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Song W, Wang W, Wang F, He X, Li X, Feng L, Cui W, Guo Q. Risk factors for high-stage histological chorioamnionitis among pregnancies with cervical incompetence. J Obstet Gynaecol Res 2024; 50:572-579. [PMID: 38196295 DOI: 10.1111/jog.15880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
AIM The study aimed to identify predictive risk factor to identify high-stage histological chorioamnionitis (HCA) in pregnancies with cervical incompetence (CIC). METHODS A retrospective cohort study was conducted by including 116 pregnant women with cervical incompetence that required prophylactical and therapeutical cerclage. The histopathology examination on placenta was conducted with informed patient consent. All the cases included in this study were divided based on the severity degree of HCA. The demographic characteristic and the parameters related to maternal and fetal outcome were all analyzed. Besides, perioperative parameters of cerclage, including cervical length, cervical morphology, and laboratory indexes were also compared between two groups. Univariate and multivariate logistic regression analysis were used to determine the risk factor of severe chorioamnionitis. RESULTS Severe HCA was significantly associated with cervical morphology, cerclage indication, cerclage type, and cervical length measured via ultrasound and vaginal examination. After adjusted for confounders, V-type funneling and short cervix was indicated as independent risk factors of severe HCA by multivariate logistic regression analysis, respectively. CONCLUSIONS V-type funneling and short cervix may indicate the elevated risk of high-stage HCA. Due to the negative outcomes related with high-stage HCA, appropriate prenatal treatment would improve the pregnancy outcomes in cerclaged population. To facilitate postpartum treatment, placental histological examination should be routinely recommended to identify the high-stage HCA, especially in high risk pregnancies.
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Affiliation(s)
- Wenhui Song
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Wei Wang
- Hebei Medical University First Affiliated Hospital, Shijiazhuang, Hebei, PR China
| | - Fengjiao Wang
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Xueqing He
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Xia Li
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Li Feng
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Wenhua Cui
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
| | - Qing Guo
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, PR China
- Hebei Key Laboratory of Maternal and Fetal Medicine, Shijiazhuang, Hebei, PR China
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Cai B, Xia Y, Na X. Correlation Between Clinical Factors and Pregnancy Outcome Following Repeat Cerclage: A Retrospective Analysis of a Chinese Population. Front Med (Lausanne) 2022; 9:846755. [PMID: 35445034 PMCID: PMC9013839 DOI: 10.3389/fmed.2022.846755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The role of repeat cerclage (RC) among patients with prolapsed membranes remains controversial. We aimed to investigate the effectiveness of RC and assess the correlation between clinical factors and pregnancy outcome following RC. Methods The clinical data of patients who underwent RC for prolapsed membranes after prior cerclage were retrospectively investigated. The clinical characteristics of patients were compared between singleton and twin pregnancies. The clinical characteristics of singleton pregnancies were compared between the gestational age (GA) at delivery <28 weeks' and ≥28 weeks' groups. Receiver operating characteristic (ROC) curve analysis was performed to determine predictive factors. Singleton patients were divided into two groups according to GA at RC as follows: GA <22.3 weeks and GA ≥22.3 weeks. Pregnancy outcomes were compared between groups. Results The mean GA at delivery of singleton pregnancies was significantly higher than that of twin pregnancies. The mean latency between RC and delivery of singleton pregnancies was significantly longer than their twin counterparts. There were significant differences in the pregnancy outcomes between the GA <22.3 weeks group and GA ≥22.3 weeks group. Kaplan–Meier survival curves showed a lower incidence of neonatal death in the GA ≥22.3 weeks group compared with that in the GA <22.3 weeks group. Conclusions RC may be an effective method to prolong the duration of pregnancy among patients with singleton pregnancy. However, the selection of RC for patients with twin pregnancies remains controversial. GA at RC appears to be fair for predicting pregnancy outcomes following RC.
