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1.
Harefuah ; 160(1): 13-18, 2021 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-33474873

RESUMO

INTRODUCTION: Preterm labor is defined as delivery before 37 weeks of gestation. Up to 17% of twin pregnancy are preterm. Arabin cervical pessary has been proven as preventing preterm labor in singleton pregnancies. The benefit of it in twin pregnancy is controversial. OBJECTIVES: The purpose of this study was to compare the rate of preterm delivery in twin gestation with short cervical length in Israel- one center utilized the combined treatment of Arabin cervical pessary and vaginal progesterone (study group) and the others utilized vaginal progesterone approach (control group). METHODS: Multi-center retrospective cohort study, including "Shamir", "Wolfson", "Shaare Zedek" and "Galilee" medical centers, between the years 2012-2016. Inclusion criteria were twin gestations and short cervical length (<25mm) between 16-28 weeks' gestation. RESULTS: The study group included 68 women, the control group 78 women. The study group had shorter cervical length at intervention in comparison to the control group (13.6 ± 5.9 vs. 16.5 ± 5.7, respectively, p = .002). The treatment started later for the study group compared to the control group (23.2 +2.2 vs 22.6 +3.0). CONCLUSIONS: Despite having shorter cervical length at recruitment, the rate of spontaneous delivery < 34-weeks' gestation was similar in both groups (36.8 vs. 37.2%, respectively). DISCUSSION: Considering the conclusion in this research it seems that the combination of the mechanical effect of the pessary by embracing the cervix, keeping the cervical mucus, bending it in a way that the pressure is towards the anterior cervical wall together with the progestative effect which increases the estrogen/progesterone ratio, creating uterine quiescence and keeping the structural connective tissue of the cervix have an added benefit. It seems that the combined use of Arabin cervical pessary and vaginal progesterone in twin pregnancy with short cervical length have a synergic effect which may have a benefit in preventing preterm labor. The combination of cervical pessary and progesterone does not negatively affect twin pregnancy outcome and does not cause preterm birth.


Assuntos
Gravidez de Gêmeos , Nascimento Prematuro , Administração Intravaginal , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Israel , Pessários , Gravidez , Nascimento Prematuro/prevenção & controle , Progesterona , Estudos Retrospectivos
2.
Arch Gynecol Obstet ; 303(3): 811-820, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33394142

RESUMO

PURPOSE: Our objective was to establish a random forest model and to evaluate its predictive capability of the treatment effect of neoadjuvant chemotherapy-radiation therapy. METHODS: This retrospective study included 82 patients with locally advanced cervical cancer who underwent scanning from March 2013 to May 2018. The random forest model was established and optimised based on the open source toolkit scikit-learn. Byoptimising of the number of decision trees in the random forest, the criteria for selecting the final partition index and the minimum number of samples partitioned by each node, the performance of random forest in the prediction of the treatment effect of neoadjuvant chemotherapy-radiation therapy on advanced cervical cancer (> IIb) was evaluated. RESULTS: The number of decision trees in the random forests influenced the model performance. When the number of decision trees was set to 10, 25, 40, 55, 70, 85 and 100, the performance of random forest model exhibited an increasing trend first and then a decreasing one. The criteria for the selection of final partition index showed significant effects on the generation of decision trees. The Gini index demonstrated a better effect compared with information gain index. The area under the receiver operating curve for Gini index attained a value of 0.917. CONCLUSION: The random forest model showed potential in predicting the treatment effect of neoadjuvant chemotherapy-radiation therapy based on high-resolution T2WIs for advanced cervical cancer (> IIb).


