The prediction of spontaneous preterm birth in women with threatened preterm labor using transvaginal ultrasound of the cervix

Background: Preterm delivery (PTD) is a major cause of perinatal morbidity and mortality. Objective of present study was to identify the women at risk of preterm delivery with the help of trans-vaginal ultrasound by assessing cervical length changes, funneling of lower uterine segment, cervical dilatation.Methods: A prospective study was carried out over a period of 2 years on 50 patients with 24-36 weeks of gestation who clinically presented with signs of threatened preterm labor and were subjected to transvaginal sonographic measurement of cervical length.Results: Prediction of spontaneous preterm birth at <37 weeks of gestation with cervical length to be 2.75 cm has sensitivity of 95%, specificity of 96.5%, positive predictive value of 86.36% and negative predictive value of 98.7%.Conclusions: Transvaginal ultrasonography is the reliable, reproducible and objective method to assess cervix and to predict the risk of preterm delivery.

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Using Cervical Length Measurement for Lower Spontaneous Preterm Birth Rates Among Women With Threatened Preterm Labor

Obstetrics and Gynecology ◽

10.1097/aog.0000000000002695 ◽

2018 ◽

Vol 132 (1) ◽

pp. 102-106 ◽

Cited By ~ 2

Author(s):

Giuseppe Chiossi ◽

George R. Saade ◽

Baha Sibai ◽

Vincenzo Berghella

Keyword(s):

Preterm Birth ◽

Preterm Labor ◽

Cervical Length ◽

Length Measurement ◽

Spontaneous Preterm Birth ◽

Birth Rates ◽

Threatened Preterm Labor ◽

Cervical Length Measurement

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Re: Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.7661 ◽

2010 ◽

pp. n/a-n/a

Author(s):

M. M. Wiegerinck ◽

J. Y. Vis ◽

B. W. Mol

Keyword(s):

Preterm Birth ◽

Preterm Labor ◽

Meta Analysis ◽

Cervical Length ◽

Length Measurement ◽

Threatened Preterm Labor ◽

Cervical Length Measurement

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Prediction of Spontaneous Preterm Birth in At-risk Women Using Thrombospondin 1 from Cervicovaginal Fluid: A Prospective Observational Study

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1486-7148 ◽

2021 ◽

Vol 81 (09) ◽

pp. 1055-1064

Author(s):

Johannes Stubert ◽

Kathleen Gründler ◽

Bernd Gerber ◽

Dagmar-Ulrike Richter ◽

Max Dieterich

Keyword(s):

At Risk ◽

Preterm Birth ◽

Predictive Value ◽

Transvaginal Ultrasound ◽

Area Under The Curve ◽

Cervical Length ◽

Multiple Gestation ◽

Spontaneous Preterm Birth ◽

Thrombospondin 1 ◽

Cervicovaginal Fluid

Abstract Introduction Thrombospondin 1, desmoplakin and stratifin are putative biomarkers for the prediction of preterm birth. This study aimed to validate the predictive capability of these biomarkers in patients at risk of preterm birth. Materials and Methods We included 109 women with symptoms of threatened spontaneous preterm birth between weeks 20 0/7 and 31 6/7 of gestation. Inclusion criteria were uterine contractions, cervical length of less than 25 mm, or a personal history of spontaneous preterm birth. Multiple gestations were also included. Samples of cervicovaginal fluid were taken before performing a digital examination and transvaginal ultrasound. Levels of cervicovaginal thrombospondin 1, desmoplakin and stratifin were quantified by enzyme-linked immunosorbent assays. The primary endpoint was spontaneous preterm birth before 34 + 0 weeks of gestation. Results Sixteen women (14.7%) delivered before 34 + 0 weeks. Median levels of thrombospondin 1 were higher in samples where birth occurred before 34 weeks vs. ≥ 34 weeks of gestation (4904 vs. 469 pg/mL, p < 0.001). Receiver operator characteristics analysis resulted in an area under the curve of 0.86 (p < 0.0001). At an optimal cut-off value of 2163 pg/mL, sensitivity, specificity, positive predictive value and negative predictive value were 0.94, 0.77, 0.42 and 0.99, respectively, with an adjusted odds ratio of 32.9 (95% CI: 3.1 – 345, p = 0.004). Multiple gestation, cervical length, and preterm labor had no impact on the results. Survival analysis revealed a predictive period of more than eight weeks. Levels of desmoplakin and stratifin did not differ between groups. Conclusion Thrombospondin 1 allowed long-term risk estimation of spontaneous preterm birth.

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Transvaginal Ultrasound Assessment of Cervical Length in Threatened Preterm Labor

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v36i2.1481 ◽

2020 ◽

pp. 81-84

Author(s):

Prasila Ekaputri

Keyword(s):

Preterm Labor ◽

Primary Outcome ◽

Uterine Contraction ◽

Transvaginal Ultrasound ◽

Cross Sectional Study ◽

Cervical Length ◽

Cross Sectional ◽

Active Labor ◽

Ultrasound Assessment ◽

Threatened Preterm Labor

Objectives: To determine the cut off point of cervical length usingtransvaginal ultrasonography to predict the actual occurrence ofpreterm labor in women with threatened preterm labor. Methods: A cross sectional study with consecutive random samplingmethod. We examined 80 women with singleton pregnancycomplaining of regular, painful uterine contraction and rupturedmembrane at 24-36 weeks of gestation. Women in active labor, definedby the presence of cervical dilatation less than or equal 3 cm, and having complicationwere excluded. When the patient was admitted, a transvaginalscan was performed to measure the cervical length. Parenteralmagnesium sulfate was given as the subsequent management.The primary outcome was delivery within 24 hours of presentation.Results: We found that the optimal cut off values for cervical lengthwas 2.65 cm with sensitivity 94.4 Percent, specificity 65.4Percent, positive predictivevalue 75.4 Percent and negative predictive value 81.8 Percent. In 69cases, the cervical length was more than or 2.65 cm, with 52 patients successfullycontinued their pregnancy until more than 24 hours. In the 11cases with cervical length less than or equal 2.65 cm, delivery within 24 hours occurredin 9 cases (81,8 Percent). Conclusion: The findings of this study suggest that in women withthreatened preterm labor, cervical length more than or equal 2.65 cm may help predictthe actual occurrence of preterm labor. Keywords: cervical length, threatened preterm labor, transvaginalultrasonography

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Protein microarray analysis of amniotic fluid proteins associated with spontaneous preterm birth in women with preterm labor

American Journal of Reproductive Immunology ◽

10.1111/aji.13517 ◽

2021 ◽

Author(s):

Kyo Hoon Park ◽

Hyeon Ji Kim ◽

Young Eun Lee ◽

Yu Mi Kim ◽

Ji Eun Lee ◽

...

Keyword(s):

Preterm Birth ◽

Amniotic Fluid ◽

Microarray Analysis ◽

Preterm Labor ◽

Protein Microarray ◽

Spontaneous Preterm Birth ◽

Protein Microarray Analysis

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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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