{"id":396,"date":"2020-08-13T20:24:05","date_gmt":"2020-08-13T20:24:05","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=396"},"modified":"2020-10-20T17:00:42","modified_gmt":"2020-10-20T17:00:42","slug":"preterm-labor-and-delivery","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/advanced-training\/preterm-labor-and-delivery\/","title":{"rendered":"Preterm Labor and Delivery"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/kntFb_TSvO4\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 16:35<\/p>\n<p>&nbsp;<\/p>\n<input type='hidden' bg_collapse_expand='69e9c869d7b878084832440' value='69e9c869d7b878084832440'><input type='hidden' id='bg-show-more-text-69e9c869d7b878084832440' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c869d7b878084832440' value='Hide Transcript'><button id='bg-showmore-action-69e9c869d7b878084832440' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#faf5f5;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c869d7b878084832440' ><\/p>\n<p>00:07<br \/>\nhi everybody this is Chris Morosky in<br \/>\n00:09<br \/>\nthis is a short video on preterm birth<br \/>\n00:11<br \/>\nand prematurity I&#8217;d like to thank dr.<br \/>\n00:13<br \/>\nAdam Borg eda for his contributions to<br \/>\n00:15<br \/>\nthis video the goals and objectives of<br \/>\n00:18<br \/>\nthis video are as follows discuss the<br \/>\n00:20<br \/>\nburden of prematurity review the trends<br \/>\n00:22<br \/>\nin Connecticut and national preterm<br \/>\n00:24<br \/>\nbirth data understand the risk factors<br \/>\n00:26<br \/>\nand drivers of preterm birth describe<br \/>\n00:28<br \/>\nthe tests available to predict preterm<br \/>\n00:30<br \/>\nbirth and review the use of progesterone<br \/>\n00:32<br \/>\nto prevent recurrent preterm birth<br \/>\n00:35<br \/>\npreterm birth or prematurity is a single<br \/>\n00:37<br \/>\nmost important cause of perinatal<br \/>\n00:39<br \/>\nmortality in the United States it is the<br \/>\n00:41<br \/>\nleading cause of neonatal mortality<br \/>\n00:42<br \/>\ndefined as death within the first 28<br \/>\n00:45<br \/>\ndays of life in the United States and is<br \/>\n00:47<br \/>\nalso the second leading cause of infant<br \/>\n00:49<br \/>\nmortality defined as death in the first<br \/>\n00:51<br \/>\nyear of life in the United States<br \/>\n00:54<br \/>\npreterm birth is a major determinant of<br \/>\n00:56<br \/>\nneonatal and infant illness this would<br \/>\n00:59<br \/>\ninclude neurodevelopmental handicaps<br \/>\n01:01<br \/>\nsuch as cerebral palsy or mental<br \/>\n01:02<br \/>\nretardation chronic respiratory problems<br \/>\n01:05<br \/>\nintraventricular hemorrhage<br \/>\n01:07<br \/>\nperiventricular leukomalacia infection<br \/>\n01:10<br \/>\nretro Lendl fiber aplasia<br \/>\n01:12<br \/>\nnecrotizing enterocolitis and neuro<br \/>\n01:14<br \/>\nsensory deficits such as hearing and<br \/>\n01:17<br \/>\nvisual prematurity generates enormous<br \/>\n01:20<br \/>\nhealthcare costs the average newborn<br \/>\n01:22<br \/>\nhospital charges for a term baby are<br \/>\n01:25<br \/>\n$4,300 vs. 58 thousand dollars for a<br \/>\n01:29<br \/>\npreterm baby the total u.s. Hospital at<br \/>\n01:31<br \/>\ncharges for infants days due to<br \/>\n01:32<br \/>\nprematurity in low birth weight or<br \/>\n01:34<br \/>\nalmost 12 