scholarly journals Use of the Arabin pessary in women at high risk for preterm birth: long-term experience at a single tertiary center in Malaysia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rahana Abd Rahman ◽  
Ixora Kamisan Atan ◽  
Anizah Ali ◽  
Aida Mohd Kalok ◽  
Nor Azlin Mohamed Ismail ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Medical Center ◽  
Demographic Data ◽  
Cervical Length ◽  
Close Monitoring ◽  
Spontaneous Preterm Birth ◽  
Antenatal Corticosteroids ◽  
Cervical Surgery ◽  
Tertiary Center

Abstract Background Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary. Methods This is a retrospective observational study involving 58 pregnancies from 1st January 2013 to 31st December 2019. Inclusion criteria were previous mid-trimester miscarriage and/or preterm birth, previous cervical surgery or short cervical length on routine sonogram. The demographic data, characteristics of each pregnancy and details of outcomes and management were described. Results The majority of women were Malay with mean age and body mass index of 32.9 ± 4.2 years and 27.1 ± 6.3 kg/m2 respectively. The most frequent indications for Arabin pessary insertion were previous mid-trimester miscarriage (46.4%) and early preterm birth (17.2%). A total of 73.4% of these women had the pessary inserted electively at a mean cervical length of 31.6 ± 9.1 mm at median gestation of 15.0 weeks. They were managed as outpatient (56.9%), inpatient (24.1%) or mixed (19.0%) with combination of progestogen (81.0%) and 53.4% received antenatal corticosteroids. Spontaneous preterm birth at or more than 34 weeks gestation occurred in 74.1% with birthweight at or more than 2000 g (82.4%). Despite cervical funneling in 12 women (20.7%), 66.7% delivered at or later than 34 weeks gestation and 2 (16.7%) resulted in miscarriage. Conclusions Insertion of the Arabin pessary is beneficial to prevent spontaneous preterm birth in pregnant women who are at high risk. In particular, early insertion and close monitoring allows the best possible outcomes. Trial registration This study was retrospectively registered with ClinicalTrials.gov (NCT04638023) on 20/11/2020.

Biomarkers and Cervical Length to Predict Spontaneous Preterm Birth in Asymptomatic High-Risk Women

2013 ◽  
Vol 122 (2, PART 1) ◽  
pp. 283-289 ◽  
Author(s):  
Jamie A. Bastek ◽  
Adi Hirshberg ◽  
Suchitra Chandrasekaran ◽  
Carter M. Owen ◽  
Laura M. Heiser ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
High Risk Women

scholarly journals Transvaginal ultrasonographic assessment of cervical length in prediction of preterm labour in high risk asymptomatic women

2018 ◽  
Vol 7 (12) ◽  
pp. 4981
Author(s):  
Seeniamal Pushparaj ◽  
Prasanna Nagaraj
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Preterm Labour ◽  
Cost Effective ◽  
Cervical Length ◽  
Length Measurement ◽  
Spontaneous Preterm Birth ◽  
High Risk Women ◽  
Asymptomatic Women ◽  
Cervical Length Measurement

Background: Preterm birth is an important cause of perinatal morbidity and mortality and has long term health implications. Aim of this study was to predict preterm labour by Transvaginal ultrasonographic cervical length measurement in high risk asymptomatic women which may help in decision making in managing these women.Methods: This study was conducted in Department of Obstetrics and Gynecology, Mahathma Gandhi Memorial Government Hospital, Trichy from August 2016 to September 2017 in 130 antenatal women with high risk factors such as prior spontaneous preterm birth, miscarriage. Transvaginal cervical length was measured and Gestational age at which delivery occurred was correlated and results were analyzed.Results: In present study, sensitivity of transvaginal cervical length measurement (cut off cervical length <25 mm) was 70.9% and specificity was 63% in prediction of preterm labour in high risk asymptomatic women. Positive and negative predictive value of cervical length in predicting preterm labour were 63.7 %and 70% respectively.Conclusions: Transvaginal cervical length measurement can be combined with anomaly scan in high risk women to predict preterm labor and is objective, reproducible and cost effective.

