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Di Renzo GC, Tosto V, Tsibizova V, Fonseca E. Prevention of Preterm Birth with Progesterone. J Clin Med 2021; 10:4511. [PMID: 34640528 PMCID: PMC8509841 DOI: 10.3390/jcm10194511] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
Gestational age at birth is a critical factor for perinatal and adulthood outcomes, and even for transgenerational conditions' effects. Preterm birth (PTB) (prematurity) is still the main determinant for infant mortality and morbidity leading cause of infant morbidity and mortality. Unfortunately, preterm birth (PTB) is a relevant public health issue worldwide and the global PTB rate is around 11%. The premature activation of labor is underlined by complex mechanisms, with a multifactorial origin influenced by numerous known and probably unknown triggers. The possible mechanisms involved in a too early labor activation have been partially explained, and involve chemokines, receptors, and imbalanced inflammatory paths. Strategies for the early detection and prevention of this obstetric condition were proposed in clinical settings with interesting results. Progesterone has been demonstrated to have a key role in PTB prevention, showing several positive effects, such as lower prostaglandin synthesis, the inhibition of cervical stromal degradation, modulating the inflammatory response, reducing gap junction formation, and decreasing myometrial activation. The available scientific knowledge, data and recommendations address multiple current areas of debate regarding the use of progesterone in multifetal gestation, including different formulations, doses and routes of administration and its safety profile in pregnancy.
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Affiliation(s)
- Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, 06132 Perugia, Italy;
- Department of Obstetrics and Gynecology, Faculty of General Medicine, I.M. Sechenov First State University of Moscow, 119991 Moscow, Russia
| | - Valentina Tosto
- Centre of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, 06132 Perugia, Italy;
| | - Valentina Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, 197341 Saint Petersburg, Russia;
| | - Eduardo Fonseca
- Department of Obstetrics and Gynecology, Federal University of Paraiba, Joao Pessoa 58051-900, PB, Brazil;
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Gudicha DW, Romero R, Kabiri D, Hernandez-Andrade E, Pacora P, Erez O, Kusanovic JP, Jung E, Paredes C, Berry SM, Yeo L, Hassan SS, Hsu CD, Tarca AL. Personalized assessment of cervical length improves prediction of spontaneous preterm birth: a standard and a percentile calculator. Am J Obstet Gynecol 2021; 224:288.e1-288.e17. [PMID: 32918893 PMCID: PMC7914140 DOI: 10.1016/j.ajog.2020.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A sonographic short cervix (length <25 mm during midgestation) is the most powerful predictor of preterm birth. Current clinical practice assumes that the same cervical length cutoff value should apply to all women when screening for spontaneous preterm birth, yet this approach may be suboptimal. OBJECTIVE This study aimed to (1) create a customized cervical length standard that considers relevant maternal characteristics and gestational age at sonographic examination and (2) assess whether the customization of cervical length evaluation improves the prediction of spontaneous preterm birth. STUDY DESIGN This retrospective analysis comprises a cohort of 7826 pregnant women enrolled in a longitudinal protocol between January 2006 and April 2017 at the Detroit Medical Center. Study participants met the following inclusion criteria: singleton pregnancy, ≥1 transvaginal sonographic measurements of the cervix, delivery after 20 weeks of gestation, and available relevant demographics and obstetrical history information. Data from women without a history of preterm birth or cervical surgery who delivered at term without progesterone treatment (N=5188) were used to create a customized standard of cervical length. The prediction of the primary outcome, spontaneous preterm birth at <37 weeks of gestation, was assessed in a subset of pregnancies (N=7336) that excluded cases with induced labor before 37 weeks of gestation. Area under the receiver operating characteristic curve and sensitivity at a fixed false-positive rate were calculated for screening at 20 to 23 6/7, 24 to 27 6/7, 28 to 31 6/7, and 32 to 35 6/7 weeks of gestation in asymptomatic patients. Survival analysis was used to determine which method is better at predicting imminent delivery among symptomatic women. RESULTS The median cervical length remained fundamentally unchanged until 20 weeks of gestation and subsequently decreased nonlinearly with advancing gestational age among women who delivered at term. The effects of parity and maternal weight and height on the cervical length were dependent on the gestational age at ultrasound examination (interaction, P<.05 for all). Parous women had a longer cervix than nulliparous women, and the difference increased with advancing gestation after adjusting for maternal weight and height. Similarly, maternal weight was nonlinearly associated with a longer cervix, and the effect was greater later in gestation. The sensitivity at a 10% false-positive rate for prediction of spontaneous preterm birth at <37 weeks of gestation by a short cervix ranged from 29% to 40% throughout pregnancy, yet it increased to 50%, 50%, 53%, and 54% at 20 to 23 6/7, 24 to 27 6/7, 28 to 31 6/7, and 32 to 35 6/7 weeks of gestation, respectively, for a low, customized percentile (McNemar test, P<.001 for all). When a cervical length <25 mm was compared to the customized screening at 20 to 23 6/7 weeks of gestation by using a customized percentile cutoff value that ensured the same negative likelihood ratio for both screening methods, the customized approach had a significantly higher (about double) positive likelihood ratio in predicting spontaneous preterm birth at <33, <34, <35, <36, and <37 weeks of gestation. Among symptomatic women, the difference in survival between women with a customized cervical length percentile of ≥10th and those with a customized cervical length percentile of <10th was greater than the difference in survival between women with a cervical length ≥25 mm and those with a cervical length <25 mm. CONCLUSION Compared to the use of a cervical length <25 mm, a customized cervical length assessment (1) identifies more women at risk of spontaneous preterm birth and (2) improves the distinction between patients at risk for impending preterm birth in those who have an episode of preterm labor.
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Affiliation(s)
- Dereje W Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI; Department of Obstetrics and Gynecology, Florida International University, Miami, FL
| | - Doron Kabiri
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Maternity Department "D," Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Beer-Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Center for Research and Innovation in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile; Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Carmen Paredes
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Stanley M Berry
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI
| | - Adi L Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, and Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Computer Science, Wayne State University College of Engineering, Detroit, MI.
