الفهرس 
PRETERM BIRTHOnly 14 pages are availabe for public view
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Abstract
P
reterm birth is the main cause of perinatal morbidity and mortality around the world. Risk factors for preterm labour include premature rupture of membranes, short cervix, infection, previous preterm labour, multiple pregnancy, maternal age > 35 years, African American descent, and smoking.
There is enough evidence to support the pathophysiological mechanism that microorganisms from the lower genital tract could cross the cervical canal and reach the decidua, especially when the cervix is shortened. It was observed that patients with preterm birth before 34 weeks have higher concentrations of interleukin 6 and white blood cells amniotic fluid, supporting the role of inflammation in the genesis of preterm labor and preterm birth. The clinical expression of amniotic inflammation is more common than proven by biochemical methods in patients with preterm labor and intact membranes; and one possibility is that these patients suffer some degree of amniotic inflammation and even infection that cannot be proven by current methods.
This randomized controlled clinical trial aimed to assess the efficacy of antenatal prophylactic Azithromycin in preventing preterm labor in pregnant women who underwent vaginal cerclage in Ain Shams University Maternity Hospital in the period from April 2019 to April 2020. Patients were randomized into two groups. Azithromycin group included 23 women received 500mg Azithromycin one tablet orally once daily for three days every month from 14weeks to 34 weeks in addition to routine usual antenatal care. While non-Azithromycin group included 22 women received routine antenatal care without antibiotic prophylaxis after cerclage. All cases were subjected to routine ANC history with special comment on history of infection as (pain, bleeding, offensive discharge), routine ANC examination with special comment on signs of infection (fever, tachycardia) and labs (CBC, Urine analysis, etc) and ultrasound
Our results showed that:
The gestational age at pregnancy termination (36.8 wks±0.9 versus 34.1 wks±4.8) and GA prolongation (23.7 wks±1.0 versus 21.1 wks±4.8) were significantly higher among azithromycin group than non azithromycin group (p=0.017 &0.005 respectively).
Miscarriage and stillbirth were not significantly different among azithromycin group and non azithromycin group (p=0.490&0.490 respectively). The documented viable neonate was more in the azithromycin group (23 (100.0%)) than the non azithromycin group (18 (81.8%)) and there is significant difference between the two groups (p= 0.049). Cesarean section was non-significantly less frequent among azithromycin group (10 (43.6%)) than non azithromycin group (12 (56.5%)) as (p=0.458).
Neonatal birth weight was significantly higher among azithromycin group (2932.6±246.6) than non azithromycin group (2401.8±851.5) as p=0.006. Low birth weight was non-significantly less frequent among azithromycin group (3 (13.0%)) than among non azithromycin group (7 (31.8%)) as (p= 0.165).
NICU admission was non-significantly less frequent among azithromycin group (1 (4.3%) versus 5 (22.7%) in non azithromycin group) as (p= 0.096). NICU admission duration was non-significantly shorter among azithromycin group than non azithromycin group (p=1).
Antepartum hemorrhage (0% versus 3 (13.6%)), Blood transfusion (0 versus 1 (4.5%)) and postpartum pyrexia (1 (4.3%) versus 2 (9.1%)) were non-significantly less frequent among azithromycin group than non azithromycin group respectively.