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Hoffmann E, Váncsa S, Váradi A, Hegyi P, Nagy R, Hamar B, Futács V, Kepkep B, Nyirády P, Demendi C, Ács N. Routine screening of abnormal vaginal flora during pregnancy reduces the odds of preterm birth: a systematic review and meta-analysis. Sci Rep 2023; 13:13897. [PMID: 37626108 PMCID: PMC10457371 DOI: 10.1038/s41598-023-40993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023] Open
Abstract
Prematurity is the leading cause of perinatal mortality and the morbidity among children under the age of 5. The prevalence of preterm birth is between 5 and 18% worldwide. Approximately 30% of preterm deliveries occur as a consequence of fetal or maternal infections. Bacterial vaginosis can increase the risk of ascending infections. However, there is no recommendation or protocol for screening of abnormal vaginal flora. The aim of this systematic review was to investigate the effectiveness of routine screening of abnormal vaginal flora during pregnancy care. We conducted our systematic search in the following databases: MEDLINE via PubMed, Embase, and Cochrane Library. Studies reporting on pregnant women with no symptoms of bacterial vaginosis were included in our analysis if they provided data on the outcome of their pregnancy. The intervention group went through screening of abnormal vaginal flora in addition to routine pregnancy care. Odds ratio (OR) with 95% confidence intervals (CIs) was used as effect size measure. From each study the total number of patients and number of events was extracted in both the intervention and control arm to calculate OR. Altogether we included 13 trials with 143,534 patients. The screening methods were Gram stain, pH screening, pH self-screening and pH screening combined with Gram stain. Regular screening of vaginal flora compared to no screening significantly reduces the odds of preterm birth before 37 weeks (8.98% vs 9.42%; OR 0.71, CI 0.57-0.87), birthweight under 2500 g (6.53% vs 7.24%; OR 0.64, CI 0.50-0.81), preterm birth before 32 weeks (1.35% vs 2.03%; OR 0.51, CI 0.31-0.85) and birthweight under 1000 g (0.86% vs 2.2%; OR 0.33, CI 0.19-0.57). In conclusion, the routine screening of abnormal vaginal flora might prevent preterm birth, extreme preterm birth, low birthweight deliveries and very low birthweight deliveries. Further research is needed to assess the problem more accurately.
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Affiliation(s)
- Eszter Hoffmann
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Balázs Hamar
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Vanda Futács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary
| | - Begüm Kepkep
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary
| | - Péter Nyirády
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Csaba Demendi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Üllői út, 78/A, 1082, Budapest, Hungary.
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
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Timing of antenatal corticosteroids in relation to clinical indication. Arch Gynecol Obstet 2022; 306:997-1005. [PMID: 35039883 DOI: 10.1007/s00404-021-06362-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/06/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed at determining the proportion of women who receive antenatal corticosteroids (ACS) within the optimal time window before birth based on the indication for ACS, and to explore in more detail indications that are associated with suboptimal timing. METHODS A retrospective cohort study of all women who received ACS in a single tertiary center between 2014 and 2017. The primary outcome was an ACS-to-birth interval ≤ 7 days. Secondary outcomes were ACS-to-birth interval of ≤ 14 days, and the proportion women who received ACS but ultimately gave birth at term (≥ 370/7 weeks). The study outcomes were stratified by the clinical indication for ACS. RESULTS A total of 1261 women met the study criteria, of whom 401 (31.8%) and 569 (45.1%) received ACS within ≤ 7 days and ≤ 14 days before birth, respectively, and 203 (16.1%) ultimately gave birth at term. The proportion of women who received ACS within 7 days before birth was highest for women with preeclampsia (50.4%), and was lowest for women with an incidental finding of a short cervix (8.4%). In the subgroup of women with an incidental finding of a short cervix, the likelihood of optimal timing was not related to the magnitude of cervical shortening, history of preterm birth, multifetal gestation, presence of cervical funneling, or the presence of cervical cerclage. CONCLUSION Over two-thirds of infants who are exposed to ACS do not get the maximal benefit from this intervention. The current study identified clinical indications for ACS that are associated with suboptimal timing of ACS where more research is needed to develop quantitative, indication-specific prediction models to guide the timing of ACS.