billion dollars when you<br \/>\n01:37<br \/>\ninclude maternity and related expenses<br \/>\n01:38<br \/>\nthis is often the largest cost to<br \/>\n01:40<br \/>\nemployers health care plans as you can<br \/>\n01:43<br \/>\nsee infant mortality death in the first<br \/>\n01:45<br \/>\nyear of life has decreased in the United<br \/>\n01:47<br \/>\nStates since 1915 to 2000 it&#8217;s going<br \/>\n01:50<br \/>\ndown from proximally one out of ten to<br \/>\n01:52<br \/>\nnow one in a thousand live births there<br \/>\n01:56<br \/>\nare multiple reasons for improved<br \/>\n01:57<br \/>\nsurvival one of these is NICU care we<br \/>\n01:59<br \/>\nnow have ventilators total parenteral<br \/>\n02:01<br \/>\nnutrition and surfactant there&#8217;s also<br \/>\n02:04<br \/>\nimproved obstetrical here we now have<br \/>\n02:06<br \/>\nsteroids for lung maturity latency<br \/>\n02:08<br \/>\nantibiotics for preterm premature<br \/>\n02:11<br \/>\nrupture of membranes and we now have<br \/>\n02:12<br \/>\nultrasounds<br \/>\n02:14<br \/>\nif you look at selected leading causes<br \/>\n02:16<br \/>\nof infant mortality in the United States<br \/>\n02:18<br \/>\nand compare 1996 vs. 2013 what you see<br \/>\n02:21<br \/>\nis that birth defects are down 164 to<br \/>\n02:25<br \/>\n121 per 1000 live births but preterm<br \/>\n02:28<br \/>\nbirth and low birth weight is up 99 to<br \/>\n02:31<br \/>\n107 per 100,000 live births SIDS is down<br \/>\n02:34<br \/>\nRDS is down and importantly maternal<br \/>\n02:37<br \/>\npregnancy complications are very much up<br \/>\n02:40<br \/>\nhaving gone from 32 to 40 per 100,000<br \/>\n02:43<br \/>\nlive births and specifically in<br \/>\n02:47<br \/>\nConnecticut looking at the leading<br \/>\n02:48<br \/>\ncauses of infant mortality to our most<br \/>\n02:50<br \/>\nup-to-date data from 2013 you can see<br \/>\n02:53<br \/>\nthat Connecticut when compared to the<br \/>\n02:55<br \/>\nUnited States is very much lower when it<br \/>\n02:57<br \/>\ncomes to birth defects preterm birth but<br \/>\n02:59<br \/>\nas higher in SIDS and is about even with<br \/>\n03:02<br \/>\nmaternal pregnancy complications preterm<br \/>\n03:05<br \/>\ndelivery in Connecticut compared to the<br \/>\n03:07<br \/>\nrest of the United States from 2007 to<br \/>\n03:09<br \/>\n2016 shows that overall our state is<br \/>\n03:13<br \/>\nslightly lower than the national average<br \/>\n03:15<br \/>\nhowever you can see that both<br \/>\n03:16<br \/>\nConnecticut and the nation have<br \/>\n03:18<br \/>\napproximately nine to ten percent of<br \/>\n03:20<br \/>\nlive births that are preterm and when<br \/>\n03:23<br \/>\nbroken down by race and ethnicity you<br \/>\n03:26<br \/>\ncan see that Asian and Pacific Islanders<br \/>\n03:28<br \/>\non average from 2013 2015 across the<br \/>\n03:31<br \/>\nnation had an 8.5% preterm birth rate<br \/>\n03:34<br \/>\nwhite ethnicity had eight point nine<br \/>\n03:36<br \/>\npercent Hispanic ethnicity or race was<br \/>\n03:38<br \/>\nnine point one percent American Indian<br \/>\n03:40<br \/>\nand Alaskan native was ten point five<br \/>\n03:42<br \/>\npercent and black women had a 13.3%<br \/>\n03:46<br \/>\npreterm birth rate what this shows is<br \/>\n03:48<br \/>\nthat in the United States the preterm<br \/>\n03:49<br \/>\nbirth rate among black