Elsevier

Obstetrics & Gynecology

Volume 98, Issue 3, September 2001, Pages 379-385
Obstetrics & Gynecology

Original research
Recurrence of preterm birth in singleton and twin pregnancies

https://doi.org/10.1016/S0029-7844(01)01466-1Get rights and content

Abstract

OBJECTIVE:

To assess recurrence of preterm birth and its impact on an obstetric population.

METHODS:

Women with consecutive births at our hospital beginning with their first pregnancy were identified (n = 15,945). The first pregnancy was categorized as delivered between 24 and 34 weeks’ gestation or 35 weeks or beyond, singleton or twin, and spontaneous or induced. The risk of preterm delivery in these same women during subsequent pregnancies was then analyzed.

RESULTS:

Compared with women who delivered a singleton at or beyond 35 weeks’ gestation in their first pregnancy, those who delivered a singleton before 35 weeks were at a significant increased risk for recurrence (odds ratio [OR] 5.6, 95% confidence interval [CI] 4.5, 7.0), whereas those who delivered twins were not (OR 1.9, 95% CI 0.46, 8.14). The OR for recurrent spontaneous preterm birth presenting with intact membranes was 7.9 (95% CI 5.6, 11.3) compared with 5.5 (95% CI 3.2, 9.4) with ruptured membranes. Of those women with a recurrent preterm birth, 49% delivered within 1 week of the gestational age of their first delivery and 70% delivered within 2 weeks. Among 15,863 nulliparous women with singleton births at their first delivery, a history of preterm birth in that pregnancy could predict only 10% of the preterm births that ultimately occurred in the entire obstetric population.

CONCLUSION:

In a population-based study at our hospital, women who initially delivered preterm and thus were identified to be at risk for recurrence ultimately accounted for only 10% of the prematurity problem in the cohort.

Section snippets

Materials and methods

Women with consecutive pregnancies, beginning with their first birth, and who were delivered at our hospital between January 1, 1988, and December 31, 1999, were identified using a computerized database. This database contains selected obstetric and neonatal outcomes for all women delivering infants at Parkland Hospital in Dallas, Texas. Nurses attending each delivery completed an obstetric data sheet, and research nurses prospectively reviewed all mother-infant charts to ensure completeness

Results

A total of 169,751 women delivered during the study period of which 15,945 (9%) were nulliparous women who ultimately delivered their first two or more consecutive pregnancies at our hospital and made up the study cohort. A total of 36,365 singleton infants were delivered of these women. The overall rate of spontaneous birth less than 35 weeks was 4% for women with singletons and 33% for those with twins. Shown in Table 1 is a comparison of demographic factors in women with or without singleton

Discussion

The results of our study suggest that when assessing a woman’s future risk of delivering a preterm infant based upon her obstetric history, several points must be considered. First, an obstetric history complicated by a twin delivery before 35 weeks’ gestation did not significantly increase subsequent risk for recurrence. Second, women whose first pregnancy ended in delivery of a singleton infant before 35 weeks were at increased risk of recurrence, and the cause of the first preterm birth also

References (15)

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