Antibiotics in Obstetrics and Gynecology (Developments in Perinatal Medicine)

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Women with celiac disease have an increased risk of the development of preterm birth. Marital status is associated with risk for preterm birth. A study in Quebec of , births from to revealed less risk of preterm birth for infants with legally married mothers compared with those with common-law wed or unwed parents. Genetic make-up is a factor in the causality of preterm birth. Genetics has been a big factor into why Filipinos have a high risk of premature birth as the Filipinos have a large prevalence of mutations that help them be predisposed to premature births.

Subfertility is associated with preterm birth. Couples who have tried more than 1 year versus those who have tried less than 1 year before achieving a spontaneous conception have an adjusted odds ratio of 1. Air pollution increases the risk of preterm birth. Living in an area with a high concentration of air pollution is a major risk factor, including living near major roadways or highways where vehicle emissions are high from traffic congestion or are a route for diesel trucks that tend to emit more pollution.

The use of fertility medication that stimulates the ovary to release multiple eggs and of IVF with embryo transfer of multiple embryos has been implicated as an important factor in preterm birth. Maternal medical conditions increase the risk of preterm birth. Often labor has to be induced for medical reasons; such conditions include high blood pressure , [52] pre-eclampsia , [53] maternal diabetes, [54] asthma, thyroid disease, and heart disease.

In a number of women anatomical issues prevent the baby from being carried to term. Some women have a weak or short cervix [52] the strongest predictor of premature birth [55] [56] [57] Women with vaginal bleeding during pregnancy are at higher risk for preterm birth. While bleeding in the third trimester may be a sign of placenta previa or placental abruption — conditions that occur frequently preterm — even earlier bleeding that is not caused by these conditions is linked to a higher preterm birth rate.

Anxiety [59] and depression have been linked to preterm birth. The use of tobacco , cocaine , and excessive alcohol during pregnancy increases the chance of preterm delivery.


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Tobacco is the most commonly abused drug during pregnancy and contributes significantly to low birth weight delivery. The World Health Organization published an international study in March Presence of anti-thyroid antibodies is associated with an increased risk preterm birth with an odds ratio of 1. A systematic review of 30 studies on the association between intimate partner violence and birth outcomes concluded that preterm birth and other adverse outcomes, including death, are higher among abused pregnant women than among non-abused women.

The frequency of infection in preterm birth is inversely related to the gestational age. Mycoplasma genitalium infection is associated with increased risk of preterm birth, and spontaneous abortion. Infectious microorganisms can be ascending, hematogeneous, iatrogenic by a procedure, or retrograde through the Fallopian tubes. From the deciduas they may reach the space between the amnion and chorion , the amniotic fluid , and the fetus.

A chorioamnionitis also may lead to sepsis of the mother. Fetal infection is linked to preterm birth and to significant long-term handicap including cerebral palsy. As the condition is more prevalent in black women in the US and the UK, it has been suggested to be an explanation for the higher rate of preterm birth in these populations.

It is opined that bacterial vaginosis before or during pregnancy may affect the decidual inflammatory response that leads to preterm birth. The condition known as aerobic vaginitis can be a serious risk factor for preterm labor; several previous studies failed to acknowledge the difference between aerobic vaginitis and bacterial vaginosis, which may explain some of the contradiction in the results.

Untreated yeast infections are associated with preterm birth. A review into prophylactic antibiotics given to prevent infection in the second and third trimester of pregnancy 13—42 weeks of pregnancy found a reduction in the number of preterm births in women with bacterial vaginosis.

These antibiotics also reduced the number of waters breaking before labor in full-term pregnancies, reduced the risk of infection of the lining of the womb after delivery endometritis , and rates of gonococcal infection. However, the women without bacterial vaginosis did not have any reduction in preterm births or pre-labor preterm waters breaking. Much of the research included in this review lost participants during follow-up so did not report the long-term effects of the antibiotics on mothers or babies.

More research in this area is needed to find the full effects of giving antibiotics throughout the second and third trimesters of pregnancy. A number of maternal bacterial infections are associated with preterm birth including pyelonephritis , asymptomatic bacteriuria , pneumonia , and appendicitis. A review into giving antibiotics in pregnancy for asymptomatic bacteriuria urine infection with no symptoms found the research was of very low quality but that it did suggest that taking antibiotics reduced the numbers of preterm births and babies with low birth weight.

A different review found that preterm births happened less for pregnant women who had routine testing for low genital tract infections than for women who only had testing when they showed symptoms of low genital tract infections.

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Even though these results look promising, the review was only based on one study so more research is needed into routine screening for low genital tract infections. Also periodontal disease has been shown repeatedly to be linked to preterm birth. There is believed to be a maternal genetic component in preterm birth. However, the occurrence of preterm birth in families does not follow a clear inheritance pattern, thus supporting the idea that preterm birth is a non-Mendelian trait with a polygenic nature. Placental alpha microglobulin-1 PAMG-1 has been the subject of several investigations evaluating its ability to predict imminent spontaneous preterm birth in women with signs, symptoms, or complaints suggestive of preterm labor.

Fetal fibronectin fFN has become an important biomarker—the presence of this glycoprotein in the cervical or vaginal secretions indicates that the border between the chorion and deciduas has been disrupted. A positive test indicates an increased risk of preterm birth, and a negative test has a high predictive value. Obstetric ultrasound has become useful in the assessment of the cervix in women at risk for premature delivery.

In humans, the usual definition of preterm birth is birth before a gestational age of 37 complete weeks. One of the main organs greatly affected by premature birth is the lungs.

