Search

Müllerian anomalies such as Robert’s uterus, which was first described by the French gynaecologist Dr Helene Robert in 1969, are rare clinical entities and have been reported in

Objectives Fetal growth and size are associated with stillbirth risk. We wanted to investigate the week by week predictive value of fetal size at term on the prospective risk of stillbirth. Methods Anonymised database from the UK GAP program, with 2,094,702 term (≥37 weeks) deliveries including 4,670 stillbirths. Prospective stillbirth risk was defined as fetal death in the current week divided by total undelivered pregnancies. The data were analysed in five centile bands for stillbirth risk and risk ratios (RR) for 38, 39, 40 and 41+ weeks, using appropriate for gestational age (AGA) at 37 weeks as reference. Results Baseline stillbirth risk at 37 weeks was 0.29 per 1,000 and rose to 1.39 at 41+ weeks, with RR increasing to 4.8. In the 390 centile band, risk increased from 0.40 to 1.50 (RR 1.4 to 5.2) and for >97 centiles, it rose from 0.80 to 2.13 (RR 2.8–7.3). Conclusions Prospective risk of fetal death at term is related to fetal size. The information provided, together with other considerations and results of investigations where available, will help clinicians to determine the advice to give to mothers about the best timing for delivery, balancing the baby’s risk of compromise with iatrogenic sequelae of early delivery.

Human phenotype ontology; Prenatal diagnosis; Prenatal phenotyping Ontología del fenotipo humano; Diagnóstico prenatal; Fenotipado prenatal Ontologia del fenotip humà; Diagnòstic prenatal; Fenotipat prenatal Technological advances in both genome sequencing and prenatal imaging are increasing our ability to accurately recognize and diagnose Mendelian conditions prenatally. Phenotype-driven early genetic diagnosis of fetal genetic disease can help to strategize treatment options and clinical preventive measures during the perinatal period, to plan in utero therapies, and to inform parental decision-making. Fetal phenotypes of genetic diseases are often unique and at present are not well understood; more comprehensive knowledge about prenatal phenotypes and computational resources have an enormous potential to improve diagnostics and translational research. The Human Phenotype Ontology (HPO) has been widely used to support diagnostics and translational research in human genetics. To better support prenatal usage, the HPO consortium conducted a series of workshops with a group of domain experts in a variety of medical specialties, diagnostic techniques, as well as diseases and phenotypes related to prenatal medicine, including perinatal pathology, musculoskeletal anomalies, neurology, medical genetics, hydrops fetalis, craniofacial malformations, cardiology, neonatal-perinatal medicine, fetal medicine, placental pathology, prenatal imaging, and bioinformatics. We expanded the representation of prenatal phenotypes in HPO by adding 95 new phenotype terms under the Abnormality of prenatal development or birth (HP:0001197) grouping term, and revised definitions, synonyms, and disease annotations for most of the 152 terms that existed before the beginning of this effort. The expansion of prenatal phenotypes in HPO will support phenotype-driven prenatal exome and genome sequencing for precision genetic diagnostics of rare diseases to support prenatal care. European Commission; National Human Genome Research Institute; NIH Office of the Director; The European Union's EIT-Health Innovation Program bp2020-2022, Grant/Award Numbers: #211015, #20062; NIH Office of the Director (OD), the European Union's Horizon 2020 research and innovation program, Grant/Award Number: 779257; NHGRI, Grant/Award Numbers: 2R24OD011883-05A1, 1U24HG011449-01A1

Objectives To identify when obstetricians would deliver a fetus with antenatal hydronephrosis and normal liquor. Designed as snap-shot survey. Setting: Survey Monkey link. Population/sample were obstetrics and fetal medicine consultants who received the survey link via closed professional forums on the North West Coast Maternity Clinical Network, Facebook, and publicly on Twitter. Methods Survey link publicised as above, obstetric consultants were asked at what gestation would they deliver a fetus with antenatal hydronephrosis and normal liquor; and what criteria would they use to make that decision. Main outcome measures were number of years in practice, gestation at delivery, anteroposterior diameter (APD) of renal pelvis. Results A total of 44/102 respondents (43%) would deliver prior to 40 weeks (median no. of years as consultant 10 years [IQR 5–17]) vs. those who would not (median years as consultant 5.5 [IQR 3–12]). Re APD threshold of delivery: 17 indicated delivery if the APD were 20 mm, 10 if it were 21–30 mm and 16 if it were >30 mm. Re gestation at which they would deliver: 13 indicated 37–38 weeks, 13 indicated 38–39 weeks and 17 indicated 39–40 weeks. Reasons selected for delivery before term were obstetric anxiety n=2, maternal request n=2, maternal anxiety n=2 and concern about fatal renal damage/renal damage n=34. Conclusions A surprising number of respondents would consider early delivery of a fetus with hydronephrosis and normal liquor despite the lack of evidence of benefit. The evidence supporting term delivery means that early term delivery is only indicated for obstetric reasons in this scenario.

