Preterm Birth in Nulliparous Women

Roziya K. Kuzibaeva, Valery G. Volkov

 
International Journal of Biomedicine. 2021;11(1):39-41.
DOI: 10.21103/Article11(1)_OA7
Originally published March 5, 2021

Abstract: 

The aim of this study was to assess the frequency and risk factors of Preterm birth (PB), depending on the mechanism of their occurrence in nulliparous women with singleton pregnancies.
Methods and Results: This retrospective, population-based cohort study included 327 nulliparous women who gave birth at 22-37 weeks gestation. Three groups of women were formed: Group 1 included 32 women with spontaneous PB, Group 2 included 115 women with preterm premature rupture of membranes (PROM), and Group 3 included 180 women with medical indication for PB. The average age of the mothers for the whole group was 29.3±6.0 years. Depending on the gestational age, PB in 22-27 weeks occurred in 23(7.4%) cases, 28-33 weeks in 110(33.6%) cases, and 34-37 weeks in 194(59%) cases.  In our cohort, the frequency of PB resulting from spontaneous PB, PROM or medical indication for PB was 9.8%, 35.2%, and 55%, respectively. The main risk factors for PB were preeclampsia of varying severity, placental abruption, placental insufficiency, and fetal growth retardation. The highest number of pregnancy complications was found in Group 3.
Conclusion: PB in nulliparous women occurs more often in the period of 34-37 weeks, the main reason being medical indications (maternal or fetal). Attempts to analyze, interpret, and reduce the level of PB should be considered separately, depending on the mechanism of their occurrence.

Keywords: 
preterm birth • nulliparity • risk factor • preterm premature rupture of membranes • preeclampsia
References: 
  1. Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2018 Oct;52:3-12. doi: 10.1016/j.bpobgyn.2018.04.003. 
  2. Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol. 2017 Nov;41(7):387-391. doi: 10.1053/j.semperi.2017.07.009.
  3. Koullali B, van Zijl MD, Kazemier BM, Oudijk MA, Mol BWJ, Pajkrt E, Ravelli ACJ. The association between parity and spontaneous preterm birth: a population based study. BMC Pregnancy Childbirth. 2020 Apr 21;20(1):233. doi: 10.1186/s12884-020-02940-w. 
  4. Son M, Miller ES. Predicting preterm birth: Cervical length and fetal fibronectin. Semin Perinatol. 2017 Dec;41(8):445-451. doi: 10.1053/j.semperi.2017.08.002.
  5. Volkov V.G., Chursina O.V. A role of comprehensive cervix assessment in the first trimester of pregnancy for predicting preterm delivery. Obstetrics, Gynecology and Reproduction. 2020;14(2):174-181. doi: 10.17749/2313-7347/ob.gyn.rep.2020.094. [Article in Russian].
  6. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014 Aug 15;345(6198):760-5. doi: 10.1126/science.1251816. 
  7. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 172: Premature Rupture of Membranes. Obstet Gynecol. 2016 Oct;128(4):e165-77. doi: 10.1097/AOG.0000000000001712. 
  8. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD. Williams obstetrics. 22nd ed. New York (NY): McGraw-Hill Medical Publishing Division; 2005.
  9. Grétarsdóttir ÁS, Aspelund T, Steingrímsdóttir Þ, Bjarnadóttir RI, Einarsdóttir K. Preterm births in Iceland 1997-2016: Preterm birth rates by gestational age groups and type of preterm birth. Birth. 2020 Mar;47(1):105-114. doi: 10.1111/birt.12467. 
  10. Lucovnik M, Bregar AT, Steblovnik L, Verdenik I, Gersak K, Blickstein I, Tul N. Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study. J Perinat Med. 2016 Jul 1;44(5):505-9. doi: 10.1515/jpm-2015-0271. 
  11. Hezelgrave NL, Watson HA, Ridout A, Diab F, Seed PT, Chin-Smith E, Tribe RM, Shennan AH. Rationale and design of SuPPoRT: a multi-centre randomised controlled trial to compare three treatments: cervical cerclage, cervical pessary and vaginal progesterone, for the prevention of preterm birth in women who develop a short cervix. BMC Pregnancy Childbirth. 2016 Nov 21;16(1):358. doi: 10.1186/s12884-016-1148-9. 
  12. Volkov VG., Chursina OV. Ultrasound assessment of cervical length in the first trimester of pregnancy to predict preterm birth. International Journal of Biomedicine. 2018; 8(4):321-323. doi: 10.21103/Article8(4)_OA10
  13. Conde-Agudelo A, Romero R, Hassan SS, Yeo L. Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010 Aug;203(2):128.e1-12. doi: 10.1016/j.ajog.2010.02.064.
  14. Lim AC, Hegeman MA, Huis In 'T Veld MA, Opmeer BC, Bruinse HW, Mol BW. Cervical length measurement for the prediction of preterm birth in multiple pregnancies: a systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol. 2011 Jul;38(1):10-7. doi: 10.1002/uog.9013. 
  15. Barros-Silva J, Pedrosa AC, Matias A. Sonographic measurement of cervical length as a predictor of preterm delivery: a systematic review. J Perinat Med. 2014 May;42(3):281-93. doi: 10.1515/jpm-2013-0115.
  16. Conde-Agudelo A, Romero R. Predictive accuracy of changes in transvaginal sonographic cervical length over time for preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2015 Dec;213(6):789-801. doi: 10.1016/j.ajog.2015.06.015. 
  17. Berghella V, Mackeen AD. Cervical length screening with ultrasound-indicated cerclage compared with history-indicated cerclage for prevention of preterm birth: a meta-analysis. Obstet Gynecol. 2011 Jul;118(1):148-155. doi: 10.1097/AOG.0b013e31821fd5b0. 
  18. Volkov VG, Granatovich NN, Survillo EV, Cherepenko OV. Retrospective analysis of maternal mortality in preeclampsia and eclampsia. Rossiyskiy Vestnik Akushera-Ginekologa. 2017;3:4-8. doi: 10.17116/rosakush20171734-8.  [Article in Russian].
  19. Jayaram A, Collier CH, Martin JN. Preterm parturition and pre-eclampsia: The confluence of two great gestational syndromes. Int J Gynaecol Obstet. 2020 Jul;150(1):10-16. doi: 10.1002/ijgo.13173. 
  20. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014 Apr 15;348:g2301. doi: 10.1136/bmj.g2301.
  21. Hoffman MK, Goudar SS, Kodkany BS, Metgud M, Somannavar M, Okitawutshu J, Lokangaka A, Tshefu A, Bose CL, Mwapule A, Mwenechanya M, Chomba E, Carlo WA, Chicuy J, Figueroa L, Garces A, Krebs NF, Jessani S, Zehra F, Saleem S, Goldenberg RL, Kurhe K, Das P, Patel A, Hibberd PL, Achieng E, Nyongesa P, Esamai F, Liechty EA, Goco N, Hemingway-Foday J, Moore J, Nolen TL, McClure EM, Koso-Thomas M, Miodovnik M, Silver R, Derman RJ; ASPIRIN Study Group. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet. 2020 Jan 25;395(10220):285-293. doi: 10.1016/S0140-6736(19)32973-3. Erratum in: Lancet. 2020 Mar 21;395(10228):e53. 

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Received February 2, 2021.
Accepted February 19, 2021.
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