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Background: Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD. Objectives: Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time‐to‐delivery. Data Sources: Cochrane Systematic Review (2013), MEDLINE, EMBASE, journal searches, and searches (January 2013–September 2022) ("bacterial vaginosis AND pregnancy") of (i) clinicaltrials.gov; (ii) Cochrane Central Register of Controlled Trials; (iii) World Health Organization International Clinical Trials Registry Platform Portal; and (iv) Web of Science ("bacterial vaginosis"). Study Selection and Data Extraction: Studies randomising asymptomatic pregnant individuals with BV to antibiotics or control, measuring delivery gestation. Extraction was from original data files. Bias risk was assessed using the Cochrane tool. Analysis used "one‐step" logistic and Cox random effect models, adjusting gestation at randomisation and PTD history; heterogeneity by I2. Subgroup analysis tested interactions with treatment. In sensitivity analyses, studies not providing IPD were incorporated by "multiple random‐donor hot‐deck" imputation, using IPD studies as donors. Results: There were 121 references (96 studies) with 23 eligible trials (11,979 participants); 13 studies (6915 participants) provided IPD; 12 (6115) were incorporated. Results from 9 (4887 participants) not providing IPD were imputed. Odds ratios for PTD for metronidazole and clindamycin versus placebo were 1.00 (95% CI 0.84, 1.17), I2 = 62%, and 0.59 (95% CI 0.42, 0.82), I2 = 0 before; and 0.95 (95% CI 0.81, 1.11), I2 = 59%, and 0.90 (95% CI: 0.72, 1.12), I2 = 0, after imputation. Time‐to‐delivery did not differ from null with either treatment. Including imputed IPD, there was no evidence that either drug was more effective when administered earlier, or among those with a PTD history. Conclusions: Clindamycin, but not metronidazole, was beneficial in studies providing IPD, but after imputing data from missing IPD studies, treatment of BV during pregnancy did not reduce PTD, nor prolong pregnancy, in any subgroup or when started earlier in gestation. [ABSTRACT FROM AUTHOR]

Genital mycoplasmas (GM), such as Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum , and Ureaplasma urealyticum are commonly associated with spontaneous preterm labor (SPTL), spontaneous preterm birth (PTB), and preterm prelabor rupture of membranes (PPROM). This study determined the association between GM and such adverse pregnancy outcomes. We searched for studies published 1980–2019 in MEDLINE, EMBASE, and Web of Science. Studies were eligible when GM was detected during pregnancy. We included 93 and 51 studies in determining the prevalence and the inflammatory biomarkers associated with GM, respectively, using the "metafor" package within R. The protocol was registered with PROSPERO (registration no. CRD42016047297). Women with the studied adverse pregnancy outcomes had significantly higher odds of presence with GM compared to women who delivered at term. For PTB, the odds ratios were: M. hominis (OR: 2.25; CI: 1.35–3.75; I 2: 44%), M. genitalium (OR: 2.04; CIL 1.18–3.53; I 2: 20%), U. parvum (OR: 1.75; CI: 1.47–2.07; I 2: 0%), U. urealyticum (OR: 1.50; CI: 1.08–2.07; I 2: 58%). SPTL had significantly higher odds with M. hominis (OR: 1.96; CI: 1.19–3.23; I 2: 1%) or U. urealyticum (OR: 2.37; CI: 1.20–4.70; I 2: 76%) compared to women without SPTL. Women with PPROM had significantly higher odds with M. hominis (OR: 2.09; CI: 1.42–3.08; I 2: 0%) than women without PPROM. However, our subgroup analysis based on the diagnostic test and the sample used for detecting GM showed a higher prevalence of GM in maternal samples than in fetal samples. GM presence of the cervix and vagina was associated with lower odds of PTB and preterm labor (PTL). In contrast, GM presence in the AF, fetal membrane, and placenta was associated with increased odds of PTB and PTL. However, genital mycoplasmas may not elicit the massive inflammation required to trigger PTB. In conclusion, GM presence in the fetal tissues was associated with significantly increased odds of PTB and PTL. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is a common gynaecological condition. Diagnosis of BV is typically based on Amsel criteria, Nugent score and/or bacterial culture. In this study, these conventional methods and two CE-IVD marked quantitative real-time (q)PCR assays were compared with microbiota analysis for the diagnosis of BV. Eighty women were evaluated for BV during two sequential hospital visits by Amsel criteria, Nugent score, culture, the AmpliSens® Florocenosis/Bacterial vaginosis-FRT PCR kit (InterLabService, Moscow, Russia), and the BD MAX™ Vaginal Panel (BD Diagnostics, MD, USA). Microbiota analysis based on amplicon sequencing of the 16S ribosomal RNA gene was used as reference test. The microbiota profile of 36/115 (31%) included cases was associated with BV. Based on microbiota analysis, the sensitivity of detecting BV was 38.9% for culture, 61.15% for Amsel criteria, 63.9% for Nugent score and the BD MAX assay, and 80.6% for the AmpliSens assay, while the specificity of all methods was ≥ 92.4%. Microbiota profiles of the cases with discrepant results between microbiota analysis and the diagnostic methods were variable. All five diagnostic methods missed BV positive cases with a relatively high abundance of the genus Alloscardovia, Bifidobacterium, or Dialister, which were categorised as unspecified dysbiosis by the AmpliSens assay. Compared to Amsel criteria, Nugent score, culture, and the BD MAX assay, the AmpliSens assay was most in agreement with microbiota analysis, indicating that currently, the AmpliSens assay may be the best diagnostic method available to diagnose BV in a routine clinical setting. [ABSTRACT FROM AUTHOR]

Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Infection/inflammation is responsible for a significant percentage of preterm birth, particularly at early gestations. A recent clinical recommendation by a guidelines group of the Danish Society of Obstetrics and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected, the conclusions would have been different. [ABSTRACT FROM AUTHOR]