Assuntos
Colo do Útero/efeitos dos fármacos , Colo do Útero/efeitos da radiação , Quimiorradioterapia/métodos , Terapia Neoadjuvante/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Colo do Útero/diagnóstico por imagem , Árvores de Decisões , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
4.
Braz J Med Biol Res ; 54(1): e10235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33338099

RESUMO

A prospective cohort study was conducted on a convenience sample of 1370 pregnant women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto. Data on obstetrical history, maternal age, parity, smoking habit, and a history of preterm delivery was collected with the application of a sociodemographic questionnaire. Cervical length was determined by endovaginal ultrasound, and urine and vaginal content samples were obtained to determine urinary tract infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this study was to verify the association of cervical length and genitourinary infections with preterm birth (PTB). Ultrasound showed no association of UTI or BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15 showed UTI (RR: 1.55, 95%CI: 0.93-2.58), 19 had BV (RR: 1.22, 95%CI: 0.77-1.94), and one had both UTI and BV (RR: 0.85, 95%CI: 0.13-5.62). Nineteen (14.4%) PTB occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89-4.43). Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR: 2.02, 95%CI: 1.05-3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI: 0.97-3.04). A short cervical length between 20 and 25 weeks of pregnancy was associated with PTB, whereas UTI and BV determined at this age were not associated with short cervical length or with PTB, although UTI, even if asymptomatic, was related to spontaneous PTB.


Assuntos
Colo do Útero/anatomia & histologia , Doenças Urogenitais Femininas/microbiologia , Nascimento Prematuro , Adulto , Brasil , Colo do Útero/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Ultrassonografia , Vagina/microbiologia , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-33039310

RESUMO

Preterm birth (PTB), which occurs in about 12% of pregnancies worldwide, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids and antibiotics has improved neonatal outcomes but has not reduced the incidence of PTB. Evidence suggests that the rate of PTB may be reduced by the prophylactic use of progesterone in women with a previous history of preterm delivery and in those with a short cervical length identified by routine transvaginal ultrasound. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of PTB.


Assuntos
Trabalho de Parto Prematuro , Nascimento Prematuro , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Progesterona , Ultrassonografia
6.
Arch Gynecol Obstet ; 302(3): 753-762, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32712928

RESUMO

PURPOSE: The purpose of this study was to evaluate stiffness changes occurring in the healthy uterine cervix according to age, parity, phase of the menstrual cycle and other factors by shear wave elastography (SWE). METHODS: Evaluations of cervical speed and stiffness measurements were performed in 50 non-pregnant patients without gynaecological pathology using SWE transvaginal ultrasound. We performed the evaluation in the midsagittal plane of the uterine cervix with measurements at 0.5, 1 and 1.5 cm from external cervical os, at both anterior and posterior cervical lips. RESULTS: We evaluated 44 patients by SWE and obtained a total average velocity of 3.48 ± 1.08 m/s and stiffness of 42.39 ± 25.33 kPa. We found differences in speed and stiffness according to the cervical lip and depth evaluated; thus, we observed a velocity of 2.70 m/s at 0.5 cm of depth in the anterior lip and 3.53 m/s at 1.5 cm of depth in the posterior lip (p < 0.05). We observed differences according to parity, obtaining a wave transmission speed of 2.67 m/s and 4.41 m/s at the cervical canal of nulliparous and multiparous patients, respectively (p < 0 0.002). We observed differences according to patient age (from a speed of 2.75 m/s at the cervical canal in the age group of 20-35 years to 5.05 m/s in the age group > 50 years) (p < 0.008). We did not observe differences in speed or stiffness according to the phase of the menstrual cycle, BMI, smoking status or the presence or absence of non-HPV infections. CONCLUSIONS: The wave transmission speed and stiffness of the uterine cervix evaluated by SWE varies according to the cervical lip and depth of the evaluation as well as according to the parity and age of the patient.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Adolescente , Adulto , Idoso , Colo do Útero/fisiopatologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
7.
Br J Radiol ; 93(1112): 20200169, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32543946