scholarly journals Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population

2018 ◽  
Vol 08 (01) ◽  
pp. e43-e50 ◽  
Author(s):  
Núria Baños ◽  
Carla Julià ◽  
Núria Lorente ◽  
Silvia Ferrero ◽  
Teresa Cobo ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Area Under The Curve ◽  
Cervical Length ◽  
Consistency Index ◽  
High Risk Population ◽  
Spontaneous Preterm Birth ◽  
Predictive Capacity ◽  
Increased Risk ◽  
Better Than

Background Short cervical length (CL) has not been shown to be adequate as a single predictor of spontaneous preterm birth (sPTB) in high-risk pregnancies. Objective The objective of this study was to evaluate the performance of the mid-trimester cervical consistency index (CCI) to predict sPTB in a cohort of high-risk pregnancies and to compare the results with those obtained with the CL. Study Design Prospective cohort study including high-risk singleton pregnancies between 19+0 and 24+6 weeks. The ratio between the anteroposterior diameter of the uterine cervix at maximum compression and at rest was calculated offline to obtain the CCI. Results Eighty-two high sPTB risk women were included. CCI (%) was significantly reduced in women who delivered <37+0 weeks compared with those who delivered at term, while CL was not. The area under the curve (AUC) of the CCI to predict sPTB <37+0 weeks was 0.73 (95% confidence interval [CI], 0.61–0.85), being 0.51 (95% CI, 0.35–0.67), p = 0.03 for CL. The AUC of the CCI to predict sPTB <34+0 weeks was 0.68 (95% CI, 0.54–0.82), being 0.49 (95% CI, 0.29–0.69), p = 0.06 for CL. Conclusion CCI performed better than sonographic CL to predict sPTB. Due to the limited predictive capacity of these two measurements, other tools are still needed to better identify women at increased risk.

scholarly journals Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kimberley P. Williams ◽  
Liam McAuliffe ◽  
Rosanna Diacci ◽  
Anne-Marie Aubin ◽  
Ashad Issah ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Meta Analysis ◽  
Cervical Length ◽  
Analysis Model ◽  
Spontaneous Preterm Birth ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
High Risk Women ◽  
Vaginal Progesterone

Abstract Background Preterm birth (PTB) is estimated to affect 14.9 million babies globally every year. Global rates of PTB continue to increase from 9.8 to 10.6% over a 15-year period from 2000 to 2014. Vaginal progesterone is commonly used by clinicians as a prevention strategy, with recent evidence affirming the benefit of vaginal (micronised) progesterone to prevent PTB in women with a shortened cervix (< 25 mm). Given the low incidence of a short cervix at mid-gestation in high-risk populations further evidence is required. The objective of this review is to determine if vaginal progesterone reduces spontaneous preterm birth (sPTB) before 37 weeks in asymptomatic high-risk women with a singleton pregnancy with a normal mid-gestation cervical length. Methods Studies will be sourced from MEDLINE, Embase and Cochrane Register of Trials (CENTRAL) from their inception onwards with the search terms ‘progesterone’ and ‘preterm birth’. Studies will be screened and included if they assess vaginal progesterone compared to placebo in women with a normal cervical length. The primary outcome will be sPTB < 37 weeks, with secondary outcomes of sPTB < 34 weeks. Two independent reviewers will conduct study screening at abstract and full text level, data extraction and risk of bias assessment with disagreements resolved by an experienced researcher. The Mantel-Haenszel statistical method and random effects analysis model will be used to produce treatment effect odds ratios and corresponding 95% confidence intervals. Discussion This review will assess the current body of evidence and provide clarity regarding the potential benefits and best practice of use of vaginal progesterone in asymptomatic women with high-risk singleton pregnancies and normal cervical length. Trial registration PROSPERO CRD42020152051

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