Objective: Despite decades of research on risk indicators of spontaneous preterm birth (PTB), reliable biomarkers are still not available to screen or diagnose high-risk pregnancies. Several biomarkers in maternal and fetal compartments have been mechanistically linked to PTB, but none of them are reliable predictors of pregnancy outcome. This systematic review was conducted to synthesize the knowledge on PTB biomarkers identified using multiplex analysis. Materials and methods: Three electronic databases (PubMed, EMBASE and Web of Science) were searched for studies in any language reporting the use of multiplex assays for maternal biomarkers associated with PTB published from January 2005 to March 2014. Results: Retrieved citations (3631) were screened, and relevant studies (33) were selected for full-text reading. Ten studies were included in the review. Forty-two PTB-related proteins were reported, and RANTES and IL-10 (three studies) followed by MIP-1β, GM-CSF, Eotaxin, and TNF-RI (two studies) were reported more than once in maternal serum. However, results could not be combined due to heterogeneity in type of sample, study population, assay, and analysis methods. Conclusion: By this systematic review, we conclude that multiplex assays are a potential technological advancement for identifying biomarkers of PTB, although no single or combination of biomarkers could be identified to predict PTB risk. [ABSTRACT FROM AUTHOR]

Introduction: Early onset neonatal Group B streptococcal disease is preventable. Intrapartum antibiotic prophylaxis has resulted in a significant reduction in neonatal mortality and morbidity. National guidelines for the selection of women eligible for intrapartum antibiotic prophylaxis, whether screening-based or risk-based, differ according to the local burden of disease. Despite the introduction of intrapartum antibiotic prophylaxis, there remains a significant burden of disease, which can be resolved by better adherence to guidelines, rapid identification of maternal colonization or in the future, vaccination. Areas covered: The introduction of a vaccine to women in the third trimester is likely to further reduce the burden of disease and provide benefits beyond the prevention of early neonatal disease, including meningitis and disability following late onset disease. Development of specific polyvalent vaccines continues, but testing has challenges and may require surrogate markers or molecular-based techniques to manipulate antigenicity and immunogenicity. Expert commentary: Group B streptococcal vaccination using conjugated polyvalent vaccines against the major disease causing serotypes of Group B streptococcus, either alone, or in combination with a policy of intrapartum antibiotic prophylaxis, may decrease the burden of Group B streptococcus beyond that achieved by current use of intrapartum antibiotic prophylaxis alone. [ABSTRACT FROM PUBLISHER]

Effect of prophylactic negative pressure wound therapy vs standard wound dressing on surgical-site infection in obese women after Cesarean delivery: a randomized clinical trial. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. [Extracted from the article]

Introduction: When complications arise in the delivery room, midwives and obstetricians operate at the interface of life and death, and in rare cases the infant or the mother suffers severe and possibly fatal injuries related to the birth. This descriptive study investigated the numbers and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns.Material and Methods: A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study with selected survey participants.Results: The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existential considerations. Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant. Feelings of guilt were reported by 36-49%, and 50% agreed that the traumatic childbirth had made them think more about the meaning of life. Sixty-five percent felt that they had become a better midwife or doctor due to the traumatic incident.Conclusions: The results of this large, exploratory study suggest that obstetricians and midwives struggle with issues of blame, guilt and existential concerns in the aftermath of a traumatic childbirth. [ABSTRACT FROM AUTHOR]

Information about the International Federation of Gynecology and Obstetrics (FIGO) World Congress 2015 held in Vancouver, British Columbia is presented. Topics include the contributions of Professor Ingemar Ingemarsson on obstetrics, the role of technology on the improvements of obstetric care and the prevention strategies for preterm and post-term labor. The speakers at the event include Christina Anne Winter, Bo Jacobsson and Jan Stener Jorgensen.

The article discusses the highlights of the 2nd Nordic Congress on Obesity in Gynecology and Obstetrics (NOCOGO) held at Hindsgavl Conference Center in Middelfart, Denmark on August 27 to 29, 2015. The conference focused on the epidemiology of obesity globally and its influence on the pre-conceptional environment. Speakers included Philip James, Sven Cnattingius and Ronnie Lamont.

Introduction: The aim of this study was to evaluate the effect of an eHealth intervention (interactive website) on pregnant women's ability to make an informed choice about Down syndrome screening.Material and Methods: The study was designed as a randomized controlled trial with allocation to an intervention group and a control group in a ratio of 1:1. Subsequent subgroup analysis was conducted. Participants were recruited from 5 August 2013 to 25 April 2014 at Odense University Hospital, Denmark. Inclusion criteria were: pregnant women aged ≥18 years who were invited to participate in Down syndrome screening. Exclusion criteria were: high risk of abortion, psycho-socially vulnerable women, late referral, inability to speak Danish and women declining to participate. The primary outcome was informed choice about Down syndrome screening. The Multidimensional Measure of Informed Choice was used to assess whether the choice was informed or uninformed.Results: A total of 1150 participants were included in the study, of which 910 (79%) completed the questionnaire. Only a minority (30% of the women in the intervention group) actually used the website. There was no significant difference in the groups with respect to making an informed choice. The mean knowledge scores were significantly higher for those in the intervention group who used the intervention.Conclusions: An interactive website with information about Down syndrome screening had no direct effect on making an informed choice. However, the majority of the pregnant women who used the website were satisfied with the website and would recommend it to others. [ABSTRACT FROM AUTHOR]

Infection-related preterm birth (PTB) is more common at early gestational ages and is associated with major neonatal mortality and morbidity. Abnormal genital tract microflora in early pregnancy predicts late miscarriage and early PTB. Accordingly, it is logical to consider antibiotics as an intervention. Unfortunately, the conclusions of systematic reviews and meta-analyses (SR&MAs) carried out in an attempt to explain the confusion over the heterogeneity of individual studies are flawed by the fact that undue reliance was placed on studies which: (a) had a suboptimal choice of antibiotic (mainly metronidazole) or used antibiotics not recommended for the treatment of bacterial vaginosis (BV) or BV-related organisms; (b) used antibiotics too late in pregnancy to influence outcome (23-27 weeks); and (c) included women whose risk of PTB was not due to abnormal genital tract colonization and hence unlikely to respond to antibiotics. These risks included: (a) previous PTB of indeterminate etiology; (b) low weight/body mass index; or (c) detection of fetal fibronectin, ureaplasmas, Group B streptococcus or Trichomonas vaginalis). While individual studies have found benefit of antibiotic intervention for the prevention of PTB, in meta-analyses these effects have been negated by large methodologically flawed studies with negative results. As a result, many clinicians think that any antibiotic given at any time in pregnancy to any woman at risk of PTB will cause more harm than good. Recently, a more focused SR&MA has demonstrated that antibiotics active against BV-related organisms, used in women whose risk of PTB is due to abnormal microflora, and used early in pregnancy before irreversible inflammatory damage has occurred, can reduce the rate of PTB. This review presents those data, the background and attempts to explain the confusion using new information from culture-independent molecular-based techniques. It also gives guidance on the structure of putative future antibiotic intervention studies. [ABSTRACT FROM AUTHOR]

