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1.
Int J Gynaecol Obstet ; 156(1): 64-70, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33471369

RESUMO

OBJECTIVE: To determine the association between cervical polyps in early pregnancy and late abortion and spontaneous preterm birth (SPTB). We also aimed to explore the relationship between cervical polyps and cervical insufficiency in the second trimester. METHODS: We conducted a retrospective cohort study of 2941 singleton pregnant women between January 2010 and December 2015. The frequency of late abortion and SPTB (before 28, 34, or 37 weeks of pregnancy) was compared between the two groups of 142 (4.8%) patients who had cervical polyps early in the pregnancy (P group) and 2799 who did not (non-P group). Multivariate analysis was performed to identify risk factors for late abortion and SPTB. RESULTS: The incidence of late abortion and SPTB was significantly higher in the P group than in the non-P group. Cervical polyps in early pregnancy were selected as independent risk factors for late abortion and SPTB before 28, 34, or 37 weeks of pregnancy. The P group had a significantly higher rate of cases requiring therapeutic cervical cerclage than the non-P group. CONCLUSION: Cervical polyps in early pregnancy are risk factors for late abortion and SPTB. They are also associated with the occurrence of cervical insufficiency.


Assuntos
Cerclagem Cervical , Nascimento Prematuro , Incompetência do Colo do Útero , Medida do Comprimento Cervical , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco , Incompetência do Colo do Útero/epidemiologia
2.
Eur J Obstet Gynecol Reprod Biol ; 266: 23-30, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34560330

RESUMO

OBJECTIVE: Our objective was to examine if US obstetrician-gynecologists (OBGYNs) practice outside of evidenced-based guidelines and use a combination of interventions to prevent spontaneous preterm birth (sPTB). STUDY DESIGN: An electronic survey was distributed to members of the Pregnancy-Related Care Research Network (PRCRN), and also to members of the Society of Maternal-Fetal Medicine (SMFM). The survey consisted of questions regarding physician demographics, and the use of interventions to prevent sPTB in women with 1) a prior sPTB, 2) an incidental short cervix (no prior sPTB), and 3) a history of cervical insufficiency. RESULTS: The PRCRN response rate was 58.6% (283/483) with an additional 143 responses from SMFM members. Among PRCRN responders, 82.7% were general OBGYNs and 17.3% were Maternal-Fetal Medicine subspecialists. Respondents were from all geographic regions of the country; most practiced in a group private practice (42.6%) or academic institution (31.4%). In women with prior sPTB, 45.2% of respondents would consider combination therapy, most commonly weekly intramuscular progesterone (IM-P) and serial cervical length (CL) measurements. If the patient then develops a short cervix, 33.7% would consider adding an ultrasound-indicated cerclage. In women with an incidental short cervix, 66.8% of respondents were likely to recommend single therapy with daily vaginal progesterone (VP). If a patient developed an incidentally dilated cervix, 40.8% of PRCRN respondents would recommend dual therapy, most commonly cerclage + VP, whereas 64.3% of SMFM respondents were likely to continue with VP only. In women with a history of cervical insufficiency, 47% of PRCRN respondents indicated they would consider a combination of IM-P, history-indicated cerclage and serial CL measurements. CONCLUSION: Although not currently supported by evidence-based medicine, combination therapy is commonly being used by U.S. OBGYNs to prevent sPTB in women with risk factors such as prior sPTB, short or dilated cervix or more than one of these risks.


Assuntos
Cerclagem Cervical , Nascimento Prematuro , Administração Intravaginal , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/prevenção & controle , Progesterona
3.
Eur J Obstet Gynecol Reprod Biol ; 264: 349-352, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34385081

RESUMO

INTRODUCTION: Preterm birth is the leading cause of neonatal morbidity and mortality. Spontaneous Preterm Birth (sPTB) has many and varied causes but is known to be strongly associated with a short or shortening cervix in the midtrimester of pregnancy. The strongest risk factor for sPTB is a previous sPTB. In women with a history of sPTB, we can offer surveillance and treatments which have been proven to reduce the risk of sPTB, such as cervical cerclage and vaginal progesterone supplementation. Alongside other indications, we currently use 25 mm or shorter as a "trigger threshold" for offering cervical cerclage treatment in the Preterm Birth Prevention Clinic at The National Maternity Hospital. AIM: To determine if using gestation-specific centiles instead of a 25 mm cut-off for cervical length changes the antenatal management of women at high risk of sPTB. METHOD: This was a retrospective chart review of all women attending the preterm birth clinic over the 2-year period 2018-2020 in a large tertiary referral unit in Dublin, Ireland. Demographic details, obstetric history, preterm birth risk factors and preventative treatments offered were collected and analysed. Cervical lengths were measured with ultrasound using a standardised protocol and all performed or supervised by 2 experienced sonographers. RESULTS: A total of 200 patients with known risk factors for sPTB attended the Preterm Birth Surveillance Clinic at the National Maternity Hospital during the study period. Of these, 36/200 (18%) went on to deliver again prior to 37 weeks despite attending the clinic +/- receiving interventions & this group are the focus of this paper. The indications for surveillance in this group that had a recurrent sPTB included recurrent second-trimester pregnancy losses/preterm delivery < 34 weeks (26/36 (72%)), cervical trauma (including treatment of CIN) (12/36 (33%)), congenital abnormalities (1/36 (2.8%)), uterine anomaly (1/36 (2.8%)) and placental bleeding (1/36 (2.8%)). There was one smoker in this series. Funnelling was observed in 3/36 cases (8.3%). Of the 36 patients, an additional 15 would have received a cerclage had gestation-specific centiles, i.e., <5th centile, been used and an additional 10/36 (28%) would have been offered progesterone therapy. CONCLUSION: In those at high risk of preterm birth, the use of gestation-specific centiles for cervical length increases the proportion of patients that would be eligible for cervical cerclage. It is unclear whether this would change clinical outcome.


