E-ISSN: 2619-9467

Contents    Cover    Publication Date: 12 Nov 2020
Year 2020 - Volume 30 - Issue 3

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GUIDELINE ON PRETERM LABOR AND DELIVERY by the Society of Specialists in Perinatology (Perinatoloji Uzmanları Derneği-PUDER), Turkey

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J Clin Obstet Gynecol. 2020;30(3):118-30
DOI: 10.5336/jcog.2020-78741
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Preterm delivery (PTD) occurs between 200/7-366/7 weeks of pregnancy and is a major cause of perinatal mortality and morbidity. The prevalence is around 12% in Turkey, ranging between 10 to 15% in different centers. Indicated preterm deliveries due to maternal or fetal reasons constitute approximately 20-30% of the total. The rest occur as a result of spontaneous preterm labor (PTL) or preterm prelabor rupture of the membranes (PPROM), about half and half. Although etiology of spontaneous preterm birth has not been fully elucidated, several risk factors are defined. History of PTD and short cervix are two most important risk factors, particularly in singleton pregnancies. If the cervical length is measured to be <25 mm via transvaginal ultrasonography before the 32nd gestational week, it is defined as short cervix. In women with prior PTD, progesterone preparations are recommended between 16th-36th gestational weeks and cervical length is monitorized; additional preventive measures may be required if short cervix is diagnosed. In women without prior PTD, we universally offer transvaginal ultrasonographic cervical length measurement at the time of midtrimester fetal anomaly scan. When short cervix is determined in such cases, cervical cerclage, vaginal progesterone, cervical pessary, alone or in combination, may be recommended depending on the measurement and the gestational age. Asymptomatically dilated cervix, PTL, and PPROM are generally managed according to the gestational age on a case-by-case basis. Data are limited in twin and higher order multiple pregnancies to recommend standart prevention and management protocols.
  1. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY. Preterm birth. In: Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY, eds. Williams Obstetrics. 25th ed. New York, USA: McGraw-Hill Education; 2018. p.803-34.
  2. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013;10 (Suppl 1):S2. [Crossref]  [PubMed]  [PMC] 
  3. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 171: management of preterm labor. Obstet Gynecol. 2016;128(4):e155-64. [Crossref]  [PubMed] 
  4. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. Çocuk Sağlığı. 2018 Türkiye Nüfus ve Sağlık Araştırması. TÜBİTAK, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı. Ankara, Türkiye: 2019. p.129-30.
  5. Atasay B, Okulu E, Akın İM, Çandır O, Arsan S, Türmen T, et al. [The early clinical outcomes of late preterm newborns]. Turkish J Pediatr Dis Derg. 2010;4(1):30-5.
  6. Ege E, Akın B, Altuntuğ K, Arıöz Düzgün A, Koçoğlu D. [Prevelance of spontaneus preterm birth and related factors]. Türk Jinekoloji ve Obstetrik Derneği (TJOD) Derg. 2009;6(3):197-205.
  7. Yanık FF, Gulumser C, Sahin Uysal N. The problem of preterm delivery in twin pregnancies. Nice, France: 13th World Congress in Fetal Medicine; 2014.
  8. Lyons CA, Garite TJ. Corticosteroids and fetal pulmonary maturity. Clin Obstet Gynecol. 2002;45(1):35-41. [Crossref]  [PubMed] 
  9. Committee on Obstetric Practice, the American Institute of Ultrasound in Medicine, and the Society for Maternal-Fetal Medicine. Committee opinion no 700: methods for estimating the due date. Obstet Gynecol. 2017;129(5):e150-4 [Crossref]  [PubMed] 
  10. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;5;371(9606):75-84. [Crossref]  [PubMed] 
  11. Suhag A. Preterm birth prevention in asymptomatic women. In: Berghella V, ed. Obstetric Evidence Based Guidelines. 3rd ed. Boca Raton, USA: CRC Press, Taylor and Francis Group; 2017. p.193-212. [Crossref] 
  12. Goldenberg RL, Iams JD, Mercer BM, Meis PJ, Moawad AH, Copper RL, et al. The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. NICHD MFMU Network. Am J Public Health. 1998;88(2):233-8. [Crossref]  [PubMed]  [PMC] 
  13. Perri T, Chen R, Yoeli R, Merlob P, Orvieto R, Shalev Y, et al. Are singleton assisted reproductive technology pregnancies at risk of prematurity? J Assist Reprod Genet. 2001;18(5):245-9. [Crossref]  [PubMed]  [PMC] 
  14. To MS, Fonseca EB, Molina FS, Cacho AM, Nicolaides KH. Maternal characteristics and cervical length in the prediction of spontaneous early preterm delivery in twins. Am J Obstet Gynecol. 2006;194(5):1360-5. [Crossref]  [PubMed] 
  15. Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet. 2008;12;371(9607):164-75. [Crossref]  [PubMed] 