Background: Miscarriage is the most common negative outcome of pregnancy, and identification of modifiable risk factors is potentially of great importance for public health. Low vitamin D concentrations in pregnancy are widespread worldwide, and vitamin D deficiency is implicated in immune cell regulation at the feto-maternal interface and several diseases of pregnancy. Objective: We investigated whether 25-hydroxyvitamin D serum concentration was a modifiable risk factor for early miscarriage. Design: In a prospective cohort study of 1683 pregnant women donating serum before gestational week 22, we investigated the association between maternal serum concentrations of serum 25- hydroxyvitamin D [25(OH)D] and the risk of subsequent miscarriage (n = 58). Results: The adjusted hazard of first-trimester miscarriage was lower with higher 25(OH)D concentrations (HR: 0.98; 95% CI: 0.96, 0.99). Concentrations of 25(OH)D<50 nmol/L were associated with a >2-fold increased adjusted HR for miscarriage (HR: 2.50; 95% CI: 1.10, 5.69). Concentrations of 25(OH)D were not associated with an increased risk of second-trimester miscarriage. Conclusions: We found an association between 25(OH)D and first-trimester miscarriages, suggesting vitamin D as a modifiable risk factor for miscarriage. To test this hypothesis, randomized controlled trials should investigate the possible effect of vitamin D supplementation to increase 25(OH)D concentrations in early pregnancy, or before conception, to decrease risk of miscarriage. This trial was registered at clinicaltrials.gov as NCT02434900. [ABSTRACT FROM AUTHOR]

Background The importance of the environment on the development of the fetus and infant throughout early life is increasingly recognised. To study such effects, biological samples and accurate data records are required. Based on multiple data collection from a healthy pregnant population, the Odense Childhood Cohort ( OCC) study aims to provide new information about the environmental impact on child health by sequential follow-up to 18 years of age among children born between 2010 and 2012. Methods A total of 2874 of 6707 pregnancies (43%) were recruited between January 2010 and December 2012. Three hundred seventy-four have since left the study, leaving 2500 active families. The non-participants act as controls contributing data through local registries. Biological material, questionnaires, and registry data were compiled. Anthropometric data and other physical data were collected. Results Two thousand five hundred families actively participated in the study with 2549 children. Sixty-four per cent of the fathers and 60% and 58% of the mothers, respectively, donated a blood sample at 10 and 28 weeks of gestation. On average, 69% completed questionnaires, 78% of the children were regularly examined, and had a blood sample taken (46%). The participating pregnant women differed from the non-participants in several respects: age, body mass index, smoking, parity, education, and ethnicity. The infants were comparable with respect to gender and mode of delivery. Conclusions The OCC provides material for in-depth analysis of environmental and genetic factors that are important for child health and disease. Registry data from non-participating women and infants are available which ensures a high degree of comparable data. [ABSTRACT FROM AUTHOR]

There are few recent data on the prevalence of substance abuse among Danish pregnant women. During 2013, in the Region of Southern Denmark, a cross-sectional, anonymous, screening-based study was conducted among pregnant women attending for routine ultrasound scan at 12 weeks gestation. The women submitted a urine sample and completed a short questionnaire. Urine samples were tested for opiates, cannabis, benzodiazepines, cocaine, methadone, amphetamine and methamphetamine. Positive samples underwent repeat analysis for confirmation. Of 690 pregnant women, 88.1% participated. Overall, 3.6% of women had a positive urine sample confirmed by repeated analysis. The age distribution in women with positive samples did not differ from the entire cohort. Our findings indicate a larger prevalence than anticipated, and that a substantial number of pregnant women with substance abuse are not appropriately referred to the focused specialist center for such women at risk. [ABSTRACT FROM AUTHOR]

Background In recent decades there have been advances in the options for prenatal screening. Screening programmes for Down syndrome are well established in many countries. It is important that pregnant women are well informed about the benefits and risks of screening. A variety of interventions has been introduced to support pregnant women in their choice of prenatal screening. Objective To summarize the literature using randomized controlled trials to compare the effects of different interventions to provide pregnant women with the information necessary to make an informed choice about screening for Down syndrome. Design Systematic review Methods A systematic search was performed using the PUBMED and EMBASE databases. The search terms included MeSH terms and free text and were combined by Boolean terms (AND, OR) with no restriction on language or time. Main outcome measures Knowledge, informed choice, patient satisfaction, anxiety, depression, conflict and worries. Results Twelve studies were included in the review. All were characterised by having one or more interventions designed to improve the level of information about prenatal screening for Down syndrome. A positive effect on knowledge and satisfaction from the information received was found in the majority of the studies. The studies were heterogeneous with respect to interventions, methodology and outcome measurements. Conclusions Interventions aimed at providing pregnant women with specific information about prenatal screening for Down syndrome can improve their ability to make an informed choice. [ABSTRACT FROM AUTHOR]

There is now incontrovertible evidence that HPV is the cause of almost all cases of genital warts, cervical dysplasia and cervical cancer. Moreover the current review of the recent literature on HPV in relation to pregnancy found strong indications that HPV plays an important role in adverse outcomes of pregnancy. HPV may contribute to infertility and may increase the risk of miscarriage. Recent studies indicate a significant rate of vertical transmission of HPV between mother and child but whether the mode of delivery makes a difference to the risk of transmission remains unknown. HPV infection appears to be correlated with both spontaneous preterm birth and preterm prelabor rupture of the membranes. [ABSTRACT FROM AUTHOR]

