The first case of Cesarean section in a pregnant woman during extracorporeal membrane oxygenation (ECMO) in Russia

A.A. Skopets1,2, A.S. Zharov1, S.I. Potapov1, E.S. Afonin1, M.D. Andreeva2, T.V. Galdina1, L.V. Shulzhenko1,2, E.V. Bezukh1, V.A. Porhanov1,2

1 State Public Health Budget Institution Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry, Krasnodar, Russia

2 State Budgetary educational institution of higher professional education Kuban State Medical University of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia

For correspondence: Alexander A. Skopets — M. D., Head of Department of Anesthesia and intensive care #2 Scientific Research Institute — Ochapovsky Regional Clinic Hospital, associate professor of the Department of Anesthesiology, Reanimatology and Transfusiology of the Kuban State Medical University, Krasnodar; e-mail:

For citation: Skopets AA, Zharov AS, Potapov SI, Afonin ES, Andreeva MD, Galdina TV, Shulzhenko LV, Bezukh EV, Porhanov VA. The first case of Cesarean section in a pregnant woman during extracorporeal membrane oxygenation (ECMO) in Russia. Article. Annals of Critical Care. 2019;3:90–97.

DOI: 10.21320/1818-474X-2019-3-90-97


A 22-year-old pregnant woman (34.6 weeks of pregnancy) with A(H1N1) influenza-associated acute respiratory distress syndrome was admitted to the intensive care unit. Results. The patient was connected to femoral-jugular veno-venous extracorporeal membrane oxygenation (ECMO) 2 hours after admission. On the 2nd day of ECMO support, in connection with the beginning of labor activity and a threat to the life of the mother and fetus, the decision was made on the implementation of caesarean section (CS) without the termination of ECMO. CS was performed under general anesthesia, 2 hours after discontinuation of heparin infusion. Were extracted a premature baby girl, weighing 2380 g. Intraoperative period was complicated by atonic uterine bleeding, requiring a hysterectomy. On the 16th day the patient was successfully weaned from ECMO and was discharged after 11 days. The newborn was discharged from the clinic in a satisfactory condition after 24 days with a weight of 2860 g. Conclusion. This is the first case in Russia of successful use of ECMO and emergency cesarean section (CS) during ECMO in a pregnant woman with acute respiratory distress syndrome (ARDS) due to complications of influenza A(H1N1).

Keywords: flu, pregnancy, extracorporeal membrane oxygenation, cesarean section.