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Ruma MS, Banker WM. Availability and use of fetal fibronectin testing and transvaginal ultrasound for preterm labor evaluation in the United States. J Matern Fetal Neonatal Med 2021; 35:8586-8593. [PMID: 34648390 DOI: 10.1080/14767058.2021.1989403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Measure availability and use of fetal fibronectin (fFN) testing and transvaginal ultrasound to measure cervical length (TVCL) for symptomatic preterm labor (PTL) patients. Additionally, assess the presence and impact of PTL triage protocols. STUDY DESIGN Cross-sectional online survey among clinicians from 255 unique hospitals regarding prior 12-month practices (pre-COVID-19). RESULTS fFN testing was always available in 87% (221) of hospitals, while TVCL was always available in 69% (175) of hospitals. Utilization was lower: fFN specimens were often/always collected in 61% (156) of hospitals and TVCL was often/always performed in 43% (110) of hospitals. fFN testing was significantly more likely than TVCL to be available and used (p < .05). Written PTL protocols were available in 47% (121) of hospitals but not consistently followed. CONCLUSION The most accurate risk assessment approach for imminent spontaneous preterm birth is the implementation of a universal screening program for symptomatic patients, including fFN testing and TVCL.
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Affiliation(s)
- Michael S Ruma
- Perinatal Associates of New Mexico, Albuquerque, NM, USA
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Dude CM, Levine LD, Schwartz N. The Impact of Previous Obstetric History on the Risk of Spontaneous Preterm Birth in Women with a Sonographic Short Cervix. Am J Perinatol 2020; 37:1189-1194. [PMID: 32198747 DOI: 10.1055/s-0040-1705169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The natural history of women with a short cervix and a low-risk obstetric history remains poorly defined. In our study, we sought to better characterize the impact of previous obstetric history on the delivery outcomes in women diagnosed with a mid-trimester sonographic short cervix. STUDY DESIGN We performed a retrospective cohort study of women with singleton gestations who underwent transvaginal cervical length screening between 16 and 24 weeks at two urban hospitals in Philadelphia between January 2013 and March 2018 and were found to have a short cervix (defined as ≤2 cm). Women were excluded from the cohort if there were major fetal anomalies noted or if delivery outcome information was not available. The cohort was then divided into three groups based on obstetric history: nulliparous, history of full-term birth only, or history of spontaneous preterm birth (sPTB). The primary outcome was sPTB <37 weeks, while the secondary outcome was sPTB <34 weeks. RESULTS Our cohort included a total of 384 singleton pregnancies that were diagnosed with a sonographic short cervix: 165 women were nulliparous, 119 women had a history of full-term birth, and 100 women with a history of sPTB. We found that women with a short sonographic cervix had a sPTB rate of 39.6% with no differences found between the three groups. Only two-thirds of nulliparous women and women with a history of full-term birth received the recommended preventative treatment, compared with almost 100% of women with a history of sPTB. CONCLUSION Women with and without a history of sPTB are at comparable risk of sPTB in the presence of a sonographically short cervix. Preventative therapies should be recommended to both nulliparous women and women with a history of full-term birth since uptake in this population are not as high.