  16. Committee on Practice Bulletins-Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012;120(4):964-73. [PubMed] 
  17. Romero R, Espinoza J, Erez O, Hassan S. The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified? Am J Obstet Gynecol. 2006;194(1):1-9. [Crossref]  [PubMed]  [PMC] 
  18. Khanprakob T, Laopaiboon M, Lumbiganon P, Sangkomkamhang US. Cyclo-oxygenase (COX) inhibitors for preventing preterm labour. Cochrane Database Syst Rev. 2012;17;10:CD007748. [Crossref]  [PubMed] 
  19. Moore Simas TA, Waring ME, Sullivan GMT, Liao X, Rosal MC, Hardy JR, et al. Institute of medicine 2009 gestational weight gain guideline knowledge: survey of obstetrics/gynecology and family medicine residents of the United States. Birth. 2013;40(4):237-46. [Crossref]  [PubMed]  [PMC] 
  20. Romero R, Yeo L, Chaemsaithong P, Chaiworapongsa T, Hassan SS. Progesterone to prevent spontaneous preterm birth. Semin Fetal Neonatal Med. 2014;19(1):15-26. [Crossref]  [PubMed]  [PMC] 
  21. Meis PJ, Klebanoff M, Thom E, Dombrowski MP, Sibai B, Moawad AH, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003;12;348(24):2379-85. [PubMed] 
  22. American College of Obstetricians and Gynecologists. ACOG practice bulletin no 142: cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372-9. [Crossref]  [PubMed] 
  23. Berghella V, Szychowski JM, Owen J, Hankins G, Iams JD, Sheffield JS, et al. Suture type and ultrasound-indicated cerclage efficacy. J Matern Fetal Neonatal Med. 2012;25(11):2287-90. [Crossref]  [PubMed]  [PMC] 
  24. Simhan HN, Berghella V, Iams JD. Prevention and management of preterm parturition. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Amsterdam, Holland: Elsevier; 2018. p.679-711.
  25. Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, Althuisius S, et al. Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol. 2017;50(5):569-77. [Crossref]  [PubMed] 
  26. Saccone G, Ciardulli A, Xodo S, Dugoff L, Ludmir J, Pagani G, et al. Cervical pessary for preventing preterm birth in singleton pregnancies with short cervical length: a systematic review and meta-analysis. J Ultrasound Med. 2017;36(8):1535-43. [Crossref]  [PubMed] 
  27. Saccone G, Maruotti GM, Giudicepietro A, Martinelli P. Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: a randomized clinical trial. JAMA. 2017;19;318(23):2317-24. [Crossref]  [PubMed]  [PMC] 
  28. Conde-Agudelo A, Romero R, Da Fonseca E, O'Brien JM, Cetingoz E, Creasy GW, et al. Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis. Am J Obstet Gynecol. 2018;219(1):10-25. [Crossref]  [PubMed]  [PMC] 
  29. Miller ES, Grobman WA, Fonseca L, Robinson BK. Indomethacin and antibiotics in examination-indicated cerclage: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1311-6. [Crossref]  [PubMed] 
  30. Awwad J, Usta IM, Ghazeeri G, Yacoub N, Succar J, Hayek S, et al. A randomised controlled double-blind clinical trial of 17-hydroxyprogesterone caproate for the prevention of preterm birth in twin gestation (PROGESTWIN): evidence for reduced neonatal morbidity. BJOG. 2015;122(1):71-9. [Crossref]  [PubMed] 
  31. Dodd JM, Grivell RM, OBrien CM, Dowswell T, Deussen AR. Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy. Cochrane Database Syst Rev. 2019;20;2019(11):CD012024. [Crossref]  [PubMed] 
  32. Li C, Shen J, Hua K. Cerclage for women with twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019;220(6):543-57.e1. [Crossref]  [PubMed] 
  33. Romero R, Conde-Agudelo A, El-Refaie W, Rode L , Brizot ML, Cetingoz E, et al. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol. 2017;49(3):303-14. [Crossref]  [PubMed]  [PMC] 
  34. Goya M, de la Calle M, Pratcorona L, Merced C, Rodó C, Mu-oz B, et al. Cervical pessary to prevent preterm birth in women with twin gestation and sonographic short cervix: a multicenter randomized controlled trial (PECEP-Twins). Am J Obstet Gynecol. 2016;214(2):145-52. [PubMed] 
  35. Liem SMS, van de Mheen L, Bekedam DJ, van Pampus MG, Opmeer BC, Lim AC, Mol BWJ. Cervical length measurement for the prediction of preterm birth in symptomatic women with a twin pregnancy: a systematic review and meta-analysis. Obstet Gynecol Int. 2013;2013:125897. [Crossref]  [PubMed]  [PMC] 
  36. Romero R, Sibai BM, Sanchez-Ramos L, Valenzuela GJ, Veille JC, Tabor B, et al. An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescue. Am J Obstet Gynecol. 2000;182(5):1173-83. [Crossref]  [PubMed] 
  37. Committee on Obstetric Practice. Committee opinion no. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2017;130(2):e102-e9. [Crossref]  [PubMed] 
  38. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY. Infectious diseases. In: Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY, eds. Williams Obstetrics. 25th ed. New York, USA: McGraw-Hill Education; 2018. p.1209-34.