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da Fonseca EB, Damião R, Moreira DA. Preterm birth prevention. Best Pract Res Clin Obstet Gynaecol 2020; 69:40-49. [DOI: 10.1016/j.bpobgyn.2020.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
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Park JY, Jung YM, Kook SY, Jeon SJ, Oh KJ, Hong JS. The effect of postoperative vaginal progesterone in ultrasound-indicated cerclage to prevent preterm birth. J Matern Fetal Neonatal Med 2019; 34:2473-2480. [PMID: 31558069 DOI: 10.1080/14767058.2019.1668371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare pregnancy outcomes according to the use of postoperative vaginal progesterone in patients who underwent ultrasound-indicated cerclage. METHODS This was a retrospective cohort study of 86 consecutive asymptomatic singleton pregnancies who had undergone cerclage because of incidentally found short cervical length under 20 mm through transvaginal ultrasound between 16°/7 and 246/7 weeks' gestational age. Outcomes were compared according to the use of vaginal progesterone after cerclage. Primary outcome measure was preterm delivery < 34 weeks of gestation. RESULTS (1) The frequency of preterm delivery < 34 weeks of gestation was significantly lower in patients with postoperative vaginal progesterone than those without (2.2 versus 18.4%, p = .021); (2) the median gestational age at delivery in the postoperative vaginal progesterone group was significantly longer than the control group (38.3 weeks (interquartile range, 37.5-39.1 weeks) versus 37.3 weeks (interquartile range 33.9-38.6 weeks), p = .020); (3) Multivariable logistic regression analysis demonstrated the use of vaginal progesterone after cerclage was found to be independently associated with decrease in preterm delivery before 34 weeks (Odds ratio 0.10; 95% confidence interval, 0.01-0.93) and 37 weeks (Odds ratio 0.24; 95% confidence interval, 0.07-0.85). CONCLUSIONS The use of vaginal progesterone was associated with lower rates of preterm birth before 34 and 37 weeks of gestation in women who underwent ultrasound-indicated cerclage placement.
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Affiliation(s)
- Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Song-Yi Kook
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Se Jeong Jeon
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Antibiotic administration can eradicate intra-amniotic infection or intra-amniotic inflammation in a subset of patients with preterm labor and intact membranes. Am J Obstet Gynecol 2019; 221:142.e1-142.e22. [PMID: 30928566 DOI: 10.1016/j.ajog.2019.03.018] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intra-amniotic infection is present in 10% of patients with an episode of preterm labor, and is a risk factor for impending preterm delivery and neonatal morbidity/mortality. Intra-amniotic inflammation is often associated with intra-amniotic infection, but is sometimes present in the absence of detectable microorganisms. Antibiotic treatment of intra-amniotic infection has traditionally been considered to be ineffective. Intra-amniotic inflammation without microorganisms has a prognosis similar to that of intra-amniotic infection. OBJECTIVE To determine whether antibiotics can eradicate intra-amniotic infection or intra-amniotic inflammation in a subset of patients with preterm labor and intact membranes. MATERIALS AND METHODS The study population consisted of women who met the following criteria: 1) singleton gestation between 20 and 34 weeks; 2) preterm labor and intact membranes; 3) transabdominal amniocentesis performed for the evaluation of the microbiologic/inflammatory status of the amniotic cavity; 4) intra-amniotic infection and/or intra-amniotic inflammation; and 5) received antibiotic treatment that consisted of ceftriaxone, clarithromycin, and metronidazole. Follow-up amniocentesis was performed in a subset of patients. Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction was performed for Ureaplasma spp. Intra-amniotic infection was defined as a positive amniotic fluid culture or positive polymerase chain reaction, and intra-amniotic inflammation was suspected when there was an elevated amniotic fluid white blood cell count or a positive result of a rapid test for matrix metalloproteinase-8. For this study, the final diagnosis of intra-amniotic inflammation was made by measuring the interleukin-6 concentration in stored amniotic fluid (>2.6 ng/mL). These results were not available to managing clinicians. Treatment success was defined as eradication of intra-amniotic infection and/or intra-amniotic inflammation or delivery ≥37 weeks. RESULTS Of 62 patients with intra-amniotic infection and/or intra-amniotic inflammation, 50 received the antibiotic regimen. Of those patients, 29 were undelivered for ≥7 days and 19 underwent a follow-up amniocentesis. Microorganisms were identified by culture or polymerase chain reaction of amniotic fluid obtained at admission in 21% of patients (4/19) who had a follow-up amniocentesis, and were eradicated in 3 of the 4 patients. Resolution of intra-amniotic infection/inflammation was confirmed in 79% of patients (15/19), and 1 other patient delivered at term, although resolution of intra-amniotic inflammation could not be confirmed after a follow-up amniocentesis. Thus, resolution of intra-amniotic inflammation/infection or term delivery (treatment success) occurred in 84% of patients (16/19) who had a follow-up amniocentesis. Treatment success occurred in 32% of patients (16/50) with intra-amniotic infection/inflammation who received antibiotics. The median amniocentesis-to-delivery interval was significantly longer among women who received the combination of antibiotics than among those who did not (11.4 days vs 3.1 days: P = .04). CONCLUSION Eradication of intra-amniotic infection/inflammation after treatment with antibiotics was confirmed in 79% of patients with preterm labor, intact membranes, and intra-amniotic infection/inflammation who had a follow-up amniocentesis. Treatment success occurred in 84% of patients who underwent a follow-up amniocentesis and in 32% of women who received the antibiotic regimen.