Received: 14.08.2019

Accepted: 03.09.2019


  1. WHO Pandemic H1N1 — update 89 (online) <http:// >; 2009 accessed 27.02.10.
  2. Louie J.K., Acosta M., Jamieson D.J., Honein M.A. Severe 2009 H1N1 influenza in pregnant and postpartum Women in California. NEJM. 2012; 362: 27–35.
  3. Patroniti N., Zangrillo A., Pappalardo F., et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011; 37: 1447–1457.
  4. Peek G.J., Mugford M., Tiruvoipati R., et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009; 374: 1351–1363.
  5. Sharma N.S., Wille K.M., Bellot S.C., Diaz-Guzman E. Modern use of extracorporeal life support in pregnancy and postpartum. ASAIO J. 2015; 61: 110–114.
  6. Jamieson D.J., Honein M.A., Rasmussen S.A., et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009; 374: 451–458.
  7. Creanga A.A., Johnson T.F., Graitcer S.B., et al. Severity of 2009 pandemic influenza A(N1N1) virus infection in pregnant women: New York City, May-June 2009. Obstet Gynecol. 2010; 115: 717–726.
  8. Fine A., Dentinger C., Johnson T.F., et al. 2009 pandemic influenza A(HH1N1) in pregnant women requiring intensive care — New York City, 2009. MMWR. 2010; 59: 321–326.
  9. Panarello G., D’Ancona G.D., Capitanio G., et al. Cesarean section during ECMO support. Minerva Anestesiol. 2011; 77(6): 654–657.
  10. Łysenko L., Zaleska-Dorobisz U., Blok R., et al. A successful cesarean section in a pregnant woman with A(H1N1) influenza requiring ECMO support. Kardiochir Torakochirurgia Pol. 2014; 11(2): 216–219.
  11. Parkins M.D., Fonseca K., Peets A.D., et al. A potentially preventable case of serious influenza infection in a pregnant patient. CMAJ. 2007; 177(8): 851–853.
  12. Kunstyr J., Lips M., Belohlavek J., et al. Spontaneous delivery during veno-venous extracorporeal membrane oxygenation in swine influenza-related acute respiratory failure. Acta Anaesthesiol Scand. 2010; 54(9): 1154–1155.
  13. Crawford T.C., Grimm J.C., Magruder J.T., et al. A curious case of acute respiratory distress syndrome. J. Surg. Case Rep. 2015; 2015(11).
  14. Liu C., Sun W., Wang C., Liu F., Zhou M. Delivery during extracorporeal membrane oxygenation (ECMO) support of pregnant woman with severe respiratory distress syndrome caused by influenza: a case report and review of the literature. J. Matern. Fetal. Neonatal. Med. 2019; 32(15): 2570–2574. DOI: 10.1080/14767058.2018.1439471
  15. Fine A., Dentinger C., Johnson T.F., et al. 2009 pandemic influenza A(HH1N1) in pregnant women requiring intensive care — New York City, 2009. MMWR. 2010; 59: 321–326.
  16. Nnaoma C., Chika-Nwosuh O.Z., Isedeh A., et al. Venovenous Extracorporeal Membrane Oxygenation in a Gravid Patient with Acute Respiratory Distress Syndrome: A Case Report. Am. J Case Rep. 2019; 20: 705–708. DOI: 10.12659/AJCR.914490
  17. Radsel P., Gorjup V., Jazbec A., et al. Pregnancy complicated by influenza A ARDS requiring consecutive VVECMO treatment with successful vaginal delivery. J Artif. Organs. 2018; 21(4): 471–474. DOI: 10.1007/s10047-018-1050-5
  18. Alyamani O., Mazzeffi M.A., Bharadwaj S., et al. Venovenous Extracorporeal Membrane Oxygenation to Prolong Pregnancy: A Case Report. AA Pract. 2018; 10(9): 229–231. DOI: 10.1213/XAA.0000000000000671
  19. Moore S.A., Dietl C.A., Coleman D.M. Extracorporeal life support during pregnancy. J. Thorac. Cardiovasc. Surg. 2016; 151(4): 1154–1160. DOI: 10.1016/j.jtcvs.2015.12.027
  20. Pacheco L.D., Saade G.R., Hankins G.D.V. Extracorporeal membrane oxygenation (ECMO) during pregnancy and postpartum. Semin. Perinatol. 2018; 42(1): 21–25. DOI: 10.1053/j.semperi.2017.11.005
