Talk:Preterm birth/Archive 1

Archive 1

Early Discussion

I'm still new at Wiki, so I hope my changes were good clean wikifications (-: I reduced the major list and rearranged the article, using the ecology article as a template (I was trained in that field so it seemed like a good place to start). JoeBoucher 22:26, Jan 14, 2004 (UTC)

I went ahead and did the merge with Prematurity.Nandesuka 15:21, 14 July 2005 (UTC)

Regional definition?

I believe "defined medically as birth occurring earlier than 37 completed weeks of gestation" is the definition proposed by the WHO but some countries have a different, equally strict, definition. PhS 20:44, 21 October 2005 (UTC)

mortality rates?

Do we have any reliable mortality rates for premature babies?DonaNobisPacem 07:08, 27 March 2006 (UTC)

37 vs 37-41

It seems as if some people prefer to say that prematurity is defined as birth "earlier than 37-41 completed weeks of gestation" rather than simply "37 completed weeks". The problem I see with "37-41" is that it's ambiguous - 40 weeks is "earlier than 41", which is in the range 37-41 so someone could argue that 40 weeks is premature. Furthermore, why 41 as the upper range? why not 42, 50, 99 or 4826? All major sources say "< 37", they don't give a range. Ciotog 13:36, 16 March 2007 (UTC)

Prematurity and periodontal disease

The evidence for a connection between prematurity and periodontal disease is not definitive. See this paper prepared by the March of Dimes http://www.marchofdimes.com/files/MP_PeriodontalDiseaseAndPretermBirth031004.pdf I plan to edit the article, but would appreciate feedback from other editors before proceeding. Thank you, marchbabies, February 2, 2007

I agree. The orginal sentence "Periodontal disease increases the risk of preterm birth more than 4 times. As a matter of fact this is one of the most serious risk factors, that is completely preventable." This seemed to me to be an editorial comment. I deleted everything except the Periodontal diease link. Some studies have suggested this but they vary considerably. Jeffjacks7 14:25, 17 March 2007 (UTC)

Factors Section

I re-did the factors section, to try to eliminate the repeated sentences that were awkward or went into far too much detail on the cited references. However, am not happy with the results. It might be better to get away from the lists, but needs to have more text than simply stating essentially 'factor X increases the risk of preterm delivery'. Also, the references contain hyperlinks that are not accessible by those who do not have special access to the web resource. This still needs significant revision.Hallbrianh 21:48, 28 May 2007 (UTC)

I really don't like the laundry list at all; whenever possible we should be moving away from adding those, not adding more of them. Rather than just revert it, I figured I'd bring it up here. Would you like to take a crack at rewriting that section again so that the laundry list is a textual paragraph (or two?) Nandesuka 01:35, 29 May 2007 (UTC)

Records section

I've removed the names of minors from the records section. All statements are sourced and the sources give the names, should anyone need them. The general principle here is to avoid this article appearing in search results on the minor's name in his or her future (hopefully very successful) life. --Tony Sidaway 23:36, 3 June 2007 (UTC)

Babson and Benda chart and update to it

Would a suitable addition to this article be a description of the role of the Babson and Benda growth graph for preterm infants and the recent revisions to this graph from increased sample sizes? I came in contact with this information while examining the top-cited papers at BioMed Central. The second most cited manuscript across the history of this resource as of 2007-12-21 (>101,000 accesses) is:

Fenton, Tanis R (2003-12-16). "A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format". BMC Pediatrics. 3 (13). BioMed Central. doi:10.1186/1471-2431-3-13. PMID 14678563. Retrieved 2007-12-21. The Babson and Benda 1976 "fetal-infant growth graph" for preterm infants is commonly used in neonatal intensive care. ... The purpose of this study was to develop an updated growth chart beginning at 22 weeks based on a meta-analysis of published reference studies. {{cite journal}}: Cite has empty unknown parameters: |laydate=, |laysource=, and |laysummary= (help)CS1 maint: unflagged free DOI (link)

Thanks for considering this. I am not a physician myself, so I would prefer to leave the integration of this information to someone with experience in the area. --User:Ceyockey (talk to me) 20:22, 21 December 2007 (UTC)

Magnesium sulfate

I added an intriguing news report (from a recent conference) that simple administration of magnesium sulfate can cut cerebral palsy in half - in case I forget, the media report should be supplemented with the proper scientific citation once it becomes available. Also, I've omitted mention of geophagy because any link with it needs proof, but it will be something interesting to watch for. Wnt (talk) 17:45, 1 February 2008 (UTC)

MCOTW + current structure comments

This page has been nominated as the new medical collaboration of the week. I've set up a topic heading here to discuss changes to the article within the period of it being the MCOTW. Perhaps, for order, we could use subheadings to discuss different issues and leave it under this one header. —Cyclonenim (talk · contribs · email) 16:19, 30 November 2008 (UTC)

Current structure

I'm not convinced the structure of the article as it stands now is the best way to do it. Perhaps I'm a sucker for conventions but I feel we should tidy it up in some way. Perhaps have topic headings as:

• Overview and/or classification
• Signs and symptoms
• Causes
• Prevention
• Treatment

• Separated into maternal and fetal treatments?

