scholarly journals Emergency versus Elective Cervical Cerclage: An Audit of Our First Two Years of Service

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
N. Vasudeva ◽  
C. Reddington ◽  
M. Bogdanska ◽  
L. De Luca
Keyword(s):  
Preterm Birth ◽  
Vaginal Swab ◽  
Cervical Length ◽  
Emergency Setting ◽  
Cervical Cerclage ◽  
Short Cervix ◽  
Neonatal Deaths ◽  
Emergency Group ◽  
Metropolitan Hospital ◽  
Tertiary Hospitals

One of the biggest obstetric challenges is the diagnosis and management of a short cervix as cervical length has an inverse relationship with risk of preterm birth. A cervical cerclage is a surgical procedure to reduce the risk of preterm birth and can be placed in an elective or emergency setting. This is a retrospective review of cervical cerclages inserted at an outer metropolitan hospital from February 2014 to May 2017. Since the introduction of the service, a total of 43 patients were identified as requiring a cervical cerclage. Four of these patients were transferred to tertiary hospitals. Of the 39 cerclages inserted, 26 were elective and 13 were emergency, placed at a mean gestation of 15.6 and 19.6 weeks. In total, there were 35 live births, 2 stillbirths, and 2 neonatal deaths. The maternal demographics (age, gravidity, parity, and preterm risk factors) were not statistically significant between the two groups. The mean pregnancy prolongation and birthweight was greater in the elective than the emergency group (21.4 versus 14.1 weeks; 3148.2 versus 2447.2 grams). There was no obvious pattern with which patients received antibiotics pre-, intra-, or postoperatively or received a vaginal swab. This audit identified the need for improvements to guidelines to standardise the use of antibiotics and progesterone in women with a cervical cerclage.

scholarly journals Evaluation of the Arabin cervical pessary for prevention of preterm birth in women with a twin pregnancy and short cervix (STOPPIT-2): An open-label randomised trial and updated meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003506
Author(s):  
Jane E. Norman ◽  
John Norrie ◽  
Graeme MacLennan ◽  
David Cooper ◽  
Sonia Whyte ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Standard Care ◽  
Twin Pregnancy ◽  
Preterm Labour ◽  
Meta Analysis ◽  
Cervical Length ◽  
Open Label ◽  
Short Cervix ◽  
Link Type ◽  
Cervical Pessary

Background Preterm-labour-associated preterm birth is a common cause of perinatal mortality and morbidity in twin pregnancy. We aimed to test the hypothesis that the Arabin pessary would reduce preterm-labour-associated preterm birth by 40% or greater in women with a twin pregnancy and a short cervix. Methods and findings We conducted an open-label randomised controlled trial in 57 hospital antenatal clinics in the UK and Europe. From 1 April 2015 to 14 February 2019, 2,228 women with a twin pregnancy underwent cervical length screening between 18 weeks 0 days and 20 weeks 6 days of gestation. In total, 503 women with cervical length ≤ 35 mm were randomly assigned to pessary in addition to standard care (n = 250, mean age 32.4 years, mean cervical length 29 mm, with pessary inserted in 230 women [92.0%]) or standard care alone (n = 253, mean age 32.7 years, mean cervical length 30 mm). The pessary was inserted before 21 completed weeks of gestation and removed at between 35 and 36 weeks or before birth if earlier. The primary obstetric outcome, spontaneous onset of labour and birth before 34 weeks 0 days of gestation, was present in 46/250 (18.4%) in the pessary group compared to 52/253 (20.6%) following standard care alone (adjusted odds ratio [aOR] 0.87 [95% CI 0.55–1.38], p = 0.54). The primary neonatal outcome—a composite of any of stillbirth, neonatal death, periventricular leukomalacia, early respiratory morbidity, intraventricular haemorrhage, necrotising enterocolitis, or proven sepsis, from birth to 28 days after the expected date of delivery—was present in 67/500 infants (13.4%) in the pessary group compared to 76/506 (15.0%) following standard care alone (aOR 0.86 [95% CI 0.54–1.36], p = 0.50). The positive and negative likelihood ratios of a short cervix (≤35 mm) to predict preterm birth before 34 weeks were 2.14 and 0.83, respectively. A meta-analysis of data from existing publications (4 studies, 313 women) and from STOPPIT-2 indicated that a cervical pessary does not reduce preterm birth before 34 weeks in women with a short cervix (risk ratio 0.74 [95% CI 0.50–1.11], p = 0.15). No women died in either arm of the study; 4.4% of babies in the Arabin pessary group and 5.5% of babies in the standard treatment group died in utero or in the neonatal period (p = 0.53). Study limitations include lack of power to exclude a smaller than 40% reduction in preterm labour associated preterm birth, and to be conclusive about subgroup analyses. Conclusions These results led us to reject our hypothesis that the Arabin pessary would reduce the risk of the primary outcome by 40%. Smaller treatment effects cannot be ruled out. Trial registration ClinicalTrials.gov ISRCTN 02235181. ClinicalTrials.gov NCT02235181.

