胎膜早破后残余羊水量对妊娠结局的影响

目的探究胎膜早破后残余羊水量对妊娠结局的影响。方法回顾性分析2015年1月-2017年1月该院收治的112例胎膜早破孕妇的临床资料,根据羊水指数(AFI)将患者分为残余羊水量正常组(8 cm≤AFI<25 cm)62例、残余羊水量偏少组(5 cm≤AFI<8 cm)25例和残余羊水量过少组(AFI<5 cm)25例。比较两组患者分娩相关指标及妊娠结局。结果残余羊水量过少组孕妇分娩孕周明显低于残余羊水量偏少组和残余羊水量正常组,新生儿出生体质量明显低于残余羊水量偏少组和残余羊水量正常组,组间比较差异有统计学意义(P<0.05)。3组产妇年龄、剖宫产分娩数及非头先露数比较,差异无统计学意义(P>0.05)。残余羊水量过少组新生儿窒息率(16.00%)、新生儿呼吸窘迫综合征发生率(12.00%)、低出生体质量儿发生率(80.00%)及新生儿病死率(8.00%)均显著高于残余羊水量偏少组(0、0、56.00%、0)和残余羊水量正常组(3.23%、1.61%、50.00%、0),组间比较差异有统计学意义(P<0.05)。3组新生儿胎儿窘迫发生率比较,差异无统计学意义(P>0.05)。残余羊水量过少组患者子宫内膜炎(12.00%)、绒毛膜羊膜炎(24.00%)及白细胞计数(WBC)>15×10~9/L或粒细胞比值>0.9发生率(80.00%)显著高于残余羊水量偏少组(0、0、56.00%)和残余羊水量正常组(1.61%、3.23%、50.00%),组间比较差异有统计学意义(P<0.05)。3组产妇产后出血、发热发生率比较,差异无统计学意义(P>0.05)。胎膜早破后残余羊水量过少组新生儿窒息发生率是残余羊水量正常组的7倍左右,低出生体质量儿发生率约是其4倍,新生儿呼吸窘迫综合征及子宫内膜炎发生率约为其14倍。结论胎膜早破后残余羊水量与妊娠结局密切相关,应严密监测胎膜早破患者残余羊水量并及时采取有效措施防止新生儿出现胎儿窘迫等情况,有效避免不良妊娠结局的发生。     

超声羊水指数临界值对临床的指导意义

目的:羊水指数临界值对临床指导意义的研究。方法:对494例≥37周的足月孕妇进行羊水指数(AFI)测定,临床观察胎儿宫内窘迫及羊水情况。结果:AFI5.1～8.0cm的胎儿宫内窘迫(CFD)、羊水量(AFQ)过少、胎粪污染(MSAF)的发生率明显低于AFI8.1～9.9cm。AFI与CFD、AFQ(≤300ml)、MSAF两组间敏感性比较有显著差异(P<0.05)。结论:将羊水指数临界值定为5.1～9.9cm,可以明显提高AFI在判定CFD、AFQ(≤300ml)、MSAF时的敏感性,对指导临床具有实际意义。     

羊水过少的原因及对妊娠结局的影响

目的探讨羊水过少可能的原因及羊水过少对妊娠结局的影响,寻找增加羊水量的方法。方法采用回顾性对照研究,对我院2002年1月~2005年6月分娩孕妇的临床资料进行研究。以及对于部分5cm<羊水指数(AFI)<8cm的孕妇进行静脉输液治疗后AFI的变化。结果羊水过少的孕妇中脐带缠绕的发生率明显增加。剖宫产率羊水过少组是非羊水过少组的2.29倍。静脉输液治疗对部分羊水过少的孕妇有用。结论脐带缠绕也可能是导致羊水过少的原因之一。羊水过少孕产妇中剖宫产的危险性增加。寻找快速、安全、有效增加羊水量的方法值得进一步探讨。     