• Prognosis

• Separated into mother and fetal prognosises?

• Epidemiology
• Records
• See also
• References
• External links

That way we can keep it as close to WP:MEDMOS as possible. Opinions, anyone? —Cyclonenim (talk · contribs · email) 16:19, 30 November 2008 (UTC)

 Except prognosis remains as complications —Cyclonenim (talk · contribs · email) 21:31, 1 December 2008 (UTC)

If it is possible to provide all the relevant content in this framework, probably good. JFW | T@lk 00:41, 2 December 2008 (UTC)

Sources

The article has a lot of sources of borderline quality. Some are from websites, and some run through IP addresses. All very messy. I'm also uncertain whether the list of ORs for certain risk factors is meaningful for any reader. Personally, I'd prefer to have all items of that list sourced to a single review. JFW | T@lk 00:41, 2 December 2008 (UTC)

Preterm labour

I was asked to expand preterm labour, which is actually about pretty much the same thing. Presently I have turned it into a redirect here. I was however wondering if it is reasonable to deal with the subject in two dedicated articles: one on prematurity from the mother's perspective (symptoms, signs, diagnosis, interventions), and another from the child's perspective (complications, treatment for those complications).

At any rate: I have identified the following recent sources on the subject:

• Lancet series 2008 (PMID 18177753 - introduction)
  • PMID 18177778 - Lancet review 2008 on epidemiology and causes
  • PMID 18191687 - Lancet review 2008 on primary, secondary and tertiary interventions
  • PMID 18207020 - Lancet review 2008 on sequelae for the child
• PMID 17671256 - NEJM review 2007 - "prevention of preterm delivery"

I am really not up-to-date with this, but I will nominate the article for MCOTW and would be happy to contribute up to GA level for this absolutely essential topic. JFW | T@lk 19:52, 27 July 2008 (UTC)

I know this is an old question, but I would keep the two articles separate. And from preterm labour I would omit all discussion of sequelae for the child, just refer to this article. In a high risk pregnancy that is being closely monitored, preterm delivery by C-section may (and increasingly does) occur without prior labor. --Una Smith (talk) 05:39, 7 December 2008 (UTC)

Disambig premature and preterm

The terms premature and preterm, as used in the lead, need disambiguation. Preterm is before 37 weeks; premature is not mature enough to do without supportive medical care. Most but not all babies born at or after 37 weeks gestation are mature. Some term babies are premature. Some preterm babies are mature. --Una Smith (talk) 17:05, 30 November 2008 (UTC)

Intro has been modified accordingly.Ekem (talk) 02:44, 1 December 2008 (UTC)

Right now, the intro half-implies they're the same thing, and half-implies they're different. Also, preterm birth redirects here. I assume it might be because they're used interchangeably among non-medical types, and have a more precise meaning among medical types. We should (a) reword the intro (easy, I'll give it a stab and you can fix or revert as needed) and (b) consider an article of its own for preterm birth (way over my head, but I enjoy adding things to other people's to do lists). --Floquenbeam (talk) 21:58, 4 December 2008 (UTC)

I tweaked it, but now I think I just re-invented the wheel, I didn't look at previous versions first. Mine is close to but different than Una's. I'll leave it at mine for now, because I think it scans a little better, but if my version lacks too much of the precision of the old version just revert back. --Floquenbeam (talk) 22:20, 4 December 2008 (UTC)

"Preterm birth" is the medically preferred term not at least because it has a more precise and workable definition than "premature". The article talks about preterm birth and prematurity is a consequence of being preterm. While used as synonyms, preterm and premature are different as pointed out above. It would make sense to move the article to "Preterm birth", redirect "Premature birth" to this article and, within the article, discuss the difference.Ekem (talk) 22:53, 4 December 2008 (UTC)

Are full-term babies that aren't fully developed classified as premature? While we're at it where does miscarriage overlap - since as I read it at the moment 'wouldn't survive without medical intervention' sounds like the definition of miscarriage? LeeVJ (talk) 23:03, 4 December 2008 (UTC)

Miscarriage is prior to 20 w gestation, then a baby born is either preterm and later term if alive or stillborn. Premature is a functional assessment (generally with the assumption of the baby being preterm).Ekem (talk) 23:41, 4 December 2008 (UTC)