RESUMO

OBJECTIVES: The aim of this study was to assess the consistency of therapy radiographers performing image registration using cone beam computed tomography (CBCT)-CT, magnetic resonance (MR)-CT, and MR-MR image guidance for cervix cancer radiotherapy and to assess that MR-based image guidance is not inferior to CBCT standard practice. METHODS: 10 patients receiving cervix radiation therapy underwent daily CBCT guidance and magnetic resonance (MR) imaging weekly during treatment. Offline registration of each MR image, and corresponding CBCT, to planning CT was performed by five radiographers. MR images were also registered to the earliest MR interobserver variation was assessed using modified Bland-Altman analysis with clinically acceptable 95% limits of agreement (LoA) defined as ±5.0 mm. RESULTS: 30 CBCT-CT, 30 MR-CT and 20 MR-MR registrations were performed by each observer. Registration variations between CBCT-CT and MR-CT were minor and both strategies resulted in 95% LoA over the clinical threshold in the anteroposterior direction (CBCT-CT ±5.8 mm, MR-CT ±5.4 mm). MR-MR registrations achieved a significantly improved 95% LoA in the anteroposterior direction (±4.3 mm). All strategies demonstrated similar results in lateral and longitudinal directions. CONCLUSION: The magnitude of interobserver variations between CBCT-CT and MR-CT were similar, confirming that MR-CT radiotherapy workflows are comparable to CBCT-CT image-guided radiotherapy. Our results suggest MR-MR radiotherapy workflows may be a superior registration strategy. ADVANCES IN KNOWLEDGE: This is the first publication quantifying interobserver registration of multimodality image registration strategies for cervix radical radiotherapy patients.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Imagem por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Variações Dependentes do Observador , Radioterapia Guiada por Imagem/métodos , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnóstico por imagem
8.
J Comput Assist Tomogr ; 44(3): 426-435, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32345807

RESUMO

The authors investigated the usefulness of diffusion-tensor imaging (DTI) for evaluating tumor invasion depth, histologic grade, and lymph node metastasis in patients with cervical carcinoma (CC). Fifteen consecutive patients with histologically confirmed CC underwent 1.5-T magnetic resonance imaging and DTI. The CCs were clearly depicted as hypointense areas on all DTI maps. Fractional anisotropy, mean diffusivity, and axial diffusivity showed significantly inverse correlations with CC histologic grades and were significantly different between metastatic and nonmetastatic lymph nodes.


Assuntos
Imagem de Tensor de Difusão/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos
9.
Int J Gynaecol Obstet ; 150(2): 206-212, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32282943

RESUMO

OBJECTIVE: To compare cervical pessaries plus vaginal progesterone versus long-term tocolysis for preventing preterm birth for women with a short cervix. METHODS: Retrospective evaluation of women with singleton pregnancy who received cervical pessaries plus vaginal progesterone (combined group) or ritodrine hydrochloride (tocolysis group) for short cervix (≤25 mm at 20-24 weeks, or ≤20 mm at 25-34 weeks) at a general hospital in Kagoshima, Japan, 2015-2019. The primary outcome was rate of preterm birth (<36 weeks); secondary outcomes were maternal hospital admittance and treatment complications. RESULTS: Data were evaluated from 95 women (combined group, n=43; tocolysis group, n=52). There was no significant difference in cervical length or gestational age at intervention between the groups. Overall, 3/43 (7.0%) women delivered before 36 weeks in the combined group versus 16/52 (30.8%) in the tocolysis group (relative risk, 0.56; 95% confidence interval, 0.41-0.76; P=0.004). Median maternal admittance was shorter in the combined group (6.6 vs 41.0 days, P<0.001). Although 36/43 (83.7%) women in the combined group reported increased vaginal discharge, no major complications occurred. CONCLUSION: A combination of pessaries and vaginal progesterone reduced the rate of preterm birth (<36 weeks) for women with short cervix as compared with long-term tocolysis.


Assuntos
Pessários , Nascimento Prematuro/prevenção & controle , Progesterona/administração & dosagem , Progestinas/administração & dosagem , Tocólise/métodos , Administração Intravaginal , Adulto , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Japão , Gravidez , Estudos Retrospectivos
10.
Fertil Steril ; 113(4): 723-732, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32228875