羊水过少51例临床分析

羊水过少严重影响围产儿的预后。我院在1995～1998年对51例羊水过少的剖宜产病例进行临床分析,现报道如下。1 临床资料1.1 一般资料 3年间我院共分娩9650例,其中剖宫产1351例,因羊水过少行剖宫产终止妊娠51例,占剖宫产分娩总数的3.8％。其中合并有其它高危因素者40例,B超提示羊水指数(AFI)正常,而实际羊水过少者8例。1.2 诊断标准1.2.1 以B超AFI≤8.0为羊水过少临界值,AFI<5.0cm为羊     

静脉输液加饮水疗法治疗羊水过少的临床效果

目的探讨静脉输液加饮水疗法治疗羊水过少的治疗效果。方法对孕30～36周行B超检查确诊为羊水过少的孕妇120例,每日给予5%葡萄糖氯化钠500mL、0.9%生理盐水500mL、乳酸林格氏液500mL、10%葡萄糖500mL加维生素C2g静滴,并嘱每日饮水2500mL,连续7d。结果 7d后复查B超测定羊水指数(AFI),AFI增加>2cm者102例(显效85%);AFI增加>1cm者12例(有效10%);无效6例,总有效率95%。结论静脉输液加饮水疗法治疗羊水过少,其简单、有效、安全、无副作用,值得临床推广使用。     

足月妊娠羊水过少对围产结局的影响

目的 :分析足月妊娠孕产妇羊水过少对围产结局的影响。方法 :应用 B超羊水最大深度法及羊水指数法估测羊水量 ,并测定脐动脉收缩期最大血流速度 (S)和舒张末期血流速度 (D)的比值 (S/D) ,比较分析 2 4 0例羊水过少 (观察组 )和 2 4 0例羊水正常的足月妊娠妇女 (对照组 ) B超测量羊水量与实际过少的符合率、分娩情况及新生儿预后。结果 :AFI小于 3.5 cm时 ,B超测量羊水量与实际羊水过少符合率为 10 0 % ;AFI为 3.5～ 5 .0 cm时为 80 % ;AFI为 5～ 8cm时为 5 8% ;观察组择期剖宫产和急诊剖宫产率均显著高于对照组 (P<0 .0 1) ;阴道分娩的成功率明显低于对照组 (P<0 .0 1) ;胎儿宫内窘迫与羊水轻度混浊的发生率明显高于对照组 (P<0 .0 1) ;新生儿轻度窒息发生率明显高于对照组 (P<0 .0 1) ;重度窒息率两组间差异无显著性 (P>0 .0 5 )。结论 :加强对羊水过少的产前及产时监护 ,对重度羊水过少者不予试产 ,对试产的孕产妇产程中出现异常及时行急诊剖宫产而不过度试产。对于羊水过少 ,同时又合并其它高危因素者 ,应禁止试产 ,以剖宫产结束妊娠。     

妊娠晚期羊水指数减少对妊娠结局的影响

目的:探讨孕晚期羊水指数减少对妊娠结局以及围生儿情况的影响。方法:选择2011年4月～2012年2月确诊的78例羊水指数减少的孕妇为研究组,随机选取同期93例羊水正常的孕产妇为对照组,比较两组孕妇的并发症发生率、分娩方式及围生儿情况(脐带绕颈、胎儿窘迫、生长受限、新生儿窒息等)。结果:研究组妊娠并发症发生率和围生儿并发症发生率明显高于对照组(P<0.05),研究组剖宫产例数也显著高于对照组(P<0.05)。结论:羊水指数减少不仅是影响妊娠结局的重要因素,也是孕晚期影响胎儿健康的危险信号,临床上应加强进行产前监测,对羊水指数减少的孕妇采取积极的处理和干预,以改善围生儿预后。     

