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Objective: The aim of this study was to examine the relation between cervical length and the presence of funneling and the risk of preterm delivery., Method: This prospective blind cohort involved 200 hospitalized women with preterm labor in a tertiary care hospital. Women were recruited for a single transvaginal ultrasonography to assess cervical length and presence of funneling. The main outcome measures were: (1) relative risks (RR) and adjusted odds ratios of preterm delivery (<37 weeks' gestation); (2) time interval between the cervical ultrasonography date to 37 weeks' gestation or to-preterm birth., Results: The RR of preterm delivery according to the cervical length (cut-off of <30 mm) was 2.79 (95% CI 1.70--4.59). The RR according to the presence of funneling (cut-off of >5 mm) was 1.39 (95% CI 0.99--1.95). The adjusted odds ratio was 3.92 (95% IC 1.75--8.75) for cervical length and 0.77 (95% CI 0.35--1.67) for funneling. Women with a cervical length of <30 mm had a significantly shorter interval from ultrasonography date up to 37 weeks' gestation than did women with a cervical length of >30 mm (P<0.003)., Conclusion: Ultrasonographic mensuration of the cervix provides predictive information on the risk of preterm delivery.

The establishment of the mother-baby relationship is often disturbed in case of preterm birth. Clinical observations and epidemiological studies have highlighted the existence of a relationship between psychological factors and preterm birth. Therefore, a psychological support may have a beneficial effect in order to prevent preterm delivery. The aim of this study was to assess the effectiveness of psychological support in pregnant women with symptoms of preterm labor, which is considered as a somatic expression of psychological difficulty related to pregnancy. The study, which involved two cohorts of women, hospitalized or not, identified during two successive periods in the same maternity ward, included 309 women in the experimental group and 323 in the control group. The women in the control group were followed up according to the usual therapeutic procedures, whereas additional psychological support was offered to the experimental group. 92% of the women who met the psychologist accepted the psychological support. The analysis, conducted "in intent to treat", showed a significant decrease in the preterm birth rate in the experimental group (12%) compared with the control group (26%). This study confirms the feasibility of this kind of intervention and the effectiveness of psychological support on the risk of preterm delivery. The interviews help the women regain confidence in their own capacity to fulfil their pregnancy.

Objective: The aim of this study was to assess the effectiveness of psychologic support against preterm delivery in pregnant women with symptoms of preterm labor., Study Design: The study, which involved two cohorts of women identified during two successive periods in the same maternity ward, included 309 women in the experimental group and 323 in the control group. The women in the control group were followed up according to the usual therapeutic procedures, whereas additional psychologic support was offered to the experimental group. The analysis, conducted "in intent to treat," was based on the estimation of the relative risk by a multivariate logistic regression adjusting for confounding factors., Results: A significant decrease in the preterm birth rate was observed in the experimental group (12.3%) compared with the control group (25.7%), with an adjusted relative risk of 0.37 (95% confidence interval 0.30 to 0.47)., Conclusion: This study confirms the feasibility of this kind of intervention and the effectiveness of psychologic support on the risk of preterm delivery.

This paper describes both the development of and results of the use of a self-administered questionnaire designed specifically to investigate the relation between the psychologic attitudes of pregnant women toward pregnancy and an eventual subsequent premature birth. The questionnaire (entitled Pregnancy Psychologic Attitudes Test--in relation to Premature Birth [PPAT(p)]) was derived from the synthesis of interviews with women who had given birth prematurely, comprised 40 questions grouped in six dimensions, and was used in a prospective survey. All women who had an antenatal visit in their fifth to sixth month of pregnancy in one of four maternity hospitals in Lyon, France, between October 1983 and March 1985 were asked to complete this questionnaire. A quantitative PPAT(p) score (ranging from 0 to 6) was constructed in a working sample (n = 643), and its relation with a subsequent premature birth was analyzed in a study sample (n = 1,500). Application of the logistic regression model showed, after controlling for personal and medical factors, that this relation was statistically significant. The risk of premature birth increased from 1 to 1.5 when the PPAT(p) score increased one point (p less than 0.001). This study contributes to a better understanding of psychologic factors that may affect pregnant women and be associated with premature birth. This new component must be considered in the development of policies for preventing premature birth.

INSERM established a working group to evaluate the effects of VDT work on pregnancy outcome. The group examined all available scientific papers concerning radiation emitted by VDTs, animal experimentation, and epidemiological studies. An estimation of risk was made for each outcome (congenital malformations, spontaneous abortion, stillbirth, premature birth, and low birthweight) according to a decisional algorithm, a method that gives preponderance to epidemiological arguments. On this basis, the group was able to show that the use of VDTs poses no increased risk of congenital anomalies, stillbirth, or premature birth. Consensus evaluation of divergent epidemiological results concluded that VDT work is not a risk factor significantly affecting spontaneous abortions. The risk of low birthweight could not be validly assessed.

A study whose aim was to define the role of psychological factors in prematurity etiology has led us to develop a methodology for evaluation of personality which could have a connection with the occurrence of a premature birth. The proposed method--interviews based on free association followed by the construction of questionnaires serving as a base for an epidemiological study--seem to us applicable in order to show the psychological components which intervene in the occurrence of a somatic illness.

The aim of this study is to identify social preventive measures in an attempt to prevent pre-term birth in pregnant women who work under strenuous conditions. A study carried out in 50 factories allowed us to gather data on 1168 pregnancies that occurred during 1 year and to study the modifications in working conditions now granted to pregnant women in many firms in France. We observed a significant relationship between 'episodes of sick leave' prescribed especially for fatigue (without any pathological reason) and a lower preterm birth rate. The potential benefit of rest-periods, granted to pregnant women working in strenuous conditions, is discussed.

The aim of this study was to determine the elements of fatigue in occupations which constitute possible risk factors for the course of a pregnancy, and, in particular, that could cause premature birth. In 1977-1978, a total of 3437 women in France were surveyed after giving birth in two maternity hospitals. One hospital was located in Lyon (a large city) and the other in Haguenau (a small town). Among 1928 working women, it was found that certain occupational categories are more prone to risk of prematurity than others. The authors carried out an analytical breakdown of the job into its diverse components which led them to define five sources of fatigue and to construct an index capable of detecting the strenuous working conditions. There is a significant relationship between the prematurity rate and the number of high fatigue scores observed in the job. When the number of scores varies from 0 to 5 the rate of premature births increases from 2.3% to 11.1%. This relationship remains significant after controlling for confounding factors.

The aim of this study was to determine the best preventive measures for employed pregnant women. Assuming that certain working conditions constitute a risk factor for preterm birth, should we give time off to women whose jobs are strenuous, reduce their weekly hours of work, or lengthen their antenatal maternity leave in an attempt to reduce risk of preterm birth? To answer this question, a survey carried out in 50 factories showed that a reduction of weekly working hours (routinely granted in many factories at present) appears helpful in reducing the preterm birth rate : this is also true for sick leaves granted for fatigue without pathological reason : on the other hand, the lengthening of antenatal maternity leave for fatigue, without medical reason, seems without effect. In the absence of experimental evaluation of preventive measures proposed at the end of this study, we provide a model for evaluating, theoretically, the relationship efficiency/cost/acceptability of such measures. Consequently, instead of lengthening antenatal maternity leave, we suggest prescribing 1 rest week (as sick leave) per month, beginning with the 4th month of pregnancy, for women working in strenuous conditions.