Objectives To study the effects of lifestyle intervention in pregnancy on weight retention 6 months postpartum among obese women from the 'Lifestyle in Pregnancy' (LiP) study, and to determine associations between breastfeeding with postpartum maternal weight. Design Six months postpartum follow up after a randomized controlled intervention trial. Setting Two university hospitals in Denmark. Population A total of 360 women with pregestational body mass index ≥30 kg/m2. Methods The intervention involved lifestyle changes (diet and exercise) during pregnancy. The control group received routine pregnancy care. Both groups received standard postnatal care. Main outcome measures Gestational weight gain, postpartum weight retention and breastfeeding. Results Follow up was completed in 238 women of whom 46% in the intervention group and 57% in the control group had retained weight 6 months postpartum ( p = 0.088). Women with gestational weight gain ≤9 kg, (recommended by the Institute of Medicine), retained less postpartum weight compared with those who exceeded 9 kg (median −0.7 vs. 1.5, p < 0.001). Ninety-two percent in both weight gain groups initiated breastfeeding. The number of breastfeeding mothers was higher among women with postpartum weight retention ≤5 kg compared with those with weight retention > 5 kg (94% vs. 85%, p = 0.034). Conclusions We could not detect sustained weight control at 6 months postpartum despite a lower gestational weight gain for obese women during pregnancy who received a lifestyle intervention rather than standard care. Women who adhered to gestational weight gain recommendations had significantly lower postpartum weight retention. Breastfeeding for 6 months was negatively associated with postpartum weight retention. [ABSTRACT FROM AUTHOR]

Objective To examine whether a 3-day training course in motivational interviewing, which is an approach to helping people to change, could improve the communication skills of obstetric healthcare professionals in their interaction with obese pregnant women. Design Intervention study. Setting The Region of Southern Denmark. Methods Eleven obstetric healthcare professionals working with obese pregnant women underwent a 3-day course in motivational interviewing techniques and were assessed before and after training to measure the impact on their overall performance as well as the effect on specific behavioral techniques observed during interviews. Findings With a few exceptions, the participants changed their behavior appropriate to the motivational interviewing technique. The participants made more interventions towards the principles of motivational interviewing (adherent and nonadherent interventions). Furthermore, the participants asked fewer closed and more open questions before training in motivational interview. In the assessment of proficiency and competency, most of the participants scored higher after the training in motivational interviewing. Conclusions Training in motivational interviewing improves healthcare professionals' proficiency and competency when communicating with obese pregnant women, albeit that the effect was not universal. [ABSTRACT FROM AUTHOR]

Objective: In obese women, 1) to assess whether lower gestational weight gain (GWG) during pregnancy in the lifestyle intervention group of a randomized controlled trial (RCT) resulted in differences in offspring anthropometrics and body composition, and 2) to compare offspring outcomes to a reference group of children born to women with a normal Body Mass Index (BMI). Research design and methods: The LiPO (Lifestyle in Pregnancy and Offspring) study was an offspring follow-up of a RCT with 360 obese pregnant women with a lifestyle intervention during pregnancy including dietary advice, coaching and exercise. The trial was completed by 301 women who were eligible for follow-up. In addition, to the children from the RCT, a group of children born to women with a normal BMI were included as a reference group. At 2.8 (range 2.5–3.2) years, anthropometrics were measured in 157 children of the RCT mothers and in 97 reference group children with Body Mass Index (BMI) Z-score as a primary outcome. Body composition was estimated by Dual Energy X-ray (DEXA) in 123 successful scans out of 147 (84%). Results: No differences between randomized groups were seen in mean (95% C.I.) BMI Z-score (intervention group 0.06 [−0.17; 0.29] vs. controls −0.18 [−0.43; 0.05]), in the percentage of overweight or obese children (10.9% vs. 6.7%), in other anthropometrics, or in body composition values by DEXA. Outcomes between children from the RCT and the reference group children were not significantly different. Conclusions: The RCT with lifestyle intervention in obese pregnant women did not result in any detectable effect on offspring anthropometrics or body composition by DEXA at 2.8 years of age. This may reflect the limited difference in GWG between intervention and control groups. Offspring of obese mothers from the RCT were comparable to offspring of mothers with a normal BMI. Trial registration: clinicaltrials.gov NCT00530439, NCT01918319 and NCT01918423. URL: NCT00530439&quest;term&hairsp;&equals;&hairsp;NCT00530439&amp;rank&hairsp;&equals;&hairsp;1, NCT01918319&quest;term&hairsp;&equals;&hairsp;NCT00530439&amp;rank&hairsp;&equals;&hairsp;2 and NCT01918423&quest;term&hairsp;&equals;&hairsp;NCT00530439&amp;rank&hairsp;&equals;&hairsp;3. [ABSTRACT FROM AUTHOR]

Objective To examine the experience of women with a pre-pregnant BMI >30 kg/m2, in their encounters with healthcare professionals during pregnancy. Design Qualitative study using a phenomenological methodology approach. Setting Face-to-face interviews with pregnant women in their own home who were referred from their general practitioner to specialist antenatal follow-up at their local hospital. Sample Sixteen women with pre-pregnant BMI >30 kg/m2. Methods Qualitative in-depth interviews. Participant's experiences of their encounters with health care professionals were recorded verbatim, transcribed and analysed using a phenomenological approach . Results Two main themes were identified, an accusatorial response from healthcare professionals and a lack of advice and helpful information on how being obese and pregnant might affect the women's health and that of their child. Conclusions Pregnant women with obesity may experience prejudice from healthcare professionals. These women felt they were treated with a lack of respect, an accusatorial response, and the feeling that information which could have been helpful was not forthcoming. Communication between obese pregnant woman and healthcare professionals appears to be lacking. Improved training in communication skills, less judgemental behaviour and better dissemination of information from healthcare professionals working with pregnant women with obesity are needed. [ABSTRACT FROM AUTHOR]

The article offers information on the First Nordic Conference on Obesity in Gynecology and Obstetrics (NOCOGO) that was held in Billund, Denmark from October 22-24, 2012. The aim of the conference was to increase interaction between obstetricians, gynecologists, nurses and midwives regarding to obesity due to its declining global nature. Several delegates nd speakers have participated in the conference including Pernille T. Jensen, Ronnie Lamont and Christina Vinter.