Assuntos
Cerclagem Cervical , Nascimento Prematuro , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Feminino , Humanos , Recém-Nascido , Placenta , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos
4.
Taiwan J Obstet Gynecol ; 60(4): 665-673, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34247804

RESUMO

OBJECTIVES: Cerclage operation is one of the most common obstetric controversies. The aim of this study was to compare the perinatal outcomes and placental inflammation of cerclage performed adherent and non-adherent to international guidelines. MATERIAL AND METHODS: This study included all consecutive women with singleton deliveries who underwent cerclage. According to the current American College of Obstetricians and Gynecologists (ACOG) guideline, we designated our study population into two groups: the adherent-to-guideline and non-adherent groups. Each group was categorized into two groups according to cervical length (CL) at the time of cerclage (<2.0 cm vs. ≥2.0 cm). We evaluated the reasons for cerclage, maternal characteristics, perioperative variables, pregnancy and neonatal outcomes, and placental inflammatory pathology according to the criteria proposed by the Society of Pediatric Pathology. RESULTS: Among 310 women with cerclage, we excluded patients (n = 21) with indicated preterm delivery (PTD), major fetal anomaly, fetal death in-utero, and missing information for reason of cerclage. We also excluded patients who underwent physical examination-indicated cerclage (n = 53) and with missing information of CL at the time of cerclage (n = 52). A total of 184 women were eventually analyzed. In women with CL < 2.0 cm, the non-adherent group showed similar PTD (<28 weeks, <34 weeks) and neonatal composite morbidity rates compared to the adherent-to-guideline group. However, in women with CL ≥ 2.0 cm, the non-adherent group manifested significantly higher PTD (<28 weeks; 16.7% vs. 4.4%, p = 0.04, <34 weeks; 23.8% vs. 5.8%, p = 0.006) and neonatal composite morbidity (20.5% vs. 5.9%, p = 0.028) rates than the adherent-to-guideline group despite similar perioperative variables and lower PTD history rates. The non-adherent group with CL ≥ 2 cm at the time of cerclage was also associated with severe histologic chorioamnionitis (p = 0.033). CONCLUSION: Cerclage performed beyond the current guidelines in pregnant women with CL ≥ 2.0 cm may confer an additional risk of perinatal complications in association with severe placental inflammation.


Assuntos
Cerclagem Cervical/efeitos adversos , Corioamnionite/etiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Resultado da Gravidez , Nascimento Prematuro/etiologia , Adulto , Cerclagem Cervical/normas , Medida do Comprimento Cervical , Colo do Útero/patologia , Feminino , Humanos , Inflamação , Obstetrícia/normas , Placenta/patologia , Gravidez , Estudos Retrospectivos
5.
BMC Pregnancy Childbirth ; 21(1): 472, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210286

RESUMO

BACKGROUND: To evaluate the self-reported pain scores as a predictor of preterm birth (PTB) in symptomatic twin pregnancy and to develop a nomogram for the prediction model. METHODS: We conducted a retrospective study of 148 cases of symptomatic twin pregnancies before 34 weeks of gestation visited at Seoul national university hospital from 2013 to 2018. With other clinical factors, self-reported pain score was evaluated by the numerical rating scale (NRS) pain scores for pain intensity. By multivariate analyses and logistic regression, we developed a prediction model for PTB within 7 days. Using the Cox proportional hazards model, the curves were plotted to show the predictability of the PTB according to NRS pain score, while adjusting the other covariates. RESULTS: Twenty-three patients (15.5 %) delivered preterm within 7 days. By a logistic regression analysis, higher NRS pain score (OR 1.558, 95 % CI 1.093-2.221, P < 0.05), shorter cervical length (OR 3.164, 95 % CI 1.262-7.936, P < 0.05) and positive fibronectin results (OR 8.799, 95 % CI 1.101-70.330, P < 0.05) affect PTB within 7 days. Using the variables, the area under the receiver operating characteristic curve (AUROC) of the prediction model was 0.917. In addition, we developed a nomogram for the prediction of PTB within 7 days. CONCLUSIONS: Self-reported pain scores combined with cervical length and fetal fibronectin are useful in predicting impending PTB in symptomatic twin pregnancy.