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

2020 ◽  
Vol 42 (09) ◽  
pp. 540-546
Author(s):  
Juliana Valente Codato Marinelli ◽  
Antonio Gomes de Amorim Filho ◽  
Monica Fairbanks de Barros ◽  
Agatha Sacramento Rodrigues ◽  
Rossana Pulcineli Vieira Francisco ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Uterine Artery ◽  
Cervical Length ◽  
Flow Index ◽  
Control Group ◽  
Short Cervix ◽  
Uterine Artery Doppler ◽  
Obstetric History ◽  
Ultrasound Parameters

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.

Ultrasonographic Change in Uterocervical Angle is not a Risk Factor for Preterm Birth in Women with a Short Cervix

2017 ◽  
Vol 34 (11) ◽  
pp. 1058-1064 ◽  
Author(s):  
Kam Szlachetka ◽  
Neil Seligman ◽  
Tara Lynch
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Preterm Birth ◽  
Primary Outcome ◽  
Cervical Length ◽  
Inclusion Criteria ◽  
Short Cervix ◽  
Increased Risk ◽  
The Difference ◽  
Singleton Pregnancies

Objective To determine if change in uterocervical angle (UCA) is associated with an increased rate of preterm birth (less than 37 weeks) for women with a short cervix. Study Design A retrospective study was performed from January 2013 to March 2016 of singleton pregnancies undergoing universal cervical length screening. The difference between the UCA for the first cervical length ≤ 2.5 cm and last recorded cervical length < 25 weeks was defined as the change in UCA. The primary outcome was the rate of preterm birth at < 37 weeks of gestation. Results A total of 176 women met the inclusion criteria. There was no difference in the rate of preterm birth at < 34 weeks (23.3 vs. 16.7%, p = 0.27) or at < 37 weeks (34.9 vs. 37.8%, p = 0.69) based on a change in UCA (i.e., decreased/no change or increased UCA). However, women with a final UCA ≥105 degrees had an increased risk of preterm birth at less than 34 weeks (24.2 vs. 6.8%, p = 0.01). Conclusion A change in UCA was not associated with an increased risk of preterm birth. Instead, a final absolute UCA ≥ 105 degrees measured < 25 weeks was associated with an increased risk of preterm birth at < 34 weeks of gestation for women with a short cervix ≤ 2.5 cm.

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 499 Midtrimester cervical length for the prediction of preterm birth: a new definition of short cervix?

2021 ◽  
Vol 224 (2) ◽  
pp. S315-S316
Author(s):  
Paul Guerby ◽  
Alexandre Fillion ◽  
Emmanuel Bujold ◽  
Jean-Charles Pasquier
Keyword(s):  
Preterm Birth ◽  
Cervical Length ◽  
Short Cervix ◽  
Definition Of
Sign in / Sign up

Export Citation Format

Share Document