Hypovitaminosis D is common in pregnancy. To systematically review the evidence on vitamin D-dependent pregnancy outcomes, PubMed and Embase were searched for randomized control trials, cohort and case-control studies. In randomized control trials ( n = 7), larger doses of vitamin D resulted in higher 25-hydroxylated vitamin D (25OHD) levels ( n = 6), increased maternal weight gain ( n = 1), and fewer classical vitamin D deficiency symptoms ( n = 1). In observational studies ( n = 32), lower vitamin D intake, or low 25OHD-levels, were associated with adverse fertility parameters ( n = 2), preeclampsia ( n = 5), gestational diabetes or higher blood glucose ( n = 6), bacterial vaginosis ( n = 4), primary cesarean section ( n = 1), none ( n = 3) or a few days' ( n = 2) shorter gestation, and postpartum depression ( n = 1). Studies with few participants having low 25OHD did not identify an association to preeclampsia ( n = 5) or gestational diabetes ( n = 2). Increased odds of pregnancy-associated breast cancer with 25OHD >25.8 nmol/L were observed ( n = 1). In conclusion, an effect of vitamin D on several pregnancy outcomes is suggested. [ABSTRACT FROM AUTHOR]

The impact of maternal vitamin D status in pregnancy on the extraskeletal health of the offspring has become a 'hot topic' with a potential for cost-beneficial prevention. The objective of this study was to systematically review the level I and II evidence. PubMed, Embase and Cochrane databases were searched using the MeSH terms 'vitamin D' AND 'pregnancy' until 1 January 2012. The search was limited to randomized controlled trials (evidence level I) and observational studies (evidence level II) in humans and in the English language. Papers reporting on vitamin D supplementation in combination with other supplements, or not reporting on 25OHD or outcomes of the offspring were excluded. Six randomized controlled trials and 24 observational studies were finally included. In randomized controlled studies, vitamin D supplementation resulted in increased birthweight in one study, but showed no effect in five other studies. In cohort and case-control studies, higher vitamin D intake, or higher 25OHD, was associated with increased birthweight in large studies only, and modified by vitamin D receptor polymorphisms and by race (U-shaped in Caucasians in one unconfirmed study). The risks of HIV mother-to-child transmission, rhinitis symptoms and eczema were lower. Data were conflicting on the effect on respiratory infections and wheezing, whereas U-shaped associations to inhalant allergen-specific IgE at five years and to schizophrenia were reported in unconfirmed studies. The risk of type 1 diabetes at 15 years was lower or unchanged. It is concluded that observational studies suggest an effect of vitamin D on several outcomes. U-Shaped associations warrant caution. [ABSTRACT FROM AUTHOR]

Background. Approximately 1-2% of women suffer from post-traumatic stress disorder (PTSD) postnatally. This review aims to elucidate how women at risk can be identified . Methods. A systematic search of the published literature was carried out using the MEDLINE database (November 2003 to 29 October 2010) with both MeSH terms and free text. Thirty-one studies were considered appropriate for qualitative synthesis. Articles were included on the basis of (a) publication pertaining to PTSD following childbirth, (b) study carried out in Western Europe and (c) publication written in English. The results were primarily based on observational studies. The literature was thoroughly read and results were compiled. Furthermore, a novel quality rating system was employed to minimize the impact of bias. Results. Subjective distress in labor and obstetrical emergencies were the most important risk factors. Infant complications, low support during labor and delivery, psychological difficulties in pregnancy, previous traumatic experiences, and obstetrical emergencies were identified as risk factors. Conclusions. We have identified factors both strongly associated and non-associated with PTSD following childbirth. While the literature is limited by methodological shortcomings, a hypothesis regarding the development of PTSD is outlined, and recommendations with respect to screening and future research are provided. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to review the evidence associating periodontal disease, and bacterial vaginosis with preterm birth, and the link with gene polymorphism, as well as the preventions and interventions which might reduce the risk of spontaneous preterm labor and preterm births in women with periodontal disease and/or bacterial vaginosis. Background. Preterm birth accounts for 70%% of perinatal mortality, nearly 50%% of long term neurological morbidity, and a significant impact on health care costs. There is evidence that spontaneous preterm labor and preterm birth are associated with intrauterine infection due to abnormal genital and/or oral colonization. Periodontal disease and bacterial vaginosis share microbiological similarities, and both conditions are associated with spontaneous preterm labor and preterm birth. In addition, periodontal disease and bacterial vaginosis have been linked through gene polymorphism. Methods. A review of the literature using widely accepted scientific search engines in English language. Results. Studies evaluating antibiotic administration to eradicate periodontal disease and/or bacterial vaginosis responsible organisms, and minimize the risk of preterm births have yielded conflicting results. With respect to bacterial vaginosis, the timing and the choice of antibiotic administration might partly explain the conflicting results. The use of scaling and/or root planning for women with periodontal disease appears to reduce the risk of preterm birth, but routine administration of antibiotics has not demonstrated any impact on preterm birth. Conclusion. Prospective studies evaluating the association of gene polymorphism with preterm birth, and the contribution of periodontal disease and bacterial vaginosis are needed. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Lamont R, Sobel J, Carrington D, Mazaki-Tovi S, Kusanovic J, Vaisbuch E, Romero R. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02983.x. Congenital varicella syndrome, maternal varicella-zoster virus pneumonia and neonatal varicella infection are associated with serious fetomaternal morbidity and, not infrequently, mortality. Vaccination against varicella-zoster virus can prevent the disease, and outbreak control limits the exposure of pregnant women to the infectious agent. Maternal varicella-zoster immunoglobulin administration before rash development, with or without antiviral medication, can modify the progression of the disease. [ABSTRACT FROM AUTHOR]

