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Dehaene I, De Coen K, Oostra A, Decruyenaere J, Roelens K, Smets K. Antenatal corticosteroids-to-birth interval in preterm birth. Acta Clin Belg 2021; 76:433-440. [PMID: 32352863 DOI: 10.1080/17843286.2020.1758471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The purpose of this study was to compare short-term outcomes in children born between 24 and 34 weeks' gestation, according to observed antenatal corticosteroids (ACS)-to-birth intervals. Research question: 'Is there a difference in short-term outcomes between observed ACS-to-birth intervals across a range of gestational ages at birth?'Methods: Cohort study assessing differences in incidence of short-term neonatal outcomes according to the observed interval between the last administration of ACS and birth. Linear, non-weighted GEE models with an independence working correlation structure were fitted to infant level data providing valid point estimates for either incidence or rate differences (binary outcomes) or average differences (continuous outcomes).Results: Of 886 children, 35.9% were born within 2 days after the last administration of ACS, 32.2% within 2 to 7 days, 14.1% within 8 to 14 days, and 17.8% more than 14 days after. Across gestational ages at birth, there were no differences in birth weight between children born at an ACS-to-birth interval of 7 days or less compared to more than 7 days, nor were there differences in respiratory outcomes, cerebral outcomes, or composite outcome.Conclusion: Drawing conclusions on the importance of the ACS-to-birth interval is difficult due to the post-hoc nature of the variable. In the absence of tools to better estimate if and when PTB will occur, it might not have any value in daily practice, regardless of whether there is an optimal ACS-to-birth interval or not.
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Affiliation(s)
- Isabelle Dehaene
- Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Kris De Coen
- Neonatal Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Anna Oostra
- Pediatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Kristien Roelens
- Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Koenraad Smets
- Neonatal Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
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Dehaene I, Roelens K, Smets K, Decruyenaere J. Relevance of the antenatal corticosteroids-to-delivery interval in the prevention of neonatal respiratory distress syndrome through the eyes of causal inference: a review and target trial. Arch Gynecol Obstet 2021; 305:885-892. [DOI: 10.1007/s00404-021-06213-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
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Benoist G. Prédiction de l’accouchement prématuré chez les femmes symptomatiques (en situation de menace d’accouchement prématuré). ACTA ACUST UNITED AC 2016; 45:1346-1363. [DOI: 10.1016/j.jgyn.2016.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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Jafari-Dehkordi E, Adibi A, Sirus M. Reference range of the weekly uterine cervical length at 8 to 38 weeks of gestation in the center of Iran. Adv Biomed Res 2015; 4:115. [PMID: 26261817 PMCID: PMC4513327 DOI: 10.4103/2277-9175.157839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 11/30/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is an inverse relation between the uterine cervical length during pregnancy and the frequency of preterm delivery. The purpose of this study was to construct a chart and evaluate the cervical length at 8 to 38 weeks of normal gestation in the center of Iran. MATERIALS AND METHODS Uterine cervical length was measured on 930 asymptomatic pregnant women by abdominal ultrasonographic technique. For statistical evaluation, regression analysis and calculation of percentiles were performed. RESULTS Our data show a significant decrease in uterine cervical length with increasing gestational age. The mean uterine cervical length exhibits minimal changes from 10 to 24 weeks for most women in this study, although the shortening is more prominent at 33 to 38 weeks' gestation. The mean shortening of the uterine cervical length between the second and the ninth months was 14.82% (P < 0.05). Also, the cervical length means in trimesters 1, 2 and 3 were 39.30 ± 4.33, 38.28 ± 5.13 and 36.58 ± 4.58 mm, respectively. The third trimester showed a significant reduction (P < 0.05) in cervical length compared to the first and second trimesters (6.92% and 4.44%, respectively). New charts with the 5(th), 10(th), 50(th), 90(th), and 95(th) percentile are presented. CONCLUSION Our study provides a new chart and reference values for normal uterine cervical length throughout gestation based on a large sample in the center of Iran. There was a progressive decrease in mean uterine cervical length with increasing gestational age in the population of this study. Our established charts for uterine cervical length throughout gestation might be more useful than a single cut-off value for more efficient prevention and management of preterm birth.