母体水化疗法治疗妊娠晚期羊水过少临床疗效分析

目的:探讨母体水化疗法对妊娠晚期羊水过少患者的治疗效果。方法:将58例妊娠28～36周确诊为羊水过少(ROH)孕妇随机分为两组,每组29人。饮水疗法组采取饮水疗法,静脉补液组采取静脉补液疗法,7天后行B超复查羊水AFI值,如AFI≤8.0 cm者继续重复疗程1次,治疗后对照其羊水AFI值的变化;另选48例妊娠28～36周确诊为羊水过少患者为对照组,除加强监护外未予特殊处理。各组临产后均予阴道试产,分析比较各组试产后的分娩结局。结果:饮水疗法及静脉补液组治疗后AFI增长与治疗前相比差异有统计学意义(P<0.01)。对照组急诊剖宫产率、新生儿窒息发生率显著高于饮水疗法及静脉补液组,差异有统计学意义(P<0.05),新生儿吸入性肺炎发生率差异有统计学意义(P<0.01)。结论 :母体水化疗法对妊娠晚期无明显妊娠合并症,对ROH患者的治疗具有良好疗效,较长期的母体水化疗法能显著增加ROH患者的羊水容量,降低因羊水过少而导致的剖宫产率,减少新生儿并发症,提高围产儿结局。     

胎膜早破后残余羊水量对孕妇宫内感染及妊娠结局的影响

目的分析胎膜早破残余羊水量对孕妇宫内感染及妊娠结局的影响。方法选择2015年3月-2016年3月杭州市妇产科医院收治的胎膜早破孕妇300例,按照羊水量分为甲组[羊水正常,羊水指数(AFI)8~25 cm]150例,乙组(羊水偏少,AFI 5~8 cm)80例,丙组(羊水过少,AFI为≤5 cm)70例,分析3组孕妇妊娠结局。结果甲组自然分娩率64.00%,明显高于乙组的18.75%、丙组的20.00%,差异有统计学意义(χ~2=42.783、36.960,P<0.05);剖宫产率、阴道助产率26.00%、10.00%,低于乙组的46.25%、35.00%和丙组的42.86%、37.14%,差异有统计学意义(χ~2=9.669、6.300、21.452、23.189,P<0.05),3组胎儿宫内窘迫发生率无统计学差异;甲组孕妇宫内感染率8.00%,明显低于乙组的21.25%、丙组的34.29%,差异有统计学意义(χ~2=8.313、24.095,P<0.05);甲组新生儿窒息率14.00%,明显低于乙组的23.75%、丙组的37.14%,差异有统计学意义(χ~2=3.852、15.216,P<0.05)。结论胎膜早破残余羊水量过少,将增加孕妇宫内感染、新生儿窒息发生风险,应密切监测孕妇羊水,一旦出现异常立即采用合适的方式进行分娩,确保母婴安全,获得良好的妊娠结局。     

经食管超声心动图在成年人房间隔缺损封堵治疗中的应用价值

目的 分析足月妊娠妇女超声检查提示羊水偏少时,阴道试产对围生期结局的影响.方法 2007年8月至2008年8月应用羊水指数(AFI)法估测羊水量,并测定多普勒监测脐动脉收缩期最大血流速度与舒张末期血流速度比值,分析比较168例超声诊断羊水偏少者(AFI 5.0～8.0cm为观察组)和172例羊水量正常的足月妊娠妇女(AFI>8.0 cm为对照组)阴道试产后的分娩结局.结果 两组胎儿窘迫发生率和新生儿重度窒息发生率比较差异无统计学意义(P>0.05),观察组急诊剖宫产率较对照组明显升高[31.0%(52/168)比12.2%(21/172)](P<0.05).结论 超声诊断羊水偏少的足月妊娠妇女,在严密监护下可行阴道试产.     

