The Society for Maternal-Fetal Medicine's 31st annual meeting, The Pregnancy Meeting, was held from Feb. 7 to 12 in San Francisco and attracted nearly 5,000 participants from around the world. The conference highlighted recent advances in basic, clinical, and epidemiological research in the area of maternal-fetal medicine, with presentations focusing on obstetrical, medical, genetic, and surgical complications of pregnancy and their effects on both the mother and the fetus.
In one study, C. Andrew Combs, M.D., of the Obstetrix Medical Group in Campbell, Calif., and colleagues found that the hormone 17-hydroxyprogesterone does not reduce the rate of preterm delivery or neonatal complications in twins. In a placebo-controlled, double-blind, multi-center study, the investigators randomized 240 mothers with diamniotic-dichorionic twins to 17-alpha-hydroxyxprogesterone caproate or placebo (castor oil vehicle), starting at 16 to 23 weeks' gestational age and repeated weekly until 34 weeks' gestational age. The investigators found that 17-hydroxyprogesterone did not reduce the rate of preterm delivery or neonatal morbidity.
"The presentation we made at the conference is very timely because KV Pharmaceuticals recently got U.S. Food and Drug Administration approval for a commercial preparation of the drug. It is only approved for use by women with a prior preterm birth and who have a singleton pregnancy. While it has not been approved for multiple gestation, there is likely to be off-label use, and we found that the drug was of no benefit in multiple gestation," Combs said.
In another study, Suneet P. Chauhan, M.D., of the Eastern Virginia Medical School in Norfolk, and colleagues found that the use of electronic fetal heart monitoring lowered the rate of infant mortality.
"The use of electronic fetal monitoring is very common in the United States, with approximately 84 percent of women having monitoring during labor. The summary of all previous randomized clinical trials demonstrated that the use of electronic fetal monitoring increases the rate of operative delivery without concomitant long-term improvements to newborns. Thus, the concern is, if electronic fetal [monitoring] has no long-term benefit, why are we using it so often?" Chauhan said. "What is overlooked is that the sample size of previous studies [was] very small, with a total of 38,000 patients in 12 reports, and they were completed before 1996, when the first guideline on proper conduct of randomized trials was published."
The investigators used a much larger sample size of 1,945,789 singleton infant birth and death records from the 2004 National Birth Cohort.
"We clearly showed that electronic fetal monitoring use was linked with a significantly lower likelihood of newborns dying within six days of birth, or within a year of birth," Chauhan added. "Ideally, a large randomized clinical trail is required, which would randomize about 50,000 women and follow the newborns for up to four to five years. This would be quite daunting and costly."
Tracy Manuck, M.D., of the University of Utah Health Sciences Center in Salt Lake City, and colleagues found that women at high risk for preterm birth who participated in a preterm birth prevention clinic were more likely to deliver full-term babies, with infant morbidity less likely.
In a retrospective review, the investigators evaluated women with a single, non-anomalous fetus and at least one documented previous spontaneous preterm birth <35 weeks. Women enrolled in a preterm birth prevention clinic were compared with women identified from a contemporary large perinatal database who received usual care.
The investigators found that enrollment in a preterm birth prevention clinic resulted in a reduction in the rate of recurrent preterm birth prior to 37 weeks and an average of a one-week longer pregnancy, as well as reduced the rates of major neonatal morbidity.
"The study showed that participants in the preterm birth prevention clinic had a 28 percent reduction in the risk of recurrent spontaneous preterm birth, as well as reductions in infant complications and short term disabilities," Manuck said in a statement. "These are significant improvements and should lead more medical facilities to think about creating similar programs."
SMFM: Very Obese May Need to Gain Less Pregnancy Weight
MONDAY, Feb. 14 (HealthDay News) -- Women who are extremely obese may not need to gain as much weight during the second and third trimesters of pregnancy as current guidelines recommend, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb. 7 to 12 in San Francisco.
SMFM: Patient-Controlled Epidural Lowers Drug Use
FRIDAY, Feb. 11 (HealthDay News) -- Women who administer their own analgesia (patient-controlled epidural analgesia [PCEA]) during labor as compared to being administered a continuous epidural infusion (CEI) use less analgesia but experience similar levels of satisfaction, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb. 7 to 12 in San Francisco.
SMFM: Folate Not Protective Against Preterm Delivery
THURSDAY, Feb. 10 (HealthDay News) -- Consumption of folate prior to or during pregnancy does not appear to protect women against spontaneous preterm delivery, according to data presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb. 7 to 12 in San Francisco.
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