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Affiliation(s)
- Carolynn M Dude
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Obstetrics and Gynecology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, Georgia
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nadav Schwartz
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Zork N, Gulersen M, Mardy A, Pessel C, Brubaker S, Vink J, Gyamfi-Bannerman C, Ananth CV. The utility of fetal fibronectin in asymptomatic singleton and twin pregnancies with a cervical length ≤ 10 mm. J Matern Fetal Neonatal Med 2020; 33:2865-2871. [PMID: 30572777 PMCID: PMC6625907 DOI: 10.1080/14767058.2018.1562541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
Objective: To examine the utility of fetal fibronectin (fFN) for predicting spontaneous preterm birth (PTB) in asymptomatic women with a cervical length (CL) ≤10 mm compared to those with a CL 11-25 mm.Methods: Data was collected on all women with nonanomalous singleton and twin gestations who underwent transvaginal CL at a single institution between 2009 and 2012. Women with an incidental short cervix (CL ≤ 25 mm) between 22 and 32 weeks who had an fFN result within 7 days thereafter were included. Indicated preterm deliveries at <14 days of fFN, women who underwent cerclage placement, and terminations of pregnancy were excluded. The primary outcome was spontaneous PTB within 7 and 14 days of the fFN. Sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) of fFN for a CL ≤ 10 mm was calculated for singletons and twins and compared to those with a CL 11-25 mm.Results: Of the 213 women included, 117 (54.9%) were singletons and 96 (45%) were twins. Baseline characteristics were similar between those with a CL ≤ 10 mm and with a CL 11-25 mm in both singletons and twins. The NPV of fFN for delivery within 7 days in singletons and twins with a CL ≤ 10 mm was 100%, similar to those with a CL 11-25 mm (93-100%). The NPV of fFN for delivery within 14 days in singletons and twins with a CL ≤ 10 mm remained high (87.5-100%) when compared to those with a CL 11-25 mm (93-100%). The PPV of fFN for delivery within 7 and 14 days in both singletons and twins with a CL ≤ 10 mm was low (10-25%) and similar to those with a CL 11-25 mm (7.1-24.4%).Conclusions: The NPV of fFN in asymptomatic singleton and twin pregnancies with a CL ≤ 10 mm is high and comparable to the NPV of fFN in women with a longer CL. Routine fFN collection in this select population should be considered as it may avoid unnecessary and costly admissions, as well as assist with timing of antenatal corticosteroids.
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Affiliation(s)
- Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Moti Gulersen
- Department of Obstetrics and Gynecology, Lenox Hill Hospital – Northwell Health, New York, NY
| | - Anne Mardy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - Caroline Pessel
- Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, NY
| | - Sara Brubaker
- Department of Obstetrics and Gynecology, New York University, New York, NY
| | - Joy Vink
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Cande V. Ananth
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
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Gulersen M, Divon MY, Krantz D, Chervenak FA, Bornstein E. The risk of spontaneous preterm birth in asymptomatic women with a short cervix (≤25 mm) at 23-28 weeks' gestation. Am J Obstet Gynecol MFM 2019; 2:100059. [PMID: 33345952 DOI: 10.1016/j.ajogmf.2019.100059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asymptomatic short cervical length is an independent risk factor for spontaneous preterm birth. However, most studies have focused on the associated risk of a short cervical length when encountered between 16 and 23 weeks' gestation. The relationship between cervical length and risk of spontaneous preterm birth after 23 weeks is not well known. OBJECTIVE To evaluate the risk of spontaneous preterm birth in asymptomatic women with a short cervix (≤25 mm) at 23-28 weeks' gestation. MATERIALS AND METHODS A retrospective cohort study of women with asymptomatic short cervix (cervical length ≤25 mm) at extreme prematurity, defined as 23-28 weeks' gestation, was performed at a single center from January 2015 to March 2018. Women with symptoms of preterm labor, multiple gestations, fetal or uterine anomalies, cervical cerclage, or those with incomplete data were excluded from the study. Demographic information as well as data on risk factors for spontaneous