Epidemiology and causes of preterm birth

The Lancet 2008; 371:75-84

DOI:10.1016/S0140-6736(08)60074-4

Series, Preterm birth

Prof Robert L Goldenberg  a ,   Jennifer F Culhane PhD a,   Prof Jay D Iams MD b   and   Prof Roberto Romero MD c d

Summary

This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks’ gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12–13% in the USA and 5–9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM—together called spontaneous preterm births—are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.

Affiliations

a. Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA
b. Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, USA
c. Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI, USA
d. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA

Correspondence to: Prof Robert Goldenberg, Department of Obstetrics and Gynecology, Drexel University College of Medicine, 245 N 15th Street, 17th Floor, Room 17113, Philadelphia, PA 19102, USA

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Public Citizen Sues FDA to Force Agency to Act on Petition Seeking Stricter Antibiotic Warnings

Public Citizen Sues FDA to Force Agency to Act on Petition Seeking Stricter Antibiotic Warnings

Fuente: Public Citizen
Despite long-standing evidence that fluoroquinolone antibiotics such as CIPRO and LEVAQUIN can cause tendon ruptures, the Food and Drug Administration (FDA) has failed to increase its warnings to patients and physicians about the dangers of the medicines, Public Citizen told a federal court Thursday.

Public Citizen, the authors of WorstPills.org, sued in the U.S. District Court for the District of Columbia, asking the court to force the FDA to act upon a petition the consumer group filed with the agency 16 months ago. The FDA has failed to respond to the petition, which Public Citizen contends is a violation of the Administrative Procedure Act.

The petition. asked the agency to put a “black box” warning on fluoroquinolone antibiotics to make doctors and patients more aware of the risk of serious tendon injury before tendons actually rupture. A “black box” is the strongest type of warning the FDA can request.

The petition also urged the FDA to send a warning letter to physicians, as well as require an FDA-approved medication guide to be dispensed when prescriptions are filled.

Stronger warnings could lead to earlier intervention and prevent needless injuries by allowing doctors to switch patients to other antibiotics, according to Dr. Sidney Wolfe, editor of WorstPills.org.

“While the FDA sits idly by and ignores the problem, more people will suffer serious tendon ruptures that could have been prevented,” Wolfe said. “The current warning is buried in a long list of possible side effects and is far too easy to miss.”

From November 1997 through December 2005, the FDA received 262 reports of tendon ruptures, mainly of the Achilles tendon, 258 cases of tendinitis and 274 cases of other tendon disorders in patients using fluoroquinolone antibiotics. An additional 74 tendon ruptures have subsequently been reported to the FDA for a total of 336. Because only a small fraction of cases are typically reported to the FDA, the actual number of ruptures and other tendon injuries attributable to the antibiotic is much higher.

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Mortalidad de los pacientes ingresados con retención urinaria aguda

Armitage JN, Sibanda N, Cathcart PJ, Emberton M, van der Meulen JHP. Mortality in men admitted to hospital with acute urinary retention: database analysis. BMJ 2007; 335: 1199-1202.  R   TC   PDF

Introducción

La retención urinaria aguda (RUA) es una complicación derivada de la progresión de la hiperplasia benigna de próstata (HBP), aunque en algunos estudios se ha asociado su presencia a la de otras enfermedades graves.

Objetivo

Estudiar si la ocurrencia de una RUA en pacientes ingresados en el hospital se asocia a un mayor riesgo de muerte.

Perfil del estudio

Tipo de estudio: Estudio de cohortes

Área del estudio: Pronóstico

Ámbito del estudio: Comunitario

Métodos

Para este estudio se utilizaron los datos del Hospital Episode Statistics, una base de datos administrativa que recoge todos los ingresos en hospitales públicos de Inglaterra, que entre otros datos incluye los diagnósticos del paciente codificados según la CIE-10. Se incluyeron en el estudio los varones >45 años ingresados desde 1988 con el diagnóstico de RUA que no habían ingresado por este motivo en los 6 meses anteriores y para todos ellos se buscaron los datos de mortalidad a partir de la Office for National Statistics. Se excluyó a los pacientes con cáncer de próstata, esclerosis múltiple o enfermedad de Parkinson.

Para detectar la comorbilidad se utilizó una versión modificda de la escala de Charlson, para la que se tomaron en consideración los otros diagnósticos que constaban en el mismo episodio de ingreso hospitalario o en los de los 6 meses previos.

Se consideró que se trataba de una RUA espontánea si el diagnóstico principal del ingreso era RUA o HBP. En caso contrario se clasificó como precipitada. La variable de resultado principal fue la mortalidad a los 90 días y al año del ingreso. A partir de estos datos se calculó la razón estandarizada de mortalidad.

Resultados

Durante el periodo de estudio ingresaron con el diagnóstico de RUA 176.046 varones. El 56,8% fueron espontáneas. Durante el primer año murieron el 15% de los varones con RUA espontánea y el 25,3% de los que presentaron una RUA precipitada, lo que suponía un riesgo de muerte 2,2 y 3,5 veces respectivamente superior a la población general. La mortalidad absoluta aumentó de forma importante con la edad, pero las razones estandarizadas de mortalidad fueron superiores en los pacientes más jóvenes (fig.1).

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