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Souka AP, Maritsa V, Antsaklis P, Pilalis A, Daskalakis G. Cervical length evolution in pregnancy and prediction of preterm delivery. Arch Gynecol Obstet 2024; 310:2477-2485. [PMID: 39311998 DOI: 10.1007/s00404-024-07745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 09/12/2024] [Indexed: 10/17/2024]
Abstract
PURPOSE To construct reference charts for cervical length (CL) in pregnancy based on longitudinal measurements and to assess the value of measuring cervical length after 24 weeks of gestation. METHODS CL was measured transvaginally in singleton pregnancies at 5 to 41 weeks. Pregnancies with more than one measurement were used for creating the CL chart, whereas any measurement after 24 weeks was considered for assessing the correlation of CL with preterm delivery. RESULTS The dataset consisted of 12,601 pregnancies and 33,899 observations. Gestational age was the main predictor of CL (R2 = 67.3%). Further adjustments in the fixed effects part for maternal characteristics (age, BMI, smoking status, parity, history of miscarriage, and cervical surgery) improved the prediction ability (R2 = 78.4%). CL was predictive of spontaneous preterm delivery before 37 weeks when measured at any gestation between 24 and 35 weeks and it was predictive of spontaneous preterm delivery before 32 weeks when measured between 28 and 31 weeks (AUC = 0.68). CONCLUSION Gestational age is the main predictor of CL followed by maternal characteristics and history. CL assessment between 24 and 35 + 6 weeks can enhance our ability to predict spontaneous preterm delivery.
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Affiliation(s)
- A P Souka
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
- Fetal-Maternal Medicine Unit, Emvryomitriki Fetal Medicine Unit, Leto Maternity Hospital, 41, D.Soutsou str, 11521, Athens, Greece.
| | - V Maritsa
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Fetal-Maternal Medicine Unit, Emvryomitriki Fetal Medicine Unit, Leto Maternity Hospital, 41, D.Soutsou str, 11521, Athens, Greece
| | - P Antsaklis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Pilalis
- Fetal-Maternal Medicine Unit, Emvryomitriki Fetal Medicine Unit, Leto Maternity Hospital, 41, D.Soutsou str, 11521, Athens, Greece
| | - G Daskalakis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Souka AP, Maritsa VA, Eleftheriades M. Screening vs. no screening for preterm delivery in low-risk singleton pregnancies: comparison by propensity score analysis. Arch Gynecol Obstet 2024; 309:133-138. [PMID: 36580115 PMCID: PMC10770190 DOI: 10.1007/s00404-022-06882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/08/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the effect of a policy of screening for spontaneous preterm delivery (SPD) by transvaginal cervical length (CL) measurement versus a no screening policy in the prevention of severe prematurity. METHODS Retrospective study on low-risk singleton pregnancies examined at 20-24 weeks. Two cohorts, one with SPD screening and the other without screening, were matched using propensity analysis to create the study groups. Women with short CL were treated with vaginal progesterone and/or cervical cerclage/pessary. The outcomes examined were SPD < 32 weeks (SPD 32) and SPD between 20 and 32 weeks (SPD 20-32). RESULTS Screening for SPD was associated with a significant reduction in the rate of SPD at less than 32 weeks (0.3 vs. 0.8%, p = 0.001 in the screened and no screened pregnancies, respectively) and in the rate of SPD 20-32 (0.3 vs. 0.9%, p = 0.005 in the screened and no screened pregnancies, respectively). After adjusting for maternal age, parity, body mass index, smoking and mode of conception, the screening group had significantly lower hazard for SPD 20-32 (HR = 0.36, 95% CI: 0.18-0.75, p = 0.006) and SPD32 (HR = 0.39, 95% CI: 0.19-0.82, p = 0.013). CONCLUSION Screening for SPD by transvaginal CL measurement in mid-pregnancy may reduce the incidence of severe prematurity in low-risk singleton pregnancies.
