Objective: This study was undertaken to characterize risk factors associated with nonanomalous stillborn (SB) infants and to ascribe the probability of fetal survival by gestational age among high- risk pregnancies. S...Objective: This study was undertaken to characterize risk factors associated with nonanomalous stillborn (SB) infants and to ascribe the probability of fetal survival by gestational age among high- risk pregnancies. Study design: We compiled a database of all SB infants and an equivalent number of controls using information obtained from Utah Birth and Fetal Death Certificates during the years 1992 through 2002. Adjusted and unadjusted odds ratios for risk factors associated with SB were generated. Cox proportional hazard models were used to generate survival curves comparing pregnancies complicated by chronic hypertension or gestational hypertension with those of controls. Results: Infants with major anomalies were eliminated from both cases and controls, to generate 1566 nonanomalous SBs and 2720 nonanomalous controls. In a logistic regression model controlling for multiple maternal and fetal factors, placental abruption, hydramnios, cord prolapse, and essential hypertension were associated with an increased risk of SB. In pregnancies complicated by essential hypertension, the survival curve diverged from that of controls at those gestational ages approaching term (hazard ratio 2.24; 95% CI 1.52- 3.32). Conclusion: SB in nonanomalous infants in Utah is more common among pregnancies complicated by placental abruption, hydramnios, cord prolapse, and essential hypertension.展开更多
We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 ...We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks’ gestation and subsequently had preterm premature rupture of membranes (< 35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase- 8 level in amniotic fluid was conducted using a commercially available enzyme- linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. The overall distribution of matrix metalloproteinase- 8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1- 10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5- 4.7, P =. 94). However, 26% of women who had preterm premature rupture of membranes had a matrix me- talloproteinase- 8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1- 8.7; P =. 03). Elevated matrix metallopro- teinase- 8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2- 9.9; P =. 03). The overall distribution of midtrimester amniotic fluid matrix metalloproteinase- 8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase- 8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.展开更多
文摘Objective: This study was undertaken to characterize risk factors associated with nonanomalous stillborn (SB) infants and to ascribe the probability of fetal survival by gestational age among high- risk pregnancies. Study design: We compiled a database of all SB infants and an equivalent number of controls using information obtained from Utah Birth and Fetal Death Certificates during the years 1992 through 2002. Adjusted and unadjusted odds ratios for risk factors associated with SB were generated. Cox proportional hazard models were used to generate survival curves comparing pregnancies complicated by chronic hypertension or gestational hypertension with those of controls. Results: Infants with major anomalies were eliminated from both cases and controls, to generate 1566 nonanomalous SBs and 2720 nonanomalous controls. In a logistic regression model controlling for multiple maternal and fetal factors, placental abruption, hydramnios, cord prolapse, and essential hypertension were associated with an increased risk of SB. In pregnancies complicated by essential hypertension, the survival curve diverged from that of controls at those gestational ages approaching term (hazard ratio 2.24; 95% CI 1.52- 3.32). Conclusion: SB in nonanomalous infants in Utah is more common among pregnancies complicated by placental abruption, hydramnios, cord prolapse, and essential hypertension.
文摘We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks’ gestation and subsequently had preterm premature rupture of membranes (< 35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase- 8 level in amniotic fluid was conducted using a commercially available enzyme- linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. The overall distribution of matrix metalloproteinase- 8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1- 10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5- 4.7, P =. 94). However, 26% of women who had preterm premature rupture of membranes had a matrix me- talloproteinase- 8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1- 8.7; P =. 03). Elevated matrix metallopro- teinase- 8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2- 9.9; P =. 03). The overall distribution of midtrimester amniotic fluid matrix metalloproteinase- 8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase- 8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.
