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Ferreira A, Bernardes J, Gonçalves H. Risk Scoring Systems for Preterm Birth and Their Performance: A Systematic Review. J Clin Med 2023; 12:4360. [PMID: 37445395 DOI: 10.3390/jcm12134360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction: Nowadays, the risk stratification of preterm birth (PTB) and its prediction remain a challenge. Many risk factors associated with PTB have been identified, and risk scoring systems (RSSs) have been developed to face this challenge. The objectives of this systematic review were to identify RSSs for PTB, the variables they consist of, and their performance. Materials and methods: Two databases were searched, and two authors independently performed the screening and eligibility phases. Records studying an RSS, based on specified variables, with an evaluation of the predictive value for PTB, were considered eligible. Reference lists of eligible studies and review articles were also searched. Data from the included studies were extracted. Results: A total of 56 studies were included in this review. The most frequently incorporated variables in the RSS included in this review were maternal age, weight, history of smoking, history of previous PTB, and cervical length. The performance measures varied widely among the studies, with sensitivity ranging between 4.2% and 92.0% and area under the curve (AUC) between 0.59 and 0.95. Conclusions: Despite the recent technological and scientifical evolution with a better understanding of variables related to PTB and the definition of new ultrasonographic parameters and biomarkers associated with PTB, the RSS's ability to predict PTB remains poor in most situations, thus compromising the integration of a single RSS in clinical practice. The development of new RSSs, the identification of new variables associated with PTB, and the elaboration of a large reference dataset might be a step forward to tackle the problem of PTB.
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Affiliation(s)
- Amaro Ferreira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Rahman RA, Atan IK, Ali A, Kalok AM, Ismail NAM, Mahdy ZA, Ahmad S. Use of the Arabin pessary in women at high risk for preterm birth: long-term experience at a single tertiary center in Malaysia. BMC Pregnancy Childbirth 2021; 21:368. [PMID: 33971828 PMCID: PMC8108362 DOI: 10.1186/s12884-021-03838-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary. Methods This is a retrospective observational study involving 58 pregnancies from 1st January 2013 to 31st December 2019. Inclusion criteria were previous mid-trimester miscarriage and/or preterm birth, previous cervical surgery or short cervical length on routine sonogram. The demographic data, characteristics of each pregnancy and details of outcomes and management were described. Results The majority of women were Malay with mean age and body mass index of 32.9 ± 4.2 years and 27.1 ± 6.3 kg/m2 respectively. The most frequent indications for Arabin pessary insertion were previous mid-trimester miscarriage (46.4%) and early preterm birth (17.2%). A total of 73.4% of these women had the pessary inserted electively at a mean cervical length of 31.6 ± 9.1 mm at median gestation of 15.0 weeks. They were managed as outpatient (56.9%), inpatient (24.1%) or mixed (19.0%) with combination of progestogen (81.0%) and 53.4% received antenatal corticosteroids. Spontaneous preterm birth at or more than 34 weeks gestation occurred in 74.1% with birthweight at or more than 2000 g (82.4%). Despite cervical funneling in 12 women (20.7%), 66.7% delivered at or later than 34 weeks gestation and 2 (16.7%) resulted in miscarriage. Conclusions Insertion of the Arabin pessary is beneficial to prevent spontaneous preterm birth in pregnant women who are at high risk. In particular, early insertion and close monitoring allows the best possible outcomes. Trial registration This study was retrospectively registered with ClinicalTrials.gov (NCT04638023) on 20/11/2020.
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Affiliation(s)
- Rahana Abd Rahman
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.
| | - Ixora Kamisan Atan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Anizah Ali
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Aida Mohd Kalok
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Nor Azlin Mohamed Ismail
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Shuhaila Ahmad
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
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Emergency Cervical Cerclage. J Clin Med 2021; 10:jcm10061270. [PMID: 33803886 PMCID: PMC8003203 DOI: 10.3390/jcm10061270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the progress of medicine in the last decades, recurrent pregnancy loss, premature birth, and related complications are still a vast problem. The reasons for recurrent pregnancy loss and preterm delivery are diverse and multifactorial. One of the main reasons for these complications is cervical insufficiency, which means that the cervix is weak and unable to remain closed until the date of delivery. It manifests as painless softening and shortening of the cervix without contractions. The aim of the study was to review the available literature on rescue sutures, which are an emergency treatment in pregnancies with premature cervical dilatation and protrusion of the fetal membranes in the second trimester of pregnancy. This review confirms that emergency cerclage reduces the rate of preterm birth in patients with advanced cervical insufficiency. This procedure prolongs gestational age and improves the chances of survival of the newborn without increasing the risk of chorioamnionitis and preterm premature rupture of membranes.