preterm birth were collected. Patients were divided into 4 groups based on the cervical length measurement (≤10 mm, 11-15 mm, 16-20 mm, and 21-25 mm). The primary outcome was time interval from enrollment to delivery. Secondary outcomes included delivery within 1 and 2 weeks of enrollment, gestational age at delivery, and delivery prior to 32, 34, and 37 weeks, respectively. Continuous variables were compared using Kruskal-Wallis test, whereas categorical variables were compared using the χ2 or Fisher exact test as appropriate. The Wilcoxon test for difference in survival time was used to compare gestational age at delivery among the 4 cervical length groups, with data stratified based on gestational age at enrollment. RESULTS Of the 126 pregnancies that met inclusion criteria, 22 (17.4%) had a cervical length of ≤10 mm, 23 (18.3%) had a cervical length of 11-15 mm, 37 (29.4%) had a cervical length of 16-20 mm, and 44 (34.9%) had a cervical length of 21-25 mm. Baseline characteristics were similar among all 4 groups. The shorter cervical length group was associated with a shorter time interval from enrollment to delivery (cervical length ≤10 mm, 10 weeks; cervical length 11-15 mm, 12.7 weeks; cervical length of 16-20 mm, 13 weeks; cervical length of 21-25 mm, 13.2 weeks; P = .006). Regardless of the cervical length measurement, delivery within 2 weeks was extremely uncommon (1 patient; 0.8%). The prevalence of spontaneous preterm birth at <32 weeks or <34 weeks was higher in women with a cervical length of ≤10 mm compared to those with a longer cervical length (P < .001). CONCLUSIONS The risk of spontaneous preterm birth in asymptomatic women with a sonographic short cervix increases as cervical length decreases. The risk is substantially higher in women with a cervical length of ≤10 mm. Women with a cervical length of ≤10 mm also had the shortest time interval to delivery. Nevertheless, delivery within 1 or 2 weeks is highly unlikely, regardless of the cervical length at the time of enrollment. Therefore, based on our data, we suggest that management decisions such as timing of administration of antenatal corticosteroids in asymptomatic patients with a cervical length of ≤25 mm at 23-28 weeks' gestation may be delayed until additional indications are present.
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Affiliation(s)
- Moti Gulersen
- Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, New York, NY.
| | - Michael Y Divon
- Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, New York, NY
| | | | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, New York, NY
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, New York, NY
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Rottenstreich A, Elchalal U, Haj Yahya R, Mankuta D, Rottenstreich M, Yagel S, Levin G. Missed opportunities for optimal antenatal corticosteroid timing in medically indicated preterm births. J Matern Fetal Neonatal Med 2019; 34:2522-2528. [PMID: 31533506 DOI: 10.1080/14767058.2019.1670159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Although delivery timing is physician dictated in indicated preterm births, suboptimal antenatal corticosteroids (ACS) administration occurs in most cases. We aimed to characterize the patterns of use of ACS in indicated preterm births and identify missed opportunities of optimal ACS administration. METHODS We reviewed the records of women who received ACS and were delivered due to maternal or fetal indications at 24-34 weeks of gestation during 2015-2017 at a university hospital. Optimal ACS timing was defined as delivery ≥24 h ≤7 d from the previous ACS course. RESULTS Overall, 188 pregnancies were included. The median gestational age at delivery was 32 weeks. Considering only the initial ACS course, the rate of optimal timing was 32.4%. Of 105 (55.8%) women eligible (delivery >7 d since the initial ACS course), only a third (n = 38) received a rescue ACS course. Among women who did not receive rescue ACS course despite their eligibility (n = 67), the decision-to-delivery was ≥3 h in 36 (53.7%), and ≥24 h in 20 (29.9%), representing 19.1 and 10.6% of the entire cohort, respectively. The urgency of the decision to deliver (i.e. in the upcoming 24 h and later) and allowing a trial of labor, were both positively associated with decision-to-delivery interval ≥3 h and ≥24 h. The rate of delivery within any optimal window (either initial or rescue course) was 40.4%, with gestational hypertensive disorders (OR [95% CI]: 2.40 (1.23, 4.72), p = .01) and decision to deliver made at first hospitalization (OR [95% CI]: 2.27 (1.04, 4.76), p = .04) as independent positive predictors of optimal ACS timing. The rate of composite adverse neonatal outcome was significantly lower in those with optimal ACS administration as compared to those with suboptimal timing (32.9 versus 50.9%, OR [95% CI]: 0.47 (0.26, 0.87), p = .02). CONCLUSIONS Suboptimal ACS administration occurred in most indicated preterm births. Underutilization of rescue ACS course and a substantial rate of missed opportunities for optimal ACS administration were identified as potentially modifiable contributors to improve ACS timing.