Assuntos
Modelos Estatísticos , Medição da Dor , Dor/epidemiologia , Gravidez de Gêmeos , Nascimento Prematuro/epidemiologia , Autorrelato , Adulto , Medida do Comprimento Cervical/estatística & dados numéricos , Feminino , Fibronectinas/análise , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Seul
6.
Femina ; 49(7): 433-438, 20210731.
Artigo em Português | LILACS | ID: biblio-1290593

RESUMO

A prematuridade é uma síndrome com múltiplos fatores de risco e cuja causa permanece desconhecida, mas, independentemente da etiologia, a parturição converge para uma via final comum de esvaecimento, dilatação e encurtamento do colo uterino. Do ponto de vista hormonal, o responsável por esse processo é a progesterona. A prevenção de quadros de prematuridade pode basear-se em tratamentos medicamentosos como a administração diária de comprimidos de progesterona; intervenções cirúrgicas para a contenção da cérvice uterina com fios inabsorvíveis mantidos até o termo, a cerclagem cervical; e o pessário cervical, dispositivo de silicone que envolve e inclina o colo uterino, evitando sua abertura. Para propor qualquer intervenção profilática ou terapêutica, a avaliação ultrassonográfica via transvaginal no segundo trimestre gestacional desempenha papel crucial. Apresentamos neste terceiro e último artigo da série sobre parto pré-termo espontâneo as intervenções terapêuticas e o rastreamento do colo uterino.(AU)


Preterm birth is a syndrome with multiple risk factors, with unknown etiology. Parturition converges to a final path with uterine cervix effacement, dilation and shortening and progesterone is the hormone responsible for this process. Preterm birth prevention relies on daily administration of progesterone pills; cerclage as a surgical intervention; or cervical pessary, a vaginal silicone device that enfolds and deflects the cervix, avoiding its opening. To propose any of these interventions it is crucial to evaluate the cervix during the second trimester by transvaginal ultrasound. Here, in the third and last article regarding preterm birth without membrane disruption, we present therapeutic interventions and ultrasound screening.(AU)


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Colo do Útero/fisiologia , Trabalho de Parto Prematuro/cirurgia , Trabalho de Parto Prematuro/prevenção & controle , Trabalho de Parto Prematuro/tratamento farmacológico , Pessários , Progesterona/uso terapêutico , Incompetência do Colo do Útero , Ultrassonografia Pré-Natal , Maturidade Cervical , Cerclagem Cervical , Medida do Comprimento Cervical
7.
Acta Obstet Gynecol Scand ; 100(9): 1644-1655, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34096036

RESUMO

INTRODUCTION: The aim of the study is to compare the effect of cervical length measured with transvaginal ultrasound in the second trimester on the risk of spontaneous preterm delivery (PTD) between different risk groups of asymptomatic women with a singleton pregnancy. MATERIAL AND METHODS: This is a pre-planned exploratory analysis of the CERVIX study, a prospective blinded multicenter diagnostic accuracy study. Asymptomatic women with a singleton pregnancy were consecutively recruited at their second-trimester routine ultrasound examination at seven Swedish ultrasound centers. Cervical length was measured with transvaginal ultrasound at 18-20 weeks (Cx1; n = 11 072) and 21-23 weeks (Cx2, optional; n = 6288). The effect of cervical length on the risk of spontaneous PTD and its discriminative ability was compared between women with: (i) previous spontaneous PTD, late miscarriage or cervical conization (high-risk group; n = 1045); (ii) nulliparae without risk factors (n = 5173); (iii) parae without risk factors (n = 4740). Women with previous indicated PTD were excluded (n = 114). Main outcome measures were: effect of cervical length on the risk of spontaneous PTD expressed as odds ratio per 5-mm decrease in cervical length with interaction analysis using logistic regression to test whether the effect differed between groups, area under the receiver operating characteristic curve (AUC), sensitivity, specificity, number needed to screen to detect one spontaneous PTD. RESULTS: The effect of cervical length at Cx2 on the risk of spontaneous PTD <33 weeks was similar in all groups (odds ratios 2.26-2.58, interaction p value 0.91). The discriminative ability at Cx2 was superior to that at Cx1 and was similar in all groups (AUC 0.69-0.76). Cervical length ≤25 mm at Cx2 identified 57% of spontaneous preterm deliveries <33 weeks in the high-risk group with number needed to screen 161. The number needed to screen for groups (ii) and (iii) were 1018 and 843. CONCLUSIONS: The effect of cervical length at 21-23 weeks on the risk of spontaneous PTD <33 weeks is similar in high- and low-risk pregnancies. The differences in number needed to screen should be considered before implementing a screening program.