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Affiliation(s)
- Athena P Souka
- Fetal Medicine Unit, Leto Maternity Hospital, 7-13 Mouson Str, 11524, Athens, Greece.
| | | | - Makarios Eleftheriades
- 2nd Department of Obstetrics and Gynecology Aretaieio Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Seravalli V, Abati I, Strambi N, Tofani L, Tucci C, Tartarotti E, Di Tommaso M. Universal cervical length screening for preterm birth is not useful after 24 weeks of gestation. Acta Obstet Gynecol Scand 2023; 102:1541-1548. [PMID: 37737470 PMCID: PMC10577617 DOI: 10.1111/aogs.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Cervical length measurement using transvaginal sonography at 18+0 -24+0 weeks of gestation is used to identify women at risk of preterm delivery, who may benefit from treatment with progesterone to prevent premature birth. Few and conflicting data exist regarding the predictive value of cervical length measurement performed at later gestational ages. The primary objective of this study was to evaluate the predictive accuracy for spontaneous preterm birth of a single cervical length measurement performed between 24 and 32 weeks of gestation in asymptomatic singleton pregnancies at low risk for spontaneous preterm birth. The secondary objective was to test the predictive accuracy of different cervical length thresholds in the same population. MATERIAL AND METHODS This was a historical cohort study conducted in a tertiary referral hospital. A total of 2728 asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth were recruited. Of these women, 1548 had cervical length measured at 24+0 -27+6 weeks of gestation and 2191 women at 28+0 -32+0 weeks. In all, 1010 women were present in both gestational age windows. Maternal demographics, medical and obstetrical history, and pregnancy outcome were reviewed. The predictive value of cervical length for spontaneous preterm birth was evaluated through logistic regression analysis. Results were adjusted for confounding factors. RESULTS Overall, spontaneous preterm birth occurred in 53/2728 women (1.9%). In both the 24+0 -27+6 and 28+0 -32+0 weeks groups, a shorter cervical length was significantly associated with spontaneous preterm birth (p < 0.01), but it had a low predictive value, as shown by the receiver operating characteristics curve analysis (areas under the curve 0.62, 95% CI 0.50-0.74 for the 24+0 -27+6 weeks group, and 0.61, 95% CI 0.52-0.70 in the 28+0 -32+0 weeks group). When the predictive accuracy for preterm delivery of different cervical length cut-offs was evaluated, the sensitivity and positive predictive value were low in both gestational age windows, irrespective of the threshold used. CONCLUSIONS In asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth, the predictive value of cervical length after 24+0 weeks of gestation is low. Therefore, cervical length screening in these women should be discouraged.
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Affiliation(s)
- Viola Seravalli
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Isabella Abati
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Noemi Strambi
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Lorenzo Tofani
- Department of StatisticsComputer Science, ApplicationsUniversity of FlorenceFlorenceItaly
| | - Claudia Tucci
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Enrico Tartarotti
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
| | - Mariarosaria Di Tommaso
- Department of Health SciencesDivision of Obstetrics and GynecologyUniversity of FlorenceCareggi HospitalFlorenceItaly
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Soysal C, Işıkalan MM. The value of measuring cervical length between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy. J Matern Fetal Neonatal Med 2020; 34:3402-3407. [PMID: 33345647 DOI: 10.1080/14767058.2020.1860934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of measuring cervical length (CL) between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy. METHODS In this prospective longitudinal study, pregnant women whose CL was measured between 24 and 28 weeks were followed until delivery. The CL was adjusted for confounders and the results are presented using odds ratio and receiver operating characteristic curve (ROC). RESULTS A total of 874 women met the inclusion criteria. The median value of CL measured between 24 and 28 weeks was 34.0 mm (30.0-38.0 25%, 75% interquartile range). The risk of late and post-term pregnancy was 5.8 times higher in pregnant women with a CL above 35 mm between the 24 and 28 weeks of gestation (95% CI: 2.65-12.94 adjusted OR = 5.8, p < .001). For pregnancies exceeding the 38th week, it was observed that the duration of the gestation increases as CL values increase. CONCLUSIONS In this study, it has been demonstrated that measuring the CL between 24 and 28 weeks of gestation can predict late and post-term pregnancy. Prolonged pregnancy may cause neonatal and fetal complications and anxiety. CL measurement performed in these weeks can help prepare pregnant women for a possible prolonged pregnancy and cope with prolonged pregnancy anxiety.
