International Journal of

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Background: Group B streptococcus is regarded as a potential factor for adverse outcomes of pregnancy such as preterm birth.
Objective: To study the association of maternal vaginal colonization with group B streptococcus (GBS) and preterm labor.
Materials and Methods: From April 2005 to May 2006, vaginal culture for GBS were conducted in 101 laboring women with a gestational age of 24-37 weeks and 105 women admitted for term delivery at maternity center of Afzalipour Hospital in Kerman, Iran. Student`s t test and Chi square test were used to compare continuous and categorical data between the groups. Using multivariate logistic regression the association between GBS colonization and preterm labor was analyzed. P-values<0.05 were considered as significant.
Results: Colonization was detected in 9.2% of all mothers. Although GBS colonization was found more frequently in preterm than term patients (12 v/s 7 cases), the difference was not statistically significant. However, GBS positivity was roughly associated with preterm labor. Age was also a risk factor for GBS colonization. No case of perinatal sepsis occurred during the study period.
Conclusion: Maternal colonization for GBS is relatively low in our center. Increasing age enhances the risk of colonization. Vaginal colonization of GBS is relatively associated with preterm labor.

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Background: Vaginal bleeding is a common complication during pregnancy, which is observed in about 1/4 of pregnancies and in half of cases can lead to abortion. If vaginal bleeding happens during pregnancy some adverse pregnancy outcomes, including perinatal mortality and morbidity, low birth weight and preterm delivery will be increased.
Objective:  The aim of this study was to determine the relationship between vaginal bleeding and its characteristics in the first and second trimester of pregnancy and preterm labor.
Materials and Methods:  This is a case-control study conducted on 440 pregnant women referred to Al-Zahra Hospital in Rasht, Iran. Data were collected by a form. The form included demographic characteristics and confounding factors, the occurrence of bleeding during pregnancy and its features. Data were analyzed by T test, chi square and logistic regression in SPSS 16.
Results:  Findings showed that vaginal bleeding was associated with 3 times increased risk of preterm delivery (OR: 3, 1.84-4.89). Also, findings showed that bleeding characteristics including bleeding time, frequency, severity and intensity was significantly associated with preterm labor.
Conclusion:  According to significant association between vaginal bleeding and preterm delivery, it seems that performing some interventions to prevent preterm labor could be appropriate.

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Background: Preterm labor (PTL) is one of the most important causes in neonatal mortality and morbidity. Late preterm labor (34-36w) includes 75% of such birth. Assisted reproductive technology (ART) pregnant women are at increased risk of PTL.
Objective: The study has been undertaken to determine whether beginning and continuing 17-α hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality.
Materials and Methods: In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-α hydroxy progesterone caproate (Femolife) was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire.
Results: The risk of PTL in placebo group was 2.48 higher than control group that was not significant (Cl: 0.81-9.94). Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups.
Conclusion: Although it seems that 17-α hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation.

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Objective Background: Preterm labor, which defines as live-birth delivery before 37 weeks of gestation is a main determinant of neonatal morbidity and mortality around the world. : The aim of this study was to determine the prevalence of preterm labor in Iran by a meta-analysis study, to be as a final measure for policy makers in this field. Materials and Methods: In this meta-analysis, the databases of Thomson database (Web of Knowledge), PubMed/Medline, Science Direct, Scopus, Google Scholar, Iranmedex, Scientific Information Database (SID), Magiran, and Medlib were searched for articles in English and Persian language published between 1995 and 2014. Among the studies with regard to the inclusion and exclusion criteria, 14 studies (out of 1370 publications) were selected. Data were analyzed by using Stata software version 11. The heterogeneity of reported prevalence among studies was evaluated by the Chi-square based Q test and I2 statistics. Results: The results of Chi-square based on Q test and I2 statistics revealed severe heterogeneity (Q=2505.12, p-value < 0.001 and I2= 99.5%) and consequently, the random effect model was used for the meta-analysis. Based on the random effect model, the overall estimated prevalence of preterm in Iran was 9.2% (95% CI: 7.6 – 10.7). Conclusion: Present study summarized the results of previous studies and provided a comprehensive view about the preterm delivery in Iran. In order to achieve a more desirable level and its reduction in the coming years, identifying affecting factor and interventional and preventive actions seem necessary.

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Background: Preterm labor and birth are associated with several neonatal complications including respiratory distress syndrome and intraventricular hemorrhage. Differentiating true and false labor pain is a dilemma to obstetricians.
Objective: To elucidate the role of cervical length measurement in prediction of birth in pregnant women with threatened preterm labor.
Materials and Methods: In this double blind randomized clinical trial, 120 women with gestational age <34 wk who presented painful uterine contractions randomly assigned to undergo measurement of cervical length. Patients were registered in the hospital and a unit number was given. Based on the unit numbers, patients were randomly assigned to two groups using a computerized random digit generator. All participants were managed accordingly (n=65) or to receive tocolysis as planned (n=55). Tocolysis was prescribed when cervical length was <15 mm while those with cervical length ≥15 mm were managed expectantly. Delivery within 7 days of the presentation was the primary outcome.
Results: This RCT showed in case group, 78.9% of patient with cervical length <15 mm were delivered within 7 days and only 21.1% of them maintained their pregnancy. Of those with cervical length ≥15 mm, only 15.2% were delivered within the study period and the rest (84.8%) maintained their pregnancy (p<0.001).
Conclusion: “Our results indicate that in women who presented preterm labor symptoms, cervical length measurement will result in decreased unnecessary tocolytic treatment. Women with cervical length ≥15mm should not receive tocolysis, however, withholding corticosteroid therapy in these patients needs further evidence.

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Background: Premature birth is the main cause of neonatal mortality and long-term complications, which imposes heavy financial and psychological burdens on the family and society; therefore, it is important to recognize the factors affecting it.
Objective: The aim of this study was to determine the relationship between socioeconomic status, psychosocial factors, and food insecurity with preterm delivery.
Materials and Methods: This longitudinal study was conducted on 674 pregnant women at 24-28 wk of gestation who met the inclusion criteria. The subjects were selected using cluster sampling. The pregnant women filled out total questionnaires of study and they followed up until delivery and the data about the newborn was collected after delivery. The data collection tools included questionnaires for evaluating socioeconomic status, psychosocial factors, and food insecurity.
Results: The prevalence of preterm delivery was 7.7%, and socioeconomic factors were not associated with preterm labor. Among the intermediary factors, social health, food insecurity, stress, and prenatal care had a significant relationship with preterm labor. The prevalence rates of preterm delivery in cases with food insecurity, stress, and inadequate prenatal care were 2, 9.1 and 13.2 times higher than those who had food security, did not experience stress, and received adequate care during pregnancy.
Conclusion: Preterm labor is a relatively common problem in which intermediary social determinants of health can play an important role. Considering the limited studies on this issue, the results of this study can lay the foundation for future studies.

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Background: Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome.
Objective: To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL.
Materials and Methods: This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20 mg of rapid release nifedipine orally. If uterine contraction continued, a 10 mg dose was repeated every 20 min with a maximum of 40 mg within the first hour. After completing the first hour, 20 mg was given every 4-6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200 mg daily.
Results: Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13±5.08 days in group A while 29.73±3.10 days in group B. (p≤ 0.001)
Conclusion: Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions.
 

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