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Maia MC, Nomura R, Mendonça F, Rios L, Moron A. Is cervical length evaluated by transvaginal ultrasonography helpful in detecting true preterm labor? J Matern Fetal Neonatal Med 2019; 33:2902-2908. [PMID: 30668186 DOI: 10.1080/14767058.2018.1564026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To investigate whether sonographic cervical markers can identify women in true preterm labor and predict delivery within 7 d and before 34 or 37 gestational weeks.Methods: This was a prospective observational study of women with singleton pregnancies and intact membranes given a diagnosis of preterm labor between 25 and 34 weeks and 6 d of gestation and who underwent transvaginal evaluation of the following characteristics: cervical length (CL), CL zeta score, absence of endocervical glandular echo, presence of cervical funneling, and presence of amniotic fluid sludge. The outcomes of interest were spontaneous delivery within 7 d of preterm labor and spontaneous delivery before 34 or 37 gestational weeks.Results: The inclusion criteria were met by 126 women, 31 (25%) of whom were excluded and 95 were analyzed. The median gestational age at admission was 31.9 weeks. The median CL at preterm labor was 22.3 mm (range: 0-42.8 mm). The delivery occurred within 7 d of presentation in 13 (13.7%) cases. Delivery before 34 weeks occurred in 16 (16.8%) cases and before 37 weeks in 40 (42.1%) cases. Logistic regression analysis showed CL in millimeters was an independent predictor of delivery within 7 d (OR 0.918, 95% CI 0.862-0.978, p = .008). For birth before 34 weeks, the predictor was gestational age at admission (OR 0.683, 95% CI 0.539-0.866, p = .002) and before 37 weeks, the presence of cervical funneling (OR 3.778, 95% CI 1.460-9.773, p = .006). The CL ≤ 15 mm had sensitivity and specificity values of 77 and 77%, respectively, and good accuracy (88%) for prediction of delivery within 7 d.Conclusion: The evaluation of the cervix by transvaginal ultrasound in women in preterm labor predicted delivery within 7 d and helped distinguish between true and false labor. The analysis of CL zeta score was not an independent factor to predict delivery in 7 d.
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Affiliation(s)
- Maria Carolina Maia
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Roseli Nomura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Mendonça
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Livia Rios
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Antonio Moron
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Eleje GU, Ezugwu EC, Eke AC, Eleje LI, Ikechebelu JI, Ezebialu IU, Obiora CC, Nwosu BO, Ezeama CO, Udigwe GO, Okafor CI, Ezugwu FO. Accuracy of a combined insulin-like growth factor-binding protein-1/interleukin-6 test (Premaquick) in predicting delivery in women with threatened preterm labor. J Perinat Med 2017; 45:915-924. [PMID: 28236632 DOI: 10.1515/jpm-2016-0339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/17/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine values of combinations of interleukin-6 (IL-6)/cervical native insulin-like growth factor-binding protein-1 (IGFBP-1)/total IGFBP-1 (Premaquick©) in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in women with threatened preterm labor. METHODS Women with singleton pregnancies between gestation age (GA) of 24 weeks and 36 weeks and 6 days with preterm labor were recruited during a prospective multicenter study. Premaquick© was positive when at least two of three biomarkers were positive. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were estimated for both prediction of spontaneous deliveries and spontaneous exclusive preterm deliveries. RESULTS Ninety-seven (99.0%) out of 98 women enrolled were analyzed. Based on delivery status 7/14 days post-enrollment of general study population, Premaquick© had a sensitivity of 87.1/85.7%, a specificity of 92.4/96.8%, a PPV of 84.4/93.8% and a NPV of 93.9/92.3% for prediction of spontaneous delivery. Predictive accuracy of Premaquick© test in relation to days of enrollment were: 90.7% (≤7 days) and 92.8% (≤14 days). For women enrolled at GA <35 weeks, Premaquick© had a sensitivity of 100.0/87.5%, a specificity of 94.1/96.9%, a PPV of 70.5/87.5%, a NPV of 100.0/96.9% and an accuracy of 95.0/95.0% for prediction of preterm delivery within 7/14 days of enrollment, respectively. PPV was most significantly different in both groups when outcomes were compared between 2 days and 14 days post-enrollment (P<0.001). CONCLUSION This novel triple biomarker model of native and total IGFBP-1 and IL-6 appears to be an accurate test in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in threatened preterm labor in singleton pregnancies.
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Kim JI, Cho MO, Choi GY. [Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth]. J Korean Acad Nurs 2017; 47:357-366. [PMID: 28706170 DOI: 10.4040/jkan.2017.47.3.357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to determine the influence of various factors on preterm labor symptoms (PLS) and preterm birth (PB). METHODS This prospective cohort study included 193 women in the second stage of pregnancy. Multiple characteristics including body mass index (BMI), smoking, and pregnancy complications were collected through a self-report questionnaire. Pregnancy stress and PLS were each measured with a related scale. Cervical length and birth outcome were evaluated from medical charts. Multiple regression was used to predict PLS and logistic regression was used to predict PB. RESULTS Multiple regression showed smoking experience, pregnancy complications and pregnancy specific stress were predictors of PLS and accounted for 19.2% of the total variation. Logistic regression showed predictors of PB to be twins (OR=13.68, CI=3.72~50.33, p<.001), shorter cervix (<25mm) (OR=5.63, CI=1.29~24.54, p<.05), BMI >25 (kg/m²) (OR=3.50, CI=1.35~9.04, p<.01) and a previous PB (OR=4.15, CI=1.07~16.03, p<.05). CONCLUSION The results of this study show that the multiple factors affect stage II pregnant women can result in PLS or PB. And preterm labor may predict PB. These findings highlight differences in predicting variables for pretrm labor and for PB. Future research is needed to develop a screening tool to predict the risk of preterm birth in pregnant women.
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Affiliation(s)
- Jeung Im Kim
- School of Nursing, Soonchunhyang University, Cheonan, Korea
| | - Mi Ock Cho
- Department of Nursing, Soonchunhyang University Hospital Cheonan, Cheonan ,Korea.
| | - Gyu Yeon Choi
- Department of Obstetrics and Gynecology, Soonchunhyang University Hospital Seoul, Seoul, Korea
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Can Transabdominal Scan Predict a Short Cervix by Transvaginal Scan? Obstet Gynecol Int 2017; 2017:3035718. [PMID: 28491092 PMCID: PMC5401726 DOI: 10.1155/2017/3035718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
Background. To determine whether transabdominal screening can be used to screen women with short cervix on transvaginal scan. Methods. The study was done between 18 and 20 weeks of gestation. Transabdominal scan was done and cervical length was measured. Transvaginal scan was also done and cervical length was measured. An attempt was made to find out whether transabdominal scan be used to predict a cervical length of 25 mm by transvaginal scan. Results. In our study the cut-off for transabdominal scan for detecting a short cervix of 25 mm by transvaginal scan was 29 mm. A transabdominal cervical length of 29 mm could predict a short cervix of 25 mm by transvaginal scan by 100% sensitivity and 92.4% sensitivity. Conclusion. A cut-off of 29 mm by transabdominal scan is very accurate in predicting a short cervix of 25 mm by transvaginal scan.