women is 49<br \/>\n03:51<br \/>\npercent higher than the rate among all<br \/>\n03:53<br \/>\nother women there are various different<br \/>\n03:56<br \/>\ntypes of preterm births there is<br \/>\n03:58<br \/>\nspontaneous preterm birth which is the<br \/>\n04:00<br \/>\nspontaneous onset of labor and<br \/>\n04:02<br \/>\ncontractions which lead to delivery of<br \/>\n04:04<br \/>\nthe infant there&#8217;s preterm premature<br \/>\n04:06<br \/>\nrupture of membranes where the water<br \/>\n04:09<br \/>\nbreaks prior to the onset of labor and<br \/>\n04:11<br \/>\nthen there&#8217;s medical intervention or<br \/>\n04:13<br \/>\nwhat we call indicated preterm birth and<br \/>\n04:15<br \/>\nwhile the suggests distinct pathways<br \/>\n04:17<br \/>\nmany of the risk factors for all three<br \/>\n04:19<br \/>\nare similar what you can see is that<br \/>\n04:23<br \/>\nover time there&#8217;s been changes in the<br \/>\n04:25<br \/>\netiology of preterm birth the<br \/>\n04:27<br \/>\ngraphs look at preterm birth from 1989<br \/>\n04:30<br \/>\nto 2001 looking at the graph on the left<br \/>\n04:33<br \/>\nyou can see that for the most part all<br \/>\n04:35<br \/>\npreterm births ruptured membranes<br \/>\n04:37<br \/>\nmedically indicated and spontaneous<br \/>\n04:40<br \/>\npreterm births seem to be changing<br \/>\n04:42<br \/>\nslightly when you superimpose them on<br \/>\n04:45<br \/>\nthemselves and the right graph what you<br \/>\n04:47<br \/>\ncan see is that the medically indicated<br \/>\n04:49<br \/>\npreterm births have greatly gone up over<br \/>\n04:52<br \/>\nthat time period while all preterm<br \/>\n04:55<br \/>\nbirths spontaneous preterm births and<br \/>\n04:57<br \/>\nruptured membranes causing preterm birth<br \/>\n05:00<br \/>\nhave either stay the same or slightly<br \/>\n05:02<br \/>\ngone down what this suggests is that<br \/>\n05:04<br \/>\nthere may be some changes in the health<br \/>\n05:05<br \/>\nof our mothers over that period of time<br \/>\n05:08<br \/>\nlooking at some of the risk factors for<br \/>\n05:10<br \/>\npreterm birth<br \/>\n05:11<br \/>\nif previous preterm birth presents a<br \/>\n05:13<br \/>\nprobability of 30 percent of preterm<br \/>\n05:16<br \/>\nbirth or subsequent pregnancy greater<br \/>\n05:18<br \/>\nthan two previous preterm births<br \/>\n05:20<br \/>\nincreases this to 70 percent twin<br \/>\n05:23<br \/>\ngestation x&#8217; has a probability of<br \/>\n05:25<br \/>\npreterm birth of 50% and triplets are<br \/>\n05:27<br \/>\nhigher this approaches 75 to 95 percent<br \/>\n05:30<br \/>\nuterine malformations such as a unicorn<br \/>\n05:32<br \/>\nuterus increased the probability of<br \/>\n05:35<br \/>\npreterm birth to 30% looking at maternal<br \/>\n05:38<br \/>\nage for a risk factor for preterm birth<br \/>\n05:40<br \/>\nin the United States from 2013 to 2015<br \/>\n05:43<br \/>\nyou can see that for the age groups of<br \/>\n05:46<br \/>\nless than 20 20 to 29 and 30 to 39 the<br \/>\n05:49<br \/>\npercentage of preterm births was pretty<br \/>\n05:52<br \/>\nmuch steady around 9 to 10 percent<br \/>\n05:54<br \/>\nhowever looking at women over 40 years<br \/>\n05:56<br \/>\nold this increased greatly to 14.3%<br \/>\n06:00<br \/>\nlooking more closely at multiple<br \/>\n06:03<br \/>\ngestation and preterm birth and