RESUMO

The prevalence of congenital cervical agenesis or dysgenesis ranges from 1/80,000 to 1/100,000, and in about 50% of these cases it coexists with congenital vaginal agenesis. This narrative review summarizes the contemporary knowledge in the field of conservative surgical restoration of the reproductive tract. The management of congenital cervical malformations aims to [1] provide relief from the obstructive symptoms, [2] establish normal sexual function, and [3] preserve the uterus for future fertility. In cases of cervical agenesis and vaginal aplasia, the surgical approach involves the creation of neovagina, the creation of neocervix, and then subsequent restoration of the continuity of the genital tract. In cases where vagina is not congenitally absent, the surgical approach involves either a direct uterovaginal anastomosis or initial creation of neocervix and then subsequent restoration of the continuity of the genital tract. The neocervix can be surgically created with small intestinal submucosa, split-thickness skin graft, full-thickness skin graft, peritoneal flap, or vaginal mucosa lined with a polytetrafluoroethylene graft. Most of the published cases report long-term menstruation and sporadic pregnancies. Conservative surgery of cervical congenital malformations could serve as a first-line treatment. Sexual function and menstruation are established in the majority of patients. Extirpatory surgery may be preserved for surgical failures after initial restoration of the continuity of uterus-cervix-vagina or in cases with more complex anatomy.


Assuntos
Colo do Útero/anormalidades , Colo do Útero/cirurgia , Gerenciamento Clínico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Colo do Útero/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Laparoscopia/métodos , Gravidez , Retalhos Cirúrgicos , Anormalidades Urogenitais/diagnóstico por imagem , Útero/diagnóstico por imagem , Útero/cirurgia , Vagina/anormalidades , Vagina/diagnóstico por imagem , Vagina/cirurgia
11.
PLoS One ; 15(3): e0229500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160214

RESUMO

OBJECTIVE: HIV-infected women on antiretroviral therapy have a higher risk of preterm birth than HIV-uninfected women in Botswana. To better understand the mechanism for preterm birth among HIV-infected women, we evaluated whether mid-trimester cervical length differed by HIV status as cervical shortening is associated with an increased risk for preterm birth. METHODS: We conducted a prospective cohort study among pregnant women receiving care at the Scottish Livingstone Hospital in Molepolole, Botswana. Consecutive women referred for routine obstetrical ultrasound were consented and enrolled if between 22w0d and 24w6d by ultrasound biometry. Blinded to maternal HIV status, an obstetrician measured transvaginal cervical length using standardized criteria. Cervical length, as well as the proportion of women with a short cervix (<25mm), were compared among HIV-infected and HIV-uninfected women. The acceptability of transvaginal ultrasound was also evaluated. RESULTS: Between April 2016 and April 2017, 853 women presenting for obstetric ultrasound were screened, 187 (22%) met eligibility criteria, and 179 (96%) were enrolled. Of those enrolled, 50 (28%) were HIV-infected (86% on antiretroviral therapy), 127 (71%) were HIV-uninfected, and 2 (1%) had unknown HIV status. There was no significant difference in mean cervical length between HIV-infected and HIV-uninfected women (32mm vs 31mm, p = 0.21), or in the proportion with a short cervix (10% vs 14%, p = 0.44). Acceptability data was available for 115 women who underwent a transvaginal ultrasound exam. Of these, 112 of 115 (97%) women deemed the transvaginal scan acceptable. CONCLUSIONS: The increased risk of preterm birth observed among HIV-infected women receiving antiretroviral therapy in Botswana is unlikely associated with mid-trimester cervical shortening. Further research is needed to understand the underlying mechanism for preterm birth among HIV-infected women.


Assuntos
Colo do Útero/diagnóstico por imagem , Infecções por HIV/patologia , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal , Adulto , Botsuana , Medida do Comprimento Cervical , Estudos de Coortes , Feminino , HIV , Humanos , Gravidez , Complicações na Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Adulto Jovem
12.
Taiwan J Obstet Gynecol ; 59(1): 28-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039796

