الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Preterm birth (PTB) is a major cause of neonatal morbidity and mortality.It is defined as delivery before the 37th week of gestation based on a woman’s last menstrual period. It has an annual global incidence of approximately 15 million cases. PTB can be classified as spontaneous preterm labor, preterm premature rupture of membranes (pPROM) and medically induced PTB due to fetomaternal complications. Preterm infants are vulnerable to serious complications including respiratory distress syndrome, cerebral palsy, necrotising enterocolitis (NEC), long-term learning disabilities, intraventricular haemorrhage, sepsis, retinopathy of prematurity and chronic lung disease. The seriousness and prevalence of PTB-associated morbidity and mortality are inversely correlated with gestational age at delivery, with very early preterm infants bearing the majority of the burden. Further, the burden of prematurity is not purely medical, there is a significant economic and societal cost associated with PTB. The cause of PTB is multifactorial, but infection and/or inflammation are the only etiology of preterm birth, with a solid evidence base; its molecular pathophysiology has also been studied. Accumulating evidence from animal to human studies supports the role of intra-amniotic infection in the pathogenesis of preterm labor and delivery. Bacteria commonly isolated from the lower genital tract can invade the amnion and chorion, causing chorioamnionitis, invasion of the amniotic cavity and fetal infection. Suggested pharmacological interventions to prolong pregnancy have included the use of tocolytics to suppress uterine contractions as well as antibiotics to treat intrauterine bacterial infection. Therapeutic agents currently believed to be clearly associated with improved neonatal outcomes include prenatal corticosteroids, for the maturation of fetal lungs and developing organ systems. Experimental use of azithromycin in women at risk of preterm labor has become prevalent in our institution without any evidence of its efficacy. Although antibiotics can prolong pregnancy in prolonged preterm rupture of membranes, there are no published data available for women with intact membranes. The study is aimed to evaluate the benefit from adding azithromycin to usual treatments to prolong pregnancy in women at high risk for preterm labour with intact membranes. This study is a randomized clinical trial study, was conducted on 130 women at high risk of preterm labor at Obstetrics and Gynecology departments at Tanta University Hospitals from outpatient clinic, divided into two groups (group I) (cases group): included 65 pregnant women at high risk for preterm labor received azithromycin and followed till delivery, (group II) (control group): included 65 pregnant women at high risk for preterm labor not received azithromycin and followed till delivery. The main results of the study revealed that: There is no significant difference between the groups regarding maternal age, BMI, parity, and gravidity. There is no significant difference between the groups regarding cervical length. There is no significant difference between the groups regarding GA, and birth weight. Incidence of preterm was lower in azithromycin group compared to control group but without statistically significant difference. There is no significant difference between the groups in term of NICU admission, severe jaundice and respiratory distress. Azithromycin and progesterone administration and absent of preterm labor history and amniotic sludge were found to be significant indictors of pregnancy prolongation. Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.