  21. Anselmi A., Ruggieri V.G., Letheulle J. Extracorporeal Membrane Oxygenation in Pregnancy. J. Card. Surg. 2015; 30(10): 781–786. DOI: 10.1111/jocs.12605
  22. Itagaki T., Onodera M., Okuda N., et al. Successful use of extracorporeal membrane oxygenation in the reversal of cardiorespiratory failure induced by atonic uterine bleeding: a case report. J. Med. Case Rep. 2014; 8: 23. DOI: 10.1186/1752-1947-8-23
  23. Jo Y.Y., Park S., Choi Y.S. Extracorporeal membrane oxygenation in a patient with stress-induced cardiomyopathy after caesarean section. Anaesth. Intensive Care. 2011; 39: 954–957.
  24. Hansen A.J., Sorrell V.L., Cooper A.D., Moulton M.J. Postpartum rupture of the posteromedial papillary muscle. J. Card. Surg. 2012; 27: 313–316. DOI: 10.1111/j.1540-8191.2011.01369.x
  25. Pagel P.S., Lilly R.E., Nicolosi A.C. Use of ECMO to temporize circulatory instability during severe Brugada electrical storm. Ann. Thorac. Surg. 2009; 88: 982–983. DOI: 10.1016/j.athoracsur.2009.01.066
  26. Scherrer V., Lasgi C., Hariri S., et al. Radiofrequency ablation under extracorporeal membrane oxygenation for atrial tachycardia in postpartum. J. Card. Surg. 2012; 27: 647–649. DOI: 10.1111/j.1540-8191.2012.01487.x
  27. Shen H.P., Chang W.C., Yeh L.S., Ho M. Amniotic fluid embolism treated with emergency extracorporeal membrane oxygenation: A case report. J. Reprod Med. 2009; 54: 706–708.
  28. Strecker T., Мunch F, Weyand M. One hundred ten days of extracorporeal membrane oxygenation in a young woman with postpartum cerebral venous thrombosis and acute respiratory distress syndrome. Heart Surg. Forum. 2012; 15: E180–E181. DOI: 10.1532/HSF98.20111068
  29. Nair P., Davies A.R., Beca J., et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med. 2011; 37: 648–654. DOI: 10.1007/s00134-011-2138-z
  30. Sim S.S., Chou H.C., Chen J.W., Ma M.H. Extracorporeal membrane oxygenation in maternal arrhythmic cardiogenic shock. Am. J. Emerg. Med. 2012; 30: 1023.E3–1012.E5. DOI: 10.1016/j.ajem.2011.03.030
  31. Weinberg L., Kay C., Liskaser F., et al. Successful treatment of peripartum massive pulmonary embolism with extracorporeal membrane oxygenation and catheter-directed pulmonary thrombolytic therapy. Anaesth Intensive Care. 2011; 39: 486–491.
  32. Robertson L.C., Allen S.H., Konamme S.P., Chestnut J., Wilson P. The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int. J. Obstet. Anesth. 2010; 19: 443–447.
  33. Burrows K., Fox J., Biblo L.A., Roth J.A. Pregnancy and short-coupled torsades de pointes. Pacing. Clin. Electrophysiol. 2013; 36: e77–e79. DOI: 10.1111/j.1540-8159.2010.02923.x
  34. Корнелюк Р., Шукевич Д, Хаес Б. и др. Экстракорпоральная мембранная оксигенация и современные методы детоксикации в лечении вирусно-бактериальной пневмонии, обусловленной вирусом гриппа A(H1N1) у родильницы. Общая реаниматология. 2017;13(1): 45–56. DOI: 10.15360/1813-9779-2017-1-45-56. [Kornelyuk R.A., Shukevich D.L., Hayes B.L., et al. Extracorporeal Membrane Oxygenation and Modern Detoxification Techniques in a Puerpera with Viral and Bacterial Pneumonia Caused by Flu A(H1N1) Virus. General Reanimatology. 2017; 13(1): 45–56. (In Russ)]
  35. Кецкало М., Нечаев Д., Москаленко О. и др. Использование метода ЭКМО в комплексной терапии тяжелого ОРДС, осложнившегося развитием пневмоторакса. Клинические случаи. Медицинский алфавит. 2018; 18(335): 29–34. [Ketskalo M.V., Nechaev D.S., Moskalenko O.O., et al. Use of ECMO-method in complex therapy of severe ARDS, complicated by development of pneumothorax. Clinical cases. Medical alphabet. 2018; 18(335):29–34. (In Russ)]