An analysis of intra-uterine growth retardation in rural Malawi

OBJECTIVE: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. METHODS: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. Newborns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. RESULTS: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight <2500 g, 17.3% were premature (<37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4--2.6), short maternal stature (RR 1.6; 95% CI 1.0--2.4), anaemia (Hb<8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2--2.2) and malaria at delivery (RR 1.4; 95% CI 1.0--1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3--2.4), number of antenatal visits (RR 2.2; 95% CI 1.6--2.9) and arm circumference <23 cm (RR 1.9; 95% CI 1.4--2.5). HIV infection was not associated with IUGR or prematurity. CONCLUSION: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of newborns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia.     

Is conception delay a risk factor for reduced gestation or birthweight?

Previous studies have suggested an association between delays in conception and adverse perinatal outcomes, specifically, low birthweight and preterm birth. We investigated the relationship between conception delay (defined as >6 months to become pregnant) and three perinatal outcomes: low birthweight (LBW; <2500 g), preterm birth (PTB; <37 weeks), and small-for-gestational-age (SGA; <10th percentile weight for given gestational age) using data from the Collaborative Perinatal Project. The study cohort was limited to pregnancies with a known time-to-pregnancy (n = 8465; 15%). Generalised estimating equations were used to estimate odds ratios (OR) and 95% confidence intervals [CI] for risk of adverse perinatal outcomes accounting for the clustering of pregnancy outcomes for women with more than one pregnancy. After adjusting for confounders, all ORs were close to the null (LBW, OR = 1.01; 95% CI = 0.86, 1.20), (PTB, OR = 1.10; 95% CI = 0.95, 1.27), (SGA, OR = 1.06; 95% CI = 0.91, 1.25). Thus, we found no evidence to support an adverse relationship between conception delay and decrements in gestation or birthweight among this select sample of fertile women, even after varying the cut-point for defining conception delay.     

Prenatal application of the individualized fetal growth reference

The individualized reference for defining small for gestational age (SGA) at birth has gained popularity in recent years. However, its utility on fetal assessment has not been evaluated. The authors compare an individualized with an ultrasound reference in predicting poor perinatal outcomes. Data from a large clinical trial in predominantly white US women (1987-1991) with singleton pregnancies (n = 9,526) were used. The individualized reference classified fewer SGA fetuses than the ultrasound reference, but the risks of adverse outcomes were similar between fetuses classified by both references. The risk increased substantially only when the percentiles fell below the 5th percentile (likelihood ratio positive at birth = 2.68 (95% confidence interval (CI): 2.00, 3.58) and 3.13 (95% CI: 2.34, 4.18) for ultrasound and individualized references, respectively). SGA fetuses defined by either the individualized or ultrasound reference alone had risk ratios of adverse outcomes of 1.91 (95% CI: 0.77, 4.77) and 1.18 (95% CI: 0.37, 3.77), respectively, compared with normal fetuses (the difference between these 2 risk ratios, P = 0.71). The authors conclude that neither the ultrasound-based nor the individualized reference does well in predicting adverse perinatal outcomes. The 5th percentile may be a better cutpoint than the 10th percentile in defining SGA.     

孕妇生殖道支原体寄居与异常围生结局关系的前瞻性研究

目的探索孕妇生殖道支原体寄居与异常围生结局的病因学关系.方法选择进行围生期保健孕妇739例,根据支原体检测结果将其分成支原体阳性孕妇队列和支原体阴性孕妇队列,随访至围生期结束,比较2组异常围生结局发生率.结果支原体阳性孕妇队列中早产产后热、产褥感染及胎儿宫内窘迫的发生率高于支原体阴性孕妇队列(P＜0.05).分析不同支原体寄居与异常围生结局关系,发现解脲脲原体主要引起早产(RR=3.28,95%CI为1.75～6.14)和胎儿宫内窘迫(RR=3.61,95%CI为1.56～8.33)发生率增加;人型支原体主要导致新生儿肺炎(RR=5.16,95%CI为1.99～13.38)、产后热(RR=5.91,95%CI为2.0～17.42)和产褥感染(RR=4.14,95%CI为1.79～9.6)等异常围生结局发生率的增加.支原体混合寄居表现出协同效应.结论围生期孕妇生殖道支原体寄居能引起异常围生结局发生率的增加,应大力加强对孕妇支原体寄居的防治工作.     