Assuntos
Colo do Útero/diagnóstico por imagem , Gravidez de Alto Risco , Nascimento Prematuro , Ultrassonografia Pré-Natal , Adulto , Medida do Comprimento Cervical , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade
8.
Healthc (Amst) ; 9(3): 100558, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34098320

RESUMO

PURPOSE: Preterm birth (PTB), a pressing issue for US maternal-child health, disproportionately impacts women in Appalachia. Transvaginal ultrasound (TVU) cervical length (CL) screening is the most accurate PTB risk predictor but remains underutilized. This study characterizes the knowledge, attitudes and beliefs of patients with prior PTB concerning PTB prevention efforts and TVU CL screening. METHODS: Participants were recruited from community-based health centers in Appalachian Kentucky. Semi-structured interviews and likert-scale surveys were conducted with 22 pregnant women with a history of spontaneous PTB. Methods for data collection were guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS: Most participants reported that TVU was uncomfortable, but none refused it. Most women were able to articulate the benefits of TVU, but several had concerns about its safety in pregnancy. Participants suggested that pregnant women receive more PTB education and self-advocate. They urged providers to take patient concerns seriously, and better educate patients on PTB risks and TVU safety. DISCUSSION: Our study contributes crucial insights about the experience of a vulnerable population as it pertains to PTB prevention and the uptake of TVU CL screening. Our findings emphasize the need for increased efforts to better educate patients on the impact of prematurity and the safety and benefits of TVU CL screening as an evidence-based strategy for PTB prevention.


Assuntos
Nascimento Prematuro , Região dos Apalaches , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Programas de Rastreamento , Gravidez
9.
Sci Rep ; 11(1): 12430, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127744

RESUMO

The purpose of this study was to develop a dynamic model to predict the risk of spontaneous preterm birth at < 32 weeks in twin pregnancy. A retrospective clinical study of consecutively asymptomatic women with twin pregnancies from January 2017 to December 2019 in two tertiary medical centres was performed. Data from one centre were used to construct the model, and data from the other were used to evaluate the model. Data on maternal demographic characteristics, transvaginal cervical length and funnelling during 20-24 weeks were extracted. The prediction model was constructed with independent variables determined by multivariate logistic regression analyses. After applying specified exclusion criteria, an algorithm with maternal and biophysical factors was developed based on 88 twin pregnancies with a preterm birth < 32 weeks and 639 twin pregnancies with a delivery ≥ 32 weeks. It was then evaluated among 34 pregnancies with a preterm birth < 32 weeks and 252 pregnancies with a delivery ≥ 32 weeks in a second tertiary centre without specific training. The model reached a sensitivity of 80.00%, specificity of 88.17%, positive predictive value of 50.33% and negative predictive value of 96.71%; ROC characteristics proved that the model was superior to any single parameter with an AUC of 0.848 (all P < 0.005). We developed and validated a dynamic nomogram model to predict the individual probability of early preterm birth to better represent the complex aetiology of twin pregnancies and hopefully improve the prediction and indication of interventions.


Assuntos
Nomogramas , Gravidez de Gêmeos/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Adulto , Medida do Comprimento Cervical/métodos , Medida do Comprimento Cervical/estatística & dados numéricos , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Ultrassonografia/estatística & dados numéricos
10.
BMC Pregnancy Childbirth ; 21(1): 433, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158010

RESUMO

BACKGROUND: Assessing the likelihood of success of induction of labour using ultrasonically measured cervical volume is an important research question. METHOD: A prospective observational study was carried out at North Colombo Teaching Hospital, Ragama, Sri Lanka. Pre-induction digital cervical assessment, transvaginal cervical length, and cervical volume measurements were performed. Inductions with singleton pregnancies at term were included. Basic demographic and clinical details, independent variables (Bishop score, cervical length and cervical volume), and dependent variables (frequency of delivery within 24 h and induction to delivery interval) were recorded. Vaginal delivery within 24 h was the primary outcome. RESULTS: We studied 100 pregnant women who had induction of labour. Median (IQR) Bishop score was 5 (3-6), mean (SD) cervical length was 3.6 (0.7) cm, and mean (SD) cervical volume was 27.5 (10.4) cm3. Cervical length was the best predictor for predicting the likelihood of vaginal delivery within 24 h [aOR - 12.12 (3.44, 42.71); < 0.001], and cervical volume also appeared to be a significant potential predictor [aOR-1.10 (1.01, 1.17); 0.01]. Cervical length was found to have the highest AUC (0.83) followed by the cervical volume (0.74). The best cut-off value for cervical volume in predicting the likelihood of vaginal delivery within 24 h was less than 28.5 cm3 with a sensitivity of 72% and specificity of 74%. CONCLUSIONS: Transvaginal sonographic measurement of cervical volume appears to be a potential novel predictor for the likelihood of vaginal delivery within 24 h of induction of labour. Cervical length is still more superior to cervical volume in predicting the likelihood of vaginal delivery. Bishop score was not a significant predictor in this context.


