Women's Obstetric History and Midtrimester Cervical Length Measurements by 2D/3D and Doppler Ultrasound

Abstract Objective The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths. Methods The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15 mm and < 25 mm (n = 68), the Very Short Cervix group for cervical lengths < 15 mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25 mm. Results When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening. Conclusion The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

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The role of uterine artery Doppler index and nuchal translucency measurement in predicting perinatal problems and the gestational age in patients diagnosed with hyperemesis gravidarum

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v2i3.63 ◽

2020 ◽

Vol 2 (3) ◽

pp. 19-22

Author(s):

Dilek Kartal ◽

Azra Arıcı Yurtkul ◽

Ayşe Rabia Şenkaya

Keyword(s):

Pregnant Women ◽

Uterine Artery ◽

Hyperemesis Gravidarum ◽

Systemic Disease ◽

Nuchal Translucency ◽

Control Group ◽

Uterine Artery Doppler ◽

Tertiary Center ◽

Group 2 ◽

Group 1

Objective: We aimed to investigate the effectiveness of uterine artery Doppler index and nuchal translucency (NT) measurement in determining perinatal problems in patients diagnosed with hyperemesis gravidarum (HEG). Material and methods: We included 80 pregnant women between the ages of 19–40 years with a singleton, noncomplicated pregnancy, no systemic disease, and no structural and chromosomal disorders in the fetus, who were admitted to our hospital which is a tertiary center with a large patient population in the region, between October 2015 and October 2016 in this study. Further, two group were formed as 40 pregnant women with the diagnosis of HEG (group 1) and 40 pregnant women for control group (group 2). Age, body mass index (BMI), educational status,pregnancy history (live birth, miscarriages), smoking, alcohol consumption, substance use, last menstrual period, serum pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin, (free ß-hCG), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) levels, nuchal translucency (NT), and uterine artery Doppler measurement values were recorded. The data between two groups were compared. Results: The education level of the group 1 was found higher (p = 0.001). The frequency of smoking in group 1 (n = 18; 45%) was found significantly higher than group 2 (n = 3; 7.5%) (p = 0.001). In group 1, uterine artery Doppler pulsatility index (PI) and resistance index (RI) values were found higher than group 2 (p = 0.026 and 0.024, respectively). Conclusion: The uterine artery Doppler PI, RI values measured at 20–24 weeks in patients with HEG were statistically significantly higher than those without HEG.

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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

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The Arabin pessary to prevent preterm birth in women with a twin pregnancy and a short cervix: the STOPPIT 2 RCT

Health Technology Assessment ◽

10.3310/hta25440 ◽

2021 ◽

Vol 25 (44) ◽

pp. 1-66

Author(s):

Jane E Norman ◽

John Norrie ◽

Graeme MacLennan ◽

David Cooper ◽

Sonia Whyte ◽

...

Keyword(s):

Preterm Birth ◽

Odds Ratio ◽

Standard Care ◽

Twin Pregnancy ◽

Adjusted Odds Ratio ◽

Intervention Group ◽

Health Technology ◽

Cervical Length ◽

Control Group ◽

Short Cervix

Background Preterm birth is common in twins and accounts for significant mortality and morbidity. There are no effective preventative treatments. Some studies have suggested that, in twin pregnancy complicated by a short cervix, the Arabin pessary, which fits around the cervix and can be inserted as an outpatient procedure, reduces preterm birth and prevents neonatal morbidity. Objective STOPPIT 2 aimed to evaluate the clinical utility of the Arabin cervical pessary in preventing preterm birth in women with a twin pregnancy and a short cervix. Design STOPPIT 2 was a pragmatic, open label, multicentre randomised controlled trial with two treatment group – the Arabin pessary plus standard care (intervention) and standard care alone (control). Participants were initially recruited into the screening phase of the study, when cervical length was measured. Women with a measured cervical length of ≤ 35 mm were then recruited into the treatment phase of the study. An economic evaluation considered cost-effectiveness and a qualitative substudy explored the experiences of participants and clinicians. Setting Antenatal clinics in the UK and elsewhere in Europe. Participants Women with twin pregnancy at < 21 weeks’ gestation with known chorionicity and gestation established by scan at ≤ 16 weeks’ gestation. Interventions Ultrasound scan to establish cervical length. Women with a cervical length of ≤ 35 mm at 18+ 0–20+ 6 weeks’ gestation were randomised to standard care or Arabin pessary plus standard care. Randomisation was performed by computer and accessed through a web-based browser. Main outcome measures Obstetric – all births before 34+ 0 weeks’ gestation following the spontaneous onset of labour; and neonatal – composite of adverse outcomes, including stillbirth or neonatal death, periventricular leukomalacia, early respiratory morbidity, intraventricular haemorrhage, necrotising enterocolitis or proven sepsis, all measured up to 28 days after the expected date of delivery. Results A total of 2228 participants were recruited to the screening phase, of whom 2170 received a scan and 503 were randomised: 250 to Arabin pessary and 253 to standard care alone. The rate of the primary obstetric outcome was 18.4% (46/250) in the intervention group and 20.6% (52/253) in the control group (adjusted odds ratio 0.87, 95% confidence interval 0.55 to 1.38; p = 0.54). The rate of the primary neonatal outcome was 13.4% (67/500) and 15.0% (76/506) in the intervention group and control group, respectively (adjusted odds ratio 0.86, 95% confidence interval 0.54 to 1.36; p = 0.52). The pessary was largely well tolerated and clinicians found insertion and removal ‘easy’ or ‘fairly easy’ in the majority of instances. The simple costs analysis showed that pessary treatment is no more costly than standard care. Limitations There was the possibility of a type II error around smaller than anticipated benefit. Conclusions In this study, the Arabin pessary did not reduce preterm birth or adverse neonatal outcomes in women with a twin pregnancy and a short cervix. The pessary either is ineffective at reducing preterm birth or has an effect size of < 0.4. Future work Women with twin pregnancy remain at risk of preterm birth; work is required to find treatments for this. Trial registration Current Controlled Trials ISRCTN98835694 and ClinicalTrials.gov NCT02235181. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 44. See the NIHR Journals Library website for further project information.