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rani Haj Yahya
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Mankuta
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Rottenstreich A, Levin G, Kleinstern G, Haj Yahya R, Rottenstreich M, Yagel S, Elchalal U. Patterns of use and optimal timing of antenatal corticosteroids in twin compared with singleton pregnancies. Acta Obstet Gynecol Scand 2018; 97:1508-1514. [DOI: 10.1111/aogs.13439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/18/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Geffen Kleinstern
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Rani Haj Yahya
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
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Malaina I, Aranburu L, Martínez L, Fernández-Llebrez L, Bringas C, De la Fuente IM, Pérez MB, González L, Arana I, Matorras R. Labor estimation by informational objective assessment (LEIOA) for preterm delivery prediction. Arch Gynecol Obstet 2018; 297:1213-1220. [PMID: 29508063 DOI: 10.1007/s00404-018-4729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To introduce LEIOA, a new screening method to forecast which patients admitted to the hospital because of suspected threatened premature delivery will give birth in < 7 days, so that it can be used to assist in the prognosis and treatment jointly with other clinical tools. METHODS From 2010 to 2013, 286 tocographies from women with gestational ages comprehended between 24 and 37 weeks were collected and studied. Then, we developed a new predictive model based on uterine contractions which combine the Generalized Hurst Exponent and the Approximate Entropy by logistic regression (LEIOA model). We compared it with a model using exclusively obstetric variables, and afterwards, we joined both to evaluate the gain. Finally, a cross validation was performed. RESULTS The combination of LEIOA with the medical model resulted in an increase (in average) of predictive values of 12% with respect to the medical model alone, giving a sensitivity of 0.937, a specificity of 0.747, a positive predictive value of 0.907 and a negative predictive value of 0.819. Besides, adding LEIOA reduced the percentage of incorrectly classified cases by the medical model by almost 50%. CONCLUSIONS Due to the significant increase in predictive parameters and the reduction of incorrectly classified cases when LEIOA was combined with the medical variables, we conclude that it could be a very useful tool to improve the estimation of the immediacy of preterm delivery.
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Affiliation(s)
- Iker Malaina
- Department of Mathematics, University of the Basque Country UPV/EHU, Barrio Sarriena, s/n, 48940, Leioa, Spain.
| | - Larraitz Aranburu
- Department of Applied Mathematics, Statistics and Operation Research, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Luis Martínez
- Department of Mathematics, University of the Basque Country UPV/EHU, Barrio Sarriena, s/n, 48940, Leioa, Spain
| | | | - Carlos Bringas
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Ildefonso M De la Fuente
- Department of Mathematics, University of the Basque Country UPV/EHU, Barrio Sarriena, s/n, 48940, Leioa, Spain.,Department of Nutrition, CEBAS-CSIC Institute, Murcia, Spain
| | - Martín Blás Pérez
- Department of Mathematics, University of the Basque Country UPV/EHU, Barrio Sarriena, s/n, 48940, Leioa, Spain
| | - Leire González
- Obstetrics and Gynecology Department, Cruces University Hospital, Barakaldo, Spain
| | - Itziar Arana
- Obstetrics and Gynecology Department, Cruces University Hospital, Barakaldo, Spain
| | - Roberto Matorras
- Obstetrics and Gynecology Department, Cruces University Hospital, Barakaldo, Spain.,Department of Medical-Surgical Specialties, University of the Basque Country UPV/EHU, Leioa, Spain
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