Change in cervical length and spontaneous preterm birth in nulliparous women with a history of loop electrosurgical excision procedure*

2019 ◽  
pp. 1-5
Author(s):  
Simi Gupta ◽  
Stefanie Chen ◽  
Mariam Naqvi ◽  
Daniel H. Saltzman ◽  
Andrei Rebarber ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Nulliparous Women ◽  
History Of ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

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

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

Cervical Length Surveillance After 24 Weeks in Women With a History of Spontaneous Preterm Birth [09K]

2020 ◽  
Vol 135 ◽  
pp. 116s
Author(s):  
Eboni Jones ◽  
Kari Whitley ◽  
Joanne Quinones ◽  
Danielle Durie ◽  
Katherine Fradeneck
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
History Of

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

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

scholarly journals Genital mycoplasma infection and spontaneous preterm birth outcome: a prospective cohort study

2021 ◽  
Author(s):  
Giulia Cunha ◽  
Larissa Bastos ◽  
Stella Freitas ◽  
Ricardo Cavalli ◽  
Silvana Quintana
Keyword(s):  
Risk Factor ◽  
Preterm Birth ◽  
Bacterial Vaginosis ◽  
Prospective Cohort ◽  
Previous History ◽  
Cervical Length ◽  
Mycoplasma Infection ◽  
Spontaneous Preterm Birth ◽  
History Of ◽  
Tract Infections

Objective To determine the prevalence of genital mycoplasma infection and the risk of spontaneous preterm birth (sPTB) in asymptomatic pregnant women. Design Prospective cohort. Setting Public and private health services in Ribeirão Preto-SP, Brazil. Population 1.349 asymptomatic women with a singleton pregnancy at 20-25 weeks of gestation (WG) recruited between 2010 and 2011. Methods Baseline data was assessed using a questionnaire, in addition to cervicovaginal fluid and blood samples, to analyze lower reproductive tract infections (RTIs) and immune mediators, respectively. The association between variables and the risk of sPTB was evaluated using logistic regression analysis to estimate the odds ratios (ORs). Main outcome measures Genital mycoplasma infection and prematurity. Results The prevalence of the sPTB and genital mycoplasma was 6.8% and 18%, respectively. The infection was not a risk factor for sPTB (aOR 0.66; 95% CI 0.32-1.35), even when associated with bacterial vaginosis (BV). However, it was associated with a low socioeconomic status (p=0.0470), cigarette use (p=0.0009), number of sexual partners (p=0.0019), and BV (p<.0001). Regarding the risk factors associated with sPTB, previous history of PTB (aOR 12.06; 95% CI 6.21-23.43) and a cervical length ≤ 2.5 cm (aOR 3.97; 95% CI 1.67-9.47) were significant. Conclusions The risk of sPTB was independently associated with the history of PTB and the cervical length but not with the genital mycoplasma infection. Funding: This work was founded by CNPq, FAPESP and CAPES. Keywords: Preterm birth, pregnancy, genital mycoplasma, bacterial vaginosis, risk factor

The Impact of Previous Obstetric History on the Risk of Spontaneous Preterm Birth in Women with a Sonographic Short Cervix

2020 ◽  
Vol 37 (12) ◽  
pp. 1189-1194
Author(s):  
Carolynn M. Dude ◽  
Lisa D. Levine ◽  
Nadav Schwartz
Keyword(s):  
Preterm Birth ◽  
Full Term ◽  
Secondary Outcome ◽  
Spontaneous Preterm Birth ◽  
Short Cervix ◽  
Term Birth ◽  
Obstetric History ◽  
Nulliparous Women ◽  
History Of ◽  
The Impact

Abstract Objective The natural history of women with a short cervix and a low-risk obstetric history remains poorly defined. In our study, we sought to better characterize the impact of previous obstetric history on the delivery outcomes in women diagnosed with a mid-trimester sonographic short cervix. Study Design We performed a retrospective cohort study of women with singleton gestations who underwent transvaginal cervical length screening between 16 and 24 weeks at two urban hospitals in Philadelphia between January 2013 and March 2018 and were found to have a short cervix (defined as ≤2 cm). Women were excluded from the cohort if there were major fetal anomalies noted or if delivery outcome information was not available. The cohort was then divided into three groups based on obstetric history: nulliparous, history of full-term birth only, or history of spontaneous preterm birth (sPTB). The primary outcome was sPTB <37 weeks, while the secondary outcome was sPTB <34 weeks. Results Our cohort included a total of 384 singleton pregnancies that were diagnosed with a sonographic short cervix: 165 women were nulliparous, 119 women had a history of full-term birth, and 100 women with a history of sPTB. We found that women with a short sonographic cervix had a sPTB rate of 39.6% with no differences found between the three groups. Only two-thirds of nulliparous women and women with a history of full-term birth received the recommended preventative treatment, compared with almost 100% of women with a history of sPTB. Conclusion Women with and without a history of sPTB are at comparable risk of sPTB in the presence of a sonographically short cervix. Preventative therapies should be recommended to both nulliparous women and women with a history of full-term birth since uptake in this population are not as high.

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