Yes, "term" babies (meaning born at 37+ weeks gestation) that aren't fully developed are regarded as premature. "Classified" isn't quite the right word, because prematurity is a transient condition. The dividing line between miscarriage and stillbirth/perinatal death is a legal one. In the US, most states define the line at 20w. Before about 24w, it is not a question of medical intervention; survival is unlikely regardless. --Una Smith (talk) 05:33, 7 December 2008 (UTC)

I revised the lead some more. I think it is important to specify that the gestational age is for humans only. And to at least acknowledge that premature birth is a concern also in animal husbandry. From the following section I deleted the tangents into calculation of gestational age, and gathered the US-specific data. The transition from US to world data is weak, but I left it at that because the world data section itself is largely a tangent into LBW and SGA. --Una Smith (talk) 06:38, 7 December 2008 (UTC)

leveles of preterm - classification

Routing around for refs found this one:[Moutquin JM (2003). "Classification and heterogeneity of preterm birth". BJOG. 110 Suppl 20: 30–3. PMID 12763108. {{cite journal}}: Unknown parameter |month= ignored (help)] I don't have full text but abstract gives several severities, and causes which seem more concise than current causes: LeeVJ (talk) 18:38, 14 December 2008 (UTC)

Preterm birth is stratified into mild preterm (32-36 weeks), very preterm (28-31 weeks) and extremely preterm (<28 weeks) with increasing neonatal mortality and morbidity. Recent studies suggested that infection was mostly responsible for extreme preterm birth, while stress and lifestyle accounted for mild preterm birth, and a mixture of both conditions contributed to very preterm birth

Revision 12/15/08

I revised the article in an attempt to bring it up to speed incorporating information of recent review articles, notably from Lancet in early 2008 that provided the framework of I, II, and III intervention. I also attempted to preserve the work that had been done as much as I could. The work is not complete (not that I expect it ever to be), and the references have not yet been all checked. Ekem (talk) 03:21, 15 December 2008 (UTC)

Did I blink? Nice job! LeeVJ (talk) 15:11, 15 December 2008 (UTC)

Post move clear-up

Ok now the page is moved, I adjusted the lead a little to reflect this, but before going further, do we leave premature birth as a straight redirect, explaining the difference in this article, or as an article in it's own right leaving this one with more focus? following is the line I cut fromintro which might the basis of premature birth miniarticle ; 'Premature birth whose organs are insufficiently developed, requiring medical support for survival. It is closely related to preterm birth' LeeVJ (talk) 16:16, 14 December 2008 (UTC)

I think Premature birth should redirect to Preterm birth, where there should be a mention of premature birth in the lead and a paragraph comparing and contrasting the two. --Una Smith (talk) 16:25, 14 December 2008 (UTC)

On further reflection, agree this is the way to go, a smaller article on premature birth would inevitably lead to a merge request into this article! LeeVJ (talk) 18:21, 14 December 2008 (UTC)

I reworked the lead and section on prematurity, inverting a lot of the paragraph structure, to better relate preterm and premature, and transition to the rest of the article. --Una Smith (talk) 00:13, 16 December 2008 (UTC)

Some information

Any baby born prior to 38 6/7 weeks of gestation is pre-term; either pre-term (up to 35 weeks of gestation) or Late Pre-term (between 35 1/7 weeks to 38 67 weeks of gestation) Developmental delays/risks are now well documented in the Pediatric literature. Jan 29, 2010 —Preceding unsigned comment added by 173.75.237.87 (talk) 21:43, 29 January 2010 (UTC)

Tasks for cleanup

This article has potential. The one thing I don't like is it's "laundry list" nature. It makes it hard to follow, and it's not very readable. I'd propose that the first thing we do is eliminate the laundry lists and replace them with well-written text. My overall goal is to make this article high-quality enough to merit being on the front page (it's clearly not there yet). Nandesuka 15:21, 14 July 2005 (UTC)

The following paragraph is unclear regarding the relationship between preterm birth and depression. Note the sentence "Depression is a leading cause for premature births." We don't know this for sure, and we also don't know if it was meant to refer to a correlation, or if there is a correlation between the two things.

"The prevention of premature births is what needs to be focused on today. That is what the professionals in the health care community are struggling with. “Reasons for this include a lack of universal access to health care for women of childbearing age or pregnant women of any age”. Depression is a leading cause for premature births. Women suffering with this disorder need to make sure they are in continuous treatment in order for their symptoms to controlled and monitored. Becoming overly stressed and upset can trigger premature labor in an otherwise healthy woman. " Sdsures (talk) 00:25, 13 February 2010 (UTC)

Prematurity and the parent

The following needs to be edited: ""Additionally, parents often have difficulty becoming involved in their child's care because of the NICU setting. This affects the parents transition into parenthood because they are unable to fulfill their expected roles."