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Affiliation(s)
- Esmat Jafari-Dehkordi
- Department of Radiology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atoosa Adibi
- Department of Radiology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Sirus
- Department of Radiology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Çetin C, Büyükkurt S, Cömert E, Özlü F, Bahar N, Demir C. Predictive factors for latency period in viable pregnancies complicated by preterm premature rupture of the membranes. Turk J Obstet Gynecol 2015; 12:30-33. [PMID: 28913037 PMCID: PMC5558401 DOI: 10.4274/tjod.30643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/16/2015] [Indexed: 12/04/2022] Open
Abstract
Objective: In this study, we aimed to evaluate some laboratory and clinical factors in the prediction of latency period for pregnant patients complicated with preterm premature rupture of the membranes. Materials and Methods: Sixty-five pregnant patients between 24 and 34 weeks of gestation, who were admitted to University of Çukurova School of Medicine Hospital with the diagnosis of preterm premature rupture of the membranes (PPROM) between January 01, 2013 and December 31, 2013, were included in this study. Serum CRP, procalcitonin, sedimentation rate, leukocyte count and cervical length (measured with transvaginal ultrasound) of patients were analyzed for the correlation with the latency period. Results: None of the parameters were found to be correlated with the latency period. However, patients with cervical length of <25 mm were found to have shorter duration of latency. Conclusion: Although preterm premature rupture of the membranes is thought to be either an infection-based disease or a disease increasing the risk of infectious complications, major infection markers are not found to be helpful criteria for the prediction of latency period. Patients with a cervical length of <25 mm can be expected to deliver earlier and, therefore, can be referred to a tertiary center earlier.
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Affiliation(s)
- Cihan Çetin
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Selim Büyükkurt
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Ercan Cömert
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Ferda Özlü
- Çukurova University Faculty of Medicine, Department of Neonatology, Adana, Turkey
| | - Nilgün Bahar
- Çukurova University Faculty of Medicine, Department of Neonatology, Adana, Turkey
| | - Cansun Demir
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
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van der Ven AJ, van Os MA, Kleinrouweler CE, de Groot CJM, Haak MC, Mol BWJ, Pajkrt E, Kazemier BM. Is cervical length associated with maternal characteristics? Eur J Obstet Gynecol Reprod Biol 2015; 188:12-6. [PMID: 25770842 DOI: 10.1016/j.ejogrb.2015.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/24/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women with a mid-trimester short cervical length (CL) are at increased risk for preterm delivery. Consequently, CL measurement is a potential screening tool to identify women at risk for preterm birth. Our objective was to assess possible associations between CL and maternal characteristics. STUDY DESIGN A nationwide screening study was performed in which CL was measured during the standard anomaly scan among low risk women with a singleton pregnancy. Data on maternal height, pre-pregnancy weight, ethnicity, parity and gestational age at the time of the CL measurement were collected from January 2010 to December 2012. Univariable and multivariable linear regression analyses were performed to assess the relationship between CL and maternal characteristics. RESULTS We included 5092 women. The mean CL was 44.3mm. No association was found between CL and maternal height or gestational age of the measurement. Maternal weight was associated with CL (p=0.007, adjusted R(2) 0.03). Separate analysis for BMI did not change these results. Ethnicity, known in 2702 out of 5092 women, was associated with CL (mean CL in Caucasian women 45.0mm, Asian 43.9mm, Mediterranean 43.1mm, and African 41.8mm, p=0.003), as well as parity (mean CL multiparous 45.3mm, nulliparous 43.5mm, p<0.0001). CONCLUSION Shorter mid-trimester cervical length is associated with higher maternal weight, younger maternal age, nulliparity and non-Caucasian ethnicity, but not with maternal height.
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Affiliation(s)
- A J van der Ven
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - M A van Os
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - C E Kleinrouweler
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA, Australia.
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - B M Kazemier
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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Benshalom-Tirosh N, Tirosh D, Aricha-Tamir B, Weintraub AY, Erez O, Mazor M, Hershkovitz R. The clinical utility of sonographic cervical length in the management of preterm parturition at 28-32 weeks of gestation. J Matern Fetal Neonatal Med 2014; 28:1929-33. [PMID: 25547187 DOI: 10.3109/14767058.2014.972929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the role of cervical length measurement in early third trimester (28-32 weeks) as a predictor of preterm delivery (PTD), in women presenting with preterm parturition. METHODS Cervical length was measured prospectively, in singleton pregnancies at 28-32 weeks with preterm contractions (PTC). A multivariate linear regression model was performed to assess the association between cervical length and gestational age at delivery. Logistic regression analysis with PTD before 34 and 37 weeks of gestation as the outcome variable was performed to control for confounders. RESULTS Fifty-six women were included, mean gestational week at presentation and at delivery were 29.88 ± 1.13 and 37.05 ± 2.86, respectively. There was a direct association between short cervical length at admission and gestational week at delivery (p = 0.027). This association remained significant even after controlling for confounders. Short cervical length was significantly associated with PTD before 34 (p = 0.045) or 37 (p = 0.046) weeks of gestation. CONCLUSIONS Third trimester cervical length measurement in patients with PTC is associated with gestational week at delivery, as well as PTD prior to 34 and 37 weeks of gestation. Therefore, examining cervical length is clinically valuable and probably cost-effective during early third trimester.
