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1.
Am J Obstet Gynecol ; 211(5): 514.e1-7, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24746997

RESUMO

OBJECTIVE: To derive a prediction rule for preeclampsia and early onset preeclampsia requiring delivery <34 weeks using first trimester maternal, ultrasound, and serum markers. STUDY DESIGN: Prospective cohort study of women enrolled at first trimester screening. Maternal history, demographics, anthropometry, ultrasound parameters, and serum analytes were compared between women with preeclampsia and normal outcome. The prediction rule was derived by Lasso logistic regression analysis. RESULTS: In 2441 women, 108 (4.4%) women developed preeclampsia, and 18 (0.7%) early preeclampsia. Nulliparity, prior hypertension, diabetes, prior preeclampsia, mean arterial pressure, and the log pregnancy-associate pregnancy protein-A multiples of the median were primary risk factors. Prediction rules for preeclampsia/early preeclampsia had an area under the curve of 0.82/0.83 respectively. Preeclampsia was predicted with 49% sensitivity and early preeclampsia with 55% sensitivity for a 10% false positive rate. CONCLUSION: First trimester prediction rules using parameters currently available at first trimester screening identify a significant proportion of women with subsequent preeclampsia.


Assuntos
Hipertensão/epidemiologia , Pré-Eclâmpsia/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Gravidez em Diabéticas/epidemiologia , Artéria Uterina/diagnóstico por imagem , Adolescente , Adulto , Área Sob a Curva , Biomarcadores/sangue , Pressão Sanguínea , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Paridade , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico por imagem , Gravidez , Primeiro Trimestre da Gravidez/sangue , Proteína Plasmática A Associada à Gravidez/metabolismo , Diagnóstico Pré-Natal , Prognóstico , Estudos Prospectivos , Medição de Risco , Ultrassonografia Pré-Natal , Adulto Jovem
2.
Am J Obstet Gynecol ; 211(3): 261.e1-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24631442

RESUMO

OBJECTIVE: First-trimester screening for subsequent delivery of a small-for-gestational-age (SGA) infant typically focuses on maternal risk factors and uterine artery (UtA) Doppler. Our aim is to test if incorporation of fetal umbilical artery (UA) and ductus venosus (DV) Doppler improves SGA prediction. STUDY DESIGN: Prospective screening study of singletons at 11-14 weeks. Maternal characteristics, serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free ß-human chorionic gonadotropin are ascertained and UtA Doppler, UA, and DV Doppler studies are performed. These parameters are tested for their ability to predict subsequent delivery of a SGA infant. RESULTS: Among 2267 enrolled women, 191 (8.4%) deliver an SGA infant. At univariate analysis women with SGA neonates are younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free ß-human chorionic gonadotropin levels. They have a higher incidence of UtA Doppler bilateral notching, higher mean UtA Doppler-pulsatility index z-scores (P < .001) and UA pulsatility index z-scores (P = .03), but no significant difference in DV-pulsatility index z-scores or in the incidence of abnormal qualitative UA and DV patterns. Multivariate logistic regression analysis identifies nulliparity and AA ethnicity (P < .001), PAPP-A multiple of the median and bilateral notching (P < .05) as determinants of SGA infant. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95% confidence interval, 0.548-0.635) for the combination of UtA Doppler and UA pulsatility index z-scores. CONCLUSION: Delivery of a SGA infant is most frequent in nulliparous women of AA ethnicity. Despite the statistical association with UtA Doppler first-trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler.


Assuntos
Recém-Nascido Pequeno para a Idade Gestacional , Artérias Umbilicais/fisiologia , Adulto , Negro ou Afro-Americano , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Primeiro Trimestre da Gravidez , Proteína Plasmática A Associada à Gravidez/análise , Estudos Prospectivos
3.
J Obstet Gynecol Neonatal Nurs ; 52(1): 84-94, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183744