This seems very unscientific, and presupposes that that the premature birth is the first child for a couple ("transition into parenthood"). I recommend deleting or editing it.

65.31.132.187 08:49, 3 October 2006 (UTC)

Perhaps a note could be made that the parental interaction may not signify that the premature infant is the parents' first child. Sdsures (talk) 00:27, 13 February 2010 (UTC)

Sense of odor

Seeing that prematuirty might demage the babies hearing or vision, can it also influence their sense of odour? !NOSIGN! —The preceding unsigned comment was added by 88.209.215.48 (talk) 10:25, 10 December 2006 (UTC).

Here is an interesting article on sensory stimulation in preemies from http://www.pregnancy.org

http://www.pregnancy.org/article/tips-sensory-stimulation-premature-infant-NICU Sdsures (talk) 00:32, 13 February 2010 (UTC)

Viability

While there is now a single well-documented case in the U.S. of an infant surviving at 21 weeks (see the article cited by RingTailedFox), viability is still generally thought to be at 23-24 weeks. The survival at 23 weeks in the best U.S. hospitals is around 15-20%. The survival at 22 weeks is still essentially 0%. As the article states, "if doctors had known Amillia's real gestational age, they might not have intervened. He said he thought she was at least 23 weeks, and doctors were shocked when the Taylors' fertility specialist pinpointed the exact date of fertilization. Fassbach cautioned against rushing to redefine the medical standards for fetus viability." Would change the sentence to "...betamethasone or dexamethasone, which are often given when the fetus approaches viability at 22-24 weeks."Hallbrianh 03:01, 22 February 2007 (UTC)

There isn't a good reference for the assertion of the limit of viability being when 50% of babies at that gestation would survive. Most of the time the definition of the limit of viability is when there is a possibility that the baby would survive to adulthood. (Dec 2012) — Preceding unsigned comment added by 70.225.161.149 (talk) 04:03, 9 December 2012 (UTC)

Pathogenesis examples?

I moved the following text from pathogenesis, because it seems to rather deal with causes. However, does anyone have access to the book to be able to check if these are general processes of pathogenesis of preterm birth, regardless of the cause?

There are four pathogenic mechanisms involved: Activation of maternal or fetal hypothalamic-pituitary-adrenal axis due to distress Inflammation of decidua, chorion, amnion or systemic inflammation Decidual bleeding Pathological distension of the uterus

Mikael Häggström (talk) 18:40, 17 August 2011 (UTC)

No, these are all separate issues and they are not present in every case (or many cases) of preterm birth. It leaves out a discussion of spontaneous versus indicated preterm birth. Many premature babies are delivered on purpose (in the absence of preterm labor) because of a condition that makes it too dangerous for mother and/or fetus to continue the pregnancy--for instance, a woman at 30 weeks who has severe preeclampsia with factors suggesting the fetus is at high risk for intrauterine death should pregnancy continue--and in these cases labor is induced with drugs or of that's too dangerous a c/sec is done. These things that are listed are not the common factors that frequently lead to preterm birth. Even if you restricted the discussion to preterm labor (and this article is not restricted to preterm birth caused by preterm labor)these are not the really important factors. This whole article is pretty messy. — Preceding unsigned comment added by 70.225.161.149 (talk) 04:00, 9 December 2012 (UTC)

I agree that these factors cannot be important in all causes. Perhaps they should remain unmentioned in the article. Mikael Häggström (talk) 21:04, 18 March 2013 (UTC)

Premature birth

Every instance of "premature birth" in Wikipedia probably should be changed, disambiguated, either to preterm birth or to "premature (baby)". Some sections of this article are not about preterm birth but about premature babies. Also, in some cases very early delivery is required; such deliveries are not preterm births in the sense of this article, but the babies nonetheless are premature. So perhaps we do need a separate article about premature babies. --Una Smith (talk) 16:55, 17 December 2008 (UTC)

I think it is ok to have both "preterm birth" and "premature babies" described in this article. Even a delivery through Cesarean section can be regarded as a birth. Mikael Häggström (talk) 21:10, 18 March 2013 (UTC)

bacterial vaginosis and abortion

There was a recent row on Abortion#Physical_health over the status of evidence on a connection between abortion and premature birth. Also bacterial vaginosis was brought up as a factor, is that included under STD's? Just wondering if one or both should be added to the factors list. - RoyBoy ⁸⁰⁰ 05:43, 11 August 2005 (UTC)