Background Generalised arterial calcification of infancy (GACI) is a rare disorder characterised by the deposition of hydroxyapatite crystals within the vessel walls. It is associated with a high mortality rate. Bisphosphonates have been used with some success in the treatment of GACI. However, there is a paucity of data on the antenatal use of bisphosphonates for GACI. In this paper, we report development of the skeletal changes suggestive of hypophosphatasia (HPP) in an infant with GACI, whose mother was treated with etidronate during pregnancy. Case report A Caucasian infant boy had a suspected antenatal diagnosis of GACI based on the findings suggestive of calcification of the annulus of the tricuspid valve and wall of the right ventricular (RV) outflow tract and main pulmonary artery on foetal echocardiography and the genetic analysis which showed a pathogenic heterozygous mutation in ABCC6. Based on these findings, mother was started on etidronate treatment from 26 weeks of gestation. A healthy male baby was delivered at 38 weeks of gestation. Initial postnatal echocardiogram on day 1 of life was normal with good biventricular function; subtle changes suggestive of microcalcifications were detected on the CT angiography. Serum calcium, phosphate, alkaline phosphatase and renal profile were normal. Further, the serum inorganic pyrophosphate (PPi) level was significantly low. Skeletal changes suggestive of HPP were seen on the radiographs. The baby developed cardiac dysfunction on day 4 of life with evidence of ischaemic changes on electrocardiogram (ECG). Treatment with etidronate was started in view of probable evolving coronary calcifications. Despite treatment with cardiac supportive measures and bisphosphonate, he succumbed to death in the third week of life. Discussion We believe, this is the first report of skeletal changes suggestive of HPP, arising secondary to antenatal etidronate (first generation bisphosphonate) used for the treatment of suspected GACI due to a heterozygous ABCC6 mutation., Highlights • Generalized arterial calcification of infancy is amineralisation defect due to low plasma inorganic pyrophosphate (PPi) . • Antenatal treatment with etidronate was found to be associated with skeletal changes suggestive of hypophosphatasia (HPP). • A contrasting radiographic feature of PPi excess state (HPP) is noted in the presence of a PPi deficient disease (GACI). • A close monitoring is warranted with an antenatal use of etidronate.

Background Antenatal detection of the small for gestational (SGA) fetus has become an important indicator of quality of antenatal care in the UK. This has been driven by a desire to reduce stillbirth in this at risk group. Methods We conducted a postal survey of 187 NHS consultant units within the UK to determine what the current practice for the detection and subsequent management of the suspected SGA fetus was following the guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2013. Results The survey was performed in 3 rounds between 2016 and 2017 with a response rate of 65%. 85% of units assessed risk factors for SGA at booking. 81% of units used a customized symphysis fundal height (SFH) chart to screen for SGA with 95% of them using a cut off of

The aim of this study was to compare the diagnostic accuracy of routine versus selective small for gestational age babies screening policy using data from two European Maternity Units. Methods for the antenatal detection of small for gestational age babies (SGA) differ between countries. This was a retrospective cohort study from Liverpool Women’s Hospital, UK, that uses selective third trimester sonography and from the University Hospital Centre Zagreb, Croatia, that uses routine third trimester sonography for SGA detection. Screen positive cases were defined as pregnancies with estimated fetal weight (EFW)

Objective To determine the accuracy of fetal and newborn growth charts for the prediction of small‐for‐gestational age (SGA ) at birth (birth weight

