Predictive Accuracy of Three Dimensional Ultrasound Measurement of Fetal Adrenal Gland Volume in Preterm Labor Cases

Abstract Background Preterm birth is one of the major clinical problems in obstetrics and neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. It is reported that more than 80% of all neonatal mortality and morbidity is due to preterm birth. Objective In this study fetal adrenal gland volume and fetal zone measurement were used as a predictors for occurrence of labor in singleton pregnancies complicated by threatened preterm labor in comparison to cervical length and cervicovaginal fetal fibronectin. Methodology The study was carried out at Ain Shams University Maternity Hospital. The current study include 88 pregnant women who presented with symptoms or signs of threatened preterm labor (PTL). All women were subjected to full history taking, full general, abdominal, pelvic examination, in addition to ultrasound fetal biometry, measurement of cervical length, measurement of fetal fibronectin, fetal adrenal gland volume AGV and fetal zone acquisitions. Results Our results showed high statistically significant difference between the two groups of women regarding CL measurement, FZE and cAGV with P values < 0.001 suggesting that ultrasound examination of fetal adrenal gland and assessment of FZE at time of evaluation for symptoms of PTL may be clinically beneficial in predicting the occurrence of labor in pregnant women at risk of preterm labor. Conclusion Our results demonstrate that in women presenting with threatened preterm labor, cAGV and FZE measured by 3-dimensional ultrasound seem to be significant predictors of delivery within 7 days, when compared to CL and cervicovaginal fetal fibronectin.

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ULTRASOUND ASSESSMENT OF FETALADRENAL GLAND VOLUME (FAGV) AND ADRENAL FETAL ZONE ENLARGEMENT(AFZE):VIABLE AND SUPERIOR ALTERNATIVES TO CERVICAL LENGTH (CL) IN ACCURATE PREDICTION OF PRETERM BIRTHS.

10.36106/ijsr/0216169 ◽

2020 ◽

pp. 26-28

Author(s):

Jatin Venugopal Kutnikar ◽

Saravanan Kannan ◽

Prabhakaran Maduraimuthu

Keyword(s):

Adrenal Gland ◽

Pregnant Women ◽

Preterm Delivery ◽

Preterm Births ◽

Cervical Length ◽

Public Health Issue ◽

Zone Length ◽

Gland Volume ◽

Study Results ◽

Adrenal Gland Volume

BACKGROUND: Owing to associated neonatal death, morbidity and impairment in later life, preterm birth is a major public health issue. Pregnant ladies presenting to the antenatal clinic were recruited in order to predict spontaneous preterm births bythe novel method of assessing the Fetal Adrenal Gland Volume (FAGV) and Adrenal Fetal ZoneEnlargement(AFZE) and comparing it with Cervical length. MATERIAL AND METHODS:This was a prospective observational study done at a tertiary hospital in Chennai.The formulae,AFZE=Gland length/Central fetal zone length and FAGV=0.523 x length x width x depth. cFAGV=fetal adrenal gland volume/estimated fetal weight =FAGV/EFW, were employed for the purpose of this study.𝛘2 or Fisher’s exact tests,Mann-Whitney or student-t test were calculated for appropriate variables. Pregnant women with uncomplicated pregnancy with gestational age between 21-34 weeks were recruited for this study. RESULTS:70 pregnant women were studied from May2019 to August 2020 and had an average age of 25 years and mean age of gestation being 27.1 weeks.26(37.1%) of these had a preterm delivery of ≤7 days.AFZE emerged as the best predictor among the three metrics with sensitivity of 100% and specificity of ~90 %.cFAGV showed ~80%/~89% sensitivity and specificity.This was in contrast to cervical length of ≤16 mm having just 55% and 60% sensitivity and specificity respectively. SUMMARY:USG estimation of AFZE and cFAGV are more reliable and accurate indicators than CL for spontaneous preterm delivery and can be used in the routine scanning of patients with early symptoms of preterm labour to plan the management more effectively.

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Threatened Preterm Labor: Which are become Preterm Labor?