Assuntos
Pesos e Medidas Corporais/métodos , Colo do Útero/diagnóstico por imagem , Trabalho de Parto Induzido , Adulto , Medida do Comprimento Cervical , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Sri Lanka , Ultrassonografia Pré-Natal
11.
Am J Obstet Gynecol ; 225(5): 525.e1-525.e9, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34051170

RESUMO

BACKGROUND: Accurate identification of the women who will have spontaneous preterm birth continues to be a great challenge. The use of cervical elastography for prediction of preterm birth is promising, but several limitations exist. Newer cervical elastography technology has been developed that may prove useful in evaluation of risk of preterm birth. OBJECTIVE: This study aimed to develop standard cervical elastography nomograms for singleton pregnancies at 18 to 22 weeks' gestation using the E-Cervix ultrasound application, assess intraobserver reliability of the E-Cervix elastography parameters, and determine whether these cervical elastography measurements can be used in the prediction of spontaneous preterm birth. STUDY DESIGN: This was a prospective cohort study of pregnant women undergoing cervical length screening assessment via transvaginal ultrasound examination at 18 to 22 weeks' gestation. A semiautomatic, cervical elastography application (E-Cervix) was used during the transvaginal examination to calculate 5 quantitative parameters (internal os stiffness, external os stiffness, internal -to -external os stiffness ratio, hardness ratio, and elasticity contrast index) and create a standard nomogram for each one of them. The intraobserver reliability was calculated using Shrout-Fleiss reliability. Cervical elastography parameters were compared between those who delivered preterm (<37 weeks) spontaneously and those who delivered full term. A multivariable logistic regression model was performed to determine the ability of the cervical elastography parameters to predict spontaneous preterm birth. RESULTS: A total of 742 women were included, of which 49 (6.6%) had a spontaneous preterm delivery. A standard nomogram was created for each of the cervical elastography parameters from those who had a full-term birth in the index pregnancy (n=693). Intraobserver reliability was good or excellent (intraclass correlation, 0.757-0.887) for each of the cervical elastography parameters except external os stiffness which was poor (intraclass correlation, 0.441). In univariate analysis, none of the cervical elastography parameters were associated with a statistically significant increased risk of spontaneous preterm birth. In a multivariable model adjusting for history of preterm birth, gravidity, ethnicity, cervical cerclage, and vaginal progesterone use, increasing elasticity contrast index was significantly associated with an increased risk of spontaneous preterm birth (odds ratio, 1.15; 95% confidence interval, 1.02-1.30; P=.02). CONCLUSION: Cervical elastography parameters are reliably measured and are stable across 18 to 22 weeks' gestation. Based on our findings, the elasticity contrast index was associated with an increased risk of spontaneous preterm birth and may be a useful parameter for future research.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade , Nascimento Prematuro , Medição de Risco/métodos , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Nomogramas , Gravidez , Reprodutibilidade dos Testes
12.
BMC Pregnancy Childbirth ; 21(1): 359, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952198

RESUMO

BACKGROUND: Diagnosis of preterm labour is difficult because initial symptoms and signs are often mild and may occur in continuing pregnancies. This study aims to investigate the utility of measuring cervical length, using transvaginal ultrasound, in women presenting to the delivery suite with symptoms of preterm labour. METHODS: This was a prospective cohort study performed in KK Women's and Children's Hospital, Singapore from September 2017 to July 2018. Women with singleton pregnancies, presenting with symptoms of contraction pain, between 24+ 0 to 36+ 6 weeks gestation, were included. Transvaginal ultrasound cervical length measurements were done at presentation to the labour ward, after four hours and in the following morning. The primary outcome of the study was delivery within 1 week. All statistical analyses were conducted with Microsoft Excel and Statistical Package for the Social Sciences. RESULTS: A total of 95 subjects were included. A one-millimeter increase in the 1st cervical length increases scan-to-delivery time by 0.802 days (p-value 0.003, CI 0.280-1.323). Receiver Operator Characteristic (ROC) curve analysis for prediction of delivery within 1 week showed an Area Under Curve (AUC) of 0.667, optimal cut-off value of 27.5mm (sensitivity 77.8 %, specificity 61.6 %). A one-millimetre increase in the 3rd cervical length increases scan-to-delivery time by 0.770 days (p-value 0.023, CI 0.108-1.432). ROC curve analysis for prediction of delivery within 1 week showed an AUC of 0.915, optimal cut-off value of 25.5mm (sensitivity 100 %, specificity 73.6 %). However, the change in cervical length over a period of 1 day was not significant in predicting delivery within 1 week. CONCLUSIONS: Our results indicate that by using a cervical length cut off of 27.5mm at presentation, we would have predicted 77.8 % of deliveries within 1 week. If we were to repeat the cervical length scan the next day, with the same cut-off of 27.5mm, we would have predicted 100 % of deliveries within 1 week. In our study, measuring the transvaginal ultrasound cervical length is a reliable diagnostic test for delivery within 1 week. However, the results are limited by the small sample size. Further studies should be conducted with a larger sample size.