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First trimester uterine artery Doppler and subsequent intrauterine growth restriction and preterm birth

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2004.09.085 ◽

2004 ◽

Vol 191 (6) ◽

pp. S22

Author(s):

Lorraine Dugoff ◽

John Hobbins ◽

Vincent Faber ◽

Fergal Malone ◽

Michael Belfort ◽

...

Keyword(s):

Preterm Birth ◽

Intrauterine Growth Restriction ◽

Uterine Artery ◽

First Trimester ◽

Growth Restriction ◽

Uterine Artery Doppler ◽

Intrauterine Growth

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Study of the association between serum zinc concentration in pregnant women and preterm birth

Journal of Shahrekord University of Medical Sciences ◽

10.34172/jsums.2021.17 ◽

2021 ◽

Vol 23 (3) ◽

pp. 102-105

Author(s):

Sheida Shabanian ◽

Abolfazl Khoshdel ◽

Majid Dezfuli ◽

Fatemeh Famouri

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Serum Zinc ◽

Control Group ◽

Zn Deficiency ◽

High Morbidity ◽

Health Maintenance ◽

Zn Concentration ◽

Serum Zn ◽

The Mean

Background and aims: Preterm birth can cause high morbidity and mortality in women. Previous evidence has confirmed the association between zinc (Zn) deficiency in x women and some pregnancy complications. This study investigated the association between serum Zn concentration in pregnant women and preterm birth. Methods: This case-control study focused on evaluating 76 pregnant women with preterm birth (case group) and 62 pregnant women with term birth (control group) and was conducted in the obstetrics ward of Hajar hospital, Shahrekord, Iran in 2014. The Zn level was measured by spectrophotometry and data were analyzed by SPSS, version 15. Results: The prevalence of Zn deficiency was 95.6%. The mean of serum Zn concentration was 39.62±11.83 and 59.81±8.8 in the preterm and term delivery groups, respectively (P<0.001). Similarly, the mean of serum Zn concentrations was 43.06±15.6 and 50.46±13.8 in women with and without the rupture of pregnancy membranes, respectively (P=0.01). Based on the findings, the serum Zn concentration was not significantly associated with parity (P=0.634). Conclusion: Although a decrease in the serum Zn concentration could lead to premature rupture of membranes during pregnancy and preterm birth, it could not be considered as the main factor for preterm birth. In addition, Zn deficiency was highly prevalent in pregnant women. Therefore, nutritional interventions should be performed to prevent complications due to the deficiency of micronutrients such as Zn so that to increase health maintenance in mothers and children.

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Prediction of preeclampsia using a combination of serum micro RNA-210 and uterine artery Doppler ultrasound

Science Progress ◽

10.1177/00368504211036856 ◽

2021 ◽

Vol 104 (3) ◽

pp. 003685042110368

Author(s):

Ananya Trongpisutsak ◽

Vorapong Phupong

Keyword(s):

Pregnant Women ◽

Doppler Ultrasound ◽

Predictive Value ◽

Early Onset ◽

Uterine Artery ◽

Micro Rna ◽

Predictive Values ◽

Uterine Artery Doppler ◽

Early Onset Preeclampsia ◽

Sensitivity Specificity

The objective was to determine whether a combination of serum micro RNA-210 level and uterine artery Doppler can predict preeclampsia in pregnant women at 16–24 weeks gestation. A prospective observational study conducted in singleton pregnant women at 16–24 weeks of gestation who had prenatal care at the King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand between 2017 and 2018. Uterine artery Doppler ultrasound and blood testing for serum micro RNA-210 were performed. Pregnancy outcomes were recorded. Optimal cut-off for uterine artery pulsatility index (PI) and serum micro RNA-210 were obtained to calculate the predictive values for preeclampsia. Data from 443 participants were analyzed. Twenty-two cases developed preeclampsia (5.0%) and seven of these preeclamptic cases had early-onset preeclampsia (1.6%). Pregnant women with preeclampsia had higher mean PI of the uterine artery (1.34 ± 0.52 vs 0.98 ± 0.28, p = 0.004), higher detection rates of diastolic notching (45.5% vs 11.2%, p < 0.001), and lower median serum micro RNA-210 level (22.86 vs 795.78, p < 0.001) than pregnant women without preeclampsia. Using abnormal serum micro RNA-210 level, abnormal mean PI or uterine artery diastolic notches to predict for preeclampsia, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.5%, 54.9%, 10.0%, and 99.6%, respectively. For early-onset preeclampsia prediction, the sensitivity, specificity, PPV, and NPV were 100.0%, 53.2%, 3.3%, and 100.0%, respectively. This study demonstrated that a combination of serum micro RNA-210 and uterine artery Doppler is effective in predicting preeclampsia in the second trimester.

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