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Affiliation(s)
- Cenk Soysal
- Department of Obstetrics and Gynecology, Kütahya Health Sciences University, Kutahya, Turkey
| | - Mehmet Murat Işıkalan
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Souka AP, Pilalis A. Reproducibility of cervical length measurement throughout pregnancy. J Matern Fetal Neonatal Med 2019; 34:2185-2191. [PMID: 31533496 DOI: 10.1080/14767058.2019.1660765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the intra- and interobserver variability of cervical length (CL) measurement in the three trimesters of pregnancy. METHODS Prospective observational study. Transvaginal CL measurement was performed by two operators ignorant of each other's results. Two methods of measurement were assessed: the straight line method (SL = from internal to external cervical os along the endocervical mucosa) and the two-line method (TL = the sum of two lines following the curvature of the endocervical canal). RESULTS There were 236 sets of CL measurements of which 96 (40.7%), 73 (30.5%), and 67 (28.8%) were performed in the first, second, and third trimesters of pregnancy, respectively. Intra- and interobserver variability was excellent for both methods (ICC 0.90) and was not influenced by gestational age. Mean difference was 1 mm (LOA -4 to -3 mm) for the same examiner and 1 mm as well between examiners (LOA -5 to -7 mm). Mean CL was slightly longer for the 2-L method (33 mm, SD = 5.2) compared to the SL method (31.4 mm, SD = 4.9). There was significantly more bias in the difference between methods the longer the CL measurement was (p <.001). CONCLUSIONS CL measurement shows excellent intra- and interobserver variability across gestation and the variability of the measurement is not influenced by gestational age or CL length for either method. The TL method produces slightly longer values.
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Affiliation(s)
- Athena P Souka
- Fetal Medicine Unit, Attikon University Hospital, Athens, Greece
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Oi R, Miyasaka N, Yamashita T, Adachi T. Associations of temporal changes in cervical length and lower uterine segment length with spontaneous preterm delivery risk: a prospective study of 727 Japanese women. J Med Ultrason (2001) 2018; 46:201-207. [PMID: 30506488 DOI: 10.1007/s10396-018-0919-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE A prospective assessment of the risk of spontaneous preterm delivery (sPTD) by evaluating temporal changes in cervical measurements. METHODS We analyzed clinical variables, focusing on cervical length (CL) and lower uterine segment (LUS) length (LUSL) as measured by transvaginal ultrasonography in 727 pregnant Japanese women. RESULTS In women undergoing term deliveries, CL increased from gestational week (GW) 8-25. In contrast, the combination of CL and LUSL (ComL for "combined length") gradually decreased and sole LUSL became almost 0 mm by GW 25. Univariate logistic regression analysis suggested that a history of PTD was a risk factor for sPTD. CL, LUSL, and ComL were not significant predictors of sPTD. CONCLUSION To assess the risk of sPTD in the second trimester, it is not necessary to distinguish the cervix from the LUS.