Assuntos
Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Início do Trabalho de Parto , Trabalho de Parto Prematuro/diagnóstico , Adulto , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Gravidez , Nascimento Prematuro , Estudos Prospectivos , Curva ROC , Fatores de Risco , Ultrassonografia Pré-Natal
13.
Rev Bras Ginecol Obstet ; 43(4): 264-274, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33979887

RESUMO

Preterm birth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasound measurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. OBJECTIVE: To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. METHODS: Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22 + 6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. RESULTS: Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8 mm, and percentiles 3, 5 and 10 corresponded to TUCLs of 25.0 mm, 27.0 mm and 29.0 mm respectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90-0.95; p < 0.001). The use of a TUCL of 20 mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. CONCLUSION: The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.


Assuntos
Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Nascimento Prematuro , Adulto , Estudos Transversais , Feminino , Humanos , Idade Materna , Portugal , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
14.
BMC Pregnancy Childbirth ; 21(1): 368, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971828

RESUMO

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.


Assuntos
Pessários/estatística & dados numéricos , Nascimento Prematuro/prevenção & controle , Progestinas/uso terapêutico , Corticosteroides/uso terapêutico , Adulto , Peso ao Nascer , Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Terapia Combinada , Feminino , Humanos , Malásia , Gravidez , Primeiro Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco
15.
Taiwan J Obstet Gynecol ; 60(3): 503-508, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33966736

RESUMO

OBJECTIVE: To evaluate whether the degree of cervical length change was associated with successful cervical dilatation during labor induction. MATERIALS AND METHODS: We conducted a secondary analysis of a prospective observational study of term singleton pregnant women who underwent labor inductions. Cases of Cesarean section due to fetal distress or maternal request during the first stage of labor were excluded. The enrolled women were categorized into two groups according to achievement of full cervical dilatation. The cervical length near induction and cervical length shortening over the last four weeks of pregnancy were compared between the two groups. A receiver operating characteristics (ROC) analysis was performed to evaluate the screening performance for failed cervical dilatation during labor induction. RESULTS: A total of 165 women were enrolled for the final analysis; of these, 145 (87.9%) women reached the second stage of labor and 20 (12.1%) women failed to achieve full cervical dilatation. Women who failed to achieve full cervical dilatation had a significantly longer cervical length near induction and less cervical length change over previous four weeks compared with women who achieved full cervical dilatation (P = 0.018 and 0.005, respectively). Multivariate analysis showed that cervical length >29 mm (odds ratios [OR], 4.15; 95% confidence interval [CI], 1.290-13.374, P = 0.017) and cervical length shortening â‰¦ 6 mm (OR, 5.87; 95% CI, 1.552-22.271, P = 0.009) were significantly associated with failed cervical dilatation after adjusting for birthweight and previous history of vaginal delivery. Cervical length shortening alone provided a better prediction of failed cervical dilatation than the combination of cervical length and shortening (sensitivity, 76.9%; specificity, 63.8%). CONCLUSION: The probability of failed cervical dilatation during labor induction was significantly increased in cases when the cervical length was greater than 29 mm near induction or when the cervical length shortening was less than 6 mm over the last four weeks.


Assuntos
Medida do Comprimento Cervical/estatística & dados numéricos , Colo do Útero/patologia , Primeira Fase do Trabalho de Parto/fisiologia , Trabalho de Parto Induzido/estatística & dados numéricos , Adulto , Colo do Útero/diagnóstico por imagem , Colo do Útero/fisiopatologia , Feminino , Humanos , Trabalho de Parto Induzido/métodos , Análise Multivariada , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Curva ROC , Resultado do Tratamento
16.
Aust N Z J Obstet Gynaecol ; 61(5): 735-741, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33872389

