Prevention of preterm birth: clinical opinion
Article Abstract:
Preterm delivery (birth before the 37th completed week of pregnancy) is associated with a poor pregnancy outcome. Although recent medical advances have improved the outcome of other complications of pregnancy, preterm delivery is still a significant problem. The mechanism causing early delivery is not well understood, despite a greater understanding of labor and delivery processes. Since preterm delivery costs the health care system billions of dollars, it seems prudent to develop strategies that prevent preterm labor instead of stopping early labor once it has started. Predicting which patients are at risk for preterm labor appears to be the most promising approach. However, the current biochemical tests are not very sensitive and programs that involve home visitation and education would require revising public policies. This is why the primary focus of preterm delivery prevention has focused on the early diagnosis and inhibition of preterm labor. Early diagnosis of labor can improve the outcome of pregnancies by initiating tocolytic agents, drugs that attempt to arrest labor. The problem with tocolysis is that patients are often treated too early or too late. Patients who do not know the signs and symptoms of labor are disadvantaged. The early diagnosis of preterm labor relies on risk evaluation, education, monthly examinations of the cervix and evaluating uterine activity for the presence of contractions. A home monitoring system designed to detect the frequency and types of uterine contractions can be used in high-risk pregnancies during the last 20 weeks of pregnancy to diagnose preterm labor. The earlier labor is detected the more effective tocolysis will be. The American Medical Association and the National Institutes of Health have issued statements on the benefits of the new home monitoring system used in conjunction with daily nursing contact to help distinguish subtle symptoms from true signs of labor. Although uterine activity alone cannot predict preterm delivery, the combination of home-monitoring, patient-perceived signs and symptoms of labor and daily contact with nurse specialists, would help decrease the incidence of preterm labor and delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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A randomized trial of nurse-midwifery prenatal care to reduce low birth weight
Article Abstract:
Low birth weight (LBW, less than 2500 grams) and very low birth weight (VLBW, less than 1500 grams) are the leading cause of infant death in the United States. In South Carolina, where the LBW and VLBW rate is the highest in the country, a program led by nurse-midwives was implemented to help reduce the LBW rate. A comprehensive prenatal program providing high quality care to adolescents attending a nurse-midwifery health clinic has been shown to reduce LBW. The pregnancy outcome of 728 women receiving prenatal care from nurse-midwives was compared with that of 730 women receiving standard care from obstetricians. Nurse-midwifery-based interventions included patient education about the subtle signs and symptoms of early labor and frequent internal examinations to assess the status of the cervix. Teaching sessions concerned substance abuse, nutrition, weight gain, and stress reduction. Emotional support was provided by allowing the women to call the midwives anytime to discuss any problems. The women in the control group had fewer visits and opportunities for patient education. Although there was a slight difference in the number of LBW infants born to women attending the nurse-midwifery-based clinic (19 percent versus 20.5 percent in the control group), the difference was not statistically significant. Black women who were at a higher risk for an early delivery or LBW infant may benefit from the increased interventions given by nurse-midwives. The incidence of VLBW in the midwifery group was 2.6 percent, compared with 6.7 percent in the control group. It was seen that nurse-midwives are equally capable in providing secure prenatal care to women at high-risk for premature birth. Midwifery-based prenatal care can be useful in treating women in medically underserved areas. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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Caring for our future: a report by the expert panel on the content of prenatal care
Article Abstract:
Prenatal care has been shown to be important in reducing the numbers of low-birth-weight infants. In 1986, the Department of Health and Human Services Low Birth Weight Prevention Work Group established a panel on prenatal care. The incidence of low birth weight has not decreased since 1980. There were more than 25,000 infants born with low birth weights in 1988, indicating a rate that has doubled in high-risk populations. The panel on prenatal care published their findings and recommendations regarding prenatal care in a report entitled Caring for Our Future: The Content of Prenatal Care, in 1989. The panel recommended that in the absence of any factors that increase the risk of low birth weight, women with no previous pregnancies should make 10 prenatal visits to their physician, whereas women with previous pregnancies should make eight prenatal visits. The number of these visits may need to be increased should any psychosocial or medical problems develop. However, the focus of the panel was directed at the content more than the number of prenatal visits. An increased need for prenatal care and caregivers, support services, and resources is anticipated. Psychosocial and environmental risks should receive more attention. Although recommendations of the panel on prenatal care require further investigation to determine their benefits, they are intended to help improve the quality of life for women, and their infants and families. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1991
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