Hospital use and health status of women during the 5 years following the birth of a premature, low-birthweight infant.

OBJECTIVE: This study examined the health status and hospital use of women after the birth of a premature, low-birthweight infant. METHODS: The subjects were women with infants who participated in a multisite, randomized trial of an early intervention program. The outcomes examined were (1) a maternal health rating of poor or fair (i.e., poorer health) 5 years following delivery and (2) hospital use for a non-pregnancy-related condition. RESULTS: By the fifth year after delivery, 29.7% of the women had been hospitalized for a non-pregnancy-related condition. Women who reported poorer health status (adjusted relative risk [RR] = 2.39; 95% confidence interval [CI] = 1.86, 3.07) or who had asthma (RR = 2.24; CI = 1.31, 3.80) were at greatest risk. After 5 years, 16.9% of the women said they were in poorer health. The number of intervening years in poorer health (1 year, RR = 3.17; CI = 2.04, 4.94; > 1 year, RR = 8.42; CI = 2.20, 12.88), more than 1 year of poverty (RR = 3.28; CI = 1.90, 5.66), obesity (RR = 3.30; CI = 1.44, 7.55), and more than 1 year of employment (RR = 0.55; CI = 0.36, 0.86) were all significantly associated with poorer health. CONCLUSIONS: The continued, substantial morbidity and hospital use of women with a premature, low-birthweight infant has not previously been reported. This observation needs to be verified.     

湖北省HIV感染孕产妇早产现状与影响因素分析

目的 了解湖北省HIV感染孕产妇早产的流行情况,探讨其相关影响因素,为制定预防HIV感染孕产妇早产的策略和措施提供参考依据。方法 收集2004—2020年全国预防艾滋病母婴传播管理信息系统中湖北地区报告的已分娩的HIV感染孕产妇相关流行病学调查资料,采用单因素χ2检验和Poisson回归模型,分析HIV感染孕产妇早产情况及其影响因素。结果 湖北省HIV感染孕产妇早产率为10.70%（66/617）,呈逐年上升趋势（χ2趋势 = 4.942,P = 0.026）,不同地区间HIV感染孕产妇早产率的差异无统计学意义。Poisson回归模型分析结果显示,年龄（35～49）岁（RR = 2.080,95%CI:1.177～3.678）、注射毒品感染HIV（RR = 2.899,95%CI:1.540～5.456）、孕期末次病毒载量≥1 000拷贝/mm3（RR = 4.567,95%CI:1.984～10.516）、胎膜早破（RR = 2.395,95%CI:1.063～5.393）、妊娠合并肝病（RR = 2.268,95%CI:1.154～4.455）和妊娠期高血压（RR = 3.540,95%CI:2.063～6.075）是影响HIV感染孕产妇早产的危险因素（P＜0.05）,不含蛋白酶抑制剂（PI）的三联用药方式（RR = 0.461,95%CI:0.231～0.917）是影响HIV感染孕产妇早产的保护性因素（P＜0.05）。结论 对于HIV感染孕产妇而言,加强围产期保健,采用不含PI的三联抗病毒治疗方案,控制孕期病毒载量水平、妊娠高血压疾病、妊娠合并肝病、胎膜早破等风险因素是降低其早产发生率的重要措施。     

Cocaine and cigarettes: a comparison of risks

Summary. In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non-smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol (n = 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy (n = 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes (n = 13043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0–9.3], small-for-ges-tational age (SGA) [RR4.2, 95% CI 2.4–7.3], prematurity [RR4.0, 95% CI 2.3–7.0], abruptio placentae [RR = 10.0,95% CI 3.5–29.0], placenta prae-via [RR = 2.4, 95% CI 0.3–17.8] and perinatal death [RR = 5.3, 95% CI 1.9–15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numbers of pregnant women.     