RESUMO

OBJECTIVE: To compare pregnancy outcomes resulting from the use of cervical cerclage for different indications and investigate factors that might influence the clinical effects of cervical cerclage. MATERIALS AND METHODS: This was a retrospective study of pregnant women who received cervical cerclage in The Women's Hospital, Zhejiang University School of Medicine, China. Patients were divided into three groups: a history-indicated group; an ultrasound-indicated group and a physical examination-indicated group. The pregnancy outcomes of the three groups were then compared. Univariate and multivariate logistic regression analysis were performed to assess the independent risk factors. RESULTS: Statistical differences were evident when the history-indicated group and the ultrasound-indicated group were compared with the physical examination-indicated group for gestational age at delivery [37.3(33.3-38.9), 35.4(28.9-38.4) vs. 26.1 (24.3-28.4) weeks, respectively, P < 0.05], percentage of cases delivered at < 28 weeks of gestation (13.4%, 20.3% vs. 74.3%, respectively, P < 0.05), percentage of cases delivered at < 37 weeks of gestation (42.7%, 54.2% vs. 91.4%, respectively, P < 0.05) and fetal survival rate (88.4%, 81.4% vs. 40.0%, respectively, P < 0.05). The history-indicated group and the ultrasound-indicated group were similar with regards to these outcomes. The independent risk factors affecting the clinical effects of cervical cerclage include age, body mass index (BMI), history of prior preterm birth and second-trimester loss, C-reactive protein (CRP) >5 mg/L and cervical dilation ≥3 cm (P < 0.05). CONCLUSION: Pregnancy outcomes were similar when compared between history-indicated and ultrasound-indicated cerclage. Serial cervical surveillance is beneficial for pregnant with a history of cervical insufficiency, and the placement of cervical cerclages in response to ultrasonographically detected shortening of the cervical length is a medically acceptable alternative to the use of history-indicated cerclage.


Assuntos
Cerclagem Cervical/estatística & dados numéricos , Complicações na Gravidez/cirurgia , Nascimento Prematuro/cirurgia , Incompetência do Colo do Útero/cirurgia , Adulto , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , China , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ultrassonografia Pré-Natal , Incompetência do Colo do Útero/diagnóstico por imagem
13.
Trials ; 21(1): 121, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000820

RESUMO

BACKGROUND: Preterm birth accounts for 75% of perinatal deaths and more than 50% of long-term neurological disabilities. For a singleton pregnancy, progesterone treatment is effective in prevention of preterm birth in women with an asymptomatic short cervix or a history of preterm birth. However, a large proportion of preterm births still is not currently preventable. The aim of this study is to determine whether early universal use of oral progesterone before 14 + 0 weeks of gestation can prevent preterm birth better than universal screening of cervical length at 18 + 0 to 23 + 6 weeks of gestation, followed by progesterone treatment in those with a short cervix in singleton pregnancy. METHODS: This is a multicenter, randomized, double-blind, placebo-controlled trial registered with ClinicalTrials.gov on 12 February 2018. Eligible consecutive pregnant women with singleton gestation attending antenatal outpatient clinics will be recruited after receiving counseling and signing the written consent form. Transvaginal cervical length measurement will be performed at recruitment (before 14 + 0 weeks of gestation) and between 18 + 0 and 23 + 6 weeks of gestation. After randomization, women will be randomly assigned to either the treatment group (oral dydrogesterone 10 mg three times daily) or the placebo group, and medication will be started before 14 + 0 weeks of gestation. Assigned groups will be unblinded if the cervical length is ≤ 25 mm between 18 + 0 and 23 + 6 weeks of gestation, and the management option for short cervix will be discussed (oral progesterone, vaginal progesterone, or cervical cerclage). The primary outcome is preterm birth before 37 + 0 weeks of gestation. DISCUSSION: Progesterone is used extensively in part of the in vitro fertilization program as luteal phase support, and it is not associated with teratogenicity. Universal progesterone supplementation may be a better approach to prevent preterm birth. This large, multicenter, randomized, double-blind, placebo-controlled trial will provide the best evidence, leading to the best strategy for the prevention of preterm birth. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03428685. Registered on 12 February 2018.