RESUMO

OBJECTIVE: To describe the frequency and severity of traumatic childbirth events (TCEs) and how they affected the professional practice and personal lives of maternity care clinicians, including registered nurses (RNs), certified nurse-midwives, attending physicians, and resident physicians. DESIGN: Descriptive cross-sectional study. SETTING: Maternity units across five hospitals in the Baltimore metropolitan area. PARTICIPANTS: Maternity care clinicians (N = 160) including RNs (n = 104), certified nurse-midwives (n = 17), attending physicians (n = 28), and resident physicians (n = 11). METHODS: Participants completed an online survey to measure the frequency and severity of TCEs and how they affect participants' professional practice and personal lives. We used descriptive statistics to characterize maternity care clinicians and bivariate analysis and linear regression to examine relationships. RESULTS: Most participants were women (92.5%), White (62.5%), between the ages of 21 and 54 years (89.4%), RNs (65.0%), and employed full-time (79.2%). Shoulder dystocia was the most frequently observed TCE (90.6%), and maternal death was the most severe TCE (M = 4.82, SD = 0.54). Attending physicians (50.0%) reported a significantly greater frequency of exposure to TCEs than the other participants, χ2(6) = 23.8 (n = 159), p <. 001. The frequency of TCEs had a significant medium correlation with perceived effect on professional practice, r(154) = 0.415, p < .001, and personal life, r(155) = 0.386, p < .001. Perception of severity was strongly associated with professional practice, ß = 0.52, p < .001, and personal life, ß = 0.46, p < .001. CONCLUSION: If severe, TCE exposure can affect the professional practice and personal life of maternity care clinicians.


Assuntos
Serviços de Saúde Materna , Tocologia , Enfermeiros Obstétricos , Obstetrícia , Feminino , Gravidez , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Estudos Transversais , Atitude do Pessoal de Saúde
4.
Arch Gynecol Obstet ; 283(3): 663-8, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20419307

RESUMO

PURPOSE: To better characterize postpartum cerebral angiitis (PPCA). METHODS: We present a case of PPCA in which a 34-year-old G6P5104 underwent a normal vaginal delivery and developed PPCA. She had no signs or symptoms of gestational hypertension or preeclampsia. She had a history of migraines and received methylergonovine at delivery. She represented postpartum with headache and hypertension. The patient had characteristic findings of cerebral angiitis on imaging, and was diagnosed with PPCA. She was treated with nimodipine and steroids. She was monitored with transcranial Dopplers. RESULTS: In reviewing the literature, we found 23 cases of PPCA. We found that none had proteinuria, most were hypertensive, and all presented with headache. CONCLUSIONS: Use of sympathomimetic agents, particularly among those with migraines, may increase risk of PPCA.


Assuntos
Complicações na Gravidez/diagnóstico , Vasculite do Sistema Nervoso Central/diagnóstico , Adulto , Anti-Hipertensivos/uso terapêutico , Angiografia Cerebral , Feminino , Humanos , Hipertensão/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Nimodipina/uso terapêutico , Período Pós-Parto/efeitos dos fármacos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do Tratamento , Vasculite do Sistema Nervoso Central/tratamento farmacológico
5.
Am J Obstet Gynecol ; 201(3): 276.e1-6, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19733278

RESUMO

OBJECTIVE: The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester. STUDY DESIGN: Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length

Assuntos
Líquido Amniótico/química , Colo do Útero/patologia , Resultado da Gravidez , Nascimento Prematuro/metabolismo , Adulto , Colo do Útero/diagnóstico por imagem , Quimiocina CCL2/análise , Citocinas , Feminino , Humanos , Gravidez , Curva ROC , Sensibilidade e Especificidade , Ultrassonografia , Adulto Jovem
6.
Am J Obstet Gynecol ; 198(2): e8-9, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18068141

RESUMO

A 35-year-old multipara woman underwent intrauterine pressure catheter placement during labor. Immediately afterwards, she had severe dyspnea develop, became unresponsive, and had a prolonged fetal bradycardia. During emergency cesarean section, she required cardiopulmonary resuscitation repetitively. She then had disseminated intravascular coagulopathy develop and underwent hysterectomy. Anaphylactic reaction may be associated with intrauterine pressure catheter placement.