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v8i4.1299 ◽

2020 ◽

pp. 216-222

Author(s):

Cut M. Yeni ◽

Rismawati Tambunan ◽

Hasanuddin

Keyword(s):

Pregnant Women ◽

Preterm Labor ◽

Case Control ◽

Cervical Length ◽

Wilcoxon Test ◽

Fetal Fibronectin ◽

Whitney Test ◽

Vaginal Ph ◽

Chi Squared ◽

Threatened Preterm Labor

Objective: The research was aimed to show about characteristics of subject, fetal fibronectin, vaginal pH, cervical length of women with threatened preterm labor, and which are become preterm labor? Preterm labor is occurs most often in 20 weeks gestation to less than 37 weeks gestation. This condition is concerned about Obstetric problem and associated with significant neonatal morbidity and mortality.Methods: This study used the design of case control where preterm pregnant women who become research subjects divided into two groups with threat and without the threat of pre-term labor. Fetal fibronectin , vaginal pHand cervical length than in both groups were evaluated as a risk factor for preterm labor. Mann-Whitney test , Wilcoxon test and Chi-squared test were used as statistical tests with a confidence level of 95%.Results: A total of 86 preterm pregnant women involved in this study with an average age 30 , 5 ± 6.25 (group threat) 32.16 ± 5.25 (non-threatening). Comparison of fetal fibronectin (p = 0.005), vaginal PH(p <0.001) and length of the cervix (p <0.001) between the two groups showed a significant difference. A total of 8 subjects of the 43 in the group of pregnant women with the threat pretem labor experiencing preterm labor .Conclusion: The size of a short cervical length, an increase in the pH of the vaginal secretions and increased levels of fetal fibronectin is a clinical indicator for screening during pregnancy to assess the risk of a preterm labor .Keywords: cervical length, fetal fibronectin, pretermlabor , vaginal pH of the secretions. Abstrak Tujuan: Persalinan preterm adalah persalinan yang terjadi padausia kehamilan 20 hingga kurang dari37 minggu. Kondisi inimerupakanpermasalahan yang sangat mengkhawatirkan dalam bidang kebidanan dan dikaitkan dengan morbiditas dan kematian neonatal yang signifikan. Evaluasi dan skrining terhadap berbagai faktor resiko terjadinya ancaman persalinan preterm adalah hal terpenting dalam mencegah berbagai komplikasi yang mungkin timbul.Metode: Penelitian ini menggunakan desain case control dimana wanita hamil preterm yang menjadi subjek penelitian terbagi menjadi dua yakni kelompok dengan ancaman dan tanpa ancaman persalinan preterm. Fetal fibronectin, pH sekret vagina dan panjang serviks dibandingkan diatara kedua kelompok sebagai faktor resiko ancaman persalinan preterm. Mann-Whitney test, Wilcoxon test dan Chi – squared digunakan sebagai uji statistik dengan tingkat kepercayaan 95%.Hasil: Sebanyak 86 wanita hamil preterm terlibat dalam penelitian ini dengan rerata usia 30,5 ± 6,25 (kelompok ancaman) 32,16 ± 5,25 (tanpa ancaman). Perbandingan Fetal fibronectin (p=0,005), pH sekret vagina (p<0,001) dan panjang serviks (p<0,001) antar kedua kelompok menunjukkan adanya perbedaan yang bermakna. Sebanyak 8 subjek dari 43 pada kelompok wanita hamil pretem dengan ancaman persalinan preterm yang mengalami persalinan pretermKesimpulan:Ukuran panjang serviks yang pendek, peningkatan pH sekret vagina dan peningkatan kadar fetal fibronectin merupakan indikator klinis untuk skrining selama kehamilan guna menilai resiko terjadinya persalinan pretermKata kunci: fetal fibronectin, persalinan preterm, Ph vagina, panjang cerviks

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A COMPARATIVE STUDY OF FETAL ADRENAL GLAND BIOMETRY AND CERVICAL LENGTH AS A PREDICTOR OF PRETERM BIRTH

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i11.2282 ◽

2021 ◽

Vol 5 (11) ◽

Author(s):

Toshi Jain ◽

Megha Agrawal ◽

Anju Sharma

Keyword(s):

Preterm Birth ◽

Adrenal Gland ◽

Cost Effective ◽

Cervical Length ◽

Singleton Pregnancy ◽

Gland Volume ◽

Important Challenge ◽

Obstetric Ultrasonography ◽

Important Marker ◽

Adrenal Gland Volume

Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth. Aim and Objectives: To assess fetal adrenal gland volume, fetal zone enlargement and cervical length on ultrasound and compare their efficacy in the prediction of preterm birth. Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume, fetal zone enlargement and cervical length was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters and cervical length was assessed. Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Cervical length was found to be the least important marker for predicting the preterm birth as having the least AUC as 0.209, sensitivity as 36.4 % and specificity as 76.1%. Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth and is a better predictor than cervical length. Keywords: Preterm, Cervical length, Adrenal biometry.