Assuntos
Medida do Comprimento Cervical/métodos , Intervenção Médica Precoce/métodos , Nascimento Prematuro , Progesterona/administração & dosagem , Tempo para o Tratamento , Adulto , Colo do Útero/diagnóstico por imagem , Método Duplo-Cego , Feminino , Humanos , Estudos Multicêntricos como Assunto , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Progesterona/efeitos adversos , Progestinas/administração & dosagem , Progestinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Prog. obstet. ginecol. (Ed. impr.) ; 63(1): 29-31, ene.-feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197730

RESUMO

Se presenta el caso de una paciente que acude a urgencias con dolor abdominal bajo, de 2 días de evolución, asociado a amenorrea tras finalizar lactancia materna. Tiene un parto eutócico a término que no precisó maniobras especiales cinco meses antes de su visita a urgencias. En la exploración se objetiva un útero aumentado de tamaño y por ecografía se comprueba la presencia de un útero con cavidad dilatada y aumentado de tamaño a expensas de un acúmulo hemático en su interior. La dilatación de orifico cervical externo no fue posible por lo que se programó para histeroscopia, pero no fue necesaria, por el drenaje espontáneo del material hemático


We present the case of a woman who shows at the acute and emergency unit with lower abdominal pain for the last 2 days and lack of menstruation after finishing maternal breastfeeding. She has had a normal vaginal delivery that did not need any further maneuvers. Physical examination showed an enlarged uterus and using transvaginal ultrasounds we could see an uterus with enlarged cavity due to the presence of an hematic accumulation inside. The dilatation of the external cervical os was not possible so the patient was planned for hysteroscopy


Assuntos
Humanos , Feminino , Adulto , Hematometra/etiologia , Hematometra/diagnóstico por imagem , Complicações do Trabalho de Parto , Dor Abdominal/etiologia , Colo do Útero/irrigação sanguínea , Colo do Útero/diagnóstico por imagem , Ultrassonografia
15.
Eur J Radiol ; 124: 108779, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31935594

RESUMO

PURPOSE: We sought to evaluate the image quality and compare the signal intensity (SI) and apparent diffusion coefficient (ADC) maps of ultra-high b-value (2000 s/mm2; B2) images against those of 800 s/mm2 b-value (B1) images of diffusion-weighted imaging (DWI) for cervical cancer. METHOD: This study was approved by the institutional review board. Sixty patients diagnosed with cervical cancer by pathology were prospectively included. Female pelvic magnetic resonance imaging was performed using a 3 T magnetic resonance scanner; B1 and B2 images were obtained for evaluation. Two radiologists blinded to the scan parameters evaluated the images for signal loss in the background, spatial distortion, image ghosting, confidence in the lesion delineation, and overall image quality using a 5-point scoring system. The scores were compared using a paired Wilcoxon test. SI was measured in the B1 and B2 images for the tumour and normal reference tissues. Additionally, the SI contrast ratios were calculated and compared using the Mann-Whitney U test, the ADC values of tumours and normal tissues were measured, and the maximum tumour diameters were measured from the B1 and B2 images and compared with those from the T2-weighted images, which was the reference standard. RESULTS: The signal loss in the background, confidence of the lesion delineation and overall image quality scores were higher for the B2 images than for the B1 images (all p < 0.001). The contrast ratios of the tumour-to-normal SI were also higher for the B2 images than for the B1 images (p < 0.01). The mean ADC values derived from the B2 images showed better correlations with the tumour differentiation grades than those from the B1 images. The tumour diameters measured from the B2 images experienced less bias than those from the B1 images. CONCLUSIONS: B2 images of DWI are technically feasible to acquire and provide more promising additional information for the delineation of cervical cancer tumours than B1 images of the female pelvis.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Adulto , Idoso , Algoritmos , Colo do Útero/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Adulto Jovem
16.
Jpn J Radiol ; 38(3): 265-273, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31907716