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Affiliation(s)
- Neta Benshalom-Tirosh
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Dan Tirosh
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Barak Aricha-Tamir
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Adi Y Weintraub
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Offer Erez
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Moshe Mazor
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Reli Hershkovitz
- a Department of Obstetrics & Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer Sheva , Israel
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Abstract
OBJECTIVE To assess the predictive role of ultrasonographic cervical length for preterm delivery in women with threatened preterm labor. METHODS A retrospective cohort study of women with singleton pregnancies who presented with preterm labor before 34 weeks of gestation and underwent ultrasonographic measurement of cervical length in a tertiary medical center. Women with cervical cerclage, cervical dilatation greater than 3 cm at presentation, and pregnancies complicated by placental abruption, clinical chorioamnionitis, stillbirth, or major fetal anomalies were excluded. The predictive accuracy of cervical length for preterm delivery was analyzed using both fixed thresholds and outcome-specific thresholds, which are associated with a detection rate of 90%, false-positive rate of 10%, or the inflexion point of the receiver operator characteristic curve. RESULTS Between 2007 and 2012, 1,077 women presented with preterm labor and met the study criteria. The correlation between cervical length and the time interval to delivery was significant but weak (r=0.293, P<.001). Cervical length was independently associated with the risk of preterm delivery at less than 37, 35, and 32 weeks of gestation and within 14 and 7 days from presentation (a 4-7% decrease in the risk for each additional millimeter of cervical length) as well as with the time interval between presentation and delivery (each additional 2 mm was associated with an increase of 1 day). Overall, the accuracy of cervical length in predicting preterm delivery was relatively poor. CONCLUSION Although cervical length is an independent predictor of preterm delivery in women with preterm labor, its predictive accuracy as a single measure is relatively limited. LEVEL OF EVIDENCE : II.
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Boots AB, Sanchez-Ramos L, Bowers DM, Kaunitz AM, Zamora J, Schlattmann P. The short-term prediction of preterm birth: a systematic review and diagnostic metaanalysis. Am J Obstet Gynecol 2014; 210:54.e1-54.e10. [PMID: 24021995 DOI: 10.1016/j.ajog.2013.09.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/08/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of fetal fibronectin (fFN), fetal breathing movements (FBM), and cervical length (CL) for the short-term prediction of preterm birth in symptomatic patients. STUDY DESIGN Diagnostic metaanalysis using bivariate methods. RESULTS Pooled sensitivities for fFN, FBM, and CL for delivery within 48 hours of testing were 0.62 (95% confidence interval [CI], 0.43-0.78), 0.75 (95% CI, 0.57-0.87) and 0.77 (95% CI, 0.54-0.90), respectively. Pooled specificities for fFN, FBM, and CL for delivery within 48 hours were 0.81 (95% CI, 0.74-0.86), 0.93 (95% CI, 0.75-0.98) and 0.88 (95% CI, 0.84-0.91). Pooled sensitivities for fFN, FBM, and CL for delivery within 7 days were 0.75 (95% CI, 0.69-0.80), 0.67 (95% CI, 0.43-0.84), and 0.74 (95% CI, 0.58-0.85). Pooled specificities for fFN, FBM, and CL for delivery within 7 days were 0.79 (95% CI, 0.76-0.83), 0.98 (95% CI, 0.83-1.00) and 0.89 (95% CI, 0.85-0.92). Based on a pretest probability of 10% for delivery within 48 hours, posttest probabilities (positive and negative) were 27% and 5% for fFN, 54% and 3% for fFN, and 42% and 3% for CL. For a pretest probability of 20% for delivery within 7 days, posttest probabilities (positive and negative) were 48% and 7% for fFN, 89% and 8% for FBM, and 63% and 7% for CL. CONCLUSION In symptomatic patients, for fFN, absence of FBM, and CL have diagnostic use as predictors of delivery within 48 hours and within 7 days of testing. Absence of FBM appears to be the best test for predicting preterm birth.
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Torricelli M, Voltolini C, De Bonis M, Vellucci FL, Conti N, Severi FM, Petraglia F. The identification of high risk pregnancy: a new challenge in obstetrics. J Matern Fetal Neonatal Med 2012; 25 Suppl 1:2-5. [DOI: 10.3109/14767058.2012.664355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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