"Previous abortion is a significant risk factor for Low Birth Weight and Preterm Birth, and the risk increases with the increasing number of previous abortions. Practitioners should consider previous abortion as a risk factor for LBW and PB. "

http://jech.bmj.com/content/62/1/16.abstract

"Induced and spontaneous abortion are associated with similarly increased ORs for preterm birth in subsequent pregnancies, and they vary inversely with the baseline preterm birth rate, explaining some of the variability among studies"

http://www.ncbi.nlm.nih.gov/pubmed/19301572

"Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1–2.0); the risk was even higher for extremely preterm deliveries (<28 weeks)"

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2004.00478.x/abstract

"This study shows that a history of induced abortion increases the risk of very preterm birth, particularly extremely preterm deliveries. It appears that both infectious and mechanical mechanisms may be involved." This study showed that women who gave birth between 28 and 32 weeks of pregnancy were 40% more likely to have had a previous abortion, and mothers who gave birth to extremeley preterm infants from 22 to 27 weeks were 70% more likely to have had an abortion.

http://journals.lww.com/obgynsurvey/Abstract/2005/10000/Previous_Induced_Abortions_and_the_Risk_of_Very.3.aspx

"A consent form that simply lists such items as "incompetent cervix" or "infection" as potential complications, but does not inform women of the elevated future risk of a preterm delivery, and that the latter constitutes a risk factor for devastating complications such as cerebral palsy, may not satisfy courts"

http://www.jpands.org/vol8no2/rooney.pdf

"Previous induced abortions significantly increased the risk of preterm delivery after idiopathic preterm labour, preterm premature rupture of membranes and ante-partum haemorrhage, but not preterm delivery after maternal hypertension. The strength of the association increased with decreasing gestational age at birth."

http://www.ncbi.nlm.nih.gov/pubmed/14998979

"The latest statistics in the USA (2007) show a preterm (less than 37 weeks) birth rate of 12.6%. Of these, Early Preterm Birth (EPB—under 32 weeks, infants weighing under 1500 grams, or about three pounds.) is at 7.8%, the highest rate in the past 30 years of stats. As noted in the studies above, previous induced abortions’ have an inordinately increased association with “extreme” (<27 wk) and “early”(<32 wk) premature deliveries (compared to 32 – 37 week premature births.) Thus, it follows that abortion will also have an inordinately increased association with cerebral palsy and other disabilities linked to extreme prematurity."

http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/general-comments-on-the-increased-risk/

Of the first-time mothers, 10.3% (n = 31 083) had one, 1.5% had two and 0.3% had three or more Induced Abortions (IAs). Most IAs were surgical (88%) performed before 12 weeks (91%) and carried out for social reasons (97%). After adjustment, perinatal deaths and very preterm birth (<28 gestational week) suggested worse outcomes after IA. Increased odds for very preterm birth were seen in all the subgroups and exhibited a dose–response relationship: 1.19 [95% confidence interval (CI) 0.98–1.44] after one IA, 1.69 (1.14–2.51) after two and 2.78 (1.48–5.24) after three IAs.

http://www.ncbi.nlm.nih.gov/pubmed/22933527

Thirty-seven studies of low-moderate risk of bias were included. A history of one Induced Termination of Pregnancy (I-TOP) was associated with increased unadjusted odds of Low Birth Weight (LBR) (Odds Ratio 1.35, 95% Confidence Interval 1.20-1.52) and Preterm Birth (PT) (OR 1.36, 95% CI 1.24-1.50), but not Small for Gestational Age (SGA) (OR 0.87, 95% CI 0.69-1.09). A history of more than one I-TOP was associated with LBW (OR 1.72, 95% CI 1.45-2.04) and PT (OR 1.93, 95% CI 1.28-2.71). Meta-analyses of adjusted risk estimates confirmed these findings. A previous I-TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I-TOP increased.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028978/

YourHumanRights (talk) 20:11, 7 April 2013 (UTC)

Abortion - preterm birth link.

I removed a contradictory sentence today that appeared below one confirming this link, as it had only one citation from a political organization (the Guttmacher Institute) that makes no issue of it's support for elective abortion and planned parenthood. The erroneous sentence referred to "uncomplicated" abortions not causing preterm birth later in life. The scientific literature makes no mention of 'complicated' vs. 'uncomplicated' as a delineating factor. The vast majority of medical studies show the link from surgical abortion to preterm birth, and make no mention of "complicated" as opposed to "uncomplicated" surgical abortions. The science regarding no link of preterm birth to medical abortions is, however, valid and should stay. —Preceding unsigned comment added by YourHumanRights (talk • contribs) 23:42, 22 July 2010 (UTC)

Very irresponsible to include the abortion and preterm birth link here. It is not a consistent finding in the literature and there's no evidence that the association is causal. I have deleted this obviously politically motivated sectionJeffreystringer (talk) 00:09, 15 January 2013 (UTC)

I mentioned the issue again, with references from BJOG and New England Journal of Medicine, which I believe are reliable enough for this purpose. Mikael Häggström (talk) 20:46, 18 March 2013 (UTC)

Except that IS indeed a VERY consistent finding in the literature, especially the published meta-analyses..