RESUMO

PURPOSE: This study aimed to identify the most appropriate volume of interest (VOI) setting in prognostic prediction using pretreatment magnetic resonance imaging (MRI) radiomic analysis for cervical cancer (CC) treated with definitive radiotherapy. MATERIALS AND METHODS: The study participants were 87 patients who had undergone pretreatment MRI and definitive radiotherapy for CC. VOItumor was created with tumor alone and VOI+4 mm-VOI+20 mm mechanically expanded by 4-20 mm around each VOItumor in axial T2-weighted images (T2WI) and an apparent diffusion coefficient (ADC) map. A model was constructed to predict recurrence within the irradiation field within 2 years after treatment using imaging features from the VOI of each sequence. Sorting ability was evaluated by area under the receiver operator characteristic curve (AUC-ROC) analysis. RESULTS: VOI expansion improved AUC-ROCs compared with the predictive models of VOItumor (0.59 and 0.67 in T2WI and ADC, respectively). The AUC-ROCs of the models with imaging features from expanded VOI+4 mm in T2WI and VOI+4 mm and VOI+8 mm in ADC were 0.82, 0.82, and 0.86, respectively. CONCLUSION: Recurrence could be predicted with high accuracy using expanded VOI for CC treated with definitive radiotherapy, suggesting that including the pathological characteristics of invasive margins in radiomics may improve predictive ability.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia , Área Sob a Curva , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Aprendizado de Máquina , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
17.
J Obstet Gynaecol Res ; 46(2): 237-248, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31814257

RESUMO

AIM: To assess the reproducibility of a semiautomatic quantification tool for cervical stiffness and evaluate the normal changes in cervical elasticity during the three trimesters of pregnancy. METHODS: This longitudinal prospective pilot study evaluated cervical elasticity during the three trimesters of pregnancy (11-14, 20-24 and 28-32 weeks) in women with singleton pregnancies. Women with a history of conization, cerclage, cervical Naboth cysts (diameter > 10 mm), cervical tumors, or uterine malformation were excluded. A semiautomatic tool was used to evaluate the stiffness of the whole cervix and the internal and external cervical os with multiple quantitative elasticity parameters and the cervical length (CL) on the sagittal view via transvaginal elastography. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to assess intra- and interobserver variability. E-Cervix parameters during the three trimesters were compared using the Friedman test. RESULTS: In total, 217 women with 651 strain examinations during the three trimesters were included. The intra- and interobserver ICC for the E-Cervix parameters ranged from 0.947 to 0.991 and 0.855 to 0.989, respectively. There were significant differences in all parameters among the three trimesters. Cervical elasticity showed significant softening and became heterogeneous during the three trimesters. The median CL was significantly shorter in the first trimester than in the second and third trimesters (P = 0.004, P < 0.001). CONCLUSION: E-Cervix provides a graphical tool for operators to easily define regions of interest and obtain multiple repeatable measures of elasticity. The normal references for E-Cervix parameters during the three trimesters reflect the physiological cervical changes during pregnancy.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador , Adulto , Elasticidade , Feminino , Humanos , Estudos Longitudinais , Variações Dependentes do Observador , Projetos Piloto , Gravidez , Trimestres da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
18.
Am J Obstet Gynecol ; 222(5): 491.e1-491.e8, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31816307

RESUMO

BACKGROUND: The cervix functions as a barrier to ascending pathogens in pregnancy. Short cervical length and lack of cervicovaginal Lactobacillus species are risk factors for spontaneous preterm birth; however, whether they interact to increase risk remains unknown. OBJECTIVE: We sought to examine the relationship between cervicovaginal microbiota and short cervix as well as their combined impact on spontaneous preterm birth risk. STUDY DESIGN: This was a secondary analysis of a prospective nested, case-control pregnancy study. Cervical swabs were collected between 16 and 20 weeks of gestation. Cervical length was measured per standard clinical care during a clinically indicated ultrasound at approximately 20 weeks of gestation. Cervicovaginal microbiota were analyzed with 16S ribosomal RNA gene sequencing and classified into community state types among 67 cases of spontaneous preterm birth, 47 cases of medically indicated preterm birth, and 358 cases of term births. Logistic regression was used to model associations of community state type IV, a community characterized by a paucity of Lactobacillus species and a wide array of anaerobic bacteria, and short cervix (<25 mm) as well as to model the association of a combination of short cervix and community state type IV with the odds of spontaneous preterm birth. RESULTS: Among the 472 women in the data set, there were 38 with short cervix (8.1%) and 177 with community state type IV (37.5%). Short cervix was associated with spontaneous preterm birth (adjusted odds ratio, 15.59; 95% confidence interval, 6.77-35.92). Women with community state type IV had higher odds of short cervix (adjusted odds ratio, 2.17; 95% confidence interval, 1.04-4.53) as well as spontaneous preterm birth (adjusted odds ratio, 1.97; 95% confidence interval, 1.06-3.65). While the interaction of community state type IV and short cervix was not significant (P = .771), women with both short cervix and community state type IV (n = 20) had higher odds of spontaneous preterm birth compared with women with both normal cervical length and community state types I, II, III, or V (n = 277) (adjusted odds ratio, 21.8; 95% confidence interval, 6.78-70.2). CONCLUSION: Community state type IV, characterized by a diverse set of strict and facultative anaerobes and a paucity of Lactobacillus species, is associated with increased odds of short cervix. Women with both community state type IV and short cervix have higher odds of spontaneous preterm birth than women with either factor alone. Determining the cascade of events leading to premature cervical shortening, including dysbiosis, may be critical in preventing spontaneous preterm birth.