Pituitary Adenoma in Pregnant Patient with Acute Visual Loss: Clinical Case Report

A.Y. Lubnin1, P.L. Kalinin1, D.V. Fomichev1, K.N. Ahvlediani2, N.M. Eliseeva1, O.F. Tropinskaya1, L.I. Astaf’eva1

1FGAU NII «N.N. Burdenko Neurosurgery Institute» MZ RF, Moscow

2GBUZ MO «Moscow Regional Research Institute of Obstetrics and Gynecology», Moscow

For correspondence: Lubnin Andrei Yurevich — Head of Anesthesiology, Intensive Care Department FGAU NII «N.N. Burdenko Neurosurgery Institute» MZ RF; e-mail:

For citation: Lubnin AY, Kalinin PL, Fomichev DV, Akhvlediani KN, Eliseev NM, Tropinskaya OF, Astaf’eva LI. Pituitary Adenoma in Pregnant Patient with Acute Visual Loss: Clinical Case Report. Intensive Care Herald. 2016;4:67–71.

We present patient with pituitary adenoma (prolactinoma) which manifested by dramatic decrease of visual function as a consequence of apoplexy during pregnancy. We decided to operate patient on hypophysis with preserved pregnancy. In conclusion we discus problem of brain tumor management in pregnant patients and anesthetic managements of such patients.

Keywords: pituitary adenoma, pregnancy, anesthetic management

Received: 05.11.2016


  1. Астафьева Л.И., Кадашев Б.А., Калинин П.Л. и др. Клиническая картина, диагностика и результаты первичной медикаментозной терапии больших и гигантских пролактинсекретирующих аденом гипофиза. Вопр. нейрохир. 2008; 4: 36–39. [Astaf’eva L.I., Kadashev B.A., Kalinin P.L. et al. Klinicheskaya kartina, diagnostika i rezul’taty pervichnoi medikamentoznoi terapii bol’shih i gigantskih prolaktinsekretiruyuschih adenom gipofiza. Vopr. neirohir. 2008; 4: 36–39. (In Russ)]
  2. Кадашев Б.А. Аденомы гипофиза. Тверь: Триада, 2007. [Kadashev B.A. Adenomy gipofiza. Tver: Triada, 2007. (In Russ)]
  3. Калинин П.Л., Фомичев Д.В., Кадашев Б.А. и др. Методика эндоскопической эндоназальной транссфеноидальной аденомэктомии. Вопр. нейрохир. 2007; 4: 42–45. [Kalinin P.L., Fomichev D.V., Kadashev B.A. et al. Metodika endoskopicheskoi endonazal’noi transsfenoidal’noi adenomektomii. Vopr. neirohir. 2007; 4: 42–45. (In Russ)]
  4. Калинин П.Л., Фомичев Д.В., Кутин М.А. и др. Эндоскопическая эндоназальная хирургия аденом гипофиза (опыт 1700 операций). Вопр. нейрохир. 2012; 3: 26–33. [Kalinin P.L., Fomichev D.V., Kutin M.A. et al. Endoskopicheskaya endonazal’naya hirurgiya adenom gipofiza (opyt 1700 operatsii). Vopr. neirohir. 2012; 3: 26–33. (In Russ)]
  5. Салова Е.М., Лубнин А.Ю., Цейтлин А.М. и др. Мониторинг глубины анестезии у нейрохирургических больных. Анест. и реан. 2011; 4: 22–27. [Salova E.M., Lubnin A.Yu., Tseitlin A.M. et al. Monitoring glubiny anestezii u heirohirurgicheskih bol’nyh. Anest. i rean. 2011; 4: 22–27. (In Russ)]
  6. Barlas O., Bayindir C., Hepgul K. et al. Bromocriptine-induced cerebrospinal fluid fistula in patiemts with macroprolactinomas: report of three cases and a review of the literature. Neurol. 1994; 41: 486–489.
  7. Cappell M.S. Sedation and analgesia for gastrointestinal endoscopy during pregnancy. Endosc. Clin. N. Am. 2006; 16: 1–31.
  8. Chen M.M., Coakley F.V., Kaimal A. et al. Guidelines for computer tomography and magnetic resonance imaging use during pregnancy and lactation. Gunecol. 2008; 112: 333–340.
  9. Chiodini I., Losa M., Pavone G. et al. Pregnancy in a Cushing’s disease shortly after treatment by gamma-knife radiosurgery. Endocrinol. Invest. 2004; 27: 954–956.