Background: In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia. Methods: In this parallel-group, non-masked, multicentre, randomised controlled trial done in 46 maternity units across England and Wales, we compared planned delivery versus expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia from 34 to less than 37 weeks' gestation and a singleton or dichorionic diamniotic twin pregnancy. The co-primary maternal outcome was a composite of maternal morbidity or recorded systolic blood pressure of at least 160 mm Hg with a superiority hypothesis. The co-primary perinatal outcome was a composite of perinatal deaths or neonatal unit admission up to infant hospital discharge with a non-inferiority hypothesis (non-inferiority margin of 10% difference in incidence). Analyses were by intention to treat, together with a per-protocol analysis for the perinatal outcome. The trial was prospectively registered with the ISRCTN registry, ISRCTN01879376. The trial is closed to recruitment but follow-up is ongoing. Findings: Between Sept 29, 2014, and Dec 10, 2018, 901 women were recruited. 450 women (448 women and 471 infants analysed) were allocated to planned delivery and 451 women (451 women and 475 infants analysed) to expectant management. The incidence of the co-primary maternal outcome was significantly lower in the planned delivery group (289 [65%] women) compared with the expectant management group (338 [75%] women; adjusted relative risk 0·86, 95% CI 0·79–0·94; p=0·0005). The incidence of the co-primary perinatal outcome by intention to treat was significantly higher in the planned delivery group (196 [42%] infants) compared with the expectant management group (159 [34%] infants; 1·26, 1·08–1·47; p=0·0034). The results from the per-protocol analysis were similar. There were nine serious adverse events in the planned delivery group and 12 in the expectant management group. Interpretation: There is strong evidence to suggest that planned delivery reduces maternal morbidity and severe hypertension compared with expectant management, with more neonatal unit admissions related to prematurity but no indicators of greater neonatal morbidity. This trade-off should be discussed with women with late preterm pre-eclampsia to allow shared decision making on timing of delivery. Funding: National Institute for Health Research Health Technology Assessment Programme.

Introduction A functionally single cardiac ventricle seen on foetal ultrasound scan carries a guarded prognosis. The antenatal diagnosis of anomalous pulmonary venous connection (APVC) remains challenging, if there is no associated structural cardiac abnormality. Antenatally, a combination of complex cardiac anomaly with suspected isomerism should raise the possibility of associated total anomalous pulmonary venous connection (TAPVC). There needs to be a high index of suspicion for TAPVC, in functional single ventricle and suspected isomerism, as this carries a very grim outcome postnatally. We illustrate foetal echocardiographic findings of suspected TAPVC and review outcomes of antenatal versus postnatal diagnosis of TAPVC with functional single ventricle. Methods We retrospectively reviewed our database over 13 years, focusing on foetal cardiac diagnosis, pregnancy outcomes, management and outcomes of livebirths with diagnosis of TAPVC with functional single ventricle. Results Thirteen patients were included in the review. For the nine antenatal patients, three pregnancies were terminated and six babies were born alive (four babies had compassionate care, two babies had cardiac surgery). One baby is alive at 8.5 years, after Fontan surgery. For the four postnatal patients, three babies had compassionate care (one alive at age 8.1 years) and one baby had cardiac surgery (died age nine weeks). Ten of the 13 patients have right atrial isomerism. Of these 10 patients, only two are alive. For the three non-isomeric babies, only one baby is still alive. There is heterogeneity of the type of TAPVC diagnosed with no particular group that offered better survival. Conclusion Antenatal diagnosis of TAPVC, even in the context of functional single ventricle remains challenging. If isomerism is suspected, targeted evaluation of pulmonary venous connection should be done. This combination of cardiac lesion carries a very grim outcome. The ability to make this diagnosis antenatally will add to the information and counselling given to these parents.

