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Chapter 39 - Management of Established Preterm Labour and Rescue Cerclage

from Section 8 - Management of Anticipated and Non-anticipated Emergencies in Pregnancy

Published online by Cambridge University Press:  06 May 2021

Edwin Chandraharan
St George's University of London
Sir Sabaratnam Arulkumaran
St George's University of London
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Preterm birth is defined by the WHO as birth before 37 completed weeks of gestation. The incidence varies across countries but is currently approximately 8% of all births in the United Kingdom and 11% worldwide. Being born too soon can confer significant clinical deficits throughout life, leading to neuro-developmental disorders such as cerebral palsy, learning impairment and visual disorders; problems which are more likely to occur with greater severity at earlier gestations of birth [1]. Preterm birth may also affect long-term physical health, with a higher risk of cardiovascular disease, and lays a huge emotional and economic burden on affected families [2]. Figure 39.1 is adapted from the EPICURE longitudinal study of morbidity and mortality of preterm infants and demonstrates that with each week of increasing gestation, rates of disability and death decrease substantially. This underlines the importance of timely treatment aimed at preventing and ameliorating the effects of preterm birth.

Obstetric and Intrapartum Emergencies
A Practical Guide to Management
, pp. 283 - 291
Publisher: Cambridge University Press
Print publication year: 2021

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Costeloe, KL, Hennessy, EM, Haider, S, et al., Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). 2012;345:e7976.Google Scholar
Hodek, J-M, von der Schulenburg, JM, Mittendorf, T. Measuring economic consequences of preterm birth: methodological recommendations for the evaluation of personal burden on children and their caregivers. Health Econ Rev. 2011;1(1):639.CrossRefGoogle ScholarPubMed
Romero, R. Espinoza, J, Kusanovic, JP, et al. The preterm parturition syndrome. BJOG. 2006;113(Suppl 3):1742.CrossRefGoogle ScholarPubMed
Iams, JD, Berghella, V. Care for women with prior preterm birth. Am J Obstet Gynecol. 2010;203(2):89100.CrossRefGoogle ScholarPubMed
Kyrgiou, M, Athanasiou, A, Paraskevaidi, M, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ. 2016;354:i3633.CrossRefGoogle ScholarPubMed
Watson, HA, Carter, J, David, AL, et al. Full dilation cesarean section: a risk factor for recurrent second-trimester loss and preterm birth. Acta Obstet Gynecol Scand. 2017;96(9):1100–5.CrossRefGoogle ScholarPubMed
Sarri, G., Davies, M, Gholitabar, M, et al. Preterm labour: summary of NICE guidance. BMJ. 2015;351:h6283.CrossRefGoogle ScholarPubMed
Varley-Campbell, J., Mújica-Mota, R, Coelho, H, et al. Three biomarker tests to help diagnose preterm labour: a systematic review and economic evaluation. Health Technol Assess. 2019;23(13):1226.CrossRefGoogle ScholarPubMed
Kuhrt, K., Hezelgrave, N, Foster, C, et al. Development and validation of a tool incorporating quantitative fetal fibronectin to predict spontaneous preterm birth in symptomatic women. Ultrasound Obstet Gynecol. 2016;47(2):210–16.Google ScholarPubMed
Watson, HA, Carter, J, Seed, PT, et al. The QUiPP App: a safe alternative to a treat-all strategy for threatened preterm labor. Ultrasound Obstet Gynecol. 2017;50(3): 342–6.CrossRefGoogle ScholarPubMed
Liggins, GC, Howie, RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972;50(4):515–25.Google ScholarPubMed
Roberts, D, Dalziel, S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006(3):CD004454.Google ScholarPubMed
Soe, A., David, ALM, Costoloe, K, et al. Perinatal management of pregnant women at the threshold of infant viability (the obstetric perspective). RCOG Scientific Impact Paper. 2014;1:115.Google Scholar
Crowther, CA, McKinlay, CJD, Middleton, P, Harding, JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2015(7).Google Scholar
Rodriguez, A, Wang, Y, Khan, AA, et al. Antenatal corticosteroid therapy (ACT) and size at birth: a population-based analysis using the Finnish Medical Birth Register. PLOS Med. 2019;16(2):e1002746.CrossRefGoogle ScholarPubMed
Crowther, CA, Middleton, PF, Voysey, M, et al. Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: an individual participant data meta-analysis. PLOS Med. 2017;14(10):e1002398.CrossRefGoogle ScholarPubMed
van Vliet, EOG, Nijman, TAJ, Schuit, E, et al. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): a multicentre, randomised controlled trial. Lancet. 2016;387(10033):2117–24.CrossRefGoogle ScholarPubMed
Kenyon, S., Taylor, DJ, Tarnow-Mordi, WO, et al. ORACLE–antibiotics for preterm prelabour rupture of the membranes: short-term and long-term outcomes. Acta Paediatr Suppl. 2002;91(437):1215.CrossRefGoogle ScholarPubMed
Hughes, RG, Brocklehurst, P, Steer, PJ, et al. Prevention of early-onset neonatal group B streptococcal disease. BJOG. 2017;124(12):e280e305.Google Scholar
Kenyon, S, Brocklehurst, P, Jones, D, et al. MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes. BMC Pregnancy Childbirth. 2008;8:1425.CrossRefGoogle ScholarPubMed
Watson, S.I., Arulampalam, W, Petrou, S, et al. The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. BMJ Open. 2014;4(7):e004856.Google ScholarPubMed
Brown, R, Gagnon, R, Delisle, MF. Guideline No. 373.Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2019;41(2):233–47.Google ScholarPubMed
Althuisius, SM, Dekker GA, Hummel P, et al. Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol. 2003;189(4):907–10.CrossRefGoogle ScholarPubMed
Stupin, JH, David M, Siedentopf J-P, et al. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks: a retrospective, comparative study of 161 women. Eur J Obstet Gynecol Reprod Biol. 2008;139(1):32–7.CrossRefGoogle ScholarPubMed
Oh, KJ, Romero R, Park JY, et al. Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency. Am J Obstet Gynecol. 2019;221(2):P140.E1–140.E18.Google ScholarPubMed
Locatelli, A, Vergani P, Bellini P, et al. Amnioreduction in emergency cerclage with prolapsed membranes: comparison of two methods for reducing the membranes. Am J Perinatol. 1999;16(2):73–7.Google ScholarPubMed

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