Reliability of the sonographic evaluation for cervical length and elastography with pelvic parameters in term pregnancy by experienced operators with varying levels of experience.

OBJECTIVE: To assess the reliability of sonographic measurements of six cervical and pelvic parameters by three sonographers with varying levels of experience. METHODS: A cross-sectional study was conducted in pregnant women with a gestational age of ≥39 weeks. Each pregnant woman was examined by two sonographers with different levels of experience. Six parameters were measured: cervical length (CL), cervical strain elastography (extrinsic type), posterior cervical angle (PCA), fetal head-to-perineum distance (FHPD), fetal head-to-pubic symphysis distance (FHSD), and angle of progression (AOP). Intra- and interobserver reliabilities were assessed using the intraclass correlation coefficient with a 95% confidence interval. Pearson pairwise correlation coefficients were used to analyze the correlation between the parameter values. RESULTS: In all, 66 pregnant women were enrolled in this study. We found excellent intraobserver reliability for measurements of CL, PCA, FHPD, FHSD, and AOP and good-to-excellent intraobserver reliability for cervical strain values in the cross-sectional view of the endocervix in the internal os area and cross-sectional view of the entire cervix in the internal os area. Interobserver reliability was excellent for all pelvic parameters, except for the FHPD. Strain values were moderate to excellent in the area of the internal os. A significant negative correlation between CL and strain values at the internal os was observed. CONCLUSIONS: Pelvic parameters, except for FHPD, have excellent intra- and interobserver reliabilities. The high reproducibility of CL and cervical strain elastography at the internal os level, with a negative correlation between these two parameters, may play an important role in predicting successful induction of labor.

Low-dose aspirin for prevention of preeclampsia: Implementation of the NICE guideline in Thailand.

AIM: To evaluate the effectiveness of a preeclampsia (PE) screening program using the National Institute for Health and Care Excellence (NICE) guideline in pregnant Thai women. METHODS: A total of 2552 pregnancies received antenatal care and were delivered at Songklanagarind Hospital between November 2016 and April 2020. PE screening with the NICE guideline was used to identify mothers at risk. In cases of positive screening results, a daily dose of 81 mg aspirin was prescribed. Pregnancy outcomes were compared with 2783 participants who had maternity care before the implementation of the screening program. The effectiveness of aspirin prophylaxis following the NICE guideline was assessed by a logistic regression model to compare the risk of PE development between before and after guidance. RESULTS: The screening positive rate by NICE was 8.3%. Of these, 77.36% of the participants received aspirin prophylaxis according to the NICE recommendation. After the implementation of the PE screening program, the incidence of PE slightly decreased (from 4.31% to 3.72%, p = 0.274). The chance of PE in pregnancies who had high-risk factors was reduced after using low-dose aspirin prophylaxis, even though the difference was not statistically significant. CONCLUSIONS: Screening with the NICE guidelines followed by prescription of low-dose aspirin (81 mg/day) was probably not an effective strategy for the prevention of PE in our population. Combining biophysical and biochemical markers to identify pregnant women who subsequently develop PE, concurrently with an increased dose of aspirin prophylaxis, may provide a better outcome in clinical practice.