the<br \/>\n06:04<br \/>\nConnecticut in the United States you can<br \/>\n06:06<br \/>\nsee that singleton pregnancies have a<br \/>\n06:08<br \/>\npreterm birth rate of 7.8% as compared<br \/>\n06:11<br \/>\nto sixty point three percent for<br \/>\n06:13<br \/>\nmultiple gestation x&#8217; in this time<br \/>\n06:15<br \/>\nperiod of 2015 you can see that multiple<br \/>\n06:18<br \/>\ngestation is accounted for 3.5% of the<br \/>\n06:20<br \/>\nlive births in the United States and 4.1<br \/>\n06:23<br \/>\npercent of the live births in<br \/>\n06:24<br \/>\nConnecticut tobacco smoking is also a<br \/>\n06:28<br \/>\nrisk factor for preterm birth there are<br \/>\n06:30<br \/>\nsome very interesting trends for<br \/>\n06:31<br \/>\nConnecticut in the United States from<br \/>\n06:33<br \/>\n2006 to 2017 what we can see is that<br \/>\n06:37<br \/>\noverall the percentage of women smoking<br \/>\n06:39<br \/>\nduring<br \/>\n06:40<br \/>\nagency has decreased over time and also<br \/>\n06:43<br \/>\nthat Connecticut has had a lower<br \/>\n06:44<br \/>\npercentage of women smoking during<br \/>\n06:45<br \/>\npregnancy compared to the nation also<br \/>\n06:49<br \/>\nlooking at BMI and its association with<br \/>\n06:51<br \/>\npreterm birth it can be seen that a low<br \/>\n06:53<br \/>\nBMI is associated with an increased risk<br \/>\n06:56<br \/>\nfor spontaneous preterm birth looking at<br \/>\n06:58<br \/>\na BMI less than 19 the percentage of<br \/>\n07:01<br \/>\nspontaneous preterm birth is sixteen<br \/>\n07:03<br \/>\npoint six percent you can see this drop<br \/>\n07:05<br \/>\nto eleven point three percent for BMI of<br \/>\n07:07<br \/>\nnineteen to twenty four point nine eight<br \/>\n07:09<br \/>\npoint one percent for normal BMI of 25<br \/>\n07:12<br \/>\nto 29 point nine seven point one percent<br \/>\n07:14<br \/>\nfor obesity at thirty to thirty four<br \/>\n07:17<br \/>\npoint nine and down to five point two<br \/>\n07:19<br \/>\nfor a BMI over thirty-five going with<br \/>\n07:22<br \/>\nthis indicated preterm birth is about<br \/>\n07:24<br \/>\nthe same but does seem to be slightly<br \/>\n07:26<br \/>\nhigher for the BMI of 30 to 34 point<br \/>\n07:28<br \/>\nnine for a long period of time there are<br \/>\n07:31<br \/>\nno tests available to predict premature<br \/>\n07:33<br \/>\nbirth<br \/>\n07:34<br \/>\nthere are now two recent advances in<br \/>\n07:36<br \/>\npredicting premature birth<br \/>\n07:38<br \/>\nthese are fetal fibronectin and cervical<br \/>\n07:41<br \/>\nlength measurement we will look at them<br \/>\n07:42<br \/>\nseparately first field of fibronectin<br \/>\n07:46<br \/>\nfetal Carrboro nekton is a intracellular<br \/>\n07:50<br \/>\nmatrix of the surveys it can be found in<br \/>\n07:52<br \/>\nbetween the chorion and the decidua as<br \/>\n07:55<br \/>\nshown in the picture it is secreted with<br \/>\n07:58<br \/>\ncervical changes and if absent from the<br \/>\n08:00<br \/>\nvagina there is a very low risk for<br \/>\n08:02<br \/>\npreterm birth FFN is low from 24 to 34<br \/>\n08:06<br \/>\nweeks gestational age it is helpful for<br \/>\n08:08<br \/>\nsymptomatic patients therefore that are<br \/>\n08:11<br \/>\ngreater than 24 weeks in gestation the<br \/>\n08:13<br \/>\nvalue of the FFN really isn&#8217;t as<br \/>\n08:15<br \/>\nnegative predictive value if an F of n<br \/>\n08:17<br \/>\nis negative there is a 98% chance that<br \/>\n08:19<br \/>\nthe patient will not deliver in the next<br \/>\n08:21<br \/>\ntwo weeks and therefore there&#8217;s no need<br \/>\n08:23<br \/>\nto spend additional money or resources<br \/>\n08:24<br \/>\non that patient<br \/>\n08:25<br \/>\nunfortunately the positive predictive<br \/>\n08:27<br \/>\nvalue is not as helpful and when the<br \/>\n08:30<br \/>\ntest is positive there&#8217;s a 50% chance<br \/>\n08:32<br \/>\nthat the patient will deliver in the<br \/>\n08:33<br \/>\nnext two weeks looking at a graph of f<br \/>\n08:37<br \/>\nFN at 24 weeks and the risk for preterm<br \/>\n08:40<br \/>\nbirth it is important to keep in mind<br \/>\n08:42<br \/>\nthat the cutoff for the FN being<br \/>\n08:44<br \/>\npositive or negative is important in<br \/>\n08:46<br \/>\nterms of how well it performs in<br \/>\n08:48<br \/>\npredicting preterm birth with the black<br \/>\n08:51<br \/>\nline the cutoff for FF n is zero<br \/>\n08:54<br \/>\nwith the redline the cutoff for FN is 1<br \/>\n08:58<br \/>\nto 50 with the blue mind the cutoff is<br \/>\n09:01<br \/>\n50 to 200 and the green line is greater<br \/>\n09:05<br \/>\nthan 200 so certainly as the<br \/>\n09:08<br \/>\nconcentration of your cutoff for F of n<br \/>\n09:10<br \/>\nincreases it is more predictive of the<br \/>\n09:12<br \/>\nrisk for preterm birth and that women<br \/>\n09:14<br \/>\nwho have such high cut-offs such as the<br \/>\n09:17<br \/>\nGreen Line certainly at risk for preterm<br \/>\n09:19<br \/>\nbirth in a Cochrane review of studies<br \/>\n09:22<br \/>\nevaluating the use of fetal fibronectin<br \/>\n09:25<br \/>\ntesting producing the risk of preterm<br \/>\n09:26<br \/>\nbirth what they found was in the top<br \/>\n09:28<br \/>\ngraph that using FF n did reduce the<br \/>\n09:31<br \/>\nrisk of preterm birth less than 37 weeks<br \/>\n09:33<br \/>\nhowever in reducing the risk of preterm<br \/>\n09:36<br \/>\nbirth less than 32 weeks FF n was not<br \/>\n09:39<br \/>\nsuccessful this can be seen in the<br \/>\n09:40<br \/>\nbottom graph and the use of FF n did not<br \/>\n09:44<br \/>\nimprove the gestational age at delivery<br \/>\n09:46<br \/>\nin this Cochrane review now moving on to<br \/>\n09:50<br \/>\na cervical length measurement in a study<br \/>\n09:53<br \/>\npublished by James in the New England<br \/>\n09:54<br \/>\nJournal Medicine in 1996 they correlated<br \/>\n09:57<br \/>\nthe length of the cervix with the risk<br \/>\n09:59<br \/>\nof preterm birth and you can see that<br \/>\n10:00<br \/>\nthe mean cervical eighth was 3.5<br \/>\n10:02<br \/>\ncentimeters and that the risk factor for<br \/>\n10:05<br \/>\npreterm birth was approximately 2 to 3<br \/>\n10:07<br \/>\npercent when the cervix was this long as<br \/>\n10:09<br \/>\nthe service gradually became shorter and<br \/>\n10:12<br \/>\nshorter and shorter are moving to the<br \/>\n10:14<br \/>\nleft side of the graph the relative risk<br \/>\n10:16<br \/>\nfor preterm birth increased greatly in<br \/>\n10:18<br \/>\nfact for a woman with a cervical length<br \/>\n10:20<br \/>\nof one point two centimeters the<br \/>\n10:22<br \/>\nrelative risk for preterm birth was over<br \/>\n10:25<br \/>\n14 this led to recommendations to