Assuntos
Anafilaxia/diagnóstico , Cateterismo/efeitos adversos , Coagulação Intravascular Disseminada/diagnóstico , Complicações do Trabalho de Parto/diagnóstico , Diagnóstico Pré-Natal , Adulto , Anafilaxia/etiologia , Reanimação Cardiopulmonar , Parto Obstétrico , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/etiologia , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/etiologia , Gravidez , Pressão
8.
Obstet Gynecol ; 123(3): 611-617, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24513777

RESUMO

OBJECTIVE: The residual risk of preeclampsia in high-risk women on aspirin prophylaxis exceeds that of low-risk populations, and this study aimed to identify first-trimester maternal characteristics associated with aspirin prophylaxis failure. METHODS: This is a nested cohort study of prospectively enrolled women with verified initiation of risk-indicated aspirin prophylaxis by 16 weeks of gestation. First-trimester maternal history, demographics, anthropometry, ultrasound parameters, and serum analytes were compared between women who developed preeclampsia and those who did not. Blood pressure measurements were classified as prehypertension or hypertension according to the Joint National Committee on Hypertension guidelines. Chi square, nonparametric, and logistic regression analyses were used to determine the contributors to preeclampsia development. RESULTS: Six hundred fourteen women prospectively enrolled at 9-14 weeks of gestation initiated aspirin by 16 weeks of gestation. The 59 (9.6%) women who developed preeclampsia were more likely to have chronic hypertension, diabetes, and obesity and had higher first-trimester blood pressure and lower serum pregnancy-associated plasma protein-A concentrations (all P<.05). Having first-trimester Joint National Committee on Hypertension prehypertension or hypertension was associated with a 2.18-fold increased risk of developing preeclampsia, whereas normotension was associated with a reduction of risk of 56%. CONCLUSION: Women who develop preeclampsia while taking aspirin prophylaxis are more likely to have elevated first-trimester blood pressures. Conversely, first-trimester normotension is associated with a reduced risk of preeclampsia.


Assuntos
Aspirina/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Pré-Eclâmpsia/prevenção & controle , Adolescente , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Técnicas de Apoio para a Decisão , Esquema de Medicação , Feminino , Seguimentos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/etiologia , Gravidez , Primeiro Trimestre da Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Fatores de Risco , Falha de Tratamento , Adulto Jovem
9.
Hypertens Pregnancy ; 33(2): 204-14, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24304164

RESUMO

OBJECTIVE: To evaluate the impact of prior preeclampsia on first trimester assessment in subsequent pregnancy. METHODS: A total of 1283 parous patients were prospectively enrolled at 9-14 weeks of gestation. Maternal biophysical characteristics, ultrasound parameters and placental analytes were compared between women with and without prior preeclampsia. RESULTS: There is no association between prior preeclampsia and the first trimester ultrasound parameters or placental analytes studied. The effects of prior preeclampsia in subsequent pregnancy are exaggerated by increasing parity and are predominantly blood pressure-related, independent of other cardiovascular risk factors. CONCLUSION: There is a potential role for lifestyle modification and stricter pregnancy blood pressure control in patients with prior preeclampsia.


Assuntos
Gonadotropina Coriônica Humana Subunidade beta/sangue , Pré-Eclâmpsia/fisiopatologia , Primeiro Trimestre da Gravidez/fisiologia , Proteína Plasmática A Associada à Gravidez/metabolismo , Artéria Uterina/fisiopatologia , Adolescente , Adulto , Biomarcadores/sangue , Pressão Sanguínea , Feminino , Humanos , Pessoa de Meia-Idade , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Ultrassonografia , Artéria Uterina/diagnóstico por imagem , Adulto Jovem
10.
J Obstet Gynaecol Res ; 35(4): 672-8, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19751326