Assuntos
Colo do Útero/diagnóstico por imagem , Colo do Útero/microbiologia , Lactobacillus/isolamento & purificação , Segundo Trimestre da Gravidez , Vagina/microbiologia , Adulto , Estudos de Casos e Controles , Medida do Comprimento Cervical , Feminino , Humanos , Microbiota , Gravidez , Ultrassonografia Pré-Natal , Vagina/diagnóstico por imagem , Adulto Jovem
19.
Am J Perinatol ; 37(7): 659-665, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31756763

RESUMO

OBJECTIVE: This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth. STUDY DESIGN: Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates. RESULTS: Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P. CONCLUSION: In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.


Assuntos
Caproato de 17 alfa-Hidroxiprogesterona/administração & dosagem , Colo do Útero/anatomia & histologia , Nascimento Prematuro/prevenção & controle , Progestinas/administração & dosagem , Adulto , Cerclagem Cervical , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Colo do Útero/efeitos dos fármacos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/prevenção & controle , Idade Gestacional , Humanos , Recém-Nascido , Injeções Intramusculares , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Falha de Tratamento
20.
Arch Gynecol Obstet ; 301(1): 207-215, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31758303

RESUMO

OBJECTIVES: To establish methodological criteria for the clinical application of E-cervix technology in non-pregnant women, evaluate cervical differences between non-pregnant CI patients and normal women, and explore the predictive value of E-cervix for CI in non-pregnant women. METHODS: In all, 46 non-pregnant women with CI and 46 non-pregnant women with full-term pregnancy experience were included. Elastic parameters (HR, IOS, EOS, IOS/EOS, CL) of the cervix were measured by transvaginal examination with a mid-sagittal section as the ROI, followed by examination of the whole cervix. The pressure of the probe on the cervix was divided into three levels. The elastic data of three consecutive images were separately obtained by two doctors for three pressure levels. Image stability and the effects of pressure were evaluated and the repeatability of the measurements was tested. In the case and control groups, cervical elasticity images were selected by standardized operation methods. Differences in the parameters between the two groups were determined and the diagnostic efficiency of each parameter was analyzed. RESULTS: The HR, IOS, and EOS showed significant differences when measured on different sequential images obtained by continuous mapping (p < 0.05). The elastic parameters obtained from the first and last two images were significantly different (p < 0.05) and there were no significant differences between the elastic parameters obtained from the last two images (p > 0.05). The HR, IOS, EOS, and IOS/EOS showed significant differences among the pressure levels (p < 0.05), while the IOS showed a significant difference only between grades 0 and 2 (p < 0.05). E-cervix showed good repeatability within and among operators. The elastic parameters obtained by E-cervix in the CI group and control group were significantly different. ROC curve analysis showed that the HR was the most sensitive index for diagnosing CI. CONCLUSION: In E-cervix data acquisition, the first image should be excluded and the probe should not put pressure on the cervix. E-cervix has good retest and inter-observer reliability. Compared with normal women, CI patients showed a relatively softer and shorter cervix. E-cervix can be used as an important diagnostic tool for assessing cervical strain.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Incompetência do Colo do Útero/diagnóstico por imagem , Adulto , Estudos de Coortes , Feminino , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
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