screen<br \/>\n10:27<br \/>\nwomen with a cervical length measurement<br \/>\n10:29<br \/>\nusing a transvaginal ultrasound to<br \/>\n10:31<br \/>\npredict the risk of preterm birth while<br \/>\n10:33<br \/>\nthis may not be applied generally across<br \/>\n10:35<br \/>\nall populations certainly all women who<br \/>\n10:37<br \/>\nhave risk factors for preterm birth are<br \/>\n10:39<br \/>\nrecommended to undergo cervical<br \/>\n10:41<br \/>\nscreening what that looks like an<br \/>\n10:44<br \/>\nultrasound is shown in this picture in<br \/>\n10:46<br \/>\nthis first picture the vaginal<br \/>\n10:48<br \/>\nultrasound probe is pressed too far into<br \/>\n10:50<br \/>\nthe vagina and compresses the cervix you<br \/>\n10:52<br \/>\ncan see the cervix in the middle of the<br \/>\n10:54<br \/>\nscreen as the greyish mass in the middle<br \/>\n10:56<br \/>\nof the ultrasound screen with the white<br \/>\n10:59<br \/>\nline running through it representing the<br \/>\n11:00<br \/>\nend of cervical canal as the vaginal<br \/>\n11:04<br \/>\nprobe is pulled out slightly from the<br \/>\n11:06<br \/>\nvagina you can begin to see some<br \/>\n11:08<br \/>\nthe amniotic fluid near the internal<br \/>\n11:10<br \/>\noffering up as a black triangle with<br \/>\n11:14<br \/>\nsome pressure on the fundus of the<br \/>\n11:16<br \/>\nuterus being transmitted through the<br \/>\n11:17<br \/>\npregnancy down to the cervix you can see<br \/>\n11:19<br \/>\nnow a black funneling of the inner<br \/>\n11:22<br \/>\nportion of the cervix the cervical<br \/>\n11:25<br \/>\nlength is then measured as the white<br \/>\n11:27<br \/>\nline of the part of the service that is<br \/>\n11:29<br \/>\nclosed and this is called the functional<br \/>\n11:31<br \/>\nlength of the cervix in this image that<br \/>\n11:34<br \/>\nthe cervical length is two point six<br \/>\n11:35<br \/>\ncentimeters and this is slightly<br \/>\n11:37<br \/>\nshortened we will end this video by<br \/>\n11:40<br \/>\ndiscussing progesterone for the<br \/>\n11:42<br \/>\nprevention of preterm birth there is<br \/>\n11:45<br \/>\nrecent evidence to suggest that<br \/>\n11:46<br \/>\nprogesterone maintains uterine<br \/>\n11:48<br \/>\nquiescence progesterone inhibits the<br \/>\n11:50<br \/>\nproduction of prostaglandins it also<br \/>\n11:52<br \/>\ninhibits the production of contraction<br \/>\n11:54<br \/>\nassociated protein genes such as<br \/>\n11:57<br \/>\noxytocin and prostaglandin receptors gap<br \/>\n12:00<br \/>\njunctions and ion channels it down<br \/>\n12:03<br \/>\nregulates the production of calcium<br \/>\n12:05<br \/>\nchannels and therefore decreases uterine<br \/>\n12:08<br \/>\ncontractions looking at some of the<br \/>\n12:10<br \/>\nhistorical Studies on the use of<br \/>\n12:12<br \/>\nprogesterone for the Prevention of<br \/>\n12:14<br \/>\nrecurrent preterm birth this goes back<br \/>\n12:16<br \/>\nto the 1970s when pepper Nick and<br \/>\n12:18<br \/>\ncolleagues published a placebo<br \/>\n12:19<br \/>\ncontrolled trial of 99 women in the<br \/>\n12:21<br \/>\nthird trimester who were given 17 alpha<br \/>\n12:24<br \/>\nhydroxy progesterone capri and they<br \/>\n12:26<br \/>\nfound that this was efficacious for<br \/>\n12:27<br \/>\npreventing preterm birth in 1975 Johnson<br \/>\n12:30<br \/>\nat all published