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Herkiloglu D, Ayvacı H, Pekin O, Tarhan N, Karateke A, Sahin S. Pessary use in patients diagnosed with short cervix and cervical insufficiency. J Matern Fetal Neonatal Med 2021; 35:1834-1840. [PMID: 33478298 DOI: 10.1080/14767058.2021.1875209] [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 was to evaluate the effectiveness of Arabin pessary use in patients with cervical insufficiency or short cervix before the 24th week of gestation and the impact of cervical examination findings prior to pessary application on the outcome in terms of the gestational week. MATERIALS AND METHODS In our study, among the pregnancies between the 12th and 24th gestational weeks, 60 pregnant women with a preterm delivery history and/or cervical length less than 25 mm were included. Among these 60 patients, 43 of them had a short cervix, 17 of them had cervical insufficiency. Routine medical and obstetric history was obtained. In the vaginal examination, the cervix was evaluated in terms of patency, dilatation, and position. Cervical length, presence of debris, and funneling were evaluated by transvaginal ultrasound. After receiving patients' approval a cervical pessary was applied to patients. Pessaries of pregnant women with 37 weeks of gestation were removed. Before reaching the 37th gestation week, pessaries were withdrawn in patients who had ongoing vaginal bleeding, premature rupture of membranes, and preterm contractions unresponsive to tocolytic treatment. RESULTS Thirty-one pregnant women (51.7%) out of 60 pregnant women who underwent pessary, delivered at 37 weeks and below. Delivery rates in the short cervical measurement group and cervical insufficiency group at ≤28 weeks, ≤34 weeks and ≤37 weeks were respectively (n = 21) 34.8% vs 36.3% (p = 0.976), (n = 29) 41.8% vs 64.7% (p = 0.111), (n = 31) 44.2% vs 70.6% (p = 0.888). The presence of cervical funneling before pessary application shows a statistically significant difference in terms of patient's giving birth before or after 28 weeks (p = 0.033). In patients with cervical funneling, there was a significant increase in a birth before 28 weeks. Depending on whether or not patients applying with pain need for tocolysis, it shows the statistically meaningful difference in terms of the patients giving birth before or after 34 weeks (p = 0.001) (OR 7, 61, 95% GA 2.4-24.6). In the group without the need for tocolysis, there is a meaningful increase in birth after 34 weeks. CONCLUSIONS Our findings showed that, alongside the defined cervical risk factors, cervical funneling and the need for tocolysis are remarkable prognostic variables in pessary application.
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Affiliation(s)
- Dilsad Herkiloglu
- Department of Obstetrics and Gynecology, Yeni Yuzyil University Private Gaziosmapasa Hospital, Istanbul, Turkey
| | - Habibe Ayvacı
- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Oya Pekin
- Department of Perinatology, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Nazan Tarhan
- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Ateş Karateke
- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Sadik Sahin
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Hospital, Istanbul, Turkey
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Mouzakiti N, Sierra F, Wolnicki B, Al Naimi A, Bahlmann F, Maul H, Kyvernitakis I. The impact of funneling shape on the secondary prevention of spontaneous preterm birth in patients treated with either an Arabin pessary, McDonald cerclage or early total cervical occlusion (ETCO). J Matern Fetal Neonatal Med 2020; 35:3309-3317. [PMID: 33019837 DOI: 10.1080/14767058.2020.1818209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Cervical funneling is associated with spontaneous preterm birth (sPTB). The aim of this analysis was to assess the relationship between funneling shape and the response to the McDonald cerclage, the Arabin pessary and the early total cervical occlusion (ETCO). METHODS We retrospectively analyzed data of 312 randomly selected singleton pregnancies with cervical shortening <25 mm or normal cervical length and evaluated them according to the progression of funneling: control group (n = 46), cervical shortening without funneling (n = 107), V-shaped funneling (n = 68), U-shaped funneling (n = 47), and prolapse of the amniotic sac (n = 44). We evaluated sPTB rates <34, <28, <32, and <37 weeks as well as prolongation of gestation and birthweight. RESULTS Regarding the rate of sPTB <34 weeks there was no statistical significance in either of the comparisons between control group and each of the four risk groups. Regarding prolongation of gestation we demonstrated a statistical significance for all risk groups compared to the control group (all p < .05) with the lowest prolongation rate noted in the group with amnion prolapse and the highest in the group with isolated cervical shortening without funneling. Similarly, progression of funnel shape resulted in an absolute decrease of birthweight for all risk groups compared to the control group, albeit not significant for the group with U-shaped funneling (p = .1058). CONCLUSION Independent of the treatment, there was a significant impact of funneling shape on pregnancy duration and birthweight.