RESUMO

AIM: Developing a method of maximizing maternal expulsive effort should be of great value in reducing the number of cesarean sections or instrumental deliveries. Various investigations have shown that use of a dental support device (DSD) increases the isometric strength of different muscle groups. The aim of our study was to investigate the role of a DSD in second stage of pushing. METHODS: Nulliparous women with an uncomplicated singleton pregnancy course were randomly assigned either to a DSD group or to a non-device group. Duration of the second stage of labor was evaluated. Rates of cesarean section or instrumental delivery indicated for failure to descend in the second stage of labor were also evaluated. Satisfaction scores for the DSD group were evaluated (range 1-5). RESULTS: Sixty-four subjects were enrolled in the study. Cesarean section and instrumental delivery were performed for 12 (18.8%) and 5 (7.8%) patients, respectively. There was no difference in obstetrical and neonatal demographics between the two groups. Among 64 enrolled patients, 38 (59.3%) were evaluated for the second stage of labor (n = 19 for each group). Duration of the second stage of labor in the DSD group was significantly shorter than in the non-device group: (median 19 min (interquartile interval, IQI, 9) vs 31 min (IQI, 23)), P < 0.001. One patient in the non-device group required a vacuum extraction for failure to descend. The mode of satisfaction score for the DSD group was 5 (59.3%). CONCLUSION: Wearing a dental support device may shorten the second stage of labor, and may decrease the number of failures to descend requiring operative intervention. CLINICAL TRIAL REGISTRATION: NCT00629369.


Assuntos
Segunda Fase do Trabalho de Parto , Aparelhos Ortodônticos , Adulto , Feminino , Humanos , Recém-Nascido , Força Muscular , Satisfação do Paciente , Projetos Piloto , Postura , Gravidez , Fatores de Tempo , Manobra de Valsalva
11.
Endocrine ; 35(1): 81-8, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19016353

RESUMO

Vascular smooth muscle cell (VSMC) migration is a pivotal early step in blood vessel remodeling; however, very little is known about the regulation of this process in the human endometrium during the menstrual cycle. In this study, explants of human endometrium were incubated with estradiol and/or progesterone and the conditioned medium (CM) applied to cultures of VSMC to test the hypothesis that estrogen and progesterone stimulate endometrial cells to secrete a factor(s) that promotes VSMC migration. Endometrial explants were composed of highly organized glands and stroma. VSMC migration (cells migrated in 21 h/mm(2) fibronectin-coated semipermeable membrane) in the presence of CM from human endometrial explants obtained in the proliferative phase of the menstrual cycle and incubated for 24 h with estradiol was approximately threefold greater (P < 0.001) than with medium alone and greater (P < 0.05) than with CM from explants treated with estradiol plus progesterone or progesterone. It is concluded, therefore, that estrogen stimulates endometrial secretion of a factor(s) that promotes VSMC migration as an early step in vessel remodeling within the endometrium.


Assuntos
Movimento Celular/efeitos dos fármacos , Movimento Celular/genética , Endométrio/efeitos dos fármacos , Estradiol/farmacologia , Músculo Liso Vascular/efeitos dos fármacos , Indutores da Angiogênese/metabolismo , Angiopoietina-1/genética , Angiopoietina-1/metabolismo , Angiopoietina-1/fisiologia , Células Cultivadas , Meios de Cultivo Condicionados/metabolismo , Meios de Cultivo Condicionados/farmacologia , Endométrio/irrigação sanguínea , Endométrio/metabolismo , Feminino , Fase Folicular/genética , Fase Folicular/metabolismo , Fase Folicular/fisiologia , Expressão Gênica/efeitos dos fármacos , Humanos , Fase Luteal/genética , Fase Luteal/metabolismo , Fase Luteal/fisiologia , Microvasos/efeitos dos fármacos , Microvasos/metabolismo , Microvasos/fisiologia , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/fisiologia , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/fisiologia , Regeneração/efeitos dos fármacos , Regeneração/genética , Fatores de Tempo
12.
J Obstet Gynaecol Res ; 34(1): 100-4, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18226139