in the New England<br \/>\n12:32<br \/>\nJournal of Medicine that initiating 17<br \/>\n12:35<br \/>\nhydroxy progesterone in the second<br \/>\n12:36<br \/>\ntrimester prevented preterm birth from<br \/>\n12:38<br \/>\n1980 there was a study that showed that<br \/>\n12:40<br \/>\nthis was not efficacious for preventing<br \/>\n12:42<br \/>\npreterm birth in twins and a 1989<br \/>\n12:45<br \/>\nmeta-analysis said that this was still<br \/>\n12:47<br \/>\nunclear more recent studies were<br \/>\n12:50<br \/>\npublished in 2003 and the papers shown<br \/>\n12:54<br \/>\nhere by Mesa dal as one of the landmark<br \/>\n12:56<br \/>\nstudies around progesterone for the<br \/>\n12:58<br \/>\nPrevention of preterm birth this was run<br \/>\n13:00<br \/>\nout of the National Institutes of child<br \/>\n13:03<br \/>\nand health development and the maternal<br \/>\n13:04<br \/>\nfetal medicine University and this was a<br \/>\n13:06<br \/>\nrandomized double-blind<br \/>\n13:07<br \/>\nplacebo-controlled trial women were<br \/>\n13:09<br \/>\nenrolled at 16 to 20 weeks and were<br \/>\n13:11<br \/>\neither given placebo or<br \/>\n13:13<br \/>\n250 milligrams of 17 hydroxy<br \/>\n13:16<br \/>\nprogesterone<br \/>\n13:16<br \/>\nall through weekly injections and the<br \/>\n13:19<br \/>\nprimary outcome for the study of a<br \/>\n13:20<br \/>\nspontaneous preterm birth less than 37<br \/>\n13:24<br \/>\n2980 women are eligible for the study<br \/>\n13:26<br \/>\n1039 met entry criteria and 463<br \/>\n13:30<br \/>\nconsented for the trial in cutting to<br \/>\n13:34<br \/>\nthe chase delivery before 37 weeks was<br \/>\n13:36<br \/>\ngreatly reduced by the use of<br \/>\n13:38<br \/>\nprogesterone by a total of 34 percent<br \/>\n13:42<br \/>\ndelivery before 35 weeks gestational age<br \/>\n13:45<br \/>\nwas reduced by 33 percent and delivery<br \/>\n13:50<br \/>\nbefore 32 weeks gestational AIDS was<br \/>\n13:52<br \/>\ndecreased by 42 percent all of these<br \/>\n13:55<br \/>\nresults were statistically significant<br \/>\n13:58<br \/>\nin a separate study by dave fonseca at<br \/>\n14:01<br \/>\nall this is also pops in 2003 they<br \/>\n14:04<br \/>\nlooked at you do vaginal progesterone in<br \/>\n14:07<br \/>\na randomized double-blind<br \/>\n14:07<br \/>\nplacebo-controlled study out of Brazil<br \/>\n14:10<br \/>\nthey looked at 142 high-risk singleton<br \/>\n14:13<br \/>\npregnancies and these patients were<br \/>\n14:15<br \/>\neither given 100 milligrams of vaginal<br \/>\n14:17<br \/>\nprogesterone or placebo daily the<br \/>\n14:21<br \/>\nvaginal suppositories<br \/>\n14:22<br \/>\ncontained 100 milligrams of natural<br \/>\n14:24<br \/>\nprogesterone and it was applied nightly<br \/>\n14:26<br \/>\nfrom 24 to 34 weeks what they found was<br \/>\n14:30<br \/>\nthat there was again a decreased risk of<br \/>\n14:32<br \/>\npreterm birth less than 37 weeks in the<br \/>\n14:35<br \/>\nprogesterone group 28.5% for placebo<br \/>\n14:39<br \/>\n13.8% for progesterone there was also a<br \/>\n14:42<br \/>\ndecreased incidence of preterm birth<br \/>\n14:43<br \/>\nless than 34 weeks 18.6% for placebo and<br \/>\n14:47<br \/>\n2.8 percent for progesterone and these<br \/>\n14:49<br \/>\nwere significantly different looking at<br \/>\n14:52<br \/>\nthe cumulative deliveries you can