Background. Preterm delivery remains a substantial healthcare problem, complicating 5-10% of pregnancies, and is the major cause of perinatal morbidity and mortality in the developed world. Few effective methods to prevent preterm delivery have been identified to date. Objective. To review systematically the evidence from randomized controlled trials with respect to the hypothesis that increased consumption of marine n-3 fatty acids in pregnancy can prevent preterm birth. Setting. Electronic searches of the following databases were performed: PubMed (1995-2009), SCOPUS including EMBASE (1995-2009), and Cochrane Library. A combination of key words and text words related to fish oil, marine n-3 fatty acids, fish consumption, preterm birth, preterm delivery, prematurity, pregnancy duration, gestational age, parturition, delivery and pregnancy were used. Methods. A systematic review of randomized controlled trials of relevance was conducted. Three trials were included, comprising 921 women for whom data on gestational age and 1 187 women for whom data on birthweight were available. Results. Overall, 46 (8.9%) of 516 women who received n-3 fatty acids gave birth before 37 completed weeks of gestation, compared with 66 (16.3%) of 405 in the control group [relative risk 0.61; 95% confidence interval (CI) 0.40-0.93; p<0.05]. Data on delivery before 34 completed weeks showed the same trend (relative risk 0.32; 95% CI 0.09-0.95). Overall, the mean birthweight was 71g higher in women who received n-3 fatty acids during pregnancy (95% CI 4.73-138.12; p<0.05). The rate of low birthweight was not statistically significantly different between the intervention and the control groups. The mean gestational age at delivery was significantly higher by 4.5days in the intervention group supplemented with n-3 fatty acids compared with placebo (95% CI 2.3-6.8; p<0.05). Conclusions. Marine n-3 fatty acids administered in pregnancy reduce the rate of preterm birth and increase birthweight. [ABSTRACT FROM AUTHOR]

Listeria is commonly found in processed and prepared foods and listeriosis is associated with high morbidity and mortality. Preventative measures are well prescribed and monitoring and voluntary recall of contaminated products has resulted in a 44% reduction in the prevalence of perinatal listeriosis in the USA. Pregnant women are at high risk for listeriosis, but symptoms are non-specific and diagnosis is difficult. The intracellular life-cycle of Listeria protects the bacterium from host innate and adaptive immune responses. Antibiotic treatment requires agents able to penetrate, distribute, and remain stable within host cells. Prolonged use of high-dose ampicillin can significantly improve neonatal outcome. [ABSTRACT FROM AUTHOR]

Background. Calcium channel blockers (CCBs) are not licensed for use in pregnancy but are used without robust surveillance to treat hypertension in pregnancy and preterm labour. The objective of this study was to evaluate the fetomaternal safety of CCB in pregnancy by a quantitative systematic review. Methods. Medline (1996–2005), EMBASE (1996–2003), BIOSIS (1993–2003), Current contents (1995–2003), DERWENT DRUGFILE (1983–2003) and Cochrane Library (2005: issue 3). The number of women reporting an adverse event was used to compute a percentage of the total number of women in whom the occurrence of that event or confirmation of its absence was reported. Meta-regression with generalised estimation equations modelling explored reasons for heterogeneity, seeking factors that increased the rates of the most commonly reported adverse events. Findings. Of 269 relevant reports, including 5607 women, adverse fetomaternal events varied according to the total dose of nifedipine and study design. Adverse events were highest amongst women given more than 60 mg total dose of nifedipine [odds ratio (OR) 3.78, 95% confidence interval (CI) 1.27–11.2, p = 0.017] and in reports from case series compared to controlled studies (OR 2.45, 95% CI 1.17–5.15, p = 0.018). Interpretation. Adverse event rates generated from this study provide an evidence base for clinical guidelines and informed patient consent for CCB use in pregnancy. [ABSTRACT FROM AUTHOR]

Preterm parturition is a syndrome caused by several mechanisms of disease, including intrauterine infection/inflammation, uteroplacental ischemia, uterine overdistension, cervical disease, maternal/fetal stress, abnormal allogeneic responses, allergic reactions, and unknown insults. An allergic-like mechanism was proposed as a potential etiology for the preterm parturition syndrome, based on the observation that eosinophils were present in the amniotic fluid in a fraction of women with preterm labor and a history of allergy, coupled with the observation that conditioned media from degranulated mast cells (the effector cells of type 1 hypersensitivity) induced contractility of human myometrial strips. This communication describes a case of a pregnant woman who had an allergic reaction and regular uterine contractions after the ingestion of lobster meat, to which she was known to be allergic. Preterm labor subsided after the treatment of antihistamines and steroids. The patient subsequently delivered at term. At follow-up, the child was diagnosed with atopy and asthma, and required frequent use of inhaled corticosteroids and β-2 adrenergic agents. The immunological basis for preterm labor induced by an allergic-like reaction (hypersensitivity) is reviewed. [ABSTRACT FROM AUTHOR]

Objective: Pentraxin 3 (PTX3) is a soluble pattern recognition receptor (PRR) that has an important role in immunoregulation and vascular integrity. The aim of this study was to determine if PTX3 is present in amniotic fluid (AF) and whether its concentration changes with gestational age (GA), in the presence of preterm or term labor, and in cases of intra-amniotic infection/inflammation (IAI) associated with spontaneous preterm labor (PTL) or preterm prelabor rupture of membranes (PROM). Study design: This cross-sectional study included the following groups: 1) mid-trimester (n=45); 2) uncomplicated pregnancies at term with (n=48) and without (n=40) spontaneous labor; 3) women with PTL and intact membranes who: a) delivered at term (n=44); b) delivered preterm without IAI (n=40); or c) delivered preterm with IAI (n=62); 4) women with preterm PROM with (n=63) and without (n=36) IAI. PTX3 concentration in AF was determined by ELISA. Non-parametric statistics were used for analyses. Results: 1) Among women with PTL and intact membranes, the median AF PTX3 concentration was significantly higher in women with IAI than in those without IAI (7.95 ng/mL vs. 0.38 ng/mL; P<0.001) and than in those who delivered at term (0.55 ng/mL; P<0.001); 2) women with preterm PROM and IAI had a higher median AF PTX3 concentration than those without IAI (9.12 ng/mL vs. 0.76 ng/mL; P<0.001); 3) the median AF PTX3 concentration did not change with GA (mid-trimester: 0.79 ng/mL vs. term not in labor: 0.58 ng/mL; P=0.09); and 4) labor at term was not associated with a significant change of AF PTX 3 concentration (in labor: 0.54 ng/mL vs. not in labor: 0.58 ng/mL, P=0.9). Conclusions: PTX3 is a physiologic constituent of the AF, and its median concentration is elevated in the presence of IAI, suggesting that PTX3 may play a role in the innate immune response against IAI. [ABSTRACT FROM AUTHOR]