RESUMO

Although extremely rare, rupture of an unscarred gravid uterus poses significant morbidity and mortality to both fetus and mother. In the past, loss of uterine contraction was thought to be characteristic of uterine rupture, while recent evidence shows that uterine contraction pattern is not associated with uterine rupture. We report two cases of rupture in the unscarred term uterus. Both patients were multiparous and denied any past medical complications, previous cesarean delivery or myomectomy. Uterine rupture occurred in the latent phase of labor at 1 cm dilation (Case 1) and during an intravenous oxytocin infusion after three doses of intravaginal misoprostol (Case 2). Case 2 required cesarean hysterectomy and blood transfusion. Case 1 was monitored with an external tocodynamometer, while Case 2 was monitored with an internal pressure transducer. External monitoring demonstrated the classic sign of complete loss of uterine tone. In contrast, internal monitoring demonstrated an increase in uterine resting tone. Both techniques revealed a stepwise gradual decrease in contraction amplitude followed by sudden onset of profound and prolonged fetal bradycardia (staircase sign). In cases of uterine rupture, differing baseline characteristics between contraction patterns were dependent on uterine monitoring technique. In both techniques a stepwise gradual decrease in contraction amplitude was followed by prolonged fetal bradycardia.


Assuntos
Monitorização Fetal , Monitorização Uterina , Ruptura Uterina/diagnóstico , Adulto , Bradicardia/embriologia , Cesárea , Diagnóstico Diferencial , Feminino , Doenças Fetais , Humanos , Recém-Nascido , Terceira Fase do Trabalho de Parto , Trabalho de Parto Induzido , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/fisiopatologia , Ocitócicos/administração & dosagem , Gravidez , Terceiro Trimestre da Gravidez , Contração Uterina/fisiologia , Ruptura Uterina/fisiopatologia
13.
Am J Obstet Gynecol ; 192(4): 1060-6, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15846180

RESUMO

OBJECTIVE: This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester. STUDY DESIGN: Between January 1998 and May 2004, all singleton pregnancies with a short cervix (< or =2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database. These no funnel patients were compared with patients with a short cervix and funnel matched in accordance with cervical length and risk factors. Multiple variables of perinatal outcome were identified and compared between the Funnel and No Funnel groups. Correlations between cervical measurements and gestational age at birth were analyzed. RESULTS: Of the 279 patients with a short cervix identified, 82 were singleton with a T-shaped cervix and no funnel and 82 patients matched with a typical Y-shaped funnel. There was no difference between groups with respect to maternal demographics, previous preterm birth (28.1% No Funnel group vs 36.5% Funnel group, P = .3), prior cervical surgery (24.3% vs 22.0 %, P = .8), gestational age at entry (20.5 +/- 2.1 vs 21.1 +/- 2.4 weeks, P = .1), and cervical length (1.9 +/- 0.4 vs 1.8 +/- 0.5 cm , P = .1). The No Funnel group had significantly less readmissions for preterm labor (43.2% vs 67.1 %, P = .004), chorioamnionitis (2.4% vs 23.2 %, P = .0002), abruption (1.2% vs 13.4 %, P = .007), preterm rupture of membranes (6.1% vs 23.4%, P = .002), and cerclage placement (23.2% vs 43 %, P = .008). The neonates in the no funnel group delivered later (36.2% +/- 4.6 vs 33.8 +/- 5.4 weeks , P = .003), and had less morbidity and mortality (17.1% vs 37.8 %, P = .02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length ( R(2) = 0.07, P = .02) and cervical funneling as a categorical variable ( r = 0.3, P = .0002) did correlate with earlier delivery. CONCLUSION: The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent).


Assuntos
Colo do Útero/diagnóstico por imagem , Trabalho de Parto Prematuro/prevenção & controle , Resultado da Gravidez , Ultrassonografia Pré-Natal , Incompetência do Colo do Útero/diagnóstico por imagem , Adulto , Colo do Útero/patologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Probabilidade , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas
15.
Am J Obstet Gynecol ; 189(6): 1688-91, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14710099

