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Notes: Objectives  To evaluate the risk of very preterm birth (22–32 weeks of gestation) associated with previous induced abortion according to the complications leading to very preterm delivery in singletons.Design  Multicentre, case-control study (the French EPIPAGE study).Setting  Regionally defined population of births in France.Sample  The sample consisted of 1943 very preterm live-born singletons (〈33 weeks of gestation), 276 moderate preterm live-born singletons (33–34 weeks) and 618 unmatched full-term controls (39–40 weeks).Methods  Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, premature rupture of membranes, idiopathic preterm labor and other causes.Main outcome measures  Odds ratios for very preterm birth by gestational age and by pregnancy complications leading to preterm delivery associated with a history of induced abortion.Results  Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1–2.0); the risk was even higher for extremely preterm deliveries (〈28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (〈28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension.Conclusion  Previous induced abortion was associated with an increased risk of very preterm delivery. The strength of the association increased with decreasing gestational age.

Notes: Objectives To relate maternal and infant characteristics to newborn shoulder width and to evaluate the predictive value of newborn shoulder width measurement in cases of shoulder dystocia.Design Newborn shoulder width was systematically measured at birth during a period of 18 months.Setting Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital, Paris, France.Population A total of 2222 newborn shoulder width measurements were performed and 22 cases of true shoulder dystocia occurred during the study period.Methods Newborn shoulder width measurements were reviewed and correlated with maternal age, parity, nonpregnant weight, weight gain during pregnancy, height, race, fasting glucose and one hour glucose levels, gestational age, birthweight and sex of the neonate. A receiver-operating characteristics curve was constructed to evaluate newborn shoulder width as a test for predicting shoulder dystocia.ResultS The mean newborn shoulder width was 122.06 mm (10.50 SD). Stepwise multiple regression showed that newborn shoulder width was significantly associated with birthweight (P 〈 0.001), parity (P= 0.04), and nonpregnant weight (P= 0.04). We estimated that the best cut off for shoulder dystocia prediction was a newborn shoulder width measurement with a low false positive rate (〈 10%) in association with a high sensitivity rate. Therefore, newborn shoulder width measurement ≥ 140 mm was selected. This measurement should have a low sensitivity of 27.27%, a specificity of 91.82%, a positive predictive value of 4.02%. and a negative predictive value of 99.01% for shoulder dystocia prediction. Nevertheless, birthweight ≥ 4000 g should have a better predictive value retrospectively for shoulder dystocia.Conclusions Newborn shoulder width measurement, which is strongly correlated with birthweight, still remains a poor predictor for shoulder dystocia, even when this evaluation is correct antenatally.

Notes: Objective  To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth.Design  Case–control study (the French Epipage study).Setting  Regionally defined population of births in France.Population  Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls.Methods  Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms.Main outcome measures  Odds ratios for very preterm birth for low to moderate (1–9 cigarettes/day) and heavy (≥10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth.Results  Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3–2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3–1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8).Conclusion  These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women.

Notes: Objectives To determine if inherited thrombophilia and immunological disorders represent risk factors for small for gestational age infants, and to assess their relationship with neonatal status.Design Case–control study.Population Ninety-seven consecutive women who had pregnancies complicated by unexplained small for gestational age infants, defined as a birthweight below the third centile and 97 women as controls who delivered infants with a birthweight ≥10th centile.Methods Patients were included in the immediate postpartum period and tested for antithrombin III, protein C, protein S, anticardiolipin and antinuclear antibodies, lupus anticoagulant, Factor V Leiden mutation, prothrombin 20210A mutation, and methylenetetrahydrofolate reductase (MTHFR) polymorphism. Women with small for gestational age infants were then divided into subgroups depending on haemostatic and immunologic status in order to compare neonatal events.Results Frequencies for anticardiolipin and antinuclear antibodies were higher in women with small for gestational age infants compared with controls (P= 0.02 and P= 0.004, respectively), and overall prevalence of inherited thrombophilia were comparable in cases and controls (19.6% and 18.6%, respectively). The subgroups of patients with small for gestational age infants were women with only one inherited thrombophilia (n= 10), only one imunological disorder (n= 14), combined disorders (n= 9), and no detected abnormality (n= 64). Admission to paediatric ward significantly increased in the group with combined disorders (P= 0.002) compared with the other groups. Also one-third of the babies from this group had a poor neonatal outcome. However, most of the neonatal deaths (6/7 = 85.7%) occurred in the group with no detected abnormality.Conclusion The prevalence of inherited thrombophilia was considered to be similar between the case and the control groups even when immunological disorders were significantly elevated in pregnancies complicated by the baby being small for gestational age. Combined disorders may represent a potential risk factor for severe small for gestational age infants. However, the aetiology of small for gestational age infants with poor neonatal outcomes remains unknown in most cases.