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Affiliation(s)
- Niki Mouzakiti
- Department Of Obstetrics and Gynecology, Centre for Ultrasound and Prenatal Medicine, Buergerhospital and Clementine Children's Hospital Frankfurt a.M, Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany.,Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Felix Sierra
- Department Of Obstetrics and Gynecology, Centre for Ultrasound and Prenatal Medicine, Buergerhospital and Clementine Children's Hospital Frankfurt a.M, Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany
| | - Bartosz Wolnicki
- Department Of Obstetrics and Gynecology, Centre for Ultrasound and Prenatal Medicine, Buergerhospital and Clementine Children's Hospital Frankfurt a.M, Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany.,Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Ammar Al Naimi
- Department Of Obstetrics and Gynecology, Centre for Ultrasound and Prenatal Medicine, Buergerhospital and Clementine Children's Hospital Frankfurt a.M, Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany
| | - Franz Bahlmann
- Department Of Obstetrics and Gynecology, Centre for Ultrasound and Prenatal Medicine, Buergerhospital and Clementine Children's Hospital Frankfurt a.M, Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany
| | - Holger Maul
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinics Hamburg, Hamburg, Germany
| | - Ioannis Kyvernitakis
- Faculty of Medicine, Philipps University of Marburg, Marburg, Germany.,Department of Obstetrics and Prenatal Medicine, Asklepios Clinics Hamburg, Hamburg, Germany
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Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis. Acta Obstet Gynecol Scand 2020; 99:1444-1457. [PMID: 32757297 DOI: 10.1111/aogs.13968] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Emergency cerclage is the most common active intervention in pregnant women with cervical insufficiency. This meta-analysis aimed to compare the effectiveness of emergency cerclage vs expectant management on maternal and perinatal outcomes, and to assess the current status of evidence. MATERIAL AND METHODS A search was conducted from 1 June 2019 until 1 September 2019 and eligible studies were identified in the MEDLINE, Scopus, Cochrane and US clinical trials registry without limitations concerning the publication dates and languages. Randomized controlled trials (RCTs), non-RCTs and observational studies comparing emergency cerclage with no cerclage/expectant management, in women presenting with painless cervical dilatation were included. RESULTS The electronic search yielded 3607 potential studies, of which 38 were fully reviewed and 12 observational studies (1021 participants) were included. Cerclage was superior to expectant management for the primary outcomes of preterm birth before 28 and 32 gestational weeks, OR 0.25 (95% CI 0.16-0.39, five studies, N = 392, I2 = 41%, low quality) and 0.08 (95% CI 0.02-0.29, four studies, N = 176, I2 = 51%, low quality), respectively. Cerclage was also superior to expectant management for the secondary outcomes of fetal loss OR 0.26 (95% CI 0.12-0.56, 8 studies, N = 455, I2 = 46%, very low-quality), pregnancy prolongation in days mean difference 47.45 (95% CI 39.89-55.0, 12 studies, N = 1027 I2 = 86%, very low quality), gestational age at birth in weeks mean difference 5.68 (95% CI 4.69-6.67, 9 studies, N = 892, I2 = 73%, very low quality), admission to neonatal intensive care OR 0.21 (95% CI 0.07-0.70, two studies, N = 79, I2 = 36%, very low quality) and neonatal death OR 0.12 (95% CI 0.04-0.34, five studies, N = 130, I2 = 0%, very low quality). There were no differences between cerclage and expectant management concerning premature rupture of membranes during or after the procedure OR 0.68 (95% CI 0.31-1.48, two studies, N = 155, I2 = 85%, very low quality) and chorioamnionitis OR 1.14 (95% CI 0.31-4.25, three studies, N = 88, I2 = 33%, very low quality). CONCLUSIONS Emergency cerclage in pregnant women with painless cervical dilatation seems to decrease preterm births, prolong the pregnancy, and decrease the neonatal deaths and fetal losses, but does not increase the risk of chorioamnionitis and premature rupture of membranes. Despite the extremely favorable estimates for cerclage, the results should be viewed with caution because, as a result of the lack of randomized control trials, the quality of evidence is low to very low.
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Affiliation(s)
- Christos Chatzakis
- 2nd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Efthymiou
- Department of Obstetrics and Gynecology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Makrydimas
- Department of Obstetrics and Gynecology, School of Medicine, University of Ioannina, Ioannina, Greece
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