Risk of spontaneous preterm birth in asymptomatic twins with a short cervix in early viability

Abstract Objectives Preterm birth clinics provide dedicated obstetric care to women at high risk of spontaneous preterm birth (SPTB). There remains a lack of conclusive evidence to support the overall utility of such clinics, attributable to a paucity and heterogeneity of primary data. This study audits Australia’s largest and oldest dedicated preterm birth clinic with the aim to add primary data to the area and offer opportunities for similar clinics to align practice. Methods A retrospective audit of referrals to the Preterm Labour Clinic at the Royal Women’s Hospital, Melbourne, Australia, between 2004 and 2018 was conducted. 1,405 singleton pregnancies met inclusion criteria. The clinic’s key outcomes, demographics, predictive tests and interventions were analysed. The primary outcomes were SPTB before 37, 34 and 30 weeks’ gestation. Results The overall incidence of SPTB in the clinic was 21.2% (n=294). Linear regression showed reductions in the adjusted rates of overall SPTB and pre-viable SPTB (delivery <24 weeks) from 2014 (108%; 8%) to 2018 (65%; 2% respectively). Neonatal morbidity and post-delivery intensive care admission concurrently declined (p=0.02; 0.006 respectively). Rates of short cervix (cervical length <25 mm) increased over time (2018: 30.9%) with greater uptake of vaginal progesterone for treatment. Fetal fibronectin, mid-trimester short cervix, and serum alkaline phosphatase were associated with SPTB on logistic regression. Conclusions Dedicated preterm birth clinics can reduce rates of SPTB, particularly deliveries before 24 weeks’ gestation, and improve short-term neonatal outcomes in pregnant women at risk of preterm birth.

Download Full-text

Prior Uterine Evacuation and Risk of Short Cervix and Spontaneous Preterm Birth [24D]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000483402.02399.d1 ◽

2016 ◽

Vol 127 ◽

pp. 40S

Author(s):

Rupsa Boelig ◽

Kelly Orzechowski ◽

Michela Villani ◽

Eva Jiang ◽

Vincenzo Berghella

Keyword(s):

Preterm Birth ◽

Spontaneous Preterm Birth ◽

Short Cervix

Download Full-text

OP10.03: Cervical pessary and micronised progesterone vaginal tablets for the prevention of spontaneous preterm birth in singleton pregnancies with mid-trimester short cervix

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.15191 ◽

2015 ◽

Vol 46 ◽

pp. 81-81

Author(s):

A.L. Zimerman ◽

O. Neeman ◽

Y. Wiener ◽

N. Glick ◽

R. Maymon

Keyword(s):

Preterm Birth ◽

Spontaneous Preterm Birth ◽

Short Cervix ◽

Cervical Pessary ◽

Singleton Pregnancies

Download Full-text

Obstetric History and Risk of Short Cervix in Women with a Prior Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0040-1717074 ◽

2020 ◽

Author(s):

Heather A. Frey ◽

Eric M. McLaughlin ◽

Erinn M. Hade ◽

Matthew M. Finneran ◽

Kara M. Rood ◽

...

Keyword(s):

Preterm Birth ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

Short Cervix ◽

Screening Guidelines ◽

Obstetric History ◽

History Of ◽

Full Term Delivery

Objective We aimed to assess the relationship between obstetric history and incidence of short cervical length (CL) at <24 weeks gestational age (GA) in women with a prior spontaneous preterm birth (PTB). Study Design Women with a singleton gestation and a history of spontaneous PTB on progesterone who received prenatal care at a single center from 2011 to 2016 were included. Those who did not undergo screening or had a history-indicated cerclage were excluded. The associations between short CL (<25 mm) before 24 weeks and obstetrical factors including: number of prior PTBs, history of term birth, and GA of earliest spontaneous PTB were estimated through modified Poisson regression, adjusting for confounding factors. Multiple pregnancies for the same woman were accounted for through robust sandwich standard error estimation. Results Among 773 pregnancies, 29% (n = 224) had a CL <25 mm before 24 weeks. The number of prior PTBs was not associated with short CL, but a prior full-term delivery conferred a lower risk of short CL (absolute risk reduction or aRR 0.79, 95% CI 0.63–1.00). Earliest GA of prior spontaneous PTB was associated with short CL. The strongest association was observed in women with a prior PTB at 160/7 to 236/7weeks (aRR 1.98, 95% CI: 1.46–2.70), compared with those with deliveries at 340/7 to 366/7 weeks. Yet, even women whose earliest PTB was 340/7 to 366/7 weeks remained at risk for a short CL, as 21% had a CL <25 mm. The number of prior PTBs did not modify the effect of GA of the earliest prior PTB (interaction test: p = 0.70). Conclusion GA of earliest spontaneous PTB, but not the number of prior PTBs, is associated with short CL. Nevertheless, women with a history of later PTBs remain at sufficiently high risk of having a short CL at <24 weeks gestation that we cannot recommend modifications to existing CL screening guidelines in this group of women. Key Points

Download Full-text

Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action!

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.12.222 ◽

2018 ◽

Vol 218 (2) ◽

pp. 151-158 ◽

Cited By ~ 19

Author(s):

Stuart Campbell

Keyword(s):

Preterm Birth ◽

Cervical Length ◽

Spontaneous Preterm Birth ◽

Short Cervix ◽

Vaginal Progesterone

Download Full-text

Human Milk Oligosaccharides modulate the risk for preterm birth in a microbiome dependent and independent manner

10.1101/683714 ◽

2019 ◽

Cited By ~ 3

Author(s):

Manuela-Raluca Pausan ◽

Vassiliki Kolovetsiou-Kreiner ◽

Gesa Lucia Richter ◽

Tobias Madl ◽

Elisabeth Giselbrecht ◽

...

Keyword(s):

Preterm Birth ◽

Human Milk ◽

Sterile Inflammation ◽

Human Milk Oligosaccharides ◽

Spontaneous Preterm Birth ◽

Milk Oligosaccharides ◽

Short Cervix ◽

Independent Manner ◽

Cross Sectional ◽

Urinary Microbiome

AbstractBackgroundPreterm birth is one of the leading causes of neonatal mortality. The causes for spontaneous preterm birth (PTB) are multifactorial and remain often unknown. In this study, we tested the hypothesis that human milk oligosaccharides (HMOs) in blood and urine modulate the maternal urinary and vaginal microbiome and influence the risk for PTB. We analyzed the vaginal and urinary microbiome of a cross-sectional cohort of women with and without preterm labor and correlated our findings with measurements of metabolites and HMOs in urine and blood.ResultsWe identified several microbial signatures associated with short cervix, PTB and/or preterm contractions such asLactobacillus jensenii,L. gasseri,Ureaplasma sp. andGardnerella sp..Additionally, we observed associations between sialylated HMOs, in particular 3’-sialyllactose, with PTB, short cervix and increased inflammation and confirmed an influence of HMOs on the microbiome profile.ConclusionsIdentifying serum and urinary HMOs and several key microorganisms associated with PTB, our findings point at two distinct processes modulating the risk for PTB. One process seems to be driven by sterile inflammation, characterized by increased concentrations of sialylated HMOs in serum. Another process might be microbiome-mediated, potentially driven by secretor-active HMOs in urine. Our results support current efforts to improve diagnostics and therapeutic strategies.

Download Full-text