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The lungs are one of the last organs to mature in the womb; because of this, many premature babies spend the first days and weeks of their lives on ventilators. Therefore, a significant overlap exists between preterm birth and prematurity. Generally, preterm babies are premature and term babies are mature. Preterm babies born near 37 weeks often have no problems relating to prematurity if their lungs have developed adequate surfactant , which allows the lungs to remain expanded between breaths.

Sequelae of prematurity can be reduced to a small extent by using drugs to accelerate maturation of the fetus, and to a greater extent by preventing preterm birth. Historically efforts have been primarily aimed to improve survival and health of preterm infants tertiary intervention. Such efforts, however, have not reduced the incidence of preterm birth. Increasingly primary interventions that are directed at all women, and secondary intervention that reduce existing risks are looked upon as measures that need to be developed and implemented to prevent the health problems of premature infants and children.

Adoption of specific professional policies can immediately reduce risk of preterm birth as the experience in assisted reproduction has shown when the number of embryos during embryo transfer was limited. The EUROPOP study showed that preterm birth is not related to type of employment, but to prolonged work over 42 hours per week or prolonged standing over 6 hours per day. Healthy eating can be instituted at any stage of the pregnancy including nutritional adjustments, use of vitamin supplements, and smoking cessation.

Additional support during pregnancy does not appear to prevent low birthweight or preterm birth. Screening for asymptomatic bacteriuria followed by appropriate treatment reduces pyelonephritis and reduces the risk of preterm birth. Self-care methods to reduce the risk of preterm birth include proper nutrition, avoiding stress, seeking appropriate medical care, avoiding infections, and the control of preterm birth risk factors e.

Self-monitoring vaginal pH followed by yogurt treatment or clindamycin treatment if the pH was too high all seem to be effective at reducing the risk of preterm birth. Women are identified to be at increased risk for preterm birth on the basis of their past obstetrical history or the presence of known risk factors. Preconception intervention can be helpful in selected patients in a number of ways. Patients with certain uterine anomalies may have a surgical correction i. In multiple pregnancies , which often result from use of assisted reproductive technology , there is a high risk of preterm birth.

Selective reduction is used to reduce the number of fetuses to two or three.

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A number of agents have been studied for the secondary prevention of indicated preterm birth. Trials using low-dose aspirin , fish oil , vitamin C and E, and calcium to reduce preeclampsia demonstrated some reduction in preterm birth only when low-dose aspirin was used.

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Reduction in activity by the mother—pelvic rest, limited work, bed rest—may be recommended although there is no evidence it is useful with some concerns it is harmful. A randomized trial showed a significant decline in preterm birth rates, [] and further studies are in the making. While antibiotics can get rid of bacterial vaginosis in pregnancy, this does not appear to change the risk of preterm birth. Progestogens , often given in the form of progesterone or hydroxyprogesterone caproate , relaxes the uterine musculature, maintains cervical length, and has anti-inflammatory properties, and thus exerts activities expected to be beneficial in reducing preterm birth.

Progestogen supplementation also reduces the frequency of preterm birth in pregnancies where there is a short cervix. In preparation for childbirth , the woman's cervix shortens. Preterm cervical shortening is linked to preterm birth and can be detected by ultrasonography.

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Cervical cerclage is a surgical intervention that places a suture around the cervix to prevent its shortening and widening. Numerous studies have been performed to assess the value of cervical cerclage and the procedure appears helpful primarily for women with a short cervix and a history of preterm birth.


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  • Tertiary interventions are aimed at women who are about to go into preterm labor, or rupture the membranes or bleed preterm. The use of the fibronectin test and ultrasonography improves the diagnostic accuracy and reduces false-positive diagnosis. While treatments to arrest early labor where there is progressive cervical dilatation and effacement will not be effective to gain sufficient time to allow the fetus to grow and mature further, it may defer delivery sufficiently to allow the mother to be brought to a specialized center that is equipped and staffed to handle preterm deliveries. Severely premature infants may have underdeveloped lungs because they are not yet producing their own surfactant.

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    This can lead directly to respiratory distress syndrome , also called hyaline membrane disease, in the neonate. To try to reduce the risk of this outcome, pregnant mothers with threatened premature delivery prior to 34 weeks are often administered at least one course of glucocorticoids , a steroid that crosses the placental barrier and stimulates the production of surfactant in the lungs of the baby.

    In cases where premature birth is imminent, a second "rescue" course of steroids may be administered 12 to 24 hours before the anticipated birth. There are still some concerns about the efficacy and side effects of a second course of steroids, but the consequences of RDS are so severe that a second course is often viewed as worth the risk. A Cochrane review supports the use of repeat dose s of prenatal corticosteroids for women still at risk of preterm birth seven days or more after an initial course.

    Beside reducing respiratory distress, other neonatal complications are reduced by the use of glucocorticosteroids, namely intraventricular bleeding, necrotising enterocolitis , and patent ductus arteriosus. Concerns about adverse effects of prenatal corticosteroids include increased risk for maternal infection, difficulty with diabetic control, and possible long-term effects on neurodevelopmental outcomes for the infants.

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    There is ongoing discussion about when steroids should be given i. Despite these unknowns, there is a consensus that the benefits of a single course of prenatal glucocorticosteroids vastly outweigh the potential risks. The routine administration of antibiotics to all women with threatened preterm labor reduces the risk of the baby to get infected with group B streptococcus and has been shown to reduce related mortality rates.

    When membranes rupture prematurely, obstetrical management looks for development of labor and signs of infection. Prophylactic antibiotic administration has been shown to prolong pregnancy and reduced neonatal morbidity with rupture of membranes at less than 34 weeks. A number of medications may be useful to delay delivery including: nonsteroidal anti-inflammatory drugs , calcium channel blockers , beta mimetics , and atosiban.

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