Summary Background Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero. Methods We did this superiority, placebo-controlled randomised trial in 19 fetal medicine units in the UK. We used random computer allocation (1:1) to assign women with singleton pregnancies between 22 weeks and 0 days' gestation and 29 weeks and 6 days' gestation and severe early-onset fetal growth restriction to receive either sildenafil 25 mg three times daily or placebo until 32 weeks and 0 days' gestation or delivery. We stratified women by site and by their gestational age at randomisation (before week 26 and 0 days or at week 26 and 0 days or later). We defined fetal growth restriction as a combination of estimated fetal weight or abdominal circumference below tenth percentile and absent or reversed end-diastolic blood flow in the umbilical artery on Doppler velocimetry. The primary outcome was the time from randomisation to delivery, measured in days. This study is registered with BioMed Central, number ISRCTN 39133303. Findings Between Nov 21, 2014, and July 6, 2016, we recruited 135 women and randomly assigned 70 women to sildenafil and 65 women to placebo. We found no difference in the median randomisation to delivery interval between women assigned to sildenafil (17 days [IQR 7–24]) and women assigned to placebo (18 days [8–28]; p=0·23). Livebirths (relative risk [RR] 1·06, 95% CI 0·84 to 1·33; p=0·62), fetal deaths (0·89, 0·54 to 1·45; p=0·64), neonatal deaths (1·33, 0·54 to 3·28; p=0·53), and birthweight (−14 g,–100 to 126; p=0·81) did not differ between groups. No differences were found for any other secondary outcomes. Eight serious adverse events were reported during the course of the study (six in the placebo group and two in the sildenafil group); none of these were attributed to sildenafil. Interpretation Sildenafil did not prolong pregnancy or improve pregnancy outcomes in severe early-onset fetal growth restriction and therefore it should not be prescribed for this indication outside of research studies with explicit participants' consent. Funding National Institute for Health Research and Medical Research Council.

This prospective study assessed von Willebrand factor (VWF) expression in the endometrium using immunohistochemical staining in women with menorrhagia with or without von Willebrand disease (VWD) compared with a control group of women with normal menstrual loss. Endometrial VWF expression is significantly lower in women with VWD, which may play a local underlying role in pathogenesis of menorrhagia in these women.

A 25-year-old gravida 2 had two right cerebral hemispheric infarcts documented on magnetic resonance imaging (MRI) and computed tomography (CT) scan at 23 and 31 weeks of pregnancy. Investigations failed to reveal any cause. She was empirically treated with heparin, aspirin and nimodipine and had a successful perinatal outcome.

An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death. Clinical examination aroused suspicion of non-communicating uterine horn with bicornuate uterus. Examination under anaesthesia and laparotomy revealed a partial vaginal septum, complete septate uterus with septum deviated to one side and fetus lying in the non-communicating right blind hemicavity (Robert's uterus). Hysterotomy and ipsilateral tubal ligation were performed.

Background. Distant metastasis in carcinoma of uterine cervix is a rare manifestation and bone metastasis is uncommon. Case. A 60-year-old woman treated by radical radiotherapy for moderately differentiated cervical carcinoma FIGO stage IIIB presented 4 months later with swelling over right side of the scalp. Fine needle aspiration cytology from swelling showed poorly differentiated metastatic carcinoma. X-ray of the skull was suggestive of osteolytic metastasis of calvaria. Conclusion. Bone metastasis in cervical carcinoma is a late manifestation of advanced malignancy and heralds poor prognosis. Scalp metastasis is a very rarely reported phenomenon.

This paper reports on an atypical presentation of imperforate hymen. A case of silent massive hematocolpos in a 11-year-old girl mimicking as a giant ovarian cyst is described. The diagnosis was made after examination under anesthesia. Successful surgery was then performed. We conclude that hematocolpos should always be included in the differential diagnosis of cystic pelvic pathology in perimenarcheal girls even in the absence of clinical symptom of cyclical lower abdominal pain.

A case of penetrating vaginal injury causing vesicovaginal and rectovaginal fistula, bladder perforation, perineal tear, mesenteric, and small bowel injury is described. Its surgical management is presented.

Background: Social deprivation is associated with higher rates of preterm birth and subsequent infant mortality. Our objective was to identify risk factors for preterm birth in the UK's largest maternity unit, with a particular focus on social deprivation, and related factors. Methodology/Principal Findings: Retrospective cohort study of 39,873 women in Liverpool, UK, from 2002-2008. Singleton pregnancies were stratified into uncomplicated low risk pregnancies and a high risk group complicated by medical problems. Multiple logistic regression, and generalized additive models were used to explore the effect of covariates including area deprivation, smoking status, BMI, parity and ethnicity on the risk of preterm birth (34(+0) weeks). In the low risk group, preterm birth rates increased with deprivation, reaching 1.6% (CI95 1.4 to 1.8) in the most deprived quintile; the unadjusted odds ratio comparing an individual in the most deprived quintile, to one in the least deprived quintile was 1.5 (CI95 1.2 to 1.9). Being underweight and smoking were both independently associated with preterm birth in the low risk group, and adjusting for these factors explained the association between deprivation and preterm birth. Preterm birth was five times more likely in the high risk group (RR 4.8 CI95 4.3 to 5.4), and there was no significant relationship with deprivation. Conclusions: Deprivation has significant impact on preterm birth rates in low risk women. The relationship between low socio-economic status and preterm births appears to be related to low maternal weight and smoking in more deprived groups.