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Hatanaka AR, Mattar R, Kawanami TEN, França MS, Rolo LC, Nomura RMY, Araujo Júnior E, Nardozza LMM, Moron AF. Amniotic fluid "sludge" is an independent risk factor for preterm delivery. J Matern Fetal Neonatal Med 2014; 29:120-5. [PMID: 25471053 DOI: 10.3109/14767058.2014.989202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence and the clinical significance of amniotic fluid "sludge" (AFS) in asymptomatic patients at low and high risk for spontaneous preterm delivery. METHOD A prospective cohort study was conducted on 195 singleton pregnancies at low or high risk for preterm birth (PTB) between the 16th and 26th weeks. Cervical length (CL) <25 mm and the presence of AFS were evaluated. The risk for preterm delivery before 28, 32, 35 and 37 weeks were determined according to the presence of AFS, CL < 25 mm and history of high risk for PTB. Stepwise logistic regression was performed to compare variables. RESULTS AFS was an independent risk factor for PTB < 35 weeks (OR: 3.08, 95% CI: 1.13-8.34, p = 0.027) but not for PTB < 28, 32 and 37 weeks. CL < 25 mm was an independent risk factor for PTB < 28, 32 and 35 but not for PTB < 37 weeks. High risk for PTB was not found as an independent risk factor for PTB. CONCLUSION AFS is an independent risk factor for PTB before 35 weeks.
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Affiliation(s)
- Alan Roberto Hatanaka
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Rosiane Mattar
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Tatiana Emy Nishimoto Kawanami
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Marcelo Santucci França
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Liliam Cristine Rolo
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Roseli Mieko Yamamoto Nomura
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Edward Araujo Júnior
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | | | - Antonio Fernandes Moron
- a Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil
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Hernandez-Andrade E, Aurioles-Garibay A, Garcia M, Korzeniewski SJ, Schwartz AG, Ahn H, Martinez-Varea A, Yeo L, Chaiworapongsa T, Hassan SS, Romero R. Effect of depth on shear-wave elastography estimated in the internal and external cervical os during pregnancy. J Perinat Med 2014; 42:549-57. [PMID: 25029081 PMCID: PMC4183447 DOI: 10.1515/jpm-2014-0073] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/19/2014] [Indexed: 12/22/2022]
Abstract
AIM To investigate the effect of depth on cervical shear-wave elastography. METHODS Shear-wave elastography was applied to estimate the velocity of propagation of the acoustic force impulse (shear wave) in the cervix of 154 pregnant women at 11-36 weeks of gestation. Shear-wave speed (SWS) was evaluated in cross-sectional views of the internal and external cervical os in five regions of interest: anterior, posterior, lateral right, lateral left, and endocervix. Distance from the center of the ultrasound (US) transducer to the center of each region of interest was registered. RESULTS In all regions, SWS decreased significantly with gestational age (P=0.006). In the internal os, SWS was similar among the anterior, posterior, and lateral regions and lower in the endocervix. In the external os, the endocervix and anterior regions showed similar SWS values, lower than those from the posterior and lateral regions. In the endocervix, these differences remained significant after adjustment for depth, gestational age, and cervical length. SWS estimations in all regions of the internal os were higher than those of the external os, suggesting denser tissue. CONCLUSION Depth from the US probe to different regions in the cervix did not significantly affect the SWS estimations.
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Affiliation(s)
- Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Alma Aurioles-Garibay
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Maynor Garcia
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Alyse G. Schwartz
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Hyunyoung Ahn
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Alicia Martinez-Varea
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics/Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, MI, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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12
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Hernandez-Andrade E, Romero R, Korzeniewski SJ, Ahn H, Aurioles-Garibay A, Garcia M, Schwartz AG, Yeo L, Chaiworapongsa T, Hassan SS. Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery. J Perinat Med 2014; 42:159-69. [PMID: 24356388 PMCID: PMC4183449 DOI: 10.1515/jpm-2013-0277] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/25/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine if there is an association between cervical strain, evaluated using ultrasound elastography, and spontaneous preterm delivery (sPTD) <37 weeks of gestation. METHODS One hundred and eighty nine (189) women at 16-24 weeks of gestation were evaluated. Ultrasound elastography was used to estimate cervical strain in three anatomical planes: one mid-sagittal in the same plane used for cervical length measurement, and two cross sectional images: one at the level of the internal cervical os, and the other at the level of the external cervical os. In each plane, two regions of interest (endocervix and entire cervix) were examined; a total of six regions of interest were evaluated. RESULTS The prevalence of sPTD was 11% (21/189). Strain values from each of the six cervical regions correlated weakly with cervical length (from r=-0.24, P<0.001 to r=-0.03, P=0.69). Strain measurements obtained in a cross sectional view of the internal cervical os were significantly associated with sPTD. Women with strain values ≤25th centile in the endocervical canal (0.19) and in the entire cervix (0.14) were 80% less likely to have a sPTD than women with strain values >25th centile [endocervical: odds ratio (OR) 0.2; 95% confidence interval (CI), 0.03-0.96; entire cervix: OR 0.17; 95% CI, 0.03-0.9]. Additional adjustment for gestational age, race, smoking status, parity, maternal age, pre-pregnancy body mass index, and previous preterm delivery did not appreciably alter the magnitude or statistical significance of these associations. Strain values obtained from the external cervical os and from the sagittal view were not associated with sPTD. CONCLUSION Low strain values in the internal cervical os were associated with a significantly lower risk of spontaneous preterm delivery <37 weeks of gestation.
