Academic journal article Central European Journal of Public Health

Association of Very High Hungarian Rate of Preterm Births with Cervical Incompetence in Pregnant Women

Academic journal article Central European Journal of Public Health

Association of Very High Hungarian Rate of Preterm Births with Cervical Incompetence in Pregnant Women

Article excerpt

SUMMARY

Background: Maternal cervical incompetence in pregnancy (CIP) showed an association with a higher rate of preterm births. The objective of this study was to determine the prevalence of CIP in Hungarian pregnant women, to determine the rate of preterm birth, and to check the preventive efficacy of preterm births due to CIP by therapeutic cerclage or bed rest alone.

Methods: Analysis of the population-based large data set of 38,151 newborns (without any defects) of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), bom during 1980-1996, i.e. 1.8% of Hungarian newborns. Prospective cohort analysis based on medically recorded variables of CIP, birth weight and gestational age.

Results: A total of 2,795 (7.33%) newborns bom to mothers with CIP. The newborns of mothers with CIP had a shorter gestational age at delivery (39.0 wk) and higher rate of preterm birth (11.1 %) than the Hungarian reference sample without CIP (39.4 wk and 9.0%). Of 2,795 pregnant women with CIP 1,112 were treated by cerclage, while 1,683 with bed rest alone. The mean gestational age was shorter both after therapeutic cerclage (39.2 wk) and particularly bed rest alone (38.9 wk). The rate of preterm births was 9.1 % and 12.7% after therapeutic cerclage and bed rest alone.

Conclusions: CIP is very frequent in Hungary probably due the extremely high number of previous induced abortion performed by dilatation and curettage method. CIP associates with an increased risk for preterm births; however, this increased risk was reduced by bed rest alone and mainly by therapeutic cerclage.

Key words: maternal cervical incompetence, preterm birth, therapeutic cerclage, bed rest alone

INTRODUCTION

The rate of preterm births is extremely high (about 9%) in Hungary (1) and preterm babies associated with about one-third of infant mortality in the 2000s (2) and with a major part of mental retardation (3), visual (4) and other handicaps. Thus it is an important public health task to reveal the possible causes of preterm birth and prevent them.

Some well-known causes of preterm births, e.g. multiple pregnancies cannot be prevented, while other causes such as sexually transmitted infections/diseases are preventable (5, 6). However, we have to elucidate the role of other factors in the origin of preterm births.

The first objective of our study was to determine the prevalence of cervical incompetence in pregnancy (CIP) in Hungary. The second aim of the study was to measure the association between CIP and the rate of preterm births, i.e. estimation of preterm birth risk due to CIP. Finally the third objective of the study was to check the efficacy of CIP treatment.

At present two kinds of CIP treatment compete with each other in Hungary. One group of obstetricians prefers the prophylactic surgical intervention used previously the Shirodkar suture (7), later therapeutic McDonald cerclage (8). Another group of obstetricians gives preference to the conservative treatment based on lasting bed-rest alone because some previous studies were not able to show the advantage of therapeutic cerclage (9). Thus we evaluated the rate of preterm births as an indicator of efficacy of the above two medical treatments in women with CIP.

The data of the population-based large data set of newborns without congenital abnormalities (the so-called controls) of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) (10, 6) were evaluated in the study.

MATERIALS AND METHODS

Newborn infants without congenital abnormalities were selected from the National Birth Registry of the Central Statistical Office for the HCCSCA. These newborns were controls of cases with congenital abnormality that were selected from the Hungarian Congenital Abnormality Registry (11) for the HCCSCA. Here only controls are evaluated because congenital abnormalities may have a more drastic effect for birth outcomes, e. …

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