Imaging of the paediatric gynaecological tract encompasses patients with vastly different physiology ranging from the neonate under maternal hormonal influence to the post-pubertal young adolescent. Ultrasound is the mainstay of imaging of the genitourinary tract. In specific clinical circumstances, cross-sectional imaging may be necessary. Magnetic resonance imaging (MRI) with its intrinsic high soft tissue contrast and multiplanar capability is preferred but will usually necessitate some of form of sedation in the younger child. Computed tomography (CT) is preferably avoided because of ionising radiation exposure. Contrast examinations are specialised imaging procedures for specific conditions. This chapter considers the various imaging modalities available for the investigation of gynaecological disorders in children.

An extremely rare case of vulval lipoma is being reported for its rarity and brief review discussed.

An extremely rare case of vaginal birth of preterm conjoined thoracopagus twins diagnosed after delivery is being described and brief review of literature discussed.

A 20-year-old primigravida initially diagnosed at 28 weeks to have superfetation in a case of a bicornuate uterus was subsequently found to have uterus pseudo didelphys during a cesarean section at 35 weeks. This type of uterine anomaly with twin gestation has been previously reported in five case reports, but superfetation with such mullerian abnormality has not been previously described.

Intrapartum uterine rupture is a well-documented complication of labor that fortunately is a rare event. The majority of these cases arise in women with scarred uteri secondary to some event such as previous cesarean section myomectomy deep cornual resection metroplasty tubo-cornual anastomosis iatrogenic or traumatic uterine rupture. Vaginal birth after cesarean (VBAC) is now a safe and well-accepted procedure of conduct in women with one previous lower segment cesarean section (LSCS). Uterine rupture in such women commonly involves the anteriorly placed scar. Posterior rupture in women in whom VBAC was attempted has also been reported although only twice in the literature. Here we report a similar case of posterior uterine rupture in a woman in labor with a previous LSCS to add further data to this rare and isolated complication. (excerpt)

Acardiac twinning is the most extreme form of twin-twin transfusion syndrome occurring in monzygotic twin pregnancies with monochorionic placentation. A case of acardiac amorphous foetus, occurring in association with spontaneously conceived triplet pregnancy, diagnosed on ultrasound in early second trimester is described and its antenatal management and brief review of literature discussed.

A 55-year-old postmenopausal lady presented with signs and symptoms of ovarian malignancy. Laparotomy revealed a 8 x 8-cm degenerated, cystic and haemorrhagic mass arising from left broad ligament which on histopathology proved to be leiomyosarcoma.

Neurofibromatosis in pregnancy has been associated with poor perinatal outcome. A 30-year-old multigravida developed peripheral lesions of neurofibromatosis during the third month of pregnancy. She had eclampsia complicated with fatal left-sided massive intracerebral haemorrhage detected on computed tomography at 8.5 months gestation. Investigations were suggestive of HELLP syndrome. A still-born male baby was delivered. In spite of all supportive measures the patient died on the third postpartum day. We conclude that recent onset neurofibromatosis in current pregnancy should be considered as a predictor of potentially adverse maternal and fetal outcome and such pregnancies be managed in tertiary level referral centre.

Recurrent vaginal discharge in children may be due to variety of causes. Intravaginal foreign body retained for long duration can be a diagnostic dilemma. This report presents the case of a girl who had an intravaginal foreign body for over four years duration. Recurrent, unremitting, foul-smelling, bloody vaginal discharge in a child should alert the clinician to the possibility of a retained vaginal foreign body.

Two cases of Cantrell syndrome occurring over a ten year period are described. One was detected following caesarean section at term and the other underwent termination of pregnancy at 20 weeks following antenatal diagnosis by ultrasound.