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Affiliation(s)
- Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Hyunyoung Ahn
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alma Aurioles-Garibay
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Maynor Garcia
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alyse G. Schwartz
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, Michigan, and Bethesda, Maryland, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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13
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Chaudhury K, Ghosh M, Halder A, Senapati S, Chaudhury S. Is transabdominal ultrasound scanning of cervical measurement in mid-trimester pregnancy a useful alternative to transvaginal ultrasound scan? J Turk Ger Gynecol Assoc 2013; 14:225-9. [PMID: 24592111 DOI: 10.5152/jtgga.2013.00378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the correlation between transabdominal and transvaginal ultrasound measurements of the cervix in pregnancy. If transabdominal ultrasound measurement of cervical length is found to provide effective information, it could be used in patient counselling and when making clinical decisions. MATERIAL AND METHODS One hundred and twenty seven pregnant patients between 18-26 weeks of pregnancy were enrolled in this prospective study for measuring cervical length, both by transabdominal and transvaginal ultrasound scan after bladder emptying. Transabdominal and transvaginal measurements were compared and correlated. RESULTS In patients with transvaginal ultrasound scan (TVS) cervical length ≤32 mm, TVS cervical length was found to be shorter than by transabdominal ultrasound scan (TAS). Most of these patients needed >3 cm of vertical pocket of urine in the bladder for adequate visualisation of the cervix. In patients with TVS cervical length >32 mm, the TVS measurement of the cervix was longer than the TAS measurement of the cervix. In these patients, the cervix could be seen by TAS when there was either ≤3 cm vertical pocket of urine in the bladder or an empty bladder. Statistical tests showed that there is a significant difference between TAS and TVS cervical measurements and that there is a significant association between these two measurements. CONCLUSION Most of the patients needed variable degrees of bladder filling for adequate visualisation of the cervix. Although minimal bladder filling does not influence TAS measurements of cervical length, moderate fullness of the bladder does cause an apparent increase in TAS measurements of cervical length. If the cervical length is ≥30 mm by TAS, regardless of urine content in the bladder, the patient can be assured vis a vis their risk of preterm labour as far as cervical length is concerned. However, in patients with TAS cervical measurement <30 mm and where the bladder needed a moderate amount of urine for adequate visualisation of the cervix, TVS cervical measurement may be close to the critical value of 25 mm. These patients need to be counselled and offered TVS for better assessment of cervical length.
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Affiliation(s)
- Kalyansree Chaudhury
- Department of Obstetrics and Gynecology, Burdwan Medical College, Burdwan, India
| | - Mrinalkanti Ghosh
- Department of Radiodiagnosis, Burdwan Medical College, Burdwan, India
| | - Atin Halder
- Department of Obstetrics and Gynecology, Burdwan Medical College, Burdwan, India
| | - Sourav Senapati
- Department of Gynecology, Kharagpur Subdivisional Hospital, Kharagpur, India
| | - Sudeshna Chaudhury
- Department of Ultrasonography, The Birth Assisted Conception Institute, Kolkata, India
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D'Agostini C, de Oliveira M, D'Souza-Li L. Comparison of cervical length in adult and adolescent nulliparae at mid-gestation. J Pediatr Adolesc Gynecol 2013; 26:209-11. [PMID: 23773795 DOI: 10.1016/j.jpag.2013.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/01/2013] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To compare cervical lengths of adolescents and adults in mid-gestation. DESIGN An analytical, observational, and cross-sectional study. SETTING Public health system in the city of Blumenau, Brazil. PARTICIPANTS Primigravidae adolescents under the age of 16 and adults over age 20 (n = 40/group) were systematically sampled. INTERVENTIONS Cervical measurements were performed between 21 and 24 weeks of gestation through transvaginal ultrasonography using a previously validated method. MAIN OUTCOME MEASURES Mean cervical length (Mann-Whitney test) and percentage of cervices below 25 mm (Fisher exact test). RESULTS For adolescents and adults, average uterine cervix lengths were 28 ± 6.6 mm 33 ± 4.1 mm (P < .0001), respectively, and the proportion of cervixes below 25 mm were 27.5% and 7.5% (P < .02), respectively. In addition, adolescents had significantly lower gynecologic age, education, and family income than adults. CONCLUSION Primigravida adolescents under the age of 16 have shorter cervices than adults, and a higher percentage of adolescents have cervices shorter than 25 mm. This may be associated with the higher risk of preterm birth observed in adolescents and suggests that this population requires special attention in prenatal care.
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Affiliation(s)
- Carla D'Agostini
- Faculty of Medical Science, University of Campinas, and Department of Medicine, Health Sciences Center, Regional University of Blumenau, Blumenau, Brazil.
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Peltier MR, Arita Y, Klimova NG, Gurzenda EM, Koo HC, Murthy A, Lerner V, Hanna N. 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) enhances placental inflammation. J Reprod Immunol 2013; 98:10-20. [PMID: 23642494 PMCID: PMC3752305 DOI: 10.1016/j.jri.2013.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/22/2013] [Accepted: 02/13/2013] [Indexed: 02/02/2023]
Abstract
Preterm birth is a leading cause of perinatal morbidity and mortality that is often associated with ascending infections from the lower genital tract. Recent studies with animal models have suggested that developmental exposure to the environmental toxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) can increase the risk of preterm birth in the offspring. How TCDD may modify placental immunity to ascending infections is unclear. Therefore, we studied the effects of TCDD treatment on basal and Escherichia coli-stimulated cytokine production by placental explants. Cultures of second-trimester placentas were treated with up to 40 nM TCDD for 72 h and then stimulated with 10(7)CFU/ml E. coli for an additional 24h. Concentrations of cytokines and PGE2 were measured in conditioned medium by immunoassay. TCDD exposure increased mRNA levels of IL-1β by unstimulated cultures, but no effects on protein levels of this cytokine were detected. TNF-α production was unaffected by TCDD for unstimulated cultures, but pre-treatment with 40 nM TCDD significantly increased E. coli-stimulated TNF-α production. Both basal and bacteria-stimulated PGE2 and COX-2 gene expression were enhanced by TCDD pretreatment. In contrast, production of the anti-inflammatory cytokine, IL-10, was reduced by TCDD pretreatment for both unstimulated and E. coli-stimulated cultures. No effect of TCDD on the viability of the cultures was detected. These results suggest that TCDD exposure may shift immunity to enhance a proinflammatory phenotype at the maternal-fetal interface that could increase the risk of infection-mediated preterm birth.