"Previous abortion is a significant risk factor for Low Birth Weight and Preterm Birth, and the risk increases with the increasing number of previous abortions. Practitioners should consider previous abortion as a risk factor for LBW and PB. "

http://jech.bmj.com/content/62/1/16.abstract

"Induced and spontaneous abortion are associated with similarly increased ORs for preterm birth in subsequent pregnancies, and they vary inversely with the baseline preterm birth rate, explaining some of the variability among studies"

http://www.ncbi.nlm.nih.gov/pubmed/19301572

"Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1–2.0); the risk was even higher for extremely preterm deliveries (<28 weeks)"

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2004.00478.x/abstract

"This study shows that a history of induced abortion increases the risk of very preterm birth, particularly extremely preterm deliveries. It appears that both infectious and mechanical mechanisms may be involved." This study showed that women who gave birth between 28 and 32 weeks of pregnancy were 40% more likely to have had a previous abortion, and mothers who gave birth to extremeley preterm infants from 22 to 27 weeks were 70% more likely to have had an abortion.

http://journals.lww.com/obgynsurvey/Abstract/2005/10000/Previous_Induced_Abortions_and_the_Risk_of_Very.3.aspx

"A consent form that simply lists such items as "incompetent cervix" or "infection" as potential complications, but does not inform women of the elevated future risk of a preterm delivery, and that the latter constitutes a risk factor for devastating complications such as cerebral palsy, may not satisfy courts"

http://www.jpands.org/vol8no2/rooney.pdf

"Previous induced abortions significantly increased the risk of preterm delivery after idiopathic preterm labour, preterm premature rupture of membranes and ante-partum haemorrhage, but not preterm delivery after maternal hypertension. The strength of the association increased with decreasing gestational age at birth."

http://www.ncbi.nlm.nih.gov/pubmed/14998979

"The latest statistics in the USA (2007) show a preterm (less than 37 weeks) birth rate of 12.6%. Of these, Early Preterm Birth (EPB—under 32 weeks, infants weighing under 1500 grams, or about three pounds.) is at 7.8%, the highest rate in the past 30 years of stats. As noted in the studies above, previous induced abortions’ have an inordinately increased association with “extreme” (<27 wk) and “early”(<32 wk) premature deliveries (compared to 32 – 37 week premature births.) Thus, it follows that abortion will also have an inordinately increased association with cerebral palsy and other disabilities linked to extreme prematurity."

http://www.aaplog.org/complications-of-induced-abortion/induced-abortion-and-pre-term-birth/general-comments-on-the-increased-risk/

Of the first-time mothers, 10.3% (n = 31 083) had one, 1.5% had two and 0.3% had three or more Induced Abortions (IAs). Most IAs were surgical (88%) performed before 12 weeks (91%) and carried out for social reasons (97%). After adjustment, perinatal deaths and very preterm birth (<28 gestational week) suggested worse outcomes after IA. Increased odds for very preterm birth were seen in all the subgroups and exhibited a dose–response relationship: 1.19 [95% confidence interval (CI) 0.98–1.44] after one IA, 1.69 (1.14–2.51) after two and 2.78 (1.48–5.24) after three IAs.

http://www.ncbi.nlm.nih.gov/pubmed/22933527

Thirty-seven studies of low-moderate risk of bias were included. A history of one Induced Termination of Pregnancy (I-TOP) was associated with increased unadjusted odds of Low Birth Weight (LBR) (Odds Ratio 1.35, 95% Confidence Interval 1.20-1.52) and Preterm Birth (PT) (OR 1.36, 95% CI 1.24-1.50), but not Small for Gestational Age (SGA) (OR 0.87, 95% CI 0.69-1.09). A history of more than one I-TOP was associated with LBW (OR 1.72, 95% CI 1.45-2.04) and PT (OR 1.93, 95% CI 1.28-2.71). Meta-analyses of adjusted risk estimates confirmed these findings. A previous I-TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I-TOP increased.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0028978/

YourHumanRights (talk) 20:13, 7 April 2013 (UTC)

I plan to add the abortion/preterm birth link again in a couple of days, unless someone can produce anything comparable in scope and detail to refute what I posted above - including THREE meta-analyses. Keeping people in the dark about this is on behalf of a political agenda is rather heinous in my view. In the USA alone, our preterm birth rate has DOUBLED the last 40 years in spite of all the other medical advancements we have made in that period.