  39. American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Committee opinion no. 573: magnesium sulfate use in obstetrics. Obstet Gynecol. 2013;122(3):727-8. [PubMed] 
  40. Varol F, Er N, Sut N, Sayın CN. Local study on antenatal features of preterm births at 26-32 versus 33-36 weeks of pregnancy. Gynecology Obstetrics & Reproductive Medicine (GORM). 2018;24:1-6. [Crossref] 
  41. Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 188: prelabor rupture of membranes. Obstet Gynecol. 2018;131(1):e1-e14. [PubMed] 
  42. Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol. 2009;201(3):230-40. [Crossref]  [PubMed] 
  43. Igbinosa I, Moore 3rd FA, Johnson C, Block JE. Comparison of rapid immunoassays for rupture of fetal membranes. BMC Pregnancy Childbirth. 2017;26;17(1):128. [Crossref]  [PubMed]  [PMC] 
  44. Kenyon SL, Taylor DJ, Tarnow-Mordi W. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomized trial. ORACLE Collaborative Group. Lancet. 2001;31;357(9261):979-88. [Crossref]  [PubMed] 
  45. Lee JH, Romero R, Kim SM, Chaemsaithong P, Park CW, Park JS, et al. A new anti-microbial combination prolongs the latency period, reduces acute histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes in preterm PROM. J Matern Fetal Neonatal Med. 2016;29(5):707-20. [Crossref]  [PubMed]  [PMC] 
  46. Chang KHJ, Kim HJ, Yu HJ, Lee J, Kim JS, Choi SJ, et al. Comparison of antibiotic regimens in preterm premature rupture of membranes: neonatal morbidity and 2-year follow-up of neurologic outcome. J Matern Fetal Neonatal Med. 2017;30(18):2212-8. [Crossref]  [PubMed] 
  47. Bauer J, Hentschel R, Zahradnik H, Karck U, Linderkamp O. Vaginal delivery and neonatal outcome in extremely-low-birth-weight infants below 26 weeks of gestational age. Am J Perinatol. 2003;20(4):181-8. [Crossref]  [PubMed] 
  48. Demirci O, Tuðrul AS, Turgut A, Ceylan S, Eren S. Pregnancy outcomes by mode of delivery among breech births. Arch Gynecol Obstet. 2012;285(2):297-303. [Crossref]  [PubMed] 
  49. Perrotin F, Simon EG, Potin J, Laffon M. [Delivery of the IUGR fetus]. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):975-84. [Crossref]  [PubMed] 
  50. Barrett JFR, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med. 2013;3;369(14):1295-305. [Crossref]  [PubMed]  [PMC] 
  51. Barzilay E, Mazaki-Tovi S, Amikam U, de Castro H, Haas J, Mazkereth R, et al. Mode of delivery of twin gestation with very low birthweight: is vaginal delivery safe? Am J Obstet Gynecol. 2015;213(2):219.e1-8. [Crossref]  [PubMed] 
  52. Committee on Obstetric Practice. Committee opinion no. 684: delayed umbilical cord clamping after birth. Obstet Gynecol. 2017;129(1):e5-e10. [Crossref]  [PubMed] 
  53. Mercer JS, Erickson-Owens DA, Vohr BR, Tucker RJ, Parker AB, Oh W, et al. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: a randomized controlled trial. J Pediatr. 2016;168:50-5.e1. [Crossref]  [PubMed]  [PMC]