  10. Dyamanna D.N., Bhakta P., Chouhan R.S. et al. Anesthetic management of a patient with pituitary adenoma for cesarean section. J. Obstet. Anesth. 2010; 19: 460–461. doi: 10.1016/j.ijoa.2010.04.006.
  11. Gist R.S., Beilin Y. The effect of anesthetic drugs on the developing fetus: considerations in nonobstetric surgery. In: Ginosar Y.F., Halpern R.S., Weiner C.P. (Eds.) Anesthesia and the fetus. UK: Wiley-Blackwell, 2013: 156–164.
  12. Grinberg M.S. Handbook of Neurosurgery, 7th Ch. 21. NY: Thieme, 2010: 582–749.
  13. Jezkova J., Marek J., Hana V. et al. Gamma knife radiosurgery for acromegaly — long-term experience. Endocrinol. 2006; 64: 588–595. doi: 10.1007/s11102-014-0584-7.
  14. Jezkova J., Hana V., Krsek M. et al. Use of the Leksell gamms knife in the treatment of prolactinoma patients. Endocrinol. 2009; 70: 732–741. doi: 10.1111/j.1365-2265.2008.03384.x.
  15. Karabulut A.K., Reisli R., Uysal I.I. et al. An investigation of non-depolarizing muscle relaxants on embryonic development in cultured rat embryos. J. Anaesthesiol. 2004; 21: 715–724.
  16. Kurdoglu Z., Cetin O., Gulsen I. et al. Intracranial meningeoma diagnosed during pregnancy caused maternal death. Case Rep. Med. 2014; 2014: 158326. doi: 10.1155/2014/158326.
  17. Landolt A.M., Lomax N. Gamma knife radiosurgery for prolactinomas. Neurosurg. 2000; 93(Suppl3): 14–18. doi: 10.3171/jns.2000.93.supplement.
  18. Leong K.S., Foy P.M., Swift A.C. et al. CSF rhinorrhea following treatment with dopamine agonists for massive invasive prolactinomas. Endocrinol. 2000; 52: 43–49.
  19. Martin L.V., Jurand A. The absence of teratogenic effects of some analgesics used in anesthesia. Additional evidence from a mouse model. Anaesthesia. 1992; 47: 473–476.
  20. Moscovici S., Fraifeld S., Cohen J.E. et al. Parasellar meningeomas in pregnancy: surgical results and visual outcomes. World Neurosurg. 2014; 82: e503–e512. doi: 10.1016/j.wneu.2013.06.019.
  21. Nosek E., Ekstein M., Rimon E. et al. Neurosurgery and pregnancy. Acta Neurochir. 2011; 153: 1727–1735. doi: 10.1007/s10143-015-0608-4.
  22. Nosek E., Ekstein M., Barklay G. et al. Visual deterioration during pregnancy due skull base tumors compressing the optic apparatus. Rev. 2015; 38: 473–479.
  23. Olivi A., Brem R.F., McPherson R., Brem H. Brain Tumors in pregnancy, In: Goldstein P.J., Stern B.J. (Eds.) Neurological disorders of pregnancy, 2nd NY: Futura Publishing Co., 1992: 85–105.
  24. Palamisamy A. Maternal anesthesia and fetal neurodevelopment. Int. J. Obstet. Anesth. 2012; 21: 152–162. doi: 10.1016/j.ijoa.2012.01.005.
  25. Powel M. Pituitary tumors and pregnancy. Acta Neurochir. 2011; 153: 1737–1738.
  26. Shah P.N., Sonawane D., Appukutty J. Anaesthetic management for cesarean section in a case of previously operated with residual pituitary tumor. Indian J. Anaesth. 2011; 55: 618–620. doi: 10.4103/0019-5049.90623.
  27. Terry A.R., Barker F.G., Leffelt L. et al. Outcomes of hospitalization in pregnant women with CNS neoplasms: a population based study. 2012; 14: 768–776. doi: 10.1093/neuonc/nos078.
  28. Wu J., Ma Y.-A., Wang T.-L. Glioma in the third trimester of pregnancy: Two cases and review of the literature. Lett. 2013; 5: 943–946. doi: 10.3892/ol.2013.1106.
  29. Zhang N., Pan L., Dai J. et al. Gamma knife radiosurgery as a primary surgical treatment for hypersrcreting pituitary adenomas. Funct. Neurosurg. 2000; 75: 123–128.