人类免疫缺陷病毒感染孕产妇所产婴儿死亡的影响因素分析

目的 了解我国获得性免疫缺陷综合征(AIDS)高流行地区人类免疫缺陷病毒(HIV)感染孕产妇所产婴儿死亡的影响因素.方法 结合2004年建立的HIV感染孕产妇及所产婴儿随访研究队列,于2008年8-11月对我国4省7县区2004年1月至2007年11月HIV感染孕产妇所产婴儿的死亡状况及其影响因素进行调查.实际收集了498对HIV感染孕产妇及所产婴儿的相关信息.采用单因素和多因素Cox比例风险模型对HIV感染孕产妇所产婴儿死亡的影响因素进行分析.结果 498名婴儿,总观察人年数为406.22人年,死亡45例,死亡密度为110.78/1000人年.单因素分析结果显示,母亲孕产期处于AIDS前期或发病期(RR=1.971,95%CI值:1.143～3.396)、孕产妇生存状况(RR=3.062,95%CI值:1.097～8.550)、经产妇(RR=0.517,95%CI值:0.278～0.961)、自然分娩(RR=0.561,95%CI值:0.345～0.910)、早产(RR=5.302,95%CI值:2.944～9.547)、低出生体重(RR=4.920,95%CI值:2.691～8.994)、母子预防性服用抗逆转录病毒药物(RR=0.227,95%CI值:0.121～0.428)及婴儿感染HIV(RR=5.870,95%CI值:3.232～10.660)等因素影响HIV感染孕产妇所产婴儿的死亡.进一步的多因素分析显示,处于AIDS前期或发病期的孕产妇较处于AIDS潜伏期者所产婴儿死亡危险增加(RR=6.99,95%CI值:1.92～25.64);孕产期CD4~+T淋巴细胞计数低于200个/μl的孕产妇,所产婴儿发生死亡的危险增加(RR=2.05,95%CI值:1.01～4.15);母子未预防性服用抗逆转录病毒药物增加婴儿死亡的危险(RR=6.17,95%CI值:1.62～23.26);早产婴儿死亡危险是足月产婴儿的2.87倍(95%CI值:1.12～7.35);HIV感染婴儿死亡危险是非HIV感染婴儿的9.87倍(95%CI值:3.81～25.62).结论 提高HIV感染孕产妇自身免疫力,降低HIV母婴传播率及HIV感染孕产妇所产婴儿早产、低出生体重的发生率有助于降低婴儿死亡率.     

Vaginal bleeding during pregnancy and preterm birth

This study investigated the relation between self-reported vaginal bleeding during pregnancy and preterm birth in a prospective cohort of 2,829 pregnant women enrolled from prenatal clinics between 1995 and 2000 in central North Carolina. The overall association between vaginal bleeding and preterm birth was modest (risk ratio (RR) = 1.3, 95% confidence interval (CI): 1.1, 1.6). Bleeding in the first trimester only was associated with earlier preterm birth (< or =34 weeks' gestation) (RR = 1.6, 95% CI: 1.1, 2.4) and preterm birth due to preterm premature rupture of the membranes (PPROM) (RR = 1.9, 95% CI: 1.1, 3.3). Bleeding in both trimesters was associated with preterm birth due to preterm labor (RR = 3.6, 95% CI: 1.9, 6.8). Bleeding of multiple episodes, on multiple days, and with more total blood loss was associated with an approximate twofold increased risk of earlier preterm birth, PPROM, and preterm labor. In contrast, bleeding in the second trimester only, of a single episode, on a single day, and with less total blood loss was not associated with any category of preterm birth. Vaginal bleeding was not associated with preterm birth among African Amercians (RR = 1.2, 95% CI: 0.9, 1.7). This study indicates that more intense but not less intense bleeding is associated with earlier preterm birth and spontaneous preterm birth presenting as PPROM or preterm labor, and it suggests that bleeding is less predictive of preterm birth among African-American compared with White women.