Objective: Intrauterine devices (IUDs) are used for contraception worldwide; however, the management of pregnancies with an IUD poses a clinical challenge. The purpose of this study was to determine the outcome of pregnancy in patients with an IUD. Study design: A retrospective cohort study (December 1997–June 2007) was conducted. The cohort consisted of 12,297 pregnancies, of which 196 had an IUD. Only singleton pregnancies were included. Logistic regression analysis was used to adjust for potential confounders between the groups. Results: 1) Pregnancies with an IUD were associated with a higher rate of late miscarriage, preterm delivery, vaginal bleeding, clinical chorioamnionitis, and placental abruption than those without an IUD; 2) among patients with available histologic examination of the placenta, the rate of histologic chorioamnionitis and/or funisitis was higher in patients with an IUD than in those without an IUD (54.2% vs. 14.7%; P<0.001). Similarly, among patients who underwent an amniocentesis, the prevalence of microbial invasion of the amniotic cavity (MIAC) was also higher in pregnant women with an IUD than in those without an IUD (45.9% vs. 8.8%; P<0.001); and 3) intra-amniotic infection caused by Candida species was more frequently present in pregnancies with an IUD than in those without an IUD (31.1% vs. 6.3%; P<0.001). Conclusion: Pregnant women with an IUD are at a very high risk for adverse pregnancy outcomes. This finding can be attributed, at least in part, to the high prevalence of intra-amniotic infection and placental inflammatory lesions observed in pregnancies with an IUD. [ABSTRACT FROM AUTHOR]

Objective: The fetal inflammatory response syndrome (FIRS) is present in a fraction of fetuses exposed to intraamniotic infection and is associated with the impending onset of labor and multisystem organ involvement. Neonates born with funisitis, the histologic counterpart of fetal systemic inflammation, are at increased risk for cerebral palsy and bronchopulmonary dysplasia. The aim of this study was to determine whether fetal and maternal granulocytes and monocytes have the phenotypic and metabolic characteristics of activation in cases with FIRS. Study design: A case-control study was conducted with umbilical cord and maternal blood samples obtained from patients who delivered preterm with (ns30) and without funisitis (ns15). The phenotypic characteristics of granulocytes and monocytes were examined using flow cytometry and monoclonal antibodies including CD11b, CD14, CD15, CD16, CD18, CD49d, CD62L, CD64, CD66b, and HLA-DR. Intracellular reactive oxygen species (iROS) were measured at the basal state and after stimulation (oxidative burst). A P-0.01 was considered statistically significant. Results: (1) Funisitis was associated with a significantincrease in the median mean channel brightness (MCB) of CD14, CD64, and CD66b on granulocytes and the MCB of CD64 on monocytes collected from umbilical cord blood. (2) The basal iROS production and oxidative burst were higher in the umbilical cord monocytes of neonates with funisitis than in those without funisitis. (3) There were no differences in the immunophenotype, basal iROS production, and oxidative burst in maternal granulocytes or monocytes between the study groups. Conclusion: Fetal systemic inflammation is associated with phenotypic and metabolic changes consistent with activation in fetal immune cells but not in maternal blood. [ABSTRACT FROM AUTHOR]

Preterm birth is the major cause of perinatal mortality and morbidity in the developed world, imposing a huge burden on healthcare costs. Tocolytic drugs inhibit contractions and delay delivery in the hope of improving survival and preventing handicap. Historically, most tocolytics were not initially developed to treat preterm labor, and so are not uterospecific and have multiorgan side effects. Atosiban (Tractocile®) is a vasopressin-oxytocin receptor antagonist, which is much more uterospecific than previous tocolytics, and, consequently has placebo-level side effects. Atosiban has a strong evidence base and is a significant addition to the treatment options for preterm labor and should be used for first-line therapy. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between unexplained elevated maternal serum β-Human chorionic gonadotrophin (HCG) in the second trimester of pregnancy and adverse pregnancy outcome. Methods In a case-controlled study of 3463 women who opted for second-trimester serum screening for Down syndrome, 142 were found to have a serum β-HCG of ≥3.5 multiples of the median (MoM), 56 of whom had a serum β-HCG of ≥5.0 MoM. These women were compared with a control group of women with serum β-HCG within the 95% confidence interval around the median. Results In the elevated β-HCG group (≥5 MoM) significantly more babies required admission to the special care baby unit ( p = 0.02) and were small for gestational age (SGA) ( p = 0.03). The mean birth weight was also significantly lower in the group with elevated β-HCG. Women with a serum β-HCG of ≥5, ≥6, ≥7 or ≥8 MoM were associated with SGA babies in 40, 44, 64 and 86% respectively. All babies born to the six women with β-HCG of 8.75-24.1 MoM were SGA. Conclusion Increased surveillance is necessary in pregnancies where the maternal serum β-HCG in the second trimester is inexplicably elevated to ≥5 MoM. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Spontaneous preterm labor leading to preterm birth is a major cause of perinatal mortality and morbidity worldwide. The etiology of spontaneous preterm labor is multifactoral but there is overwhelming evidence to implicate infection in up to 40% of cases. Historically, this infective link has focused on the associations between abnormal genital tract flora in pregnancy (diagnosed by the presence of bacterial vaginosis) and preterm birth. Recently, another condition related to abnormal flora (periodontal disease) has been linked with preterm birth. There are microbiological similarities between the oral cavity and the female genital tract giving rise to a possible common pathophysiology. This review records the interrelationship between periodontal disease, bacterial vaginosis, and preterm birth. We postulate on the mechanism linking the three conditions, particularly through microbiology and gene-environmental interactions. Periodontal disease and bacterial vaginosis may be risk factors in their own rights or may be interrelated. We speculate on whether periodontitisis a marker for an immune hyperresponse to abnormal flora which in the oral cavity results in periodontitis and in the case of bacterial vaginosis might result in preterm birth. We also postulate on the riskof preterm birth by periodontitis alone, bacterial vaginosis alone, or both. [ABSTRACT FROM AUTHOR]