YourHumanRights (talk) 20:17, 7 April 2013 (UTC)

I see now that Mikael Häggström has already re-edited the page to include my previous additions, but citations 9 and 10 are redundant. The meta-analyses above and a perhaps a few others should be added to the list of citations regarding the abortion/preterm link in addition to the Caroline Moreau study. YourHumanRights (talk) 19:40, 9 April 2013 (UTC)

Just calling attention to the fact that this debate is also happening at talk:abortion. Triacylglyceride (talk) 18:38, 1 June 2013 (UTC)

I finally updated the redundant citations (9 and 10) and changed # 9 to the Shah and Zao meta-analysis of 37 studies that they published in 2009. I will probably add a few more when I have the time. Alas, there are so many.. I also removed the word "slightly" that had been recently inserted before 'increased risk,' as that is NOT what the ANY of the meta-analyses show in their results. Among the primary results of the Shah & Zao meta-analysis, it was discovered that women with one previous induced termination of a pregnancy were 35% more likely to have a low birth weight child and 36% more likely to give birth before 37 weeks gestational age. In the case of women who had had more than one abortion, these rates rose to 72% and 93% respectively. The researchers themselves describe these as "significantly increased risks.” Such a word would never be inserted regarding the link to smoking and preterm birth, even though the numbers with that link are dwarfed by the abortion link.

I have also attempted to insert this very real link and very serious risk onto the abortion article itself, but that article is 'protected' from edits to a select few. My attempts to get this issue spotlighted on the talk page of the abortion article have thus far been met with an avalanche of baseless accusations that, essentially, the published science is nonsense and the sources unreliable. No evidence has been offered to refute any of the science, but rather there is now a very concerted effort to silence me and get me banned from even posting on the talk page and/or wikipedia itself. So the abortion/preterm birth link is here on this preterm birth page, but totally absent from the abortion article that at present reads just as if Cecile Richards wrote it!

Thank you, Mikael Häggström for your earlier edit reinserting the science here. I just noticed the term "slightly" had been inserted by someone else since then. So for now it looks like wikipedia will simply contradict itself. I suspect that I will soon be banned altogether from commenting, as this science has riled up a lot of folks who clearly have very strong political views on the topic of abortion. Nothing wrong with that, but when that is used as an excuse to run to the censors and try to get published science squelched and silenced - that tells us all we need to know about them. And it obviously doesn't make wikipedia too look good either.

YourHumanRights (talk) 01:17, 5 June 2013 (UTC)

I recommend that users interested in this issue first review YHR's contributions at talk:abortion, which have lead to several users, myself included, choosing to invoke WP:SHUN against them. Triacylglyceride (talk) 18:57, 6 June 2013 (UTC)

I think the current expression on the topic is acceptable for now, since it is based on a major RCOG guideline that came out two years after the Zhao review, so I'm pretty sure they took the review into account. Mikael Häggström (talk) 11:17, 10 June 2013 (UTC)

Yes, the review is covered in "The Care of Women Requesting Induced Abortion" (PDF). Evidence-based Clinical Guideline No. 7. Royal College of Obstetricians and Gynaecologists. 2011. pp. 44, 45....

A systematic review and meta-analysis by Shah et al. in 2009 reported that a history of abortion is associated with a small increase in the risk of preterm birth, giving an adjusted odds ratio of 1.27 (95% CI 1.12–1.44) increasing to 1.62 (95% CI 1.27 to 2.07) with more than one abortion. A recent large Australian population study of 42 269 births comparing term with preterm deliveries supports these findings. Among women with no history of miscarriage or induced abortion, 7.1% had a preterm birth compared with 8.9% of women who had one or more induced abortion (OR 1.25, 95% CI 1.13–1.40). Among women with a history of one or more miscarriages, 8.4% had a preterm birth, which also represents a borderline increased risk (OR 1.11, 95% CI 1.00–1.23).

However, these findings should be interpreted with caution since few of the reviewed studies controlled for important confounders associated with preterm birth (such as socioeconomic status), and the associations have not yet been shown to have a causal relationship.

In addition, the Shah review was confined to surgical methods of abortion. Where medical (mifepristone and prostaglandin) and surgical methods have been compared, there has been no significant difference reported in the risk of preterm birth.

— ArtifexMayhem (talk) 19:11, 13 June 2013 (UTC)

Survival chance graphic

Whilst there is perhaps a 50% survival chance of a 24 week old baby being born surviving in some places in the world, it's 0% in others. I can't believe this graphic is on this subject. — Preceding unsigned comment added by 212.159.67.94 (talk) 05:15, 7 January 2014 (UTC)

Set of three Lancet articles

These three articles were presented as a set by the Lancet.