RESUMO

BACKGROUND: The Western Australian Preterm Birth Prevention Initiative was officially launched in November 2014. It demonstrated an initial decrease in the preterm birth rate in Western Australia. One of the key points of this initiative is the routine ultrasound measurement of the cervical length in mid-pregnancy. AIM: The aim of this study was to evaluate the perceptions and attitudes of Western Australian women regarding transvaginal cervical length (TVCL) screening for preterm birth prevention. MATERIALS AND METHODS: Self-administered questionnaires were completed by pregnant women before and after their mid-trimester obstetric ultrasound. Maternal demographical and medical data were collected in addition to opinions of TVCL screening. RESULTS: A total of 598 women participated with the maternal age range representative of the Western Australian obstetric population. There was a high rate of acceptance of TVCL imaging, with 2% of the 149 women declining a transvaginal ultrasound (TVU) offered in this study, 1.5% refusing a TVU in the past and 5.7% reporting that they would have a concern in having a TVU in the future. Women stated that they either had declined TVCL in the past (11%) or would decline in the future (30.7%) as they wanted to discuss the procedure with their clinician first, had been advised not to have a TVU by their clinician (11% in the past and 47.7% in the future) or felt uncomfortable with the operator (22% at a previous TVU and 34.4% in the future). CONCLUSION: Pregnant women participating in this study had a high acceptance of TVCL screening for preterm birth prevention.


Assuntos
Medida do Comprimento Cervical , Nascimento Prematuro , Austrália , Feminino , Humanos , Recém-Nascido , Percepção , Gravidez , Gestantes , Nascimento Prematuro/prevenção & controle
17.
Am J Obstet Gynecol ; 225(2): 179.e1-179.e6, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33652056

RESUMO

BACKGROUND: In women with a previous preterm birth, a protocol for serial cervical length screening has been studied and recommended for the identification and treatment of a short cervix. Cervical length screening along with vaginal progesterone has been suggested for low-risk women with singleton pregnancies to treat a short cervix and reduce preterm birth. However, specific protocols for single vs serial ultrasound measuring cervical length in this population are not established. Cost-effectiveness of universal cervical length screening depends on the cost of screening; follow-up of borderline measurements can contribute to increased costs with uncertain benefit. OBJECTIVE: This study aimed to determine the utility of follow-up cervical length screening in otherwise low-risk women with singleton pregnancies with a midtrimester cervical length measurement of 26 to 29 mm through the assessment of the rate of short cervix (≤25 mm) on follow-up ultrasound and subsequent delivery outcomes. STUDY DESIGN: This was a 2-year retrospective cohort study at a single urban institution of women with singleton pregnancies with no previous spontaneous preterm birth and an initial transvaginal ultrasound cervical length measurement of 26 to 29 mm identified during universal cervical length screening at time of anatomy ultrasound (18 0/7 to 22 6/7 weeks' gestation). The primary outcome was the rate of short cervix (defined as ≤25 mm on transvaginal ultrasound) on follow-up ultrasound at <24 weeks' gestation. Secondary outcomes included the rate of spontaneous preterm birth (<37 and <34 weeks' gestation). RESULTS: During the study period, there were 2801 women with singleton pregnancies at 18 0/7 to 22 6/7 weeks' gestation with transvaginal ultrasound cervical length screening at time of anatomy scan. Among those women, 201 had a cervical length of 26 of 29 mm, and 184 (7%) had no previous spontaneous preterm birth and were included in the study. Furthermore, 144 women (78%) had a follow-up cervical length completed before 24 weeks' gestation. The mean follow-up interval was 1.5±0.6 weeks. Overall, the percentage of short cervix (≤25 mm) on follow-up was 15% (n=21). Baseline characteristics were similar, but the initial cervical length measurement was shorter in women who subsequently developed a short cervix (26.7±0.8 vs 27.8±1.0; P<.01). Delivery outcomes were available for 126 patients. The rate of spontaneous preterm birth at <37 weeks' gestation in women with an initial cervical length 26 to 29 mm and subsequent short cervix was significantly higher than the rate of spontaneous preterm birth in a historical cohort of low risk women with an initial cervical length >25 mm (16% vs 3%; P=.03). The rate of spontaneous preterm birth at <34 weeks' gestation in women with a subsequent short cervix was 11% (2 of 19). CONCLUSION: Here, approximately 15% of low-risk women with singleton pregnancies with a midtrimester cervical length measurement of 26 to 29 mm will experience cervical shortening of ≤25 mm before 24 weeks' gestation. Compared to women with singleton pregnancies without a history of preterm birth, the rate of spontaneous preterm birth (16%) in women with an initial cervical length of 26 to 29 mm and a subsequent cervical shortening of ≤25 mm is significantly higher. A total of 111 follow-up ultrasounds measuring cervical length would be required to prevent 1 early preterm birth at <34 weeks' gestation.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Nascimento Prematuro/prevenção & controle , Administração Intravaginal , Adulto , Colo do Útero/patologia , Estudos de Coortes , Feminino , Humanos , Tamanho do Órgão , Gravidez , Segundo Trimestre da Gravidez , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Estudos Retrospectivos , Risco , Medição de Risco , Adulto Jovem
18.
Arch Gynecol Obstet ; 304(5): 1179-1188, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33783615

