Measurement of the uterocervical angle for the prediction of preterm birth in symptomatic women

Abstract 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.

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Progesterone for the Prevention of Preterm Birth – an Update of Evidence-Based Indications

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-0854-6472 ◽

2019 ◽

Vol 79 (08) ◽

pp. 844-853 ◽

Cited By ~ 6

Author(s):

Ruben-J. Kuon ◽

Pauline Voß ◽

Werner Rath

Keyword(s):

Preterm Birth ◽

Critical Evaluation ◽

Experimental Studies ◽

Cervical Length ◽

Study Data ◽

Evidence Based ◽

Uterine Contractions ◽

Positive Effects ◽

Randomised Controlled ◽

Singleton Pregnancies

AbstractThe prevention and treatment of preterm birth remains one of the biggest challenges in obstetrics. Worldwide, 11% of all children are born prematurely with far-reaching consequences for the children concerned, their families and the health system. Experimental studies suggest that progesterone inhibits uterine contractions, stabilises the cervix and has immunomodulatory effects. Recent years have seen the publication of numerous clinical trials using progestogens for the prevention of preterm birth. As a result of different inclusion criteria and the use of different progestogens and their methods of administration, it is difficult to draw comparisons between these studies. A critical evaluation of the available studies was therefore carried out on the basis of a search of the literature (1956 to 09/2018). Taking into account the most recent randomised, controlled studies, the following evidence-based recommendations emerge: In asymptomatic women with singleton pregnancies and a short cervical length on ultrasound of ≤ 25 mm before 24 weeks of gestation (WG), daily administration of vaginal progesterone (200 mg capsule or 90 mg gel) up until 36 + 6 WG leads to a significant reduction in the preterm birth rate and an improvement in neonatal outcome. The latest data also suggest positive effects of treatment with progesterone in cases of twin pregnancies with a short cervical length on ultrasound of ≤ 25 mm before 24 WG. The study data for the administration of progesterone in women with singleton pregnancies with a previous preterm birth have become much more heterogeneous, however. It is not possible to make a general recommendation for this indication at present, and decisions must therefore be made on a case-by-case basis. Even if progesterone use is considered to be safe in terms of possible long-term consequences, exposure should be avoided where it is not indicated. Careful patient selection is crucial for the success of treatment.

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Cerclage outcomes in singleton pregnancies at risk for preterm birth following assisted reproductive treatments

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v3i3.108 ◽

2021 ◽

Vol 3 (3) ◽

pp. 78-82

Author(s):

Gülnaz Şahin ◽

Ferruh Acet ◽

Ege Nazan Tavmergen Goker ◽

Erol Tavmergen

Keyword(s):

At Risk ◽

Preterm Birth ◽

Gestational Age ◽

Cervical Insufficiency ◽

Special Group ◽

Cervical Cerclage ◽

Unicornuate Uterus ◽

Gestational Age At Delivery ◽

History Of ◽

Singleton Pregnancies

Objective: We aimed to evaluate the obstetric and neonatal outcomes of singleton pregnancies at risk for preterm birth (PTB) following assisted reproductive treatments and underwent cervical cerclage placement. Material and methods: A total of 42 women with singleton pregnancies following ART who underwent cerclage between 2009-2021 were included in this retrospective study. Indications of the cerclage procedure, gestational age at cerclage placement and delivery, neonatal birthweight, and requirement for admission to the neonatal unit of newborns were evaluated. Results: Of those cerclage placement performed in women with a history of second-trimester loss (19%), women with suspected cervical insufficiency according to pre-pregnancy evaluation (52.4%), women with the unicornuate uterus (4.8%), women with cervical shortening/or suspicious changes on ultrasonography (11.9%), and women with detection of cervical dilatation/shortening beyond 20 weeks of gestation (11.9%). Of the total group, 7.1% resulted in late miscarriages, while the remaining 92.9% ended with a live birth with mean gestational age at delivery of 37.0±2.5 weeks. Of those live births, 92.3% (36/39) delivered at >34 weeks and %74.4 (29/39) delivered at term. Except one neonatal death due to extremely PTB at 26th weeks, all infants were discharged from the hospital with well condition. Conclusion: ART pregnancies are evaluated as a special group as having a higher PTB risk at baseline. Cerclage may be considered in broader indications for suspected cervical insufficiency in these pregnancies. There is need for further studies on the effectiveness of cerclage in these ART pregnancies with suspected cervical insufficiency based on different criterions used.

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Endocrine disrupting chemical-associated hair product use during pregnancy and gestational age at delivery: a pilot study

Environmental Health ◽

10.1186/s12940-021-00772-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Emma V. Preston ◽

Victoria Fruh ◽

Marlee R. Quinn ◽

Michele R. Hacker ◽

Blair J. Wylie ◽

...