RESUMO

OBJECTIVE: The study was undertaken to measure cerclage location within the cervix and to determine whether placement closer to the internal os is related to perinatal outcome. STUDY DESIGN: We analyzed data collected during a randomized trial of cervical cerclage versus no cerclage that was conducted at Lehigh Valley Hospital between May 1998 and June 2001 in women with ultrasound findings of short cervix less than 25 mm or funneling between 16 and 24 weeks' gestation. Women who were randomly assigned to the cerclage arm had cervical measurements performed before cerclage, including dilation of the internal os, depth of membrane prolapse into the endocervical canal, cervical length below any funnel (distal length), and total cervical length (including any funnel). Measurements obtained after cerclage placement included the distance from external os to cerclage (A), and a repeat of the same four measurements. The distance from the external os to the cerclage (A) was divided by the total cervical length (B) and a cerclage to cervical length ratio (A/B) was calculated. The relationship between these measurements and gestational age at birth was assessed by linear regression analysis. RESULTS: Of 150 patients enrolled, 74 received a McDonald cerclage suture. Mean distal cervical length was 1.9+/-0.9 cm before and 2.9+/-1.0 cm after cerclage (P=.001). The mean distance between the cerclage and external os (A) was 1.8+/-0.6 cm; the total cervical length after cerclage (B) was 3.6+/-0.9 cm. The mean cerclage to cervical length ratio (A/B) was 0.5+/-0.1. Linear regression analysis did not demonstrate a correlation between either the cerclage to external os measurement (A) or the cervical length ratio (A/B) and gestational age at birth (R(2)=0.0006 and 0.008, P=.8 and.6, respectively). CONCLUSION: The length of the cervix below the level of cerclage is not related to duration of pregnancy in women treated with cerclage because of ultrasound evidence of cervical effacement.


Assuntos
Cerclagem Cervical/métodos , Colo do Útero/fisiopatologia , Trabalho de Parto Prematuro/prevenção & controle , Resultado da Gravidez , Incompetência do Colo do Útero/diagnóstico por imagem , Incompetência do Colo do Útero/cirurgia , Adulto , Feminino , Idade Gestacional , Humanos , Incidência , Modelos Lineares , Assistência Perinatal , Gravidez , Probabilidade , Valores de Referência , Medição de Risco , Ultrassonografia Pré-Natal
16.
Aust N Z J Obstet Gynaecol ; 42(1): 46-50, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11926640

RESUMO

OBJECTIVE: To investigate the outcomes and risk factors associated with the second trimester sonographic findings of premature dilation of the internal cervical os, prolapse of the membranes into the endocervical canal and shortening of the distal segment. STUDY DESIGN: Retrospective chart review to identify patients who met the following criteria: (i) gestational age between 16 and 24 weeks; (ii) a vaginal probe ultrasound documenting dilatation of the internal os, prolapsed membranes into the endocervical canal but not extending beyond the external os, and a shortened distal cervix; and (iii) no evidence of increased uterine activity METHODS: Sonographic measurements obtained included: (i) the width of the internal os dilation; (ii) the depth of membranes prolapsed into endocervix (funneling); (iii) the distal cervical length; and (iv) the total cervical length. Patients were stratified into two groups according to gestational age at delivery: the preterm group (< 34 weeks) and the near-term group (> or = 34 weeks). RESULTS: Thirty-seven patients had complete records for analysis and their pregnancies resulted in 47 live births. Eighteen patients were stratified to the near term group and 19 were stratified to the preterm group. There were no stillborn infants and 10 neonatal deaths. Ten patients received cerclage and seven patients delivered at < 34 weeks gestational age. Risk factors found to be significant for preterm delivery included a gestational age at diagnosis of < or = 20 weeks gestation (p = 0.03), dilatation of the internal os > 1.3 cm (p = 0.04), and a composite Benham score > or = 1.0 (p = 0.02). CONCLUSIONS: The sonographic findings of premature dilatation of the internal os, prolapse of the membranes into the endocervical canal and shortening of the distal cervix are associated with a high rate of delivery < 34 weeks (51%) and neonatal death (27%).


Assuntos
Maturidade Cervical/fisiologia , Ruptura Prematura de Membranas Fetais/diagnóstico por imagem , Recém-Nascido Prematuro , Trabalho de Parto Prematuro/diagnóstico por imagem , Trabalho de Parto Prematuro/epidemiologia , Placenta Prévia/diagnóstico por imagem , Resultado da Gravidez , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Contração Uterina/fisiologia
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