A 23-year-old woman, Gravida 3, Para 2 presented following termination of a 10 weeks pregnancy by an unauthorised local practitioner 2 days earlier with complains of severe pain in lower abdomen, recurrent vomiting and inability to pass stools or flatus for 24 h. She was hypothermic, pale and dehydrated with a pulse rate of 100/min and blood pressure of 90/70 mmHg. The respiratory and cardiovascular system examination were normal. The abdomen was distended, tense and tender with guarding and rigidity all over. Shifting dullness was present and bowel sounds were sluggish. On speculum examination, blood clots were seen in the vagina and the cervical os was not visualised. On vaginal palpation the os was open, with tissue fragments felt in the vagina which could not be removed. There was severe lower abdominal tenderness and both fornices appeared full. The exact size of the uterus could not be made out as the patient was very tender. An erect abdominal X-ray revealed the presence of gas under the diaphragm and ultrasound of the abdomen was suggestive of multiple organised fluid pockets with dilated bowel loops. A provisional diagnosis of septic abortion with uterine and gut perforation with peritonitis was made, and the patient was prepared for exploratory laparotomy. At operation fecal peritonitis was present with about 2 l of dirty foul smelling fluid. The uterus was normal in shape and size with multiple loops of ileum seen entering it via a fundal perforation (Fig. 1). The loops could not be extracted even after giving pressure through the vagina. Bowel exploration revealed a terminal gangrenous ileum within 5 cm of the ilieo–caecal junction. A single 1 cm 1 cm perforation was found in the ileum proximal to the gangrenous area. Total abdominal hysterectomy with right hemicolectomy with excision of the gangrenous bowel (Fig. 2) with ileo-transverse anastomosis with peritoneal lavage was done. Two drains were left in the peritoneal cavity—one in the pelvis and the other in Morrison’s pouch. Intraoperatively, she received 6 units of whole blood and 4 units of plasma. On postoperative day 7, her condition deteriorated suddenly, and fecal matter started discharging from the abdominal wound. A repeat laparotomy confirmed an ilieo–colic anastomotic leak. Closure of the colon segment with terminal ileostomy was done. She had a stormy postoperative course complicated by septicaemia and chest infection requiring ventilatory support for 10 days. She was discharged in satisfactory condition on postoperative day 27 and closure of the ileostomy was successfully accomplished 3 months later.

Objective To explore risk factors for preterm birth (PTB) between 24+0 and 34+0 gestational weeks in the UK9s largest maternity unit, with a particular focus on low risk pregnancies and the effect of socioeconomic status. Design Retrospective cohort study of routinely collected obstetric and neonatal data. Setting 50 486 singleton pregnancies booked at the Liverpool Women9s NHS Foundation Trust for all women delivering after 24+0 weeks gestation over a 7-year period from 2002 to to 2008. Main Outcome Measure The primary outcome was preterm birth. Pregnancies were stratified into three groups: low risk; those complicated by medical problems; pregnancies in women with a history of preterm delivery. Multiple logistic regression and generalised additive models were used to explore the effect of covariates including area deprivation, smoking status, BMI, parity and ethnicity. Results The proportion of PTB was significantly different in the three groups: 1.35% (95% CI 1.24 to 1.47, n=38 994) in the low risk group, compared to 6.55% (CI 6.09 to 7.03, n=10 760) in the medical disorder group and 9.2% (CI 7.39 to 11.61, n=732) in the previous preterm group. 64% of the women delivering at LWH were in the most deprived quintile relative to the English population. The unadjusted odds of preterm delivery in the most deprived quintile compared to the least was 1.60 (CI 1.28 to 2.00) in the uncomplicated group. In a multiple regression model, ever having smoked (OR 1.68 CI 1.35 to 2.08), underweight (OR 1.65 CI 1.005 to 2.56) and highest quintile of area deprivation (OR 1.59 CI 1.19 to 2.11) were associated with increased the risk of PTB. Being overweight decreased the risk of PTB (OR 0.76 CI 0.59 to 0.97). In the medical disorders group, age (OR 1.02 CI 1.011 to 1.04), highest quintile of area deprivation (OR 1.46 CI 1.14 to 1.88), underweight (OR 1.68 CI 1.09 to 2.51), ever having smoked (OR 1.19 CI 1.00 to 1.44), nulliparity (OR 1.37 CI 1.13 to 1.66) and black ethnic group (OR 1.61 CI 1.00 to 2.48) were associated with PTB. Conclusions Preterm delivery contributes to inequalities in infant mortality. In a cohort of women with no identifiable risk factors for PTB at booking, deprivation of area of residence is associated with higher risk of PTB, even with adjustment for smoking and underweight, which are also important independent risk factors. Deprivation of area of residence needs to be considered when comparing obstetric outcomes in units around the UK.