregnancy was developed. We report a case of successful gestational outcome in the presence of preterm labor due to hematometrocolpora caused by uterine didelphys with unilateral imperforated vagina and ipsilateral renal agenesis with brief review of the literatures.
Birth Rate ; Early Diagnosis ; Female ; Hematometra ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Rate ; Uterus* ; Vagina