Successful Completion of Pregnancy and Delivery in Patient in Coma

E.Yu. Upryamova1, A.L. Gridchik1, O.F. Serova2, M.V. Vatsik3, N.M. Smirnova3, E.M. Shifman4

1Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow

2Moscow Regional Perinatal Center, Balashikha

3Domodedovo central hospital, Domodedovo

4M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Moscow

For correspondence: Upryamova Ekaterina Yur’evna — MD, Senior Researcher of the Department of Anesthesiology and Intensive Care, Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow; e-mail:

For citation: Upryamova EYu, Gridchik AL, Serova OF, Vatsik MV, Smirnova NM, Shifman EM. Successful Completion of Pregnancy and Delivery in Patient in Coma. Intensive Care Herald. 2016;4:62–66.

Severe neurological injury during pregnancy without intensive care for a woman is a potentially dangerous condition for both the mother and the fetus. High risk of secondary infection with the development of inflammatory complications, decompensation of vital functions of the mother due to the increased load on the organs and systems due to ongoing pregnancy have special requirements for the organization and carrying out of intensive care on the part of intensivist and obstetricians. In this clinical observation, we analyzed medical history, clinical and instrumental examination, especially prenatal care, intensive care and delivery of patient staying in persistent vegetative state being a result of severe traumatic brain injury.

The present clinical case is a unique event in Russian medical practice. Its uniqueness lies in the fact that the patient has spent in a coma in fact the entire pregnancy (4–5 weeks before a full-term period), that is more than 8 months. The obstetric department of Domodedovo central hospital performed cesarean section under general anesthesia when the term was around 36–37 weeks. In the 4th minute they extracted preterm alive weight 2180 g girl, 46 cm, with Apgar scores of 3–5 points. In May 2015, the specialists carried out in-depth examination of the child. According to the results of the survey, the child did not reveal any abnormalities in the development and health.

Thus, a consistent multidisciplinary approach, an individual program of intensive therapy, taking into account the type and extent of damage to the central nervous system, the parent status, gestational age and fetal condition allowed achieving significant results in the treatment and giving a chance to live for the child not yet born.

Keywords: pregnancy, delivery, traumatic brain injury, coma, persistent vegetative state, Glasgow score, Apgar score

Received: 23.09.2016


  1. Постановление Правительства Российской Федерации №294 от 15.04.2014 «Об утверждении государственной программы Российской Федерации “Развитие здравоохранения”». М., 2014. [Russian Federation Government Resolution № 294 of 15.04.2014. «On approval of the state program of the Russian Federation “Health Development”». Mоscow; 2014. (In Russ)]
  2. О материнской смертности в Российской Федерации в 2014 году: Информационное письмо. Минздрав РФ. 2014. [The maternal mortality rate in the Russian Federation 2014: Newsletter. The Ministry of Health of the Russian Federation. 2014. (In Russ)]
  3. Dillon W.P., Lee R.V., Tronolone M.J. et al. Life support and maternal death during pregnancy. JAMA. 1982; 248(9): 1089–1091. doi: 10.1001/jama.1982.03330090059030.
  4. Hnat M.D., Sibai B.M., Kovilam O. An initial Glasgow score of 4 and Apgar scores of 9 and 9: A case report of a pregnant comatose woman. Am. J. Obstet. Gynecol. 2003; 189(3): 877–87 doi: 10.1067/s0002-9378(03)00589-1.
  5. Яшлавский А. Рожденный в коме [электронный документ]. URL: Ссылка активна на 14.09.2016. [Yashlavskii A. Born in coma [Internet]. URL: (accessed 14.09.2016). (In Russ)]
  6. Находившаяся в вегетативном состоянии немка родила здорового ребенка. [электронный документ]. URL: Ссылка активна на 14.09.2016. [German in a vegetative state has given birth to a healthy baby [Internet]. URL: (accessed 14.09.2016). (In Russ)]
  7. Bush M.C., Nagy S., Berkowitz R.L., Gaddipati S. Pregnancy in a persistent vegetative state: case report, comparison to brain death, and review of the literature. Obstet. Gynecol. Surv. 2003; 58(11): 738–748. doi: 10.1097/01.ogx.0000093268.20608.53.
  8. Feldman D.M., Borgida A.F., Rodis J.F., Campbell W.A. Irreversible maternal brain injury during pregnancy: a case report and review of the literature. Obstet. Gynecol. Surv. 2000; 55(11): 708–714. doi: 10.1097/00006254-200011000-00023.
  9. Slattery M., Morrison J.J. Preterm delivery. Lancet. 2002; 360(9344): 1489–1497. doi: 10.1016/s0140-6736(02)11476-0.