see<br \/>\n14:54<br \/>\nthat the progesterone group had more<br \/>\n14:56<br \/>\nundelivered patients compared to the<br \/>\n14:58<br \/>\nplacebo group this again was too<br \/>\n15:00<br \/>\ndistantly sniffing in brief summary of<br \/>\n15:03<br \/>\nprogesterone<br \/>\n15:04<br \/>\nit appears that randomized studies show<br \/>\n15:06<br \/>\nbenefit to using 17 hydroxy progesterone<br \/>\n15:09<br \/>\nin vaginal progesterone in patients with<br \/>\n15:11<br \/>\na short cervix or with a history of<br \/>\n15:13<br \/>\npreterm birth rain in my studies so far<br \/>\n15:15<br \/>\nshowed no benefit in using progesterone<br \/>\n15:17<br \/>\nfor patients with twins triplets or if a<br \/>\n15:21<br \/>\nstitch called a cerclage is placed in<br \/>\n15:23<br \/>\nthe cervix so importantly what we can do<br \/>\n15:27<br \/>\nas providers and decreasing preterm<br \/>\n15:29<br \/>\nbirth is to recommend our patients to<br \/>\n15:31<br \/>\nstop smoking improve their BMI and<br \/>\n15:34<br \/>\nnutrition and take a good history<br \/>\n15:36<br \/>\nspontaneous preterm birth and find women<br \/>\n15:39<br \/>\nwith short services and offer them<br \/>\n15:41<br \/>\nprogesterone the take-home messages here<br \/>\n15:44<br \/>\nare that all women are at risk for<br \/>\n15:46<br \/>\npreterm labor and birth the rate of<br \/>\n15:48<br \/>\npreterm labor in birth is rising mostly<br \/>\n15:50<br \/>\ndue to indicated preterm births we know<br \/>\n15:52<br \/>\nnow that 700c progesterone and vaginal<br \/>\n15:55<br \/>\nprogesterone may be beneficial in<br \/>\n15:56<br \/>\ncertain populations and really everybody<br \/>\n15:58<br \/>\nshould just stop smoking so wrapping it<br \/>\n16:02<br \/>\nup I think we did meet our goals and<br \/>\n16:03<br \/>\nobjectives they were to discuss the<br \/>\n16:05<br \/>\nburden of prematurity review the trends<br \/>\n16:07<br \/>\nin Connecticut and national preterm<br \/>\n16:08<br \/>\nbirth data understand the risk factors<br \/>\n16:10<br \/>\nand drivers of preterm birth describe<br \/>\n16:13<br \/>\nthe tests available to predict preterm<br \/>\n16:14<br \/>\nbirth and review the use of progesterone<br \/>\n16:16<br \/>\nto prevent recurrent preterm birth thank<br \/>\n16:19<br \/>\nyou for watching this video we hope you<br \/>\n16:21<br \/>\nfound it helpful good luck with their<br \/>\n16:23<br \/>\nstudies and we&#8217;ll be seeing you soon in<br \/>\n16:24<br \/>\nclass<\/p>\n<p><\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/k64Dz6oZzy4\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 5:32<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Duration 16:35 &nbsp; Duration 5:32 &nbsp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":160,"menu_order":14,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-396","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/396","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=396"}],"version-history":[{"count":2,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/396\/revisions"}],"predecessor-version":[{"id":487,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/396\/revisions\/487"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/160"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=396"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}