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Affiliation(s)
- Benshuo Cai
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yajun Xia
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinni Na
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Nooshin E, Mahdiss M, Maryam R, Amineh SN, Somayyeh NT. Prediction of Preterm Delivery by Ultrasound Measurement of Cervical Length and Funneling Changes of the Cervix in Pregnant Women with Preterm Labor at 28-34 weeks of Gestation. J Med Life 2021; 13:536-542. [PMID: 33456603 PMCID: PMC7803305 DOI: 10.25122/jml-2020-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present study aims at predicting preterm delivery by ultrasound measurement of cervical length and the funneling changes of the cervix in preterm labor pregnant women at 28-34 weeks of gestation. The present study is an observational-analytical study with a prospective cohort design. The statistical population of this study includes 70 preterm labor pregnant women who were referred to Tehran hospitals from March 2018 to March 2020. The case group includes 35 women who had short cervical length as well as the funneling changes of the cervix. The control group includes 35 patients whose cervical length was normal and lacked the funneling changes of the cervix. The samples were analyzed after being collected. The mean age of mothers was 29.22 years in the short cervical length group (SD=4.64) and 28.45 years in the normal cervical length group (SD=4.59). The mean length of cervical length was 17.34 mm in the short cervical length group (SD=5.64) and 38.74 mm in the normal cervical length group (SD=4.53). In the case group, the delivery occurred two or seven days after the first visit; as for the proper cervical length group without funneling changes, the delivery occurred 14 days after the first delivery. Thus, the difference is statistically significant (P=0.00). In terms of the preterm delivery before week 34, there was also a significant difference between the short and normal cervical length group, as well as the groups with the funnel-shaped and non-funnel-shaped cervix (P=0.00). However, in terms of post-term delivery before week 37, there was no significant difference between short and normal cervical length groups as well as funneled and non-funneled groups (P=0.78). In terms of term labor, there was a significant difference between short and normal cervical length groups, as well as funneled and non-funneled groups (P=0.00). In investigating the cut-off point with good sensitivity, it was indicated that the cervical length and cervical funneling in pregnant women at risk predict preterm labor before week 34. With the measurement of cervical length and diagnosis of cervical funneling by applying ultrasound, preterm delivery before week 34 can be predicted. Therefore, neonatal mortality and morbidity rates can be reduced in this way.
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Affiliation(s)
- Eshraghi Nooshin
- 1. Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamadianamiri Mahdiss
- 1. Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Rahimi Maryam
- 1. Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shafei-Nia Amineh
- 1. Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Noei Teymoordash Somayyeh
- 1. Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
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Pils S, Eppel W, Promberger R, Winter MP, Seemann R, Ott J. The predictive value of sequential cervical length screening in singleton pregnancies after cerclage: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16:79. [PMID: 27085320 PMCID: PMC4833952 DOI: 10.1186/s12884-016-0866-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 04/07/2016] [Indexed: 11/11/2022] Open
Abstract
Background There are few valid predictors for preterm delivery after cerclage. Experience with a screening program that included four sequential cervical length measurements in singleton pregnancies after cerclage is reviewed. Methods In this retrospective cohort study, 88 singleton pregnancies after cerclage were included. Cervical length (CL) measurements were performed perioperatively and at weeks 16 + 0, 18 + 0, 20 + 0, and 22 + 0 by transvaginal ultrasound. Predictive factors for early preterm delivery included patient characteristics, obstetric history and CL measurements and were analyzed separately for women with ultrasound-indicated cerclage and those with history-indicated cerclage. Women with emergency cerclage were excluded. Results In women with delivery <35 weeks, CL declined from the 16 + 0 to the 22 + 0 weeks of gestation (p = 0.009). In univariate analysis, all CL measurements were predictive for delivery <35 weeks in women who underwent ultrasound-indicated cerclage and in women who received a history-indicated cerclage, whereas in multivariate analysis only CL three to six days after cerclage remained significant (odds ratio 0.85, 95 % CI 0.73–0.98). In women with ultrasound-indicated cerclage, optimized cut-off was ≤20 mm (specificity 83.8 %, sensitivity 84.2 %). Conclusions CL measured three to six days after cerclage placement provides the best information about the risk for delivery <35 weeks.
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Affiliation(s)
- Sophie Pils
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Krankenhaus Hietzing, Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Sim S, Da Silva Costa F, Araujo Júnior E, Sheehan PM. Factors associated with spontaneous preterm birth risk assessed by transvaginal ultrasound following cervical cerclage. Aust N Z J Obstet Gynaecol 2015. [PMID: 26223688 DOI: 10.1111/ajo.12361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the predictive value of various cervical length measurements postcerclage for the outcome of preterm birth following both elective and rescue cerclage. MATERIALS AND METHODS Over a five-year period, we identified 59 women who had a transvaginal cerclage inserted followed by serial cervical length measurement. Of these, 18 were elective cerclages placed at 14 weeks of gestation on the basis of a history of cervical insufficiency and 41 were rescue cerclages performed at gestations ranging from 17 to 23 weeks following a diagnosis of shortened cervix on ultrasound. The women were asymptomatic throughout. RESULTS There was a strong correlation between cervical length postcerclage and gestation at delivery. For both groups, preterm birth could be predicted by the total cervical length. In the rescue cerclage group, the change in cervical length was predictive, with positive changes associated with later gestation at delivery. The presence of funnelling was predictive of preterm birth in the elective cerclage group only. CONCLUSION Transvaginal cervical length measurement is useful in the prediction of preterm birth postcerclage placement. Serial cervical length measurement postcerclage may assist with timely addition of interventions such, progesterone and antenatal cortico steroids for fetal lung maturation.