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Prediction of preterm birth by evaluating the fetal adrenal gland volume and blood flow: a pilot study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184112 ◽

2018 ◽

Vol 7 (10) ◽

pp. 3906

Author(s):

Ali Saber Ali ◽

Mostafa Hussein ◽

Ahmed N. Fetih ◽

Abdelghafar M. Ahmed ◽

Ahmed M. Abbas

Keyword(s):

Blood Flow ◽

Preterm Birth ◽

Adrenal Gland ◽

Pregnant Women ◽

Women's Health ◽

Gland Volume ◽

Group I ◽

Group Ii ◽

Health Hospital ◽

Adrenal Gland Volume

Background: The aim of the current study was to estimate the risk of preterm birth (delivery < 37 weeks of gestation) by evaluating the fetal adrenal gland volume and blood flow at Women’s Health Hospital, Assiut University, Egypt.Methods: A pilot prospective cohort study included pregnant women presented to our hospital with threatened preterm labor between December 2016 and May 2018. All women were recruited consecutively at the emergency unit of Women’s Health Hospital at Assiut University. The fetal adrenal gland volume was assessed using 3-dimensional images of the fetal adrenal with the aid of Virtual Organ Computer-Aided Analysis (VOCAL) software. Doppler evaluation of the fetal adrenal blood vessels was carried out. The RI, PI and S/D ratio was calculated for every case. The neonatal outcomes at delivery were assessed and compared with respect to the duration of actual delivery from the time of evaluation. The obtained data were analyzed by SPSS software (version 22.0) and p<0.05 was taken as the significant level.Results: The study included 30 pregnant women at the final analysis. Women were classified according to the time of actual delivery into two groups. Group (I, n=13) those who delivered within 7 days and group (II, n=17) those who delivered 7 days or more. No difference between both groups regarding the baseline characteristics. No difference regarding the mode of delivery (p=0.708). All Doppler indices were statistically in-different between both groups. The fetal adrenal gland volume was significantly lower in group II than group I (p=0.001). On ROC analysis, the area under the curve (AUC) for prediction of preterm birth based on the fetal adrenal gland volume was (AUC= 0.873). The ROC curve shows that the best cut off value using the volume was ≥0.461 with 76.92% sensitivity and 88.24% specificity for prediction of preterm birth with an overall accuracy of 83.3%.Conclusions: Fetal adrenal gland volume was identified as a significant predictor of delivery in pregnant women who had spontaneous preterm births with intact membranes.

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FETAL ADRENAL GLAND BIOMETRY: A POTENTIAL PREDICTOR OF PRETERM BIRTH

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i11.2283 ◽

2021 ◽

Vol 5 (11) ◽

Author(s):

Toshi Jain ◽

Megha Agrawal ◽

Anju Sharma

Keyword(s):

Preterm Birth ◽

Adrenal Gland ◽

Preterm Labor ◽

Cost Effective ◽

Potential Mechanism ◽

Singleton Pregnancy ◽

Gland Volume ◽

Important Challenge ◽

Obstetric Ultrasonography ◽

Adrenal Gland Volume

Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth. Aim and Objectives: To assess fetal adrenal gland volume and fetal zone enlargement on ultrasound and evaluate its efficacy in the prediction of preterm birth. Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume and fetal zone enlargement was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters was assessed. Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth.

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Effect of Bacterial Vaginozis and cervikal length on preterm delivery in second trimester

Medical Science and Discovery ◽

10.36472/msd.v6i11.325 ◽

2019 ◽

Vol 6 (11) ◽

pp. 305-309

Author(s):

Hacı Öztürk Şahin ◽

Ahmet Gülkılık

Keyword(s):

