Change in cervical length after arrested preterm labor and risk of preterm birth.

OBJECTIVE: To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women. METHODS: In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15-30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission. RESULTS: A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09-0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62-3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84-0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82-1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results. CONCLUSION: Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

How cold is too cold during maternal sepsis? Navigating between maternal hypothermia and fetal bradycardia.

Hypothermia is a relatively rare condition in pregnancy and has been associated with fetal bradycardia. The management of maternal hypothermia resulting in fetal bradycardia presents a challenging dilemma for healthcare professionals. Currently, no evidence exists to advise on the duration of this condition before obstetric interventions are necessary for a safe outcome for both mother and infant. We discuss a case of a 26-year old primigravida with a gestational age of 32 weeks, who presented with clinical urosepsis, resulting in severe hypothermia up to 32 degrees Celsius. Active warming measures were taken and intravenous antibiotic treatment was started. Fetal evaluation on the cardiotocogram showed prolonged bradycardia (90 BPM) prompting consideration of a cesarean section. However, after multidisciplinary consultation, conservative treatment was proposed since there were no other signs of fetal hypoxia; no decelerations, good variability and accelerations. The patient started to show clinical improvement and had a body core temperature of 36 degrees Celsius after approximately 60 h of active rewarming measures. Fetal heartrate baseline normalized as the maternal temperature raised. Subsequently the patient was discharged in good clinical condition and had an uncomplicated vaginal delivery of a healthy newborn at term. In conclusion, when fetal bradycardia occurs due to maternal hypothermia, in the absence of signs for fetal hypoxia on the cardiotocogram, treatment of the underlying maternal condition instead of immediate obstetrics intervention is the best clinical option. This strategy aims to address the underlying cause of maternal hypothermia and consequently fetal bradycardia while ensuring the well-being of both mother and fetus and preventing unnecessary premature delivery.