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Affiliation(s)
- Morgan R. Peltier
- Women and Children’s Health Research Laboratory, Winthrop University Hospital, Mineola, NY, USA
- Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY, USA
| | - Yuko Arita
- Women and Children’s Health Research Laboratory, Winthrop University Hospital, Mineola, NY, USA
| | - Natalia G. Klimova
- Women and Children’s Health Research Laboratory, Winthrop University Hospital, Mineola, NY, USA
- Department of Pediatrics, Winthrop University Hospital, Mineola, NY, USA
| | - Ellen M. Gurzenda
- Women and Children’s Health Research Laboratory, Winthrop University Hospital, Mineola, NY, USA
| | - Hchi-Chi Koo
- Women and Children’s Health Research Laboratory, Winthrop University Hospital, Mineola, NY, USA
- Department of Pediatrics, Winthrop University Hospital, Mineola, NY, USA
| | | | - Veronica Lerner
- Department of Obstetrics and Gynecology, Bellevieu Hospital, New York, NY, USA
| | - Nazeeh Hanna
- Women and Children’s Health Research Laboratory, Winthrop University Hospital, Mineola, NY, USA
- Department of Pediatrics, Winthrop University Hospital, Mineola, NY, USA
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16
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Pina A, Lavallée S, Ndiaye C, Mayrand MH. Reproductive Impact of Cervical Conization. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0042-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Hernandez-Andrade E, Romero R, Ahn H, Hussein Y, Yeo L, Korzeniewski SJ, Chaiworapongsa T, Hassan SS. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. J Matern Fetal Neonatal Med 2012; 25:1682-9. [PMID: 22273078 PMCID: PMC3422449 DOI: 10.3109/14767058.2012.657278] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of transabdominal sonographic measurement of cervical length in identifying patients with a short cervix. METHODS Cervical length was measured in 220 pregnant women using transabdominal and transvaginal ultrasound (US). Reproducibility and agreement between and within both methods were assessed. The diagnostic accuracy of transabdominal US for identifying cases with a cervical length <25 mm was evaluated. RESULTS Twenty-one out of 220 cases (9.5%) had a cervical length <25 mm by transvaginal US. Only 43% (n = 9) of patients with a short cervix were correctly identified by transabdominal US. In patients with a cervical length of <25 mm by transvaginal US, transabdominal measurement of the cervix overestimated this parameter by an average of 8 mm (95% LOAs, -26.4 to 10.5 mm). Among women without a short cervix, transabdominal US underestimated cervical length on average (LOA) by 1.1 mm (95% LOAs, -11.0 to 13.2 mm). Transvaginal US was also more reproducible (intraclass correlation coefficient: (ICC) (0.96; 95% CI, 0.94 to 0.97) based on comparisons between 2D images and immediately acquired 3D volume datasets relative to transabdominal US (ICC: 0.71; 95% CI, 0.57 to 0.84). Transvaginal US detected 13 cases with funneling and six cases with sludge whereas only three cases of funneling and one of sludge were detected by transabdominal US. CONCLUSION Transabdominal measurement overestimated cervical LOA by 8 mm among women with a short cervix and resulted in the underdiagnosis of 57% of cases.
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Affiliation(s)
- Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
| | - Hyunyoung Ahn
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
| | - Youssef Hussein
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Steven J. Korzeniewski
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Sonia S Hassan
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Predictive model for spontaneous preterm labor among pregnant women with contractions and intact amniotic membranes. Arch Gynecol Obstet 2012; 286:893-900. [PMID: 22674420 DOI: 10.1007/s00404-012-2397-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine a predictive model for supporting decisions relating to the prognosis for women presenting with preterm labor and intact membranes. METHOD We conducted a prospective observational cohort study on 70 pregnant women at between 22 and 34 weeks of gestation. Transvaginal sonographic evaluation on the cervix was performed once on women who had completed a course of parenteral tocolysis. The sonographic parameters of cervical length measurement and presence of cervical glandular area were obtained. The outcome variable was occurrences of preterm delivery (<35 weeks). Using a univariate logistic regression model, the coefficients of each independent variable were first estimated. To construct the predictive model, multivariate logistic regression containing all the selected variables that might be related to preterm delivery was used as the starting point. Accuracy, sensitivity, specificity and predictive values were used to measure associations of predicted probabilities and to check the ability of the model to predict outcomes. The predictive analyses were based on logistic regression models, with calculation of odds ratios and 95 % confidence intervals. RESULTS The incidence of preterm delivery was 32.80 % (23/70). After validation, the predictive model proposed showed accuracy of 87.88 %, sensitivity of 78.26 % and specificity of 93.02 %. CONCLUSION The model presented good accuracy with correspondence between predictions and observations, and has the capacity to become a useful tool for management of pregnant women with preterm labor and intact amniotic membranes.
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Taylor BK. Sonographic Assessment of Cervical Length and the Risk of Preterm Birth. J Obstet Gynecol Neonatal Nurs 2011; 40:617-31. [DOI: 10.1111/j.1552-6909.2011.01284.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Parra-Saavedra M, Gómez L, Barrero A, Parra G, Vergara F, Navarro E. Prediction of preterm birth using the cervical consistency index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:44-51. [PMID: 21465603 DOI: 10.1002/uog.9010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To assess the diagnostic power of a new cervical consistency index (CCI) obtained using transvaginal sonography for the prediction of spontaneous preterm birth (PTB) and to establish reference ranges for this new variable. METHODS Included in this prospective cross-sectional study were 1115 singleton pregnancies at 5-36 weeks of gestation. Anteroposterior cervical diameter was measured before (AP) and after (AP') application of pressure on the cervix using the transvaginal probe. The index was calculated using the formula: CCI=((AP'/AP) × 100). Cervical length was also measured. The outcomes evaluated were spontaneous PTB before 32, 34 and 37 weeks. Logistic regression and analysis of receiver-operating characteristics (ROC) curves were performed to evaluate the diagnostic power of CCI and cervical length (adjusted for gestational age). Intraclass correlation coefficients (ICCs) and Bland-Altman analysis were used to evaluate intra- and interobserver variability. RESULTS In the 1031 women with follow-up, the rate of spontaneous PTB before 32 weeks was 0.87%, before 34 weeks was 2.13% and before 37 weeks was 7.76% (n=80). There were 31 (3.01%) iatrogenic PTBs before 37 weeks. An inverse linear correlation between gestational age and CCI was observed, with regression equation: CCI (in %)=89.8 - 1.35 × (GA in weeks); r(2)=0.66, P<0.001. Cervical length showed an inverse quadratic, though non-significant, relationship with gestational age: CL (in mm)=31.084 - 0.0278× (GA in weeks)(2) + 1.0772× (GA in weeks); r(2)=0.076, P<0.14. The intra- and interobserver ICCs for CCI were 0.99 (95% CI, 0.988-0.994) and 0.98 (95% CI, 0.973-0.987), respectively. The area under the ROC curve for CCI in the prediction of spontaneous PTB before 32 weeks was 0.947, for spontaneous PTB before 34 weeks it was 0.943 and for spontaneous PTB before 37 weeks it was 0.907. For a 5% screen-positive rate, CCI had a sensitivity of 67%, 64% and 45% for prediction of spontaneous PTB before 32, 34 and 37 weeks, respectively, with equivalent values of 11%, 9% and 11% for cervical length. CONCLUSIONS CCI shows a clear inverse linear relationship with GA. Assessment of CCI is reproducible and is effective in the prediction of spontaneous PTB. This new variable appears to provide better prediction of spontaneous PTB than does cervical length.