RESUMO

PURPOSE: To identify patient perspectives of barriers to cervical length screening to prevent preterm births. METHODS: In Phase I of this prospective descriptive implementation study, 40 pregnant women of up to 24 week gestation were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was subsequently administered to 400 participants in Phase III. RESULTS: Most participants (74.3%) realised preterm babies have complications and high care costs (53%). They recognised that premature-birth risk identification enables appropriate pregnancy care (93.8%), but they were unaware that cervical length measurements indicate the risk (59.5%). The participants who were aware wanted to be examined (63.5%) because of concern about preterm birth (95.8%). Husbands were reported to influence decision-making about screening (81.3%) and subsequent treatment (42.5%). If the associated costs were subsidised, the majority of participants (67.3%) would undergo screening. CONCLUSION: Physicians do not explain ways to prevent preterm births. Government policy on preventing preterm births is not well established. Screening and treatment costs are major barriers. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR) number: TCTR20190813003.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Nascimento Prematuro/prevenção & controle , Adolescente , Adulto , Idoso , Feminino , Humanos , Ciência da Implementação , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Centros de Atenção Terciária , Tailândia , Adulto Jovem
19.
Eur J Obstet Gynecol Reprod Biol ; 260: 131-136, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33773259

RESUMO

OBJECTIVE: To compare the performance of uterocervical angle (UCA) and cervical length (CL) measurement at 20 weeks of pregnancy for prediction of spontaneous preterm birth (sPTB) in twin pregnancies. STUDY DESIGN: We conducted a retrospective cohort study of 424 twin pregnancies who delivered in our center from October 2014 to December 2018 and who underwent transvaginal ultrasound between 19+0-22+0 weeks to measure CL during routine second trimester scan. Recorded ultrasound images of CL were reassessed to evaluate UCA. Medical and obstetric data were also collected for statistical analysis. RESULTS: A total of 424 women were included. The rates of sPTB rate below 28, 32 and 34 weeks of gestation were 2.8 %, 5.4 % and 10.4 %, respectively. ROC curves showed a better area under the curve (AUC) for UCA at all gestational ages compared with CL (AUC for sPTB <28 weeks 0.902 (p < 0.001) vs 0.620 (p 0.175); AUC for sPTB <32 weeks 0.740 (p 0.001) vs 0.620 (p 0.058); AUC for sPTB <34 weeks 0.676 (p 0.001) vs 0.632 (p 0.047). UCA > 120 degrees was significantly associated with sPTB <28 weeks (p < 0.001; OR 39.17; CI 4.81-319.23; NPV, 99.65 %), <32 weeks (OR 4.23; p 0.002) and <34 weeks of gestation (OR 2.66; p 0.01). CONCLUSION: In our study, an UCA > 120 degrees allowed to identify those women with twin pregnancies at risk of sPTB and performed better than CL measurement.


Assuntos
Nascimento Prematuro , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Gravidez de Gêmeos , Nascimento Prematuro/diagnóstico por imagem , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos
20.
Arch Gynecol Obstet ; 304(3): 663-669, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33674963

RESUMO

PURPOSE: To examine if the uterocervical angle (UCA) can be used to predict preterm delivery in women with painful and regular uterine contractions and a cervical length of 25 mm or less. METHODS: Retrospective study at the perinatal unit of the University Hospital of Tuebingen, Germany. Women with singleton gestation and preterm contractions between 24 + 0 and 33 + 6 weeks' gestation were included. For the UCA measurement, a line is placed from the internal os to the external os irrespective of whether the cervix is straight or curved. A second line is drawn to delineate the lower uterine segment. The angle between the two lines is the UCA measurement. The measurements were taken on stored images from our database. RESULTS: The study consisted of 213 singleton pregnancies. At the time of UCA measurement, median maternal and gestational age was 31.4 years and 29.7 weeks' gestation. Median gestational age at delivery was 35.3 weeks and the corresponding birth weight 2480 g, respectively. The UCA measurement in women who delivered within 2 days, between 3-7 days and after 7 days was not helpful to distinguish between these three groups [median UCA measurements: 108.5°, 108.0° and 107.3° (Kruskal-Wallis test p = 0.576)]. Uni- and multivariate logistic multiple regression analysis demonstrated that the delivery within 2 days was only dependent on the gestational age and the cervical length at the time of presentation. CONCLUSION: The measurement of UCA is not useful in predicting preterm birth in the subsequent 7 days after an episode of preterm contractions.


Assuntos
Medida do Comprimento Cervical/estatística & dados numéricos , Colo do Útero/diagnóstico por imagem , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Alemanha , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Útero/diagnóstico por imagem
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