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Affiliation(s)
- Shirlene Sim
- Pregnancy Research Centre, Department of Perinatal Medicine, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Fabricio Da Silva Costa
- Pregnancy Research Centre, Department of Perinatal Medicine, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Edward Araujo Júnior
- Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo-SP, Brazil
| | - Penelope M Sheehan
- Pregnancy Research Centre, Department of Perinatal Medicine, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
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Miller ES, Gerber SE. Association between sonographic cervical appearance and preterm delivery after a history-indicated cerclage. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2181-2186. [PMID: 25425376 DOI: 10.7863/ultra.33.12.2181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine which transvaginal cervical sonographic characteristics are associated with preterm delivery after placement of a history-indicated cerclage. METHODS We conducted a case-control study of all women with a singleton gestation and a history-indicated cerclage placed at a single center between January 1, 2008, and October 1, 2012. Cerclages were placed between 12 and 16 weeks' gestation. Cases were defined as women who delivered before 34 weeks' gestation; controls delivered at or after 34 weeks. Transvaginal cervical characteristics, such as cervical funneling, proximal cervical length, distal cervical length, and total cervical length, obtained between 18 and 24 weeks were compared between the two groups. Bivariable, multivariable, and log rank analyses were performed. RESULTS A total of 124 women met inclusion criteria, with 17 (14%) delivering before 34 weeks. Cervical funneling, a proximal cervical length of less than 1.5 cm, and a total cervical length of less than 2.5 cm were associated with an increased odds of preterm birth before 34 weeks in the bivariable analysis [odds ratio (OR), 10.9 (95% confidence interval (CI), 2.3-62.8), 2.9 (95% CI, 1.0-8.5), and 4.5 (95% CI, 1.3-16.4), respectively], whereas distal cervical length of less than 1 cm was not significantly associated with delivery before 34 weeks [OR, 3.0 (95% CI, 0.8-11.1)]. In multivariable analysis, only cervical funneling remained associated with preterm delivery before 34 weeks [adjusted OR, 10.6 (95% CI, 2.2-51.5)]. CONCLUSIONS In women with a history-indicated cerclage, cervical funneling is the only independently significant sonographic finding associated with an increased risk of preterm birth before 34 weeks.
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Affiliation(s)
- Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois USA.
| | - Susan E Gerber
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois USA
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Progesterone interactions with the cervix: translational implications for term and preterm birth. Infect Dis Obstet Gynecol 2011; 2011:353297. [PMID: 22114461 PMCID: PMC3206389 DOI: 10.1155/2011/353297] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/29/2011] [Indexed: 01/04/2023] Open
Abstract
The uterine cervix plays a vital role in maintaining pregnancy and an equally important role in allowing parturition to occur. Progesterone, either endogenously produced or supplied exogenously, supports the function of the cervix in sustaining intrauterine pregnancy, and the withdrawal of progesterone, either through natural processes or pharmacologic intervention, leads to delivery which underscores the importance of the progesterone's biological activities manifest in normal gestation and pregnancy that ends prematurely. Research crossing many scientific disciplines has demonstrated that progesterone is a pleotropic compound that affects the cervix through cytoplasmic and membrane receptors with profound effects on cellular and molecular functions that influence inflammatory cascades and extracellular matrix, both of which have consequences for parturition. Beyond the local cell and molecular biology of progesterone, it has systemic effects of relevance to pregnancy as well. This paper examines the biology of the cervix from its gross to cellular structure and biological activities of its cell and molecular processes that may be affected by progesterone. The implications of these processes for preterm birth are explored, and direction of current research is in relation to translational medicine implications for diagnostic, prognostic, and therapeutic approaches to threatened preterm birth.
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