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Affiliation(s)
- M Parra-Saavedra
- Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia.
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Wulff CB, Ekelund CK, Hedegaard M, Tabor A. Can a 15-mm Cervical Length Cutoff Discriminate between Low and High Risk of Preterm Delivery in Women with Threatened Preterm Labor? Fetal Diagn Ther 2011; 29:216-23. [DOI: 10.1159/000322131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
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Nam KH, Kwon JY, Kim YH, Park YW. Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage. J Gynecol Oncol 2010; 21:225-9. [PMID: 21278883 DOI: 10.3802/jgo.2010.21.4.225] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/20/2010] [Accepted: 08/06/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study examined the risk factors for preterm birth and the efficacy of prophylactic cerclage in patients who had undergone cervical conization due to cervical intraepithelial neoplasia before pregnancy. METHODS We reviewed the medical records of all patients who gave live singleton births between May 1996 and April 2009, after having cervical conization. Delivery before 37 gestational weeks was considered as preterm birth. The pregnancy outcomes were analyzed with independent sample t-test, chi-square test, and multiple logistic regression using the SPSS ver. 12.0. RESULTS Sixty five cases were found. The mean gestational age at delivery was 37 weeks (SD, 3.5). Eighteen patients (27.7%) had preterm delivery. The type of conization, the volume of the specimen, and second trimester cervical length were related to preterm birth (p≤0.001, p=0.019, p≤0.001, respectively). In multivariate analysis, only mid-trimester cervical length was statistically significant for preterm birth (p=0.012; odds ratio, 0.194; confidence interval, 0.055 to 0.693). Six out of 65 patients had undergone prophylactic cerclage, and three (50%) of them had preterm births, while 15 (25%) patients without cerclage had preterm births. CONCLUSION The type of conization, the volume of specimen, and second trimester cervical length may be the risk factors for preterm birth in patients who have a prior history of cervical conization. Prophylactic cerclage may not be helpful in preventing preterm birth, therefore more careful consideration should be paid in deciding cerclage after conization during prenatal counseling.
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Affiliation(s)
- Ka Hyun Nam
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Itaborahy RMR, Carmo AV, Medeiros SFD, Yassin A. Avaliação do comprimento do colo uterino em gestantes normais entre 20 e 34 semanas de gestação por meio da ultrassonografia endovaginal. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000600009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar o comprimento do colo uterino pela ultrassonografia transvaginal em uma população de gestantes normais e construir uma curva de normalidade no período de 20 a 34 semanas de gestação. MATERIAIS E MÉTODOS: Estudo de corte transversal, incluindo 145 gestantes normais, com feto único, vivo, sem enfermidades, entre 20 e 34 semanas de gravidez, examinadas nos serviços de ultrassonografia do Hospital Universitário Júlio Müller e de uma clínica privada. As gestantes foram submetidas a ultrassonografia endovaginal, com registro do comprimento cervical. Critérios de exclusão foram: parto prematuro, rotura prematura pré-termo das membranas, placenta prévia, uso de fármacos tocolíticos e/ou progesterona, cerclagem ou qualquer intervenção cirúrgica prévia no colo. A associação entre o comprimento do colo uterino e a idade gestacional foi examinada por regressão linear. RESULTADOS: O comprimento cervical diminuiu progressivamente em 0,8 mm a cada semana, à medida que a idade gestacional progrediu (r = -0,351; p < 0,001). As mulheres que tiveram afunilamento cervical apresentaram colo mais curto que as demais (p = 0,001). A interpolação dos percentis 5, 50 e 95 provê gráfico passível de ser utilizado como referência. CONCLUSÃO: O comprimento médio cervical em gestantes normais diminui 0,8 mm por semana, entre a 20ª e a 34ª semanas de gestação.
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Affiliation(s)
| | | | | | - Ali Yassin
- Universidade Federal de Mato Grosso, Brasil
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Azlin MIN, Bang HK, An LJ, Mohamad SN, Mansor NA, Yee BS, Zulkifli NH, Tamil AM. Role of phIGFBP-1 and ultrasound cervical length in predicting pre-term labour. J OBSTET GYNAECOL 2010; 30:456-9. [PMID: 20604646 DOI: 10.3109/01443615.2010.489162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This prospective observational study was to evaluate the efficacy of combining phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and transvaginal ultrasound cervical length (CL) compared with either indicator alone in predicting pre-term labour (PTL). Women with singleton pregnancy between 24 and 36 weeks' gestation with evidence of PTL were subjected to phIGFBP-1 and CL tests. Of the 51 women, five were tested positive (phIGFBP-1 positive and CL <2.5 cm) for combination of phIGFBP-1 and CL (four delivered within 1 week), whereas 46 tested negative, of which, only one delivered. A much higher negative predictivity (NP), positive predictivity (PP) and specificity (SP) in the combination test was seen compared with phIGFBP-1 or CL alone (NP: 97.8% vs 97.7% vs 97.1%; PP: 80.0% vs 51.1% and CL 23.5%; SP: 97.8% vs 93.5% vs 71.1%, respectively). The cervical os dilatation of 2 cm with combined positive test (p = 0.001) indicated a higher likelihood of PTL.