Preterm Birth ◽

Bacterial Vaginosis ◽

Pregnant Women ◽

Preterm Delivery ◽

Preterm Labor ◽

Cervical Length ◽

Delivery Rate ◽

Significant Difference ◽

Detailed Medical History ◽

The Mean

Objective: Preterm birth is one of the major cause of perinatal morbidity and mortality. Clinical studies have pointed out the association between preterm birth and bacterial vaginosis (BV) infection. Our aim is to discover the incidence of BV and search for the mean cervical length and parameters for the prediction of preterm delivery. Materials and Methods: 130 pregnant woman between the 16th and 24th gestational week were included in our study. A detailed medical history was obtained from all of the women, and patients with a history of preterm delivery and the Vaginal Ph values and cervical length measurement were evaluated. Vaginal samples were analyzed, gram staining was performed, and a bacterial vaginosis diagnosis was made with Nugent’s criteria. Results: Of 130 woman that we included in our study, only 19 had bacterial vaginosis (14.6 %), and the mean cervical length was measured as 41.79 mm. Preterm birth occurred in nine of the pregnant women (6.9%), and no statistically significant difference was found between BV and shortened cervical length or preterm labor. When we excluded the known preterm birth risk factors from our study, we could not find a significant difference between preterm labor and BV. Conclusion: We concluded that BV by itself is not a preterm risk factor. The frequency of BV in the pregnant women in our study group according to the preterm delivery rate and the mean cervical length were similar to those in international studies in which the relationship between cervical length and preterm delivery has been established. We did not come to a significant conclusion in our research; nevertheless, we can relate this result to the preterm delivery rate that is found to be lower than expected.

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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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Comparison of Nifedipine and Isoxsuprine to Cervical Length in Threatened Preterm Labor

Indonesian Journal of Obstetrics & Gynecology Science ◽

10.24198/obgynia/v4.n1.255 ◽

2021 ◽

Vol 4 (1) ◽

pp. 56-63

Author(s):

Triyoga Pramadana ◽

◽

Anita Rachmawati ◽

Dini Pusianawati

Keyword(s):

Pregnant Women ◽

General Hospital ◽

Preterm Labor ◽

Cervical Length ◽

P Value ◽

Inclusion Criteria ◽

Key Word ◽

Before And After ◽

Threatened Preterm Labor ◽

Length Changes

Objective: This study aimed to determine differences in cervical length changes between administration of nifedipine and isoxsuprine. Method: Subjects of the study were pregnant women who meet the inclusion criteria (n=16). Treatments were given for 48 hours. Parameters measured was the cervical length before and after the administration of nifedipine and isoxsuprine. This study was conducted in Dr. Hasan Sadikin General Hospital from January until April 2020. Result: Less shortening of the cervical length after administration of tocolytic isoxsuprin for 48 hours compared with tocolytic nifedipine and statistically significant with p value of 0.0001 (p<0.05) using Paired T tests. Conclusion: Isoxsuprin is more effective to prevent shortening of the cervical length compared to nifedipine in cases of threatened preterm labor. Key word: Nifedipine, Isoxsuprine, cervical length, threatened preterm labor

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MON-161 Body Weight Reduction Not Always Reduced Adrenal Gland Volume in Obese Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1792 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Tao Chen

Keyword(s):

Weight Loss ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Adrenal Gland ◽

Morphological Changes ◽

Normal Weight ◽

Obese Patients ◽

Gland Volume ◽

Significant Difference ◽

Adrenal Gland Volume

Abstract Recent studies have shown that obesity is a major risk factor for idiopathic hyperaldosteronism (IHA). IHA patients have greater AGV than normal controls. However, it is unclear whether such changes are caused by obesity and whether losing weight could reverse the morphological and functional abnormalities of the adrenal gland. This study was to investigate the association of obesity with adrenal gland volume (AGV) and the effects of weight loss on AGV. This study recruited obese patients (N=25) who underwent sleeve gastrectomy and age- and sex-matched normal-weight (N=25) and overweight healthy volunteers (HV) (N=21). Thin-slice computed tomography was used to evaluate adrenal morphological changes. AGV was measured semiautomatically based on the digital imaging and communications in medicine (DICOM) image. The effects of weight loss on AGV were evaluated in patients for one year or more after sleeve gastrectomy. The results showed that left, right and total AGV were larger in obese patients than those in overweight and normal- weight HVs (6.77±0.36, 5.76±0.31, and 12.53±0.64 cm3 vs. 3.88±0.14, 3.09± 0.13 and 6.97± 0.24 cm3 vs. 3.38±0.23, 2.67±0.15 and 6.04±0.36 cm3). No statistically significant difference was identified between overweight and normal-weight HVs. Sleeve gastrectomy significantly reduced body weight (-27.1±2.5 kg), left AGV (-0.80±0.26 cm3), and right AGV (-0.88±0.20 cm2). However, the adrenal volume in five patients was not reduced, despite significant weight loss postsurgery. In brief, obesity leads to increased AGV, and in some cases, this effect seems to be irreversible. We speculate that obesity causes permanently adrenal morphological changes (increased volume or hyperplasia), and under certain circumstances, it results in excessive aldosterone secretion via altered adipokines (leptin, CTRP1, etc.).

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