Keyword(s):

Preterm Birth ◽

Black Women ◽

Pilot Study ◽

Gestational Age ◽

Endocrine Disrupting Chemical ◽

Product Use ◽

Frequent Use ◽

Increased Risk ◽

Endocrine Disrupting ◽

Gestational Age At Delivery

Abstract Background Prenatal endocrine disrupting chemical (EDC) exposure has been associated with increased risk of preterm birth. Non-Hispanic Black women have higher incidence of preterm birth compared to other racial/ethnic groups and may be disproportionately exposed to EDCs through EDC-containing hair products. However, research on the use of EDC-associated hair products during pregnancy and risk of preterm birth is lacking. Therefore, the objective of this pilot study was to estimate associations of prenatal hair product use with gestational age at delivery in a Boston, Massachusetts area pregnancy cohort. Methods The study population consisted of a subset of participants enrolled in the Environmental Reproductive and Glucose Outcomes (ERGO) Study between 2018 and 2020. We collected self-reported data on demographics and hair product use using a previously validated questionnaire at four prenatal visits (median: 12, 19, 26, 36 weeks’ gestation) and abstracted gestational age at delivery from medical records. We compared gestational age and hair product use by race/ethnicity and used linear regression to estimate covariate-adjusted associations of product use and frequency of use at each study visit with gestational age at delivery. Primary models were adjusted for maternal age at enrollment and delivery method. Results Of the 154 study participants, 7% delivered preterm. Non-Hispanic Black participants had lower mean gestational age at delivery compared to non-Hispanic White participants (38.2 vs. 39.2 weeks) and were more likely to report ever and more frequent use of hair products. In regression models, participants reporting daily use of hair oils at visit 4 had lower mean gestational age at delivery compared to non-users (β: -8.3 days; 95% confidence interval: -14.9, -1.6). We did not find evidence of associations at earlier visits or with other products. Conclusions Frequent use of hair oils during late pregnancy may be associated with shorter gestational duration. As hair oils are more commonly used by non-Hispanic Black women and represent potentially modifiable EDC exposure sources, this may have important implications for the known racial disparity in preterm birth.

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508: Influence of earliest gestational age of prior spontaneous preterm birth on subsequent mid-trimester cervical length, pregnancy duration and cerclage efficacy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2009.10.674 ◽

2009 ◽

Vol 201 (6) ◽

pp. S190 ◽

Cited By ~ 2

Author(s):

Deborah Wing ◽

Jeff Szychowski

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Cervical Length ◽

Spontaneous Preterm Birth

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Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

American Journal of Perinatology ◽

10.1055/s-0041-1728818 ◽

2021 ◽

Author(s):

Paul Guerby ◽

Mario Girard ◽

Geneviève Marcoux ◽

Annie Beaudoin ◽

Jean-Charles Pasquier ◽

...

Keyword(s):

Preterm Birth ◽

Health Care Providers ◽

Gestational Age ◽

Roc Curve ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Care Providers ◽

Operating Characteristics ◽

Spontaneous Preterm Birth ◽

Nulliparous Women

Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

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Gestational Age at Cervical Length Measurement and Incidence of Preterm Birth

Obstetrics and Gynecology ◽

10.1097/01.aog.0000270112.05025.1d ◽

2007 ◽

Vol 110 (2, Part 1) ◽

pp. 311-317 ◽

Cited By ~ 123

Author(s):

Vincenzo Berghella ◽

Amanda Roman ◽

Constantine Daskalakis ◽

Amen Ness ◽

Jason K. Baxter

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Cervical Length ◽

Length Measurement ◽

Cervical Length Measurement

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Gestational Age at Cervical Length Measurement and Incidence of Preterm Birth

Obstetrics and Gynecology ◽

10.1097/01.aog.0000296099.06676.ca ◽

2007 ◽

Vol 110 (6) ◽

pp. 1427

Author(s):

Constantine Daskalakis ◽

Vincenzo Berghella ◽

Amanda Roman ◽

Amen Ness ◽

Jason Baxter

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Cervical Length ◽

Length Measurement ◽

Cervical Length Measurement

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Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0075 ◽

2017 ◽

Vol 45 (1) ◽

Cited By ~ 6

Author(s):

Jovana Lekovich ◽

Joshua Stewart ◽

Sarah Anderson ◽

Erin Niemasik ◽

Nigel Pereira ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Placenta Previa ◽

Preterm Births ◽

Mullerian Anomalies ◽

Müllerian Anomalies ◽

Increased Risk ◽

Uterine Anomalies ◽

Gestational Age At Delivery ◽

Term Births

AbstractObjective:Müllerian anomalies are associated with increased risk of miscarriage, intrauterine growth restriction (IUGR) and preterm birth. While a commonly implicated cause is restricted expansion of endometrial cavity, alternatively it could be due to abnormal placentation. We sought to examine clinical and histopathologic factors associated with preterm delivery in women with Müllerian anomalies.Study design:One hundred and eleven singleton pregnancies in 85 women were analyzed retrospectively. There were 42 pregnancies with bicornaute, 24 with unicornuate, 24 with septate, 19 with didelphys and one each with arcuate and T-shaped uterus. Primary outcomes included gestational age at delivery, placental histopathology, placenta previa and accreta.Results:Twenty-eight (25.2%) of pregnancies were delivered prior to term. Of those, only 14 (50%) were due to preterm labor or preterm premature rupture of membranes (PPROM). Histological evidence of placental malperfusion was present in 22% of all pregnancies and those delivered at an earlier median gestational age [34 (IQR 31–37) vs. 37 weeks (IQR 34–39); P=0.001]. Malperfusion was more common in preterm than in full term births (46% vs. 14%; P=0.04). Conversely, inflammation was not more common in preterm compared to term deliveries (17.9% vs. 16.9%; P=0.89). Five pregnancies had placenta previa, three of which were complicated by accreta.Conclusion:Placental malperfusion, rather than inflammation, was more commonly associated with preterm births in women with uterine anomalies.

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