scholarly journals A Combination of Cervicovaginal Fluid Glutamate, Acetate and D-Lactate Identified Asymptomatic Low-Risk Women Destined to Deliver Preterm: a Prospective Cohort Study

2021 ◽  
Author(s):  
Emmanuel Amabebe ◽  
Dilly O. C. Anumba
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Characteristic Curve ◽  
Cervical Length ◽  
Low Risk ◽  
Prior History ◽  
Study Cohort ◽  
Fetal Fibronectin ◽  
Low Risk Women ◽  
Cervicovaginal Fluid

AbstractDue to the modest predictive capacities and limited clinical application of transvaginal ultrasonographic cervical length (CL) and quantitative fetal fibronectin (qfFN) in pregnant women at low risk of preterm birth (PTB), we sought to determine the utility of cervicovaginal fluid (CVF) metabolites (by-products of host-microbial metabolism) for prediction of spontaneous PTB in asymptomatic low-risk women at mid-gestation. This was a prospective sub-cohort study from the ECCLIPPx study cohort. CVF from asymptomatic singleton women (20–22 weeks, n = 168) without a prior history of PTB were analysed for metabolites by enzyme-based spectrophotometry. CL, vaginal pH and qfFN were also measured. Correlation and predictive analyses were performed by Spearman’s correlation, and binary logistic regression and area under receiver operating characteristic curve (AUC), respectively. Of the 168 women enrolled, only CVF samples from 135 (80.4%) women were analysed. There were 6/135 (4.4%) spontaneous PTB (sPTBs), with two of these pregnancies ending ≤ 28 weeks’ gestation. Individually (AUC, 95% CI), only glutamate (0.72, 0.64–0.80) and CL (0.69, 0.60–0.77) were predictive of PTB. However, five multivariable models that more accurately predicted sPTB were also identified, i.e. a combination of: glutamate, acetate and D-lactate (GAD, 0.82, 0.74–0.89); CL and qfFN only (0.78, 0.70–0.85); CL, qfFN, glutamate and acetate (0.88, 0.81–0.93); CL, qfFN and GAD (0.94, 0.88–0.98); and GAD and pH (0.86, 0.79–0.92). Correlations between CL, pH and qfFN and metabolites were also observed. In this cohort, a midtrimester combination of CVF glutamate, acetate and D-lactate predicted preterm birth more accurately than individual metabolites, cervical length and fetal fibronectin with a very low false-positive rate and high positive predictive value. Further testing in populations with higher preterm birth rates is required.

Cervical Cerclage versus Vaginal Progesterone for Management of Short Cervix in Low-Risk Women

2018 ◽  
Vol 36 (02) ◽  
pp. 111-117 ◽  
Author(s):  
Sarah Dotters-Katz ◽  
Brenna Hughes ◽  
Amber Wood
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Low Risk ◽  
Prior History ◽  
Short Cervix ◽  
Vaginal Progesterone ◽  
History Of ◽  
Secondary Outcomes ◽  
Low Risk Women

Objective To evaluate the risk of preterm birth in low-risk women with cervical length (CL) ≤25 mm on transvaginal ultrasound (TVUS) managed with vaginal progesterone (VagP) therapy versus cerclage. Study Design This is a retrospective cohort of women with no prior history of preterm birth or cervical insufficiency and CL ≤ 25 mm on TVUS, managed with either VagP therapy alone or cerclage (with or without VagP). The primary outcome was rate of preterm delivery < 37 weeks gestational age (GA). Secondary outcomes included delivery at ≤ 32 or ≤ 28 weeks GA, premature preterm rupture of membranes, pregnancy latency, GA at delivery, and composite neonatal outcome. Results Women undergoing cerclage placement (n = 31) were older and had an earlier GA at the time of diagnosis of short cervix compared with women receiving VagP (n = 62). Delivery at < 37 weeks occurred in 21/62 (33.9%) in the VagP group and 14/31 (45.2%) in the cerclage group (adjusted odds ratio: 1.72, 95% confidence interval: 0.52, 5.66). There were no differences in secondary outcomes. Conclusion Cerclage compared with VagP therapy did not decrease risk of preterm birth in women with CL ≤ 25 mm. Further research is needed to determine optimal management in such women given a residual 40% risk of preterm birth despite optimal therapy.

scholarly journals The capacity of mid-pregnancy cervical length to predict preterm birth in low-risk women: a national cohort study

2015 ◽  
Vol 94 (11) ◽  
pp. 1223-1234 ◽  
Author(s):  
Jeanine van der Ven ◽  
Melanie A. van Os ◽  
Brenda M. Kazemier ◽  
Emily Kleinrouweler ◽  
Corine J. Verhoeven ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Cervical Length ◽  
Low Risk ◽  
National Cohort ◽  
Low Risk Women

scholarly journals Preventing preterm birth with progesterone: costs and effects of screening low risk women with a singleton pregnancy for short cervical length, the Triple P study

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Melanie A van Os ◽  
Jeanine A van der Ven ◽  
C Emily Kleinrouweler ◽  
Eva Pajkrt ◽  
Esteriek de Miranda ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Low Risk ◽  
Triple P ◽  
Singleton Pregnancy ◽  
Low Risk Women

scholarly journals The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1784
Author(s):  
Johannes van der Merwe ◽  
Isabel Couck ◽  
Francesca Russo ◽  
Xavier P. Burgos-Artizzu ◽  
Jan Deprest ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Transvaginal Ultrasound ◽  
Characteristic Curve ◽  
Cervical Length ◽  
Consistency Index ◽  
Spontaneous Preterm Birth ◽  
Twin Pregnancies

Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0–22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72–0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57–0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.

scholarly journals The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention

2016 ◽  
Vol 215 (3) ◽  
pp. B2-B7 ◽  
Author(s):  
Jennifer McIntosh ◽  
Helen Feltovich ◽  
Vincenzo Berghella ◽  
Tracy Manuck
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Low Risk ◽  
Low Risk Women
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