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Affiliation(s)
- M I Nor Azlin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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STONE PR, CHAN EH, MCCOWAN LME, TAYLOR RS, MITCHELL JM. Transabdominal scanning of the cervix at the 20-week morphology scan: Comparison with transvaginal cervical measurements in a healthy nulliparous population. Aust N Z J Obstet Gynaecol 2010; 50:523-7. [DOI: 10.1111/j.1479-828x.2010.01225.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Iams JD, Berghella V. Care for women with prior preterm birth. Am J Obstet Gynecol 2010; 203:89-100. [PMID: 20417491 PMCID: PMC3648852 DOI: 10.1016/j.ajog.2010.02.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/01/2009] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
Abstract
Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately.
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Affiliation(s)
- Jay D Iams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH
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Antsaklis P, Daskalakis G, Pilalis A, Papantoniou N, Mesogitis S, Antsaklis A. The role of cervical length measurement at 11-14 weeks for the prediction of preterm delivery. J Matern Fetal Neonatal Med 2010; 24:465-70. [PMID: 20608797 DOI: 10.3109/14767058.2010.501124] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether cervical length (CL) measurement at 11?14 weeks is predictive of preterm delivery (PTD). METHODS This was a prospective study of a low-risk population of 1113 women, who underwent CL measurement at 11-14 weeks. Mean CL was calculated for deliveries at >37, <37 and <34 weeks. Cut-off limits of 27 mm and 30 mm were used to examine the predictive value of CL. RESULTS Mean +/- SD CL for the entire study population was 40.6 +/- 5.5 mm. CL was analyzed for term and PTD (<37 weeks) and further analyzed for deliveries at 34-37 and <34 weeks. Mean CL was 38.9 +/- 5.5 mm for PTD and 40.8 +/- 5.5 mm for deliveries >37 weeks (p=0.001). Receiver operating characteristic analysis showed small predictive value of CL for PTD <37 weeks (sensitivity = 63.3% and specificity = 51.1%, area under the curve (AUC)=0.60, 95% CI: 0.54-0.66) (p=0.001) and did not show any predictive value for PTD <35 weeks (AUC=0.55, 95% CI: 0.43-0.67, p=0.355) or PTD <32 weeks (AUC=0.51, 95% CI: 0.30-0.74, p=0.851). CONCLUSION CL at 11-14 weeks does not appear to be predictive of PTD. Statistical analysis of CL did not show any predictive value for PTD <35 weeks, or <32 weeks and although it showed a predictive value for PTD at <37 weeks, the sensitivity was very low.
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Affiliation(s)
- Panos Antsaklis
- First Department of Obstetrics and Gynaecology, Alexandra Maternity Hospital, University of Athens, Athens, Greece.
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Londero AP, Bertozzi S, Fruscalzo A, Driul L, Marchesoni D. Ultrasonographic assessment of cervix size and its correlation with female characteristics, pregnancy, BMI, and other anthropometric features. Arch Gynecol Obstet 2010; 283:545-50. [PMID: 20145939 DOI: 10.1007/s00404-010-1377-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Cervical length during the first trimester of pregnancy has not been completely investigated yet. The objective of our study is to compare cervical size in the first ten gestational weeks with that of non-pregnant women, and to determine its correlation with maternal factors, including age, anthropometric features, and reproductive history. METHODS We collected retrospective data about women who applied to the Obstetrics and Gynecology Outpatients Facility of Udine between February and June 2009, selecting both pregnant and non-pregnant women possessing a transvaginal ultrasonographic measurement of their cervix, and focusing on their age, parity, BMI, cervical, and uterine size. Data were analyzed by R (version.2.8.0), considering significant P < 0.05. RESULTS 135 women were recruited. By multivariate linear regression, both cervical length and width result independently influenced by pregnancy status, and among non-pregnant nullipara, cervical length results to be significantly lower in women younger than 20 (P < 0.05). CONCLUSIONS During the first ten gestational weeks, cervix results to be longer and wider than in non-pregnant women, suggesting the possible existence of early gestational, morphological, uterine, and cervical modifications. Women under the age of 20 have a significantly shorter cervix, suggesting an incomplete cervix maturity in this group of women, which may justify the higher prevalence of pre-term births in teenage pregnancies.
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Affiliation(s)
- A P Londero
- Clinic of Obstetrics and Gynecology, University Hospital of Udine, p.le SSMM Misericordia 15, 33100 Udine, Italy.
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Abstract
The cervix has to open to allow vaginal birth. Ultrasound has now shown that this lower part of the uterus begins to show changes weeks before eventual birth. Only transvaginal ultrasound should be used to evaluate the cervix for prediction of preterm birth (PTB). The shortest best cervical length (CL) is the most effective measurement for clinical use. Proper technique is paramount for accurate results. The risk of PTB increases with ever shorter CL (<25 mm). Other factors that must be carefully considered when using CL for prediction of PTB are number of fetuses, risk factors for PTB, and gestational age at screening.
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Affiliation(s)
- Maria Teresa Mella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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30
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Abstract
A short cervix in the second trimester is a powerful predictor of preterm birth risk. Multiple cervical length screens for patients in midpregnancy will likely become the standard of obstetrical care as a result of the development of effective methods (eg, cerclage, progesterone) to prevent early delivery in patients with a short cervix. Because of the high cost and infrastructure requirements, providing multiple cervical length evaluations through transvaginal ultrasound will likely be a significant barrier to universal screening. A cost-effective, low-technology method of cervical length screening is necessary to implement such programs. Available data suggest that digital examination is not sufficiently sensitive and reproducible to reliably screen for short cervix in presymptomatic patients in the mid trimester. New modalities for nonsonographic cervical length assessment (ie, Cervilenz) provide for a cost-effective, sensitive, and reproducible method of screening patients for short cervical length, which deserves further research in comparing its efficacy to sonographic cervical length.
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Affiliation(s)
- Michael G Ross
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
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Abstract
Preterm delivery, which occurs in about 5%-13% of pregnancies in most countries, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids has improved perinatal outcome but has not reduced the incidence of preterm delivery. Recent evidence suggests that the rate of preterm delivery may be reduced by the prophylactic use of progesterone in women with a history of preterm delivery and in those with a short cervical length identified by routine transvaginal sonography. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of preterm birth.
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