I Sir, i We commend the study by Hasperhoven et al.,1 which demonstrates a lower incidence of early-onset group B streptococcal (GBS) disease (EOGBSD) using screening-based, compared with risk-based protocols, albeit that the usage of intrapartum antibiotic prophylaxis (IAP) under both policies was similar. Group B streptococcal immunisation of pregnant women for the prevention of early and late onset group B streptococcal infection of the neonate as well as adult disease. [Extracted from the article]

Objective: To develop a technique that would permit the identfication of dendritic cells (DC) in small volumes of preterm neonatal cord blood in order to investigate neonatal immune response in relation to infection and preterm labor.Methods: We used three-color flow cytometry and a fixed quantity of fluorospheres to determine absolute cell numbers. Four red cell lysis techniques, sample dilution, time delay experiments, and a comparison with traditional Ficoll cell separation techniques were performed. Absolute numbers of DC recovered using each technique were calculated and compared.Results: With increasing time delay, there was a statistically significant reduction in the numbers of leukocytes in adult blood. In contrast, there was a significant increase in leukocytes in umbilical cord blood. Sample dilution did not significantly affect the total number of leukocytes or DC. The use of the reagent Optilyse B (Immunotech, Oxford, UK) combined with an additional washing step produced the best discrimination of all populations based on light scatter properties. For the same blood sample, antibody labeling of whole blood resulted in a greater recovery of DC when compared to prior cell purfication using a Ficoll density gradient.Conclusion: Using traditional Ficoll cell separation, cell manipulation requires large volumes of blood and leads to cell loss and alteration in phenotype. We have validated a novel method using small volumes of whole blood, diluted if necessary, and using red cell lysis to enable analysis of small volumes of preterm neonatal cord blood. This may permit further analysis of the contribution of the fetal immune response in the development of spontaneous preterm labor and preterm birth due to infection. [ABSTRACT FROM PUBLISHER]

Presents a letter to the editor about long-term eating disorder, Bartter's syndrome, and pregnancy.

We investigated the possibility of preterm birth misclassification as a determinant of variation in its reported rates. Using a database of 497,105 deliveries from 17 hospitals, the best estimate of gestational age made at delivery and entered into the database at that time was recalculated from the menstrual dates and mid-trimester ultrasound scan. The recalculated completed weeks of gestation at delivery was compared with that made at birth. Calculation of estimated gestational age varied between hospitals due to inconsistencies in‘rounding’ and‘truncating’ the weeks of gestation at delivery. This resulted in preterm birth misclassification rates of up to 10.1%. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of 2% clindamycin vaginal cream (CVC) to treat bacterial vaginosis (BV) in pregnancy. Methods: A prospective, randomized, double-blind, placebo-controlled, tricenter study. Four hundred and four women with BV on Gram stain at their first antenatal clinic visit were randomized to receive a 3-day course of 2% CVC or placebo. The outcome was assessed using an intention to treat analysis at 3 weeks and 6 weeks post-treatment according to three different diagnostic methods based on five criteria (Gram stain and all four elements of clinical composite criteria: vaginal discharge, abnormal vaginal pH, clue cells, amine odor), three criteria (vaginal pH, clue cells, amine odor) or two criteria (clue cells and amine odor) to reflect stringency of diagnosis, historical precedence and government agency recommendations respectively. Results: Using five diagnostic criteria, 18% of CVC patients were cured and 70.8% either cured and/or improved compared to 1.6% and 12% of placebo patients respectively (p < 0.0001). Using three diagnostic criteria, 44.8% of CVC patients were cured and 77.3% were either cured and/or improved compared to 9.3% and 28.8% of placebo patients respectively (p < 0.0001). Using two diagnostic criteria, 75.0% of CVC patients were cured compared to 18.0% of placebo patients (p < 0.0001). Recurrence rates in those CVC patients successfully treated were approximately 6% at 6 weeks post baseline and 10% at 28 to 34 weeks gestation. Conclusions: A 3-day course of CVC appears to be well tolerated by the mother and statistically significantly more efficacious than placebo in the treatment of BV during the second trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Since the 7th and 13th Study Groups of the Royal College of Obstetricians and Gynaecologists met in 1977 and 1985, respectively, no meeting of this magnitude has convened to discuss the problems of spontaneous preterm labour and delivery and the associated fetomaternal mortality and morbidity. In the 17 years or so since that time, advances have been made in our understanding of the mechanisms of labour, the role of infection, the benefit of antepartum corticosteroids and the development of safer more specific tocolytics. In the future, an understanding of the genetic risk of spontaneous preterm labour and preterm birth is essential, particularly with respect to the predisposition to produce potentially damaging pro-inflammatory cytokines. The examination of the tissue damage will require pathologists specifically trained in perinatal pathology if the aetiology is to be ascertained and future management tailored to the risks. A greater understanding of fetomaternal immunology and response to antigen exposure in pregnancy may help us to understand which fetomaternal pairs are at greatest risk of responding by delivering preterm, with greater or lesser tissue damage than others with similar risk. Specifically, the relation between spontaneous preterm labour and proteinuric pre-eclampsia with their common immunology, inflammatory response and tissue damage leading to either spontaneous preterm labour or iatrogenic preterm birth will need to be addressed. This meeting has been very clinically and obstetrically orientated, in future we will need to involve epidemiologists, neonatologists, microbiologists, genito-urinary medicine physicians, immunologists, geneticists, biochemists, physiologists and endocrinologists. Although spontaneous preterm labour and preterm birth are the major causes of perinatal mortality and morbidity in the developed world, the definition and management protocols for spontaneous preterm labour varies from unit to unit and country to country. A process has already begun, hopefully fuelled by this meeting and those attending, to develop an international consensus on definitions and evidence-based practical guidelines on the management of spontaneous preterm labour. Perhaps in the longer term it may be possible to influence standards of care, outcome measures and training across international boundaries. [Copyright &y& Elsevier]