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Affiliation(s)
- Rie Oi
- Maternal and Child Health Center Aiiku Hospital, 1-16-10 Shibaura, Minato-ku, Tokyo, 105-0023, Japan. .,Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Naoyuki Miyasaka
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takahiro Yamashita
- Maternal and Child Health Center Aiiku Hospital, 1-16-10 Shibaura, Minato-ku, Tokyo, 105-0023, Japan
| | - Tomoko Adachi
- Maternal and Child Health Center Aiiku Hospital, 1-16-10 Shibaura, Minato-ku, Tokyo, 105-0023, Japan
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Cho GJ, Ouh YT, Kim LY, Lee TS, Park GU, Ahn KH, Hong SC, Oh MJ, Kim HJ. Cerclage is associated with the increased risk of preterm birth in women who had cervical conization. BMC Pregnancy Childbirth 2018; 18:277. [PMID: 29970019 PMCID: PMC6029404 DOI: 10.1186/s12884-018-1765-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 04/23/2018] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to determine the effect of cerclage in women who underwent cervical conization. Methods Study data were collected from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2009–2013. Women who had a conization in 2009 and a subsequent first delivery between 2009 and 2013 in Korea were enrolled. Results Among the women who had conization in 2009, 1075 women had their first delivery between 2009 and 2013. A cerclage was placed in 161 of the women who were treated by conization. The rate of preterm birth was higher in the women who were treated with cerclage following a conization compared with those without cerclage (10.56 vs 4.27, p < 0.01, respectively). The multivariate regression analysis revealed that the women who were treated cerclage following a conization had an increased risk of preterm delivery compared with women without cerclage (odds ratio (OR), 2.6, 95% confidence interval (CI), 1.4–4.9). Conclusion Our study showed that cerclage associated with an increased risk of preterm birth and preterm premature rupture of membranes in women who underwent conization. Further studies are required to clarify the mechanism by which cerclage affects the risk of preterm birth.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Log Young Kim
- The Health Insurance Review and Assessment Service of Korea, Seoul, South Korea
| | - Tae-Seon Lee
- The Health Insurance Review and Assessment Service of Korea, Seoul, South Korea
| | - Geun U Park
- Department of applied statistics, Chung-Ang University, Seoul, South Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
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Peiris HN, Vaswani K, Almughlliq F, Koh YQ, Mitchell MD. Review: Eicosanoids in preterm labor and delivery: Potential roles of exosomes in eicosanoid functions. Placenta 2016; 54:95-103. [PMID: 27988062 DOI: 10.1016/j.placenta.2016.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 12/11/2022]
Abstract
Preterm delivery is a major obstetric health problem contributing to poor neonatal outcome including low birth weight, respiratory distress syndrome, gastrointestinal, immunologic, central nervous system, hearing, and vision problems. Worldwide, approximately 15 million babies are born prematurely each year. The critical question which remains is how to identify women destined to deliver preterm from those who will achieve a term delivery. Prostaglandins, in all mammals, are important in the parturient process. Increased intrauterine prostaglandin production is associated with labor and in fact prostaglandin E2 (PGE2) or analogs are widely used clinically for cervical ripening and labor induction. Measurements of circulating eicosanoids have been problematic because of the rapid and major clearance by the lungs and then kidneys resulting in very low concentrations in plasma. Moreover, since eicosanoids are produced by all mammalian tissues, the sources of the measured eicosanoids are unknown. Our understanding of how cells communicate has undergone a paradigm shift with the recognition of the role of exosomes in intercellular signaling. Recent publications have identified enzymes and products of arachidonic acid metabolism (eicosanoids) within exosomes. This review will explore the potential roles of exosomes in eicosanoid functions that are critical in preterm labor and delivery.
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Affiliation(s)
- H N Peiris
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - K Vaswani
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - F Almughlliq
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Y Q Koh
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - M D Mitchell
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
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Papastefanou I, Pilalis A, Kappou D, Souka AP. Cervical length at 11-40 weeks: unconditional and conditional longitudinal reference ranges. Acta Obstet Gynecol Scand 2016; 95:1376-1382. [DOI: 10.1111/aogs.13025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Ioannis Papastefanou
- Fetal Medicine Unit; Leto Maternity Hospital; Athens Greece
- Emvryomitriki; Fetal Medicine Unit; Athens Greece
| | - Athanasios Pilalis
- Fetal Medicine Unit; Leto Maternity Hospital; Athens Greece
- Emvryomitriki; Fetal Medicine Unit; Athens Greece
| | | | - Athena P. Souka
- Fetal Medicine Unit; Leto Maternity Hospital; Athens Greece
- Emvryomitriki; Fetal Medicine Unit; Athens Greece
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