Detection and risk stratification of women at high risk of preterm birth in rural communities near Nagpur, India.
Detection and risk stratification of women at high risk of preterm birth in rural communities near Nagpur, India.
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DOI：
10.1186/s12884-017-1504-4
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发表时间：
2017-09-19
影响因子：
3.1
通讯作者：
Hibberd P
中科院分区：
文献类型：
--
作者：
Patel A;Prakash AA;Pusdekar YV;Kulkarni H;Hibberd P
目前，早产是全球新生儿死亡的主要原因。以社区为基础及时识别早产高危妇女既可以帮助避免早产，也可以采取有效的干预措施，降低早产造成的新生儿死亡率。我们评估了培训社区工作者检测HRPB体征或症状的一揽子方案的性能。在印度纳格布尔进行的一项孕妇皮质类固醇的随机分组试验（ACT试验）中，将4种可直接观察到的早产体征和症状告知入组的孕妇。社区卫生工作者积极监测这些妇女从妊娠24至36周的这些体征或症状。如果她们在场（HRPB呈阳性），则将确定的妇女带到政府卫生设施进行评估和管理。如果妇女直接到设施，也可以由提供者确定HRPB阳性。风险分层是基于存在的体征或症状的数量。早产的结局基于分娩时胎龄< 37周或出生体重<2000 g的临床评估。在2012年7月1日至2013年11月30日期间，7050名孕妇中有686名（9.7%）早产。732例（10.4%）HRPB阳性，其中333例（45.5%）早产。其余6318例（89.6%）HRPB阴性妇女中，353例（5.6%）早产。HRPB阳性早产的似然比（LR）为8.14（95%置信区间7.16-9.26）。早产的LR增加的妇女有更多的HRBP的迹象或症状（p < 0.00001）。HRPB的更多体征或症状也与分娩时间较短、出生体重较低、死胎率较高、新生儿死亡率较高和产后并发症有关。增加风险分层改善了早产的预测（综合判别力改善17%（95% CI 15-19%））。用于检测HRPB的体征和症状的包是可行的，有前途的，并有可能改善早产的管理。 2010年2月21日的NCT 01073475和2010年3月9日的NCT 01084096。
Presently, preterm birth is globally the leading cause of neonatal mortality. Prompt community based identification of women at high risk for preterm births (HRPB) can either help to avert preterm births or avail effective interventions to reduce neonatal mortality due to preterm births. We evaluated the performance of a package to train community workers to detect the presence of signs or symptoms of HRPB. Pregnant women enrolled in the intervention arm of a cluster randomized trial of Antenatal Corticosteroids (ACT Trial) conducted at Nagpur, India were informed about 4 directly observable signs and symptoms of preterm labor. Community health workers actively monitored these women from 24 to 36 weeks of gestation for these signs or symptoms. If they were present (HRPB positive) the identified women were brought to government health facilities for assessment and management. HRPB positive could also be determined by the provider if the woman presented directly to the facility. Risk stratification was based on the number of signs or symptoms present. The outcome of preterm birth was based on the clinical assessment of gestational age < 37 weeks at delivery or a birth weight of <2000 g. Between July 1, 2012 and 30 November, 2013, 686 of 7050 (9.7%) pregnant women studied, delivered preterm. 732 (10.4%) women were HRPB positive, of whom 333 (45.5%) delivered preterm. Of the remaining 6318(89.6%) HRPB negative women 353 (5.6%) delivered preterm. The likelihood ratio (LR) of a preterm birth in the HRPB positives was 8.14 (95% confidence interval 7.16–9.26). The LR of a preterm birth increased in women who had more signs or symptoms of HRBP (p < 0.00001). More signs or symptoms of HRPB were also associated with a shorter time to delivery, lower birth weight and higher rates of stillbirths, neonatal deaths and postnatal complications. Addition of risk stratification improved the prediction of preterm delivery (Integrated Discrimination Improvement 17% (95% CI 15–19%)). The package for detection of signs and symptoms of HRPB is feasible, promising and likely to improve management of preterm labor. NCT01073475 on February 21, 2010 and NCT01084096 on March 9, 2010.
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影响因子：
3.8
作者：
Goudar, Shivaprasad S.;Carlo, Waldemar A.;McClure, Elizabeth M.;Pasha, Omrana;Patel, Archana;Esamai, Fabian;Chomba, Elwyn;Garces, Ana;Althabe, Fernando;Kodkany, Bhalachandra;Sami, Neelofar;Derman, Richard J.;Hibberd, Patricia L.;Liechty, Edward A.;Krebs, Nancy F.;Hambidge, K. Michael;Buekens, Pierre;Moore, Janet;Wallace, Dennis;Jobe, Alan H.;Koso-Thomas, Marion;Wright, Linda L.;Goldenberg, Robert L.
通讯作者：
Goldenberg, Robert L.
影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
影响因子：
5.7
作者：
BOYKO, EJ;ALDERMAN, BW;BARON, AE
通讯作者：
BARON, AE
DOI：
10.4137/cmwh.s34684
发表时间：
2016-01-01
期刊：
CLINICAL MEDICINE INSIGHTS-WOMENS HEALTH
影响因子：
--
作者：
Satterfield, Nichelle;Newton, Edward R.;May, Linda E.
通讯作者：
May, Linda E.
影响因子：
168.9
作者：
Blencowe, Hannah;Cousens, Simon;Lawn, Joy E.
通讯作者：
Lawn, Joy E.