• Goldenberg, Robert L; Culhane, Jennifer F; Iams, Jay D; Romero, Roberto (2008). "Epidemiology and causes of preterm birth". The Lancet. 371 (9606): 75–84. doi:10.1016/S0140-6736(08)60074-4. ISSN 0140-6736.
• Iams, Jay D; Romero, Roberto; Culhane, Jennifer F; Goldenberg, Robert L (2008). "Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth". The Lancet. 371 (9607): 164–175. doi:10.1016/S0140-6736(08)60108-7. ISSN 0140-6736.
• Saigal, Saroj; Doyle, Lex W (2008). "An overview of mortality and sequelae of preterm birth from infancy to adulthood". The Lancet. 371 (9608): 261–269. doi:10.1016/S0140-6736(08)60136-1. ISSN 0140-6736.

Two were already cited. I just added the third one in the section on signs and symptoms. All together these cover a lot and I would encourage anyone developing this article to start by sharing the fundamental concepts outlined in these papers, or even just their summaries. Blue Rasberry (talk) 16:13, 19 September 2014 (UTC)

Is corticosteroid prevention of RDS "still controversial"?

Please look att the paragraf in "steroids" section, beginning with "Despite being used for over 50 years to treat respiratory distress syndrome, glucocorticosteroid therapy is still controversial." Is it? I think we should rewrite the paragraf, mentioning relevant concerns (not osteoporosis!), but saying that despite these concerns steroid prevention is consensus, even if doses/regimens are discussed. What do you think?Dr Curat (talk) 19:49, 17 July 2017 (UTC)

Thanks for mentioning this. Yes the sources are poor. Have trimmed[1] Feel free to work on it further :-) Doc James (talk · contribs · email) 04:42, 18 July 2017 (UTC)

Thank you! Made some changes, as a beginner a bit anxious about my language and format, quite sure about the content though! Grateful if you can throw a glance. Julia Dr Curat (talk) 18:40, 18 July 2017 (UTC)

User:Dr Curat looking good. Simplified the wording a bit. Doc James (talk · contribs · email) 08:10, 19 July 2017 (UTC)

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New addition

We do have a new addition here[2]. Slow to load. Will check to see if it says the same. Doc James (talk · contribs · email) 05:08, 21 February 2018 (UTC)

Oral contraceptives & pre-term birth

I recently came across this: Pregravid Oral Contraceptive Use and the Risk of Preterm Birth, Low Birth Weight, and Spontaneous Abortion: A Systematic Review and Meta-Analysis. It seems that refraining from the use of oral contraceptives should be included in the "Prevention" section.--Epiphyllumlover (talk) 05:49, 11 January 2020 (UTC)

Useful reference?

Is this a useful reference? Lanaro, D; Ruffini, N; Manzotti, A; Lista, G (March 2017). "Osteopathic manipulative treatment showed reduction of length of stay and costs in preterm infants: A systematic review and meta-analysis". Medicine. 96 (12): e6408. doi:10.1097/MD.0000000000006408. PMC 5371477. PMID 28328840. KFvdL (talk) 16:14, 22 August 2019 (UTC)

@Doc James: What do you think? KFvdL (talk) 13:19, 26 August 2019 (UTC)

As the studies had moderate heterogeneity, the evidence would be tentative. But yes a reasonable ref. Doc James (talk · contribs · email) 13:22, 26 August 2019 (UTC)

@Doc James:I've a COI on this topic (Osteopathic medicine), so if you feel it is useful, could you please introduce it to the article.... KFvdL (talk) 14:04, 26 August 2019 (UTC)

I added it to the article.--Epiphyllumlover (talk) 01:46, 12 January 2020 (UTC)

Split article?

Hi, I notice that the article is getting quite long. I am trying to re-arrange content to improve readability. Does anyone have any ideas on how we could split? One idea is to split it and create a separate Neonatal care article. Right now Neonatal care re-directs to Neonatal nursing, which introduces the subspeciality of nursing and also has a few paragraphs on neonatal care. We would have to remove this redirect in this case. I am not sure who is following this talk page, but if you see this please weigh in! Thanks! JenOttawa (talk) 13:07, 8 July 2021 (UTC)

Lucky Preemies

Is there such a thing as a 'lucky preemie'? I mean to say, a baby who was born at least two months before scheduled with low birthweight (but not under 2600 grams) and yet this has no effect on him in any way? —The preceding unsigned comment was added by Waux J.V. Trident (talk • contribs) 17:23, 6 December 2006 (UTC).

• Wasn't Winston Churchill a preemie?

There have been many references to preemies throughout history. It would make an interesting subtopic if there was a way to provide citation to the facts. Sdsures (talk) 00:29, 13 February 2010 (UTC)

Winston Churchill was a premmie. So yes, premature babies can be completely normal. Rosejoyleader (talk) 22:34, 6 February 2022 (UTC)